Risultati per: GPG: Versione 5.6.2.1 (Aprile 2021)

Objective
While continuous glucose monitoring (CGM) utilisation has been increasing among patients with type 1 diabetes (T1D), few studies have examined patterns of use across age, race/ethnicity and insurance status together. In this study, we examine CGM utilisation among patients with T1D from a regional academic medical centre across all insurance types.

Design and setting
This is a retrospective cohort study including both paediatric and adult patients with T1D who visited a regional academic medical centre between 1 January 2018 and 31 December 2021.

Methods
Patients were followed from the date of their first T1D encounter during the study period until the first of the following: CGM use was documented, ≥730 days with no encounters at this centre or the end of the study period. We compared CGM use across demographic and clinical characteristics and used logistic regression models to assess the association between demographic variables and CGM utilisation.

Results
Among 3311 eligible patients with T1D, CGM utilisation was 51.22%. The highest utilisation rates were among patients

Stroke, Ahead of Print. BACKGROUND:Subarachnoid hemorrhage (SAH) is a critical condition that has far-reaching implications for public health systems globally due to its severe consequences and long-term disabilities. This study aims to provide a comprehensive analysis of SAH trends from 1990 to 2021 and project future trends up to 2041, aiding in better understanding and management of its global burden.METHODS:We utilized data from the GBD (Global Burden of Disease) 2021 database, using joinpoint regression, frontier, and decomposition analyses to assess changes in SAH burden. Bayesian Age-Period-Cohort modeling was implemented to predict future trends. Our study included populations from 204 countries and territories.RESULTS:From 1990 to 2021, SAH incidence decreased by −1.03% for men and −1.16% for women, while mortality rates declined by −2.56% for men and −2.69% for women. Middle sociodemographic index locations and East Asia experienced substantial declines, particularly among women. However, countries like the Philippines and Turkmenistan showed increasing trends. Population aging and growth significantly contributed to these trends, while epidemiological changes led to reductions in SAH burden. The prediction model forecasts continued decreases in SAH mortality and disability-adjusted life years over the next 20 years, although incidence rates may slightly increase.CONCLUSIONS:The global burden of SAH has significantly diminished from 1990 to 2021, with considerable variations across regions, sexes, and countries. Ongoing and future research should prioritize high-risk populations and develop innovative interventions to further decrease SAH incidence and enhance outcomes.

Objectives
To examine the prevalence and days of long-term sickness absence (LTSA) by occupational class and by most important diagnostic groups in Finland during 2011–2021.

Design
Population-based cross-sectional study.

Setting and participants
National comprehensive register data were linked for all employed persons and entrepreneurs in Finland aged 25–64 for years 2011–2021 (yearly number of individuals in the study population around 2 million persons).

Main outcome measures
LTSA was measured by sickness allowance that covers over 10-day long absences. Yearly age-standardised LTSA prevalences and average number of LTSA days were calculated for women and men in four occupational classes, separately for all-cause LTSA and LTSA due to mental disorders, musculoskeletal diseases and injuries. Modified Poisson regression and negative binomial regression models were run to assess relative differences between occupational classes, adjusted for age, marital status, education and region of residence.

Results
All-cause LTSA slightly decreased between years 2011 and 2021, but the trends varied by occupational class and diagnostic group. LTSA due to mental disorders increased in all occupational classes after 2016 among both sexes, while LTSA due to musculoskeletal diseases and injuries continued to decrease in all occupational classes. The increase in LTSA due to mental disorders was largest among lower non-manual employees, especially among women, whereby all-cause LTSA prevalence among female lower non-manual employees reached the level of female manual workers. Men showed broadly similar trends, but manual workers still had the highest all-cause LTSA prevalence at the end of the study period. The main results were similar adjusted for covariates.

Conclusions
The magnitude and order of the occupational-class differences in LTSA changed between 2011 and 2021, along with increasing LTSA due to mental disorders, especially among employees, and decreasing LTSA due to somatic diagnoses, especially among manual workers. Occupational-class differences should be taken into account when aiming to prevent LTSA and especially further increases in LTSA due to mental disorders.

