Risk of Stroke in Nasopharyngeal Cancer Survivors: A National Registry-Based Population Cohort Study

BackgroundWe aim to determine the risk of stroke and death within 30 days post stroke in nasopharyngeal cancer (NPC) survivors.MethodsWe conducted a population-based cohort study of patients diagnosed with NPC from Jan 1, 2005 to Dec 31, 2017. Using the cancer and stroke disease registries and the Singapore general population as the reference population, we report the age-standardized incidence rate differences (SIRDs) ratios (SIRs) and the cumulative incidence of stroke and the standardized mortality rate differences (SMRDs) and ratios (SMRs) for all causes of death within 30 days post stroke for NPC survivors.FindingsAt a median follow up of 48.4 months (IQR 19.8 – 92.9) for 3849 patients diagnosed with NPC, 96 patients developed stroke. The overall SIRD and SIR for stroke was 3.12 (95% CI 2.09 – 4.15) and 2.54 (95% CI 2.08 – 3.10) respectively. The SIRD was highest for the age group 70 – 79 years old (8.84 cases per 1000 person-years (PY); 0.46 – 17.21) while the SIR was highest for the age group 30 – 39 years old (16.41; 6.01 – 35.82). The SIRD and SIR for stage 1 disease was (6.96 cases per 1000 PY; 2.16 – 11.77) and (4.15; 2.46 – 7.00) respectively. The SMRD and SMR for all cause deaths within 30 days of stroke was (3.20 cases per 100 persons; -3.87 – 10.28) and (1.34; 0.76 – 2.37) respectively.InterpretationThe overall risk of stroke was markedly elevated in survivors of NPC, especially in Stage 1 disease when compared to the general population. The risk of death within 30 days of stroke was not significantly higher for NPC survivors.Classification of EvidenceThis study provides Class II evidence of the increased risk of stroke in survivors of nasopharyngeal cancer compared to general population.

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Cutaneous lupus erythematosus and the risk of deep venous thrombosis and pulmonary embolism: A Danish nationwide cohort study

Lupus ◽

10.1177/0961203317716306 ◽

2017 ◽

Vol 26 (13) ◽

pp. 1435-1439 ◽

Cited By ~ 9

Author(s):

O Ahlehoff ◽

J J Wu ◽

J Raunsø ◽

S L Kristensen ◽

U Khalid ◽

...

Keyword(s):

Cohort Study ◽

Venous Thromboembolism ◽

General Population ◽

Lupus Erythematosus ◽

Cutaneous Lupus Erythematosus ◽

Significant Risk ◽

Reference Population ◽

Incidence Rates ◽

Health Concern ◽

Increased Risk

Background Venous thromboembolism (VTE) is a major public health concern. Lupus erythematosus (LE) is a chronic autoimmune disease ranging from localized cutaneous disease (CLE) to systemic involvement (SLE). Patients with SLE have an increased risk of venous thromboembolism (VTE), but little is known about the CLE-related risk of VTE. Methods To evaluate the risk of VTE in patients with SLE and CLE as compared to the general population, a retrospective cohort study was conducted. Incidence rates and hazard ratios (HRs) with 95% confidence intervals (CIs) from multivariable Cox regression models were used to evaluate and compare the risk of VTE. Registries of hospitalizations, outpatient visits, and prescription drug use were studied to determine the risk of VTE in patients with CLE and SLE and the general population between 1997 and 2011. Results A total of 3234 patients with CLE and 3627 patients with SLE were identified and compared to 5,590,070 individuals in the reference population. The incidence rates per 1000 year of VTE were higher in patients with LE, i.e. 1.20, 3.06, and 5.24 for the reference population, CLE, and SLE, respectively. In adjusted models, both CLE (HR 1.39; 95% CI 1.10–1.78) and SLE (HR 3.32; 95% CI 2.73–4.03) were associated with a statistically significant increased risk of VTE, compared to the reference population. Conclusion In this nationwide study, both CLE and SLE were significant risk factors for VTE. The results add to our understanding of comorbidities in patients with LE, and call for further studies and increased awareness of thromboembolic complications in patients with CLE.

