1
|
Burton JK, Marwick CA, Galloway J, Hall C, Nind T, Reynish EL, Guthrie B. Identifying care-home residents in routine healthcare datasets: a diagnostic test accuracy study of five methods. Age Ageing 2019; 48:114-121. [PMID: 30124764 PMCID: PMC6322499 DOI: 10.1093/ageing/afy137] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2018] [Accepted: 07/26/2018] [Indexed: 11/12/2022] Open
Abstract
Background there is no established method to identify care-home residents in routine healthcare datasets. Methods matching patient's addresses to known care-home addresses have been proposed in the UK, but few have been formally evaluated. Study design prospective diagnostic test accuracy study. Methods four independent samples of 5,000 addresses from Community Health Index (CHI) population registers were sampled for two NHS Scotland Health Boards on 1 April 2017, with one sample of adults aged ≥65 years and one of all residents. To derive the reference standard, all 20,000 addresses were manually adjudicated as 'care-home address' or not. The performance of five methods (NHS Scotland assigned CHI Institution Flag, exact address matching, postcode matching, Phonics and Markov) was evaluated compared to the reference standard. Results the CHI Institution Flag had a high PPV 97-99% in all four test sets, but poorer sensitivity 55-89%. Exact address matching failed in every case. Postcode matching had higher sensitivity than the CHI flag 78-90%, but worse PPV 77-85%. Area under the receiver operating curve values for Phonics and Markov scores were 0.86-0.95 and 0.93-0.98, respectively. Phonics score with cut-off ≥13 had PPV 92-97% with sensitivity 72-87%. Markov PPVs were 90-95% with sensitivity 69-90% with cut-off ≥29.6. Conclusions more complex address matching methods greatly improve identification compared to the existing NHS Scotland flag or postcode matching, although no method achieved both sensitivity and positive predictive value > 95%. Choice of method and cut-offs will be determined by the specific needs of researchers and practitioners.
Collapse
Affiliation(s)
- Jennifer K Burton
- Alzheimer Scotland Dementia Research Centre, University of Edinburgh, Edinburgh, UK
- Centre for Cognitive Ageing and Cognitive Epidemiology, University of Edinburgh, Edinburgh, UK
| | - Charis A Marwick
- Population Health Sciences Division, School of Medicine, University of Dundee, Dundee, UK
| | - James Galloway
- Health Informatics Centre, Ninewells Hospital, University of Dundee, Dundee, UK
| | - Christopher Hall
- Health Informatics Centre, Ninewells Hospital, University of Dundee, Dundee, UK
| | - Thomas Nind
- Health Informatics Centre, Ninewells Hospital, University of Dundee, Dundee, UK
| | - Emma L Reynish
- Dementia and Ageing Research Group, Faculty of Social Science, University of Stirling, Stirling, UK
| | - Bruce Guthrie
- Population Health Sciences Division, School of Medicine, University of Dundee, Dundee, UK
| |
Collapse
|
2
|
Burton JK, Guthrie B, Hapca SM, Cvoro V, Donnan PT, Reynish EL. Living at home after emergency hospital admission: prospective cohort study in older adults with and without cognitive spectrum disorder. BMC Med 2018; 16:231. [PMID: 30526577 PMCID: PMC6288896 DOI: 10.1186/s12916-018-1199-z] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/06/2018] [Accepted: 10/26/2018] [Indexed: 12/02/2022] Open
Abstract
BACKGROUND Cognitive spectrum disorders (CSDs) are common in hospitalised older adults and associated with adverse outcomes. Their association with the maintenance of independent living has not been established. The aim was to establish the role of CSDs on the likelihood of living at home 30 days after discharge or being newly admitted to a care home. METHODS A prospective cohort study with routine data linkage was conducted based on admissions data from the acute medical unit of a district general hospital in Scotland. 5570 people aged ≥ 65 years admitted from a private residence who survived to discharge and received the Older Persons Routine Acute Assessment (OPRAA) during an incident emergency medical admission were included. The outcome measures were living at home, defined as a private residential address, 30 days after discharge and new care home admission at hospital discharge. Outcomes were ascertained through linkage to routine data sources. RESULTS Of the 5570 individuals admitted from a private residence who survived to discharge, those without a CSD were more likely to be living at home at 30 days than those with a CSD (93.4% versus 81.7%; difference 11.7%, 95%CI 9.7-13.8%). New discharge to a care home affected 236 (4.2%) of the cohort, 181 (76.7%) of whom had a CSD. Logistic regression modelling identified that all four CSD categories were associated with a reduced likelihood of living at home and an increased likelihood of discharge to a care home. Those with delirium superimposed on dementia were the least likely to be living at home (OR 0.25), followed by those with dementia (OR 0.43), then unspecified cognitive impairment (OR 0.55) and finally delirium (OR 0.57). CONCLUSIONS Individuals with a CSD are at significantly increased risk of not returning home after hospitalisation, and those with CSDs account for the majority of new admissions to care homes on discharge. Individuals with delirium superimposed on dementia are the most affected. We need to understand how to configure and deliver healthcare services to enable older people to remain as independent as possible for as long as possible and to ensure transitions of care are managed supportively.
