Social Security Administration Death Master Research Articles

Validation of a Composite Real-World Mortality Variable Among Patients with Hematologic Malignancies Treated in the United States

Introduction: Real-world data (RWD) is being increasingly used to support clinical and regulatory decisions where utilization of clinical trial data is difficult or impractical. With this expanded utilization comes a need to ensure RWD is of sufficient quality and completeness to adequately answer relevant research questions. Given the importance of overall survival (OS) for oncology research, treatment and care, complete and accurate real-world mortality data capture is of critical importance. Currently the industry standard practice aggregates mortality data across available data sources to maximize data capture. This study sought to validate and benchmark a composite real-world mortality variable against the gold standard data source from the National Death Index (NDI). Methods: This observational study was conducted using the COTA real-world database, a de-identified database derived from the electronic health records (EHRs) of partnered healthcare providers in the United States. Patients diagnosed with select cancers between January 1st, 2015 and December 31st, 2020 were included. Cancer types included in this study were: acute myeloid leukemia (AML), chronic lymphocytic leukemia (CLL), diffuse large B-cell lymphoma (DLBCL), follicular lymphoma (FL), marginal zone B-cell lymphoma (MZL), multiple myeloma (MM), and myelodysplastic syndrome (MDS). COTA's composite mortality variable utilizes structured and unstructured data from the EHRs of COTA partnered healthcare provider sites and commercially available obituary data including the Social Security Administration death master file. To conduct the validation study, COTA records were matched to NDI records using an NDI-developed matching algorithm. Patients without an NDI match were considered alive according to the NDI. Validation metrics were calculated in the overall population and by subgroup including cancer type and key demographic characteristics. Metrics assessed included sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV), and date concordance (exact, ± 7 days, ± 15 days, ± 30 days). Corresponding 95% confidence intervals were estimated using the Wilson method for calculating confidence intervals for proportions. Results: The final study population included 21,567 patients across 7 cancer types (AML N=2638, CLL N=2502, DLBCL N=6066, FL N=2835, MM N=4234, MDS N=2295, and MZL N=997). Within the overall study population, validation analysis comparing the real-world composite mortality variable to the NDI demonstrated high sensitivity (87.8), specificity (95.7), PPV (90.9) and NPV (94.1). (Table 1) Some variability in validation metrics by disease was observed with MM having the highest sensitivity (90.4) and FL having the highest specificity (99.0). Sensitivity and specificity across all cancer types were greater than 80%. Patients 18-29 years of age had the lowest sensitivity (75.0), while patients 90 years of age or greater had the highest sensitivity (92.7), but lowest specificity (77.1). Validation metrics were similar across sex, race, and year of diagnosis subgroups. Date concordance between the real-world composite mortality variable and NDI dates of death was high. In the study population (N=21,567), exact date concordance was observed in 88.0% of patients, and concordance rates for 7-, 15- and 30-day intervals were 93.1%, 93.8%, and 94.3%, respectively. (Table 2) Rates of concordance were consistent across disease subtypes, subgroups, and date intervals. Conclusions: This study found that a composite real-world mortality variable yielded strong performance in comparison to the gold-standard NDI database, as measured by the validation metrics of sensitivity, specificity, PPV and NPV. Additionally, high rates of date concordance were observed across the exact, 7-, 15- and 30-day intervals. These findings are critical to ensure the reliability of results generated using RWD, and further establish the use of a composite real-world mortality variable as best practice. Future research will expand this validation methodology to a cohort of patients with solid tumor cancers, as well as investigate the performance of overall survival using a composite real-world mortality variable.

In utero and childhood exposure to alcohol and old age mortality: Evidence from the temperance movement in the US

Previous research suggests the relevance of in-utero insults and early-life circumstances for a wide array of life cycle outcomes. This research note joins this strand of studies by exploring the long-run mortality effects of in-utero and early-life exposure to alcohol accessibility. In so doing, we take advantage of the prohibition movement during the early part of the twentieth century that generated quasi-natural reductions in alcohol consumption. We use Social Security Administration Death Master Files linked to the full-count 1940 census and compare the longevity of male individuals exposed to the prohibition during in-utero and early childhood (1900–1930) as a result of statewide and federal alcohol ban to those wet counties after the law change to before. The results suggest an intent-to-treat effect of 0.17 years higher longevity as a result of prohibition. A back-of-an-envelope calculation suggests a minimum treatment-on-treated effect of 1.7 years impact. Furthermore, we show that these effects are not driven by other county-level demographic and socioeconomic changes, endogenous selection of births, and preexisting trends in the outcome. Our findings contribute to the growing body of research that explores the in-utero and childhood circumstances on long-term health outcomes.

