Temporal trends in hematopoietic stem cell transplantation in Argentina between 2009 and 2018: A collaborative study by GATMO-TC and INCUCAI.

INTRODUCTION: Hematopoietic stem cell transplantation is the only curative treatment for many disorders and international data shows a growing trend. METHOD: We aimed to evaluate the temporal trends in HSCT transplant rates in Argentina. A time-series analysis was performed for the period 2009 to 2018 using the national database from the National Central Coordinating Institute for Ablations and Implants. Crude and standardized transplant rates were calculated. A permutation joinpoint regression model analysis was used to identify significant changes over time. RESULTS: Altogether, 8,474 transplants were reported to INCUCAI by 28 centers (autologous 67.5%); the main indication was multiple myeloma (30%). The WHO age-sex standardized HSCT rates for the entire country were 153.3 HSCT/10 million inhabitants (95% CI 141.7-165.8) in 2009 and 260.1 HSCT/10 million inhabitants (95% CI 245.5-275.5) in 2018. There was a large gap in HSCT rates among the states and regions. The transplant rate was higher for autologous transplants throughout the years. Within the allogeneic group, the related donor transplant rate was higher than the unrelated donor transplant rate. The joinpoint regression analysis of HSCT rates for the whole country over time showed an observed annual percentage change of 6.3% (95% CI 5.4-7.3; p < 0.01). No changes were observed for unrelated donors during the study period. CONCLUSIONS: Age-sex standardized HSCT rates in Argentina are increasing, mainly due to autologous and family donor allogeneic transplants. A wide variation across the country was found, demonstrating differences in the access to transplantation among Argentine regions.

Temporal trends in hematopoietic stem cell transplantation in Argentina between 2009 and 2018: A collaborative study by GATMO-TC and INCUCAI

Special Article Introduction Hematopoietic stem cell transplantation is the only curative treatment for many disorders and international data shows a growing trend. Method We aimed to evaluate the temporal trends in HSCT transplant rates in Argentina. A time-series analysis was performed for the period 2009 to 2018 using the national database from the National Central Coordinating Institute for Ablations and Implants. Crude and standardized transplant rates were calculated. A permutation joinpoint regression model analysis was used to identify significant changes over time. Results Altogether, 8,474 transplants were reported to INCUCAI by 28 centers (autologous 67.5%); the main indication was multiple myeloma (30%). The WHO age-sex standardized HSCT rates for the entire country were 153.3 HSCT/10 million inhabitants (95% CI 141.7-165.8) in 2009 and 260.1 HSCT/10 million inhabitants (95% CI 245.5-275.5) in 2018. There was a large gap in HSCT rates among the states and regions. The transplant rate was higher for autologous transplants throughout the years. Within the allogeneic group, the related donor transplant rate was higher than the unrelated donor transplant rate. The joinpoint regression analysis of HSCT rates for the whole country over time showed an observed annual percentage change of 6.3% (95% CI 5.4-7.3; p< 0.01). No changes were observed for unrelated donors during the study period. Conclusions Age-sex standardized HSCT rates in Argentina are increasing, mainly due to autologous and family donor allogeneic transplants. A wide variation across the country was found, demonstrating differences in the access to transplantation among Argentine regions.

Vacunas COVID-19 y su protección contra la mortalidad intrahospitalaria / COVID-19 vaccines and their protection against in-hospital mortality

INTRODUCCIÓN El desarrollo de varias vacunas contra COVID-19 demostró su eficacia para reducir los malos resultados clínicos, incluida la muerte, con una eficacia superior al 90 % para evitar la hospitalización. OBJETIVOS Analizar si la vacuna contra COVID-19 reduce la mortalidad en pacientes con enfermedad COVID-19 moderada o grave que requieren oxigenoterapia. MÉTODOS Se realizó un estudio de cohortes retrospectivo, con datos de 148 hospitales tanto de España (111) como de Argentina (37). Se evaluó a pacientes hospitalizados por COVID-19 mayores de 18 años con requerimientos de oxígeno. La protección de la vacuna frente a la muerte se evaluó mediante regresión logística multivariable y propensity score matching. También se realizó un análisis de subgrupos según el tipo de vacuna. El modelo ajustado se utilizó para determinar el Riesgo Atribuible Poblacional. RESULTADOS Entre enero de 2020 y mayo de 2022, se evaluó a 21 479 pacientes hospitalizados por COVID-19 con necesidades de oxígeno. De ellos, 338 pacientes (1,5 %) recibieron una dosis única de la vacuna contra COVID-19 y 379 (1,8 %) fueron vacunados en su totalidad. En los pacientes vacunados, la mortalidad fue del 20,9 % (IC95% 17,9-24 %), frente al 19,5 % (IC95% 19-20 %) en los pacientes no vacunados, lo que dio lugar a una Odds Ratio (OR) bruta de 1,07 (IC95% 0,89-1,29; p=0,41). Sin embargo, tras considerar las múltiples comorbilidades en el grupo vacunado, la OR ajustada fue de 0,73 (IC95% 0,56-0,95; p=0,02) con una reducción del Riesgo Atribuible a la Población del 4,3% (IC95% 1-5 %). La mayor reducción del riesgo de mortalidad se produjo con el ARNm BNT162b2 (Pfizer) (OR de 0,37 [IC95% 0,23-0,59; p<0,01]), ChAdOx1 nCoV-19 (AstraZeneca) (OR de 0,42 [IC95% 0.20-0,86; p=0,02]) y mRNA-1273 (Moderna) (OR de 0,68 [IC95% 0,41-1,12; p=0,13]), y menor con Gam-COVID-Vac (Sputnik) (OR de 0,93 [IC95% 0,6-1,45; p=0,76]). DISCUSIÓN Las vacunas contra COVID-19 reducen significativamente la probabilidad de muerte en pacientes que padecen una enfermedad moderada o grave (oxigenoterapia).

Association between non-attendance to outpatient clinics and emergency department consultations, hospitalizations and mortality in a Health Maintenance Organization.

BACKGROUND: Non-attendance to scheduled medical appointments in outpatient clinics is a problem that affects patient health and health-care systems. OBJECTIVE: Evaluate association of non-attendance to scheduled appointments in outpatient clinics and Emergency Department (ED) visits, hospitalizations and mortality. METHODS: Retrospective cohort study of outpatients enrolled in 2015 to 2016 in the Hospital Italiano de Buenos Aires HMO with over five scheduled appointments. Individual non-attendance proportion was obtained by dividing missed over scheduled appointment numbers in the 365 days prior to index date. Outcomes were evaluated with a Cox proportional-hazards or Fine and Gray model for competing risks. We adjusted by several variables. RESULTS: Sixty-five thousand two hundred sixty-five adults were included. Mean age was 63.6 years (SD 18.16), 29.9% male. Outpatients had average 10.18 (SD 5.59) appointments. Non-attendance the year before the index appointment had a median of 20%. A 10% increase in non-attendance was significantly associated with ED visits (asHR 1.19; 95%CI 1.08-1.32, P < .001) and all-cause mortality (aHR 7.57; 95%CI 4.88-11.73, P < .001). In the matched subcohort analysis we observed a crude significant association of non-attendance with ED visits (P < .001) and all-cause mortality (P < .001). DISCUSSION: Our findings show non-attendance could be a marker of health events that lead to emergency department evaluations and/or death.