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Aims/hypothesisThe aim of this work was to investigate diabetes incidence after infection with coronavirus disease-2019 (Covid-19). Individuals with acute upper respiratory tract infections (AURI), which are frequently caused by viruses, were selected as a non-exposed control group.MethodsWe performed a retrospective cohort analysis of the Disease Analyzer, which comprises a representative panel of 1171 physicians’ practices throughout Germany (March 2020 to January 2021: 8.8 million patients). Newly diagnosed diabetes was defined based on ICD-10 codes (type 2 diabetes: E11; other forms of diabetes: E12–E14) during follow-up until July 2021 (median for Covid-19, 119 days; median for AURI 161 days). Propensity score matching (1:1) for sex, age, health insurance, index month for Covid-19/AURI and comorbidity (obesity, hypertension, hyperlipidaemia, myocardial infarction, stroke) was performed. Individuals using corticosteroids within 30 days after the index dates were excluded. Poisson regression models were fitted to obtain incidence rate ratios (IRRs) for diabetes.ResultsThere were 35,865 individuals with documented Covid-19 in the study period. After propensity score matching, demographic and clinical characteristics were similar in 35,865 AURI controls (mean age 43 years; 46% female). Individuals with Covid-19 showed an increased type 2 diabetes incidence compared with AURI (15.8 vs 12.3 per 1000 person-years). Using marginal models to account for correlation of observations within matched pairs, an IRR for type 2 diabetes of 1.28 (95% CI 1.05, 1.57) was estimated. The IRR was not increased for other forms of diabetes.Conclusions/interpretationCovid-19 confers an increased risk for type 2 diabetes. If confirmed, these results support the active monitoring of glucose dysregulation after recovery from mild forms of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection.

To examine the association of several antihypertensive medication classes with incidence of Parkinson's disease (PD), taking into account possible underlying conditions. In a case-control study based on a large primary care database and including 21,981 PD cases and 21,981 non-PD controls matched for age, sex, and possible treatment indications associations with different antihypertensive medication groups, including diuretics, betablockers, calcium channel blockers, angiotensin-converting enzyme inhibitors and angiotensin-II receptor-blockers and PD were examined. Antihypertensive medications overall were associated with a lower risk of subsequent diagnosis of PD (OR: 0.94, 95% CI 0.90-0.97), with the negative association most significant for medications acting on the renin-angiotensin-aldosterone system. A positive association with diagnosis of PD was only seen for betablockers and restricted to those with relatively young age and not in those with longer treatment duration. When taking into account underlying diagnoses, antihypertensive medications overall were associated with a reduced incidence of PD.

Background Events of cardiovascular disease (CVD) remain a critical concern in patients with Type 2 diabetes mellitus (T2D). Over 17 years, this study analyzed time changes in the 5‐year incidence of myocardial infarction (MI), chronic coronary heart disease (CHD), transient ischemic attack (TIA), and ischemic stroke (IS). Methods This retrospective cohort study was conducted using the Disease Analyzer database, including patients aged ≥ 18 years with at least 12 months of no prior CVD with new‐onset T2D in 2001–2006 (n = 10 162) and in 2013–2018 (n = 30 486), matched 1:3 by age and sex. Kaplan–Meier survival analysis estimated the 5‐year cumulative incidence of the outcomes. Multivariable Cox regression models assessed temporal changes, adjusted for comorbidities. Results The incidence of CHD and TIA significantly declined in 2013–2018 compared to 2001–2006, with HRs of 0.68 (95% CI: 0.63–0.73; p < 0.001) and 0.63 (95% CI: 0.52–0.76; p < 0.001), respectively. Reductions were more pronounced in women and older patients. Surprisingly, MI incidence showed only a trend of reduction (HR: 0.82; 95% CI: 0.68–0.99; p = 0.045) and IS incidence was not different (HR: 0.97; 95% CI: 0.85–1.12; p = 0.722) between time periods. Conclusions This study is the first to report time trends in CVD incidence in new‐onset T2D in Germany. From 2001 to 2018, the 5‐year incidence of CHD and TIA decreased in new‐onset T2D, reflecting demographic‐specific advancements in diabetes and cardiovascular care. However, the stable incidence of IS and MI underscores a persistent challenge in prevention strategies in patients with prediabetes and T2D.

