Incidence of Major Hemorrhage Among CLL and MCL Patients Compared to the General Elderly Population: An Analysis of the US SEER-Medicare Linked Database

Abstract Introduction: Patients with B cell malignancies have an inherent increased risk of bleeding. However, the incidence of major hemorrhage among patients with MCL and CLL has not been described. The objective of this study is to evaluate the risk of major hemorrhage in a real world setting by using a population-based data source. Methods: The SEER-Medicare linked database, a database of SEER cancer registry data linked to individual Medicare administrative claims, was utilized to follow a cohort of persons newly treated for CLL or MCL to estimate the incidence of major hemorrhage (CNS and non-CNS). Major hemorrhage was defined as having at least one code for hemorrhage in a critical area or organ or having another bleeding code with a transfusion within 14 days of the event. Patients with a cancer diagnosis on or after 1/1/2000 were followed through disenrollment from the database, death, the occurrence of major hemorrhage, or the end of the study period (12/31/2011), whichever came first. Incidence rates (IR) of major hemorrhage were characterized in terms of incidence per person-years (pys) of follow-up with 95% confidence intervals calculated according to a Poisson distribution. Rates in the CLL and MCL populations were compared to those in the age and gender-matched general population of a sample of non-cancer Medicare patients using Cox proportional hazards models. Results: A total of 1,587 treated MCL patients, 6,717 treated CLL/SLL patients, and 14,816 age and gender-matched non-cancer patients were identified in the database. Median age among all three cohorts was approximately 75 years. Among patients treated for MCL, 287 (18%) had at least one major hemorrhage, corresponding to an incidence of 5.8 per 100 pys. Among 6,717 CLL patients, 1,211 (18%) had at least one major hemorrhage (IR: 6.0 per 100 pys). In the age and gender-matched non-cancer population, incidence of major hemorrhage was 1.6 per 100 pys. The hazard ratio for development of any major hemorrhage among CLL patients compared to the non-cancer cohort was 8.3 (95% CI: 7.5-9.2), and for MCL compared to the non-cancer cohort was 8.8 (95% CI: 7.6-10.2). IR of CNS hemorrhage was also higher among MCL and CLL patients (0.9 and 1.2 per 100 pys, respectively) compared to the non-cancer cohort (0.04 per 100 pys). Gastrointestinal hemorrhage was the most frequent site of occurrence. Conclusions: Among persons newly initiating treatment for CLL and MCL, incidence of major hemorrhage was found to be over 8 times higher than that of the age- and gender-matched general population. Additional analyses to establish whether this increased risk is attributable to the disease itself, comorbid conditions, choice of cancer therapy, or concomitant medications in the patient population and/or other risk factors are planned. Baseline risks among CLL and MCL patients should be considered when establishing risk/benefit profiles of a particular treatment. Disclosures Gifkins: Johnson and Johnson: Employment. Matcho:Johnson and Johnson: Employment. Yang:Pharmacyclics, Inc: Employment. Xu:Johnson and Johnson: Employment. Gooden:Pharmacyclics, Inc.: Employment. Wildgust:Janssen Pharmaceuticals, Inc.: Employment.

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Is ankylosing spondylitis a risk factor for cardiovascular disease, and how do these risks compare with those in rheumatoid arthritis?

Annals of the Rheumatic Diseases ◽

10.1136/annrheumdis-2016-209315 ◽

2016 ◽

Vol 76 (2) ◽

pp. 364-370 ◽

Cited By ~ 47

Author(s):

Jonas K Eriksson ◽

Lennart Jacobsson ◽

Karin Bengtsson ◽

Johan Askling

Keyword(s):

