Reduced Risk Of Mortality Research Articles

Time-varying exposure to food retailers and cardiovascular disease hospitalization and mortality in the netherlands: a nationwide prospective cohort study.

Very few studies to date investigated the prospective association of changes in exposure to the food environment with cardiovascular disease (CVD) risk. We aim to explore if time-varying exposure to the food environment was associated with hospitalization and mortality due to total and specific types of CVD in The Netherlands. In this prospective cohort study, 4,641,435 Dutch adults aged 35 + years who did not change residence in 2002-2018 were identified through registry data. Exposure to the food environment was defined as time-varying Food Environment Healthiness Index (FEHI) scores (range: - 5 to 5) and time-varying kernel density of specific food retailers (e.g., fast food outlets, supermarkets) around the home location between 2004 and 2018. The main outcome measures were hospitalization and mortality due to overall CVD, stroke, HF, and CHD occurring between 2004 and 2020, based on hospital and death registries. In Cox regression models, each unit increase in the FEHI was associated with a lower hospitalization and mortality of CVD (hospitalization hazard ratio (HRh) = 0.90 (0.89 to 0.91), mortality hazard ratio (HRm) = 0.85 (0.82 to 0.89)), CHD (HRh = 0.88 (0.85 to 0.91), HRm = 0.80 (0.75 to 0.86)), stroke (HRh = 0.89 (0.84 to 0.93)), HRm = 0.89 (0.82 to 0.98)), and HF (HRh = 0.90 (0.84-0.96), HRm = 0.84 (0.76 to 0.92)). Increased density of local food shops, fast food outlets, supermarkets, and convenience stores and decreased density of food delivery outlets and restaurants were associated with a higher risk of CVD, CHD, stroke, and HF hospitalization and mortality. In this observational longitudinal study, changes in exposure to a healthier food environment over 14years were associated with a risk reduction in CVD hospitalization and mortality, in particular in urbanized areas and for younger adults and those with higher incomes.

Effective management of endangered Blanding’s Turtle (Emydoidea blandingii) populations in Nova Scotia, Canada, requires consideration of threats posed by legacy gold mine contamination

The Nova Scotia, Canada, Blanding’s turtle (Emydoidea blandingii) population is designated as endangered both federally and provincially. Currently, its range is confined to five disjunct sub-populations in the province’s southwestern interior. With fewer than 500 breeding adults in the wild, current recovery efforts are focused on reducing mortality risk to adult and juvenile turtles. However, little is being done to address the cumulative impacts of environmental contamination on species fitness and reproductive capacity. This paper focuses on legacy impacts of Nova Scotia’s gold mining industry within present-day Blanding’s turtle critical habitat, with a focus on mercury and arsenic contamination. To date, previous studies have not considered the impacts of legacy gold mining contaminants on Blanding’s turtle recovery and conservation. Three historical gold mining areas were identified as overlapping with Blanding’s turtle ranges (West Caledonia District, Brookfield District, and Pleasant River Barrens District). To address the current knowledge gap, site assessments for Blanding’s turtle presence, food web contamination surveys, turtle claw tissue sampling, and overall site remediation are recommended to complement existing recovery efforts. Keywords: Blanding’s turtle, critical habitat, environmental con-tamination, gold mine tailings

Optimal lifestyle patterns for delaying ageing and reducing all-cause mortality: insights from the UK Biobank

BackgroundWith the rapid aging of the global population, identifying lifestyle patterns that effectively delay aging and reduce mortality risk is of paramount importance. This study utilizes the UK Biobank to analyze the associations of the Dietary Inflammatory Index, physical activity, and sleep on biological aging and all-cause mortality.MethodsA prospective cohort study was conducted using data from over half a million UK Biobank participants. Two datasets were created by subjective and objective measurements of physical activity: the Subjective Physical Activity (SPA) and Objective Physical Activity (OPA) datasets. Lifestyle patterns, including diet habits, exercise levels, and sleep quality, were assessed within these datasets. Biological aging was quantified using validated methods, including Homeostatic Dysregulation, Klemera-Doubal Method Biological Age, Phenotypic Age, and Telomere Length. All-cause mortality data were obtained from the National Health Service. Statistical analyses included weighted linear regression and Cox proportional hazard models, adjusted for a range of covariates.ResultsThe findings indicate that, in most cases, maintaining an anti-inflammatory diet, engaging in at least moderate physical activity, and ensuring healthy sleep conditions are associated with delayed physiological aging (Cohen’s d ranging from 0.274 to 0.633) and significantly reduced risk of all-cause mortality (HR-SPA: 0.690, 95% CI: 0.538, 0.884; HR-OPA: 0.493, 95% CI: 0.293, 0.828). These effects are particularly pronounced in individuals under 60 years of age and in women. However, it was observed that the level of physical activity recommended by the World Health Organization (600 MET-minutes/week) does not achieve the optimal effect in delaying biological aging. The best effect in decelerating biological aging was seen in the high-level physical activity group (≥ 3000 MET-minutes/week). The study also highlights the potential of biological age acceleration and telomere length as biomarkers for predicting the risk of mortality.ConclusionsChoosing healthy lifestyle patterns, especially an anti-inflammatory diet, at least moderate physical activity, and healthy sleep patterns, is crucial for delaying aging and reducing mortality risk. These findings support the development of targeted interventions to improve public health outcomes. Future research should focus on objective assessments of lifestyle to further validate these associations.