Background At the present time, there is no consensus on the association between benign thyroid diseases and breast cancer (BC). Therefore, the aim of this study is to help shed some light on the association between hyperthyroidism, hypothyroidism, and thyroiditis and breast cancer risk. Methods Use of the Disease Analyzer database (IQVIA) enabled us to perform a retrospective case–control study of 7408 women aged between 18 and 80, who were treated for an initial breast cancer diagnosis in a general practice in the United Kingdom between 2006 and 2015 (index date). Patients with a previous cancer diagnosis and an observation time of less than 12 months prior to the index date were excluded. The control group consisted of 7408 healthy women, who were matched to cases 1:1 by age, body mass index, hormone replacement therapy, and physician. The main outcome parameters of this study were the presence of thyroid disease (hypothyroidism, hyperthyroidism, struma, and thyroiditis) and the TSH values in the two groups. A univariate logistic regression model was used to investigate the association between benign thyroid diseases, TSH values, and BC. Results The mean age was 58.4 years in both groups. We found a significant association between thyroiditis and BC (OR: 1.91, p  = 0.01) and were able to refute the association between hyperthyroidism/hypothyroidism and BC. We also found that thyroid-stimulating hormone (TSH) had no significant effect on breast cancer risk. Conclusion Many experimental studies suggest a link between hyperthyroidism/hypothyroidism and BC. We were able to demonstrate an epidemiological association between thyroiditis and an increased BC risk. This shows the need for close monitoring for BC in women with thyroiditis.

BackgroundPatients with NAFLD are considered at a high risk of cardiovascular events due to underlying metabolic risk factors. Currently, data related to the impact of NAFLD on cardiovascular risk in the general population are lacking.AimsThe aim of this study was to investigate the role of NAFLD on risk of myocardial infarction (MI), coronary heart disease (CHD), atrial fibrillation (AF), and stroke in primary care in Germany.MethodsThe study included patients diagnosed with NAFLD in primary care between 2010 and 2015. NAFLD cases (n = 22,048) were matched to a cohort without NAFLD (n = 22,048) based on age, sex, treating physician, type 2 diabetes, arterial hypertension, and hyperlipidemia. The primary outcome of the study was the incidence of MI, CHD, AF, and stroke.ResultsWithin 10 years of the index date, 12.8% of patients with NAFLD and 10.0% of controls were diagnosed with CHD (p < 0.001). Additionally, frequency of MI was significantly higher in NAFLD (2.9% vs. 2.3%, p < 0.001). On regression analysis, HR for incidence of MI was 1.34 (p = 0.003) in all NAFLD patients and 1.35 (p = 0.013) for men. Incidence of AF was significantly higher in patients with NAFLD. On regression analysis, HR for incidence of AF was 1.15 (p = 0.005). NAFLD was not associated with a higher incidence of stroke (HR 1.09, p = 0.243).ConclusionsNAFLD constitutes an independent risk factor for CHD, MI, and AF in primary care in Germany. Identification of patients with NAFLD in primary care will allow specifically managing and modifying underlying risk factors to improve the overall prognosis.

Background ADHD is associated with several health outcomes, but its long-term cerebrovascular associations, particularly in adults with metabolic conditions, remain poorly understood. Methods A retrospective cohort analysis was performed using the Disease Analyzer database (IQVIA) and included adults with ADHD which were compared to a propensity score matched non-ADHD cohort. The 10-year incidence of acute ischemic stroke (AIS) or transient ischemic attack (TIA) was analyzed using Kaplan-Meier curves and univariable conditional Cox regression models with hazard ratios (HRs) and 99% confidence intervals (CIs). Results Among 8,943 ADHD patients and 44,660 controls, 1.7% of ADHD patients and 1.2% of controls experienced AIS or TIA (log-rank test, p = 0.006). In the regression analysis, there was a significant association between ADHD and subsequent TIA or AIS in the total population (HR: 1.69; 99% CI:1.13-2.51). This association was stronger and significant in subgroups of patients aged >45 years (HR: 2.34; 99% CI: 1.43-3.81) and those with obesity (HR: 1.86; 99% CI: 1.22-2.83), hypertension (HR: 2.18; 99% CI: 1.19-3.97), or dyslipidemia (HR: 2.89; 99% CI: 1.48-5.52). Conclusion ADHD in adults, particularly those over 45 years of age and those with metabolic comorbidities, is associated with an increased risk of cerebrovascular disease. Further research is needed to confirm these associations and to explore the underlying mechanisms.

