scholarly journals 2625. Incidence of Bronchiolitis Requiring Hospitalization in the First 2 years of Life Among Healthy Term Infants with Different Races/Ethnicities: A Population-based Longitudinal Study

2019 ◽  
Vol 6 (Supplement_2) ◽  
pp. S914-S915
Author(s):  
Kengo Inagaki ◽  
Chad Blackshear ◽  
Charlotte V Hobbs
Keyword(s):  
New York ◽  
Socioeconomic Status ◽  
Proportional Hazards ◽  
New York State ◽  
Multivariable Analysis ◽  
Population Based ◽  
Cox Proportional Hazards ◽  
Indigenous Populations ◽  
Term Infants ◽  
Race Ethnicity

Abstract Background Race/ethnicity is currently not considered a risk factor for bronchiolitis, except for indigenous populations in western countries. We sought to determine the incidence of hospitalization with bronchiolitis among different races/ethnicities, because such information can lead to more tailored preventive care. Methods We performed a population-based longitudinal observational study using the State Inpatient Database from New York state. Infants born between 2009 and 2013 at term without comorbidities were followed for the first 2 years of life, up to 2015. We calculated incidence among different race/ethnicity groups, and evaluated risks by developing Cox proportional hazards regression models. Results Of 877,465 healthy term infants, 10 356 infants were hospitalized with bronchiolitis. Overall, incidence was 11.8 per 1,000 births. Substantial difference in infants born in different seasons was observed (Figure 1). The incidence in non-Hispanic white, non-Hispanic black, Hispanic, and Asian infants was 8.6, 15.4, 19.1, and 6.5 per 1,000 births, respectively (table). On multivariable analysis adjusting for socioeconomic status, the risks remained substantially high among non-Hispanic black (hazard ratio [HR] 1.42, 95% confidence interval [CI]: 1.34–1.51) and Hispanic infants (HR 1.77, 95% CI: 1.67–1.87), particularly beyond 2–3 months of age, whereas Asian race was protective (HR 0.62, 95% CI: 0.56–0.69) (Figure 2, 3). Conclusion The risks of bronchiolitis hospitalization in the first 2 years of life was substantially higher among infants with non-Asian minority infants, particularly beyond 2–3 months of age. Further research efforts to identify effective public health interventions in each race/ethnic groups with varied socioeconomic status, such as improvement in access to care and anticipatory guidance, is warranted to overcome health disparity. Disclosures All authors: No reported disclosures.

Racial/Ethnic Disparity in the Incidence of Bronchiolitis Requiring Hospitalization

2020 ◽  
Author(s):  
Kengo Inagaki ◽  
Chad Blackshear ◽  
Paul A Burns ◽  
Charlotte V Hobbs
Keyword(s):  
New York ◽  
Cumulative Incidence ◽  
New York State ◽  
Multivariable Analysis ◽  
The United States ◽  
Population Based ◽  
Indigenous Populations ◽  
Term Infants ◽  
Logistic Regression Models ◽  
Race Ethnicity

Abstract Background Race/ethnicity is currently not considered a risk factor for bronchiolitis, except for indigenous populations in western countries. A better understanding of the potential impact of race/ethnicity can inform programs, policy and practice related to bronchiolitis. Methods We performed a population-based longitudinal observational study using the State Inpatient Database from New York state in the United States. Infants born between 2009 and 2013 at term without comorbidities were followed for the first two years of life, up to 2015. We calculated the cumulative incidence among different race/ethnicity groups, and evaluated the risks by developing logistic regression models. Results Of 877 465 healthy term infants, 10 356 infants were hospitalized with bronchiolitis. The overall cumulative incidence was 11.8 per 1000 births. The cumulative incidences in non-Hispanic white, non-Hispanic black, Hispanic, and Asian infants were 8.6, 15.4, 19.1, and 6.5 per 1000 births, respectively. On multivariable analysis adjusting for socioeconomic status, the risks remained substantially high among non-Hispanic black (odds ratio [OR] 1.42, 95% confidence interval [CI]: 1.34-1.51) and Hispanic infants (OR 1.77, 95%CI: 1.67-1.87), whereas Asian race was protective (aHR 0.62, 95%CI: 0.56-0.69). Conclusions The risks of bronchiolitis hospitalization in the first two years of life were substantially different by race/ethnicity, with Hispanic and black infants having highest rates of hospitalization. Further research is needed to develop and implement culturally appropriate public health interventions to reduce racial and ethnic health disparities in bronchiolitis.

