Colorectal cancer survival among Ministry of National Guard-Health Affairs (MNG-HA) population 2009–2017: retrospective study

Abstract Background Colorectal cancer (CRC) is the most diagnosed cancer among males and third among females in Saudi Arabia, with up to two-third diagnosed at advanced stage. The objective of our study was to estimate CRC survival and determine prognostic factors. Methods Ministry of National Guard- Health Affairs (MNG-HA) registry data was utilized to identify patients diagnosed with CRC between 2009 and 2017. Cases were followed until December 30th, 2017 to assess their one-, three-, and five-year CRC-specific survivals. Kaplan-Meier method and Cox proportional hazard models were used to assess survival from CRC. Results A total of 1012 CRC patients were diagnosed during 2009–2017. Nearly, one-fourth of the patients presented with rectal tumor, 42.89% with left colon and 33.41% of the cases were diagnosed at distant metastasis stage. The overall one-, three-, and five-year survival were 83, 65 and 52.0%, respectively. The five-year survival was 79.85% for localized stage, 63.25% for regional stage and 20.31% for distant metastasis. Multivariate analyses showed that age, diagnosis period, stage, nationality, basis of diagnosis, morphology and location of tumor were associated with survival. Conclusions Findings reveal poor survival compared to Surveillance, Epidemiology, and End Results (SEER) population. Diagnoses at late stage and no surgical and/or perioperative chemotherapy were associated with increased risk of death. Population-based screening in this population should be considered.

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The risk of metachronous cancers in patients with small-intestinal carcinoid tumors: a US population-based study

Endocrine Related Cancer ◽

10.1530/erc-11-0392 ◽

2012 ◽

Vol 19 (3) ◽

pp. 381-387 ◽

Cited By ~ 12

Author(s):

Sunil Amin ◽

Richard R P Warner ◽

Steven H Itzkowitz ◽

Michelle Kang Kim

Keyword(s):

Small Bowel ◽

Population Based ◽

Proportional Hazard ◽

Population Based Study ◽

Cox Proportional Hazard ◽

Kaplan Meier ◽

Increased Risk ◽

Before And After ◽

Cox Proportional Hazard Models ◽

Small Intestinal

Small-intestinal carcinoids (SIC) are the most common small-bowel malignancies. We sought to determine the risk of developing SIC before and after other primary malignancies (PM) and the prognosis of patients with SIC, with and without another PM. We used the Surveillance, Epidemiology, and End Results database to identify patients diagnosed with SICs between 1973 and 2007. Multiple primary-standardized incidence ratios were calculated as an approximation of relative risk (RR) to explore the association of SICs with metachronous malignancies. Survival analysis was performed using Kaplan–Meier methods and Cox proportional-hazard models. Among 8331 patients with SICs, 2424 (29%) had another PM at some time. The most common sites were prostate (26.2%), breast (14.3%), colon (9.1%), lung/bronchus (6.3%), and bladder (5.3%). Overall, 67% of patients had a PM diagnosed before SIC (pre-SIC), 33% after SIC (post-SIC), and 8% had a PM both before and after SIC. Among the pre-SIC group, the risk of future SIC was increased after cancers of the small bowel (RR 11.86 (95% CI: 6.13–20.72)), esophagus (4.05 (1.10–10.36)), colon (1.39 (1.05–1.81)), kidney (1.93 (1.12–3.09)), prostate (1.38 (1.17–1.62)), and leukemia (2.15 (1.18–3.61)). Among the post-SIC group, there was an increased risk of future PM of the small bowel (8.78 (4.54–15.34)), liver (2.49 (1.08–4.91)), prostate (1.25 (1.0–1.53)), and thyroid (2.73 (1.10–5.62)). Compared to patients with only SIC, those with a PM pre-SIC had worse mean survival (57.9 vs 40.9 months, HR 1.55 (1.42–1.69), P<0.001). In conclusion, almost one-third of patients with SICs have an associated metachronous primary tumor. When these primaries occur prior to (but not after) the SIC diagnosis, the prognosis is worse than with an initial SIC. The type of malignancies associated with SICs may guide future screening efforts.