Background
The introduction of immune checkpoint inhibitors (ICIs) has modified treatment modalities for patients with lung cancer, offering new alternatives for treatment. Despite improved survival benefits, ICIs may cause side effects impacting patients’ quality of life (QoL). We aim to study the changes in global QoL (gQoL) of patients with advanced-stage lung cancer up to 18 months after treatment with ICIs between 2015 and 2021.

Methods and analysis
A longitudinal cohort study was conducted using the Oncological Life Study: Living well as a cancer survivor data-biobank from the University Medical Center Groningen. Participants completed the European Organisation for Research and Treatment of Cancer QoL 30-item questionnaire, at the beginning of their ICI treatment (baseline) and then at 6, 12 and 18 months. Using joint modelling, changes in predicted mean gQoL were studied by treatment regimens from baseline to 18 months, while accounting for the competing risk of death and adjusting for prespecified covariates.

Results
Of the 418 participants with median age of 66 years, 39% were women. Patients receiving first-line immuno-monotherapy with palliative intent had a small improvement in their gQoL within 6 months and no clinically significant change thereafter. Patients receiving first-line immune-chemotherapy with palliative intent had a small improvement in their gQoL within 12 months and no clinically significant change thereafter. Patients with second/further line immunotherapy with palliative intent or first-line chemoradiotherapy followed by durvalumab with curative intent had no clinically significant change in their gQoL over 18 months.

Conclusion
The changes in gQoL over time among patients with advanced-stage lung cancer may vary by treatment regimens based on drug intensity, line and intent of treatment, which will help clinicians and patients understand the potential dynamic of treatments on QoL. It may further influence treatment decisions and patient management strategies, reflecting the practical implications of different treatment regimens.

Objectives
To estimate the levels and trends of maternal and child healthcare (MCH) service utilisation in India across subsidised and unsubsidised health sectors and to explore total market approach to identify geographies where the private sector has potential to improve MCH services in India.

Design and setting
This study used three recent rounds of the National Family Health Survey (NFHS), a cross-sectional survey in India, conducted in 2005–2006, 2015–2016 and 2019–2021. Bivariate analysis and multinomial logistic regression were used to estimate the utilisation of key MCH indicators from subsidised and unsubsidised health sectors. Market sustainability of key MCH indicators was assessed by level of MCH services and subsidisation.

Participants
36 850, 190 898 and 176 843 ever-married women aged 15–49 years, 4440, 22 500 and 15 334 children under 5 years of age with diarrhoea before the survey, and 2552, 6960 and 6117 children with symptoms of acute respiratory infections (ARI) in NFHS 2005–2006, 2015–2016 and 2019–2021, respectively.

Outcome measures
The study used three maternal healthcare indicators: women had four or more antenatal care (ANC) visits, had institutional delivery, and received postnatal care (PNC); and two child healthcare indicators: care seeking for ARI and diarrhoea.

Results
In India, utilisation of maternal healthcare services increased over the last 15 years: four or more ANC visits increased from 37% to 58% and PNC of mothers increased from 33% to 78% between 2005–2006 and 2019–2021. The results of the multivariate analysis showed that utilisation of ANC (67% from public vs 18% from private health facilities), institutional delivery (64% from public vs 25% from private health facilities) and PNC (73% from public vs 27% from private health facilities) was significantly higher (p

Objectives
This study aims to systematically assess the global, regional, and national burden of asthma attributable to nitrogen dioxide (NO2) pollution.

Design and setting
Analysis of population-level data from 1990 to 2021 obtained from the Global Burden of Disease Study 2021, covering 204 countries and territories.

Participants
Participants included patients with asthma attributable to NO2 pollution.

Main outcomes and measures
Asthma-related disability-adjusted life-years (DALYs) and age-standardised DALY rates (ASDR) attributable to NO2 pollution across 204 countries and territories. The estimated annual percentage change (EAPC) was used to assess temporal trends to identify regions with increasing or decreasing asthma burdens.

