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Acromegaly incidence, prevalence, complications and long-term prognosis: a nationwide cohort study.

https://arctichealth.org/en/permalink/ahliterature280006
Source
Eur J Endocrinol. 2016 Sep;175(3):181-90
Publication Type
Article
Date
Sep-2016
Author
Jakob Dal
Ulla Feldt-Rasmussen
Marianne Andersen
Lars Ø Kristensen
Peter Laurberg
Lars Pedersen
Olaf M Dekkers
Henrik Toft Sørensen
Jens Otto L Jørgensen
Source
Eur J Endocrinol. 2016 Sep;175(3):181-90
Date
Sep-2016
Language
English
Publication Type
Article
Keywords
Acromegaly - diagnosis - epidemiology
Adult
Aged
Cohort Studies
Comorbidity
Denmark - epidemiology
Diabetes Mellitus - epidemiology
Female
Heart Failure - epidemiology
Humans
Incidence
Male
Middle Aged
Myocardial Infarction - epidemiology
Prevalence
Prognosis
Registries
Stroke - epidemiology
Abstract
Valid data on acromegaly incidence, complications and mortality are scarce. The Danish Health Care System enables nationwide studies with complete follow-up and linkage among health-related databases to assess acromegaly incidence, prevalence, complications and mortality in a population-based cohort study.
All incident cases of acromegaly in Denmark (1991-2010) were identified from health registries and validated by chart review. We estimated the annual incidence rate of acromegaly per 10(6) person-years (py) with 95% confidence intervals (95% CIs). For every patient, 10 persons were sampled from the general population as a comparison cohort. Cox regression and hazard ratios (HRs) with 95% confidence intervals (95% CIs) were used.
Mean age at diagnosis (48.7 years (CI: 95%: 47.2-50.1)) and annual incidence rate (3.8 cases/10(6) persons (95% CI: 3.6-4.1)) among the 405 cases remained stable. The prevalence in 2010 was 85 cases/10(6) persons. The patients were at increased risk of diabetes mellitus (HR: 4.0 (95% CI: 2.7-5.8)), heart failure (HR: 2.5 (95% CI: 1.4-4.5)), venous thromboembolism (HR: 2.3 (95% CI: 1.1-5.0)), sleep apnoea (HR: 11.7 (95% CI: 7.0-19.4)) and arthropathy (HR: 2.1 (95% CI: 1.6-2.6)). The complication risk was also increased before the diagnosis of acromegaly. Overall mortality risk was elevated (HR: 1.3 (95% CI: 1.0-1.7)) but uninfluenced by treatment modality.
(i) The incidence rate and age at diagnosis of acromegaly have been stable over decades, and the prevalence is higher than previously reported. (ii) The risk of complications is very high even before the diagnosis. (iii) Mortality risk remains elevated but uninfluenced by mode of treatment.
PubMed ID
27280374 View in PubMed
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Cushing's syndrome in children and adolescents: a Danish nationwide population-based cohort study.

https://arctichealth.org/en/permalink/ahliterature280916
Source
Eur J Endocrinol. 2017 May;176(5):567-574
Publication Type
Article
Date
May-2017
Author
Johanne Marie Holst
Erzsébet Horváth-Puhó
Rikke Beck Jensen
Mariane Rix
Kurt Kristensen
Niels Thomas Hertel
Olaf M Dekkers
Henrik Toft Sørensen
Anders Juul
Jens Otto L Jørgensen
Source
Eur J Endocrinol. 2017 May;176(5):567-574
Date
May-2017
Language
English
Publication Type
Article
Keywords
Adolescent
Child
Child, Preschool
Cohort Studies
Cushing Syndrome - diagnosis - epidemiology - surgery
Denmark - epidemiology
Female
Follow-Up Studies
Humans
Infant
Infant, Newborn
Male
Population Surveillance - methods
Young Adult
Abstract
Cushing's syndrome (CS) affects all age groups, but epidemiologic data in young patients are very limited. We therefore examined the incidence, prevalence and hospital morbidity of CS in children and adolescents.
