Mortality In US Research Articles

Cost-effectiveness of zanubrutinib versus ibrutinib in adult patients with Waldenström macroglobulinemia in the United States.

e18856 Background: The efficacy of zanubrutinib and ibrutinib was examined in the randomized ASPEN trial (NCT03053440) in adult patients with Waldenström macroglobulinemia (WM). This analysis assessed the cost-effectiveness (CE) of zanubrutinib vs ibrutinib in this population from a US payer perspective. Methods: A 3-state (pre-progression, post-progression, and death) partitioned survival model was used to estimate the life years (LYs), quality-adjusted life years (QALYs), and costs for each treatment over a 30-year lifetime horizon. Overall survival (OS), progression-free survival (PFS), and time-to-discontinuation (TTD) curves were fitted using parametric distributions to extrapolate long-term outcomes. Selection of the parametric models for each outcome and treatment was based on assessments of 1) the proportional hazard assumption, 2) goodness-of-fit, and 3) clinical plausibility of extrapolated mean OS and associated hazard patterns (based on literature and US clinical expert input) and the alignment between PFS and TTD. Background US mortality was accounted for in the model. Utilities were based on the ASPEN EQ-5D data and literature. Costs (2020 US$) included drug (wholesale acquisition cost from RED BOOK) and adverse event management (Healthcare Cost and Utilization Project) for zanubrutinib and ibrutinib, routine care, and terminal care. Sensitivity analyses were conducted to evaluate the impact of parameter uncertainty. All outcomes were discounted at 3% annually. Results: In the base case analyses using the dependent exponential model for all outcomes over a 30-year time horizon, zanubrutinib led to 0.94 LY and 0.84 QALY gained with an additional total drug cost of $11,132. This additional cost was primarily driven by patients staying on zanubrutinib treatment longer as zanubrutinib has longer time to treatment failure. However, this is partially offset by zanubrutinib’s lower monthly drug acquisition, reduced cost of routine care (–$2,935) and terminal care (–$2,964) than ibrutinib. The incremental cost-effectiveness ratio (ICER) of zanubrutinib is $13,205 per QALY gained. The deterministic sensitivity analyses showed that ICER was most sensitive to the monthly costs of routine care. The probabilistic sensitivity analyses showed that the mean probabilistic ICER was $16,804, and that the probability of zanubrutinib being cost-effective was 61% at a willingness-to-pay threshold of $100,000 per QALY gained. Varying the time horizon to 5, 10, or 15 years consistently led to zanubrutinib being dominant (i.e., greater QALYs but lower costs). Conclusions: Zanubrutinib appears to be cost-effective compared with ibrutinib for the treatment of patients with WM in the US.[Table: see text]

Association of Screening Lower Endoscopy With Colorectal Cancer Incidence and Mortality in Adults Older Than 75 Years

Evidence indicates that screening for colorectal cancer (CRC) beginning at 50 years of age can detect early-stage CRC and premalignant neoplasms (eg, adenomas) and thus prevent CRC-related mortality. At present, the US Preventive Services Task Force recommends continuing CRC screening until 75 years of age and individualized decision-making for adults older than 75 years, while accounting for a patient's overall health and screening history. However, scant data exist to support these recommendations. To examine the association of lower gastrointestinal tract screening endoscopy with the risk of CRC incidence and CRC-related mortality in older US adults. This prospective cohort study of health care professionals in the US included data from the Nurses' Health Study (NHS) and Health Professionals Follow-up Study (HPFS) from January 1, 1988, through January 31, 2016, for the HPFS and June 30, 2016, for the NHS. Data were analyzed from May 8, 2019, to July 9, 2020. History of screening sigmoidoscopy or colonoscopy (routine/average risk or positive family history) to 75 years of age and after 75 years of age, assessed every 2 years. Incidence of CRC and CRC-related mortality confirmed by National Death Index, medical records, and pathology reports. Among 56 374 participants who reached 75 years of age during follow-up (36.8% men and 63.2% women), 661 incident CRC cases and 323 CRC-related deaths were documented. Screening endoscopy after 75 years of age was associated with reduced risk of CRC incidence (multivariable hazard ratio [HR], 0.61; 95% CI, 0.51-0.74) and CRC-related mortality (HR, 0.60; 95% CI, 0.46-0.78), regardless of screening history. The HR comparing screening with nonscreening after 75 years of age was 0.67 (95% CI, 0.50-0.89) for CRC incidence and 0.58 (95% CI, 0.38-0.87) for CRC-related mortality among participants who underwent screening endoscopy before 75 years of age, and 0.51 (95% CI, 0.37-0.70) for CRC incidence and 0.63 (95% CI, 0.43-0.93) for CRC-related mortality among participants without a screening history. However, screening endoscopy after 75 years of age was not associated with risk reduction in CRC death among participants with cardiovascular disease (HR, 1.18; 95% CI, 0.59-2.35) or significant comorbidities (HR, 1.17; 95% CI, 0.57-2.43). In this cohort study, endoscopy among individuals older than 75 years was associated with lower risk of CRC incidence and CRC-related mortality. These data support continuation of screening after 75 years of age among individuals without significant comorbidities.

