scholarly journals A contemporary survival analysis of individuals with cystic fibrosis: a cohort study

2014 ◽  
Vol 45 (3) ◽  
pp. 670-679 ◽  
Author(s):  
Anne L. Stephenson ◽  
Melissa Tom ◽  
Yves Berthiaume ◽  
Lianne G. Singer ◽  
Shawn D. Aaron ◽  
...  
Keyword(s):  
Risk Factors ◽  
Cystic Fibrosis ◽  
Proportional Hazards ◽  
Patient Characteristics ◽  
Population Based ◽  
Forced Expiratory Volume ◽  
Cox Proportional Hazards ◽  
Risk Of Death ◽  
Cox Proportional Hazards Models ◽  
Increased Risk

Previously established predictors of survival may no longer apply in the current era of cystic fibrosis (CF) care. Our objective was to identify risk factors associated with survival in a contemporary CF population.We used the Canadian CF Registry, a population-based cohort, to calculate median age of survival and summarise patient characteristics from 1990 to 2012. Clinical, demographic and geographical factors, and survival were estimated for a contemporary cohort (2000–2012) using Cox proportional hazards models.There were 5787 individuals in the registry between 1990 and 2012. Median survival age increased from 31.9 years (95% CI 28.3–35.2 years) in 1990 to 49.7 years (95% CI 46.1–52.2 years) in the most current 5-year window ending in 2012. Median forced expiratory volume in 1 s improved (p=0.04) and fewer subjects were malnourished (p<0.001) over time. Malnourished patients (hazard ratio (HR) 2.1, 95% CI 1.6–2.8), those with multiple exacerbations (HR 4.5, 95% CI 3.2–6.4) and women with CF-related diabetes (HR 1.8, 95% CI 1.2–2.7) were at increased risk of death.Life expectancy in Canadians with CF is increasing. Modifiable risk factors such as malnutrition and pulmonary exacerbations are associated with an increased risk of death. The sex gap in CF survival may be explained by an increased hazard for death in women with CF-related diabetes.

Abstract P378: Risk Factors for Incident Venous Thrombosis and their Associations with Recurrence

Circulation ◽  
2014 ◽  
Vol 129 (suppl_1) ◽  
Author(s):  
Kerri L Wiggins ◽  
Laura B Harrington ◽  
Marc Blondon ◽  
Kenneth M Rice ◽  
Colleen M Sitlani ◽  
...  
Keyword(s):  
Risk Factors ◽  
Venous Thrombosis ◽  
Proportional Hazards ◽  
Anticoagulation Therapy ◽  
Population Based ◽  
Cox Proportional Hazards ◽  
Time Dependent ◽  
Vein Thrombosis ◽  
Cox Proportional Hazards Models ◽  
Increased Risk

Background: Risk factors for incident venous thrombosis (VT) have been studied extensively, yet less is known about risk factors for recurrent VT in population-based settings. Objective: To evaluate whether established risk factors for incident VT are associated with recurrent VT in women. Methods: In a population-based, case-control study, we identified 1575 incident VT cases in 2002-2010 among women aged 18-89 and 3254 matched controls. Incident VT cases were followed for VT recurrence, defined by physician diagnosis with clinical and/or imaging evidence of a new or expanded clot. We used separate Cox proportional hazards models to evaluate the association of risk factors, assessed at the time of the incident VT, with the hazard of VT recurrence. Established risk factors for incident VT included: age, race, body mass index (BMI), hospitalization or inpatient surgery ≤30 days prior to event, recent cancer diagnosis or treatment, history of cardiovascular disease, and current estrogen use (oral contraceptive or hormone therapy). Incident VT characteristics (distal vs. proximal deep vein thrombosis [DVT] and pulmonary embolism [PE] with or without DVT) were also evaluated. Models were adjusted for all factors simultaneously and were run with and without adjustment for time-dependent oral anticoagulation therapy (OAT). Risk factors were assessed by chart review, telephone interview, and computerized pharmacy records. Results: For these interim analyses, follow-up data were available for 1285 women who were followed for a mean of 39.6 months with a 13% probability of a recurrent VT at 3 years. Higher BMI and recent cancer were associated with an increased risk of recurrent VT. When time-dependent OAT was included in the models, estimates were essentially unchanged. Conclusions: In our population-based study, most risk factors for incident VT were poor predictors of recurrence. However, we provide further evidence that BMI and recent cancers are associated with modestly increased hazards of VT recurrence in women.