Dementia and NAFLD are two frequent conditions that share underlying risk factors mainly in the realm of metabolic disease. Additionally, an association between NAFLD and brain aging has been proposed. Therefore, we investigated the hypothesis if NAFLD is an independent risk factor for emerging dementia. In this population-based cohort study, elderly patients (≥ 65 years) with NAFLD diagnosed between 2000 and 2015 were matched 1:1 to a cohort without NAFLD based on ICD-10 coding in the Disease Analyzer database. Matching criteria were age, sex, physician, index year, and co-diagnoses associated with dementia. The primary outcomes of this study were all-cause dementia diagnoses, the incidence of vascular dementia, and antidementive drug prescription. A total of 22,317 patients with NAFLD were matched to 22,317 patients without NAFLD. Within 10 years of the index date, 16.0% of patients with NAFLD and 15.6% of the patients without NAFLD were diagnosed with dementia. On Cox regression analysis, there is no association between NAFLD and the incidence of all-cause dementia (HR 0.97, 95% CI 0.92–1.04), vascular dementia (HR 0.89, 95% CI 0.78–1.02), or the new prescription of antidementive therapy (HR 0.87, 95% CI 0.76–1.01). In sensitivity analyses, there was no association between NAFLD and dementia in different age-groups as well as men or women. In conclusion, in this database study of elderly patients coded with NAFLD no independent association with incident dementia was detected. Risk assessment regarding dementia in patients with NAFLD should be carried out in the same way as for metabolic burdened patients.

Background: Numerous studies have demonstrated the beneficial effects of sodium-glucose cotransporter-2 (SGLT2) inhibitors on cardiovascular and renal outcomes in patients with heart failure and chronic kidney disease. However, whether SGLT2 inhibitors are also associated with a reduced risk of tinnitus has not been investigated. Objective: This study aimed to investigate the association between SGLT2 inhibitor therapy and the incidence of tinnitus in patients with type 2 diabetes. Methods: This retrospective cohort study was based on data from a nationally representative database of primary care practices in Germany from 2012 to 2023. Patients with type 2 diabetes who were treated with metformin and additionally received either an SGLT2 inhibitor or a dipeptidyl peptidase-4 (DPP4) inhibitor were included. Patients with a previous diagnosis of tinnitus were excluded. The primary outcome was the first tinnitus diagnosis documented by a primary care physician. The SGLT2 and DPP4 cohorts were compared for tinnitus incidence using Kaplan–Meier analysis and multivariable Cox regression. Results: 66,750 patients with SGLT2 inhibitors and 82,830 with DPP4 inhibitors were analyzed. The cumulative 5-year incidence of tinnitus was 1.9% in both groups. The multivariable regression analysis did not show a significant association between SGLT2 therapy and the occurrence of a tinnitus diagnosis (HR: 1.04; 95% CI: 0.89–1.21). Conclusion: There was no difference in tinnitus incidence between patients with SGLT2 or DPP4 inhibitors. The causes could lie in the heterogeneous, not purely vascular, etiology of tinnitus in general practitioners’ practices. Future studies should include further clinical data, including confirmed hearing impairments.

Background: Depression and cancer share common risk factors and mechanisms of disease. The current literature has not explored the effect of depression on cancer risk. We assessed the difference in cancer risk in patients with and without depression in a large cohort in Germany. Methods: We compared cancer risk and incidence in patients with and without depression aged 18 or above diagnosed between 2015 and 2018 documented in the Disease Analyzer Database. Patients from a comparator group were matched 1:1 to patients with depression based on propensity scores. Patients with previous bipolar disorder (F31), mania (F30) or schizophrenia (F20–29) and cancer diagnosis 3 years prior to index date were excluded. Analyses were stratified by cancer type, age group, and gender. Results: A total of 117,702 patients with depression were included and matched 1:1, resulting in a cohort overall of 235,404. 4.9% of patients with depression compared to 4.1% without depression received at least one cancer diagnosis over 3.9 years median follow-up. The depression group showed an 18% increase in risk for a cancer diagnosis overall, with largest increased risk in lung cancer (HR: 1.39 [1.21–1.60], p < 0.0001), cancers of the gastro-intestinal-tract (HR: 1.30 [1.15–1.46], p < 0.0001), breast (HR: 1.23 [1.12–1.35], p < 0.0001) and urinary (HR: 1.23 [1.06–1.43], p < 0.01). Similarly, the incidence of cancer diagnosis overall increased by 22% for depressed patients. IRs showed no difference across cancer types. Conclusions: Depression increased the risk for cancer diagnosis consistently independent of the comparison method used. The potential mediating factors or shared mechanisms of the disease require further investigation.