Comparison of 20-Year Obesity-Associated Cancer Mortality Trends With Heart Disease Mortality Trends in the US

Heart disease and cancer are the 2 major diseases associated with mortality risk in the United States. Four decades of improvements in heart disease mortality slowed after 2011; this slowing has been associated with the obesity epidemic. The same pattern has not been observed for total cancer mortality. However, trends in total cancer mortality may obscure patterns specific to obesity-associated cancers. To investigate whether trends in obesity-associated cancer mortality mirror the slowed mortality improvements observed for heart disease associated with the obesity epidemic. This cross-sectional study compared US mortality trends for International Statistical Classification of Diseases and Related Health Problems, Tenth Revision-defined cancer (total cancer, obesity-associated cancer, and cancer not associated with obesity) and heart disease deaths from January 1, 1999, to December 31, 2018. Data were included on decedents with complete information on the underlying cause of death, age, sex, race, and ethnicity. Changes in age-adjusted cause-specific mortality rates between 1999-2011 and 2011-2018 were compared. Annual relative rates of change in age-adjusted mortality rates (AAMRs) in the overall population and stratified by sex, race, and ethnicity were estimated using Poisson regression. Differences in AAMR annual relative rates of change before and after 2011 were evaluated using Wald tests. A total of 50 163 483 decedents met the inclusion criteria (50.1% female decedents, 79.9% non-Hispanic White decedents, and 11.7% non-Hispanic Black decedents; mean [SD] age, 72.8 [18.5] years). In contrast with heart disease mortality, for which improvements slowed between 1999-2011 and 2011-2018, decreases in total cancer AAMR relative change accelerated between 1999-2011 (-1.48 [95% CI, -1.43 to -1.52]) and 2011-2018 (-1.77 [95% CI, -1.67 to -1.86]) (P < .001). For obesity-associated cancer mortality, which accounted for approximately 33% of total cancer deaths annually, decreases in annual AAMR relative change decelerated from -1.19 (95% CI, -1.13 to -1.26) in 1999-2011 to -0.83 (95% CI, -0.70 to -0.96) in 2011-2018 (P < .001). The largest decelerations in obesity-associated cancer mortality were observed for female decedents (-1.45 [95% CI, -1.36 to -1.53] in 1999-2011 and -0.91 [95% CI, -0.75 to -1.07] in 2011-2018; P < .001) and non-Hispanic White individuals (-1.16 [95% CI, -1.09 to -1.22] in 1999-2011 and -0.68 [95% CI, -0.55 to -0.81] in 2011-2018; P < .001). Slowing improvements in obesity-associated cancer mortality were obscured when considering total cancer mortality. These findings potentially signal a changing profile of cancer-associated mortality that may parallel trends previously observed for heart disease as the consequences of the obesity epidemic are understood.

