History of Autoimmune Disease Is Associated with Increased Risk for Myelodysplastic Syndromes

Background With the exception of therapy related MDS due to treatment with alkylating agents and/or radiation or with a topoisomerase II inhibitor, little is known about the etiology of myelodysplastic syndromes (MDS). A few studies have evaluated pre-existing medical conditions as risk factors for MDS, with evidence suggesting that autoimmune disease is associated with an increased risk of MDS. Here, we evaluated associations between history of autoimmune disease, overall and by individual disease subtype, and risk of MDS in a population-based case control study. Methods MDS cases were identified by rapid case ascertainment through the population-based Minnesota Cancer Surveillance System (MCSS). Participants were recruited if they were diagnosed with MDS between April 1, 2010 and October 31, 2014. Eligibility criteria included residence in Minnesota, age at diagnosis between 20 and 85 years, and ability to understand English or Spanish. Centralized pathology and cytogenetics review were conducted to confirm diagnosis and classify by subtypes. Controls were identified through the Minnesota State driver's license/identification card list. History of autoimmune disease was reported using a self-administered questionnaire; proxy interviews were not conducted. Unconditional logistic regression with adjustment for age, sex and confounders (education, NSAID use, benzene exposure, BMI) was used to calculate adjusted odds ratios (ORs) and 95% confidence intervals (CI) for autoimmune disease and MDS. Results A total of 399 cases with a confirmed diagnosis of MDS and 1399 controls were included. Cases were significantly more likely to report a diagnosis of any autoimmune disease when compared with controls (OR=1.49, 95% CI 1.13-1.97). As illustrated in Figure 1, specific associations were observed for hypothyroidism (OR=2.07, 95% CI 1.39-3.08), ulcerative colitis (OR=2.26, 95% CI 1.09-4.69), Crohn's disease (OR=3.88, 95% CI 1.23-12.2), and systemic lupus erythematosus (SLE; OR=7.52, 95% CI 1.98-28.6). Autoimmune conditions were more commonly reported in both female cases and female controls when compared with males; however, associations for hypothyroidism and ulcerative colitis were significantly associated with MDS in males in an analysis stratified by sex. Associations between autoimmune disease and MDS remained statistically significant after exclusion of therapy-related MDS cases. Discussion Our results validate previous findings of an association between autoimmune disease and MDS risk from population-based registry studies and case-control studies. In addition, our results provide additional evidence to suggest that this association is largely driven by hypothyroidism, inflammatory bowel disease, and SLE. This increased MDS risk following a diagnosis for an autoimmune condition is hypothesized to be due to shared genetic or environmental risk factors, treatment for autoimmune diseases, altered immune surveillance or damage to the bone marrow caused by the autoimmune condition. Further studies are required to confirm which of these is the most plausible explanation. Disclosures No relevant conflicts of interest to declare.

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Periodontal disease and effects of antipsychotic medications in patients newly diagnosed with schizophrenia: a population-based retrospective cohort

Epidemiology and Psychiatric Sciences ◽

10.1017/s204579601900043x ◽

2019 ◽

Vol 29 ◽

Author(s):

Kai-Fang Hu ◽

Pei-Shan Ho ◽

Yu-Hsiang Chou ◽

Jui-Hsiu Tsai ◽

Chung-Hung Richard Lin ◽

...

Keyword(s):

