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1.
J Rheumatol ; 47(2): 197-203, 2020 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-31043549

RESUMO

OBJECTIVE: The effects of rheumatoid arthritis (RA) and spondyloarthritis (SpA) on maternal and neonatal outcomes at a population level have not previously been well compared. METHODS: A contemporary pregnancy cohort of 312,081 women and corresponding birth events was assembled for the province of Alberta from the random selection of 1 live birth event per woman. We identified 3 groups: (1) no inflammatory arthritis (no IA, n = 308,989), (2) RA (n = 631), and (3) SpA (n = 2461). We compared maternal and neonatal outcomes, comorbid conditions, and medication use among the 3 groups. Multivariable logistic regression models evaluated the independent association between RA and SpA, relative to no IA, and the outcomes of small for gestation age (SGA) and hypertensive disorders during pregnancy. RESULTS: Pregnant women with RA were significantly more likely to have preterm delivery (13.5%), cesarean delivery (33.9%), hypertensive disorders in pregnancy (10.5%), and SGA babies (15.6%), compared to pregnant women with either SpA or no IA. Nonsteroidal antiinflammatory drugs and corticosteroid use were significantly higher in pregnant women with RA compared to the other groups. Women with RA were significantly more likely to have an SGA baby (OR 1.51, 95% CI 1.21-1.88; p < 0.01), and hypertensive disorder in pregnancy (OR 1.51, 95% CI 1.16-1.97; p < 0.01), compared to women with no IA, while no difference was found between women with SpA and those with no IA. CONCLUSION: Women with RA have a higher risk of worse maternal and neonatal outcomes, whereas the risk of these events is similar between women with and without SpA.

3.
Diabetologia ; 62(2): 249-258, 2019 02.
Artigo em Inglês | MEDLINE | ID: mdl-30421138

RESUMO

AIMS/HYPOTHESIS: This study aimed to examine the association of maternal diabetes, being large for gestational age (LGA) and breast-feeding with being overweight or obese in pre-school-aged children. METHODS: Data on height and weight at the time of their pre-school (age 4-6 years) immunisation visit between January 2009 and August 2017, as well as breast-feeding status in the first 5 months of life, for 81,226 children born between January 2005 and August 2013 were linked with maternal hospitalisation and outpatient records and birth registry data. Children were grouped into six categories based on maternal diabetes status during pregnancy (no diabetes, gestational diabetes or pre-existing diabetes) and birthweight (appropriate for gestational age [AGA] or LGA). WHO criteria were used to identify children who were overweight or obese. RESULTS: There were 69,506 children in the no diabetes/AGA group (control), 5926 in the no diabetes/LGA group, 4563 in the gestational diabetes/AGA group, 573 in the gestational diabetes/LGA group, 480 in the pre-existing diabetes/AGA group and 178 in the pre-existing diabetes/LGA group. The rate of being overweight/obese at pre-school age ranged from 20.5% in the control group to 42.9% in the gestational diabetes/LGA group. The adjusted attributable risk per cent for LGA alone (39.4%) was significantly higher than that for maternal gestational diabetes (16.0%) or pre-existing diabetes alone (15.1%); the risk for the combinations of gestational diabetes/LGA and pre-existing diabetes/LGA were 50.1% and 39.1%, respectively. Further stratification of the pre-existing diabetes groups found the prevalence of being overweight/obese was 21.2% in the type 1/AGA group, 31.4% in the type 1/LGA group (similar to those in the no diabetes groups), 26.7% in the type 2/AGA group and 42.5% in the type 2/LGA group. Breast-feeding was associated with a lower likelihood of being overweight/obese in childhood in all groups except gestational diabetes/LGA and pre-existing diabetes/LGA (both type 1 and type 2). CONCLUSION/INTERPRETATION: LGA is a stronger marker for risk of being overweight/obese in early childhood, compared with maternal diabetes during pregnancy. Rates of being overweight/obese in childhood were highest in LGA children born to mothers with gestational diabetes or pre-existing type 2 diabetes. Breast-feeding was associated with a lower risk of being overweight/obese in childhood in the majority of children; however, this association was not maintained in LGA children of mothers with diabetes.