Healthcare Prometrics in the Era of Redeployment

A bid is made to measure health as a value. Continuous and conceptual variables pertaining to healthcare distribution, expenses and outcomes are obtained from 70 studies presenting 4,245,866 patient-population from Finland and 4,304,049 from the USA—clustered for three periods: biennium, lustrum, decade. Two causality loops are sampled per country of interest: prematurity–perinatal mortality (PPM), tobacco consumption–respiratory cancer (TRC). Both in Finland and the USA, attribute risk for hypothyroidism, autoimmune disorders, and cardiomyopathy outstage other predictors of perinatal mortality. Diabetes mellitus, diabetes insipidus, obesity, and urinary tract infections are increasingly dominating PPM risks in the USA. Perinatal and maternal mortality ratios are consistently lower in Finland (RR 1.8–4.35). The mean duration of NICU-stay among the surviving and non-surviving low-weight infants is higher in Finland (RR 1.3–3.0). Regardless the term, cost of one NICU-day is 36–53-fold higher in the USA. The state-sponsored prenatal care is 2.58 times more consumed in Finland where the cost of basic prenatal care (excluding childbirth expenses) is 1.6 times lower. Low income is a substantial contributor to tobacco smoking (OR 5.0–15.6)—with a stronger connection (RR 3.56) in the USA. The US mortality rates from active smoking (R 1.5) and nicotine consumption by non-smoking means (RR 2.22) are higher even when the leading death predictors (COPD, Fanconi anemia, thromboembolism, TP53 gene mutation, KRAS mutation) are significantly higher in Finland (RR 2.57–12.85). High asthma rates among the US smokers (RR 4.21) are distinct predictors of poor survival rates from lung cancer—also reflected in higher Tiffeneau-Pinelli index reduction (RR 3.96). Delays in detection of respiratory cancer inversely relate to the survival rates (r =− 0.56). Where results are chaotic, data are assessed through holomorphic operation, each domain as complex-valued function of differentiable variable(s). Under the Riemannian and Finsler reasoning, each variable is a manifold in a spatial unit where tangent sits with the fourth root of differential expression. Such indexing could interprete functional relationships between healthcare value, demand elasticity, attributable or relative risk, prognosis—in the non-cohort samples, as suggested by the following equation matrix: R = ( [η (t) η (t’)/δ (t−t’) ]−D1xμ r − D1[μ xr + μ r x] − D2x(1 − λ s) + D2[λ xs + λ s x])ik (lj Rjikl ll). Due to its inherent dissonance property enabling data triangulation in infinitesimal points, Euclidean reasoning may help devise comprehensive healthcare index to predict perinatal and tobacco mortality. Findings of this study suggest that health value is higher in Finland. The need for health policy reform in the USA is warranted.

US State Disparities in Life Expectancy, Disability-Free Life Expectancy, and Disabled Life Expectancy Among Adults Aged 25 to 89 Years.

Objectives. To estimate total life expectancy (TLE), disability-free life expectancy (DFLE), and disabled life expectancy (DLE) by US state for women and men aged 25 to 89 years and examine the cross-state patterns.Methods. We used data from the 2013-2017 American Community Survey and the 2017 US Mortality Database to calculate state-specific TLE, DFLE, and DLE by gender for US adults and hypothetical worst- and best-case scenarios.Results. For men and women, DFLEs and DLEs varied widely by state. Among women, DFLE ranged from 45.8 years in West Virginia to 52.5 years in Hawaii, a 6.7-year gap. Men had a similar range. The gap in DLEs across states was 2.4 years for women and 1.6 years for men. The correlation among DFLE, DLE, and TLE was particularly strong in southern states. The South is doubly disadvantaged: residents have shorter lives and spend a greater proportion of those lives with disability.Conclusions. The stark variation in DFLE and DLE across states highlights the large health inequalities present today across the United States, which have significant implications for individuals' well-being and US states' financial costs and medical care burden.

Trends in the Mortality of Biliary Tract Cancers Based on Their Anatomical Site in the United States From 2009 to 2018.

Recent trends in the incidence and mortality of biliary tract cancers are unknown. We estimated the trends in biliary tract cancers-related incidence and mortality stratified by anatomical site, age, sex, and race/ethnicity in the US adults. We performed a population-based trend analysis using the US national incidence (2009-2017) and mortality records (2009-2018). We identified age-standardized incidence and mortality from intrahepatic cholangiocarcinoma (ICC), extrahepatic cholangiocarcinoma, gallbladder cancer, and ampulla of Vater cancer using appropriate ICD-10 code. Temporal mortality was calculated by joinpoint trend analysis with estimates of annual percentage change (APC) described as each trend segment. The incidence rates of ICC increased linearly (APC 8.9%, 95% confidence interval [CI] 7.8%-10.0%) while gallbladder cancer-related incidence rates remained stable early and decreased significantly later in the study (APC -2.8%, 95% CI -5.5% to -0.0% [2014-2017]). Age-standardized mortality from biliary tract cancers steadily increased with an annual increase of 2.0% (95% CI 1.6%-2.3%). Although there was a linear increase in the ICC-related mortality (APC 3.5%, 95% CI 3.1%-3.8%), extrahepatic cholangiocarcinoma-related mortality tended to remain stable earlier and increased later (APC 7.0%, 95% CI 4.6%-9.5% [2013-2018]). By contrast, gallbladder cancer-related mortality steadily decreased over 10 years (APC -1.6%, 95% CI -2.1% to -1.1%). Significant differences in mortality and changes in trends over time were observed in non-Hispanic blacks, Hispanics, and non-Hispanic Asians. In this analysis of nationally representative data, changing mortality trends in various biliary tract cancers was noted with a disproportionately higher burden of fatality in minorities.

