scholarly journals Association of Happiness and Life Satisfaction with Cancer Mortality in the United States: A Longitudinal Analysis

2020 ◽  
Vol 4 (2) ◽  
pp. 162-169
Author(s):  
Hyunjung Lee ◽  
Gopal K. Singh
Keyword(s):  
United States ◽  
Life Satisfaction ◽  
Mortality Risk ◽  
Cancer Mortality ◽  
Proportional Hazards ◽  
The United States ◽  
Cox Proportional Hazards ◽  
Cox Models ◽  
Creative Commons ◽  
Cancer Mortality Risk

Background: Theimpact of happiness and life satisfaction on cancer mortality is not well studied. Using a longitudinal dataset, we examined the association between levels of happiness/life satisfaction and cancer mortality in the United States. Methods: We analyzed the 2001 National Health Interview Survey (NHIS) prospectively linked to 2001-2014 mortality records in the National Death Index (NDI) (N=30,933). Cox proportional hazards regression was used to model survival time as a function of happiness, life satisfaction, and sociodemographic and behavioral characteristics. Results: In Cox models with 14 years of mortality follow-up, cancer mortality risk was 78% higher (hazard ratio [HR]=1.78; 95% CI=1.42,2.23) in adults with little or no happiness, controlling for age, and 53% higher (HR=1.53; 95% CI=1.19,1.97) in adults with little/no happiness, controlling for sociodemographic, behavioral and health characteristics, when compared with adults reporting happiness most or all of the time. Age-adjusted cancer mortality risk increased by 41% (HR=1.41; 95% CI=1.21,1.77) in adults who were very dissatisfied with their life. Cancer mortality did not vary by life satisfaction after adjusting for all covariates. Conclusions and Implications for Translation: Adults with lower happiness levels had significantly higher cancer mortality risks than those with higher happiness levels. Excess mortality was substantially accounted for by sociodemographic, behavioral, and health risk factors. Key words: • Happiness • Life satisfaction • Cancer • Mortality • Longitudinal • Social determinants   Copyright © 2020 Lee and Singh. Published by Global Health and Education Projects, Inc. This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY 4.0) which permits unrestricted use, distribution, and reproduction in any medium, provided the original work, first published in this journal, is properly cited.

scholarly journals Marked Disparities in Cardiovascular Disease Mortality by Levels of Happiness and Life Satisfaction in the United States

2020 ◽  
Vol 4 (2) ◽  
pp. 170-177
Author(s):  
Hyunjung Lee ◽  
Gopal K. Singh
Keyword(s):  
United States ◽  
Cardiovascular Disease ◽  
Life Satisfaction ◽  
Mortality Risk ◽  
Proportional Hazards ◽  
Well Being ◽  
The United States ◽  
Cox Proportional Hazards ◽  
Subjective Well Being ◽  
Cvd Mortality

Background: Theimpact of happiness and life satisfaction on cardiovascular disease (CVD) mortality is not well-studied. Using a longitudinal dataset, we examined the association between levels of happiness/life satisfaction and CVD mortality in the United States. Methods: We analyzed the 2001 National Health Interview Survey (NHIS) prospectively linked to 2001-2014 mortality records in the National Death Index (NDI) (N=30,933). Cox proportional hazards regression was used to model survival time as a function of happiness, life satisfaction, and sociodemographic and behavioral characteristics. Results: In Cox models with 14 years of mortality follow-up, CVD mortality risk was 59% higher (hazard ratio [HR]=1.59; 95% CI=1.26,2.02) in adults with little or no happiness, controlling for age, and 30% higher (HR=1.30; 95% CI=1.01,1.67) in adults with little/no happiness, controlling for sociodemographic, behavioral and health characteristics, when compared with adults reporting happiness most or all of the time. Mortality risk was 81% higher (HR=1.81; 95% CI=1.40,2.34) in adults who were very dissatisfied with their life, controlling for age, and 39% higher (HR=1.39; 95% CI=1.05,1.82) in adults who were very dissatisfied, controlling for all covariates, when compared with adults who were very satisfied. Conclusions and Implications for Translation: Adults with lower happiness and life satisfaction levels had significantly higher CVD mortality risks than those with higher happiness and life satisfaction levels. Subjective well-being is an important determinant of CVD mortality. Key words: • Happiness • Life satisfaction • Cardiovascular • Mortality • Longitudinal • Social determinants   Copyright © 2020 Lee and Singh. Published by Global Health and Education Projects, Inc. This is an open-access arti-cle distributed under the terms of the Creative Commons Attribution License (CC BY 4.0) which permits unrestricted use, distribution, and reproduction in any medium, provided the original work, first published in this journal, is properly cited.

