Vital Status Information Research Articles

Coverage with evidence development program on stereotactic body radiotherapy in Belgium (2013–2019): a nationwide registry-based prospective study

Although stereotactic body radiotherapy (SBRT) was progressively adopted in clinical practice in Belgium, a reimbursement request in 2011 was not granted because of remaining clinical and economic uncertainty. Acoverage with evidence development (CED) program on SBRT started in 2013, with the aim to assess clinical and technical patterns-of-care in Belgium and monitor survival per indication, in view of supporting inclusion in the reimbursement system. The Belgian National Institute for Health and Disability Insurance (NIHDI) initiated this prospective observational registry. Participating departments, using SBRT in clinical practice, signed the 'NIHDI convention'. Eligible patients had a primary tumour (PT) or oligometastatic disease (OMD). Patient, tumour, and treatment characteristics were collected through an online module of the Belgian Cancer Registry, prerequisite for financing. Five-year overall survival (5YOS) and 30- and 90-days mortality were primary outcomes, derived from vital status information. Between 10/2013 and 12/2019, 20 of the 24 accredited radiotherapy departments participated, 6 were academic. Registered cases per department ranged from 21 to 867. Of 5675 registrations analysed, the majority had good performance status and limited number of lesions. Enrolment of PTs remained stable over time, OMDs almost doubled. Peripheral lung lesions dominated in PTs as in OMDs. Other metastases were (para)spinal, 'non-standard' and hepatic. Thirty- and 90-days mortalities remained below 0.5% [95% CI 0.3%-0.8%] respectively 2.1% [95% CI 1.6%-2.7%]. 5YOS varied by indication, primary prostate patients performing best (85%, 95% CI [76%, 96%]), those with liver metastases worst (19%, 95% CI [15%, 24%]). Better OS was observed in academic departments, department size did not significantly impact survival. OMD survival was better in 2018-19. CED can be used to define patterns-of-care and real-life outcome of innovative radiotherapy. As the observed survival for different indications was in line with outcome in emerging literature, SBRT was included in the Belgian reimbursement system as of January2020. NIHDI financed participating departments per registered case.

Mortality Among HIV-Infected Adults on Antiretroviral Therapy in Southern Uganda.

Monitoring and evaluation of clinical programs requires assessing patient outcomes. Numerous challenges complicate these efforts, the most insidious of which is loss to follow-up (LTFU). LTFU is a composite outcome, including individuals out of care, undocumented transfers, and unreported deaths. Incorporation of vital status information from routine patient outreach may improve the mortality estimates for those LTFU. We analyzed routinely collected clinical and patient tracing data for individuals (15 years or older) initiating antiretroviral treatment between January 2014 and December 2018 at 2 public HIV care clinics in greater Rakai, Uganda. We derived unadjusted mortality estimates using Kaplan-Meier methods. Estimates, adjusted for unreported deaths, applied weighting through the Frangakis and Rubin method to represent outcomes among LTFU patients who were successfully traced and for whom vital status was ascertained. Confidence intervals were determined through bootstrap methods. Of 1969 patients with median age at antiretroviral treatment initiation of 31 years (interquartile range: 25-38), 1126 (57.2%) were female patients and 808 (41%) were lost. Of the lost patients, 640 patient files (79.2%) were found and reviewed, of which 204 (31.8%) had a tracing attempt. Within the electronic health records of the program, 28 deaths were identified with an estimated unadjusted mortality 1 year after antiretroviral treatment initiation of 2.5% (95% CI: 1.8% to 3.3%). Using chart review and patient tracing data, an additional 24 deaths (total 52) were discovered with an adjusted 1-year mortality of 3.8% (95% CI: 2.6% to 5.0%). Data from routine outreach efforts by HIV care and treatment programs can be used to support plausible adjustments to estimates of client mortality. Mortality estimates without active ascertainment of vital status of LTFU patients may significantly underestimate program mortality.