scholarly journals Fatigue at enrollment predicts EDSS worsening in the New York State Multiple Sclerosis Consortium

2018 ◽  
Vol 26 (1) ◽  
pp. 99-108 ◽  
Author(s):  
Caila B Vaughn ◽  
Katelyn S Kavak ◽  
Michael G Dwyer ◽  
Aisha Bushra ◽  
Muhammad Nadeem ◽  
...  
Keyword(s):  
Multiple Sclerosis ◽  
New York ◽  
Proportional Hazards ◽  
New York State ◽  
Cox Proportional Hazards ◽  
Common Symptom ◽  
York State ◽  
Study Enrollment ◽  
Severe Fatigue ◽  
Patient Reported

Background: Fatigue is one of the most common and distressing symptoms among persons with multiple sclerosis (pwMS). Objective: The aim of this study is to evaluate fatigue as a predictor for disease worsening among pwMS. Methods: In this retrospective cohort study of New York State MS Consortium (NYSMSC) registry, MS patients reporting moderate-to-severe fatigue at study enrollment ( n = 2714) were frequency matched to less-fatigued subjects ( n = 2714) on age, baseline Kurtzke Expanded Disability Status Scale (EDSS), disease duration, and MS phenotype. Change from baseline patient-reported outcomes (PROs), as measured by LIFEware™, categorized participants into two groups: those with stable/improved outcomes and those who worsened. In a subgroup of patients with longitudinal data ( n = 1951), sustained EDSS worsening was analyzed using Cox proportional hazards modeling to explore the effect of fatigue. Results: The median survival time from study enrollment to sustained EDSS worsening was 8.7 years (CI: 7.2–10.1). Participants who reported fatigue at baseline were more likely to experience sustained EDSS worsening during follow-up (HR: 1.4, 95% CI: 1.2–1.7). Patients who were fatigued at baseline were also more likely to report worsening psychosocial limitations (all ps ⩽ 0.01). Conclusion: In addition to being a common symptom of MS, severe fatigue was a significant predictor for EDSS worsening in the NYSMSC.

scholarly journals The effect of surgery type on survival and recurrence in very young women with breast cancer.

2013 ◽  
Vol 31 (15_suppl) ◽  
pp. 1002-1002
Author(s):  
May Lynn Quan ◽  
Lawrence Frank Paszat ◽  
Kimberley Fernandes ◽  
Rinku Sutradhar ◽  
David R. McCready ◽  
...  
Keyword(s):  
Breast Cancer ◽  
Overall Survival ◽  
Young Women ◽  
Proportional Hazards ◽  
Large Population ◽  
Multivariable Analysis ◽  
Retrospective Chart Review ◽  
Population Based ◽  
Cox Proportional Hazards ◽  
Breast Cancers

1002 Background: Young age has been identified as an independent predictor of recurrence and mortality in women with breast cancer. The equivalence of breast conserving surgery (BCS) with mastectomy remains unclear in this population in an era of multimodal therapy. We sought to determine the effect of surgery type on the risk of recurrence and survival in a large, population based cohort of very young women. Methods: All women diagnosed with breast cancer aged ≤35 between 1994 and 2003 in Ontario were identified from the Ontario Cancer Registry, a population based registry of all incident invasive breast cancers in the province. A retrospective chart review was undertaken to identify patient, tumor and treatment variables, as well as locoregional, distant recurrences and death. Univariable and multivariable Cox proportional hazards regression models were fit to determine the effect of primary surgery type on overall survival while controlling for known confounders. To examine time to recurrence in a multivariable analysis, the proportional subdistribution hazards model (Fine and Gray) was used to account for death being a competing risk. Results: A total of 1,381 patients were identified; the median age was 33 (range 18 – 35), median follow up was 11 years. Primary surgical treatment was BCS in 793 (57%) patients of which 89% had adjuvant radiotherapy. Of the 588 (43%) having mastectomy, 53% underwent post mastectomy radiation. Overall, 38% of patients sustained a recurrence of any type and 31% had died. After controlling for tumor size, margin status, node status, grade, LVI, ER/PR, HER2 and treatment (chemotherapy, radiation, hormones) there was no difference in overall survival (HR 0.99, 95% CI 0.79,1.26) or recurrence (HR 0.96, 95% CI 0.73,1.26) among women treated with BCS or mastectomy. Predictors of recurrence were size ≥2 cm, ≥ 1 positive node, neoadjuvant chemotherapy, and lack of radiation. Predictors of death were similar and included high grade and presence of LVI. Conclusions: Very young women selected for BCS had similar outcomes to those selected for mastectomy after controlling for known prognostic factors for recurrence and death.