Mediating role of accelerated aging in the association between depression and mortality risk: findings from NHANES

ObjectiveTo investigate the association between depression, accelerated biological aging, and mortality risk, and to assess whether accelerated aging mediates the relationship between major depression and mortality risk.MethodsA prospective cohort of 12,761 participants aged 20 years or older from the 2005–2010 cycle of the National Health and Nutrition Examination Survey (NHANES) was analyzed. Depression was assessed using the Patient Health Questionnaire-9 (PHQ-9), with scores of ≥ 10 indicating major depression. Accelerated biological aging was measured using phenotypic age acceleration (PhenoAgeAccel). Multivariable linear regression models and subgroup analyses were used to examine the association between depression and accelerated aging, while weighted multivariable Cox proportional hazards regression models and subgroup analyses assessed the impact of major depression on mortality risk. Mediation analysis was performed to assess whether PhenoAgeAccel mediated the relationship between major depression and mortality outcomes.ResultsAmong the 12,761 adults, the weighted mean age was 46.6 years, with 48.8% being male, and 6.9% experiencing major depression. The results showed a positive association between major depression and PhenoAgeAccel (β: 0.61, 95% CI: 0.06–1.16). Over a median follow-up duration of 11.3 years (interquartile range: 9.9–13.1), major depression was associated with increased all-cause mortality (HR: 1.35, 95% CI: 1.13–1.62) and cardiovascular mortality (HR: 1.73, 95% CI: 1.18–2.54). However, the relationship with cancer mortality was not statistically significant after full adjustment for confounding factors. The mediation analysis further revealed that PhenoAgeAccel accounted for 10.32% and 5.12% of the associations between major depression and all-cause mortality, and cardiovascular mortality, respectively.ConclusionDepression is associated with accelerated aging and contributes to increased all-cause and cardiovascular mortality. Accelerated aging partially mediates the association between major depression and mortality risk. Our findings highlight the urgent need to incorporate mental health care into public health strategies to delay population aging and reduce mortality risk.

Correlation between fruit consumption and 10-year all-cause mortality in patients with dyslipidemia.

Consuming fruit provides health benefits. Reportedly, increased fruit consumption reduces the risks of hypertension and cardiovascular disease. However, existing studies have not clarified the effect of fruit consumption on mortality risk in patients with dyslipidemia. This study aimed to assess the correlation between the consumption of different types of fruits and all-cause mortality in patients with dyslipidemia. A total of 2,184 patients with dyslipidemia were included in this study, and trends in the correlation between the frequency of consumption of different types of fruits and the 10-year all-cause mortality risk in patients with dyslipidemia were analyzed by smoothed curve fitting, Cox regression, and Kaplan-Meier curve analysis. Subgroup analysis and interaction test were applied to analyze the stability of the effect of apple consumption on 10-year all-cause mortality in patients with dyslipidemia. Smoothed curve fitting and Cox regression analyses revealed a significant reduction in the 10-year all-cause mortality risk in patients with dyslipidemia who consumed apples 3-4 times/week (hazard ratio [HR] = 0.61, 95% confidence interval [CI]: 0.43-0.87, p = 0.007) and in those who consumed bananas 3-4 times/week (HR = 0.71, 95% CI: 0.52-0.98, p = 0.039), with a more pronounced effect in patients who consumed both apples and bananas (HR = 0.55, 95% CI: 0.30-0.99, p = 0.045). Other fruits did not exhibit similar effects. Consuming apples or bananas 3-4 times/week significantly improved the 10-year survival rate in patients with dyslipidemia, and the effect was even more profound in patients who consumed both fruits.

