Reaching 80 Years of Age: Clinical, Behavioral, and Psychosocial Related Risk Factors in a Large Cohort of Israeli Working Men

The objective of this study was to estimate the probability of long-term overall survival based on total number of risk factors (RF). We also sought to examine the role of midlife clinical, behavioral, and psychosocial predictors of longevity in a large cohort of Israeli men. This study was based on the Israeli Ischemic Heart Disease (IIHD) cohort that included over 10,000 men who were followed up for mortality over more than four decades. During the 43 years of follow-up, 4634 (46.1%) men survived to 80 years of age or older. We considered cigarette smoking, diabetes mellitus, high systolic blood pressure, hypercholesterolemia, low socioeconomic status, and serious family problems as RF at ages 40–65. Cox proportional hazards regression models, with age as the time scale, were constructed to estimate the hazard ratios (HRs) for failure to survive 80 years of age. Compared with men free of all the above RF, those with one identified RF (HR = 1.58, 95% CI: 1.42–1.75) and counterparts with two identified RF (HR = 2.18, 95% CI: 1.96–2.43) were at a significantly greater risk of death before 80. Additional RF further increased the risk of early mortality (HR = 3.62, 95% CI: 1.50–8.73 for men with 5 RF). The results suggest a role of physiological, behavioral, and psychological risk factors at midlife in predicting longevity.

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The role of ALBI and IGF-CTP score in refining prognostication of HCC.

Journal of Clinical Oncology ◽

10.1200/jco.2020.38.15_suppl.e16659 ◽

2020 ◽

Vol 38 (15_suppl) ◽

pp. e16659-e16659

Author(s):

Sunyoung S. Lee ◽

Yehia I. Mohamed ◽

Aliya Qayyum ◽

Manal Hassan ◽

Lianchun Xiao ◽

...

Keyword(s):

Overall Survival ◽

Proportional Hazards ◽

Cox Proportional Hazards ◽

Survival Prediction ◽

Score System ◽

Risk Of Death ◽

U Statistics ◽

Cox Proportional Hazards Models ◽

Ctp Score

e16659 Background: Child-Turcotte-Pugh (CTP) score is widely used in the assessment of prognosis of HCC and CTP-A is the standard criterion for active therapy and clinical trials entry. Recently, ALBI and insulin-like growth factor-1 (IGF)-CTP scores have been reported to improve survival prediction over CTP score. However, comparative studies to compare both scores and to integrate IGF into Albi score are lacking. Methods: After institutional board approval, data and samples were prospectively collected. 299 HCC patients who had data to generate both IGF-CPG and Albi index were used. The ALBI index, and IGF score were calculated, Cox proportional hazards models were fitted to evaluation the association between overall survival (OS) and CTP, IGF-CTP, Albi and IGF, albumin, bilirubin. Harrell’s Concordance index (C-index) was calculated to evaluate the ability of the three score system to predict overall survival. And the U-statistics was used to compare the performance of prediction of OS between the score system. Results: OS association with CTP, IGF-CTP and Albi was performed (Table). IGF-CTP B was associated with a higher risk of death than A (HR = 1.6087, 95% CI: 1.2039, 2.1497, p = 0.0013), ALBI grade 2 was also associated with a higher risk of death than 1 (HR = 2.2817, 95% CI: 1.7255, 3.0172, p < 0.0001). IGF-1(analyzed as categorical variable) was independently associated with OS after adjusting for the effects of ALBI grade. Which showed IGF-1 ≤26 was significantly associated with poor OS, P = 0.001. Conclusions: Although ALBI grade and IGF-CTP score in this analysis had similar prognostic values in most cases, their benefits might be heterogenous in some specific conditions. We looked into corporation of IGF-1 into ALBI grade, IGF score with cutoff ≤26 which clearly refined OS prediction and better OS stratification of ALBI-grade.

