Risk Of Overall Mortality Research Articles

Early life adversity, reproductive history and breast cancer risk.

Background and objectivesIndividuals who experience early life adversity are at an increased risk for chronic disease later in life. Less is known about how early life factors are associated with cancer susceptibility. Here, we use a life history framework to test whether early life adversity increases the risk of breast cancer. We predict that early life adversity can shift investment in somatic maintenance and accelerate the timing of reproduction, which may mediate or interact with the risk of breast cancer.MethodologyWe use population-wide data from the Utah Population Database (UPDB) and Utah Cancer Registry, leading to 24 957 cases of women diagnosed with breast cancer spanning 20 years (1990–2010) and 124 785 age-matched controls. We generated a cumulative early life adversity summation score to evaluate the interaction (moderation) and mediation between early life adversity, reproductive history and their association with breast cancer risk.ResultsOur analyses led to three key findings: (i) more early life adversity, when considered as a main effect, accelerates the time to first birth and death, (ii) early age at first birth and high parity decreases the risk of breast cancer and (iii) we find no association between early adversity and breast cancer risk either as a main effect or in its interaction with reproductive history.Conclusion and implicationsEarly adversity elevates the risk of overall mortality through mechanisms other than breast cancer risk. This suggests early life factors can generate different effects on health. Future work should incorporate more complex view of life history patterns, including multiple life stages, when making predictions about cancer susceptibility.

Electrocardiographic markers of ventricular repolarization in the obese population: A descriptive review

Abstract Obesity is a global epidemiological problem that significantly contributes to the development of cardiovascular diseases. It is a proven factor for an increased risk of overall mortality and the occurrence of sudden cardiac death (SCD). The disease is accompanied by a structural and functional myocardium remodeling, which often results in ventricular repolarization abnormalities and contributes to the triggering of life-threatening arrhythmias. This heightened state of readiness for proarrhythmia is the cause of the sudden cardiac deaths which are recorded in this group of patients and which often constitute the first manifestation of ongoing cardiac pathology. One of the reasons for these arrhythmias may be abnormalities of ventricular muscle repolarization. In this descriptive review, we demonstrate electrocardiographic markers of ventricular repolarization (J point, QT/QTc/QTc-d, JT/JTc/JTc-d, ST segment, T wave and Tp-e/Tp-ed/Tp-e/QT), analyze their abnormalities in the obese population, and discuss their changes after weight loss.

The risk of overall mortality and cardiovascular mortality depending on the direction of body weight dynamics: a prospective cohort study

<h3></h3> Масса тела (МТ) в течение взрослого периода жизни нестабильна и может изменяться в связи с рядом заболеваний, влияющих на жировую и нежировую составляющие МТ. Поэтому при прогнозировании вероятности развития заболеваний, ассоциированных с ожирением, и оценке риска смертности важно учитывать не только текущий показатель, но и направленность динамики МТ. <h3>ЦЕЛЬ ИССЛЕДОВАНИЯ</h3> Изучить влияние направленности динамики МТ на формирование риска общей смертности и смертности от сердечно-сосудистых заболеваний (ССЗ) в когортном проспективном исследовании неорганизованной популяции города Томска. <h3>МАТЕРИАЛ И МЕТОДЫ</h3> Представлены результаты 10-летнего наблюдения мужчин и женщин с изученной предшествующей 17-летней динамикой МТ. Обследованы 1089 человек в возрасте 37—76 лет. В зависимости от направленности динамики МТ выделены группы: 1) МТ снизилась более чем на 5%; 2) стабильная МТ (±5% от исходной); 3) МТ увеличилась более чем на 5%. За период наблюдения умерли 166 человек. <h3>РЕЗУЛЬТАТЫ</h3> В проспективном когортном 10-летнем исследовании у лиц с ранее установленным снижением МТ по сравнению с лицами, у которых МТ не изменилась, выявлено увеличение риска общей смертности в 1,76 раза, риска смертности от ССЗ — в 1,73 раза. У лиц с абдоминальным ожирением потеря МТ также ассоциировалась с более высокой общей смертностью и смертностью от ССЗ. Наименьший 10-летний риск смертности наблюдался у лиц, у которых произошло увеличение МТ более чем на 5%, по сравнению с лицами, у которых МТ не изменилась или снизилась. <h3>ЗАКЛЮЧЕНИЕ</h3> При оценке риска общей смертности и смертности от сердечно-сосудистых заболеваний необходимо учитывать не только текущий показатель массы тела, но и направленность динамики массы тела.