scholarly journals Racial and Ethnic Variations in Mortality Rates for Patients Undergoing Maintenance Dialysis Treated in US Territories Compared with the US 50 States

2019 ◽  
Vol 15 (1) ◽  
pp. 101-108 ◽  
Author(s):  
Guofen Yan ◽  
Jenny I. Shen ◽  
Rubette Harford ◽  
Wei Yu ◽  
Robert Nee ◽  
...  
Keyword(s):  
United States ◽  
Confidence Interval ◽  
Ethnic Group ◽  
Proportional Hazards ◽  
The United States ◽  
Mortality Rates ◽  
American Samoa ◽  
Cox Proportional Hazards ◽  
Maintenance Dialysis ◽  
Racial Ethnic

Background and objectivesIn the United States mortality rates for patients treated with dialysis differ by racial and/or ethnic (racial/ethnic) group. Mortality outcomes for patients undergoing maintenance dialysis in the United States territories may differ from patients in the United States 50 states.Design, setting, participants, & measurementsThis retrospective cohort study of using US Renal Data System data included 1,547,438 adults with no prior transplantation and first dialysis treatment between April 1, 1995 and September 28, 2012. Cox proportional hazards regression was used to calculate hazard ratios (HRs) of death for the territories versus 50 states for each racial/ethnic group using the whole cohort and covariate-matched samples. Covariates included demographics, year of dialysis initiation, cause of kidney failure, comorbid conditions, dialysis modality, and many others.ResultsOf 22,828 patients treated in the territories (American Samoa, Guam, Puerto Rico, Virgin Islands), 321 were white, 666 were black, 20,299 were Hispanic, and 1542 were Asian. Of 1,524,610 patients in the 50 states, 838,736 were white, 444,066 were black, 182,994 were Hispanic, and 58,814 were Asian. The crude mortality rate (deaths per 100 patient-years) was lower for whites in the territories than the 50 states (14 and 29, respectively), similar for blacks (18 and 17, respectively), higher for Hispanics (27 and 16, respectively), and higher for Asians (22 and 15). In matched analyses, greater risks of death remained for Hispanics (HR, 1.65; 95% confidence interval, 1.60 to 1.70; P<0.001) and Asians (HR, 2.01; 95% confidence interval, 1.78 to 2.27; P<0.001) living in the territories versus their matched 50 states counterparts. There were no significant differences in mortality among white or black patients in the territories versus the 50 states.ConclusionsMortality rates for patients undergoing dialysis in the United States territories differ substantially by race/ethnicity compared with the 50 states. After matched analyses for comparable age and risk factors, mortality risk no longer differed for whites or blacks, but remained much greater for territory-dwelling Hispanics and Asians.

scholarly journals Incidence and Survival Changes in Patients with Esophageal Adenocarcinoma during 1984–2013

2019 ◽  
Vol 2019 ◽  
pp. 1-11 ◽  
Author(s):  
Zhang Haiyu ◽  
Pei Xiaofeng ◽  
Mo Xiangqiong ◽  
Qiu Junlan ◽  
Zheng Xiaobin ◽  
...  
Keyword(s):  
United States ◽  
Risk Factors ◽  
Esophageal Adenocarcinoma ◽  
Proportional Hazards ◽  
Proportional Hazards Model ◽  
The United States ◽  
Cox Proportional Hazards ◽  
Cox Proportional Hazards Model ◽  
Hazards Model ◽  
Potential Risk Factors

Purpose. The morbidity of esophageal adenocarcinoma (EAC) has significantly increased in Western countries. We aimed to identify trends in incidence and survival in patients with EAC in the recent 30 years and then analyzed potential risk factors, including race, sex, age, and socioeconomic status (SES). Methods. All data were collected from the Surveillance, Epidemiology, and End Results or SEER database. Kaplan–Meier analysis and the Cox proportional hazards model were conducted to compare the differences in survival between variables, including sex, race, age, and SES, as well as to evaluate the association of these factors with prognosis. Results. A total of 16,474 patients with EAC were identified from 1984 to 2013 in the United States. Overall incidence increased every 10 years from 1.8 to 3.1 to 3.9 per 100. Overall survival gradually improved (p<0.0001), which was evident in male patients ((hazard ratio (HR) = 1.111; 95% confidence interval (CI) (1.07, 1.15)); however, the 5-year survival rate remained low (20.1%). The Cox proportional hazards model identified old age, black ethnicity, and medium/high poverty as risk factors for EAC (HR = 1.018; 95% CI (1.017, 1.019; HR = 1.240, 95% CI (1.151,1.336), HR = 1.000, 95% CI (1.000, 1.000); respectively). Conclusions. The incidence of EAC in the United States increased over time. Survival advantage was observed in white patients and patients in the low-poverty group. Sex was an independent prognostic factor for EAC, but this finding has to be confirmed by further research.