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Racial disparity in survival of patients diagnosed with early-onset colorectal cancer

Colorectal Cancer ◽

10.2217/crc-2020-0015 ◽

2020 ◽

Vol 9 (3) ◽

pp. CRC32

Author(s):

Kristin Wallace ◽

Hong Li ◽

Chrystal M Paulos ◽

David N Lewin ◽

Alexander V Alekseyenko

Keyword(s):

Colorectal Cancer ◽

Racial Differences ◽

Proportional Hazards ◽

Age Groups ◽

Tumor Location ◽

Cox Proportional Hazards ◽

Risk Of Death ◽

Study Materials ◽

Caucasian Americans

Background: Survival is reduced in African–Americans (AAs) diagnosed with colorectal cancer (CRC), especially in those <50 years old, when compared with Caucasian Americans (CAs). Yet, the role of clinicopathologic features of CRCs on racial differences in survival needs further study. Materials & methods: Over 1000 individuals (CA 709, AA 320) diagnosed with CRC were studied for survival via the Cox proportional hazards regression analysis based on race and risk of death in two age groups (<50 or 50+). Results: Risk of death for younger AAs (<50) was elevated compared with younger CAs (hazard ratio [HR] 1.98 [1.26–3.09]). Yet no racial differences in survival was observed in older cohort (50+ years), HR 1.07 (0.88–1.31); p for interaction = 0.01. In younger AAs versus CAs only, colonic location attenuated the risk of death. Conclusion: The tumor location and histology influence the poorer survival observed in younger AAs suggesting these may also influence treatment responses.

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Symptomatic presentation of cervical cancer in emergency departments in California

Cancer Causes & Control ◽

10.1007/s10552-021-01489-z ◽

2021 ◽

Author(s):

Frances B. Maguire ◽

Julianne J. P. Cooley ◽

Cyllene R. Morris ◽

Arti Parikh-Patel ◽

Vanessa A. Kennedy ◽

...

Keyword(s):

Cervical Cancer ◽

Low Socioeconomic Status ◽

Emergency Departments ◽

Regression Models ◽

Proportional Hazards ◽

Hpv Vaccination ◽

Cox Proportional Hazards ◽

Study Cohort ◽

Risk Of Death ◽

Increased Risk

Abstract Purpose Through screening and HPV vaccination, cervical cancer can mostly be prevented or detected very early, before symptoms develop. However, cervical cancer persists, and many women are diagnosed at advanced stages. Little is known about the degree to which U.S. women may begin their diagnostic workup for cervical cancer in Emergency Departments (ED). We sought to quantify the proportion of women presenting symptomatically in the ED prior to their diagnosis with cervical cancer and to describe their characteristics and outcomes. Methods We identified women diagnosed from 2006 to 2017 with cervical cancer in the California Cancer Registry. We linked this cohort to statewide ED discharge records to determine ED use and symptoms present at the encounter. Multivariable logistic regression models examined associations with ED use and multivariable Cox proportional hazards regression models examined associations with survival. Results Of the more than 16,000 women with cervical cancer in the study cohort, 28% presented symptomatically in the ED prior to diagnosis. Those presenting symptomatically were more likely to have public (odds ratio [OR] 1.16; 95% confidence interval [CI] 1.06–1.27) or no insurance (OR 4.81; CI 4.06–5.71) (vs. private), low socioeconomic status (SES) (OR 1.76; CI 1.52–2.04), late-stage disease (OR 5.29; CI 4.70–5.96), and had a 37% increased risk of death (CI 1.28–1.46). Conclusion Nearly a third of women with cervical cancer presented symptomatically, outside of a primary care setting, suggesting that many women, especially those with low SES, may not be benefiting from screening or healthcare following abnormal results.

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Impact of biological sex on cryptococcal meningitis mortality in Uganda and South Africa

Medical Mycology ◽

10.1093/mmy/myaa108 ◽

2021 ◽

Author(s):

Anna M Stadelman ◽

Kenneth Ssebambulidde ◽

Lillian Tugume ◽

Katelyn A Pastick ◽

Kathy Huppler Hullsiek ◽

...