Impact of socioeconomic status on anal cancer survival.

2017 ◽  
Vol 35 (15_suppl) ◽  
pp. e18060-e18060
Author(s):  
Daniel Lin ◽  
Heather Taffet Gold ◽  
David Schreiber ◽  
Lawrence P. Leichman ◽  
Scott Sherman ◽  
...  
Keyword(s):  
Socioeconomic Status ◽  
Overall Survival ◽  
Anal Cancer ◽  
Proportional Hazards ◽  
Multivariable Analysis ◽  
Income Level ◽  
Cox Proportional Hazards ◽  
Survival Outcomes ◽  
Primary Malignancy ◽  
Black Race

e18060 Background: Despite an increase in incidence of anal cancer over recent decades, improvements in awareness and therapy have improved survival outcomes. We hypothesized that the gains in outcomes were not shared equally by patients of disparate socioeconomic status (SES). We investigated whether area-based median household income (MHI) predicts survival of patients with anal cancer, after controlling for known predictors. Methods: Patients diagnosed with squamous cell carcinoma of the anus (SCCA) as the first primary malignancy from 2004 to 2013 in the Surveillance Epidemiology and End Results (SEER) registry were included. SES was defined by census-tract MHI, and divided into quintiles. Multivariable Cox Proportional Hazards models were used to evaluate the effect of (MHI) on cancer-specific (CSS) and overall survival (OS). A multivariable logistic regression was used to assess whether these same measures predicted receipt of radiation. Results: A total of 9,550 cases of SCCA were included; median age was 58 years, 63% were female, 85% were white, and 38% were married. In multivariable analyses, patients living in areas with lower MHI had worse OS and CSS compared to those in the highest income areas. Mortality HR’s in order of lowest to highest income were 1.32 (95%CI 1.18-1.49), 1.31 (95%CI 1.16-1.48), 1.19 (95%CI 1.06-1.34), 1.16 (95%CI 1.03-1.30); CSS HR similarly range from 1.34-1.22 from lowest to highest income. Other significant predictors of increased cancer specific mortality included older age, black race (HR 1.44, 95%CI 1.26-1.64), male gender, un-married, earlier year of diagnosis, higher grade, and later stage. Income level, however, was not associated with odds of initiating radiation in multivariable analysis (OR 0.87 for lowest to highest income level, 95%CI 0.63-1.20). Conclusions: SES measured by area-based MHI independently predicts cancer-specific and overall survival outcomes in patients with anal cancer, despite similar rates of initiating radiation therapy. Black race remains a predictor of anal cancer outcomes despite controlling for income. Further investigation is warranted to understand the mechanisms in which socioeconomic inequalities affect cancer care and outcomes.

Socioeconomic status, race, and mortality disparities in insured patients in southern California.