Abstract PO-169: Impacts of neighborhood characteristics and surgical treatment disparities on overall mortality in stage I renal cell carcinoma patients

Abstract Background Racial/ethnic minority groups in the United States have high kidney cancer mortality rates. Disparities in treatments may contribute to higher mortality in racial/ethnic minority groups, but the relationship between treatment disparities and kidney cancer mortality is not well understood. In this study, we assessed if there are differences in surgical treatments across racial/ethnic groups and surgical treatments influence disparities in overall mortality. Methods Stage I renal cell carcinoma patients who were diagnosed between 2004 and 2016 from National Cancer Database were included. Logistic regression was performed to assess associations between race/ethnicity and treatment patterns adjusting for neighborhood socioeconomic (SES) and other factors. Cox regression analysis was performed to assess associations between race/ethnicity and overall mortality. Results A total of 238,141 patients were included in the analysis. Compared to non-Hispanic Whites, American Indians/Alaska Natives, and non-Hispanic Blacks (NHBs) were more likely not to receive surgical care even after adjusting for neighborhood SES (OR 1.85, 95% CI: 1.28-2.70 and OR 1.32 95% CI: 1.20-1.45 respectively). Although all racial/ethnic groups had significantly increased odds of undergoing radical nephrectomy rather than partial nephrectomy,. NHBs had the greatest odds of receiving radical rather than partial nephrectomy (OR 1.38, 95% CI: 1.33-1.44).. The associations were slightly attenuated after including healthcare access and neighborhood SESNHBs had an elevated risk of overall mortality, while Asian Americans and Hispanic Americans had reduced risk. Including surgical treatment, health access and neighborhood factors slightly attenuated the association for NHBs, but the associations between race/ethnicity and overall mortality remained significant. Analysis was performed stratifying samples based on surgical treatment to further assess effects of surgical treatment disparities on associations between race/ethnicity and overall mortality. NHBs who had surgical treatment had increased risk of mortality (HR 1.11, 95% CI:1.06-1.17).. Among patients who underwent nephrectomy, NHBs who underwent radical nephrectomy had increased risk of mortality (HR 1.15, 95% CI: 1.08-1.23), but not NHBs who underwent partial nephrectomy (HR 0.92, 95% CI:0.84-1.02). Conclusion Racial/ethnic minority patients were more likely not to receive surgical treatment. When they do, they are likely to have less optimal surgical treatment (radical rather than partial nephrectomy). Surgical treatment disparities account for high kidney cancer mortality in NHBs. Citation Format: Alejandro Cruz, Faith Dickerson, Kathryn R. Pulling, Kyle Garcia, Francine C. Gachupin, Chiu-Hsieh Hsu, Juan Chipollini, Benjamin R. Lee, Ken Batai. Impacts of neighborhood characteristics and surgical treatment disparities on overall mortality in stage I renal cell carcinoma patients [abstract]. In: Proceedings of the AACR Virtual Conference: 14th AACR Conference on the Science of Cancer Health Disparities in Racial/Ethnic Minorities and the Medically Underserved; 2021 Oct 6-8. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2022;31(1 Suppl):Abstract nr PO-169.

Mediterranean Diet a Potential Strategy against SARS-CoV-2 Infection: A Narrative Review.

Mediterranean Diet represents the traditional eating habits of populations living around the Mediterranean Sea, and it is associated with a lower risk of overall mortality and cancer incidence and cardiovascular diseases. Severe acute respiratory syndrome coronavirus 2 is a new pandemic, and represents a significant and critical threat to global human health. In this study, we aimed to review the possible effects of Mediterranean Diet against the risk of the coronavirus disease 2019. Several vitamins, minerals, fatty acids, and phytochemicals with their potential anti-COVID-19 activity are presented. Different risk factors may increase or reduce the probability of contracting the disease. Mediterranean Diet has also a positive action on inflammation and immune system and could have a protective effect against severe acute respiratory syndrome coronavirus 2. Further studies are needed to corroborate the benefits of the Mediterranean Diet protective role on infection with SARS-CoV-2.

