Abstract 18634: Favorable Cardiovascular Health and the Compression of Morbidity: Findings From the Chicago Heart Detection Project in Industry Study

Circulation ◽  
2015 ◽  
Vol 132 (suppl_3) ◽  
Author(s):  
Norrina B Allen ◽  
Lihui Zhao ◽  
Lei Liu ◽  
Martha Daviglus ◽  
Kiang Liu ◽  
...  
Keyword(s):  
Risk Factors ◽  
Risk Factor ◽  
High Risk ◽  
Healthcare Costs ◽  
Cardiovascular Health ◽  
Heart Association ◽  
Baseline Risk ◽  
Compression Of Morbidity ◽  
High Risk Factors ◽  
Morbidity Score

Introduction: We sought to determine the association of CV health at younger ages with the proportion of life lived free of morbidity, the cumulative burden of morbidity, and average healthcare costs at older ages. Methods: The Chicago Heart Association (CHA) study is a longitudinal cohort of employed men and women aged 18-59 years at baseline exam in 1967-1973. Baseline risk factor levels included blood pressure, cholesterol, diabetes, BMI and smoking. Individuals were classified into one of four strata: favorable levels of all factors, 0 factors high but 1+ elevated, 1 high, and ≥2 high risk factors. Linked CMS/NDI data from 1984-2010 were used to determine morbidity in older age providing up to 40 years of follow-up. We included participants who were age 65+ between 1984 and 2010 and enrolled in Medicare FFS. All-cause morbidity was defined using the Gagne score. A CV morbidity score was defined as the sum of 4 CVDs including CHD (includes MI), PVD, cerebrovascular disease and CHF. Results: We included 25,390 participants (43% female, 90% White, mean age 44 at baseline); 6% had favorable levels, 19% had 1+ risk factors at elevated levels, 40% had 1 high risk factor and 35% had 2+ high risk factors. As compared to those with 2+ high risk factors, favorable CV health had lower levels of all-cause and CV morbidity from age 65-90 years, and a lower cumulative morbidity burden (p<0.001) translating to lower average annual healthcare costs ($15,905 vs $20,791 per year, p<0.001). Favorable CV health postponed the onset of all-cause morbidity by 4.5 years, the onset of CV morbidity by almost 7 years and extended life by almost 4 years resulting in a compression of morbidity on both the absolute and relative scale (see figure). Conclusion: Individuals in favorable CV health live a longer, healthier life and a greater proportion of life free of morbidity. These findings provide support for prevention efforts aimed at preserving cardiovascular health and reducing the burden of disease in older ages.

Abstract 31: Cardiovascular Health at Young and Middle Ages and Dementia in Older Age - The Chicago Heart Association Detection Project in Industry Study

Circulation ◽  
2017 ◽  
Vol 135 (suppl_1) ◽  
Author(s):  
Thanh Huyen T Vu ◽  
Donald M Lloyd-Jones ◽  
Cuiping Schiman ◽  
Lei Liu ◽  
Lihui Zhao ◽  
...  
Keyword(s):  
Risk Factors ◽  
High Risk ◽  
Cardiovascular Health ◽  
Heart Association ◽  
Later Life ◽  
Older Age ◽  
Dementia Diagnosis ◽  
High Risk Factors ◽  
Industry Study ◽  
Younger Age

Background: Data are sparse regarding the association of cardiovascular health (CVH) in younger/middle age with the diagnosis of dementia later in life. Methods: We used linked data from the Chicago Heart Association Detection Project in Industry Study assessed in 1967-73 with fee-for-service Medicare claims and National Death Index data from 1991-2010. Participants were ≤65 years old in 1991 and Medicare eligible during 1991-2010. Baseline CVD risk factors included blood pressure, cholesterol, BMI, smoking, and diabetes. Participants were classified into four strata: favorable levels of all factors, 0 factors high but 1+ elevated, 1 high, and ≥2 high risk factors. ICD-9 codes were used to identify date of first dementia diagnosis. We used competing Cox models to estimate hazards for dementia in Medicare data after age 65 with competing event of all-cause mortality prior to dementia diagnosis. Covariates included baseline age, race, sex, and education attainment. Results: This study included 4,273 females and 8,381 males, 10.3% Black, baseline ages 18-48. Dementia was diagnosed in 5.1% of study participants. The prevalence of dementia diagnosis increased with increasing CVH burden from 3.4% to 6.4%. During 1991-2010 in Medicare, the average time from age 65 to the first dementia diagnosis was 7.7 years. Greater CVH in younger age was associated with a reduced risk of being diagnosed with dementia in later life. Hazards ratios of experiencing dementia in those with baseline favorable levels, 0 RF high, and 1 only high RF were lower by 36%, 29%, and 28% respectively as compared to those with 2+ high-risk factors (see Table - Model 1). Similar trends were observed when deaths were treated as competing events although the association was attenuated (Model 2). Patterns were similar when stratified by sex or race. Conclusions: Having a favorable CVH profile at younger age is associated with lower risk of dementia in older age. Improvements in CVH in younger age may translate to increased independence and quality of life later in life.

