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Introduction: Conservative therapy is a viable option for patients with chronic subdural hematoma (cSDH) who express no, or only mild symptoms. It is not clear which factors are associated with success of conservative therapy. This study aims to determine conservative therapy's success rate and to identify features possibly associated with success. Methods: A monocenter retrospective cohort study, including cSDH patients treated conservatively (wait-and-watch) from 2012 to 2022, was performed. The primary outcome was success of conservative therapy, defined as 'no crossover to surgery' during the follow-up period. Secondary outcomes were (1) factors associated with success, analyzed with univariate and multivariable logistic regression analyses, (2) 30-day mortality (3) time to crossover and (4) reasons for crossover. Results: We included 159 patients. Conservative therapy was successful in 96 (60%) patients. Hematoma volume (OR 0.79, 95% CI 0.69–0.92) and hypodense hematoma type (OR 3.57, 95% 1.38–9.23) were associated with success. Thirty-day mortality rate was 5% and the median duration between diagnosis and surgery was 19 days (IQR 8–39). Clinical deterioration was the most frequent reason for crossover (in 61/63 patients, 97%) and was accompanied by radiological hematoma progression in 42 patients (67%). Conclusion: In this selected group of patients, conservative therapy was successful in 60%. Smaller hematoma volume and hypodense hematoma type were associated with success. As time until crossover was approximately three weeks, deploying conservative therapy as primary treatment seems safe and could be rewarding as surgical complications can be avoided. Improvement in patient selection in future cohorts remains warranted. [ABSTRACT FROM AUTHOR]

Background and purpose: Risk factors for stroke differ between women and men in general populations. However, little is known about sex differences in secondary prevention. We investigated if sex interacted with modifiable risk factors for stroke in a large arterial disease cohort. Methods: Within the prospective UCC-SMART study, 13,898 patients (35% women) with atherosclerotic disease or high-risk factor profile were followed up to 23 years for stroke incidence or recurrence. Hypertension, smoking, diabetes, overweight, dyslipidemia, high alcohol use, and physical inactivity were studied as risk factors. Association between these factors and ischemic and hemorrhagic stroke incidence or recurrence was studied in women and men using Cox proportional hazard models and Poisson regression models. Women-to-men relative hazard ratios (RHR) and rate differences (RD) were estimated for each risk factor. Left-truncated age was used as timescale. Results: The age-adjusted stroke incidence rate was lower in women than men (3.9 vs 4.4 per 1000 person-years), as was the age-adjusted stroke recurrence rate (10.0 vs 11.7). Hypertension and smoking were associated with stroke risk in both sexes. HDL cholesterol was associated with lower stroke incidence in women but not in men (RHR 0.49; CI 0.27–0.88; and RD 1.39; CI − 1.31 to 4.10). Overweight was associated with a lower stroke recurrence in women but not in men (RHR 0.42; CI 0.23–0.80; and RD 9.05; CI 2.78–15.32). Conclusions: In high-risk population, sex modifies the association of HDL cholesterol on stroke incidence, and the association of overweight on stroke recurrence. Our findings highlight the importance of sex-specific secondary prevention. [ABSTRACT FROM AUTHOR]

This study aimed to assess the correlation between glycemic status (prediabetes and type 2 diabetes mellitus) and the risk of gastric cancer according to menopausal status. A total of 982,559 pre/peri-menopausal and 1445,419 postmenopausal women aged ≥ 40, who underwent the Korean national health screening in 2009, were included and followed up until 2018. Hazard ratio (HR) and 95% confidence interval (CI) were calculated for development of gastric cancers according to hyperglycemic status in both groups using Cox proportional hazards models. Over a mean follow-up period of 8.3 years, 3259 (0.33%) pre/peri-menopausal women and 13,245 (0.92%) postmenopausal women were diagnosed with gastric cancer. In postmenopausal women, only diabetes mellitus conferred a higher risk of gastric cancer compared to normal glycemic status (HR, 1.15; 95% CI, 1.09–1.20), with an increasing trend of gastric cancers from prediabetes to diabetes (P for trend < 0.001) observed regardless of menopausal status. Obesity, smoking, and heavy alcohol consumption was associated with increased gastric cancer risk mainly in the postmenopausal period. The risk of gastric cancer escalates with deteriorating glycemic status in a dose-response manner. Diabetes mellitus is linked with an elevated risk of gastric cancer in postmenopausal women. [ABSTRACT FROM AUTHOR]

Alongside a marked increase in the population of older New Zealanders has been an increase in tooth retention: more and more older adults now have at least some of their own teeth. Understanding their oral health demands consideration of their journey along the life course. The common clinical oral conditions – dental caries ('tooth decay') and periodontitis ('gum disease') – are both chronic and cumulative, and highly socially patterned in their occurrence, being more prevalent and severe in those of lower socio-economic position. Those who have ended up with 'good oral health' in old age are those who have had the wherewithal to adapt successfully to their oral disease burden as it has accumulated over the years. In this paper, I consider the utility of the life course approach for interpreting and understanding data, and I apply its principles to a number of important observations on older people's oral health. [ABSTRACT FROM AUTHOR]

Persistent human papillomavirus (HPV) infection can cause anogenital and oropharyngeal cancers. Many HPV infections and HPV-associated cancers are vaccine-preventable. Studies suggest long-term persistence of vaccine-induced antibodies. However, data are limited among Alaska Native people. During 2011–2014, we enrolled Alaska Native children aged 9–14 years who received a 3-dose series of quadrivalent HPV vaccine (4vHPV). We collected sera at 1 month and 1, 2, 3, and 5 years post-vaccination to evaluate trends in type-specific immunoglobulin G antibody concentrations for the 4vHPV types (HPV 6/11/16/18). All participants (N = 469) had detectable antibodies against all 4vHPV types at all timepoints post-vaccination. For all 4vHPV types, antibody levels peaked by 1 month post-vaccination and gradually declined in subsequent years. At 5 years post-vaccination, antibody levels were higher among children who received 4vHPV at a younger age. Alaska Native children maintained antibodies against all 4vHPV types at 5 years post-vaccination. [ABSTRACT FROM AUTHOR]

Background: Plasma amyloid-β (Aβ) has emerged as an important tool to detect risks of Alzheimer's disease and related dementias, although research in diverse populations is lacking. Objective: We compared plasma Aβ42/40 by race with dementia risk over 15 years among Black and White older adults. Methods: In a prospective cohort of 997 dementia-free participants (mean age 74±2.9 years, 55% women, 54% Black), incident dementia was identified based on hospital records, medication, and neurocognitive test over 15 years. Plasma Aβ42/40 was measured at Year 2 and categorized into low, medium, and high tertile. We used linear regression to estimate mean Aβ42/40 by race and race-stratified Cox proportional hazards models to assess the association between Aβ42/40 tertile and dementia risk. Results: Black participants had a lower age-adjusted mean Aβ 42/40 compared to White participants, primarily among APOE ɛ4 non-carriers (Black: 0.176, White: 0.185, p = 0.035). Among Black participants, lower Aβ 42/40 was associated with increased dementia risk: 33% in low (hazard ratios [HR] = 1.77, 95% confidence interval 1.09–2.88) and 27% in medium tertile (HR = 1.67, 1.01–2.78) compared with 18% in high Aβ 42/40 tertile; Increased risks were attenuated among White participants: 21% in low (HR = 1.43, 0.81–2.53) and 23% in medium tertile (HR = 1.27, 0.68–2.36) compared with 15% in high Aβ 42/40 tertile. The interaction by race was not statistically significant. Conclusions: Among community-dwelling, non-demented older adults, especially APOE ɛ4 non-carriers, Black individuals had lower plasma Aβ 42/40 and demonstrated a higher dementia risk with low Aβ42/40 compared with White individuals. [ABSTRACT FROM AUTHOR]

Background: Loneliness, dementia, and mortality are interconnected. Objective: We aimed at understanding mediating pathways and interactions between loneliness and dementia in relation to mortality risk. Methods: The study tested bi-directional relationships between dementia, loneliness, and mortality, by examining both interactions and mediating effects in a large sample of older US adults participating in the nationally representative Health and Retirement Study. Out of≤6,468 older participants selected in 2010, with mean baseline age of 78.3 years and a follow-up time up to the end of 2020, 3,298 died at a rate of 64 per 1,000 person-years (P-Y). Cox proportional hazards and four-way decomposition models were used. Results: Algorithmically defined dementia status (yes versus no) was consistently linked with a more than two-fold increase in mortality risk. Dementia status and Ln(odds of dementia) were strongly related with mortality risk across tertiles of loneliness score. Loneliness z-score was also linked to an elevated risk of all-cause mortality regardless of age, sex, or race or ethnicity, and its total effect (TE) on mortality was partially mediated by Ln(odds of dementia), z-scored, (≤40% of the TE was a pure indirect effect). Conversely, a small proportion (<5%) of the TE of Ln(odds of dementia), z-scored, on mortality risk was explained by the loneliness z-score. Conclusions: In sum, dementia was positively associated with all-cause mortality risk, in similar fashion across loneliness score tertiles, while loneliness was associated with mortality risk. TE of loneliness on mortality risk was partially mediated by dementia odds in reduced models. [ABSTRACT FROM AUTHOR]

