Risk of Type 2 Diabetes among Osteoarthritis Patients in a Prospective Longitudinal Study

Objectives. Our aim was to determine the risk of diabetes among osteoarthritis (OA) cases in a prospective longitudinal study.Methods. Administrative health records of 577,601 randomly selected individuals from British Columbia, Canada, from 1991 to 2009, were analyzed. OA and diabetes cases were identified by checking physician’s visits and hospital records. From 1991 to 1996 we documented 19,143 existing OA cases and selected one non-OA individual matched by age, sex, and year of administrative records. Poisson regression and Cox proportional hazards models were fitted to estimate the effects after adjusting for available sociodemographic and medical factors.Results. At baseline, the mean age of OA cases was 61 years and 60.5% were women. Over 12 years of mean follow-up, the incidence rate (95% CI) of diabetes was 11.2 (10.90–11.50) per 1000 person years. Adjusted RRs (95% CI) for diabetes were 1.27 (1.15–1.41), 1.21 (1.08–1.35), 1.16 (1.04–1.28), and 0.99 (0.86–1.14) for younger women (age 20–64 years), older women (age ≥ 65 years), younger men, and older men, respectively.Conclusion. Younger adults and older women with OA have increased risks of developing diabetes compared to their age-sex matched non-OA counterparts. Further studies are needed to confirm these results and to elucidate the potential mechanisms.

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Mortality inequalities by occupational status and type of job in men and women: results from the Rome Longitudinal Study

BMJ Open ◽

10.1136/bmjopen-2019-033776 ◽

2020 ◽

Vol 10 (6) ◽

pp. e033776

Author(s):

Lorenzo Paglione ◽

Laura Angelici ◽

Marina Davoli ◽

Nera Agabiti ◽

Giulia Cesaroni

Keyword(s):

Longitudinal Study ◽

Proportional Hazards ◽

Occupational Status ◽

Cox Proportional Hazards ◽

Working Environment ◽

Health Determinants ◽

Strong Impact ◽

Men And Women ◽

Cox Proportional Hazards Models ◽

Working Age

ObjectivesSocioeconomic inequalities have a strong impact on population health all over the world. Occupational status is a powerful determinant of health in rich societies. We aimed at investigating the association between occupation and mortality in a large metropolitan study.DesignCohort study.SettingRome, capital of Italy.ParticipantsWe used the Rome Longitudinal Study, the administrative cohort of residents in Rome at the 2001 general census, followed until 2015. We selected residents aged 15–65 years at baseline. For each subject, we had information on sex, age and occupation (occupational status and type of job) according to the Italian General Census recognition.Main outcome measuresWe investigated all-cause, cancer, cardiovascular and accidental mortality, major causes of death in the working-age population. We used Cox proportional hazards models to investigate the association between occupation and all-cause and cause-specific mortality in men and women.ResultsWe selected 1 466 726 subjects (52.1% women). 42 715 men and 29 915 women died during the follow-up. In men, 47.8% of deaths were due to cancer, 26.7% to cardiovascular causes and 6.4% to accidents, whereas in women 57.8% of deaths were due to cancer, 19.3% to cardiovascular causes and 3.5% to accidents. We found an association between occupational variables and mortality, more evident in men than in women. Compared with employed, unemployed had a higher risk of mortality for all causes with an HR=1.99 (95% CI 1.92 to 2.06) in men and an HR=1.49 (95% CI 1.39 to 1.60) in women. Compared with high-qualified non-manual workers, non-specialised manual workers had a higher mortality risk (HR=1.68, 95% CI 1.59 to 1.77 and HR=1.30, 95% CI 1.20 to 1.40, for men and women, respectively).ConclusionsThis study shows the importance of occupational variables as social health determinants and provides evidence for policy-makers on the necessity of integrated and preventive policies aimed at improving the safety of the living and the working environment.

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Acute myeloid leukemia (AML) in older women after adjuvant breast cancer therapy

Journal of Clinical Oncology ◽

10.1200/jco.2006.24.18_suppl.560 ◽

2006 ◽

Vol 24 (18_suppl) ◽

pp. 560-560 ◽

Cited By ~ 2

Author(s):

D. A. Patt ◽

Z. Duan ◽

G. Hortobagyi ◽

S. H. Giordano

Keyword(s):