Collapse
Affiliation(s)
- Jennifer K Burton
- Academic Geriatric Medicine, Institute of Cardiovascular and Medical Sciences, University of Glasgow, New Lister Building Glasgow Royal Infirmary, 10 Alexandra Parade, G31 2ER, Glasgow, Scotland
| | - Bruce Guthrie
- Population Health Sciences Division, University of Dundee, Mackenzie Building, Kirsty Semple Way, Dundee, DD2 4BF, Scotland
| | - Simona M Hapca
- Population Health Sciences Division, University of Dundee, Mackenzie Building, Kirsty Semple Way, Dundee, DD2 4BF, Scotland
| | - Vera Cvoro
- NHS Fife, Kirkcaldy, Fife, KY2 5AH, Scotland
| | - Peter T Donnan
- Population Health Sciences Division, University of Dundee, Mackenzie Building, Kirsty Semple Way, Dundee, DD2 4BF, Scotland
| | - Emma L Reynish
- Dementia and Ageing Research Group, Faculty of Social Science, University of Stirling, Stirling, FK9 4LA, Scotland.
| |
Collapse
|
3
|
Hapca SM, Burton JK, Cvoro V, Donnan PT, Guthrie B, Reynish EL. 16COGNITIVE SPECTRUM DISORDERS AND NEW CARE HOME ADMISSION FROM HOSPITAL: INSIGHTS FROM THE OPRAA COHORT. Age Ageing 2018. [DOI: 10.1093/ageing/afy134.05] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Affiliation(s)
- S M Hapca
- Population Health Sciences Division, University of Dundee
| | - J K Burton
- Alzheimer Scotland Dementia Research Centre, University of Edinburgh
- Centre for Cognitive Ageing and Cognitive Epidemiology, University of Edinburgh
| | | | - P T Donnan
- Population Health Sciences Division, University of Dundee
| | - B Guthrie
- Population Health Sciences Division, University of Dundee
| | - E L Reynish
- Dementia and Ageing Research Group, Faculty of Social Science, University of Stirling
| |
Collapse
|
4
|
Burton JK, Lynch E, Reynish EL, MacLullich AMJ, Starr JM, Shenkin SD. 13USING ROUTINE SOCIAL CARE DATA TO EXPLORE CARE HOME ADMISSIONS: A COHORT ANALYSIS OF THE SCOTTISH CARE HOME CENSUS 2013–2016. Age Ageing 2018. [DOI: 10.1093/ageing/afy134.02] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Affiliation(s)
- J K Burton
- Alzheimer Scotland Dementia Research Centre University of Edinburgh
- Centre for Cognitive Ageing and Cognitive Epidemiology University of Edinburgh
- Geriatric Medicine University of Edinburgh
| | - E Lynch
- Health and Social Care Analysis Division Scottish Government
| | - E L Reynish
- Geriatric Medicine University of Edinburgh
- Dementia and Ageing Research Group University of Stirling
| | - A M J MacLullich
- Centre for Cognitive Ageing and Cognitive Epidemiology University of Edinburgh
- Geriatric Medicine University of Edinburgh
| | - J M Starr
- Alzheimer Scotland Dementia Research Centre University of Edinburgh
- Centre for Cognitive Ageing and Cognitive Epidemiology University of Edinburgh
- Geriatric Medicine University of Edinburgh
| | - S D Shenkin
