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

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.

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

BioMed Research International ◽

10.1155/2019/7431850 ◽

2019 ◽

Vol 2019 ◽

pp. 1-11 ◽

Cited By ~ 1

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.

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Changing Spatiotemporal Trends in County‐Level Heart Failure Death Rates in the United States, 1999 to 2018

Journal of the American Heart Association ◽

10.1161/jaha.120.018125 ◽

2021 ◽

Vol 10 (4) ◽

Author(s):

Adam S. Vaughan ◽

Mary G. George ◽

Sandra L. Jackson ◽

Linda Schieb ◽

Michele Casper

Keyword(s):

United States ◽

Heart Failure ◽

Ethnic Group ◽

The United States ◽

Local Context ◽

County Level ◽

Age Group ◽

Death Rates ◽

Spatiotemporal Trends ◽

Racial Ethnic

Background Amid recently rising heart failure (HF) death rates in the United States, we describe county‐level trends in HF mortality from 1999 to 2018 by racial/ethnic group and sex for ages 35 to 64 years and 65 years and older. Methods and Results Applying a hierarchical Bayesian model to National Vital Statistics data representing all US deaths, ages 35 years and older, we estimated annual age‐standardized county‐level HF death rates and percent change by age group, racial/ethnic group, and sex from 1999 through 2018. During 1999 to 2011, ~30% of counties experienced increasing HF death rates among adults ages 35 to 64 years. However, during 2011 to 2018, 86.9% (95% CI, 85.2–88.2) of counties experienced increasing mortality. Likewise, for ages 65 years and older, during 1999 to 2005 and 2005 to 2011, 27.8% (95% CI, 25.8–29.8) and 12.6% (95% CI, 11.2–13.9) of counties, respectively, experienced increasing mortality. However, during 2011 to 2018, most counties (67.4% [95% CI, 65.4–69.5]) experienced increasing mortality. These temporal patterns by age group held across racial/ethnic group and sex. Conclusions These results provide local context to previously documented recent national increases in HF death rates. Although county‐level declines were most common before 2011, some counties and demographic groups experienced increasing HF death rates during this period of national declines. However, recent county‐level increases were pervasive, occurring across counties, racial/ethnic group, and sex, particularly among ages 35 to 64 years. These spatiotemporal patterns highlight the need to identify and address underlying clinical risk factors and social determinants of health contributing to these increasing trends.

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

10.21203/rs.3.rs-33141/v1 ◽

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.

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Trends in Cigar Use in the United States, 2002–2016: Diverging Trends by Race/Ethnicity

Nicotine & Tobacco Research ◽

10.1093/ntr/ntz060 ◽

2019 ◽

Vol 22 (4) ◽

pp. 583-587 ◽

Cited By ~ 1

Author(s):

Andrea H Weinberger ◽

Cristine D Delnevo ◽

Jiaqi Zhu ◽

Misato Gbedemah ◽

Joun Lee ◽

...

Keyword(s):

