A Prospective Study of Community Mediators on the Risk of Sepsis After Cancer

Background: Few studies have examined whether community factors mediate the relationship between patients surviving cancer and future development of sepsis. We determined the influence of community characteristics upon risk of sepsis after cancer, and whether there are differences by race. Methods: We performed a prospective analysis using data from the REasons for Geographic and Racial Differences in Stroke cohort years 2003 to 2012 complemented with county-level community characteristics from the American Community Survey and County Health Rankings. We categorized those with a self-reported prior cancer diagnosis as “cancer survivors” and those without a history of cancer as “no cancer history.” We defined sepsis as hospitalization for a serious infection with ≥2 systemic inflammatory response syndrome criteria. We examined the mediation effect of community characteristics on the association between cancer survivorship and sepsis incidence using Cox proportional hazards models adjusted for age, sex, race, and total number of comorbidities. We repeated analysis stratified by race. Results: There were 28 840 eligible participants, of which 2860 (9.92%) were cancer survivors, and 25 289 (90.08%) were no cancer history participants. The only observed community-level mediation effects were from income (% mediated 0.07%; natural indirect effect [NIE] on hazard scale] = 1.001, 95% confidence interval [95% CI]: 1.000-1.005) and prevalence of adult smoking (% mediated = 0.21%; NIE = 1.002, 95% CI: 1.000-1.004). We observed similar effects when stratified by race. Conclusion: Cancer survivors are at increased risk of sepsis; however, this association is weakly mediated by community poverty and smoking prevalence.

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Mediating Effects of Frailty Indicators on the Risk of Sepsis After Cancer

Journal of Intensive Care Medicine ◽

10.1177/0885066618779941 ◽

2018 ◽

Vol 35 (7) ◽

pp. 708-719 ◽

Cited By ~ 1

Author(s):

Justin Xavier Moore ◽

Tomi Akinyemiju ◽

Alfred Bartolucci ◽

Henry E. Wang ◽

John Waterbor ◽

...

Keyword(s):

Physical Activity ◽

Cancer Survivors ◽

Racial Differences ◽

Cancer Survivorship ◽

Cox Regression ◽

Mediation Effect ◽

Cancer History ◽

Mediation Effects ◽

Increased Risk ◽

Using Data

Background: Cancer survivors are at increased risk of sepsis, possibly attributed to weakened physiologic conditions. The aims of this study were to examine the mediation effect of indicators of frailty on the association between cancer survivorship and sepsis incidence and whether these differences varied by race. Methods: We performed a prospective analysis using data from the REasons for Geographic and Racial Differences in Stroke cohort from years 2003 to 2012. We categorized frailty as the presence of ≥2 frailty components (weakness, exhaustion, and low physical activity). We categorized participants as “cancer survivors” or “no cancer history” derived from self-reported responses of being diagnosed with any cancer. We examined the mediation effect of frailty on the association between cancer survivorship and sepsis incidence using Cox regression. We repeated analysis stratified by race. Results: Among 28 062 eligible participants, 2773 (9.88%) were cancer survivors and 25 289 (90.03%) were no cancer history participants. Among a total 1315 sepsis cases, cancer survivors were more likely to develop sepsis (12.66% vs 3.81%, P < .01) when compared to participants with no cancer history (hazard ratios: 2.62, 95% confidence interval: 2.31-2.98, P < .01). The mediation effects of frailty on the log-hazard scale were very small: weakness (0.57%), exhaustion (0.31%), low physical activity (0.20%), frailty (0.75%), and total number of frailty indicators (0.69%). Similar results were observed when stratified by race. Conclusion: Cancer survivors had more than a 2-fold increased risk of sepsis, and indicators of frailty contributed to less than 1% of this disparity.

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Abstract 187: Electrocardiographic Heart Rate-corrected Qt Interval And Risk Of Stroke In The REasons For Geographic And Racial Differences In Stroke (REGARDS) Study

Stroke ◽

10.1161/str.43.suppl_1.a187 ◽

2012 ◽

Vol 43 (suppl_1) ◽

Author(s):

Elsayed Z Soliman ◽

George Howard ◽

Mary Cushman ◽

Brett Kissela ◽

...