scholarly journals Survival Analysis of COVID-19 on Democracy with Cox Proportional Hazards Model

2020 ◽  
Author(s):  
Yue Zhao ◽  
Deepika Dilip
Keyword(s):  
United States ◽  
Survival Analysis ◽  
South Korea ◽  
Proportional Hazards ◽  
Proportional Hazards Model ◽  
The United States ◽  
Cox Proportional Hazards ◽  
Cox Proportional Hazards Model ◽  
Effective Measure ◽  
Hazards Model

Abstract Background: The outbreak of Coronavirus disease 2019 (COVID-19) has struck us in many ways and we observed that China and South Korea found an effective measure to contain the virus. Conversely, the United States and the European countries are struggling to fight the virus. China is not considered a democracy and South Korea is less democratic than the United States. Therefore, we want to explore the association between the deaths of COVID-19 and democracy. Methods: We collected COVID-19 deaths data for each country from the Johns Hopkins University website and democracy indices of 2018 from the Economist Intelligence Unit website in May 2020. Then we conducted a survival analysis, regarding each country as a subject, with the Cox Proportional Hazards Model, adjusting for other selected variables. Result: The result showed that the association between democracy and deaths of COVID-19 was significant (P=0.04), adjusting for other covariates. Conclusion: In conclusion, less democratic governments performed better in containing the virus and controlling the number of deaths.

Significantly Higher Mortality Following Liver Transplantation Among Patients Aged 70 Years and Older

2017 ◽  
Vol 27 (3) ◽  
pp. 225-231 ◽  
Author(s):  
Mokshya Sharma ◽  
Aijaz Ahmed ◽  
Robert J. Wong
Keyword(s):  
United States ◽  
Hepatocellular Carcinoma ◽  
Liver Transplantation ◽  
Hepatitis C ◽  
Proportional Hazards ◽  
The United States ◽  
Cox Proportional Hazards ◽  
Cox Proportional Hazards Models ◽  
Using Data ◽  
The Impact

Introduction: The age of liver transplantation recipients in the United States is steadily increasing. However, the impact of age on liver transplant outcomes has demonstrated contradictory results. Research Questions: We aim to evaluate the impact of age on survival following liver transplantation among US adults. Design: Using data from the United Network for Organ Sharing registry, we retrospectively evaluated all adults undergoing liver transplantation from 2002 to 2012 stratified by age (aged 70 years and older vs aged <70 years), presence of hepatocellular carcinoma, and hepatitis C virus status. Overall survival was evaluated with Kaplan-Meier methods and multivariate Cox proportional hazards models. Results: Compared to patients aged <70 years, those aged 70 years and older had significantly lower 5-year survival following transplantation among all groups analyzed (hepatocellular carcinoma: 59.9% vs 68.6%, P < .01; nonhepatocellular carcinoma: 61.2% vs 74.2%, P < .001; hepatitis C: 60.7% vs 69.0%, P < .01; nonhepatitis C: 62.6% vs 78.5%, P < .001). On multivariate regression, patients aged 70 years and older at time of transplantation was associated with significantly higher mortality compared to those aged <70 years (hazards ratio: 1.67; 95% confidence interval: 1.48-1.87; P < .001). Conclusion: The age at the time of liver transplantation has continued to increase in the United States. However, patients aged 70 years and older had significantly higher mortality following liver transplantation. These observations are especially important given the aging cohort of patients with chronic liver disease in the United States.

scholarly journals Contemporary Associations of Exclusive Cigarette, Cigar, Pipe, and Smokeless Tobacco Use With Overall and Cause-Specific Mortality in the United States

