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

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

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

European Respiratory Journal ◽

10.1183/09031936.00119714 ◽

2014 ◽

Vol 45 (3) ◽

pp. 670-679 ◽

Cited By ~ 91

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.

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

Circulation ◽

10.1161/circ.129.suppl_1.p378 ◽

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.

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Air Pollution Is Associated with Cognitive Deterioration of Alzheimer’s Disease

Gerontology ◽

10.1159/000515162 ◽

2021 ◽

pp. 1-9

Author(s):

Feng Cheng Lin ◽

Chih Yin Chen ◽

Chung Wei Lin ◽

Ming Tsang Wu ◽

Hsuan Yu Chen ◽

...

Keyword(s):

Risk Factors ◽

Air Pollution ◽

Social Engagement ◽

Proportional Hazards ◽

Cox Proportional Hazards ◽

Rank Test ◽

Cognitive Deterioration ◽

Clinical Dementia Rating ◽

Severe Stage ◽

Increased Risk

Introduction: Dementia is one of the major causes of disability and dependency among older people worldwide. Alzheimer’s disease (AD), the most common cause of dementia among the elderly, has great impact on the health-care system of developed nations. Several risk factors are suggestive of an increased risk of AD, including APOE-ε4, male, age, diabetes mellitus, hypertension, and low social engagement. However, data on risk factors of AD progression are limited. Air pollution is revealed to be associated with increasing dementia incidence, but the relationship between air pollution and clinical AD cognitive deterioration is unclear. Methods: We conducted a case-control and city-to-city study to compare the progression of AD patients in different level of air-polluted cities. Clinical data of a total of 704 AD patients were retrospectively collected, 584 residences in Kaohsiung and 120 residences in Pingtung between 2002 and 2018. An annual interview was performed with each patient, and the Clinical Dementia Rating score (0 [normal] to 3 [severe stage]) was used to evaluate their cognitive deterioration. Air pollution data of Kaohsiung and Pingtung city for 2002–2018 were retrieved from Taiwan Environmental Protection Administration. Annual Pollutant Standards Index (PSI) and concentrations of particulate matter (PM10), sulfur dioxide (SO2), ozone (O3), nitrogen dioxide (NO2), and carbon monoxide (CO) were obtained. Results: The PSI was higher in Kaohsiung and compared with Pingtung patients, Kaohsiung patients were exposed to higher average annual concentrations of CO, NO2, PM10, and SO2. AD patients living in Kaohsiung suffered from faster cognitive deterioration in comparison with Pingtung patients (log-rank test: p = 0.016). When using multivariate Cox proportional hazards regression analysis, higher levels of CO, NO2, PM10, and SO2 exposure were associated with increased risk of AD cognitive deterioration. Among all these air pollutants, high SO2 exposure has the greatest impact while O3 has a neutral effect on AD cognitive deterioration. Conclusions: Air pollution is an environment-related risk factor that can be controlled and is associated with cognitive deterioration of AD. This finding could contribute to the implementation of public intervention strategies of AD.

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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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Osteoarthritis and risk of mortality in the USA: a population-based cohort study

International Journal of Epidemiology ◽

10.1093/ije/dyy187 ◽

2018 ◽

Vol 47 (6) ◽

pp. 1821-1829 ◽

Cited By ~ 15

Author(s):

Angelico Mendy ◽

JuYoung Park ◽

Edgar Ramos Vieira

Keyword(s):