Long-Term Follow-up and Mortality Rate of Patients of the Randomized Freeway Stent Study

PurposeThis follow-up study was designed as a reopen of the completed Freeway Stent Study and collected mortality and clinical outcome data for at least 5 years after enrollment to evaluate long-term patient safety and treatment efficacy. The primary study enrolled 204 patients with stenosis or occlusion in the superficial femoral artery and proximal popliteal artery. Patients were randomized to primary nitinol stenting followed by standard PTA or primary nitinol stenting followed by FREEWAY™ paclitaxel-eluting balloon PTA.MethodsPrevious patients were recontacted by phone or during a routine hospital visit, and medical records were reviewed. Vital and clinical status information was collected.ResultsNo increased late mortality was observed at 5 years, with an all-cause mortality rate of 12.0% in the FREEWAY drug-eluting balloon group versus 15.0% in the non-paclitaxel PTA group. No accumulation of any cause of death was observed in either group, nor was there any correlation with the dose of paclitaxel used. Freedom from clinically driven target lesion revascularization at 5 years was significantly higher in the FREEWAY drug eluting balloon group (85.3%) compared to standard PTA group (72.7%) Log-rank p = 0.032.ConclusionThe safety results presented support the recent conclusions that the use of paclitaxel technology does not lead to an increase in mortality. At the same time, the efficacy results clearly demonstrate that the potential benefits of drug-eluting balloon treatment are maintained over a 5-year period.Graphical

The Danish Atrial Fibrillation Registry: A Multidisciplinary National Pragmatic Initiative for Monitoring and Supporting Quality of Care Based on Data Retrieved from Administrative Registries.

The Danish Atrial Fibrillation (AF) Registry monitors and supports improvement of quality of care for all AF patients in Denmark. This report describes the registry's administrative and organizational structure, data sources, data flow, data analyses, annual reporting, and feedback between the registry, clinicians, and the administrative system. We also report the selection process of the quality indicators and the temporal trends in results from 2017-2021. The Danish AF Registry aims for complete registration and monitoring of care for all patients diagnosed with AF in Denmark. Administrative registries provide data on contacts to general practice, contacts to private cardiology practice, hospital contacts, medication prescriptions, updated vital status information, and biochemical test results. The Danish Stroke Registry provides information on stroke events. From 2017 to 2021, the proportion with a reported echocardiography among incident AF patients increased from 39.9% (95% CI: 39.3-40.6) to 82.6% (95% CI: 82.1-83.1). The initiation of oral anticoagulant therapy among patients with incident AF and a CHA2DS2-VASc score of ≥1 in men and ≥2 in women increased from 85.3% (95% CI: 84.6-85.9) to 90.4% (95% CI: 89.9-91.0). The 1-year and 2-year persistence increased from 85.2% (95% CI: 84.5-85.9) to 88.7% (95% CI: 88.0-89.3), and from 85.4% (95% CI: 84.7-86.2) to 88.2% (95% CI: 87.5-88.8), respectively. The 1-year risk of ischemic stroke among prevalent patients with AF decreased from 0.88% (95% CI: 0.83-0.93) to 0.71% (95% CI: 0.66-0.75). Variation in clinical performance between the five administrative Danish regions was reduced. Continuous nationwide monitoring of quality indicators for AF originating from administrative registries is feasible and supportive of improvements of quality of care.

Liver-related mortality among people with hepatitis B and C: Evaluation of definitions based on linked healthcare administrative datasets.

Routinely collected and linked healthcare administrative datasets could be used to monitor mortality among people with hepatitis B (HBV) and C (HCV). This study aimed to evaluate the concordance in records of liver-related mortality among people with an HBV or HCV notification, between data on hospitalization for end-stage liver disease (ESLD) and death certificates. In New South Wales, Australia, HBV and HCV notifications (1993-2017) were linked to hospital admissions (2001-2018), all-cause mortality (1993-2018) and cause-specific mortality (1993-2016) datasets. Hospitalization for ESLD was defined as a first-time hospital admission due to decompensated cirrhosis (DC) or hepatocellular carcinoma (HCC). Consistency of liver death definition of mortality following hospitalization for ESLD was compared with two death certificate-based definitions of liver deaths coded among primary and secondary cause-specific mortality data, including ESLD-related (deaths due to DC and HCC) and all-liver deaths (ESLD-related and other liver-related causes). Of 63,292 and 107,430 individuals with an HBV and HCV notification, there were 4478 (2.6%) post-ESLD hospitalization deaths, 5572 (3.3%) death certificate liver disease deaths and 2910 (1.7%) death certificate ESLD deaths. Between 2001 and 2016, among HBV post-ESLD hospitalization deaths (n= 891), 63% (562) had death certificate ESLD recorded, and 83% (741) had death certificate liver disease recorded. Between 2001 and 2016, among HCV post-ESLD hospitalization deaths (n= 3587), 58% (2082) had death certificate ESLD recorded, and 87% (3135) had death certificate liver disease recorded. At least one-third of death certificates with DC and HCC as cause of death had no mention of HBV, HCV or viral hepatitis. Our study identified limitations in estimating and tracking HBV and HCV liver disease mortality using death certificate-based data only. The optimum data for this purpose is either ESLD hospitalisations with vital status information or a combination of these with cause-specific death certificate data.