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Increased risk of rheumatoid arthritis among patients with endometriosis: a nationwide population-based cohort study

Rheumatology ◽

10.1093/rheumatology/keaa784 ◽

2020 ◽

Author(s):

Yu-Hao Xue ◽

Liang-Tian You ◽

Hsin-Fu Ting ◽

Yu-Wen Chen ◽

Zi-Yun Sheng ◽

...

Keyword(s):

Cohort Study ◽

Retrospective Cohort Study ◽

Retrospective Cohort ◽

Propensity Scores ◽

Population Based ◽

Cox Proportional Hazard ◽

Kaplan Meier ◽

Increased Risk ◽

Potential Risks ◽

Using Data

Abstract Objectives Autoimmunity may play a role in endometriosis. The association between endometriosis and RA remains unknown. This study was conducted to identify any evidence for this relationship. Methods This 13-year, nationwide, population-based, retrospective cohort study analysed the risk of RA in a cohort of individuals with endometriosis. We investigated the incidence of RA among patients with endometriosis using data from the Longitudinal Health Insurance Database 2000, which is maintained by the Taiwan National Health Research Institutes. We used propensity scores to match comorbidities in the two cohorts. Kaplan–Meier analysis and Cox proportional hazard model were employed to analyse the association between endometriosis and RA among patients with different potential risks. Results Patients with endometriosis [adjusted hazard ratio (HR) 1.75, 95% CI 1.27, 2.41], aged ≥45 years (adjusted HR 1.50, 95% CI 1.06–2.13) and with autoimmune disease (adjusted HR 6.99, 95% CI 2.84–17.21) had a significantly higher risk of RA. The analyses also showed that when stratified by age, comorbidities and medication use, the risk of RA in patients with endometriosis was also higher than in those without endometriosis. Conclusions This 14-year, nationwide, population-based retrospective cohort study revealed that patients with endometriosis have a higher risk of RA. In the clinical management of patients with RA, rheumatologists should be especially mindful of the possibility of underlying endometriosis.

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Colorectal Cancer Survival in 50- to 69-Year-Olds after Introducing the Faecal Immunochemical Test

Cancers ◽

10.3390/cancers12092412 ◽

2020 ◽

Vol 12 (9) ◽

pp. 2412

Author(s):

María Angeles Gutierrez-Stampa ◽

Vanessa Aguilar ◽

Cristina Sarasqueta ◽

Joaquín Cubiella ◽

Isabel Portillo ◽

...

Keyword(s):

Colorectal Cancer ◽

Cancer Survival ◽

Gastrointestinal Symptoms ◽

Diagnostic Strategy ◽

Rank Tests ◽

Faecal Immunochemical Test ◽

Risk Of Death ◽

Kaplan Meier ◽

Immunochemical Test ◽

Group 3

Population screening has improved early diagnosis of colorectal cancer (CRC). Nonetheless, most cases are diagnosed in symptomatic patients. Faecal immunochemical testing has been recommended for assessing patients with lower gastrointestinal symptoms, but whether it improves patient survival is unknown. Our objective was to compare CRC survival in 50- to 69-year-olds between asymptomatic screen-detected patients and symptomatic patients by route to diagnosis. Methods: We identified all cases of CRC diagnosed in 50-to 69-year-olds between 2009 and 2016, in Donostialdea (Gipuzkoa, Spain). Three groups were created: 1-screen-detected CRC; 2-CRC detected in symptomatic patients after a positive faecal immunochemical test(FIT); and 3-CRC detected in symptomatic patients without a FIT or after a negative result. We analysed survival using the Kaplan-Meier method and log-rank tests. Results: Of 930 patients diagnosed with CRC, 433 cases were detected through screening and 497 in symptomatic patients, 7.9% after a positive FIT and 45.5% by other means. The 3-year CRC survival was significantly lower in group 3 (69.5%) than groups 1 (93%; p = 0.007) or 2 (87.5%; p = 0.02). The risk of death was lower in groups 1 (HR 0.42, 95% CI 0.30–0.58) and 2 (HR 0.51; 95% CI 0.29–0.87). Conclusion: Half of CRC cases in 50- to 69-year-olds are diagnosed outside screening. Use of the FIT as a diagnostic strategy in symptomatic patients may improve survival.

