Spatial variability of Middle East respiratory syndrome coronavirus survival rates and mortality hazard in Saudi Arabia, 2012–2019

About 83% of laboratory-confirmed Middle East respiratory syndrome coronavirus (MERS-CoV) cases have emerged from Saudi Arabia, which has the highest overall mortality rate worldwide. This retrospective study assesses the impact of spatial/patient characteristics for 14-and 45-day MERS-CoV mortality using 2012–2019 data reported across Saudi regions and provinces. The Kaplan–Meier estimator was employed to estimate MERS-CoV survival rates, Cox proportional-hazards (CPH) models were applied to estimate hazard ratios (HRs) for 14-and 45-day mortality predictors, and univariate local spatial autocorrelation and multivariate spatial clustering analyses were used to assess the spatial correlation. The 14-day, 45-day and overall mortality rates (with estimated survival rates) were 25.52% (70.20%), 32.35% (57.70%) and 37.30% (56.50%), respectively, with no significant rate variations between Saudi regions and provinces. Nationally, the CPH multivariate model identified that being elderly (age ≥ 61), being a non-healthcare worker (non-HCW), and having an underlying comorbidity were significantly related to 14-day mortality (HR = 2.10, 10.12 and 4.11, respectively; p < 0.0001). The 45-day mortality model identified similar risk factors but with an additional factor: patients aged 41–60 (HR = 1.44; p < 0.0001). Risk factors similar to those in the national model were observed in the Central, East and West regions and Riyadh, Makkah, Eastern, Madinah and Qassim provinces but with varying HRs. Spatial clusters of MERS-CoV mortality in the provinces were identified based on the risk factors (r2 = 0.85–0.97): Riyadh (Cluster 1), Eastern, Makkah and Qassim (Cluster 2), and other provinces in the north and south of the country (Cluster 3). The estimated HRs for the 14-and 45-day mortality varied spatially by province. For 45-day mortality, the highest HRs were found in Makkah (age ≥ 61 and non-HCWs), Riyadh (comorbidity) and Madinah (age 41–60). Coming from Makkah (HR = 1.30 and 1.27) or Qassim province (HR = 1.77 and 1.70) was independently related to higher 14-and 45-day mortality, respectively. MERS-CoV patient survival could be improved by implementing appropriate interventions for the elderly, those with comorbidities and non-HCW patients.

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Nephrectomy Delay of More than 10 Weeks from Diagnosis Is Associated with Decreased Overall Survival in pT3 RCC

Journal of Kidney Cancer and VHL ◽

10.15586/jkcvhl.v8i2.125 ◽

2021 ◽

Vol 8 (2) ◽

pp. 27-33

Author(s):

Jiping Zeng ◽

Ken Batai ◽

Benjamin Lee

Keyword(s):

Risk Factors ◽

Overall Survival ◽

Logistic Regression ◽

Proportional Hazards ◽

Surgical Margin ◽

Cox Proportional Hazards ◽

Cancer Center ◽

Integrated Network ◽

Factors Associated ◽

The Impact

In this study, we aimed to evaluate the impact of surgical wait time (SWT) on outcomes of patients with renal cell carcinoma (RCC), and to investigate risk factors associated with prolonged SWT. Using the National Cancer Database, we retrospectively reviewed the records of patients with pT3 RCC treated with radical or partial nephrectomy between 2004 and 2014. The cohort was divided based on SWT. The primary out-come was 5-year overall survival (OS). Logistic regression analysis was used to investigate the risk factors associated with delayed surgery. Cox proportional hazards models were fitted to assess relations between SWT and 5-year OS after adjusting for confounding factors. A total of 22,653 patients were included in the analysis. Patients with SWT > 10 weeks had higher occurrence of upstaging. Using logistic regression, we found that female patients, African-American or Spanish origin patients, treatment in academic or integrated network cancer center, lack of insurance, median household income of <$38,000, and the Charlson–Deyo score of ≥1 were more likely to have prolonged SWT. SWT > 10 weeks was associated with decreased 5-year OS (hazard ratio [HR], 1.24; 95% confidence interval [CI], 1.15–1.33). This risk was not markedly attenuated after adjusting for confounding variables, including age, gender, race, insurance status, Charlson–Deyo score, tumor size, and surgical margin status (adjusted HR, 1.13; 95% CI, 1.04–1.24). In conclusion, the vast majority of patients underwent surgery within 10 weeks. There is a statistically significant trend of increasing SWT over the study period. SWT > 10 weeks is associated with decreased 5-year OS.

