Is There a Link Between Hormone Use and Diabetes Incidence in Transgender People? Data from the STRONG Cohort

2021 ◽  
Author(s):  
Noreen Islam ◽  
Rebecca Nash ◽  
Qi Zhang ◽  
Leonidas Panagiotakopoulos ◽  
Tanicia Daley ◽  
...  
Keyword(s):  
Proportional Hazards ◽  
Health Care Systems ◽  
Cox Proportional Hazards ◽  
Diabetes Incidence ◽  
Logistic Regression Models ◽  
Comparison Groups ◽  
Care Systems ◽  
Hormone Use ◽  
And Gender ◽  
Confidence Interval Estimates

Abstract Background Risk of type 2 diabetes mellitus (T2DM) in transgender and gender diverse (TGD) persons, especially those receiving gender affirming hormone therapy (GAHT) is an area of clinical and research importance. Methods We used data from an electronic health record-based cohort study of persons 18 years and older enrolled in three integrated health care systems. The cohort included 2869 transfeminine members matched to 28,300 cisgender women and 28,258 cisgender men on age, race/ethnicity, calendar year, and site, and 2133 transmasculine members matched to 20,997 cisgender women and 20,964 cisgender men. Cohort ascertainment spanned 9 years from 2006 through 2014 and follow up extended through 2016. Data on T2DM incidence and prevalence were analyzed using Cox proportional hazards and logistic regression models, respectively. All analyses controlled for body mass index. Results Both prevalent and incident T2DM was more common in the transfeminine cohort relative to cisgender female referents with odds ratio and hazard ratio (95% confidence interval) estimates of 1.3 (1.1-1.5) and 1.4 (1.1-1.8), respectively. No significant differences in prevalence or incidence of T2DM were observed across the remaining comparison groups, both overall and in TGD persons with evidence of GAHT receipt. Conclusion Although transfeminine people may be at higher risk for T2DM compared to cisgender females the corresponding difference relative to cisgender males is not discernable. Moreover, there is little evidence that T2DM occurrence in either transfeminine or transmasculine persons is attributable to GAHT use.

scholarly journals Are there sex differences among colorectal cancer patients in treatment and survival? A Swiss cohort study

2021 ◽  
Vol 147 (5) ◽  
pp. 1407-1419
Author(s):  
Manuela Limam ◽  
Katarina Luise Matthes ◽  
Giulia Pestoni ◽  
Eleftheria Michalopoulou ◽  
Leonhard Held ◽  
...  
Keyword(s):  
Colorectal Cancer ◽  
Regression Models ◽  
Proportional Hazards ◽  
Treatment Decision ◽  
Tumor Stage ◽  
Primary Treatment ◽  
Cox Proportional Hazards ◽  
Men And Women ◽  
Logistic Regression Models ◽  
Comorbidity Index

Abstract Background Colorectal cancer (CRC) is among the three most common incident cancers and causes of cancer death in Switzerland for both men and women. To promote aspects of gender medicine, we examined differences in treatment decision and survival by sex in CRC patients diagnosed 2000 and 2001 in the canton of Zurich, Switzerland. Methods Characteristics assessed of 1076 CRC patients were sex, tumor subsite, age at diagnosis, tumor stage, primary treatment option and comorbidity rated by the Charlson Comorbidity Index (CCI). Missing data for stage and comorbidities were completed using multivariate imputation by chained equations. We estimated the probability of receiving surgery versus another primary treatment using multivariable binomial logistic regression models. Univariable and multivariable Cox proportional hazards regression models were used for survival analysis. Results Females were older at diagnosis and had less comorbidities than men. There was no difference with respect to treatment decisions between men and women. The probability of receiving a primary treatment other than surgery was nearly twice as high in patients with the highest comorbidity index, CCI 2+, compared with patients without comorbidities. This effect was significantly stronger in women than in men (p-interaction = 0.010). Survival decreased with higher CCI, tumor stage and age in all CRC patients. Sex had no impact on survival. Conclusion The probability of receiving any primary treatment and survival were independent of sex. However, female CRC patients with the highest CCI appeared more likely to receive other therapy than surgery compared to their male counterparts.

