Suicide among Swedish Dentists

In the present study, we have followed a national cohort of dentists, academics, i.e. people with three or more years of post-high school education, and the general population for a period of ten years, and identified all cases of recognized suicide during the period 1961 to 1970. The aim of the study was to assess whether suicide rates are higher among dentists even after adjustment for socioeconomic factors. Results show an elevated standardized mortality ratio (SMR) for male dentists compared to other male academics. Female dentists did not exhibit any increased risk. It is suggested that enhanced interest should be given to the possible etiologic role of not only psychosocial factors but also to psychoorganic consequences of mercury exposure among dentists.

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Incidence of Suicide in Persons With Cancer

Journal of Clinical Oncology ◽

10.1200/jco.2007.13.8941 ◽

2008 ◽

Vol 26 (29) ◽

pp. 4731-4738 ◽

Cited By ~ 303

Author(s):

Stephanie Misono ◽

Noel S. Weiss ◽

Jesse R. Fann ◽

Mary Redman ◽

Bevan Yueh

Keyword(s):

United States ◽

General Population ◽

The United States ◽

Mortality Data ◽

Standardized Mortality Ratio ◽

Patients With Cancer ◽

Suicide Rates ◽

Increased Risk ◽

Mortality Ratio ◽

Adjusted Rate

Purpose The purpose of this study was to characterize suicide rates among patients with cancer in the United States and identify patient and disease characteristics associated with higher suicide rates. Prior studies, mostly in Europe, have suggested that patients with cancer may be at increased risk for suicide, but large cohort studies comparing patients with cancer with the general population have not been performed in the United States. Methods Patients in the study were residents of geographic areas served by the Surveillance, Epidemiology, and End Results (SEER) program who were diagnosed with cancer from 1973 to 2002. Comparisons with the general US population were based on mortality data collected by the National Center for Health Statistics. This was a retrospective cohort study of suicide in persons with cancer. Results Among 3,594,750 SEER registry patients observed for 18,604,308 person-years, 5,838 suicides were identified, for an age-, sex-, and race-adjusted rate of 31.4/100,000 person-years. In contrast, the suicide rate in the general US population was 16.7/100,000 person-years. Higher suicide rates were associated with male sex, white race, and older age at diagnosis. The highest suicide risks were observed in patients with cancers of the lung and bronchus (standardized mortality ratio [SMR] = 5.74; 95% CI, 5.30 to 6.22), stomach (SMR = 4.68; 95% CI, 3.81 to 5.70), oral cavity and pharynx (SMR = 3.66; 95% CI, 3.16 to 4.22), and larynx (SMR = 2.83; 95% CI, 2.31 to 3.44). SMRs were highest in the first 5 years after diagnosis with cancer. Conclusion Patients with cancer in the United States have nearly twice the incidence of suicide of the general population, and suicide rates vary among patients with cancers of different anatomic sites. Further examination of the psychological experience of patients with cancer, particularly that of patients with certain types of cancer, is warranted.

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Risk and timing of cardiovascular death among patients with myelodysplastic syndromes

Blood Advances ◽

10.1182/bloodadvances.2017010165 ◽

2017 ◽

Vol 1 (23) ◽

pp. 2032-2040 ◽

Cited By ~ 26

Author(s):

Andrew M. Brunner ◽

Traci M. Blonquist ◽

Gabriela S. Hobbs ◽

Philip C. Amrein ◽

Donna S. Neuberg ◽

...

Keyword(s):

General Population ◽

Myelodysplastic Syndromes ◽

Lower Risk ◽

Clinical Care ◽

Cardiovascular Death ◽

Standardized Mortality Ratio ◽

Hematopoietic Stem ◽

Clonal Hematopoiesis ◽

Increased Risk ◽

Mortality Ratio

Abstract Myelodysplastic syndromes (MDS) are clonal hematopoietic stem cell disorders associated with progression to leukemia and poor survival. Clonal hematopoiesis in people without an MDS diagnosis carries an increased risk of cardiovascular death. Many clonally restricted mutations are shared between patients with MDS and those with non-MDS clonal hematopoiesis; therefore, we evaluated the risk of cardiovascular death among patients with MDS. We evaluated adults with MDS in the Surveillance, Epidemiology, and End Results database of the National Cancer Institute and compared them with the general population living in the same states. We grouped histological subtypes of MDS into lower-, intermediate-, and higher-risk disease. The primary outcomes were overall survival and primary cause of death (COD) as reported to state registries. A total of 21 372 patients with MDS between 2001 and 2011 died during follow-up with a known COD. The rate of death due to cardiovascular disease (CVD) was 4613 per 100 000 person-years, compared with 2091 in the age- and-sex-adjusted US population (standardized mortality ratio, 2.21). At 24 months, the cumulative incidence of death attributed to MDS or leukemia was 23% vs 8% for CVD. Among those alive at 60 months, 27% eventually died of CVD compared with 29% from MDS or leukemia; those with lower-risk disease who survived >60 months had more deaths attributed to cardiovascular causes (30%; 95% confidence interval [CI], 26.7-33.2%) than MDS itself (24%; 95% CI, 21.4-27.5%). Patients with MDS are more likely to die of cardiovascular causes than the general population. Modifying cardiovascular risk factors, especially among those with lower-risk disease, may be warranted for MDS-related clinical care.