2020 ◽  
Vol 38 (15_suppl) ◽  
pp. e19060-e19060
Author(s):  
Robert Michael Cooper ◽  
Reina Haque ◽  
Joanne E. Schottinger
Keyword(s):  
Socioeconomic Status ◽  
Mortality Risk ◽  
Southern California ◽  
Proportional Hazards ◽  
Insurance Coverage ◽  
Health Insurance Coverage ◽  
Cox Proportional Hazards ◽  
Cox Proportional Hazards Models ◽  
Race Ethnicity ◽  
Overall Mortality

e19060 Background: One known factor related to increased mortality is lack of health insurance coverage. To eliminate this variable we evaluated overall mortality by socioeconomic status (SES) in an insured southern California population diagnosed with cancer accounting for confounding factors including race/ethnicity. Methods: We identified adults diagnosed with eight common cancers from 2009-2014 from the California Cancer Registry and followed them through 2017. We calculated person-year mortality rates by SES and race/ethnicity. Adjusted hazard ratios for the association between all-cause mortality and SES were estimated using Cox proportional hazards models accounting for covariates (race/ethnicity, demographics, stage, treatments). Results: A total of 164,197 adults were diagnosed with cancers of the breast, prostate, lung, colon, melanoma, uterus, kidney and bladder; total of numbers of deaths was N=41,727. Compared to subjects in the highest SES quintile, we found an increased overall mortality risk in each of the lower SES quintiles. In multivariable models, mortality risk was 16% to 37% greater in the lower SES groups versus the highest SES group. Conclusions: After multivariable adjustment that accounted for race/ethnicity, cancer treatments and tumor factors, insured individuals in lower SES groups had a significantly higher overall mortality risk compared those in the highest SES group. [Table: see text]

scholarly journals Survival by Race and Ethnicity in Pediatric and Adolescent Patients With Hodgkin Lymphoma: A Children’s Oncology Group Study

2019 ◽  
Vol 37 (32) ◽  
pp. 3009-3017 ◽  
Author(s):  
Justine M. Kahn ◽  
Kara M. Kelly ◽  
Qinglin Pei ◽  
Rizvan Bush ◽  
Debra L. Friedman ◽  
...  
Keyword(s):  
Hodgkin Lymphoma ◽  
Race And Ethnicity ◽  
Proportional Hazards ◽  
De Novo ◽  
Combined Modality Therapy ◽  
Population Based ◽  
Cox Proportional Hazards ◽  
Phase Iii ◽  
Oncology Group ◽  
Race Ethnicity

PURPOSE Population-based studies of children and adolescents with Hodgkin lymphoma (HL) report a survival disadvantage in nonwhite—non-Hispanic black (NHB) and Hispanic—patients. Whether disparities persist after adjustment for clinical and treatment-related variables is unknown. We examined survival by race/ethnicity in children receiving risk-based, response-adapted, combined-modality therapy for HL in contemporary Children’s Oncology Group trials. PATIENTS AND METHODS This pooled analysis used individual-level data from 1,605 patients (younger than age 1 to 21 years) enrolled in phase III trials for low-risk (AHOD0431), intermediate-risk (AHOD0031), and high-risk (AHOD0831) HL from 2002 to 2012. Event-free survival (EFS) and overall survival (OS) were compared between non-Hispanic white (NHW) and nonwhite patients. Cox proportional hazards for survival were estimated for both de novo and relapsed HL, adjusting for demographics, disease characteristics, and therapy. RESULTS At median follow up of 6.9 years, cumulative incidence of relapse was 17%. Unadjusted 5-year EFS and OS were 83% (SE, 1.2%) and 97% (SE, < 1%), respectively. Neither differed by race/ethnicity. In multivariable analyses for OS, nonwhite patients had a 1.88× higher hazard of death (95% CI, 1.1 to 3.3). Five-year postrelapse survival probabilities by race were as follows: NHW, 90%; NHB, 66%; and Hispanic, 80% ( P < .01). Compared with NHW, Hispanic and NHB children had 2.7-fold (95% CI, 1.2 to 6.2) and 3.5-fold (95% CI, 1.5 to 8.2) higher hazard of postrelapse mortality, respectively. CONCLUSION In patients who were treated for de novo HL in contemporary Children’s Oncology Group trials, EFS did not differ by race/ethnicity; however, adjusted OS was significantly worse in nonwhite patients, a finding driven by increased postrelapse mortality in this population. Additional studies examining treatment and survival disparities after relapse are warranted.

