Prevalence of inflammatory bowel disease: estimates for 2010 and trends in Germany from a large insurance-based regional cohort

Abstract

Objective. A worldwide increase in prevalence of inflammatory bowel disease (IBD) has been reported. For Germany, latest publications not restricted to actively treated disease present data of the 1980s. This study estimates the administrative 1-year period IBD prevalence in 2010 and investigates the trend in prevalence of actively treated disease between 2001 and 2010. Material and methods. Utilizing an insurance-based cohort (n = 311,001 in 2001 to 265,102 in 2010), case definition was based on ICD-10 codes. The prevalence of active treatment was based on internally validated IBD cases of the respective year. The 1-year period prevalence in 2010 accounts for cases actively treated in at least one of the years between 2001 and 2010. Estimates were directly standardized by age and sex to the population of Germany. The change in prevalence of actively treated disease over the years was evaluated by means of Poisson regression. Results. The IBD prevalence in 2010 was 744 (95% confidence interval [CI]: 707–775) per 100,000 (Crohn’s disease: 322 [95% CI: 302–346], ulcerative colitis: 412 [95% CI: 389–436] per 100,000). The prevalence of actively treated disease increased significantly between 2001 (344 [95% CI: 324–364] per 100,000) and 2010 (493 [95% CI: 464–519] per 100,000; increase in prevalence by 42% [95% CI: 31%–53%], p _trend = 6.0 × 10^?19). Conclusion. In line with worldwide reports, our results based on a large insurance cohort suggest a considerable increase in IBD prevalence in Germany since the 1980s. The significant increase in prevalence of actively treated disease in our cohort highlights the need to adapt healthcare services and deal with the burden associated with increasing numbers of IBD patients.     

Hepatitis C time trends in reported cases and estimates of the hidden population born before 1965, Denmark and Sweden, 1990 to 2020

BackgroundAccording to the World Health Organization, hepatitis C virus (HCV) infection should be under control by 2030.AimOur aim was to describe the size and temporal changes in reported cases of chronic HCV infection in Denmark and Sweden and to estimate the size of the hidden (undiagnosed) population born before 1965.MethodsWe extracted all HCV infections reported to national surveillance systems in Denmark and Sweden from 1990 to 2020. Prediction of the size of the hidden HCV-infected population was restricted to the cohort born before 1965 and cases reported up to 2017. We applied a model based on removal sampling from binomial distributions, estimated the yearly probability of diagnosis, and deducted the original HCV-infected population size.ResultsDenmark (clinician-based) reported 10 times fewer hepatitis C cases annually than Sweden (laboratory and clinician-based), peaking in 2007 (n = 425) and 1992 (n = 4,537), respectively. In Denmark, the birth year distribution was monophasic with little change over time. In recent years, Sweden has had a bimodal birth year distribution, suggesting ongoing infection in the young population. In 2017, the total HCV-infected population born before 1965 was estimated at 10,737 living persons (95% confidence interval (CI): 9,744–11,806), including 5,054 undiagnosed, in Denmark and 16,124 (95% CI: 13,639–18,978), including 10,580 undiagnosed, in Sweden.ConclusionsThe reporting of HCV cases in Denmark and Sweden was different. For Denmark, the estimated hidden population was larger than the current national estimate, whereas in Sweden the estimate was in line with the latest published numbers.     

Drug-resistant tuberculosis: worldwide trends, problems specific to Eastern Europe and other hotspots, and the threat to developing countries

Although it had been appreciated that high levels of antituberculous drug resistance existed in some regions of the world, the full extent of the problem was not known. A combined initiative by the World Health Organization and the International Union Against Tuberculosis and Lung Disease was launched in 1994 to address this. A second report was issued in March 2000, in which surveillance of drug resistance had been extended to 72 countries and regions. A number of drug resistant "hotspots," where there are high levels of combined multidrug-resistant tuberculosis (> 3% prevalence), have been identified. Particular areas of concern are countries of the former Soviet Union, India, and China, because these countries have the highest burden of multidrug-resistant tuberculosis. For the first time, information on trends in global drug resistance is available.     

