scholarly journals A long-term follow-up study of mortality in transsexuals receiving treatment with cross-sex hormones

2011 ◽  
Vol 164 (4) ◽  
pp. 635-642 ◽  
Author(s):  
Henk Asscheman ◽  
Erik J Giltay ◽  
Jos A J Megens ◽  
W (Pim) de Ronde ◽  
Michael A A van Trotsenburg ◽  
...  
Keyword(s):  
General Population ◽  
Sex Hormones ◽  
Cancer Mortality ◽  
Ethinyl Estradiol ◽  
Total Mortality ◽  
Mortality Rates ◽  
Cardiovascular Death ◽  
Mortality Data

ObjectiveAdverse effects of long-term cross-sex hormone administration to transsexuals are not well documented. We assessed mortality rates in transsexual subjects receiving long-term cross-sex hormones.DesignA cohort study with a median follow-up of 18.5 years at a university gender clinic.MethodsMortality data and the standardized mortality rate were compared with the general population in 966 male-to-female (MtF) and 365 female-to-male (FtM) transsexuals, who started cross-sex hormones before July 1, 1997. Follow-up was at least 1 year. MtF transsexuals received treatment with different high-dose estrogen regimens and cyproterone acetate 100 mg/day. FtM transsexuals received parenteral/oral testosterone esters or testosterone gel. After surgical sex reassignment, hormonal treatment was continued with lower doses.ResultsIn the MtF group, total mortality was 51% higher than in the general population, mainly from increased mortality rates due to suicide, acquired immunodeficiency syndrome, cardiovascular disease, drug abuse, and unknown cause. No increase was observed in total cancer mortality, but lung and hematological cancer mortality rates were elevated. Current, but not past ethinyl estradiol use was associated with an independent threefold increased risk of cardiovascular death. In FtM transsexuals, total mortality and cause-specific mortality were not significantly different from those of the general population.ConclusionsThe increased mortality in hormone-treated MtF transsexuals was mainly due to non-hormone-related causes, but ethinyl estradiol may increase the risk of cardiovascular death.In the FtM transsexuals, use of testosterone in doses used for hypogonadal men seemed safe.

Long-term survival and competing causes of death in men with stage I seminoma.

2011 ◽  
Vol 29 (7_suppl) ◽  
pp. 226-226 ◽  
Author(s):  
C. Beard ◽  
M. Chen ◽  
N. D. Arvold ◽  
P. L. Nguyen ◽  
A. K. Ng ◽  
...  
Keyword(s):  
General Population ◽  
Testicular Cancer ◽  
Cancer Mortality ◽  
Stage I ◽  
Second Malignancy ◽  
Term Survival ◽  
All Cause Mortality ◽  
Stage I Seminoma

226 Background: To better understand the impact of RT on mortality, we analyzed long-term survival and patterns of excess mortality in men with stage I seminoma. Methods: 9,045 men with stage I seminoma were identified in the Surveillance Epidemiology and End Results database. Time to testicular-cancer mortality (TCM), death from second malignancy (SM), cardiovascular mortality (CVM) or suicide (SUIC) and all-cause mortality (ACM) were calculated. Survival estimates were calculated using the Kaplan-Meier method. Gender- and age-adjusted standardized mortality ratios (SMR) were calculated using U.S. population data. Cox and Fine and Gray multivariable analysis were used to evaluate the effect of RT on mortality outcomes. Results: 7,025 men (78%) received RT. After a median follow-up of 11.7 years, 869 men (9.6%) had died: sixty-five from TCM, 279 from SM, 169 from CVM and 37 from SUIC. 10-year rates of ACM and TCM were 4.24% and 0.52% among men who received RT and 7.14% and 1.22% among men who did not. Compared to the adjusted general population, men with seminoma had increased risk of ACM (SMR 1.12; 95% confidence interval [CI] 1.12-1.28), SM (SMR 1.78; 95% CI 1.58-2.00) and SUIC (SMR 1.40; 95% CI 1.02-1.94) and decreased risk of CVM (SMR 0.73; 95% CI 0.62-0.84). Rates of ACM, SM and SUIC (SMR, all p < 0.05) were increased whether RT was used or not. Men who received RT were less likely to die (adjusted hazard ratio [AHR] 0.76; 95% CI 0.65-0.89; p < 0.001) and had a lower risk of TCM (AHR 0.39; 95% CI 0.24-0.65; p < 0.001). There was no difference in CVM between men who did and did not receive RT (AHR 0.89; 95% CI 0.60-1.15; p = 0.230) and a numerical increase in SM in men who received RT as compared to others (AHR 1.25; 95% CI 0.90-1.72; p=0.180). Conclusions: Compared to the general population, men with a history of stage I seminoma had increased risks of all-cause mortality, death from second malignancies, and suicide. Our data suggest that 15 years after diagnosis, men who did receive RT may be more likely to die from a second malignancy than men who did not. Although not receiving RT was associated with higher testicular-cancer mortality, the results may reflect decreased access to care or follow-up as active surveillance protocols were not common during the study era. No significant financial relationships to disclose.