Abstract 14396: Periprocedural Myocardial Injury After Elective Percutaneous Coronary Intervention is Associated With Excess Long-Term Mortality

Introduction: Periprocedural myocardial injury (pMI), characterized by elevations in circulating cardiac biomarkers, is common following percutaneous coronary intervention (PCI) for stable ischemic heart disease. We sought to characterize incidence, risk factors, and long-term outcomes of pMI early after PCI. Methods: Patients who underwent elective PCI at a large academic medical center between 2011 and 2020 were included in this retrospective, observational study. We characterized patient and procedural characteristics from local submissions to the NCDR CathPCI registry. All patients underwent routine measurements of CK-MB at 1 and 3 hours post-PCI. Patients with abnormal CK-MB or troponin pre-PCI were excluded. For patients with multiple PCI, only the first PCI was included in the analysis. pMI was defined as any post-PCI CK-MB >99th percentile upper reference limit of the assay. The primary outcome was all-cause mortality derived from the Social Security Administration Death Master File. Cox proportional hazards models were generated to estimate the hazard of mortality associated with pMI. Results: We identified 10,923 patients undergoing elective PCI with routine post-PCI CK-MB measurement, with 47,959 patient-years of follow-up (mean: 4.4 years, range: 0 - 9.7). pMI occurred in 1843 cases (16.9%). Patients with pMI were older, more likely to be men, and had a higher burden of cardiovascular risk factors compared to those without pMI ( Table ). Over long-term follow-up, 483 patients (4.4%) died. Long-term, all-cause mortality was higher among patients with versus without pMI (8.0% vs. 3.7%, p<0.001). After adjustment for age and sex, pMI was associated with an excess hazard for long-term mortality (hazard ratio 1.48, 95% CI 1.22-1.80). Conclusion: Myocardial injury detected early after PCI is common and is associated with increased long-term all-cause mortality. Efforts to reduce pMI incidence are needed.

Assessment of the Social Security Administration Death Master File for Comparative Analysis Studies of Peripheral Vascular Devices

ObjectivesThe objective of this study was to assess the reliability the Social Security Administration Death Master File (SSADMF) for evaluating mortality in comparative peripheral vascular device studies. MethodsWe leveraged 2 versions of an administrative claims data set that were identical except for the source of mortality data. The SSADMF was the primary source of mortality records in one version. The SSADMF was combined with mortality from Medicare beneficiary records in the other. Our study was set in the context of a comparative effectiveness analysis of recent Food and Drug Administration interest involving peripheral paclitaxel-coated devices. Mortality of patients with Medicare Advantage insurance coverage from 2015 to 2018 who underwent femoropopliteal artery revascularization with a drug-coated device (DCD) or non-DCD was assessed through 2019. Covariate differences between treatment groups were adjusted by inverse propensity treatment weighting. The hazard ratio of DCD to non-DCD mortality was estimated using Cox regression. ResultsThe cumulative incidences of mortality differed substantially between versions of the data. Nevertheless, we could not reject the null hypothesis that the hazard ratios of the SSADMF (1.05; 95% confidence interval 0.95-1.17) and the Master Beneficiary Summary File/SSADMF (1.03; 95% confidence interval 0.96-1.11) were the same (P = .63). ConclusionsThe SSADMF is a common source of mortality records in the United States that can be linked to real-world data sources but is known to underreport mortality rates. We find that the SSADMF provides a reliable source of all-cause mortality for a comparative study assessing the safety of peripheral vascular devices.

Postdiagnosis Multivitamin and Individual Vitamin Supplement Use and Mortality Among Patients With Colorectal Cancer in the NIH-AARP Diet and Health Study