Neighborhood and Individual Socioeconomic Disadvantage and Survival Among Patients With Nonmetastatic Common Cancers

Disadvantaged neighborhood-level and individual-level socioeconomic status (SES) have each been associated with suboptimal cancer care and inferior outcomes. However, independent or synergistic associations between neighborhood and individual socioeconomic disadvantage have not been fully examined, and prior studies using simplistic neighborhood SES measures may not comprehensively assess multiple aspects of neighborhood SES. To investigate the associations of neighborhood SES (using a validated comprehensive composite measure) and individual SES with survival among patients with nonmetastatic common cancers. This prospective, population-based cohort study was derived from the Surveillance, Epidemiology, and End Results-Medicare database from January 1, 2008, through December 31, 2011, with follow-up ending on December 31, 2017. Participants included older patients (≥65 years) with breast, prostate, lung, or colorectal cancer. Neighborhood SES was measured using the area deprivation index (ADI; quintiles), a validated comprehensive composite measure of neighborhood SES. Individual SES was assessed by Medicare-Medicaid dual eligibility (yes vs no), a reliable indicator for patient-level low income. The primary outcome was overall mortality, and the secondary outcome was cancer-specific mortality. Hazard ratios (HRs) for the associations of ADI and dual eligibility with overall and cancer-specific mortality were estimated via Cox proportional hazards regression. Statistical analyses were conducted from January 23 to April 15, 2021. A total of 96 978 patients were analyzed, including 25 968 with breast, 35 150 with prostate, 16 684 with lung, and 19 176 with colorectal cancer. Median age at diagnosis was 76 years (IQR, 71-81 years) for breast cancer, 73 years (IQR, 70-77 years) for prostate cancer, 76 years (IQR, 71-81 years) for lung cancer, and 78 years (IQR, 72-84 years) for colorectal cancer. Among lung and colorectal cancer patients, 8412 (50.4%) and 10 486 (54.7%), respectively, were female. The proportion of non-Hispanic White individuals among breast cancer patients was 83.7% (n = 21 725); prostate cancer, 76.8% (n = 27 001); lung cancer, 83.5% (n = 13 926); and colorectal cancer, 81.1% (n = 15 557). Neighborhood-level and individual-level SES were independently associated with overall mortality, and no interactions were detected. Compared with the most affluent neighborhoods (ADI quintile 1), living in the most disadvantaged neighborhoods (ADI quintile 5) was associated with higher risk of overall mortality (breast: HR, 1.34; 95% CI, 1.26-1.43; prostate: HR, 1.51; 95% CI, 1.42-1.62; lung: HR, 1.21; 95% CI, 1.14-1.28; and colorectal: HR, 1.24; 95% CI, 1.17-1.32). Individual socioeconomic disadvantage (dual eligibility) was associated with higher risk of overall mortality (breast: HR, 1.22; 95% CI, 1.15-1.29; prostate: HR, 1.29; 95% CI, 1.21-1.38; lung: HR, 1.14; 95% CI, 1.09-1.20; and colorectal: HR, 1.23; 95% CI, 1.17-1.29). A similar pattern was observed for cancer-specific mortality. In this cohort study, neighborhood-level deprivation was associated with worse survival among patients with nonmetastatic breast, prostate, lung, and colorectal cancer, even after accounting for individual SES. These findings suggest that, in order to improve cancer outcomes and reduce health disparities, policies for ongoing investments in low-resource neighborhoods and low-income households are needed.

Obesity Duration, Severity, and Distribution Trajectories and Cardiovascular Disease Risk in the Atherosclerosis Risk in Communities Study.

BackgroundResearch examining the role of obesity in cardiovascular disease (CVD) often fails to adequately consider heterogeneity in obesity severity, distribution, and duration.Methods and ResultsWe here use multivariate latent class mixed models in the biracial Atherosclerosis Risk in Communities study (N=14 514; mean age=54 years; 55% female) to associate obesity subclasses (derived from body mass index, waist circumference, self‐reported weight at age 25, tricep skinfold, and calf circumference across up to four triennial visits) with total mortality, incident CVD, and CVD risk factors. We identified four obesity subclasses, summarized by their body mass index and waist circumference slope as decline (4.1%), stable/slow decline (67.8%), moderate increase (24.6%), and rapid increase (3.6%) subclasses. Compared with participants in the stable/slow decline subclass, the decline subclass was associated with elevated mortality (hazard ratio [HR] 1.45, 95% CI 1.31, 1.60, P<0.0001) and with heart failure (HR 1.41, 95% CI 1.22, 1.63, P<0.0001), stroke (HR 1.53, 95% CI 1.22, 1.92, P=0.0002), and coronary heart disease (HR 1.36, 95% CI 1.14, 1.63, P=0.0008), adjusting for baseline body mass index and CVD risk factor profile. The moderate increase latent class was not associated with any significant differences in CVD risk as compared to the stable/slow decline latent class and was associated with a lower overall risk of mortality (HR 0.85, 95% CI 0.80, 0.90, P<0.0001), despite higher body mass index at baseline. The rapid increase latent class was associated with a higher risk of heart failure versus the stable/slow decline latent class (HR 1.34, 95% CI 1.10, 1.62, P=0.004).ConclusionsConsideration of heterogeneity and longitudinal changes in obesity measures is needed in clinical care for a more precision‐oriented view of CVD risk.