United States ◽

Black Women ◽

Ethnic Group ◽

Ethnic Groups ◽

Ethnic Differences ◽

Mixed Race ◽

The United States ◽

Race Ethnicity ◽

Racial Ethnic ◽

Over Time

Abstract Introduction Although there are racial/ethnic differences in cigarette use, little is known about how non-cigarette tobacco use differs among racial/ethnic groups. This study investigated trends in cigar use from 2002 to 2016, by racial/ethnic group, in nationally representative US data. Methods Data were drawn from the 2002–2016 National Survey on Drug Use and Health public use data files (total analytic sample n = 630 547 including 54 060 past-month cigar users). Linear time trends of past-month cigar use were examined by racial/ethnic group (Non-Hispanic [NH] White, NH Black, Hispanic, NH Other/Mixed Race/Ethnicity) using logistic regression models. Results In 2016, the prevalence of past-month cigar use was significantly higher among NH Black respondents than among other racial/ethnic groups (ps < .001). Cigar use was also higher among NH White respondents than among Hispanic and NH Other/Mixed Race/Ethnicity respondents. The year by racial/ethnic group interaction was significant (p < .001). Past-month cigar use decreased significantly from 2002 to 2016 among NH White and Hispanic respondents (ps = .001), whereas no change in prevalence was observed among NH Black (p = .779) and NH Other/Mixed Race/Ethnicity respondents (p = .152). Cigar use decreased for NH White men (p < .001) and did not change for NH White women (p = .884). Conversely, cigar use increased for NH Black women (p < .001) and did not change for NH Black men (p = .546). Conclusions Cigar use remains significantly more common among NH Black individuals in the United States and is not declining among NH Black and NH Other/Mixed Race/Ethnicity individuals over time, in contrast to declines among NH White and Hispanic individuals. Implications This study identified racial/ethnic differences in trends in past-month cigar use over 15 years among annual cross-sectional samples of US individuals. The highest prevalence of cigar use in 2016 was found among NH Black individuals. In addition, cigar use prevalence did not decline from 2002 to 2016 among NH Black and NH Other/Mixed Race/Ethnicity groups over time, in contrast to NH White and Hispanic groups. Further, cigar use increased over time for NH Black women. Targeted public health and clinical efforts may be needed to decrease the prevalence of cigar use, especially for NH Black individuals.

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

Progress in Transplantation ◽

10.1177/1526924817715468 ◽

2017 ◽

Vol 27 (3) ◽

pp. 225-231 ◽

Cited By ~ 6

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.

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

JNCI Cancer Spectrum ◽

10.1093/jncics/pkz036 ◽

2019 ◽

Vol 3 (3) ◽

Cited By ~ 4

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.

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

ESIC MARKET Economic and Business Journal ◽

10.7200/esicm.169.0522.2 ◽

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.

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

International Journal of Gynecological Cancer ◽

10.1097/igc.0000000000001222 ◽

2018 ◽

Vol 28 (4) ◽

pp. 738-748 ◽

Cited By ~ 3

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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The epidemiology of malignant giant cell tumors of bone: an analysis of data from the Surveillance, Epidemiology and End Results Program (1975–2004)

Rare Tumors ◽

10.4081/rt.2009.e52 ◽

2009 ◽

Vol 1 (2) ◽

pp. 159-163

Author(s):

Jennifer L Beebe-Dimmer ◽

Karynsa Cetin ◽

Jon P Fryzek ◽

Scott M Schuetze ◽

Kendra Schwartz

Keyword(s):

United States ◽

Giant Cell ◽

Proportional Hazards ◽

Bone Destruction ◽

The United States ◽

Cox Proportional Hazards ◽

Giant Cell Tumors ◽

Term Survival ◽

Increased Risk ◽

End Results

Malignant giant cell tumor (GCT) of bone is a rare tumor with debilitating consequences. Patients with GCT of bone typically present with mechanical difficulty and pain as a result of bone destruction and are at an increased risk for fracture. Because of its unusual occurrence, little is known about the epidemiology of malignant GCT of bone. This report offers the first reliable population-based estimates of incidence, patient demographics, treatment course and survival for malignancy in GCT of bone in the United States. Using data from the National Cancer Institute's Surveillance, Epidemiology and End Results (SEER) program, we estimated the overall incidence and determinants of survival among patients diagnosed with malignant GCT of bone from 1975–2004. Cox proportional hazards regression was used to evaluate demographic and clinical determinants of survival among malignant GCT cases. Based on analyses of 117 malignant GCT cases, the estimated annual incidence in the United States was 1.6 per 10,000,000 persons per year. Incidence was highest among adults aged 20 to 44 years (2.4 per 10,000,000 per year) and most patients were diagnosed with localized (31.6%) or regional (29.9%) disease compared to distant disease (16.2%). Approximately 85% of patients survived at least 5 years, with survival poorest among older patients and those with evidence of distant metastases at time of diagnosis. The current study represents the largest systematic investigation examining the occurrence and distribution of malignancy in GCT of bone in the general U.S. population. We confirm its rare occurrence and suggest that age and stage at diagnosis are strongly associated with long-term survival.

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