CLINICAL PREDICTORS OF SYMPTOM RESOLUTION FOR CHILDREN AND ADOLESCENTS WITH SPORT-RELATED CONCUSSION

Background: Early prognosis of expected recovery duration after a sport-related concussion is a challenging task for sports medicine clinicians, as various pre-morbid, injury characteristic, and functional factors have been identified to help predict recovery. The purpose of this investigation was to determine which variables obtained as a part of a routine concussion clinical evaluation were independently associated with symptom resolution time among pediatric patients evaluated after sport-related concussion by a sports medicine physician. Methods: We conducted an analysis of data collected from a prospective clinical registry of children with concussion. Patients included in the current investigation were seen for care at a pediatric sports medicine concussion clinic between January 1, 2015 to August 31, 2017, were less than 19 years of age, evaluated within 10 days of a sport-related concussion, and followed until they no longer reported symptoms. The primary outcome variable was the number of days from injury until symptom resolution. The predictor variables included those assessed during the initial clinical evaluation. They were obtained via a medical history form (pre-injury history of attention-deficit/hyperactivity disorder, learning disability, anxiety, depression, and migraine or headaches), the Health and Behavior Inventory (HBI) symptom frequency questionnaire, headache severity rating (rated on a scale from 0-10), sleep disturbance questionnaire, and performance on a set of balance, vestibular, and oculomotor function tests (Balance Error Scoring System, Romberg, tandem gait, gaze stability, and near point of convergence). Tests were considered abnormal if patients could not maintain balance or demonstrated exaggerated upper body movement (Romberg/tandem gait tests), if they reported symptom provocation after test administration (gaze stability), or if the near point of convergence was greater than 5 cm from the tip of the nose. To identify the independent factors associated with symptom resolution time, we first constructed univariate Cox proportional models with time to symptom resolution as the outcome and each clinical variable as a separate predictor variable. Predictor variables with a univariate significance level of p < 0.05 were then used to construct a multivariate Cox proportional hazards model where total duration of concussion symptoms remained the outcome variable. Results: We examined data from 351 children and adolescents (mean age= 14.6±2.2 years, 33% female, evaluated 5.6±2.6 days after concussion) who required a median of 11.5 [interquartile range= 7-21] days for symptom resolution. One hundred and sixty-three (46%) of patients reported a prior history of concussion, while other pre-injury health conditions were reported less often (Table 1). The most commonly endorsed symptoms by patients at the initial visit were headaches, difficulty paying attention, difficulty concentrating, and getting distracted easily (Table 2). The most common abnormal vestibular or oculomotor test was symptom provocation brought on by gaze stability testing, while 20% of patients had an abnormal Romberg test, 15% demonstrated abnormal tandem gait, and 15% had abnormal near point of convergence (Table 3). Results from univariate Cox proportional hazards models indicated headache severity, headache frequency, confusion, forgetfulness, attentional difficulties, trouble remembering, getting tired often, getting tired easily, dizziness, and an abnormal Romberg test were associated with a longer symptom duration (Tables 2 and 3). The multivariate Cox proportional hazard model indicated that an abnormal Romberg test was independently associated with a longer symptom duration after adjusting for the effect of all other covariates included in the model (Table 4 and Figure 1). Headache frequency and “being tired easily” were not included in the final model due to collinearity with headache severity and “being tired a lot”, respectively. Conclusions: For adolescent and child patients assessed within 10 days of concussion, an abnormal Romberg test was independently associated with longer symptom duration during recovery. This is in line with other recent studies investigating early predictors of symptom resolution, demonstrating that postural instability appears to provide valuable prognostic information for sports medicine clinicians. [Table: see text]

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Clinical predictors of symptom resolution for children and adolescents with sport-related concussion

Journal of Neurosurgery Pediatrics ◽

10.3171/2018.11.peds18626 ◽

2019 ◽

Vol 24 (1) ◽

pp. 54-61 ◽

Cited By ~ 5

Author(s):

David R. Howell ◽

Morgan N. Potter ◽

Michael W. Kirkwood ◽

Pamela E. Wilson ◽

Aaron J. Provance ◽

...

