Is there an association between endometriosis and subsequent breast cancer? A retrospective cohort study from Germany.

PURPOSE: Given the relatively high incidence of both endometriosis and breast cancer, investigating the potential connection between these gynecological diseases is of substantial clinical significance. However, there is no clear consensus in the literature on the extent to which the risk of breast cancer is increased in patients with endometriosis. Therefore, we conducted a large-scale observational study investigating the association between endometriosis and breast cancer risk. METHODS: This study included women aged ≥ 18 years with an initial endometriosis diagnosis from one of 315 office-based gynecologists in Germany between January 2005 and December 2021. Non-endometriosis patients were matched 1:1 to patients with endometriosis based on age, index year, average yearly consultation frequency, and predefined co-diagnoses within 12 months before or on the index date, including obesity and benign breast disorders. The association between endometriosis and the 10-year incidence of breast cancer was studied using Kaplan-Meier curves and log-rank tests. Finally, a univariable Cox regression analysis was conducted to assess the association between endometriosis and breast cancer. RESULTS: Over a follow-up period of up to 10 years, no significant difference was observed between the endometriosis (2.4%) and the matched non-endometriosis group (2.5%) with regard to breast cancer diagnoses. Furthermore, the regression analysis revealed no significant association between endometriosis and subsequent breast cancer. CONCLUSION: In summary, our comprehensive 10-year study involving a substantial sample of women indicates that endometriosis is not significantly associated with an increased risk of subsequent breast cancer.

Is there an association between mastitis and breast cancer? a retrospective cohort study from Germany.

PURPOSE: The aim of the study was to explore the association between mastitis and subsequent breast cancer. METHODS: This retrospective cohort study included women aged ≥ 18 years with an initial mastitis diagnosis from 315 office-based gynecologists in Germany between January 2005 and December 2021. Women without mastitis were matched to women with mastitis using propensity score matching based on age, index year, average yearly consultation frequency during the follow-up period, and coexisting diseases such as obesity, benign mammary dysplasia, hypertrophy of the breast, unspecified lump of breast, and other disorders of the breast. The 10-year cumulative incidence of breast cancer for the mastitis-cohort and non-mastitis-cohort was studied with Kaplan-Meier curves using the log-rank test. The association between mastitis and breast cancer was studied separately for four age groups with univariable Cox regression analyses. RESULTS: In the follow-up period of 7 months to 10 years after the index date, 2.9% of mastitis patients and 2.4% of matched non-mastitis patients were diagnosed with breast cancer. A Cox regression analysis revealed a significant association between mastitis and subsequent breast cancer (HR: 1.37; 95% CI: 1.11-1.70). According to the age-stratified analyses, a strong and significant association was only observed in the age group > 50 years (HR: 1.73; 95% 1.25-2.40). CONCLUSION: The findings of our retrospective cohort study support an association between mastitis and subsequent breast cancer diagnoses in women aged > 50 years. The pathophysiological basis and possibility of confounders however requires further investigation.

Type 2 diabetes incidence in patients initiating denosumab or alendronate treatment: a primary care cohort study.

Denosumab initiation is related to a lower risk of type 2 diabetes than alendronate in anti-osteoporotic treatment-naïve users in primary care practices. PURPOSE: Links have been suggested between bone metabolism and glucose tolerance. Downregulation of the receptor activator of nuclear factor κ B ligand (RANKL) signaling improves glucose metabolism. Denosumab, a human monoclonal antibody against RANKL, may be associated with a lower risk of type 2 diabetes (T2D). The aim was to compare incidence rates of T2DM in primary care patients initiating denosumab or alendronate, which is a first-line therapy of osteoporosis. Alendronate as comparator enhances comparability of the two cohorts. METHOD: The IQVIA Disease Analyzer comprises a representative panel of general and specialist practices (Germany). A new-user comparative study was conducted among patients with denosumab or alendronate treatment (2010-2021) without history of diabetes and age ≥ 45 years. Incidence rates (per 1,000 person-years) and Cox proportional hazard ratios (HR; 95%CI) for T2DM were estimated. RESULTS: The cohorts consisted of 3,354 denosumab (age: 75 years; women: 87%) and 27,068 alendronate (76 years; 86%) users. Overall, 1,038 persons developed T2D during 54,916 person-years. T2DM incidence rates per 1,000 person-years were 11.9 (9.5-14.4) for denosumab and 20.1 (18.8-21.3) for alendronate users, respectively. Denosumab was associated with a reduced risk of T2DM compared to alendronate, adjusting for age, sex, index year, visits, obesity, comorbidities and statins (HR: 0.73; 0.58-0.89). CONCLUSION: In this comparative study of older patients seen in routine practices, denosumab was associated with a lower risk of developing T2DM than alendronate.

