Publications by authors named "Andrzej Śliwczyński"

62 Publications

Antithrombotic Management and Long-Term Outcomes of Patients with Atrial Fibrillation. Insights from CRAFT Trial.

J Clin Med 2021 Apr 19;10(8). Epub 2021 Apr 19.

1st Department of Cardiology, Medical University of Warsaw, 02-091 Warsaw, Poland.

Background: We aimed to compare long-term outcomes in Polish patients with atrial fibrillation (AF) according to oral anticoagulation (OAC) type and to evaluate the predictive value of common thromboembolic and bleeding risk scores.

Methods: Data from the CRAFT trial (NCT02987062) were included. The primary study endpoint was major adverse event (MAE; all-cause death, thromboembolic and hemorrhagic event) during the mean four-year follow-up period.

Results: Out of 2983 patients with available follow-up data, 1686 (56%) were prescribed with vitamin K antagonist (VKA), 891 (30%) with rivaroxaban and 406 (14%) with dabigatran. Predominance of elderly and female patients with previous history of thromboembolic and hemorrhagic events was observed within rivaroxaban (vs. other OAC) group. Higher rate of MAEs and its components was observed in patients on VKA followed by rivaroxaban as compared to patients on dabigatran (43% vs. 42% vs. 31%, < 0.01). After group matching based on clinical characteristics, higher risk of hemorrhagic events in VKA (vs. dabigatran) and rivaroxaban (vs. dabigatran) group were observed. The available thromboembolic (CHADS-VASs, ATRIA, RCHADS) and bleeding (HAS-BLED, ATRIA, ORBIT) risk scores showed poor prediction value.

Conclusions: Despite no difference in the thromboembolic event rate, treatment with VKA and rivaroxaban was associated with a significant increase in the risk of hemorrhagic events.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.3390/jcm10081780DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8073861PMC
April 2021

Impact of Immunoablation and Autologous Hematopoietic Stem Cell Transplantation (AHSCT) on Treatment Cost of Multiple Sclerosis: Real-World Nationwide Study.

Value Health Reg Issues 2021 Apr 14;25:104-107. Epub 2021 Apr 14.

Medical University of Warsaw, Hematology, Oncology, and Internal Diseases, Warsaw, Poland. Electronic address:

Objectives: To provide real-world data on the impact of autologous hematopoietic stem cell transplantation (AHSCT) on treatment costs of patients with multiple sclerosis (MS) in Poland.

Methods: Medical data of 105 patients who underwent AHSCT in the years 2011 to 2016 were obtained from the National Health Fund (NHF) database. Treatment costs were calculated from the public payer's perspective per patient-year for the total available period as well as 12 months before and after AHSCT. The statistical analysis was performed using MATLAB 2016b.

Results: Mean treatment-related costs covered by the NHF per patient-year before and after the transplantation were €4314.9 and €1188.8 , respectively. The average cost of disease-modifying drugs per patient was reduced from €2497.9/year before to €65.3/year after AHSCT.

Conclusions: Although the initial cost of AHSCT is high, the costs involving AHSCT and post-AHSCT treatment could, according to our analysis, pay off in 3.9 years, when compared to the costs of disease-modifying drug therapy in aggressive MS. The study provides evidence that the AHSCT can lead to significant savings in treatment costs of aggressive MS from the public payer's perspective.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1016/j.vhri.2020.10.008DOI Listing
April 2021

Schizophrenic patients with type 2 diabetes: An 8-year population-based observational study.

PLoS One 2021 16;16(3):e0248407. Epub 2021 Mar 16.

Department of Education and Research in Health Sciences, Faculty of Health Sciences, Medical University of Warsaw, Warsaw, Poland.

This paper presents a realistic evaluation of the prevalence of type 2 diabetes mellitus (T2DM) among Polish schizophrenic patients who have sought treatment through the Polish National Health Fund in the years 2010-2017. Data from the National Health Fund database was used and T2DM and schizophrenia groups were defined according to International Classification of Diseases (ICD-10) codes. Demographic data were collected from the web page of Statistics Poland (GUS). The annual prevalence of T2DM and schizophrenia was estimated, and the age groups were categorised into eight sets. The incidence of schizophrenia in T2DM patients in the years 2010-2017 was measured, including relative risk and 95% confidence interval (95% CI). The incidence of T2DM has been assessed in various subtypes of schizophrenia. In the eight years of follow-up study, 1,481,642 patients with schizophrenia were included, of which 185,205 were also diagnosed with T2DM. This accounted for 12.50% of all patients with schizophrenia. The trend of comorbid schizophrenia (F20) and T2DM (E11) in the general population of patients with schizophrenia, who sought treatment through the National Health Fund, was relatively stable in the years 2010-2017. The relative risk of T2DM in those with schizophrenia was 8.33 (95% CI 8.23-8.43) in 2017. Taking actions to enable the detection of diabetes in patients with concomitant schizophrenia is well-grounded, although these actions should be gender-dependent. There is also a need to take adequate actions to improve the efficiency of diabetological care among patients with schizophrenia.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://journals.plos.org/plosone/article?id=10.1371/journal.pone.0248407PLOS
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7963070PMC
March 2021

Cost-effectiveness of colonoscopy in an organized screening program.

Pol Arch Intern Med 2021 02 25;131(2):128-135. Epub 2021 Jan 25.

Department of Cancer Prevention, The Maria Sklodowska-Curie National Research Institute of Oncology, Warsaw, Poland

Introduction: Colorectal cancer (CRC) is a serious health problem, and various screening programs to reduce CRC have been introduced worldwide. However, the cost‑effectiveness of a program based on once‑in‑a‑lifetime colonoscopy in Poland is unknown.

