Higher Risk Of Cancer Mortality Research Articles

Cardiovascular Diseases Increase Cancer Mortality in Adults: NHANES-Continuous Study.

Both cancer and cardiovascular disease (CVD) are the leading causes of death worldwide. Although our previous study detected a relationship between CVD and cancer incidence, limited evidence is available regarding the relationship between CVD, cardiovascular risk factors, and cancer mortality. A prospective cohort study using data from the continuous NHANES (National Health and Nutrition Examination Survey, 1999-2016) merged with Medicare and National Death Index mortality data, through December 31, 2018. We included individuals with no history of cancer at baseline. The primary exposure was CVD at baseline. We also conducted a comprehensive risk factor analysis as secondary exposure. The main outcome was cancer mortality data collected from Medicare and National Death Index. We included 44 591 adult individuals representing 1 738 423 317 individuals (52% female, 67% non-Hispanic White, and 9% Hispanic). Competing risk modeling showed a significantly higher risk of cancer mortality in individuals with CVD (adjusted hazard ratio [aHR], 1.37 [95% CI 1.07-1.76], P=0.01) after adjusting for age, sex, and race and ethnicity. Notably, cancer mortality increased with aging (aHR, 1.08 [95% CI 1.05-1.11], P<0.0001), current smoking status (aHR, 6.78 [95% CI, 3.43-13.42], P<0.0001), and obesity (aHR, 2.32 [95% CI, 1.13-4.79], P=0.02). Finally, a significant interaction (P=0.034) was found where those with CVD and obesity showed higher cancer mortality than those with normal body mass index (aHR, 1.73 [95% CI, 1.03-2.91], P=0.04). Our study highlights the close relationship between cardiovascular health and cancer mortality. Our findings suggest that obesity may play a significant role in cancer mortality among individuals with CVD. These findings emphasize the need for a more proactive approach in managing the shared risk factors for CVD and cancer.

Endocrine disrupting chemical Bisphenol A and its association with cancer mortality: a prospective cohort study of NHANES.

There is evidence suggesting that Bisphenol A (BPA) is associated with increased all-cause mortality in adults. However, the specific nature of the relationship between BPA exposure and cancer mortality remains relatively unexplored. The National Health and Nutrition Examination Survey (NHANES) dataset was used to recruit participants. Urinary BPA was assessed using liquid chromatography-mass spectrum (LC-MS). Through the use of multivariable Cox proportional hazard regressions and constrained cubic splines, the relationships between urine BPA and death from all causes and cancer were investigated. This study has a total of 8,035 participants, and 137 died from cancers after a 7.5-year follow-up. The median level of BPA was 2.0 g/mL. Urinary BPA levels were not independently associated with all-cause mortality. For cancer mortality, the second quartile's multivariable-adjusted hazard ratio was 0.51 (95% confidence interval: 0.30 to 0.86; p = 0.011) compared to the lowest quartile. The restricted cubic splines showed that the association was nonlinear (p for nonlinearity = 0.028) and the inflection point was 1.99 ng/mL. Urinary BPA exposure was U-shaped associated with the risk of cancer mortality, and a lower level of BPA less than 1.99 ng/mL was associated with a higher risk of cancer mortality.

The association between polychlorinated dibenzo-p-dioxin exposure and cancer mortality in the general population: a cohort study.

Earlier research has indicated that being exposed to polychlorinated dibenzo-p-dioxins (PCDDs) in the workplace can heighten the likelihood of cancer-related deaths. Nevertheless, there is limited information available regarding the connection between PCDD exposure and the risk of cancer mortality in the general population (i.e., individuals not exposed to these substances through their occupation). The National Health and Nutrition Examination Survey (NHANES) detected PCDDs in the general population, and the death data were recently updated as of December 31, 2019. We conducted Cox regression analysis and controlled for covariates including age, gender, ethnicity, educational attainment, physical activity, alcohol intake, NHANES survey period, BMI category, cotinine concentration, and household earnings. After accounting for confounding factors, the findings indicated that for each incremental rise of 1 log unit in 1,2,3,4,6,7,8,9-octachlorodibenzo-p-dioxin, there was a 76% rise in the likelihood of death from any cause, with a p value of 0.003. An increase of 1 log unit in the concentration of 1,2,3,4,6,7,8-heptachlorodibenzofuran could potentially lead to a 90% higher risk of cancer mortality, as indicated by a p value of 0.034 and a 95% confidence interval of 0.05-2.43. As the concentrations of 1,2,3,4,6,7,8-heptachlorodibenzofuran increased, the dose-response curve indicated a proportional rise in the risk of cancer mortality, accompanied by a linear p value of 0.044. The sensitivity analysis demonstrated that our findings were resilient. In the general population, an elevated risk of cancer mortality was observed in PCDDs due to the presence of 1,2,3,4,6,7,8-heptachlorodibenzofuran. Mechanistic research is required to further confirm it.