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

2016 ◽  
Vol 2 (3_suppl) ◽  
pp. 76s-76s ◽  
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.

scholarly journals Long-term cardiovascular and cerebrovascular morbidity in Israeli thyroid cancer survivors

2019 ◽  
Vol 8 (4) ◽  
pp. 398-406 ◽  
Author(s):  
Elena Izkhakov ◽  
Joseph Meyerovitch ◽  
Micha Barchana ◽  
Yacov Shacham ◽  
Naftali Stern ◽  
...  
Keyword(s):  
Thyroid Cancer ◽  
Thyroid Disease ◽  
Proportional Hazards ◽  
Population Based ◽  
Cox Proportional Hazards ◽  
Control Group ◽  
Study Group ◽  
American Thyroid Association ◽  
Cox Proportional Hazards Models ◽  
Increased Risk

Objective Thyroid cancer (TC) survivors may be at risk of subsequent cardiovascular and cerebrovascular (CaV&CeV) morbidity. The 2009 American Thyroid Association (ATA) guidelines recommended less aggressive treatment for low-risk TC patients. The aim of this study was to assess the atherosclerotic CaV&CeV outcome of Israeli TC survivors compared to individuals with no thyroid disease, and the atherosclerotic CaV&CeV outcome before (2000–2008) and after (2009–2011) implementation of the 2009 ATA guidelines. Methods All members of the largest Israeli healthcare organization who were diagnosed with TC from 1/2000 to 12/2014 (study group) and age- and sex-matched members with no thyroid disease (controls) were included. Adjusted hazard ratios (HRs) and 95% confidence intervals (95% CIs) were calculated using Cox proportional hazards models. Results The mean follow-up was 7.6 ± 4.2 and 7.8 ± 4.1 years for the study (n = 5,677, 79% women) and control (n = 23,962) groups, respectively. The former had an increased risk of new atherosclerotic CaV&CeV events (adjusted HR 1.26, 95% CI 1.15–1.39). The 5-year incidence of CaV&CeV was lower (adjusted HR 0.49, 95% CI 0.38–0.62) from 2009 to 2011 compared to 2000 to 2008, but remained higher in the study group than in the control group (adjusted HR 1.5, 95% CI 1.14–1.69). Conclusions This large Israeli population-based cohort study showed greater atherosclerotic CaV&CeV morbidity in TC survivors compared to individuals with no thyroid diseases. There was a trend toward a decreased 5-year incidence of atherosclerotic CaV&CeV events among TC survivors following the implementation of the 2009 ATA guidelines, but it remained higher compared to the general population.

scholarly journals Visual impairment and risk of dementia in two population-based prospective cohorts: UK Biobank and EPIC-Norfolk

2021 ◽  
Author(s):  
Thomas J Littlejohns ◽  
Shabina Hayat ◽  
Robert Luben ◽  
Carol Brayne ◽  
Megan Conroy ◽  
...  
Keyword(s):  
Visual Impairment ◽  
Proportional Hazards ◽  
Population Based ◽  
Cox Proportional Hazards ◽  
Uk Biobank ◽  
Cox Proportional Hazards Models ◽  
Hazard Ratios ◽  
Promising Target ◽  
Increased Risk

Abstract Visual impairment has emerged as a potential modifiable risk factor for dementia. However, there are a lack of large studies with objective measures of vison and with more than ten years of follow-up. We investigated whether visual impairment is associated with an increased risk of incident dementia in UK Biobank and EPIC-Norfolk. In both cohorts, visual acuity was measured using a “logarithm of the minimum angle of resolution” (LogMAR) chart and categorised as no (≤0.30 LogMAR), mild (&gt;0.3 - ≤0.50 LogMAR), and moderate to severe (&gt;0.50 LogMAR) impairment. Dementia was ascertained through linkage to electronic medical records. After restricting to those aged ≥60 years, without prevalent dementia and with eye measures available, the analytic samples consisted of 62,206 UK Biobank and 7,337 EPIC-Norfolk participants, respectively. In UK Biobank and EPIC-Norfolk. respectively, 1,113 and 517 participants developed dementia over 11 and 15 years of follow-up. Using multivariable cox proportional-hazards models, the hazard ratios for mild and moderate to severe visual impairment were 1.26 (95% Confidence Interval [CI] 0.92-1.72) and 2.16 (95% CI 1.37-3.40), in UK Biobank, and 1.05 (95% CI 0.72-1.53) and 1.93 (95% CI 1.05-3.56) in EPIC-Norfolk, compared to no visual impairment. When excluding participants censored within 5 years of follow-up or with prevalent poor or fair self-reported health, the direction of the associations remained similar for moderate impairment but were not statistically significant. Our findings suggest visual impairment might be a promising target for dementia prevention, however the possibility of reverse causation cannot be excluded.

