scholarly journals Disparities in Outcomes Among Patients Diagnosed With Cancer in Proximity to an Emergency Department Visit

2022 ◽  
Author(s):  
Nicholas Pettit ◽  
Elisa Sarmiento ◽  
Jeffrey Kline
Keyword(s):  
Emergency Department ◽  
Low Income ◽  
Control Analysis ◽  
Adjusted Risk ◽  
Risk Of Death ◽  
Department Of Health ◽  
Prostate Cancers ◽  
Poor Outcomes ◽  
Case Control Analysis ◽  
First Time

Abstract A suspected diagnosis of cancer in the emergency department (ED) may be associated with poor outcomes, related to health disparities, however data are limited. This study is a case-control analysis of the Indiana State Department of Health Cancer Registry, and the Indiana Network for Patient Care. First time cancer diagnoses appearing in the registry between January 2013 and December 2017 were included. Cases were patients who had an ED visit in the 6 months before their cancer diagnosis; controls had no recent ED visits. The primary outcome was mortality, comparing ED-associated mortality to non-ED-associated. 134,761 first-time cancer patients were identified, including 15,432 (11.5%) cases. The mean age was same at 65, more of the cases were Black than the controls (12.4% vs 7.4%, P<.0001) and more were low income (36.4%. vs 29.3%). The top 3 ED-associated cancer diagnoses were lung (18.4%), breast (8.9%), and colorectal cancers (8.9%), whereas the controls were breast (17%), lung (14.9%), and prostate cancers (10.1%). Cases observed an over three-fold higher mortality, with cumulative death rate of 32.9% for cases vs 9.0% for controls (P<.0001). Regression analysis predicting mortality, controlling for many confounders produced an odds ratio of 4.12 (95% CI 3.72-4.56 for cases). This study found that an ED visit within 6 months prior to the first time of ICD-coded cancer is associated with Black race, low income and an overall three-fold increased adjusted risk of death. The mortality rates for ED-associated cancers are uniformly worse for all cancer types. These data suggest that additional work is needed to reduce disparities among ED-associated cancer diagnoses.

scholarly journals Disparities in outcomes among patients diagnosed with cancer associated with emergency department visits

2021 ◽  
Author(s):  
Nicholas Pettit ◽  
Elisa Sarmiento ◽  
Jeffrey Kline
Keyword(s):  
Emergency Department ◽  
Low Income ◽  
Emergency Department Visits ◽  
Transitions Of Care ◽  
Control Analysis ◽  
Chi Square ◽  
Entire Study ◽  
Risk Of Death ◽  
Increased Risk ◽  
First Time

Importance: Diagnosis of cancer in the emergency department (ED) may be associated with poor outcomes, related to socioeconomic (SES) disparities, however data are limited. Objective: To examine the morality and associated disparities for cancer diagnoses made less than six months after an ED visit. Design: This study is case-control analysis of the Indiana State Department of Health Cancer Registry, and the Indiana Network for Patient Care. First time diagnoses of ICD-cancer appearing in the registry between January 2013 and December 2017 were included. Cases were patients who had an ED visit in the 6 months before their cancer diagnosis; controls had no recent ED visits. Main Outcome(s) and Measure(s): Primary outcome was mortality, comparing ED-associated mortality to non-ED-associated. Secondary outcomes include SES and demographic disparities. Results: 134,761 first-time cancer patients were identified, including 15,432 (11.5%) cases. In cases and controls, the mean age was same at 65 and the Charlson Comorbidity Index (CCI) was the same at 2.0 in both groups. More of the ED cohort were Black than the non-ED cohort (12.4% vs 7.4%, P<.0001, Chi Square) and more were low income (36.4%. vs 29.3%). The top 3 ED-associated cancer diagnoses were lung (18.4%), breast (8.9%), and colorectal cancer (8.9%), vs. the non-ED cohort were breast (17%), lung (14.9%), and prostate cancer (10.1%). Regardless of type, all ED-associated cancers had an over three-fold higher mortality, with cumulative death rate of 32.9% for cases vs 9.0% for controls (P<.0001) over the entire study period. Regression analysis predicting mortality, clustering by city, controlling for age, gender, race, SES, drug/alcohol/tobacco use, and CCI score, produced an odds ratio of 4.12 (95% CI 3.72-4.56 for ED associated cancers). Conclusion and Relevance: This study found that an ED visit within 6 months prior to the first time of ICD-coded cancer is associated with Black race, low income and an overall three-fold increased risk of death. The mortality rates for ED-associated cancers are uniformly worse for all cancer types. These data suggest that additional work is needed in order to reduce disparities among ED-associated cancer diagnoses, including increased surveillance and improved transitions of care.