Abstract C015: Bridging the gap: A literature review of cancer mortality and incarcerated individuals

Abstract There is a large and increasing rate of incarcerated individuals that face a risk of cancer. Cancer is the leading cause of death among the incarcerated population, resulting in a significantly shortened survival rate amongst said population. Very few studies have been conducted to truly assess the knowledge gap between incarceration and cancer outcomes. But, from the few that have been done, like the population-based study done by UF Radiation Oncology assistant professor, Dr. Oladeru, it was discovered that a higher risk of cancer mortality was prevalent in those who were diagnosed with cancer during their time incarcerated as well as one year post release than the general population. My goal and intent with this literature review is to open the conversation about possible ways to bridge the knowledge gap between cancer health disparities amongst incarcerated patients and contribution factors. Citation Format: Tamia Isaacs, Oluwadamilola Oladeru, Jian Li, Yoshiko Iwai. Bridging the gap: A literature review of cancer mortality and incarcerated individuals [abstract]. In: Proceedings of the 16th AACR Conference on the Science of Cancer Health Disparities in Racial/Ethnic Minorities and the Medically Underserved; 2023 Sep 29-Oct 2;Orlando, FL. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2023;32(12 Suppl):Abstract nr C015.

Abstract B099: Association between obesity and mortality by race, ethnicity, and sex in the United States, 1999-2018

Abstract Background The association between obesity and mortality risk is well established. This prospective cohort study will examine whether there are disparities in this across sex and race/ethnicity in the US and provide updated risk estimates for all-cause, cancer, and five other leading causes of death. Methods We created a cohort of 282,602 never-smoking participants using the National Health Interview Survey (NHIS) linked to the National Death Index that follows mortality up to December 31, 2019. We considered participants aged 25-84 years at enrollment, with at least 2 years follow up, and the following race/ethnicity groups: non-Hispanic White[White], non-Hispanic Black[Black], Hispanic, and other. Self-reported BMI values from NHIS were adjusted using the National Health and Nutrition Examination Survey objectively measured BMI averages by sex, race/ethnicity, and education. The adjusted BMI categories included 12-&amp;lt;18.5(underweight), 18.5-&amp;lt;25(healthy weight), 25-&amp;lt;30(overweight), 30-&amp;lt;40(obese), and 40-≤70(severely obese). Adjusted mortality rate ratios (RR) obtained by the Cox proportional hazard model using NHIS complex survey design compared individuals with healthy weight to those with lower or higher BMI by sex and race/ethnicity. Results A total of 22,591 deaths occurred in this study period, of which 4,539 were cancer. In men and women, obesity and severe obesity were associated with higher risk of cancer mortality. Compared to men with healthy weight, the risk of cancer mortality was higher among individuals who were underweight (RR=1.95,95%CI=1.06-3.58), overweight (RR=1.03,95%CI=0.88-1.19), obese (RR=1.30,95%CI=1.11-1.53), and severely obese (RR=1.68,95%CI=1.21-2.32). Among women, the risk for cancer mortality was higher among individuals who were underweight (RR=1.18,95%CI=0.78-1.80), overweight (RR=1.06,95%CI=0.95-1.18), obese (RR=1.17,95%CI=1.04-1.32), and severely obese (RR=1.62,95%CI=1.35-1.93) compared to the risk for those with healthy weight. In general, similar patterns were observed in all-cause and leading causes of death evaluated in this study. Similarly, being underweight, obese, and severely obese, as compared to being healthy weight, was generally associated with all-cause and cause-specific mortality among White and Hispanic populations. However, obesity and severe obesity were not significantly associated with cancer mortality among Black people likely due to sparse data. The magnitude of some mortality associations also differed by sex and race/ethnicity. For example, the association between obesity and all-cause mortality was stronger among Hispanic men (RR=1.64,95%CI=1.33-2.02) compared to Hispanic women (RR=1.10,95%CI=0.94-1.28). The all-cause RR for severe obesity among White females (RR=1.96,95%CI=1.78-2.17) was larger than among Black females (RR=1.52,95%CI=1.31-1.76). Conclusions Higher BMI was associated with higher risk of all-cause and leading causes of mortality by sex and race/ethnicity, emphasizing the importance of interventions to help reduce excess body weight and maintaining healthy body weight. Citation Format: Emily C. Marlow, Blake Thomson, Ahmedin Jemal, Farhad Islami. Association between obesity and mortality by race, ethnicity, and sex in the United States, 1999-2018 [abstract]. In: Proceedings of the 16th AACR Conference on the Science of Cancer Health Disparities in Racial/Ethnic Minorities and the Medically Underserved; 2023 Sep 29-Oct 2;Orlando, FL. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2023;32(12 Suppl):Abstract nr B099.