Keyword(s):

Proportional Hazards ◽

Proportional Hazards Model ◽

Cox Proportional Hazards ◽

Cox Proportional Hazards Model ◽

Outcome Variable ◽

Duration Of Symptoms ◽

Symptom Resolution ◽

Hazards Model ◽

Romberg Test ◽

Abnormal Performance

OBJECTIVEThe goal of this study was to determine which variables assessed during an initial clinical evaluation for concussion are independently associated with time until symptom resolution among pediatric patients.METHODSData collected from a prospective clinical registry of pediatric patients with concussion were analyzed. The primary outcome variable was time from injury until symptom resolution. Predictor variables assessed within 10 days after injury included preinjury factors, Health and Behavior Inventory scores, headache severity, and balance, vestibular, and oculomotor test performances. The researchers used univariate Cox proportional models to identify potential predictors of symptom resolution time and constructed a multivariate Cox proportional hazards model in which total duration of concussion symptoms remained the outcome variable.RESULTSThe sample consisted of 351 patients (33% female, mean age 14.6 ± 2.2 years, evaluated 5.6 ± 2.6 days after concussion). Univariate Cox proportional hazards models indicated that several variables were associated with a longer duration of symptoms, including headache severity (hazard ratio [HR] 0.90 [95% CI 0.85–0.96]), headache frequency (HR 0.83 [95% CI 0.71–0.96]), confusion (HR 0.79 [95% CI 0.69–0.92]), forgetfulness (HR 0.79 [95% CI 0.68–0.92]), attention difficulties (HR 0.83 [95% CI 0.72–0.96]), trouble remembering (HR 0.84 [95% CI 0.72–0.98]), getting tired often (HR 0.86 [95% CI 0.76–0.97]), getting tired easily (HR 0.86 [95% CI 0.76–0.98]), dizziness (HR 0.86 [95% CI 0.75–0.99]), and abnormal performance on the Romberg test (HR 0.59 [95% CI 0.40–0.85]). A multivariate Cox proportional hazards model indicated that an abnormal performance on the Romberg test was independently associated with a longer duration of symptoms (HR 0.65 [95% CI 0.44–0.98]; p = 0.038).CONCLUSIONSFor children and adolescents evaluated within 10 days after receiving a concussion, abnormal performance on the Romberg test was independently associated with a longer duration of symptoms during recovery. In line with findings of other recent studies investigating predictors of symptom resolution, postural stability tests may provide useful prognostic information for sports medicine clinicians.

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Exploring the Outcomes and Experiences of Black and White Athletes Following a Sport-Related Concussion: A Retrospective Cohort Study

Neurology ◽

10.1212/01.wnl.0000801756.53005.b1 ◽

2021 ◽

Vol 98 (1 Supplement 1) ◽

pp. S3.1-S3

Author(s):

Viviana Jimenez ◽

Aaron Yengo-Kahn ◽

Jessica Wallace ◽

Douglas Totten ◽

Christopher Bonfield ◽

...

Keyword(s):

Proportional Hazards ◽

Cox Proportional Hazards ◽

Return To School ◽

Black Athletes ◽

Symptom Resolution ◽

Phone Calls ◽

Sport Concussion ◽

Television Time ◽

Psychiatric Conditions ◽

Specific Activities

ObjectiveYoung American athletes, at risk of sport-related concussion (SRC), represent many races, however, it is unknown how race influences the experience and outcome of SRC. Our objective was to compare White and Black athletes' recovery and subjective experiences after SRC.BackgroundNA.Design/MethodsA retrospective study was performed using the Vanderbilt Sport Concussion registry. Self-reported White (n = 211) and Black (n = 36) athletes (ages 12–23) treated for SRC between 2012 and 15 were included. Athletes with learning disabilities or psychiatric conditions were excluded. Data was collected by EMR review and phone calls to athletes and parents/guardians. The primary outcomes were: (1) days to symptom resolution (SR), (2) days to return-to-school, (3) changes in any daily activity (binary), (4) and sport behavior (binary). Secondary outcomes were changes in specific activities such as sleep, schoolwork, television time, as well as equipment (binary), playing style (more reckless, unchanged, less reckless) and whether the athlete retired from sport. Descriptive analyses, multivariable Cox proportional hazards and logistic regression were performed.ResultsA retrospective study was performed using the Vanderbilt Sport Concussion registry. Self-reported White (n = 211) and Black (n = 36) athletes (ages 12–23) treated for SRC between 2012 and 15 were included. Athletes with learning disabilities or psychiatric conditions were excluded. Data was collected by EMR review and phone calls to athletes and parents/guardians. The primary outcomes were: (1) days to symptom resolution (SR), (2) days to return-to-school, (3) changes in any daily activity (binary), (4) and sport behavior (binary). Secondary outcomes were changes in specific activities such as sleep, schoolwork, television time, as well as equipment (binary), playing style (more reckless, unchanged, less reckless) and whether the athlete retired from sport. Descriptive analyses, multivariable Cox proportional hazards and logistic regression were performed.ConclusionsRacial differences appear to exist in the outcomes and experience of SRC for young athletes, as Black athletes reached symptom resolution and return-to-school sooner than White athletes. Race should be considered as an important social determinant in SRC treatment.