Aims Methods Results Conclusions The aim of this study is to compare quality of diabetes care in people with type 2 diabetes by ethnicity, in Scotland.Using a linked national diabetes registry, we included 162,122 people newly diagnosed with type 2 diabetes between 2009 and 2018. We compared receipt of nine guideline indicated processes of care in the first‐year post‐diabetes diagnosis using logistic regression, comparing eight ethnicity groups to the White group. We compared annual receipt of HbA1c and eye screening during the entire follow‐up using generalised linear mixed effects. All analyses adjusted for confounders.Receipt of diabetes care was lower in other ethnic groups compared to White people in the first‐year post‐diagnosis. Differences were most pronounced for people in the: African, Caribbean or Black; Indian; and other ethnicity groups for almost all processes of care. For example, compared to White people, odds of HbA1c monitoring were: 44% lower in African, Caribbean or Black people (OR 0.56 [95% CI 0.48, 0.66]); 47% lower in Indian people (OR 0.53 [95% CI 0.47, 0.61]); and 50% lower in people in the other ethnicity group (OR 0.50 [95% CI 0.46, 0.58]). Odds of receipt of eye screening were 30%–40% lower in most ethnic groups compared to the White group. During median 5 year follow‐up, differences in HbA1c monitoring and eye screening largely persisted, but attenuated slightly for the former.There are marked ethnic disparities in routine diabetes care in Scotland in the short‐ and medium‐term following diabetes diagnosis. Further investigation is needed to establish and effectively address the underlying reasons. [ABSTRACT FROM AUTHOR]

Background and purpose Methods Results Conclusions Cardiovascular outcome trials demonstrate that glucagonlike peptide‐1 receptor agonists (GLP‐1RAs) reduce the risk of major adverse cardiovascular events in patients with type 2 diabetes (T2D), whereas dipeptidyl peptidase‐4 inhibitors (DPP‐4is) have not shown cardiovascular benefits. We compared acute ischemic stroke (AIS) with T2D treated with either a GLP‐1RA or DPP‐4i prior to the index stroke.This national cohort study included AIS patients with T2D from 2017 to 2020 in Denmark who were users of a GLP‐1RA or DPP‐4i. To be categorized as a user, we required at least 12 months of exposure and no concurrent treatment with another newer glucose‐lowering medication during the last 3 months prior to the index stroke. GLP‐1RA users were compared to users of DPP‐4i while adjusting for the calendar year of index stroke, age, sex, comorbidity, and socioeconomic factors.The study included 1567 AIS events with T2D; 593 were users of GLP‐1RA and 974 of DPP‐4i. The absolute risk of a very severe stroke was 2.4% (95% confidence interval [CI] = 1.2–3.7) in GLP‐1RA users and 6.1% (95% CI = 4.6–7.7) in DPP‐4i users. The corresponding adjusted risk ratio (aRR) of GLP‐1RA versus DPP‐4i was 0.49 (95% CI = 0.24–1.00). The aRRs of 30‐day and 365‐day mortality were 0.55 (95% CI = 0.32–0.94) and 0.72 (95% CI = 0.53–0.98), respectively.The risk of a very severe stroke as well as the 30‐day and 365‐day poststroke mortality rates were lower among the AIS patients with comorbid T2D receiving GLP‐1RA prior to the index stroke compared to those receiving DPP‐4i. Hence, GLP‐1RA may improve stroke outcomes in comparison with DPP‐4i. [ABSTRACT FROM AUTHOR]

Background Methods Results Conclusions We examine precursors of child emotional distress during the COVID‐19 pandemic in a prospective intergenerational Australian cohort study.Parents (N = 549, 60% mothers) of 934 1–9‐year‐old children completed a COVID‐19 specific module in 2020 and/or 2021. Decades prior, a broad range of individual, relational and contextual factors were assessed during parents' own childhood, adolescence and young adulthood (7–8 to 27–28 years old; 1990–2010) and again when their children were 1 year old (2012–2019).After controlling for pre‐pandemic socio‐emotional behaviour problems, COVID‐19 child emotional distress was associated with a range of pre‐pandemic parental life course factors including internalising difficulties, lower conscientiousness, social skills problems, poorer relational health and lower trust and tolerance. Additionally, in the postpartum period, pre‐pandemic parental internalising difficulties, lower parental warmth, lower cooperation and fewer behavioural competencies predicted child COVID‐19 emotional distress.Findings highlight the importance of taking a larger, intergenerational perspective to better equip young populations for future adversities. This involves not only investing in child, adolescent, and young adult emotional and relational health, but also in parents raising young families. [ABSTRACT FROM AUTHOR]

Background: Air pollution has been recognised as a potential risk factor for dementia. Yet recent epidemiological research shows mixed evidence. The aim of this study is to investigate the longitudinal associations between ambient air pollution exposure and dementia in older people across five urban and rural areas in the UK. Methods: This study was based on two population-based cohort studies of 11329 people aged ≥ 65 in the Cognitive Function and Ageing Study II (2008–2011) and Wales (2011–2013). An algorithmic diagnosis method was used to identify dementia cases. Annual concentrations of four air pollutants (NO2, O3, PM10, PM2.5) were modelled for the year 2012 and linked via the participants' postcodes. Multistate modelling was used to examine the effects of exposure to air pollutants on incident dementia incorporating death and adjusting for sociodemographic factors and area deprivation. A random-effect meta-analysis was carried out to summarise results from the current and nine existing cohort studies. Results: Higher exposure levels of NO2 (HR: 1.04; 95% CI: 0.94, 1.14), O3 (HR: 0.90; 95% CI: 0.70, 1.15), PM10 (HR: 1.17; 95% CI: 0.86, 1.58), PM2.5 (HR: 1.41; 95% CI: 0.71, 2.79) were not strongly associated with dementia in the two UK-based cohorts. Inconsistent directions and strengths of the associations were observed across the two cohorts, five areas, and nine existing studies. Conclusions: In contrast to the literature, this study did not find clear associations between air pollution and dementia. Future research needs to investigate how methodological and contextual factors can affect evidence in this field and clarity the influence of air pollution exposure on cognitive health over the lifecourse. [ABSTRACT FROM AUTHOR]

Background: Vaginal bleeding (VB) before 20 gestational weeks of a viable pregnancy is a manifestation of a threatened miscarriage. VB is associated with increased levels of pro‐inflammatory cytokines such as interferon‐gamma, tumour necrosis factor‐alpha and interleukin‐6. Increased levels of these cytokines and oxidative stress are risk factors for cancer. The risk of cancer following a VB‐affected pregnancy that ended in childbirth is unknown. Objectives: To investigate the associations between VB in pregnancy that resulted in delivery and risk of incident cancer. Methods: We conducted a cohort study (1995–2018) in Denmark using administrative and healthcare registries. We included 37,082 VB‐affected deliveries, 1,363,614 VB‐unaffected deliveries, 324,328 pregnancies ending in terminations, and 137,104 miscarriages. We computed the absolute risk of cancer and hazard ratios (HR) with 95% confidence intervals (CI) adjusted for age, calendar year, morbidities, and socio‐economic factors using Cox proportional hazards regression. Multiple pregnancies to the same woman were accounted for in the analysis. Results: The median (25th–75th percentile) follow‐up in the study was 12.6 (6.9, 18.2) years. The prevalence of VB in the present study was 3%. At the end of the follow‐up, there were 1320 cancer cases among the VB‐affected delivery cohort, 40,420 among the VB‐unaffected delivery cohort, 10,300 among the termination cohort and 4790 among the miscarriage cohort. HRs for any cancer among VB‐affected deliveries were 1.03 (95% CI 0.97, 1.08) compared with VB‐unaffected deliveries, 1.03 (95% CI 0.97, 1.09) compared with terminations and 0.90 (95% CI 0.84, 0.95) compared with miscarriages. There were no increased risks of premenopausal breast cancer, cervical cancer, ovary and fallopian tube cancer or uterine cancer following VB‐affected deliveries vs. comparison cohorts. Conclusions: We found no evidence of an association between vaginal bleeding in pregnancy and an increased risk of cancer. [ABSTRACT FROM AUTHOR]

Cohort study in deprived communities to investigate the persistence of food insecurity (FI) during the COVID-19 was conducted. Sample were derived from a list of mobile phone numbers provided by community leaders and local nonprofit organizations. Temporal trends and prevalence ratios of FI persistence, categorized as "never," "occasional FI," "consistent FI," were calculated. A total of 302 households completed three assessments, the majority nonwhite women. During the follow-up, families covered by social assistance increased; however, their income decreased (p < 0.05). 33% were "consistent," and 46% "occasional" FI. Permanent difficulties accessing gas canisters, hygiene products, and hand sanitizers were observed. [ABSTRACT FROM AUTHOR]

Background/Aims: Pneumocystis jirovecii pneumonia (PJP) is a rare but potentially fatal infection. This study was conducted to investigate the risk factors for PJP in inflammatory bowel disease (IBD) patients. Methods: This nationwide, population-based study was conducted in Korea using claims data. Cases of PJP were identified in patients diagnosed with ulcerative colitis (UC) or Crohn’s disease (CD) between 2010 and 2017, and the clinical data of each patient was analyzed. Dual and triple therapy was defined as the simultaneous prescription of two or three of the following drugs: steroids, calcineurin inhibitors, immunomodulators, and biologics. Results: During the mean follow-up period (4.6±2.3 years), 84 cases of PJP were identified in 39,462 IBD patients (31 CD and 53 UC). For CD patients, only age at diagnosis >40 years (hazard ratio [HR], 6.12; 95% confidence interval [CI], 1.58 to 23.80) was significantly associated with the risk of PJP, whereas in UC patients, diagnoses of diabetes (HR, 2.51; 95% CI, 1.19 to 5.31) and chronic obstructive pulmonary disease (HR, 3.41; 95% CI, 1.78 to 6.52) showed significant associations with PJP risk. Triple therapy increased PJP risk in both UC (HR, 3.90; 95% CI, 1.54 to 9.88) and CD patients (HR, 5.69; 95% CI, 2.32 to 14.48). However, dual therapy increased PJP risk only in UC patients (HR, 2.53; 95% CI, 1.36 to 4.70). Additionally, 23 patients (27%) received intensive care treatment, and 10 (12%) died within 30 days. Conclusions: PJP risk factors differ in CD and UC patients. Considering the potential fatality of PJP, prophylaxis should be considered for at-risk IBD patients. [ABSTRACT FROM AUTHOR]