scholarly journals Intake of starch and sugars and total and cause-specific mortality in a Japanese community: the Takayama Study

2019 ◽  
Vol 122 (07) ◽  
pp. 820-828 ◽  
Author(s):  
Chisato Nagata ◽  
Keiko Wada ◽  
Michiyo Yamakawa ◽  
Kie Konishi ◽  
Yuko Goto ◽  
...  
Keyword(s):  
Cardiovascular Mortality ◽  
Total Mortality ◽  
Mortality Data ◽  
High Intake ◽  
Free Sugars ◽  
Baseline Mortality ◽  
Specific Mortality ◽  
Self Administered Questionnaire

AbstractStudies on the intake of different types of carbohydrates and long-term mortality are sparse. We examined the association of starch, total and each type of sugar and free sugars with the risk of total and cause-specific mortality in a cohort of the general population in Japan. Study subjects were 29 079 residents from the Takayama Study, Japan, who responded to a self-administered questionnaire in 1992. Diet was assessed by a validated FFQ at the baseline. Mortality was ascertained during 16 years of follow-up. We noted 2901 deaths (974 cancer related and 775 cardiovascular related) in men and 2438 death (646 cancer related and 903 cardiovascular related) in women. In men, intake of starch was inversely associated with total mortality after controlling for covariates (hazard ratio (HR) for the highest quartile v. lowest quartile: 0·71; 95 % CI 0·60, 0·84; Ptrend &lt; 0·001). Intakes of total sugars, glucose, fructose, sucrose, maltose and free and naturally occurring sugars were significantly positively associated with total mortality in men (HR for the highest v. lowest quartile of total sugar: 1·27; 95 % CI 1·12, 1·45; Ptrend &lt; 0·0001). Similar relations were observed for cardiovascular mortality and non-cancer, non-cardiovascular mortality in men. In women, there was no significant association between any type of carbohydrates and mortality except that intake of free sugars was significantly positively associated with total and non-cancer, non-cardiovascular mortality. Data suggest that the high intake of starch reduces mortality, whereas the high intake of sugars, including glucose, fructose and sucrose, increases mortality in Japanese men.

scholarly journals Limitations in the Effect of Screening on Breast Cancer Mortality

2018 ◽  
Vol 36 (30) ◽  
pp. 2988-2994 ◽  
Author(s):  
Anna-Belle Beau ◽  
Per Kragh Andersen ◽  
Ilse Vejborg ◽  
Elsebeth Lynge
Keyword(s):  
Breast Cancer ◽  
Cancer Mortality ◽  
Observational Studies ◽  
Evaluation Model ◽  
Breast Cancer Mortality ◽  
Mortality Rates ◽  
Term Effect ◽  
Long Term Effect

Purpose Randomized, controlled trials showed that screening reduces breast cancer mortality rates, but some recent observational studies have concluded that programmatic screening has had minor effect on breast cancer mortality rates. This apparent contradiction might be explained by the use of aggregated data in observational studies. We assessed the long-term effect of screening using individual-level data. Materials and Methods Using data from mammography screening in the Copenhagen and Danish national registers, we compared the observed breast cancer mortality rate in women invited to screening with the expected rate in absence of screening. The effect was examined using the “naïve model,” which included all breast cancer deaths; the “follow-up model,” which counted only breast cancer deaths in women diagnosed after their first invitation to screening; and the “evaluation model,” which is similar to the follow-up model during screening age, but after screening age, which counted only breast cancer deaths and person-years in women diagnosed during screening age. Results We included 18,781,292 person-years, 976,743 of which were from women invited to screening. The naïve and follow-up models showed, respectively, 10% and 11% reduction in breast cancer mortality after invitation to screening. However, many breast cancer deaths occurred in women whose cancer was diagnosed when they were no longer eligible for screening. Accounting for this dilution, the evaluation model showed a 20% (95% CI, 10% to 29%) reduction in breast cancer mortality after invitation to screening. Conclusion Screening had a clear long-term beneficial effect with a 20% reduction in breast cancer–associated mortality in the invited population. However, this effect was, by nature, restricted to breast cancer deaths in women who could potentially benefit from screening. Our study highlights the complexity in evaluating the long-term effect of breast cancer screening from observational data.