Risk of Lymphoma and Leukemia in Thyroid Cancer Patients: A Retrospective Cohort Study in Germany.

Thyroid cancer is the ninth most common cancer worldwide. While differentiated thyroid cancer (DTC) has a high survival rate, concerns arise regarding optimal treatment strategies and potential long-term risks, including second primary malignancies (SPMs), associated with therapies such as radioiodine (RAI). The aim of the present study was to investigate the association between thyroid cancer and the incidence of subsequent lymphoma and leukemia in Germany. This retrospective cohort study used the IQVIA TM Disease Analyzer database and included adults with a first documented diagnosis of thyroid cancer between January 2005 and December 2021 as well as propensity score matched individuals without thyroid cancer in 1284 general practices. Univariate Cox regression models were performed to examine the association between thyroid cancer and the incidence of subsequent lymphoma and leukemia. A total of 4232 thyroid cancer patients (mean age: 54.2 years; 73.6% female) and 21 160 controls (mean age: 54.2 years; 72.6% female) were available for analyses. Thyroid cancer was significantly associated with a higher lymphoma incidence (HR: 3.35, 95% CI: 2.04-5.52), especially in men (HR: 5.37) and those aged 61-70 years. Leukemia incidence was not significantly associated with thyroid cancer (HR: 1.79, 95% CI: 0.91-3.53), although associations were notable in younger age groups. Thyroid cancer is positively associated with a risk of subsequent lymphoma, highlighting the need for vigilant surveillance and tailored treatment strategies. While the association with leukemia is less pronounced, close surveillance remains critical, especially in younger patients.

Proton pump inhibitor use and bone fractures in patients with chronic kidney disease.

BACKGROUND AND HYPOTHESIS: Patients with chronic kidney disease (CKD) are at high risk for bone fractures, which are associated with high morbidity and mortality. Proton pump inhibitors (PPI) have been linked to an increased risk for fractures in the general population as well as in patients with need for hemodialysis, but studies in patients with CKD are currently missing. METHODS: We performed a population-based observational case-control study exploring a sample of patients with CKD derived from the IQVIATM Disease Analyzer database. Patients with and without fractures were matched using the 1:1 nearest neighbor propensity score matching method. To investigate the association between PPI use and fractures, multivariable logistic regression analyses were performed adjusting for confounding factors. RESULTS: In total, 6076 patients with and 6076 patients without fractures were matched and subsequently available for analyses. In the total cohort, PPI use was associated with an increased risk for fractures (OR 1.68; 95% CI 1.55-1.83). This association was noted for nearly all types of fractures. The strongest association between PPI use and fractures was found in patients below the age of 60 with a PPI prescription for longer than two years (OR 6.85, 95% CI 1.85-25.38). The same was true, when analyzing cumulative PPI doses. Here, patients below the age of 60 with a cumulative PPI dose above 16 000 mg (highest quartile) had the highest risk for fractures (OR 4.62, 95% CI 1.87-11.44). There was no difference between men or women regarding the association between PPI use and fractures. CONCLUSIONS: This study provides evidence that PPI use is associated with fractures in patients with CKD. Deprescription of PPI in patients without an indication for treatment could be a modifiable risk factor to reduce fracture risk in this high-risk group.

Comparative Effectiveness of Intravenous Thrombolysis plus Mechanical Thrombectomy versus Mechanical Thrombectomy Alone in Acute Ischemic Stroke: A Systematic Review and Meta-Analysis.