Risk Factors ◽

Periodontal Disease ◽

First Generation ◽

Protective Factor ◽

Population Based ◽

Newly Diagnosed ◽

Sugary Drinks ◽

Increased Risk ◽

History Of ◽

Independent Risk Factors

Abstract Aim Compared with the general population, individuals with schizophrenia have a higher risk of periodontal disease, which can potentially reduce their life expectancy. However, evidence for the early development of periodontal disease in schizophrenia is scant. The current study investigated risk factors for periodontal disease in patients newly diagnosed with schizophrenia. Methods We identified a population-based cohort of patients in Taiwan with newly diagnosed schizophrenia who developed periodontal disease within 1 year of their schizophrenia diagnosis. Treatment with antipsychotics and other medications was categorised according to medication type and duration, and the association between medication use and the treated periodontal disease was assessed through logistic regression. Results Among 3610 patients with newly diagnosed schizophrenia, 2373 (65.7%) had an incidence of treated periodontal disease during the 1-year follow-up. Female sex (adjusted odds ratios [OR] 1.40; 95% confidence interval [CI] 1.20–1.63); young age (adjusted OR 0.99; 95% CI 0.98–0.99); a 2-year history of periodontal disease (adjusted OR 2.45; 95% CI 1.84–3.26); high income level (adjusted OR 2.24; 95% CI 1.64–3.06) and exposure to first-generation (adjusted OR 1.89; 95% CI 1.54–2.32) and secondary-generation (adjusted OR 1.33; 95% CI 1.11–1.58) antipsychotics, anticholinergics (adjusted OR 1.24; 95% CI 1.03–1.50) and antihypertensives (adjusted OR 1.91; 95% CI 1.64–2.23) were independent risk factors for periodontal disease. Hyposalivation – an adverse effect of first-generation antipsychotics (FGAs) (adjusted OR 2.00; 95% CI 1.63–2.45), anticholinergics (adjusted OR 1.27; 95% CI 1.05–1.53) and antihypertensives (adjusted OR 1.90; 95% CI 1.63–2.22) – was associated with increased risk of periodontal disease. Therefore, hypersalivation due to FGA use (adjusted OR 0.72; 95% CI 0.59–0.88) was considered a protective factor. Conclusions The current study highlights that early prevention of periodontal disease in individuals with schizophrenia is crucial. Along with paying more attention to the development of periodontal disease, assessing oral health regularly, helping with oral hygiene, and lowering consumption of sugary drinks and tobacco, emphasis should also be given by physicians to reduce the prescription of antipsychotics to the extent possible under efficacious pharmacotherapy for schizophrenia.

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Family History Of Hematologic Malignancies and Disorders In a Population Based Study Of Myelodysplastic Syndromes (MDS)

Blood ◽

10.1182/blood.v122.21.1541.1541 ◽

2013 ◽

Vol 122 (21) ◽

pp. 1541-1541

Author(s):

Angela R. Smith ◽

Erica D. Warlick ◽

Rachel K. Fonstad ◽

Michelle A. Roesler ◽

Jenny N. Poynter ◽

...

Keyword(s):

Family History ◽

Conflicts Of Interest ◽

Positive Family History ◽

Hematologic Malignancies ◽

Population Based ◽

Newly Diagnosed ◽

Population Based Study ◽

Hematopoietic Stem ◽

Increased Risk ◽

History Of

Abstract Background MDS is a clonal hematopoietic stem cell disorder characterized by dysplastic changes in the bone marrow, ineffective hematopoiesis and an increased risk for developing acute myeloid leukemia (AML). The majority of MDS cases are sporadic, but rare familial cases have been described and are often ascertained through clinic-based referrals. To our knowledge, no population based study of MDS has examined the frequency of family history of hematologic malignancies and disorders in patients, nor associations with disease characteristics and outcomes. Methods Newly diagnosed MDS cases are being identified by rapid case ascertainment by the Minnesota Cancer Surveillance System (MCSS), a population-based cancer registry in Minnesota. Eligibility criteria include all newly diagnosed cases of MDS during the period April 1, 2010-October 31, 2014, between 20-85 years, Minnesota resident, and ability to understand English or Spanish. Proxy interviews are not being conducted. Medical records and biologic samples are obtained and questionnaires are filled out by participants. Centralized pathology and cytogenetics review confirm diagnosis and classify by subtype and risk score including the Revised International Prognostic Scoring System (IPSS-R). Since 2010, information on family history has been obtained through questionnaire responses and/or medical record review on 353 MDS patients. Cases were considered to have a positive family history if they reported a first degree relative with MDS, leukemia, lymphoma or other hematologic condition (multiple myeloma [n=4], Waldenstrom’s macroglobulinemia [n=1] and idiopathic thrombocytopenic purpura [n=1]). Treatment related MDS cases were excluded leaving 330 MDS patients for analysis. Unconditional logistic regression was used to calculate crude odds ratios (ORs) and 95% confidence intervals (CI) overall and by sex. Results A total of 61/330 (18.5%) cases reported a family history of a hematologic condition. The mean age at diagnosis was 71.3 years in those with a family history compared to 72.2 years in those without a family history (p=0.53). There was no difference in the sex distribution between the two groups. Though not statistically significant, the odds of having abnormal cytogenetics or an IPSS-R of High/Very High was lower for those having a positive family history (OR 0.57 [CI 0.25-1.33, p=0.19 and 0.67 [CI 0.24-1.84, p=0.29], respectively). The odds of survival at one year after diagnosis was significantly higher in those with a family history (OR 2.79 [CI 1.04-7.51, p=0.04]) compared to those without (Table). Further stratification by sex revealed that this association was strongest for males (OR=4.23, [CI 0.94-19.0, p=0.06] compared to females (OR=1.84 [CI=0.47-7.19, p=0.38]). Discussion In this population based study of adults with MDS, the prevalence of MDS cases having a positive family history was higher than previous reports. Additionally, cases reporting a family history of hematologic malignancies and disorders appear to experience lower risk disease and have significantly improved overall survival, especially males. It is possible that patients with a family history of hematologic conditions are diagnosed earlier in the course of their disease secondary to increased awareness about blood disorders and/or more active screening within the family. Our analysis is limited by relatively small numbers, but enrollment is ongoing so subsequent analyses with larger numbers of subjects may be more revealing. Additionally, a prospective study to examine these families further, including detailed medical histories and collection of biospecimens (saliva, blood, skin) for genetic analyses is underway in order to identify potential mechanisms and mutations involved in the development of MDS and progression to AML. Disclosures: No relevant conflicts of interest to declare.