Rheumatoid Arthritis ◽

Ankylosing Spondylitis ◽

General Population ◽

Proportional Hazards ◽

Population Based ◽

Incidence Rates ◽

Cox Proportional Hazards ◽

Relative Risks ◽

Cox Proportional Hazards Models ◽

Increased Risk

AimsTo assess and compare the incidence of cardiovascular (CV) events, by CV phenotype, between patients with ankylosing spondylitis (AS), rheumatoid arthritis (RA) and the general population.MethodsUsing linkages of national and population-based registers, we identified one cohort of prevalent patients with AS (n=5358), one with RA (n=37 245) and one with matched general population subjects (n=25 006). These cohorts were identified in 2006 through 2011 and were followed in 31 December 2012, for first ever occurrence of acute coronary syndromes (ACS), deep venous thromboembolism, pulmonary embolism and stroke, respectively. For each outcome, we calculated incidence rates standardised to the age and sex distribution of the AS cohort, as well as relative risks using Cox proportional hazards models.ResultsBased on 69 ACS events during 20 251 person-years of follow-up of the patients with AS, and 966 events during 127 014 person-years in the RA cohort, the age/sex-adjusted relative risks for ACS compared with the general population was 1.3 (95% CI 1.0 to 1.7) for AS and 1.7 (1.4 to 2.0) for RA. For thromboembolic events, the corresponding risks were 1.4 (1.1 to 1.9) in AS and 1.8 (1.5 to 2.1) in RA. Finally, for stroke, the relative risks were 1.5 (1.1 to 2.0) in AS and 1.5 (1.2 to 1.8) in RA, compared with the general population.ConclusionsPrevalent patients with AS are at a 30%–50% increased risk of incident CV events. When compared with patients with RA, this level of increase was similar for stroke, but only half as high for ACS and thrombotic events.

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Risk of Appendicitis among Children with Different Piped Water Supply: A Nationwide Population-Based Study

International Journal of Environmental Research and Public Health ◽

10.3390/ijerph15081601 ◽

2018 ◽

Vol 15 (8) ◽

pp. 1601

Author(s):

Hao-Ming Li ◽

Shi-Zuo Liu ◽

Ying-Kai Huang ◽

Yuan-Chih Su ◽

Chia-Hung Kao

Keyword(s):

Water Supply ◽

Proportional Hazards ◽

Population Based ◽

Incidence Rates ◽

Cox Proportional Hazards ◽

Sensitivity Analyses ◽

Study Cohort ◽

Research Database ◽

Piped Water ◽

Increased Risk

Appendicitis is a common surgical condition for children. However, environmental effects, such as piped water supply, on pediatric appendicitis risk remain unclear. This longitudinal, nationwide, cohort study aimed to compare the risk of appendicitis among children with different levels of piped water supply. Using data from Taiwan Water Resource Agency and National Health Insurance Research Database, we identified 119,128 children born in 1996–2010 from areas of the lowest piped water supply (prevalence 51.21% to 63.06%) as the study cohort; additional 119,128 children of the same period in areas of the highest piped water supply (prevalence 98.97% to 99.63%) were selected as the controls. Both cohorts were propensity-score matched by baseline variables. We calculated the hazard ratios (HRs) and 95% confidence intervals (CIs) of appendicitis in the study cohort compared to the controls by Cox proportional hazards regression. The study cohort had a raised overall incidence rates of appendicitis compared to the control cohort (12.8 vs. 8.7 per 10,000 person-years). After covariate adjustment, the risk of appendicitis was significantly increased in the study cohort (adjusted HR = 1.46, 95% CI: 1.35, 1.58, p < 0.001). Subgroup and sensitivity analyses showed consistent results that children with low piped water supply had a higher risk of appendicitis than those with high piped water supply. This study demonstrated that children with low piped water supply were at an increased risk of appendicitis. Enhancement of piped water availability in areas lacking adequate, secure, and sanitized water supply may protect children against appendicitis.

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Increased risk of trigeminal neuralgia in patients with migraine: A nationwide population-based study

Cephalalgia ◽

10.1177/0333102415623069 ◽

2016 ◽

Vol 36 (13) ◽

pp. 1218-1227 ◽

Cited By ~ 12

Author(s):

Kuan-Hsiang Lin ◽

Yung-Tai Chen ◽

Jong-Ling Fuh ◽

Shuu-Jiun Wang

Keyword(s):