ObjectivesWe aimed to evaluate the association of postdiagnostic multivitamin and individual vitamin supplement use with total and cancer-specific mortality among colorectal cancer (CRC) survivors.MethodsIn the National Institutes of Health (NIH)–AARP Diet and Health Study, we estimated the associations between vitamin use and total mortality and cancer-specific mortality risk among 2,136 CRC survivors. Use of multivitamin and individual vitamins (vitamin A, vitamin C, vitamin E, beta-carotene, and calcium) were assessed by a food-frequency questionnaire at baseline in 1995–1996 and follow-up questionnaire in 2004–2005. Participants reported frequency of use as never, < 1 time per week, 1–3 times per week, 4–6 times per week, or every day and categories were assigned a corresponding value (never = 0, < 1 time per week = 0.5, 1–3 times per week = 2, 4–6 times per week = 5, and every day = 7). Based on the sum of these values, participants were assigned to one of the following groups: never use (0 times/week), casual use (>0 to 6 times/week), consistent use (7 times/week), or heavy use (>7 times/week). Vital status was ascertained annually by linkage to the Social Security Administration Death Master File and the National Death Index Plus through December 31, 2019. Hazard ratios (HRs) and 95% CIs were estimated using Cox proportional hazards models with age as the underlying time metric and adjusting for potential confounders.ResultsPostdiagnosis multivitamin use was not associated with all-cause mortality or CRC-specific mortality, but consistent, as compared with never, postdiagnosis vitamin A use was associated with a 12% lower risk of total mortality (HR: 0.88, 95% CI: 0.78–1.00). Consistent, as compared with never, postdiagnosis vitamin C and calcium use were also associated with lower risk of total mortality (HR: 0.86, 95% CI: 0.75–0.99 and HR: 0.84 95% CI: 0.73–0.97, respectively). Use of vitamin E or beta-carotene supplements were not associated with total mortality or CRC-specific mortality.ConclusionsIn the NIH-AARP cohort, consistent use of vitamin A, vitamin C, and calcium but not multivitamins was associated with lower total mortality and CRC-specific mortality among CRC cancer survivors.Funding SourcesThis work was supported by the NCI Intramural Research Program.

Association between infertility and all-cause mortality: analysis of US claims data

The consequences of an infertility diagnosis extend beyond the pursuit of family building, because women with infertility also face increased risks for severe maternal morbidity, cancer, and chronic disease. This study aimed to examine the association between female infertility and all-cause mortality. This retrospective analysis compared 72,786 women with infertility, identified in the Optum Clinformatics Datamart from 2003 to 2019 by infertility diagnosis, testing, and treatment codes, with 3,845,790 women without infertility seeking routine gynecologic care. The baseline comorbidities were assessed using the presence of ≥1 metabolic syndrome diagnoses and the Charlson Comorbidity Index. The primary outcome, which was all-cause mortality, was identified by linkage to the Social Security Administration Death Master File outcomes and medical claims. The association between infertility and mortality was examined using a Cox proportional hazard regression by adjusting for age, hypertension, hyperlipidemia, type II diabetes, year of evaluation, smoking, number of visits per year, nulliparity, obesity, region of the country, and race. Among 16,473,458 person-years of follow-ups, 13,934 women died. Women with infertility had a 32% higher relative risk for death from any cause (0.42% vs 0.35%, adjusted hazard ratio, 1.32; 95% confidence interval, 1.18-1.48) than women without infertility. The mean follow-up time per patient was 4.0±3.7 years vs 4.2±3.8 years for women with and without infertility, respectively. When stratified by age of <35 or ≥35 years or baseline medical comorbidity, the association between infertility and mortality remained. Women with infertility who delivered a child during the follow-up period faced a similar increased risk for mortality than the overall infertile group. Finally, receiving fertility treatment was not associated with a higher risk for death than receiving an infertility diagnosis or testing alone. Although the absolute risk for death was low in both groups, women with infertility faced a higher relative risk for mortality than women without infertility. The association remained across all age, race and ethnicity groups, morbidities, and delivery strata. Importantly, infertility treatment was not associated with an increased risk for death. These findings reinforce the disease burden associated with infertility and its potential for long-term sequelae.

Increased Mortality Among Men Diagnosed With Impaired Fertility: Analysis of US Claims Data

To determine whether male infertility or impaired spermatogenesis is associated with mortality. The Optum de-identified Clinformatics Data Mart database was queried from 2003 to 2017. Infertile men were compared to subjects undergoing semen analysis (ie, infertility testing). Infertile men with oligozoospermia or azoospermia were included. Mortality was determined by data linkage to the Social Security Administration Death Master File. Results were adjusted for age, smoking, obesity, year of evaluation, and health care visits as well as for most prevalent comorbidities. We separately examined men with prevalent or incident cardiovascular disease and cancer diagnoses to determine associations with mortality. A total of 134,796 infertile men and 242,282 controls were followed for a mean of 3.6 and 3.1 years respectively. Overall, infertile men had a higher risk of death (Hazard Ratio [HR]= 1.42, 95% CI: 1.27-1.60) The diagnosis of azoospermia was associated with a significantly increased risk of death (HR= 2.01, 95% CI: 1.60-2.53) with a higher trend among men with oligospermia (HR: 1.17, 95% CI: 0.92-1.49) compared to controls. Subanalysis was done excluding prevalent cardiovascular and malignant disease (alone and combined) showing similar hazard ratios. Male infertility is associated with a higher risk of mortality especially among azoospermic men. Prevalent disease (which is known to be higher among infertile men) did not explain the higher risk of death among infertile men. The implications for treatment and surveillance of infertile men require further study.