Results
In 2021, NO2 pollution contributed to approximately 176.73 thousand DALYs globally, with an ASDR of 2.48 per 100 000 population (95% uncertainty interval (UI) –2.26 to 10.30). The global ASDR declined significantly from 1990 to 2021, with an EAPC of –1.93% (95% CI –2.14% to –1.72%). High-income North America had the highest ASDR (10.74 per 100 000; 95% UI 10.12 to 46.56), while Australasia experienced the most significant reduction in ASDR over the study period (EAPC –3.92%; 95% CI –4.46% to –3.37%). In contrast, Oceania and Southeast Asia showed increasing trends in asthma burden, with EAPCs of 2.33% (95% CI 1.57% to 3.10%) and 1.14% (95% CI 0.81% to 1.47%), respectively. The 5–9 age group carried the highest asthma burden, reflecting the vulnerability of younger children to NO2 exposure. A positive correlation between ASDR and sociodemographic index (SDI) was observed (R=0.637, p

Objective
To examine longitudinal trends in infertility management in women attending general practice.

Design
Cohort study using the national general practice dataset, MedicineInsight.

Setting
Australian general practice.

Intervention(s)
Not applicable.

Participants
The cohort included 2 552 339 women aged 18–49 years with one or more general practice clinical encounters between January 2011 and December 2021.

Primary and secondary outcome measures(s)
The primary outcome assessed was the proportion of women who had a clinical encounter related to infertility, stratified by year and age group. Second, the proportions of women receiving relevant clinical management actions, including selected pathology tests, imaging ordered and selected medications, were calculated. Univariable logistic regression analyses compared the likelihood of women having a documented clinical encounter related to infertility and receiving selected management actions based on individual characteristics. We also examined practice-level variation in the proportion receiving selected management for infertility by stratifying proportions based on practice site.

Results
A total of 2 552 339 women had one or more clinical encounters with their general practitioner (GP) between January 2011 and December 2021, of which 27 671 (1.1%) had a clinical encounter related to infertility management. The rate of infertility encounters increased from 3.4 per 1000 in 2011 to 5.7 per 1000 in 2021. Over episodes of care, half (50.9%) of women presenting for an infertility encounter had at least one specified pathology test, and almost a quarter (23.1%) had a specified imaging test. A relatively small proportion of infertility encounters (5.4%) resulted in prescribing of a selected infertility medication by the GP.
Large variation in clinical management (pathology, imaging and medication prescribing) was evident according to both individual characteristics and also at the clinical-practice level. Factors associated with increased likelihood of being provided infertility medications included younger age, holding a Commonwealth concession card (indicating low income), lower socioeconomic status and living outside a major city.

Conclusions
Clinical encounters related to infertility are increasing in primary care, with large variation evident in corresponding clinical management. These findings support the development of clinical practice guidelines to enhance standardised and equitable approaches towards the management of infertility in primary care.

Stroke, Volume 56, Issue Suppl_1, Page ATP309-ATP309, February 1, 2025. Introduction:A nation-wide stroke surveillance system is not available in the US, limiting analyses to identify subgroups at disproportionate risk for ischemic stroke (IS). These data are needed to help inform targeted interventions to improve primary stroke prevention in high-risk populations. We assessed trends in IS hospitalizations and risk factor prevalence by age, sex, and racial/ethnic subgroups using data from GWTG-Stroke.Methods:The sample included patients discharged from GWTG-Stroke participating hospitals in 2010-2021 with a final diagnosis of IS. We conducted a stratified analysis to determine the proportionate composition and temporal trends in IS hospitalizations by race/ethnicity (non-Hispanic White [NHW], non-Hispanic Black [NHB], Hispanic, or Other), sex (women, men), and age (18-44, 45-64, 65+ y). We then used logistic regression to calculate the unadjusted prevalence odds for 10 stroke risk factors for the different race/ethnic, sex, and age groups.Results:There were 4,229,981 IS hospitalizations (mean age 70.1±14.4 y, 49.8% women) from 2,771 hospitals. The Hispanic and Other groups comprised an increasingly greater proportion of total IS hospitalizations over the study period in both women and men and in all age groups (P for trend