Investigating the association between educational attainment and allostatic load with risk of cancer mortality among African American women

BackgroundAfrican American (AA) women navigate the world with multiple intersecting marginalized identities. Accordingly, AA women have higher cumulative stress burden or allostatic load (AL) compared to other women. Studies suggest that AA women with a college degree or higher have lower AL than AA women with less than a high school diploma. We examined the joint effect of educational attainment and AL status with long-term risk of cancer mortality, and whether education moderated the association between AL and cancer mortality.MethodsWe performed a retrospective analysis among 4,677 AA women within the National Health and Nutrition Examination Survey (NHANES) from 1988 to 2010 with follow-up data through December 31, 2019. We fit weighted Cox proportional hazards models to estimate adjusted hazard ratios (aHRs) of cancer death between educational attainment/AL (adjusted for age, income, and smoking status).ResultsAA women with less than a high school diploma living with high AL had nearly a 3-fold increased risk (unadjusted HR: 2.98; 95%C CI: 1.24–7.15) of cancer death compared to AA college graduates living with low AL. However, after adjusting for age, this effect attenuated (age-adjusted HR: 1.11; 95% CI: 0.45–2.74). AA women with high AL had 2.3-fold increased risk of cancer death (fully adjusted HR: 2.26; 95% CI: 1.10–4.57) when compared to AA with low AL, specifically among women with high school diploma or equivalent and without history of cancer.ConclusionsOur findings suggest that high allostatic load is associated with a higher risk of cancer mortality among AA women with lower educational attainment, while no such association was observed among AA women with higher educational attainment. Thus, educational attainment plays a modifying role in the relationship between allostatic load and the risk of cancer death for AA women. Higher education can bring several benefits, including improved access to medical care and enhanced medical literacy, which in turn may help mitigate the adverse impact of AL and the heightened risk of cancer mortality among AA women.

Cancer mortality in Common Mental Disorders: A 10-year retrospective cohort study

PurposeIndividuals with Common Mental Disorders (CMDs) may have a higher cancer mortality. The purpose of this study was to examine cancer-related mortality among patients with CMDs and verify which cancer types are predominantly involved.MethodsWe used the Regional Mental Health Registry of the Emilia-Romagna region, in Northern Italy to identify patients aged ≥ 18 years who received an ICD 9-CM diagnosis of CMDs (i.e., depressive and neurotic disorders) over a 10 year period (2008–2017). Information on cause of death was retrieved from the Regional Cause of Death Registry. Comparisons were made with data from the regional population without CMDs.ResultsAmong 101,487 patients suffering from CMDs (55.7% depression; 44.3% neurotic disorders), 3,087 (37.8%) died from neoplasms. The total standardized mortality ratio (SMR) was 1.82 (95% CI 1.78–1.86) while the SMR for all neoplasms was 2.08 (95% CI 2.01–2.16). Individuals of both genders, with both depressive and neurotic disorders had a higher risk of death from almost all cancers compared with the regional population.ConclusionPatients with CMDs have considerably higher cancer mortality risk than the general population. Higher mortality was observed for a broad range of cancers associated with different aetiologies. It is imperative to promote cancer awareness, prevention and treatment for people with CMDs.

Occupation- and industry-specific cancer mortality among Japanese women from 1980 to 2015

BackgroundThe number of women in Japan who continue working after childbirth is on the rise. Over the past few years, Japan’s cancer mortality rate has increased. About 50% of all cancer deaths among Japanese women aged 25–64 are caused by lung, gastric, pancreatic and colorectal cancers. This study aims to examine the difference in mortality risk for key cancers among women and explore the effect of the economic crisis in the mid-1990s separately for occupational and industrial categories.MethodsData from 1980 to 2015 were gathered from the Japanese Population Census and National Vital Statistics conducted in the same year. A Poisson regression analysis was used to estimate mortality risk and mortality trends for lung, gastric, pancreatic and colorectal cancer among Japanese working women aged 25–64 years.ResultsAcross most industrial and occupational groups, the trends in age-standardised cancer mortality rate for women have declined. Workers in management, security and transportation have a higher cancer mortality risk than sales workers. The risk of death from all four cancers is higher for workers in the mining and electricity industries than for wholesale and retail workers.ConclusionTo improve the health and well-being of employed Japanese women, it is crucial to monitor cancer mortality trends. Using these population-level quantitative risk estimates, industry- and occupation-specific prevention programmes can be developed to target women at higher cancer risk and enable the early detection and treatment of cancer.