Association of Smoking Cessation and Survival Among Young Adults With Myocardial Infarction in the Partners YOUNG-MI Registry

Despite significant progress in primary prevention, the rate of myocardial infarction (MI) continues to increase in young adults. To identify the prevalence of tobacco use and to examine the association of both smoking and smoking cessation with survival in a cohort of adults who experienced an initial MI at a young age. The Partners YOUNG-MI registry is a retrospective cohort study from 2 large academic centers in Boston, Massachusetts, that includes patients who experienced an initial MI at 50 years or younger. Smoking status at the time of presentation and at 1 year after MI was determined from electronic medical records. Participants were 2072 individuals who experienced an MI at 50 years or younger between January 2000 and April 2016. The dates of analysis were October to December 2019. Deaths were ascertained from the Social Security Administration Death Master File, the Massachusetts Department of Vital Statistics, and the National Death Index. Cause of death was adjudicated independently by 2 cardiologists. Propensity score-adjusted Cox proportional hazards modeling was used to evaluate the association between smoking cessation and both all-cause and cardiovascular mortality. Among the 2072 individuals (median age, 45 years [interquartile range, 42-48 years]; 1669 [80.6%] men), 1088 (52.5%) were smokers at the time of their index hospitalization. Of these, 910 patients were further classified into either the cessation group (343 [37.7%]) or the persistent smoking group (567 [62.3%]) at 1 year after MI. Over a median follow-up of 11.2 years (interquartile range, 7.3-14.2 years), individuals who quit smoking had a statistically significantly lower rate of all-cause mortality (hazard ratio [HR], 0.35; 95% CI, 0.19-0.63; P < .001) and cardiovascular mortality (HR, 0.29; 95% CI, 0.11-0.79; P = .02). These values remained statistically significant after propensity score adjustment (HR, 0.30 [95% CI, 0.16-0.56; P < .001] for all-cause mortality and 0.19 [95% CI, 0.06-0.56; P = .003] for cardiovascular mortality). In this cohort study, approximately half of individuals who experienced an MI at 50 years or younger were active smokers. Among them, smoking cessation within 1 year after MI was associated with more than 50% lower all-cause and cardiovascular mortality.

A change of heart: Preliminary results of the US 2018 adult heart allocation revision.

In 2018, the Organ Procurement and Transplantation Network (OPTN) modified adult heart allocation to better stratify candidates and provide broader access to the most medically urgent candidates. We analyzed OPTN data that included waiting list and transplant characteristics, geographical distribution, and early outcomes 1year before (pre: October 18, 2017-October 17, 2018) and following (post: October 18, 2018-October 17, 2019) implementation. The number of adult heart transplants increased from 2954 pre- to 3032 postimplementation. Seventy-eight percent of transplants in the post era were for the most medically urgent (statuses 1-3) compared to 68% for status 1A in the pre era. The median distance between the donor hospital and transplant center increased from 83 to 216 nautical miles, with an increase in total ischemic time from 3 to 3.4hours (all P<.001). Waiting list mortality was not different across eras (14.8 vs 14.9 deaths per 100 patient-years pre vs post respectively). Posttransplant patient survival was not different, 93.6% pre and 92.8% post. There is early evidence that the heart allocation policy has enhanced stratification of candidates by their medical urgency and broader distribution for the most medically urgent candidates with minimal impact on overall waiting list mortality and posttransplant outcomes.

Vital Status Ascertainment for a Historic Diverse Cohort of U.S. Women.

Studies linking large pregnancy cohorts with mortality data can address critical questions about long-term implications of gravid health, yet relevant US data are scant. We examined the feasibility of linking the Collaborative Perinatal Project, a large multiracial U.S. cohort study of pregnant women (n = 48,197; 1959-1966), to death records. We abstracted essential National Death Index (NDI) (1979-2016) (n = 46,428). We performed a linkage to the Social Security Administration Death Master File through 2016 (n = 46,450). Genealogists manually searched vital status in 2016 for a random sample of women (n = 1,249). We conducted agreement analyses for women with abstracted data among the three sources. As proof of concept, we calculated adjusted associations between mortality and smoking and other sociodemographic factors using Cox proportional hazards regression. We successfully abstracted identifying information for most of the cohort (97%). National Death Index identified the greatest proportion of participants deceased (35%), followed by genealogists (31%) and Death Master File (23%). Estimates of agreement (κ [95% confidence interval]) between National Death Index and Death Master File were lower (0.52 [0.51, 0.53]) than for National Death Index and genealogist (0.66 [0.61, 0.70]). As expected, compared with nonsmokers, smoking ≥1 pack per day was associated with elevated mortality for all vital sources and was strongest for National Death Index. Linking this historic cohort with mortality records was feasible and agreed reasonably on vital status when compared with other data sources. Such linkage enables future examination of pregnancy conditions in relation to mortality in a diverse U.S. cohort.