Objective: Understanding factors driving variation in status epilepticus outcomes would be critical to improve care. We evaluated the degree to which patient and hospital characteristics explained hospital‐to‐hospital variability in intubation and postacute outcomes. Methods: This was a retrospective cohort study of Medicare beneficiaries admitted with status epilepticus between 2009 and 2019. Outcomes included intubation, discharge to a facility, and 30‐ and 90‐day readmissions and mortality. Multilevel models calculated percent variation in each outcome due to hospital‐to‐hospital differences. Results: We included 29 150 beneficiaries. The median age was 68 years (interquartile range [IQR] = 57–78), and 18 084 (62%) were eligible for Medicare due to disability. The median (IQR) percentages of each outcome across hospitals were: 30‐day mortality 25% (0%–38%), any 30‐day readmission 14% (0%–25%), 30‐day status epilepticus readmission 0% (0%–3%), 30‐day facility stay 40% (25%–53%), and intubation 46% (20%–61%). However, after accounting for many hospitals with small sample size, hospital‐to‐hospital differences accounted for 2%–6% of variation in all unadjusted outcomes, and approximately 1%–5% (maximally 8% for 30‐day readmission for status epilepticus) after adjusting for patient, hospitalization, and/or hospital characteristics. Although many characteristics significantly predicted outcomes, the largest effect size was cardiac arrest predicting death (odds ratio = 10.1, 95% confidence interval = 8.8–11.7), whereas hospital characteristics (e.g., staffing, accreditation, volume, setting, services) all had lesser effects. Significance: Hospital‐to‐hospital variation explained little variation in studied outcomes. Rather, certain patient characteristics (e.g., cardiac arrest) had greater effects. Interventions to improve outcomes after status epilepticus may be better focused on individual or prehospital factors, rather than at the inpatient systems level. [ABSTRACT FROM AUTHOR]

The spread of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) since late 2019 represented an unprecedented public health emergency, which included a need to fully understand coronavirus disease 2019 (COVID-19) across all ages and populations. In response, the US National Institute of Allergy and Infectious Diseases (NIAID) rapidly funded epidemiology studies that monitored COVID-19. However, the diversity and breadth of the populations studied in NIAID-funded COVID-19 observational cohorts were not easy to extrapolate because of siloed approaches to collect and report data within NIAID. Here, we describe the effort to develop a harmonized cohort-study reporting tool that includes common epidemiologic data elements as well as NIAID priorities. We report its implementation to analyze metadata from 58 COVID-19 cohort studies funded from February 2020 to June 2021, and we visualize key metadata, including geographic distribution, study duration, participant demographic characteristics, sample types collected, and scientific priorities addressed. A bibliographic analysis highlights the scientific publications and citations across these funded studies and demonstrates their enormous impact on the COVID-19 field. These analyses highlight how common data elements and reporting tools can assist funding agencies to capture the landscape and potential gaps during public health responses and how they can assist in decision making. [ABSTRACT FROM AUTHOR]

Background: The emotional impact of the coronavirus disease 2019 (COVID-19) pandemic on people with dementia has been quantified. However, little is known about the impact of change in home-care use owing to the pandemic. Objective: To determine the longitudinal association between dementia, change in home-care use, and depressive symptoms during the pandemic. Methods: We included data of 43,782 home-dwelling older adults from the English Longitudinal Study of Ageing (ELSA), Study of Health, Ageing and Retirement in Europe (SHARE), and National Health and Aging Trends Study (NHATS). This study considered the latest main wave survey prior to the pandemic as the baseline, and the COVID-19 survey as follow-up. In a series of coordinated analyses, multilevel binomial logistic regression model was used to examine the association between baseline dementia, change in home-care use at follow-up, and presence of depressive symptoms. Results: Dementia, using the ELSA, SHARE, and NHATS datasets, was identified in 2.9%, 2.3%, and 6.5% of older adults, and home-care use reduced in 1.7%, 2.8%, and 1.1% of individuals with dementia, respectively. Dementia was significantly associated with the increased risk of depressive symptoms in all three cohorts. However, the interaction between dementia and period (follow-up) was non-significant in SHARE and NHATS. Across all three cohorts, home-care use during the pandemic, regardless of change in amount, was significantly associated with increased depressive symptoms, compared to the non-use of home care. Conclusions: These results highlight the need for tailoring dementia care at home to promote independence and provide sustainable emotional support. [ABSTRACT FROM AUTHOR]

Introduction: Bacillus Calmette–Guérin (BCG) vaccination induces long-lasting effects on the adaptive and innate immune systems and prevents development of experimental autoimmune encephalomyelitis and possibly also inflammatory disease activity in multiple sclerosis (MS). Objective: The objective is to examine if BCG given in early adulthood decreases MS risk. Methods: From 791,369 (52% females) Norwegians participating in a national tuberculosis screening program from 1963 to 1975, we collected information on BCG vaccination and tuberculosis disease status. Later, MS disease was ascertained through both the Norwegian MS Registry and Biobank and the Norwegian Death Registry. We used logistic regression models to assess the relationship between BCG vaccination and MS risk. Results: In those BCG vaccinated, mean age at vaccination was 15.6 (standard deviation (SD) = 5.5) years. A total of 2862 (65% females) MS cases were retrieved. Overall, we found no association between MS risk and BCG vaccination. Compared to non-BCG-vaccinated individuals with no signs of tuberculosis infection, odds ratio (OR) for MS was 1.00 (95% confidence interval (CI) = 0.80–1.25) in the BCG-vaccinated group. In those not BCG vaccinated because of latent tuberculosis infection, the corresponding OR was 0.86 (95% CI = 0.66–1.13). Conclusion: We found no evidence of BCG vaccination or latent tuberculosis infection in young adulthood being linked to MS risk. [ABSTRACT FROM AUTHOR]

Objectives To investigate the effects of passive immunization with the anti-severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) monoclonal antibodies tixagevimab/cilgavimab on humoral responses and on coronavirus disease 2019 (COVID-19) outcomes in vaccine-refractory patients with immune-mediated inflammatory diseases (IMIDs) at high risk of severe COVID-19. Methods A prospective cohort study was performed on a cohort of high-risk vaccine-refractory IMID patients treated with a single dose of tixagevimab/cilgavimab (150 mg/150 mg). COVID-19 outcomes as well as serum and salivary anti-SARS-CoV-2 IgG were assessed at baseline and for at least 6 months. Results were compared with an untreated high-risk vaccine-refractory IMID population. Standardized incidence ratios (SIRs) of COVID-19 compared with the general population were calculated for both groups. Results A total of 38 high-risk IMID patients received tixagevimab/cilgavimab and were compared with 114 untreated high-risk IMID controls. Serum anti-spike IgG increased to 6.6 OD (s. d. 0.8) at day 1 and remained positive up to month 6 [6.3 OD (s. d. 1.4)]. Salivary anti-spike IgG peaked at month 2 [1.6 OD (s. d. 1.1)] and decreased from month 3 [0.8 OD (s. d. 0.3)]. No severe or extended infection was observed in the tixagevimab/cilgavimab group. Compared with the general population, the SIR of COVID-19 in treated patients was 0.76 (95% CI 0.24, 1.58) despite the increased risk profile. The SIR of the control group was 1.51 (95% CI 1.07, 2.02), corresponding to a significantly increased incidence. Conclusions Passive immunization with tixagevimab/cilgavimab is safe and effective in inducing anti-SARS-CoV-2 immunity and potentially in preventing COVID-19 in high-risk vaccine-refractory IMID patients. These data provide a proof of concept for the use of monoclonal antibodies as a preventative strategy against SARS-CoV-2 in vulnerable populations. [ABSTRACT FROM AUTHOR]

Objectives This study examines the gender-specific associations between a wide range of social activities and dementia risk. Methods A prospective cohort study was conducted involving community-dwelling older Australians (≥70 years) without significant cognitive impairment at enrolment. During the first year of enrolment, we assessed 25 self-reported social activities covering various aspects, including support from relatives and friends, community participation, social interactions with surroundings, and loneliness. Dementia diagnosis followed DSM-IV criteria, adjudicated by an international expert panel. To estimate hazard ratios (HR) and 95% confidence intervals (CI) for associations between social activities and dementia, we performed Cox proportional hazards models, adjusting for age, educational attainment, baseline global cognition, and depressive symptoms. Results Among 9,936 participants who completed all social activity questionnaires (median [IQR] age: 73.4 [71.6–77.1] years; 47.4% men), dementia was diagnosed in 3.8% of men (n  = 181/4,705) and 2.6% of women (n  = 138/5,231) over a median 6.4 years (IQR: 5.3–7.6, range: 0.2–10.1) follow-up. Gender-specific relationships emerged: caregiving for a person with illness/disability in women (HR: 0.65, 95% CI: 0.42–0.99), and having ≥9 relatives feeling close to call for help in men (HR: 0.56, 95% CI: 0.33–0.96; reference <9 relatives) were associated with reduced dementia risk. Unexpectedly, in women, having ≥5 friends with whom they felt comfortable discussing private matters were associated with a greater dementia risk (HR: 1.69, 95% CI: 1.10–2.59; reference ≤2 friends). Imputed models further identified that babysitting/childminding was associated with lower dementia risk in men (HR: 0.75, 95% CI: 0.56–0.99). No other social activities showed significant associations with dementia. Discussion This study provides evidence of social activities influencing dementia risk. Further investigations are required to uncover the mechanisms driving these observed relationships. [ABSTRACT FROM AUTHOR]