Keyword(s):

Heart Rate ◽

Racial Differences ◽

Qt Interval ◽

Proportional Hazards ◽

Left Ventricular ◽

Cox Proportional Hazards ◽

Corrected Qt Interval ◽

Cardiovascular Morbidity And Mortality ◽

Increased Risk ◽

Regards Study

Background: Prolongation of heart rate-corrected QT interval (QTc) is a well established predictor of cardiovascular morbidity and mortality. Little is known, however, about the relationship between this simple electrocardiographic (ECG) marker and risk of stroke. Methods: A total of 27,411 participants aged > 45 years without prior stroke from the REasons for Geographic and Racial Differences in Stroke (REGARDS) study were included in this analysis. QTc was calculated using Framingham formula (QTcFram). Stroke cases were identified and adjudicated during an up to 7 years of follow-up (median 2.7 years). Cox proportional hazards analysis was used to estimate the hazard ratios for incident stroke associated with prolonged QTcFram interval (vs. normal) and per 1 standard deviation (SD) increase, separately, in a series of incremental models. Results: The risk of incident stroke in the study participants with baseline prolonged QTcFram was almost 3 times the risk in those with normal QTcFram [HR (95% CI): 2.88 (2.12, 3.92), p<0.0001]. After adjustment for age, race, sex, antihypertensive medication use, systolic blood pressure, current smoking, diabetes, left ventricular hypertrophy, atrial fibrillation, prior cardiovascular disease, QRS duration, warfarin use, and QT-prolonging drugs (full model), the risk of stroke remained significantly high [HR (95% CI): 1.67 (1.16, 2.41), p=0.0060)], and was consistent across several subgroups of REGARDS participants. When the risk of stroke was estimated per 1 SD increase in QTcFram, a 24% increased risk was observed [HR (95% CI): 1.24 (1.16, 1.33), p<0.0001)]. This risk remained significant in the fully adjusted model [HR (95% CI): 1.12 (1.03, 1.21), p=0.0055]. Similar results were obtained when other QTc correction formulas including Hodge’s, Bazett’s and Fridericia’s were used. Conclusions: QTc prolongation is associated with a significantly increased risk of incident stroke independently from known stroke risk factors. In light of our results, examining the risk of stroke associated with QT-prolonging drugs may be warranted.

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Premature Ventricular Complexes on Screening Electrocardiogram and Risk of Ischemic Stroke

Stroke ◽

10.1161/strokeaha.114.008447 ◽

2015 ◽

Vol 46 (5) ◽

pp. 1365-1367 ◽

Cited By ~ 7

Author(s):

Sunil K. Agarwal ◽

Jennifer Chao ◽

Frederick Peace ◽

Suzanne E. Judd ◽

Brett Kissela ◽

...

Keyword(s):

Blood Pressure ◽

Ischemic Stroke ◽

Racial Differences ◽

Proportional Hazards Model ◽

Geographic Region ◽

Left Ventricular ◽

Cox Proportional Hazards ◽

Cox Proportional Hazards Model ◽

Premature Ventricular Complexes ◽

Increased Risk

Background and Purpose— Premature ventricular complexes (PVCs) detected from long-term ECG recordings have been associated with an increased risk of ischemic stroke. Whether PVCs seen on routine ECG, commonly used in clinical practice, are associated with an increased risk of ischemic stroke remains unstudied. Methods— This analysis included 24 460 participants (aged, 64.5+9.3 years; 55.1% women; 40.0% blacks) from the Reasons for Geographic and Racial Differences in Stroke (REGARDS) study who were free of stroke at the time of enrollment. PVCs were ascertained from baseline ECG (2003–2007), and incident stroke cases through 2011 were confirmed by an adjudication committee. Results— A total of 1415 (5.8%) participants had at least 1 PVC at baseline, and 591 developed incident ischemic stroke during an average (SD) follow-up of 6.0 (2.0) years. In a cox proportional hazards model adjusted for age, sex, race, geographic region, education, previous heart disease, systolic blood pressure, blood pressure–lowering medications, current smoking, diabetes mellitus, left ventricular hypertrophy by ECG, and aspirin use and warfarin use, the presence of PVCs was associated with 38% increased risk of ischemic stroke (hazard ratio [95% confidence interval], 1.38 [1.05–1.81]). Conclusions— PVCs are common on routine screening ECGs and are associated with an increased risk of ischemic stroke.