Obtaining vital status and cause of death on a million persons

Purpose To present the methodology used to determine vital status and obtain cause of death (COD) within the Million Person Study of Low-Dose Health Effects (MPS). Data sources and vital status tracing techniques used to obtain vital status and COD for six (n = 424,238 subjects) of the ∼20+ cohorts under study are described. Methods and materials A multistage approach using multiple sources of vital status information was used to determine vital status (or ‘trace’) study participants from as early as 1940 to the present. Mortality records from state departments of vital statistics and the Social Security Administration Death Master File (SSA-DMF) were matched to study participants by Social Security Number (SSN), full name, date of birth (DOB), and/or sex using deterministic and probabilistic algorithms. The National Death Index (NDI) and SSA Service for Epidemiological Researchers (SSA-SER) were used to obtain COD (after 1978) and verification of alive status, respectively. Online public records and ancestry services, death certificates, and specialized mortality sources were also utilized. Results For the MPS cohorts traced to date (nuclear power plant workers, industrial radiographers, atomic veterans, and workers at Rocketdyne/Atomics International, Mound nuclear facility, and Mallinckrodt Chemical Works), vital status was confirmed for over 90% of all study subjects in all but one cohort (88%). The ascertainment of COD was over 96% for all cohorts. Conclusions A hallmark of a high-quality epidemiologic cohort mortality study is a low percentage of subjects with unknown vital status and a low percentage of deaths without a COD. The sources and methods used for vital status tracing and COD determination for the MPS have been successful and should be useful for other investigators tracing large, historic study populations. Some of the approaches would be applicable for use in all cohort studies using regional-specific mortality data or modifications to the approach.

Alive or dead: Validity of the Social Security Administration Death Master File after 2011.

To determine the reliability of the Social Security Death Master File (DMF) after the November 2011 changes limiting the inclusion of state records. Secondary data from the DMF, New York State (NYS) and New Jersey (NJ) Vital Statistics (VS), and institutional data warehouse. Retrospective study. Two cohorts: discharge date before November 1, 2011, (pre-2011) or after (post-2011). Death in-hospital used as gold standard. NYS VS used for out-of-hospital death. Sensitivity, specificity, Cohen's Kappa, and 1-year survival calculated. Patients matched to DMF using Social Security Number, or date of birth and Soundex algorithm. Patients matched to NY and NJ VS using probabilistic linking. 97069 patients January 2007-March 2016: 39075 pre-2011; 57994 post-2011. 3777 (3.9 percent) died in-hospital. DMF sensitivity for in-hospital death 88.9 percent (κ=0.93) pre-2011 vs 14.8 percent (κ=0.25) post-2011. DMF sensitivity for NY deaths 74.6 percent (κ=0.71) pre-2011 vs 26.6 percent (κ=0.33) post-2011. DMF sensitivity for NJ deaths 62.6 percent (κ=0.64) pre-2011 vs 10.8 percent (κ=0.15) post-2011. DMF sensitivity for out-of-hospital death 71.4 percent pre-2011 (κ=0.58) vs 28.9 percent post-2011 (κ=0.34). Post-2011, 1-year survival using DMF data was overestimated at 95.8 percent, vs 86.1 percent using NYS VS. The DMF is no longer a reliable source of death data. Researchers using the DMF may underestimate mortality.

Ten-Year Change in Neighborhood Socioeconomic Deprivation and Rates of Total, Cardiovascular Disease, and Cancer Mortality in Older US Adults.

Low neighborhood socioeconomic status has been linked to adverse health outcomes. However, it is unclear whether changing the neighborhood may influence health. We examined 10-year change in neighborhood socioeconomic deprivation in relation to mortality rate among 288,555 participants aged 51-70 years who enrolled in the National Institutes of Health-AARP Diet and Health Study in 1995-1996 (baseline) and did not move during the study. Changes in neighborhood socioeconomic deprivation between 1990 and 2000 were measured by US Census data at the census tract level. All-cause, cardiovascular disease, and cancer deaths were ascertained through annual linkage to the Social Security Administration Death Master File between 2000 and 2011. Overall, our results suggested that improvement in neighborhood socioeconomic status was associated with a lower mortality rate, while deterioration was associated with a higher mortality rate. More specially, a 30-percentile-point reduction in neighborhood deprivation among more deprived neighborhoods was associated with 11% and 19% reductions in the total mortality rate among men and women, respectively. On the other hand, a 30-point increase in neighborhood deprivation in less deprived neighborhoods was associated with an 11% increase in the mortality rate among men. Our findings support a longitudinal association between changing neighborhood conditions and mortality.

