Cumulative Risk Of Death Research Articles

Reproductive health indicators and fetal medicine – many things will change

Reproductive health indicators and fetal medicine – many things will change

Big data: a new look at old problems.

The term Big Data is an elusive term with a definition that is not commonly agreed upon. According to a recent definition, the term would encompass any data that is around a petabyte (1015 bytes) or more in size.1 In health informatics research, Big Data of this size is quite rare. Nevertheless, data used for health informatics research can be considered Big Data in terms of their richness of clinical information and complex structure and may represent an important source of information relevant to the clinical decision-making in real-world patient settings.2 Rapsomaniki et al. 3 used samples of national, ongoing, unselected record sources to assess three outcomes: all-cause death; a composite of myocardial infarction (MI), stroke, and all-cause death; and hospitalized bleeding. Patients aged 65 years and older entered the study 1 year following the most recent discharge for MI. The data bases used were the Echantillon Generaliste des Beneficiaires from France, the CALIBER research platform of primary care linked via Myocardial Ischaemia National Audit Project (MINAP), the Hospital Episodes Statistics database, and the nationwide cause-specific mortality database from England, the National Inpatient Register, the Swedish Prescribed Drug Register, and the Cause of Death Register from Sweden, and the Medicare database from the USA. The information from these large administrative databases provided an overview of the effectiveness of specific procedures. For example, coronary artery bypass graft and coronary angioplasty results were described in the four populations. The study found that compared with patients from France (64.6%), patients from Sweden (61.3%), England (42.8%), and the USA (59.8%) were less likely to have undergone revascularization either by coronary artery bypass graft or percutaneous coronary intervention (PCI). Unadjusted 3-year cumulative risk of death was considerably lower among English patients (19.6%) than the corresponding figures from the USA (30.2%), Sweden (26.9%), and … [↵][1]*Corresponding author. Tel: +39 051 347290, Fax: +39 051 347290, Email: raffaele.bugiardini{at}unibo.it [1]: #xref-corresp-1-1

Assessing Consequences of Intraaortic Balloon Counterpulsation Versus Left Ventricular Assist Devices at the Time of Heart Transplantation.

The proportion of heart transplant recipients bridged with durable, intracorporeal left ventricular assist devices (dLVADs) has dramatically increased; however, concern exists regarding obligate repeat sternotomy, increased bleeding risk because of anticoagulation and acquired von Willebrand disease, and increased rates of allosensitization. Whether dLVAD patients have impaired posttransplant outcomes compared with equivalent patients with less invasive intraaortic balloon pump counterpulsation (IABP) at the time of transplant is unknown. Therefore, we analyzed adult, first time, heart-only transplant procedures with dLVAD (n = 2,636) compared with IABP (n = 571) at the time of transplant based on data from the United Network for Organ Sharing (UNOS) July 2004 to December 2011. There was clear geographic variation in IABP and dLVAD at transplant. Multivariable analysis demonstrated equivalent cumulative risk of death (adjusted Cox proportional hazard ratio, 1.08; 95% confidence interval, 0.87-1.33; p = 0.51). There was no significant difference in adjusted comparison of perioperative morality, length of stay, postoperative renal failure requiring dialysis, or early acute rejection (p ≥ 0.14 for all). Therefore, data from UNOS suggest that the presence of dLVAD at the time of heart transplantation does not have a detrimental effect on postoperative outcomes compared with IABP, which must be considered in the context of pretransplant mortality and locoregional organ availability.

Somatic, hematologic phenotype, long-term outcome, and effect of hematopoietic stem cell transplantation. An analysis of 97 Fanconi anemia patients from the Italian national database on behalf of the Marrow Failure Study Group of the AIEOP (Italian Association of Pediatric Hematology-Oncology).