Breast Cancer ◽

Adjuvant Chemotherapy ◽

Older Women ◽

Proportional Hazards ◽

Cox Proportional Hazards ◽

Significant Independent Predictor ◽

Kaplan Meier ◽

Cox Proportional Hazards Models ◽

Adjuvant Breast Cancer ◽

Comorbidity Scores

560 Background: Adjuvant chemotherapy for breast cancer is associated with the development of secondary AML, but this risk in an older population has not been previously quantified. Methods: We queried data from the Surveillance, Epidemiology, and End Results-Medicare (SEER-Medicare) database for women who were diagnosed with nonmetastatic breast cancer from 1992–1999. We compared the risk of AML in patients with and without adjuvant chemotherapy (C), and by differing C regimens. The primary endpoint was a claim with an inpatient or outpatient diagnosis of AML (ICD-09 codes 205–208). Risk of AML was estimated using the method of Kaplan-Meier. Cox proportional hazards models were used to determine factors independently associated with AML. Results: 36,904 patients were included in this observational study, 4,572 who had received adjuvant C and 32,332 who had not. The median patient age was 75.3 (66.0–103.3). The median follow up was 63 months (13–132). Patients who received C were significantly younger, had more advanced stage disease, and had lower comorbidity scores (p<0.001). The unadjusted risk of developing AML at 10 years after any adjuvant C for breast cancer was 1.6% versus 1.1% for women who had not received C. The adjusted HR for AML with adjuvant C was 1.72 (1.16–2.54) compared to women who did not receive C. HR for radiation was 1.21 (0.86–1.70). HR was higher with increasing age but p>0.05. An analysis was performed among women who received C. When compared to other C regimens, anthracycline-based therapy (A) conveyed a significantly higher hazard for AML HR 2.17 (1.08–4.38), while patients who received A plus taxanes (T) did not have a significant increase in risk HR1.29 (0.44–3.82) nor did patients who received T with some other C HR 1.50 (0.34–6.67). Another significant independent predictor of AML included GCSF use HR 2.21 (1.14–4.25). In addition, increasing A dose was associated with higher risk of AML (p<0.05). Conclusions: There is a small but real increase in AML after adjuvant chemotherapy for breast cancer in older women. The risk appears to be highest from A-based regimens, most of which also contained cyclophosphamide, and may be dose-dependent. T do not appear to increase risk. The role of GCSF should be further explored. No significant financial relationships to disclose.

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Use and Outcomes of Adjuvant Chemotherapy in Older Women With Breast Cancer

Journal of Clinical Oncology ◽

10.1200/jco.2005.02.3028 ◽

2006 ◽

Vol 24 (18) ◽

pp. 2750-2756 ◽

Cited By ~ 219

Author(s):

Sharon H. Giordano ◽

Zhigang Duan ◽

Yong-Fang Kuo ◽

Gabriel N. Hortobagyi ◽

James S. Goodwin

Keyword(s):

Breast Cancer ◽

Adjuvant Chemotherapy ◽

Older Women ◽

Proportional Hazards ◽

Breast Cancer Mortality ◽

Population Based ◽

Cox Proportional Hazards ◽

Significant Shift ◽

Breast Cancer Chemotherapy ◽

Cox Proportional Hazards Models

Purpose This study was undertaken to determine patterns and outcomes of adjuvant chemotherapy use in a population-based cohort of older women with primary breast cancer. Patients and Methods Women were identified from the Surveillance, Epidemiology, and End Results–Medicare-linked database who met the following criteria: age ≥ 65 years, stage I to III breast cancer, and diagnosis between 1991 and 1999. Adjuvant chemotherapy use was ascertained by Common Procedural Terminology J codes. Logistic regression analysis was performed to determine factors associated with chemotherapy use. Multivariate Cox proportional hazards models were used to calculate the hazard of death for women with and without chemotherapy. Results A total of 41,390 women met study criteria, of whom 4,500 (10.9%) received chemotherapy. The use of adjuvant chemotherapy more than doubled during the 1990s, from 7.4% in 1991 to 16.3% in 1999 (P < .0001), with a significant shift toward anthracycline use. Women who were younger, white, with lower comorbidity scores, more advanced stage disease, and estrogen receptor (ER) –negative disease were significantly more likely to receive chemotherapy. Chemotherapy was not associated with improved survival among women with lymph node–negative (LN) disease or LN-positive, ER-positive disease (hazard ratio [HR], 1.05; 95% CI, 0.85 to 1.31). However, among women with LN-positive, ER-negative breast cancer, chemotherapy was associated with a significant reduction in breast cancer mortality (HR, 0.72; 95% CI, 0.54 to 0.96). A similar significant benefit of chemotherapy was seen in the subset of women age 70 years or older (HR, 0.74; 95% CI, 0.56 to 0.97). Conclusion In this observational cohort, chemotherapy was associated with a significant reduction in mortality among older women with ER-negative, LN-positive breast cancer.

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Central Blood Pressure and Cardiovascular Outcomes in Chronic Kidney Disease

Clinical Journal of the American Society of Nephrology ◽

10.2215/cjn.08620817 ◽

2018 ◽

Vol 13 (4) ◽

pp. 585-595 ◽

Cited By ~ 7

Author(s):

Mahboob Rahman ◽

Jesse Yenchih Hsu ◽

Niraj Desai ◽

Chi-yuan Hsu ◽

Amanda H. Anderson ◽

...