Health effects of greenspace morphology: Large, irregular-shaped, well-connected, and close-clustered greenspaces may reduce mortality risks, especially for neighborhoods with higher aging levels

The healthcare burden has intensified with urbanization and aging populations in many global cities. While the health effects of urban greenspaces have been well documented, little is known about the associations between greenspace morphological features and health, especially in a high-density city with significant aging populations. Drawing on land use data with 10-m resolution, we assessed seven greenspace morphological metrics in terms of size (the percentage of greenspace, the largest pixel index, the average greenspace area), fragmentation (the patch density), shape (the average weighted shape index), connectedness (the cohesion index), and proximity (the aggregation index). We further conducted an ecological study to examine their associations with all-cause and three cause-specific (cardiovascular disease, respiratory disease, and cancer) mortality. Results from the negative binomial regression models revealed protective effects of five greenspace morphology metrics, including the percentage of greenspace, the largest pixel index, the average weighted shape index, the cohesion index, and the aggregation index, on mortality. The shape index showed the greatest effects, with every 1 Standard Deviation (SD) increase in the shape index linked to a reduction of 22.1% (95% CI: 22.0%–31.0%) in all-cause mortality, 22.1% (12.2%–30.8%) in mortality from cardiovascular diseases, 25.0% (14.0%–34.6%) in mortality from respiratory diseases, and 22.0% (12.3%–30.6%) in mortality from cancers. Moreover, stratified analyses revealed that the health effects of the cohesion index and the aggregation index were significantly more pronounced in neighborhoods with higher aging levels. Our findings highlight the significance of greenspace morphology features, beyond greenspace quantity, in improving residents’ health, particularly for societies with high aging populations.

Metformin use is associated with reduced mortality risk in diabetic patients with Parkinson’s disease

Metformin use is associated with reduced mortality risk in diabetic patients with Parkinson’s disease

The Impact of Social Determinants of Health on Peripheral T Cell Lymphoma Outcomes: Treatment Center-Type Emerges as a Powerful Prognostic Indicator

BackgroundPrognostic models in peripheral T cell lymphoma (PTCL) have identified biological factors including age, performance status, LDH, and bone marrow involvement as prognostic for survival. The association of nonbiological factors, termed social determinants of health (SDH), on PTCL outcomes remains unexplored. MethodsTo evaluate the impact of actionable SDH on PTCL mortality across race groups, we conducted a retrospective cohort study that included all White, Hispanic, Asian/Pacific Islander (PI) and Black adult patients with PTCL (AITL, ALCL, NKTCL and PTCL, NOS), diagnosed from 2000 to 2020, in California. We utilized Chi2 and Wilcoxon rank-sum tests for descriptive metrics and Kaplan-Meier statistics for mortality estimation. Regression models included patient- (age, sex, race, stage, Charlson Comorbidity Index, histology, treatment type, treatment at an academic center, payer), and neighborhood-level factors (socioeconomic (SES) quintile, proportion without a high school diploma, and rural/urban). Risk factors significant in univariate regression at a P-value < .10 were incorporated into the multivariable model. FindingsOur analysis included 6158 patients: 51.8% White, 25.8% Hispanic, 14.7% Asians/PI, and 7.6% Black. Hispanics exhibited the longest median survival (33 months) followed by Whites, Blacks, and Asian/PI (25, 20, and 14 months, respectively; P = .011). Risk factors independently associated with inferior lymphoma-specific survival (LSS) included Asian/PI compared with NH White race (HR, 1.23; 95% CI, 1.10-1.34; P = .0002), AITL and ALCL compared with PTCL, NOS histology (AITL HR, 1.14; 95% CI, 1.02-1.25; P = .011; ALCL HR, 1.15; 95% CI, 1.04-1.26; P = .004), academic compared to nonacademic facility-type (HR 0.71; 95% CI, 0.64-0.77; P < .01), Medicare compared with uninsured status (HR 1.48, 95% CI, 1.25-1.73; P < .01), and the lowest 3 education quartiles compared to the highest education quartile (Q2 HR 1.13; 95% CI, 1.01-1.25; P = .021; Q3 HR 1.14; 95% CI, 1.02-1.26; P = .018; Q4 HR 1.22; 95% CI, 1.08-1.36; P < .001). In the least resourced patients, histology, treatment, treatment facility-type, payer and education were independently prognostic for LSS. Treatment at an academic institution was associated with a striking improvement in LSS (academic institution: yes = 101 months, no = 17 months; P < .01). InterpretationThese data identify treatment facility-type, payer and education, as an independent actionable SDH for PTCL mortality. Treatment center-type had the strongest prognostic association with LSS in our PTCL cohort, conferring a risk reduction of PTCL mortality by nearly 30%. Interventions targeted at improving access to academic centers may improve outcomes for all PTCL patients.