Early hemoglobin decline and survival prognosis in epoetin alfa studies

2009 ◽  
Vol 27 (15_suppl) ◽  
pp. 9625-9625
Author(s):  
J. A. Berlin ◽  
P. J. Bowers ◽  
S. Rao ◽  
S. Sun ◽  
K. Liu ◽  
...  
Keyword(s):  
Proportional Hazards ◽  
Cox Proportional Hazards ◽  
Time Dependent ◽  
Epoetin Alfa ◽  
Survival Prognosis ◽  
Proportional Hazards Models ◽  
Risk Of Death ◽  
Cox Proportional Hazards Models ◽  
Level Data ◽  
Increased Risk

9625 Background: When cancer patients (pts) with chemotherapy-induced anemia (CIA) respond to erythropoietic-stimulating agents (ESA), hemoglobin (Hb) typically increases within 4–8 weeks. This exploratory analysis examined whether mortality differs depending on Hb response after 4 or 8 weeks of epoetin alfa (EPO) treatment or depending on transfusion. Methods: Pt-level data were analyzed from 31 randomized studies (7,215 pts) of epoetin alfa vs non-EPO (15 studies) or placebo (16 studies) in pts with CIA. A landmark analysis was used; Hb change was set at a specific time (4 and 8 weeks) and subsequent survival was examined separately for EPO and placebo. Pts were categorized as “Hb increased” (>0.5 g/dL), “Hb decreased” (>0.5 g/dL), or “Hb stable” (within ±0.5 g/dL) compared to baseline. Hb stable was compared to other Hb change categories with Cox proportional hazards models, stratified by study and adjusted for potential confounders. Results: The hazard ratio (HR) for Hb decreased versus Hb stable at 4 weeks was 1.44 for EPO (95% CI: 1.04, 1.99), indicating worse survival for pts with a decline in Hb. This association was weaker for placebo (HR: 1.12; 95% CI: 0.74, 1.67). Increased risk with declining Hb in EPO-treated pts was most pronounced in studies that maintained Hb ≥12 g/dL or treated pts for >12–16 weeks (1,876 pts). Patterns were similar using the 8-week landmark. In both EPO-treated and placebo pts, transfusion increased the rate of on-study death ∼3.5 fold (treating transfusion as a time-dependent variable). Conclusions: These exploratory findings suggest that both decreased Hb after 4 or 8 weeks of EPO treatment and transfusion are associated with increased risk of death. In spite of adjustment for other prognostic factors, it is likely that this association reflects poorer underlying prognosis of pts whose Hb fails to respond. ESAs should be discontinued in the absence of a Hb response. [Table: see text]

The Use of Multiple Correspondence Analysis and K-means to Explore Associations between Risk Factors and Patient Characteristics in Colorectal Cancer (Preprint)

2021 ◽  
Author(s):  
Dídac Florensa ◽  
Jordi Mateo ◽  
Francesc Solsona ◽  
Teresa Pedrol ◽  
Miquel Mesas ◽  
...  
Keyword(s):  
Colorectal Cancer ◽  
Risk Factors ◽  
Correspondence Analysis ◽  
Multiple Correspondence Analysis ◽  
Clinical History ◽  
Patient Characteristics ◽  
Population Based ◽  
Cross Sectional ◽  
Risk Of Death ◽  
Increased Risk

BACKGROUND Previous works have shown that risk factors are associated with an increased risk of colorectal cancer. OBJECTIVE The purpose of this study was to detect these associations in the region of Lleida (Catalonia) using Multiple Correspondence Analysis (MCA) and K-means. METHODS The cross-sectional study was made up of 1,085 colorectal cancer episodes between 2012 and 2015, extracted from the Population-based Cancer Registry (PCR) for the province of Lleida (Spain), the Primary Care Centers database and the Catalan Health Service Register. The relations between risk factors and patient characteristics were identified using MCA and K-means. RESULTS The combination of these techniques helps to detect clusters of patients with similars risk factors. Risk of death is associated with elderly people and obesity or overweight. Stage III is related with people aged ≥65 and rural/semi-urban population while younger people were related with stage 0. CONCLUSIONS MCA and K-means were a significant help for detecting associations between risk factors and patient characteristics. These techniques have proven to be effective tools for analyzing the incidence of some factors in colorectal cancer. The outcomes obtained help to corroborate suspected trends, as well as stimulating new hypotheses about the previous clinical history and how to prevent it.