Impact of donor types on reduced-intensity conditioning allogeneic stem cell transplant for mature lymphoid malignancies.

We retrospectively compared the outcomes of reduced-intensity conditioning (RIC) transplantation from matched related donors (MRD; n = 266), matched unrelated donors (MUD; n = 277), and umbilical cord blood (UCB; n = 513) for mature lymphoid malignancies. The 3-year overall survival rates for the MRD, MUD, and UCB groups were 54%, 59%, and 40%, respectively (P < 0.001). Multivariate analysis showed no differences in survival between the MRD group and the MUD or UCB group. However, survival was significantly affected by the conditioning regimen and graft-versus-host disease (GVHD) prophylaxis in the UCB group, but not in the MRD and MUD groups. Notably, multivariate analysis showed that the risk of overall mortality in the UCB recipients who received the optimal conditioning regimen and GVHD prophylaxis (n = 116) was lower than that in the MRD group (relative risk [RR], 0.69; P = 0.03) and tended to be lower than that in the MUD group (RR, 0.75; P = 0.09). Our results suggest that UCB transplantation performed with the optimal conditioning regimen and GVHD prophylaxis is highly effective. Moreover, UCB is readily available. Thus, UCB transplantation with the optimal conditioning regimen and GVHD prophylaxis is preferable to MUD transplantation when MRD are not available in the setting of RIC transplantation for mature lymphoid malignancies.

Clinical Outcomes of Hepatitis B Virus-Related Hepatocellular Carcinoma Patients with Undetectable Serum HBV DNA Levels.

Some hepatitis B virus (HBV)-related hepatocellular carcinoma (HCC) patients show undetectable serum HBV DNA levels at HCC diagnosis. The risk of HBV reactivation and its impact on clinical outcomes are not well-unknown. This retrospective cohort study included a total of 985 HBV-related HCC patients with undetectable serum HBV DNA levels (< 12IU/mL) at HCC diagnosis (112 were antiviral treatment (AVT)-naïve; 873 were receiving AVT). Incidence and risk factors for HBV reactivation (re-detection of HBV DNA in serum) during follow-up, as well as its association to overall survival, were assessed. During a median of 33.4months of follow-up (range: 0.2-124.2months), HBV reactivation was observed in 279 patients. HBV reactivation rate was significantly lower for patients receiving AVT than AVT-naïve patients (three-year cumulative incidence rate: 27.3% versus 56.0%; P < 0.001). In multivariable-adjusted analysis, the risk of HBV reactivation was lower for those receiving AVT compared to AVT-naïve patients (adjusted hazard ratio: 0.39, 95% confidence interval: 0.29-0.54). Overall survival was significantly lower for those experiencing HBV reactivation than those who did not (71.5% and 85.7% at five-year) and was associated with higher risk of overall mortality (adjusted hazard ratio: 5.15, 95% confidence interval: 3.60-7.38). More than half of AVT-naïve patients experienced HBV reactivation within three years, which was associated with increased risk of overall mortality. The risk of HBV reactivation was lower for those receiving AVT, suggesting that prompt AVT needs to be considered for AVT naïve HBV-related HCC patients with undetectable HBV DNA levels.