Association of Medical Stimulants With Mortality in the US From 2010 to 2017

Association of Medical Stimulants With Mortality in the US From 2010 to 2017

Association between county level cannabis dispensary counts and opioid related mortality rates in the United States: panel data study

ObjectiveTo examine county level associations between the prevalence of medical and recreational cannabis stores (referred to as dispensaries) and opioid related mortality rates.DesignPanel regression methods.Setting812 counties in the United States...

Epidemiology, Staging, and Management of Multiple Myeloma.

Multiple myeloma (MM) is a plasma cell disorder that is on the rise throughout the world, especially in the US, Australia, and Western Europe. In the US, MM accounts for almost 2% of cancer diagnoses and over 2% of cancer deaths (more than double the global proportion). Incidence has risen by 126% globally and over 40% in the US since 1990, while global mortality has risen by 94% and US mortality has fallen by 18%. The 5 year survival in the US has more than doubled over the past decades with the introduction of new targeted therapies and transplant techniques. Risk factors for MM include age (average age of diagnosis is 69), race (African Americans are over double as likely to be diagnosed), sex (men are at a 1.5× risk), and family history. Diagnosis includes serum or urine electrophoresis and free light-chain assay but requires bone marrow biopsy. It is distinguished from smoldering myeloma and monoclonal gammopathy of undetermined significance by a high (>3 g/dL) level of M-protein (monoclonal light chains) and the presence of CRAB (Hypercalcemia, Renal failure, Anemia, Bone pain) symptoms, which include hypercalcemia, renal failure, anemia, and bone pain, suggesting an end-organ damage. International staging system staging involves beta 2 microglobulin and albumin levels, while the revised system considers prognostic factors such as lactate dehydrogenase levels and chromosomal abnormalities. Front-line management includes induction regimen, maintenance therapy and hematopoietic cell transplantation for eligible patients and bisphosphonates or bone-stimulating agents for the prevention of skeletal events. Treatment for relapsed disease includes newly approved monoclonal antibodies like the CD38-targeting daratumumab, proteasome inhibitors, immunomodulating agents, and investigational therapies such as B cell maturation antigen Chimeric antigen receptor T cells.

Pricing Extreme Mortality Risk amid the COVID-19 Pandemic

In pricing extreme mortality risk, it is commonly assumed that the interest rate and mortality rate are independent. However, the recent COVID-19 outbreak calls this assumption into question. We propose a bivariate affine jump-diffusion structure to jointly model the interest rate and excess mortality, allowing for both correlated diffusions and joint jumps. Utilizing the latest US mortality and interest rate data, we find a strong negative correlation between the jump sizes of interest rate and excess mortality, and a much higher jump intensity when the pandemic data is included. Moreover, we construct a risk-neutral pricing measure that accounts for both a diffusion risk premium and a jump risk premium. We then solve for the market prices of risk based on mortality bond prices. Our results show that the pandemic experience can drastically change investors’ risk perception and will likely reshape the post-pandemic mortality risk market.

Uncertainty and the reporting of intellectual disability on death certificates: a cross-sectional study of US mortality data from 2005 to 2017

ObjectiveTo investigate whether uncertainty surrounding the death is associated with the inaccurate reporting of intellectual disability as the underlying cause of death.DesignNational Vital Statistics System 2005–2017 US Multiple Cause-of-Death Mortality...

Outcomes in patients hospitalized for COVID-19 among Asian, Pacific Islander, and Hispanic subgroups in the American Heart Association COVID-19 registry

BackgroundCoronavirus disease 2019 (COVID-19) data from race/ethnic subgroups remain limited, potentially masking subgroup-level heterogeneity. We evaluated differences in outcomes in Asian American/Pacific Islander (AAPI) and Hispanic/Latino subgroups compared with non-Hispanic White patients hospitalized with COVID-19. MethodsIn the American Heart Association COVID-19 registry including 105 US hospitals, mortality and major adverse cardiovascular events in adults age ≥18 years hospitalized with COVID-19 between March-November 2020 were evaluated. Race/ethnicity groups included AAPI overall and subgroups (Chinese, Asian Indian, Vietnamese, and Pacific Islander), Hispanic/Latino overall and subgroups (Mexican, Puerto Rican), compared with non-Hispanic White (NHW). ResultsAmong 13,511 patients, 7% were identified as AAPI (of whom 17% were identified as Chinese, 9% Asian Indian, 8% Pacific Islander, and 7% Vietnamese); 35% as Hispanic (of whom 15% were identified as Mexican and 1% Puerto Rican); and 59% as NHW. Mean [SD] age at hospitalization was lower in Asian Indian (60.4 [17.4] years), Pacific Islander (49.4 [16.7] years), and Mexican patients (57.4 [16.9] years), compared with NHW patients (66.9 [17.3] years, p<0.01). Mean age at death was lower in Mexican (67.7 [15.5] years) compared with NHW patients (75.5 [13.5] years, p<0.01). No differences in odds of mortality or MACE in AAPI or Hispanic patients relative to NHW patients were observed after adjustment for age. ConclusionsPacific Islander, Asian Indian, and Mexican patients hospitalized with COVID-19 in the AHA registry were significantly younger than NHW patients. COVID-19 infection leading to hospitalization may disproportionately burden some younger AAPI and Hispanic subgroups in the US.