Maternal body mass index and risk of birth and maternal health outcomes in low‐ and middle‐income countries: a systematic review and meta‐analysis

We conducted a systematic review and meta‐analysis of population‐based cohort studies of maternal body mass index (BMI) and risk of adverse birth and health outcomes in low‐ and middle‐income countries. PubMed, Embase, CINAHL and the British Nursing Index were searched from inception to February 2014. Forty‐two studies were included. Our study found that maternal underweight was significantly associated with higher risk of preterm birth (odds ratio [OR], 1.13; 95% confidence interval [CI], 1.01–1.27), low birthweight (OR, 1.66; 95% CI, 1.50–1.84) and small for gestational age (OR, 1.85; 95% CI, 1.69–2.02). Compared with mothers with normal BMI, overweight or obese mothers were at increased odds of gestational diabetes, pregnancy‐induced hypertension, pre‐eclampsia, caesarean delivery and post‐partum haemorrhage. The population‐attributable risk (PAR) indicated that if women were entirely unexposed to overweight or obesity during the pre‐pregnancy or early pregnancy period, 14% to 35% fewer women would develop gestational diabetes, pre‐eclampsia or pregnancy‐induced hypertension in Brazil, China, India, Iran or Thailand. The highest PAR of low birthweight attributable to maternal underweight was found in Iran (20%), followed by India (18%), Thailand (10%) and China (8%). Treatment and prevention of maternal underweight, overweight or obesity may help reduce the burden on maternal and child health in developing countries.     

Maternal body mass index and post‐term birth: a systematic review and meta‐analysis

Post‐term birth is a preventable cause of perinatal mortality and severe morbidity. This review examined the association between maternal body mass index (BMI) and post‐term birth at ≥42 and ≥41 weeks' gestation. Five databases, reference lists and citations were searched from May to November 2015. Observational studies published in English since 1990 were included. Linear and nonlinear dose–response meta‐analyses were conducted by using random effects models. Sensitivity analyses assessed robustness of the results. Meta‐regression and sub‐group meta‐analyses explored heterogeneity. Obesity classes were defined as I (30.0–34.9 kg m^?2), II (35.0–39.9 kg m^?2) and III (≥40 kg m^?2; IIIa 40.0–44.9 kg m^?2, IIIb ≥ 45.0 kg m^?2). Searches identified 16,375 results, and 39 studies met the inclusion criteria (n = 4,143,700 births). A nonlinear association between maternal BMI and births ≥42 weeks was identified; odds ratios and 95% confidence intervals for obesity classes I–IIIb were 1.42 (1.27–1.58), 1.55 (1.37–1.75), 1.65 (1.44–1.87) and 1.75 (1.50–2.04) respectively. BMI was linearly associated with births ≥41 weeks: odds ratio is 1.13 (95% confidence interval 1.05–1.21) for each 5‐unit increase in BMI. The strength of the association between BMI and post‐term birth increases with increasing BMI. Odds are greatest for births ≥42 weeks among class III obesity. Targeted interventions to prevent the adverse outcomes associated with post‐term birth should consider the difference in risk between obesity classes.     

Increased fracture rates in people with haemophilia: a 10‐year single institution retrospective analysis

Sporadic essential thrombocythaemia (ET) is rare in paediatrics, and the diagnostic and clinical approach to paediatric cases cannot be simply copied from experience with adults. Here, we assessed 89 children with a clinical diagnosis of ET and found that 23 patients (25·8%) had a clonal disease. The JAK2 V617F mutation was identified in 14 children, 1 child had the MPL W515L mutation, and 6 had CALR mutations. The monoclonal X‐chromosome inactivation pattern was seen in six patients (two with JAK2 V617F and two with CALR mutations). The other 66 patients (74·2%) had persistent thrombocytosis with no clonality. There were no clinical or haematological differences between the clonal and non‐clonal patients. The relative proportion of ET‐specific mutations in the clonal children was much the same as in adults. The higher prevalence of non‐clonal cases suggests that some patients may not have myeloproliferative neoplasms, with significant implications for their treatment.     