Background: Help‐seeking provides opportunities for early prevention and intervention of mental health problems. However, little is known about factors that impact help‐seeking from a life‐course and socioecological perspective. This study aimed to examine factors that impact adolescents' formal and informal help‐seeking in three population groups: the whole population, adolescents with depressive symptoms and adolescents with anxiety symptoms. Methods: We drew on data from the Longitudinal Study of Australian Children birth cohort. Participants were followed from birth to 14–15 years. Based on previous literature and life‐course and socioecological models, we measured a range of factors at individual and family, interpersonal and community levels at three time points (0–1 year, 4–5 years and 12–13 years). Outcomes at 14–15 years were help‐seeking behaviours divided into three categories (formal help from health professionals, close informal help from friends and family members and broad informal help from other sources). Generalised linear models with logit‐binomial links were used. Results: There were varying and common patterns of influencing factors across the three population groups and sources of help‐seeking. In the whole population, five common factors (female, previous depressive or anxiety symptoms, discrimination and bully victimisation) were associated with all three sources of help‐seeking. Among adolescents with depressive or anxiety symptoms, four common barriers to help‐seeking were male adolescents, speaking a language other than English, having poor relationships with peers and less social support. Conclusion: Both intrinsic and extrinsic barriers exist for adolescents' mental health help‐seeking. There are priority groups of adolescents with mental health problems who are unlikely to seek support and warrant attention. There is a need for multisector collaborations to address barriers to mental health care and promote help‐seeking among adolescents. [ABSTRACT FROM AUTHOR]

Aims Methods Results Conclusions Type 2 diabetes (T2D) is a risk factor for ischemic stroke (IS) and associated with an adverse prognosis. Both stroke and diabetes care has evolved substantially during the last decade.This study aimed to determine the prevalence of T2D among IS patients along with time trends in the risk profile, use of glucose‐lowering medications, quality‐of‐care and clinical outcomes, including stroke severity; length‐of‐stay; mortality, readmission and recurrent stroke in a large national cohort.Registry‐based cohort study including all IS events in Denmark from 2004 to 2020.IS with co‐morbid T2D were compared to IS without diabetes while adjusting for age, sex, stroke severity, co‐morbidity and socio‐economic factors.The study included 169,262 IS events; 24,479 with co‐morbid T2D. The prevalence of T2D in IS increased from 12.0% (2004–2006) to 17.0% (2019–2020). The adjusted absolute 30‐day mortality risk in IS with T2D decreased from 9.9% (2004–2006) to 7.8% (2019–2020). The corresponding adjusted risk ratios (aRR) were 1.22 95% confidence interval (1.09–1.37) and 1.29 (1.11–1.50), respectively. The aRR of 365‐day mortality was in 2004–2006: 1.20 (1.12–1.29) and in 2019–2020: 1.34 (1.22–1.47). The 30‐ and 365‐day readmissions rates were also consistently higher in IS with T2D.The prevalence of T2D in IS increased over time. The 30‐ and 365‐day mortality rates decreased over the time‐period but were consistently higher in IS with co‐morbid T2D. Readmissions were also higher in IS with T2D. This highlights an urgent need for strategies to further improve the prognosis in IS patients with co‐morbid T2D. [ABSTRACT FROM AUTHOR]

Observational data provide invaluable real-world information in medicine, but certain methodological considerations are required to derive causal estimates. In this systematic review, we evaluated the methodology and reporting quality of individual-level patient data meta-analyses (IPD-MAs) conducted with non-randomized exposures, published in 2009, 2014, and 2019 that sought to estimate a causal relationship in medicine. We screened over 16,000 titles and abstracts, reviewed 45 full-text articles out of the 167 deemed potentially eligible, and included 29 into the analysis. Unfortunately, we found that causal methodologies were rarely implemented, and reporting was generally poor across studies. Specifically, only three of the 29 articles used quasi-experimental methods, and no study used G-methods to adjust for time-varying confounding. To address these issues, we propose stronger collaborations between physicians and methodologists to ensure that causal methodologies are properly implemented in IPD-MAs. In addition, we put forward a suggested checklist of reporting guidelines for IPD-MAs that utilize causal methods. This checklist could improve reporting thereby potentially enhancing the quality and trustworthiness of IPD-MAs, which can be considered one of the most valuable sources of evidence for health policy. [ABSTRACT FROM AUTHOR]

Background: The pathogenesis of inflammatory bowel disease (IBD) has not been fully elucidated. The aim of this study was to analyze the pregnancy period, perinatal period, and infancy period risk factors for IBD in a well-characterized birth cohort from Northern Finland. Methods: The Northern Finland Birth Cohort 1966 (NFBC1966) population comprises mothers living in the two northernmost provinces of Finland, Oulu, and Lapland, with dates of delivery between Jan 1st and Dec 31st, 1966 (12 055 mothers, 12 058 live-born children, 96.3% of all births during 1966). IBD patients were identified using hospital registries (from 1966 to 2020) and Social Insurance Institution (SII) registry reimbursement data for IBD drugs (from 1978 to 2016). The data were analyzed by Fisher's exact test and logistic regression. Results: In total, 6972 individuals provided informed consent for the use of combined SII and hospital registry data. Of those, 154 (2.1%) had IBD (113 [1.6%] had ulcerative colitis (UC), and 41 (0.6%) had Crohn's disease (CD)). According to multivariate analysis, maternal smoking > 10 cigarettes/day during pregnancy was associated with a nearly 6-fold increased risk of CD in the offspring (OR 5.78, 95% CI 1.70–17.3). Breastfeeding (OR = 0.18, 95% CI 0.08–0.44) and iron supplementation during the first year of life (OR = 0.43, 95% CI 0.21–0.89) were negatively associated with CD. Conclusions: Smoking during pregnancy was associated with the risk of CD while Breastfeeding and oral iron supplementation at infancy were negatively associated with the risk of CD later in life. [ABSTRACT FROM AUTHOR]

Purpose The association of physical activity with the risk of bladder cancer remains inconsistent among Asian populations. We aimed to examine the association in a large Japanese cohort. Materials and Methods In a population-based prospective cohort study, a total of 50,374 Japanese adults aged 40-79 years without a history of cancer or cardiovascular disease who had information on physical activity from self-administrated questionnaires were used for analysis. We performed Cox proportional hazard models to estimate the hazard ratios (HRs) and 95% confidence intervals (CIs) for incident bladder cancer after adjusting for several potential confounders. Results During the median 17.5 years of follow-up, 153 incident bladder cancers (116 men and 37 women) were identified. After the multivariable adjustment, HRs (95% CI) of bladder cancer concerning those with recreational sports participation of 1-2 hr/wk, 3-4 hr/wk, and 5 hr/wk and more were 0.67 (0.38-1.20), 0.79 (0.36-1.74), and 0.28 (0.09-0.89), respectively (p for trend=0.017). Compared with mostly sitting at the workplace, occupational physical activity of standing and walking were associated with a lower risk of bladder cancer (HR, 0.53 [95% CI, 0.32 to 0.85]). Hours of daily walking were not associated with the risk. The lower risk of bladder cancer was more evident for recreational sports (HR, 0.33 [95% CI, 0.10 to 1.00]), and for occupational standing and walking activity at work (HR, 0.57 [95% CI, 0.33 to 0.98]) among men. Conclusion Recreational sports participation and occupational physical activity were inversely associated with the risk of bladder cancer among Japanese, especially in men. [ABSTRACT FROM AUTHOR]

Aim: The study aimed to characterize phlebitis in adults in a clinical hospitalization sector, in terms of incidence, related factors and grade. Method: This is a cohort carried out in a clinical hospitalization department of a philanthropic hospital in the interior of the state of São Paulo, Brazil. The study included adults over 18 years old, hospitalized and using peripheral venous access; the invitation was made to each patient on their first day of hospitalization and those who accepted signed the informed consent form (ICF), were included, and evaluated daily for the occurrence of phlebitis, as well as its characteristics. A total of 49 people participated in the research, with a mean age of 61.29 years (sd: 20.692), mostly women (69.39%), white (65.30%). Results: The incidence of phlebitis was 28.56%; age over 60 years (p=0.004) and use of anticoagulants (p=0.025) increased the risk of developing phlebitis. The use of intravenous anti-inflammatory drugs (p=0.008) was related to reduce the amount of phlebitis. Conclusion: It was concluded that the incidence of phlebitis was related to age and use of anticoagulants; intravenous anti-inflammatory medications appear to be a protective factor. [ABSTRACT FROM AUTHOR]

Socioeconomic factors are important correlates of drug use behaviors and health-related outcomes in people who use drugs (PWUD) residing in urban areas. However, less is known about the complex overlapping nature of socioeconomic conditions and their association with a range of individual, drug use, and health-related factors in men and women who use drugs. Data were obtained from two community-recruited prospective cohorts of PWUD. Using a gender-stratified approach, we conducted repeated measures latent class analyses (RMLCA) to identify discrete latent socioeconomic subgroups. Multivariable generalized estimating equations were then used to identify correlates of class membership. Between June 2014 and December 2018, RMLCA of 9844 observations from 1654 participants revealed five distinct patterns of socioeconomic status for both men and women. These patterns were primarily distinguished by variations in income, material and housing security, income generation activity, exposure to violence, criminal justice involvement, and police contact. Across gender, progressive increases in exposure to multiple dimensions of socioeconomic disadvantage were found to be associated with frequent use of opioids and stimulants, accessing social services, and being hepatitis C virus antibody-positive. Similar but less congruent trends across gender were observed for age, binge drug use, engagement with opioid agonist therapy, and living with HIV. Gendered patterns of multiple and overlapping dimensions of socioeconomic adversity aligned with patterns of frequent drug use and health-related concerns, highlighting priority areas for gender-inclusive, multilevel responses to mitigate health disparities and meet the diverse socioeconomic needs of urban-dwelling men and women who use drugs. [ABSTRACT FROM AUTHOR]

