Socioeconomic status, race, and mortality disparities in insured patients in southern California.

e19060 Background: One known factor related to increased mortality is lack of health insurance coverage. To eliminate this variable we evaluated overall mortality by socioeconomic status (SES) in an insured southern California population diagnosed with cancer accounting for confounding factors including race/ethnicity. Methods: We identified adults diagnosed with eight common cancers from 2009-2014 from the California Cancer Registry and followed them through 2017. We calculated person-year mortality rates by SES and race/ethnicity. Adjusted hazard ratios for the association between all-cause mortality and SES were estimated using Cox proportional hazards models accounting for covariates (race/ethnicity, demographics, stage, treatments). Results: A total of 164,197 adults were diagnosed with cancers of the breast, prostate, lung, colon, melanoma, uterus, kidney and bladder; total of numbers of deaths was N=41,727. Compared to subjects in the highest SES quintile, we found an increased overall mortality risk in each of the lower SES quintiles. In multivariable models, mortality risk was 16% to 37% greater in the lower SES groups versus the highest SES group. Conclusions: After multivariable adjustment that accounted for race/ethnicity, cancer treatments and tumor factors, insured individuals in lower SES groups had a significantly higher overall mortality risk compared those in the highest SES group. [Table: see text]

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High School Quality and 56-Year All-Cause Mortality Risk Across Race and Ethnicity

Innovation in Aging ◽

10.1093/geroni/igaa057.1632 ◽

2020 ◽

Vol 4 (Supplement_1) ◽

pp. 505-506

Author(s):

Dominika Seblova ◽

Kelly Peters ◽

Susan Lapham ◽

Laura Zahodne ◽

Tara Gruenewald ◽

...

Keyword(s):

High School ◽

Mortality Risk ◽

Race And Ethnicity ◽

Proportional Hazards ◽

School Quality ◽

Cox Proportional Hazards ◽

School Level ◽

Lower Mortality ◽

All Cause Mortality ◽

Race Ethnicity

Abstract Having more years of education is independently associated with lower mortality, but it is unclear whether other attributes of schooling matter. We examined the association of high school quality and all-cause mortality across race/ethnicity. In 1960, about 5% of US high schools participated in Project Talent (PT), which collected information about students and their schools. Over 21,000 PT respondents were followed for mortality into their eighth decade of life using the National Death Index. A school quality factor, capturing term length, class size, and teacher qualifications, was used as the main predictor. First, we estimated overall and sex-stratified Cox proportional hazards models with standard errors clustered at the school level, adjusting for age, sex, composite measure of parental socioeconomic status, and 1960 cognitive ability. Second, we added an interaction between school quality and race/ethnicity. Among this diverse cohort (60% non-Hispanic Whites, 23% non-Hispanic Blacks, 7% Hispanics, 10% classified as another race/s) there were 3,476 deaths (16.5%). School quality was highest for Hispanic respondents and lowest for non-Hispanic Blacks. Non-Hispanic Blacks also had the highest mortality risk. In the whole sample, school quality was not associated with mortality risk. However, higher school quality was associated with lower mortality among those classified as another race/s (HR 0.75, 95% CI: 0.56-0.99). For non-Hispanic Blacks and Whites, the HR point estimates were unreliable, but suggest that higher school quality is associated with increased mortality. Future work will disentangle these differences in association of school quality across race/ethnicity and examine cause-specific mortality.

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Abstract 2791: Silent Brain Infarction Predicts Cardiovascular Events And Mortality In Long-term Hemodialysis Patients

Circulation ◽

10.1161/circ.116.suppl_16.ii_620 ◽

2007 ◽

Vol 116 (suppl_16) ◽

Author(s):

Toru Aoyama ◽

Hideki Ishii ◽

Hiroshi Takahashi ◽

Takanobu Toriyama ◽

Toru Aoyama ◽

...