2019 ◽  
Vol 3 (3) ◽  
Author(s):  
Maki Inoue-Choi ◽  
Meredith S Shiels ◽  
Timothy S McNeel ◽  
Barry I Graubard ◽  
Dorothy Hatsukami ◽  
...  
Keyword(s):  
United States ◽  
Tobacco Use ◽  
Smokeless Tobacco ◽  
Proportional Hazards ◽  
The United States ◽  
Cox Proportional Hazards ◽  
Hazard Ratios ◽  
Specific Mortality ◽  
Smokeless Tobacco Use ◽  
Overall Mortality

Abstract Background A growing proportion of tobacco users in the United States use non-cigarette products including cigars, pipes, and smokeless tobacco. Studies examining the disease and mortality risks of these products are urgently needed. Methods We harmonized tobacco use data from 165 335 adults in the 1991, 1992, 1998, 2000, 2005, and 2010 National Health Interview Surveys. Hazard ratios (HRs) and 95% confidence intervals (CIs) for overall and cause-specific mortality occurring through December 31, 2015, were estimated by exclusive use of cigarettes, cigars, pipes, or smokeless tobacco using Cox proportional hazards regression with age as the underlying time metric and never tobacco users as the referent group. Results Current use of cigarettes (HR = 2.23, 95% CI = 2.13 to 2.33) and smokeless tobacco (HR = 1.36, 95% CI = 1.17 to 1.59) were each associated with overall mortality. Relative to never tobacco users, higher risks were observed both in daily (HR = 2.34, 95% CI = 2.24 to 2.44) and nondaily (HR = 1.69, 95% CI = 1.54 to 1.86) cigarette smokers, with associations also observed across major smoking-related causes of death. Daily use of smokeless tobacco was also associated with overall mortality (HR = 1.41, 95% CI = 1.20 to 1.66) as was daily use of cigars (HR = 1.52, 95% CI = 1.12 to 2.08). Current smokeless tobacco use was associated with a higher risk of mortality from heart disease and smoking-related cancer, with strong associations observed for cancers of the oral cavity and bladder. Conclusions Exclusive daily use of cigarettes, cigars, and smokeless tobacco was associated with higher mortality risk. Tobacco control efforts should include cigars and smokeless tobacco.

The Association Between Psychological Distress and Cancer Mortality in the United States: Results from the 1997–2014 NHIS-NDI Record Linkage Study

2021 ◽  
Author(s):  
Hyunjung Lee ◽  
Gopal K Singh
Keyword(s):  
Psychological Distress ◽  
Mortality Risk ◽  
Cancer Mortality ◽  
Well Being ◽  
The United States ◽  
Poverty Level ◽  
Adjusted Model ◽  
Distress Scale ◽  
Cancer Mortality Risk

Abstract Background/Purpose Psychological distress can influence cancer mortality through socioeconomic disadvantage, health-risk behaviors, or reduced access to care. These disadvantages can result in higher risks of cancer occurrence, a delayed cancer diagnosis, hamper adherence to treatment, and provoke inflammatory responses leading to cancer. Previous studies have linked psychological distress to cancer mortality. However, studies are lacking for the U.S. population. Methods This study examines the Kessler six-item psychological distress scale as a risk factor for U.S. cancer mortality using the pooled 1997–2014 data from the National Health Interview Survey (NHIS) linked to National Death Index (NDI) (N = 513,012). Cox proportional hazards regression was used to model survival time as a function of psychological distress and sociodemographic and behavioral covariates. Results In Cox models with 18 years of mortality follow-up, the cancer mortality risk was 80% higher (hazard ratio [HR] = 1.80; 95% CI = 1.64, 1.97) controlling for age; 61% higher (HR = 1.61; 95% CI = 1.46, 1.76) in the SES-adjusted model, and 33% higher (HR = 1.33; 95% CI = 1.21, 1.46) in the fully-adjusted model among adults with serious psychological distress (SPD), compared with adults without psychological distress. Males, non-Hispanic Whites, and adults with incomes at or above 400% of the federal poverty level had greater cancer mortality risk associated with SPD. Using an 8 years of mortality follow-up, those with SPD had 108% increased adjusted risks of mortality from breast cancer. Conclusion Our study findings underscore the significance of addressing psychological well-being in the population as a strategy for reducing cancer mortality.

scholarly journals Effect of Financial Literacy on Starting a New Business: Using Survival Analysis to Examine Differences between Older and Younger Entrepreneurs

2020 ◽  
pp. 343-372
Author(s):  
Felichism W. Kabo
Keyword(s):  
United States ◽  
Older Adults ◽  
Financial Literacy ◽  
Proportional Hazards ◽  
The United States ◽  
Study Data ◽  
Cox Proportional Hazards ◽  
Wide Range ◽  
New Business ◽  
Nationally Representative