Objectives: The main aim of this study was to assess the cost‑effectiveness of Polish Colonoscopy Screening Platform (PCSP), the colonoscopy screening program in Poland.

Patients And Methods: A Markov model was constructed to compare the strategy of colonoscopy screening as compared with no screening in 100 000 subjects. The model was based on data collected from the nationwide Polish CRC screening program whenever possible. The incremental cost‑effectiveness ratio (ICER) was calculated and compared with the willingness‑to‑pay thresholds. A sensitivity analysis was also performed using the Monte Carlo simulation.

Results: Colonoscopy screening within PCSP resulted in a 18.9% reduction in CRC incidence and 19.8% reduction in CRC mortality. The strategy allowed a gain of 2317 life‑years saved (1959 after discount‑ ing). The cost of colonoscopy screening per participant examined was estimated at 267.70 USD (95% CI, 263.08-272.32 USD). The ICER was less than 6500 USD, which was much lower than the accepted willingness‑to‑pay thresholds, indicating that the screening was cost‑effective.

Conclusions: Colonoscopy screening within the PCSP is cost‑effective and may have a substantial impact on the Polish society due to life‑years saved. The results have good informative value not only for health policy makers and medical practitioners, but also for health technology assessment.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.20452/pamw.15779DOI Listing
February 2021

Relationship between age and in-hospital mortality during 15,345,025 non-surgical hospitalizations.

Arch Med Sci 2021 5;17(1):40-46. Epub 2021 Jan 5.

Department of Internal Diseases, Endocrinology and Diabetology, Central Clinical Hospital of the Ministry of the Interior and Administration, Warsaw, Poland.

Introduction: Mortality, whether in or out of hospital, increases with age. However, studies evaluating in-hospital mortality in large populations did not distinguish between surgical and non-surgical causes of death, either in young or in elderly patients. The aim of the study was to assess in-hospital non-surgical mortality in a large group of patients, with a special focus on the elderly.

Material And Methods: Data from the database of the Polish National Health Fund (NHF) regarding hospitalizations of adult (≥ 18 years) patients not related to surgical procedures in the years 2009-2013 were used to assess in-hospital mortality.

Results: 15,345,025 hospitalizations were assessed. The mean in-hospital non-surgery-related mortality rate was 3.96 ±0.17%, and increased from 3.79% to 4.2% between 2009 and 2013. The mean odds ratio for in-hospital death increased with the age of patients, reaching a 229-fold higher rate in the ≥ 95 years age group as compared to the 18-24 age group. The highest mean mortality was associated with respiratory diseases (6.91 ±0.20%), followed by heart and vascular diseases, nervous system diseases, as well as combined gastrointestinal tract, liver, biliary tract, pancreas and spleen diseases (5.65 ±0.27%, 5.46 ±0.05% and 4.01 ±0.13%, respectively).

Conclusions: The in-hospital non-surgery-related mortality rate was approximately 4%. It significantly increased with age and, regardless of age, was highest in patients suffering from respiratory diseases.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.5114/aoms/89768DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7811322PMC
January 2021

Trends in psoriatic arthritis epidemiology in Poland.

Rheumatol Int 2021 Jan 28;41(1):139-145. Epub 2020 Oct 28.

Department of Internal Diseases and Rheumatology, Military Institute of Medicine, Warsaw, Poland.

Psoriatic arthritis (PsA) is a heterogeneous inflammatory arthritis, usually seronegative and associated with psoriasis (Ps). The prevalence and incidence of psoriatic arthritis show strong ethnic and geographic variations. The aim of the study was to assess the epidemiological trends in psoriatic arthritis in Poland. The National Health Fund (NHF) database for the period 2008-2018 was analyzed. PsA was defined as ICD-10 codes L40.5, M07, M07.0, M07.1, M07.2 and M07.3, while psoriasis as ICD-10 codes L40 and L40.X (L40.0 to L40.9). A steady increase in the number of PsA patients (from 16,790 to 32,644) and in PsA recorded prevalence (from 38.47 per 100,000 in 2008 to 73.11 per 100,000 in 2018) was observed between 2008 and 2018. The PsA/Ps ratio increased to a similar extent (from 8.3 to 17.5%). The percentage of PsA patients receiving rehabilitation services remained constant throughout the observation period (mean: 17.35%; range 16.7-18.9%). The study showed a steady and continuous increase in PsA recorded prevalence. A simultaneous increase in the PsA/Ps ratio suggests that the main reason for the observed trend is greater disease detection .
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1007/s00296-020-04734-xDOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7806568PMC
January 2021

Predictors of In-Hospital Mortality in Surgical Wards: A Multivariable Retrospective Cohort Analysis of 2,800,069 Hospitalizations.

World J Surg 2021 Feb 26;45(2):480-487. Epub 2020 Oct 26.

Department of Internal Diseases, Endocrinology and Diabetology, Central Clinical Hospital MSWiA, ul. Woloska 137, 02-507, Warsaw, Poland.

Background: Identifying prognostic factors that are predictive of in-hospital mortality for patients in surgical units may help in identifying high-risk patients and developing an approach to reduce mortality. This study analyzed mortality predictors based on outcomes obtained from a national database of adult patients.

Materials And Methods: This retrospective study design collected data obtained from the National Health Fund in Poland comprised of 2,800,069 hospitalizations of adult patients in surgical wards during one calendar year. Predictors of mortality which were analyzed included: the patient's gender and age, diagnosis-related group category assigned to the hospitalization, length of the hospitalization, hospital type, admission type, and day of admission.