Keyword(s):

Proportional Hazards ◽

Brain Infarction ◽

Cox Proportional Hazards ◽

Powerful Predictor ◽

Cardiac Events ◽

Cox Proportional Hazards Models ◽

Silent Brain Infarction ◽

Cv Disease ◽

Overall Mortality

Background: The cardiovascular (CV) events and mortality are significantly higher in hemodialysis (HD) patents compared to the general population. Although it is of clinical concern to predict the occurrence of CV events in long-term HD patients, more powerful predictor has under exploration. We investigated as to whether silent brain infarction (SBI) would be a predictable factor for future CV events and mortality in a large cohort of patients with long-term HD patients. Methods: After cranial magnetic resonance imaging to detect SBI, 202 long-term HD patients (7.1 ± 5.9 years) without symptomatic stroke were prospectively followed up until the incident of CV events (stroke, cardiac events, and death). We analyzed the prognostic role of SBI in CV events with the Kaplan-Meier method and Cox proportional hazards analysis. Results: The prevalence of SBI was quite higher compared to the previous reports (71.8% in all the patients). In overall patients, 60 patients suffered from CV disease (31 for coronary artery disease, 7 for congestive heart failure, 14 for symptomatic stroke) and 29 patients died (16 for CV death) during a follow up period (mean= 23 ± 13 months). In subgroup analysis regarding the presence of SBI, CV event-free survival rate for 4 years was significantly lower in the patients with SBI compared to those without SBI (54.6% vs. 86.7%, p=0.0003). CV and overall mortality were also significantly higher in SBI patients compared with No-SBI patients (CV mortality; 20.5 % vs. 4.3 %, overall mortality; 29.0% vs. 9.1% p< 0.01, respectively). Cox proportional hazards models showed that the presence of SBI was a significant predictor of cerebrovascular and CV events and CV and overall mortality even after adjustment for other CV risk factors listed on the Table . Conclusion: SBI detected with MRI would be powerful predictor of CV events and mortality in long-term HD patients. Hazard ratio (HR) of SBI for future events and mortality

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2625. Incidence of Bronchiolitis Requiring Hospitalization in the First 2 years of Life Among Healthy Term Infants with Different Races/Ethnicities: A Population-based Longitudinal Study

Open Forum Infectious Diseases ◽

10.1093/ofid/ofz360.2303 ◽

2019 ◽

Vol 6 (Supplement_2) ◽

pp. S914-S915

Author(s):

Kengo Inagaki ◽

Chad Blackshear ◽

Charlotte V Hobbs

Keyword(s):

New York ◽

Socioeconomic Status ◽

Proportional Hazards ◽

New York State ◽

Multivariable Analysis ◽

Population Based ◽

Cox Proportional Hazards ◽

Indigenous Populations ◽

Term Infants ◽

Race Ethnicity

Abstract Background Race/ethnicity is currently not considered a risk factor for bronchiolitis, except for indigenous populations in western countries. We sought to determine the incidence of hospitalization with bronchiolitis among different races/ethnicities, because such information can lead to more tailored preventive care. Methods We performed a population-based longitudinal observational study using the State Inpatient Database from New York state. Infants born between 2009 and 2013 at term without comorbidities were followed for the first 2 years of life, up to 2015. We calculated incidence among different race/ethnicity groups, and evaluated risks by developing Cox proportional hazards regression models. Results Of 877,465 healthy term infants, 10 356 infants were hospitalized with bronchiolitis. Overall, incidence was 11.8 per 1,000 births. Substantial difference in infants born in different seasons was observed (Figure 1). The incidence in non-Hispanic white, non-Hispanic black, Hispanic, and Asian infants was 8.6, 15.4, 19.1, and 6.5 per 1,000 births, respectively (table). On multivariable analysis adjusting for socioeconomic status, the risks remained substantially high among non-Hispanic black (hazard ratio [HR] 1.42, 95% confidence interval [CI]: 1.34–1.51) and Hispanic infants (HR 1.77, 95% CI: 1.67–1.87), particularly beyond 2–3 months of age, whereas Asian race was protective (HR 0.62, 95% CI: 0.56–0.69) (Figure 2, 3). Conclusion The risks of bronchiolitis hospitalization in the first 2 years of life was substantially higher among infants with non-Asian minority infants, particularly beyond 2–3 months of age. Further research efforts to identify effective public health interventions in each race/ethnic groups with varied socioeconomic status, such as improvement in access to care and anticipatory guidance, is warranted to overcome health disparity. Disclosures All authors: No reported disclosures.