Recent land cover changes in the Southwestern US lead to an increase in surface temperature

The increase in large-scale land cover change (LCC) in recent decades, particularly in response to climate-driven disturbances, has potential to impact local and regional changes in climate due to modification of carbon sources and sinks, albedo, surface roughness and energy fluxes. Using observational data, we predict the impact of two of the most extensive LCCs occurring in the Southwestern US: drought-induced tree mortality and shrub encroachment into grasslands, on surface temperature. We developed a new energy balance method that extracts the biophysical responses to environmental conditions, to predict how structural changes in albedo, surface roughness and canopy conductance following LCC will alter surface temperature. This method allows us not only to explain the observed differences in surface temperature between two non-adjacent study sites with different environmental conditions, but also to separate the contribution of biophysical and non-biophysical properties to surface temperature. Our results suggest that changes in biophysical properties due to shrub encroachment and tree mortality in the Southwestern US (independent of changes in other environmental properties) can potentially lead to an increase in midday surface temperature (11AM to 2PM) of 1 to 2 degrees Celsius, comparable to changes in surface temperature following deforestation. Although the average surface temperature increase in response to both shrub encroachment and tree mortality is similar, the biophysical properties driving the temperature change are different in each scenario. Change in aerodynamic conductance following tree mortality is the largest contributor to heating, while reduced albedo and canopy conductance drive the increase in surface temperature following shrub encroachment. We also show how this increase in daytime surface temperature could be further intensified with future climate, especially with the expected reduction in soil water availability in the Southwest.

Estimation of Long-Term Survival with Tafasitamab + Lenalidomide in Relapsed/Refractory Diffuse Large B-Cell Lymphoma

