The global, regional, and national burden of inflammatory bowel diseases, 1990-2019: A systematic analysis for the global burden of disease study 2019.

BACKGROUND: In recent years, the global epidemiology of inflammatory bowel disease (IBD) has changed rapidly. AIMS: We described the updated global IBD epidemiology results based on the 2019 Global Burden of Diseases, Injuries, and Risk Factors Study (GBD). METHODS: We estimated the prevalence rate, death rate, years of life lost (YLLs), years lived with disability (YLDs), and disability-adjusted life-years (DALYs) from GBD 2019 in 195 countries and territories between 1990 and 2019. RESULTS: The crude prevalence of IBD increased by 47% in 2019 globally. Accordingly, the age-standardized prevalence rate showed 19% decrease. The age-standardized death rates, YLDs, YLLs, and DALYs of IBD in 2019 decreased compared to those in 1990. The annual percentage change in age-standardized prevalence rate decreased most in United States and increased in East Asia and high-income Asia Pacific from 1990 to 2019. Continents with high socioeconomic index (SDI) had higher age-standardized prevalence rates compared to continents with low SDI. The 2019 age-standardized prevalence rate of high latitudes was higher than that of low latitudes in Asia, Europe, and North America. CONCLUSION: The observed trends and geographic variations in IBD documented in the 2019 GBD study will aid policymakers in policy, research, and investment development.

Global, Regional, and National Burden of Mesothelioma 1990-2019: A Systematic Analysis of the Global Burden of Disease Study 2019.

Rationale: Mesothelioma has become a major health burden since World War II because of the use of asbestos. Although many countries have imposed bans on asbestos, there remain significant mortality and morbidity from mesothelioma because of its long latent period and aggressiveness. Also, the use of asbestos is increasing in low-income countries, potentiating risk of mesothelioma in the coming decades. Assessment of the global burden of mesothelioma is required to take proper measures against the disease. Objectives: To assess the burden of mesothelioma from 1990 to 2019 at the global, regional, and national levels and to investigate patterns according to sex, age, sociodemographic index, and risk factors. Methods: The numbers, rates, and age-standardized rates of incidence, death, and disability-adjusted life years (DALYs) of mesothelioma in 204 countries and territories from 1990 to 2019 were estimated using vital registration and cancer registry data. The relationship between sociodemographic index and age-standardized DALY rate was determined, and DALYs attributable to occupational exposure to asbestos were calculated. Results: In 2019, there were 34,511 (95% uncertainty interval [UI], 31,199 to 37,771) incident cases of mesothelioma globally, with an age-standardized rate of 0.43 per 100,000 persons (95% UI, 0.38 to 0.47), which decreased between 1990 and 2019 by -12.6% (95% UI, -21.8% to -2.3%). Mesothelioma was responsible for 29,251 (95% UI, 26,668 to 31,006) deaths in 2019, with an age-standardized rate of 0.36 deaths per 100,000 persons (95% UI, 0.33 to 0.39), which decreased between 1990 and 2019 by -9.6% (95% UI, -17.8% to -1.1%). The age-standardized incidence rate increased in central Europe between 1990 and 2019 by 46.1% (95% UI, 16.6% to 72.4%). The Netherlands, Australia, and the United Kingdom had the highest age-standardized incidence rates. Incidence rates were higher in men than in women ages 45-49 to 90-94 years, peaking at 85-89 years. Occupational exposure to asbestos contributed to 85.2% (95% UI, 82.1% to 88.1%) of DALYs. Conclusions: The global burden of mesothelioma is decreasing in terms of age-standardized incidence and mortality rates. Mesothelioma remains a substantial public health challenge in many parts of the world.

Global burden of primary liver cancer and its association with underlying aetiologies, sociodemographic status, and sex differences from 1990-2019: A DALY-based analysis of the Global Burden of Disease 2019 study.