Objective: This paper focuses on financial literacy as an antecedent to entrepreneurial involvement in order to examine and better understand differences between older and younger entrepreneurs. Financial literacy is the ability to apply the knowledge and skills needed to effectively manage financial resources over the life-course and is related to a wide range of economic outcomes. Methodology: The antecedence of financial literacy with respect to entrepreneurial engagement is examined using novel entrepreneurship data the United States. The study uses three waves (2014, 2016, and 2019) of complex survey data the Understanding America Study (UAS), a nationally representative and probability-based internet panel of households representing roughly 8,500 respondents ages 18 and older, and active since 2014. The data are used to generate survival curves using the Kaplan-Meier method, and to run survey linear and Cox proportional hazards regression models outcomes are starting a new business with respect to two time frames: over one’s lifetime, and since 2014. Results: The results show that there are associations between financial literacy and the rate of starting a new business both over one’s lifetime and since 2014, but only among older adults. Limitations: The study data were collected using a sample of adults in the United States which may limit the generalizability of the study findings to countries and regions other than the United States. Practical implications: This paper presents evidence that indicates that financial literacy is correlated with business start-up activities among older adults. This implies that financial literacy programs targeted at older adults may have an appreciable and significant multiplier effect.

Treatment Patterns and Health Outcomes in Platinum-Refractory or Platinum-Resistant Ovarian Cancer: A Retrospective Medical Record Review

2018 ◽  
Vol 28 (4) ◽  
pp. 738-748 ◽  
Author(s):  
Rohan Parikh ◽  
Samantha K. Kurosky ◽  
Margarita Udall ◽  
Jane Chang ◽  
Joseph C. Cappelleri ◽  
...  
Keyword(s):  
United States ◽  
United Kingdom ◽  
Proportional Hazards ◽  
Performance Status ◽  
The United States ◽  
Cox Proportional Hazards ◽  
Treatment Patterns ◽  
High Grade ◽  
The United Kingdom ◽  
Platinum Refractory

ObjectiveThe objective of this article is to describe real-world treatment patterns and outcomes in patients with platinum-refractory/resistant epithelial ovarian, fallopian tube, or primary peritoneal cancer (PRROC) in the United States, United Kingdom, and Canada.Methods/MaterialsPhysicians retrospectively reviewed medical records of women aged 18 years or older who were diagnosed with PRROC between January 2010 and June 2014. Patient characteristics, initial PRROC therapy, and health care utilization were assessed; progression-free survival (PFS) and overall survival were estimated using Kaplan-Meier and Cox proportional hazards methods.ResultsData were obtained on 392 US, 296 UK, and 82 Canadian patients. At initial ovarian cancer diagnosis, 65.8% (United States), 93.3% (United Kingdom), and 82.9% (Canada) of patients had stage III/IV disease; 43.6%, 73.7%, and 56.1%, respectively, had high-grade tumors. At PRROC diagnosis, mean age was 57.2 years (United States), 59.2 years (United Kingdom), and 57.4 years (Canada). Eastern Cooperative Oncology Group performance status was 0/1 at PRROC diagnosis for 57.7% (United States), 80.1% (United Kingdom), and 36.6% (Canada) of patients. Most patients initiated systemic treatment after PRROC diagnosis (United States, 71.4%; United Kingdom, 83.1%; Canada, 81.7%). The most common initial PRROC therapy was pegylated liposomal doxorubicin monotherapy (United States, 18.6%; United Kingdom, 50.0%; Canada, 34.3%). During initial PRROC treatment, 80.7%, 59.8%, and 44.8% of patients had 1 office visit or more and 17.5%, 10.2%, and 14.9% of patients had 1 hospitalization or more in the United States, the United Kingdom, and Canada, respectively. Treatment toxicity was the most common reason for hospitalization (United States, 75.5%; United Kingdom, 64.0%; Canada, 80.0%). Median (95% confidence interval) PFS was 5.6 (4.9–6.2), 8.0 (6.8–9.2), and 6.4 (5.4–9.3) months in the United States, the United Kingdom, and Canada. The Cox proportional hazards model showed that stage III/IV, high-grade tumors, and poorer performance status were associated with shorter survival.ConclusionsCurrent treatments for PRROC yield limited PFS and frequent hospitalizations reported to be related to toxicities or procedural complications, suggesting a continued unmet need for more effective and tolerable therapeutic strategies for PRROC.

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