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Are patients with rheumatoid arthritis still at an increased risk of tuberculosis and what is the role of biological treatments?

Annals of the Rheumatic Diseases ◽

10.1136/annrheumdis-2013-204960 ◽

2014 ◽

Vol 74 (6) ◽

pp. 1212-1217 ◽

Cited By ~ 46

Author(s):

Elizabeth V Arkema ◽

Jerker Jonsson ◽

Eva Baecklund ◽

Judith Bruchfeld ◽

Nils Feltelius ◽

...

Keyword(s):

Rheumatoid Arthritis ◽

General Population ◽

Population Based ◽

Calendar Time ◽

Cox Models ◽

Increased Risk ◽

National Cohort ◽

Biologics Register

ObjectiveTo estimate the risk of tuberculosis (TB) in patients with rheumatoid arthritis (RA) both with and without exposure to biological therapy and to directly compare the risks between therapies.MethodsData from the Swedish National Population Registers, Tuberculosis Register and the Swedish Biologics Register were used to conduct a prospective population-based national cohort study (2002–2011). We estimated the rate of incident TB in the general population and in a cohort of biological-naïve and biological-exposed patients diagnosed with RA. Cox models were used to estimate HRs with particular attention to risks by calendar and follow-up time and individual biologics.ResultsCompared to the general population, RA patients not exposed to biologicals had a fourfold increased risk of TB (HR 4.2; 95% CI 2.7 to 6.7), which did not decline over calendar time. In contrast, the risk of TB in the biological-exposed RA population decreased since 2002 compared with biological-naïve; from HR=7.9 (95% CI 3.3 to 18.9) in 2002–2006 to HR=2.4 (95% CI 0.9 to 6.1) in 2007–2011. The HRs for most recent exposure to adalimumab and infliximab compared with etanercept were 3.1 (95% CI 0.8 to 12.5) and 2.7 (95% CI 0.7 to 10.9), respectively, and the HR for etanercept compared with biological-naïve RA was 1.7 (95% CI 0.6 to 4.6).ConclusionsIn the past decade, the risk of TB has decreased among biological-exposed RA patients but remains higher than in biological-naïve RA patients. Most cases of TB in RA occur in biological-naïve RA patients, underscoring the elevated risk also in these patients.

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Flavonoid Intake Varies by Racial/Ethnic Groups Within Sociodemographic Categories

Current Developments in Nutrition ◽

10.1093/cdn/nzaa061_054 ◽

2020 ◽

Vol 4 (Supplement_2) ◽

pp. 1426-1426

Author(s):

Kijoon Kim ◽

Kyungho Ha ◽

Junichi Sakaki ◽

Hwayoung Noh ◽

Ock Chun

Keyword(s):