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Improvement of Abandonment of Therapy in Pediatric Patients with Cancer in Guatemala

Journal of Global Oncology ◽

10.1200/jgo.2016.004648 ◽

2016 ◽

Vol 2 (3_suppl) ◽

pp. 76s-76s ◽

Cited By ~ 2

Author(s):

Elysia Alvarez ◽

Midori Seppa ◽

Kevin Messacar ◽

John Kurap ◽

E. Alejandro Sweet-Cordero ◽

...

Keyword(s):

Risk Factors ◽

Psychosocial Intervention ◽

Intervention Program ◽

Proportional Hazards ◽

Conflicts Of Interest ◽

Population Based ◽

Cox Proportional Hazards ◽

Middle Income ◽

Targeted Interventions ◽

Increased Risk

Abstract 59 Background: Abandonment of therapy is a major cause of therapeutic failure in the treatment of childhood cancer in Low and Middle Income Countries (LMIC). This study examines factors associated with increased risk of therapy abandonment in Guatemalan children with cancer and the rates of therapy abandonment before and after implementation of a multidisciplinary psychosocial intervention program. Methods: A retrospective population-based study was performed to identify risk factors for abandonment of therapy in Guatemalan children, ages 0-18, with cancer who were seen at UNOP from 2001-2008. Patient data was collected from the Pediatric Oncology Networked Database (POND4Kids). Abandonment was defined as a lapse of 4 weeks in planned treatment or failure to begin treatment for a potentially curable cancer. Cox proportional hazards analysis identified the effect of age, sex, year of diagnosis, distance travelled to UNOP, ethnicity, and principal diagnosis on abandonment of therapy. Kaplan Meier analysis was used to evaluate survival. Results: A retrospective analysis of 1,789 charts was performed and 367 patients abandoned therapy. The rate of abandonment decreased from 27% in 2001 to 7% in 2008 following a multidisciplinary psychosocial intervention program. Greater distance to UNOP (p = 0.00), younger age (p = 0.02) and earlier year of diagnosis (p = 0.00) were associated with increased risk of abandonment. Abandonment of therapy correlated with decreased survival. The cumulative survival at 8.3 years was 0.57 ± 0.02 (survival±SE) for those who completed therapy vs 0.06 ± 0.02 for those who abandoned and refused therapy (p=0.000) in an abandonment sensitive analysis. Conclusion: This study identified distance, age, and year of diagnosis as risk factors for abandonment of therapy for pediatric cancer in Guatemala. This study highlights risk factors for abandonment of therapy and the role of targeted interventions in altering rates of abandonment that could be replicated in other LMIC countries. AUTHORS' DISCLOSURES OF POTENTIAL CONFLICTS OF INTEREST: No COIs from the authors.

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Heparin-Induced Thrombocytopenia: Analysis of Risk Factors In Medicine Inpatients.

