Abstract
Background
The objective of this paper was to examine temporal changes of infective endocarditis (IE) incidence and epidemiology in North America.
Methods
A systematic review was conducted ...at Mayo Clinic, Rochester. Ovid EBM Reviews, Ovid Embase, Ovid Medline, Scopus, and Web of Science were searched for studies published between January 1, 2000, and May 31, 2020. Four referees independently reviewed all studies, and those that reported a population-based incidence of IE in patients aged 18 years and older in North America were included.
Results
Of 8588 articles screened, 14 were included. Overall, IE incidence remained largely unchanged throughout the study period, except for 2 studies that demonstrated a rise in incidence after 2014. Five studies reported temporal trends of injection drug use (IDU) prevalence among IE patients with a notable increase in prevalence observed. Staphylococcus aureus was the most common pathogen in 7 of 9 studies that included microbiologic findings. In-patient mortality ranged from 3.7% to 14.4%, while the percentage of patients who underwent surgery ranged from 6.4% to 16.0%.
Conclusions
The overall incidence of IE has remained stable among the 14 population-based investigations in North America identified in our systematic review. Standardization of study design for future population-based investigations has been highlighted for use in subsequent systematic reviews of IE.
Abstract
Background
Population-based studies of Staphylococcus aureus bacteremia (SAB) in the United States are limited. We provide a contemporary evaluation of SAB incidence in Olmsted County, ...Minnesota, from 2006 to 2020.
Methods
This was a retrospective population-based study of all adult patients with SAB residing in Olmsted County from 1 January 2006 through 31 December 2020. Initial episodes of SAB were identified using the microbiology laboratory databases at both Olmsted Medical Center and Mayo Clinic Rochester.
Results
Overall, 541 incident SAB cases were identified with a median age of 66.8 (interquartile range, 54.4–78.5) years, and 60.4% were male. Among these cases, 298 (56.2%) were due to methicillin-susceptible S aureus (MSSA) and 232 (43.8%) cases of methicillin-resistant S aureus (MRSA). The overall age- and sex-adjusted SAB incidence rate (IR) was 33.9 (95% confidence interval CI, 31.0–36.8) cases/100 000 person-years (PY). Males had a higher age-adjusted IR of 46.0 (95% CI, 41.0–51.0) cases/100 000 PY compared to females (IR, 24.4 95% CI, 21.1–27.7 cases/100 000 PY). Age- and sex-adjusted SAB IRs due to MSSA and MRSA were 18.7 and 14.6 cases/100 000 PY, respectively, and the percentage of incident SAB cases due to MRSA fluctuated across the study period. There was no apparent temporal trend in SAB incidence over the study period (P = .093).
Conclusions
Our investigation represents the only contemporary population-based study in the United States. Despite the impression that SAB incidence may have increased based on Centers for Disease Control and Prevention surveillance data, our finding of no change in SAB incidence was somewhat unanticipated.
Abstract
Background
The aim of this study was to determine the incidence, epidemiology, and associated risk factors of bloodstream infection (BSI) in patients who had previously undergone cardiac ...valve repair.
Methods
A population-based study that included 7 counties in southeastern Minnesota using the expanded Rochester Epidemiology Project (e-REP) for adults (≥18 years) who underwent valve repair between 1 January 2010 and 31 December 2018 was conducted. Electronic health records were screened for development of BSI and infective endocarditis (IE) from the date of valve repair through 30 July 2020. A 1:4 nested case-control analysis was performed to determine an association, if any, of male sex, Charlson comorbidity index (CCI), and county of residence with BSI.
Results
A total of 335 patients underwent valve repair, of whom 28 (8.3%) developed an index case of BSI, with 14 episodes occurring within 1 year of surgery. The median age of patients with BSI was 70 years, and 79% were male. The crude incidence of BSI was 1671 cases per 100000 person-years and Escherichia coli was the most common pathogen. Case-control analysis demonstrated a significant correlation between CCI and incidence of BSI (P < .001). Only 4 (14.3%) patients developed IE concurrent with the onset of BSI, and no patients developed IE subsequent to BSI.
Conclusions
The crude incidence of BSI following valve repair was higher in our e-REP cohort than previous population-based studies, and half of the BSI cases occurred within 1 year of surgery. Patients with a higher CCI at baseline were at increased risk of subsequent BSI.
ASCVD/CVD in Special Populations
Association between socioeconomic status and cardiovascular diseases (CVD) is well-documented. Racial disparities in prevalence and outcomes of CVD have also been ...extensively studied. The intersection of income, race, and CVD is relatively underexplored. Hence, we aimed to study the prevalence of CVD and associated risk factors among different races/ethnicities across different income groups.
This retrospective analysis included data from participants from the National Health and Nutrition Examination Survey from 2005-2018. Adults ≥20 years who identified as non-Hispanic (NH) White, NH Black, or Hispanic (Mexican-American and other Hispanics) were included. Family income to poverty ratio (PIR) was calculated by dividing family (or individual) income by poverty guidelines specific to the survey year and used as a measure of socioeconomic status. The participants were divided into four quartiles based on PIR <1.08 (lowest income), 1.09-2.03, 2.04-3.9, and >3.9 (highest income). Weighted logistic regression was performed to estimate adjusted odds ratios (ORs) and 95% confidence intervals (CIs) to determine the association of race/ethnicity and CVD and associated risk factors in each quartile. Models were adjusted for age, sex, race, health insurance, marital status, citizenship status, and level of education and PIR.