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Is more aggressive lymph node assessment associated with improved survival in stage II-III colorectal cancer? Evidence from the Surveillance, Epidemiology and End Results (SEER) cancer registry

Journal of Clinical Oncology ◽

10.1200/jco.2007.25.18_suppl.4048 ◽

2007 ◽

Vol 25 (18_suppl) ◽

pp. 4048-4048

Author(s):

Y. Yeh ◽

Q. Cai ◽

J. Chao ◽

M. Russell

Keyword(s):

Colorectal Cancer ◽

Risk Factors ◽

Proportional Hazards ◽

Survival Rates ◽

Cox Proportional Hazards ◽

Stage Ii ◽

Rank Test ◽

Stage Iiia ◽

Nccn Guidelines ◽

Cox Proportional Hazards Models

4048 Background: NCCN guidelines recommend assessment of =12 lymph nodes (LN) to improve accuracy in colorectal cancer (CRC) staging. Previous studies have used various cut-points to assess the relationship between the number of LN sampled and survival. The association between NCCN guideline-compliant nodal sampling and survival is assessed, while controlling for other risk factors. Methods: We selected 145,485 adult patients newly diagnosed with stage II or III from SEER during 1990–2003. Kaplan-Meier curves were compared using the log-rank test. Cox proportional hazards models were constructed to determine the effect of sampling ≥ 12 LN on survival. Results: Median patient follow-up was 5.7 years. The table shows overall survival rates in CRC patients with < 12 versus =12 LN assessed: After adjusting for age, sex, tumor size and grade, sampling ≥ 12 LN was independently associated with improved survival. For patients with =12 versus <12 LN assessed, survival increased by 13% for stage IIa [HR=0.75; 95%CI 0.72–0.78; p< .001], 16% for stage IIb [HR=0.69; 95%CI 0.67- 0.71; p< .001], 12% for stage IIIb [HR=0.75; 95%CI 0.72–0.77], and 10% for stage IIIc [HR=0.85, 95%CI 0.81–0.89]. The association was not statistically significant for stage IIIa patients. Conclusion: Consistent with previous reports, this analysis found that optimal nodal sampling increased survival across stage II and III, specifically when ≥ 12 LN are sampled and when controlling for other risk factors. Furthermore, the results underscore the need for adhering to the NCCN guidelines. The lack of a statistically significant association in stage IIIa patients may be due to small cohort size. [Table: see text] [Table: see text]

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The impact of risk factor trends on intracerebral hemorrhage incidence over the last two decades—The Tromsø Study

International Journal of Stroke ◽

10.1177/1747493018789996 ◽

2018 ◽

Vol 14 (1) ◽

pp. 61-68 ◽

Cited By ~ 2

Author(s):

Maria Carlsson ◽

Tom Wilsgaard ◽

Stein Harald Johnsen ◽

Liv-Hege Johnsen ◽

Maja-Lisa Løchen ◽

...

Keyword(s):

Risk Factors ◽

Risk Factor ◽

Intracerebral Hemorrhage ◽

Proportional Hazards ◽

Temporal Trends ◽

Population Based ◽

Incidence Rates ◽

Cox Proportional Hazards ◽

Intracerebral Hemorrhages ◽

The Impact

Background Studies on the relationship between temporal trends in risk factors and incidence rates of intracerebral hemorrhage are scarce. Aims To analyze temporal trends in risk factors and incidence rates of intracerebral hemorrhage using individual data from a population-based study. Methods We included 28,167 participants of the Tromsø Study enrolled between 1994 and 2008. First-ever intracerebral hemorrhages were registered through 31 December 2013. Hazard ratios (HRs) for intracerebral hemorrhage were analyzed by Cox proportional hazards models, risk factor levels over time by generalized estimating equations, and incidence rate ratios (IRR) by Poisson regression. Results We registered 219 intracerebral hemorrhages. Age, male sex, systolic blood pressure (BP), diastolic BP, and hypertension were associated with intracerebral hemorrhage. Hypertension was more strongly associated with non-lobar intracerebral hemorrhage (HR 5.08, 95% CI 2.86–9.01) than lobar intracerebral hemorrhage (HR 1.91, 95% CI 1.12–3.25). In women, incidence decreased significantly (IRR 0.46, 95% CI 0.23–0.90), driven by a decrease in non-lobar intracerebral hemorrhage. Incidence rates in men remained stable (IRR 1.27, 95% CI 0.69–2.31). BP levels were lower and decreased more steeply in women than in men. The majority with hypertension were untreated, and a high proportion of those treated did not reach treatment goals. Conclusions We observed a significant decrease in intracerebral hemorrhage incidence in women, but not in men. A steeper BP decrease in women may have contributed to the diverging trends. The high proportion of untreated and sub-optimally treated hypertension calls for improved strategies for prevention of intracerebral hemorrhage.

