scholarly journals Diagnostic Features and Mortality of Tuberculosis by TNF-alpha Inhibitor Use in the United States, 2010–2017

2021 ◽  
Author(s):  
Shereen S Katrak ◽  
Rongxia Li ◽  
Sue Reynolds ◽  
Suzanne M Marks ◽  
Jessica R Probst ◽  
...  
Keyword(s):  
United States ◽  
The United States ◽  
Mortality Data ◽  
Sputum Smear ◽  
Smear Microscopy ◽  
Diagnostic Features ◽  
Necrosis Factor Alpha ◽  
Resistant Disease ◽  
Tnf Α ◽  
High Index Of Suspicion

Abstract Background An elevated risk of tuberculosis disease (TB) in persons who have received tumor necrosis factor-alpha inhibitor medications (TNF-α inhibitors) has been reported for nearly two decades, but clinical diagnostic features and outcomes of TB in this population remain poorly described. Methods We analyzed national surveillance data for TB cases among persons aged 15 years and older reported in the United States during 2010–2017 and associated mortality data reported through 2019 to describe the clinical characteristics of those receiving TNF-α inhibitors. Results Of 70,129 TB cases analyzed, 504 (0.7%) of the patients had TNF-α inhibitor use reported at TB diagnosis. Patients with TNF-α inhibitor use at TB diagnosis were more likely than TB patients not receiving TNF-α inhibitors to have TB diagnosed in extrapulmonary sites in conjunction with pulmonary sites (28.8% vs 10.0%, P<0.001). Patients receiving TNF-α inhibitors were less likely to have acid-fast bacilli (AFB) noted on sputum smear microscopy (25.6% vs 39.1%, P=0.04), and more likely to have drug-resistant disease (13.5% vs 10.0%, P<0.001). TB-attributed deaths did not significantly differ between patients receiving and not receiving TNF-α inhibitors (adjusted odds ratio 1.46, 95% confidence interval 0.95-2.26). Conclusions Clinicians evaluating TNF-α inhibitor-treated patients should have a high index of suspicion for TB and be aware that extrapulmonary or sputum smear negative TB disease is more common in these patients. No significantly diminished survival of TB patients treated with TNF-α inhibitor therapy before TB diagnosis was noted.

scholarly journals Outcomes for Children and Adolescents With Cancer: Challenges for the Twenty-First Century

2010 ◽  
Vol 28 (15) ◽  
pp. 2625-2634 ◽  
Author(s):  
Malcolm A. Smith ◽  
Nita L. Seibel ◽  
Sean F. Altekruse ◽  
Lynn A.G. Ries ◽  
Danielle L. Melbert ◽  
...  
Keyword(s):  
United States ◽  
Childhood Cancer ◽  
Cancer Mortality ◽  
Lymphoblastic Leukemia ◽  
The United States ◽  
Mortality Rates ◽  
Mortality Data ◽  
Childhood Cancers ◽  
Essential Information ◽  
The Impact

Purpose This report provides an overview of current childhood cancer statistics to facilitate analysis of the impact of past research discoveries on outcome and provide essential information for prioritizing future research directions. Methods Incidence and survival data for childhood cancers came from the Surveillance, Epidemiology, and End Results 9 (SEER 9) registries, and mortality data were based on deaths in the United States that were reported by states to the Centers for Disease Control and Prevention by underlying cause. Results Childhood cancer incidence rates increased significantly from 1975 through 2006, with increasing rates for acute lymphoblastic leukemia being most notable. Childhood cancer mortality rates declined by more than 50% between 1975 and 2006. For leukemias and lymphomas, significantly decreasing mortality rates were observed throughout the 32-year period, though the rate of decline slowed somewhat after 1998. For remaining childhood cancers, significantly decreasing mortality rates were observed from 1975 to 1996, with stable rates from 1996 through 2006. Increased survival rates were observed for all categories of childhood cancers studied, with the extent and temporal pace of the increases varying by diagnosis. Conclusion When 1975 age-specific death rates for children are used as a baseline, approximately 38,000 childhood malignant cancer deaths were averted in the United States from 1975 through 2006 as a result of more effective treatments identified and applied during this period. Continued success in reducing childhood cancer mortality will require new treatment paradigms building on an increased understanding of the molecular processes that promote growth and survival of specific childhood cancers.