Abstract 13773: Hyperuricemia is Associated With Increased Mortality in Heart Failure Patients With Preserved Ejection Fraction: A Systematic Review and Meta-Analysis

Introduction: Recent data has emerged suggesting prognostic value of serum uric acid in heart failure with preserved ejection fraction (HFpEF), however, there are conflicting data. This is the first meta-analysis to assess the associations of serum uric acid and clinical outcomes in patients with HFpEF. Methods: Comprehensive literature search was conducted from MEDLINE and EMBASE through November 2020. We included cohort studies and post-hoc analyses of randomized controlled trials that investigated the associations between serum uric acid and clinical outcomes in patients with HFpEF. Data was combined using the random-effects, generic inverse variance method of DerSimonian and Laird to calculate hazard ratios and 95% confidence intervals (CI). Only studies using multivariable analyses were included. Results: Six studies were included in this meta-analysis, including 12,976 patients with HFpEF. The studies dated from 2015 to 2020. We found that in patients with HFpEF, hyperuricemia was associated with an increased risk of overall mortality (pooled adjusted HR 1.236, 95% CI 1.002-1.525, p=0.048, I 2 =84.6%) and cardiac mortality (pooled adjusted HR 1.589, 95% CI 1.273-1.984, p&lt;0.05, I 2 = 0%) after multivariable adjustments. The results were significant on sensitivity analysis. Conclusions: Our meta-analysis suggested that hyperuricemia was associated with increased mortality in patients with HFpEF. Further studies are warranted to elucidate mechanism underlying this association and possible therapeutic interventions for HFpEF patients with hyperuricemia.

Abstract 13764: Prognostic Value of a Novel Echocardiographic Risk Score for Long-Term Clinical Outcomes in Patients With Ischemic Heart Failure

Introduction: Two-dimensional-echocardiography (2DE) derived global longitudinal strain (GLS) could predict outcome in patients with heart failure. Mitral annular plane systolic excursion (MAPSE) derived from M-mode echocardiography is a classical indicator of clinical outcome in heart failure patients. Hypothesis: This study aimed to compare the prognostic performance of GLS and MAPSE as well as a new echocardiographic risk score for the prediction of mortality and cardiovascular (CV) rehospitalization risk in ischemic heart failure (IHF) patients with reduced left ventricular ejection fraction (LVEF). Methods: This retrospective observational study comprised 1277 IHF patients with reduced LVEF (&lt;50%) receiving echocardiography including GLS. All patients completed at least one-year clinical follow-up by telephone interview or clinical visit. The primary endpoints included all-cause death, heart transplantation, CV death, or rehospitalization. Measures were used to develop a novel risk score for clinical outcome. Results: After adjusted for age, sex, and other clinical risk factors, lower LVEF (≤30% vs. &gt;30%, HR=1.39 and 1.53, P=0.005 and 0.002), lower MAPSE (≤7 vs. &gt;7mm, HR=1.35 and 1.35, P=0.007 and P=0.021), or lower GLS (≤8.4% vs. &gt;8.4%, HR=1.31 and 1.51, P=0.012 and 0.001) remained as independent predictors for overall and CV mortality, but not for CV rehospitalization. Prediction efficacy of a new echocardiographic risk score including multiple echocardiographic parameters, including systolic dysfunction (LVEF, MAPSE, or GLS), diastolic dysfunction, LV remodeling, and right-side cardiac dysfunction (right ventricular diameter and systolic pulmonary artery pressure) was tested stratifying low, intermediate, and high risk. Patients with high-risk score faced both significantly higher risk of overall mortality (HR=1.99 or 1.42) CV mortality (HR=2.15 or 1.60), and CV rehospitalization risk (HR=2.01 or 1.43) as compared patients with low or intermediate risk score (all P&lt;0.05). Conclusions: The new echocardiographic risk score derived from multiple echocardiographic indicators is associated with satisfactory prognostic performance on both mortality and CV rehospitalization.

The Survival Benefit for Optimal Glycemic Control in Advanced Non-Small Cell Lung Cancer Patients With Preexisting Diabetes Mellitus.