Background: We investigated the association between post‐hospital discharge use of sodium glucose cotransporter‐2 inhibitors (SGLT‐2is) compared to dipeptidyl peptidase‐4 inhibitors (DPP‐4is) and the incidence of hospitalization for acute renal failure (ARF) and chronic kidney disease (CKD) in people with type 2 diabetes. Methods: We conducted a retrospective cohort study using linked hospital and prescription data. Our cohort included people aged ≥30 years with type 2 diabetes discharged from a hospital in Victoria, Australia, from December 2013 to June 2018. We compared new users of SGLT‐2is with new users of DPP‐4is following discharge. People were followed from first dispensing of a SGLT‐2i or DPP‐4i to a subsequent hospital admission for ARF or CKD. We used competing risk models with inverse probability of treatment weighting (IPTW) to estimate subhazard ratios. Results: In total, 9620 people initiated SGLT‐2is and 9962 initiated DPP‐4is. The incidence rate of ARF was 12.3 per 1000 person‐years (median years of follow‐up [interquartile range [IQR] 1.4 [0.7–2.2]) among SGLT‐2i initiators and 18.9 per 1000 person‐years (median years of follow‐up [IQR] 1.7 [0.8–2.6]) among DPP‐4i initiators (adjusted subhazard ratio with IPTW 0.78; 95% confidence interval [CI] 0.70–0.86). The incidence rate of CKD was 6.0 per 1000 person‐years (median years of follow‐up [IQR] 1.4 [0.7–2.2]) among SGLT‐2i initiators and 8.9 per 1000 person‐years (median years of follow‐up [IQR] 1.7 [0.8–2.6]) among DPP‐4i initiators (adjusted subhazard ratio with IPTW 0.83; 95% CI 0.73–0.94). Conclusions: Real‐world data support using SGLT‐2is over DPP‐4is for preventing acute and chronic renal events in people with type 2 diabetes. [ABSTRACT FROM AUTHOR]

Objectives: Several studies suggest that antibiotic use may affect overall cancer incidence, but the association between antibiotics and prostate cancer is still unclear. This retrospective cohort study aimed to assess the association between antibiotics and the risk of prostate cancer. Methods: A population‐based retrospective cohort study was conducted using the Korean National Health Insurance Service (NHIS) database. 1 032 397 individuals were followed up from January 1, 2007, to December 31, 2019. Multivariable Cox hazards regression was utilized to calculate adjusted hazard ratios (aHRs) and 95% confidence intervals (CIs) for the risk of prostate cancer according to accumulative days of antibiotic use and the number of antibiotic classes used from 2002 to 2006. Results: Individuals who used antibiotics for 180 or more days had a higher risk of prostate cancer (aHR, 1.46; 95% CI, 1.11–1.91) than those who did not use antibiotics. Also, individuals who used four or more kinds of antibiotics had a higher risk of prostate cancer (aHR, 1.18; 95% CI, 1.07–1.30) than antibiotic non‐users. An overall trend was observed among participants who underwent health examinations. Conclusions: Our findings suggest that long‐term use of antibiotics may affect prostate cancer incidence. Further studies are needed to improve understanding of the association between antibiotic use and prostate cancer incidence. [ABSTRACT FROM AUTHOR]

Objective　To investigate the influence of triglyceride （TG）/high-density lipoprotein cholesterol （HDL-C） ratio on the onset of primary liver cancer. Methods　A prospective cohort study was conducted. Physical examination data were collected from 99 750 cases of on-the-job and retired employees of Kailuan Group who participated health examination from July 2006 to December 2007， and they were followed up till December 31， 2021 to observe the onset of primary liver cancer. A one-way analysis of variance was used for comparison of normally distributed continuous data between multiple groups， and the Kruskal-Wallis H test was used for comparison of continuous data with skewed distribution between multiple groups； the chi-square test was used for comparison of categorical data between groups. According to the tertiles of TG/HDL-C ratio， the subjects were divided into Q1， Q2， and Q3 groups， and the incidence density of primary liver cancer was calculated for each group. The Kaplan-Meier method was used to calculate the cumulative incidence rate of primary liver cancer in each group， and the log-rank test was used to compare the difference in cumulative incidence rate between groups. The Cox proportional hazards model was used to analyze the influence of TG/HDL-C ratio on the onset of primary liver cancer. Results　There were significant differences between the three groups in age， proportion of male subjects， waist circumference， body mass index， fasting blood glucose， systolic pressure， diastolic pressure， triglyceride， total cholesterol， HDL-C， low-density lipoprotein cholesterol， alanine aminotransferase， high-sensitivity C-reactive protein， chronic liver diseases， hypertension， diabetes， the family history of malignant tumor， drinking， smoking， physical exercise， and educational level （P<0.05）. During the mean follow-up time of 14.06±2.71 years， there were 484 cases of new-onset liver cancer， among whom there were 446 male subjects and 38 female subjects. The incidence density of primary liver cancer was 0.39/1 000 person-years in the Q1 group， 0.35/1 000 person-years in the Q2 group， and 0.30/1 000 person-years in the Q3 group， and the cumulative incidence rates of primary liver cancer in the three groups were 6.03‰， 5.28‰， and 4.49‰， respectively， with a significant difference between the three groups based on the long-rank test （χ²=6.06， P=0.048）. After adjustment for the confounding factors considered， the Cox proportional hazards model showed that compared with the Q3 group， the Q1 group had a hazard ratio of 2.04（ 95% confidence interval［ CI］： 1.61 — 2.58， Pfor trend<0.05）， and the Q2 group had a hazard ratio of 1.53（ 95%CI： 1.21 — 1.92， Pfor trend<0.05）. Conclusion　The reduction in TG/HDL-C ratio is associated with an increase in the rask of primary liver cancer， especially in people with chronic liver diseases. [ABSTRACT FROM AUTHOR]

Purpose: Patients with diffuse large B-cell lymphoma (DLBCL) are typically treated with rituximab, cyclophosphamide, doxorubicin, vincristine, and prednisone (R-CHOP). However, a standard of care for managing adolescents and young adults (AYAs) with DLBCL is lacking. We examine treatment approaches and outcomes of this population. Methods: We included 90 AYAs (15–39 years) diagnosed with DLBCL between 2008 and 2018 in three tertiary centers in Peru. Overall response rates (ORR) were available for all patients. Overall survival (OS) and progression-free survival (PFS) rates were estimated using the Kaplan–Meier method. Results: The median age at diagnosis was 33 years, 57% were males, 57% had good performance status (Lansky/Karnofsky ≥90), and 61% were diagnosed with early-stage disease (Ann Arbor stages I–II). R-CHOP (n = 69, 77%) was the most frequently used first-line regimen, with an ORR of 91%. With a median follow-up of 83 months, the 5-year OS and PFS among all patients were 79% and 67%, respectively. Among the patients who received R-CHOP, the 5-year OS and PFS were 77% and 66%, respectively. Of the 29 (32%) patients with relapsed/refractory (R/R) disease, 83% received second-line treatment and only 14% underwent consolidation therapy with autologous transplantation. The 3-year OS for R/R DLBCL was 36%. Conclusion: Our data show that AYAs with DLBCL who received conventional therapy had comparable outcomes to those observed in studies conducted among the adult population. However, the prognosis for AYAs with R/R disease was dismal, indicating the unmet need for developing and increasing access to novel treatment modalities in AYAs. [ABSTRACT FROM AUTHOR]

Background: Traumatic esophageal perforations (TEP) are a grave medical condition and require immediate intervention. Techniques such as Esophageal Self-Expandable Metal Stent (E-SEMS) and Endoscopic Vacuum Therapy (EVT) show promise in reducing tissue damage and controlling esophageal leakage. The present study aims to compare the application of EVT to E-SEMS placement in TEP. Methods: Retrospective cohort study valuated 30 patients with TEP. The E-SEMS and EVT groups were assessed for time of hospitalization, treatment duration, costs, and clinical outcome. Results: Patients treated with EVT (24.4 ± 13.2) demonstrated significantly shorter treatment duration (p < 0.005) compared to the group treated with E-SEMS (45.8 ± 12.9) and patients submitted to E-SEMS demonstrated a significant reduction (p = 0.02) in the time of hospitalization compared to the EVT (34 ± 2 vs 82 ± 5 days). Both groups demonstrated a satisfactory discharge rate (E-SEMS 93.7% vs EVT 71.4%) but did not show statistically significant difference (p = 0.3155). E-SEMS treatment had a lower mean cost than EVT (p < 0.05). Descriptive statistics were utilized, arranged in table form, where frequencies, percentages, mean, median, and standard deviation of the study variables were calculated and counted. The Fisher's Exact Test was used to evaluate the relationship between two categorical variables. To evaluate differences between means and central points, the parametric t-test was utilized. Comparisons with p value up to 0.05 were considered significant. Conclusion: E-SEMS showed a shorter time of hospitalization, but a longer duration of treatment compared to EVT. The placement of E-SEMS and EVT had the same clinical outcome. Treatment with E-SEMS had a lower cost compared with EVT. [ABSTRACT FROM AUTHOR]