We analyzed 97 Fanconi anemia patients from a clinic/biological database for genotype, somatic, and hematologic phenotype, adverse hematological events, solid tumors, and treatment. Seventy-two patients belonged to complementation group A. Eighty percent of patients presented with mild/moderate somatic phenotype and most with cytopenia. No correlation was seen between somatic/hematologic phenotype and number of missense mutations of FANCA alleles. Over follow-up, 33% of patients improved or maintained mild/moderate cytopenia or normal blood count, whereas remaining worsened cytopenia. Eleven patients developed a hematological adverse event (MDS, AML, pathological cytogenetics) and three developed solid tumors. 10 years cumulative risk of death of the whole cohort was 25.6% with median follow-up 5.8 years. In patients eligible to hematopoietic stem cell transplantation because of moderate cytopenia, mortality was significantly higher in subjects transplanted from matched unrelated donor over nontransplanted subjects, whereas there was no significant difference between matched sibling donor transplants and nontransplanted patients. In patients eligible to transplant because of severe cytopenia and clonal disease, mortality risk was not significantly different in transplanted from matched unrelated versus matched sibling donor versus nontransplanted subjects. The decision to transplant should rely on various elements including, type of donor, HLA matching, patient comorbidities, impairment, and clonal evolution of hematopoiesis. Am. J. Hematol. 91:666-671, 2016. © 2016 Wiley Periodicals, Inc.

Risk of Adverse Health and Social Outcomes Up to 50 Years After Wilms Tumor: The British Childhood Cancer Survivor Study.

Survivors of Wilms tumor (WT) are at risk for adverse health and social outcomes but risks beyond 30 years from diagnosis remain uncertain. We investigated the risks of adverse outcomes among 5-year survivors of WT, in particular, those between 30 and 50 years from diagnosis. The British Childhood Cancer Survivor Study includes 1,441 5-year survivors of WT. We investigated cause-specific mortality, risk of subsequent primary neoplasms (SPNs), and, for those who completed a questionnaire, the extent of smoking and drinking, educational achievement, health status, and health service use compared with the general population. Cumulative risk of death from all causes, excluding recurrence, increased substantially from 5.4% to 22.7% at 30 years and 50 years, respectively, after WT diagnosis-75% of excess deaths beyond 30 years from diagnosis were attributable to SPNs (50%) and cardiac diseases (25%). Digestive cancer, most frequently bowel, accounted for 41% of excess cancers beyond 30 years. Between 30 and 50 years from diagnosis, survivors of WT are at a substantially increased risk of premature mortality, and 75% of excess deaths were accounted for by SPNs and cardiac diseases. Radiotherapy exposure was a risk factor for both outcomes. The proportion of patients with WT who are exposed to radiotherapy has reduced substantially in recent decades because of initiatives such as the SIOP WT 2001 clinical trial, which sought to reduce late effects; however, the majority of current survivors, who are at least 30 years from diagnosis, received radiotherapy. Surveillance of this group should focus on SPNs, in particular, bowel and breast cancers, and cardiac conditions.

Risk Factors for the Development of Hepatocellular Carcinoma in Thailand.

Hepatocellular carcinoma (HCC) is the most common type of liver cancer worldwide. The incidence of HCC is on the rise in Thailand, where it has become the most common malignancy in males and the third most common in females. Here, we review some of the risk factors that have contributed to this increase in HCC incidence in the Thai population. Hepatitis B virus (HBV) is the main etiologic risk factor for HCC, followed by hepatitis C virus (HCV). Patients with HBV genotype C have a higher positive rate of hepatitis B early antigen (HBeAg) and progress to cirrhosis and HCC earlier than genotype B. For HCV patients, 16% developed HCC associated cirrhosis by year 5 after diagnosis, and the cumulative risk for death from HCC at year 10 was 60%. Dietary exposure to the fungal hepatocarcinogen aflatoxin B1 has been shown to interact synergistically with HBV infection to increase the risk of early onset HCC. Chronic alcohol abuse remains an important risk factor for malignant transformation of hepatocytes, frequently in association with alcohol-induced cirrhosis. In recent years, obesity and metabolic syndrome have markedly increased the incidence of HCC and are important causes of HCC in some resource-rich regions.