Results: The overall mortality rate was 0.8%, and the highest rate was seen in trauma admissions (24.5%). There was an exponential growth in mortality with respect to the patient's age, and male gender was associated with a higher risk of death. Compared to elective admissions, the mortality was 6.9-fold and 15.69-fold greater for urgent and emergency admissions (p < 0.0001), respectively. Weekend or bank holiday admissions were associated with a higher risk of death than working day admissions. The "weekend" effect appears to begin on Friday. The highest mortality was observed in less than 1 day emergency cases and with a hospital stay longer than 61 days in any type of admission.

Conclusion: Age, male gender, emergency admission, and admission on the weekend or a bank holiday are factors associated with greater mortality in surgical units.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1007/s00268-020-05841-3DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7773611PMC
February 2021

Managing Cystic Fibrosis in Polish Healthcare.

Int J Environ Res Public Health 2020 10 20;17(20). Epub 2020 Oct 20.

Institute of Medical Sciences, Medical College, University of Rzeszów, 35-959 Rzeszów, Poland.

The quality and length of life of patients with cystic fibrosis (CF) are determined by a number of factors including the quality of healthcare received by patients, as well as access to drug programs dedicated to this particular disease. The purpose of this paper is to present an overview of changes in the average life expectancy and mortality rate of the CF population in Poland between 2000 and 2018. Furthermore, we would like to evaluate access to healthcare services, including the drug program, guaranteed by public healthcare system, and funded by National Health Fund (NHF). The average life expectancy of patients with CF increased in the period in question from ca. 14.5 ± 7.6-24.5 ± 8.9 years (mean ± SD, = 0.0001). We have observed a drop in the number of deaths in paediatric age during that period. Despite the increase in life expectancy, the use of health resources in patients with CF, especially the drug program, is dramatically low. Considering the fact that in Poland there was no active countrywide CF registry, now it is possible to estimate the frequency of use of CF healthcare services in various provinces exclusively on the basis of database maintained by the Polish NHF.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.3390/ijerph17207630DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7589707PMC
October 2020

Football spectatorship and selected acute cardiovascular events: lack of a population-scale association in Poland.

Kardiol Pol 2020 11 21;78(11):1148-1155. Epub 2020 Sep 21.

Background: The status of football spectatorship-induced emotional stress as a risk factor for acute cardiovascular events remains a matter of dispute.              Aims: This study aimed to investigate the relationship between football spectatorship and the incidenceof selected acute cardiovascular events in the Polish male population.

Methods: Events that occurred in male patients aged 35 years and older in Poland during 3 tournaments(2012 and 2016 European Championships and 2018 World Cup) were retrospectively analyzed based onhospital admission codes (International Statistical Classification of Diseases and Related Health Problems, Tenth Revision [ICD‑10]) obtained from the Polish National Health Fund (Narodowy Fundusz Zdrowia). The followingprimary diagnoses were of interest: acute myocardial infarction (AMI; I21), sudden cardiac arrest (I46),sudden arrhythmias (I47-I49). The corresponding dates in the years before and after the tournamentsconstituted the reference periods.

Results: A total of 255 383 patients were included in this study. There were no significant differences in the incidence of events between the combined exposure and reference periods: relative risk [RR] = 1.05 (95% CI, 0.97-1.14; P = 0.2) for AMI, RR = 1.08 (95% CI, 0.87-1.35;P = 0.47) for sudden cardiac arrest, and RR = 1.02 (95% CI, 0.98-1.06; P = 0.32) for sudden arrhythmias. Individual tournament analyses revealeda higher incidence of AMI (RR = 1.2; 95% CI, 1.12-1.3; P <0.001) during the World Cup. However, day ‑by ‑‑day analysis for the World Cup did not show a higher incidence of AMI on match versus match‑free days.

Conclusions: Emotional stress evoked by football spectatorship is insufficiently potent to precipitatea population‑scale increase in the incidence of selected acute cardiovascular events.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.33963/KP.15606DOI Listing
November 2020

Influence of Chronic Periodontitis on the Long-Term Mortality and Cardiovascular Events in Kidney Transplant Recipients.

J Clin Med 2020 Jun 23;9(6). Epub 2020 Jun 23.

Department of Nephrology, Transplantation and Internal Medicine, Medical University of Silesia, Francuska 20, 40-027 Katowice, Poland.

Chronic periodontitis (CP) is associated with cardiovascular disease and mortality in different populations. The aim of this study was to examine an association of CP with hard endpoints in patients after kidney transplantation during a 15-year follow-up period. Study group consist of 117 patients (77M/40F, median age 44 years) divided into two subgroups: those with initially advanced CP (CPITN 3-4) and those with no or moderate CP (CPITN 0-2). All cardiovascular events, graft losses, and re-transplantations were recorded. All deaths were noted and verified, including those occurred after the return to dialysis therapy, the causes of death were identified. Cox regression with Firth's penalized maximum likelihood models were used for data analysis. During the observation period, 49 deaths occurred. Advanced CP ( = 35) was not associated with overall mortality but was associated with increased risk of death with functioning graft (DWFG) [HR 3.54 (1.20-10.45); < 0.05]. Risk of graft loss was not associated with CP status. In conclusion, an advanced CP was independently associated with increased risk of DWFG, but not all-cause or cardiovascular mortality after renal transplantation.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.3390/jcm9061968DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7355563PMC
June 2020

The short-term effects of air pollution on respiratory disease hospitalizations in 5 cities in Poland: comparison of time-series and case-crossover analyses.

Environ Sci Pollut Res Int 2020 Jul 30;27(19):24582-24590. Epub 2020 Apr 30.

Central Clinical Hospital MSWiA in Warsaw, Wołoska 137, 02-507, Warsaw, Poland.