Blood ◽

10.1182/blood.v116.21.3689.3689 ◽

2010 ◽

Vol 116 (21) ◽

pp. 3689-3689

Author(s):

Shumei Kato ◽

Koichi Takahashi ◽

Kengo Ayabe ◽

Reza Samad ◽

Eri Fukaya ◽

...

Keyword(s):

Risk Factors ◽

Heart Failure ◽

New York ◽

Autoimmune Disease ◽

Conflicts Of Interest ◽

Heparin Induced Thrombocytopenia ◽

Medicine Service ◽

Increased Risk ◽

Medical Inpatients ◽

Inpatient Medicine

Abstract Abstract 3689 Background: Heparin-induced thrombocytopenia (HIT) is an unpredictable drug reaction to heparin characterized by thrombocytopenia and increased risk of life threatening venous and/or arterial thrombosis. Although HIT is uncommon, it is a serious side effect in patients receiving heparin. Data are lacking if there are additional risk factors that may be associated with the development of HIT. Accordingly, the aim of this study was to identify the risk factors that may be associated with the development of HIT in medical inpatients receiving heparin. Methods: This is a retrospective cohort study with 25,653 patients who were admitted to the medicine service and received heparin products (unfractionated heparin [UFH] or enoxaparin) in an urban teaching hospital in New York City from August 2005 to January 2010. Computerized discharge summaries, medical charts, radiology and laboratory reports were used in this retrospective study. Demographics such as age, gender and race were recorded. Details of medical history and hospital course of each patient was reviewed to obtain the known risk factors for HIT as well as possible confounding factors that may be related to the development of HIT. The diagnosis of HIT was confirmed if the platelet count dropped >50% from baseline and there was a positive laboratory HIT assay. Results: Fifty-five cases of in-hospital HIT (raw incidence, 0.21%, 95% CI [0.16, 0.28]) were observed (Table 1). After multivariate analysis, patients whose race was either Asian or Hispanic demonstrated an increased risk of developing HIT (relative risk [RR]= 2.61; 95% CI [1.10, 6.17]; p= 0.03 and RR= 2.21; 95% CI [1.22, 4.02]; p= 0.01 respectively). Additionally, patients who received full anticoagulation dose with UFH (RR= 3.66; 95% CI [1.98, 6.75]; p= <0.0001) or were exposed to heparin products for more than 5 days also had an increased risk of HIT (RR= 5.51; 95% CI [2.48, 12.2]; p= <0.0001 if heparin given 5 to 10 days, RR= 7.66; 95% CI [3.31, 17.8]; p= <0.0001 if heparin given more than 10 days). Moreover, patients who were on hemodialysis, carried a diagnosis of autoimmune disease, gout or heart failure remained as a independent risk factor for HIT (RR= 9.68; 95% CI [4.90, 19.1]; p= <0.0001, RR= 3.47; 95% CI [1.93, 6.26]; p= <0.0001, RR= 2.89; 95% CI [1.09, 7.68]; p= 0.03, and RR= 2.10; 95% CI [1.09, 4.08]; p= 0.03 respectively) (Table 2). Conclusion: Among patients admitted to inpatient medicine service receiving heparin products, patients who were Asian or Hispanic, who were treated with full anticoagulation dose with UFH or who received heparin product >5 days were at increased risk of HIT. Furthermore, patients who were on hemodialysis, had autoimmune disease, gout and heart failure were also at increased risk of in-hospital HIT. The results suggest that when using heparin products in these patient cohorts, increased surveillance of HIT is necessary. Disclosures: No relevant conflicts of interest to declare.

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Risk factors for human cysticercosis morbidity: a population-based case-control study

Epidemiology and Infection ◽

10.1017/s0950268897007619 ◽

1997 ◽

Vol 119 (2) ◽

pp. 231-235 ◽

Cited By ~ 17

Author(s):

W. CAO ◽

C. P. B. VAN DER PLOEG ◽

J. XU ◽

C. GAO ◽

L. GE ◽

...