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Mortality in Eosinophilic Esophagitis – a nationwide, population-based matched cohort study from 2005 to 2017

Upsala Journal of Medical Sciences ◽

10.48101/ujms.v126.7688 ◽

2021 ◽

Vol 126 (1) ◽

Author(s):

Lovisa Röjler ◽

John J. Garber ◽

Bjorn Roelstraete ◽

Marjorie M. Walker ◽

Jonas F. Ludvigsson

Keyword(s):

Cohort Study ◽

General Population ◽

Eosinophilic Esophagitis ◽

Population Based ◽

Sensitivity Analyses ◽

Matched Cohort ◽

Matched Cohort Study ◽

Risk Of Death ◽

Gastrointestinal Pathology ◽

Increased Risk

Background: There is a lack of knowledge about mortality in eosinophilic esophagitis (EoE). Therefore, this study aimed to examine the mortality in EoE. Methods: A nationwide, population-based matched cohort study was conducted of all EoE patients in Sweden diagnosed between July 2005 and December 2017. Individuals with EoE (n = 1,625) were identified through prospectively recorded histopathology codes from all gastrointestinal pathology reports in Sweden, representing 28 pathology departments (the ESPRESSO study). Each individual with EoE was then matched with up to five reference individuals from the general population (n = 8,003) for age, sex, year of birth, and place of residence. We used the Cox proportional hazard modeling to estimate the adjusted hazard ratio (aHR) and 95% confidence interval (95% CI) while adjusting for other potential confounders. In sensitivity analyses, mortality in EoE patients was compared with mortality in their siblings. Results: Through December 2017, 34 deaths were confirmed in EoE patients (4.60 per 1,000 person-years) compared with 165 in reference individuals (4.57 per 1,000 person-years). This rate corresponds to an aHR of 0.97 (95% CI = 0.67–1.40). HRs were similar in males (aHR = 1.00 [0.66–1.51]) and females (aHR = 0.92 [0.38–2.18]). We observed no increased risk in mortality due to esophageal or other gastrointestinal cancers in patients with EoE (aHR = 1.02 [0.51–2.02]). Mortality was similar in EoE patients and their siblings (aHR = 0.91 [0.44–1.85]). Conclusion: In this nationwide, population-based matched cohort study in Sweden, there was no increased risk of death in patients with EoE compared with their siblings and the general population.

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Mortality and causes of death among people suspected of driving under the influence and testing positive for multiple substances

Scandinavian Journal of Public Health ◽

10.1177/1403494819894166 ◽

2019 ◽

Vol 48 (8) ◽

pp. 809-816

Author(s):

Karoliina Karjalainen ◽

Jari Haukka ◽

Kristiina Kuussaari ◽

Sanna Hautala ◽

Pekka Hakkarainen

Keyword(s):

General Population ◽

Causes Of Death ◽

Social Background ◽

Reference Population ◽

Elevated Risk ◽

Driving Under The Influence ◽

Finnish Population ◽

Risk Of Death ◽

Increased Risk ◽

Specific Mortality

Aims: Understanding the mortality of drug users using multiple substances is helpful in preventing the harmful effects of polydrug use. We examined overall and cause-specific mortality and differences in mortality based on social background among people suspected of driving under the influence and testing positive for multiple substances (DUIMS) compared with the general Finnish population. Methods: Register data from 785 DUIMS during 2003–2006 were studied, with a reference population ( n = 25,381) drawn from the general Finnish population. The effect of DUIMS on all-cause and cause-specific mortality was estimated using a Poisson regression model. Results: DUIMS had an increased risk of death compared with the general population (MRR 5.3, 95% CI 4.2–6.6). The most common causes of death in DUIMS were poisonings (37.9%) and suicides (13.6%), whereas in the reference population these were cardiovascular diseases (30.8%) and cancer (26.6%). The cause-specific risk of death among DUIMS was higher in all observed causes of death, except for cancer. The effect of DUIMS on mortality was modified by age, employment status and marital status; DUIMS was associated with an elevated risk of death especially in younger age groups and in singles. Conclusions: DUIMS indicates higher mortality, and DUIMS’ profiles in causes of death differ from the general population. Elevated risk for, for instance, suicidal, accidental and violent death among those using multiple substances highlights the need to also pay attention to causes of death other than poisoning/overdose.