Stroke, Volume 56, Issue Suppl_1, Page ATP122-ATP122, February 1, 2025. Background:Classification of etiologic ischemic stroke subtype guides post-stroke care and secondary prevention. Etiologic ischemic stroke subtypes are often not clearly documented in post-stroke care plans especially when transferring from one facility to another. In 2021, AHA/ASA published updated secondary stroke prevention guidelines recommending identifying etiologic ischemic stroke subtypes when possible. The impact of this on post-stroke care is unknown.Methods:Charts of all patients ages 18 and up, admitted from 1/1/20 to 5/23/21 and from 1/1/22 to 5/23/23 to 3 long-term acute care (LTAC) facilities, on antiplatelet therapy, and with an ascertainable history of stroke within 90 days of admission, were retrospectively reviewed to assess for documentation of ischemic stroke subtype at discharge/transfer to an LTAC facility and to assess for appropriateness of secondary stroke prevention therapies. Care plans from those two time periods were compared to assess for any impact the 2021 guidelines may have had on discharge practices.Results:Subtypes were not defined for the majority of ischemic strokes. Classification by etiologic subtype was observed in 33% of cases. Classification by territory or location was more common (Fig. 1). One-quarter of patients were on dual antiplatelet therapy (DAPT) and 75% of patients were on single antiplatelet therapy (SAPT) with more patients on DAPT in the latter time period (Fig. 2A). Rationale for DAPT were not provided for the majority of patients and NIHSS and ABCD2 scored were also not commonly provided for patients on DAPT (Fig. 2B). Close to 90% of patients were treated with antihypertensives and statin therapy at discharge to LTAC; 71% of patients were treated with diabetic therapies at discharge; stroke education at discharge to LTAC was documented for 43% of patients; and LDL was documented in 56% of patients (Fig. 3).Conclusions:Etiologic ischemic stroke subtypes were not documented for the majority of patients transferred to LTACs. Despite recent guideline revisions, an increase in documentation of stroke subtype was not observed. Optimal secondary stroke prevention strategies were difficult to assess without this information including appropriate antiplatelet regimens. Our findings highlight the importance of the need to improve post-stroke care plans at discharge and transfer including documentation of etiologic ischemic stroke subtypes to facilitate optimal post-stroke care across all transitions.

Stroke, Volume 56, Issue Suppl_1, Page AWMP27-AWMP27, February 1, 2025. Introduction:For the 240,000 patients presenting to the emergency department (ED) annually with transient ischemic attack (TIA), a resource-intensive multimodal evaluation and possible admission to the hospital may help prevent a subsequent stroke. Multiple strategies to approach the location and timing of these evaluations exist. Using a nationally representative data source, we evaluated variation and trends in ED practices for patients with suspected TIA.Methods:Retrospective cross-sectional study of ED visits using the 2013-2021 National Emergency Department Sample, a 20% sample of ED encounters in the United States maintained by the Healthcare Cost and Utilization Project (HCUP). TIA diagnosis was determined by first-listed ICD-9 or -10 code. Imaging utilization was determined in discharged ED patients by CPT code for TIA related modalities. Factors associated with discharge from the ED in a TIA encounter were evaluated with a multivariable logistic regression.Results:Percentage of ED TIA patients discharged from the ED increased from 47% (95%CI 46-49) to 68% (95% CI 66-69) between 2013 and 2021. Average cost per discharged TIA encounter increased from $1559 (95% CI 1482-1635) to $2753 (95% CI 2649-2857). Imaging utilization in discharged TIA patients increased markedly between 2013 and 2021. In 2013, 3.6% (95% CI 2.8-4.4) of discharged TIA patients received a CTA Head during their evaluation, while in 2021 this had increased to 44%(95% CI 42-46). Logistic regression analysis for factors associated with discharge in ED TIA encounters in 2021 showed patients from rural areas were more likely to be discharged (OR 2.95 (95% CI 2.42-3.59) than those in densely populated areas (OR 0.68 (95% CI 0.54-0.86).Conclusion:Discharge rates for patients with TIA increased between 2013 and 2021, with a parallel increase in the ED charges for patients discharged with TIA. Utilization of imaging in the ED increased during the time interval and may explain some of this increased cost. This may suggest a shifting of previously inpatient TIA evaluations to the non-admitted ED setting. Likelihood of discharge with a TIA was inversely related with population density of the patient’s location. More resources should be focused on optimizing ED evaluation and follow up of TIA patients in non-urban areas.