Incarceration status and cancer mortality: A population-based study.

The complex relationship between incarceration and cancer survival has not been thoroughly evaluated. We assessed whether cancer diagnosis during incarceration or the immediate post-release period is associated with higher rates of mortality compared with those never incarcerated. We conducted a population-based study using a statewide linkage of tumor registry and correctional system movement data for Connecticut adult residents diagnosed with invasive cancer from 2005 through 2016. The independent variable was place of cancer diagnosis: during incarceration, within 12 months post-release, and never incarcerated. The dependent variables were five-year cancer-related and overall survival rates. Of the 216,540 adults diagnosed with invasive cancer during the study period, 239 (0.11%) people were diagnosed during incarceration, 479 (0.22%) within 12 months following release, and the remaining were never incarcerated. After accounting for demographics and cancer characteristics, including stage of diagnosis, the risk for cancer-related death at five years was significantly higher among those diagnosed while incarcerated (AHR = 1.39, 95% CI = 1.12-1.73) and those recently released (AHR = 1.82, 95% CI = 1.57-2.10) compared to the never-incarcerated group. The risk for all-cause mortality was also higher for those diagnosed with cancer while incarcerated (AHR = 1.92, 95% CI = 1.63-2.26) and those recently released (AHR = 2.18, 95% CI = 1.94-2.45). There is a higher risk of cancer mortality among individuals diagnosed with cancer during incarceration and in the first-year post-release, which is not fully explained by stage of diagnosis. Cancer prevention and treatment efforts should target people who experience incarceration and identify why incarceration is associated with worse outcomes.

Three-year weight change and risk of all-cause, cardiovascular, and cancer mortality among Iranian adults: over a decade of follow-up in the Tehran Lipid and Glucose Study

BackgroundWe investigated the impact of weight change on mortality in a population-based cohort setting.MethodsWe conducted two weight measurements for 5436 participants aged ≥ 30 years with an approximate 3-year interval. Based on their weight change, we categorized participants to: > 5% weight loss, 3–5% weight loss, stable weight (± < 3%), 3–5% weight gain, > 5% weight gain. We followed participants for mortality annually up to March 20th 2018. We applied the multivariable Cox proportional hazard models to estimate hazard ratios (HRs) and 95% confidence intervals (CIs) of weight change categories for all-cause, cardiovascular (CV), and cancer mortality, considering stable weight as reference. The Cox models was adjusted for age, sex, educational level, body mass index, smoking status, hypertension, hypercholesterolemia, diabetes, and cardiovascular disease (CVD) at baseline.ResultsDuring a median follow-up of 14.4 years, 629 deaths (247 CV and 126 cancer deaths) have occurred. Over 5% weight loss and gain were associated with increased risk of all-cause mortality in multivariable analysis with HRs of 1.47 [95% CI: 1.17–1.85] and 1.27 [1.02–1.57], respectively; however, a 3–5% loss or gain did not alter the risk of all-cause mortality significantly. These significant risks for wight change > 5% were not modified by the presence of diabetes, obesity, and smoking status; however, the unfavorable impact of weight change on mortality events was more prominent in those older than > 65 years (P-value for interaction: 0.042). After excluding those with history of CVD, diabetes, and cancer during the weight measurements period, these associations significantly attenuated (HR: 1.29 [0.89–1.87] for > 5% weight loss and 1.12 [0.84–1.50] for > 5% weight gain). Additionally, a > 5% weight loss was also associated with about 60% higher risk for CV mortality (HR: 1.62 [1.15–2.28]), and a 3–5% weight loss was associated with about 95% higher risk of cancer mortality (HR: 1.95 [1.13–3.38]).ConclusionsOur findings showed a U-shaped association across weight change categories for all-cause mortality risk with over 5% weight gain and loss causing higher risk. Moreover, weight loss can have adverse impact on CV and cancer mortality events.

Association of lung function with the risk of cardiovascular diseases and all-cause mortality in patients with diabetes: Results from NHANES III 1988-1994.

