Dataset Information

Association of Exfoliation Syndrome With Risk of Indirect Inguinal Hernia: The Utah Project on Exfoliation Syndrome.

ABSTRACT:

Importance

Exfoliation syndrome (XFS) is a systemic connective tissue disease, and abnormal connective tissue metabolism is implicated in inguinal hernias (IH). Associating XFS with comorbid conditions may illuminate their underlying pathophysiology and affect clinical screening and treatment. Exfoliation syndrome involves altered systemic extracellular matrix (ECM) homeostasis involving elastin metabolism. Hernias occur owing to abnormal ECM synthesis, metabolism, or repair. Inguinal hernias involve weakening or rupture of the abdominal/groin wall.

Objective

To determine an association between patients with XFS and patients with IH in Utah, possibly differing between direct or indirect hernia.

Design, setting, and participants

Cross-sectional study in a large health care system of Utah hospitals and clinics. Conditional logistic regression odds ratios were used to estimate risk of XFS in patients with IH overall and by subtype (direct or indirect) compared with control individuals. Codes specific to direct and indirect IH with additional medical records review of 186 procedures were used to classify IH subtypes that were not prespecified. Bootstrap resampling with jackknife estimation used to calculate 95% confidence intervals. The model accounted for matching on sex and age and adjusted for body mass index and tobacco use. Population-based sample using medical records from 1996 to 2015 that identified 2594 patients 40 years or older on January 1, 1996, with surgical IH repair and 12?966 random control patients with no IH history matched 5:1 on sex and birth year. Data were analyzed between September 10, 2017, and October 23, 2017.

Main outcomes and measures

Exfoliation syndrome outcome defined by diagnosis codes for XFS or exfoliation glaucoma from 1996 to 2015.

Results

Participants were primarily white (2532 of 2594 patients, [96.1%]; 12?454 of 12?966 control individuals [97.6%]) and non-Hispanic (2396 of 2594 patients [92.4%]); 250 participants were women (9.6%). Of study participants, 22 patients with IH and 43 control individuals were diagnosed as having XFS, respectively. Patients with IH had a 2.3-fold risk for an XFS diagnosis compared with control individuals (95% CI, 1.4-3.5; P?=?.03), and XFS risk with indirect IH appeared especially pronounced.

Conclusions and relevance

Inguinal hernia was associated with an increased risk of XFS in this Utah population. Further work is needed to understand the pathophysiology, genetics, and environmental factors contributing to both diseases.

SUBMITTER: Besch BM

PROVIDER: S-EPMC6583040 | biostudies-literature | 2018 Dec

REPOSITORIES: biostudies-literature

ACCESS DATA

Publications

Association of Exfoliation Syndrome With Risk of Indirect Inguinal Hernia: The Utah Project on Exfoliation Syndrome.

Besch Brian M BM Curtin Karen K Ritch Robert R Allingham R Rand RR Wirostko Barbara M BM

JAMA ophthalmology 20181201 12

<h4>Importance</h4>Exfoliation syndrome (XFS) is a systemic connective tissue disease, and abnormal connective tissue metabolism is implicated in inguinal hernias (IH). Associating XFS with comorbid conditions may illuminate their underlying pathophysiology and affect clinical screening and treatment. Exfoliation syndrome involves altered systemic extracellular matrix (ECM) homeostasis involving elastin metabolism. Hernias occur owing to abnormal ECM synthesis, metabolism, or repair. Inguinal he ...[more]

PMID: 30242396

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Project description:PurposeExfoliation syndrome (XFS), the most common recognizable cause of open-angle glaucoma worldwide, is a systemic disorder with genetic predisposition due to variations in lysyl oxidase-like 1 (LOXL1) function, leading to altered elastin matrices in ocular and systemic tissues. Obstructive sleep apnea (OSA) is a highly prevalent disorder also involving elastic tissue dysfunction and is associated with glaucoma. Because of the similarities between the disorders, we sought to uncover any relationship in the prevalence of these diagnoses.DesignCase-control, retrospective cohort study.ParticipantsA cohort of 81 735 patients diagnosed with OSA at ages 50 to 90 years was identified from medical records from 1996 to 2017 in the Utah Population Database. Case subjects were matched to random controls on sex and birth year in a 4:1 ratio.MethodsInternational Classification of Diseases, Ninth Revision (ICD-9) codes or their Tenth Revision equivalent were used to define a diagnosis of OSA (ICD-9 327.23) and a diagnosis of XFS (ICD-9 365.52 and 366.11). Conditional logistic regression odds ratios (ORs) accounting for individual matching on sex and birth year were used to estimate the risk of XFS in patients with OSA. Models included adjustment for race, obesity, tobacco use, hypertension (HTN), atrial fibrillation (AF), and chronic obstructive pulmonary disease (COPD).Main outcome measureWhether patients with OSA have an increased risk of diagnosis of XFS compared with controls without OSA.ResultsThere was an increased risk of an XFS diagnosis in patients with OSA compared with non-OSA controls (OR, 1.27; 95% confidence interval [CI], 1.02-1.59; P = 0.03). In a stratification of patients by HTN diagnosis history, patients with OSA and HTN exhibited an increased risk of XFS compared with non-OSA controls with HTN (OR, 2.67; 95% CI, 2.06-3.46; P < 0.0001).ConclusionsPatients with OSA may be at an increased risk of XFS compared with patients without OSA, particularly in patients with a history of HTN.