Very few publications have compared different study designs investigating the short-term effects of air pollutants on healthcare visits and hospitalizations for respiratory tract diseases. This study describes, using two different study designs (a case-crossover design and a time-series analysis), the association of air pollutants and respiratory disease hospitalizations. The study has been conducted on 5 cities in Poland on a timeline of almost 4 years. DLNM and regression models were both used for the assessment of the short-term effects of air pollution peaks on respiratory hospitalizations. Both case-crossover and time-series studies equally revealed a positive association between air pollution peaks and hospitalization occurrences. Results were provided in the form of percentage increase of a respiratory visit/hospitalization, for each 10-μg/m increment in single pollutant level for both study designs. The most significant estimated % increases of hospitalizations linked to increase of 10 μg/m of pollutant have been recorded in general with particulate matter, with highest values for 24 h PM in Warsaw (6.4%, case-crossover; 4.5%, time series, respectively) and in Białystok (5.6%, case-crossover; 4.5%, time series, respectively). The case-crossover analysis results have shown a larger CI in comparison to the results of the time-series analysis, while the lag days were easier to identify with the case-crossover design. The trends and the overlap of the results occurring from both methods are good and show applicability of both study designs to air pollution effects on short-term hospitalizations.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1007/s11356-020-08542-5DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7326830PMC
July 2020

Geographic variability of major non-traumatic lower limb amputations in diabetic and non-diabetic patients in Poland.

Ann Agric Environ Med 2020 Mar 11;27(1):76-79. Epub 2019 Dec 11.

University of Humanities and Economics, Łódź, Satellite Campus, Warsaw, Poland.

Introduction: High amputation of the lower limb not only causes immense physical disability but also the destruction of the patient's mental state, and helps to shorten life of patients with diabetes. The incidence of amputations in diabetic patients is 10 times higher in comparison to non-diabetic subjects (2.8% vs. 0.29%). The purpose of the study is an analysis of the geographic variability of major non-traumatic lower limb amputation in diabetic and non-diabetic patients in Poland.

Material And Methods: All major non-traumatic lower limb amputations performed for the first time, in particular databetween 1 January 2013 - 31 December 2013, and between 1 January 2014 - December 2014, were identified in the National Health Fund (NHF) database. In the presented study, the patients were grouped in relevant provincial departments of the NHF according to their place of residence, and not according to the hospital where lower limb amputation was performed.

Results: In 2013 in Poland, 4,727 major non-traumatic lower limb amputation were performed in diabetic patients, and 4,350 in 2014. On the other hand, in non-diabetic patients, 3,469 major non-traumatic lower limb amputations were performed in 2013, and 3149 in 2014. The mean number indicator of major non-traumatic lower limb amputations in diabetic patients in Poland, compared to the average indicator of amputations in patients without diagnosed diabetes in Poland was 19.9-fold in 2013 and 19.4-fold higher in 2014.

Conclusions: In populations of diabetic patients and individuals without diagnosed diabetes major non-traumatic lower limb amputations are performed over 19-fold more frequently.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.26444/aaem/114725DOI Listing
March 2020

Predictors of in-hospital mortality in nonsurgical departments: a multivariable regression analysis of 2 855 029 hospitalizations.

Pol Arch Intern Med 2020 04 11;130(4):268-275. Epub 2020 Feb 11.

Department of Internal Diseases, Endocrinology and Diabetology, Central Clinical Hospital of the Ministry of the Interior and Administration, Warsaw, Poland; Department of Human Epigenetics, Mossakowski Medical Research Centre, Warsaw, Poland.

Introduction: In‑hospital mortality is a relevant outcome of hospital admissions.

Objectives: This study aimed to identify predictors independently associated with in‑hospital mortality in nonsurgical departments.

Patients And Methods: In 2014, the Polish National Health Fund database provided data on 2 855 029 hospitalizations of adults, which were not related with surgical procedures. Patients' age and sex, diagnosis‑related group category assigned to the hospitalization, length of stay, types of hospital and admission, and day of the week and month of admission were analyzed as mortality predictors.

Results: The mean (SD) in‑hospital mortality rate was 4.1% (0.01%). Odds ratios for in‑hospital death increased with patients' age. The female sex was associated with lower odds ratios of death than the male sex. Among the diagnosis‑related groups assigned to hospitalizations, the highest mortality was found in patients with vascular diseases (11.95%). Considering the length of stay, the lowest mortality occurred during 5- to 7‑day (2.63%). Compared with teaching hospitals, the odds ratio of death was 1.31‑fold higher for regional hospitals, 1.35‑fold higher for private hospitals, and 1.48‑fold higher for district and city hospitals; 92% of all in‑hospital deaths occurred after urgent and emergency admissions. Hospital admissions at weekends or on other nonworking days (public holidays) were significant predictors of in‑hospital mortality. Differences in mortality rates were found between particular months, but no seasonal relationship was established.

Conclusions: Age, male sex, emergency admission, admission at the weekend or on another nonworking day (during public holidays), and hospitalization in a district, city, private, or regional hospital (compared with a university hospital) were factors associated with higher mortality in nonsurgical departments.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.20452/pamw.15185DOI Listing
April 2020

Epidemiology and direct costs of atopic dermatitis in Poland based on the National Health Fund register (2008-2017).

Postepy Dermatol Alergol 2019 Dec 19;36(6):727-733. Epub 2018 Oct 19.

Faculty of Health Sciences, Medical University of Lodz, Lodz, Poland.

Introduction: Epidemiological data indicate significant differences in atopic dermatitis (AD) prevalence between countries.

Aim: The purpose of this study is to (i) analyse the recorded prevalence of atopic dermatitis (diagnoses of AD reported to the Polish National Health Fund (NHF)) and to (ii) estimate direct costs of medical care for AD incurred by the NHF.