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Abstract P316: Multiple Vulnerabilities to Health Disparities and Incident Coronary Heart Disease in the Reasons for Geographic and Racial Differences in Stroke (REGARDS) Study

Circulation ◽

10.1161/circ.137.suppl_1.p316 ◽

2018 ◽

Vol 137 (suppl_1) ◽

Author(s):

Monika M Safford ◽

Laura Pinheiro ◽

Madeline Sterling ◽

Joshua Richman ◽

Paul Muntner ◽

...

Keyword(s):

Health Disparities ◽

Racial Differences ◽

Low Income ◽

Proportional Hazards ◽

Health Management ◽

Cox Proportional Hazards ◽

Southeastern Us ◽

Cox Proportional Hazards Models ◽

Increased Risk ◽

Regards Study

Social determinants contribute to disparities in incident CHD but it is not known if they have an additive effect. We hypothesized that having more socially determined vulnerabilities to health disparities is associated with increased risk of incident CHD in the REGARDS study, a large biracial prospective cohort with physiological and survey measures. Experts adjudicated incident fatal and nonfatal CHD over 10 years of follow-up. Vulnerabilities included black race, low education, low income, and Southeastern US residence. The risks for CHD outcomes associated with 1, 2, and 3+ vs 0 vulnerabilities were calculated with Cox proportional hazards models adjusted for medical conditions, functional status, health behaviors, and physiologic variables. Of the 19,645 participants free of CHD at baseline (mean age 64 years, 57% women), 16% had 0 vulnerabilities, 36% had 1, 29% had 2, and 18% had 3+. Increasing numbers of vulnerabilities were associated with higher incidence (Figure) and risk of CHD that attenuated somewhat after multivariable adjustment (Table). These findings may provide a method of risk stratification useful for population health management.

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Risk and Prognosis of Subsequent Primary Gastric Cancer

Oncology Research and Treatment ◽

10.1159/000521846 ◽

2022 ◽

Author(s):

Rongrong Wei ◽

Xinyu Du ◽

Jing Wang ◽

Qi Wang ◽

Xiaojie Zhu ◽

...

Keyword(s):

Gastric Cancer ◽

Cancer Survivors ◽

Cox Regression ◽

Prognostic Impact ◽

Cancer Specific Survival ◽

Cancer History ◽

Primary Gastric Cancer ◽

Actual Observation ◽

Increased Risk

Introduction: The incidence and prognostic impact of subsequent primary gastric cancer (GC) in a population of other cancer survivors is unclear. We aimed to evaluate susceptibility to subsequent primary GC in cancer survivors and prognosis of GC with prior cancer history. Methods: 2,211 and 23,416 GC cases with and without prior cancer history were retrospectively selected from the Surveillance, Epidemiology and End Results (SEER) database. Potential risk of developing subsequent primary GC was assessed through standardized incidence ratios (SIRs). Cox regression were adopted to analyze the influence of prior cancer history and clinical characteristic factors on the prognosis of subsequent primary GC. A nomogram was established to predict overall survival (OS). Propensity score matching (PSM) was conducted to eliminate possible bias. Results: Compared with general population, cancer survivors had an increased risk of subsequent primary GC (SIR 1.17, 95% CI 1.15-1.20, P<0.05). Prior cancer history was related to poor OS of GC [adjusted hazard ratio (aHR) 1.12, 95% CI 1.06-1.19, P<0.001], but not cancer-specific survival (aHR 0.97, 95% CI 0.89-1.05, P=0.441). In addition, age, grade, stage, year of diagnosis, surgery, TNM stage and tumor size were independent prognostic factors for OS in GC cases with prior cancers. The concordance index of the nomogram was 0.72 (95% CI 0.71-0.74), and calibrate curves showed good agreement between prediction by the nomogram and actual observation. Conclusions: Cancer survivors with increased risk of developing subsequent primary GC should strengthen their monitoring and follow-up to prevent occurrence of subsequent primary gastric cancer.