Proportional Hazards ◽

Population Based ◽

Cox Proportional Hazards ◽

Self Report ◽

Joint Disease ◽

Renal Diseases ◽

X Rays ◽

Risk Of Mortality ◽

Increased Risk ◽

Risk Of Cancer

Abstract Background Osteoarthritis (OA) is the most common joint disease, but its association with mortality is unclear. Methods We analysed data on adult participants in the 1988–94 and 1999–2010 National Health and Nutrition Examination Surveys, followed for mortality through 2011. OA was defined by self-report, and in a subset of participants 60 years or older with knee X-rays, radiographic knee OA (RKOA) was defined as Kellgren–Lawrence score ≥2. Cox proportional hazards were used to determine the mortality hazard ratio (HR) associated with self-reported OA and RKOA, adjusting for covariates. Results The sample included 51 938 participants followed for a median 8.9 years; 2589 of them had knee X-rays and were followed for a median of 13.6 years. Self-reported OA and RKOA prevalences were 6.6% and 40.6%, respectively. Self-reported OA was not associated with mortality. RKOA was associated with an increased risk of mortality from cardiovascular diseases (CVD) {HR 1.43 [95% confidence interval (CI): 1.32, 1.64]}, diabetes [HR 2.04 (1.87, 2.23)] and renal diseases [HR 1.14 (1.04, 1.25)], but with a reduced risk of cancer mortality [HR 0.88 (0.80, 0.96)]. Participants with early RKOA onset (diagnosed before age 40) had a higher risk of mortality from all causes [HR 1.53 (1.43, 1.65)] and from diabetes [HR 7.18 (5.45, 9.45)]. Obese participants with RKOA were at increased risk of mortality from CVD [HR 1.89 (1.56, 2.29)] and from diabetes [HR: 3.42 (3.01, 3.88)]. Conclusions Self-reported OA was not associated with mortality. RKOA was associated with higher CVD, diabetes and renal mortality, especially in people with early onset of the disease or with obesity.

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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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Chemotherapy and Cardiotoxicity in Older Breast Cancer Patients: A Population-Based Study

Journal of Clinical Oncology ◽

10.1200/jco.2005.02.5841 ◽

2005 ◽

Vol 23 (34) ◽

pp. 8597-8605 ◽

Cited By ~ 226

Author(s):

John J. Doyle ◽

Alfred I. Neugut ◽

Judith S. Jacobson ◽

Victor R. Grann ◽

Dawn L. Hershman

Keyword(s):

Breast Cancer ◽

Cancer Patients ◽

Proportional Hazards ◽

Population Based ◽

Cox Proportional Hazards ◽

Stage I ◽

Breast Cancer Patients ◽

Primary Tumors ◽

Increased Risk

Purpose Adjuvant chemotherapy, especially with anthracyclines, is known to cause acute and chronic cardiotoxicity in breast cancer patients. We studied the cardiac effects of chemotherapy in a population-based sample of breast cancer patients aged ≥ 65 years with long-term follow-up. Patients and Methods In the Surveillance, Epidemiology, and End Results (SEER)-Medicare database, we analyzed treatments and outcomes among women ≥ 65 years of age who were diagnosed with stage I to III breast cancer from January 1, 1992 to December 31, 1999. Propensity scores were used to control for baseline heart disease (HD) and other known predictors of chemotherapy, and Cox proportional hazards models were used to estimate the risk of cardiomyopathy (CM), congestive heart failure (CHF), and HD after chemotherapy. Results Of 31,748 women with stage I to III breast cancer, 5,575 (18%) received chemotherapy. Chemotherapy was associated with younger age, fewer comorbidities, hormone receptor negativity, multiple primary tumors, and advanced disease. Patients who received chemotherapy were less likely than other patients to have pre-existing HD (45% v 55%, respectively; P < .001). The hazard ratios for CM, CHF, and HD for patients treated with doxorubicin (DOX) compared with patients who received no chemotherapy were 2.48 (95% CI, 2.10 to 2.93), 1.38 (95% CI, 1.25 to 1.52), and 1.35 (95% CI, 1.26 to 1.44), respectively. The relative risk of cardiotoxicity among patients who received DOX compared with untreated patients remained elevated 5 years after diagnosis. Conclusion When baseline HD was taken into account, chemotherapy, especially with anthracyclines, was associated with a substantially increased risk of CM. As the number of long-term survivors grows, identifying and minimizing the late effects of treatment will become increasingly important.