Efficacy and toxicity of postoperative external beam radiotherapy or chemoradiation for early-stage cervical cancer

2020 ◽  
Vol 30 (12) ◽  
pp. 1878-1886
Author(s):  
Mick J E van den Akker ◽  
Nanda Horeweg ◽  
Jogchum Jan Beltman ◽  
Carien L Creutzberg ◽  
Remi A Nout
Keyword(s):  
Risk Factors ◽  
Cervical Cancer ◽  
Overall Survival ◽  
Risk Factor ◽  
High Risk ◽  
Early Stage ◽  
Free Survival ◽  
High Risk Factors ◽  
Early Stage Cervical Cancer ◽  
Risk Factors For Recurrence

ObjectiveThe aim of this study was to assess the impact of the evolving role of the addition of chemotherapy to postoperative radiotherapy on oncological outcomes and toxicity in patients with early-stage cervical cancer after radical hysterectomy.MethodsRetrospective cohort study of patients with stage IB1–IIB FIGO 2009 cervical cancer treated from November 1999 to May 2015 by primary surgery and radiotherapy (46–50.4 Gy in 1.8–2.0 Gy fractions) with or without concurrent cisplatin (40 mg/m2, 5–6 weekly cycles) with or without a brachytherapy boost. Chemotherapy was allocated depending on the risk factors for recurrence. Incidences of all outcomes were calculated using Kaplan–Meier’s methodology and compared by log-rank tests. Risk factors for recurrence and survival were identified using Cox’s proportional hazards models.ResultsA total of 154 patients were included, median follow-up was 9.6 years (IQR: 6.1–12.8). Five-year pelvic recurrence-free survival was 75.3%; 74.7% in patients with high-risk factors treated with radiotherapy; and 77.3% in those treated with chemoradiation (P=0.43). Distant metastasis-free survival at 5 years was 63.4%; 63.6% in high-risk patients after radiotherapy; and 57.1% after chemoradiation (P=0.36). Five-year overall survival was 63.9%: 66.8% and 51.6% after radiotherapy and after chemoradiation in patients with high-risk factors (P=0.37), respectively. Large tumor size was a risk factor for vaginal and pelvic recurrence, ≥2 involved lymph nodes was a significant risk factor for para-aortic recurrence and death. Mild treatment-related late toxicity was observed in 53.9% of the patients. Five-year severe (grade 3–5) late rectal, bladder, bowel, and vaginal toxicities were, respectively, 1.3%, 0%, 3.4%, and 0.9%. Any late severe toxicity was observed in 5.5% of patients treated with radiotherapy and in 15.3% of those treated with chemoradiation (P=0.07).ConclusionPostoperative (chemo)radiation for early-stage cervical cancer patients with risk factors for recurrence yields adequate pelvic tumor control, but overall survival is limited due to distant metastasis.

Pre-Transplant Variables Affecting the Outcome of Submyeloablative Allogeneic HSCT in Uniformly Treated Patients with Hematologic Malignancies.