INTRODUCTION: The treatment of acute ischemic stroke due to large artery vessel occlusion experienced a dramatic development within the last decade. This meta-analysis investigates the effectiveness of bridging therapy (BT) versus mechanical thrombectomy (MT) alone in treating acute ischemic stroke. METHODS: Two independent reviewers assessed two-arm clinical trials from Scopus, PubMed, Web of Science, and the Cochrane Library up to January 2024. Data extraction and quality were evaluated using the ROBINS-2 tool. Our primary outcomes were improvement in NIHSS scores and 90-day modified Rankin Scale (mRS) score. RESULTS: This meta-analysis, which included 2,638 participants from 8 randomized controlled trials, found that BT resulted in a greater improvement in NIHSS scores from baseline compared to endovascular treatment alone (mean difference [MD] 0.96, 95% confidence interval [CI]: [0.73-1.20], p < 0.00001). Additionally, BT group achieved successful recanalization more frequently before and after thrombectomy. Thrombectomy alone hat a shorter time from stroke onset to groin puncture compared to BT (MD 9.91, 95% CI: [4.31-15.52], p = 0.005). Functional outcomes, mortality rates, symptomatic intracerebral hemorrhage rates, and long-term recovery metrics, such as Barthel index and modified Rankin Scale scores, were comparable between both treatment approaches. CONCLUSION: BT is superior to endovascular treatment alone based on NIHSS score improvement and successful reperfusion rates before and after thrombectomy. Despite MT alone demonstrating a shorter time from stroke onset to groin puncture (MD of 9.91 min), it did not contribute to greater NIHSS improvement at 24 h and 7 days. Further trials with larger sample sizes are warranted to enhance precision in clinical guidance.

Temporal trends of carbonated soft-drink consumption among adolescents aged 12-15 years from eighteen countries in Africa, Asia and the Americas.

Carbonated soft-drink consumption is detrimental to multiple facets of adolescent health. However, little is known about temporal trends in carbonated soft-drink consumption among adolescents, particularly in non-Western countries. Therefore, we aimed to examine this trend in representative samples of school-going adolescents from eighteen countries in Africa, Asia and the Americas. Cross-sectional data from the Global School-based Student Health Survey 2009-2017 were analysed. Carbonated soft-drink consumption referred to drinking carbonated soft-drinks at least once per day in the past 30 d. The prevalence of carbonated soft-drink consumption was calculated for each survey, and crude linear trends were assessed by linear regression models. Data on 74 055 students aged 12-15 years were analysed (mean age 13·9 (sd 1·0) years; 49·2 % boys). The overall mean prevalence of carbonated soft-drink consumption was 42·1 %. Of the eighteen countries included in the study, significant decreasing, increasing and stable trends of carbonated soft-drink consumption were observed in seven, two and nine countries, respectively. The most drastic decrease was observed in Kuwait between 2011 (74·4 %) and 2015 (51·7 %). Even in countries with significant decreasing trends, the decrease was rather modest, while some countries with stable trends had very high prevalence across time (e.g. Suriname 80·5 % in 2009 and 79·4 % in 2016). The prevalence of carbonated soft-drink consumption was high in all countries included in the present analysis, despite decreasing trends being observed in some. Public health initiatives to reduce the consumption of carbonated soft-drink consumption among adolescents are urgently required.

Microembolizations in the arterial cerebral circulation during atrial fibrillation ablation: cryoballoon technique advantages and neurocognitive safety-results of a prospective observational study.

AIMS: The significance of micro-embolic signals (MESs) during atrial fibrillation (AF) ablation is unclear. Previous studies had limitations, and cryoballoon (CB) ablation patients were under-represented. Minimizing MESs is recommended due to their uncertain neurocognitive impact. METHODS AND RESULTS: This prospective observational study included AF patients from a German centre between February 2021 and August 2022. Patients were equally divided into paroxysmal (Group A) and persistent (Group B) AF. Group A received cryoballoon-pulmonary vein isolation only, while Group B also had left atrial roof ablation. MESs were detected using transcranial Doppler ultrasonography during ablation. Neurocognitive status was assessed pre- and post-procedure and at 3 months using the CERAD Plus battery. The study analyzed 100 patients with a median age of 65.5 years. A total of 19 698 MESs were observed, with 80% being gaseous and 20% solid in origin, primarily occurring during pulmonary vein angiography and the balloon freeze and thawing phase. The median MES per patient was 130 (IQR: 92-256) in total, 298 (IQR: 177-413) in bilateral (36%), and 110 (IQR: 71-130) in unilateral (64%) recordings. No significant difference in total MES counts was found between the groups. None of the 11 neuropsychological tests showed cognitive decline post-procedure or at 3 months. CONCLUSION: Our observations confirm that neurocognitive abilities are not affected either 24 h or 3 months after AF ablation using the CB technique. However, despite the low MES burden associated with the CB, more work is needed to reduce small embolic events during AF ablation.

