Social restrictions due to COVID-19 and the incidence of intoxicated patients in pediatric emergency department

Background Social restrictions set due to COVID-19 decreased pediatric emergency department (ED). The aim is to report epidemiology of intoxicated patients in pediatric ED during the first and second waves of COVID-19. Methods Data for this retrospective hospital discharge register study was gathered from January 2017 to December 2020. Patients aged <18 and intoxicated were included. Incidences are reported per 10,000 children and compared by incidence rate rations (IRRs) with 95% confidence intervals (CIs). Results Incidence of ED visit for intoxicated patient was 65 per 10,000 in 2020 and 54 per 10,000 in 2017–2019 (IRR 1.20 CI 0.87–1.68). Incidence was lower during the lockdown compared to reference years (IRR 0.50 CI 0.17–1.44). Peak monthly incidence (12 per 10000) was recorded after lockdown in July 2020 (IRR 2.45 CI 1.01-5.92). Discussion Based on these results, the lockdown and social restrictions did not decrease heavy alcohol or drug consumption among adolescents in Finland.

Prediagnosis cardiovascular risk and subsequent myocardial infarction (MI) among lymphoma survivors.

7564 Background: Chest radiation is associated with increased risk of MI among lymphoma survivors. The extent to which pre-existing cardiovascular risk factors also contribute to risk is understudied. We investigated this association among a national population of lymphoma survivors with a full range of cardiovascular risk factors. Methods: Using Danish population-based registries, we identified all adults diagnosed with aggressive non-Hodgkin lymphoma or Hodgkin lymphoma from 2000-2010 and followed them from 1 year after diagnosis through 2016. MI was ascertained from the nationwide Hospital Discharge Register and Cause of Death Register. Cardiovascular risk factors (hypertension, dyslipidemia, and diabetes), vascular disease, and intrinsic heart disease prevalent at lymphoma diagnosis were ascertained algorithmically using the National Prescription Register and the Hospital Discharge Register. Controlling for age, sex, histology, receipt of chest radiation, and prevalent cardiovascular diseases, we used multivariable Cox regression to test the association between pre-existing cardiovascular risk factors and subsequent MI. Results: Among 4246 survivors of lymphoma, median age at diagnosis was 60 (interquartile range 45-70 years); median follow-up was 6.9 years (range 0-16 years). 115 survivors were diagnosed with MI. Before lymphoma diagnosis, 28% of survivors had ≥1 cardiovascular risk factor, and 16% of survivors received chest radiation. In multivariable analysis, survivors who received chest radiation had an increased risk of MI compared to survivors who did not (HR=1.92 [95% CI=1.16-3.17]). Survivors with ≥1 cardiovascular risk factor had an increased risk of MI compared to survivors with none (HR = 2.44 [95% CI=1.65-3.62]). Conclusions: In a large, well-characterized, nationally representative study of contemporarily treated lymphoma survivors, prevalent hypertension, dyslipidemia, and diabetes were associated with later MI. Findings suggest that pre-existing cardiovascular risk factors confer the same amount of MI risk as does chest radiation. To prevent MI among survivors, decisions about post-treatment monitoring should address prevalent cardiovascular risk.

Lyme neuroborreliosis epidemiology in Sweden 2010 to 2014: clinical microbiology laboratories are a better data source than the hospital discharge diagnosis register

Background In a study from 2013 that prioritised communicable diseases for surveillance in Sweden, we identified Lyme borreliosis as one of the diseases with highest priority. In 2014, when the present study was designed, there were also plans to make neuroborreliosis notifiable within the European Union. Aim We compared possibilities of surveillance of neuroborreliosis in Sweden through two different sources: the hospital discharge register and reporting from the clinical microbiology laboratories. Methods We examined the validity of ICD-10 codes in the hospital discharge register by extracting personal identification numbers for all cases of neuroborreliosis, defined by a positive cerebrospinal fluid–serum anti-Borrelia antibody index, who were diagnosed at the largest clinical microbiology laboratory in Sweden during 2014. We conducted a retrospective observational study with a questionnaire sent to all clinical microbiology laboratories in Sweden requesting information on yearly number of cases, age group and sex for the period 2010 to 2014. Results Among 150 neuroborreliosis cases, 67 (45%) had received the ICD-10 code A69.2 (Lyme borreliosis) in combination with G01.9 (meningitis in bacterial diseases classified elsewhere), the combination that the Swedish National Board of Health and Welfare recommends for neuroborreliosis. All 22 clinical laboratories replied to our questionnaire. Based on laboratory reporting, the annual incidence of neuroborreliosis in Sweden was 6.3 cases per 100,000 in 2014. Conclusion The hospital discharge register was unsuitable for surveillance of neuroborreliosis, whereas laboratory-based reporting was a feasible alternative. In 2018, the European Commission included Lyme neuroborreliosis on the list of diseases under epidemiological surveillance.