Objective Existing data suggest that obstetric outcomes for individuals with twin gestations, who have gestational diabetes mellitus (GDM), may be comparable to those who do not have GDM, yet studies are limited by small sample sizes. The aim of this study was to examine differences in maternal and neonatal outcomes of individuals with twin gestations based on presence of GDM. Methods This was a population-based retrospective cohort study of individuals giving birth to twins in the United States between 2012 and 2014. Inclusion criteria were live births (≥24 weeks) and available information on GDM status; individuals with pregestational diabetes were excluded. Participants were categorized as either having had or not had GDM. Multivariable logistic regression was utilized to assess the independent association of GDM with adverse maternal outcomes, whereas generalized estimating equation models were used to estimate associations with neonatal outcomes to account for clustering. Results Of 173,196 individuals meeting inclusion criteria, 13,194 (7.6%) had GDM. Individuals with GDM were more likely to be older, identify as Hispanic or Asian race and ethnicity, married, college educated, privately insured, and obese than those without GDM. After adjusting for potential confounding variables, those with GDM were more likely to have hypertensive disorders (18.0 vs. 10.2%) and undergo cesarean delivery (51.2 vs. 47.3%). Neonates born to individuals with GDM were more likely to require mechanical ventilation for greater than 6 hours (6.5 vs. 5.6%) and experience neonatal intensive care unit (NICU) admission (41.1 vs. 36.2%), but were less likely to be low birth weight or have small for gestational age status (16.2 vs. 19.5%). Findings were confirmed in a sensitivity analysis of neonates born at 32 weeks of gestation or greater. Conclusion Odds of poor obstetric and neonatal outcomes are increased for individuals with twin gestations complicated by GDM. Key Points Individuals with GDM and twin gestation have higher odds of developing hypertensive disorders during pregnancy and of undergoing cesarean delivery. Neonates of such pregnancies are less likely to be low birth weight or small for gestational age. Neonates of pregnancies complicated by GDM and twin gestation are more likely to require mechanical ventilation and experience NICU admission. [ABSTRACT FROM AUTHOR]

Significant variations in the variables collected in clinical studies focusing on bacteraemia lead to inconsistency in the evaluation of risk factors for mortality. We aimed to define a minimum set of risk factors that should be assessed and reported in all studies assessing survival in bacteraemia. We conducted a systematic review including observational prospective and retrospective cohort studies that assessed all-cause mortality among patients with bacteraemia. We included only studies computing an adjusted analysis for mortality, with >500 participants. Independently significant risk factors for all-cause, preferably 30-day, mortality. PubMed was used to identify eligible studies published between 2000 and 2020. A Delphi survey among experts was used to evaluate and prioritize the factors identified by the systematic review. SIGN checklist complemented by risk of bias assessment of the adjusted analysis. Definite universal risk factors were defined as those assessed in >50% of all included studies and significant in >50% of those. Potential universal risk factors were defined as those significant in >50% of studies evaluating the factor and a subgroup analysis was performed for studies of Staphylococcus aureus bacteraemia. We included in the systematic review 62 studies, comprising more than 300,000 patients, from which a list of 17 risk factors was derived, whose association with all-cause mortality was statistically significant in most studies. The factors address baseline patient variables, the setting of infection acquisition, factors associated with the specific infection, the inflammatory response at onset of sepsis and management parameters where relevant. There were 14 risk factors for S. aureus bacteraemia. We identified a minimum set of universal factors to be collected, reported, and assessed, in all future studies evaluating factors associated with mortality in bacteraemia to improve study quality and harmonization. [ABSTRACT FROM AUTHOR]

Background and purpose: Previous studies have examined the risk of stroke in patients with Parkinson disease (PD), but the incidence of PD onset among stroke patients and its risk according to severity of poststroke disabilities have scarcely been investigated. This study aims to determine whether the risk of PD is increased among stroke patients using a retrospective cohort with a large population‐based database. Methods: We used data collected by the Korean National Health Insurance Service from 2010 to 2018 and examined 307,361 stroke patients and 380,917 sex‐ and age‐matched individuals without stroke to uncover the incidence of PD. Cox proportional hazards regression was used to calculate the hazard ratio (HR) and 95% confidence interval (CI), and the risk of PD was compared according to presence and severity of disability. Results: During 4.31 years of follow‐up, stroke patients had a 1.67 times higher risk of PD compared to individuals without stroke (adjusted HR = 1.67, 95% CI = 1.57–1.78). The risk of PD was greater among stroke patients with disabilities than among those without disabilities, even after adjustment for multiple covariates (adjusted HR = 1.72, 95% CI = 1.55–1.91; and adjusted HR = 1.66, 95% CI = 1.56–1.77, respectively). Conclusions: Our study demonstrated an increased risk of PD among stroke patients. Health professionals need to pay careful attention to detecting movement disorders as clues for diagnosing PD. [ABSTRACT FROM AUTHOR]

Despite much empirical evidence highlighting the harmful effect of socioeconomic disadvantage on educational outcomes, there is a relative lack of understanding of how different risk factors impact upon attainment. Importantly, it has yet to be established what effect, if any, austerity cuts have had on the most disadvantaged students. Using rich data from two British cohort studies (Next Steps and MCS), this cross-cohort study explores how educational inequalities impact on attainment in distinct cohorts of students at identical age-points, whilst also examining the role of wider political and socioeconomic circumstances. The analysis reconfirms the detrimental effect of exposure to socioeconomic risk factors on attainment, highlighting the relative importance of some (e.g. social housing) over others, and emphasising the disproportionate association of exposure to multiple risks with poorer outcomes. For both cohorts, the attainment gap is already clear at age 11, and widens at every level of risk across secondary education. Despite the implementation of austerity, no evidence is found for worsening inequalities at an individual level. However, the persistent link between disadvantage and attainment means that, on a cohort level, increasing levels of disadvantage during austerity will inevitably lead to greater proportions of young people facing an attainment 'penalty'. [ABSTRACT FROM AUTHOR]

Evidence is strong for adverse fetal effects of high level or chronic prenatal alcohol exposure (PAE), but many pregnant women continue to drink at lower levels. The 'Asking Questions about Alcohol in pregnancy' prospective cohort aimed to determine the neurodevelopmental consequences at 6–8 years of age of low to moderate PAE. 1570 women from seven public antenatal clinics in Melbourne, Australia, provided information on frequency and quantity of alcohol use, and obstetric, lifestyle and socio-environmental confounders at four gestation timepoints. PAE was classified into five trajectories plus controls. At 6–8 years, 802 of 1342 eligible families took part and completed a questionnaire (60%) and 696 children completed neuropsychological assessments (52%). Multiple linear regressions examined mean outcome differences between groups using complete case and multiple imputation models. No meaningful relationships were found between any of the PAE trajectories and general cognition, academic skills, motor functioning, behaviour, social skills, social communication, and executive function. Maternal education most strongly influenced general cognition and academic skills. Parenting behaviours and financial situation were associated with academic skills, behaviour, social skills and/or executive function. The lack of association between PAE and neurodevelopment at 6–8 years may partly be explained by cumulative positive effects of socio-environmental factors. [ABSTRACT FROM AUTHOR]

Objectives Methods Results Conclusion Transfers between health facilities of people living with HIV attending primary health care (PHC) including hospital to PHC facility, PHC facility to hospital and PHC facility to PHC facility transfers occur frequently, affect health service planning, and are associated with disengagement from care and viraemia. Data on transfers among people living with diabetes attending PHC, particularly transfers between PHC facilities, are few. We assessed the transfer incidence rate of people living with diabetes attending PHC, and the association between transfers between PHC facilities and subsequent HbA1c values.We analysed data on HbA1c tests at public sector facilities in the Western Cape Province (2016–March 2020). Individuals with an HbA1c in 2016–2017 were followed‐up for 27 months and included in the analysis if ≥18 years at first included HbA1c, ≥2 HbA1cs during follow‐up and ≥1 HbA1c at a PHC facility. A visit interval was the duration between two consecutive HbA1cs. Successive HbA1cs at different facilities of any type indicated any transfer, and HbA1cs at different PHC facilities indicated a transfer between PHC facilities. Mixed effects logistic regression adjusted for sex, age, rural/urban facility attended at the start of the visit interval, disengagement (visit interval >14 months) and a hospital visit during follow‐up assessed the association between transfers between PHC facilities and HbA1c >8%.Among 102,813 participants, 22.6% had ≥1 transfer of any type. Including repeat transfers, there were 29,994 transfers (14.4 transfers per 100 person‐years, 95% confidence interval [CI] 14.3–14.6). A total of 6996 (30.1%) of those who transferred had a transfer between PHC facilities. Visit intervals with a transfer between PHC facilities were longer (349 days, interquartile range [IQR] 211–503) than those without any transfer (330 days, IQR 182–422). The adjusted relative odds of an HbA1c ≥8% after a transfer between PHC facilities versus no transfer were 1.20 (95% CI 1.05–1.37).The volume of transfers involving PHC facilities requires consideration when planning services. Individuals who transfer between PHC facilities require additional monitoring and support. [ABSTRACT FROM AUTHOR]