In a nationwide cohort study, we included all Danish citizens aged 0-20 years from 1977 to 2012. Data were obtained from the Danish National Patient Registry using the International Classification of Diseases (ICD) codes and the Danish Civil Registration System. The diagnosis and treatment were validated by means of individual patient charts. Incidence rate of CS patients aged 0-20 years at diagnosis were computed (standardized to the age and sex distribution of the Danish population). The patients were followed for a maximum of 36 years. Standardized incidence ratios (SIRs) of different hospital-recorded outcomes based on the ICD codes in patients with CS compared to the general population were assessed.
We identified a total of 40 pediatric patients with CS, yielding an annual incidence of 0.89 cases/10(6) population (95% confidence interval (CI)?=?0.63-1.16). The median age at the time of diagnosis was 13.8 years (interquartile range: 10.5-18.2 years), 58% were female and 70% had adrenocorticotropic hormone-producing pituitary adenomas. During follow-up, CS patients (excluding three malignant cases) were at increased risk of being diagnosed with infections (SIR: 3.24, 95% CI: 1.05-7.54) and infertility (SIR: 4.56, 95% CI: 1.48-10.63). The three patients with an adrenocortical carcinoma died shortly after diagnosis, but mortality was not increased in the remaining patients.
CS is rare in the pediatric population. The risk of morbidity related to infections and infertility is elevated and merits further attention.
PubMed ID
28179451 View in PubMed
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Hypothyroidism and hyperthyroidism and breast cancer risk: a nationwide cohort study.

https://arctichealth.org/en/permalink/ahliterature273843
Source
Eur J Endocrinol. 2016 Apr;174(4):409-14
Publication Type
Article
Date
Apr-2016
Author
Mette Søgaard
Dóra Körmendiné Farkas
Vera Ehrenstein
Jens Otto Lunde Jørgensen
Olaf M Dekkers
Henrik Toft Sørensen
Source
Eur J Endocrinol. 2016 Apr;174(4):409-14
Date
Apr-2016
Language
English
Publication Type
Article
Keywords
Adult
Aged
Aged, 80 and over
Breast Neoplasms - epidemiology - etiology
Cohort Studies
Denmark - epidemiology
Female
Humans
Hyperthyroidism - complications - epidemiology
Hypothyroidism - complications - epidemiology
Middle Aged
Registries
Risk factors
Abstract
The association between thyroid disease and breast cancer risk remains unclear. We, therefore examined the association between hypothyroidism, hyperthyroidism and breast cancer risk.
This was a population-based cohort study.
Using nationwide registries, we identified all women in Denmark with a first-time hospital diagnosis of hypothyroidism or hyperthyroidism, 1978-2013. We estimated the excess risk of breast cancer among patients with hypothyroidism or hyperthyroidism compared with the expected risk in the general population, using standardized incidence ratios (SIRs) as a measure of risk ratio. Breast cancer diagnoses in the first 12 months following diagnosis of thyroid disease were excluded from the calculations to avoid diagnostic work-up bias.
We included 61,?873 women diagnosed with hypothyroidism and 80,?343 women diagnosed with hyperthyroidism. Median follow-up time was 4.9 years (interquartile range (IQR): 1.8-9.5 years) for hypothyroidism and 7.4 years (IQR: 3.1-13.5 years) for hyperthyroidism. Hyperthyroidism was associated with a slightly increased breast cancer risk compared with the general population (SIR: 1.11, 95% CI: 1.07-1.16), which persisted beyond 5 years of follow-up (SIR: 1.13, 95% CI: 1.08-1.19). In comparison, hypothyroidism was associated with a slightly lower risk of breast cancer (SIR: 0.94, 95% CI: 0.88-1.00). Stratification by cancer stage at diagnosis, estrogen receptor status, age, comorbidity, history of alcohol-related disease and clinical diagnoses of obesity produced little change in cancer risk.
We found an increased risk of breast cancer in women with hyperthyroidism and a slightly decreased risk in women with hypothyroidism indicating an association between thyroid function level and breast cancer risk.
PubMed ID
26863886 View in PubMed
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Impact of Glycemic Control on Risk of Infections in Patients With Type 2 Diabetes: A Population-Based Cohort Study.