scholarly journals Mortality due to Influenza in the United States—An Annualized Regression Approach Using Multiple-Cause Mortality Data

2005 ◽  
Vol 163 (2) ◽  
pp. 181-187 ◽  
Author(s):  
Jonathan Dushoff ◽  
Joshua B. Plotkin ◽  
Cecile Viboud ◽  
David J. D. Earn ◽  
Lone Simonsen
Keyword(s):  
United States ◽  
The United States ◽  
Mortality Data ◽  
Regression Approach

External Validation of the Cardiac Surgery Score in a Quaternary Hospital in the United States of America

2021 ◽  
pp. 088506662110668
Author(s):  
Asha Singh ◽  
Chen Liang ◽  
Stephanie L. Mick ◽  
Chiedozie Udeh
Keyword(s):  
United States ◽  
Cardiac Surgery ◽  
United States Of America ◽  
Predictive Accuracy ◽  
External Validation ◽  
Cleveland Clinic ◽  
Area Under The Curve ◽  
The United States ◽  
Mortality Data ◽  
The Usa

Background The Cardiac Surgery Score (CASUS) was developed to assist in predicting post-cardiac surgery mortality using parameters measured in the intensive care unit. It is calculated by assigning points to ten physiologic variables and adding them to obtain a score (additive CASUS), or by logistic regression to weight the variables and estimate the probability of mortality (logistic CASUS). Both additive and logistic CASUS have been externally validated elsewhere, but not yet in the United States of America (USA). This study aims to validate CASUS in a quaternary hospital in the USA and compare the predictive performance of additive to logistic CASUS in this setting. Methods Additive and logistic CASUS (postoperative days 1-5) were calculated for 7098 patients at Cleveland Clinic from January 2015 to February 2017. 30-day mortality data were abstracted from institutional records and the Death Registries for Ohio State and the Centers for Disease Control. Given a low event rate, model discrimination was assessed by area under the curve (AUROC), partial AUROC (pAUC), and average precision (AP). Calibration was assessed by curves and quantified using Harrell's Emax, and Integrated Calibration Index (ICI). Results 30-day mortality rate was 1.37%. For additive CASUS, odds ratio for mortality was 1.41 (1.35-1.46, P <0.001). Additive and logistic CASUS had comparable pAUC and AUROC (all >0.83). However, additive CASUS had greater AP, especially on postoperative day 1 (0.22 vs. 0.11). Additive CASUS had better calibration curves, and lower Emax, and ICI on all days. Conclusions Additive and logistic CASUS discriminated well for postoperative 30-day mortality in our quaternary center in the USA, however logistic CASUS under-predicted mortality in our cohort. Given its ease of calculation, and better predictive accuracy, additive CASUS may be the preferred model for postoperative use. Validation in more typical cardiac surgery centers in the USA is recommended.

scholarly journals Volunteers’ Felt Respect and Its Associations With Volunteering Retention, Daily Affect, Well-being, and Mortality

2018 ◽  
Vol 75 (8) ◽  
pp. 1625-1636 ◽  
Author(s):  
Dwight C K Tse
Keyword(s):  
United States ◽  
Negative Affect ◽  
Positive Affect ◽  
Well Being ◽  
The United States ◽  
National Sample ◽  
Retention Rates ◽  
Mortality Data ◽  
Volunteer Work ◽  
Daily Affect

Abstract Objectives Volunteering is associated with improved physical and psychological well-being; volunteers feeling more respect for their work may have better well-being than their counterparts. Methods This study investigated the effects of felt respect for volunteer work on volunteering retention, daily affect, well-being (subjective, psychological, and social), and mortality. The study analyzed survey and mortality data from a national sample of 2,677 volunteers from the Midlife in the United States Study over a 20-year span. Daily affect data were obtained from a subsample of 1,032 volunteers. Results Compared to volunteers feeling less respect from others, those feeling more respect (a) were more likely to continue volunteering 10 and 20 years later, (b) had higher levels of daily positive affect and lower levels of daily negative affect, and (c) had higher levels of well-being over a 20-year period. The effect of felt respect on mortality was not statistically significant. Discussion Greater level of felt respect for volunteer work is positively related to volunteers’ retention rates, daily affective experience, and well-being.