Dose-response association of an accelerometer-measured physical activity with all-cause mortality and cardiovascular disease incidence: Prospective cohort with 76,074 participants

ObjectiveTo investigate the prospective dose-response association of accelerometer-measured moderate-to-vigorous physical activity (PA;MVPA) with all-cause mortality and cardiovascular disease (CVD) incidence. MethodsThis prospective cohort of 76,074 participants from the UK Biobank study contained one week of individual accelerometer-based PA data collected between June 1, 2013 and December 23, 2015. Using restricted cubic splines to allow for potential non-linearity, we examined dose-response associations of MVPA with all-cause mortality and incident CVD, respectively. ResultsThe median follow-up time was 8.0 years (IQR 7.5–8.5). The dose-response association of MVPA with all-cause mortality and CVD showed a similar L-shaped association, with significant risk reductions already from 10 min of MVPA per week for all-cause mortality (hazard ratio [HR], 0.98 [95 % CI,0.98–0.99]) and 15 min per week for CVD incidence (HR, 0.99 [95 % CI,0.98–0.99]). Doing more MVPA was associated with further risk reduction, but beyond around 500 min per week the benefits levelled off at HR's around 0.6 to 0.7. The highest additional benefit of adding more minutes per week for all-cause mortality and CVD incidence were observed between 100 and 250 weekly minutes of MVPA. From this point forward, the mean risk reduction rates decreased and were close to 0 beyond 500 weekly minutes. ConclusionsSignificant, but small, risk reductions in all-cause mortality and CVD incidence can be achieved with as little as 10 and 15 min of MVPA per week, respectively. However, public health organizations should promote the attainment of 250 min of MVPA per week (with 100 min as a possible first target for inactive individuals), as these thresholds are associated with the greatest efficiency. Beyond that, less pronounced risk reductions can be achieved by accumulating additional MVPA, with hardly any additional benefits beyond 500 weekly minutes.

Alcohol-related diseases: from metabolism to the main effect on the body.

Alcohol consumption can cause, beyond addiction, roughly 200 different diseases and at least fourteen types of cancer. In 2016 the WHO estimated that 29% of alcohol-related deaths were mainly due to oncological diseases, liver cirrhosis (20%), and cardiovascular disorders (19%). The aim of this review was to focus on the absorption and metabolism of ethanol and discuss the main conditions caused by alcohol consumption (i.e., liver and cardiovascular diseases, and tumors). This narrative review is based on a detailed analysis of the scientific literature published before January 31, 2024 (PubMed, Web of Science, Scopus, Google Scholar). Approximately 90% of the absorbed alcohol reaches the liver where it is metabolized to acetaldehyde, a highly reactive and toxic compound. The excessive use of alcohol causes damage to several organs and systems, mainly the liver (e.g., steatosis, steato-hepatitis, fibrosis, and cirrhosis), cardiovascular system (cardiomyopathy, arrythmias, arterial hypertension, and stroke), and significantly contribute to the onset of neoplastic lesions to various organs including the esophagus, liver and breast. Even moderate drinking appears not to reduce mortality risk. Alcohol intake is one of the main risk factors for several pathological conditions and social problems, thus drastically impacting on public health. Proper awareness of the high risk related to alcohol consumption is of crucial importance to reduce the harm to public health.

Fiberoptic bronchoscopy for the prevention of ventilator-associated pneumonia: a meta-analysis of randomized controlled trials.

Ventilator-associated pneumonia (VAP) causes increased time of mechanical ventilation (MV), prolonged intensive care unit (ICU) stay, and a higher mortality risk. The systematic review and meta-analysis aimed to compare the efficacies between fiberoptic bronchoscopy (FOB) and general sputum suction for the prevention of VAP in patients with invasive MV. Relevant randomized controlled trials (RCTs) were obtained via a search of PubMed, Embase, Cochrane Library, Wanfang, and CNKI databases. A random-effects model was used to pool the results if significant heterogeneity was observed. Otherwise, a fixed-effects model was used. Sixteen RCTs were included. Compared to general sputum suction, sputum suction with FOB was associated with a significantly reduced risk of VAP (risk ratio [RR]: 0.56, 95% CI: 0.47 to 0.67, p < 0.001; I2 = 0%). Subgroup analyses showed that the combination of FOB-assisted sputum suction with bronchoalveolar lavage (BAL) further reduced the risk of VAP as compared to FOB-assisted sputum suction alone (p for subgroup difference = 0.04). In addition, FOB-assisted treatment was also associated with a reduced MV time (mean difference [MD]: -2.19 days, 95% CI: -2.69 to -1.68, p < 0.001; I2 = 18%), a shorter ICU stay (MD: 2.9 days, 95% CI: -3.68 to -2.13, p < 0.001; I2 = 34%), and a reduced mortality risk (RR: 0.46, 95% CI: 0.24 to 0.90, p = 0.02; I2 = 0%) in patients with invasive MV. FOB for sputum suction and BAL in patients with invasive MV is effective in reducing the incidence of VAP.