scholarly journals Who Is Not Linking to HIV Care in Tennessee — the Benefits of an Intersectional Approach

2021 ◽  
Author(s):  
Leslie J. Pierce ◽  
Peter Rebeiro ◽  
Meredith Brantley ◽  
Errol L. Fields ◽  
Cathy A. Jenkins ◽  
...  
Keyword(s):  
Black Males ◽  
Proportional Hazards ◽  
Cox Proportional Hazards ◽  
Hiv Care ◽  
Older Individuals ◽  
Hiv Diagnosis ◽  
Race And Gender ◽  
Targeted Interventions ◽  
And Gender ◽  
Linkage To Hiv Care

Abstract Introduction Guided by an intersectional approach, we assessed the association between social categories (individual and combined) on time to linkage to HIV care in Tennessee. Methods Tennessee residents diagnosed with HIV from 2012-2016 were included in the analysis (n=3750). Linkage was defined by the first CD4 or HIV RNA test date after HIV diagnosis. We used Cox proportional hazards models to assess the association of time to linkage with individual-level variables. We modeled interactions between race, age, gender, and HIV acquisition risk factor (RF), to understand how these variables jointly influence linkage to care. Results Age, race, and gender/RF weAima A. Ahonkhaire strong individual (p < 0.001 for each) and joint predictors of time to linkage to HIV care (p < 0.001 for interaction). Older individuals were more likely to link to care (aHR comparing 40 vs. 30 years, 1.20, 95%CI 1.11-1.29). Blacks were less likely to link to care than Whites (aHR= 0.73, 95% CI: 0.67-0.79). Men who have sex with men (MSM) (aHR = 1.18, 95%CI: 1.03-1.34) and heterosexually active females (females) (aHR = 1.32, 95%CI: 1.14-1.53) were more likely to link to care than heterosexually active males. The three-way interaction between age, race, and gender/RF showed that Black males overall and young, heterosexually active Black males in particular were least likely to establish care. Conclusions Racial disparities persist in establishing HIV care in Tennessee, but data highlighting the combined influence of age, race, gender, and sexual orientation suggest that heterosexually active Black males should be an important focus of targeted interventions for linkage to HIV care.

A Motion of No Confidence: Leadership and Rebel Fragmentation

2020 ◽  
Vol 5 (4) ◽  
pp. 598-616 ◽  
Author(s):  
Austin C Doctor
Keyword(s):  
Civil War ◽  
Proportional Hazards ◽  
Original Data ◽  
Cox Proportional Hazards ◽  
Stage I ◽  
Logistic Regression Models ◽  
Structure And Agency ◽  
Rebel Groups ◽  
Cox Proportional Hazards Models ◽  
War Experiences

Abstract Why do rebel organizations splinter into competing factions during civil war? To explain this outcome, I leverage variation in rebel leadership. I argue that rebel leaders draw on their pre-war experiences—i.e., their military and political experiences—to manage their organizations during conflict. These experiences bear unique patterns of rebel management and, thus, corresponding risks of fragmentation. Empirical evidence comes from a two-stage research design and original data featuring over 200 rebel leaders from 1989 to 2014. In the first stage, I estimate the probability of group fragmentation with a series of logistic regression models. In the second stage, I use Cox proportional-hazards models to estimate leadership effects on the rate of group fragmentation. Results indicate that variation in rebel leadership corresponds with unique risks of fragmentation. In particular, the results suggest that leaders with real military experience are best equipped to maintain group cohesion. This study offers insight into the processes by which rebel groups splinter into armed factions. In addition, it makes an important contribution to the broader discussion on the roles of structure and agency in shaping the dynamics of civil war.