- Centre for Cognitive Ageing and Cognitive Epidemiology University of Edinburgh
- Geriatric Medicine University of Edinburgh
| |
Collapse
|
5
|
Reynish EL, Hapca SM, De Souza N, Cvoro V, Donnan PT, Guthrie B. Epidemiology and outcomes of people with dementia, delirium, and unspecified cognitive impairment in the general hospital: prospective cohort study of 10,014 admissions. BMC Med 2017; 15:140. [PMID: 28747225 PMCID: PMC5530485 DOI: 10.1186/s12916-017-0899-0] [Citation(s) in RCA: 128] [Impact Index Per Article: 18.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/27/2017] [Accepted: 06/22/2017] [Indexed: 12/23/2022] Open
Abstract
BACKGROUND Cognitive impairment of various kinds is common in older people admitted to hospital, but previous research has usually focused on single conditions in highly-selected groups and has rarely examined associations with outcomes. This study examined prevalence and outcomes of cognitive impairment in a large unselected cohort of people aged 65+ with an emergency medical admission. METHODS Between January 1, 2012, and June 30, 2013, admissions to a single general hospital acute medical unit aged 65+ underwent a structured specialist nurse assessment (n = 10,014). We defined 'cognitive spectrum disorder' (CSD) as any combination of delirium, known dementia, or Abbreviated Mental Test (AMT) score < 8/10. Routine data for length of stay (LOS), mortality, and readmission were linked to examine associations with outcomes. RESULTS A CSD was present in 38.5% of all patients admitted aged over 65, and in more than half of those aged over 85. Overall, 16.7% of older people admitted had delirium alone, 7.9% delirium superimposed on known dementia, 9.4% known dementia alone, and 4.5% unspecified cognitive impairment (AMT score < 8/10, no delirium, no known dementia). Of those with known dementia, 45.8% had delirium superimposed. Outcomes were worse in those with CSD compared to those without - LOS 25.0 vs. 11.8 days, 30-day mortality 13.6% vs. 9.0%, 1-year mortality 40.0% vs. 26.0%, 1-year death or readmission 62.4% vs. 51.5% (all P < 0.01). There was relatively little difference by CSD type, although people with delirium superimposed on dementia had the longest LOS, and people with dementia the worst mortality at 1 year. CONCLUSIONS CSD is common in older inpatients and associated with considerably worse outcomes, with little variation between different types of CSD. Healthcare systems should systematically identify and develop care pathways for older people with CSD admitted as medical emergencies, and avoid only focusing on condition-specific pathways such as those for dementia or delirium alone.
Collapse
Affiliation(s)
- Emma L Reynish
- Dementia and Ageing Research Group, Faculty of Social Science, University of Stirling, Stirling, FK9 4LA, UK.