Assuntos
Aleitamento Materno , Diabetes Mellitus Tipo 2/complicações , Diabetes Gestacional/metabolismo , Macrossomia Fetal/etiologia , Sobrepeso/etiologia , Obesidade Pediátrica/etiologia , Índice de Massa Corporal , Criança , Pré-Escolar , Diabetes Mellitus Tipo 2/metabolismo , Feminino , Humanos , Recém-Nascido , Masculino , Sobrepeso/metabolismo , Obesidade Pediátrica/metabolismo , Gravidez , Gravidez em Diabéticas/metabolismo , Fatores de Risco
4.
Int J Cardiol ; 272: 33-39, 2018 Dec 01.
Artigo em Inglês | MEDLINE | ID: mdl-30119915

RESUMO

BACKGROUND: With acute coronary syndromes (ACS), activation of emergency medical services (EMS) ensures early treatment. However, EMS activation remains under-utilized. We examined whether ground EMS use varied by sex or ethnicity among a population-based cohort of ACS patients. METHODS: We used linked administrative health datasets to identify patients who were hospitalized with an ACS (April 1, 2002-March 31, 2016). Validated naming algorithms were used to categorize patients according to ethnicity (Caucasian, South Asian, Chinese). RESULTS: Of the 60,717 patients with an ACS (male: 41,175; female: 19,542), 42.3% presented to hospital via ground ambulance. Compared to males, females were more likely to activate EMS (38.9% vs. 49.3%, p < 0.001). Compared to the Caucasians (n = 58,666), EMS activation was significantly higher among Chinese (n = 793) (42.1% vs. 49.8%; p = 0.0007) and slightly higher in South Asians (n = 1258) (42.1% vs. 44.7%; p = 0.45). The relatively higher EMS use among females was maintained across the ethnic groups. In multivariable adjusted analyses, females were more likely to use EMS compared to males (OR: 1.31; 95% CI: 1.26-1.36). Compared to the Caucasians, a weaker trend towards South Asian and Chinese EMS activation was observed (OR: 1.08; 95% CI 0.96-1.21; OR: 1.10; 95% CI 0.95-1.28, respectively). In the male cohort only, South Asians and Chinese tended to activate EMS more often than the Caucasians (Males: South Asian OR: 1.14; 95% CI 1.00-1.31, Chinese OR: 1.15; 95% CI 0.96-1.38; Females: South Asian OR: 0.93; 95% CI 0.75-1.15, Chinese OR: 1.01; 95% CI 0.77-1.30). CONCLUSION: EMS use was sub-optimal and differed based on sex and ethnicity. Our results reinforce the need for targeted public health efforts to enhance ambulance activation.


Assuntos
Síndrome Coronariana Aguda/etnologia , Síndrome Coronariana Aguda/terapia , Ambulâncias , Serviços Médicos de Emergência/tendências , Hospitalização/tendências , Caracteres Sexuais , Idoso , Idoso de 80 Anos ou mais , Alberta/etnologia , Estudos de Coortes , Grupos Étnicos , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos
5.
Can J Diabetes ; 41(2): 204-210, 2017 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-27908558