Blood ◽  
2004 ◽  
Vol 104 (11) ◽  
pp. 2324-2324
Author(s):  
Jayesh Mehta ◽  
S. Singhal ◽  
M. Tallman ◽  
S. Williams ◽  
J. Winter ◽  
...  
Keyword(s):  
Risk Factors ◽  
Overall Survival ◽  
Risk Factor ◽  
High Risk ◽  
Cox Model ◽  
Performance Status ◽  
Hematologic Malignancies ◽  
Current Treatment ◽  
Allogeneic Hsct ◽  
High Risk Factors

Abstract The outcome of 63 consecutive submyeloablative allografts (27–66 y, median 52) performed for hematologic malignancies after 100 mg/m2 melphalan without (n=21; prior autograft) or with (n=42; no prior autograft) 50 mg/kg cyclophosphamide was analyzed to study the effect of pre-transplant characteristics. GVHD prophylaxis comprised cyclosporine-mycophenolate (n=37; HLA-identical sibling donors) or tacrolimus-mycophenolate (n=26, 1-locus mismatched sibling or 9–10/10 allele-matched unrelated). No growth factors were administered routinely post-transplant and supportive care was uniform. 14 patients experienced transplant-related mortality (TRM), and 32 relapsed. 24 relapsing patients died, and 7 of the other 8 are alive in CR or with declining disease. The following factors were analyzed in a Cox model for their effect on TRM and relapse: chemosensitive (n=25) vs refractory disease (n=38), age ≤55 (n=44) vs >55 (n=19), normal (n=32) vs abnormal (n=31) LDH, HLA match (n=56) vs mismatch (n=7), prior autograft or not, performance status 0–1 (n=47) vs 2–3 (n=16). Outcome Favorable factor RR (95% CI) P TRM Age ≤55 0.20 (0.04–0.86) 0.03 HLA matched 0.21 (0.05–0.89) 0.04 Performance status 0-1 0.25 (0.06–0.99) 0.05 Relape Chemosensitive disease 0.28 (0.11–0.73) 0.01 Fig 1 shows TRM for patients with 0, 1 or 2 high-risk factors for TRM. Fig 1 shows TRM for patients with 0, 1 or 2 high-risk factors for TRM. Fig 2 shows overall survival (OS) for patients with 0 or 1 high-risk factors for TRM by disease chemosensitivity. Fig 2 shows overall survival (OS) for patients with 0 or 1 high-risk factors for TRM by disease chemosensitivity. Table 2 shows the causes of death by risk factors for TRM and disease chemosensitivity. Group (n) Alive TRM Death from disease A: 2 risk factors for TRM (7) 1 (14%) 5 (71%) 1 (14%) B: 1 risk factor for TRM + Refractory (19) 2 (11%) 6 (32%) 11 (58%) C: 1 risk factor for TRM + Sensitive (9) 5 (56%) 1 (11%) 3 (33%) D: 0 risk factor for TRM + Refractory (12) 3 (25%) 1 (8%) 8 (67%) E: 0 risk factor for TRM + Sensitive (16) 13 (81%) 1 (6%) 2 (13%) These data suggest that while the current treatment approach is optimal for patients falling in Group E, modified approaches are needed for other patients. Based on the causes of failure, the following modifications appear to be warranted. Group A: A completely non-ablative regimen to reduce toxicity. Group B: A completely non-ablative regimen to reduce toxicity with augmentation of graft-vs-tumor effects by elective donor leukocyte infusions and/or abbreviated immunosuppression. Group C: Augmentation of graft-vs-tumor effects by elective donor leukocyte infusions and/or abbreviated immunosuppression. Group D: Conventional-intensity rather than reduced-intensity allogeneic HSCT.

scholarly journals Objective screening of hearing impairment using brainstem evoked response audiometry in children below 5 years of age and assessing the high risk factors

2018 ◽  
Vol 4 (4) ◽  
pp. 923 ◽  
Author(s):  
Mallikarjun Patil ◽  
Prakash Handi ◽  
K. R. Prasenkumar ◽  
Kranti Gouripur
Keyword(s):  
Risk Factors ◽  
Hearing Loss ◽  
Risk Factor ◽  
High Risk ◽  
Hearing Impairment ◽  
Hearing Threshold ◽  
Evoked Response ◽  
Common Risk Factor ◽  
High Risk Factors ◽  
Evoked Response Audiometry