BACKGROUND/AIMS: Global distribution of dominant liver cancer aetiologies has significantly changed over the past decades. This study analyzed the updated temporal trends of liver cancer aetiologies and sociodemographic status in 204 countries and territories from 1990 to 2019. METHODS: The Global Burden of Disease 2019 report was used for statistical analysis. In addition, we performed stratification analysis to five quintiles using sociodemographic index and 21 geographic regions. RESULTS: The crude numbers of liver cancer disease-adjusted life years (DALYs) and deaths significantly increased during the study period (DALYs; 11,278,630 in 1990 and 12,528,422 in 2019, deaths; 365,215 in 1990 and 484,577 in 2019). However, the Age-standardized DALY and mortality rates decreased. Hepatitis B virus (HBV) remains the leading cause of liver cancer DALYs and mortality, followed by hepatitis C virus (HCV), alcohol consumption, and non-alcoholic steatohepatitis/non-alcoholic fatty liver disease (NASH/NAFLD). Although Age-standardized DALY and mortality rates of liver cancer due to HBV and HCV have decreased, the rates due to alcohol consumption and NASH/NAFLD have increased. In 2019, the population of the East Asia region had the highest Age-standardized DALY and mortality rates, followed by high-income Asia-Pacific and Central Asia populations. Although East Asia and high-income Asia-Pacific regions showed a decrease during the study period, Age-standardized DALY rates increased in Central Asia. High-income North American and Australasian populations also showed a significant increase in Age-standardized DALY. CONCLUSION: Liver cancer remains an ongoing global threat. The burden of liver cancer associated with alcohol consumption and NASH/NAFLD is markedly increasing and projected to continuously increase.

Global burden of gout in 1990-2019: A systematic analysis of the Global Burden of Disease study 2019.

BACKGROUND AND AIMS: Although gout is one of the most common rheumatic diseases, world data are lacking because most studies have focused on industrialized countries. Therefore, we aimed to investigate the global burden of gout and its associations with the year of diagnosis, age, geographical region, sociodemographic status and various further risk factors. METHODS: Retrospective data from the Global Burden of Disease (GBD) were used, initially collected between 1990 and 2019. Raw numbers and age-standardized rates (per 100,000 persons) of prevalence, incidence and years lived with disability (YLDs) of gout were extracted from GBD 2019 for 204 countries and territories and stratified by sex, age, year, sociodemographic index and geographic region. Correlations between gout and other chronic diseases were identified, and the burden attributable to high body mass index (BMI) and kidney dysfunction was described. RESULTS: The total number of patients and gout age-standardized prevalence rate increased between 1990 and 2019. Gout was most prevalent in Australasia and high-income North America, and a higher sociodemographic index (SDI) was associated with higher age-standardized prevalence, incidence and YLDs. High BMI and kidney dysfunction were risk factors for gout, while gout was correlated with other kidney diseases. CONCLUSIONS: The global prevalence of gout, as well as incidence, and YLDs increased worldwide from 1990 to 2019 and had a significant association with sex, age, geographic region, SDI and risk factors. Understanding the complex interplay of environmental, sociodemographic and geographic risk factors is essential in mitigating the ever-rising disease burden of gout.

Burden of neurological diseases in Asia from 1990 to 2019: a systematic analysis using the Global Burden of Disease Study data.