Keyword(s):

South Africa ◽

Cryptococcal Meningitis ◽

Proportional Hazards ◽

Opportunistic Infections ◽

Altered Mental Status ◽

Cox Proportional Hazards ◽

Csf Biomarkers ◽

Biological Sex ◽

Risk Of Death

Abstract The role of biological sex on clinical outcomes and the pathogenesis of AIDS-related opportunistic infections is unknown. We assessed baseline biomarkers and outcomes between 577 men and 400 women in HIV-related cryptococcal meningitis cohorts in Uganda and South Africa from 2010 to 2017. We compared 10-week mortality by sex via Cox proportional hazards models. The 10-week mortality for women was 50% (198/400) and 43% (247/577) for men. Women had higher risk of death in an unadjusted model (Hazard Ratio (HR) = 1.20; 95%CI, 1.00–1.45; P = .05). Women maintained a higher risk when adjusting for quantitative CSF culture, altered mental status, CSF pleocytosis, age, and antiretroviral status (HR = 1.31; 95%CI, 1.07–1.59; P < .01). However, after adjusting for hemoglobin, the risk of death did not differ between women and men (HR = 1.17; 95%CI, 0.94–1.45; P = .17). Moderate to severe anemia (hemoglobin < 8.5 g/dL) was present among 16% (55/355) of women and 10% (55/532) of men (P = .02). Of the 373 participants with CSF biomarkers, men had higher median pro- and anti-inflammatory, monocyte/macrophage differentiation, maturation, and migration, immune exhaustion, and cytotoxicity cytokines than women (P < .05). We identified biological sex as proxy for anemia, a potentially modifiable risk factor for cryptococcal meningitis mortality. Immune response may contribute to the multifaceted underlying mechanisms for the discrepancy in mortality based on sex. Lay Summary We examined the role of biological sex in cryptococcal meningitis mortality in a large cohort. Our findings reveal significant differences in inflammatory markers by biological sex. Women have significantly higher mortality due to cryptococcal meningitis that is attributable to anemia at baseline.

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Multimorbidity in South Asian adults: prevalence, risk factors and mortality

Journal of Public Health ◽

10.1093/pubmed/fdy017 ◽

2018 ◽

Vol 41 (1) ◽

pp. 80-89 ◽

Cited By ~ 12

Author(s):

Kalpana Singh ◽

Shivani A Patel ◽

Suddhendu Biswas ◽

Roopa Shivashankar ◽

Dimple Kondal ◽

...

Keyword(s):

Risk Factors ◽

South Asian ◽

Chronic Conditions ◽

Proportional Hazards ◽

South Asians ◽

Logistic Models ◽

Cox Proportional Hazards ◽

High Waist Circumference ◽

Risk Of Death ◽

Urban South

Abstract Background We report the prevalence, risk factors and mortality associated with multimorbidity in urban South Asian adults. Methods Hypertension, diabetes, heart disease, stroke and chronic kidney disease were measured at baseline in a sample of 16 287 adults ages ≥20 years in Delhi, Chennai and Karachi in 2010–11 followed for an average of 38 months. Multimorbidity was defined as having ≥2 chronic conditions at baseline. We identified correlates of multimorbidity at baseline using multinomial logistic models, and we assessed the prospective association between multimorbidity and mortality using Cox proportional hazards models. Results The adjusted prevalence of multimorbidity was 9.4%; multimorbidity was highest in adults who were aged ≥60 years (37%), consumed alcohol (12.3%), body mass index ≥25 m/kg2 (14.1%), high waist circumference (17.1%) and had family history of a chronic condition (12.4%). Compared with adults with no chronic conditions, the fully adjusted relative hazard of death was twice as high in adults with two morbidities (hazard ratio [HR] = 2.3; 95% confidence interval [CI]: 1.6, 3.3) and thrice as high in adults with ≥3 morbidities (HR = 3.1; 95% CI: 1.9, 5.1). Conclusion Multimorbidity affects nearly 1 in 10 urban South Asians, and each additional morbidity carries a progressively higher risk of death. Identifying locally appropriate strategies for prevention and coordinated management of multimorbidity will benefit population health in the region.