Combined therapy using peritoneal dialysis and hemodialysis may increase the indications for peritoneal dialysis in the United States

To the Editor: The survival of propensity-matched incident peritoneal dialysis (PD) and hemodialysis (HD) patients in the United States health-care system has been investigated.1 The cumulative hazard ratio for death at 1 year was higher for the HD patients, compared with the PD patients, in as-treated and intent-to-treat analyses, respectively. However, the cumulative risk of death, as estimated using the cumulative hazard ratio, favored PD for nearly 3 years of follow-up in the as-treated analysis, based on the decline in residual renal function.

Seasonality and survival associated with three outbreak seasons of West Nile virus disease in Oklahoma--2003, 2007, and 2012.

West Nile virus (WNV) activity has fluctuated in the south-central United States since its introduction. Seasonal outbreaks are common, with three in Oklahoma during 2003, 2007, and 2012. Morbidity and mortality rates vary during each outbreak. Long-term neurologic sequelae in association with West Nile virus disease (WNVD) are well-described, but limited information is available about delayed mortality among acute WNV infection survivors. A retrospective cohort analysis of all confirmed and probable WNVD cases reported to the Oklahoma State Department of Health (OSDH) during 2003, 2007, and 2012 was performed. OSDH surveillance data and mortality data from Oklahoma's vital statistics database were used to construct a descriptive epidemiologic analysis of the geography, temporality, severity, and associated mortality for each outbreak season. A Kaplan-Meier survival curve and standardized mortality ratios (SMRs) were calculated to measure survival of the 2003 and 2007 WNVD cohorts. Seventy-nine cases during 2003, 107 cases during 2007, and 180 cases during 2012 met inclusion criteria. Median ages of the 2003, 2007, and 2012 cohorts were 48, 58, and 59 years, respectively; race, sex, and symptom information were not substantially different. Each outbreak season had a different severity, temporality, and geography. Age- and sex-adjusted SMRs for the combined 2003 and 2007 cohorts censored at 5 years was 0.9 (95% confidence interval 0.51-1.75); no substantial difference was observed between the survival curves. Although similar patterns of long-term mortality were evident on the survival curves, SMRs did not demonstrate increased 5-year cumulative risk for death for patients surviving acute WNV infection.

Three-year survival and recurrence after first-ever stroke: the Joinville stroke registry.

BackgroundData estimating the recurrence and risk of death are lacking in low and middle income countries, where two thirds of the stroke burden occurs. Previously we had shown that the incidence and mortality have been decreasing over the last 18 years in Joinville, Southern Brazil. In this study, we aim to determine the recurrence rates, survival rates and the cause of death in 3 years after their first-ever incident in a urban population-based setting.MethodsFrom the Joinville Stroke Registry, we identified all the cases of first-ever stroke that occurred from October 2009 to September 2010. Multiple overlapping sources of information were used to ensure the completeness of case identification. Patients were followed up prospectively at regular intervals from 30-days to 3 years after the index event. Kaplan-Meir and Cox proportional hazards were used to assess the cumulative risk of death and recurrence.ResultsWe registered 407 first-ever stroke patients. After 3 years, 136 (33%) had died. In the first year of stroke the risk of death was 28% (95% CI, 25 to 32). Beyond the first year, approximately 3 to 5% of survivors died each year. The cumulative risk of death in ischemic stroke (IS) subtypes was 3.6 higher for cardioembolic (CE) IS (hazard ratio 3.6, 95% CI, 2.1 to 6.4; p = 0.001) and 3.3 times higher for undetermined IS (HR 3.3, 95% CI 1.9 to 5.8; p = 0.001) compared to small artery occlusion IS. Over 3 years, the overall stroke recurrence risk was 9% (35/407). We found no difference in stroke recurrence risk between IS subtypes. Cardiovascular disease was the main cause of death all follow up time.ConclusionsCompared to other cohort studies conducted between 10 and 20 years ago in high-income countries, our recurrence rates and 3-year risk of death were similar. Among IS subtypes, we confirmed that CE has highest risk of death. The most common cause of death after a first-ever stroke is cardiovascular disease. This has implications for the uptake of current secondary preventive strategies and the development of new strategies.