OBJECTIVES: The burden of neurological disorders is increasing worldwide, including Asia. The purpose of this study was to determine the burden of neurological disorders between 1990 and 2019 in Asia using the Global Burden of Disease (GBD) Sociodemographic Index. DESIGN, SETTING, OUTCOME AND PARTICIPANTS: The GBD Study is updated every year and the most recent version provides the burden of diseases according to age, gender and region from 1990 to 2019. The burden of neurological disorders was evaluated as incidence, prevalence, mortality, disability-adjusted life-years (DALYs), years of life lost and years lived with disability. RESULTS: In 2019, DALYs of neurological diseases were 64.4 million in South-East Asia (95% uncertainty interval (UI) 45.2 to 94.2) and 85.0 million in Western Pacific regions (95% UI 63.0 to 118.5). Stroke, migraine, Alzheimer's disease and other dementias had the highest DALYs in the WHO South-East Asia and WHO Western Pacific regions in 2019. DALYs of stroke, Alzheimer's disease and other dementias, Parkinson's disease, brain and central nervous system cancer, multiple sclerosis, migraine and tension-type headache increased in both regions in 2019 compared with 1990. Infectious diseases such as tetanus, meningitis and encephalitis decreased in both regions. DALYs of idiopathic epilepsy and motor neuron disease increased in the WHO South-East Asia region and decreased in the WHO Western Pacific region. CONCLUSIONS: This study demonstrated the burden of neurological diseases in Asia. To reduce the burden of neurological diseases, strategies suitable for each country's real healthcare needs and challenges are needed; this study can serve as the cornerstone of these strategies.

Incidence, prevalence, and global burden of autism spectrum disorder from 1990 to 2019 across 204 countries.

Autism spectrum disorder (ASD) substantially contributes to the burden of mental disorders. Improved awareness and changes in diagnostic criteria of ASD may have influenced the diagnostic rates of ASD. However, while data on trends in diagnostic rates in some individual countries have been published, updated estimates of diagnostic rate trends and ASD-related disability at the global level are lacking. Here, we used the Global Burden of Diseases, Injuries, and Risk Factors Study data to address this gap, focusing on changes in prevalence, incidence, and disability-adjusted life years (DALYs) of ASD across the world. From 1990 to 2019, overall age-standardized estimates remained stable globally. Both prevalence and DALYs increased in countries with high socio-demographic index (SDI). However, the age-standardized incidence decreased in some low SDI countries, indicating a need to improve awareness. The male/female ratio decreased between 1990 and 2019, possibly accounted for by increasing clinical attention to ASD in females. Our results suggest that ASD detection in low SDI countries is suboptimal, and that ASD prevention/treatment in countries with high SDI should be improved, considering the increasing prevalence of the disorder. Additionally, growing attention is being paid to ASD diagnosis in females, who might have been left behind by ASD epidemiologic and clinical research previously. ASD burden estimates are underestimated as GBD does not account for mortality in ASD.

Sexual Orientation and Functional Limitations: Cross-sectional Analyses From the Adult Psychiatric Morbidity Survey.

OBJECTIVE: To assess the association between sexual orientation and functional limitations in a large representative sample of the English population. DESIGN: Cross-sectional. SETTING: Data were from the 2007 Adult Psychiatric Morbidity Survey. PARTICIPANTS: A total of 7403 adults aged 16-95 years (51.4% female; mean age, 46.3±18.6y) were included in the present study. INTERVENTIONS: Not applicable. MAIN OUTCOME MEASURES: Sexual orientation was assessed using 2 items adapted from the Kinsey scale and was dichotomized into heterosexual and sexual minority orientation. Functional limitations were assessed using 7 activities of daily living (ADL) and instrumental activities of daily living (IADL). Functional limitations were defined as at least 1 difficulty in 1 of 7 ADL and IADL. Adjusted logistic regression analyses were conducted to investigate the association between sexual orientation (independent variable) and functional limitations (dependent variable). RESULTS: The level of sexual minority orientation and prevalence of functional limitations in the sample was 7.1% and 32.9%, respectively. After adjusting for several potential confounders, sexual minority orientation was positively and significantly associated with functional limitations (odds ratio, 1.51; 95% confidence interval, 1.18-1.95; reference group: heterosexual orientation). CONCLUSIONS: Based on the findings of this study, interventions aiming to prevent against and/or manage/reduce functional limitations in sexual minorities are needed. More research is also warranted to better understand mediators (eg, obesity, cognitive complaints, psychiatric disorders) involved in the sexual orientation-functional limitation relationship.

Discrimination and Multimorbidity Among Black Americans: Findings from the National Survey of American Life.