New-onset systemic sclerosis and scleroderma renal crisis under docetaxel

2021 ◽  
pp. 239719832110076
Author(s):  
Véronique Debien ◽  
Arthur Petitdemange ◽  
Dorothée Bazin ◽  
Carole Ederle ◽  
Benoit Nespola ◽  
...  
Keyword(s):  
Systemic Sclerosis ◽  
Rna Polymerase Iii ◽  
Systemic Autoimmune Disease ◽  
Scleroderma Renal Crisis ◽  
Prostate Cancers ◽  
Poor Outcomes ◽  
Induced Changes ◽  
First Time ◽  
Lung And Kidney ◽  
New Onset

Systemic sclerosis is a rare systemic autoimmune disease characterized by microvascular impairment and fibrosis of the skin and other organs with poor outcomes. Toxic causes may be involved. We reported the case of a 59-year-old woman who developed an acute systemic sclerosis after two doses of adjuvant chemotherapy by docetaxel and cyclophosphamide for a localized hormone receptor + human epithelial receptor 2—breast cancer. Docetaxel is a major chemotherapy drug used in the treatment of breast, lung, and prostate cancers, among others. Scleroderma-like skin-induced changes (morphea) have been already described for taxanes. Here, we report for the first time a case of severe lung and kidney flare with thrombotic microangiopathy after steroids for acute interstitial lung disease probably induced by anti-RNA polymerase III + systemic sclerosis after docetaxel.

scholarly journals Inhaled Corticosteroids and COVID-19 Risk and Mortality: A Nationwide Cohort Study

2020 ◽  
Vol 9 (11) ◽  
pp. 3406 ◽  
Author(s):  
Jae Chol Choi ◽  
Sun-Young Jung ◽  
Una A. Yoon ◽  
Seung-Hun You ◽  
Myo-Song Kim ◽  
...  
Keyword(s):  
Clinical Outcomes ◽  
Case Control Study ◽  
Inhaled Corticosteroids ◽  
Case Control ◽  
Control Analysis ◽  
Hospital Type ◽  
Poor Outcomes ◽  
Case Control Analysis ◽  
Nested Case Control ◽  
Control Study

Inhaled corticosteroids (ICS) could increase both the risk of coronavirus disease 2019 (COVID-19) and experiencing poor outcomes. To compare the clinical outcomes between ICS users and nonusers, COVID-19-related claims in the Korean Health Insurance Review and Assessment database were evaluated. To evaluate susceptibility to COVID-19 among patients with COPD or asthma, a nested case-control study was performed using the same database. In total, 7341 patients were confirmed to have COVID-19, including 114 ICS users and 7227 nonusers. Among 5910 patients who were hospitalized, death was observed for 9% of ICS users and 4% of nonusers. However, this association was not significant when adjusted for age, sex, region, comorbidities, and hospital type (aOR, 0.94; 95% CI, 0.43–2.07). The case-control analysis of COPD compared 640 cases with COVID-19 to 2560 matched controls without COVID-19, and the analysis of asthma compared 90 cases with COVID-19 to 360 matched controls without COVID-19. Use of ICS was not significantly associated with COVID-19 among patients with COPD (aOR, 1.02; 95% CI, 0.46–2.25) or asthma (aOR, 0.38; 95% CI, 0.13–1.17). Prior ICS use was not significantly associated with COVID-19 in patients with COPD or asthma, nor with clinical outcomes among patients with COVID-19.

scholarly journals Risk of clinical severity by age and race/ethnicity among adults hospitalized for COVID-19 — United States, March–September 2020

2020 ◽  
Author(s):  
Audrey F Pennington ◽  
Lyudmyla Kompaniyets ◽  
April D Summers ◽  
Melissa L Danielson ◽  
Alyson B Goodman ◽  
...  
Keyword(s):  
Older Adults ◽  
Ethnic Groups ◽  
Invasive Mechanical Ventilation ◽  
Clinical Severity ◽  
Adjusted Risk ◽  
Icu Admission ◽  
Risk Of Death ◽  
Race Ethnicity ◽  
Poor Outcomes ◽  
The Impact

Abstract Background Older adults and people from certain racial and ethnic groups are disproportionately represented in COVID-19 hospitalizations and deaths. Methods Using data from the Premier Healthcare Database on 181,813 hospitalized adults diagnosed with COVID-19 during March–September 2020 we applied multivariable log-binomial regression to assess the associations between age and race/ethnicity and COVID-19 clinical severity (intensive care unit [ICU] admission, invasive mechanical ventilation [IMV], and death); and determine whether the impact of age on clinical severity differs by race/ethnicity. Results Overall, 84,497 (47%) patients were admitted to the ICU, 29,078 (16%) received IMV, and 27,864 (15%) died in the hospital. Increased age was strongly associated with clinical severity when controlling for underlying medical conditions and other covariates; the strength of this association differed by race/ethnicity. Compared with non-Hispanic White patients, risk of death was lower among non-Hispanic Black patients (adjusted risk ratio [95% CI]: 0.96 [0.92, 0.99]), and higher among Hispanic/Latino patients (RR [95% CI]: 1.15 [1.09, 1.20]), non-Hispanic Asian patients (RR [95% CI]: 1.16 [1.09, 1.23]), and patients of other racial and ethnic groups (RR [95% CI]: 1.13 [1.06, 1.21]). Risk of ICU admission and IMV was elevated among some racial and ethnic groups. Conclusions These results indicate that age is a driver of poor outcomes among hospitalized persons with COVID-19. Additionally, clinical severity may be elevated among patients of some racial and ethnic minority groups. Public health strategies to reduce SARS-CoV-2 infection rates among older adults and racial and ethnic minorities are essential to reduce poor outcomes.