P.123 Functional status in neurosurgery and out of hospital outcomes: insights from a 12 year, 2300 patient retrospective cohort study

Background: Limited information exists in neurosurgery regarding the association between functional status at hospital discharge and adverse events following discharge. Methods: A retrospective cohort study included all adults in one Boston teaching hospital who underwent neurosurgery between 2000-2012, survived hospitalization and had a Physical Therapist functional status assessment within 48-hours of discharge. 90-day post-discharge all-cause mortality was obtained from the US Social Security Administration Death Master File. Logistic regression analysis was used. Results: 2,369 patients were included, comprising 65% cranial and 35% spinal. Malignancy and trauma was 47% and 13%, respectively. 238 patients had independent functional status. 90-day mortality and readmission was 8.3% and 28%, respectively. Second, third and lowest quartile of functional status was associated with a 3.16 (95%CI 1.08-9.24), 6.00 (2.11-17.04) and 6.26 (2.16-18.16) respective increased odds of 90-day post-discharge mortality compared to patients with independent functional status, adjusting for age, gender, race, length of stay, presence of malignancy and Deyo-Charlson comorbidity. Good discrimination (AUC 0.82) and calibration (Hosmer-Lemeshow χ2 P = 0.23) were demonstrated. Adjusted odds of 90-day readmission in patients with the lowest quartile of functional status was 1.89 (1.28-2.80) higher than patients with independent functional status. Conclusions: Lower functional status at hospital discharge following neurosurgery is associated with increased post-discharge mortality and hospital readmission.

Long term mortality in critically ill burn survivors

IntroductionLittle is known about long term survival risk factors in critically ill burn patients who survive hospitalization. We hypothesized that patients with major burns who survive hospitalization would have favorable long term outcomes. MethodsWe performed a two center observational cohort study in 365 critically ill adult burn patients who survived to hospital discharge. The exposure of interest was major burn defined a priori as >20% total body surface area burned [TBSA]. The modified Baux score was determined by age + %TBSA+ 17(inhalational injury). The primary outcome was all-cause 5year mortality based on the US Social Security Administration Death Master File. Adjusted associations were estimated through fitting of multivariable logistic regression models. Our final model included adjustment for inhalational injury, presence of 3rd degree burn, gender and the acute organ failure score, a validated ICU risk-prediction score derived from age, ethnicity, surgery vs. medical patient type, comorbidity, sepsis and acute organ failure covariates. Time-to-event analysis was performed using Cox proportional hazard regression. ResultsOf the cohort patients studied, 76% were male, 29% were non white, 14% were over 65, 32% had TBSA >20%, and 45% had inhalational injury. The mean age was 45, 92% had 2nd degree burns, 60% had 3rd degree burns, 21% received vasopressors, and 26% had sepsis. The mean TBSA was 20.1%. The mean modified Baux score was 72.8. Post hospital discharge 5year mortality rate was 9.0%. The 30day hospital readmission rate was 4%. Patients with major burns were significantly younger (41 vs. 47 years) had a significantly higher modified Baux score (89 vs. 62), and had significantly higher comorbidity, acute organ failure, inhalational injury and sepsis (all P<0.05). There were no differences in gender and the acute organ failure score between major and non-major burns. In the multivariable logistic regression model, major burn was associated with a 3 fold decreased odds of 5year post-discharge mortality compared to patients with TBSA<20% [OR=0.29 (95%CI 0.11–0.78; P=0.014)]. The adjusted model showed good discrimination [AUC 0.81 (95%CI 0.74–0.89)] and calibration (Hosmer–Lemeshow χ2 P=0.67). Cox proportional hazard multivariable regression modeling, adjusting for inhalational injury, presence of 3rd degree burn, gender and the acute organ failure score, showed that major burn was predictive of lower mortality following hospital admission [HR=0.34 (95% CI 0.15–0.76; P=0.009)]. The modified Baux score was not predictive for mortality following hospital discharge [OR 5year post-discharge mortality=1.00 (95%CI 0.99–1.02; P=0.74); HR for post-discharge mortality=1.00 (95% CI 0.99–1.02; P=0.55)]. ConclusionsCritically ill patients with major burns who survive to hospital discharge have decreased 5year mortality compared to those with less severe burns. ICU Burn unit patients who survive to hospital discharge are younger with less comorbidities. The observed relationship is likely due to the relatively higher physiological reserve present in those who survive a Burn ICU course which may provide for a survival advantage during recovery after major burn.