RESUMO

OBJECTIVES: To explore detection bias in the association between glucose-lowering therapies and breast cancer in a cohort of women with type 2 diabetes. METHODS: This was a retrospective, population-based cohort study. We identified new users of metformin, sulfonylureas, thiazolidinediones and insulin during the index period of January 1, 2003, to December 31, 2010. The main outcome was incident breast cancer, and patients were followed up from drug exposure index date until death, diagnosis of another type of cancer, termination of medical insurance or December 31, 2010. To explore detection bias, we split follow-up time into 2 discrete time periods of 0 to 3 months and 3 months to 6 years after drug index date. We performed time-varying Cox regression analyses, including duration of cumulative drug exposure and ever/never drug exposure for each glucose-lowering therapy into our model. The reference was no use of the same drug-exposure category. RESULTS: There were 22,169 women with type 2 diabetes, with a mean (SD) age of 53.0 (9.2) years and mean (SD) follow up of 2.2 (1.5) years. Hazard ratios for breast cancer in the first 3 months following initiation of metformin, sulfonylurea or thiazolidinedione were 0.66 (0.43 to 1.02), 0.74 (0.44 to 1.25) and 0.67 (0.38 to 1.18), respectively. In the later period of 3 months to 6 years following drug start, hazard ratios (95% CI) for breast cancer were 1.00 (0.98 to 1.02), 1.01 (0.98 to 1.03) and 0.98 (0.95 to 1.01) for metformin, sulfonylurea and thiazolidinedione cumulative exposure, respectively. CONCLUSIONS: Our findings suggest that no detection bias exists for glucose-lowering therapies and breast cancer in this population.


Assuntos
Neoplasias da Mama/epidemiologia , Diabetes Mellitus Tipo 2/complicações , Hipoglicemiantes/efeitos adversos , Insulina/efeitos adversos , Metformina/efeitos adversos , Compostos de Sulfonilureia/efeitos adversos , Tiazolidinedionas/efeitos adversos , Adulto , Neoplasias da Mama/complicações , Diabetes Mellitus Tipo 2/tratamento farmacológico , Feminino , Humanos , Hipoglicemiantes/uso terapêutico , Insulina/uso terapêutico , Metformina/uso terapêutico , Modelos de Riscos Proporcionais , Análise de Regressão , Estudos Retrospectivos , Medição de Risco , Compostos de Sulfonilureia/uso terapêutico , Tiazolidinedionas/uso terapêutico
6.
Diabetologia ; 58(3): 493-504, 2015 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-25481707

RESUMO

AIMS/HYPOTHESIS: The evidence on the association between pioglitazone use and bladder cancer is contradictory, with many studies subject to allocation bias. The aim of our study was to examine the effect of exposure to pioglitazone on bladder cancer risk internationally across several cohorts. The potential for allocation bias was minimised by focusing on the cumulative effect of pioglitazone as the primary endpoint using a time-dependent approach. METHODS: Prescription, cancer and mortality data from people with type 2 diabetes were obtained from six populations across the world (British Columbia, Finland, Manchester, Rotterdam, Scotland and the UK Clinical Practice Research Datalink). A discrete time failure analysis using Poisson regression was applied separately to data from each centre to model the effect of cumulative drug exposure on bladder cancer incidence, with time-dependent adjustment for ever use of pioglitazone. These were then pooled using fixed and random effects meta-regression. RESULTS: Data were collated on 1.01 million persons over 5.9 million person-years. There were 3,248 cases of incident bladder cancer, with 117 exposed cases and a median follow-up duration of 4.0 to 7.4 years. Overall, there was no evidence for any association between cumulative exposure to pioglitazone and bladder cancer in men (rate ratio [RR] per 100 days of cumulative exposure, 1.01; 95% CI 0.97, 1.06) or women (RR 1.04; 95% CI 0.97, 1.11) after adjustment for age, calendar year, diabetes duration, smoking and any ever use of pioglitazone. No association was observed between rosiglitazone and bladder cancer in men (RR 1.01; 95% CI 0.98, 1.03) or women (RR 1.00; 95% CI 0.94, 1.07). CONCLUSIONS/INTERPRETATION: The cumulative use of pioglitazone or rosiglitazone was not associated with the incidence of bladder cancer in this large, pooled multipopulation analysis.