Impact of screening mammography on mortality from breast cancer before age 60 in women 40 to 49 years of age.

Whether screening mammography programs should include women in their 40s is controversial. In Canada, screening of women aged 40-49 years has not been shown to reduce mortality from breast cancer. Given that screening mammography reduces mean tumour size and that tumour size is inversely associated with survival, the lack of benefit seen with screening is puzzling and suggests a possible adverse effect on mortality of mammography or subsequent treatment (or both) that counterbalances the expected benefit derived from downstaging. We followed 50,436 women 40-49 years of age until age 60 for mortality from breast cancer. Of those women, one half had been randomly assigned to annual mammography and one half to no mammography. The impact of mammography on breast cancer mortality was estimated using a left-censored Cox proportional hazards model. Of 256 deaths from breast cancer recorded in the study cohort, 134 occurred in women allocated to mammography, and 122 occurred in those receiving usual care and not allocated to mammography. The cumulative risk of death from breast cancer to age 60 was 0.53% for women assigned to mammography and 0.48% for women not so assigned. The hazard ratio for breast cancer-specific death associated with 1 or more screening mammograms before age 50 was 1.10 (95% confidence interval: 0.86 to 1.40). Mammography in women 40-49 years of age is associated with a small but nonsignificant increase in the risk of dying of breast cancer before age 60. Caution should be exercised when recommending mammographic screening to women before age 50.

Predicting the cumulative risk of death during hospitalization by modeling weekend, weekday and diurnal mortality risks.

BackgroundCurrent prognostic models factor in patient and disease specific variables but do not consider cumulative risks of hospitalization over time. We developed risk models of the likelihood of death associated with cumulative exposure to hospitalization, based on time-varying risks of hospitalization over any given day, as well as day of the week. Model performance was evaluated alone, and in combination with simple disease-specific models.MethodPatients admitted between 2000 and 2006 from 501 public and private hospitals in NSW, Australia were used for training and 2007 data for evaluation. The impact of hospital care delivered over different days of the week and or times of the day was modeled by separating hospitalization risk into 21 separate time periods (morning, day, night across the days of the week). Three models were developed to predict death up to 7-days post-discharge: 1/a simple background risk model using age, gender; 2/a time-varying risk model for exposure to hospitalization (admission time, days in hospital); 3/disease specific models (Charlson co-morbidity index, DRG). Combining these three generated a full model. Models were evaluated by accuracy, AUC, Akaike and Bayesian information criteria.ResultsThere was a clear diurnal rhythm to hospital mortality in the data set, peaking in the evening, as well as the well-known ‘weekend-effect’ where mortality peaks with weekend admissions. Individual models had modest performance on the test data set (AUC 0.71, 0.79 and 0.79 respectively). The combined model which included time-varying risk however yielded an average AUC of 0.92. This model performed best for stays up to 7-days (93% of admissions), peaking at days 3 to 5 (AUC 0.94).ConclusionsRisks of hospitalization vary not just with the day of the week but also time of the day, and can be used to make predictions about the cumulative risk of death associated with an individual’s hospitalization. Combining disease specific models with such time varying- estimates appears to result in robust predictive performance. Such risk exposure models should find utility both in enhancing standard prognostic models as well as estimating the risk of continuation of hospitalization.

Long-term mortality of persons with severe mental illness and diabetes: a population-based cohort study in Denmark.