Background L-MIND (NCT02399085) is an ongoing, open-label, single-arm, Phase II study of tafasitamab + lenalidomide (LEN) in patients with relapsed/refractory (R/R) diffuse large B-cell lymphoma (DLBCL) who are ineligible for autologous stem cell transplant. Progression-free survival (PFS) estimates the treatment effect of the study drug only, while overall survival (OS) also includes effects of potential subsequent cancer treatments or palliative care. Given that not all OS and PFS events have occurred after a long follow-up duration, traditional survival analyses may underestimate survival benefit for tafasitamab + LEN by assuming the same mortality rate for the whole population. We used mixture cure models to estimate the proportion of long-term survivors (LTS) and survival benefit associated with tafasitamab + LEN treatment. Methods In the L-MIND study (data cut-off: Nov 30, 2019), 80/81 enrolled patients with R/R DLBCL received tafasitamab + LEN, with a median and maximum follow-up duration of 31.8 months (95% CI: 27.2-35.9) and 43.5 months, respectively. The Kaplan-Meier (KM) plots of PFS and OS were observed to plateau after 30 months, with the majority of events reported up to that time-point and very few events beyond this time-point. Patients without a PFS event or patients who did not decease after the observed plateau exhibit a high survival benefit from tafasitamab + LEN treatment and are considered LTS. Thus, the patient population can be considered to consist of two sub-populations - LTS and non-LTS. A "mixture cure model" was fitted on the PFS and OS data to estimate the proportion of LTS and associated mean survival for the two sub-populations (Lambert PC, et al. 2007). To incorporate background mortality (Bansal, et al. 2019), age- and sex-specific US mortality rates (US CDC 2017) were factored in for the entire study population (enrolled in Europe and US). The weighted average of the mean survival for the two sub-populations provided an estimate of the mean survival for the whole population. For comparative purposes, standard parametric models without considering an LTS proportion were fitted on PFS and OS data additionally. Sensitivity analyses were performed considering different survival distributions (exponential distribution, Weibull distribution and log-logistic distribution). Results By using a mixture cure model fitted to PFS and OS data separately, the estimated proportion of LTS for the tafasitamab + LEN combination was 42% (95% CI: 30-55) and 47% (95% CI: 29-66), respectively. The predicted mean survival when mixture cure model was fitted on PFS data was 16.7 years for LTS patients vs 0.5 years for non-LTS patients, yielding 7.3 years for the overall population. Under this mixture cure model, the survival rates of patients with tafasitamab + LEN treatment were 40.2% and 36.0% at 2 and 5 years. Similar results were obtained when the mixture cure model was fitted on OS data. Using a standard parametric model (Weibull distribution), the predicted mean survival in the overall population was 2.8 years fitting PFS data (Figure 1) and 4.5 years fitting OS data (Figure 2). Conclusions PFS and OS KM curves for the L-MIND study reaching a long plateau and not following a Weibull distribution suggest the presence of an LTS subgroup. Standard parametric models may lead to a biased estimation of the OS benefit in such situations. The mixture cure model suggests that the treatment of R/R DLBCL patients with tafasitamab + LEN is associated with a high LTS proportion. The survival rates of patients with tafasitamab + LEN treatment were 40.2% and 36.0% at 2 and 5 years. Disclosures Salles: Takeda:Honoraria;BMS/Celgene:Honoraria, Other: consultancy or advisory role;Debiopharm:Consultancy, Honoraria, Other: consultancy or advisory role;Genmab:Honoraria, Other;Karyopharm:Honoraria;Kite, a Gilead Company:Honoraria, Other: consultancy or advisory role ;Epizyme:Honoraria, Other: consultancy or advisory role;Janssen:Honoraria, Other: consultancy or advisory role;Abbvie:Other: consultancy or advisory role;Roche:Honoraria, Other: consultancy or advisory role;Novartis:Honoraria, Other: consultancy or advisory role;MorphoSys:Honoraria, Other: consultancy or advisory role;Autolos:Other: consultancy or advisory role.Goswami:MorphoSys AG:Ended employment in the past 24 months.Bagnardi:MorphoSys AG:Consultancy.Dey:MorphoSys AG:Current Employment.Winderlich:MorphoSys AG:Current Employment.Ambarkhane:MorphoSys AG:Current Employment.Huang:MorphoSys AG:Current Employment.Nowakowski:Curis:Consultancy;Kymera:Consultancy;Kite:Consultancy;Ryvu:Consultancy, Membership on an entity's Board of Directors or advisory committees;Celgene/BMS:Consultancy, Research Funding;Seattle Genetics:Consultancy;MorphoSys:Consultancy, Research Funding;NanoString:Research Funding.

First-Trimester Abortion Complications: Simulation Cases for OB/GYN Residents in Sepsis and Hemorrhage

IntroductionSerious complications associated with first-trimester abortions are rare. The US mortality rate for these procedures is 0.7 per 100,000, primarily due to infection and hemorrhage. While complications are unlikely to arise during training, residents must be prepared to manage them in practice. To address this, we developed a 2-hour simulation-based abortion complication curriculum for OB/GYN resident learners.MethodsOB/GYN residents participated in three sessions: a case-based didactic reviewing institutional aspiration abortion practice and preop preparation; an in-vivo aspiration abortion hemorrhage simulation; and an interdepartmental postabortal sepsis simulation. Participants completed surveys before and after their participation that evaluated clinical knowledge, and self-rated competence in, and preparedness for, managing first-trimester abortion complications.ResultsResident learners (N = 26) represented all four classes of OB/GYN residents. Residents initially showed stronger clinical knowledge in managing postabortal hemorrhage than sepsis (90% vs. 62%, p < .001). Clinical knowledge improved following the sepsis simulation (62% to 91%, p < .001), and remained strong but unchanged after the hemorrhage simulation (90% to 87%, p = .3). Resident self-assessments of competence and preparedness were significantly improved after both the hemorrhage (p = .006) and sepsis (p = .002) simulations. Learners reported that the simulation increased their level of comfort in managing these complications in their future practice.DiscussionPostabortal hemorrhage and sepsis simulations increased OB/GYN residents' knowledge, comfort, and preparedness for managing rare complications of first-trimester abortions. In-vivo simulation and interdepartmental collaboration were novel aspects of these simulations that may facilitate increased preparedness and management skills.

Association of sugar-sweetened beverage and artificially sweetened beverage intakes with mortality: an analysis of US National Health and Nutrition Examination Survey.