scholarly journals The Impact of Waist Circumference on Incident of Cardiovascular Death During 9 Years of Follow Up in General Population

2021 ◽  
Author(s):  
Man Li ◽  
Shu-xia Wang ◽  
Yong-kang Su ◽  
Jin Sun ◽  
An-hang Zhang ◽  
...  
Keyword(s):  
Waist Circumference ◽  
General Population ◽  
Regression Models ◽  
Prognostic Value ◽  
Cox Regression ◽  
Cardiovascular Death ◽  
Kaplan Meier ◽  
Increased Risk

Abstract Background: Risk assessment is essential for the primary prevention of cardiovascular death among general population. Although studies have shown that waist circumference (WC) is positively associated with an increased risk of cardiovascular death among the general population, few studies have investigated the prognostic value of WC during a long-term follow up and the risk threshold of WC remains controversial. We aimed to investigate whether higher level of WC measurements was able to predict mortality in general population.Methods: In this prospective cohort study, a total of 1521 consecutive subjects free of clinical cardiovascular disease were included. The end point was cardiovascular death. The Kaplan-Meier method was used to evaluate the cumulative risk of outcome at different WC levels, and compared by log-rank tests. Univariate and multivariable-adjusted Cox regression models were used to investigate the association between WC and outcomes.Results: During a median follow up of 9.2 years, there were 265 patients died. Kaplan-Meier survival estimates indicated that the patients with higher levels of WC (WC> 94cm) had a significantly increased risk of cardiovascular death (log-rank p＜0.001). After adjustment for potential confounders, multiple COX regression models showed that higher level of WC was an independent predictor in developing cardiovascular death (HR 3.02; 95% CI: 1.88–3.83; p＜0.001). We saw a significant increase of (area under the curve) AUC in ROC (receiver operating characteristic) curve after addition of WC to a clinical model, for long-term cardiovascular death the increase of AUC 0.766 vs 0.642 (95% CI: 0.787–0.846 p＜0.001). The addition of WC to established risk factors significantly improved risk prediction of cardiovascular death (net reclassification index, and integrated discrimination improvement, all p＜0.05).Conclusion: Higher level of WC is significantly associated with long-term cardiovascular death. WC may provide incremental prognostic value beyond traditional risks factors.

scholarly journals Health Consequences of an Elite Sporting Career: Long-Term Detriment or Long-Term Gain? A Meta-Analysis of 165,000 Former Athletes

2020 ◽  
Author(s):  
Adam Runacres ◽  
Kelly A. Mackintosh ◽  
Melitta A. McNarry
Keyword(s):  
General Population ◽  
Cancer Mortality ◽  
English Language ◽  
Meta Analysis ◽  
Premature Mortality ◽  
Epidemiological Studies ◽  
Registration Number ◽  
Mortality Ratio ◽  
Former Elite Athletes

Abstract Introduction Exercise is widely accepted to improve health, reducing the risk of premature mortality, cardiovascular disease (CVD) and cancer. However, several epidemiological studies suggest that the exercise-longevity relationship may be ‘J’ shaped; with elite athlete’s likely training above these intensity and volume thresholds. Therefore, the aim of this meta-analysis was to examine this relationship in former elite athletes. Methods 38,047 English language articles were retrieved from Web of Science, PubMed and SportDiscus databases published after 1970, of which 44 and 24 were included in the systematic review and meta-analysis, respectively. Athletes were split into three groups depending on primary sport: Endurance (END), Mixed/Team, or power (POW). Standard mortality ratio’s (SMR) and standard proportionate mortality ratio (SPMR) were obtained, or calculated, and combined for the meta-analysis. Results Athletes lived significantly longer than the general population (male SMR 0.69 [95% CI 0.61–0.78]; female SMR 0.51 [95% CI 0.40–0.65]; both p < 0.01). There was no survival benefit for male POW athletes compared to the general population (SMR 1.04 [95% CI 0.91–1.12]). Although male athlete’s CVD (SMR 0.73 [95% CI 0.62–0.85]) and cancer mortality (SMR 0.75 [95% CI 0.63–0.89]), were significantly reduced compared to the general population, there was no risk-reduction for POW athletes CVD mortality (SMR 1.10 [0.86–1.40]) or END athletes cancer mortality (SMR 0.73 [0.50–1.07]). There was insufficient data to calculate female sport-specific SMR’s. Discussion Overall, athletes live longer and have a reduced incidence of both CVD and cancer mortality compared to the general population, refuting the ‘J’ shape hypothesis. However, different health risks may be apparent according to sports classification, and between sexes, warranting further investigation. Trial registration PROSPERO (registration number: CRD42019130688).