Material And Methods: The analysis was based on data reported to the database of the public payer (NHF). The prevalence rates were calculated using the NHF data and population estimates were obtained from the Central Statistical Office of Poland (GUS).

Results: In 2017, the annual prevalence rate of AD in the Polish population was 32.5 per 10,000 inhabitants (34.7/10,000 for women and 30.1/10,000 for men). The highest prevalence was observed in the youngest age groups (300/10,000 in children up to 4 years of age and 141/10,000 in 5-9-year-olds). The prevalence rate decreased with age and AD was the least prevalent in patients over 85 years of age (4/10,000). In 2008-2017, NHF expenditure on AD treatment varied between PLN 19.9 million (EUR 5.6 million) in 2008 and PLN 28.4 million (EUR 6.5 million) in 2016.

Conclusions: The prevalence rates of AD in Poland estimated on the basis of NHF data are significantly lower than those reported in previous epidemiological studies conducted in Poland and worldwide. This may indicate that the prevalence of AD in the Polish population is underestimated or that there are no adequate disease control measures in patients with a confirmed diagnosis.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.5114/ada.2018.79099DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6986289PMC
December 2019

Geographic disparities in the application of endovascular repair of unruptured abdominal aortic aneurysm - Polish population analysis.

Adv Med Sci 2020 Mar 21;65(1):170-175. Epub 2020 Jan 21.

Department of Internal Medicine, Hypertension and Vascular Diseases, Medical University of Warsaw, Warsaw, Poland.

Purpose: Differences between the regions of the same country regarding the management of abdominal aortic aneurysm (AAA) have rarely been published. The aim of the study was to analyze the absolute and relative number of unruptured AAA repairs, utilizing endovascular aneurysm repair (EVAR) vs. open aneurysm repairs (OAR) and compare the AAA patients population from all 16 administrative districts in Poland.

Material And Methods: We used the Polish National Health Fund data of all patients who underwent elective treatment of AAA between 1 January 2011 and 22 March 2016 and analyzed the absolute/relative number of all AAA repairs, OAR, EVAR and incidence of concomitant diseases in distinctive regions. Relationships between the utilization of EVAR and the number of procedures, age, gender and concomitant diseases were studied.

Results: A total of 7805 patients (mean age 70.9 ± 8.1 yrs) underwent OAR (n = 2336) or EVAR (n = 5469). The age and the incidence of concomitant diseases differed significantly between districts. The highest absolute number of all repairs was performed in the Masovian district (n = 1442), while the highest relative number of all repairs in the Lublin district (36.3/100,000 65+/year). The utilization of EVAR ranged from 34.5% to 93.9% and correlated positively with the number of EVAR, age and chronic obstructive pulmonary disease occurrence and negatively with OAR number.

Conclusions: Striking differences in the relative numbers of unruptured AAA repairs and in the population characteristics in various districts of the country point to the possibility of different health needs in the regions and variations in standards of care.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1016/j.advms.2020.01.003DOI Listing
March 2020

Population morbidity in elderly lung cancer patients from Poland with specific trends in elderly women.

Prz Menopauzalny 2019 Dec 20;18(3):161-165. Epub 2019 Dec 20.

Department of Management and Logistics in Health Care, Medical University of Lodz, Lodz, Poland.

Introduction: Lung cancer remains a leading cause of morbidity and mortality in Poland and globally. The objective of the study was to assess lung cancer incidence among elderly patients in Poland, including data for urban and rural populations, with trend analysis between 2008 and 2012.

Material And Methods: Differences between lung cancer prevalence in the Polish population aged 65 years or older were assessed with respect to province, gender, and rural vs. urban areas during the 2008-2012 period. Data were extracted from the Polish National Health Authority and Statistical Bureau databases.

Results: Lung cancer morbidity among the elderly increased by 14.05% in urban areas but only by 4.01% in rural areas. A 22.41% overall increase was noted in the elderly female population, compared to a 7.29% increase among men aged 65 years and over. Regional differences in morbidity were observed.

Conclusions: The rationale behind the differences is likely to be multi-factorial. A change in risk factor exposure in the past is probably now being reflected in lung cancer morbidity. The difference between sexes can potentially be regarded as an unfortunate side-effect of increasing female empowerment. Urban vs. rural, as well as regional, variances are probably due to a multitude of factors, including differences in socio-economic status.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.5114/pm.2019.90811DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6970423PMC
December 2019

Analysis of National Health and Insurance Registers for All-Cause Mortality in Patients with Heart Failure with and without Diabetes Mellitus in Poland in 2012.

Med Sci Monit 2019 Dec 31;26:e921138. Epub 2019 Dec 31.

Department of Prevention of Environmental Hazards and Allergology, Medical University of Warsaw, Warsaw, Poland.

BACKGROUND This retrospective study aimed to analyze all-cause mortality in patients with heart failure with and without diabetes mellitus in 2012 in Poland using data from the National Health Fund [Narodowy Fundusz Zdrowia] (NFZ), the Central Register of the Insured [Centralna Baza Ubezpieczonych] (CBU), and the Polish Universal Electronic System for Registration of the Population (PESEL). MATERIAL AND METHODS Between 1st January 2012 and 31st December 2012, data were analyzed from the NFZ, CBU, and PESEL to include all patients with a primary diagnosis of heart failure, with and without diabetes mellitus and all-cause mortality data. Structured Query Language (SQL) was used to retrieve and manage data from NFZ, CBU, and PESEL. RESULTS In Poland, 32.58% of 201,586 patients with a primary diagnosis of heart failure who died in 2012 also had a diagnosis of diabetes mellitus. The overall mortality rate in men with heart failure and diabetes was eight times higher than for men with heart failure without diabetes. The overall mortality rate in women with diabetes and heart failure was 5.5 times higher compared with women with heart failure without diabetes. More than 90% of deaths in female patients with heart failure, with or without diabetes, occurred in women >60 years. For male patients with heart failure with or without diabetes, 70% of deaths occurred in men >60 years. CONCLUSIONS These findings support the need for continued prevention programs, early diagnosis, and treatment of diabetes, and highlight the increase in mortality for patients with heart failure and diabetes.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.12659/MSM.921138DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6953437PMC
December 2019

Prevalence of axial spondyloarthritis in Poland.