Projected All-Cause Deaths Attributable to COVID-19–Related Unemployment in the United States

2021 ◽  
Vol 111 (4) ◽  
pp. 696-699
Author(s):  
Ellicott C. Matthay ◽  
Kate A. Duchowny ◽  
Alicia R. Riley ◽  
Sandro Galea
Keyword(s):  
United States ◽  
The United States ◽  
Mortality Data ◽  
Economic Policies ◽  
Gender And Education ◽  
Hazard Ratios ◽  
Low Education ◽  
Unemployment Data ◽  
Bureau Of Labor Statistics ◽  
Excess Deaths

Objectives. To project the range of excess deaths potentially associated with COVID-19–related unemployment in the United States and quantify inequities in these estimates by age, race/ethnicity, gender, and education. Methods. We used previously published meta-analyzed hazard ratios (HRs) for the unemployment–mortality association, unemployment data from the Bureau of Labor Statistics, and mortality data from the National Center for Health Statistics to estimate 1-year age-standardized deaths attributable to COVID-19–related unemployment for US workers aged 25 to 64 years. To accommodate uncertainty, we tested ranges of unemployment and HR scenarios. Results. Our best estimate is that there will be 30 231 excess deaths attributable to COVID-19–related unemployment between April 2020 and March 2021. Across scenarios, attributable deaths ranged from 8315 to 201 968. Attributable deaths were disproportionately high among Blacks, men, and those with low education. Conclusions. Deaths attributable to COVID-19–related unemployment will add to those directly associated with the virus and will disproportionately burden groups already experiencing incommensurate COVID-19 mortality. Public Health Implications. Supportive economic policies and interventions addressing long-standing harmful social structures are essential to mitigate the unequal health harms of COVID-19.

scholarly journals Clustering of 27,525,663 Death Records from the United States Based on Health Conditions Associated with Death: An Example of big Health Data Exploration

2019 ◽  
Vol 8 (7) ◽  
pp. 922
Author(s):  
Daisy J.A. Janssen ◽  
Simon Rechberger ◽  
Emiel F.M. Wouters ◽  
Jos M.G.A. Schols ◽  
Miriam J. Johnson ◽  
...  
Keyword(s):  
United States ◽  
Palliative Care ◽  
End Of Life ◽  
Cause Of Death ◽  
The United States ◽  
Population Based ◽  
Health Conditions ◽  
Mortality Data ◽  
Self Organizing Map ◽  
Multiple Health

Background: Insight into health conditions associated with death can inform healthcare policy. We aimed to cluster 27,525,663 deceased people based on the health conditions associated with death to study the associations between the health condition clusters, demographics, the recorded underlying cause and place of death. Methods: Data from all deaths in the United States registered between 2006 and 2016 from the National Vital Statistics System of the National Center for Health Statistics were analyzed. A self-organizing map (SOM) was used to create an ordered representation of the mortality data. Results: 16 clusters based on the health conditions associated with death were found showing significant differences in socio-demographics, place, and cause of death. Most people died at old age (73.1 (18.0) years) and had multiple health conditions. Chronic ischemic heart disease was the main cause of death. Most people died in the hospital or at home. Conclusions: The prevalence of multiple health conditions at death requires a shift from disease-oriented towards person-centred palliative care at the end of life, including timely advance care planning. Understanding differences in population-based patterns and clusters of end-of-life experiences is an important step toward developing a strategy for implementing population-based palliative care.

scholarly journals 370. Comparing Trends and Outcomes among HIV-Infected vs. HIV Uninfected Patients with Tuberculosis: A 5-Year Experience Within the Florida Department of Health in Hillsborough County

2019 ◽  
Vol 6 (Supplement_2) ◽  
pp. S194-S194
Author(s):  
Shylah M Moore-Pardo ◽  
Anteneh Addisu ◽  
Tea Reljic ◽  
Sadaf Aslam ◽  
Beata Casanas
Keyword(s):  
United States ◽  
The United States ◽  
Homeless Persons ◽  
Sputum Smear ◽  
Foreign Born ◽  
Female Ratio ◽  
Risk Of Death ◽  
Increased Risk ◽  
The Difference ◽  
Hiv Negative