High School ◽

Marital Status ◽

College Education ◽

School Education ◽

High School Education ◽

Total Flavonoid ◽

Sociodemographic Characteristics ◽

Increased Risk ◽

Flavonoid Intake ◽

Race Ethnicity

Abstract Objectives Diets rich in flavonoids can reduce the risk of developing chronic diseases through their antioxidant and anti-inflammatory properties. While differences in flavonoid intake by race/ethnicity have been previously described, differences between race/ethnicity within categories sociodemographic characteristics have not been fully assessed. Therefore, the objective of this study was to estimate flavonoid intake and evaluate the disparities by race/ethnicity within categories of sociodemographic characteristics in US adults. Methods A total of 15,775 US adults aged 20 years and older in NHANES 2007–2014 were included in this cross-sectional study. Flavonoid intake was calculated by linking food consumption data from a 24-hour diet recall to a flavonoid database which has been expanded on by our research group using the USDA Databases for the Flavonoid (Release 3.3), and Isoflavone (Release 2.1) in addition to the USDA's Expanded Flavonoid Database for the Assessment of Dietary Intakes (Release 1.1). Mean (SE) flavonoid intakes by sociodemographic categories were compared with one-way ANOVA. Results Among US adults, mean (SE) total flavonoid intake was 227.6 (8.0) mg/day, and total flavonoid intake was highest in 40–59 year olds, non-Hispanic whites, those with a poverty-income ratio (PIR) ≥1.85, those with a college education or above, and those married or living with a partner. In most sociodemographic categories, Hispanics consistently had the lowest total flavonoid intakes compared to other races/ethnicities. Among Hispanic subgroups, total flavonoid intake was lowest in men, 20–39 years olds, PIR < 1.3, less than high school education, and single marital status (men only). Ethnic disparities in flavonoid intake were more pronounced between certain sociodemographic subcategories including men, 40–59 year olds, PIR < 1.3, less than high school education, and married marital status (men only). Conclusions These findings indicate that there are significant racial differences in flavonoid intake. Notably, Hispanics tended to have the lowest intake. Certain sociodemographic populations such as males, low income or low educated may be at an increased risk of flavonoid under-consumption. Funding Sources This research received no external funding.

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Death From Stroke in End-Stage Kidney Disease

Stroke ◽

10.1161/strokeaha.118.023644 ◽

2019 ◽

Vol 50 (2) ◽

pp. 487-490 ◽

Cited By ~ 1

Author(s):

Nicole L. De La Mata ◽

Philip Masson ◽

Rustam Al-Shahi Salman ◽

Patrick J. Kelly ◽

Angela C. Webster

Keyword(s):

Kidney Disease ◽

General Population ◽

Standardized Mortality Ratio ◽

Stroke Mortality ◽

End Stage Kidney Disease ◽

Mortality Ratio ◽

Standardized Mortality Ratios ◽

Using Data ◽

End Stage ◽

Over Time

Background and Purpose— People with end-stage kidney disease (ESKD) are at greater risk of stroke. We aimed to compare stroke mortality between the ESKD population and the general population. Methods— We included all patients with incident ESKD in Australia, 1980 to 2013, and New Zealand, 1988 to 2012. The primary cause of death was ascertained using data linkage with national death registers. We produced standardized mortality ratios for stroke deaths, by age, sex, and calendar year. Results— We included 60 823 patients with ESKD, where 941 stroke deaths occurred during 381 874 person-years. Patients with ESKD had >3× the stroke deaths compared with the general population (standardized mortality ratio, 3.4; 95% CI, 3.2–3.6), markedly higher in younger people and women. The greatest excess was in intracerebral hemorrhages (standardized mortality ratio, 5.2; 95% CI, 4.5–5.9). Excess stroke deaths in patients with ESKD decreased over time, although were still double in 2013 (2013 standardized mortality ratio, 2.1; 95% CI, 1.5–2.9). Conclusions— People with ESKD experience much greater stroke mortality with the greatest difference for women and younger people. However, mortality has improved over time.

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P142: Gaps in public preparedness to be a substitute decision maker and the acceptability of high school education on resuscitation and end-of-life care: a mixed-methods study

CJEM ◽

10.1017/cem.2019.333 ◽

2019 ◽

Vol 21 (S1) ◽

pp. S115-S116

Author(s):

M. Wong ◽

M. Medor ◽

K. Yelle Labre ◽

M. Jiang ◽

J. Frank ◽

...

Keyword(s):

High School ◽

Mixed Methods ◽

Critical Illness ◽

End Of Life ◽

Decision Maker ◽

End Of Life Care ◽

High School Education ◽

Life Care ◽

Substitute Decision Maker

Introduction: When a patient is incapable of making medical decisions for themselves, choices are made according to the patient's previously expressed, wishes, values, and beliefs by a substitute decision maker (SDM). While interventions to engage patients in their own advance care planning exist, little is known about public readiness to act as a SDM on behalf of a loved one. This mixed-methods survey aimed to describe attitudes, enablers and barriers to preparedness to act as a SDM, and support for a population-level curriculum on the role of an SDM in end-of-life and resuscitative care. Methods: From November 2017 to June 2018, a mixed-methods street intercept survey was conducted in Ottawa, Canada. Descriptive statistics and logistic regression analysis were used to assess predictors of preparedness to be a SDM and understand support for a high school curriculum. Responses to open-ended questions were analyzed using inductive thematic analysis. Results: The 430 respondents were mostly female (56.5%) with an average age of 33.9. Although 73.0% of respondents felt prepared to be a SDM, 41.0% of those who reported preparedness never had a meaningful conversation with loved ones about their wishes in critical illness. The only predictors of SDM preparedness were the belief that one would be a future SDM (OR 2.36 95% CI 1.34-4.17), and age 50-64 compared to age 16-17 (OR 7.46 95% CI 1.25-44.51). Thematic enablers of preparedness included an understanding of a patient's wishes, the role of the SDM and strong familial relationships. Barriers included cultural norms, family conflict, and a need for time for high stakes decisions. Most respondents (71.9%) believed that 16 year olds should learn about SDMs. They noted age appropriateness, potential developmental and societal benefit, and improved decision making, while cautioning the need for a nuanced approach respectful of different maturity levels, cultures and individual experiences. Conclusion: This study reveals a concerning gap between perceived preparedness and actions taken in preparation to be an SDM for loved ones suffering critical illness. The results also highlight the potential role for high school education to address this gap. Future studies should further explore the themes identified to inform development of resources and curricula for improved health literacy in resuscitation and end-of-life care.

