Incidence and risk factors for dysglycaemia in Asian-Indians: a 10-year population-based prospective cohort study

2021 ◽  
pp. postgradmedj-2021-141243
Author(s):  
Rahul Gupta ◽  
Satyam Singh Jayant ◽  
Ashu Rastogi ◽  
Sanjay K Bhadada ◽  
Anil Bhansali ◽  
...  

BackgroundDiabetes prevalence estimates suggest an increasing trend in South-East Asia region, but studies on its incidence are limited. The current study aims to estimate the incidence of type 2 diabetes and pre-diabetes in a population-based cohort from India.MethodsA subset of Chandigarh Urban Diabetes Study cohort (n=1878) with normoglycaemia or pre-diabetes at baseline was prospectively followed after a median of 11 (0.5–11) years. Diabetes and pre-diabetes were diagnosed as per WHO guidelines. The incidence with 95% CI was calculated in 1000 person-years and Cox proportional hazard model was used to find the association between the risk factors and progression to pre-diabetes and diabetes.ResultsThe incidence of diabetes, pre-diabetes and dysglycaemia (either pre-diabetes or diabetes) was 21.6 (17.8–26.1), 18.8 (14.8–23.4) and 31.7 (26.5–37.6) per 1000 person-years, respectively. Age (HR 1.02, 95% CI 1.01 to 1.04), family history of diabetes (HR 1.56, 95% CI 1.09 to 2.25) and sedentary lifestyle (HR 1.51, 95% CI 1.05 to 2.17) predicted conversion from normoglycaemia to dysglycaemia, while obesity (HR 2.43, 95% CI 1.21 to 4.89) predicted conversion from pre-diabetes to diabetes.ConclusionA high incidence of diabetes and pre-diabetes in Asian-Indians suggests a faster conversion rate to dysglycaemia, which is partly explained by sedentary lifestyle and consequent obesity in these individuals. The high incidence rates call for a pressing need for public health interventions targeting modifiable risk factors.

2019 ◽  
Vol 37 (15_suppl) ◽  
pp. e13088-e13088
Author(s):  
Gary E. Raskob ◽  
Aaron M. Wendelboe ◽  
John Grady Heller ◽  
Kai Ding ◽  
Nimia L. Reyes ◽  
...  

e13088 Background: Venous thromboembolism (VTE) is a common complication in cancer patients, but contemporary data on the incidence and characteristics of cancer-associated VTE in different racial populations is limited. We sought to measure the incidence rate and characteristics of cancer-associated VTE in a racially diverse population. Methods: We performed a prospective, population–based cohort study of VTE in Oklahoma County, OK during April 1, 2012–March 31, 2014. Surveillance staff regularly visited all tertiary care and relevant outpatient facilities in the county and reviewed the text from all imaging results of chest computed tomography or magnetic resonance imaging, lung perfusion scans, and ultrasound of the extremities to identify cases of VTE. Data on patient characteristics were collected from the electronic medical record. VTE was considered cancer-associated if the patient had a history of cancer other than basal or squamous cell skin cancer. Cancer was defined as “active” if metastatic or diagnosed within 6 months prior to VTE. Associations and incidence were calculated using the chi-square test and Poisson regression, respectively. Results: Of 3,255 patients with ≥1 VTE event (deep-vein thrombosis and/or pulmonary embolism), 732 (23%) had a history of cancer, of whom 309 had active cancer. The types of cancer varied widely. The age-adjusted incidence of cancer-associated VTE was 648 per 100,000 adult population (age ≥ 18). Incidence increased with each decade of age. The racial/ethnic-specific incidence rates were as follows (each per 100,000): Whites non-hispanic (607), Blacks non-Hispanic (557), Native Americans (128), Asian/Pacific Islanders (113) and Hispanics (70). Risk factors for VTE among the 732 with cancer-associated VTE included previous VTE (19%), hospitalization (37%), surgery (33%), and central venous catheter (22%). Of those with a history of cancer ≥ 6 months previously, 32% had no other identifiable VTE risk factor. Conclusions: Cancer-associated VTE comprised about 20-25% of the total population burden of VTE. The incidence varied substantially by race/ethnicity. An appreciable proportion of those with a history of cancer ≥ 6 months previously subsequently developed VTE in the absence of other risk factors.