The Longitudinal Association of Vision Impairment with Transitions to Cognitive Impairment and Dementia: Findings from The Aging, Demographics and Memory Study

2021 ◽  
Author(s):  
Joshua R Ehrlich ◽  
Bonnielin K Swenor ◽  
Yunshu Zhou ◽  
Kenneth M Langa
Keyword(s):  
Visual Acuity ◽  
Logistic Regression ◽  
Cognitive Impairment ◽  
Proportional Hazards ◽  
Population Based ◽  
Cox Proportional Hazards ◽  
Vision Impairment ◽  
Logistic Regression Models ◽  
Cox Proportional Hazards Models ◽  
Longitudinal Association

Abstract Background Vision impairment (VI) is associated with incident cognitive decline and dementia. However, it is not known whether VI is associated only with the transition to cognitive impairment, or whether it is also associated with later transitions to dementia. Methods We used data from the population-based Aging, Demographics and Memory Study (ADAMS) to investigate the association of visual acuity impairment (VI; defined as binocular presenting visual acuity &lt;20/40) with transitions from cognitively normal (CN) to cognitive impairment no dementia (CIND) and from CIND to dementia. Multivariable Cox proportional hazards models and logistic regression were used to model the association of VI with cognitive transitions, adjusted for covariates. Results There were 351 participants included in this study (weighted percentages: 45% male, 64% age 70-79 years) with a mean follow-up time of 4.1 years. In a multivariable model, the hazard of dementia was elevated among those with VI (HR=1.63, 95%CI=1.04-2.58). Participants with VI had a greater hazard of transitioning from CN to CIND (HR=1.86, 95%CI=1.09-3.18). However, among those with CIND and VI a similar percentage transitioned to dementia (48%) and remained CIND (52%); there was no significant association between VI and transitioning from CIND to dementia (HR=0.94, 95%CI=0.56-1.55). Using logistic regression models, the same associations between VI and cognitive transitions were identified. Conclusions Poor vision is associated with the development of CIND. The association of VI and dementia appears to be due to the higher risk of dementia among individuals with CIND. Findings may inform the design of future interventional studies.

Patient gender bias on the diagnosis of idiopathic pulmonary fibrosis

Thorax ◽  
2020 ◽  
Vol 75 (5) ◽  
pp. 407-412 ◽  
Author(s):  
Deborah Assayag ◽  
Julie Morisset ◽  
Kerri A Johannson ◽  
Athol U Wells ◽  
Simon L F Walsh
Keyword(s):  
Idiopathic Pulmonary Fibrosis ◽  
Pulmonary Fibrosis ◽  
Proportional Hazards ◽  
Usual Interstitial Pneumonia ◽  
Clinical Information ◽  
Cox Proportional Hazards ◽  
Diagnostic Confidence ◽  
Patient Gender ◽  
And Gender ◽  
Gender Influences

BackgroundPatient sex has clinical and prognostic implications in idiopathic pulmonary fibrosis (IPF). It is not known if sex-related and gender-related discrepancies exist when establishing a diagnosis of IPF. The aim was to determine how patient gender influences the diagnosis of IPF and the physician’s diagnostic confidence.MethodsThis study was performed using clinical cases compiled from a single centre, then scored by respiratory physicians for a prior study. Using clinical information, physicians were asked to provide up to five diagnoses, together with their diagnostic confidence. Logistic regression was used to assess the odds of receiving a diagnosis of IPF based on patient gender. Prognostic discrimination between IPF and non-IPF was used to assess diagnostic accuracy with Cox proportional hazards modelling.ResultsSixty cases were scored by 404 physicians. IPF was diagnosed more frequently in men compared with women (37.8% vs 10.6%; p<0.0001), and with greater mean diagnostic confidence (p<0.001). The odds of a male patient receiving an IPF diagnosis was greater than that of female patients, after adjusting for confounders (OR=3.05, 95% CI: 2.81 to 3.31), especially if the scan was not definite for the usual interstitial pneumonia pattern. Mortality was higher in women (HR=2.21, 95% CI: 2.02 to 2.41) than in men with an IPF diagnosis (HR=1.26, 95% CI: 1.20 to 1.33), suggesting that men were more often misclassified as having IPF.ConclusionPatient gender influences diagnosis of IPF: women may be underdiagnosed and men overdiagnosed with IPF.

scholarly journals Diabetes, Metformin, and Breast Cancer in Postmenopausal Women