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Incidence and predictors of lost to follow-up among women under Option B+ PMTCT program in western Ethiopia: a retrospective follow-up study

BMC Research Notes ◽

10.1186/s13104-019-4882-z ◽

2020 ◽

Vol 13 (1) ◽

Cited By ~ 3

Author(s):

Tadesse Tolossa ◽

Getachew Mullu Kassa ◽

Habtamu Chanie ◽

Amanuel Abajobir ◽

Diriba Mulisa

Keyword(s):

Proportional Hazards ◽

Previous History ◽

Cox Proportional Hazards ◽

Hiv Disclosure ◽

Outcome Variable ◽

P Value ◽

Pmtct Program ◽

Follow Up Study ◽

Western Ethiopia

Abstract Objective Although Ethiopia has been implementing Option B+ program, LTFU of women from the Option B+ program is one of the challenges that minimizes its implementation. Thus, this study assessed the incidence and predictors of LTFU among women under Option B+ PMTCT program in western Ethiopia. An institution-based retrospective follow-up study was conducted. A cox proportional hazards regression model was fitted to identify predictors of LTFU. A Hazard ratios with 95% confidence CI was computed and all predictors that were associated with the outcome variable at p-value ≤ 0.05 in the multivariable cox proportional hazards were declared as a significance predictor of the outcome. Results A total of 330 women were followed for a mean follow up time of 16.9 (± 7.6) months. An overall incidence rate of LTFU was 9/1000 person-months. Women’s educational status, residence, HIV-disclosure status, the status of women at enrollment, previous history of HIV and ART adherence were significant predictors of LTFU. The incidence of LTFU from Option B+ PMTCT is lower as compared to evidence from sub-Saharan African and strengthening linkage and referral system between clinics as well as establishing appropriates tracing mechanisms would retain pregnant women in the program.

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Identifying Persistent Postconcussion Symptom Risk in a Pediatric Sports Medicine Clinic

The American Journal of Sports Medicine ◽

10.1177/0363546518796830 ◽

2018 ◽

Vol 46 (13) ◽

pp. 3254-3261 ◽

Cited By ~ 19

Author(s):

David R. Howell ◽

Roger Zemek ◽

Anna N. Brilliant ◽

Rebekah C. Mannix ◽

Christina L. Master ◽

...

Keyword(s):