Keyword(s):

Risk Factors ◽

Case Control Study ◽

Taenia Solium ◽

Population Based ◽

Case Control ◽

Personal Hygiene ◽

Prevalence Survey ◽

History Of ◽

Behavioural Factors ◽

Control Study

A population-based case-control study to determine social and behavioural risk factors for Taenia solium cysticercosis in humans was carried out in a rural area, Shandong province, China. Forty-eight cases with cysticercosis were ascertained through a prevalence survey conducted among 7281 persons in 1993. For each case, four controls residing in the same village and matched for age and sex were randomly selected. Information regarding demographic, social and behavioural factors was collected during house visits through interviews and direct observation. Risk factors strongly associated with human cysticercosis included poor personal hygiene, being unable to recognize cysticerci-containing meat, poor pig-raising practices and a history of passing tapeworm proglottides. The results indicate that health education in combination with chemotherapy for taeniasis is required for the control of cysticercosis in humans.

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Risk Factors for Branch and Central Retinal Vein Occlusion

50 Studies Every Ophthalmologist Should Know ◽

10.1093/med/9780190050726.003.0020 ◽

2020 ◽

pp. 115-120

Author(s):

Alan D. Penman ◽

Kimberly W. Crowder ◽

William M. Watkins

Keyword(s):

Risk Factors ◽

Retinal Vein Occlusion ◽

Open Angle Glaucoma ◽

Case Control ◽

Systemic Hypertension ◽

Vein Occlusion ◽

Increased Risk ◽

History Of ◽

Control Study ◽

Central Retinal Vein

The Eye Disease Case-Control Study was a clinic-based, case-control study that investigated risk factors for 5 retinal diseases—branch retinal vein occlusion (BRVO), central retinal vein occlusion (CRVO), neovascular age-related macular degeneration (AMD), idiopathic macular hole, and rhegmatogenous retinal detachment—using a similar protocol and the same large pool of controls. An increased risk of BRVO was found in persons with a history of systemic hypertension, cardiovascular disease, increased body mass index at 20 years of age, a history of glaucoma, and higher serum levels of alpha 2 globulin. An increased risk of CRVO was found in persons with systemic hypertension, diabetes mellitus, and open-angle glaucoma. The authors recommended that patients with BRVO and CRVO should be evaluated for risk factors for cardiovascular disease (hypertension, hyperlipidemia, and diabetes), as well as for open-angle glaucoma.

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Personal and family history of immune-related conditions increase the risk of plasma cell disorders: a population-based study

Blood ◽

10.1182/blood-2011-04-347559 ◽

2011 ◽

Vol 118 (24) ◽

pp. 6284-6291 ◽

Cited By ~ 45

Author(s):

Ebba K. Lindqvist ◽

Lynn R. Goldin ◽

Ola Landgren ◽

Cecilie Blimark ◽

Ulf-Henrik Mellqvist ◽

...

Keyword(s):

Family History ◽

Autoimmune Disease ◽

Large Population ◽

Population Based ◽

Personal History ◽

Population Based Study ◽

Inflammatory Conditions ◽

Increased Risk ◽

Plasma Cell Disorders ◽

History Of

Abstract The associations between immune-related conditions and multiple myeloma (MM) and monoclonal gammopathy of undetermined significance (MGUS) have previously been investigated with inconsistent results. In a large population-based study, we identified 19 112 patients with MM, 5403 patients with MGUS, 96 617 matched control subjects, and 262 931 first-degree relatives. We calculated odds ratios (ORs) and 95% confidence intervals (CIs) for the association of MM and MGUS with immune-related conditions by use of logistic regression. A personal history of all infections combined was associated with a significantly increased risk of MM (OR = 1.2; 95% CI, 1.1-1.3), and a personal history of all conditions in the categories infections (OR = 1.6; 95% CI, 1.5-1.7), inflammatory conditions (OR = 1.4; 95% CI, 1.2-1.5), and autoimmune diseases (OR = 2.1; 95% CI, 1.9-2.4) was associated with a significantly increased risk of MGUS. Several specific immune-related conditions elevated the risk of MM and/or MGUS. A family history of autoimmune disease was associated with a significantly increased risk of MGUS (OR = 1.1; 95% CI, 1.00-1.2), but not MM. Our findings suggest that immune-related conditions and/or their treatment are of importance in the etiology of MGUS and possibly MM. The association of both personal and family history of autoimmune disease with MGUS indicates the potential for shared susceptibility for these conditions.

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Risk factors for extensive ulcerative colitis and ulcerative proctitis: a population based case-control study.