OBJECTIVES: There is a notable lack of research on the risk factors for multimorbidity, which has become more common over recent decades. Black Americans experience discrimination more often than their White counterparts, and also have significantly higher prevalence of multimorbidity. This paper examines the associations between discrimination and multimorbidity among Black Americans. METHODS: We analyzed data from the National Survey of American Life to calculate the prevalence of two types of discrimination (everyday discrimination, major discriminatory events) and multimorbidity (physical, psychiatric, mixed, any). Using multivariable logistic regression, we examined the associations between discrimination and multimorbidity, adjusting for age, sex, years of education, income-to-poverty ratio, and ethnicity. The everyday discrimination scale was discretized into five categories (none, low, medium, high, very high), but was also treated as a continuous variable. The major discriminatory events were analyzed in separate adjusted models, and as a count of events. RESULTS: When compared with those who did not experience any discrimination, people who experienced everyday discrimination were significantly more likely to report all types of multimorbidity in a dose-response fashion at a conventional level of statistical significance. Most major discriminatory events were associated with greater odds of reporting all types of multimorbidity, as were the counts of major discriminatory events, in a dose-response fashion. CONCLUSIONS: We found strong evidence to suggest that discrimination was associated with greater odds of reporting multimorbidity. Future studies can expand on these findings using longitudinal data to capture the relations between discrimination and health over time, or by testing preventive interventions that allay the damaging health effects of discrimination.

Association between intelligence quotient and disability: The role of socioeconomic status.

BACKGROUND: No study has investigated the association between intelligence quotient (IQ) and disability (i.e., difficulties in activities of daily living [ADL] or instrumental activities of daily living [IADL]) in the general population. OBJECTIVE: The goal of this nationally representative study was to analyse the potential IQ-disability association in England and identify influential factors in this association. METHODS: Cross-sectional data were analyzed from the 2007 Adult Psychiatric Morbidity Survey (n=6872). IQ was assessed by using the National Adult Reading Test, which consists of a list of 50 words and is scored by counting the number of errors in reading the words aloud. Disability was defined as difficulties in at least 1 of the 7 domains of ADL and IADL. Regression and mediation analyses were conducted to analyze the association between IQ and disability and identify potential factors involved in this relationship, estimating odds ratios (ORs) and 95% confidence intervals (CIs). RESULTS: Among the 6872 participants, the mean (SD) age was 46.9 (18.9) years; 51.8% were women. The prevalence of disability increased from 27.7% with IQ 120-129 to 51.0% with IQ 70-79. After adjusting for sex, age and ethnicity, as compared with IQ 120-129, with IQ 110-119, 100-109, 90-99, 80-89, and 70-79, the probability of disability was increased (OR 1.22 [95% CI 1.01-1.48], 1.42 [1.16-1.72], 1.86 [1.54-2.25], 2.41 [1.92-3.03], and 4.71 [3.56-6.17], respectively). In addition, we found a positive association between a 1-SD decrease in IQ and disability (OR 1.53, 95% CI 1.43-1.63). Finally, income (mediated percentage 26.9%), social class (18.0%) and education (11.6%) strongly affected the IQ-disability association, and these socioeconomic factors collectively explained 37.1% of the association. CONCLUSIONS: Low IQ was positively associated with disability in England, and socioeconomic status explained more than one-third of this relationship.

Value of Molecular Classification for Prognostic Assessment of Adrenocortical Carcinoma.