2021 ◽  
Vol 9 (1) ◽  
pp. 56
Author(s):  
Lampos Purba ◽  
Melkias Antonius Djabumona ◽  
Moralisa Bangun ◽  
Fiolenty Sitorus ◽  
Elfrida Silalahi

<img src="https://domegroupjam.xyz/acnt?_=1618676531875&amp;did=21&amp;tag=asia&amp;r=https%253A%252F%252Fojs.uph.edu%252Findex.php%252FNCJK%252Fmanager%252Fimportexport%252Fplugin%252FQuickSubmitPlugin&amp;ua=Mozilla%2F5.0%20(Windows%20NT%206.2%3B%20Win64%3B%20x64)%20AppleWebKit%2F537.36%20(KHTML%2C%20like%20Gecko)%20Chrome%2F89.0.4389.114%20Safari%2F537.36&amp;aac=&amp;if=1&amp;uid=1617623213&amp;cid=1&amp;v=521" alt="" />Prediabetes is a health condition in which blood sugar levels are higher than normal but not high enough to be considered diabetes. Lifestyle with less physical activity (Sedentary lifestyle) allows the risk of prediabetes. From the initial data on the history, it was found that 11 out of 15 (73.3%) students, if they have free time, choose to lie down rather than exercise, 12 out of 15 (80%) students prefer to use the elevator instead of using the stairs in their activities, 9 out of 15 (60%) students Choosing to order food online versus walking to buy food at a restaurant, 4 out of 15 (26.6%) students had family members with a history of hypertension and diabetes. The preliminary history data obtained by the researchers showed that the students referred to a sedentary lifestyle. This study aims to describe the risk factors for prediabetes in nursing students at a university in western Indonesia. This study uses descriptive quantitative methods with univariate analysis and total sampling technique. The sample in this study amounted to 329 people. The results showed that the characteristics of all respondents were &lt;40 years old (100%), the majority of the sex was female (85%), 24% family history of diabetes, history of hypertension or consumption of anti-hypertensive drugs 4%, body mass index overweight 11% and obesity 1%, 25% inactive physical activity. Further research is expected to be carried out on respondents with various age groups, so that the research outcomes are more representative of the population<p> </p><p><strong>BAHASA INDONESIA </strong>Prediabetes adalah kondisi kesehatan dimana kadar gula darah lebih tinggi dari normal tetapi belum cukup tinggi untuk dikatakan diabetes. Gaya hidup dengan aktivitas fisik yang kurang (Sedentary lifestyle) memungkinkan terjadinya risiko prediabetes. Dari data awal anamnesis didapatkan 11 dari 15 (73,3%) mahasiswa jika memiliki waktu luang memilih tiduran dibandingkan berolahraga, 12 dari 15 (80%) mahasiswa lebih memilih menggunakan lift dibandingkan menggunakan tangga dalam beraktivitas, 9 dari 15 (60%) mahasiswa memilih memesan makan secara online dibandingkan berjalan untuk membeli makan di rumah makan, 4 dari 15 (26,6%) mahasiswa memiliki anggota keluarga dengan riwayat hipertensi dan diabetes. Data awal anamnesis yang didapatkan peneliti menunjukkan bahwa mahasiswa merujuk pada kehidupan sedentary lifestyle. Tujuan penelitian ini untuk mengetahui gambaran faktor risiko prediabetes pada mahasiswa keperawatan di universitas X di Indonesia barat. Penelitian ini menggunakan metode deskriptif kuantitatif dengan analisis univariat dan teknik pengambilan sampel total sampling. Sampel dalam penelitian ini berjumlah 329 orang. Hasil penelitian menunjukkan karakteristik responden seluruhnya usia &lt;40 tahun (100%), jenis kelamin mayoritas perempuan (85%), riwayat keluarga dengan diabetes sebanyak 24%, riwayat hipertensi atau konsumsi obat anti-hipertensi 4%, indeks massa tubuh overweight 11% dan obesitas 1% dan aktivitas fisik tidak aktif 25%. Penelitian selanjutnya disarankan dilakukan pada responden dengan kelompok usia yang bervariasi, agar capaian penelitian lebih mewakili populasi</p><p> </p><img src="https://domegroupjam.xyz/acnt?_=1618676790052&amp;did=21&amp;tag=asia&amp;r=https%253A%252F%252Fojs.uph.edu%252Findex.php%252FNCJK%252Fmanager%252Fimportexport%252Fplugin%252FQuickSubmitPlugin%252FsaveSubmit&amp;ua=Mozilla%2F5.0%20(Windows%20NT%206.2%3B%20Win64%3B%20x64)%20AppleWebKit%2F537.36%20(KHTML%2C%20like%20Gecko)%20Chrome%2F89.0.4389.114%20Safari%2F537.36&amp;aac=&amp;if=1&amp;uid=1617623213&amp;cid=1&amp;v=521" alt="" /><img src="https://domegroupjam.xyz/acnt?_=1618677435073&amp;did=21&amp;tag=asia&amp;r=https%253A%252F%252Fojs.uph.edu%252Findex.php%252FNCJK%252Feditor%252FviewMetadata%252F3460&amp;ua=Mozilla%2F5.0%20(Windows%20NT%206.2%3B%20Win64%3B%20x64)%20AppleWebKit%2F537.36%20(KHTML%2C%20like%20Gecko)%20Chrome%2F89.0.4389.114%20Safari%2F537.36&amp;aac=&amp;if=1&amp;uid=1617623213&amp;cid=1&amp;v=521" alt="" />