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Electrocardiographic ST-T Abnormities Are Associated With Stroke Risk in the REGARDS Study

Stroke ◽

10.1161/strokeaha.119.028069 ◽

2020 ◽

Vol 51 (4) ◽

pp. 1100-1106

Author(s):

Mitsuaki Sawano ◽

Ya Yuan ◽

Shun Kohsaka ◽

Taku Inohara ◽

Takeki Suzuki ◽

...

Keyword(s):

Ischemic Stroke ◽

Racial Differences ◽

Stroke Risk ◽

Proportional Hazards ◽

The United States ◽

Incidence Rates ◽

Cox Proportional Hazards ◽

Hazard Ratio ◽

Common Finding ◽

Increased Risk

Background and Purpose— In previous studies, isolated nonspecific ST-segment and T-wave abnormalities (NSSTTAs), a common finding on ECGs, were associated with greater risk for incident coronary artery disease. Their association with incident stroke remains unclear. Methods— The REGARDS (Reasons for Geographic and Racial Differences in Stroke) study is a population-based, longitudinal study of 30 239 white and black adults enrolled from 2003 to 2007 in the United States. NSSTTAs were defined from baseline ECG using the standards of Minnesota ECG Classification (Minnesota codes 4-3, 4-4, 5-3, or 5-4). Participants with prior stroke, coronary heart disease, and major and minor ECG abnormalities other than NSSTTAs were excluded from analysis. Multivariable Cox proportional hazards regression was used to examine calculate hazard ratios of incident ischemic stroke by presence of baseline NSSTTAs. Results— Among 14 077 participants, 3111 (22.1%) had NSSTTAs at baseline. With a median of 9.6 years follow-up, 106 (3.4%) with NSSTTAs had ischemic stroke compared with 258 (2.4%) without NSSTTAs. The age-adjusted incidence rates (per 1000 person-years) of stroke were 2.93 in those with NSSTTAs and 2.19 in those without them. Adjusting for baseline age, sex, race, geographic location, and education level, isolated NSSTTAs were associated with a 32% higher risk of ischemic stroke (hazard ratio, 1.32 [95% CI, 1.05–1.67]). With additional adjustment for stroke risk factors, the risk of stroke was increased 27% (hazard ratio, 1.27 [95% CI, 1.00–1.62]) and did not differ by age, race, or sex. Conclusions— Presence of NSSTTAs in persons with an otherwise normal ECG was associated with a 27% increased risk of future ischemic stroke.

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Peripheral Blood Cytopenia and Risk of Cardiovascular Disease and Mortality

Journal of the American Heart Association ◽

10.1161/jaha.121.020809 ◽

2021 ◽

Vol 10 (18) ◽

Author(s):

Radhika Gangaraju ◽

Insu Koh ◽

Marguerite R. Irvin ◽

Leslie Lange ◽

Damon E. Houghton ◽

...

Keyword(s):