Profiles of behavioral, social and psychological well-being in old age and their association with mobility-limitation-free survival.

Introduction: Successful aging is a multidimensional construct covering behavioral, social, and psychological domains of well-being. We aimed to identify well-being profiles and their association with mobility-limitation-free survival.Methods: A total of 1488 healthy individuals aged 60+ from the Swedish National study on Aging and Care in Kungsholmen (SNAC-K) were followed-up for 15 years. Mobility limitation was defined as a walking speed <0.8m/s and vital status information was obtained from the National Cause of Death Register. Well-being profiles were derived from different behavioral, social and psychological indicators using latent class analysis among men and women. Cox and Laplace regression models were applied to examine the association with the incidence of a composite endpoint of mobility limitation or death.Results: At baseline, three well-being profiles (i.e., worst, intermediate, best) were identified, which followed a clear gradient in all behavioral, social and psychological indicators. Compared to those in the worst profile, men and women in the intermediate profile had 27% (HR 0.73; 95% CI 0.56-0.94) and 23% (HR 0.77; 95% CI 0.59-1.00) lower hazard of developing mobility limitation/death. An even greater protective effect was seen among individuals in the best versus worst profile (HR 0.47; 95% CI 0.31-0.70 in men; HR 0.60; 95% CI 0.46-0.78 in women). Men in the intermediate and best profiles survived 1 and 3 years longer without mobility limitation, respectively; these figures were 2 and 3 years for women.Conclusions: Better profiles of behavioral, social and psychological well-being may prolong mobility-limitation-free survival by at least one year among older adults. Our findings strengthen the evidence-base to achieve successful aging through multi-domain interventions.

Severity of alcohol dependence and mortality after 20years in an adult general population sample.

ObjectivesTo estimate mortality on grounds of the severity of alcohol dependence which has been assessed by two approaches: the frequency of alcohol dependence symptoms (FADS) and the number of alcohol dependence criteria (NADC).MethodsA random sample of adult community residents in northern Germany at age 18 to 64 had been interviewed in 1996. Among 4075 study participants at baseline, for 4028 vital status was ascertained 20 years later. The FADS was assessed by the Severity of Alcohol Dependence Scale among the 780 study participants who had one or more symptoms of alcohol dependence or abuse and vital status information. The NADC was estimated by the Munich Composite International Diagnostic Interview among 4028 study participants with vital status information. Cox proportional hazard models were used.ResultsThe age‐adjusted hazard ratio for the FADS (value range: 0–79) was 1.02 (95% confidence interval, CI: 1.016–1.028), for the NADC (value range: 0–7) it was 1.25 (CI: 1.19–1.32).ConclusionsThe FADS and NADC predicted time to death in a dose‐dependent manner in this adult general population sample.

Reduction in Late Mortality after Autologous Blood or Marrow Transplantation (autoBMT) in Childhood - a Report from the Blood or Marrow Transplant Survivor Study-2 (BMTSS-2)

