Dataset Information

Comparing the burdens of opportunistic infections among patients with systemic rheumatic diseases: a nationally representative cohort study.

ABSTRACT:

Objective

To estimate and compare the burdens of opportunistic infections and herpes zoster in real-world practice among patients with various systemic rheumatic diseases.

Methods

This 13-year cohort study used national health insurance data to compare the incidence rates (IRs) of nine opportunistic infections among patients with five rheumatic diseases. The analyses were stratified according to follow-up duration using Poisson regression, and Cox models were used to compare the risk of first opportunistic infection.

Results

During 2000-2013, we identified 76,966 patients who had polymyositis/dermatomyositis (PM/DM, 2270 cases), systemic lupus erythematosus (SLE, 15,961 cases), systemic sclerosis (SSc, 2071 cases), rheumatoid arthritis (RA, 38,355 cases), or primary Sjögren's syndrome (pSS, 18,309 cases). The IR of opportunistic infections was highest for PM/DM cases (61.3/1000 person-years, 95% confidence interval [CI] 56.6-66.2), followed by SLE cases (43.1/1000 person-years, 95% CI 41.7-44.5), SSc cases (31.6/1000 person-years, 95% CI 28.3-35.1), RA cases (25.0/1000 person-years, 95% CI 24.4-25.7), and pSS cases (24.1/1000 person-years, 95% CI 23.1-25.2). Multivariable Cox analysis revealed that, relative to SLE, PM/DM was associated with a significantly higher risk of opportunistic infections (hazard ratio 1.18, 95% CI 1.08-1.29). The risk of opportunistic infections was highest during the first year after the diagnosis of all five rheumatic diseases.

Conclusions

The risk of opportunistic infection was highest for PM/DM, followed by SLE, SSc, RA, and pSS. Careful observation and preventive therapy for opportunistic infections may be warranted in selected PM/DM patients, especially during the first year after the diagnosis.

SUBMITTER: Hsu CY

PROVIDER: S-EPMC6790041 | biostudies-literature | 2019 Oct

REPOSITORIES: biostudies-literature

ACCESS DATA

Publications

Comparing the burdens of opportunistic infections among patients with systemic rheumatic diseases: a nationally representative cohort study.

Hsu Chung-Yuan CY Ko Chi-Hua CH Wang Jiun-Ling JL Hsu Tsai-Ching TC Lin Chun-Yu CY

Arthritis research & therapy 20191012 1

<h4>Objective</h4>To estimate and compare the burdens of opportunistic infections and herpes zoster in real-world practice among patients with various systemic rheumatic diseases.<h4>Methods</h4>This 13-year cohort study used national health insurance data to compare the incidence rates (IRs) of nine opportunistic infections among patients with five rheumatic diseases. The analyses were stratified according to follow-up duration using Poisson regression, and Cox models were used to compare the r ...[more]

PMID: 31604447

Similar Datasets

Project description:BackgroundThere is a paucity of specific data on early stages of chronic kidney disease (CKD) among Asian Americans (AAs). The objective of this study was to examine the independent association of Asian race/ethnicity and socio-demographic and co-morbidity factors with markers of early kidney damage, ascertained by ACR levels, as well as kidney dysfunction, ascertained by eGFR levels in a large cross-sectional sample of AAs enrolled in the National Health and Nutrition Examination Survey (NHANES).MethodsSecondary data analyses of the NHANES 2011-2014 data of a nationally representative sample of 5907 participants 18?years and older, US citizens, and of Asian and White race. NHANES data included race (Asian vs. White), as well as other socio-demographic information and comorbidities. Urine albumin-to-creatinine ratio (ACR) categories and estimated glomerular filtration rate (eGFR) were used as indicators for CKD. Descriptive analyses using frequencies, means (standard deviations), and chi-square tests was first conducted, then multivariable logistic regression serial adjustment models were used to examine the associations between race/ethnicity, other socio-demographic factors (age, sex, education), and co-morbidities (obesity, diabetes, hypertension) with elevated ACR levels (A2 & A3 - CKD Stages 3 and 4-5, respectively) as well as reduced eGFR (G3a-G5 and G3b -G5 - CKD Stage 3-5).ResultsAAs were more likely than White participants to have ACR levels >?300?mg/g (A3) (adjusted OR (aOR) (95% CI) 2.77 (1.55, 4.97), p?=?0.001). In contrast, adjusted analyses demonstrated that AAs were less likely to have eGFR levels <?60?ml/min/1.73?m2 (G3a-G5) (aOR (95% CI) 0.50 (0.35, 0.72), p?<?.001).ConclusionsThis is one of the first large U.S. population-based studies of AAs that has shown a comparatively higher risk of elevated ACR?>?300?mg/g levels (A3) but lower risk of having eGFR levels <?60?ml/min/1.732?m2 (G3a-G5). The findings support the need to address the gaps in knowledge regarding disparities in risk of early stage CKD among AAs.

Project description:Evidence connects mental illness to other adverse health conditions, including oral health. However, longitudinal associations between mental and oral health remain understudied. We aimed to examine mental health-oral health associations prospectively in a nationally representative US cohort. Data were from the Population Assessment of Tobacco and Health (PATH) Study. The Global Appraisal of Individual Needs-Short Screener measured 3 types of mental health symptoms: internalizing, externalizing, and substance use problems. Six self-reported oral health conditions related to periodontal disease were evaluated: self-rated oral health, bleeding gums, loose teeth, tooth extraction, gum disease, and bone loss around teeth. Cross-sectional analysis within PATH Study wave 4 (2016 to 2018, n = 30,746) compared the survey-weighted prevalence of the 6 oral health outcomes according to severity of mental health problems. Prospectively, oral health outcomes were assessed 2 y later (wave 5, 2018 to 2019) according to wave 4 (baseline) mental health problems (n = 26,168). Survey-weighted logistic regression models controlled for confounders (age, sex, tobacco use, etc.) with imputation for missing values. All 6 adverse oral health conditions were greater in prevalence among participants with severe internalizing problems. Multiple conditions were also associated with severe externalizing or substance use problems. Longitudinally associations attenuated, but multiple associations of meaningful magnitude persisted, most with internalizing problems. For example, the adjusted odds ratio was 1.27 (95% CI, 1.08 to 1.50) for bleeding gums and 1.37 (95% CI, 1.12 to 1.68) for tooth extraction when we compared severe versus none/low internalizing problems. Providers should expect higher levels of oral disease among patients with adverse mental health symptoms. Independent of externalizing and substance use problems, symptoms of internalizing problems (related to depression and/or anxiety) are plausible risk factors for future oral disease. Better integration and coordination of mental and oral health treatment and prevention are recommended.

Dataset Information

Comparing the burdens of opportunistic infections among patients with systemic rheumatic diseases: a nationally representative cohort study.

Objective

Methods

Results

Conclusions

Publications

Comparing the burdens of opportunistic infections among patients with systemic rheumatic diseases: a nationally representative cohort study.

Similar Datasets

OmicsDI is part of the ELIXIR infrastructure

Tweets