Childhood and adult socioeconomic status influence on late-life healthy longevity: evidence from the Chinese longitudinal healthy longevity survey.

Older people in low- and middle-income countries are more susceptible to the impact of childhood experiences. This study comprehensively examines how childhood socioeconomic status (SES) and adult SES collectively influence late-life healthy longevity from a life course perspective, providing insights for shaping health-related policies. This study analyzed data from the Chinese Longitudinal Healthy Longevity Survey (1998-2018) with 37,264 individuals aged 65 and above. Using R software, we applied continuous-time multi-state models incorporating the Rockwood frailty index with 38 indicators to assess participants' health. Childhood SES or life course SES trajectories were core explanatory variables, while age and gender were controlled. Multinomial regression estimated annual transition probabilities between different states, and the multi-state life table method calculated total and frailty-specific life expectancy (LE). (1) Social mobility among older people in China showed an upward trend from childhood to adulthood. (2) Transition probabilities for robust-frailty, robust-dead, and frailty-dead increased with age, while frailty-robust decreased. Transition probabilities and LE varied across different childhood SES (low, medium, high) or life-course SES trajectory categories (low-low, low-medium, low-high, medium-low, medium-medium, medium-high, high-low, high-medium, high-high), with probabilities of robust-frailty, robust-dead, and frailty-dead decreasing sequentially across different categories, and frailty-robust increasing sequentially across different categories. Total LE, robust LE, and robust LE proportion increased sequentially across different categories, while frailty LE decreased sequentially across different categories. (3) Women had higher total LE and frailty incidence, but lower recovery rate, mortality risk, robust LE, and robust LE proportion compared to men. Favorable childhood SES and lifelong accumulation of SES advantages protect against frailty morbidity, improve recovery rate, reduce mortality risk, and increase total LE, robust LE, and robust LE proportion. High childhood SES has a stronger protective effect than high adult SES, indicating the lasting impact of childhood conditions on healthy longevity. Systematic interventions in education, food supply, and medical accessibility for children from impoverished families are crucial.

Telemedical strategies for improving systolic blood pressure control in secondary prevention of cerebrovascular events-a systematic review and meta-analysis

BackgroundStroke remains the second leading cause of death worldwide, with a 20 % risk of recurrence within 5 years. Preventing secondary stroke events is crucial for patient management. Kraft et al. highlighted the potential of telemedicine in secondary prevention, but noted the need for further research. Our study incorporates recent trials to provide an updated analysis of telemedical strategies in stroke prevention. MethodsWe reviewed and analyzed RCTs and observational studies from PubMed, Cochrane, Google Scholar, and Clinicaltrials.gov (May 19, 2016 - March 20, 2024) comparing telephone-based follow-up to standard care in stroke patients. The meta-analysis focused on SBP changes within 12 months. We conducted a systematic review and meta-analysis of randomized controlled trials (RCTs) and observational studies, sourced from PubMed, Cochrane, Google Scholar, and ClinicalTrials.gov (May 19, 2016 – March 20, 2024). We compared telephone-based follow-up to standard care in stroke patients, and the primary outcome was systolic blood pressure (SBP) changes within 12 months. ResultsOur systematic review included data from 21,904 patients. The meta-analysis focused on studies with comparable systolic blood pressure (SBP) data. It involved 3,501 individuals in the control group and 3,485 in the experimental group. The analysis revealed a significant reduction in SBP with telemedicine strategies for secondary stroke prevention, with a p-value of 0.003. Additionally, a systemic review of the included studies demonstrated that these strategies improved medication adherence, lifestyle habits, and physical performance, positively correlating with better health outcomes and reduced mortality risk. ConclusionWith the inclusion of recent clinical trials, our updated systematic review and meta-analysis concludes that telemedicine supports secondary prevention in cerebrovascular diseases, particularly blood pressure control. While telemedicine may have a role in reducing recurrent stroke risk, we believe further studies with longer follow-up periods are needed to validate the role of telemedical strategies in reducing recurrence rates.