Rheumatol Int 2020 Feb 4;40(2):323-330. Epub 2019 Dec 4.

Satellite Campus in Warsaw, University of Humanities and Economics in Lodz, Łódź, Poland.

The prevalence of axial spondyloarthritis (axSpA) in the published data varies significantly. Two types of axSpA can be distinguished depending upon the presence of abnormalities consistent with sacroiliitis on plain radiography: ankylosing spondylitis (AS) and nonradiographic axial SpA (nr-axSpA). The aim of this study is to perform a retrospective analysis of axSpA prevalence in Poland in the years 2008-2017. The National Health Fund (NHF) database for the period 2008-2017 was analysed. Data of all patients with the ICD-10 codes M46 (M46.1, M46.8, M46.9) or M45 (further named other inflammatory spondylopathies-OIS and AS, respectively) as the main or co-existing diagnosis were extracted and analysed. The AS prevalence was stable during the period under examination amounting to approximately 0.083%, while the OIS prevalence increased from 0.036 to 0.059%. For both men and women, the AS prevalence increased with age, reaching a maximum around the age of 70; however, in men, a marked increase in prevalence was observed earlier as compared to women (20-24 vs. 40-44 years, respectively). The OIS prevalence also increased with age; however, the maximum was reached earlier as in case of AS. Moreover, a sharp increase in OIS prevalence occurred earlier than in AS (15-19 years) with no difference between sexes. In Poland, approximately 0.1% of the population suffers from AS-the prevalence remained stable over the last decade. The prevalence of OIS increased markedly over the studied period which presumably reflects an increasing prevalence of nr-axSpA as the effect of the introduction of ASAS classification criteria for axSpA.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1007/s00296-019-04482-7DOI Listing
February 2020

Analysis of the survival of patients receiving systemic treatment for melanoma of the skin: a retrospective population study with patients treated in Poland in 2011-2015.

Postepy Dermatol Alergol 2019 Aug 30;36(4):438-441. Epub 2019 Aug 30.

Division of Quality Services, Procedures and Medical Standards, Medical University of Lodz, Lodz, Poland.

Introduction: In Poland, it is uniquely possible to assess real effects of the introduction of new oncological therapies on the overall survival in patients as such therapies are funded by one payer only - the National Health Fund (NHF). Data collected by the NHF make it possible to analyse the survival of all patients who were diagnosed with melanoma.

Aim: The paper presents findings of a retrospective analysis of the efficacy of systemic treatment in patients with malignant melanoma of the skin in Poland with regard to the overall survival.

Material And Methods: The analysis of the overall survival was performed with the Kaplan-Meier method in the population receiving systemic treatment. Three groups of patients were analysed. Group 1 included all patients who had started systemic treatment between 1 March 2011 and 1 March 2015: 1,258 patients. The median overall survival was 8.4 months. Group 2 included 444 patients who had started systemic treatment between 1 March 2011 and 28 February 2013. The median overall survival was 6.6 months in this group. Group 3 included 814 patients who had started systemic treatment between 1 March 2013 and 1 March 2015 and included 546 patients who were also treated in drug programmes with ipilimumab and vemurafenib (approx. 67%). The median overall survival was 9.4 months.

Results: A difference in the overall survival between group 3 and 2 was statistically significant ( < 0.05).

Conclusions: The introduction of vemurafenib and ipilimumab into systemic treatment in Poland using public funds had a significant effect on the prolongation of the overall survival in patients with malignant melanoma of the skin.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.5114/ada.2019.83368DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6791149PMC
August 2019

The Increase of Osteoporotic Hip Fractures and Associated One-Year Mortality in Poland: 2008-2015.

J Clin Med 2019 Sep 18;8(9). Epub 2019 Sep 18.

National Health Fund, 02-390 Warsaw, Poland.

Introduction: Hip fractures are a worldwide public health issue associated with significant mortality. Previous Polish studies reported an increasing trend in the number of hip fractures for both men and women, although lower than most other European countries.

Materials And Methods: The Polish National Database was analyzed to examine osteoporotic hip fractures in the population aged 50 and over. Hip fracture incidence, rate, one-year mortality, and postoperative length of hospitalization were analyzed using the national health system data. Hospital discharge registry ICD-10 codes were reviewed from 2008 to 2015.

Results: The incidence of hip fractures increased in both women and men by 19.4% and 14.2%, respectively. The female to male fracture ratio was 2.46. Mean postoperative hospitalization decreased from 13.6 to 11.2 days. The one-year mortality ranged between 30.45% to 32.8% for men and 26.2% to 28% for women. Of note, women aged 80-89 had the highest one-year mortality, 50.7%-55.4% after femoral neck fracture and 53%-58.5% after a pertrochanteric fracture.

Conclusions: Hip fractures in Poland are increasingly more prevalent in the aging population. The unfavorable trends observed in this study indicate higher annual mortality after hip fracture, compared with other European countries.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.3390/jcm8091487DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6780214PMC
September 2019

Syphilis in Poland is on the rise and underreported.

Postepy Dermatol Alergol 2019 Apr 14;36(2):192-195. Epub 2019 May 14.

Lomza State University of Applied Sciences and Department of Nephrology and Transplantation, Medical University of Bialystok, Bialystok, Poland.