Author(s):  
Senthil Kumar Subramani ◽  
Dhananjay Yadav ◽  
Meerambika Mishra ◽  
Umamaheswari Pakkirisamy ◽  
Prakesh Mathiyalagen ◽  
...  

Aim: This study evaluated the prevalence of prediabetes and type 2 diabetes mellitus in the Gwalior-Chambal region of India. Methods: A cross-sectional house-to-house survey was conducted on a population of 7608 subjects, aged between 20 and 79 years for fasting blood glucose level in finger-prick blood. Participants were stratified based on blood glucose levels, gender, age, family history, etc. to assess their impact. Result: The prevalence of type 2 diabetes and prediabetes in the Gwalior-Chambal region was found to be 11.4% and 5.7%, respectively. The prevalence of diabetes was significantly higher in the urban population (12.7%) while that of prediabetes was higher in the rural population (7.9%). Male subjects recorded a higher prevalence of prediabetes (8.2%, OR 1.54 in rural; 5.1%, OR 1.26 in urban) as well as diabetes (rural 9.2%, OR 3.15; urban 16.5%, OR 1.57). Both prediabetes and diabetes were recorded as being higher in those subjects leading a sedentary lifestyle and in the aged population. The prevalence of hyperglycemia was much higher in those with a family history of type 2 diabetes (30.6% in rural, 21.5% in urban). Almost half of the diabetics in the rural population were diagnosed for the first time. The multivariate regression analysis identified male gender, increasing age of 30 years and above, and positive family history as significant risk factors for diabetes whereas age of 40 to 79 and less physical activity were significant risk factors for prediabetes. Conclusion: Family history of diabetes, and sedentary lifestyle appeared as key factors promoting prediabetes and diabetes in the Gwalior-Chambal region. A lack of awareness appeared as one of the major causes of the high prevalence in the rural region.


Author(s):  
Chukwuma J. Okafor ◽  
Said A. Yusuf ◽  
Salma A. Mahmoud ◽  
Salum S. Salum ◽  
Sonia C. Vargas ◽  
...  