BackgroundDiabetes mellitus (DM) is a frequent comorbidity in patients with cancer. This study aimed to evaluate the prognosis of advanced non-small cell lung cancer (NSCLC) patients with DM and to assess whether an optimal glycemic control improves overall survival (OS).MethodsA total of 1279 advanced NSCLC patients including 300 (23.5%) with preexisting DM were retrospectively reviewed. The continuous relationship between glycated hemoglobin A1C (HbA1c) level and OS was analyzed by restricted cubic spline (RCS) function. Optimal HbA1c cut-off point was determined using X-tile analysis. Survival was analyzed with the Kaplan–Meier method and compared among groups stratified by diabetes status and HbA1c. Multivariable Cox proportional hazards regression analysis was employed to identify prognostic factors for OS after adjusting for baseline characteristics.ResultsDM and non-DM patients had similar OS (median (95% CI): 22.85 (20.05-26.73) vs. 22.22 (20.35-24.76) months, P=0.950). The multivariate Cox regression analyses showed that DM status was not a prognostic factor for OS (HR: 0.952, 95% CI: 0.808-1.122, P=0.559). However, there existed a non-linear but generally positive relationship between the elevated HbA1c level and increased risk of overall mortality. HbA1c > 6.6% was a negative prognostic factor for OS (HR: 1.593, 95% CI: 1.113-2.280, P=0.011). The median OS (95% CI) for nondiabetic patients, DM patients with HbA1c ≤6.6% and those with HbA1c > 6.6% was 22.22 (20.01-24.43), 25.28 (21.79-28.77) and 15.45 (7.57-23.33) months, respectively. Well-controlled DM patients had a comparable crude OS (HR (95% CI): 0.90 (0.76-1.08), P=0.273] compared to nondiabetic patients while patients with HbA1c>6.6% had a worse crude OS than patients without DM (HR (95% CI): 1.70 (1.24-2.34), P=0.001]. The survival benefit of good HbA1c control was prominent in all subgroups.ConclusionImpaired glycemic level negatively affects survival for patients with advanced NSCLC while proper glycemic control with HbA1c ≤6.6% improves the OS.

Mediation analysis of social isolation and mortality by health behaviors

Social isolation associated with greater risk for mortality is well documented, however, it is unclear whether and the extent to which social isolation influences mortality through health behaviors. We therefore assessed the mediation between social isolation and mortality by health behaviors. 15,000 adults ages 18–89 years in the Third National Health and Nutrition Examination Survey in the US (NHANES III) (1988–1994) were followed through 2015. The outcomes of overall and cause-specific mortality were assessed by linking with the National Death Index. Social isolation was based on a modified Social Network Index. Mediation analyses were conducted under the counterfactual framework. Compared with participants who were not socially isolated, those who were isolated had significantly increased risk for overall mortality (HR = 1.33, 95% CI: 1.15–1.54), cardiovascular disease (CVD)-specific mortality (HR = 1.28, 95% CI: 1.01–1.62) and mortality from causes other than CVD or cancer (HR = 1.53, 95% CI: 1.22–1.90). Social isolation was not independently associated with risk for cancer-specific mortality. The association between social isolation and cancer-specific mortality was largely (74%) mediated by health behaviors, including smoking, physical activity and quality of diet. The associations between social isolation and CVD or other specific mortality were partly (about one-fifth) explained by unhealthy behaviors. In conclusion, the extent to which social isolation and mortality was mediated by healthy behaviors varies by causes of death. Given mounting evidence that social isolation is increasing in society, it is important to add social isolation to the list of public health concerns in addition to conventional risk factors.

Estimation of long-term and short-term health effects attributed to PM2.5 standard pollutants in the air of Ardabil (using Air Q + model).

Clean air is considered as a basic need for human health. However, air pollution is a significant threat to health in developed and developing countries. The aim of this study was to estimate the health effects attributed to PM2.5 pollutants in the air of Ardabil in 2018 (using Air Q + model). Raw data related to particles were collected from the Department of Environment and processed in Excel software and converted into an input file of the Air Q + model, and in the final stage, by considering appropriate epidemiological parameters and combining these data with air quality data, it was possible to estimate the health effects of air pollution. The results showed that the average annual concentrations of PM2.5 and PM10 were 15.47 and 30.94 in the study year, respectively. The total number of deaths due to ALRI, COPD, lung cancer, IHD, and stroke deaths on average during the study period were estimated to be 73, 11, 7, 15, and 14 deaths, respectively, which include 14.62, 15.78, 4.9, 12.43, and 11.6% of deaths due to ALRI, COPD, lung cancer, IHD, and stroke deaths, respectively. In conditions of concentration above 5µg/m3, attributed proportion, total number of attributed cases and number of attributed cases per 100,000 population (with moderate relative risk and confidence interval of 95%) for cardiovascular diseases have been estimated to be 0.95% 103 people and 42.19 people. Also, the attributed proportion, the total number of attributable cases, and the number of attributable cases per 100,000 population (with moderate relative risk and confidence of 95%) for the admission of respiratory diseases have been estimated at 97.1%, 68 persons and 3 persons, respectively. Our results suggest that particle exposure even at low concentrations is associated with an increased risk of overall mortality and specific cause mortality and hospital admissions for respiratory and cardiovascular diseases.