Cardiovascular Disease ◽

Racial Differences ◽

Mortality Risk ◽

Peripheral Blood ◽

Stroke Risk ◽

Complete Blood Count ◽

Disease Risk ◽

Cox Proportional Hazards ◽

Increased Risk ◽

Study Participants

Background Individual blood cell count abnormalities have been associated with cardiovascular disease and increased mortality. In this study, we defined a “cytopenia phenotype,” reflecting bone marrow hypoproliferation, to determine if peripheral blood cytopenia is associated with increased cardiovascular disease and mortality risk. Methods and Results Study participants were derived from a biracial observational cohort study, REGARDS (Reasons for Geographic and Racial Differences in Stroke), that enrolled 30 239 Black and White participants aged ≥45 years between 2003 and 2007. Median follow up was ≈9 years. The current study included 19 864 participants from REGARDS study (37.9% men, 40% Black participants) who have complete blood count available at study enrollment. We defined a cytopenia phenotype based on age‐, sex‐, and race‐adjusted lowest fifth percentile of blood counts. Multivariable Cox proportional hazards models estimated the hazard ratios (HR) and 95% CI of cytopenia for mortality and incident cardiovascular disease in adjusted models. Mean age of the study participants was 64 years (SD:9.7). The prevalence of cytopenia was 1.9% (n=378). Cytopenia was associated with increased risk of all‐cause mortality (HR, 1.73; 95% CI, 1.34–2.22) and cardiovascular disease mortality (HR, 1.56; 95% CI, 1.11–2.29). Cytopenia was associated with stroke risk in Black but not White participants (HR, 1.96 versus 0.86; P ‐interaction for race=0.08) and was not associated with coronary heart disease risk. Conclusions We defined a cytopenia phenotype with clinical implications for mortality and stroke risk in a large biracial and geographically diverse population. Whether generated through somatic mutations or decreased organ function, cytopenia was associated with mortality risk and was a race‐specific risk factor for stroke.

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Association between Post-Diagnosis Particulate Matter Exposure among 5-Year Cancer Survivors and Cardiovascular Disease Risk in Three Metropolitan Areas from South Korea

International Journal of Environmental Research and Public Health ◽

10.3390/ijerph17082841 ◽

2020 ◽

Vol 17 (8) ◽

pp. 2841

Author(s):

Seulggie Choi ◽

Kyae Hyung Kim ◽

Kyuwoong Kim ◽

Jooyoung Chang ◽

Sung Min Kim ◽

...

Keyword(s):

Cardiovascular Disease ◽

Particulate Matter ◽

Cancer Survivors ◽

Disease Risk ◽

Cardiovascular Disease Risk ◽

Cox Proportional Hazards ◽

Cvd Risk ◽

Increased Risk ◽

Yearly Average ◽

Pm2.5 Exposure

Cancer survivors are at an increased risk for cardiovascular disease (CVD). However, the association between particulate matter (PM) and CVD risk among cancer survivors (alive >5 years since diagnosis) is unclear. We investigated the risk of CVD among 40,899 cancer survivors within the Korean National Health Insurance Service database. Exposure to PM was determined by assessing yearly average PM levels obtained from the Air Korea database from 2008 to 2011. PMs with sizes <2.5 (PM2.5), <10 (PM10), or 2.5–10 (PM2.5–10) μm in diameter were compared, with each PM level exposure further divided into quintiles. Patients were followed up from January 2012 to date of CVD event, death, or December 2017, whichever came earliest. Adjusted hazard ratios (aHRs) and 95% confidence intervals (CIs) for CVD were calculated using Cox proportional hazards regression by PM exposure levels. Compared with cancer survivors in the lowest quintile of PM2.5 exposure, those within the highest quintile had a greater risk for CVD (aHR 1.31, 95% CI 1.07–1.59). Conversely, increasing PM10 and PM2.5–10 levels were not associated with increased CVD risk (p for trend 0.078 and 0.361, respectively). Cancer survivors who reduce PM2.5 exposure may benefit from lower risk of developing CVD.

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Prevalence of Underlying Medical Conditions Associated with Severe COVID-19 Illness in Adult Cancer Survivors in the United States

JNCI Journal of the National Cancer Institute ◽

10.1093/jnci/djab012 ◽

2021 ◽

Author(s):

Changchuan Jiang ◽

K Robin Yabroff ◽

Lei Deng ◽

Stuthi Perimbeti ◽

Xuesong Han

Keyword(s):