Introduction: Despite the availability of diagnostic tests and effective treatment, there has been a problem with vigilance and reporting of that infectious disease in many countries including Poland.

Aim: To compare the incidence of syphilis in Poland in years 2010-2016 according to the mandatory epidemiological surveillance system with the data of the National Health Fund (NHF).

Material And Methods: Data of the NHF in Poland were collected. The total number of patients with syphilis (all forms) was estimated on the basis of their unique identifying numbers (PESEL).

Results: The steady increase in the incidence of syphilis in Poland throughout 2010-2016 was found, apart from the congenital form of the disease, which decreased since 2010. The higher prevalence of syphilis was noted in men. The number of hospitalized patients remained constant. According to the data of the NHF, the number of cases of syphilis in Poland was twofold higher as compared to the statistics of the mandatory epidemiological surveillance system (National Institute of Public Health - National Institute of Hygiene, NIPH-NIH), which was the basis of reports published up to date.

Conclusions: Our work shows that there is a remarkable underreporting of syphilis in the mandatory epidemiological surveillance system in Poland, involving also hospitalized patients. The use of the data of NHF in the surveillance of syphilis in Poland is proposed.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.5114/ada.2019.84595DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6627260PMC
April 2019

Eating Disorders in Males: An 8-Year Population-Based Observational Study.

Am J Mens Health 2019 Jul-Aug;13(4):1557988319860970

1 Department of Education and Research in Health Sciences, Faculty of Health Sciences, Medical University of Warsaw, Poland.

The objective of the study was the realistic evaluation of the prevalence of eating disorders (ED) among Polish men who sought treatment through the National Health Fund (NFZ) in the years 2010-2017. According to ICD-10, four types of ED were analyzed: anorexia nervosa-AN (F50.0), atypical anorexia nervosa (F50.1), bulimia nervosa-BN (F50.2), and atypical bulimia nervosa (F50.3). The NFZ database was used. The ED groups were defined according to ICD-10 codes. Demographic data were collected from the web page of Statistics Poland (GUS). The annual prevalence of EDs was estimated, and the age groups were categorized into nine groups. For the incidence of EDs in male patients in the years 2010-2017, relative risk (RR) with 95% confidence interval (95% CI) was calculated. The frequency trend of AN in males remains relatively stable. AN occurred mainly in young men (between 11 and 30 years). It was noted that AN affected approximately 100 men in each year of observation, while atypical anorexia nervosa affected about 40 men. In 2017, the RR for EDs in young males was 0.041 (95% CI [0.033, 0.051]). Bulimia was relatively rare (about 35 males each year). The incidence of EDs in males is a relatively constant phenomenon. The real number of male patients with EDs may be higher. The current conceptualizations of ED pathology should be modified and better adapted to men. Clinical guidelines for specialists working with males with EDs should be developed.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1177/1557988319860970DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6610443PMC
July 2020

Real-World Evidence of Patient Outcome Following Treatment of Advanced Gastrointestinal Stromal Tumor (GIST) with Imatinib, Sunitinib, and Sorafenib in Publicly Funded Health Care in Poland.

Med Sci Monit 2019 May 23;25:3846-3853. Epub 2019 May 23.

Division of Quality Services, Procedures and Medical Standards, Medical University of Łódź, Łódź, Poland.

BACKGROUND This study aimed to undertake an analysis of ten years of real-world evidence (RWE) on overall survival (OS) following treatment of advanced gastrointestinal stromal tumor (GIST) with imatinib, sunitinib, and sorafenib using data from the Polish National Health Fund. MATERIAL AND METHODS Data from the Polish National Health Fund, the sole Polish public payer, identified 1,641 patients with advanced GIST who were treated with imatinib (n=1047), sunitinib (n=457), and sorafenib (n=137). The differences in overall survival (OS) were analyzed. RESULTS For patients with advanced GIST, the median follow-up time for patients treated with imatinib was 71 months (95% CI, 64.8-79.2), the median OS was 56.9 months (95% CI, 50.4-61.2), with survival at 12 months (89.5%), 24 months (77.9%), 36 months (66.9%), and 60 months (48.4%). The median follow-up time for patients treated with sunitinib was 41.4 months (95% CI, 34.6-49.3), the median OS was 22.8 months (95% CI, 19.2-26.8), with survival at 12 months (68.2%), 24 months (47.1%), and 36 months (31%). The median follow-up time for patients treated with sorafenib was 17.4 months (95% CI, 14.6-22.9), the median OS was 16.9 months (95% CI, 13.7-24.3), with survival at 12 months (61.9%), at 24 months (36.2%), and at 36 months (16.8%). CONCLUSIONS Real-world data collected in a ten-year period confirmed the effectiveness of the use of imatinib, sunitinib, or sorafenib for the treatment of advanced GIST and was comparable with the findings from clinical trials.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.12659/MSM.914517DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6543874PMC
May 2019

Evaluation of the incidence of aortic aneurysms in patients with and without diabetes in Poland in 2012 based on the database of the National Health Fund.

Arch Med Sci 2019 May 5;15(3):607-612. Epub 2017 Oct 5.

Division of Quality Services, Procedures and Medical Standards, Medical University of Lodz, Lodz, Poland.

Introduction: There are reports that diabetes mellitus reduces the risk of aortic aneurysms and many reports that diabetes mellitus reduces the risk of abdominal aortic aneurysms. In earlier years there were also studies that did not demonstrate any effects of diabetes on the rate of aortic aneurysms.

Material And Methods: For the year 2012, between 1 January and 31 December, reports for services regarding treatment for aortic aneurysms were found. At the same time, the reports for services associated with diabetes with the main diagnosis of "diabetes mellitus" were found in National Health Fund databases for 2012 with the special determinants.