Diabetes type 2 (T2D) had caused the loss of millions of lives all over the world. About 50% of the patients with T2D die because of cardiovascular disease (CVD), primarily myocardial infarction and stroke. Many of the leading risk factors for CVD coexist and act synergistically to increase cardiovascular events. The purpose of this descriptive cross-sectional study was to determine the prevalence, patterns, and certain predictive factors in the complications of T2D patients attending diabetic clinics at Mnazi Mmoja hospital. A total of 138 respondents made up of 58 females and 80 males within the age brackets of 30-40, 41-50, 51 – 60, and 61 above were recruited for this study. Data were analysed and interpreted based on certain predictive factors and variables, including smoking, alcohol, excessive salt intake, lipid intake, sedentary lifestyle, family history of diabetes, and hypertension, on how they relate to the development of complications of type 2 diabetes. Pearson Chi-Square test was used to compare the levels of significances. Probability values of less or equal to 0.05 were accepted to be significant. The combination of salt intake, sedentary lifestyle, family history of diabetes, and lipid intake was the commonest risk factor for developing complications of T2D. However, alcohol and cigarette smoking had the most negligible impact on developing complications in T2D. The result also shows the patients between the age bracket of 30 and 40 have more risk factors for developing complications. The result showed no gender difference in the number of risk factors. There was a statistically significant association between some of the risk factors (smoking, alcohol, sedentary lifestyle, and salt intake) and the gender of respondents (p<0.05). Males smoked (43.8%) and consumed alcohol (32.5%) than females, while females were prone to a sedentary lifestyle (63.8%) and consume salt (82.8%) than males. On the other hand, this research showed that the significant complication for both males and females are numbness, pain sensation, and dry skin (diabetic neuropathy). Gender and certain predictive risk factors like salt intake, sedentary lifestyle, and family history of diabetes, and lipid intake are fundamental parameters to be tackled to reduce the complications of type 2 diabetes mellitus. There is a greater need now for awareness of the risk factors through effective health promotion in Zanzibar. Also, secondary prevention through regular screening, early detection, and appropriate treatment of chronic complications could reduce the morbidity and mortality caused by diabetes mellitus.


2021 ◽  
Vol 11 (1) ◽  
Author(s):  
Inés Urrutia ◽  
◽  
Alicia Martín-Nieto ◽  
Rosa Martínez ◽  
J Oriol Casanovas-Marsal ◽  
...  

AbstractThe aim of this study was to estimate the incidence of diabetes mellitus in the Basque Country and the risk factors involved in the disease by reassessing an adult population after 7 years of follow-up. In the previous prevalence study, 847 people older than 18 years were randomly selected from all over the Basque Country and were invited to answer a medical questionnaire, followed by a physical examination and an oral glucose tolerance test. In the reassessment, the same variables were collected and the resulting cohort comprised 517 individuals of whom 43 had diabetes at baseline. The cumulative incidence of diabetes was 4.64% in 7 years and the raw incidence rate was 6.56 cases/1000 person-years (95%CI: 4.11–9.93). Among the incident cases, 59% were undiagnosed. The most strongly associated markers by univariate analyses were age > 60 years, dyslipidaemia, prediabetes and insulin resistance. We also found association with hypertension, obesity, family history of diabetes and low education level. Multivariate analysis adjusted for age and sex showed that a set of risk factors assessed together (dyslipidaemia, waist-to-hip-ratio and family history of diabetes) had great predictive value (AUC-ROC = 0.899, 95%CI: 0.846–0.953, p = 0.942), which suggests the need for early intervention before the onset of prediabetes.


Author(s):  
Salma Younes ◽  
Muthanna Samara ◽  
Rana Al-Jurf ◽  
Gheyath Nasrallah ◽  
Sawsan Al-Obaidly ◽  
...  

Preterm birth (PTB) and early term birth (ETB) are associated with high risks of perinatal mortality and morbidity. While extreme to very PTBs have been extensively studied, studies on infants born at later stages of pregnancy, particularly late PTBs and ETBs, are lacking. In this study, we aimed to assess the incidence, risk factors, and feto-maternal outcomes of PTB and ETB births in Qatar. We examined 15,865 singleton live births using 12-month retrospective registry data from the PEARL-Peristat Study. PTB and ETB incidence rates were 8.8% and 33.7%, respectively. PTB and ETB in-hospital mortality rates were 16.9% and 0.2%, respectively. Advanced maternal age, pre-gestational diabetes mellitus (PGDM), assisted pregnancies, and preterm history independently predicted both PTB and ETB, whereas chromosomal and congenital abnormalities were found to be independent predictors of PTB but not ETB. All groups of PTB and ETB were significantly associated with low birth weight (LBW), large for gestational age (LGA) births, caesarean delivery, and neonatal intensive care unit (NICU)/or death of neonate in labor room (LR)/operation theatre (OT). On the other hand, all or some groups of PTB were significantly associated with small for gestational age (SGA) births, Apgar <7 at 1 and 5 minutes and in-hospital mortality. The findings of this study may serve as a basis for taking better clinical decisions with accurate assessment of risk factors, complications, and predictions of PTB and ETB.


2021 ◽  
Vol 80 (Suppl 1) ◽  
pp. 613.2-614
Author(s):  
L. Kondrateva ◽  
T. Panafidina ◽  
T. Popkova ◽  
M. Cherkasova ◽  
A. Lila ◽  
...  