Is there a link between appendicitis and the risk of diverticular disease?: a large German cohort study.

PURPOSE: Appendicitis, characterized by inflammation of the vermiform appendix, is a common abdominal emergency necessitating appendectomy. Recent evidence suggests a potential link between appendicitis and subsequent diverticular disease, yet population-based studies investigating this association are limited. METHODS: Utilizing the Disease Analyzer database encompassing data from over 1000 primary care practices in Germany, we conducted a retrospective cohort study. We included 25,379 adults diagnosed with appendicitis and an equal number of matched controls without appendicitis. The incidence of diverticular disease over a 10-year follow-up period was compared between the two cohorts. Cox regression analysis was performed to assess the association between appendicitis and diverticular disease, adjusting for potential confounders. RESULTS: Our findings revealed a significant association between appendicitis and subsequent diverticular disease (HR: 1.76; 95% CI: 1.57-1.97), with an increased risk observed across all age groups. Notably, this association was stronger in men (HR: 2.00; 95% CI: 1.68-2.37) than in women (HR: 1.58; 95% CI: 1.36-1.84). The cumulative 10-year incidence of diverticular disease was higher in patients with appendicitis (6.5%) compared to those without (3.6%). Additionally, we observed a clear age-dependent increase in the incidence of diverticular disease. CONCLUSION: This large-scale population-based study provides valuable insights into the interaction between appendicitis and diverticular disease. The study underscores the need for further research elucidating the underlying mechanisms linking appendicitis to diverticular disease. Probiotics emerge as a potential therapeutic avenue warranting exploration in the management of both conditions. These findings have important implications for clinical practice, highlighting the importance of considering appendicitis as a potential risk factor for diverticular disease, particularly in men. Further investigation is warranted to validate these findings and explore potential therapeutic interventions targeting the shared pathophysiological pathways underlying both conditions.

Prevalence of and factors associated with the early prescription of antiseizure medications in adults newly diagnosed with epilepsy in Germany.

BACKGROUND: There is little information on prescription patterns of antiseizure medications (ASMs) during the early management of patients with epilepsy in Germany. Therefore, this study investigated the prevalence of and the factors associated with ASM prescription in patients newly diagnosed with epilepsy in this country. METHODS: Adults diagnosed for the first time with epilepsy in one of 128 neurology practices in Germany between 2005 and 2021 were included (Disease Analyzer database, IQVIA). The prescription of ASMs was assessed within 30 days, six months, and 12 months of the diagnosis. Covariates were demographic factors, epilepsy sub-diagnoses, and co-diagnoses frequently associated with epilepsy. RESULTS: This study included 55,962 participants (mean [SD] age 52.5 [20.0] years; 50.5 % men). The prevalence of ASM prescription ranged from 45.0 % within 30 days to 66.0 % within 12 months of the diagnosis. Men were less likely to receive ASMs within six and 12 months of epilepsy diagnosis than women. In addition, epilepsy sub-diagnoses of symptomatic, complex, or generalized nature were associated with increased odds of ASM prescription compared with epilepsy of unspecified nature. Finally, there was an inverse and significant association between multiple co-diagnoses (e.g., diabetes, mental and behavioral disorders due to use of alcohol, and traumatic brain injury) and ASM prescribing. CONCLUSIONS: A substantial proportion of participants were prescribed ASMs in the year following epilepsy diagnosis, highlighting that the early prescription of ASMs was necessary for these patients. Further research is warranted to corroborate the present findings in other countries and settings.

Helicobacter pylori infection associated with an increased incidence of cholelithiasis: A retrospective real-world cohort study of 50 832 patients.