2012 ◽  
Vol 30 (23) ◽  
pp. 2844-2852 ◽  
Author(s):  
Rowan T. Chlebowski ◽  
Anne McTiernan ◽  
Jean Wactawski-Wende ◽  
JoAnn E. Manson ◽  
Aaron K. Aragaki ◽  
...  
Keyword(s):  
Breast Cancer ◽  
Postmenopausal Women ◽  
Cancer Incidence ◽  
Proportional Hazards ◽  
Breast Cancer Incidence ◽  
Cox Proportional Hazards ◽  
Diabetes Incidence ◽  
Breast Cancers ◽  
Cancer Risk Factors ◽  
Cancer Management

Purpose Emerging evidence suggests that metformin may reduce breast cancer incidence, but reports are mixed and few provide information on tumor characteristics. Therefore, we assessed associations among diabetes, metformin use, and breast cancer in postmenopausal women participating in Women's Health Initiative clinical trials. Patients and Methods In all, 68,019 postmenopausal women, including 3,401 with diabetes at study entry, were observed over a mean of 11.8 years with 3,273 invasive breast cancers diagnosed. Diabetes incidence status was collected throughout follow-up, with medication information collected at baseline and years 1, 3, 6, and 9. Breast cancers were confirmed by review of central medical records and pathology reports. Cox proportional hazards regression, adjusted for breast cancer risk factors, compared breast cancer incidence in women with diabetes who were metformin users or nonusers with breast cancer incidence in women without diabetes. Results Compared with that in women without diabetes, breast cancer incidence in women with diabetes differed by diabetes medication type (P = .04). Women with diabetes receiving medications other than metformin had a slightly higher incidence of breast cancer (hazard ratio [HR], 1.16; 95% CI, 0.93 to 1.45), and women with diabetes who were given metformin had lower breast cancer incidence (HR, 0.75; 95% CI, 0.57 to 0.99). The association was observed for cancers positive for both estrogen receptor and progesterone receptor and those that were negative for human epidermal growth factor receptor 2. Conclusion Metformin use in postmenopausal women with diabetes was associated with lower incidence of invasive breast cancer. These results can inform future studies evaluating metformin use in breast cancer management and prevention.

The association of a 17-gene genomic prostate score with adverse surgical pathology and recurrence following surgery for localized prostate cancer (PCa): A comparison of African American and Caucasian patients.

2015 ◽  
Vol 33 (7_suppl) ◽  
pp. 86-86
Author(s):  
Jennifer Cullen ◽  
Inger L. Rosner ◽  
Timothy C. Brand ◽  
Amina Ali ◽  
Yongmei Chen ◽  
...  
Keyword(s):  
Clinical Outcomes ◽  
Proportional Hazards ◽  
Tumor Biology ◽  
Cox Proportional Hazards ◽  
National Database ◽  
Racial Groups ◽  
Logistic Regression Models ◽  
Gleason Pattern ◽  
Medical Centers ◽  
Or Gene

86 Background: Molecular assays can improve risk assessment for newly diagnosed PCa, but it is imperative to characterize assay performance in different racial groups, since tumor biology and clinical outcomes may vary. A racially diverse cohort of men (20% AA) with PCa in the Center for Prostate Disease Research multi-center national database was used to determine the association of GPS with outcomes in men treated with radical prostatectomy (RP) for localized PCa. Methods: Biopsy specimens from 431 men treated with RP for NCCN very low, low or intermediate risk PCa at 2 U.S. military medical centers were tested with a 17-gene RT-PCR assay to validate the association between GPS (scale 0-100) and 1) biochemical recurrence (BCR) following RP, and 2) adverse pathology (AP) at RP. BCR was defined as 2 successive PSA levels > 0.2 ng/mL. AP was defined as high-grade (primary Gleason pattern 4 or any pattern 5) and/or pT3 disease. Cox proportional hazards and logistic regression models were used. Results: GPS was obtained in 402 cases (93%), including 82 AA men. A broad range of GPS results was observed in both AA and CA men; GPS distributions were similar between AA (median GPS = 30.3; inter-quartile range (IQR): 23-38) and CA (median GPS = 30.3; IQR: 23-40); no correlation was observed between GPS and race (r = -0.04, p = 0.45). No differences in expression of individual genes or gene groups in the assay were observed between the two groups. In univariable analysis, PSA, biopsy GS and NCCN risk group were associated with BCR and AP, but race was not. The associations between GPS and clinical outcomes were similarly strong and statistically significant in both AA and CA men - BCR HR/20 GPS units = 3.0 (95% CI: 2.0-4.3) for CA vs. 3.5 (95% CI: 1.0-11.7) for AA; AP OR/20 units = 4.0 (95% CI: 2.6-6.6) for CA vs. 2.9 (95% CI: 1.2-7.6) for AA (p < 0.05 for all). Conclusions: In this cohort of patients treated in a health care system with equal access, clinical outcomes and the tumor biology measured by GPS were similar between AA and CA patients. GPS is a significant predictor of BCR and AP in men treated with RP for localized PCa in both AA and CA men.