Current evidence on the associations between sugar-sweetened beverage (SSB) intakes and mortality is inconsistent, whereas the evidence on artificially sweetened beverages (ASBs) was sparse. We aimed to investigate the associations of SSB and ASB intakes with mortality in a nationally representative sample of US adults. Participants from the National Health and Nutrition Examination Survey (NHANES, 1999-2014; n = 31,402) were linked to the US mortality registry by the end of 2015. SSB and ASB intakes were collected using 24-h dietary recalls. Cox proportional hazard regression models were used to assess the associations of intakes of SSBs, ASBs, and added sugar from SSBs with mortality with adjustment for demographic, lifestyle, comorbidity, and dietary factors. After a mean follow-up of 7.9years, 3878 deaths were identified. The multivariate-adjusted hazard ratios (95% confidence intervals) associated with each additional serving/d of SSB were 1.05 (1.01-1.09) for all-cause mortality and 1.11 (1.03-1.21) for heart disease mortality. Hazard ratios (95% confidence intervals) comparing the extreme quintiles of added sugar intakes from SSBs were 1.22 (1.05-1.42) for all-cause mortality and 1.45 (1.06-1.97) for heart disease mortality. No significant relationship was found between SSB intakes and cancer mortality or between high ASB intakes and mortality. Substituting one serving/d of SSB by an equivalent amount of ASBs, unsweetened coffees and teas, and plain water was associated with a 4-7% lower risk of all-cause mortality. Higher SSB intakes were associated with higher risks of all-cause mortality and heart disease mortality. High ASB intakes were not significantly associated with mortality. ASBs, unsweetened coffees and teas, and plain water might be optional alternatives for reducing SSB intakes.

Trends in Sickle Cell Disease–Related Mortality in the United States, 1979 to 2017

We provide an updated assessment of trends in sickle cell disease (SCD)-related mortality, a significant source of mortality in the United States among black persons, using 1979 to 2017 US mortality data. SCD-related deaths were identified with International Classification of Diseases codes. Because SCD-related death is rare in other races, the analysis focused on black decedents. Age-specific and average annual SCD-related death rates were calculated. Causes of death codes were categorized into 20 groups relevant to SCD outcomes. SCD-related deaths were compared with non-SCD-related deaths after matching on race, sex, age group, and year of death. There were 25,665 SCD-related deaths reported among blacks in the United States from 1979 through 2017. During that period, the annual SCD-related death rate declined in children and increased in adults, and the median age at death increased from 28 to 43 years. Acute causes of death, such as infection and cerebrovascular complications, were more common in younger age groups. Chronic complications were more common in adults. SCD-related deaths were more likely to be related to acute cardiac, pulmonary, and cerebrovascular complications; acute infections; and chronic cardiac and pulmonary complications and renal disorders; and less likely to be related to drug overdose and chronic infections than non-SCD-related deaths. These data indicate SCD-related deaths are now more likely to be related to chronic complications of the disease than to acute complications. More research regarding prevention and treatment of chronic complications of SCD is necessary because persons with SCD are living longer.

Estimates of the Association of Dementia With US Mortality Levels Using Linked Survey and Mortality Records

Vital statistics are the primary source of data used to understand the mortality burden of dementia in the US, despite evidence that dementia is underreported on death certificates. Alternative estimates, drawing on population-based samples, are needed. To estimate the percentage of deaths attributable to dementia in the US. A prospective cohort study of the Health and Retirement Study of noninstitutionalized US individuals with baseline exposure assessment in 2000 and follow-up through 2009 was conducted. Data were analyzed from November 2018 to May 2020. The sample was drawn from 7489 adults aged 70 to 99 years interviewed directly or by proxy. Ninety participants with missing covariates or sample weights and 57 participants lost to follow-up were excluded. The final analytic sample included 7342 adults. Dementia and cognitive impairment without dementia (CIND) were identified at baseline using Health and Retirement Study self- or proxy-reported cognitive measures and the validated Langa-Weir score cutoff. Hazard ratios relating dementia and CIND status to all-cause mortality were estimated using Cox proportional hazards regression models, accounting for covariates, and were used to calculate population-attributable fractions. Results were compared with information on cause of death from death certificates. Of the 7342 total sample, 4348 participants (60.3%) were women. At baseline, 4533 individuals (64.0%) were between ages 70 and 79 years, 2393 individuals (31.0%) were between 80 and 89 years, and 416 individuals (5.0%) were between 90 and 99 years; percentages were weighted. The percentage of deaths attributable to dementia was 13.6% (95% CI, 12.2%-15.0%) between 2000 and 2009. The mortality burden of dementia was significantly higher among non-Hispanic Black participants (24.7%; 95% CI, 17.3-31.4) than non-Hispanic White participants (12.2%; 95% CI, 10.7-13.6) and among adults with less than a high school education (16.2%; 95% CI, 13.2%-19.0%) compared with those with a college education (9.8%; 95% CI, 7.0%-12.5%). Underlying cause of death recorded on death certificates (5.0%; 95% CI, 4.3%-5.8%) underestimated the contribution of dementia to US mortality by a factor of 2.7. Incorporating deaths attributable to CIND revealed an even greater underestimation. The findings of this study suggest that the mortality burden associated with dementia is underestimated using vital statistics, especially when considering CIND in addition to dementia.