Abstract 10079: Socioeconomic Status and the Development of Atrial Fibrillation in Hispanics, African Americans and non-Hispanic Whites

Circulation ◽  
2015 ◽  
Vol 132 (suppl_3) ◽  
Author(s):  
Eric Shulman ◽  
Philip Aagaard ◽  
Faraj Kargoli ◽  
Ethan Hoch ◽  
Scott Schafler ◽  
...  
Keyword(s):  
Atrial Fibrillation ◽  
New York ◽  
Socioeconomic Status ◽  
African Americans ◽  
New York State ◽  
Rank Test ◽  
Cox Regression Analysis ◽  
York State ◽  
Log Rank Test ◽  
Race Ethnicity

Introduction: Atrial fibrillation (AF) is the most common arrhythmia and is associated with significant morbidity and mortality. Despite having a higher burden of traditional AF risk factors, African American and Hispanic minorities have a lower incidence of AF when compared to non-Hispanic Whites, referred to as the “racial paradox.” Hypothesis: We investigated if socioeconomic status (SES) could be an explanatory factor for the “racial paradox.” Methods: An ECG/EMR database from a tertiary-care center in New York State was interrogated for individuals free of AF for development of subsequent AF from 2000-2013. SES was assessed per zip code via a log composite of six measures Z-scored to the New York State average (income; value of housing unit; percentage of receiving interest/dividend/rental income; education; percentage completed college; individuals in professional positions). SES was reclassified into decile groups (1 lowest and 10 highest). The Log-Rank test was used to determine difference in survival times to develop AF by race/ethnicity stratified by SES decile. Cox regression analysis controlling for all baseline differences was used to estimate the independent predictive ability of SES for AF. P-trend was calculated by race/ethnicity to determine if there was a trend by SES decile to develop AF. Results: We identified 48,631 persons (43% Hispanic, 37% African Americans and 20% non-Hispanic White, mean age 59 years, mean follow-up of 3.2 years) of which 4,556 AF cases occurred. Hispanics and African Americans had lower AF risk than Whites in all SES deciles (p-value < 0.001 by Log Rank Test). Higher SES was borderline associated with lower AF risk (HR=0.990, 95% CI 0.980-1.001, p=0.061). P-trend analysis was not significant by any race/ethnic group by SES deciles for AF (Figure 1). Conclusions: Our study suggests that non-Hispanic Whites are at higher risk for AF compared to non-Whites, and this is independent of socioeconomic status.

scholarly journals Associations of Dietary Patterns with Incident Depression: The Maastricht Study

Nutrients ◽  
2021 ◽  
Vol 13 (3) ◽  
pp. 1034
Author(s):  
Vincenza Gianfredi ◽  
Annemarie Koster ◽  
Anna Odone ◽  
Andrea Amerio ◽  
Carlo Signorelli ◽  
...  
Keyword(s):  
Depressive Symptoms ◽  
Dietary Patterns ◽  
Proportional Hazards ◽  
A Priori ◽  
Preventive Measure ◽  
Population Based ◽  
Cox Proportional Hazards ◽  
Healthy Diet ◽  
Patient Health

Our aim was to assess the association between a priori defined dietary patterns and incident depressive symptoms. We used data from The Maastricht Study, a population-based cohort study (n = 2646, mean (SD) age 59.9 (8.0) years, 49.5% women; 15,188 person-years of follow-up). Level of adherence to the Dutch Healthy Diet (DHD), Mediterranean Diet, and Dietary Approaches To Stop Hypertension (DASH) were derived from a validated Food Frequency Questionnaire. Depressive symptoms were assessed at baseline and annually over seven-year-follow-up (using the 9-item Patient Health Questionnaire). We used Cox proportional hazards regression analyses to assess the association between dietary patterns and depressive symptoms. One standard deviation (SD) higher adherence in the DHD and DASH was associated with a lower hazard ratio (HR) of depressive symptoms with HRs (95%CI) of 0.78 (0.69–0.89) and 0.87 (0.77–0.98), respectively, after adjustment for sociodemographic and cardiovascular risk factors. After further adjustment for lifestyle factors, the HR per one SD higher DHD was 0.83 (0.73–0.96), whereas adherence to Mediterranean and DASH diets was not associated with incident depressive symptoms. Higher adherence to the DHD lowered risk of incident depressive symptoms. Adherence to healthy diet could be an effective non-pharmacological preventive measure to reduce the incidence of depression.

