Socioeconomic deprivation is inversely associated with measles incidence: a longitudinal small-area analysis,Germany, 2001 to 2017

BackgroundAlthough measles is endemic throughout the World Health Organization European Region, few studies have analysed socioeconomic inequalities and spatiotemporal variations in the disease’s incidence.AimTo study the association between socioeconomic deprivation and measles incidence in Germany, while considering relevant demographic, spatial and temporal factors.MethodsWe conducted a longitudinal small-area analysis using nationally representative linked data in 401 districts (2001–2017). We used spatiotemporal Bayesian regression models to assess the potential effect of area deprivation on measles incidence, adjusted for demographic and geographical factors, as well as spatial and temporal effects. We estimated risk ratios (RR) for deprivation quintiles (Q1–Q5), and district-specific adjusted relative risks (ARR) to assess the area-level risk profile of measles in Germany.ResultsThe risk of measles incidence in areas with lowest deprivation quintile (Q1) was 1.58 times higher (95% credible interval (CrI): 1.32–2.00) than in those with highest deprivation (Q5). Areas with medium-low (Q2), medium (Q3) and medium-high deprivation (Q4) had higher adjusted risks of measles relative to areas with highest deprivation (Q5) (RR: 1.23, 95%CrI: 0.99–1.51; 1.05, 95%CrI: 0.87–1.26 and 1.23, 95%CrI: 1.05–1.43, respectively). We identified 54 districts at medium-high risk for measles (ARR > 2) in Germany, of which 22 were at high risk (ARR > 3).ConclusionSocioeconomic deprivation in Germany, one of Europe’s most populated countries, is inversely associated with measles incidence. This association persists after demographic and spatiotemporal factors are considered. The social, spatial and temporal patterns of elevated risk require targeted public health action and policy to address the complexity underlying measles epidemiology.     

Intraventricular dyssynchrony predicts mortality and morbidity after cardiac resynchronization therapy: a study using cardiovascular magnetic resonance tissue synchronization imaging.

OBJECTIVES: We aimed to assess a novel measure of left ventricular (LV) dyssynchrony, a cardiovascular magnetic resonance-tissue synchronization index (CMR-TSI), in patients with heart failure (HF). A further aim was to determine whether CMR-TSI predicts mortality and major cardiovascular events (MCE) after cardiac resynchronization therapy (CRT). BACKGROUND: Cardiac dyssynchrony is a predictor of mortality in patients with HF. The unparalleled spatial resolution of CMR may render CMR-TSI a predictor of clinical benefit after CRT. METHODS: In substudy A, CMR-TSI was assessed in 66 patients with HF (age 60.8 +/- 10.8 years, LV ejection fraction 23.9 +/- 12.1% [mean +/- SD]) and 20 age-matched control subjects. In substudy B, CMR-TSI was assessed in relation to clinical events in 77 patients with HF and with a QRS > or =120 ms undergoing CRT. RESULTS: In analysis A, CMR-TSI was higher in patients with HF and a QRS <120 ms (79.5 +/- 31.2 ms, p = 0.0003) and in those with a QRS > or =120 ms (105.9 +/- 55.8 ms, p < 0.0001) than in control subjects (21.2 +/- 8.1 ms). In analysis B, a CMR-TSI > or =110 ms emerged as an independent predictor of the composite end points of death or unplanned hospitalization for MCE (hazard ratio [HR] 2.45; 95% confidence interval [CI] 1.51 to 4.34, p = 0.0002) or death from any cause or unplanned hospitalization for HF (HR 2.15; 95% CI 1.23 to 4.14, p = 0.0060) as well as death from any cause (HR: 2.6; 95% CI 1.29 to 6.73, p = 0.0061) and cardiovascular death (HR 3.82; 95% CI 1.63 to 16.5, p = 0.0007) over a mean follow-up of 764 days. CONCLUSIONS: Myocardial dyssynchrony assessed by CMR-TSI is a powerful independent predictor of mortality and morbidity after CRT.     

The effect of endocardial defibrillator shocks on basic atrial electrophysiology in man. Is post cardioversion atrial electrical 'remodelling' artefact?

AIMS: To determine the effect of an endocardial DC shock on the basic electrophysiology of the human atrium if delivered in sinus rhythm. METHODS AND RESULTS: A 5J endocardial R wave synchronized DC shock was delivered in 10 patients in stable sinus rhythm during ICD implantation for ventricular arrhythmias. There was no prior history of atrial fibrillation. Monophasic action potential duration (APD) and atrial effective refractory periods (AERP) were evaluated before, 1 min post DC shock, and 15 min post shock. These parameters were assessed at basic cycle lengths and at atrial paced cycle lengths of 600 ms and 400 ms at two right atrial sites; mid lateral right atrial wall (MRLA) and the right atrial appendage (RAA). There were no significant differences in APD 90, AERP or atrial refractory dispersion at any site or drive cycle length before, immediately after or 15 min after shock delivery. CONCLUSIONS: There are no significant changes in basic electrophysiological parameters following a DC shock delivered in sinus rhythm in patients with no prior history of atrial fibrillation. This suggests that atrial electrical remodelling occurs as a result of atrial fibrillation and is unrelated to shock artefact.