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Eosinophil count and mortality risk in incident hemodialysis patients

Nephrology Dialysis Transplantation ◽

10.1093/ndt/gfz296 ◽

2020 ◽

Vol 35 (6) ◽

pp. 1032-1042

Author(s):

Duk-Hee Kang ◽

Yuji Lee ◽

Carola Ellen Kleine ◽

Yong Kyu Lee ◽

Christina Park ◽

...

Keyword(s):

Mortality Risk ◽

Eosinophil Count ◽

Proportional Hazards ◽

Cox Proportional Hazards ◽

Time Varying ◽

Cox Proportional Hazards Models ◽

Lower Baseline ◽

All Cause Mortality ◽

Relationship Of ◽

The Relationship

Abstract Background Eosinophils are traditionally known as moderators of allergic reactions; however, they have now emerged as one of the principal immune-regulating cells as well as predictors of vascular disease and mortality in the general population. Although eosinophilia has been demonstrated in hemodialysis (HD) patients, associations of eosinophil count (EOC) and its changes with mortality in HD patients are still unknown. Methods In 107 506 incident HD patients treated by a large dialysis organization during 2007–11, we examined the relationships of baseline and time-varying EOC and its changes (ΔEOC) over the first 3 months with all-cause mortality using Cox proportional hazards models with three levels of hierarchical adjustment. Results Baseline median EOC was 231 (interquartile range 155–339) cells/μL and eosinophilia (>350 cells/μL) was observed in 23.4% of patients. There was a gradual increase in EOC over time after HD initiation with a median ΔEOC of 5.1 (IQR −53–199) cells/μL, which did not parallel the changes in white blood cell count. In fully adjusted models, mortality risk was highest in subjects with lower baseline and time-varying EOC (<100 cells/μL) and was also slightly higher in patients with higher levels (≥550 cells/μL), resulting in a reverse J-shaped relationship. The relationship of ΔEOC with all-cause mortality risk was also a reverse J-shape where both an increase and decrease exhibited a higher mortality risk. Conclusions Both lower and higher EOCs and changes in EOC over the first 3 months after HD initiation were associated with higher all-cause mortality in incident HD patients.

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Comparative analysis of treatments, utilization, and survival benefit in HCC patients: A real-world analysis of SEER Medicare.

Journal of Clinical Oncology ◽

10.1200/jco.2012.30.4_suppl.214 ◽

2012 ◽

Vol 30 (4_suppl) ◽

pp. 214-214

Author(s):

Fadia T. Shaya ◽

Ian Michael Breunig ◽

C. Daniel Mullins ◽

Naimish B. Pandya ◽

Viktor Chirikov ◽

...

Keyword(s):