Persons with severe mental illness (SMI) have excess mortality, which may partly be explained by their high prevalence of diabetes. We compared the overall and cause-specific mortality in persons with SMI and diabetes with that of the general Danish population between 1997 and 2009 by linking data from Danish national registries. The cohort counted 4 734 703 persons, and during follow-up 651 080 persons died of whom 1083 persons had SMI and diabetes. Compared with the background population, the overall mortality rate ratios (MRRs) for persons with SMI and diabetes were 4.14 [95% confidence interval (CI) 3.81-4.51] for men and 3.13 (95% CI 2.88-3.40) for women. The cause-specific MRRs for persons with SMI and diabetes were lowest for malignant neoplasms (women: MRR = 1.98, 95% CI 1.64-2.39; men: MRR = 2.08, 95% CI 1.69-2.56) and highest for unnatural causes of death (women: MRR = 12.31, 95% CI 6.80-22.28; men: MRR = 7.89, 95% CI 5.51-11.29). The cumulative risks of death within 7 years of diabetes diagnosis for persons with SMI and diabetes were 15.0% (95% CI 12.4-17.6%) for those younger than 50 years, 30.7% (95% CI 27.8-33.4%) for those aged 50-69 years, and 63.8% (95% CI 58.9-68.2%) for those aged 70 years or older. Among persons suffering from both diseases, 33.4% of natural deaths were attributed to diabetes and 14% of natural deaths were attributed to the interaction between diabetes and SMI. Long-term mortality is high for persons with SMI and diabetes. This calls for effective intervention from a coordinated and collaborating healthcare system.

Coronary Revascularization in Lung Transplant Recipients With Concomitant Coronary Artery Disease

Coronary artery disease (CAD) is not uncommon among lung transplant candidates. Several small, single-center series have suggested that short-term outcomes are acceptable in selected patients who undergo coronary revascularization prior to, or concomitant with, lung transplantation. Our objective was to evaluate perioperative and intermediate-term outcomes in this patient population at our institution. We performed a retrospective, observational cohort analysis of 898 lung transplant recipients between 1997 and 2010. Pediatric, multivisceral, lobar or repeat transplantations were excluded, resulting in 791 patients for comparative analysis, of which 49 (median age 62, 79.6% bilateral transplant) underwent concurrent coronary artery bypass and 38 (median age 64, 63.2% bilateral transplant) received preoperative percutaneous coronary intervention (PCI). Perioperative mortality, overall unadjusted survival and adjusted hazard ratio for cumulative risk of death were similar among both revascularization groups as well as controls. The rate of postoperative major adverse cardiac events was also similar among groups; however, concurrent coronary artery bypass was associated with longer postoperative length of stay, more time in the intensive care unit and more postoperative days requiring ventilator support. These results suggest that patients with CAD need not be excluded from lung transplantation. Preferential consideration should be given to preoperative PCI when feasible.

Abstract 203: Longterm Assessment Is Important in Patients Undergoing Decompressive Craniectomy for Malignant Middle Cerebral Artery Infarction

Objective: Decompressive hemicraniectomy (DC) has been shown to reduce mortality among patients with malignant middle cerebral artery ( MCA) infarction in short term. The present study aimed at studying the long term functional outcome of patients undergoing DC for malignant MCA infarctions. Methods: All patients malignant MCA infarction requiring DC were prospectively enrolled. Patients meeting the inclusion criteria but not undergoing surgery due to any reason were taken as controls. Aphasia testing using was done using Western Aphasia Battery. Modified Rankin Scale (mRS) was done at 3, 6 and12 months to grade functional outcome. mRS ≤ 3 was defined as a good outcome. Results: 60 patients were enrolled during the study period. Mean age was 49.6 years with 72% males. 36 patients (60%) underwent decompressive hemicraniectomy (surgery group) and 24 (40%) received best medical management only (medical group). Mean delay to surgery from time of onset of symptoms was 56 hours (9-148). One year follow up completed for 57 patients and 35 patients (61.4%) died over a period of 1year. Significantly high mortality was noted in the control group at discharge, 3, 6 & 12 months. Cumulative risk of death was 83% in controls compared to 38% in surgical group at 1 year. 2.78% (1/36),16.67% (6/36) and 20% (7/35) patients achieving good outcome at 3, 6 and 12 months in the surgery group and none in controls. Repeated ANOVA showed progressive improvement over time from 3 to 6 months (p< 0.01), 3 months to 1year (p< 0.001), and 6 months to 1 year (p<0.019). Mean aphasia quotient improved progressively over time. Conclusions: Decompressive hemicraniectomy leads to a increased and functionally better survival compared to medical management alone. The outcome assessment at 3 months underrepresants the benefits in trials. For life threatening strokes it is prudent to make assessment at longer intervals. There is progressive improvement in aphasia over time in the surgically survived group