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The overall and sex- and age-group specific incidence rates of cancer in people with schizophrenia: a population-based cohort study

Epidemiology and Psychiatric Sciences ◽

10.1017/s204579602000044x ◽

2020 ◽

Vol 29 ◽

Cited By ~ 1

Author(s):

D. Pettersson ◽

M. Gissler ◽

J. Hällgren ◽

U. Ösby ◽

J. Westman ◽

...

Keyword(s):

General Population ◽

Population Based ◽

Incidence Rates ◽

Age Group ◽

Calendar Time ◽

Population Based Study ◽

Risk Of Death ◽

Increased Risk ◽

Prevention Programmes ◽

Cancer Types

Abstract Aims Decades of research show that people with schizophrenia have an increased risk of death from cancer; however, the relationship between schizophrenia and cancer incidence remains less clear. This population-based study investigates the incidence of seven common types of cancer among people with a hospital diagnosis of schizophrenia and accounting for the effects of age, sex and calendar time. Methods This population-based study used 1990–2013 data from three nationwide Swedish registries to calculate the incidence (in total, by age group and by sex) of any cancer and of lung, oesophageal, pancreatic, stomach, colon, (in men) prostate and (in women) breast cancer in 111 306 people with a hospital diagnosis of schizophrenia. The incidence in people with diagnosed schizophrenia was compared with the incidence in the general population. Risk estimates accounted for the effects of calendar time. Results In 1 424 829 person-years of follow-up, schizophrenia did not confer an overall higher cancer risk (IRR 1.02, 95% CI 0.91–1.13) but was associated with a higher risk for female breast (IRR 1.19, 95% CI 1.12–1.26), lung (IRR 1.42, 95% CI 1.28–1.58), oesophageal (IRR 1.25, 95% CI 1.07–1.46) and pancreatic (IRR 1.10, 95% CI 1.01–1.21) and a lower risk of prostate (IRR 0.66, 95% CI 0.55–0.79) cancer. Some age- and sex-specific differences in risk were observed. Conclusions People with schizophrenia do not have a higher overall incidence of cancer than people in the general population. However, there are significant differences in the risk of specific cancer types overall and by sex calling for efforts to develop disease-specific prevention programmes. In people with schizophrenia, higher risk generally occurs in those <75 years.

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Mortality in biopsy-proven alcohol-related liver disease: a population-based nationwide cohort study of 3453 patients

Gut ◽

10.1136/gutjnl-2019-320446 ◽

2020 ◽

Vol 70 (1) ◽

pp. 170-179 ◽

Cited By ~ 2

Author(s):

Hannes Hagström ◽

Maja Thiele ◽

Bjorn Roelstraete ◽

Jonas Söderling ◽

Jonas F Ludvigsson

Keyword(s):

Cohort Study ◽

Liver Disease ◽

General Population ◽

Liver Biopsy ◽

Cox Regression ◽

Population Based ◽

Risk Of Death ◽

Increased Risk ◽

Related Liver Disease

ObjectivePatients with alcohol-related liver disease (ALD) are at increased risk of death, but studies have rarely investigated the significance of histological severity or estimated relative risks compared with a general population. We examined mortality in a nationwide cohort of biopsy-proven ALD.DesignPopulation-based cohort study in Sweden comparing 3453 individuals with an International Classification of Disease (ICD) code for ALD and a liver biopsy from 1969 to 2017 with 16 535 matched general population individuals. Swedish national registers were used to ascertain overall and disease-specific mortality, starting follow-up at the latest of first ICD diagnosis or liver biopsy plus 3 months. Cox regression adjusted for relevant confounders was used to estimate HRs in ALD and histopathological subgroups.ResultsMedian age at diagnosis was 58 years, 65% were men and 52% had cirrhosis at baseline. Five-year cumulative mortality was 40.9% in patients with ALD compared with 5.8% in reference individuals. The risk for overall mortality was significantly increased (adjusted HR (aHR)=4.70, 95% CI 4.35 to 5.08). The risk of liver-related death was particularly high (43% of all deaths, aHR=167.6, 95% CI 101.7 to 276.3). Mortality was significantly increased also in patients with ALD without cirrhosis and was highest in the first year after baseline but persisted after ≥10 years of follow-up (aHR=2.74, 95% CI 2.37 to 3.16).ConclusionIndividuals with biopsy-proven ALD have a near fivefold increased risk of death compared with the general population. Individuals with ALD without cirrhosis were also at increased risk of death, reaffirming the need to increase vigilance in the management of these individuals.