IMPORTANCE: The risk stratification of adrenocortical carcinoma (ACC) based on tumor proliferation index and stage is limited. Adjuvant therapy after surgery is recommended for most patients. Pan-genomic studies have identified distinct molecular groups closely associated with outcome. OBJECTIVE: To compare the molecular classification for prognostic assessment of ACC with other known prognostic factors. DESIGN, SETTING, AND PARTICIPANTS: In this retrospective biomarker analysis, ACC tumor samples from 368 patients who had undergone surgical tumor removal were collected from March 1, 2005, to September 30, 2015 (144 in the training cohort and 224 in the validation cohort) at 21 referral centers with a median follow-up of 35 months (interquartile range, 18-74 months). Data were analyzed from March 2016 to March 2018. EXPOSURES: Meta-analysis of pan-genomic studies (transcriptome, methylome, chromosome alteration, and mutational profiles) was performed on the training cohort. Targeted biomarker analysis, including targeted gene expression (BUB1B and PINK1), targeted methylation (PAX5, GSTP1, PYCARD, and PAX6), and targeted next-generation sequencing, was performed on the training and validation cohorts. MAIN OUTCOMES AND MEASURES: Disease-free survival. Cox proportional hazards regression and C indexes were used to assess the prognostic value of each model. RESULTS: Of the 368 patients (mean [SD] age, 49 [16] years), 144 were in the training cohort (100 [69.4%] female) and 224 were in the validation cohort (142 [63.4%] female). In the training cohort, pan-genomic measures classified ACC into 3 molecular groups (A1, A2, and A3-B), with 5-year survival of 9% for group A1, 45% for group A2, and 82% for group A3-B (log-rank P < .001). Molecular class was an independent prognostic factor of recurrence in stage I to III ACC after complete surgery (hazard ratio, 55.91; 95% CI, 8.55-365.40; P < .001). The combination of European Network for the Study of Adrenal Tumors (ENSAT) stage, tumor proliferation index, and molecular class provided the most discriminant prognostic model (C index, 0.88). In the validation cohort, the molecular classification, determined by targeted biomarker measures, was confirmed as an independent prognostic factor of recurrence (hazard ratio, 5.96 [95% CI, 1.81-19.58], P = .003 for the targeted classifier combining expression, methylation, and chromosome alterations; and 2.61 [95% CI, 1.31-5.19], P = .006 for the targeted classifier combining methylation, chromosome alterations, and mutational profile). The prognostic value of the molecular markers was limited for patients with stage IV ACC. CONCLUSIONS AND RELEVANCE: The findings suggest that in localized ACC, targeted classifiers may be used as independent markers of recurrence. The determination of molecular class may improve individual prognostic assessment and thus may spare unnecessary adjuvant treatment.

Prevalence and predictors of prescription of antibiotics in pregnant women treated by gynecologists in Germany
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AIM: The aim of this study is to estimate the prevalence and potential predictors of the prescription of antibiotics in pregnant women treated by gynecologists in Germany. METHODS: The current study included 90,312 women aged between 18 and 45 years with a full-term documented pregnancy during the index period (2005 - 2014). The primary outcome was the proportion of pregnant women with antibiotic prescriptions. Potential predictors of antibiotic prescriptions considered in the present analysis were age, index year, and gynecological/urinary disorders. Disorders included in this analysis were frequent gynecological and urinary conditions that are often treated with antibiotics. Multivariate logistic regression models were used to estimate the probability of antibiotic use depending on age, index year, and codiagnoses. RESULTS: In this population, 14.7% of pregnant women had antibiotic prescriptions. Pregnant women in the age groups ≤ 20 and 21 - 25 years were more likely to be prescribed antibiotics than pregnant women in the age group 41 - 45 years (odds ratios equal to 1.55 and 1.27, respectively). Pregnant women analyzed in 2009 - 2011 and 2012 - 2014 received prescriptions for antibiotics more frequently compared to those analyzed in 2005 - 2008 (odds ratios equal to 1.12 and 1.08, respectively). Finally, being affected by chlamydial infection, cystitis, urinary tract infection (site not specified), genitourinary tract infections in pregnancy, acute vaginitis, and other noninflammatory disorders of the vagina was associated with a higher chance of being prescribed antibiotics. CONCLUSIONS: Approximately 15% of pregnant women received antibiotic prescriptions. Age, index year, and gynecological/urinary disorders were all found to be associated with these prescriptions.
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Prescription Patterns and the Cost of Antihyperglycemic Drugs in Patients With Type 2 Diabetes Mellitus in Germany.