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Trends in Incidence and Survival of Patients with Pancreatic Neuroendocrine Neoplasm, 1987–2016

Journal of Oncology ◽

10.1155/2021/4302675 ◽

2021 ◽

Vol 2021 ◽

pp. 1-11

Author(s):

Jingxuan Wang ◽

Jianhua Liu ◽

Chao He ◽

Tiantian Sun ◽

Yan Yan ◽

...

Keyword(s):

Risk Factors ◽

Large Scale ◽

Proportional Hazards ◽

Survival Rates ◽

Relative Survival ◽

Cox Proportional Hazards ◽

Neuroendocrine Neoplasm ◽

Survival Duration ◽

Term Survival ◽

Pancreatic Neuroendocrine Neoplasm

Background. Pancreatic neuroendocrine neoplasm (pNEN), with the lowest 5-year survival rates in neuroendocrine tumors (NETs), exerts great threat to human health. Because large-scale population research aimed at pNEN is rare, we aimed to explore the tendencies and differences of changes in incidences and survival rates of pNEN in each decade from 1987 to 2016 and evaluate the impacts of age, sex, race, socioeconomic status (SES), and grade. Methods. Data on pNEN cases from 1987 to 2016 were extracted from the Surveillance, Epidemiology, and End Results Program (SEER) database. Kaplan–Meier, Cox proportional hazards regression analyses, and relative survival rates (RSRs) were used to identify risk factors for pNEN. Results. The incidence and survival duration of pNEN increase every decade due to medical developments. The disparities of long-term survival in different age, sex, and grade groups expanded over time while that in race and SES groups narrowed. Older age and higher grade are independent risk factors for poorer survival. Females have lower incidence and longer survival than males. Prognosis of Black patients and poor (medium and high poverty) patients improved. Conclusions. This study depicted changes in incidence and survival rates of pNEN over the past three decades and evaluated potential risk factors related to pNEN, benefiting future prediction of vulnerable and clinical options.

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Middle East Respiratory Syndrome in Al Ahsa, Saudi Arabia, 2015-18: A lingering epidemic

International Journal of Infection Control ◽

10.3396/ijic.v16i2.012.20 ◽

2020 ◽

Vol 16 (2) ◽

Author(s):

Hanan Al Shaikh ◽

Balaji Rama Naik ◽

Ahmed Saleh Alsaad ◽

Abdullah Ali Albinsaleh

Keyword(s):

Risk Factors ◽

Saudi Arabia ◽

Middle East ◽

Middle East Respiratory Syndrome ◽

Control Measures ◽

Limited Information ◽

Comorbid Conditions ◽

Presenting Symptoms ◽

Security Personnel ◽

Poor Outcomes

Middle East respiratory syndrome (MERS), an emerging disease with fatal outcomes, has limited information on regional variations and their impact on the control measures. The aim of this study was to describe data on distribution of and possible association of risk factors for the disease and poorer outcomes, and recommendations for better control of the disease. Data were collected for 2015-2018 in Al Ahsa, the largest region (population 1.2 million) in the eastern part of Saudi Arabia. In total, 103 cases were reported during the study period with fever and cough as predominant presenting symptoms. The majority were male, >50 years old, and Saudi nationals. One third of patients had comorbid conditions (diabetes and cardiac predominantly). Occupation profiles of the patients varied, with camel owners and security personnel constituting 40% of the study population. In conclusions, older age, nationality, extracorporeal membrane oxygenation (ECMO) treatment, and associated comorbid conditions were found to be probable risk factors for poor outcomes. The mortality rate (59%) was distinctly higher in patients aged >60 years. The study highlights probable risk factors for poor outcomes in MERS patients, and discusses scope for further intervention and better management.