BACKGROUND AND AIM: Helicobacter pylori (H. pylori) infection is a bacterial disease of the stomach that has been associated with an increased incidence of cholelithiasis. While the updated German guideline emphasizes the relevance of H. pylori as a pathogen and recommends eradication therapy, systematic data on the association between H. pylori infection, its eradication, and the subsequent diagnosis of cholelithiasis in Germany are missing. METHODS: A total of 25 416 patients with and 25 416 propensity score-matched individuals without H. pylori infection were identified from the Disease Analyzer database (IQVIA) between 2005 and 2021. A subsequent diagnosis of cholelithiasis was analyzed as a function of H. pylori infection as well as its eradication using Cox regression models. RESULTS: After 10 years of follow-up, 8.0% versus 5.8% of patients with and without H. pylori infection were diagnosed with cholelithiasis (P < 0.001). Regression analysis revealed a significant association between H. pylori infection and cholelithiasis (hazard ratio [HR]: 1.45; 95% confidence interval [CI]: 1.33-1.58), which was stronger in men (HR: 1.63; 95% CI: 1.41-1.90) than in women (HR: 1.36; 95% CI: 1.22-1.52). In terms of eradication therapy, both an eradicated H. pylori infection (HR: 1.48; 95% CI: 1.31-1.67) and a non-eradicated H. pylori infection (HR: 1.41; 95% CI: 1.25-1.60) were associated with a subsequent diagnosis of cholelithiasis. CONCLUSION: The present study reveals a strong association between H. pylori infection and a subsequent diagnosis of cholelithiasis in a large real-world cohort from Germany. Eradication therapy was not associated with a reduced incidence of cholelithiasis in our cohort.

Trends and outcomes in colorectal cancer surgery: a multicenter cross-sectional study of minimally invasive versus open techniques in Germany.

BACKGROUND: The objective of this study was to assess the trend from open to modern minimally invasive (laparoscopic and robot-assisted) surgical techniques for colorectal cancer (CRC) in Germany, with a particular focus on hospital mortality, postoperative complications, and length of hospital stay. METHODS: A multicenter cross-sectional study was conducted using data from 36 German hospitals, encompassing 1,250,029 cases from January 2019 to December 2023. The study included all hospitalized patients aged ≥ 18 with CRC who underwent surgery. Surgical cases were categorized as open or minimally invasive. Outcomes assessed included in-hospital mortality, morbidity, and hospital length of stay. Statistical analyses involved multivariable logistic and linear regression models adjusted for main diagnosis, metastasis presence, age, sex, and comorbidities. RESULTS: The study included 4525 CRC cases: 2767 underwent open surgery and 1758 underwent minimally invasive surgery (173 robotic). In-hospital mortality was significantly higher in open surgery (6.1% vs. 1.7%). Open surgery was also significantly associated with higher rates of acute post-hemorrhagic anemia (OR: 2.38; 95% CI: 1.87-3.02), respiratory failure (OR: 1.71; 95% CI: 1.34-2.18), and intraoperative and postprocedural complications (OR: 3.64; 95% CI: 2.83-4.70). Average hospital stay was longer for open surgery (19.5 days vs. 11.0 days). CONCLUSION: Despite the advantages of minimally invasive surgery, including reduced mortality, morbidity, and shorter hospital stays, open surgery remains the predominant approach for CRC in Germany. These findings underscore the need for increased adoption of minimally invasive techniques and highlight the potential benefits of shifting toward minimally invasive methods to enhance the overall quality of CRC care.

Mortality rate and factors associated with in-hospital mortality in patients hospitalized with pulmonary embolism in Germany.

Pulmonary embolism (PE) is a life-threatening condition, the prognosis of which is determined in particular by acute decompensation and hospitalization. The goal of this study was to investigate the prevalence of and the factors associated with the in-hospital mortality of patients hospitalized with acute PE. This multicenter cross-sectional study was based on the data of PE patient cases from 36 hospitals across Germany. A multivariable logistic regression analysis was conducted to assess the associations between demographic and clinical variables and in-hospital mortality. A total of 7136 hospitalization cases were included (mean age: 68.6 years, 49.2% female). 60.2% of patients received PE as primary and 39.8% as secondary diagnosis. The mortality rate was 13.2%. Age group 71-80 years (OR: 1.49; 95% CI: 1.18-1.88) and > 80 years (OR: 2.06; 95% CI: 1.61-2.62), PE as secondary diagnosis (OR: 2.12; 95% CI: 1.676-2.56), respiratory failure (OR: 2.88; 95% CI: 2.44-3.41), acute renal failure (OR: 2.65; 95% CI: 2.14-3.27), hypokalemia (OR: 1.51; 95% CI: 1.28-1.79), heart failure (OR: 1.43; 95% CI: 1.18-1.73), and acute posthemorrhagic anemia (OR: 1.34; 95% CI: 1.04-1.74) were associated with an increased mortality risk. Our findings underscore the significant impact of age, acute renal failure, and respiratory complications on the mortality of patients with PE. While our study provides a comprehensive snapshot of in-hospital mortality in acute PE patients, it also highlights the need for ongoing research to deepen our understanding of the interplay between various risk factors.