Assuntos
Diabetes Mellitus Tipo 2/tratamento farmacológico , Hipoglicemiantes/efeitos adversos , Tiazolidinedionas/efeitos adversos , Neoplasias da Bexiga Urinária/induzido quimicamente , Neoplasias da Bexiga Urinária/epidemiologia , Idoso , Colúmbia Britânica/epidemiologia , Feminino , Finlândia/epidemiologia , Humanos , Incidência , Masculino , Pessoa de Meia-Idade , Pioglitazona , Rosiglitazona , Escócia/epidemiologia
8.
Diabetes Care ; 36(10): 3070-5, 2013 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-23990517

RESUMO

OBJECTIVE: To investigate whether the risk of bladder cancer in individuals with newly diagnosed type 2 diabetes is influenced by the frequency of physician visits before diagnosis as a measure of detection bias. RESEARCH DESIGN AND METHODS: With the use of linked administrative databases from 1996 to 2006, we established a cohort of 185,100 adults from British Columbia, Canada, with incident type 2 diabetes matched one to one with nondiabetic individuals on age, sex, and index date. Incidence rates and adjusted hazard ratios (aHRs) for bladder cancer were calculated during annual time windows following the index date. Analyses were stratified by number of physician visits in the 2 years before diabetes diagnosis and adjusted for age, sex, year of cohort entry, and socioeconomic status. RESULTS: The study population was 54% men and had an average age of 60.7±13.5 years; 1,171 new bladder cancers were diagnosed over a median follow-up of 4 years. In the first year after diabetes diagnosis, bladder cancer incidence in the diabetic cohort was 85.3 (95% CI 72.0-100.4) per 100,000 person-years and 66.1 (54.5-79.4) in the control cohort (aHR 1.30 [1.02-1.67], P=0.03). This first-year increased bladder cancer risk was limited to those with the fewest physician visits 2 years before the index date (≤12 visits, aHR 2.14 [1.29-3.55], P=0.003). After the first year, type 2 diabetes was not associated with bladder cancer. CONCLUSIONS: The results suggest that early detection bias may account for an overestimation in previously reported increased risks of bladder cancer associated with type 2 diabetes.


Assuntos
Diabetes Mellitus Tipo 2/epidemiologia , Neoplasias da Bexiga Urinária/epidemiologia , Adulto , Idoso , Canadá/epidemiologia , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Fatores de Risco
9.
CMAJ ; 184(12): E675-83, 2012 Sep 04.
Artigo em Inglês | MEDLINE | ID: mdl-22761478

RESUMO

BACKGROUND: Patients with type 2 diabetes have a 40% increased risk of bladder cancer. Thiazolidinediones, especially pioglitazone, may increase the risk. We conducted a systematic review and meta-analysis to evaluate the risk of bladder cancer among adults with type 2 diabetes taking thiazolidinediones. METHODS: We searched key biomedical databases (including MEDLINE, Embase and Scopus) and sources of grey literature from inception through March 2012 for published and unpublished studies, without language restrictions. We included randomized controlled trials (RCTs), cohort studies and case-control studies that reported incident bladder cancer among people with type 2 diabetes who ever (v. never) were exposed to pioglitazone (main outcome), rosiglitazone or any thiazolidinedione. RESULTS: Of the 1787 studies identified, we selected 4 RCTs, 5 cohort studies and 1 case-control study. The total number of patients was 2,657,365, of whom 3643 had newly diagnosed bladder cancer, for an overall incidence of 53.1 per 100,000 person-years. The one RCT that reported on pioglitazone use found no significant association with bladder cancer (risk ratio [RR] 2.36, 95% confidence interval [CI] 0.91-6.13). The cohort studies of thiazolidinediones (pooled RR 1.15, 95% CI 1.04-1.26; I(2) = 0%) and of pioglitazone specifically (pooled RR 1.22, 95% CI 1.07-1.39; I(2) = 0%) showed significant associations with bladder cancer. No significant association with bladder cancer was observed in the two RCTs that evaluated rosiglitazone use (pooled RR 0.87, 95% CI 0.34-2.23; I(2) = 0%). INTERPRETATION: The limited evidence available supports the hypothesis that thiazolidinediones, particularly pioglitazone, are associated with an increased risk of bladder cancer among adults with type 2 diabetes.