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Breast cancer multifocality-multicentricity and locoregional recurrance.

Journal of Clinical Oncology ◽

10.1200/jco.2012.30.15_suppl.1029 ◽

2012 ◽

Vol 30 (15_suppl) ◽

pp. 1029-1029

Author(s):

Xiudong Lei ◽

Siobhan P. Lynch ◽

Limin Hsu ◽

Funda Meric-Bernstam ◽

Thomas A. Buchholz ◽

...

Keyword(s):

Breast Cancer ◽

Risk Factors ◽

Radiation Therapy ◽

Treatment Modality ◽

Proportional Hazards ◽

Therapy Group ◽

Local Treatment ◽

Breast Conservation ◽

Cox Proportional Hazards ◽

The Impact

1029 Background: The impact of multifocality (MF) and multicentricity (MC) on locoregional (LR) control for invasive breast cancer, and the optimal local treatment strategy for these tumors, is unknown. In particular, there is disagreement in the literature regarding the use of Breast Conservation Therapy (BCT). We evaluated a large single institution cohort of MF and MC breast cancers to determine if they had inferior LR control rate when compared to their unifocal counterparts. Methods: MF and MC were defined pathologically as more than one lesion in the same quadrant and more than one lesion in separate quadrants, respectively. Patients were categorized by presence or absence of MF or MC disease and by the LR treatment modality received – BCT (n=256), mastectomy alone (n=466), or mastectomy plus post-mastectomy radiation therapy (n=184). 10 patients who underwent BCT for MC disease against physician advice were excluded. MF and MC tumors were analyzed both as a group and as separate entities. Kaplan-Meier product limit method was used to calculate 5-year LR control rate. Cox proportional hazards models were fit to determine independent associations of MF/MC disease with LR control. Results: Median follow up was 52 months. Out of 3722 patients with stage I-III disease who did not receive neoadjuvant chemotherapy, 906 (24%) had MF (n=673) or MC (n=233) disease. 5-year rate of LR control rate was 99% in the MF group, 96% in the MC group, and 98% in the unifocal group, (P = 0.44). Subset analysis revealed no statistical difference in LR control regardless of the type of LR treatment, (P = 0.67 in the BCT group, P = 0.37 in the mastectomy alone group, and P = 0.29 in the mastectomy plus post-mastectomy radiation therapy group). There were 21 in-breast recurrences after BCT (8.2%). After controlling for other risk factors, MF and MC did not have an independent impact on LR control rate. Conclusions: MF and MC disease are not independent risk factors for LR recurrence. Patients with MF and MC breast cancer had similar rates of LR control to their unifocal counterparts, regardless of LR treatment modality. Our data suggest that BCT is a safe option for patients with MF tumors and that MF or MC disease alone is not an indication for post-mastectomy radiation therapy.

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Differences in survival for metastatic colorectal cancer patients by lines of therapy received.

Journal of Clinical Oncology ◽

10.1200/jco.2012.30.15_suppl.e14016 ◽

2012 ◽

Vol 30 (15_suppl) ◽

pp. e14016-e14016

Author(s):

Brian S. Seal ◽

Benjamin Chastek ◽

Mahesh Kulakodlu ◽

Satish Valluri

Keyword(s):