Abstract Background Although the rate of tuberculosis (TB) has significantly declined in the United States, elimination has plateaued. Florida is one of the states with the greatest number of cases. The majority of cases occur in foreign-born individuals. Human immunodeficiency virus (HIV) is also a major contributor. HIV-TB coinfection leads to reciprocal interactions with significant clinical impact. We aim to compare the risk factors, clinical findings, and outcomes among HIV-infected vs. HIV uninfected patients. Methods A retrospective cohort study of TB cases over a 5 year period (2012–2017) was conducted. All patients with HIV co-infection with age- and gender-matched HIV negative controls were included. The diagnosis of TB was made via clinical, microbiological, radiological, and/or PCR based methods. SPSS was used for statistical data analysis. Results A total of 411 TB cases were identified and 66 patients (33 HIV-infected plus 33 HIV un-infected) were eligible for inclusion. The median age was 49 years (range 22–70). The male to female ratio was 21:12 and 50% of patients had TB symptoms; the rest had abnormal imaging or lab finding. Cases were confirmed via positive sputum smear, culture, or PCR (Figures 1–3). Only 11 patients were lost to follow-up, thus 83.3% completed therapy. A total of 5 persons died (Table 1). Conclusion The rate of HIV-TB coinfection in the United States was 5.3% in 2018; higher among injection drugs users, homeless persons, inmates, and alcoholics. In our study, the rate of HIV-TB coinfection was slightly higher (8%). The difference was not statistically significant in regards to foreign born, homelessness, and incarceration. Only 3 patients admitted to injection drug use and 9 used alcohol (all HIV negative). Traditionally, HIV-TB coinfected patients have extra-pulmonary TB with higher rates of negative sputum and are at increased risk of death. In our cohort, the difference was statistically significant (P = 0.009) only for cavitary TB (predominated in HIV un-infected) but no difference in outcomes was observed between the two groups. These findings suggest changing trends in HIV-TB coinfection which may be partly related to our setting and demographics but may be attributed to better access to care and antiretroviral therapy at large. Disclosures All authors: No reported disclosures.

scholarly journals Male Mortality Trends in the United States, 1900-2010: Progress, Challenges, and Opportunities

2019 ◽  
Vol 135 (1) ◽  
pp. 150-160
Author(s):  
Wanda K. Jones ◽  
Robert A. Hahn ◽  
R. Gibson Parrish ◽  
Steven M. Teutsch ◽  
Man-Huei Chang
Keyword(s):  
United States ◽  
Causes Of Death ◽  
The United States ◽  
Recent Analysis ◽  
Mortality Data ◽  
Female Mortality ◽  
Mortality Trends ◽  
Male Mortality ◽  
Death Rates ◽  
White Males

Objectives: Male mortality fell substantially during the past century, and major causes of death changed. Building on our recent analysis of female mortality trends in the United States, we examined all-cause and cause-specific mortality trends at each decade from 1900 to 2010 among US males. Methods: We conducted a descriptive study of age-adjusted death rates (AADRs) for 11 categories of disease and injury stratified by race (white, nonwhite, and, when available, black), the excess of male mortality over female mortality ([male AADR − female AADR]/female AADR), and potential causes of persistent excess of male mortality. We used national mortality data for each decade. Results: From 1900 to 2010, the all-cause AADR declined 66.4% among white males and 74.5% among nonwhite males. Five major causes of death in 1900 were pneumonia and influenza, heart disease, stroke, tuberculosis, and unintentional nonmotor vehicle injuries; in 2010, infectious conditions were replaced by cancers and chronic lower respiratory diseases. The all-cause excess of male mortality rose from 9.1% in 1900 to 65.5% in 1980 among white males and a peak of 63.7% in 1990 among nonwhite males, subsequently falling among all groups. Conclusion: During the last century, AADRs among males declined more slowly than among females. Although the gap diminished in recent decades, exploration of social and behavioral factors may inform interventions that could further reduce death rates among males.

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