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Exploring the Role of Breast Density on Cancer Prognosis among Women Attending Population-Based Screening Programmes

Journal of Oncology ◽

10.1155/2019/1781762 ◽

2019 ◽

Vol 2019 ◽

pp. 1-8

Author(s):

Laia Domingo ◽

Maria Sala ◽

Javier Louro ◽

Marisa Baré ◽

Teresa Barata ◽

...

Keyword(s):

Breast Cancer ◽

Breast Density ◽

Proportional Hazards ◽

Population Based ◽

Cox Proportional Hazards ◽

High Density ◽

Cancer Prognosis ◽

Low Density ◽

Risk Of Death

Background. Our aim was to assess the role of breast density on breast cancer mortality and recurrences, considering patient and tumour characteristics and the treatments received among women attending population-based screening programmes. Methods. We conducted a retrospective cohort study among women aged 50–69 years attending population-based screening programmes, diagnosed with invasive breast cancer between 2000 and 2009, and followed up to 2014. Breast density was categorised as low density (≤25% dense tissue), intermediate density (25–50%), and high density (≥50%). Cox proportional hazards regression models were fitted to estimate the adjusted hazard ratios (aHR) and 95% confidence intervals (95% CI) for death and recurrences, adjusting by patient characteristics, mode of detection (screen-detected vs. interval cancer), and tumour features. Results. The percentage of deaths and recurrences was higher among women with intermediate- and high-density breasts than among women with low-density breasts (p=0.011 for death; p=0.037 for recurrences). Adjusted Cox proportional hazards regression models revealed that women with intermediate- and high-density breasts had a higher risk of death than women with low-density breasts, being statistically significant for intermediate densities (aHR = 2.19 [95% CI: 1.16–4.13], aHR = 1.44 [95% CI: 0.67–3.1], respectively). No association was found between breast density and recurrences. Conclusions. Breast density was associated with a higher risk of death, but not of recurrences, among women participating in breast cancer screening. These findings reinforce the need to improve screening sensitivity among women with dense breasts and to routinely assess breast density, not only for its role as a risk factor for breast cancer but also for its potential influence on cancer prognosis.

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Abstract 11900: Influence of Competing Risks on the Association Between Warfarin and Ischemic Stroke in Atrial Fibrillation: The Anticoagulation and Risk Factors in Atrial Fibrillation (ATRIA) Study

Circulation ◽

10.1161/circ.132.suppl_3.11900 ◽

2015 ◽

Vol 132 (suppl_3) ◽

Author(s):

Jeffrey M Ashburner ◽

Alan S Go ◽

Yuchiao Chang ◽

Margaret C Fang ◽

Lisa Fredman ◽

...

Keyword(s):