scholarly journals Physical activity during video capsule endoscopy correlates with shorter bowel transit time

2017 ◽  
Vol 05 (09) ◽  
pp. E856-E860 ◽  
Author(s):  
Peter Stanich ◽  
Joshua Peck ◽  
Christopher Murphy ◽  
Kyle Porter ◽  
Marty Meyer
Keyword(s):  
Physical Activity ◽  
Transit Time ◽  
Capsule Endoscopy ◽  
Proportional Hazards ◽  
Cox Proportional Hazards ◽  
Step Count ◽  
Video Capsule Endoscopy ◽  
Logistic Regression Models ◽  
Cox Proportional Hazards Models ◽  
Transit Times

Abstract Background and study aim Video capsule endoscopy (VCE) is limited by reliance on bowel motility for propulsion, and lack of physical activity has been proposed as a cause of incomplete studies. Our aim was to prospectively investigate the association between physical activity and VCE bowel transit. Patients and methods Ambulatory outpatients receiving VCE were eligible for the study. A pedometer was attached at the time of VCE ingestion and step count was recorded at the end of the procedure. VCE completion was assessed by logistic regression models, which included step count (500 steps as one unit). Total transit time was analyzed by Cox proportional hazards models. The hazard ratios (HR) with 95 % confidence interval (CI) indicated the “hazard” of completion, such that HRs > 1 indicated a reduced transit time. Results A total of 100 patients were included. VCE was completed in 93 patients (93 %). The median step count was 2782 steps. Step count was not significantly associated with VCE completion (odds ratio 1.45, 95 %CI 0.84, 2.49). Pedometer step count was significantly associated with shorter total, gastric, and small-bowel transit times (HR 1.09, 95 %CI 1.03, 1.16; HR 1.05, 95 %CI 1.00, 1.11; HR 1.07, 95 %CI 1.01, 1.14, respectively). Higher body mass index (BMI) was significantly associated with VCE completion (HR 1.87, 95 %CI 1.18, 2.97) and shorter bowel transit times (HR 1.05, 95 %CI 1.02, 1.08). Conclusions Increased physical activity during outpatient VCE was associated with shorter bowel transit times but not with study completion. In addition, BMI was a previously unreported clinical characteristic associated with VCE completion and should be included as a variable of interest in future studies.

scholarly journals Twinning and Risk of Stillbirth Subtypes in Pediatric Mothers

2006 ◽  
Vol 9 (5) ◽  
pp. 673-676 ◽  
Author(s):  
Hamisu M. Salihu ◽  
Puza P. Sharma ◽  
Shillena Peters
Keyword(s):  
Adolescent Mothers ◽  
Proportional Hazards ◽  
Single Case ◽  
The United States ◽  
Cox Proportional Hazards ◽  
Adjusted Risk ◽  
Proportional Hazards Regression ◽  
Hazard Ratios ◽  
Comparison Groups ◽  
Twin Pregnancies