Results: In Poland in 2012 the mean incidence of aortic aneurysms in both sexes in the group of subjects with diabetes calculated per 100,000 subjects with diabetes was 167.78 ±49.10, and the mean incidence of aortic aneurysms in both sexes in the group of subjects without diabetes calculated per 100,000 of the general population after subtracting the number of subjects with diabetes was 27.72 ±9.40. The incidence of aortic aneurysms among subjects with diabetes was significantly higher ( < 0.001) than the incidence of aortic aneurysms among subjects without diabetes.

Conclusions: Aortic aneurysms were more frequently observed in the group of patients with diabetes than in those without diabetes. Aortic aneurysms were observed three times more frequently in men than in women. In Poland in 2012, 27.20% of patients diagnosed with aortic aneurysms also had diabetes.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.5114/aoms.2017.68410DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6524175PMC
May 2019

Improvement in outcomes of breast cancer patient treatment in Poland in the 21st century.

Breast J 2019 05 13;25(3):474-478. Epub 2019 Apr 13.

National Health Fund, Warsaw, Poland.

Breast cancer accounts for 22%-25% of all female cancers diagnosed worldwide. The aim of study was to compare the 5-year relative survival rates for breast cancer patients treated in the years 2008-2010, 2000-2002, and 2005-2007, and to determine their relationships with the methods and costs of treatment. Data were collected from the National Cancer Registry and the Narodowy Fundusz Zdrowia (National Health Fund) data bases. An increase in the 5-year survival rate was observed. The results show the impact of some factors on the survival and treatment costs. It is necessary to create data bases being a platform for further comprehensive analyses.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1111/tbj.13245DOI Listing
May 2019

Impact of air pollution on hospital admissions with a focus on respiratory diseases: a time-series multi-city analysis.

Environ Sci Pollut Res Int 2019 Jun 30;26(17):16998-17009. Epub 2019 Mar 30.

Central Clinical Hospital MSWiA in Warsaw, Wołoska 137, 02-507, Warsaw, Poland.

Together with the growing availability of data from electronic records from healthcare providers and healthcare systems, an assessment of associations between different environmental parameters (e.g., pollution levels and meteorological data) and hospitalizations, morbidity, and mortality has become possible. This study aimed to assess the association of air pollution and hospitalizations using a large database comprising almost all hospitalizations in Poland. This time-series analysis has been conducted in five cities in Poland (Warsaw, Białystok, Bielsko-Biała, Kraków, Gdańsk) over a period of almost 4 years (2014-2017, 1255 days), covering more than 20 million of hospitalizations. The hospitalizations have been extracted from the National Health Fund registries as daily summaries. Correlation analysis and distributed lag nonlinear models have been used to investigate for statistically relevant associations of air pollutants on hospitalizations, trying by various methods to minimize potential bias from atmospheric parameters, days of the week, bank holidays, etc. A statistically significant increase of respiratory disease hospitalizations has been detected after peaks of particulate matter concentrations (particularly PM, between 0.9 and 4.5% increase per 10 units of pollutant increase, and PM, between 0.9 and 3.5% per 10 units of pollutant increase), with a typical time lag between the pollutant peak and the event of 2 to 6 days. For other pollution parameters and other types of hospitalizations (e.g., cardiovascular events, eye and skin diseases, etc.), a weaker and ununiform correlations were recorded. Ambient air pollution exposure increases are associated with a short-term increase of hospitalizations due to respiratory tract diseases. The most prominent effect was recorded with the correlation of PM and PM. There is only weak evidence indicating that such short-term associations exist between peaks of air pollution concentrations and increased hospitalizations for other (e.g., cardiovascular) diseases. The obtained information could be used to better predict hospitalization patterns and costs for the healthcare system and perhaps trigger additional vigilance on particulate matter pollution in the cities.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1007/s11356-019-04781-3DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6546668PMC
June 2019

Comparison of the incidence of new malignancies in diabetic patients in urban and rural populations in Poland in the years 2008-2014 based on the database of the National Health Fund.

Arch Med Sci 2019 Mar 5;15(2):330-336. Epub 2017 Oct 5.

Department of Health Care, Center of Postgraduate Medical Education, Warsaw, Poland.

Introduction: Many epidemiological studies show a correlation between the risk of cancer and type 2 diabetes mellitus in various populations.

Material And Methods: The material was obtained from the database of the National Health Fund. This publication presents a comparison of the incidence of new malignancies in rural and urban populations of diabetic patients in Poland based on the database of the National Health Fund for the period between 1.05.2008 and 30.09.2014.

Results: Comparison of the mean incidence of selected malignancies in diabetic patients in the population analysed indicated significant differences between the incidence rate in the urban and rural populations ( < 0.001). The mean incidence of gastric cancer, colorectal cancer, kidney cancer, brain tumours and leukaemia in both sexes was significantly higher in rural areas compared to urban. The mean incidence of oesophageal cancer and pancreatic cancer in females was significantly higher among in the urban population compared to the rural areas ( < 0.001). No differences in the incidence rate of these neoplasms were observed in men ( > 0.05).

Conclusions: The incidence of gastric cancer, colorectal cancer, laryngeal cancer, lung cancer, testicular cancer, kidney cancer, lung cancer, lymphocytic leukaemia and myeloid leukaemia is higher in diabetic males in rural areas than the incidence in the urban population. The incidence of the malignancies liver cancer, malignant skin melanoma, malignant skin, prostate cancer, urinary bladder cancer and multiple myeloma in male diabetic patients living in urban areas is higher than the incidence in rural areas.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.5114/aoms.2017.68409DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6425219PMC
March 2019