Risk Factors ◽

Atrial Fibrillation ◽

Ischemic Stroke ◽

Competing Risks ◽

Stroke Risk ◽

Proportional Hazards ◽

Cox Proportional Hazards ◽

Subdistribution Hazard ◽

Risk Of Death

Introduction: Studies examining the association between warfarin therapy and incidence of ischemic stroke in adults with atrial fibrillation (AF) have not accounted for patients who die of non-stroke causes. Hypothesis: Accounting for the competing risk of death may provide greater understanding of the “real world” impact of warfarin on stroke risk during multiyear follow-up in a large, diverse cohort of AF patients. Methods: We assessed this association in the ATRIA community-based cohort of AF patients (n=13,559; study years 1996-2003), with thromboembolic (>90% ischemic stroke) events (TEE) being clinician-adjudicated. Extended Cox proportional hazards regression with time-varying warfarin exposure estimated the cause-specific hazard ratio (HR) for TEE while adjusting for stroke risk factors. Fine and Gray subdistribution regression was used to estimate this association while also accounting for competing death events. Results: Patients using warfarin were younger, more likely to have had a prior stroke, and to have known diabetes, coronary disease, and heart failure, and also had higher mean CHA2DS2VASc scores (3.68 vs. 3.22). The death rate was much higher in the non-warfarin group (8.1 deaths/100 person-years; 2637 deaths vs. 5.5 deaths/100 person-years; 1777 deaths on warfarin). The cause-specific HR indicated a large reduction in TE with warfarin use (adjusted HR: 0.57, 95% CI: 0.50-0.65). In subdistribution hazard models accounting for competing death events over the full follow-up of 6 years, this association was substantially attenuated (adjusted HR: 0.87, 95% CI: 0.77-0.99). In analyses limited to 1-year follow-up with only 648 competing death events, the results without accounting for competing risks (adjusted cause-specific HR: 0.55, 95% CI: 0.43-0.71) were similar to the results that did account for competing risks (adjusted subdistribution HR: 0.59, 95% CI: 0.46-0.75). Conclusions: By accounting for competing death events, our results reflect a more realistic estimate of the multi-year stroke prevention benefits of warfarin for patients with AF. Many old/frail individuals with AF will not live long enough to gain substantial benefit from warfarin.

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A contemporary survival analysis of individuals with cystic fibrosis: a cohort study

European Respiratory Journal ◽

10.1183/09031936.00119714 ◽

2014 ◽

Vol 45 (3) ◽

pp. 670-679 ◽

Cited By ~ 91

Author(s):

Anne L. Stephenson ◽

Melissa Tom ◽

Yves Berthiaume ◽

Lianne G. Singer ◽

Shawn D. Aaron ◽

...

Keyword(s):

Risk Factors ◽

Cystic Fibrosis ◽

Proportional Hazards ◽

Patient Characteristics ◽

Population Based ◽

Forced Expiratory Volume ◽

Cox Proportional Hazards ◽

Risk Of Death ◽

Cox Proportional Hazards Models ◽

Increased Risk

Previously established predictors of survival may no longer apply in the current era of cystic fibrosis (CF) care. Our objective was to identify risk factors associated with survival in a contemporary CF population.We used the Canadian CF Registry, a population-based cohort, to calculate median age of survival and summarise patient characteristics from 1990 to 2012. Clinical, demographic and geographical factors, and survival were estimated for a contemporary cohort (2000–2012) using Cox proportional hazards models.There were 5787 individuals in the registry between 1990 and 2012. Median survival age increased from 31.9 years (95% CI 28.3–35.2 years) in 1990 to 49.7 years (95% CI 46.1–52.2 years) in the most current 5-year window ending in 2012. Median forced expiratory volume in 1 s improved (p=0.04) and fewer subjects were malnourished (p<0.001) over time. Malnourished patients (hazard ratio (HR) 2.1, 95% CI 1.6–2.8), those with multiple exacerbations (HR 4.5, 95% CI 3.2–6.4) and women with CF-related diabetes (HR 1.8, 95% CI 1.2–2.7) were at increased risk of death.Life expectancy in Canadians with CF is increasing. Modifiable risk factors such as malnutrition and pulmonary exacerbations are associated with an increased risk of death. The sex gap in CF survival may be explained by an increased hazard for death in women with CF-related diabetes.

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EPIDEMIOLOGICAL AND CLINICAL CHARACTERISTICS OF COVID-19 PATIENTS IN KENYA

10.1101/2020.11.09.20228106 ◽

2020 ◽

Author(s):

Loice Achieng Ombajo ◽

Nyamai Mutono ◽

Paul Sudi ◽

Mbuvi Mutua ◽

Mohammed Sood ◽

...