Radiation Therapy ◽

Health Status ◽

Proportional Hazards ◽

Cox Proportional Hazards ◽

External Beam Radiation ◽

Beam Radiation ◽

Cox Proportional Hazards Models ◽

Severe Liver Dysfunction ◽

Related Mortality ◽

Overall Mortality

214 Background: We explore various treatments at all stages of Hepatocellular Carcinoma (HCC), in a SEER (Surveillance, Epidemiology and End-Results Program) Medicare population and assess their impact on HCC-specific and overall survival. Methods: Medicare enrollees, older than 65, with an initial diagnosis of a primary HCC between 2000-07 were followed up through end of 2009. Data are from the SEER and linked Medicare databases, with claims generated from Medicare parts A and B. Using multivariate Cox-proportional hazards models, we assessed overall and HCC-related mortality in relation to receipt of treatment/no treatment, adjusting for demographics, general health status (CCI), cancer stage and liver conditions. Results: Out of the 9054 HCC patients, older than 65, who did not get a liver transplant, 76% were Caucasian, 8% African American (AA), 63% male, and 37% got treatment [12% transarterial chemoembolization (TACE), 12% systemic chemotherapy, 1.5% selective internal radiation therapy (SIRT), 9% external beam radiation therapy (EBRT), 8% surgical resection and 9% ablative therapy]. Treatment was associated with a reduction of overall (HR=0.35, P= <0.001) and HCC-related (0.33, <0.001) mortality. HCC-related mortality was significantly reduced in those getting resection (0.38, <0.001), ablation (0.59, <0.001), TACE (0.76, <0.001), EBRT (0.85, 0.017), or chemotherapy (0.85, 0.013). Significant reduction in overall mortality was seen with resection, ablation and TACE but not with chemotherapy, EBRT or SIRT. No particular treatment was associated with greater mortality reduction in early vs advanced stages. Patients with poor underlying health status (CCI>1) had higher mortality (1.27, <0.001). Alcohol related disease, Hep C, and moderate/severe liver dysfunction were not significantly associated with overall or HCC related mortality. Caucasians and non-African Americans had lower overall mortality (0.87, <0.001). Conclusions: In HCC SEER Medicare patients, all treatments except SIRT were associated with a significant reduction in HCC related mortality. A limitation of this study is that, through the data, we cannot accurately depict the severity of the disease.

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Radical Versus Non-Radical Resection for Early-Stage Retroperitoneal Sarcoma: A Propensity Score-Matched Analysis

Frontiers in Oncology ◽

10.3389/fonc.2021.706543 ◽

2021 ◽

Vol 11 ◽

Author(s):

Chengxin Weng ◽

Jiarong Wang ◽

Jichun Zhao ◽

Ding Yuan ◽

Bin Huang ◽

...

Keyword(s):

Propensity Score ◽

Proportional Hazards ◽

Early Stage ◽

Radical Resection ◽

Cox Proportional Hazards ◽

Retroperitoneal Sarcoma ◽

Stage I ◽

National Database ◽

Cox Proportional Hazards Models ◽

Overall Mortality

BackgroundThe appropriate surgical procedure for early-stage retroperitoneal sarcoma (RPS) is unclear. Thus, we used a national database to compare the outcomes of radical and non-radical resection in patients with early stage RPS.MethodsThis retrospective study included 886 stage I RPS patients from 2004 to 2015 in the SEER database. Outcomes were compared using the multivariate Cox proportional hazards models and the results were presented as adjusted hazards ratio (AHR) with corresponding 95% confidence intervals (95%CIs). Propensity score-matched analyses were also performed for sensitive analyses.ResultsFor the 886 stage I RPS patients, 316 underwent radical resection, and 570 underwent non-radical resection, with a median follow-up of 4.58 (2.73-8.35) years. No difference was observed in overall mortality (AHR 0.84, 95%CI 0.62-1.15; P = 0.28) or RPS-specific mortality (AHR 0.88, 95%CI 0.57-1.36; P = 0.56) between groups. The results were similar in propensity score-matching analyses. However, subgroup analysis revealed that radical resection was associated with significantly decreased risks of overall mortality in male (AHR 0.61, 95%CI 0.38-0.98; P = 0.04) and in patients with radiotherapy (AHR 0.56, 95%CI 0.32-0.98; P = 0.04).ConclusionRadical resection did not improve midterm survival outcomes compared with non-radical resection in overall patients with early stage RPS. However, male patients or patients who received radiotherapy might benefit from radical resection with improved overall survival.