Clinical Significance of Clonal Hematopoiesis in the Setting of Autologous Stem Cell Transplantation for Lymphoma

Clinical Significance of Clonal Hematopoiesis in the Setting of Autologous Stem Cell Transplantation for Lymphoma

Mortality-based definition of renal hyperfiltration in middle-aged men: a 35-year cohort from Finland

BackgroundWhile the impact of low glomerular filtration rate (eGFR) on various outcomes has been extensively studied, the other adverse occurrence, renal hyperfiltration (RHF), remains understudied, poorly defined, and, therefore, its impact on mortality unestablished.MethodsUsing a population-based subcohort from the Kuopio Ischaemic Disease Risk Factor Study restricted to non-diabetic Finnish men aged 54 or 55 years, we followed up n = 1179 study participants for up to 35 years. We evaluated the hazard of all-cause mortality associated to RHF at different cutoff points defining eGFR. Based on models’ accuracy we suggested an optimal eGFR cutoff point for the definition of RHF. We divided the RHF category to three subgroups and evaluated them in terms of baseline characteristics and mortality hazard.ResultsThe eGFR value of 97 mL/min/1.73 m2 corresponded to the models with the highest accuracy. Overall RHF associated with an increased risk of mortality (hazard ratio [HR] 1.42; 95% confidence interval [CI] 1.21 to 1.67). Moderate RHF associated with a decreased HR of mortality when compared to mild (0.64; 95% CI 0.46 to 0.9) or to extreme RHF (0.61; 95% CI 0.43 to 0.85), suggesting a rather U-shaped relationship between RHF’s eGFR values and mortality hazard.ConclusionThe burden of increased eGFR within what is still considered normal eGFR category was highly underestimated. RHF’s eGFR values had a U-shaped association with the risk of overall mortality. A more uniform consensual definition of RHF is needed, as higher to normal eGFR values that are not without consequences.

The Impact of Palliative Transurethral Resection of the Prostate on the Prognosis of Patients With Bladder Outlet Obstruction and Metastatic Prostate Cancer: A Population-Matched Study.

Objective: This study aimed to evaluate the survival outcomes of patients with bladder outlet obstruction (BOO) and metastatic prostate cancer (mPCa) after having a palliative transurethral resection of the prostate (pTURP) surgery.Methods: We identified patients with mPCa between 2004 and 2016 in the Surveillance, Epidemiology, and End Results (SEER) database. Patients who received pTURP and non-surgical therapy were identified. A propensity-score matching was introduced to balance the covariate. Kaplan–Meier analysis and COX regression were conducted to evaluate the overall survival (OS) and cancer-specific survival (CSS) outcomes.Results: A total of 36,003 patients were identified; 2,823 of them were in the pTURP group and 33,180 were in the non-surgical group. The survival curves of the overall cohort showed that the pTURP group was associated with worse outcomes in both OS (HR: 1.12, 95% CI: 1.07–1.18, p < 0.001) and CSS (HR: 1.08, 95% CI: 1.02–1.15, p = 0.004) compared with the non-surgical group. The mean survival time in the overall cohort of the pTURP group was shorter than the non-surgical group in both OS [35.13 ± 1.53 vs. 40.44 ± 0.59 months] and CSS [48.8 ± 1.27 vs. 55.92 ± 0.43 months]. In the matched cohort, the pTURP group had significantly lower survival curves for both OS (HR: 1.25, 95% CI: 1.16–1.35, p < 0.001) and CSS (HR: 1.23, 95% CI: 1.12–1.35, p < 0.001) than the non-surgical group. pTURP significantly reduced the survival months of the patients (36.49 ± 0.94 vs. 45.52 ± 1.23 months in OS and 50.1 ± 1.49 vs. 61.28 ± 1.74 months in CSS). In the multivariate COX analysis, pTURP increased the risk of overall mortality (HR: 1.19, 95% CI: 1.09–1.31, p < 0.001) and cancer-specific mortality CSS (HR: 1.23, 95% CI: 1.14–1.33, p < 0.001) compared with the non-surgical group.Conclusions: For mPCa patients with BOO, pTURP could reduce OS and CSS while relieving the obstruction.

Mineralocorticoid receptor antagonists use in patients with heart failure and impaired renal function.