Background: AutoBMT is used with a curative intent for several types of childhood cancer. However, there is paucity of information regarding the long-term outcome after autoBMT performed in childhood, and whether mortality rates have changed over the past 4 decades. We address these gaps by examining all-cause, relapse-related [RRM] and non-relapse-related [NRM] mortality in patients undergoing autoBMT between 1980 and 2010 at City of Hope, University of Minnesota or University of Alabama at Birmingham. Methods: To be included in this analysis, patients had to have received a single autoBMT before age 22y, and survived ≥2y after transplantation. Vital status information was ascertained as of December 31, 2016, using medical records, the National Death Index (NDI), and Accurint databases. Information on the cause of death was obtained from the NDI Plus program and medical records. Using Kaplan-Meier techniques, we describe overall survival conditional on surviving 2y and 15y from autoBMT. We describe cumulative incidence of RRM and NRM using competing risk methods. We also describe trends in all-cause mortality over 3 time periods: <1990, 1990-1999 and 2000-2010. Standardized mortality ratio (SMR) was used to compare the mortality of this cohort to the age- sex-, and calendar-specific mortality of the US general population. Proportional subdistribution hazards model (Fine-Gray) for competing risks was used for identifying predictors of late mortality (demographics, primary disease, conditioning agents, and disease status at autoBMT). Results: In this cohort of 364 2+y survivors of autoBMT performed in childhood, the most common primary diagnoses were Hodgkin lymphoma (HL: 26%), neuroblastoma (23%), acute myeloid leukemia (AML: 13%), acute lymphoblastic leukemia (ALL: 12%), and non-Hodgkin lymphoma (NHL: 9%). The distribution of the cohort over the 3 time periods was: <1990 (20%); 1990-1999 (37%); 2000-2010 (43%). After a median follow-up of 14.2y, 104 deaths were observed in this 2+y survivor cohort. The leading causes of death included primary disease (49.5%), subsequent malignant neoplasms (21.0%) and infection (18.2%). The 10y cumulative incidence of RRM (13.6%) exceeded that of NRM (10.2%) (Fig 1). Overall, the cohort was at a 23-fold higher risk of late mortality (SMR 23.6, 95% CI 19.3-28.6), when compared with the general population. The SMR was significantly increased in all groups of primary diagnoses; ALL (SMR 27.0), AML (SMR 7.8), HL (SMR 15.1), NHL (SMR 13.5), and neuroblastoma (SMR 60.7). Conditional on surviving 2y, 5y, 10y and 15y, the overall survival was 81.9%, 91.4%, 95.6% and 99.4%, respectively. Mortality rates continued to remain higher than the general population among those who had survived at least 10y after autoBMT (SMR 12.4, 95% CI 4.9-25.1), but approached those of the general population among the 15+y survivors (SMR 3.0, 95%CI, 0.5-9.4). The all-cause 10y cumulative mortality rate declined over the 3 eras (<1990: 35.1%, 1990-1999: 24.4%; 2000-2010: 20.6%, p=0.02) (Fig 2). Adjusting for demographic and clinical variables, as well as preparative regimens, the hazard ratio (HR) of all-cause mortality declined in the more recent treatment eras (<1990 (referent group): HR=1.0; 1990-1999: HR=0.5, 95%CI, 0.3-0.9, p=0.02; 2000-2010: HR=0.4, 95%CI, 0.2-0.8, p=0.007). Conclusion: Taken together, these findings suggest that the mortality rates of autoBMT recipients are significantly higher than those of the general population. Relapse is the leading cause of death for the first 10y after autoBMT. Importantly, there has been a significant decline in all-cause mortality in children undergoing autoBMT over the past 4 decades. [Display omitted] DisclosuresArora:Takeda Oncology: Consultancy.

Association between waiting time for radiotherapy initiation and disease progression among women with cervical cancer in Addis Ababa, Ethiopia.

There is shortage of radiotherapy machines in low-income countries, including Ethiopia. Data on adverse effects of this on cancer outcomes are limited, however. Herein, we examined the extent of waiting time for radiotherapy and its association with disease progression based on a prospective cohort study of women diagnosed with stage IA-IVA cervical cancer in Addis Ababa and who were scheduled to receive radiotherapy at Tikur Anbessa Specialized Hospital, the only hospital that provides radiotherapy services in the country. Association was examined using Multivariable mixed effects logistic regression model. Among the 178 women with cervical cancer scheduled for receipt of radiotherapy and with vital status information, 16 deceased (9.0%) while waiting for radiotherapy. For the remaining 162 women who initiated radiotherapy, the median treatment waiting period was 137 days (IQR=60-234 days), with 74.1% of women waiting for >60 days. Tumor progressed to higher stage for 44.4% of these women. Compared to those women who initiated radiotherapy ≤60 days after diagnostic confirmation, the odds of tumor progression to higher stage was three times higher in those women who initiated radiotherapy between 120-179 days (aOR =3.30, 95%CI: 1.18-9.27) and ≥180 days (aOR =3.06, 95%CI: 1.24-7.52). Waiting period for receipt of radiotherapy among women with cervical cancer is exceedingly long in Addis Ababa, and it is associated with disease progression to higher stages. These findings reinforce the need to expand radiotherapy infrastructure in order to mitigate the undue high burden of the disease in Ethiopia and other parts of Africa.

Supplemental Intraoperative Oxygen and Long-term Mortality: Subanalysis of a Multiple Crossover Cluster Trial.