Keyword(s):

Cardiovascular Disease ◽

Confidence Interval ◽

Proportional Hazards ◽

Cox Proportional Hazards ◽

Cardiovascular Outcomes ◽

Hazard Ratio ◽

Cardiovascular Outcome ◽

Prospective Longitudinal Study ◽

Disease Outcomes ◽

Prospective Longitudinal

Background and objectivesCentral BP measurements provide noninvasive measurement of aortic BP; our objectives were to examine the association of central and brachial BP measurements with risk of cardiovascular outcomes and mortality in patients with CKD and to determine the role of central BP measurement in conjunction with brachial BP in estimating cardiovascular risk.Design, setting, participants, & measurementsIn a prospective, longitudinal study (the Chronic Renal Insufficiency Cohort), central BP was measured in participants with CKD using the SphygmoCorPVx System. Cox proportional hazards models were used for analyses.ResultsMean age of the participants (n=2875) was 60 years old. After a median follow-up of 5.5 years, participants in the highest quartile of brachial systolic BP (≥138 mm Hg) were at higher risk for the composite cardiovascular outcome (hazard ratio, 1.59; 95% confidence interval, 1.17 to 2.17; c statistic, 0.76) but not all-cause mortality (hazard ratio, 1.28; 95% confidence interval, 0.90 to 1.80) compared with those in the lowest quartile. Participants in the highest quartile of central systolic BP were also at higher risk for the composite cardiovascular outcome (hazard ratio, 1.69; 95% confidence interval, 1.24 to 2.31; c statistic, 0.76) compared with participants in the lowest quartile.ConclusionsWe show that elevated brachial and central BP measurements are both associated with higher risk of cardiovascular disease outcomes in patients with CKD. Measurement of central BP does not improve the ability to predict cardiovascular disease outcomes or mortality in patients with CKD compared with brachial BP measurement.

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Comorbidity, chemotherapy toxicity, and outcomes among older women receiving adjuvant chemotherapy for breast cancer (BC).

Journal of Clinical Oncology ◽

10.1200/jco.2012.30.15_suppl.6015 ◽

2012 ◽

Vol 30 (15_suppl) ◽

pp. 6015-6015

Author(s):

Heidi D. Klepin ◽

Brandy Pitcher ◽

Karla V. Ballman ◽

Gretchen Genevieve Kimmick ◽

Alice B. Kornblith ◽

...

Keyword(s):

Adjuvant Chemotherapy ◽

Older Women ◽

Proportional Hazards ◽

Early Stage ◽

Median Number ◽

Cox Proportional Hazards ◽

Comorbid Condition ◽

Cox Proportional Hazards Models ◽

Comorbidity Burden ◽

Group B

6015 Background: Comorbidity increases with age. We evaluated how comorbidity was associated with toxicity and clinical outcomes among older women with BC who received adjuvant chemotherapy. Methods: Cancer and Leukemia Group B (CALGB 49907) enrolled 633 women ≥65 years with early stage BC and randomized them to standard adjuvant chemotherapy (AC or CMF) or capecitabine (N Eng J Med 360:2055, 2009). 329 women on the Quality of Life companion study completed a pre-treatment health survey (Older American Resources and Services Questionnaire, physical health subscale). The survey evaluates 14 conditions and the degree to which each interferes with daily activities (rated from 1 “not at all” to 3 “a great deal”). Comorbidity was analyzed as follows: 1) total number 2) comorbidity burden score (summed conditions multiplied by interference rating); and 3) individual diseases. Primary outcomes were: 1) grade 3-5 toxicity (incident and cumulative); 2) time to relapse (TTR), and 3) overall survival (OS). Contingency table methods were used to evaluate the association between comorbidity and toxicity. Cox proportional hazards models were used to evaluate TTR and survival outcomes. Results: Among 329 women [median age 71 years (range 65-89), 86% white, 98% ECOG performance score 0-1, 75% stage 1-2] the median number of comorbidities was 2 (0-10), median comorbidity burden score was 3 (0-25), and most common conditions were arthritis (58%) and hypertension (54%). Few patients had diabetes (17%), heart disease (16%), and pulmonary disease (9%). No comorbidity measure was associated with toxicity or TTR. With a median follow-up of 5.4 years, increasing comorbidity was associated with shorter OS. For each additional comorbid condition the hazard of death increased by 18% (HR 1.18 [95% CI; 1.06-1.33]) after adjusting for age, tumor size, treatment, node status and receptor status. Comorbidity burden score was similarly associated with OS (HR 1.08 [95% CI; 1.03-1.14]), while no specific condition was independently associated. Conclusions: Among older women with good functional status, comorbidity was not associated with toxicity or BC relapse. However, comorbidity burden was associated with shorter OS.