ObjectiveThe potential effects of pulmonary dysfunction on cardiovascular diseases (CVD) and all-cause mortality are receiving attention. The current study aimed to explore whether reduced lung function predicts CVD and all-cause mortality in people with diabetes.MethodsA total of 1,723 adults with diabetes (mean age 60.2 years) were included in the National Health and Nutrition Examination Survey (NHANES III). Death outcomes were ascertained by linkage to the database records through 31 December 2015. Cox proportional hazards regression models were used to estimate hazard ratios (HRs) and 95% confidence intervals (CIs) for coronary heart disease (CHD), CVD, and all-cause mortalities. We conducted stratified analyses based on age, body mass index (BMI), history of hypertension, and dyslipidemia.ResultsDuring a mean follow-up of 14.62 years (25,184 person-year), a total of 1,221 deaths were documented, of which 327 were CHD, 406 were CVD, and 197 were cancer. After multi-factor adjustment, participants with lower FEV1 and FVC had a higher risk of CHD, CVD, and all-cause mortality. This association was also found in lower FVC and a higher risk of cancer mortality [HR: 3.85 (1.31–11.32); P for trend = 0.040], but the association of FEV1 was attenuated after adjustment for covariates [HR:2.23 (0.54–9.17); P for trend = 0.247]. In subgroup analysis, we found that the adverse associations of FEV1 and FVC with CVD mortality were observed in subgroups of age, BMI, and history of hypertension and dyslipidemia.ConclusionDeclined lung function was associated with a higher risk of CVD and all-cause mortality in people with diabetes. Lung function tests, especially FEV1 and FVC, should be encouraged to provide prognostic and predictive information for the management of CVD and all-cause mortality in patients with diabetes.

Association of phthalate exposure with all-cause and cause-specific mortality among people with hypertension: The U.S. National Health and Nutrition Examination Survey, 2003-2014.

There is growing evidence that phthalate exposure results in a deteriorated effect on human health, while very few studies directly investigate the relationship of phthalate metabolites with mortality among people with hypertension. We aimed to explore whether exposure to phthalates is associated with all-cause and cause-specific mortality among people with hypertension. This study included 4012 people with hypertension from the National Health and Nutrition Examination Survey from 2003 to 2014. Death information was obtained from the National Death Index until 2015. A total of 577 deaths including 196 deaths due to cardiovascular disease (CVD) and 119 deaths due to cancer were documented. Cox proportional hazards regression models were used to estimate hazard ratios (HR) and 95% confidence intervals (CI). After adjustment for potential covariates, participants exposed to mono-ethyl phthalate (MEP) had a higher risk of cancer mortality (HR, 2.06; 95% CI, 1.07-3.95). Participants exposed to mono-n-butyl phthalate (MnBP) had higher risks of all-cause (HR, 1.83; 95% CI, 1.28-2.60), CVD (HR, 2.19; 95% CI, 1.21-3.95), and cancer (HR, 2.35; 95% CI, 1.07-5.17) mortality. Participants exposed to mono-benzyl phthalate (MBzP) had higher risks of all-cause (HR, 2.19; 95% CI, 1.58-3.05) and CVD (HR, 2.36; 95% CI, 1.35-4.13) mortality. Participants exposed to di-2-ethylhexylphthalate (DEHP) had a higher risk of all-cause mortality (HR, 1.69; 95% CI, 1.19-2.39). Our findings suggested that higher levels of specific phthalates were significantly associated with increased risks of all-cause, CVD, and cancer mortality among people with hypertension. Further studies are needed to confirm these findings and identify the underlying mechanisms.

Birth weight and long-term risk of mortality among US men and women: Results from three prospective cohort studies

Weight at birth has been associated with the development of various adult diseases, but its association with mortality remains unclear. We included 22,389 men from the Health Professionals Follow-up Study (1994-2018) and 162,231 women from the Nurses' Health Study (1992-2018) and the Nurses' Health Study II (1991-2019). The hazard ratios (HRs) of mortality according to birth weight were estimated by Cox proportional hazards regression models with adjustment for potential confounders. Compared to women reporting a birth weight of 3.16-3.82 kg, the pooled HRs for all-cause mortality were 1.13 (95% CI, 1.08 to 1.17), 0.99 (95% CI, 0.96 to 1.02), 1.04 (95% CI, 1.00 to 1.08), and 1.03 (95% CI, 0.96 to 1.10), respectively, for women with a birth weight of <2.5, 2.5-3.15, 3.83-4.5, and >4.5 kg. In cause-specific mortality analyses, women reporting birth weight >4.5 kg had a higher risk of cancer mortality (HR=1.15, 95% CI: 1.00 to 1.31), whereas women with a birth weight <2.5 kg had an elevated risk of mortality from cardiovascular diseases (HR=1.15; 95% CI, 1.05 to 1.25) and respiratory diseases (HR=1.35; 95% CI, 1.18 to 1.54). Birth weight was unrelated to all-cause mortality among men, but cause-specific mortality analyses showed an inverse association with cardiovascular disease mortality and a positive association with cancer mortality (p for linear trend = 0.012 and 0.0039, respectively). low birth weight was associated with a greater risk of cardiovascular and respiratory disease mortality among women, while large birth weight was associated with a greater cancer mortality risk in both men and women. The National Institutes of Health grants U01-HL145386, U01-CA176726, R01-HL034594, R01-HL088521, UM-CA186107, P01-CA87969, R01-CA49449, R01-CA67262, U01-HL145386, U01-CA167552, R01-HL35464, and R24-ES028521-01 support this study.