The aim of this prospective cohort study was to compare changes in lifestyle behaviours over nine years in women who were and were not diagnosed with osteoarthritis (OA). Data were from the 1945–51 cohort of the Australian Longitudinal Study on Women’s Health (aged 50–55 in 2001) who completed written surveys in 2001, 2004, 2007 and 2010. The sample included 610 women who were, and 3810 women who were not diagnosed with OA between 2004 and 2007. Descriptive statistics were used to assess changes in lifestyle behaviours (weight, sitting time, physical activity, alcohol and smoking) in the two groups, over three survey intervals: from 2001–2004 (prior to diagnosis); from 2004–2007 (around diagnosis); and from 2007–2010 (following diagnosis). Compared with women without OA (28%), a greater proportion of women with OA (38%) made at least one positive lifestyle change (p < 0.001). These included losing > 5 kg (9.8% vs. 14.4%, p < 0.001), and reducing sitting time by an hour (29.5% vs. 39.1%, p < 0.001) following diagnosis. However, women with OA also made negative lifestyle changes (35% vs. 29%, p < 0.001), for example, gaining > 5 kg around the time of diagnosis (21.4% vs. 14.5%, p < 0.001) and increasing sitting time by an hour following diagnosis (38.4% vs. 32.3%, p = 0.003). More women with OA also started smoking following diagnosis (8.9% vs. 0.8%, p < 0.001). While some women made positive changes in lifestyle behaviours during and following OA diagnosis, others made negative changes. Consistent support from clinicians for managing OA symptoms may enable patients to make more positive changes in lifestyle behaviours. [ABSTRACT FROM AUTHOR]

Simple Summary: Rheumatoid arthritis (RA) exhibits an elevated susceptibility to cancer. Nevertheless, the equivalence of this risk among those afflicted with head and neck cancer (HNC) remains a subject of uncertainty. Our findings unveiled a heightened probability of RA development among individuals with HNC. Notably, this risk is most pronounced immediately following the diagnosis of HNC and exhibits a persistent upward trajectory. Particularly noteworthy is the discerned association between men in their middle age, specifically those with oral cancer, and an augmented linkage to RA. These revelations furnish novel insights and significant information concerning the interconnection between HNC and RA. An increased risk of cancer among patients with rheumatoid arthritis (RA) has been reported. However, the risk of RA events among patients with head and neck cancer (HNC) is unknown. Therefore, we investigated the incidence and risk of RA among patients with HNC. This study was based on a cohort dataset. Overall, 2824 individuals without HNC and 706 patients with HNC were selected using propensity score matching. The overall RA event rate was 12.19 for patients with HNC and 7.60 for those without HNC. A significantly increased risk of developing RA was also observed among patients with HNC. The risk of developing RA over time was relatively high within the first year after HNC diagnosis; further, it increased significantly during the follow-up period. Moreover, middle-aged male patients with HNC exhibited an increased risk of developing RA compared with the controls; however, no significant difference was noted among female patients or other age groups. Notably, subgroup analysis according to cancer subtype revealed that only oral cancer survivors had an increased risk of developing RA. These results underscore the importance of vigilant monitoring by clinicians to promptly identify the onset of RA in patients with HNC. [ABSTRACT FROM AUTHOR]

Objective Methods Results Conclusions To explore the risk of breast cancer associated with menopausal hormone therapy (MHT), including the various progestogens used today.The study included postmenopausal women over 40 years from the National Health Insurance Database in South Korea (2011–2014) who either used MHT for over 6 months (MHT group) or never used MHT (non‐MHT group) and were matched 1:1 based on several variables using propensity score matching. Both groups were followed until 2020.The non‐MHT and MHT groups comprised 153 736 women each. In Cox proportional hazard analysis with time‐dependent covariates, MHT was associated with an increased risk of breast cancer (hazard ratio [HR] 1.22, 95% confidence interval [CI] 1.15–1.3). Tibolone, estradiol valerate (EV)/medroxyprogesterone acetate (MPA), EV/norethisterone acetate (NETA), conjugated equine estrogen (CEE), EV, estradiol hemihydrate (EH), CEE/micronized progesterone (MP), CEE/MPA, EV/MP, EV/MPA, and EH/MP did not increase the risk of breast cancer compared with the non‐MHT group. However, EH/drospirenone (DRSP) (HR 1.51, 95% CI 1.38–1.66), EH/NETA (HR 1.66, 95% CI 1.34–2.06), EH/dydrogesterone (DYD) (HR 1.37, 95% CI 1.12–1.68), and EV/cyproterone acetate (CPA) (HR 1.74, 95% CI 1.54–1.96) increased the risk of breast cancer compared with the non‐MHT group.MHT was linked to increased breast cancer risk, but not all MHTs. Specific combined therapies (EH/DRSP, EH/DYD, EH/NETA, and EV/CPA) were associated with higher risk, whereas estrogen alone and tibolone were not. [ABSTRACT FROM AUTHOR]

Background: The caesarean section (CS) rate has increased worldwide and there is an increasing public and scientific interest in the potential long-term health consequences for the offspring. CS is related to persistent aberrant microbiota colonization in the offspring, which may negatively interfere with sex hormone homeostasis and thus potentially affect the reproductive health. It remains unknown whether adult sons' semen quality is affected by CS. We hypothesize that CS is associated with lower semen quality. Methods: This study was based on the Fetal Programming of Semen Quality cohort (FEPOS, enrolled from 2017 to 2019) nested within the Danish National Birth Cohort (DNBC, enrolled from 1996 to 2002). A total of 5697 adult sons of mothers from the DNBC were invited to the FEPOS cohort, and 1044 young men participated in this study. Information on mode of delivery was extracted from the Danish Medical Birth Registry, and included vaginal delivery, elective CS before labor, emergency CS during labor and unspecified CS. The young men provided a semen sample for analysis of semen volume, sperm concentration, motility and morphology. Negative binomial regression models were applied to examine the association between CS and semen characteristics with estimation of relative differences in percentages with 95% confidence intervals (CIs). Results: Among included sons, 132 (13%) were born by CS. We found a slightly lower non-progressive sperm motility (reflecting higher progressive sperm motility) among sons born by CS compared to sons born by vaginal delivery [relative difference (95% CI): − 7.5% (− 14.1% to − 0.4%)]. No differences were observed for other sperm characteristics. When CS was further classified into elective CS, emergency CS and unspecified CS in a sensitivity analysis, no significant differences in non-progressive motility were observed among sons born by any of the three types of CS compared to sons born vaginally. Conclusions: This large population-based cohort study found no significant evidence for an adverse effect on semen quality in adult sons born by CS. Plain language summary: Caesarean section is one of the most frequently used interventions during childbirth and global cesarean delivery rates continue to increase. The rising cesarean delivery rate has been reported to be related with series of adverse health outcomes in children, such as asthma, allergies, obesity, diabetes and even poor emotional, behavioral and educational outcomes. Still, it remains unknown whether children's reproductive health is affected by this delivery mode. Based on data from the Fetal Programming of Semen Quality cohort (FEPOS,) nested within the Danish National Birth Cohort, we have therefore analyzed the potential effect of caesarean section on son's semen quality in 1044 young men. We found a slightly higher progressive sperm motility among sons born by caesarean section compared to sons born by vaginal delivery. No differences, however, were observed for semen volume, sperm concentration and morphology between the two delivery modes. The FEPOS cohort is the largest population-based male offspring cohort worldwide. This is the first study aiming to examine the association between caesarean section and semen quality in adulthood. Although the findings need to be confirmed in other studies, it is reassuring that this large population-based cohort study finds no significant evidence for an adverse effect on semen quality in adult sons born by caesarean section. [ABSTRACT FROM AUTHOR]

Introduction: In a context of declining condom use and high sexually transmitted infection (STI) incidence, the diffusion of "treatment as prevention" (Tasp) and more recently pre‐exposure prophylaxis (PrEP) may have changed the sexual behaviour of newly diagnosed men who have sex with men (MSM) with HIV. Methods: Six hundred and nine MSM were enrolled and followed annually between 2014 and 2021 in the ANRS PRIMO Cohort (ClinicalTrials.gov:NCT03148964) from the time of HIV seroconversion. We studied changes over calendar time in sexual behaviour before and after HIV diagnosis. Factors associated with inconsistent condom use (ICU) after HIV diagnosis, PrEP use by partner(s) and bacterial STI acquisition were studied in random‐effects models. Results: In the 6 months preceding HIV diagnosis, the number of sexual partners decreased from a median of 10 (IQR: 4−19) in 2014 to 6 (3−11) in 2021. After HIV diagnosis, ICU increased from 57.1% (16/28) of visits in 2014 up to 84.2% (229/272) in 2020−2021. Up to 25% (63/229) of MSM with HIV in recent years reported the use of PrEP by their partner(s) as the reason for ICU; these MSM were less frequently in a stable relationship, had a higher number of sexual partners and higher education level than those who did not report the use of PrEP by their partner(s). STI incidence after HIV diagnosis increased between 2014 and 2016 and remained high afterwards. STI risk was no longer associated with PrEP use by partners after adjustment for the number of partners and calendar period. ICU, age below 35 years, not being in a stable relationship, higher number of sexual partners were independently associated with an increased risk of STI. Conclusions: Implementation of TasP and more recently PrEP has led to major changes in the sexual behaviour of MSM with HIV. ICU has become overwhelmingly prevalent, PrEP use by the partner increasingly being the reported reason for ICU, behind TasP, which remains the main reason. Characteristics of MSM at the time of diagnosis of HIV have changed, with fewer number of sexual partners today than in 2014, which must lead to broaden the indications for PrEP prescription. STIs incidence remains high in MSM with HIV and requires improvements in screening and prevention methods such as pre‐ or post‐exposition antibiotics or vaccines. [ABSTRACT FROM AUTHOR]