Keyword(s):

Risk Factors ◽

Medical Records ◽

Clinical Characteristics ◽

Proportional Hazards ◽

Outcome Data ◽

Cox Proportional Hazards ◽

Rt Pcr ◽

Blood Cell Count ◽

Risk Of Death ◽

Risk Patients

AbstractBackgroundMore than 49,000 cases of infection and 900 deaths from COVID-19 have been recorded in the Kenya. However, the characteristics and risk factors for severe outcomes among hospitalized COVID-19 patients in this setting have not been described.MethodsWe extracted demographic, laboratory, clinical and outcome data from medical records of RT-PCR confirmed SARS-CoV2 patients admitted in six hospitals in Kenya between March and September, 2020. We used Cox proportional hazards regressions to determine factors related to in-hospital mortality.ResultsData from 787 COVID-19 patients was available. The median age was 43 years (IQR 30-53), with 505 (64%) males. At admission, 455 (58%) were symptomatic. The commonest symptoms were cough (337, 43%), loss of taste or smell (279, 35%), and fever (126, 16%). Co-morbidities were reported in 340 (43%), with cardiovascular disease, diabetes and HIV documented in 130 (17%), 116 (15%), 53 (7%) respectively. 90 (11%) were admitted to ICU for a mean of 11 days, 52 (7%) were ventilated with a mean of 10 days, 107 (14%) died. The risk of death increased with age [hazard ratio (HR) 1.57 (95% CI 1.13 – 2.19)] for persons >60 years compared to those <60 years old; having co-morbidities [HR 2.34 (1.68 – 3.25)]; and among males [HR 1.76 (1.27, 2.44)] compared to females. Elevated white blood cell count and aspartate aminotransferase were associated with higher risk of death.ConclusionsWe identify the risk factors for mortality that may guide stratification of high risk patients.

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Military-related risk factors in female veterans and risk of dementia

Neurology ◽

10.1212/wnl.0000000000006778 ◽

2018 ◽

Vol 92 (3) ◽

pp. e205-e211 ◽

Cited By ~ 11

Author(s):

Kristine Yaffe ◽

Sandy J. Lwi ◽

Tina D. Hoang ◽

Feng Xia ◽

Deborah E. Barnes ◽

...

Keyword(s):

Risk Factors ◽

Proportional Hazards ◽

The United States ◽

Female Veterans ◽

Veterans Health ◽

Medical Conditions ◽

Health Administration ◽

Risk Of Death ◽

Related Risk

ObjectiveTo determine whether diagnoses of traumatic brain injury (TBI), posttraumatic stress disorder (PTSD), and depression, alone or in combination, increase dementia risk among older female veterans.MethodsThis cohort study included data from 109,140 female veterans ≥55 years of age receiving care from Veterans Health Administration medical centers in the United States between October 2004 and September 2015 with at least 1 follow-up visit. TBI, PTSD, depression, and medical conditions at study baseline and incident dementia were determined according to ICD-9-CM codes. Fine-Gray proportional hazards models were used to determine the association between military-related risk factors and dementia diagnosis, accounting for the competing risk of death.ResultsDuring follow-up (mean 4.0 years, SD 2.3), 4% of female veterans (n = 4,125) developed dementia. After adjustment for demographics and medical conditions, women with TBI, PTSD, and depression had a significant increase in risk of developing dementia compared to women without these diagnoses (TBI-adjusted subdistribution hazard ratio [adjusted sHR] 1.49, 95% confidence interval [CI] 1.01–2.20; PTSD adjusted sHR 1.78, 95% CI 1.34–2.36; and depression-adjusted sHR 1.67, 95% CI 1.55–1.80), while women with >1 diagnosis had the highest risk for dementia (adjusted sHR 2.15, 95% CI 1.84–2.51).ConclusionsWe found that women with military-related risk factors had an ≈50% to 80% increase in developing dementia relative to women without these diagnoses, while female veterans with multiple risk factors had a >2-fold risk of developing dementia. These findings highlight the need for increased screening of TBI, PTSD, and depression in older women, especially female veterans.

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