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Waist Circumference and Mortality or Cardiovascular Events in a General Korean Population

10.21203/rs.3.rs-926930/v1 ◽

2021 ◽

Author(s):

Do Kyeong Song ◽

Young Sun Hong ◽

Yeon-Ah Sung ◽

Hyejin Lee

Keyword(s):

Waist Circumference ◽

National Health ◽

Proportional Hazards ◽

Positive Association ◽

Cox Proportional Hazards ◽

Korean Population ◽

Health Examination ◽

Men And Women ◽

Cox Proportional Hazards Models ◽

Overall Mortality

Abstract Obesity is associated with cardiovascular diseases (CVD). However, body mass index (BMI) has a limited ability to measure abdominal obesity. We aimed to evaluate the associations between waist circumference (WC) and mortality or CVD incidence in a general Korean population. We analyzed a total of 204,068 adults older than 40 years of age who had undergone a national health examination in the Korean National Health Insurance Service Cohort. Hazard ratios for death and CVD incidence were calculated using Cox proportional hazards models after adjustment for age, smoking, alcohol consumption status, levels of physical activity, total cholesterol, hypertension, and diabetes mellitus status. In men, WC and overall mortality showed a reverse J-shaped association. For both men and women, WC was not associated with risk of cardiovascular mortality. Contrary to mortality trend, CVD incidence was positively associated with WC in both men and women, and risk of the CVD incidence was the lowest in subjects with a WC < 80 cm. WC exhibited a significant J-shaped association with overall mortality in men. The risk of incident CVD showed a positive association with central obesity, where the lowest risk was observed for subjects in the lowest WC group in a general Korean population.

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Socioeconomic status and disability progression in multiple sclerosis

Neurology ◽

10.1212/wnl.0000000000007190 ◽

2019 ◽

Vol 92 (13) ◽

pp. e1497-e1506 ◽

Cited By ~ 12

Author(s):

Katharine E. Harding ◽

Mark Wardle ◽

Robert Carruthers ◽

Neil Robertson ◽

Feng Zhu ◽

...

Keyword(s):

Multiple Sclerosis ◽

Socioeconomic Status ◽

Drug Exposure ◽

Proportional Hazards ◽

Meta Analysis ◽

Random Effect ◽

Cox Proportional Hazards ◽

Disability Progression ◽

Cox Proportional Hazards Models ◽

Neighborhood Level

ObjectiveTo examine the association between socioeconomic status (SES) and disability outcomes and progression in multiple sclerosis (MS).MethodsHealth administrative and MS clinical data were linked for 2 cohorts of patients with MS in British Columbia (Canada) and South East Wales (UK). SES was measured at MS symptom onset (±3 years) based on neighborhood-level average income. The association between SES at MS onset and sustained and confirmed Expanded Disability Status Scale (EDSS) 6.0 and 4.0 and onset of secondary progression of MS (SPMS) were assessed using Cox proportional hazards models. EDSS scores were also examined via linear regression, using generalized estimating equations (GEE) with an exchangeable working correlation. Models were adjusted for onset age, sex, initial disease course, and disease-modifying drug exposure. Random effect models (meta-analysis) were used to combine results from the 2 cohorts.ResultsA total of 3,113 patients with MS were included (2,069 from Canada; 1,044 from Wales). A higher SES was associated with a lower hazard of reaching EDSS 6.0 (adjusted hazard ratio [aHR] 0.90, 95% confidence interval [CI] 0.89–0.91), EDSS 4.0 (aHR 0.93, 0.88–0.98), and SPMS (aHR 0.94, 0.88–0.99). The direction of findings was similar when all EDSS scores were included (GEE: β = −0.13, −0.18 to −0.08).ConclusionsLower neighborhood-level SES was associated with a higher risk of disability progression. Reasons for this association are likely to be complex but could include factors amenable to modification, such as lifestyle or comorbidity. Our findings are relevant for planning and development of MS services.