German longitudinal prescription database (LRx): Description of characteristics, use in pharmacoepidemiological research, and limitations
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Large databases have played a critical role in pharmacoepidemiological research in the last decade, with this role likely to gain further importance in the future. The aim of the present paper is to describe the characteristics, the recent use, and the limitations of the German longitudinal prescription (LRx) database. The LRx database contains patient-level data on prescriptions collected in retail pharmacies, corresponding to ~ 80% of prescriptions reimbursed by statutory health insurance funds in Germany. The LRx database includes a higher proportion of older adults and women compared to the overall German population with statutory health insurance. Coverage per family of drugs ranges from 71.8% for antiepileptics to 94.7% for urological agents. Multiple pharmacoepidemiological studies based on the data from the German LRx database have been published in the last years on topics such as patterns of prescription and treatment adherence and persistence. A large number of disorders have been investigated in this research (e.g., type 2 diabetes, inflammatory diseases, and psychiatric conditions). The major limitations of the LRx database are the lack of formal diagnoses and the absence of hospital data. In conclusion, the German LRx database could be a key source of data for future pharmacoepidemiological studies.

Association between sedentary behavior and dynapenic abdominal obesity among older adults from low- and middle-income countries.

BACKGROUND: Sedentary behavior, or time spent sitting, may increase risk for dynapenic abdominal obesity (DAO), but there are currently no studies on this topic. AIMS: Therefore, we investigated the association between sedentary behaviour and DAO in a nationally representative sample of older adults from six low- and middle-income countries. METHODS: Cross-sectional data from the Study on Global AGEing and Adult Health were analysed. Dynapenia was defined as handgrip strength < 26 kg for men and < 16 kg for women. Abdominal obesity was defined as waist circumference of > 88 cm (> 80 cm for Asian countries) for women and > 102 cm (> 90 cm) for men. DAO was defined as having both dynapenia and abdominal obesity. Self-reported sedentary behavior was categorized as ≥ 8 h/day (high sedentary behaviour) or < 8 h/day. Multivariable multinomial logistic regression was conducted. RESULTS: Data on 20,198 adults aged ≥ 60 years were analyzed [mean (SD) age 69.3 (13.1) years; 54.1% females]. In the overall sample, ≥ 8 h of sedentary behavior per day (vs. <8 h) was significantly associated with 1.52 (95%CI = 1.11-2.07) times higher odds for DAO (vs. no dynapenia and no abdominal obesity), and this was particularly pronounced among males (OR = 2.27; 95%CI = 1.42-3.62). Highly sedentary behavior was not significantly associated with dynapenia alone or abdominal obesity alone. DISCUSSION: High sedentary behaviour may increase risk for DAO among older adults. CONCLUSIONS: Interventions to reduce sedentary behaviour may also lead to reduction of DAO and its adverse health outcomes, especially among males, pending future longitudinal research.

Seasonal variation and demographic characteristics of acute tonsillitis and peritonsillar abscess in ENT practices in Germany (2019-2023).