Long-term Outcomes Among Noncuratively Treated Men According to Prostate Cancer Risk Category in a Nationwide, Population-based Study

BackgroundLimited data exist on long-term outcomes among men with prostate cancer (PCa) from population-based cohorts incorporating information on clinical risk category. ObjectiveTo assess 15-yr mortality for men with PCa treated with noncurative intent according to clinical stage, Gleason score (GS), serum levels of prostate specific antigen (PSA), comorbidity, and age. Design, setting, and participantsRegister-based cohort study of 76 437 cases in the National Prostate Cancer Register (NPCR) of Sweden diagnosed from 1991 through 2009 and treated with noncurative intent. Each case was placed in one of five risk categories: (1) low risk: T1–T2 tumor, PSA level <10 ng/ml, and GS ≤6; (2) intermediate risk: T1–T2 tumor and PSA level 10–<20 ng/ml or GS 7; (3) high risk: T3 tumor or PSA level 20–<50 ng/ml or GS ≥8; (4) regional metastases: N1 or T4 tumor or PSA level 50–100 ng/ml; and (5) distant metastases: M1 tumor or PSA ≥100 ng/ml. Outcome measurements and statistical analysisTen- and 15-yr cumulative risk of death after diagnosis from PCa, cardiovascular disease, and other causes. Results and limitationsAmong men with a Charlson Comorbidity Index (CCI) score of 0, no differences were found in observed versus expected all-cause mortality in the low-risk group. Observed mortality was only slightly greater in the intermediate-risk group, but men with high-risk localized PCa or more advanced disease had substantially higher mortality than expected. CCI was strongly associated with cumulative 10-yr mortality from causes other than PCa, especially for men <65 yr. Limitations include potential misclassification in risk category due to GS assignment. ConclusionsPCa mortality rates vary 10-fold according to risk category. The risk of death from causes other than PCa is most strongly related to comorbidity status in younger men.

157 LONG-TERM OUTCOMES ACCORDING TO RISK CATEGORY OF PROSTATE CANCER IN A NATION-WIDE, POPULATION-BASED STUDY

You have accessJournal of UrologyProstate Cancer: Epidemiology and Natural History I1 Apr 2012157 LONG-TERM OUTCOMES ACCORDING TO RISK CATEGORY OF PROSTATE CANCER IN A NATION-WIDE, POPULATION-BASED STUDY Jennifer Rider, Fredrik Sandin, Katja Fall, and Pär Stattin Jennifer RiderJennifer Rider Boston, MA More articles by this author , Fredrik SandinFredrik Sandin Uppsala, Sweden More articles by this author , Katja FallKatja Fall Örebro, Sweden More articles by this author , and Pär StattinPär Stattin Umeå, Sweden More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2012.02.208AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES There are very limited data on long-term outcomes among men diagnosed with prostate cancer (PCa) from cohorts that incorporate information on risk categories. We aimed to separately assess death from PCa, cardiovascular disease (CVD), and other causes for men with PCa according to risk category defined by clinical stage, Gleason score and serum levels of PSA at diagnosis. METHODS We utilized a population-based cohort study of 117,328 PCa cases in the National Prostate Cancer Register (NPCR) of Sweden diagnosed between 1991-2009 categorized into five risk categories according to the National Comprehensive Cancer Network. The cumulative probability of death for up to 15 years of follow-up was estimated using a period analysis and by treating death from PCa, death from CVD, and death from other causes as competing events. Estimates were stratified by risk group and by age. The observed overall mortality was also compared to expected mortality as estimated by use of population death rates from the Swedish male population matched to the study population by age and calendar year. RESULTS As shown in Figure 1, the cumulative risk of death from PCa and other causes, respectively, at 15 years following diagnosis ranged from 7.2% (95% CI: 5.9-8.6%) and 38.6% (36.0-41.3%) for men with low-risk disease, to 68.9% (67.7-70.1%) and 28.1% (95% CI: 26.9-29.2%) for men presenting with distant metastases. At 15 years, CVD alone was responsible for the greatest proportion of deaths among PCa patients with low- and intermediate-risk disease. Regardless of age, observed mortality was no different than expected among men with localized low-risk PCa. Risk of excess mortality increased steadily with longer follow-up among men with localized intermediate-risk, localized high-risk, regionally metastatic, and metastatic disease at diagnosis. CONCLUSIONS The majority of deaths among men with localized disease - even disease considered high risk at diagnosis - are from causes other than PCa. Our results not only highlight the need for more refined tools for PCa diagnosis and therapeutic selection, but also demonstrate the importance of strategies to reduce CVD and other preventable causes of death among men with PCa. © 2012 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 187Issue 4SApril 2012Page: e65 Peer Review Report Advertisement Copyright & Permissions© 2012 by American Urological Association Education and Research, Inc.MetricsAuthor Information Jennifer Rider Boston, MA More articles by this author Fredrik Sandin Uppsala, Sweden More articles by this author Katja Fall Örebro, Sweden More articles by this author Pär Stattin Umeå, Sweden More articles by this author Expand All Advertisement Advertisement PDF downloadLoading ...