Assuntos
Diabetes Mellitus Tipo 2/epidemiologia , Tiazolidinedionas/efeitos adversos , Neoplasias da Bexiga Urinária/epidemiologia , Adulto , Estudos de Coortes , Comorbidade , Diabetes Mellitus Tipo 2/tratamento farmacológico , Humanos , Incidência , Pioglitazona , Ensaios Clínicos Controlados Aleatórios como Assunto , Fatores de Risco , Rosiglitazona , Tiazolidinedionas/uso terapêutico
10.
Diabetes Care ; 34(12): 2542-4, 2011 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-21972408

RESUMO

OBJECTIVE: To examine the risk of breast cancer in pre- and postmenopausal women with type 2 diabetes (T2D). RESEARCH DESIGN AND METHODS: This was a population-based retrospective cohort study. Cox regression, stratified by pre- (<55 years) and postmenopausal (≥55 years) status, was used to estimate hazard ratios (HRs) for breast cancer, during earlier (0-3 months) and later (3 months to 10 years) time windows after diabetes index date. RESULTS: Compared with women without T2D, HRs for breast cancer were 0.95 (95% CI 0.48-1.86; P = 0.88) and 1.31 (0.92-1.86; P = 0.14) in pre- and postmenopausal women with T2D, respectively, in the early time window, and 0.92 (0.75-1.13; P = 0.45) and 1.00 (0.90-1.11; P = 0.93) in pre- and postmenopausal women with T2D, respectively, in the later time window. CONCLUSIONS: We observed a trend toward an increased risk of breast cancer in postmenopausal women with T2D, but only in the time period immediately after diabetes index date.


Assuntos
Neoplasias da Mama/epidemiologia , Diabetes Mellitus Tipo 2/epidemiologia , Pós-Menopausa , Adulto , Viés , Neoplasias da Mama/etiologia , Colúmbia Britânica/epidemiologia , Estudos de Coortes , Diabetes Mellitus Tipo 2/complicações , Feminino , Humanos , Incidência , Pessoa de Meia-Idade , Estudos Retrospectivos , Risco , Medição de Risco
13.
Health Qual Life Outcomes ; 4: 17, 2006 Mar 22.
Artigo em Inglês | MEDLINE | ID: mdl-16553957

RESUMO

BACKGROUND: Numerous studies have identified a reduced health related quality of life (HRQL) in patients that have either diabetes or cancer. We assessed the HRQL burden in patients with these comorbid conditions, postulating that they would have even greater HRQL deficits. METHODS: Data from the Public Use File of the Canadian Community Health Survey (PUF CCHS) Cycle 1.1 (September 2000-November 2001) were used for this analysis. The total sample size of the CCHS PUF is 130,880 individuals. We used the Health Utilities Index Mark 3 (HUI3) to assess HRQL in patients with: 1) comorbid diabetes and cancer, 2) diabetes alone, 3) cancer alone, and 4) no diabetes or cancer. Analysis of covariance was used to compare the mean overall HUI3 score, controlling for age, sex, marital status, body mass index (BMI), physical activity level, smoking status, education level, depression status, and other chronic conditions. RESULTS: We identified 113,587 individuals (87%) with complete data for the analysis. The comorbid diabetes and cancer group were older and a larger proportion reported being obese, inactive, having less than a secondary education and more chronic conditions when compared to the other three cohorts (p < 0.0001). However, the diabetes and cancer cohort was less likely to be depressed (p < 0.0001). Overall HUI3 scores were significantly lower for the diabetes and cancer group (unadjusted mean (SD): 0.67 (0.30)), compared to diabetes (0.78 (0.27)), cancer (0.78 (0.25)), and the reference group (0.89 (0.18)) (p < 0.0001). After adjusting for covariates, the comorbid diabetes and cancer group continued to have significantly lower overall HUI3 scores than the reference group (unstandardized mean difference: -0.11, 95% CI: -0.13 to -.0.09) (p < 0.0001). CONCLUSION: Individuals with diabetes and cancer had a clinically important and significantly lower HRQL than those with either condition alone. A better understanding of the relationship between diabetes and cancer, and their associated comorbidities, complications, and HRQL deficits may have important implications for prevention and management strategies.