scholarly journals High School Quality and 56-Year All-Cause Mortality Risk Across Race and Ethnicity

2020 ◽  
Vol 4 (Supplement_1) ◽  
pp. 505-506
Author(s):  
Dominika Seblova ◽  
Kelly Peters ◽  
Susan Lapham ◽  
Laura Zahodne ◽  
Tara Gruenewald ◽  
...  
Keyword(s):  
High School ◽  
Mortality Risk ◽  
Race And Ethnicity ◽  
Proportional Hazards ◽  
School Quality ◽  
Cox Proportional Hazards ◽  
School Level ◽  
Lower Mortality ◽  
All Cause Mortality ◽  
Race Ethnicity

Abstract Having more years of education is independently associated with lower mortality, but it is unclear whether other attributes of schooling matter. We examined the association of high school quality and all-cause mortality across race/ethnicity. In 1960, about 5% of US high schools participated in Project Talent (PT), which collected information about students and their schools. Over 21,000 PT respondents were followed for mortality into their eighth decade of life using the National Death Index. A school quality factor, capturing term length, class size, and teacher qualifications, was used as the main predictor. First, we estimated overall and sex-stratified Cox proportional hazards models with standard errors clustered at the school level, adjusting for age, sex, composite measure of parental socioeconomic status, and 1960 cognitive ability. Second, we added an interaction between school quality and race/ethnicity. Among this diverse cohort (60% non-Hispanic Whites, 23% non-Hispanic Blacks, 7% Hispanics, 10% classified as another race/s) there were 3,476 deaths (16.5%). School quality was highest for Hispanic respondents and lowest for non-Hispanic Blacks. Non-Hispanic Blacks also had the highest mortality risk. In the whole sample, school quality was not associated with mortality risk. However, higher school quality was associated with lower mortality among those classified as another race/s (HR 0.75, 95% CI: 0.56-0.99). For non-Hispanic Blacks and Whites, the HR point estimates were unreliable, but suggest that higher school quality is associated with increased mortality. Future work will disentangle these differences in association of school quality across race/ethnicity and examine cause-specific mortality.

Reporting of Multivariable Methods in the Medical Literature

2008 ◽  
Vol 56 (7) ◽  
pp. 954-957 ◽  
Author(s):  
Jeanette M. Tetrault ◽  
Maor Sauler ◽  
Carolyn K. Wells ◽  
John Concato
Keyword(s):  
Logistic Regression ◽  
New England ◽  
Proportional Hazards ◽  
Medical Literature ◽  
Multivariable Analysis ◽  
Cox Proportional Hazards ◽  
Primary Method ◽  
Primary Analysis ◽  
Proportional Hazards Assumption ◽  
Complete Reporting

BackgroundMultivariable models are frequently used in the medical literature, but many clinicians have limited training in these analytic methods. Our objective was to assess the prevalence of multivariable methods in medical literature, quantify reporting of methodological criteria applicable to most methods, and determine if assumptions specific to logistic regression or proportional hazards analysis were evaluated.MethodsWe examined all original articles in Annals of Internal Medicine, British Medical Journal, Journal of the American Medical Association, Lancet, and New England Journal of Medicine, from January through June 2006. Articles reporting multivariable methods underwent a comprehensive review; reporting of methodological criteria was based on each article's primary analysis.ResultsAmong 452 articles, 272 (60%) used multivariable analysis; logistic regression (89 [33%] of 272) and proportional hazards (76 [28%] of 272) were most prominent. Reporting of methodological criteria, when applicable, ranged from 5% (12/265) for assessing influential observations to 84% (222/265) for description of variable coding. Discussion of interpreting odds ratios occurred in 13% (12/89) of articles reporting logistic regression as the primary method and discussion of the proportional hazards assumption occurred in 21% (16/76) of articles using Cox proportional hazards as the primary method.ConclusionsMore complete reporting of multivariable analysis in the medical literature can improve understanding, interpretation, and perhaps application of these methods.

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