Projected life expectancy of people with HIV according to timing of diagnosis

Effective antiretroviral therapy (ART) has contributed greatly toward survival for people with HIV, yet many remain undiagnosed until very late. Our aims were to estimate the life expectancy of an HIV-infected MSM living in a developed country with extensive access to ART and healthcare, and to assess the effect of late diagnosis on life expectancy. A stochastic computer simulation model of HIV infection and the effect of ART was used to estimate life expectancy and determine the distribution of potential lifetime outcomes of an MSM, aged 30 years, who becomes HIV positive in 2010. The effect of altering the diagnosis rate was investigated. Assuming a high rate of HIV diagnosis (median CD4 cell count at diagnosis, 432 cells/μl), projected median age at death (life expectancy) was 75.0 years. This implies 7.0 years of life were lost on average due to HIV. Cumulative risks of death by 5 and 10 years after infection were 2.3 and 5.2%, respectively. The 95% uncertainty bound for life expectancy was (68.0,77.3) years. When a low diagnosis rate was assumed (diagnosis only when symptomatic, median CD4 cell count 140 cells/μl), life expectancy was 71.5 years, implying an average 10.5 years of life lost due to HIV. If low rates of virologic failure observed in treated patients continue, predicted life expectancy is relatively high in people with HIV who can access a wide range of antiretrovirals. The greatest risk of excess mortality is due to delays in HIV diagnosis.

Five-year mortality and related prognostic factors after inpatient stroke rehabilitation: A European multi-centre study

To determine 5-year mortality and its association with baseline characteristics and functional status 6 months post-stroke for patients who received inpatient rehabilitation. A prospective rehabilitation-based cohort study. A total of 532 consecutive stroke patients from 4 European rehabilitation centres. Predictors were recorded on admission. Barthel Index was assessed at 6 months (BI6mths) and patients were followed for 5 years post-stroke. Survival probability was computed using Kaplan-Meier analysis and compared across 3 BI6mths-classes (0-60, 65-90, 95-100) (log-rank test). Significant independent predictors were determined using multivariate Cox regression analysis (hazard ratio (HR)). Five-year cumulative risk of death was 29.12% (95% confidence interval (CI): 22.86-35.38). Age (HR=1.06, 95% CI: 1.04-1.09), cognitive impairment (HR=1.77, 95% CI: 1.21-2.57), diabetes mellitus (HR=1.68, 95% CI: 1.16-2.41) and atrial fibrillation (HR=1.52, 95% CI: 1.08-2.14) were independent predictors of increased mortality. Hyperlipidaemia (HR=0.66, 95% CI: 0.46-0.94), and higher BI6mths (HR=0.98, 95% CI: 0.97-0.99) were independent predictors of decreased mortality. Five-year survival probability was 0.85 (95% CI: 0.80-0.89) for patients in BI6mths-class: 95-100, 0.72 (95% CI: 0.63-0.79) in BI6mths-class: 65-90 and 0.50 (95% CI: 0.40-0.60) in BI6mths-class: 0-60 (p<0.0001). Nearly one-third of rehabilitation patients died during the first 5 years following stroke. Functional status at 6 months was a powerful predictor of long-term mortality. Maximum functional independence at 6 months post-stroke should be promoted through medical interventions and rehabilitation. Future studies are recommended to evaluate the direct effect of rehabilitation on long-term survival.