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

10.2196/preprints.29056 ◽

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.

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Sex-specific temporal trends in ambulatory heart failure incidence, mortality and hospitalisation in Ontario, Canada from 1994 to 2013: a population-based cohort study

BMJ Open ◽

10.1136/bmjopen-2020-044126 ◽

2020 ◽

Vol 10 (11) ◽

pp. e044126

Author(s):

Louise Y Sun ◽

Lisa M Mielniczuk ◽

Peter P Liu ◽

Rob S Beanlands ◽

Sharon Chih ◽

...

Keyword(s):

Heart Failure ◽

Cohort Study ◽

Temporal Trends ◽

Population Based ◽

Outpatient Setting ◽

Secondary Outcome ◽

Cox Proportional Hazard ◽

Kaplan Meier ◽

Cox Proportional Hazard Models ◽

New Diagnosis

ObjectivesTo examine the temporal trends in mortality and heart failure (HF) hospitalisation in ambulatory patients following a new diagnosis of HF.DesignRetrospective cohort studySettingOutpatientParticipantsOntario residents who were diagnosed with HF in an outpatient setting between 1994 and 2013.Primary and secondary outcome measuresThe primary outcome was all-cause mortality within 1 year of diagnosis and the secondary outcome was HF hospitalisation within 1 year. Risks of mortality and hospitalisation were calculated using the Kaplan-Meier method and the relative hazard of death was assessed using multivariable Cox proportional hazard models.ResultsA total of 352 329 patients were studied (50% female). During the study period, there was a greater decline in age standardised 1-year mortality rates (AMR) in men (33%) than in women (19%). Specifically, female AMR at 1 year was 10.4% (95% CI 9.1% to 12.0%) in 1994 and 8.5% (95% CI 7.5% to 9.5%) in 2013, and male AMR at 1 year was 12.3% (95% CI 11.1% to 13.7%) in 1994 and 8.3% (95% CI 7.5% to 9.1%) in 2013. Conversely, age standardised HF hospitalisation rates declined in men (11.4% (95% CI 10.1% to 12.9%) in 1994 and 9.1% (95% CI 8.2% to 10.1%) in 2013) but remained unchanged in women (9.7% (95% CI 8.3% to 11.3%) in 1994 and 9.8% (95% CI 8.6% to 11.0%) in 2013).ConclusionAmong patients with HF over a 20-year period, there was a greater improvement in the prognosis of men compared with women. Further research should focus on the determinants of this disparity and ways to reduce this gap in outcomes.

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Primary aldosteronism is associated with risk of urinary bladder stones in a nationwide cohort study

Scientific Reports ◽

10.1038/s41598-021-86749-3 ◽

2021 ◽

Vol 11 (1) ◽

Author(s):

Mu-Chi Chung ◽

Cheng-Li Lin ◽

Ming-Ju Wu ◽

Cheng-Hsu Chen ◽

Jeng-Jer Shieh ◽

...

Keyword(s):

Cohort Study ◽

Primary Aldosteronism ◽

Risk Model ◽

Population Based ◽

Bladder Stones ◽

Risk Of Death ◽

Cox Proportional Hazard ◽

Hazard Ratios ◽

Taiwan National Health Insurance ◽

Cox Proportional Hazard Models

AbstractWe analyzed database from the Taiwan National Health Insurance to investigate whether primary aldosteronism (PA) increases the risk of bladder stones. This retrospective nationwide population-based cohort study during the period of 1998–2011 compared patients with and without PA extracted by propensity score matching. Cox proportional hazard models and competing death risk model were used to estimate the hazard ratios (HRs), sub-hazard ratios (SHRs) and corresponding 95% confidence intervals (CIs). There were 3442 patients with PA and 3442 patients without PA. The incidence rate of bladder stones was 5.36 and 3.76 per 1000 person-years for both groups, respectively. In adjusted Cox hazard proportional regression models, the HR of bladder stones was 1.68 (95% CI 1.20–2.34) for patients with PA compared to individuals without PA. Considering the competing risk of death, the SHR of bladder stones still indicates a higher risk for PA than a comparison cohort (SHR, 1.79; 95% CI 1.30–2.44). PA, age, sex, and fracture number were the variables significantly contributing to the formation of bladder stones. In conclusion, PA is significantly associated with risk of bladder stones.