Disparities in Telemedicine Success and Their Association With Adverse Outcomes in Patients With Thoracic Cancer During the COVID-19 Pandemic

Disparities in access to telemedicine were identified at the onset of the COVID-19 pandemic, but the consequences of these disparities are not well characterized. To investigate factors associated with successfully accessing and completing telemedicine visits and the association between telemedicine visit success and clinical outcomes among patients with thoracic cancer. This retrospective cohort study included patients who attended outpatient visits at the thoracic oncology division of Johns Hopkins Medical Institute in Baltimore, Maryland, from March 1 to July 17, 2020. Associations of age, sex, race, ethnicity, insurance status, marital status, zip code, type of cancer, cancer stage, and type of therapy with telemedicine visit success (defined as completed visits with synchronous audio-video connection) and of visit success status with changes in therapy and odds of emergency department and urgent care visits, hospitalizations, and death were assessed using χ2 and Fisher exact tests and are reported as odds ratios (ORs). A total of 720 patients and 1940 visits with complete data were included in the analysis; the median patient age was 65.7 years (range, 54.7-76.7 years), and 384 (53.33%) were male. Of the 1940 visits, 679 (35.00%) were in person and 1261 (65.00%) were telemedicine. Of the telemedicine visits, 717 (56.86%) were successful and 544 (43.14%) were unsuccessful. Patients who were Black (OR, 0.62; 95% CI, 0.41-0.95), had Medicaid (OR, 0.38; 95% CI, 0.18-0.81), or were from a zip code with an elevated risk of cancer mortality (OR, 0.51; 95% CI, 0.29-0.90) were less likely to have successful telemedicine visits than to have unsuccessful visits. Patients with at least 1 unsuccessful telemedicine visit had higher likelihood of an emergency department (OR, 2.73; 95% CI, 1.42-5.22) or urgent care (OR, 4.50; 95% CI, 2.41-8.41) visit or hospitalization (OR, 2.37; 95% CI, 1.17-4.80). Similarly, patients who had no successful telemedicine visits and for whom more than 1 telemedicine visit was scheduled had a higher likelihood of an emergency department (OR, 3.43; 95% CI 1.80-6.52) or urgent care (OR, 4.24; 95% CI 2.24-8.03) visit or hospitalization (OR, 4.19; 95% CI 2.17-8.10). Patients with all successful telemedicine visits (OR, 0.52; 95% CI, 0.30-0.90) or only 1, unsuccessful visit (OR, 0.32; 95% CI, 0.13-0.75) had lower odds of death compared with patients seen in-person only. Starting a new therapy was associated with lower odds of having a telemedicine visit vs an in-person visit (OR, 0.49; 95% CI, 0.37-0.64) and higher odds of a successful telemedicine visit vs an unsuccessful telemedicine visit (OR, 1.90; 95% CI, 1.28-2.82). In this cohort study, patients with thoracic cancer who were Black, had Medicaid, or were from a zip code with a high risk of cancer mortality had increased odds of unsuccessful telemedicine visits compared with their counterparts and unsuccessful telemedicine visits were associated with worse clinical outcomes compared with successful visits. These findings suggest that more work is needed to improve telemedicine access for disadvantaged patients.

Retinal photograph-based deep learning predicts biological age, and stratifies morbidity and mortality risk.