https://arctichealth.org/en/permalink/ahliterature285668
Source
Am J Epidemiol. 2017 Jul 15;186(2):227-236
Publication Type
Article
Date
Jul-15-2017
Author
Anil Mor
Olaf M Dekkers
Jens S Nielsen
Henning Beck-Nielsen
Henrik T Sørensen
Reimar W Thomsen
Source
Am J Epidemiol. 2017 Jul 15;186(2):227-236
Date
Jul-15-2017
Language
English
Publication Type
Article
Keywords
Adult
Aged
Aged, 80 and over
Anti-Infective Agents - therapeutic use
Blood Glucose - analysis
Cohort Studies
Community Health Services - statistics & numerical data
Comorbidity
Denmark - epidemiology
Diabetes Mellitus, Type 2 - complications - epidemiology
Female
Hemoglobin A, Glycosylated - analysis
Humans
Hyperglycemia - complications - epidemiology
Incidence
Infection - drug therapy - epidemiology - etiology
Inpatients - statistics & numerical data
Male
Middle Aged
Proportional Hazards Models
Registries
Risk factors
Abstract
Infections are a major clinical challenge for type 2 diabetes patients, but little is known about the impact of glycemic control. We used Cox regression analyses to examine the association between baseline and time-varying hemoglobin A1c (HbA1c) values and development of community antiinfective-agent-treated and hospital-treated infections in 69,318 patients with type 2 diabetes diagnosed between 2000 and 2012 in Northern Denmark. Incidence rates were 394/1,000 patient-years for community-treated infections and 63/1,000 patient-years for hospital-treated infections. The adjusted hazard ratios for community-treated infection at an HbA1c level of =10.50%, as compared with 5.50%-
PubMed ID
28459981 View in PubMed
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Preadmission Use of Glucocorticoids and 30-Day Mortality After Stroke.

https://arctichealth.org/en/permalink/ahliterature274581
Source
Stroke. 2016 Mar;47(3):829-35
Publication Type
Article
Date
Mar-2016
Author
Jens Sundbøll
Erzsébet Horváth-Puhó
Morten Schmidt
Olaf M Dekkers
Christian F Christiansen
Lars Pedersen
Hans Erik Bøtker
Henrik T Sørensen
Source
Stroke. 2016 Mar;47(3):829-35
Date
Mar-2016
Language
English
Publication Type
Article
Keywords
Aged
Aged, 80 and over
Cohort Studies
Denmark - epidemiology
Female
Follow-Up Studies
Glucocorticoids - administration & dosage
Humans
Male
Middle Aged
Mortality - trends
Patient Admission - trends
Population Surveillance
Registries
Stroke - diagnosis - drug therapy - mortality
Time Factors
Abstract
The prognostic impact of glucocorticoids on stroke mortality remains uncertain. We, therefore, examined whether preadmission use of glucocorticoids is associated with short-term mortality after ischemic stroke, intracerebral hemorrhage (ICH), or subarachnoid hemorrhage (SAH).
We conducted a nationwide population-based cohort study using medical registries in Denmark. We identified all patients with a first-time inpatient diagnosis of stroke between 2004 and 2012. We categorized glucocorticoid use as current use (last prescription redemption =90 days before admission), former use, and nonuse. Current use was further classified as new or long-term use. We used Cox regression to compute 30-day mortality rate ratios with 95% confidence intervals (CIs), controlling for confounders.
We identified 100 042 patients with a first-time stroke. Of these, 83 735 patients had ischemic stroke, 11 779 had ICH, and 4528 had SAH. Absolute mortality risk was higher for current users compared with nonusers for ischemic stroke (19.5% versus 10.2%), ICH (46.5% versus 34.4%), and SAH (35.0% versus 23.2%). For ischemic stroke, the adjusted 30-day mortality rate ratio was increased among current users compared with nonusers (1.58, 95% CI: 1.46-1.71), driven by the effect of glucocorticoids among new users (1.80, 95% CI: 1.62-1.99). Current users had a more modest increase in the adjusted 30-day mortality rate ratio for hemorrhagic stroke (1.26, 95% CI: 1.09-1.45 for ICH and 1.40, 95% CI: 1.01-1.93 for SAH) compared with nonusers. Former use was not substantially associated with mortality.