<p class="abstract"><strong>Background:</strong> Hearing impairment is a common disability in children. This study is to evaluate the common high risk factors for hearing loss in our locality and to estimate hearing threshold by brain stem evoked response audiometry.</p><p class="abstract"><strong>Methods:</strong> 100 children under five years were subjected to brainstem evoked response audiometry. Wave V morphology was studied and hearing threshold estimated. The high risk factor(s) were analysed and degree of hearing impairment assessed.  </p><p class="abstract"><strong>Results:</strong> 38 children were found to have hearing impairment. Most of the children had bilateral hearing impairment. Of them 30 children (79%) had profound hearing loss. Consanguineous marriage was the most common risk factor.</p><p class="abstract"><strong>Conclusions:</strong> Since consanguinity is the most common risk factor, health education and genetic counselling will help to decrease the incidence of autosomal recessive nonsyndromic deafness. Improvement in immunization for rubella can decrease the hearing impairment due to these infections. Due to availability of medical facilities hearing impairment due to perinatal factors have decreased.</p>

Abstract P058: Cardiovascular Health Screening In 26,063 Adolescent Blood Donors

Circulation ◽  
2014 ◽  
Vol 129 (suppl_1) ◽  
Author(s):  
Maria Odette Gore ◽  
Stephen J Eason ◽  
Colby R Ayers ◽  
Jarett D Berry ◽  
Amit Khera ◽  
...  
Keyword(s):  
Risk Factors ◽  
Risk Factor ◽  
Cardiovascular Risk ◽  
High Risk ◽  
School District ◽  
Cardiovascular Risk Factors ◽  
Low Income ◽  
Blood Donors ◽  
Socioeconomic Characteristics ◽  
High Risk Factors

Introduction and Objective: Cardiovascular risk factors in adolescents track into adulthood and are associated with morbidity and early mortality. As part of a pilot health screening program implemented by Carter BloodCare, the largest independent blood program in Texas, we screened a large adolescent blood donor population for key cardiovascular risk factors. Methods: Blood pressure (SBP and DBP), total cholesterol and hemoglobin A1C (HbA1C) were measured in 26,063 volunteer high-school blood donors, 16-19 years of age, between 2011 and 2013. Cardiovascular risk factors were classified as high risk (SBP ≥ 140 mm Hg and/or DBP ≥ 90 mm Hg, cholesterol ≥ 200 mg/dL, HbA1C ≥ 6.5%) and intermediate or high risk (SBP ≥ 120 mm Hg and/or DBP ≥ 80 mm Hg, cholesterol ≥ 170 mg/dL, HbA1C ≥ 5.7%). The main study measures were the prevalence of 1, 2 or 3 risk factors within the same individual in the study population, with stratification by age, sex, race/ethnicity, and school district socioeconomic characteristics. Results: In the overall cohort, 66.5% of donors had at least one and 20.3% had at least two intermediate or high risk factors, and 15.3% had at least one high risk factor (Table). The percentage of donors in each non-zero category of intermediate or high risk factors increased with age (Ptrend<0.001), was higher in ethnic minorities (P<0.001 each for Asian, Black and Hispanic vs. White), and there were more boys than girls in all non-zero risk categories (P<0.001 for all). There were no statistically significant relationships between risk factor categories and socioeconomic characteristics (urban vs. rural and low-income vs. not low-income donor school district). Conclusions: The prevalence of cardiovascular risk factors among adolescent blood donors is common, with two or more concomitant risk factors identifiable in many donors. Blood donation programs may provide a unique portal for early screening and targeted preventive intervention in youth, with potential for cardiovascular disease prevention in the community.

The Health Check-Up Data-Analysis for Risk Assessment of Chronic Kidney Disease (CKD) in Taiwan

2021 ◽  
Author(s):  
Ming-Shu Chen ◽  
Mao-Jhen Jhou ◽  
Chi-Jie Lu ◽  
Chung-Chih Hung
Keyword(s):  
Risk Factors ◽  
Cardiovascular Disease ◽  
Risk Assessment ◽  
Chronic Kidney Disease ◽  
Risk Factor ◽  
High Risk ◽  
Kidney Disease ◽  
High Risk Population ◽  
Healthy Population ◽  
High Risk Factors

Early detection of chronic kidney disease (CKD) for high-risk population adults is very important. It has a common risk factor and causal relationship with chronic diseases such as diabetes, hypertension and cardiovascular disease etc. The results of this study provide that for early high-risk factors detection in CKD healthy population can be used by home care to recommend adjuvant treatment.

