Risk of cardiovascular events after influenza infection-related hospitalizations in adults with congenital heart disease: A nationwide population based study.

BACKGROUND: Cardiovascular complications due to viral infection pose a significant risk in vulnerable patients such as those with congenital heart disease (CHD). Limited data exists regarding the incidence of influenza and its impact on cardiovascular outcomes among this specific patient population. METHODS: A retrospective cohort study was designed using the Canadian Congenital Heart Disease (CanCHD) database-a pan-Canadian database of CHD patients with up to 35 years of follow-up. CHD patients aged 40 to 65 years with influenza virus-associated hospitalizations between 2010 and 2017 were identified and 1:1 matched with CHD patients with limb fracture hospitalizations on age and calendar time. Our primary endpoint was cardiovascular complications: heart failure, acute myocardial infarction, atrial arrhythmia, ventricular arrhythmia, heart block, myocarditis, and pericarditis. RESULTS: Of the 303 patients identified with incident influenza virus-associated hospitalizations, 255 were matched to 255 patients with limb fracture hospitalizations. Patients with influenza virus-related hospitalizations showed significantly higher cumulative probability of cardiovascular complications at 1 year (0.16 vs. 0.03) and 5 years (0.33 vs. 0.15) compared to patients hospitalized with bone fracture. Time-dependent hazard function modeling demonstrated a significantly higher risk of cardiovascular complications within 9 months postdischarge for influenza-related hospitalizations. This association was confirmed by Cox regression model (average hazard ratio throughout follow-up: 2.48; 95% CI: 1.59-3.84). CONCLUSIONS: This pan-Canadian cohort study of adults with CHD demonstrated an association between influenza virus-related hospitalization and risk of cardiovascular complications during the 9 months post discharge. This data is essential in planning surveillance strategies to mitigate adverse outcomes and provides insights into interpreting complication rates of other emerging pathogens, such as COVID-19.

CanCHD Study of Hematopoietic Cancers in Children With and Without Genetic Syndromes.

BACKGROUND: Individuals with genetic syndromes can manifest both congenital heart disease (CHD) and cancer attributable to possible common underlying pathways. To date, reliable risk estimates of hematopoietic cancer (HC) among children with CHD based on large population-based data remain scant. This study sought to quantify the risk of HC by the presence of genetic syndrome among children with CHD. METHODS AND RESULTS: Data sources were the Canadian CHD database, a nationwide database on CHD (1999-2017), and the CCR (Canadian Cancer Registry). Standardized incidence ratios were calculated for comparing HC incidences in children with CHD with the general pediatric population. A modified Kaplan-Meier curve was used to estimate the cumulative incidence of HC with death as a competing risk. A total of 143 794 children (aged 0-17 years) with CHD were followed up from birth to age 18 years for 1 314 603 person-years. Of them, 8.6% had genetic syndromes, and 898 HC cases were observed. Children with known syndromes had a substantially higher risk of incident HC than the general pediatric population (standardized incidence ratio, 13.4 [95% CI, 11.7-15.1]). The cumulative incidence of HC was 2.44% (95% CI, 2.11-2.76) among children with a syndrome and 0.79% (95% CI, 0.72-0.87) among children without a syndrome. Acute myeloid leukemia had a higher cumulative incidence during early childhood than acute lymphoblastic leukemia. CONCLUSIONS: This is the first large population-based analysis documenting that known genetic syndromes in children with CHD are a significant predictor of HC. The finding could be essential in informing risk-stratified policy recommendations for cancer surveillance in children with CHD.

Adolescent motherhood in Bangladesh: Trends and determinants.

BACKGROUND: While studies on fertility and contraceptives issues are available, until recently adolescent motherhood has not received enough attention among policy makers in understanding adolescent motherhood in Bangladesh. We aimed to examine the trends and determinants of adolescent motherhood among women aged 15-49 years. METHODS: For trend analysis we used all the 7 waves of Bangladesh Demographic and Health Survey (BDHS, 1993-2014) data but for multivariate analysis 4 waves of BDHS (2004-2014). Two separate analyses were carried out on ever married women aged 15-49: (1) teenage girls aged 15-19 and (2) adult women aged 20 and above. RESULTS: The prevalence of adolescent motherhood had declined to a slower pace from 1993 to2014 (from 33.0% to 30.8%). Lower spousal age gap and higher education were found to be associated with lower likelihood of adolescent motherhood both among teenage girls [OR 0.447 (0.374-0.533)] and adult women [OR 0.451 (0.420-0.484)]. Teenage girls in the poorest wealth quintile [OR 1.712 [1.350-2.173] were more likely to experience adolescent motherhood than the richest wealth quintile. Teenage girls who had no education were found to have 2.76 times higher odds of adolescent motherhood than their counterparts who had higher than secondary education. Concerning the time effect, the odds of adolescent motherhood among adult women was found to decline overtime. CONCLUSIONS: Despite substantial decrease in total fertility rate in Bangladesh adolescent motherhood is still highly prevalent though declining from 1993 to 2014. Social policies including those addressing poverty, ensuring greater emphasis on education for women; and adolescent mothers in rural areas are needed.