Association of residential air pollution and green space with all-cause and cause-specific mortality in individuals with diabetes: an 11-year prospective cohort study

To assess the long-term impact of residential air pollution and green space exposure on cause-specific mortality in individuals with type 2 diabetes mellitus (T2DM). This study includes 174,063 participants newly diagnosed with T2DM from a prospective cohort in Shanghai, China, enrolled between 2011 and 2013. Residential annual levels of air pollutants, including fine (PM2.5) and coarse (PM2.5-10) particulate matter, nitrogen dioxide (NO2), along with the normalized difference vegetation index (NDVI), were derived from satellite-based exposure models. During a median follow-up of 7.9 years (equivalent to 1,333,343 person-years), this study recorded 22,205 deaths. Higher exposure to PM2.5 was significantly associated with increased risks for all mortality outcomes, whilst PM2.5-10 showed no significant impacts. The strongest associations of PM2.5 were observed for diabetes with peripheral vascular diseases [hazard ratio (HR): 2.70; per 10μg/m3 increase] and gastrointestinal cancer (2.44). Effects of NO2 became significant at concentrations exceeding approximately 45μg/m³, with the highest associations for lung cancer (1.20) and gastrointestinal cancer (1.19). Conversely, each interquartile range increase in NDVI (0.10) was linked to reduced mortality risks across different causes, with HRs ranging from 0.76 to 1.00. The association between greenness and mortality was partly and significantly mediated by reduced PM2.5 (23.80%) and NO2 (26.60%). There was a significant and negative interaction between NO2 and greenness, but no interaction was found between PM2.5 and greenness. Our findings highlight the vulnerability of individuals with T2DM to the adverse health effects of air pollution and emphasise the potential protective effects of greenness infrastructure. The 6th Three-year Action Program of Shanghai Municipality for Strengthening the Construction of Public Health System (GWVI-11.1-22), the National Key Research and Development Program (2022YFC3702701), and the National Natural Science Foundation of China (82030103, 82373532).

Predictive model of prognosis index for invasive micropapillary carcinoma of the breast based on machine learning: a SEER population-based study

BackgroundInvasive micropapillary carcinoma (IMPC) is a rare subtype of breast cancer. Its epidemiological features, treatment principles, and prognostic factors remain controversial.ObjectiveThis study aimed to develop an improved machine learning-based model to predict the prognosis of patients with invasive micropapillary carcinoma.MethodsA total of 1123 patients diagnosed with IMPC after surgery between 1998 and 2019 were identified from the Surveillance, Epidemiology, and End Results (SEER) database for survival analysis. Univariate and multivariate analyses were performed to explore independent prognostic factors for the overall and disease-specific survival of patients with IMPC. Five machine learning algorithms were developed to predict the 5-year survival of these patients.ResultsCox regression analysis indicated that patients aged > 65 years had a significantly worse prognosis than those younger in age, while unmarried patients had a better prognosis than married patients. Patients diagnosed between 2001 and 2005 had a significant risk reduction of mortality compared with other periods. The XGBoost model outperformed the other models with a precision of 0.818 and an area under the curve of 0.863.ConclusionsA machine learning model for IMPC in patients with breast cancer was developed to estimate the 5-year OS. The XGBoost model had a promising performance and can help clinicians determine the early prognosis of patients with IMPC; therefore, the model can improve clinical outcomes by influencing management strategies and patient health care decisions.

Survival of hospitalised COVID-19 patients in Hawassa, Ethiopia: a cohort study

The COVID-19 pandemic, caused by SARS-CoV-2, led to 622,119,701 reported cases and 6,546,118 deaths. Most studies on COVID-19 patients in hospitals are from high-income countries, lacking data for developing countries such as Ethiopia.This study assesses clinical features, demographics, and risk factors for in-hospital mortality in Hawassa, Ethiopia. The research cohort comprises 804 cases exhibiting clinical diagnoses and/or radiological findings and indicative of symptoms consistent with COVID-19 at Hawassa University Comprehensive Specialized Hospital from September 24, 2020, to November 26, 2021. In-hospital mortality rate was predicted using Cox regression. The median age was 45 years, with males making up 64.1% of the population. 173 (21.5%) fatalities occurred, with 125 (72.3%) among males. Male patients had higher mortality rates than females. Severe and critical cases were 24% and 21%. 49.1% had at least one comorbidity, with 12.6% having multiple. Common comorbidities were diabetes (15.9%) and hypertension (15.2%). The Cox regression in Ethiopian COVID-19 patients found that factors like gender, advanced age group, disease severity, symptoms upon admission, shortness of breath, sore throat, body weakness, hypertension, diabetes, multiple comorbidities, and prior health facility visits increased the risk of COVID-19 death, similar to high-income nations. However, in Ethiopia, COVID-19 patients were young and economically active. Patients with at least one symptom had reduced death risk. As a conclusion, COVID-19 in Ethiopia mainly affected the younger demographic, particularly economically active individuals. Early detection can reduce the risk of mortality. Prompt medical attention is essential, especially for individuals with comorbidities. Further research needed on diabetes and hypertension management to reduce mortality risk. Risk factors identified at admission play a crucial role in guiding clinical decisions for intensive monitoring and treatment. Broader risk indicators help prioritize patients for allocation of hospital resources, especially in regions with limited medical facilities. Government’s focus on timely testing and strict adherence to regulations crucial for reducing economic impact.