Project description:PurposeTo investigate demographic, clinical, and behavioral risk factors for undergoing inguinal hernia repair within a large and ethnically diverse cohort.MethodsWe conducted a retrospective case-control study from 2007 to 2020 on 302,532 US individuals from a large, integrated healthcare delivery system with electronic health records, who participated in a survey of determinants of health. Participants without diagnosis or procedure record of an inguinal hernia at enrollment were included. We then assessed whether demographic (age, sex, race/ethnicity), clinical, and behavioral factors (obesity status, alcohol use, cigarette smoking and physical activity) were predictors of undergoing inguinal hernia repair using survival analyses. Risk factors showing statistical significance (P < 0.05) in the univariate models were added to a multivariate model.ResultsWe identified 7314 patients who underwent inguinal hernia repair over the study period, with a higher incidence in men (6.31%) compared to women (0.53%). In a multivariate model, a higher incidence of inguinal hernia repair was associated with non-Hispanic white race/ethnicity, older age, male sex (aHR = 13.55 [95% confidence interval 12.70-14.50]), and more vigorous physical activity (aHR = 1.24 [0.045]), and alcohol drinker status (aHR = 1.05 [1.00-1.11]); while African-American (aHR = 0.69 [0.59-0.79]), Hispanic/Latino (aHR = 0.84 [0.75-0.91]), and Asian (aHR = 0.35 [0.31-0.39]) race/ethnicity, obesity (aHR = 0.33 [0.31-0.36]) and overweight (aHR = 0.71 [0.67-0.75]) were associated with a lower incidence. The use of cigarette was significantly associated with a higher incidence of inguinal hernia repair in women (aHR 1.23 [1.09-1.40]), but not in men (aHR 0.96 [0.91-1.02]).ConclusionInguinal hernia repair is positively associated with non-Hispanic white race/ethnicity, older age, male sex, increased physical activity, alcohol consumption and tobacco use (only in women); while negatively associated with obesity and overweight status. Findings from this large and ethnically diverse study may support future prediction tools to identify patients at high risk of this surgery.

Project description:Introduction Risk factors associated with inguinal hernia include a patent processus vaginalis due to an obliteration failure, defects in the transversalis fascia, increased intra-abdominal pressure, smoking, malnutrition, genetic factors, connective tissue defects and impaired collagen metabolism. Type I collagen predominates in the fascia, which plays a key role in the development of an inguinal hernia. Molecularly, the production of abnormal matrix components or increased inflammatory mediators in collagen such as TNF-α has a very important role in the occurrence of inflammation in inguinal hernias. The study aimed to determine the factors associated with TNF-alpha levels in patients with indirect inguinal hernias. Methods We evaluate the effect of TNF-α on the anterior rectus sheath tissue collagen in 46 patients with indirect inguinal hernia using a cross-sectional study design. The ELISA method was used to evaluate the levels of collagen TNF-α. We used ANOVA, Pearson's correlation test, and Spearman's correlation test to determine which results were statistically significant, defined by a p-value < 0.05. Results Body mass index (BMI) average results were 25.7 kg/m2. Mean clinical onset was 70.13 months across 46 samples. TNF-α levels and BMI were correlated (p = 0.009). The TNF-α levels in the clinical-grade group (p = 0.044) and the clinical onset group (p = 0.047) varied according to ANOVA. Conclusion Clinical onset, BMI, clinical grade of indirect inguinal hernia, and TNF-α levels have a significant relationship. Highlights • Several risk factors are associated with inguinal hernia.• TNF-α inhibits the synthesis of structural components, which lowers extracellular matrix deposition.• TNF-α inhibits type I collagen gene expression by TGF-β, disrupting the structure and strength of the abdominal wall.• Clinical onset, body mass index, and clinical grade of indirect inguinal hernia all significantly correlate with TNF-α levels.• Age and occupational group do not have a significant relationship with TNF-α levels.

Dataset Information

Association of Exfoliation Syndrome With Risk of Indirect Inguinal Hernia: The Utah Project on Exfoliation Syndrome.

Importance

Objective

Design, setting, and participants

Main outcomes and measures

Results

Conclusions and relevance

Publications

Association of Exfoliation Syndrome With Risk of Indirect Inguinal Hernia: The Utah Project on Exfoliation Syndrome.

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