Health Care ◽

Cancer Survivors ◽

Health Care Providers ◽

The United States ◽

Health Care Facilities ◽

Medical Conditions ◽

Care Providers ◽

Cancer History ◽

Increased Risk ◽

Adult Cancer Survivors

Abstract Cancer, and other underlying medical conditions, including chronic obstructive pulmonary disease, heart diseases, diabetes, chronic kidney disease, and obesity, are associated with increased risk of severe COVID-19 illness. We identified 6,411 cancer survivors and 77,748 adults without a cancer history from the 2016-2018 National Health Interview Survey and examined the prevalence and sociodemographic factors associated with these conditions in the US. Most survivors reported having ≥1 of the conditions (56.4% [95% CI = 54.8% to 57.9%] vs 41.6% [95% CI = 40.9% to 42.2%] in adults without a cancer history) and nearly one-quarter (22.9%, 95% CI = 21.6% to 24.3%) reported ≥2, representing 8.7 million and 3.5 million cancer survivors, respectively. These conditions were more prevalent in survivors of kidney, liver and uterine cancers as well as Black survivors, those with low socioeconomic status, and public insurance. Findings highlight the need to protect survivors against COVID-19 transmission in health-care facilities and prioritize cancer patients, survivors, caregivers, and their health-care providers in vaccine allocation.

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Risk of Endometrial Cancer and Frequencies of Invasive Endometrial Procedures in Young Breast Cancer Survivors Treated With Tamoxifen: A Nationwide Study

Frontiers in Oncology ◽

10.3389/fonc.2021.636378 ◽

2021 ◽

Vol 11 ◽

Author(s):

Soojeong Choi ◽

Young Jae Lee ◽

Jae Ho Jeong ◽

Jinhong Jung ◽

Jong Won Lee ◽

...

Keyword(s):

Breast Cancer ◽

Endometrial Cancer ◽

Cancer Survivors ◽

Breast Cancer Survivors ◽

Proportional Hazards ◽

Postmenopausal Breast Cancer ◽

Cox Proportional Hazards ◽

Close Monitoring ◽

Increased Risk ◽

Young Breast Cancer

BackgroundAlthough the guidelines recommend gynecological assessment and close monitoring for symptoms of endometrial cancer in postmenopausal breast cancer survivors taking tamoxifen (TAM), the risk of endometrial cancer in young breast cancer survivors has not yet been fully assessed. This study aimed to investigate the risk of developing endometrial cancer and the frequencies of gynecological examinations in young breast cancer survivors taking TAM in South Korea.MethodsA nationwide retrospective cohort study was conducted using the Health Insurance Review and Assessment Service claims data. Kaplan–Meier analyses and log-rank tests were used to assess the probability of endometrial cancer, benign endometrial conditions, and the probability of invasive endometrial procedure. To analyze the risk of endometrial cancer and benign endometrial conditions, we used a multivariable Cox proportional hazards regression model.ResultsBetween 2010 and 2015, 60,545 newly diagnosed female breast cancer survivors were included. The total person–years were 256,099 and 140 (0.23%) patients developed endometrial cancer during the study period. In breast cancer survivors aged ≥60 years [hazard ratio (HR), 5.037; 95% confidence interval (CI), 2.185–11.613], 50–59 years (HR, 4.343; 95% CI, 2.122–8.891), and 40–49 years (HR, 2.121; 95% CI, 1.068–4.213), TAM was associated with an increased risk of endometrial cancer. In subjects aged below 40 years, TAM did not significantly increase the risk of endometrial cancer. However, among the TAM subgroups, breast cancer survivors aged below 40 years [1.61 per 1,000 person–years (PY); HR, 12.460; 95% CI, 2.698–57.522] and aged 40–49 years (2.22 per 1,000 PY; HR, 9.667; 95% CI, 4.966–18.819) with TAM-related endometrial diseases showed significantly increased risks of endometrial cancer. Among the TAM subgroup with benign endometrial conditions, the ratios of the frequency of invasive diagnostic procedures to the incidence of endometrial cancer were higher in subjects under 40 than subjects aged 60 or more.ConclusionYoung breast cancer survivors with TAM-related benign endometrial diseases are at a higher risk of developing endometrial cancer. Gynecological surveillance should be tailored to the risk of endometrial cancer in young breast cancer survivors to improve the early detection of endometrial cancer and avoid unnecessary invasive procedures.

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