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Genetic variation in the folate metabolic pathway and risk of childhood leukemia

Blood ◽

10.1182/blood-2009-10-249722 ◽

2010 ◽

Vol 115 (19) ◽

pp. 3923-3929 ◽

Cited By ~ 69

Author(s):

Tracy J. Lightfoot ◽

W. Thomas Johnston ◽

Dan Painter ◽

Jill Simpson ◽

Eve Roman ◽

...

Keyword(s):

Genetic Variation ◽

Myeloid Leukemia ◽

Childhood Leukemia ◽

Lymphoblastic Leukemia ◽

Folate Metabolism ◽

The United Kingdom ◽

Etiologic Role ◽

Increased Risk ◽

Metabolism Enzymes

Abstract Studies of childhood leukemia and the potential etiologic role of genetic variation in folate metabolism have produced conflicting findings and have often been based on small numbers. We investigated the association between polymorphisms in key folate metabolism enzymes (MTHFR 677 C>T, MTHFR 1298 A>C, SHMT1 1420 C>T, MTR 2756 A>G, TS 1494del6, and TS 28bp repeat) in 939 cases of childhood acute lymphoblastic leukemia (ALL) and 89 cases of acute myeloid leukemia (AML) recruited into the United Kingdom Childhood Cancer Study. We also examined the maternal genotypes of 752 of these cases. Data from 824 noncancer controls recruited were used for comparison. No evidence of an association with MTHFR 677 was observed for ALL or AML, either in children or their mothers. However, in children an increased risk of ALL (odds ratio [OR] = 1.88; 95% confidence interval [CI], 1.16-3.07; P = .010) and AML (OR = 2.74; 95% CI, 1.07-7.01; P = .036) was observed with the MTR 2756 GG genotype; the association was most pronounced for cases with the MLL translocation (OR = 4.90; 95% CI, 1.30-18.45; P = .019). These data suggest that genetic variation in methionine synthase could mediate risk of childhood leukemia, either via effects on DNA methylation or via effects on fetal growth and development.

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The frequency of combined IFITM3 haplotype involving the reference alleles of both rs12252 and rs34481144 is in line with COVID-19 standardized mortality ratio of ethnic groups in England

PeerJ ◽

10.7717/peerj.10402 ◽

2020 ◽

Vol 8 ◽

pp. e10402

Author(s):

Dimitris Nikoloudis ◽

Dimitrios Kountouras ◽

Asimina Hiona

Keyword(s):

Ethnic Groups ◽

Transmembrane Protein ◽

Standardized Mortality Ratio ◽

White People ◽

Immune Effector ◽

The Usa ◽

Mortality Ratio ◽

Standardized Mortality Ratios ◽

Severity Of The Disease

Evidence was brought forward in England and the USA that Black, Asian, Latino and Minority Ethnic people exhibit higher mortality risk from COVID-19 than White people. While socioeconomic factors were suggested to contribute to this trend, they arguably do not explain the range of the differences observed, allowing for possible genetic implications. Almost concurrently, the analysis of a cohort in Chinese COVID-19 patients proposed an association between the severity of the disease and the presence of the minor allele of rs12252 of the Interferon-induced transmembrane protein 3 (IFITM3) gene. This SNP, together with rs34481144, are the two most studied polymorphisms of IFITM3 and have been associated in the past with increased severity in Influenza, Dengue, Ebola, and HIV viruses. IFITM3 is an immune effector protein that is pivotal for the restriction of viral replication, but also for the regulation of cytokine production. Following up on these two developments in the ongoing SARS-CoV-2 pandemic, the present study investigates a possible association between the differences in mortality of ethnic groups in England and the combined haplotypes of rs12252 and rs34481144. The respective allele frequencies were collected for 26 populations from the 1000 Genomes Project and subgroups were pooled wherever possible to create correspondences with ethnic groups in England. A significant correlation (r = 0.9687, p = 0.0003) and a striking agreement was observed between the reported Standardized Mortality Ratios and the frequency of the combined haplotype of both reference alleles, suggesting that the combination of the reference alleles of the specific SNPs may be implicated in more severe outcomes of COVID-19. This study calls for further focus on the role of IFITM3 variants in the mechanism of cellular invasion of SARS-CoV-2, their impact in COVID-19 severity and their possible implications in vaccination efficacy.