Risk Score ◽

Sports Medicine ◽

Risk Scores ◽

Secondary Outcome ◽

Symptom Duration ◽

Clinical Risk Score ◽

Symptom Resolution ◽

Sports Concussion ◽

Clinical Risk ◽

Pediatric Sports Medicine

Background: Although most children report symptom resolution within a month of a concussion, some patients experience persistent postconcussion symptoms (PPCS) that continues for more than 1 month. Identifying patients at risk for PPCS soon after an injury can provide useful clinical information. Purpose: To determine if the Predicting Persistent Post-concussive Problems in Pediatrics (5P) clinical risk score, an emergency department (ED)–derived and validated tool, is associated with developing PPCS when obtained in a primary care sports concussion setting. Study Design: Cohort study; Level of evidence, 3. Methods: We conducted a study of patients seen at a pediatric sports medicine concussion clinic between May 1, 2013, and October 1, 2017, who were <19 years of age and evaluated within 10 days of a concussion. The main outcome was PPCS, defined as symptoms lasting >28 days. Nine variables were used to calculate the 5P clinical risk score, and we assessed the association between the 5P clinical risk score and PPCS occurrence. The secondary outcome was total symptom duration. Results: We examined data from 230 children (mean age, 14.8 ± 2.5 years; 50% female; mean time from injury to clinical assessment, 5.6 ± 2.7 days). In univariable analyses, a greater proportion of those who developed PPCS reported feeling slowed down (72% vs 44%, respectively; P < .001), headache (94% vs 72%, respectively; P < .001), sensitivity to noise (71% vs 43%, respectively; P < .001), and fatigue (82% vs 51%, respectively; P < .001) and committed ≥4 errors in tandem stance (33% vs 7%, respectively; P < .001) than those who did not. Higher 5P clinical risk scores were associated with increased odds of developing PPCS (adjusted odds ratio [OR], 1.62 [95% CI, 1.30-2.02]) and longer symptom resolution times (β = 8.40 [95% CI, 3.25-13.50]). Among the individual participants who received a high 5P clinical risk score (9-12), the majority (82%) went on to experience PPCS. The area under the curve for the 5P clinical risk score was 0.75 (95% CI, 0.66-0.84). After adjusting for the effect of covariates, fatigue (adjusted OR, 2.93) and ≥4 errors in tandem stance (adjusted OR, 7.40) were independently associated with PPCS. Conclusion: Our findings extend the potential use for an ED-derived clinical risk score for predicting the PPCS risk into the sports concussion clinic setting. While not all 9 predictor variables of the 5P clinical risk score were independently associated with the PPCS risk in univariable or multivariable analyses, the combination of factors used to calculate the 5P clinical risk score was significantly associated with the odds of developing PPCS. Thus, obtaining clinically pragmatic risk scores soon after a concussion may be useful for early treatments or interventions to mitigate the PPCS risk.

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Model Selection Strategy for Cox Proportional Hazards Model

Dhaka University Journal of Science ◽

10.3329/dujs.v67i2.54582 ◽

2019 ◽

Vol 67 (2) ◽

pp. 111-116

Author(s):

Fabiha Binte Farooq ◽

Md Jamil Hasan Karami

Keyword(s):

Model Selection ◽

Proportional Hazards ◽

Proportional Hazards Model ◽

Cox Model ◽

Information Criterion ◽

Cox Proportional Hazards ◽

Cox Proportional Hazards Model ◽

Outcome Variable ◽

Selection Strategy ◽

True Model

Often in survival regression modelling, not all predictors are relevant to the outcome variable. Discarding such irrelevant variables is very crucial in model selection. In this research, under Cox Proportional Hazards (PH) model we study different model selection criteria including Stepwise selection, Least Absolute Shrinkage and Selection Operator (LASSO), Akaike Information Criterion (AIC), Bayesian Information Criterion (BIC) and the extended versions of AIC and BIC to the Cox model. The simulation study shows that varying censoring proportions and correlation coefficients among the covariates have great impact on the performances of the criteria to identify a true model. In the presence of high correlation among the covariates, the success rate for identifying the true model is higher for LASSO compared to other criteria. The extended version of BIC always shows better result than the traditional BIC. We have also applied these techniques to real world data. Dhaka Univ. J. Sci. 67(2): 111-116, 2019 (July)

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Factors that Influence the Duration of Symptom Resolution in COVID-19 Patients in Ethiopia: A Follow up Study Involving 60 Symptomatic Cases.

10.21203/rs.3.rs-137978/v1 ◽

2021 ◽

Author(s):

Saro Abrahim ◽

Masresha Tesema ◽

Eshetu Ejeta ◽

Mahammed Ahmed ◽

Atkure Defar ◽

...

Keyword(s):