Trigeminal Neuralgia ◽

Proportional Hazards ◽

Underlying Mechanism ◽

Population Based ◽

Incidence Rates ◽

Cox Proportional Hazards ◽

Sensitivity Analyses ◽

Research Database ◽

Increased Risk ◽

Using Data

Objectives The objectives of this article are to evaluate the association between migraine and trigeminal neuralgia and to investigate the effects of age, sex, migraine subtype, and comorbid risk factors on trigeminal neuralgia development. Methods This population-based cohort study was conducted using data from Taiwan’s National Health Insurance Research Database. Individuals aged ≥ 20 years with neurologist-diagnosed migraine between 2005 and 2009 were included. A non-headache age-, sex-, and propensity score-matched control cohort was selected for comparison. All participants were followed until the end of 2010, death, or the occurrence of trigeminal neuralgia. Cox proportional hazards regression was used to calculate hazard ratios (HRs) and 95% confidence intervals (CIs) for comparison of the risk of trigeminal neuralgia between groups. Results Both cohorts ( n = 137,529 each) were followed for a mean of 3.1 years. During the follow-up period, 575 patients (421,581 person-years) in the migraine cohort and 88 matched controls (438,712 person-years) were newly diagnosed with trigeminal neuralgia (incidence rates, 136.39 and 20.06/100,000 person-years, respectively). The HR for trigeminal neuralgia was 6.72 (95% CI, 5.37–8.41; p < 0.001). The association between migraine and trigeminal neuralgia remained significant in sensitivity analyses. Among migraine subtypes, patients with migraine with aura were at greater risk of trigeminal neuralgia development. No other significant interaction was identified in subgroup analyses. Conclusions Migraine is a previously unidentified risk factor for trigeminal neuralgia. The association between these conditions suggests a linked underlying mechanism, which is worthy of further exploration.

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The Risk and Consequences of Vertebral Fracture in Patients with Ankylosing Spondylitis: A Population-based Data Linkage Study

The Journal of Rheumatology ◽

10.3899/jrheum.190675 ◽

2020 ◽

Vol 47 (11) ◽

pp. 1629-1636 ◽

Cited By ~ 2

Author(s):

Milica Ognjenovic ◽

Warren D. Raymond ◽

Charles A. Inderjeeth ◽

Helen I. Keen ◽

David B. Preen ◽

...

Keyword(s):

Ankylosing Spondylitis ◽

Vertebral Fracture ◽

Proportional Hazards ◽

Tumor Necrosis Factor Inhibitor ◽

Population Based ◽

Linkage Study ◽

Incidence Rates ◽

Cox Proportional Hazards ◽

Risk Of Death ◽

Increased Risk

Objective.To compare the long-term prevalence, incidence, and outcomes of vertebral fracture (VF) between ankylosing spondylitis (AS) patients and matched controls, including the role of extraarticular manifestations (EAM) and osteoporosis.Methods.This was a statewide observational study using linked health data for 2321 patients with AS and 22,976 controls presenting to hospital from 1980 to 2015. Data were analyzed using incidence rates (per 1000 person-yrs) and ratios (IRR), multivariable Cox proportional hazards regression, and Kaplan-Meier survival curves.Results.Over a median 13.92 (interquartile range 7.58–21.67) years of follow-up, patients with AS had a greater VF prevalence and greater incidence of developing a new VF compared to controls (9.3% vs 2.5%, 6.8% vs 1.9%, respectively, all P < 0.001). Patients with AS had an increased risk of developing a VF after adjustments for age, sex, and osteoporosis (HR 2.55, 95% CI 2.11–3.09) compared to controls; this risk remained throughout the study period. Patients with AS were 5 years younger at time of first VF (P = 0.008) and had a greater likelihood of a recurrent VF (IRR 4.64; 95% CI 4.54–4.75) compared to respective controls. Mortality overall was comparable between patients with AS and controls after adjustment for age, sex, osteoporosis, and VF status (HR 0.90; 95% CI 0.80–1.01).Conclusion.The significantly increased risk of VF in patients with AS has not altered following the introduction of tumor necrosis factor inhibitor treatment. Although patients with AS experience a first VF at a younger age than controls, this does not lead to an increased risk of death.

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Prenatal diethylstilbestrol exposure and risk of diabetes, gallbladder disease, and pancreatic disorders and malignancies

Journal of Developmental Origins of Health and Disease ◽

10.1017/s2040174420000872 ◽

2020 ◽

pp. 1-8

Author(s):

Rebecca Troisi ◽

Marianne Hyer ◽

Linda Titus ◽

Julie R. Palmer ◽

Elizabeth E. Hatch ◽

...

Keyword(s):