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The Impact of Attrition in an 11-Year Prospective Longitudinal Study of Younger Women

Annals of Epidemiology ◽

10.1016/j.annepidem.2010.01.002 ◽

2010 ◽

Vol 20 (4) ◽

pp. 318-321 ◽

Cited By ~ 79

Author(s):

Jennifer Powers ◽

Deborah Loxton

Keyword(s):

Longitudinal Study ◽

Prospective Longitudinal Study ◽

Younger Women ◽

Prospective Longitudinal ◽

The Impact

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What Protects Youth Residential Caregivers from Burning Out? A Longitudinal Analysis of Individual Resilience

International Journal of Environmental Research and Public Health ◽

10.3390/ijerph17072212 ◽

2020 ◽

Vol 17 (7) ◽

pp. 2212 ◽

Cited By ~ 2

Author(s):

Nina Kind ◽

David Bürgin ◽

Jörg M. Fegert ◽

Marc Schmid

Keyword(s):

Longitudinal Analysis ◽

Self Efficacy ◽

Proportional Hazards ◽

Multiple Stressors ◽

Self Care ◽

Cox Proportional Hazards ◽

Prospective Longitudinal Study ◽

Work Related ◽

Individual Resilience ◽

Prospective Longitudinal

Background: Professional caregivers are exposed to multiple stressors and have high burnout rates; however, not all individuals are equally susceptible. We investigated the association between resilience and burnout in a Swiss population of professional caregivers working in youth residential care. Methods: Using a prospective longitudinal study design, participants (n = 159; 57.9% women) reported on burnout symptoms and sense of coherence (SOC), self-efficacy and self-care at four annual sampling points. The associations of individual resilience measures and sociodemographic variables, work-related and personal stressors, and burnout symptoms were assessed. Cox proportional hazards regressions were calculated to compute hazard ratios over the course of three years. Results: Higher SOC, self-efficacy and self-care were related to lower burnout symptoms in work-related and personal domains. Higher SOC and self-efficacy were reported by older caregivers and by those with children. All three resilience measures were highly correlated. A combined model analysis weakened the protective effect of self-efficacy, leaving only SOC and self-care negatively associated with burnout. Conclusion: This longitudinal analysis suggests that SOC and self-caring behaviour in particular protect against burnout. Our findings could have implications for promoting self-care practices, as well as cultivating a meaningful, comprehensible and manageable professional climate in all facets of institutional care.

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Nomogram to Predict the Benefit of Radiation for Older Patients With Breast Cancer Treated With Conservative Surgery

Journal of Clinical Oncology ◽

10.1200/jco.2011.41.0076 ◽

2012 ◽

Vol 30 (23) ◽

pp. 2837-2843 ◽

Cited By ~ 47

Author(s):

Jeffrey M. Albert ◽

Diane D. Liu ◽

Yu Shen ◽

I-Wen Pan ◽

Ya-Chen Tina Shih ◽

...

Keyword(s):

Breast Cancer ◽

Older Women ◽

Older Patients ◽

Clinical Decision Making ◽

Proportional Hazards ◽

Estrogen Receptor Status ◽

Clinical Decision ◽

Conservative Surgery ◽

Cox Proportional Hazards ◽

Cox Proportional Hazards Models

Purpose The role of radiation therapy (RT) after conservative surgery (CS) remains controversial for older patients with breast cancer. Guidelines based on recent clinical trials have suggested that RT may be omitted in selected patients with favorable disease. However, it is not known whether this recommendation should extend to other older women. Accordingly, we developed a nomogram to predict the likelihood of long-term breast preservation with and without RT. Methods We used Surveillance, Epidemiology, and End Results–Medicare data to identify 16,092 women age 66 to 79 years treated with CS between 1992 and 2002, using claims to identify receipt of RT and subsequent mastectomy. Time to mastectomy was estimated using the Kaplan-Meier method. Cox proportional hazards models determined the effect of covariates on mastectomy-free survival (MFS). A nomogram was developed to predict 5- and 10-year MFS, given associated risk factors, and bootstrap validation was performed. Results With a median follow-up of 7.2 years, the overall 5- and 10-year MFS rates were 98.1% (95% CI, 97.8% to 98.3%) and 95.4% (95% CI, 94.9% to 95.8%), respectively. In multivariate analysis, age, race, tumor size, estrogen receptor status, and receipt of RT were predictive of time to mastectomy and were incorporated into the nomogram. Nodal status was also included given a significant interaction with RT. The resulting nomogram demonstrated good accuracy in predicting MFS, with a bootstrap-corrected concordance index of 0.66. Conclusion This clinically useful tool predicts 5- and 10-year MFS among older women with early breast cancer using readily available clinicopathologic factors and can aid individualized clinical decision making by estimating predicted benefit from RT.

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