Long-Term Clinical Outcome in Elderly Patients Undergoing Mitral Valve Repair

2020 ◽  
Author(s):  
Julia Götte ◽  
Armin Zittermann ◽  
Kavous Hakim-Meibodi ◽  
Masatoshi Hata ◽  
Rene Schramm ◽  
...  
Keyword(s):  
Mitral Valve ◽  
General Population ◽  
Elderly Patients ◽  
Cox Regression ◽  
Functional Class ◽  
Tricuspid Valve Repair ◽  
Valve Repair ◽  
Cox Regression Analysis

Abstract Background Long-term data on patients over 75 years undergoing mitral valve (MV) repair are scarce. At our high-volume institution, we, therefore, aimed to evaluate mortality, stroke risk, and reoperation rates in these patients. Methods We investigated clinical outcomes in 372 patients undergoing MV repair with (n = 115) or without (n = 257) tricuspid valve repair. The primary endpoint was the probability of survival up to a maximum follow-up of 9 years. Secondary clinical endpoints were stroke and reoperation of the MV during follow-up. Univariate and multivariable Cox regression analysis was performed to assess independent predictors of mortality. Mortality was also compared with the age- and sex-adjusted general population. Results During a median follow-up period of 37 months (range: 0.1–108 months), 90 patients died. The following parameters were independently associated with mortality: double valve repair (hazard ratio, confidence interval [HR, 95% CI]: 2.15, 1.37–3.36), advanced age (HR: 1.07, CI: 1.01–1.14 per year), diabetes (HR: 1.97, CI: 1.13–3.43), preoperative New York Heart Association (NYHA) functional class (HR: 1.41, CI: 1.01–1.97 per class), and operative creatininemax levels (HR: 1.32, CI: 1.13–1.55 per mg/dL). The risk of stroke in the isolated MV and double valve repair groups at postoperative year 5 was 5.0 and 4.1%, respectively (p = 0.65). The corresponding values for the risk of reoperation were 4.0 and 7.0%, respectively (p = 0.36). Nine-year survival was comparable with the general population (53.2 vs. 53.1%). Conclusion Various independent risk factors for mortality in elderly MV repair patients could be identified, but overall survival rates were similar to those of the general population. Consequently, our data indicates that repairing the MV in elderly patients represents a suitable and safe surgical approach.

scholarly journals Outcomes for Children and Adolescents With Cancer: Challenges for the Twenty-First Century

2010 ◽  
Vol 28 (15) ◽  
pp. 2625-2634 ◽  
Author(s):  
Malcolm A. Smith ◽  
Nita L. Seibel ◽  
Sean F. Altekruse ◽  
Lynn A.G. Ries ◽  
Danielle L. Melbert ◽  
...  
Keyword(s):  
United States ◽  
Childhood Cancer ◽  
Cancer Mortality ◽  
Lymphoblastic Leukemia ◽  
The United States ◽  
Mortality Rates ◽  
Mortality Data ◽  
Childhood Cancers ◽  
Essential Information ◽  
The Impact

Purpose This report provides an overview of current childhood cancer statistics to facilitate analysis of the impact of past research discoveries on outcome and provide essential information for prioritizing future research directions. Methods Incidence and survival data for childhood cancers came from the Surveillance, Epidemiology, and End Results 9 (SEER 9) registries, and mortality data were based on deaths in the United States that were reported by states to the Centers for Disease Control and Prevention by underlying cause. Results Childhood cancer incidence rates increased significantly from 1975 through 2006, with increasing rates for acute lymphoblastic leukemia being most notable. Childhood cancer mortality rates declined by more than 50% between 1975 and 2006. For leukemias and lymphomas, significantly decreasing mortality rates were observed throughout the 32-year period, though the rate of decline slowed somewhat after 1998. For remaining childhood cancers, significantly decreasing mortality rates were observed from 1975 to 1996, with stable rates from 1996 through 2006. Increased survival rates were observed for all categories of childhood cancers studied, with the extent and temporal pace of the increases varying by diagnosis. Conclusion When 1975 age-specific death rates for children are used as a baseline, approximately 38,000 childhood malignant cancer deaths were averted in the United States from 1975 through 2006 as a result of more effective treatments identified and applied during this period. Continued success in reducing childhood cancer mortality will require new treatment paradigms building on an increased understanding of the molecular processes that promote growth and survival of specific childhood cancers.

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