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Post-Diagnostic Beta Blocker Use and Breast Cancer-Specific Mortality: A Population-Based Cohort Study

10.21203/rs.3.rs-1106678/v1 ◽

2021 ◽

Author(s):

Oliver William Scott ◽

Sandar TinTin ◽

J Mark Elwood ◽

Alana Cavadino ◽

Laurel A Habel ◽

...

Keyword(s):

Breast Cancer ◽

Beta Blockers ◽

Cancer Registries ◽

Population Based ◽

Hospital Discharges ◽

Cox Proportional Hazard ◽

Breast Cancer Outcomes ◽

Increased Risk ◽

Cox Proportional Hazard Models ◽

Cancer Specific Mortality

Abstract Purpose Beta blockers (BB) have been associated with improved, worsened, or unchanged breast cancer outcomes in previous studies. This study examines the association between the post-diagnostic use of BBs and death from breast cancer in a large, representative sample of New Zealand (NZ) women with breast cancer. Methods Women diagnosed with a first primary breast cancer between 2007 and 2016 were identified from four population-based regional NZ breast cancer registries and linked to national pharmaceutical data, hospital discharges, and death records. The median follow up time was 4.51 years. Cox proportional hazard models were used to estimate the hazard of breast cancer-specific death (BCD) associated with post-diagnostic BB use. Results Of the 14,976 women included in analyses, 21% used a BB after diagnosis. BB use (vs non-use) was associated with a small and non-statistically significant increased risk of BCD ( adjusted hazard ratio: 1.11; 95% CI: 0.95-1.29). A statistically significant increased risk confined to short-term use (0-3 months) was seen (HR=1.40; 1.14-1.73), and this risk steadily decreased with increasing duration of use and became a statistically significant protective effect at 3+ years of use (HR=0.54; 0.34-0.87). Conclusion Our findings suggest that any increased risk associated with BB use may be driven by risk in the initial few months of use. Long-term BB use may be associated with a reduction in BCD.

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Effect of comorbidity on the risk of death associated with antipsychotic use among community-dwelling older adults

International Psychogeriatrics ◽

10.1017/s1041610212000117 ◽

2012 ◽

Vol 24 (7) ◽

pp. 1058-1064 ◽

Cited By ~ 7

Author(s):

Natasa Gisev ◽

Sirpa Hartikainen ◽

Timothy F. Chen ◽

Mikko Korhonen ◽

J. Simon Bell

Keyword(s):

Older Adults ◽

Respiratory Disease ◽

Population Based ◽

Community Dwelling ◽

Risk Of Death ◽

Hazard Ratios ◽

Increased Risk ◽

Cox Proportional Hazard Models ◽

Antidepressant Use ◽

Community Dwelling Older Adults

ABSTRACTBackground: Antipsychotics are associated with adverse events and mortality among older adults with dementia. The objective of this study was to evaluate the risk of death associated with antipsychotic use among community-dwelling older adults with a range of comorbidities.Methods: This was a population-based cohort study of all 2,224 residents of Leppävirta, Finland, aged ≥65 years on 1 January 2000. Records of all reimbursed drug purchases were extracted from the Finnish National Prescription Register and diagnostic data were obtained from the Special Reimbursement Register. All-cause mortality was evaluated over a nine-year follow-up period. Time-dependent Cox proportional hazard models were used to compute unadjusted and adjusted hazard ratios (HRs) and 95% confidence intervals (CIs) of mortality of antipsychotic use compared to non-use.Results: In total, 332 residents used antipsychotics between 2000 and 2008. The unadjusted HR for risk of death associated with antipsychotic use was 2.71 (95% CI = 2.3–3.2). After adjusting for baseline age, sex, antidepressant use, and diagnostic confounders, the HR was 2.07 (95% CI = 1.73–2.47). The adjusted HR was the highest among antipsychotic users with baseline respiratory disease (HR = 2.21, 95% CI = 1.30–3.76).Conclusions: The increased risk of death associated with antipsychotic use was similar across diagnostic categories, the highest being among those with baseline respiratory disease. However, the results should be interpreted with caution, as the overall sample size of antipsychotic users was small. As in other observational studies, residual confounding may account for the higher mortality observed among antipsychotic users. Further research is needed to confirm these findings.