Size at birth and abdominal adiposity in adults: a systematic review and meta‐analysis

We performed a systematic literature review on the associations between birth size and abdominal adiposity in adults, while also investigating the role of the adjustment for adult body mass index (BMI). MEDLINE, Scopus, Web of Science, LILACS and SciELO databases were searched for articles published up to February 2013. Only prospective studies were included. After screening 2,570 titles, we selected 31 publications for the narrative synthesis, of which 13 were considered to be of high methodological quality. Six main indicators of birth size were identified, and birth weight (BW) was the most extensively studied. Most studies relied on anthropometric measurements as proxies for abdominal fatness or as indicators of body fat distribution. Few studies assessed abdominal adiposity through imaging methods, generally with small sample sizes. Eleven articles could be included in the meta‐analyses. BW was found to be positively associated with waist circumference in adulthood, but the association disappeared after adjustment for adult BMI. In contrast, there was no association between BW and waist‐to‐hip ratio, whereas a strong negative association became evident after controlling for adult BMI. In conclusion, BW seems to be associated with larger adult size in general, including both waist and hip circumferences. The marked change in coefficients after adjustment for adult BMI suggests that post‐natal growth strongly affects relative central adiposity, whereas BW per se does not play a role. Given the potential impact of post‐natal growth, further research is needed to identify different growth trajectories that lead to abdominal adiposity, as well as studies on interactions of foetal and post‐natal growth patterns.     

Population-attributable estimates for risk factors associated with hepatitis B and C: policy implications for Pakistan and other South Asian countries

Introduction

Reuse of contaminated syringes, high frequency of injections, tattooing and skin piercing have repeatedly been shown to be important and independent risk factors for the transmission of hepatitis B (HBV) and C (HCV) infections in South Asian countries. Estimation of population-attributable risks indicates the potential for hepatitis prevention if the exposure to certain modifiable factors can be eliminated.

Methods

We estimated the population-attributable risks of various risk factors for transmission of HBV and HCV using data from a large, nationally representative survey conducted in 2007 across Pakistan, a country known to have a high prevalence of chronic viral hepatitis. Odds ratio estimates and observed prevalence of the risk factors were used for calculating PAR estimates. We also performed a systematic review of published studies that identify the prevalence of similar modifiable risk factors for HBV and HCV from other South Asian countries in order to define an overall prevention strategy for the region.

Results

For HBV, a high frequency (>10) of therapeutic injections in the past 1 year had an attributable risk of 3.5 % (95 % CI 2.9–3.9), reuse of syringes had a 2.7 % risk (95 % CI 2.2–3.1), the practice of being shaved by a barber 2.1 % (95 % CI 1.7–2.6), sharing of smoking utensils 4.4 % (95 % CI 3.8–4.9) and ear/nose piercing 1.4 % (95 % CI 1.2–1.7). Population-attributable risks for HCV were as follows: high frequency of therapeutic injections in the past 1 year 11.3 % (95 % CI 10.5–11.7), reuse of syringes 6.2 % (95 % CI 6.1–6.9), practice of being shaved by a barber shop 7.9 % (95 % CI 7.1–8.2), sharing of smoking utensils 8.1 % (95 % CI 6.9–8.5), practice of ear/nose piercing among females 5.9 % (95 % CI 5.2–6.1) and tattooing 5 % (95 % CI 4.3–5.6). A systematic review showed that other South Asian countries share a number of common risk factors for the transmission of viral hepatitis.

Conclusion

A substantial number of HBV and HCV infections in Pakistan and other South Asian countries can be prevented by key interventions targeted toward a few selected and modifiable risk factors. Hence, policies specifically targeted at key risk factors for HBV and HCV such as safe and rational use of injections prescribed by trained health-care providers are urgently needed for countries like Pakistan.     

Research trends for papillary thyroid carcinoma from 2010 to 2019: A systematic review and bibliometrics analysis

Background:Thyroid carcinoma comprises the fastest rising incidence of carcinomas over the past decade. Papillary thyroid carcinoma (PTC) is the most predominant type of thyroid carcinoma. This study aimed to assess the research trends in the field of PTC.Methods:Publications from January 2010 to December 2019 were retrieved from the Web of Science Core Collection database using Thompson Reuters. Searching strategies were determined according to Medical Subject Heading terms. Different kinds of bibliometrics software, such as HistCite and VOSviewer, and online bibliometrics analysis platforms were utilized to evaluate and visualize the results.Results:A total of 8102 publications across 93 countries were identified, with the annual number of publications showing an increasing trend. The United States, China, and South Korea showed their dominant position in PTC publication outputs, H-index, total citations, and international collaborations. Thyroid was the most productive journal. Akira Miyauchi published the most articles, and the most productive institution was Yonsei University. The hotspots keywords proliferation, invasion and metastasis, diagnoses and prognoses, therapeutic resistance, recurrence, and microcarcinomas appeared earlier and were sustained over the last 3 years.Conclusions:This bibliometric study provides a comprehensive analysis delineating the scientific productivity, collaboration, and research hotspots within the PTC field, which will be very helpful when focusing on the direction of research over the next few years.     