AIMS: The goals were to analyze prescription patterns and the cost of antihyperglycemic drugs in patients with type 2 diabetes (T2DM) treated in Germany in 2015. METHODS: This study included 36382 patients aged 40 years or over treated in general practices (GPs) and diabetologist practices who were diagnosed with T2DM in 2015. Nine different families of antihyperglycemic therapy were included in the analysis. Demographic data included age, gender, and type of health insurance coverage. Clinical data included HbA1c level, body mass index (BMI), and the number of T2DM complications. The annual antihyperglycemic treatment cost per patient was calculated based on pharmacy retail prices. The multivariate regression analysis was fitted to estimate the adjusted treatment cost differences. RESULTS: The percentage of T2DM patients receiving antihyperglycemic treatments was 87.6. This share was slightly higher in men than in women (89.1% vs 86.0%). Interestingly, the share of people treated with antihyperglycemic drugs decreased with age yet increased with HbA1c levels, BMI, and the number of complications. The average annual cost of antihyperglycemic drugs amounted to €498. It was significantly higher in men than in women (difference of €22). It was also significantly higher in individuals with private health insurance coverage than in people with public health insurance coverage (difference of €153). The annual cost decreased with age. It is compelling to note that this cost increased with HbA1c levels and BMI. Finally, the annual cost also increased with the number of complications. CONCLUSIONS: The share and the cost of antihyperglycemic treatments vary with gender, age, type of health insurance coverage, HbA1c levels, BMI, and the number of complications.

Prescription Patterns and the Cost of Migraine Treatments in German General and Neurological Practices.

OBJECTIVES: The aim of this study was to analyze prescription patterns and the cost of migraine treatments in general practices (GPs) and neurological practices (NPs) in Germany. METHODS: This study included 43,149 patients treated in GPs and 13,674 patients treated in NPs who were diagnosed with migraine in 2015. Ten different families of migraine therapy were included in the analysis: triptans, analgesics, anti-emetics, beta-blockers, antivertigo products, gastroprokinetics, anti-epileptics, calcium channel blockers, tricyclic antidepressants, and other medications (all other classes used in the treatment of migraine including homeopathic medications). The share of migraine therapies and their costs were estimated for GPs and NPs. RESULTS: The mean age was 44.4 years in GPs and 44.1 years in NPs. Triptans and analgesics were the 2 most commonly prescribed families of drugs in all patients and in the 9 specific subgroups. Interestingly, triptans were more commonly prescribed in NPs than in GPs (30.9% to 55.0% vs. 30.0% to 44.7%), whereas analgesics were less frequently given in NPs than in GPs (11.5% to 17.2% vs. 35.3% to 42.4%). Finally, the share of patients who received no therapy was higher in NPs than in GPs (33.9% to 58.4% vs. 27.5% to 37.9%). The annual cost per patient was €66.04 in GPs and €94.71 in NPs. Finally, the annual cost per patient increased with age and was higher in women and in individuals with private health insurance coverage than in men and individuals with public health insurance coverage. CONCLUSION: Triptans and analgesics were the 2 most commonly prescribed drugs for the treatment of migraine. Furthermore, approximately 30% to 40% of patients did not receive any therapy. Finally, the annual cost per patient was higher in NPs than in GPs.