AimsImpaired renal function is a major contributor to the low proportion of mineralocorticoid receptor antagonist (MRA) treatment in patients with heart failure with reduced ejection fraction (HFrEF). Our aims were to investigate the impact of MRA treatment on all-cause mortality and worsening renal function (WRF) in patients with HFrEF and moderately impaired renal function.MethodsRetrospective data between 2010–2018 on HFrEF patients from a single-centre hospital with estimated glomerular renal function (eGFR) < 60 ml/min/1.73 m2 were analysed. WRF was defined as a decline of by eGFR ≥ 20%.Results416 patients were included, 131 patients on MRA and 285 without MRA, mean age was 77 years (SD ± 9) and 82 years (SD ± 9), respectively. Median follow-up was 2 years. 128 patients (32%) experienced WRF, 25% in the MRA group and 30% in patients without MRA (p = 0.293). In multivariable analysis, hospitalization for heart failure and systolic blood pressure were associated with WRF (p = 0.015 and p = <0.001), but not use of MRA (p = 0.421). MRA treatment had no impact on the risk of adjusted all-cause mortality (HR 0.93; 95% CI, 0.66–1.32 p = 0.685). WRF was associated with increased adjusted risk of all-cause mortality (HR 1.43; 95% CI, 1.07–1.89 p = 0.014). Use of MRA did not increase the adjusted overall risk of mortality even when experiencing WRF (HR 1.15; 95% CI, 0.81–1.63 p = 0.422).ConclusionIn this cohort of elderly HFrEF patients with moderately impaired renal function, MRA did not increase risk for WRF or all-cause mortality.

Racial Differences in the Prognosis and Survival of Cutaneous Melanoma From 1990 to 2020 in North America: A Systematic Review and Meta-Analysis.

BackgroundFactors influencing the difference in the diagnosis and treatment of melanoma in racial minority groups are well-described in the literature and include atypical presentations and socioeconomic factors that impede access to care.ObjectiveTo characterize the differences in melanoma survival outcomes between non-Hispanic white patients and ethnic minority patients in North America.MethodsWe conducted searches of Embase via Ovid and MEDLINE via Ovid of studies published from 1989 to August 5, 2020. We included observational studies in North America which reported crude or effect estimate data on patient survival with cutaneous melanoma stratified by race.ResultsForty-four studies met our inclusion criteria and were included in this systematic review. Pooled analysis revealed that black patients were at a significantly increased risk for overall mortality (HR 1.42, 95% CI, 1.25-1.60), as well as for melanoma-specific mortality (HR 1.27, 95% CI, 1.03-1.56). Pooled analyses using a representative study for each database yielded similar trends. Other ethnic minorities were also more likely report lower melanoma-specific survival compared to non-Hispanic white patients.ConclusionOur results support findings that melanoma patients of ethnic minorities, particularly black patients, experience worse health outcomes with regards to mortality. Overall survival and melanoma-specific survival are significantly decreased in black patients compared to non-Hispanic white patients. With the advent of more effective, contemporary treatments such as immunotherapy, our review identifies a gap in the literature investigating present-day or prospective data on melanoma outcomes, in order to characterize how current racial differences compare to findings from previous decades.

Mortality in patients with isolated congenital complete atrioventricular block in Sweden: a register-based, nationwide cohort study

Abstract Purpose The congenital heart block is a rare but potentially serious heart conduction disease and associated with high mortality during the fetal or neonatal periods. Earlier reports are based on relatively small number of patients and there are limited data about long-term outcomes. Methods Data were collected from the Swedish Patient and Cause of Death register to identify all patients who were born and diagnosed with isolated congenital complete atrioventricular block (CCAVB) between 1970 and 2017. Each patient with isolated CCAVB was matched with 10 control individuals, by birth year and sex from the Total Population Register. Results Totally 506 patients with CCAVB and 5,050 controls included in the study (55.3% males). The incidence rate of mortality in patients with isolated CCAVB was 166 per 10.000 person-years. The overall risk of mortality in patients with isolated CCAVB was 45.4 times (95% confidence interval (CI) 32.7–62.9) higher compared to matched controls. In a subgroup investigation, the highest risk of mortality was found in patients with isolated CCAVB from birth until the age of 17 (hazard ratio 80.8, 95% CI 51.6–126.4), compared to matched controls without CCAVB. Conclusion In this nationwide cohort study, patients with isolated CCAVB was associated with more than 40-fold risk for overall mortality compared to age and sex matched controls. The greatest risk was found during childhood. Regularly follow-up in tertiary centers and the aware of high risk of complications may be the key to prevention. Funding Acknowledgement Type of funding sources: Public grant(s) – National budget only. Main funding source(s): The Swedish Government, the Swedish Research Council