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Provincial trends in Legionnaires' disease are not explained by population structure in Denmark, 2015 to 2018.

ABSTRACT: BackgroundLegionnaires' disease (LD) incidence has been increasing in several European countries since 2011. Currently, Denmark is experiencing one of the highest annual incidences of LD despite its relatively cold climate and homogenous population, and the incidence differs notably across the country.AimWe sought to determine whether provincial differences in LD incidence are attributable to the age and sex distribution of the population, and to characterise the risk of LD by province and age group in Denmark.MethodsUsing national routine surveillance data for domestic LD cases collected between 2015 and 2018, we assessed the incidence of disease by province and year. Poisson regression models were fit to understand the risk of LD by year and province, as well as by 5-year age groups.ResultsIncidence of domestic LD increased 48% between 2015 and 2018 across Denmark. Some provinces continuously had a high incidence of disease, even after adjusting for yearly trends and the underlying population distribution. Variations in the proportion of the population aged 65 years and older were not responsible for the increase in disease in our analysis. Finally, incidence of disease increased with each 5-year age group in both men and women.ConclusionsThe relative differences in incidence between Danish provinces could not be explained by the age and sex distribution of the population, indicating that other factors must be responsible for the varying incidence across the country. These results may help inform trends in other countries in Europe also experiencing an unexplained high incidence of LD.

SUBMITTER: Cassell K

PROVIDER: S-EPMC8229376 | biostudies-literature |

REPOSITORIES: biostudies-literature

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Project description:ImportanceSpontaneous (nontraumatic) intracerebral hemorrhage (ICH) is the most severe complication of antithrombotic drug use.ObjectivesTo estimate the strength of association between use of antithrombotic drugs and risk of ICH and to examine major changes in the incidence of ICH in the general population.Design, setting, and participantsThis case-control study of patients with a first-ever ICH from January 1, 2005, to December 31, 2018, matched by age, sex, and calendar year with general population controls (1:40 ratio), assessed case and control patients 20 to 99 years of age in population-based nationwide registries in Denmark (population of 5.8 million).ExposuresUse of low-dose aspirin, clopidogrel, a vitamin K antagonist (VKA), or a direct oral anticoagulant (DOAC).Main outcomes and measuresAssociation of ICH with antithrombotic drug use, annual age- and sex-standardized incidence rate of ICH, and prevalence of treatment with antithrombotic drugs. Conditional logistic regression models estimated adjusted odds ratios (aORs) (95% CIs) for the association of antithrombotic drugs with ICH.ResultsAmong 16 765 cases with ICH (mean [SD] age, 72.8 [13.1] years; 8761 [52.3%] male), 7473 (44.6%) were exposed to antithrombotic medications at the time of ICH onset. The association with ICH was weakest for current use of low-dose aspirin (cases: 28.7%, controls: 22.6%; aOR, 1.51; 95% CI, 1.44-1.59) and clopidogrel (cases: 6.2%, controls: 3.4%; aOR, 1.65; 95% CI, 1.47-1.84) and strongest with current use of a VKA (cases: 12.0%, controls: 5.0%; aOR, 2.76; 95% CI, 2.58-2.96). The association with ICH was weaker for DOACs (cases: 3.0%, controls: 1.8%; aOR, 1.83; 95% CI, 1.61-2.07) than for VKAs. Compared with 2005, the prevalence of use of oral anticoagulants among general population controls in 2018 was higher (3.8% vs 11.1%), predominantly because of increased use of DOACs (DOACs: 0% vs 7.0%; VKA: 3.8% vs 4.2%). Antiplatelet drugs were used less frequently (24.7% vs 21.4%) because of decreased use of low-dose aspirin (24.3% vs 15.3%), whereas clopidogrel use increased (1.0% vs 6.8%). The age- and sex-standardized incidence rate of ICH decreased from 33 per 100 000 person-years in 2005 to 24 per 100 000 person-years in 2018 (P < .001 for trend).Conclusions and relevanceIn Denmark from 2005 to 2018, use of antithrombotic drugs, especially VKAs, was associated with ICH. Although use of oral anticoagulation increased substantially during the study period, the incidence rate of ICH decreased.

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Provincial trends in Legionnaires' disease are not explained by population structure in Denmark, 2015 to 2018.

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