Stroke, Volume 56, Issue Suppl_1, Page A120-A120, February 1, 2025. Background:Decompressive hemicraniectomy (DHC) and mechanical thrombectomy (MT) are critical interventions for acute ischemic stroke. This study examined trends in their use from 2016 to 2021, the relationship between them, and associated patient demographics and outcomes.Methods:National inpatient Sample (NIS) (n=798,712) was analyzed. Trends in DHC and MT per year were analyzed using the Cochran-Armitage test for trend to assess changes in DHC use over time and assessed overall and stratified by MT status. Logistic regression evaluated the association between year, MT, and their interaction with DHC odds. Patient demographics and outcomes were also examined.Results:Overall, DHC use increased significantly from 2016 to 2021 with a non-linear trend (chi2(4)=86.69, p

Stroke, Volume 56, Issue Suppl_1, Page AWP257-AWP257, February 1, 2025. Background:Non-Hispanic Black (NHB) and other minority patients in the United States (US) receive intravenous thrombolysis (IVT) and mechanical thrombectomy (MT) less frequently compared with non-Hispanic White (NHW) patients during acute ischemic stroke (AIS) admission. It remains uncertain how the interaction between race and the income category of patients influences treatment and outcome.Methods:We identified all primary AIS hospitalizations in the 2006-2021 National Inpatient Sample (NIS) receiving IVT and MT using International Classification of Diseases (ICD) codes. Admissions were categorized into income quartiles (Q1-Q4) using the median household income of the patient’s zip code. Multivariable logistic regression models adjusted for age, sex, clinical and hospitalization factors were used to compare odds of IVT, MT, in-hospital mortality and good outcome (defined as routine home discharge) between race and income groups.Results:Of 7,476,163 weighted AIS hospitalizations from 2006-2021, 31.1% were in the lowest (Q1) and 19.4% in the highest (Q4) income quartile. 9.3 % of admissions received IVT and 2.7% received MT across the study period. Utilization of both procedures increased in all income groups over time but usage was persistently lower in Q1 admissions compared to Q4 (figure 1). In multivariable-adjusted models restricted to 2015-2021, all minority racial groups including NHB admissions had lower odds of IVT (OR 0.74, 95%CI 0.72-0.76) and MT (OR 0.74, 95%CI 0.71-0.77) vs NHW. Q1, Q2 and Q3 admissions had lower odds of IVT compared to Q4 and Q1 admissions had lower MT odds (OR 0.92, 95%CI 0.90-0.95) vs Q4. Further stratification by income and race, showed that IVT and MT odds increased with income for NHW admissions but notably all quartiles of NHB admissions including Q4 had up to 20% lower odds of IVT and MT compared to Q1 of NHW admissions (Figures 2a and 2c). Among NHB and NHW admissions, odd of in-hospital mortality was significantly lower in Q4 vs Q1, while odds of good outcome was greater in Q4 vs Q1 income categories, but these differences were not consistently seen in Hispanic and Asian hospitalizations (Figure 3).Conclusion:Racial disparities in IVT and MT use in the US is not explained by income alone. NHB individuals in all income categories receive IVT and MT at rates less than the lowest income category of NHW individuals. Q1 admissions have higher mortality and lower odds of good outcome compared to Q4 admissions.

Life expectancy in the US may now vary by more than 2 decades based on demographic differences, according to a new systematic analysis. The largest gap between highest and lowest life expectancies was 12.6 years in 2000. It reached 13.9 years in 2010 and 15.8 years by 2019 before climbing to 20.4 years after the first 2 years of the COVID-19 pandemic—with the largest life expectancy difference being between Asian individuals and American Indian or Alaska Native people in the West.

Objectives
To determine the prevalence of hospital discharge communication problems with older adults, compare them across countries and determine factors associated with those problems.

Design
Secondary analysis of cross-sectional survey data.

Setting
2021 Commonwealth Fund International Health Policy (IHP) Survey of Older Adults conducted across 11 high-income countries, including Australia, Canada, France, Germany, the Netherlands, New Zealand, Norway, Sweden, Switzerland, the UK and the USA.

Participants
4501 respondents aged 60 and older in the USA and 65 and older in all other included countries who were hospitalised at least once in the past 2 years before the survey and answered discharge communication-related questions.