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Association of household secondhand smoke exposure and mortality risk in patients with heart failure

BMC Cardiovascular Disorders ◽

10.1186/s12872-019-1269-y ◽

2019 ◽

Vol 19 (1) ◽

Cited By ~ 1

Author(s):

Xin He ◽

Jingjing Zhao ◽

Jiangui He ◽

Yugang Dong ◽

Chen Liu

Keyword(s):

Heart Failure ◽

Mortality Risk ◽

Secondhand Smoke ◽

Proportional Hazards ◽

Univariate Analysis ◽

Cox Proportional Hazards ◽

Heart Failure Patients ◽

Cox Proportional Hazards Models ◽

Patients With Heart Failure ◽

Shs Exposure

Abstract Background Secondhand smoke (SHS) exposure is a well-established cardiovascular risk factor, yet association between SHS and prognosis of heart failure remains uncertain. Method Data were obtained from the US National Health and Nutrition Examination Surveys III from 1988 to 1994. Currently nonsmoking adults with a self-reported history of heart failure were included. Household SHS exposure was assessed by questionnaire. Participants were followed up through December 31, 2011. Cox proportional-hazards models were used to assess the association of household SHS exposure and mortality risk. Potential confounding factors were adjusted. Results Of 572 currently nonsmoking patients with heart failure, 88 were exposed to household SHS while 484 were not. There were totally 475 deaths during follow-up. In univariate analysis, household SHS was not associated with mortality risk (hazard ratio [HR]: 0.98, 95% confidence interval [CI]: 0.76–1.26, p = 0.864). However, after adjustment for demographic variables, socioeconomic variables and medication, heart failure patients in exposed group had a 43% increase of mortality risk compared with those in unexposed group (HR: 1.43, 95% CI: 1.10–1.86, p = 0.007). Analysis with further adjustment for general health status and comorbidities yielded similar result (HR: 1.47, 95% CI: 1.13–1.92, p = 0.005). Conclusion Household SHS exposure was associated with increased mortality risk in heart failure patients.

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Mortality in people with psychotic disorders in Finland: A population-based 13-year follow-up study

European Psychiatry ◽

10.1016/j.eurpsy.2017.01.1587 ◽

2017 ◽

Vol 41 (S1) ◽

pp. s816-s816

Author(s):

J. Keinänen ◽

O. Mantere ◽

N. Markkula ◽

K. Partti ◽

J. Perälä ◽

...

Keyword(s):

Mortality Risk ◽

Psychotic Disorders ◽

Proportional Hazards ◽

Sociodemographic Factors ◽

Population Based ◽

Cox Proportional Hazards ◽

Related Factors ◽

Cox Proportional Hazards Models ◽

Health Related ◽

Nationally Representative

IntroductionPeople with psychotic disorders have increased mortality compared to the general population. The mortality is mostly due to natural causes and it is disproportionately high compared to the somatic morbidity of people with psychotic disorders.ObjectivesWe aimed to find predictors of mortality in psychotic disorders and to evaluate the extent to which sociodemographic and health-related factors explain the excess mortality.MethodsIn a nationally representative sample of Finns aged 30–70 years (n = 5642), psychotic disorders were diagnosed in 2000–2001. Information on mortality and causes of death was obtained of those who died by the end of year 2013. Cox proportional hazards models were used to investigate the mortality risk.ResultsAdjusting for age and sex, diagnosis of nonaffective psychotic disorder (NAP) (n = 106) was statistically significantly associated with all-cause mortality (HR 2.99, 95% CI 2.03–4.41) and natural-cause mortality (HR 2.81, 95% CI 1.85–4.28). After adjusting for sociodemographic factors, health status, inflammation and smoking, the HR dropped to 2.11 (95% CI 1.10–4.05) for all-cause and to 1.98 (95% CI 0.94–4.16) for natural-cause mortality. Within the NAP group, antipsychotic use at baseline was associated with reduced HR for natural-cause mortality (HR 0.25, 95% CI 0.07–0.96), and smoking with increased HR (HR 3.54, 95% CI 1.07–11.69).ConclusionsThe elevated mortality risk associated with NAP is only partly explained by socioeconomic factors, lifestyle, cardiometabolic comorbidities and inflammation. Smoking cessation should be prioritized in treatment of psychotic disorders. More research is needed on the quality of treatment of somatic conditions in people with psychotic disorders.Disclosure of interestJaakko Keinänen owns shares in pharmaceutical company Orion.

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