Preadmission use of glucocorticoids was associated with increased 30-day mortality among patients with ischemic stroke, ICH, and SAH.
PubMed ID
26903585 View in PubMed
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Use of glucocorticoids and risk of venous thromboembolism: a nationwide population-based case-control study.

https://arctichealth.org/en/permalink/ahliterature115084
Source
JAMA Intern Med. 2013 May 13;173(9):743-52
Publication Type
Article
Date
May-13-2013
Author
Sigrun A Johannesdottir
Erzsébet Horváth-Puhó
Olaf M Dekkers
Suzanne C Cannegieter
Jens Otto L Jørgensen
Vera Ehrenstein
Jan P Vandenbroucke
Lars Pedersen
Henrik Toft Sørensen
Author Affiliation
Department of Clinical Epidemiology, Institute of Clinical Medicine, Aarhus University Hospital, Aarhus N, The Netherlands. saj@dce.au.dk
Source
JAMA Intern Med. 2013 May 13;173(9):743-52
Date
May-13-2013
Language
English
Publication Type
Article
Keywords
Aged
Betamethasone
Case-Control Studies
Denmark - epidemiology
Drug Prescriptions - statistics & numerical data
Female
Glucocorticoids - administration & dosage - adverse effects
Humans
Hydrocortisone
Incidence
Logistic Models
Male
Methylprednisolone
Middle Aged
Odds Ratio
Prednisolone
Prednisone
Registries
Risk assessment
Risk factors
Triamcinolone
Venous Thromboembolism - chemically induced - epidemiology
Abstract
Excess endogenous cortisol has been linked to venous thromboembolism (VTE) risk, but whether this relationship applies to exogenous glucocorticoids remains uncertain. Because the prevalence of glucocorticoid use and the incidence of VTE are high, an increased risk of VTE associated with glucocorticoid use would have important implications.
To examine the association between glucocorticoid use and VTE.
Population-based case-control study using nationwide databases.
Denmark (population 5.6 million).
We identified 38,765 VTE cases diagnosed from January 1, 2005, through December 31, 2011, and 387,650 population controls included through risk-set sampling and matched by birth year and sex. The VTE diagnosis date for the case was the index date for cases and matched controls.
We classified individuals who filled their most recent glucocorticoid prescription 90 days or less, 91 to 365 days, and more than 365 days before the index date as present, recent, and former users, respectively. Present users were subdivided into new (first-ever prescription 90 days or less before the index date) and continuing users (others).
We used conditional logistic regression adjusted for VTE risk factors to estimate incidence rate ratios (IRRs) and 95% CIs for glucocorticoid users vs nonusers.
Systemic glucocorticoids increased VTE risk among present (adjusted IRR, 2.31; 95% CI, 2.18-2.45), new (3.06; 2.77-3.38), continuing (2.02; 1.88-2.17), and recent (1.18; 1.10-1.26) users but not among former users (0.94; 0.90-0.99). The adjusted IRR increased from 1.00 (95% CI, 0.93-1.07) for a prednisolone-equivalent cumulative dose of 10 mg or less to 1.98 (1.78-2.20) for more than 1000 to 2000 mg, and to 1.60 (1.49-1.71) for doses higher than 2000 mg. New use of inhaled (adjusted IRR, 2.21; 95% CI, 1.72-2.86) and intestinal-acting (2.17; 1.27-3.71) glucocorticoids also increased VTE risk.
The risk of VTE is increased among glucocorticoid users. Although residual confounding may partly explain this finding, we consider a biological mechanism likely because the association followed a clear temporal gradient, persisted after adjustment for indicators of severity of underlying disease, and existed also for noninflammatory conditions. Hence, our observations merit clinical attention.
Notes
Comment In: JAMA Intern Med. 2013 May 13;173(9):75223546642
PubMed ID
23546607 View in PubMed
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6 records – page 1 of 1.