| | - Simona M Hapca
- Population Health Sciences Division, University of Dundee, Dundee, DD2 4BF, UK
| | - Nicosha De Souza
- Population Health Sciences Division, University of Dundee, Dundee, DD2 4BF, UK
| | | | - Peter T Donnan
- Epidemiology and Biostatistics, Population Health Sciences Division, University of Dundee, Dundee, DD2 4BF, UK
| | - Bruce Guthrie
- Primary Care Medicine, Population Health Sciences Division, University of Dundee, Dundee, DD2 4BF, UK
| |
Collapse
|
6
|
Harrison JK, Walesby KE, Hamilton L, Armstrong C, Starr JM, Reynish EL, MacLullich AMJ, Quinn TJ, Shenkin SD. Predicting discharge to institutional long-term care following acute hospitalisation: a systematic review and meta-analysis. Age Ageing 2017; 46:547-558. [PMID: 28444124 PMCID: PMC5860007 DOI: 10.1093/ageing/afx047] [Citation(s) in RCA: 38] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2016] [Accepted: 03/21/2017] [Indexed: 01/29/2023] Open
Abstract
Background moving into long-term institutional care is a significant life event for any individual. Predictors of institutional care admission from community-dwellers and people with dementia have been described, but those from the acute hospital setting have not been systematically reviewed. Our aim was to establish predictive factors for discharge to institutional care following acute hospitalisation. Methods we registered and conducted a systematic review (PROSPERO: CRD42015023497). We searched MEDLINE; EMBASE and CINAHL Plus in September 2015. We included observational studies of patients admitted directly to long-term institutional care following acute hospitalisation where factors associated with institutionalisation were reported. Results from 9,176 records, we included 23 studies (n = 354,985 participants). Studies were heterogeneous, with the proportions discharged to a care home 3–77% (median 15%). Eleven studies (n = 12,642), of moderate to low quality, were included in the quantitative synthesis. The need for institutional long-term care was associated with age (pooled odds ratio (OR) 1.02, 95% confidence intervals (CI): 1.00–1.04), female sex (pooled OR 1.41, 95% CI: 1.03–1.92), dementia (pooled OR 2.14, 95% CI: 1.24–3.70) and functional dependency (pooled OR 2.06, 95% CI: 1.58–2.69). Conclusions discharge to long-term institutional care following acute hospitalisation is common, but current data do not allow prediction of who will make this transition. Potentially important predictors evaluated in community cohorts have not been examined in hospitalised cohorts. Understanding these predictors could help identify individuals at risk early in their admission, and support them in this transition or potentially intervene to reduce their risk.
Collapse
Affiliation(s)
- Jennifer Kirsty Harrison
- Alzheimer Scotland Dementia Research Centre, University of Edinburgh, Edinburgh, UK
- Centre for Cognitive Ageing and Cognitive Epidemiology, University of Edinburgh, Edinburgh, UK
| | - Katherine E Walesby
- Alzheimer Scotland Dementia Research Centre, University of Edinburgh, Edinburgh, UK
- Centre for Cognitive Ageing and Cognitive Epidemiology, University of Edinburgh, Edinburgh, UK
| | - Lorna Hamilton
- Department of Medicine for the Elderly, NHS Lothian, Edinburgh, UK
| | | | - John M Starr
- Alzheimer Scotland Dementia Research Centre, University of Edinburgh, Edinburgh, UK
- Centre for Cognitive Ageing and Cognitive Epidemiology, University of Edinburgh, Edinburgh, UK
- Department of Medicine for the Elderly, NHS Lothian, Edinburgh, UK
| | - Emma L Reynish
- Department of Medicine for the Elderly, NHS Lothian, Edinburgh, UK
- School of Applied Social Science, University of Stirling, Stirling, UK
| | - Alasdair M J MacLullich
- Centre for Cognitive Ageing and Cognitive Epidemiology, University of Edinburgh, Edinburgh, UK
- Department of Medicine for the Elderly, NHS Lothian, Edinburgh, UK
- Geriatric Medicine, University of Edinburgh, Edinburgh, UK
| | - Terry J Quinn
- Institute of Cardiovascular and Medical Sciences, University of Glasgow, Glasgow, UK
| | - Susan D Shenkin
- Centre for Cognitive Ageing and Cognitive Epidemiology, University of Edinburgh, Edinburgh, UK
- Department of Medicine for the Elderly, NHS Lothian, Edinburgh, UK
- Geriatric Medicine, University of Edinburgh, Edinburgh, UK
| |
Collapse
|
7
|