Backgroundageing is an important risk factor for a variety of human pathologies. Biological age (BA) may better capture ageing-related physiological changes compared with chronological age (CA).Objectivewe developed a deep learning (DL) algorithm to predict BA based on retinal photographs and evaluated the performance of our new ageing marker in the risk stratification of mortality and major morbidity in general populations.Methodswe first trained a DL algorithm using 129,236 retinal photographs from 40,480 participants in the Korean Health Screening study to predict the probability of age being ≥65 years (‘RetiAGE’) and then evaluated the ability of RetiAGE to stratify the risk of mortality and major morbidity among 56,301 participants in the UK Biobank. Cox proportional hazards model was used to estimate the hazard ratios (HRs).Resultsin the UK Biobank, over a 10-year follow up, 2,236 (4.0%) died; of them, 636 (28.4%) were due to cardiovascular diseases (CVDs) and 1,276 (57.1%) due to cancers. Compared with the participants in the RetiAGE first quartile, those in the RetiAGE fourth quartile had a 67% higher risk of 10-year all-cause mortality (HR = 1.67 [1.42–1.95]), a 142% higher risk of CVD mortality (HR = 2.42 [1.69–3.48]) and a 60% higher risk of cancer mortality (HR = 1.60 [1.31–1.96]), independent of CA and established ageing phenotypic biomarkers. Likewise, compared with the first quartile group, the risk of CVD and cancer events in the fourth quartile group increased by 39% (HR = 1.39 [1.14–1.69]) and 18% (HR = 1.18 [1.10–1.26]), respectively. The best discrimination ability for RetiAGE alone was found for CVD mortality (c-index = 0.70, sensitivity = 0.76, specificity = 0.55). Furthermore, adding RetiAGE increased the discrimination ability of the model beyond CA and phenotypic biomarkers (increment in c-index between 1 and 2%).Conclusionsthe DL-derived RetiAGE provides a novel, alternative approach to measure ageing.

Dietary intake and biomarkers of alpha linolenic acid and risk of all cause, cardiovascular, and cancer mortality: systematic review and dose-response meta-analysis of cohort studies

ObjectiveTo examine the associations between dietary intake and tissue biomarkers of alpha linolenic acid (ALA) and risk of mortality from all causes, cardiovascular disease (CVD), and cancer.DesignSystematic review and meta-analysis...

Current evidence on dietary intakes of fatty acids and mortality

Findings from the associations between dietary intakes of different fatty acids and longevity are of particular interest to researchers, healthcare providers, and patients. Based on our meta-analysis of 41 articles...

MP13-11 COBRA SCORE ADEQUATELY IDENTIFIES HIGHER RISK OF CANCER MORTALITY AND LYMPHOVASCULAR INVASION INFORMATION FURTHER IMPROVES ITS PERFORMANCE

You have accessJournal of UrologyBladder Cancer: Invasive I (MP13)1 Sep 2021MP13-11 COBRA SCORE ADEQUATELY IDENTIFIES HIGHER RISK OF CANCER MORTALITY AND LYMPHOVASCULAR INVASION INFORMATION FURTHER IMPROVES ITS PERFORMANCE Anna Colomer Gallardo, Oscar Buisan Rueda, Roger Freixa Sala, Petr Macek, Yann Barbe, Xavier Cathelineau, Marco Moschini, Rafael Sánchez-Salas, and Joan Areal Calama Anna Colomer GallardoAnna Colomer Gallardo More articles by this author , Oscar Buisan RuedaOscar Buisan Rueda More articles by this author , Roger Freixa SalaRoger Freixa Sala More articles by this author , Petr MacekPetr Macek More articles by this author , Yann BarbeYann Barbe More articles by this author , Xavier CathelineauXavier Cathelineau More articles by this author , Marco MoschiniMarco Moschini More articles by this author , Rafael Sánchez-SalasRafael Sánchez-Salas More articles by this author , and Joan Areal CalamaJoan Areal Calama More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000001994.11AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: To externally validate the COBRA score (tool predicting cancer-specific survival after radical cystectomy for urothelial carcinoma; Welty et al Cancer 2017, DOI: 10.1002/cncr.30918) and to add lymphovascular invasion(LVI) information from cystectomy final pathology to verify its impact on the predictive model. METHODS: Clinicopathological and survival data from 789 patients who underwent radical cystectomy and pelvic lymph node dissection between January 2007 and December 2020 were analysed. External validation was determined using regression coefficients abstracted from previously published data. COBRA score was applied to our sample and Cancer Specific Survival (CSS) Kaplan-Meier (KM) curves were performed. After adding LVI new CCS curves were plotted. RESULTS: A total 789 patients were analyzed, with median follow up of 32 months. Cancer Specific Mortality was 218 patients (27,6%). When COBRA score was applied to our cohort, the discriminatory power was found to have high precision with a c- index of 71% for the full model.Regression COX analysis showed Group 1 HR 0.36, IC (0.16-0.83), p=0.016; Group 2 HR 0, IC (0-1.77) p=0.94; Group 3 HR 0.51, IC (0.39 -0.67), p=0.001; Group 4 HR 1.67, IC (1.23-2.27), p=0.001; Group 5 HR 2.45, IC (1.51-3.99); p=0.001; Group 6 HR 2.01, IC (1.42-2.85), p=0.001; Group 7 HR 0.66, IC (0.09-4.73), p=0.682. KM curves for COBRA score in our sample are presented. When the LVI was added to the model, a poorer CSS was verified (Figure 1, without LVI vs with LVI). CONCLUSIONS: COBRA adequately identifies those patients with a higher risk of cancer mortality in our population. Furthermore, adding LVI information further improves the prediction. LVI could be further evaluated and eventually included in the prediction model. Source of Funding: No source of funding © 2021 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 206Issue Supplement 3September 2021Page: e247-e247 Advertisement Copyright & Permissions© 2021 by American Urological Association Education and Research, Inc.MetricsAuthor Information Anna Colomer Gallardo More articles by this author Oscar Buisan Rueda More articles by this author Roger Freixa Sala More articles by this author Petr Macek More articles by this author Yann Barbe More articles by this author Xavier Cathelineau More articles by this author Marco Moschini More articles by this author Rafael Sánchez-Salas More articles by this author Joan Areal Calama More articles by this author Expand All Advertisement Loading ...