Epidemiology of venous thromboembolism in 9489 patients with malignant glioma

2007 ◽  
Vol 106 (4) ◽  
pp. 601-608 ◽  
Author(s):  
Thomas J. Semrad ◽  
Robert O'Donnell ◽  
Ted Wun ◽  
Helen Chew ◽  
Danielle Harvey ◽  
...  
Keyword(s):  
Risk Factors ◽  
Venous Thromboembolism ◽  
Malignant Glioma ◽  
Malignant Gliomas ◽  
Vena Cava ◽  
Control Analysis ◽  
Discharge Data ◽  
Risk Of Death ◽  
Case Control Analysis ◽  
Nested Case Control

Object The authors sought to define the incidence of symptomatic venous thromboembolism (VTE) in patients harboring malignant gliomas. Methods The authors conducted a retrospective analysis of data obtained in all cases of malignant glioma diagnosed in California during a 6-year period; the occurrence of a VTE was identified using linked hospital discharge data. The Cox proportional hazard model was used to analyze the association of specific risk factors with the development of a VTE or death within 2 years of the cancer diagnosis. Among 9489 cases, the 2-year cumulative incidence of VTE was 7.5% (715 cases), with a rate of 16.1 events per 100 person-years during the first 6 months. Three hundred ninety-one (55%) of these 715 cases were diagnosed within 61 days of major neurosurgery. Risk factors for VTE included older age (hazard ratio [HR] 2.6, confidence interval [CI] 2.0–3.4 for age range 65–74 years compared with ≤ 45 years), glioblastoma multiforme histology (HR 1.7, CI 1.4–2.1), three or more chronic comorbidities (HR 3.5, CI 2.8–4.3 [compared with no comorbidity]), and neurosurgery within 61 days (HR 1.7, CI 1.3–2.3). Patients in whom a VTE was present were at higher risk of dying within 2 years (HR 1.3, CI 1.2–1.4). In a nested case–control analysis of all VTE cases, there was no association between insertion of a vena cava filter and the risk of a recurrent VTE. Conclusions In patients harboring a glioma there was a very high incidence of symptomatic VTEs, particularly within 2 months of neurosurgery. The development of a VTE was associated with a 30% increase in the risk of death within 2 years. Further studies are needed to determine if risk stratification and the use of medical prophylaxis after neurosurgery improves outcomes.

scholarly journals Effectiveness of SARS-CoV-2 mRNA Vaccines for Preventing Covid-19 Hospitalizations in the United States

2021 ◽  
Author(s):  
Mark W. Tenforde ◽  
Manish M. Patel ◽  
Adit A. Ginde ◽  
David J. Douin ◽  
H. Keipp Talbot ◽  
...  
Keyword(s):  
United States ◽  
Real World ◽  
The United States ◽  
Case Control ◽  
Vaccine Effectiveness ◽  
Control Analysis ◽  
Illness Onset ◽  
Increased Risk ◽  
Poor Outcomes ◽  
Case Control Analysis

Background: As SARS-CoV-2 vaccination coverage increases in the United States (US), there is a need to understand the real-world effectiveness against severe Covid-19 and among people at increased risk for poor outcomes. Methods: In a multicenter case-control analysis of US adults hospitalized March 11 through May 5, 2021, we evaluated vaccine effectiveness to prevent Covid-19 hospitalizations by comparing odds of prior vaccination with an mRNA vaccine (Pfizer-BioNTech or Moderna) between cases hospitalized with Covid-19 and hospital-based controls who tested negative for SARS-CoV-2. Results: Among 1210 participants, median age was 58 years, 22.8% were Black, 13.8% were Hispanic, and 20.6% had immunosuppression. SARS-CoV-2 lineage B.1.1.7 was most common variant (59.7% of sequenced viruses). Full vaccination (receipt of two vaccine doses at least 14 days before illness onset) had been received by 45/590 (7.6%) cases and 215/620 (34.7%) controls. Overall vaccine effectiveness was 86.9% (95% CI: 80.4 to 91.2%). Vaccine effectiveness was similar for Pfizer-BioNTech and Moderna vaccines, and highest in adults aged 18-49 years (97.3%; 95% CI: 78.9 to 99.7%). Among 45 patients with vaccine-breakthrough Covid hospitalizations, 44 (97.8%) were at least 50 years old and 20 (44.4%) had immunosuppression. Vaccine effectiveness was lower among patients with immunosuppression (59.2%; 95% CI: 11.9 to 81.1%) than without immunosuppression (91.3%; 95% CI: 85.5 to 94.7%). Conclusion: During March through May 2021, SARS-CoV-2 mRNA vaccines were highly effective for preventing Covid-19 hospitalizations among US adults. SARS-CoV-2 vaccination was beneficial for patients with immunosuppression, but effectiveness was lower in the immunosuppressed population.

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