Primary outcome measure
Our primary outcome measure is poor discharge communication (PDC), a composite variable of three IHP questions related to written information, doctor follow-up and medicines discussed.

Results
Overall PDC rate was 19.2% (864/4501), although rates varied by nation. PDC was highest in Norway (31.5%) and lowest in the USA (7.5%). Gender, education, income and the presence of at least one chronic disease were not statistically associated with PDC.

Conclusions
Given the high rate of PDC observed, hospital discharge teams and leadership should carefully examine communication during the hospital discharge process to ensure minimisation of care gaps, particularly regarding medication, since this was the most reported problem.

Objective
This study examined economic inequality in coverage of selected maternal and child healthcare (MCH) indicators in India and its states over the last 15 years.

Design
The study analysed last three rounds of the National Family Health Survey data, conducted during 2005–2006, 2015–2016 and 2019–2021. Bivariate analyses, ratio of richest to poorest, slope index of inequality (SII) and multivariate binary logistic regression analyses were used to examine the coverage as well as inequalities in the outcome indicators for India and its states and at district level.

Primary outcomes
The outcome variables analysed in the study were full antenatal care, institutional delivery, postnatal care of mothers within 48 hours of delivery, and full immunisation among children.

Participants
Women aged 15–49 who had given a birth in the last 5 years before the surveys were unit of analysis for the maternal healthcare indicators, and children aged 12–23 months were unit of the analysis for childhood immunisation.

Results
Over the last 15 years, coverage of the MCH indicators has increased in India and across socioeconomic segment of the population, and the absolute increase was higher among the worse-off segments than the better-off. This led to decline in the inequality in coverage of all the MCH indicators. For instance, the value of SII for institutional births decreased from 0.76 in 2005–2006 to 0.45 in 2015–2016 and further to 0.37 in 2019–2021. Although inequality has decreased, geographic disparities persist across states and districts.

Conclusion
Though substantial improvement was observed, coverage of MCH indicators increased and the economic inequality declined; certain geographies are still characterised with the low coverage and persistent high inequality. This suggests that adding a spatial perspective to the inequality research and targeted strategies is essential for achieving universal access to reproductive healthcare services by 2030 in India.

Objectives
We aim to delineate the digestive congenital abnormalities burden in children under 14 years old between 1990 and 2021.

Design
We implemented data from the Global Burden of Disease (GBD) 2021 database to evaluate digestive congenital abnormalities burden with different measures in 204 countries and territories from 1990 to 2021. We present precise estimations with 95% uncertainty intervals. In addition, we computed the estimated annual percentage change (EAPC) to examine the temporal patterns of these indicators.

Setting
It uses prevalence, deaths and disability-adjusted life years (DALYs) data from the GBD study to analyse this issue.

Participants
Patients with digestive congenital abnormalities diagnosis.

Outcomes
Total numbers, age-standardised rates (ASRs) of prevalence, mortality and DALYs and their EAPCs were the main outcomes among children aged 0–14 years.

Results
In 2021, 2206.79 thousand prevalent cases were reported worldwide, with digestive congenital anomalies accounting for 47.16 thousand deaths and 4324.56 thousand DALYs among children aged 0–14 years. Digestive congenital anomalies prevalence was mitigated by 8.15% between 1990 and 2021, with the global ASR of prevalence declining to 40.09 per 100 000. Digestive congenital anomalies mortality was mitigated by 35.35% between 1990 and 2021, with an ASR of deaths declining to 0.77 per 100 000. The worldwide burden of digestive congenital anomalies decreased by 34.96% in terms of DALYs from 1990 to 2021, with an ASR of 70.44 DALYs per 100 000 population. There was a significant hindrance in the prevalence, particularly among older children. The likelihood of digestive congenital abnormalities peaked during infancy (2–4 years) in all regions.

Conclusion
We highlight promising global declines in the digestive congenital anomalies burden among children over the past 32 years. Prevalence, deaths and DALYs associated with these anomalies have shown consistent decreases, although regional variations persist. These findings offer crucial insights for shaping effective prevention and management strategies for paediatric digestive congenital anomalies.