Clinical procedures used to diagnose inflammatory bowel disease:real-world evidence from a Danish nationwide population-based study

OBJECTIVE: Although clinical guidelines exist, the diagnostic work-up for diagnosing inflammatory bowel disease (IBD) is complex and varies in clinical practice. This study used real-life data to characterise the current diagnostic procedures used to establish IBD diagnoses in a Danish nationwide setting. DESIGN: Person-level data on patients diagnosed with IBD between 1 January 2014 and 30 June 2018 were linked between Danish health registers. Information on age, sex, registration of other gastrointestinal diseases, and diagnostic procedures (endoscopies, biopsies, and imaging) performed in relation to the first IBD hospital admission was analysed for the total study population and was stratified by IBD type, sex, and age. RESULTS: The majority of the 12 871 patients with IBD included underwent endoscopy (84%), had a biopsy taken (84%), and/or underwent imaging procedures (44%). In total, 7.5% of the population (6% for Crohn’s disease and 8% for ulcerative colitis) were diagnosed with IBD despite not undergoing any of these diagnostic procedures. Patients with Crohn’s disease underwent more procedures than patients with ulcerative colitis (94% vs 92%, p<0.001). Children underwent slightly fewer diagnostic procedures than adults (92% vs 93%, p=0.004). Slightly more men underwent at least one procedure than women (92% vs 94%, p<0.001). CONCLUSION: For 7.5% of patients with IBD, this study did not detect any registrations of the recommended diagnostic procedures for establishing an IBD diagnosis. Further research is needed to examine whether these findings are mainly explained by limitations of the register data or also indicate shortcomings of the general approach to IBD

Prevalence and incidence of chronic kidney disease stage 3–5 – results from KidDiCo

Abstract Background Chronic kidney disease (CKD) is a global challenge. CKD prevalence estimation is central to management strategies and prevention. It is necessary to predict end stage kidney disease (ESKD) and, subsequently, the burden for healthcare systems. In this study we characterize CKD stage 3–5 prevalence and incidence in a cohort covering the majority of the Region of Southern Denmark and investigate individuals’ demographic, socioeconomic, and comorbidity status. Methods We used data from the Kidney Disease Cohort (KidDiCo) combining laboratory data from Southern Denmark with Danish national databases. Chronic kidney disease was defined according to the Kidney Disease: Improving Global Outcomes (KDIGO) guidelines. Results The prevalence varied between 4.83 and 4.98% and incidence rate of CKD was 0.49%/year. The median age was 76.4 years. The proportion of individuals with CKD stage 3–5 in the entire population increased consistently with age. The percentage of women in the CKD 3–5 group was higher than in the background population. Diabetes mellitus, hypertension and cardiovascular disease were more prominent in patients with CKD. CKD stage 5 and ESKD were more frequent as incident CKD stages in the 18–49 year olds when compared to older individuals. CKD patients tended to have a lower socioeconomic status. Conclusion Chronic kidney disease stage 3–5 is common, especially in the elderly. Patients with CKD stage 3–5 are predominantly female. The KidDiCo data suggests an association between lower socioeconomic status and prevalence of CKD

Rate and Risk Factors of Acute Myocardial Infarction after Debut of Chronic Kidney Disease—Results from the KidDiCo

Chronic kidney disease (CKD) is a known risk factor for cardiovascular disease, including acute myocardial infarction. However, whether this risk is only associated with severe kidney disease or is also related to mildly impaired kidney function is still under debate. The incidence rate and risk factors of incident acute myocardial infarction (AMI) in patients with CKD are sparse. Potential differences in risk factor profiles between CKD patients with incident AMI and CKD patients with a prior AMI have not been sufficiently investigated. Furthermore, important factors such as albuminuria and socio-economic factors are often not included. The primary aim of this study was to establish the incidence rate of AMI after CKD debut. Secondly, to evaluate the importance of different CKD stages and the risk of having an AMI. Finally, to identify individuals at risk for AMI after CKD debut adjusted for prevalent AMI. Based on data from the kidney disease cohort of Southern Denmark (KidDiCo), including 66,486 CKD patients, we established incidence rates and characteristics of incident AMI among patients within a 5-year follow-up period after CKD debut. A Cox regression was performed to compute the cause-specific hazard ratios for the different risk factors. The incidence rate for CKD stage G3–5 patients suffering acute myocardial infarction is 2.5 cases/1000 people/year. In patients without a previous myocardial infarction, the risk of suffering a myocardial infarction after CKD debut was only significant in CKD stage G4 (HR = 1.402; (95% CI: 1.08–1.81); p-value = 0.010) and stage G5 (HR = 1.491; (95% CI: 1.01–2.19); p-value = 0.042). This was not the case in patients who had suffered an acute myocardial infarction prior to their CKD debut. In this group, a previous myocardial infarction was the most critical risk factor for an additional myocardial infarction after CKD debut (HR = 2.615; (95% CI: 2.241–3.05); p-value < 0.001). Irrespective of a previous myocardial infarction, age, male sex, hypertension, and a low educational level were significant risk factors associated with an acute myocardial infarction after CKD debut. The incidence rate of AMI in patients with CKD stage G3–5 was 2.5 cases/1000 people/year. Risk factors associated with incident AMI in CKD stage G3–5 patients were CKD stage, age, and hypertension. Female sex and higher educational levels were associated with a lower risk for AMI. Prior AMI was the most significant risk factor in patients with and without previous AMI before fulfilling CKD stage G3–5 criteria. Only age, sex, and a medium-long educational level were significant risk factors in this group

Time trends in patients managed simultaneously in multiple hospital outpatient specialty clinics for chronic diseases: A register-based cross-sectional study

Background: The increasing prevalence of patients with multimorbidity in the general population affects the health-care system. There is a lack of knowledge of the proportion of patients attending multiple hospital outpatient specialty clinics simultaneously. Objective: This study describes the development in the proportion of patients managed simultaneously in multiple hospital outpatient specialty clinics. Design: We obtained three cross-sectional samples from all of the hospitals in Denmark. The data set consists of adults (age 18+) in long-term outpatient care on January 1 in 2004, 2009, and 2014 with one or more of 50 consensus-selected chronic diseases. Descriptive statistics were used to examine and compare the proportion of patients treated simultaneously in multiple outpatient specialty clinics. We also investigated the most common combinations of outpatient specialty clinics. Results: In 2004, 176,786 patients with chronic diseases were registered as receiving outpatient care in Denmark. This figure increased to 246,542 patients in 2009 and 341,015 in 2014. The proportion of patients managed simultaneously in multiple outpatient specialty clinics was 4.0% in 2004, 5.5% in 2009, and 7.7% in 2014. The most common specialty clinic combination was endocrinology and cardiology, accounting for 12.1% in 2004, 11.5% in 2009, and 9.6% in 2014. Conclusions: The proportion of patients in multiple clinics nearly doubled over a 10-year period. While there were some common specialty clinic combinations in which patients were treated most often, there was also considerable variation. Further studies are needed to identify generic and disease-specific initiatives