Median Duration ◽

Proportional Hazards ◽

Statistical Significance ◽

Signs And Symptoms ◽

Cox Proportional Hazards ◽

Treatment Center ◽

Symptom Resolution ◽

Proportional Hazards Regression ◽

Study Participants

Abstract Background: The newly identified virus, Severe Acute Respiratory Syndrome Corona Virus-two (SARS-CoV-2) has claimed more than a million lives worldwide since it was first recognized in Wuhan, China in December 2019. Understanding the clinical features of COVID-19 and duration for resolution of symptoms is crucial for isolation of patients and tailoring public health messaging, interventions, and policy. Therefore, this study aims to assess the median duration of COVID-19 signs and symptoms resolution and explore it’s predictors among symptomatic COVID-19 patients in EthiopiaMethods: A hospital-based prospective cohort study involving 60 COVID-19 cases was conducted at Eka Kotebe General Hospital, COVID-19 Isolation and Treatment Center. The study participants were all symptomatic COVID-19 adult patients admitted to the hospital from March 18 to June 27, 2020. Physicians at the center recorded the data using a log sheet. Cox proportional-hazards regression model was conducted. Statistical significance was defined at P<0.05. All analyses were done using STATA version 16.1 software.Results: A total of 60 symptomatic COVID-19 patients with a mean age of 34.8 years (+1.8) were involved in the study. The median duration of symptom resolution of COVID-19 was seven days with a minimum of two and a maximum of 68 days. Sex and Body Mass Index (BMI) were statistically significant predictors of the symptom resolution. The hazard of having delayed sign or symptom resolution in males was 55% higher than in females (P=0.039, CI: 0.22 to 0.96) and the hazard of the delayed sign or symptom in those with BMI ≥25 was 48% higher than in those with BMI <25 (P=0.051; CI: 0.272 to 1.003). In this study, age and comorbidity had no association with the duration of sign or symptom resolution in COVID-19 patients.Conclusions: The median duration of COVID-19 symptom resolution was seven days. Being male or having a BMI ≥ 25 were predictors for having a delayed sign or symptom resolution time. Therefore, understanding the duration of COVID-19 sign or symptom resolution helps to guide the patient isolation period and prioritize COVID-19 patients to be shielded.

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Plasma Transthyretin as a Predictor of Amnestic Mild Cognitive Impairment Conversion to Dementia

Scientific Reports ◽

10.1038/s41598-019-55318-0 ◽

2019 ◽

Vol 9 (1) ◽

Cited By ~ 1

Author(s):

Yi-Ting Tien ◽

Wei-Ju Lee ◽

Yi-Chu Liao ◽

Wen-Fu Wang ◽

Kai-Ming Jhang ◽

...

Keyword(s):

Cognitive Impairment ◽

Mild Cognitive Impairment ◽

Proportional Hazards ◽

Continuous Variable ◽

Cox Proportional Hazards ◽

Amnestic Mild Cognitive Impairment ◽

Teaching Hospitals ◽

Outcome Variable ◽

Control Group

AbstractAmnestic mild cognitive impairment (MCI) is a prodromal stage of dementia, with a higher incidence of these patients progressing to Alzheimer’s disease (AD) than normal aging people. A biomarker for the early detection and prediction for this progression is important. We recruited MCI subjects in three teaching hospitals and conducted longitudinal follow-up for 5 years at one-year intervals. Cognitively healthy controls were recruited for comparisom at baseline. Plasma transthyretin (TTR) levels were measured by ELISA. Survival analysis with time to AD conversion as an outcome variable was calculated with the multivariable Cox proportional hazards models using TTR as a continuous variable with adjustment for other covariates and bootstrapping resampling analysis. In total, 184 MCI subjects and 40 sex- and age-matched controls were recruited at baseline. At baseline, MCI patients had higher TTR levels compared with the control group. During the longitudinal follow-ups, 135 MCI patients (73.4%) completed follow-up at least once. The TTR level was an independent predictor for MCI conversion to AD when using TTR as a continuous variable (p = 0.023, 95% CI 1.001–1.007). In addition, in MCI converters, the TTR level at the point when they converted to AD was significantly lower than that at baseline (328.6 ± 66.5 vs. 381.9 ± 77.6 ug/ml, p < 0.001). Our study demonstrates the temporal relationship between the plasma TTR level and the conversion from MCI to AD.

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Factors that influence the duration of symptom resolution in COVID-19 patients in Ethiopia: A follow up study involving 60 symptomatic cases.

10.21203/rs.3.rs-138076/v1 ◽

2020 ◽

Author(s):

Saro Abdella Abrahim ◽

Masresha Tessema ◽

Eshetu Ejeta ◽

Mahammed Ahmed ◽

Atkure Defar ◽

...