Harrison JK, Noel-Storr AH, Demeyere N, Reynish EL, Quinn TJ. Outcomes measures in a decade of dementia and mild cognitive impairment trials. Alzheimers Res Ther 2016; 8:48. [PMID: 27866472 PMCID: PMC5116815 DOI: 10.1186/s13195-016-0216-8] [Citation(s) in RCA: 62] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/18/2016] [Accepted: 10/14/2016] [Indexed: 12/18/2022]
Abstract
Background In a research study, to give a comprehensive evaluation of the impact of interventions, the outcome measures should reflect the lived experience of the condition. In dementia studies, this necessitates the use of outcome measures which capture the range of disease effects, not limited to cognitive functioning. In particular, assessing the functional impact of cognitive impairment is recommended by regulatory authorities, but there is no consensus on the optimal approach for outcome assessment in dementia research. Our aim was to describe the outcome measures used in dementia and mild cognitive impairment (MCI) intervention studies, with particular interest in those evaluating patient-centred outcomes of functional performance and quality of life. Methods We performed a focused review of the literature with multiple embedded checks of internal and external validity. We used the Cochrane Dementia and Cognitive Improvement Group’s register of dementia studies, ALOIS. ALOIS was searched to obtain records of all registered dementia and MCI intervention studies over a 10-year period (2004–2014). We included both published and unpublished materials. Outcomes were categorised as cognitive, functional, quality of life, mood, behaviour, global/disease severity and institutionalisation. Results From an initial return of 3271 records, we included a total of 805 records, including 676 dementia trial records and 129 MCI trial records. Of these, 78 % (630) originated from peer-reviewed publications and 60 % (487) reported results of pharmacological interventions. Cognitive outcomes were reported in 70 % (563), in contrast with 29 % (237) reporting measures of functional performance and only 13 % (102) reporting quality of life measures. We identified significant heterogeneity in the tools used to capture these outcomes, with frequent use of non-standardised tests. Conclusions This focus on cognitive performance questions the extent to which intervention studies for dementia are evaluating outcome measures which are relevant to individual patients and their carers. The heterogeneity in measures, use of bespoke tools and poor descriptions of test strategy all support the need for a more standardised approach to the conduct and reporting of outcomes assessments. Electronic supplementary material The online version of this article (doi:10.1186/s13195-016-0216-8) contains supplementary material, which is available to authorized users.
Collapse
Affiliation(s)
- Jennifer Kirsty Harrison
- Alzheimer Scotland Dementia Research Centre, University of Edinburgh, c/o Room S1642, Geriatric Medicine, Royal Infirmary of Edinburgh, 51 Little France Crescent, Edinburgh, EH16 4SB, UK. .,Centre for Cognitive Ageing and Cognitive Epidemiology, University of Edinburgh, Edinburgh, UK.
| | - Anna H Noel-Storr
- Cochrane Dementia and Cognitive Improvement Group, University of Oxford, Oxford, UK
| | - Nele Demeyere
- Department of Experimental Psychology, University of Oxford, Oxford, UK
| | - Emma L Reynish
- School of Applied Social Sciences, University of Stirling, Stirling, UK
| | - Terry J Quinn
- Institute of Cardiovascular and Medical Sciences, University of Glasgow, Glasgow, UK
| |
Collapse
|
8
|
Guthrie B, Clark SA, Reynish EL, McCowan C, Morales DR. Differential impact of two risk communications on antipsychotic prescribing to people with dementia in Scotland: segmented regression time series analysis 2001-2011. PLoS One 2013; 8:e68976. [PMID: 23874832 PMCID: PMC3714253 DOI: 10.1371/journal.pone.0068976] [Citation(s) in RCA: 36] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2013] [Accepted: 06/11/2013] [Indexed: 11/18/2022] Open
Abstract