scholarly journals Biomarkers Associated with Death After Initiating Treatment for Tuberculosis and HIV in Patients with Very Low CD4 Cells

2018 ◽  
Vol 3 (1) ◽  
pp. 46 ◽  
Author(s):  
Fred Richard Sattler ◽  
Daniel Chelliah ◽  
Xingye Wu ◽  
Alejandro Sanchez ◽  
Michelle A. Kendall ◽  
...  
Keyword(s):  
Proportional Hazards ◽  
Cox Proportional Hazards ◽  
C Reactive Protein ◽  
Retrospective Case ◽  
Reactive Protein ◽  
Risk Of Death ◽  
Cox Proportional Hazards Models ◽  
Increased Risk ◽  
Treatment Naïve ◽  
Low Bmi

Background: The risk of short-term death for treatment naive patients dually infected with Mycobacterium tuberculosis and HIV may be reduced by early anti-retroviral therapy. Of those dying, mechanisms responsible for fatal outcomes are unclear. We hypothesized that greater malnutrition and/or inflammation when initiating treatment are associated with an increased risk for death.Methods: We utilized a retrospective case-cohort design among participants of the ACTG A5221 study who had baseline CD4 < 50 cells/mm3. The case-cohort sample consisted of 51 randomly selected participants, whose stored plasma was tested for C-reactive protein, cytokines, chemokines, and nutritional markers. Cox proportional hazards models were used to assess the association of nutritional, inflammatory, and immunomodulatory markers for survival.Results: The case-cohort sample was similar to the 282 participants within the parent cohort with CD4 < 50 cells/mm3. In the case cohort, 7 (14%) had BMI < 16.5 (kg/m2) and 17 (33%) had BMI 16.5-18.5(kg/m2). Risk of death was increased per 1 IQR width higher of log10 transformed level of C-reactive protein (adjusted hazard ratio (aHR) = 3.42 [95% CI = 1.33-8.80],P = 0.011), interferon gamma (aHR = 2.46 [CI = 1.02-5.90], P = 0.044), MCP-3 (3.67 [CI = 1.08-12.42], P = 0.037), and with IL-15 (aHR = 2.75 [CI = 1.08-6.98], P = 0.033) and IL-17 (aHR = 3.99 [CI = -1.06-15.07], P = 0.041). BMI, albumin, hemoglobin, and leptin levels were not associated with risk of death.Conclusions: Unlike patients only infected with M. tuberculosis for whom malnutrition and low BMI increase the risk of death, this relationship was not evident in our dually infected patients. Risk of death was associated with significant increases in markers of global inflammation along with soluble biomarkers of innate and adaptive immunity.

scholarly journals Factors Predicting Treatment of World Trade Center-Related Lung Injury: A Longitudinal Cohort Study

2020 ◽  
Vol 17 (23) ◽  
pp. 9056
Author(s):  
Barbara Putman ◽  
Lies Lahousse ◽  
David G. Goldfarb ◽  
Rachel Zeig-Owens ◽  
Theresa Schwartz ◽  
...  
Keyword(s):  
Lung Injury ◽  
World Trade ◽  
Proportional Hazards ◽  
World Trade Center ◽  
Patient Characteristics ◽  
Forced Expiratory Volume ◽  
Cox Proportional Hazards ◽  
Beta Agonist ◽  
Cox Proportional Hazards Models ◽  
Trade Center

The factors that predict treatment of lung injury in occupational cohorts are poorly defined. We aimed to identify patient characteristics associated with initiation of treatment with inhaled corticosteroid/long-acting beta-agonist (ICS/LABA) >2 years among World Trade Center (WTC)-exposed firefighters. The study population included 8530 WTC-exposed firefighters. Multivariable logistic regression assessed the association of patient characteristics with ICS/LABA treatment for >2 years over two-year intervals from 11 September 2001–10 September 2017. Cox proportional hazards models measured the association of high probability of ICS/LABA initiation with actual ICS/LABA initiation in subsequent intervals. Between 11 September 2001–1 July 2018, 1629/8530 (19.1%) firefighters initiated ICS/LABA treatment for >2 years. Forced Expiratory Volume in 1 s (FEV1), wheeze, and dyspnea were consistently and independently associated with ICS/LABA treatment. High-intensity WTC exposure was associated with ICS/LABA between 11 September 2001–10 September 2003. The 10th percentile of risk for ICS/LABA between 11 September 2005–10 Septmeber 2007 was associated with a 3.32-fold increased hazard of actual ICS/LABA initiation in the subsequent 4 years. In firefighters with WTC exposure, FEV1, wheeze, and dyspnea were independently associated with prolonged ICS/LABA treatment. A high risk for treatment was identifiable from routine monitoring exam results years before treatment initiation.