Type 2 Diabetes ◽

Pancreatic Cancer ◽

General Population ◽

Proportional Hazards ◽

Gallbladder Disease ◽

Incidence Rates ◽

Cox Proportional Hazards ◽

Increased Risk ◽

Pancreatic Disorders

Abstract Prenatal diethylstilbestrol (DES) exposure is associated with increased risk of hormonally mediated cancers and other medical conditions. We evaluated the association between DES and risk of pancreatic cancer and pancreatic disorders, type 2 diabetes, and gallbladder disease, which may be involved with this malignancy. Our analyses used follow-up data from the US National Cancer Institute DES Combined Cohort Study. Cox proportional hazards models estimated hazard ratios (HRs) and 95% confidence intervals (CIs) adjusted for age, sex, cohort, body mass index, smoking, and alcohol for the association between prenatal DES exposure and type 2 diabetes, gallbladder disease (mainly cholelithiasis), pancreatic disorders (mainly pancreatitis), and pancreatic cancer among 5667 exposed and 3315 unexposed individuals followed from 1990 to 2017. Standardized incidence rate (SIR) ratios for pancreatic cancer were based on age-, race-, and calendar year-specific general population cancer incidence rates. In women and men combined, the hazards for total pancreatic disorders and pancreatitis were greater in the prenatally DES exposed than the unexposed (HR = 11, 95% CI 2.6–51 and HR = 7.0, 95% CI 1.5–33, respectively). DES was not associated overall with gallbladder disease (HR = 1.2, 95% CI 0.88–1.5) or diabetes (HR = 1.1, 95% CI 0.9–1.2). In women, but not in men, DES exposure was associated with increased risk of pancreatic cancer compared with the unexposed (HR: 4.1, 95% CI 0.84–20) or general population (SIR: 1.9, 95% CI 1.0–3.2). Prenatal DES exposure may increase the risk of pancreatic disorders, including pancreatitis in women and men. The data suggested elevated pancreatic cancer risk in DES-exposed women, but not in exposed men.

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Appendectomy and Non-Typhoidal Salmonella Infection: A Population-Based Matched Cohort Study

Journal of Clinical Medicine ◽

10.3390/jcm10071466 ◽

2021 ◽

Vol 10 (7) ◽

pp. 1466

Author(s):

Den-Ko Wu ◽

Kai-Shan Yang ◽

James Cheng-Chung Wei ◽

Hei-Tung Yip ◽

Renin Chang ◽

...

Keyword(s):

Proportional Hazards ◽

International Classification Of Diseases ◽

Population Based ◽

Incidence Rates ◽

Cox Proportional Hazards ◽

Sensitivity Analyses ◽

Control Group ◽

Research Database ◽

Cox Proportional Hazards Models ◽

Increased Risk

The potential association between appendectomy and non-typhoidal Salmonella (NTS) infection has not been elucidated. We hypothesized that appendectomy may be associated with gut vulnerability to NTS. The data were retrospectively collected from the Taiwan National Health Insurance Research Database to describe the incidence rates of NTS infection requiring hospital admission among patients with and without an appendectomy. A total of 208,585 individuals aged ≥18 years with an appendectomy were enrolled from January 2000 to December 2012, and compared with a control group of 208,585 individuals who had never received an appendectomy matched by propensity score (1:1) by index year, age, sex, occupation, and comorbidities. An appendectomy was defined by the International Classification of Diseases, Ninth Revision, Clinical Modification Procedure Codes. The main outcome was patients who were hospitalized for NTS. Cox proportional hazards models were applied to estimate the hazard ratios (HRs) and 95% confidence intervals (CIs). Two sensitivity analyses were conducted for cross-validation. Of the 417,170 participants (215,221 (51.6%) male), 208,585 individuals (50.0%) had an appendectomy, and 112 individuals developed NTS infection requiring hospitalization. In the fully adjusted multivariable Cox proportional hazards regression model, the appendectomy group had an increased risk of NTS infection (adjusted HR (aHR), 1.61; 95% CI, 1.20–2.17). Females and individuals aged 18 to 30 years with a history of appendectomy had a statistically higher risk of NTS than the control group (aHR, 1.92; 95% CI, 1.26–2.93 and aHR, 2.67; 95% CI, 1.41–5.07). In this study, appendectomy was positively associated with subsequent hospitalization for NTS. The mechanism behind this association remains uncertain and needs further studies to clarify the interactions between appendectomy and NTS.

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Independent impact of gout on the risk of acute myocardial infarction among elderly women: a population-based study

Annals of the Rheumatic Diseases ◽

10.1136/ard.2009.122770 ◽

2010 ◽

Vol 69 (6) ◽

pp. 1162-1164 ◽

Cited By ~ 83

Author(s):

Mary A De Vera ◽

M Mushfiqur Rahman ◽

Vidula Bhole ◽

Jacek A Kopec ◽

Hyon K Choi

Keyword(s):