Background Regulatory risk communications are an important method for disseminating drug safety information, but their impact varies. Two significant UK risk communications about antipsychotic use in older people with dementia were issued in 2004 and 2009. These varied considerably in their content and dissemination, allowing examination of their differential impact. Methods Segmented regression time-series analysis 2001–2011 for people aged ≥65 years with dementia in 87 Scottish general practices, examining the impact of two pre-specified risk communications in 2004 and 2009 on antipsychotic and other psychotropic prescribing. Results The percentage of people with dementia prescribed an antipsychotic was 15.9% in quarter 1 2001 and was rising by an estimated 0.6%/quarter before the 2004 risk communication. The 2004 risk communication was sent directly to all prescribers, and specifically recommended review of all patients prescribed relevant drugs. It was associated with an immediate absolute reduction in antipsychotic prescribing of 5.9% (95% CI −6.6 to −5.2) and a change to a stable level of prescribing subsequently. The 2009 risk communication was disseminated in a limited circulation bulletin, and only specifically recommended avoiding initiation if possible. There was no immediate associated impact, but it was associated with a significant decline in prescribing subsequently which appeared driven by a decline in initiation, with the percentage prescribed an antipsychotic falling from 18.4% in Q1 2009 to 13.5% in Q1 2011. There was no widespread substitution of antipsychotics with other psychotropic drugs. Conclusions The two risk communications were associated with reductions in antipsychotic use, in ways which were compatible with marked differences in their content and dissemination. Further research is needed to ensure that the content and dissemination of regulatory risk communications is optimal, and to track their impact on intended and unintended outcomes. Although rates are falling, antipsychotic prescribing in dementia in Scotland remains unacceptably high.
Collapse
Affiliation(s)
- Bruce Guthrie
- Primary Care Medicine, Population Health Sciences Division, Medical Research Institute, Dundee, Scotland, United Kingdom.
| | | | | | | | | |
Collapse
|
9
|
Henderson P, Hansen R, Cameron FL, Gerasimidis K, Rogers P, Bisset WM, Reynish EL, Drummond HE, Anderson NH, Van Limbergen J, Russell RK, Satsangi J, Wilson DC. Rising incidence of pediatric inflammatory bowel disease in Scotland. Inflamm Bowel Dis 2012; 18:999-1005. [PMID: 21688352 DOI: 10.1002/ibd.21797] [Citation(s) in RCA: 136] [Impact Index Per Article: 11.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/27/2011] [Accepted: 05/16/2011] [Indexed: 02/06/2023]
Abstract
BACKGROUND An accurate indication of the changing incidence of pediatric inflammatory bowel disease (PIBD) within a population is useful in understanding concurrent etiological factors. We aimed to compare the current incidence and other demographic attributes of PIBD in the Scottish population to previous data. METHODS A national cohort of prospectively and retrospectively acquired incident cases of PIBD diagnosed less than 16 years old in pediatric services in Scotland was captured for the period 2003-2008; historical Scottish data were used for comparison (1990-1995). Age/sex-adjusted incidences were calculated and statistical comparisons made using Poisson regression. RESULTS During the 2003-2008 study period 436 patients were diagnosed with PIBD in Scotland, giving an adjusted incidence of 7.82/100,000/year. The incidence of Crohn's disease (CD) was 4.75/100,000/year, ulcerative colitis (UC) 2.06/100,000/year, and inflammatory bowel disease-unclassified (IBDU) 1.01/100,000/year. Compared with data from 1990-1995 when 260 IBD patients were diagnosed, significant rises in the incidence of IBD (from 4.45/100,000/year, P < 0.0001), CD (from 2.86/100,000/year, P < 0.0001), and UC (from 1.59/100,000/year, P = 0.023) were seen. There was also a significant reduction in the median age at IBD diagnosis from 12.7 years to 11.9 years between the periods (P = 0.003), with a continued male preponderance. CONCLUSIONS The number of Scottish children diagnosed with IBD continues to rise, with a statistically significant 76% increase since the mid-1990 s. Furthermore, PIBD is now being diagnosed at a younger age. The reason for this continued rise is not yet clear; however, new hypotheses regarding disease pathogenesis and other population trends may provide further insights in future years.
Collapse
Affiliation(s)
- Paul Henderson
- Department of Child Life and Health, University of Edinburgh, Edinburgh, UK
| | | | | | | | | | | | | | | | | | | | | | | | | |
Collapse
|