Dairy consumption and pre‐school,school‐age and adolescent obesity in developed countries: a systematic review and meta‐analysis

Childhood obesity, the primary health problem affecting children in developed countries, has been attributed in part to changes in dietary patterns. Secular trends suggest a decrease in childhood dairy consumption coinciding with the rise in obesity prevalence. The objective of the present systematic review and meta‐analysis was to consider evidence of associations between dairy intake and adiposity in pre‐schoolers, school‐age children and adolescents in developed countries. Of 36 studies included in the systematic review, sufficient data for effect size estimation and inclusion in the meta‐analysis were obtained from 22 studies. No significant association was found between dairy intake and adiposity in the aggregated data, although statistical heterogeneity was high (I² = 0.72). Among adolescents, however, dairy intake was inversely associated with adiposity (effect size ?0.26, [?0.38, ?0.14], P < 0.0001). Effect size was not predicted by exposure variable (milk vs. dairy), study design, statistical methods, outcome variables or sex. Interpretation of results was complicated by variability in study methods and insufficient adjustment for relevant confounders, particularly dietary reporting accuracy, sweetened beverage intake and pubertal development. Despite limitations, available data suggest a neutral effect of dairy intake on adiposity during early and middle childhood and a modestly protective effect in adolescence.     

Global variations and time trends in the prevalence of childhood myopia: a systematic review and meta-analysis

BackgroundEthnic and geographical differences in prevalence of childhood myopia seem to have changed over time. We aimed to quantify the variation in prevalence of childhood myopia over time, accounting for demographic and study design factors.MethodsPopulation-based surveys of myopia prevalence published in English were identified from a combination of text words for myopia (short$sight*/myopi?/myope$/refractive error$/ocular refraction), childhood (child/childhood/children/adolescent/adolescence/teenage), epidemiology (incident/incidence/prevalen*/population$/survey$) combined with the related subject headings in Medline (from Jan 1, 1950, to Feb 16, 2015), Embase (Jan 1, 1980, to Feb 16, 2015), and Web of Science (Jan 1, 1970, to Feb 16, 2015). Bayesian multilevel binomial logistic regression analyses of log-odds of myopia provided mutually adjusted associations for age, ethnicity, sex, urban versus rural setting, survey year, and study design factors.Findings143 articles (374 349 participants aged 6 months to 18 years, 74 847 cases of myopia) reported age-specific prevalence of childhood myopia in 42 countries representing nine ethnic groups between 1958 and 2014. Increase in myopia prevalence with age varied by ethnicity. East Asians showed the highest prevalence at all ages, reaching 69% (95% credible interval [CrI] 61–77) at 15 years of age (86% [79–91] among Singaporean-Chinese). In Africa, blacks had the lowest prevalence (5·5% at 15 years [3·1–9·0]). Whites had the highest prevalence at 15 years (16·7%, 10·6–24·5). Time trends in myopia prevalence were stable in whites, and increased by 23% per decade in East Asians (odds ratio 1·23, 95% CrI 1·00–1·55), with no clear evidence of time trends in other ethnic groups. In all ethnic groups, children from urban environments were more than twice as likely to be myopic as those from rural environments (2·61, 1·79–3·86). In whites and East Asians, sex differences emerged at about 9 years of age; by late adolescence girls were twice as likely as boys to be myopic.InterpretationMarked ethnic differences in age-specific prevalence of myopia exist, with significant increases in prevalence over time in East Asians. An urban environment seems to be universally associated with a high risk of myopia. Findings suggest that environmental factors have an important role in explaining ethnic variations in myopia prevalence and differences in time trends.FundingBUPA foundation.