AbstractWe sought to estimate levels of risk for stillbirth subtypes associated with twin gestations among pediatric mothers (10–14 years). Analysis was on twin pregnancies covering the period 1989 to 2000 in the United States. We classified stillbirth as term, preterm, small-for-gestational-age (SGA) or preterm-SGA. We then assessed the risks of these stillbirth subtypes in pediatric mothers using two comparison groups consisting of women aged 15 to 19 years old (adolescent mothers) and 20 to 24 years old (mature mothers). Adjusted risk estimates were by means of hazard ratios generated from a Cox proportional hazards regression model. We adjusted for dependence of observations within twin clusters using the robust sandwich estimator. The rate of stillbirth was highest among pediatric mothers (56/1000), followed by adolescent gravidas (29/1000) and lowest in mature mothers (20/1000; p for trend < .01). Overall, preterm stillbirth was the most frequent stillbirth phenotype while term stillbirth was the least frequent. Not a single case of term stillbirth was recorded in pediatric mothers. Among pediatric gravidas, the risk for preterm stillbirth was more than tripled (adjusted hazard ratio [AHR] = 3.4; 95% confidence interval [CI] = 2.5–4.6), and that of preterm-SGA stillbirth more than doubled (AHR = 2.6; 95% CI = 1.8–3.7) that of mature mothers respectively. The 30% risk elevation for SGA stillbirth among pediatric mothers was not found to be statistically significant (AHR = 1.1; 95% CI = 0.3–4.3). Pediatric motherhood is a risk factor for stillbirth in twin gestation, especially, preterm and preterm-SGA stillbirth phenotypes. Prevention of stillbirth among this category of mothers should target the period preceding full term.

scholarly journals Breakfast Frequency and Diabetes Incidence in a Cohort of Middle-Age Women

2021 ◽  
Vol 5 (Supplement_2) ◽  
pp. 470-470
Author(s):  
Claudia Martinez ◽  
Eduardo Ortíz-Panozo ◽  
Dalia Stern ◽  
Adrián Cortés ◽  
Josiemer Mattei ◽  
...  
Keyword(s):  
Risk Factors ◽  
Proportional Hazards ◽  
Cox Proportional Hazards ◽  
Diabetes Incidence ◽  
Breakfast Consumption ◽  
Funding Sources ◽  
Cox Proportional Hazards Models ◽  
Potential Component ◽  
A Prospective Study ◽  
Stratified Analysis

Abstract Objectives To examine the relation between breakfast frequency and incidence of diabetes in middle-aged women. Methods The Mexican Teacher´s Cohort is a prospective study in women. We included 71,373 participants at baseline (2006–2008). Participants were classified according to breakfast frequency 0, 1–3, 4–6, or 7 d/wk; and meal frequency 1–2, 3–4, or ≥5 meals/d. Diabetes was self-reported. We used Cox proportional hazards models to calculate hazard ratios (HR) and 95% confidence intervals (CI) to estimate the association between breakfast frequency and diabetes incidence. Models were adjusted for sociodemographic and lifestyle confounders that are associated with breakfast consumption and are risk factors for diabetes. Stratified analyses were performed for age, birth weight, indigenous background, and physical activity. Results We identified 3,613 new diabetes cases during a median of 2.2 years of follow-up. Prevalence of daily breakfast consumers was 25%. After adjustment for known risk factors for diabetes, compared to 0 d/wk, women who eat daily breakfast had 12% lower rate of diabetes (HR = 0.88; 95% CI 0.78, 0.99; p-trend = 0.0018). One day additional per week having breakfast decreased the risk of diabetes (HR = 0.98; CI 0.97, 0.99). In stratified analysis, women with indigenous background who consumed breakfast 4–6 d/wk and 7 d/wk vs. 0 d/wk shown lower risk (HR = 0.68; 95% CI 0.47, 0.98) and HR = 0.76; 95% CI 0.76 (0.51, 1.15) respectively; p-interaction = 0.197). Conclusions Daily breakfast was associated with a lower incidence of diabetes, independently of dietary and lifestyle factors. Likely effect modifiers as ethnicity warrants more research. Daily breakfast consumption is a potential component of diabetes prevention. Funding Sources This work is supported by the American Institute for Cancer Research (05B047) and Consejo Nacional de Ciencia y Tecnología (CONACyT) grant S0008-2009-1: 000000000115312.

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