Prescription patterns and drug costs in German patients with dementia in nursing homes and home-care settings
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AIMS: To analyze prescription patterns and drug costs in German patients with dementia who are in home-care settings and nursing homes. METHODS: The present retrospective study based on the Disease Analyzer epidemiological database and included 41,064 patients treated by general practitioners (GPs) and 20,649 patients treated by psychiatric practitioners (PPs), who were diagnosed with dementia in 2014. Four different types of antidementia therapy were included in the analysis. The shares of prescriptions and the associated costs in dementia patients in home-care settings and nursing homes were estimated. Regression analyses were performed to study the impact of the type of residence on the likelihood of receiving a defined therapy and incurring its associated cost. RESULTS: Antidementives were more frequently prescribed to patients in home-care settings, whereas antidepressants, antipsychotics, and benzodiazepines were more commonly administered to nursing-home patients in both the GP and the PP groups. Individuals residing in nursing homes had a lower likelihood of receiving antidementives but exhibited a higher likelihood of being prescribed antidepressants, antipsychotics, and benzodiazepines. The total cost of therapy was higher in nursing homes than in home-care settings (GPs: difference of € 27.20; PPs: difference of € 107.90). The cost of antidementives was significantly lower in GP patients residing in nursing homes than in GP patients living at home. There was no significant difference in the cost of antidementives in the PP groups. By contrast, the costs of the three other families of drugs were lower in individuals cared for at home than in individuals residing in nursing homes, in both practice types. CONCLUSION: Prescription patterns and the drug costs in dementia patients significantly differed between home-care settings and nursing-home settings.
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Impact of comorbidities on the cost of depression drug therapy in general practices in Germany.

BACKGROUND: The goal of this study was to analyze the impact of comorbidities on the cost of antidepressant drug therapy in patients with depression treated in German general practices (GPs). METHODS: The present study included 31,741 patients diagnosed with depression and treated with antidepressant drugs in 2015. Demographic data included age, gender, and type of health insurance coverage. Twenty comorbidities were included. The study sample was stratified by age, gender, type of health insurance coverage, type of comorbidity, and number of comorbidities. The annual antidepressant treatment cost per patient was calculated based on pharmacy sale prices. The multivariate regression analysis was fitted to estimate the adjusted treatment cost differences. RESULTS: The annual cost of antidepressant drugs was €107 in the population. It was similar in men and in women (difference of €1) but was significantly higher in individuals with private health insurance coverage than in people with public health insurance coverage (difference of €63). The annual cost increased with age, from €85 in patients aged 40 years or younger to €116 in patients aged between 61 and 70 years (difference of €11), and with the number of comorbidities, from €78 when there was no comorbidity to €134 when there were more than 5 comorbidities (difference of €57). CONCLUSION: The cost of antidepressant treatment in Germany increased with the number of comorbidities.

Age-related differences in persistence in women with breast cancer treated with tamoxifen or aromatase inhibitors in Germany.

AIMS: To study age-related persistence in postmenopausal women with endocrine-responsive breast cancer treated with tamoxifen (TAM) and aromatase inhibitors (AI). METHODS: Data on 29,245 patients diagnosed with metastatic or non-metastatic breast cancer (BC) and initially treated with TAM or AI between 2004 and 2013 were included. The primary outcome measure was the age-dependent rate of discontinuation of endocrine treatment within 5years after initiation. Discontinuation of therapy was defined as a period of at least 90days without treatment. A multivariate Cox regression model was created to determine the influence of age on the risk of discontinuation. Health insurance type (private/statutory), type of care (gynecological/general), region (West/East Germany), concomitant diagnoses (depression, osteoporosis, and diabetes), and Charlson Comorbidity Score were included as covariates. RESULTS: The mean ages of the women in the <70 and ≥70 groups were 55.9 (SD: 9.7) and 77.4 (SD: 5.4) years, respectively. Within 5years after treatment initiation, 88.8% of women <70 of age and 82% of women ≥70 years of age had terminated treatment (p-value<0.001). Patients aged ≥70 exhibited a lower risk of treatment discontinuation than patients aged <70 (HR=0.75, 95% CI: 0.66-0.85). Furthermore, gynecological practices, disease management programs, and high Charlson scores increased persistence. CONCLUSIONS: Overall, the present study indicates that persistence rates are low in both women with BC aged <70 and those aged ≥70 years. We also found that younger women with BC are at a higher risk of treatment discontinuation than older women.

Gender-based differences in the antidepressant treatment of patients with depression in German psychiatric practices.