Abstract P155: Cardiovascular Health at Young and Middle Ages and Medical Care Costs at Old Age

Circulation ◽  
2017 ◽  
Vol 135 (suppl_1) ◽  
Author(s):  
Cuiping Schiman ◽  
Lei Liu ◽  
Tina Shih ◽  
Lihui Zhao ◽  
Martha Daviglus ◽  
...  
Keyword(s):  
Risk Factors ◽  
High Risk ◽  
Medical Care ◽  
Old Age ◽  
Cardiovascular Health ◽  
Home Health ◽  
Medical Care Cost ◽  
High Risk Factors ◽  
Medical Care Costs ◽  
Care Costs

Introduction: We investigate the association between cardiovascular health at young and middle age and medical care costs and utilization in old age. Methods: We linked Chicago Heart Association (CHA) study participants’ baseline cardiovascular health (CVH) (18-59 yrs) to their Medicare claims (1991-2010) for all Part A and Part B services, including inpatient and skilled nursing facility, outpatient, home health, durable medical equipment, and hospice care. Baseline CVH is a composite measure of BP, cholesterol, diabetes, BMI, and smoking and is divided into four strata representing increasing burden. Medical care utilization (e.g., admissions and visits) and costs (in 2010 dollars) were calculated from the claims. We analyzed both the overall costs and the composition of costs among various medical care services and by CVD (non-CVD) morbidity and sex. Conditional quantile regressions were used to estimate the association between increased CVH and costs and negative binomial regressions were used for the number of inpatient admissions and outpatient visits, and the length of inpatient or hospice stay. Results: Among the 22,236 participants (222,816 person-years) 41.7% are female, 5.7% had favorable levels of all factors, 19.6% had 1+ risk factors at elevated levels, 40.9% had 1 high risk factor, and 33.7% had 2+ high risk factors. The median (mean) health care costs over the sample is $12,477 ($189,598) per person year in 2010 dollars, poorer CVH was associated with higher total medical care costs and a greater proportion of spending on home health visits (Figure). A greater CVH burden was associated with greater utilization and length of stay. Individuals with 2+ high risk factors on average have 0.22 more inpatient admissions per year and their inpatient stay is almost 2.91 days longer per year than individuals with favorable CVH. Conclusion: Unfavorable CVH early in life is associated with higher medical care cost burden in old age. Future interventions to improve CVH may result in reduced healthcare costs and utilization.

scholarly journals Perineural Invasion Should Be Regarded as an Intermediate-Risk Factor for Recurrence in Surgically Treated Cervical Cancer: A Propensity Score Matching Study

2021 ◽  
Vol 2021 ◽  
pp. 1-8
Author(s):  
Ting Wan ◽  
Hua Tu ◽  
Lili Liu ◽  
He Huang ◽  
Yanling Feng ◽  
...  
Keyword(s):  
Risk Factors ◽  
Cervical Cancer ◽  
Overall Survival ◽  
Risk Factor ◽  
High Risk ◽  
Propensity Score ◽  
Cancer Patients ◽  
Perineural Invasion ◽  
Intermediate Risk ◽  
High Risk Factors

Background. Perineural invasion (PNI) is considered as a poor prognostic factor in cervical cancer, but there has been no postoperative adjuvant therapy for it, because whether it belongs to high- or intermediate-risk factors has not been determined, this study intends to provide evidences to solve this problem. Methods. We conducted a retrospective analysis of cervical cancer patients who underwent radical surgery and be reported PNI from January 2012 to June 2017 at the Sun Yat-sen University Cancer Center. After 1 : 1 propensity score matching (PSM), a group of patients without PNI was matched according to the clinical pathological features. Postoperative pathological parameters and prognosis were evaluated between the PNI and the matched groups. Results. 1836 patients were screened, of which 162 (8.8%) diagnosed as stages IB1 to IIB reported PNI. Comparing to the matched group, more PNI (+) patients had deep outer cervix stromal invasion, cervical tunica adventitia invasion, positive lymph nodes, and positive margins. Among patients without high-risk factors, PNI (+) patients had worse 3-year overall survival (90.8% vs. 98.1%, P = 0.02 ), PNI (+) patients with single intermediate-risk factor and PNI (-) patients who meet with SEDLIS criteria had similar progress free survival ( P = 0.63 ) and overall survival ( P = 0.63 ), even similar survival curves. Conclusion. PNI is related to a worse overall survival among cervical cancer patients without high-risk factors and play the role as an intermediate-risk factor.

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