Prediagnosis Sleep Duration, Napping, and Mortality Among Colorectal Cancer Survivors in a Large US Cohort.

Prediagnosis lifestyle factors can influence colorectal cancer (CRC) survival. Sleep deficiency is linked to metabolic dysfunction and chronic inflammation, which may contribute to higher mortality from cardiometabolic conditions and promote tumor progression. We hypothesized that prediagnosis sleep deficiency would be associated with poor CRC survival. No previous study has examined either nighttime sleep or daytime napping in relation to survival among men and women diagnosed with CRC. We examined self-reported sleep duration and napping prior to diagnosis in relation to mortality among 4869 CRC survivors in the NIH-AARP Diet and Health Study. Vital status was ascertained by linkage to the Social Security Administration Death Master File and the National Death Index. We examined the associations of sleep and napping with mortality using traditional Cox regression (total mortality) and Compositing Risk Regression (cardiovascular disease [CVD] and CRC mortality). Models were adjusted for confounders (demographics, cancer stage, grade and treatment, smoking, physical activity, and sedentary behavior) as well as possible mediators (body mass index and health status) in separate models. Compared to participants reporting 7-8 hours of sleep per day, those who reported <5 hr had a 36% higher all-cause mortality risk (Hazard Ratio (95% Confidence Interval), 1.36 (1.08-1.72)). Short sleep (<5 hr) was also associated with a 54% increase in CRC mortality (Substitution Hazard Ratio (95% Confidence Interval), 1.54 (1.11-2.14)) after adjusting for confounders and accounting for competing causes of death. Compared to no napping, napping 1 hr or more per day was associated with significantly higher total and CVD mortality but not CRC mortality. Prediagnosis short sleep and long napping were associated with higher mortality among CRC survivors.

Rationale and design of the coronary artery calcium consortium: A multicenter cohort study

BackgroundAlthough coronary artery calcium (CAC) has been investigated for over two decades, there is very limited data on the association of CAC with cause of death. The CAC Consortium is a large ongoing multi-center observational cohort of individuals who underwent non-contrast cardiac-gated CAC testing and systematic, prospective, long-term follow-up for mortality with ascertainment of cause of death. MethodsFour participating institutions from three states within the US (California, Minnesota, and Ohio) have contributed individual-level patient data to the CAC Consortium (spanning years 1991–2010). All CAC scans were clinically indicated and physician-referred in patients without a known history of coronary heart disease. Using strict inclusion and exclusion criteria to minimize missing data and to eliminate non-dedicated CAC scans (i.e. concomitant CT angiography), a sharply defined and well-characterized cohort of 66,636 patients was assembled. Mortality status was ascertained using the Social Security Administration Death Master File and a validated algorithm. In addition, death certificates were obtained from the National Death Index and categorized using ICD (International Classification of Diseases) codes into common causes of death. ResultsMean patient age was 54 ± 11 years and the majority were male (67%). Prevalence of CVD risk factors was similar across sites and 55% had a <5% estimated 10-year atherosclerotic cardiovascular disease (ASCVD) risk. Approximately 45% had a Calcium score of 0 and 11% had an Agatston Score ≥400. Over a mean follow-up of 12 ± 4 years, there were 3158 deaths (4.15 per 1000 person-years). The majority of deaths were due to cancer (37%) and CVD (32%). Most CVD deaths were due to CHD (54%) followed by stroke (17%). In general, CAC score distributions were similar across sites, and there were similar cause of death patterns. ConclusionsThe CAC Consortium is large and highly generalizable data set that is uniquely positioned to expand the understanding of CAC as a predictor of mortality risk across the spectrum of disease states, allowing innovative modeling of the competing risks of cardiovascular and non-cardiovascular death.

Assessment of survival in retrospective studies: The Social Security Death Index is not adequate for estimation

Assessment of survival in retrospective studies: The Social Security Death Index is not adequate for estimation

Risk prediction to inform surveillance of chronic kidney disease in the US Healthcare Safety Net: a cohort study.