O-57 - Cancer mortality in patients with psychiatric diagnoses: a higher hazard does not lead to a higher cumulative risk of death

Introduction Altered cancer mortality among psychiatric patients has been reported, but competing death causes were often ignored. Objectives To investigate whether observed cancer mortality in patients with various psychiatric disorders might be biased by competing death causes. Aims To assess the importance of cancer as death cause and as cause of physical comorbidity among patients with a mental illness. Methods In this retrospective cohort study on data from the Psychiatric Case Register Middle Netherlands linked to the death register of Statistics Netherlands, the risk of cancer death among patients with schizophrenia (N = 4,590), bipolar disorder (N = 2,077) and depression (N = 15,130) and their matched controls (N = 87,405) was analyzed using a competing risk model. Results Compared to controls from the general population, higher hazards of cancer death were found in patients (schizophrenia: HR = 1.61, 95%CI: 1.26−2.06; bipolar disorder: HR = 1.20, 95%CI: 0.81−1.79), depression: HR = 1.26, 95%CI: 1.10− 1.44). However, the HRs of death due to suicide and other death causes were more increased. Therefore, among those who died, the 12-years-cumulative risk of cancer death was significantly lower among the three patient groups. Conclusions Our analysis shows that, compared to the general population, patients with a mental illness are at higher risk of dying from cancer, given that they survive the much more increased risks of suicide and other death causes.

Time trends in cervical cancer epidemiology in the Slovak Republic: reflection on the non-implementation of screening with international comparisons

Cervical cancer is a serious public health problem with high geographical variations in incidence, mainly due to historical patterns of risk factors and the influence of screening activities. To reduce both cervical cancer incidence and mortality is the primary objective of organized screening and annual reports of high quality utilising accepted interventional measures. Currently, the time-trends in overall incidence and mortality from cervical cancer in the Slovak Republic are implacable. The high incidence values of this condition that have stabilized long term without any signs of a significant decrease rank us among the "developing countries" in Europe. Moreover, the continuing low accessibility of vaccinations for the population lowers the potential effect of an improvement in the incidence of pre-malignant lesions of cervical cancer. Without a basic analysis of the cervical cancer epidemiological data it is not possible to discover the causes of this unfavorable situation and thus condition changes at the level of screening and early diagnostics.Following this, we aimed to analyse the incidence and mortality of cervical cancer over the period 1968-2006 and to point out the necessity for the early introduction of interventional measures in accordance with organized screening in the Slovak Republic.There was recorded a stabilized trend in incidence with an estimated average annual change -0.008/100.000 (95% CI = -0.048 to 0,032, p =0.689) and a moderately increasing trend in mortality with average annual increase 0.049/100,000 (95% CI = 0.033 to 0.065, p < 0.0001). In 2003-2006, the cumulative risk of disease (0-74 years) averaged 1.5 %, the cumulative risk of death reached 0.5%. The analyses of clinical stages during the period 1978-2003 showed that the number of cases in clinical stage I increased, the stage II rate declined, and the numbers of cases in stages III and IV were still high with, moreover, a rising tendency. In comparison with other European countries these trends are unfavorable and our results have confirmed the necessity of an immediate introduction of organized screening in the SR.