Background: The COVID‐19 pandemic has been associated with detrimental effects on mental health and psychological well‐being. Although multiple studies have shown decreases in mental health‐related Emergency Department (ED) presentations early in the COVID‐19 pandemic, the medium‐term effects on mental health‐related ED presentations have remained less clear. This study aimed to evaluate the effect of the pandemic on mental health ED presentations by comparing observed presentation numbers to predictions from pre‐pandemic data. Methods: This retrospective cohort study tallied weekly ED presentations associated with mental health disorders from a state‐wide minimum dataset. Three time periods were identified: Pre‐Pandemic (January 1, 2018–March 8, 2020), Statewide Lockdown (March 9, 2020–June 28, 2020), and Restrictions Easing (June 29, 2020–June 27, 2021). Time series analysis was used to generate weekly presentation forecasts using pre‐pandemic data. Observed presentation numbers were compared to these forecasts. Results: Weekly presentation numbers were lower than predicted in 11 out of 16 weeks in the Statewide Lockdown period and 52 out of 52 weeks in the Restrictions Easing period. The largest decrease was seen for anxiety disorders (Statewide Lockdown: 76.8% of forecast; Restrictions Easing: 36.4% of forecast), while an increase was seen in presentations for eating disorders (Statewide Lockdown: 139.5% of forecast; Restrictions Easing: 194.4% of forecast). Conclusions: Overall weekly mental health‐related presentations across Queensland public EDs were lower than expected for the first 16 months of the COVID‐19 pandemic. These findings underline the limitations of emergency department provision of mental health care and the importance of alternate care modalities in the pandemic context. [ABSTRACT FROM AUTHOR]

Electronic health records (EHRs) have been increasingly adopted in clinical practices across the United States, providing a primary source of data for clinical research, particularly observational cohort studies. EHRs are a high-yield, low-maintenance source of longitudinal real-world data for large patient populations and provide a wealth of information and clinical contexts that are useful for clinical research and translation into practice. Despite these strengths, it is important to recognize the multiple limitations and challenges related to the use of EHR data in clinical research. Missing data are a major source of error and biases and can affect the representativeness of the cohort of interest, as well as the accuracy of the outcomes and exposures. Here, we aim to provide a critical understanding of the types of data available in EHRs and describe the impact of data heterogeneity, quality, and generalizability, which should be evaluated prior to and during the analysis of EHR data. We also identify challenges pertaining to data quality, including errors and biases, and examine potential sources of such biases and errors. Finally, we discuss approaches to mitigate and remediate these limitations. A proactive approach to addressing these issues can help ensure the integrity and quality of EHR data and the appropriateness of their use in clinical studies. [ABSTRACT FROM AUTHOR]

Objectives In patients with RA, the association between mortality and depression has been investigated only in patients with prevalent RA. In this study, we estimated the mortality risk associated with depression, defined as the first filling of a prescription for antidepressants, in patients with incident RA and background population comparators. Methods From 2008 to 2018, we identified patients with incident RA in the nationwide Danish rheumatologic database, DANBIO. For each patient, we randomly selected five comparators. Participants were not treated with antidepressants or diagnosed with depression 3 years prior to the index date. From other registers we collected data on socioeconomic status, mortality and cause of death using unique personal identifiers. Using Cox models, we calculated hazard rate ratios (HRR) with 95% CI. Results In depressed patients with RA vs patients without depression, adjusted HRR for all-cause mortality was 5.34 (95% CI 3.02, 9.45) during 0–2 years and 3.15 (95% CI 2.62, 3.79) during the total follow-up period, and highest in patients <55 years with HRR 8.13 (95% CI 3.89, 17.02). In comparators with depression vs comparators without depression, the association with mortality was similar to that in patients with RA. There were no unnatural causes of death among depressed patients with RA. The most frequent natural causes of death were cancer, cardiovascular disease, stroke and pneumonia. Conclusion In patients with RA, depression was a predictor of death but with a strength similar to that in matched comparators. [ABSTRACT FROM AUTHOR]

We aimed to synthesise information related to the incidence of depression and depressive symptoms (DDS) in a community‐dwelling older adult population at a global level. In this systematic review, we included articles with a cohort study design that evaluated the incidence of depression or depressive symptoms in older adults aged 60 years or more in a community‐dwelling environment. Six databases were used: Web of Science, PubMed, Scopus, LILACS, SciELO, and Cochrane, and the entire selection process was independently performed by peers. We divided the included articles into subgroups according to the DDS assessment instrument: (i) Geriatric Depression Scale; (ii) Center for Epidemiologic Studies Depression Scale; (iii) miscellaneous scales; and (iv) diagnostic interviews. Each cumulative incidence value obtained per item was adjusted for a 1‐year follow‐up period, which generated an annual cumulative incidence (AcI). From 46 articles, 42 used scales to evaluate the depressive variable, with an AcI estimate of around 4.5%. The articles that assessed depression categorically observed a variation in AcI between 0.2% and 7.0%. Among all the materials included, the group that used the Geriatric Depression Scale observed the lowest and the highest AcI, 1.3% and 26.6% respectively. Most of the productions were from countries in the Asian continent (52.2%), followed by Europe (30.4%), the Americas (13%), and Oceania (4.4%). Despite the variation of AcI, we found a frequent occurrence of DDS in older adults in the community‐dwelling environment, which highlights the need for preventive actions and better‐targeted early care, especially in terms of primary health care. [ABSTRACT FROM AUTHOR]

Background: Studies have demonstrated a prognostic role of sarcopenia (i.e., loss of skeletal muscle volume and functionality) in patients with various cancer types. In patients with biliary tract cancer, the quantity and quality of skeletal muscles and their serial changes have not been fully investigated in relation to survival outcomes. Methods: We identified 386 patients with unresectable or recurrent biliary tract cancer and calculated skeletal muscle index (SMI) and skeletal muscle density (SMD) to estimate muscular quantity and quality, respectively, based on computed tomography images. Using the Cox regression model with adjustment for potential confounders, we calculated hazard ratios (HRs) and 95% confidence intervals (CIs) for progression-free survival (PFS) and overall survival (OS) according to skeletal muscle status and its serial change. Results: Compared to patients without sarcopenia, patients with sarcopenia were associated with shorter PFS (multivariable HR, 1.60; 95% CI, 1.15–2.22; P = 0.005), but not with OS (P = 0.027) at the adjusted α level of 0.013. SMD at baseline was associated with OS (multivariable HR comparing the extreme quartiles, 1.52; 95% CI, 1.07–2.14; Ptrend = 0.012), but not with PFS (Ptrend = 0.13). A reduction in SMI rather than that in SMD was associated with OS. Progressive disease was a risk factor for reductions in SMI and SMD. Conclusions: Skeletal muscle quantity and quality and their serial changes were associated with survival outcomes in patients with advanced biliary tract cancer. Our data highlight the importance of designing nutritional and physical interventions for improvements in skeletal muscle status. [ABSTRACT FROM AUTHOR]

Background: This study aimed to investigate the association between gastrectomy and endoscopic resection for gastric cancer and the subsequent tuberculosis incidence. Methods: We conducted a nationwide matched cohort study using data from the Korea National Health Insurance Service from 2013 to 2019. We created two cohorts: patients who underwent gastrectomy and those who had endoscopic resection. Each patient was matched 1:1 with an unexposed individual based on index year, age, sex, income, and various comorbidities. The primary outcome was the incidence of tuberculosis during the follow-up period. Results: Our study comprised 90,886 gastrectomy patients and 46,759 endoscopic resection patients. The tuberculosis incidence was significantly higher in the gastrectomy group compared to its matched non-gastrectomy group (IRR 1.69, 95% CI 1.43–1.99, p <.001). In contrast, there was no significant difference in tuberculosis incidence between the endoscopic resection group and its matched non-resection group (IRR 0.95, 95% CI 0.75–1.19, p = 0.627). The Kaplan–Meier cumulative incidence also did not differ between the two groups. However, tuberculosis incidence significantly increased in the first year after endoscopic resection. Conclusion: Gastrectomy for gastric cancer is associated with a higher incidence of subsequent tuberculosis, while no significant association was observed for endoscopic resection. However, tuberculosis incidence increases significantly during the first year after endoscopic resection. [ABSTRACT FROM AUTHOR]

Aim: To assess whether sodium‐glucose cotransporter‐2 (SGLT2) inhibitors reduce myocardial infarction (MI) incidence in patients with or without type 2 diabetes. Methods: PubMed, Embase, Web of Science, the Cochrane library, and https://ClinicalTrials.gov were searched up to 7 May 2022. Randomized controlled trials (RCTs) and cohort studies reporting the effects of SGLT2 inhibitor treatment on MI incidence were included. Relative risks (RRs) with a 95% confidence interval (CI) for MI incidence were extracted and pooled. Subgroup analysis and meta‐regression were performed to explore the heterogeneity. Results: This meta‐analysis included 54 RCTs and 32 cohort studies, with data from six SGLT2 inhibitors and 3 394 423 individuals. In the overall analysis, SGLT2 inhibitors significantly reduced MI incidence in RCTs (RR 0.9, 95% CI 0.84–0.96) and cohort studies (RR 0.89, 95% CI 0.83–0.94). In RCTs, the results of the subgroup analysis revealed no significant alterations in outcomes based on different SGLT2 inhibitor types, control drug types, cardiovascular disease (CVD) status and sources of outcome extraction (p for interaction >0.05). In cohort studies, the presence or absence of CVD led to similar effects of SGLT2 inhibitors on decreasing MI incidence (p for interaction = 0.179). However, variations in results were observed based on the type of control group in cohort studies (p for interaction = 0.036). Meta‐regression results did not reveal an association between baseline cardiovascular risk factors, follow‐up length, or MI incidence. Conclusions: In both RCTs and cohort studies, SGLT2 inhibitors reduced MI incidence. The cardioprotective effects of SGLT2 inhibitors were observed in patients with and without a history of CVD. [ABSTRACT FROM AUTHOR]