Assuntos
Diabetes Mellitus Tipo 2/complicações , Nível de Saúde , Neoplasias/complicações , Qualidade de Vida , Perfil de Impacto da Doença , Adolescente , Adulto , Fatores Etários , Canadá/epidemiologia , Criança , Comorbidade , Estudos Transversais , Diabetes Mellitus Tipo 2/psicologia , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Neoplasias/psicologia , Fatores Sexuais
14.
Diabetes Care ; 29(2): 254-8, 2006 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-16443869

RESUMO

OBJECTIVE: Numerous studies have identified an increased risk of cancer in type 2 diabetes. We explored the association between antidiabetic therapies and cancer-related mortality in patients with type 2 diabetes, postulating that agents that increase insulin levels might promote cancer. RESEARCH DESIGN AND METHODS: This was a population-based cohort study using administrative databases from Saskatchewan Health. Cancer-related mortality was compared among inception cohorts of metformin users and sulfonylurea monotherapy users. Multivariate Cox regression was used to estimate the hazard ratio (HR) of cancer-related mortality, after adjusting for age, sex, insulin use, and chronic disease score. All statistical tests were two-sided. RESULTS: We identified 10,309 new users of metformin or sulfonylureas with an average follow-up of 5.4 +/- 1.9 years (means +/- SD). The mean age for the cohort was 63.4 +/- 13.3 years, and 55% were men. Cancer mortality over follow-up was 4.9% (162 of 3,340) for sulfonylurea monotherapy users, 3.5% (245 of 6,969) for metformin users, and 5.8% (84 of 1,443) for subjects who used insulin. After multivariate adjustment, the sulfonylurea cohort had greater cancer-related mortality compared with the metformin cohort (adjusted HR 1.3 [95% CI 1.1-1.6]; P = 0.012). Insulin use was associated with an adjusted HR of cancer-related mortality of 1.9 (95% CI 1.5-2.4; P < 0.0001). CONCLUSIONS: Patients with type 2 diabetes exposed to sulfonylureas and exogenous insulin had a significantly increased risk of cancer-related mortality compared with patients exposed to metformin. It is uncertain whether this increased risk is related to a deleterious effect of sulfonylurea and insulin or a protective effect of metformin or due to some unmeasured effect related to both choice of therapy and cancer risk.


Assuntos
Diabetes Mellitus Tipo 2/tratamento farmacológico , Hipoglicemiantes/efeitos adversos , Insulina/efeitos adversos , Metformina/efeitos adversos , Neoplasias/mortalidade , Compostos de Sulfonilureia/efeitos adversos , Idoso , Estudos de Coortes , Comorbidade , Quimioterapia Combinada , Feminino , Seguimentos , Humanos , Hipoglicemiantes/uso terapêutico , Insulina/uso terapêutico , Masculino , Metformina/uso terapêutico , Pessoa de Meia-Idade , Análise Multivariada , Neoplasias/etiologia , Modelos de Riscos Proporcionais , Estudos Retrospectivos , Fatores de Risco , Saskatchewan , Índice de Gravidade de Doença , Compostos de Sulfonilureia/uso terapêutico
15.
CMAJ ; 171(1): 39-43, 2004 Jul 06.
Artigo em Inglês | MEDLINE | ID: mdl-15238494