Keyword(s):

Median Duration ◽

Proportional Hazards ◽

Statistical Significance ◽

Signs And Symptoms ◽

Cox Proportional Hazards ◽

Treatment Center ◽

Symptom Resolution ◽

Proportional Hazards Regression ◽

Study Participants

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Mixed Method Examination of the Brain Health of Former NCAA Division I Football Players and Former NFL Players

Neurology ◽

10.1212/01.wnl.0000801748.20025.f5 ◽

2021 ◽

Vol 98 (1 Supplement 1) ◽

pp. S1.2-S1

Author(s):

Samuel Fuller ◽

Esha Jain ◽

Newton Venkat Nagirimadugu ◽

Robert W. Turner

Keyword(s):

Proportional Hazards ◽

Cox Proportional Hazards ◽

Return To School ◽

Black Athletes ◽

Symptom Resolution ◽

Phone Calls ◽

Sport Concussion ◽

Television Time ◽

Psychiatric Conditions ◽

Specific Activities

ObjectiveYoung American athletes, at risk of sport-related concussion (SRC), represent many races; however, it is unknown how race influences the experience and outcome of SRC. Our objective was to compare White and Black athletes' recovery and subjective experiences after SRC.BackgroundNA.Design/MethodsA retrospective study was performed using the Vanderbilt Sport Concussion registry. Self-reported White (n = 211) and Black (n = 36) athletes (ages 12–23) treated for SRC between 2012 and 15 were included. Athletes with learning disabilities or psychiatric conditions were excluded. Data was collected by EMR review and phone calls to athletes and parents/guardians. The primary outcomes were: (1) days to symptom resolution (SR), (2) days to return-to-school, (3) changes in any daily activity (binary), (4) and sport behavior (binary). Secondary outcomes were changes in specific activities such as sleep, schoolwork, television time, as well as equipment (binary), playing style (more reckless, unchanged, less reckless) and whether the athlete retired from sport. Descriptive analyses, multivariable Cox proportional hazards and logistic regression were performed.ResultsA retrospective study was performed using the Vanderbilt Sport Concussion registry. Self-reported White (n = 211) and Black (n = 36) athletes (ages 12–23) treated for SRC between 2012 and 15 were included. Athletes with learning disabilities or psychiatric conditions were excluded. Data was collected by EMR review and phone calls to athletes and parents/guardians. The primary outcomes were: (1) days to symptom resolution (SR), (2) days to return-to-school, (3) changes in any daily activity (binary), (4) and sport behavior (binary). Secondary outcomes were changes in specific activities such as sleep, schoolwork, television time, as well as equipment (binary), playing style (more reckless, unchanged, less reckless) and whether the athlete retired from sport. Descriptive analyses, multivariable Cox proportional hazards and logistic regression were performed.ConclusionsRacial differences appear to exist in the outcomes and experience of SRC for young athletes, as Black athletes reached symptom resolution and return-to-school sooner than White athletes. Race should be considered as an important social determinant in SRC treatment.

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Physical Activity Decreases Kidney Cancer Mortality

Current Urology ◽

10.1159/000447180 ◽

2016 ◽

Vol 10 (4) ◽

pp. 193-198 ◽

Cited By ~ 5

Author(s):

Michael Liss ◽

Loki Natarajan ◽

Aws Hasan ◽

Jonathan L. Noguchi ◽

Martha White ◽

...

Keyword(s):

Physical Activity ◽

Kidney Cancer ◽

Cancer Mortality ◽

Proportional Hazards ◽

Normal Weight ◽

Cox Proportional Hazards ◽

Outcome Variable ◽

Mortality Data ◽

Cancer Specific Mortality ◽

Never Smokers

Background: To investigate associations of kidney cancer mortality with modifiable risk factors of obesity, physical activity, and smoking. Methods: We evaluate baseline data from US National Health Information Survey from 1998 through 2004 linked to mortality data reporting deaths through 2006. The primary outcome variable was kidney cancer-specific mortality and primary exposure variables were self-reported physical activity and body mass index (BMI). We utilized multivariable adjusted Cox proportional hazards regression models, with delayed entry to account for age at survey interview. Results: Among 222,163 individuals with complete follow-up data we identified 71 kidney cancer-specific deaths. In multivariate analyses, individuals who reported “any physical activity” were 50% less likely [adjusted hazard ratio (adjusted HR) 0.50, 95% CI 0.27-0.93, p = 0.028] to die of kidney cancer than non-exercisers, while obese individuals (BMI ≥ 30 kg/m2) were nearly 3 times more likely (adjusted HR 2.84, 95% CI 1.30-6.23, p = 0.009) compared to those of normal weight (BMI < 25 kg/m2). Compared to never smokers, former smokers were twice as likely to die of kidney cancer (adjusted HR 2.00, 95% CI 1.05-3.80, p = 0.034). Conclusion: Physical activity decreases and obesity increases the risk of kidney cancer mortality.

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