Racial disparities in positive airway pressure therapy adherence among veterans with obstructive sleep apnea.

Black individuals are disproportionately affected by diabetes, cardiovascular disease, obesity, and OSA. Adherence to PAP therapy has been reported to be lower among black individuals. This study seeks to examine associations between black race and PAP adherence among veterans with OSA. This was a retrospective study. Veterans newly diagnosed with OSA at a single Department of Veterans Affairs sleep center who were prescribed a modem-enabled PAP device between January 2015 and November 2017 were enrolled. PAP adherence was defined as ≥ 4 hours nightly usage for at least 70% of nights measured at 30 days from PAP setup. We examined the relationship between race and adherence, controlling for sex, marital status, age, socioeconomic status, residual apnea-hypopnea index), and mask leak. Of 3013 patients identified with OSA, 2571 (85%) were newly started on PAP therapy (95% male, aged 59 years ± 14 years, 45% married, 8% with neighborhood socioeconomic disadvantage). Twenty-five percent of participants were black, and 57% were white. PAP adherence at 30 days was 50% overall (42% among blacks, 53% among nonblacks). Black race was associated with reduced 30-day PAP adherence in unadjusted (P < .001) and adjusted logistic regression models (odds ratio = 0.64; 95% CI, 0.53 - 0.78; P < .001). Among veterans with OSA, black race was associated with reduced PAP adherence. These findings suggest health inequality among black individuals in the treatment of OSA.

Abstract 2321: Validating breast cancer risk prediction models in the Korean Cancer Prevention Study-II Biobank

Abstract Background: Informative and well-calibrated risk prediction models may be useful for precision breast-cancer screening. However, these models often have not been validated across diverse populations. Validation in East Asian populations is particularly lacking. Objective: To evaluate the performance of breast cancer risk models developed in European-ancestry studies in a Korean population, both directly and after recalibration. Methods: We compared discrimination and calibration of three multivariable risk models in a cohort of 77,457 women from the Korean Cancer Prevention Study-II. The first incorporated US breast-cancer incidence and mortality rates, US risk-factor distributions, and relative risk (RR) estimates from European-ancestry studies. The second recalibrated the first by using Korean incidence and mortality rates and Korean risk factor distributions, while retaining the European-ancestry RR estimates. Finally, we derived a Korea-specific model incorporating the RR estimates from Korean Cancer Prevention Study. The Individualized Coherent Absolute Risk Estimation (iCARE) software package was used to calculate 5 year predicted absolute risks of breast cancer and assess model performance. Results: The US European-ancestry breast cancer risk model was well calibrated among Korean women &amp;lt;50 years (E/O=1.124 (0.989, 1.278)) but markedly overestimated the risk for those ≥50 years (E/O=2.472 (2.005, 3.049)). Recalibrating absolute risk estimates using Korean breast cancer rates and risk distributions markedly improved the calibration in women ≥50 (E/O=1.018 (0.825, 1.255)). The model incorporating Korean-based RRs had similar but not clearly improved performance relative to the recalibrated model; this may reflect at most modest differences in the RRs between European and Korean populations and the relatively small sample used to estimate RRs among Korean women. Conclusions: The poor performance of the US European-ancestry breast cancer risk model among older Korean women highlights the importance of tailoring absolute risk models to specific populations. Recalibrating the model using Korean incidence and mortality rates and risk factor distributions greatly improved performance; we anticipate the performance could be further improved by incorporating multivariable risk-factor RRs from large Korea-based studies. Citation Format: Yon Ho Jee, Chi Gao, Jihye Kim, Seho Park, Sun Ha Jee, Peter Kraft. Validating breast cancer risk prediction models in the Korean Cancer Prevention Study-II Biobank [abstract]. In: Proceedings of the Annual Meeting of the American Association for Cancer Research 2020; 2020 Apr 27-28 and Jun 22-24. Philadelphia (PA): AACR; Cancer Res 2020;80(16 Suppl):Abstract nr 2321.