BackgroundThe capacity of electronic health record (EHR) data to guide targeted surveillance in chronic kidney disease (CKD) is unclear. We sought to leverage EHR data for predicting risk of progressing from CKD to end-stage renal disease (ESRD) to help inform surveillance of CKD among vulnerable patients from the healthcare safety-net.MethodsWe conducted a retrospective cohort study of adults (n = 28,779) with CKD who received care within 2 regional safety-net health systems during 1996–2009 in the Western United States. The primary outcomes were progression to ESRD and death as ascertained by linkage with United States Renal Data System and Social Security Administration Death Master files, respectively, through September 29, 2011. We evaluated the performance of 3 models which included demographic, comorbidity and laboratory data to predict progression of CKD to ESRD in conditions commonly targeted for disease management (hypertension, diabetes, chronic viral diseases and severe CKD) using traditional discriminatory criteria (AUC) and recent criteria intended to guide population health management strategies.ResultsOverall, 1730 persons progressed to end-stage renal disease and 7628 died during median follow-up of 6.6 years. Performance of risk models incorporating common EHR variables was highest in hypertension, intermediate in diabetes and chronic viral diseases, and lowest in severe CKD. Surveillance of persons who were in the highest quintile of ESRD risk yielded 83–94 %, 74–95 %, and 75–82 % of cases who progressed to ESRD among patients with hypertension, diabetes and chronic viral diseases, respectively. Similar surveillance yielded 42–71 % of ESRD cases among those with severe CKD. Discrimination in all conditions was universally high (AUC ≥0.80) when evaluated using traditional criteria.ConclusionsRecently proposed discriminatory criteria account for varying risk distribution and when applied to common clinical conditions may help to inform surveillance of CKD in diverse populations.Electronic supplementary materialThe online version of this article (doi:10.1186/s12882-016-0272-0) contains supplementary material, which is available to authorized users.

Association between blood alcohol concentration and mortality in critical illness

ObjectiveIn animal models of renal, intestinal, liver, cardiac, and cerebral ischemia, alcohol exposure is shown to reduce ischemia-reperfusion injury. Inpatient mortality of trauma patients is shown to be decreased in a dose-dependent fashion relative to blood alcohol concentration (BAC) at hospital admission. In this study, we examined the association between BAC at hospital admission and risk of 30-day mortality in critically ill patients. DesignWe performed a 2-center observational study of patients treated in medical and surgical intensive care units in Boston, Massachusetts. SettingMedical and surgical intensive care units in 2 teaching hospitals in Boston, Massachusetts. PatientsWe studied 11850 patients, 18 years or older, who received critical care between 1997 and 2007. The exposure of interest was the BAC determined in the first 24 hours of hospital admission and categorized a priori as BAC less than 10 mg/dL (below level of detection), 10 to 80 mg/dL, 80 to 160 mg/dL, and greater than 160 mg/dL. The primary outcome was all-cause mortality in the 30 days after critical care initiation. Secondary outcomes included 90- and 365-day mortality after critical care initiation. Mortality was determined using the US Social Security Administration Death Master File, and 365-day follow-up was present in all cohort patients. Adjusted odds ratios (ORs) were estimated by multivariable logistic regression models with inclusion of covariate terms thought to plausibly interact with both BAC and mortality. Adjustment included age, sex, race (white or nonwhite), type (surgical vs medical), Deyo-Charlson index, sepsis, acute organ failure, trauma, and chronic liver disease. ResultsThirty-day mortality of the cohort was 13.7%. Compared to patients with BAC levels less than 10 mg/dL, patients with levels greater than or equal to 10 mg/dL had lower odds of 30-day mortality; for BAC levels 10 to 79.9 mg/dL, the OR was 0.53 (95% confidence interval [CI], 0.40-0.70); for BAC levels 80 to 159.9 mg/dL, it was 0.36 (95% CI, 0.26-0.49); and for BAC levels greater than or equal to 160 mg/dL, it was 0.35 (95% CI, 0.27-0.44). After multivariable adjustment, the OR of 30-day mortality was 0.97 (0.72-1.31), 0.79 (0.57-1.10), and 0.69 (0.54-0.90), respectively. When the cohort was analyzed with sepsis as the outcome of interest, the multivariable adjusted odds of sepsis in patients with BAC 80 to 160 mg/dL or greater than 160 mg/dL were 0.72 (0.50-1.04) or 0.68 (0.51-0.90), respectively, compared to those with BAC less than 10 mg/dL. In a subset of patients with blood cultures drawn (n = 4065), the multivariable adjusted odds of bloodstream infection in patients with BAC 80 to 160 mg/dL or greater than 160 mg/dL were 0.53 (0.27-1.01) or 0.49 (0.29-0.83), respectively, compared to those with BAC less than 10 mg/dL. ConclusionsAnalysis of 11850 adult patients showed that having a detectable BAC at hospitalization was associated with significantly decreased odds of 30-day mortality after critical care. Furthermore, BAC greater than 160 mg/dL is associated with significantly decreased odds of developing sepsis and bloodstream infection.