We included 31,884 unweighted participants that corresponded to 191,307,167 weighted, nationally representative participants. Of these, 8,009 (weighted 16.3%), 7,967 (weighted 19.2%), 7,944 (weighted 26.9%), and 7,964 (weighted 37.5%) participants belonged to 1st, 2nd, 3rd, and 4th quartiles respectively. The proportion of NH-Whites increased with increasing PIR quartiles whereas the proportion of NH-Blacks and Hispanics decreased with increasing PIR quartiles. In adjusted analyses, the prevalence odds of diabetes mellitus (DM), hypertension, coronary artery disease (CAD), congestive heart failure (CHF), and stroke decreased in a step-wise manner from 1st to 4th PIR quartile. Overall, NH Blacks had higher prevalence odds of DM, hypertension, obesity, CHF, and stroke compared to NH Whites, whereas NH Whites had higher prevalence odds of CAD and dyslipidemia compared to NH Blacks (Figure 1). The model testing for PIR-race/ethnicity interaction revealed that PIR-race/ethnicity interaction was significant for obesity (P-interaction 0.002) and diabetes mellitus (P-interaction 0.027) (Figure 2). The difference in prevalence odds between NH White adults and NH Black adults was greater for obesity and diabetes mellitus in the highest PIR quartile compared to the lowest PIR quartile. PIR-race/ethnicity interaction for stroke was 0.053 with the difference in prevalence odds between NH White adults and NH Black adults being greater in the higher PIR quartiles compared to the lowest PIR quartile.
The difference in prevalence between NH White and NH Black adults was greater for diabetes mellitus, obesity and stroke in the highest PIR quartile compared to the lowest PIR quartile. These data suggest a complex interplay between race/ethnicities and income inequalities resulting in disparities in CVD.
ASCVD/CVD in Special Populations
Association between socioeconomic status and cardiovascular diseases (CVD) is well-documented. Racial disparities in prevalence and outcomes of CVD have also been ...extensively studied. The intersection of income, race, and CVD is relatively underexplored. Hence, we aimed to study the prevalence of CVD and associated risk factors among different races/ethnicities across different income groups.
This retrospective analysis included data from participants from the National Health and Nutrition Examination Survey from 2005-2018. Adults ≥20 years who identified as non-Hispanic (NH) White, NH Black, or Hispanic (Mexican-American and other Hispanics) were included. Family income to poverty ratio (PIR) was calculated by dividing family (or individual) income by poverty guidelines specific to the survey year and used as a measure of socioeconomic status. The participants were divided into four quartiles based on PIR <1.08 (lowest income), 1.09-2.03, 2.04-3.9, and >3.9 (highest income). Weighted logistic regression was performed to estimate adjusted odds ratios (ORs) and 95% confidence intervals (CIs) to determine the association of race/ethnicity and CVD and associated risk factors in each quartile. Models were adjusted for age, sex, race, health insurance, marital status, citizenship status, and level of education and PIR.
We included 31,884 unweighted participants that corresponded to 191,307,167 weighted, nationally representative participants. Of these, 8,009 (weighted 16.3%), 7,967 (weighted 19.2%), 7,944 (weighted 26.9%), and 7,964 (weighted 37.5%) participants belonged to 1st, 2nd, 3rd, and 4th quartiles respectively. The proportion of NH-Whites increased with increasing PIR quartiles whereas the proportion of NH-Blacks and Hispanics decreased with increasing PIR quartiles. In adjusted analyses, the prevalence odds of diabetes mellitus (DM), hypertension, coronary artery disease (CAD), congestive heart failure (CHF), and stroke decreased in a step-wise manner from 1st to 4th PIR quartile. Overall, NH Blacks had higher prevalence odds of DM, hypertension, obesity, CHF, and stroke compared to NH Whites, whereas NH Whites had higher prevalence odds of CAD and dyslipidemia compared to NH Blacks (Figure 1). The model testing for PIR-race/ethnicity interaction revealed that PIR-race/ethnicity interaction was significant for obesity (P-interaction 0.002) and diabetes mellitus (P-interaction 0.027) (Figure 2). The difference in prevalence odds between NH White adults and NH Black adults was greater for obesity and diabetes mellitus in the highest PIR quartile compared to the lowest PIR quartile. PIR-race/ethnicity interaction for stroke was 0.053 with the difference in prevalence odds between NH White adults and NH Black adults being greater in the higher PIR quartiles compared to the lowest PIR quartile.
The difference in prevalence between NH White and NH Black adults was greater for diabetes mellitus, obesity and stroke in the highest PIR quartile compared to the lowest PIR quartile. These data suggest a complex interplay between race/ethnicities and income inequalities resulting in disparities in CVD.
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