BACKGROUND: Depression is recognized as the leading cause of disability in the world. Our goal was to compare treatment initiation in men and women treated in German neuropsychiatric practices after diagnosis of depression. METHODS: Patients aged between 18 and 80 first diagnosed with depression between 2010 and 2013 were identified by 223 psychiatrists in the IMS Disease Analyzer database. Patients who had received antidepressant prescriptions prior to the index date were excluded. The main outcome measure was the initiation of antidepressant drug therapy in men and women within three years after index date in three subgroups of different severity (mild, moderate and severe depression). RESULTS: A total of 35,495 men and 54,467 women were included in this study. After 3 years of follow-up, 77.3% of men and 78.5% of women diagnosed with mild depression (p-value=0.887), 89.2% of men and 90.7% of women with moderate depression (p-value=0.084), and 88.6% of men and 89.5% of women with severe depression (p-value=0.769) had been treated. No association was found between the chances of treatment initiation after diagnosis of depression and gender. Finally, patients with moderate and severe depression were more likely to receive therapy than those with mild depression. Selective serotonin reuptake inhibitors and tricyclic antidepressants were the two most commonly prescribed families of drugs in this study (SSRIs: 34.5% to 44.6%, and TCAs: 19.1% to 26.9%). CONCLUSIONS: Gender did not impact therapy initiation in depressed patients. Further studies are needed to identify other potential factors involved.

Treatment of depression in cancer and non-cancer patients in German neuropsychiatric practices.

AIMS: The aim of this study is to analyze the use of antidepressants in German patients with and without cancer. METHODS: This study included patients with cancer diagnosed with depression in German neuropsychiatric practices between 2004 and 2013. Each patient was matched for age, gender, health insurance, physician, and index year with a depressed, cancer-free control. The share of patients and controls receiving medical therapy within 1 year after depression diagnosis and the proportion of subjects treated with tricyclic antidepressants, selective serotonin reuptake inhibitors, serotonin and norepinephrine reuptake inhibitors, or benzodiazepines were analyzed. RESULTS: A total of 604 depressed cancer patients and 604 depressed controls were included. There are 27.6% of patients that had breast cancer, 13.3% malignant neoplasms of the lymphoid or hematopoietic tissue, 12.5% brain tumors, 8.3% prostate cancer, and 10.0% cancer of the digestive organs. After 1 year of follow up, 66.5% of patients and 72.8% of controls had received antidepressant drugs (p = 0.017). Tricyclic antidepressants was given less frequently to patients than to controls (31.2% vs 38.2%, p-value = 0.011). By contrast, 7.0% of patients with cancer and 4.2% of controls received benzodiazepines (p-value = 0.033). CONCLUSIONS: The use of antidepressants in Germany is less common in patients with cancer and depression than in people with depression only. Copyright © 2016 John Wiley & Sons, Ltd.

Socioeconomic status and prognosis of COPD in Denmark.

We investigated the association between length of school education and 5-year prognosis of chronic obstructive lung disease (COPD), including exacerbations, hospital admissions and survival. We used sample of general population from two independent population studies: The Copenhagen City Heart Study and Copenhagen General Population Study. A total of 6,590 individuals from general population of Copenhagen with COPD defined by the Global initiative for obstructive lung disease criteria were subdivided into 4 groups based on the length of school education: 1,590 with education < 8 years; 3,131 with education 8-10 years, 1,244 with more than 10 years, but no college/university education and 625 with college/university education. Compared with long education, short education was associated with current smoking (p < 0.001), higher prevalence of respiratory symptoms (p < 0.001) and lower forced expiratory volume in the first second in percent of predicted value (FEV1%pred) (p < 0.001). Adjusting for sex, age, FEV1%pred, dyspnea, frequency of previous exacerbations and smoking we observed that shortest school education (in comparison with university education), was associated with a higher risk of COPD exacerbations (hazards ratio 1.65, 95% CI 1.15-2.37) and higher risk of all-cause mortality (hazards ratio 1.96, 95% CI 1.28-2.99). We conclude that even in an economically well-developed country with a health care system (which is largely free of charge), low socioeconomic status, assessed as the length of school education, is associated with a poorer clinical prognosis of COPD.