Proportional Hazards ◽

Survival Rates ◽

Patient Characteristics ◽

Cox Proportional Hazards ◽

Research Database ◽

First Line ◽

Cox Proportional Hazards Models ◽

Stage 4 ◽

Similar Survival ◽

The Impact

e14016 Background: Improvements in survival for advanced-stage CRC patients who receive chemotherapy have been reported. We compared survival rates for patients with 3+ vs. <3 lines of therapy. Methods: Adult patients with a diagnosis of CRC between 01/01/05 and 05/31/10 were identified from the Impact Intelligence Oncology Management (IIOM) registry. Patients with either stage 4 CRC at original diagnosis or development of metastasis were included. Registry data included original stage and date of diagnosis. Linked healthcare claims from the Life Sciences Research Database, a large US health insurance database affiliated with OptumInsight, were used to identify lines of therapy after metastases and patient characteristics. Death data were obtained from the Social Security Administration’s master death file. Patients were categorized by number of lines of therapy received (0, 1, 2, 3+) and original stage at diagnosis (0-2, 3, 4, unknown). Survival following metastases was evaluated using Cox proportional hazards models controlling for lines of therapy received, stage, and other patient characteristics. Results: 598 patients, followed for a mean of 653 days after becoming metastatic, were included. Mean unadjusted length of follow-up was lowest among patients who received no chemotherapy (516 days) or only 1 line (511 days), and increased to 627 days for those with 2 lines and 930 days for those with 3+ lines. However, multivariate analysis indicated that patients with 3+ lines had comparable survival vs. those with 0 (HR=0.79), 1 (HR=1.59), or 2 (HR=1.15) lines of therapy (p>0.05 for all comparisons). Compared to patients who presented with stage 4 CRC, those who progressed from stage 0-2 (HR=1.22), stage 3 (HR=0.83), or unknown stage (HR=1.18) had similar survival after metastases (p>0.05 for all comparisons). After excluding 94 patients who didn’t receive chemotherapy, patients treated with an oxaliplatin-based regimen (HR=1.28; p=0.24) in first line had similar survival compared to patients treated with an irinotecan-based or anti-EGFR regimen in first line. Conclusions: Lines of therapy received and initial stage were not associated with survival after development of metastases.

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Poor Renal and Cardiovascular Outcomes in Patients with Biopsy-Proven Diabetic Nephropathy

Kidney & Blood Pressure Research ◽

10.1159/000505919 ◽

2020 ◽

Vol 45 (3) ◽

pp. 378-390 ◽

Cited By ~ 1

Author(s):

Yiyun Wang ◽

Ting Zhou ◽

Qiming Zhang ◽

Yang Fei ◽

Ze Li ◽

...

Keyword(s):

Risk Factors ◽

Diabetic Nephropathy ◽

Proportional Hazards ◽

Proportional Hazards Model ◽

Survival Rates ◽

Left Ventricular ◽

Cox Proportional Hazards ◽

Cox Proportional Hazards Model ◽

Diabetic Patients ◽

Family History Of Diabetes

Background: Despite the high mortality of cardiovascular disease (CVD) in diabetic patients with renal injury, few studies have compared cardiovascular characteristics and outcomes between patients with diabetic nephropathy (DN) and non-diabetic renal disease (NDRD). Methods: A total of 326 type 2 diabetes mellitus patients with renal biopsy were assigned to DN and NDRD groups. Echocardiography and Doppler ultrasound were performed to evaluate left ventricular hypertrophy (LVH) and peripheral atherosclerosis disease (PAD). Renal and cardiovascular survival rates were compared between the DN and NDRD groups by Kaplan-Meier analysis. Risk factors for renal and cardiovascular events in DN patients were identified by a Cox proportional hazards model. Results: In total, 179 patients entered the DN group (54.9%) and 147 made up the NDRD group (45.1%). The presence of diabetic retinopathy, family history of diabetes, and dependence on insulin therapy were associated with the presence of DN. DN patients had more CVD with more severe LVH and PAD. Poorer renal (log-rank χ2 = 26.534, p < 0.001) and cardiovascular (log-rank χ2 = 16.257, p < 0.001) prognoses were seen in the DN group. DR (HR 1.539, 95% CI 1.332–1.842), eGFR (HR 0.943, 95% CI 0.919–0.961), and 24-h proteinuria (HR 1.211, 95% CI 1.132–1.387) were identified as risk factors for renal endpoints. Age (HR 1.672, 95% CI 1.487–1.821), HbA1C (HR 1.398, 95% CI 1.197–1.876), and 24-h proteinuria (HR 1.453, 95% CI 1.289–1.672) were associated with cardiovascular endpoints. Conclusion: Patients with DN had more severe CVD along with poorer renal and cardiovascular prognoses than those with NDRD.

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The Impact of Insurance and Marital Status on Survival in Patients with Nasopharyngeal Carcinoma

Biology ◽

10.3390/biology9040084 ◽

2020 ◽

Vol 9 (4) ◽

pp. 84

Author(s):

Chih-Chun Wang ◽

Ching-Chieh Yang ◽

Shyh-An Yeh ◽

Chung-I Huang ◽

Tzer-Zen Hwang ◽

...