scholarly journals Survival of patients with rare diseases: a population-based study in Tuscany (Italy)

2021 ◽  
Vol 16 (1) ◽  
Author(s):  
Francesca Gorini ◽  
Alessio Coi ◽  
Lorena Mezzasalma ◽  
Silvia Baldacci ◽  
Anna Pierini ◽  
...  
Keyword(s):  
Rare Diseases ◽  
Proportional Hazards ◽  
Large Population ◽  
Circulatory System ◽  
Population Based ◽  
Cox Proportional Hazards ◽  
Public Health Issue ◽  
Risk Of Death ◽  
Increased Risk ◽  
Circulatory System Diseases

Abstract Background Rare diseases (RDs) encompass a heterogeneous group of life-threatening or chronically debilitating conditions that individually affect a small number of subjects but overall represent a major public health issue globally. There are still limited data on RD burden due to the paucity of large population-based epidemiological studies. The aim of this research was to provide survival estimates of patients with a RD residing in Tuscany, Italy. Methods Cases collected in the Rare Diseases Registry of Tuscany with diagnosis between 1st January 2000 and 31th December 2018 were linked to the regional health databases in order to retrieve information on mortality of all subjects. Survival at 1, 5 and 10 years from diagnosis with 95% confidence intervals (CI) was estimated by sex, age class, nosological group and subgroup using the Kaplan–Meier method. The effect of sex, age and period of diagnosis (years 2000–2009 or 2010–2018) on survival was estimated using Cox proportional hazards regression. Results Survival at 1, 5 and 10 years from diagnosis was 97.3%, 88.8% and 80.8%, respectively. Respiratory diseases and peripheral and central nervous system disorders were characterized by the lowest survival at 5 and 10 years. Despite a modest higher prevalence of RDs among females (54.0% of the total), male cases had a significant increased risk of death (hazard ratio, HR 1.48, 95% CI 1.38–1.58). Cases diagnosed during 2010–2018 period had a risk of death significantly lower than those diagnosed during 2000–2009 (HR 0.81, 95% CI 0.82–0.96), especially for immune system disorders (HR 0.48, 95% CI 0.26–0.87), circulatory system diseases (HR 0.61, 95% CI 0.45–0.84) and diseases of the musculoskeletal system and connective tissue (HR 0.64, 95% CI 0.49–0.84). Conclusions An earlier diagnosis as well as the improvement in the efficacy of treatment resulted in a decreased risk of death over the years for specific RDs. The linkage between a population-based registry and other regional databases exploited in this study provides a large and accurate mass of data capable of estimating patients’ life-expectancy and increasing knowledge on the collective burden of RDs.

scholarly journals History of premorbid depression is a risk factor for COVID-related mortality: Analysis of a retrospective cohort of 1,387 COVID+ patients

2020 ◽  
Author(s):  
Sean Clouston ◽  
Benjamin J Luft ◽  
Edward Sun
Keyword(s):  
Risk Factors ◽  
Risk Factor ◽  
Proportional Hazards ◽  
Cox Proportional Hazards ◽  
Cox Proportional Hazards Models ◽  
Risk Of Mortality ◽  
Increased Risk ◽  
History Of ◽  
History Of Depression ◽  
Related Mortality

Background: The goal of the present work was to examine risk factors for mortality in a 1,387 COVID+ patients admitted to a hospital in Suffolk County, NY. Methods: Data were collated by the hospital epidemiological service for patients admitted from 3/7/2020-9/1/2020. Time until final discharge or death was the outcome. Cox proportional hazards models were used to estimate time until death among admitted patients. Findings: In total, 99.06% of cases had resolved leading to 1,179 discharges and 211 deaths. Length of stay was significantly longer in those who died as compared to those who did not p=0.007). Of patients who had been discharged (n=1,179), 54 were readmitted and 9 subsequently died. Multivariable-adjusted Cox proportional hazards regression revealed that in addition to older age, male sex, and heart failure, a history of premorbid depression was a risk factor for COVI-19 mortality. Interpretation: While an increasing number of studies have shown effects linking cardiovascular risk factors with increased risk of mortality in COVID+ patients, this study reports that history of depression is a risk factor for COVID mortality.

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