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Faculty Opinions recommendation of Decreased risk of death from coronary heart disease amongst men with higher 'femininity' scores: a general population cohort study.

Faculty Opinions – Post-Publication Peer Review of the Biomedical Literature ◽

10.3410/f.1126994.584119 ◽

2008 ◽

Author(s):

Wizdom Powell

Keyword(s):

Coronary Heart Disease ◽

Cohort Study ◽

Heart Disease ◽

General Population ◽

Risk Of Death ◽

Population Cohort ◽

General Population Cohort ◽

Population Cohort Study

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AB0393 PRE-EXISTING MORBIDITY AS A RISK FACTORS FOR MORTALITY IN IgA VASCULITIS

Annals of the Rheumatic Diseases ◽

10.1136/annrheumdis-2021-eular.2307 ◽

2021 ◽

Vol 80 (Suppl 1) ◽

pp. 1224.3-1225

Author(s):

J. Nossent ◽

D. Preen ◽

W. Raymond ◽

H. Keen ◽

C. Inderjeeth

Keyword(s):

Risk Factors ◽

Cohort Study ◽

Mortality Rate ◽

Data Collection ◽

Premature Death ◽

Iga Vasculitis ◽

Risk Of Death ◽

Increased Risk ◽

Serious Infections ◽

Western Australian

Background:IgA vasculitis is generally considered to be a self-limiting condition, but this is at odds with the increased mortality observed in adult patients with IgA vasculitis (1).Objectives:With sparse data on prognostic factors in IgAV, we investigated whether pre-existing conditions are risk factors for mortality in adult IgAV patients.Methods:Observational population-based cohort study using state-wide linked longitudinal health data for adults with IgAV (n=267) and matched controls (n=1080) between 1980-2015. Charlson comorbidity index (CCI) and serious infections (SI) were recorded over an extensive lookback period prior to diagnosis. Date and causes of death were extracted from the WA Death Registry. Mortality rate (deaths/1000 person-years) ratios (MRR) and time dependent survival analysis assessed the risk of death. Age and gender specific mortality rate data were obtained from the Australian Bureau of Statistics.Results:During 9.9 (±9.8) years lookback IgAV patients accrued higher CCI scores (2.60 vs1.50 p<0.001) and had higher risk of SI (OR 8.4, p<0.001), not fully explained by CCI scores. During 19 years follow-up, the risk of death in IgAV patients (n=137) was higher than in controls (n=397) (MRR 2.06, CI 1.70-2.50, p<0.01) and the general population (SMRR 5.64, CI 4.25, 7.53, p<0.001). Survival in IgAV was reduced at five (72.7 vs. 89.7 %) and twenty years (45.2% vs. 65.6 %) (both p<0.05). CCI (HR1.88, CI:1.25 - 2.73, p=0.001), renal failure (HR 1.48, CI: 1.04 - 2.22, p=0.03) and prior SI (HR 1.48, CI:1.01 – 2.16, p=0.04) were independent risk factors. Death from infections (5.8 vs 1.8%, p=0.02) was significantly more frequent in IgAV patients.Conclusion:Premorbid accrual of comorbidity is increased and predicts premature death in IgAV patients. However, comorbidity does not fully explain the increased risk of serious infections prior to diagnosis or the increased mortality due to infections in IgAV.References:[1]Villatoro-Villar M, Crowson CS, Warrington KJ, Makol A, Ytterberg SR, Koster MJ. Clinical Characteristics of Biopsy-Proven IgA Vasculitis in Children and Adults: A Retrospective Cohort Study. Mayo Clin Proc. 2019;94(9):1769-80.Acknowledgements:The authors would like to acknowledge the support of the Arthritis Foundation of WA and acknowledge the Western Australian Data Linkage Branch, the Western Australian Department of Health, and the data custodians of, the Hospital and Morbidity Data Collection, the Emergency Department Data Collection the WA Cancer Register and the WA Death Register for their assistance with the study.Disclosure of Interests:None declared

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Adverse Perinatal Outcomes Associated with Stage 1 Hypertension in Pregnancy: A Retrospective Cohort Study

American Journal of Perinatology ◽

10.1055/s-0041-1739470 ◽

2021 ◽

Author(s):