Corticosteroids for Managing Pediatric Sepsis and Septic Shock: A Systematic Review and Meta-analysis.

To assess the efficacy and safety of corticosteroids for the management of pediatric sepsis and septic shock. Ovid MEDLINE, Ovid Embase, CENTRAL, Web of Science (Core Collection) and China National Knowledge Infrastructure were systematically searched up to September 2023. Preprint servers, clinical trial registries and the reference sections of previous reviews were hand-searched. Randomized controlled trials that enrolled pediatric sepsis, septic shock or systemic inflammatory response syndrome patients, compared the use of corticosteroid regimens against standard sepsis care and reported eligible outcomes were included. Title/abstract and full-text screening were conducted in-duplicate. Eligible articles were extracted using a standardized form in-duplicate. Outcomes extracted include mortality incidence, hospital and pediatric intensive care unit length of stay, duration of shock, incidence of adverse events and serious adverse events and incidence of corticosteroid-related adverse events. The risk of bias was assessed using the Revised Cochrane Risk of Bias Tool for Assessing Randomized Trials. Random-effects meta-analyses were conducted, and the quality of evidence was assessed using the Grading of Recommendations, Assessment, Development and Evaluations approach. Sixteen randomized controlled trials (N = 973) were included. Corticosteroid use may be associated with reduced mortality risks (risk ratio: 0.65, 95% CI: 0.50-0.85), shorter length of hospital stay (MD: -3.76 days, 95% CI: -6.66 to -0.86), and shorter pediatric intensive care unit length of stay (MD -2.34 days, 95% CI: -3.14 to -1.53 days). Corticosteroid use may be associated with gastrointestinal bleeding but not a higher risk of secondary infection. No studies reported on serious adverse events. All findings were based on low to very low quality of evidence. While corticosteroids show promise for managing pediatric sepsis and septic shock, the question of how to select the best candidate and the most optimal regimen remains unanswered. Future trials need to focus on assessing corticosteroid-related adverse events and stratifying patient inclusion by sepsis subphenotypes.

Comparative effectiveness and cost‐effectiveness of endoscopic nasopharyngectomy versus intensity‐modulated radiotherapy in the treatment of recurrent nasopharyngeal carcinoma: A microsimulation analysis

AbstractBackgroundNasopharyngeal carcinoma (NPC) is a significant health concern in southern China, like Guangdong and Hong Kong. This study aims to predict the effectiveness and cost‐effectiveness of two prevalent NPC treatments, intensity‐modulated radiotherapy (IMRT) and endoscopic nasopharyngectomy (ENPG).MethodsA microsimulation model was developed to project the long‐term outcomes of IMRT and ENPG, simulating 5000 patients with hypothetical locally recurrent NPC for each treatment option. The tumors of patients confined to the nasopharyngeal cavity, the post‐naris or nasal septum, the superficial parapharyngeal space, or the base wall of the sphenoid sinus. Analyses were performed from the healthcare system perspectives of Mainland China and the healthcare provider perspective of Hong Kong, with input parameters sourced from the existing literature and databases. The robustness of findings was evaluated through one‐way and probabilistic sensitivity analyses.ResultsFor DFS, ENPG showed a 29% reduction in risk with an HR of 0.71 (95% CI: 0.64–0.77) compared to IMRT. ENPG demonstrated a significant survival benefit in OS with an HR of 0.59 (95% CI: 0.54–0.65), equating to a 41% reduction in mortality risk. In Hong Kong, IMRT and ENPG yielded QALY gains of 4.59 and 6.29, respectively, with ENPG exhibiting an incremental cost‐effectiveness ratio (ICUR) of USD 13 057 per QALY. For Mainland China, ENPG denominated the IMRT and the ICUR was USD −1450 QALY. Probabilistic sensitivity analysis showed a 100% probability of ENPG being cost‐effective at the willingness‐to‐pay thresholds of USD 130 490 per QALY in Hong Kong and USD 12 741 per QALY in Mainland China.ConclusionThe analysis confirms that ENPG is more effective and cost‐effective than IMRT for treating recurrent NPC in both Hong Kong and Mainland China.

Association of immunoglobulin E levels with glioma risk and survival.