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Disparities in COVID-19 Related Mortality in U.S. Prisons and the General Population

10.1101/2020.09.17.20183392 ◽

2020 ◽

Author(s):

Kathryn M Nowotny ◽

David Cloud ◽

Alysse G. Wurcel ◽

Lauren Brinkley-Rubinstein

Keyword(s):

General Population ◽

Single Case ◽

Prison Population ◽

State Level ◽

Mortality Data ◽

Standardized Mortality Ratio ◽

Mortality Ratio ◽

Prison Systems ◽

Related Mortality

We provide an analysis of COVID-19 mortality data to assess the potential magnitude of COVID-19 among prison residents. Data were pooled from Covid Prison Project and multiple publicly available national and state level sources. Data analyses consisted of standard epidemiologic and demographic estimates. A single case study was included to generate a more in-depth and multi-faceted understanding of COVID-19 mortality in prisons. The increase in crude COVID-19 mortality rates for the prison population has outpaced the rates for the general population. People in prison experienced a significantly higher mortality burden compared to the general population (standardized mortality ratio (SMR) = 2.75; 95% confidence interval = 2.54, 2.96). For a handful of states (n = 5), these disparities were more extreme, with SMRs ranging from 5.55 to 10.56. Four states reported COVID-19 related death counts that are more than 50% of expected deaths from all-causes in a calendar year. The case study suggested there was also variation in mortality among units within prison systems, with geriatric facilities potentially at highest risk. Understanding the dynamic trends in COVID-19 mortality in prisons as they move in and out of hotspot status is critical.

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Specialist psychiatric health care utilization among older people with intellectual disability – predictors and comparisons with the general population: a national register study

BMC Psychiatry ◽

10.1186/s12888-020-02491-6 ◽

2020 ◽

Vol 20 (1) ◽

Cited By ~ 2

Author(s):

G. Ahlström ◽

A. Axmon ◽

M. Sandberg ◽

J. Hultqvist

Keyword(s):

Health Care ◽

Intellectual Disability ◽

General Population ◽

Health Care Utilization ◽

Older People ◽

Age Groups ◽

Care Utilization ◽

Increased Risk ◽

National Cohort ◽

Specialist Health Care

Abstract Background People with intellectual disability (ID) face considerable barriers to accessing psychiatric health care, thus there is a risk for health disparity. The aims of the present study were 1) to compare specialist psychiatric health care utilization among older people with ID to that with their age peers in the general population, taking into account demographic factors and co-morbidities associated with specialist psychiatric health care utilization and 2) to determine a model for prediction of specialist psychiatric health care utilization among older people with ID. Material and methods We identified a national cohort of people with ID (ID cohort), aged 55+ years and alive at the end of 2012 (n = 7936), and a referent cohort from the general population (gPop cohort) one-to-one matched by year of birth and sex. Data on utilization of inpatient and outpatient specialist psychiatric health care, as well as on co-morbidities identified in either psychiatric or somatic specialist health care, were collected from the National Patient Register for the time period 2002–2012. Results After adjusting for sex, age, specialist psychiatric health care utilization the previous year, and co-morbidities, people in the ID cohort still had an increased risk of visits to unplanned inpatient (relative risk [RR] 1.95), unplanned outpatient (RR 1.59), planned inpatient (RR 2.02), and planned outpatient (RR 1.93) specialist psychiatric health care compared with the general population. Within the ID cohort, increasing age was a predictor for less health care, whereas psychiatric health care the previous year predicted increased risk of health care utilization the current year. As expected, mental and behavioral disorders predicted increased risk for psychiatric health care. Furthermore, episodic and paroxysmal disorders increased the risk of planned psychiatric health care. Conclusions Older people with ID have a high need for psychiatric specialist health care due to a complex pattern of diagnoses. Further research needs to investigate the conditions that can explain the lesser psychiatric care in higher age groups. There is also a need of research on health care utilization among people with ID in the primary health care context. This knowledge is critical for policymakers’ plans of resources to meet the needs of these people.

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