Background:Insulin resistance (IR) is considered as initial stage of diseases continuum from development of prediabetes to eventual progression to type 2 diabetes mellitus (T2DM). Individuals with prediabetes have also elevated leptin levels, so this adipocytokine along with IR can be considered as predictive laboratory markers of higher risk of T2DM. It is not yet clear whether presence of individual or multiple SLE-related and/or known traditional risk factors of T2DM (such as unhealthy diet, physical inactivity, family history of diabetes, or being overweight) can precipitate the development of IR.Objectives:To analyze the relationship between IR and increasing leptin levels rates. To identify the presence and evaluate the potential role of traditional and disease-related risk factors for IR in SLE patients without T2DM or hyperglycemia.Methods:A total of 49 SLE pts (46 women, 3 men, 40 [33;48] years old) without established DM and with normal fasting glucose levels (<6,1 mmol/l) were enrolled in the study. Median disease duration was 3,0[0,7;8,0] years, SLEDAI-2K was 5[2;8]. SLE pts were treated with glucocorticoids (GC) (84%), hydroxychloroquine (78%), immunosuppressive drugs (20%) and biological agents (10%). Insulin levels were measured using electrochemiluminescence assay Elecsys (Roche Diagnostics), serum leptin concentrations were estimated using ELISA (DBS-Diagnostics Biochem Canada Inc.). IR was defined as Homeostasis Model Assessment of Insulin Resistance index (HOMA-IR) ≥2,77. Leptin levels were considered elevated at values ≥11,1 ng/ml for women, ≥5.6 ng/ml for men. Eight traditional T2DM risk factors from the FINDRISK (Finnish Type 2 Diabetes Risk Assessment Form) questionnaire (older age, being overweight, abdominal obesity, family history of diabetes, sedentary lifestyle, lack of regular dietary fiber intake, taking antihypertensive medications as a surrogate marker of high blood pressure, documented episodes of hyperglycemia) were evaluated. This study used 5 risk categories for developing T2DM proposed by FINDRISK questionnaire: low, slightly elevated, moderate, high or very high.Results:Median HOMA-IR levels were 1,7 [1,2;2,5]. HOMA-IR correlated with leptin levels (r=0,7, p<0,001), body mass index (BMI) (r=0,6, p<0,001), waist circumference (WC) (r=0,5, p<0,001), T2DM risk categories by FINDRISK (r=0,3, p=0,03), SLEDAI-2K (r= -0,4, p<0,01), and duration of GCs therapy (r=0,3, p=0,03). Current GC use had no influence on HOMA-IR in SLE. IR was detected in 10 (20%) SLE pts. The traditional T2DM risk factors profiles were similar in pts with (Group 1) or without IR (Group 2) except for higher anthropometric parameters in group 1 (for BMI 27,2[24,8;32,2]kg/m2 vs 23,7[20,6;26,7]kg/m2, p<0,01; for WC: 93[86;102]cm vs 83[76;93]cm, p=0,02). Leptin levels were also higher in SLE pts with IR compared to pts without IR (74,2[30,4;112,7]ng/ml vs 25,0[6,7;42,4]ng/ml, p<0,01). Increased leptin levels were found in 35 (71%) pts, more often in pts with IR (100 vs 64%, p=0,04).Conclusion:IR was found in 20% of SLE pts without T2DM having normal serum fasting glucose concentration. Emergence of IR was commonly preceded by increased leptin levels. IR values were closely associated with accumulation of adipose tissue facilitated by long-term GCs use and disease activity decrease. Contribution of other traditional risk factors of T2DM seemed insignificant.Disclosure of Interests:None declared


2011 ◽  
Vol 140 (7) ◽  
pp. 1277-1285 ◽  
Author(s):  
C. H. CHEN ◽  
H. J. WEN ◽  
P. C. CHEN ◽  
S. J. LIN ◽  
T. L. CHIANG ◽  
...  