Previous epidemiologic studies have reported an association of serum immunoglobulin E (IgE) levels with reduced glioma risk, but the association between IgE and glioma prognosis has not been characterized. This study aimed to examine how sex, tumor subtype, and IgE class modulate the association of serum IgE levels with glioma risk and survival. We conducted a case-control study using participants from the University of California, San Francisco Adult Glioma Study (1997-2010). Serum IgE levels for total, respiratory and food allergy were measured in adults diagnosed with glioma (n=1319) and cancer-free controls (n=1139) matched based on age, sex, and race and ethnicity. Logistic regression was adjusted for patient demographics to assess the association between IgE levels and glioma risk. Multivariable Cox regression adjusted for patient-specific and tumor-specific factors compared survival between the elevated and normal IgE groups. All statistical tests were 2-sided. Elevated total IgE was associated with reduced risk of IDH-wildtype (RR=0.78, 95% CI: 0.71-0.86) and IDH-mutant glioma (RR=0.73, 95% CI: 0.63-0.85). In multivariable Cox regression, positive respiratory IgE was associated with improved survival for IDH-wildtype glioma (RR=0.79, 95% CI: 0.67-0.93). The reduction in mortality risk was significant in females only (RR=0.75, 95% CI: 0.57-0.98) with an improvement in median survival of 6.9 months (P<.001). Elevated serum IgE was associated with improved prognosis for IDH-wildtype glioma, with a more pronounced protective effect in females than males, which has implications for the future study of IgE-based immunotherapies for glioma.

Abstract B006: Reduced survival outcomes in lower income quintile groups for women with breast cancer treated with chemotherapy in Ontario, Canada

Abstract Background: Despite the comparably comprehensive healthcare system in Canada, health inequities are widespread, and this holds true for breast cancer patients in Ontario. It is thus essential to learn if socio-demographic disparities continue after diagnosis of breast cancer, and if these contribute to higher mortality rates in the lower income quintile groups. Methods: We conducted a real-word population-based study using a provincial health administrative dataset from Ontario, Canada. We included patients diagnosed with HER2-negative breast cancer, treated with surgery and adjuvant chemotherapy, between 2009 to 2017. We used log-rank test and Kaplan Meier curves to compare overall survival (OS) between breast cancer populations among income quintile groups, and Cox regression to evaluate risk factors, using hazard ratio (HR) and 95% confidence intervals (CI). Results: We analysed 10,634 women diagnosed with stage I-III breast cancer. At diagnosis, in the Q1 group, there were 248 (15.8%) women with stage I, 997 (63.7%) with stage II, and 320 (20.45%) with stage III. In the Q5 group, there were 568 (22.15%), with stage I, 1,532 (59.75%) with stage II and 464 (18%) with stage III. Comparison between those in the lowest versus highest income quintile groups, and lymph node (LN) status at diagnosis, showed that in Q1, 534 (34%) women had LN 0 and 897 (57.3%) had LN+. In Q5, there were 954 (37.2%) women with LN 0 and 1,379 (53.8%) with LN+. Similarly, comparing tumor size (TS) at diagnosis, we found that in Q1, there were 463 (32.2%) women with TS≤ 2 cm and 974 (67.8%) with TS &amp;gt; 2 cm. In Q5, 915 (39%) women had TS≤ 2 cm and 1,426 (61%) had TS &amp;gt; 2 cm. In the Q1 group, there were 325 (20.7%) patients who received non- anthracycline and 1,240 (79.3%) treated with anthracycline-taxane chemotherapy. In Q5, there were 673 (26.2%) women treated with non-anthracycline and 1,891 (73.8%) who received anthracycline-taxane chemotherapy. The OS analysis based on the household income group compared to Q5 showed a substantial difference in the Q1 (HR 1.52, 1.2–1.9, p = 0.0002) and Q2 (HR 1.34, 1.1–1.7, p = 0.006) groups. In Cox regression models, Q5 group and endocrine receptor (ER) positive were significantly associated with reduced mortality risk. There was a significant correlation between increased risk of death and the following: receipt of non- anthracycline chemotherapy, TS &amp;gt; 2 cm, LN+ and grade 3 histology. Conclusion: Our study found an uneven distribution of breast cancer patients between the lowest and highest income quintile groups. Women with HER2-negative breast cancer who were part of the lower income quintile groups, thereby likely with a socioeconomic disadvantage, had the lowest OS. At diagnosis, these women were more likely to have more advanced breast cancer staging, including larger tumors, LN+, and receive anthracycline-based chemotherapy as compared to those with higher household income. Further research is warranted to identify the key social determinants that are systematically associated with disparities in equitable access to care. Citation Format: Danilo Giffoni M. M. Mata, Rossanna C. Pezo, Kelvin K.W. Chan, Ines Menjak, Andrea Eisen, Maureen Trudeau. Reduced survival outcomes in lower income quintile groups for women with breast cancer treated with chemotherapy in Ontario, Canada [abstract]. In: Proceedings of the 17th AACR Conference on the Science of Cancer Health Disparities in Racial/Ethnic Minorities and the Medically Underserved; 2024 Sep 21-24; Los Angeles, CA. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2024;33(9 Suppl):Abstract nr B006.