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Increased risk of prostate cancer following sexually transmitted infection in an Asian population

Epidemiology and Infection ◽

10.1017/s0950268813000459 ◽

2013 ◽

Vol 141 (12) ◽

pp. 2663-2670 ◽

Cited By ~ 6

Author(s):

S. D. CHUNG ◽

Y. K. LIN ◽

C. C. HUANG ◽

H. C. LIN

Keyword(s):

Prostate Cancer ◽

Proportional Hazards ◽

Asian Population ◽

Population Based ◽

Cox Proportional Hazards ◽

Study Cohort ◽

Transmitted Infection ◽

Sexually Transmitted ◽

Increased Risk ◽

History Of

SUMMARYThe relationship between sexually transmitted infections (STIs) and prostate cancer (PC) remains inconclusive. Moreover, all such studies to date have been conducted in Western populations. This study aimed to investigate the risk of PC following STI using a population-based matched-cohort design in Taiwan. The study cohort comprised 1055 patients with STIs, and 10 550 randomly selected subjects were used as a comparison cohort. Cox proportional hazards regression analysis revealed that the hazard ratio for PC during the 5-year follow-up period for patients with a STI was 1·95 (95% confidence interval 1·18–3·23), that of comparison subjects after adjusting for urbanization level, geographical region, monthly income, hypertension, diabetes, hyperlipidaemia, obesity, chronic prostatitis, history of vasectomy, tobacco use disorder, and alcohol abuse. We concluded that the risk of PC was higher for men who were diagnosed with a STI in an Asian population.

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The impact of risk factor trends on intracerebral hemorrhage incidence over the last two decades—The Tromsø Study

International Journal of Stroke ◽

10.1177/1747493018789996 ◽

2018 ◽

Vol 14 (1) ◽

pp. 61-68 ◽

Cited By ~ 2

Author(s):

Maria Carlsson ◽

Tom Wilsgaard ◽

Stein Harald Johnsen ◽

Liv-Hege Johnsen ◽

Maja-Lisa Løchen ◽

...

Keyword(s):

Risk Factors ◽

Risk Factor ◽

Intracerebral Hemorrhage ◽

Proportional Hazards ◽

Temporal Trends ◽

Population Based ◽

Incidence Rates ◽

Cox Proportional Hazards ◽

Intracerebral Hemorrhages ◽

The Impact

Background Studies on the relationship between temporal trends in risk factors and incidence rates of intracerebral hemorrhage are scarce. Aims To analyze temporal trends in risk factors and incidence rates of intracerebral hemorrhage using individual data from a population-based study. Methods We included 28,167 participants of the Tromsø Study enrolled between 1994 and 2008. First-ever intracerebral hemorrhages were registered through 31 December 2013. Hazard ratios (HRs) for intracerebral hemorrhage were analyzed by Cox proportional hazards models, risk factor levels over time by generalized estimating equations, and incidence rate ratios (IRR) by Poisson regression. Results We registered 219 intracerebral hemorrhages. Age, male sex, systolic blood pressure (BP), diastolic BP, and hypertension were associated with intracerebral hemorrhage. Hypertension was more strongly associated with non-lobar intracerebral hemorrhage (HR 5.08, 95% CI 2.86–9.01) than lobar intracerebral hemorrhage (HR 1.91, 95% CI 1.12–3.25). In women, incidence decreased significantly (IRR 0.46, 95% CI 0.23–0.90), driven by a decrease in non-lobar intracerebral hemorrhage. Incidence rates in men remained stable (IRR 1.27, 95% CI 0.69–2.31). BP levels were lower and decreased more steeply in women than in men. The majority with hypertension were untreated, and a high proportion of those treated did not reach treatment goals. Conclusions We observed a significant decrease in intracerebral hemorrhage incidence in women, but not in men. A steeper BP decrease in women may have contributed to the diverging trends. The high proportion of untreated and sub-optimally treated hypertension calls for improved strategies for prevention of intracerebral hemorrhage.

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