RESUMO

BACKGROUND: Public insurance for testing supplies for self-monitoring of blood glucose is highly variable across Canada. We sought to determine if insured patients were more likely than uninsured patients to use self-monitoring and whether they had better glycemic control. METHODS: We used baseline survey and laboratory data from patients enrolled in a randomized controlled trial examining the effect of paying for testing supplies on glycemic control. We recruited patients through community pharmacies in Alberta and Saskatchewan from Nov. 2001 to June 2003. To avoid concerns regarding differences in provincial coverage of self-monitoring and medications, we report the analysis of Alberta patients only. RESULTS: Among our sample of 405 patients, 41% had private or public insurance coverage for self-monitoring testing supplies. Patients with insurance had significantly lower hemoglobin A(1c) concentrations than those without insurance coverage (7.1% v. 7.4%, p = 0.03). Patients with insurance were younger, had a higher income, were less likely to have a high school education and were less likely to be married or living with a partner. In multivariate analyses that controlled for these and other potential confounders, lack of insurance coverage for self-monitoring testing supplies was still significantly associated with higher hemoglobin A(1c) concentrations (adjusted difference 0.5%, p = 0.006). INTERPRETATION: Patients without insurance for self-monitoring test strips had poorer glycemic control.


Assuntos
Automonitorização da Glicemia/economia , Diabetes Mellitus Tipo 2/sangue , Cobertura do Seguro , Seguro Saúde , Cooperação do Paciente , Idoso , Alberta , Estudos Transversais , Diabetes Mellitus Tipo 2/economia , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Análise Multivariada , Fitas Reagentes/economia , Análise de Regressão
16.
Can J Public Health ; 95(3): 188-92, 2004.
Artigo em Inglês | MEDLINE | ID: mdl-15191121

RESUMO

OBJECTIVE: To describe the demographics and estimate the prevalence of hepatitis C virus (HCV) in a cohort of Human Immunodeficiency Virus (HIV) positive patients in Northern Alberta. METHODS: A cross-sectional (prevalence) study was performed on a cohort of HIV-positive patients. HCV testing was not widely available until December 1989, and the more sensitive, second generation immunoassay was not available until 1992. To reduce the effect of testing bias, we restricted consideration of HCV status to patients first seen January 1, 1992 onward. RESULTS: Forty-four percent of patients in the whole cohort were tested for HCV (564/1,276) and 62% (505/809) of patients entered since January 1, 1992 were tested for HCV. During the period January 1, 1992-December 31, 1999, the prevalence of HCV in our cohort of northern Alberta HIV-positive patients was at least 37.9% (307/809) and was 60.8% (307/505) among those who were tested for HCV in 1992 or later. The mean age of the co-infected group was 33.6 years, 66.1% were male, 91.2% were injection drug users (IDUs), 56.8% were Caucasian, and 40.0% were Aboriginal. A statistically significant difference was found between the HCV-negative cohort, the HCV co-infected cohort, and the HCV-untested cohort for the following variables: risk behaviour, gender, ethnic status, death, occurrence of an AIDS-defining illness (p < 00.0001), and mean baseline CD4 cell count (p = 0.002). CONCLUSION: A high proportion of the HIV-infected IDUs was co-infected with HCV. Compared to the HCV-negative group, the co-infected group appears to have had less advanced HIV disease. This is likely a reflection of more recent HIV infection in the HCV co-infected group.


Assuntos
Infecções por HIV/epidemiologia , Hepatite C/epidemiologia , Adulto , Distribuição por Idade , Alberta/epidemiologia , Estudos Transversais , Feminino , Infecções por HIV/transmissão , Hepatite C/transmissão , Humanos , Masculino , Prevalência , Fatores de Risco , Distribuição por Sexo , Abuso de Substâncias por Via Intravenosa
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