OBJECTIVE: Peritonsillar abscess (PTA) is a common soft tissue infection of the head and neck. It remains unclear to what extent inflammatory diseases of the palatine tonsils or other infections contribute to the development of PTA. This study examines the demographic characteristics and seasonal variations of acute tonsillitis (aT) and PTA in ENT practices in Germany using a practice database. METHODS: Retrospective analysis based on data from the German-wide IQVIA™ Disease Analyzer database for the period 2019 to 2023. Data include diagnoses of aT (ICD-10: J03) and PTA (ICD-10: J36) as well as patient demographics (age, sex). Seasonal variations were identified by analysing the monthly diagnosis rates. The Pearson correlation between the monthly case numbers of aT and PTA was determined. RESULTS: 59,934 cases of aT and 5,024 cases of PTA were recorded. The mean age was 30.3 years (aT) and 39.4 years (PTA). The proportion of female patients was 60% (aT) and 49% (PTA). Both diagnoses showed seasonal variations with peaks in winter and spring and a decline in summer, although the decline was less pronounced for PTA. The monthly case numbers of aT and PTA showed high correlations between r = 0.75 (2019) and r = 0.94 (2020). The average correlation for the period 2019-2023 was r = 0.81. During the coronavirus pandemic, a significant decrease in the case numbers of both diseases was observed, while the typical seasonal variations disappeared. After the pandemic, the case numbers increased to higher levels than before the pandemic. CONCLUSIONS: aT and PTA both show seasonal variations with peaks in winter and spring and a decline in summer. The correlation between the variations of aT and PTA could be related to a partly common aetiology or to the specific sample of the practice database. The attenuation of seasonal variation during the coronavirus pandemic illustrates the impact of COVID-19 on the incidence of other diseases and on the use of healthcare pathways by patients.

Diseases associated with subsequent peritonsillar abscess: a case-control-study from ENT practices in Germany.

OBJECTIVE: Peritonsillar abscess (PTA) is the most common deep soft tissue infection necessitating surgical intervention in the head and neck region. Potential causes include infections of the palatine tonsils, palatine glands, or branchiogenic rudiments ("acute tonsillitis hypothesis" vs. "Weber's gland hypothesis"). Understanding the currently still unknown predominant cause is crucial for guiding therapeutic strategies, such as abscess tonsillectomy versus incision and drainage alone. This study aims to investigate the pre-diagnoses associated with subsequent PTA using a nationally representative practice database in Germany. METHODS: Data were collected from 195 ENT practices across Germany utilizing the nationally representative practice database IQVIA™ Disease Analyzer. Included were patients aged 18 years and older with a first diagnosis of PTA (index date) between January 2005 and December 2022 and a minimum observation period of 12 months preceding the index date. These patients were matched (1:5) with controls without PTA, based on age, sex, and index year. Frequencies of prior diagnoses coded according to ICD-10 in the 12 months preceding the index date were computed. The association between prior diagnoses and PTA was evaluated using multivariable logistic regression (MLR) and sensitivity analysis (SA). RESULTS: A total of 5,325 cases were compared with 26,725 controls in the multivariable logistic regression (MLR) analysis, and 16,251 cases were compared with 81,255 controls in the sensitivity analysis (SA). Mean age was 45.3 ± 18.3 years (MLR) and 41.9 ± 16.7 years (SA). The proportion of female patients was 51.8% (MLR) and 46.9% (SA), respectively. MLR showed the strongest associations with PTA for the prior diagnoses of "acute tonsillitis" (odds ratio, OR: 6.71; 95% CI: 5.81-7.74), "chronic tonsillitis" (OR: 2.00; 95% CI: 1.58-2.52), and "acute pharyngitis" (OR: 1.74; 95% CI: 1.50-2.03). SA similarly indicated the strongest associations with PTA for the prior diagnoses of "acute tonsillitis" (OR: 5.02; 95% CI: 4.60-5.47), "chronic tonsillitis" (OR: 1.87; 95% CI: 1.64-2.12), and "acute pharyngitis" (OR: 1.27; 95% CI: 1.14-1.41). CONCLUSION: The most prevalent prior diagnosis associated with PTA was acute tonsillitis, followed by chronic tonsillitis and acute pharyngitis. The association with acute pharyngitis suggests possible non-tonsillogenic causes. Other specific causes of PTA, such as inflammation of the palatine gland or branchiogenic remnants, are not captured by the ICD system or the database utilized in this study.

Death anxiety among the oldest old in Germany. Evidence from the nationally representative 'Old Age in Germany (D80+)'.