SUMMARYPneumonia is an important cause of mortality and morbidity in infants. However, information of risk factors for pneumonia in children aged <6 months is limited. This study aimed to evaluate the risk factors and their contribution to infantile pneumonia in a large population-based survey. Of 24 200 randomly sampled main caregivers invited, 21 248 (87·8%) participated in this study. A structured questionnaire was used to interview the main caregivers. Information regarding whether hospitalization was required, family environment, and medical history were obtained. The prevalence of pneumonia was 0·62% in our study cohort. Multivariate logistic regression analysis showed that preterm birth, congenital cardiopulmonary disease, antibiotic use during pregnancy, maternal overweight, daily prenatal exposure to environmental tobacco smoke, maternal smoking during pregnancy, and visible mould on walls at home are risk factors associated with infantile pneumonia. Further study is warranted to investigate the causality and mechanisms of these novel factors.


Stroke ◽  
2021 ◽  
Vol 52 (Suppl_1) ◽  
Author(s):  
Robert J Stanton ◽  
Eleni Antzoulatos ◽  
Elisheva R Coleman ◽  
Felipe De Los Rios La Rosa ◽  
Stacie L Demel ◽  
...  

Background: Hemorrhagic transformation (HT) of ischemic stroke can have devastating consequences, leading to longer hospitalizations, increased morbidity and mortality. We sought to identify the rate of HT in stroke patients not treated with tPA within a large, biracial population. Methods: The GCNKSS is a population-based stroke epidemiology study from five counties in the Greater Cincinnati region. During 2015, we captured all hospitalized strokes by screening ICD-9 codes 430-436 and ICD-10 codes I60-I68, and G45-46. Study nurses abstracted all potential cases and physicians adjudicated cases, including classifying the degree of HT. Patients treated with thrombolytics were excluded. Incidence rates per 100,000 and associated 95% confidence intervals (CI) were estimated for HT cases, age and sex adjusted to the 2000 US population. Multiple logistic regression was used to examine risk factors associated with HT. Results: In 2015, there were 2301 ischemic strokes included in the analysis. Of these 104 (4.5%) had HT; 23 (22.1%) symptomatic, 55 (52.9%) asymptomatic and 26 (25%) unknown. Documented reasons for not receiving tPA in these patients were: time (71, 68.3%), anticoagulant use (1, 1.0%), other (18,17.3%) and unknown (14, 13.5%), which were not significantly different compared to those without HT. Only 29/104 (18.3%) had HT classified as PH-1 or PH-2. The age, sex and race-adjusted rate of HT was 9.8 (7.9, 11.6) per 100,000. The table shows rates of potential risk factors and the adjusted odds of developing HT. 90 day all-cause case fatality for patients with HT was significantly higher, 27.9% vs. 15.7%, p<0.0001. Conclusion: We found that 4.5% of non-tPA treated IS patients had HT. These patients had more severe strokes, were more likely to have abnormal coagulation tests or anticoagulant use, and were more likely to die within 90 days. We also report the first population-based incidence rate of HT in non-tPA treated of 9.8/100,000, a rate similar to the incidence of SAH.


Author(s):  
J. Skov Neergaard ◽  
K. Dragsbæk ◽  
C. Christiansen ◽  
M. Asser Karsdal ◽  
S. Brix ◽  
...  

Background: Identification of subjects with a progressive disease phenotype is an urgent need in the pharmaceutical industry where most of the recent clinical trials in Alzheimer’s disease have failed. Objectives: The objective of this study was to identify subgroups of individuals with objective cognitive impairment (OCI), who were most likely to progress to dementia and to identify the risk factors associated with progression. Design: Prospective cohort study. Setting: Population-based. Participants: 5,380 elderly women from Denmark. Measurements: The Short Blessed Test and a category fluency test with animal naming, was used to assess cognitive function, and to classify them into different groups of OCI. Results: OCI was identified in 852 subjects at baseline. The risk of dementia was elevated for OCI subjects as compared to subjects with normal cognition (HR 1.46[1.19-1.79]). The courses of OCI were studied in a sub-cohort who completed the cognitive assessment at both the baseline and the follow-up visit (n = 1,933). Of these subjects 203 had OCI at baseline. The multi-domain subtypes of OCI were associated with progressive OCI. Subjects most likely to progress were older, physically inactive, had a higher level of total cholesterol (>6.5 mmol/L) and had a history of depression as compared to subjects with a non-progressive course of OCI. Conclusions: In this cohort we identified a risk profile associated with progression from OCI in older women. The degree of impairment at baseline was an important predictor of conversion to dementia, additionally several modifiable risk factors were associated with progression.


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