Myocardial Infarction ◽

Acute Myocardial Infarction ◽

Proportional Hazards ◽

Elderly Women ◽

Population Based ◽

Incidence Rates ◽

Cox Proportional Hazards ◽

Cox Proportional Hazards Models ◽

Prescription Drug Use ◽

Increased Risk

BackgroundMen with gout have been found to have an increased risk of acute myocardial infarction (AMI), but no corresponding data are available among women.ObjectiveTo evaluate the potential independent association between gout and the risk of AMI among elderly women, aged ≥65 years.MethodsA population-based cohort study was conducted using the British Columbia Linked Health Database and compared incidence rates of AMI between 9642 gout patients and 48 210 controls, with no history of ischaemic heart disease. Cox proportional hazards models stratified by gender were used to estimate the relative risk (RR) for AMI, adjusting for age, comorbidities and prescription drug use.ResultsOver a 7-year median follow-up, 3268 incident AMI cases, were identified, 996 among women. Compared with women without gout, the multivariate RRs among women with gout were 1.39 (95% CI 1.20 to 1.61) for all AMI and 1.41 (95% CI 1.19 to 1.67) for non-fatal AMI. These RRs were significantly larger than those among men (multivariate RRs for all AMI and non-fatal AMI, 1.11 and 1.11; p values for interaction, 0.003 and 0.005, respectively).ConclusionThese population-based data suggest that women with gout have an increased risk for AMI and the magnitude of excess risk is higher than in men.

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Race and Ethnic Disparities in Stroke Incidence in the Northern Manhattan Study

Stroke ◽

10.1161/strokeaha.119.028806 ◽

2020 ◽

Vol 51 (4) ◽

pp. 1064-1069 ◽

Cited By ~ 1

Author(s):

Hannah Gardener ◽

Ralph L. Sacco ◽

Tatjana Rundek ◽

Valeria Battistella ◽

Ying Kuen Cheung ◽

...

Keyword(s):

Incidence Rate ◽

Low Socioeconomic Status ◽

Proportional Hazards ◽

Ethnic Disparities ◽

Population Based ◽

Incidence Rates ◽

Cox Proportional Hazards ◽

Hazard Ratio ◽

Stroke Incidence ◽

Increased Risk

Background and Purpose— An excess incidence of strokes among blacks versus whites has been shown, but data on disparities related to Hispanic ethnicity remain limited. This study examines race/ethnic differences in stroke incidence in the multiethnic, largely Caribbean Hispanic, NOMAS (Northern Manhattan Study), and whether disparities vary by age. Methods— The study population included participants in the prospective population-based NOMAS, followed for a mean of 14±7 years. Multivariable-adjusted Cox proportional hazards models were constructed to estimate the association between race/ethnicity and incident stroke of any subtype and ischemic stroke, stratified by age. Results— Among 3298 participants (mean baseline age 69±10 years, 37% men, 24% black, 21% white, 52% Hispanic), 460 incident strokes accrued (400 ischemic, 43 intracerebral hemorrhage, 9 subarachnoid hemorrhage). The most common ischemic subtype was cardioembolic, followed by lacunar infarcts, then cryptogenic. The greatest incidence rate was observed in blacks (13/1000 person-years), followed by Hispanics (10/1000 person-years), and lowest in whites (9/1000 person-years), and this order was observed for crude incidence rates until age 75. By age 85, the greatest incidence rate was in Hispanics. Blacks had an increased risk of stroke versus whites overall in multivariable models that included sociodemographics (hazard ratio, 1.51 [95% CI, 1.13–2.02]), and stratified analyses showed that this disparity was driven by women of age ≥70. The increased rate of stroke among Hispanics (age/sex-adjusted hazard ratio, 1.48 [95% CI, 1.13–1.93]) was largely explained by education and insurance status (a proxy for socieoeconomic status; hazard ratio after further adjusting for these variables, 1.17 [95% CI, 0.85–1.62]) but remained significant for women age ≥70. Conclusions— This study provides novel data regarding the increased stroke risk among Caribbean Hispanics in this elderly population. Results highlight the need to create culturally tailored campaigns to reach black and Hispanic populations to reduce race/ethnic stroke disparities and support the important role of low socioeconomic status in driving an elevated risk among Caribbean Hispanics.

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Diet Inflammatory Index and Dementia Incidence: A Population-Based Study

Neurology ◽

10.1212/wnl.0000000000012973 ◽

2021 ◽

pp. 10.1212/WNL.0000000000012973

Author(s):

Sokratis Charisis ◽

Eva Ntanasi ◽

Mary Yannakoulia ◽

Costas A Anastasiou ◽

Mary H Kosmidis ◽

...