BACKGROUND: There is a lack of studies investigating death anxiety among the oldest old based on a large, nationally representative sample during the pandemic. Thus, our aim was to investigate the prevalence and determinants of death anxiety among the oldest old in Germany during the Covid-19 pandemic. METHODS: Cross-sectional data were taken from the 'Old Age in Germany' (D80+) study. This is a large, nationwide representative study including individuals 80 years and over living at home and individuals in institutionalised settings (N = 9542 individuals in the analytic sample). RESULTS: Overall, 30% of the respondents reported the absence of death anxiety, 45.5% reported a rather not strong death anxiety, 20.2% reported a rather strong death anxiety, and 4.3% reported a very strong death anxiety. Linear regressions revealed that higher death anxiety was significantly associated with being female (ß = 0.21, P < 0.01), younger age (ß = -0.02, P < 0.001), being married (ß = 0.09, P < 0.001), high education (compared to low education, ß = 0.07, P < 0.05), the presence of meaning in life (ß = 0.13, P < 0.001), higher loneliness levels (ß = 0.18, P < 0.001), the presence of multimorbidity (ß = 0.07, P < 0.05), and poorer self-rated health (ß = -0.07, P < 0.001). A further analysis showed that probable depression (ß = 0.31, P < 0.001) is also associated with higher death anxiety. CONCLUSION: About one in four individuals had a strong or very strong fear of death during the pandemic. Several sociodemographic, psychosocial, and health-related factors are associated with higher death anxiety. This better understanding of the determinants of death anxiety can be relevant for, among others, the affected individuals, informal and professional carers, as well as friends and relatives.

Changes in the incidence of early-onset breast cancer in Germany between 2010 and 2022.

PURPOSE: The aim of this study was to identify the mean age at which breast cancer (BC) was first diagnosed in 2010 or 2022, and to evaluate whether there were any changes in age groups at first BC diagnosis. METHODS: This retrospective cross-sectional study included adult women (18 years or older) who were diagnosed with BC (ICD-10: C50) for the first time in 2010 or 2022 in office-based practices in Germany (in 300 general practices or 95 gynecological practices). We examined the mean age at diagnosis and the percentage of patients in three age groups (18-49, 50-65, and > 65) for both 2010 and 2022. The average age difference between 2010 and 2022 was analyzed using Wilcoxon rank tests, and the proportions of the three age groups were analyzed using chi-squared tests. These analyses were performed separately for patients in general and gynecological practices. RESULTS: The mean age at which BC was initially diagnosed in 2022 was found to be significantly greater than that in 2010 for both general practices (66.9 years vs. 64.0 years p < 0.001) and gynecological practices (62.2 years vs. 60.3 years, p < 0.001). Early-onset BC decreased from 15.6 to 12.0% in general practices and from 23.2 to 18.2% in gynecological practices between 2010 and 2022. The proportion of new BC diagnoses in the age group 50-65 increased from 36.6 to 40.9% in gynecological practices, but did not increase in general practices. CONCLUSION: The study found that BC was diagnosed at an older age in 2022 than in 2010. In addition, the proportion of early-onset BC cases decreased, while the proportion of cases in the age group 50-65 increased in gynecological practices in Germany.

Association between gout and subsequent breast cancer: a retrospective cohort study including 67,598 primary care patients in Germany.

PURPOSE: The aim of this retrospective cohort study was to analyze the cumulative incidence of breast cancer following gout and to investigate the association between gout and subsequent breast cancer in 67,598 primary care patients in Germany. METHODS: This study included adult female patients (≥ 18 years) with an initial diagnosis of gout in 1284 general practices in Germany between January 2005 and December 2020. Individuals without gout were matched to gout patients using propensity score matching based on average yearly consultation frequency during the follow-up period, diabetes, obesity, chronic bronchitis/COPD diagnoses, and diuretic therapy. The 10-year cumulative incidence of breast cancer in the cohorts with and without gout was also studied using Kaplan-Meier curves, which were then compared using the log-rank test. Finally, a univariable Cox regression analysis was conducted to assess the association between gout and breast cancer. RESULTS: After up to 10 years of follow-up, 4.5% of gout and 3.7% of non-gout patients were diagnosed with breast cancer. A Cox regression analysis revealed a significant association between gout and subsequent breast cancer in the total population (HR: 1.17; 95% CI: 1.05-1.31). In the age-stratified analyses, gout was only strongly associated with subsequent breast cancer in the age group ≤ 50 (HR: 1.58; 95% CI: 1.10-2.27), but the association was not significant in women over 50 years old. CONCLUSION: Taken together, the findings of our study provide evidence for the association between gout and subsequent breast cancer diagnosis, particularly in the youngest age group.