Gut ◽

10.1136/gut.32.12.1526 ◽

1991 ◽

Vol 32 (12) ◽

pp. 1526-1530 ◽

Cited By ~ 33

Author(s):

S M Samuelsson ◽

A Ekbom ◽

M Zack ◽

C G Helmick ◽

H O Adami

Keyword(s):

Risk Factors ◽

Ulcerative Colitis ◽

Case Control Study ◽

Population Based ◽

Case Control ◽

Ulcerative Proctitis ◽

Control Study

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Risk Factors for Malignancies in Pediatric Population: Results of A Population-Based Case-Control Study

10.21203/rs.3.rs-271529/v1 ◽

2021 ◽

Author(s):

Yolande Saab ◽

Mirna Naccache ◽

Rony Zeenny ◽

Shereen Nabhani-Gebara ◽

Lydia Sholy

Keyword(s):

Risk Factors ◽

Case Control Study ◽

Pediatric Population ◽

Population Data ◽

Population Based ◽

Case Control ◽

Electrical Networks ◽

Face To Face ◽

History Of ◽

Control Study

Abstract Cancer is the most common cause of disease-related deaths in childhood. Many sociodemographic, socioeconomic, environmental and genetic risk factors have been associated with a childhood cancer risk. However, few to no such studies have been conducted in the Middle East including Lebanon. This is a population-based case-control study that was conducted in the Lebanese pediatric population. Data was collected through face- to-face interviews, using a questionnaire, with parents of children with cancer in Lebanese pediatric cancer centers over a two-year period. In total, the sample consisted of 322 participants. Results showed that there are several sociodemographic, socioeconomic, environmental factors, in addition to consanguinity between parents, level of education and occupation of the parents , area of residence of the child (location and proximity to high-voltage electrical networks, garbage disposal areas, industrial factories and high-ways) as well as sibling history of cancer are risk factors for childhood cancers in Lebanon. Conclusion: This study informs policy makers on the risk factors in order to find solution as well as policies to decrease and mitigate these risks.

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Thyroid disorders and breast cancer risk in Asian population: a nationwide population-based case–control study in Taiwan

BMJ Open ◽

10.1136/bmjopen-2017-020194 ◽

2018 ◽

Vol 8 (3) ◽

pp. e020194 ◽

Cited By ~ 8

Author(s):

Chien-Hsiang Weng ◽

Yi-Huei Chen ◽

Ching-Heng Lin ◽

Xun Luo ◽

Tseng-Hsi Lin

Keyword(s):

Breast Cancer ◽

Index Date ◽

Case Control Study ◽

Asian Population ◽

Population Based ◽

Case Control ◽

Thyroid Disorders ◽

Increased Risk ◽

History Of ◽

Control Study

ObjectiveTo evaluate whether hyperthyroidism or hypothyroidism increases the risk of subsequent breast cancer in an Asian population.DesignNationwide population-based case–control study.SettingAll healthcare facilities in Taiwan.ParticipantsA total of 103 466 women (mean age 53.3 years) were enrolled.Methods51 733 adult women with newly diagnosed primary breast cancer without a previous cancer history between 2006 and 2011 were identified and included in our study. 51 733 women with no cancer diagnosis prior to the index date were age matched as controls. Diagnosis of hyperthyroidism or hypothyroidism prior to the diagnosis of breast cancer or the same index date was identified, age, histories of thyroid disease treatment, oestrogen use and radioactive iodine treatment were adjusted.Main outcome measuresTo identify risk differences in developing breast cancer among patients with a medical history of hyperthyroidism or hypothyroidism.ResultsThere was a significantly increased risk of breast cancer in women with hyperthyroidism under the age of 55 years (age <45: OR 1.16, P=0.049; age 45–55: OR 1.15, P=0.019). Patients with hypothyroidism also showed an increased risk of breast cancer (OR 1.19, P=0.029) without statistical significance after stratification by age group (age <45, 45–55, >55 years). Treatment for thyroid disorders did not alter the association in subgroup analyses (P=0.857; 0.262, respectively).ConclusionsAsian women under 55 years of age with history of hyperthyroidism have a significantly increased risk of breast cancer regardless of treatment. Women with history of hypothyroidism may also have an increased risk.

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