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The effect of marital status on stage at diagnosis and survival in Saudis diagnosed with colorectal cancer: cancer registry analysis

Scientific Reports ◽

10.1038/s41598-021-88042-9 ◽

2021 ◽

Vol 11 (1) ◽

Author(s):

Mesnad Alyabsi ◽

Majed Ramadan ◽

Mohammed Algarni ◽

Kanan Alshammari ◽

Abdul Rahman Jazieh

Keyword(s):

Colorectal Cancer ◽

Marital Status ◽

Cancer Registry ◽

National Guard ◽

Early Stage ◽

Stage At Diagnosis ◽

Risk Of Death ◽

Kaplan Meier ◽

Registry Analysis

AbstractColorectal cancer (CRC) is the most common cancer in males and third in females in Saudi Arabia, with the majority (66%) diagnosed at a late stage. We evaluated the effect of marital status on stage at diagnosis and CRC survival. We hypothesized that married patients would be more likely to present at an early stage and have higher survival than unmarried patients. The Ministry of National Guard-Health Affairs (MNG-HA) cancer registry was used to identify patients diagnosed with CRC from 2009 to 2017. A competing risk analysis was performed to assess the 5-year CRC-specific survival, adjusting for potential confounders. The Kaplan–Meier method and the Cox regressions were used to assess survival. Two-thirds (76.50%) of the 936 CRC patients were married, 11.64% were unmarried, and 11.86% had an unknown marital status. With multiple imputation-based analysis, the multivariate analysis indicated that unmarried patients were 52% more likely to present at an advanced stage [adjusted odds ratio (aOR) 1.52; 95% CI 1.33–1.73], and had a 30% higher risk of death due to CRC compared to the married patients (aHR 1.30; CI 1.17, 1.44). Future CRC screening and survivorship programs should assess the needs of the vulnerable unmarried population. Interventions supporting the early detection of CRC in this population may be beneficial in the long term and lead to improved cancer outcomes.

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The Influence of Early Menopause on Cardiovascular Risk in Women with Rheumatoid Arthritis

The Journal of Rheumatology ◽

10.3899/jrheum.131234 ◽

2014 ◽

Vol 41 (7) ◽

pp. 1270-1275 ◽

Cited By ~ 5

Author(s):

Emily C. Pfeifer ◽

Cynthia S. Crowson ◽

Shreyasee Amin ◽

Sherine E. Gabriel ◽

Eric L. Matteson

Keyword(s):

Rheumatoid Arthritis ◽

Hormone Replacement ◽

Population Based ◽

Proportional Hazard ◽

Inception Cohort ◽

Early Menopause ◽

American College Of Rheumatology ◽

Cox Proportional Hazard ◽

Increased Risk ◽

Cox Proportional Hazard Models

Objective.Early menopause is associated with an increased risk for developing rheumatoid arthritis (RA). The risk for cardiovascular disease (CVD) in women increases following menopause. Because RA is associated with an increased risk of CVD, this study was undertaken to determine whether early menopause affects the risk of developing CVD in women with RA.Methods.A population-based inception cohort of 600 women with RA who fulfilled 1987 American College of Rheumatology criteria for RA between 1955 and 2007 and were age ≥ 45 years at diagnosis was assembled and followed. Age at menopause and duration of hormone replacement therapy, along with occurrence of CVD, was ascertained by review of medical records. Cox proportional hazard models compared women who underwent early menopause (natural or artificial menopause at age ≤ 45 yrs) to those within the cohort who did not undergo early menopause.Results.Of 600 women, 79 experienced early menopause. Women who underwent early menopause were at significantly higher risk for developing CVD when compared to women who did not (HR 1.56; 95% CI 1.08–2.26).Conclusion.The risk of CVD in women with RA was higher in those who experienced early menopause, and like other known risk factors should increase clinician concern for development of CVD in these patients.

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