Keyword(s):

Proportional Hazards ◽

Population Based ◽

Cox Proportional Hazards ◽

Community Dwelling ◽

Dietary Interventions ◽

Clinical Criteria ◽

Inflammatory Index ◽

Incident Dementia ◽

Dementia Incidence ◽

Increased Risk

Background and objectives:Aging is characterized by a functional shift of the immune system towards a proinflammatory phenotype. This derangement has been associated with cognitive decline and has been implicated in the pathogenesis of dementia. Diet can modulate systemic inflammation; thus, it may be a valuable tool to counteract the associated risks for cognitive impairment and dementia. The present study aimed to explore the associations between the inflammatory potential of diet, assessed using an easily applicable, population-based, biomarker-validated diet inflammatory index (DII), and the risk for dementia in community-dwelling older adults.Methods:Individuals from the Hellenic Longitudinal Investigation of Aging and Diet (HELIAD) were included in the present cohort study. Participants were recruited through random population sampling, and were followed for a mean of 3.05 (SD=0.85) years. Dementia diagnosis was based on standard clinical criteria. Those with baseline dementia and/or missing cognitive follow-up data were excluded from the analyses. The inflammatory potential of diet was assessed through a DII score which considers literature-derived associations of 45 food parameters with levels of pro- and anti-inflammatory cytokines in the blood; higher values indicated a more pro-inflammatory diet. Consumption frequencies were derived from a detailed food frequency questionnaire, and were standardized to representative dietary intake normative data from 11 different countries. Analysis of dementia incidence as a function of baseline DII scores was performed by Cox proportional hazards models.Results:Analyses included 1059 individuals (mean age=73.1 years; 40.3% males; mean education=8.2 years), 62 of whom developed incident dementia. Each additional unit of DII was associated with a 21% increase in the risk for dementia incidence [HR=1.21 (1.03 – 1.42); p=0.023]. Compared to participants in the lowest DII tertile, participants in the highest one (maximal pro-inflammatory diet potential) were 3 [(1.2 – 7.3); p=0.014] times more likely to develop incident dementia. The test for trend was also significant, indicating a potential dose-response relationship (p=0.014).Conclusions:In the present study, higher DII scores (indicating greater pro-inflammatory diet potential) were associated with an increased risk for incident dementia. These findings might avail the development of primary dementia preventive strategies through tailored and precise dietary interventions.

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Alpha-1 blocker use increased risk of subsequent renal cell carcinoma: A nationwide population-based study in Taiwan

PLoS ONE ◽

10.1371/journal.pone.0242429 ◽

2020 ◽

Vol 15 (11) ◽

pp. e0242429

Author(s):

Shian-Ying Sung ◽

Trang Thi Huynh Le ◽

Jin- Hua Chen ◽

Teng-Fu Hsieh ◽

Chia-Ling Hsieh

Keyword(s):

Renal Cell Carcinoma ◽

Cell Carcinoma ◽

Renal Cell ◽

Proportional Hazards ◽

Population Based ◽

Cox Proportional Hazards ◽

Research Database ◽

Antihypertensive Medications ◽

Increased Risk ◽

Underlying Mechanisms

Elevated Renal cell carcinoma (RCC) risk has been associated with the use of several antihypertensive medications but has not yet been elucidated in the populations prescribed alpha-1 blockers that are commonly used in the treatment of hypertension and lower urinary tract symptoms associated with benign prostatic hyperplasia (LUTS-BPH). The aim of the present study was to investigate the association between alpha-1 blocker use and the risk of developing RCC using a nationwide population-based database in Taiwan. Patients who were treated with alpha-1 blockers for at least 28 days were identified through the Taiwan National Health Insurance Research Database from 2000 to 2010. The unexposed participants were matched with the exposed cases according to age, sex, and index year at a ratio of 3:1. Cox proportional hazards regression, stratified by sex and comorbidities and adjusted for age, was performed to estimate hazard ratios (HRs) for the risk of subsequent RCC. Among 2,232,092 subjects, patients who received alpha-1 blocker treatment had a higher risk of RCC than the unexposed group. Taking into account hypertension and BPH, the adjusted HR was significantly higher in male alpha-1 blocker users who had no BPH and either the presence (HR: 1.63, 95% confidence interval [CI] = 1.22–2.18) or absence (HR: 2.31, 95% CI = 1.40–3.81) of hypertension than in men not receiving these drugs. Taken together, male alpha-1 blocker users who had no comorbidity of BPH exhibited an increased risk for developing RCC independent of hypertension. Further study is warranted to elucidate the underlying mechanisms of this association.

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