Combined Effects of Chronic PM2.5 Exposure and Habitual Physical Activity on Cancer Mortality: A Longitudinal Cohort Study

BACKGROUND AND AIM: Physical activity (PA) may increase the inhalation and deposition of air pollutants, possibly reducing its beneficial effects. We thus examined the combined effects of chronic exposure to fine particle matter (PM2.5) and habitual PA on the risk of cancer mortality in Taiwan. METHODS: A total of 384,128 adults (≥18 years) with 842,384 medical examinations were recruited between 2001 and 2016. All participants were followed up until May 31, 2019. Vital data were obtained from the National Death Registry of Taiwan. Ambient PM2.5 exposure was estimated using a satellite-based spatiotemporal model. Information on habitual PA was collected using a standard self-administered questionnaire. The time-dependent Cox regression model was used to evaluate the combined effects. RESULTS:Higher habitual PA was associated with lower risk of cancer mortality, whereas higher PM2.5 exposure was associated with higher risk of cancer mortality. The inverse associations of habitual PA with cancer mortality were not modified by chronic exposure to PM2.5. Compared to the participants with inactive-low-PA and high-PM2.5, those with high-PA and low-PM2.5 exhibited a 35% lower risk of cancer mortality [95% confidence interval (CI): 28%-42%]. CONCLUSIONS:Increased PA and reduced PM2.5 exposure are associated with lower risk of cancer mortality. Habitual PA reduces the risk of cancer mortality regardless of the levels of chronic PM2.5 exposure. Our results indicate that habitual PA is a suitable health promotion strategy even for people residing in relatively polluted regions. KEYWORDS: Particulate matter, Long-term exposure, cancer mortality

Associations of sleep duration and quality with incident cardiovascular disease, cancer, and mortality: a prospective cohort study of 407,500 UK biobank participants

ObjectiveFew studies have investigated the associations of sleep duration and sleep quality with incident cardiovascular diseases (CVDs), cancer, and mortality in the same large population. This study aimed at estimating the independent risk factors of long or short sleep durations and several typical characteristics of poor sleep quality for incident CVDs, cancer, and mortality. MethodsIn this prospective cohort study, 407 500 individuals were enrolled. Cox proportional hazards models were used to calculate the adjusted hazard ratios and 95% confidence intervals (HR, 95%CI) of associations of sleep duration and quality with incident CVDs, cancer, and mortality. ResultsCompared with the sleep duration of 7 h, sleep duration of ≤5 h and ≥9 h were both associated with higher risk of all-cause mortality (HR = 1.25, 95% CI: 1.16–1.34 and HR = 1.30, 95% CI: 1.22–1.38, respectively), CVD mortality (HR = 1.27, 95% CI: 1.09–1.49 and HR = 1.32, 95% CI: 1.16–1.50, respectively), and CVD incidence (HR = 1.23, 95% CI: 1.16–1.31 and HR = 1.08, 95% CI: 1.02–1.15, respectively). Additionally, long sleep duration (≥9 h) was associated with a higher risk of cancer mortality (HR = 1.19, 95% CI: 1.10–1.30) and cancer incidence (HR = 1.08, 95% CI: 1.04–1.12). Moreover, CVD incidence was significantly associated with snoring, insomnia and narcolepsy, increasing the risk by 7%, 26%, and 20%, respectively. ConclusionLong sleep durations may substantially increase the risk of mortality and morbidity. Snoring, insomnia, and narcolepsy were independent risk factors for incident CVD.