Keyword(s):

Nasopharyngeal Carcinoma ◽

Marital Status ◽

Proportional Hazards ◽

Survival Rates ◽

Cox Proportional Hazards ◽

Disease Specific Survival ◽

Uninsured Patients ◽

The Impact ◽

To Receive ◽

Disease Specific

Objective: This study aimed to explore the influence of social support on the survival outcomes of patients with nasopharyngeal carcinoma (NPC). We examined whether the combined proxy influenced whether patients were more likely to receive radiotherapy. Methodology: data were collected from the 18 registries of the National Cancer Institute’s Surveillance, Epidemiology, and End Results database. The association between both insurance status and marital status and disease-specific survival rates were evaluated with a multivariate Cox proportional-hazards regression model to calculate the hazard ratios and associated confidence intervals. Odds ratio (OR) computed by logistic regression was also used to examine the relationship between the receipt of radiotherapy and insurance and marital status. Results: insured and uninsured patients differed significantly in T-stage, N-stage, M-stage, radiotherapy use, race, and marital status. The uninsured-non-married patients showed the lowest 5-year disease-specific survival rates. We further found unmarried patients with either Medicaid (OR, 0.40), or no insurance (OR, 0.24) had lower odds of receiving radiotherapy than those with insurance at diagnosis. Conclusions: uninsured-unmarried NPC patients had a significantly higher risk of distant metastasis at diagnosis, poorer 5-year disease-specific survival, and were less likely to receive radiotherapy than insured-married patients.

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Impact of peritoneal dialysis-related peritonitis on PD discontinuation and mortality: A population-based national cohort study

Peritoneal Dialysis International ◽

10.1177/08968608211018949 ◽

2021 ◽

pp. 089686082110189

Author(s):

Mu-Chi Chung ◽

Tung-Min Yu ◽

Ming-Ju Wu ◽

Ya-Wen Chuang ◽

Chih-Hsin Muo ◽

...

Keyword(s):

Risk Factors ◽

Peritoneal Dialysis ◽

Proportional Hazards ◽

Female Gender ◽

Cox Proportional Hazards ◽

Time Dependent ◽

Long Term Outcomes ◽

Increased Risk ◽

The Impact

Background: The impact of peritoneal dialysis-associated peritonitis (PD peritonitis) on long-term outcomes is uncertain. This nationwide retrospective study was conducted in Taiwan to understand the incidence, risk factors and long-term outcomes of PD peritonitis. Methods: A total of 11,202 incident adult peritoneal dialysis (PD) patients from 2000 to 2010 were collected from a Longitudinal Health Insurance Database and followed up until the end of 2011. Definition of peritonitis, the primary outcome, simultaneously met the diagnosis of peritonitis (International Classification of Diseases, Ninth Revision, Clinical Modification 567) and antibiotic use. Secondary outcomes included the impact of peritonitis on PD discontinuation and survival. Cox proportional hazards models with and without time-dependent variables were used to calculate hazard ratios (HRs) and 95% confidence intervals (CIs). Results: There were 7634 peritonitis episodes in 4245 patients during the follow-up period. The overall incidence of peritonitis was 0.18 episodes per patient-year. Peritonitis-associated risk factors included older age, female gender, chronic heart failure, cerebrovascular disease, liver cirrhosis and lower monthly income. In an adjusted Cox hazard proportional regression with the time-dependent model, peritonitis patients had a higher risk of PD discontinuation (HR 2.71, 95% CI 2.52–2.92) and mortality (HR 1.68, 95% CI 1.57–1.81) compared to patients without peritonitis. The adjusted HRs for mortality increased with each prior episode: one episode, two episodes and more than two episodes (all p < 0.05). The adjusted HRs for PD discontinuation also increased with the frequency of peritonitis. These negative effects were greatest during the first year and persisted significantly after 5 years. In a sensitivity analysis in which peritonitis within 30 days of death or PD discontinuation was excluded, peritonitis patients still had significantly increased risk of PD discontinuation and mortality compared to patients without peritonitis. Conclusions: Although peritonitis incidence was low, our findings reveal that peritonitis carried acute and long-term sequelae of higher PD discontinuation and lower patient survival.

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