Elizabeth Norton ◽

Frances Shofer ◽

Hannah Schwartz ◽

Lorraine Dugoff

Keyword(s):

Cohort Study ◽

Retrospective Cohort ◽

Perinatal Outcomes ◽

Hypertensive Disorder ◽

Hypertension In Pregnancy ◽

Increased Risk ◽

Hypertensive Disorder Of Pregnancy ◽

Adverse Perinatal Outcomes ◽

Stage 1 ◽

In Pregnancy

Objective To determine if women who newly met criteria for stage 1 hypertension in early pregnancy were at increased risk for adverse perinatal outcomes compared with normotensive women. Study Design We conducted a retrospective cohort study of women who had prenatal care at a single institution and subsequently delivered a live infant between December 2017 and August 2019. Women with a singleton gestation who had at least two prenatal visits prior to 20 weeks of gestation were included. We excluded women with known chronic hypertension or other major maternal illness. Two groups were identified: (1) women newly diagnosed with stage 1 hypertension before 20 weeks of gestation (blood pressure [BP] 130–139/80–89 on at least two occasions) and (2) women with no known history of hypertension and normal BP (<130/80 mm Hg) before 20 weeks of gestation. The primary outcome was any hypertensive disorder of pregnancy; secondary outcomes were indicated preterm birth and small for gestational age. Generalized linear models were used to compare risk of adverse outcomes between the groups. Results Of the 1,630 women included in the analysis, 1,443 women were normotensive prior to 20 weeks of gestation and 187 women (11.5%) identified with stage 1 hypertension. Women with stage 1 hypertension were at significantly increased risk for any hypertensive disorder of pregnancy (adjusted risk ratio [aRR]: 1.86, 95% confidence interval [CI]: 1.12–3.04) and indicated preterm birth (aRR: 1.83, 95% CI: 1.12–3.02). Black women and obese women with stage 1 hypertension were at increased for hypertensive disorder of pregnancy compared with white women and nonobese women, respectively (aRR: 1.32, 95% CI: 1.11–1.57; aRR: 1.69, 95% CI: 1.39–2.06). Conclusion These results provide insight about the prevalence of stage 1 hypertension and inform future guidelines for diagnosis and management of hypertension in pregnancy. Future research is needed to assess potential interventions to mitigate risk. Key Points

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Mortality following new-onset Rheumatoid Arthritis: has modern Rheumatology had an impact?

Annals of the Rheumatic Diseases ◽

10.1136/annrheumdis-2017-212131 ◽

2017 ◽

Vol 77 (1) ◽

pp. 85-91 ◽

Cited By ~ 25

Author(s):

Marie Holmqvist ◽

Lotta Ljung ◽

Johan Askling

Keyword(s):

Rheumatoid Arthritis ◽

General Population ◽

Excess Mortality ◽

Disease Onset ◽

Mortality Rates ◽

Calendar Time ◽

Risk Of Death ◽

Quality Register ◽

Increased Risk ◽

New Onset

ObjectiveTo investigate if, and when, patients diagnosed with rheumatoid arthritis (RA) in recent years are at increased risk of death.MethodsUsing an extensive register linkage, we designed a population-based nationwide cohort study in Sweden. Patients with new-onset RA from the Swedish Rheumatology Quality Register, and individually matched comparators from the general population were followed with respect to death, as captured by the total population register.Results17 512 patients with new-onset RA between 1 January 1997 and 31 December 2014, and 78 847 matched general population comparator subjects were followed from RA diagnosis until death, emigration or 31 December 2015. There was a steady decrease in absolute mortality rates over calendar time, both in the RA cohort and in the general population. Although the relative risk of death in the RA cohort was not increased (HR=1.01, 95% CI 0.96 to 1.06), an excess mortality in the RA cohort was present 5 years after RA diagnosis (HR after 10 years since RA diagnosis=1.43 (95% CI 1.28 to 1.59)), across all calendar periods of RA diagnosis. Taking RA disease duration into account, there was no clear trend towards lower excess mortality for patients diagnosed more recently.ConclusionsDespite decreasing mortality rates, RA continues to be linked to an increased risk of death. Thus, despite advancements in RA management during recent years, increased efforts to prevent disease progression and comorbidity, from disease onset, are needed.

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