The validity of heart failure diagnoses in the Finnish Hospital Discharge Register

Background: Contemporary validation studies of register-based heart failure diagnoses based on current guidelines and complete clinical data are lacking in Finland and internationally. Our objective was to assess the positive and negative predictive values of heart failure diagnoses in a nationwide hospital discharge register. Methods: Using Finnish Hospital Discharge Register data from 2013–2015, we obtained the medical records for 120 patients with a register-based diagnosis for heart failure (cases) and for 120 patients with a predisposing condition for heart failure, but without a heart failure diagnosis (controls). The medical records of all patients were assessed by a physician who categorized each individual as having heart failure (with reduced or preserved ejection fraction) or no heart failure, based on the definition of current European Society of Cardiology heart failure guidelines. Unclear cases were assessed by a panel of three physicians. This classification was considered as the clinical gold standard, against which the registers were assessed. Results: Register-based heart failure diagnoses had a positive predictive value of 0.85 (95% CI 0.77–0.91) and a negative predictive value of 0.83 (95% CI 0.75–0.90). The positive predictive value decreased when we classified patients with transient heart failure (duration <6 months), dialysis/lung disease or heart failure with preserved ejection fraction as not having heart failure. Conclusions: Heart failure diagnoses of the Finnish Hospital Discharge Register have good positive predictive value and negative predictive value, even when patients with pre-existing heart conditions are used as healthy controls. Our results suggest that heart failure diagnoses based on register data can be reliably used for research purposes.

Distribution of malignant neoplasms among patients with endometriosis: an epidemiological study

Hypothesis/aims of study. The current analysis was undertaken to assess the incidence of malignant diseases in patients with endometriosis. Study design, materials and methods. This is a cohort study of women with surgically verified endometriosis retrieved from the Saint Petersburg 122 Clinical Hospital Discharge Register 1996–2006 (n = 1551). Data were linked to the Saint Petersburg Cancer Agency to identify cases of malignancy. Results. Malignant diseases were identified in 6.3% (n = 98) of cases. The median follow-up was 12.2 (7.5) years. Breast cancer (n = 29), ovarian cancer (n = 7), endometrial cancer (n = 7), thyroid cancer (n = 7), colorectal cancer (n = 6), melanoma (n = 6), non-Hodgkin’s lymphoma (n = 4), and glioblastoma (n = 3) were prevalent. Conclusion. The incidence of cancer in patients with endometriosis is low. Women with endometriosis have an increased risk of some malignancies, particularly ovarian cancer.

The contribution of pre-existing cardiovascular (CV) risk factors to the risk of stroke or heart attack among non-Hodgkin lymphoma (NHL) survivors.

10082 Background: Increased risk of myocardial infarction (MI) and cerebrovascular accident (CVA) among NHL survivors is commonly attributed to NHL treatment. The extent to which pre-existing CV risk factors also contribute to increased risk is unknown. We investigated this association among an entire national population of NHL survivors who have a full range of important CV risk factors. Methods: Using Danish population-based registries, we identified all adults diagnosed with primary aggressive NHL from 2000-2010 and followed them for MI and CVA from 9 months after diagnosis through 2012. MI and CVA diagnoses were ascertained from the nationwide Hospital Discharge Register and Cause of Death Register. CV risk factors (hypertension, dyslipidemia, and diabetes), vascular disease, and intrinsic heart disease prevalent at NHL diagnosis were ascertained algorithmically using the National Prescription Register and the Hospital Discharge Register. Cumulative anthracycline dose was coded continuously. Receipt of radiation was coded dichotomously for both chest and neck. Controlling for age, sex, treatment, and CV diseases, we used Cox multivariate regression to test the association between pre-existing CV risk factors and subsequent CVA or MI. Results: Among 2604 patients with NHL, median age was 62, and median follow-up time was 2.4 years. Overall, 131 patients were diagnosed with MI or CVA. Before NHL diagnosis, 40% of patients had at ≥1 CV risk factor, 13% had vascular disease, and 6% had intrinsic heart disease. 90% of the patients were treated with anthracyclines, 9% had received chest radiation, and 15% had received neck radiation. Patients with ≥1 CV risk factor had an increased risk of MI or CVA compared to patients with none (HR = 1.5 [95% CI = 1.1-2.2). Prevalent vascular disease, prevalent intrinsic heart disease, and NHL treatment were not associated with MI or CVA (p’s > 0.05). Conclusions: In a large, well-characterized, and nationally representative cohort of NHL survivors, prevalent CV risk factors were associated with later CVA and MI. To prevent MI and CVA among survivors, decisions about post-treatment monitoring should take into account prevalent CV risk.