Whether supplemental oxygen worsens long-term mortality remains unclear, with contradictory trial results. The authors therefore tested the hypothesis that supplemental oxygen (80% vs. 30%) increases the hazard for long-term mortality. The authors conducted a post hoc analysis of a large multiple crossover cluster trial in which more than 5,000 colorectal surgeries on 4,088 adults were allocated to receive either 30% or 80% inspired oxygen during general anesthesia. The authors assessed the effect of 80% versus 30% target-inspired oxygen on long-term mortality and calculated Kaplan-Meier survival estimates. Analysis was restricted to patients with a home address in Ohio because the authors could obtain reliable vital status information from the Ohio Department of Health (Columbus, Ohio) for them. A total of 3,471 qualifying colorectal surgeries performed in 2,801 patients were analyzed, including 1,753 (51%) surgeries in 1,577 patients given 80% oxygen and 1,718 surgeries in 1,551 patients given 30% oxygen. The observed incidence of death after a median of 3 yr was 13% (234 of 1,753) in the 80% oxygen group and 14% (245 of 1,718) in the 30% oxygen group. The estimated hazard ratio for mortality was 0.94 (95% CI, 0.78 to 1.13; P = 0.493). In this post hoc analysis of a large, controlled trial, supplemental oxygen did not increase postoperative mortality.

Linkage of Hospital Records and Death Certificates by a Search Engine and Machine Learning

IntroductionVital status is of central importance to hospital clinical research. However, hospital information systems record only in-hospital death information. Recently, the French government released a publicly available dataset containing death-certificate data for over 25 million individuals. The objective of this study was to link French death certificates to the Bordeaux University Hospital records to complete the vital status information.Materials and MethodsOur linkage strategy was composed of a search engine to reduce the number of comparisons and machine-learning algorithms. The overall pipeline was evaluated by assembling a file containing 3,565 in-hospital deaths and 15,000 alive persons.ResultsThe recall and precision of our linkage strategy were 97.5% and 99.97% for the upper threshold and 99.4% and 98.9% for the lower threshold, respectively.ConclusionIn this study, we demonstrated the feasibility of accurately linking hospital records with death certificates using a search engine and machine learning.

Parental lifespan and the likelihood of reaching the age of 90 years in the Netherlands Cohort Study.

AimGrowing evidence suggests an association between parental longevity and lifespan of subsequent generations. We aimed to reproduce earlier findings, showing a positive association between parental longevity and offspring's longevity. Additionally, we investigated whether this is mainly driven by the maternal or paternal germline in male and female offspring.MethodsFor these analyses, data from the oldest birth cohort (1916–17) of the Netherlands Cohort Study was used. Participants filled in a baseline questionnaire in 1986 (at age 68–70 years). Follow up for vital status information until the age of 90 years (2006–07) was >99.9% complete. Multivariable‐adjusted Cox regression analyses with a fixed follow‐up time were based on 2368 men and 2657 women with complete parental survival data and relevant confounders to calculate risk ratios (RR) of reaching longevity.ResultsIn age‐adjusted models, paternal and maternal age at death were significantly positively associated with reaching 90 years in both male and female offspring. In male offspring, paternal age at death (≥90 years vs <80 years) showed the strongest association with survival to 90 years (RR 1.42, 95% CI 1.07–1.89), after confounder correction. In female offspring, maternal age at death (≥90 years vs <80 years) showed the strongest association with survival to 90 years (RR 1.20, 95% CI 1.04–1.40).DiscussionAfter confounder adjustment, stronger and significant associations were observed between paternal lifespan and male offspring longevity, and maternal lifespan and female offspring longevity. Future research should investigate through which pathways a longer lifespan of parents is transmitted to their offspring. Geriatr Gerontol Int 2021; 21: 215–221.

Loneliness in Later Life and Reaching Longevity: Findings From the Longitudinal Aging Study Amsterdam.

ObjectivesThere is an increasing research interest in factors that characterize those who reach exceptionally old ages. Although loneliness is often associated with an increased risk for premature mortality, its relationship with reaching longevity is still unclear. We aimed to quantify the association between (social/emotional) loneliness and the likelihood of reaching the age of 90 years in men and women separately.MethodsFor these analyses, data from the Longitudinal Aging Study Amsterdam (LASA) were used. Loneliness, social loneliness, and emotional loneliness were assessed at baseline using the 11-item De Jong-Gierveld scale in 1992–1993 (at age 64–85 years). Follow-up for vital status information until the age of 90 years was 99.5% completed. Multivariable-adjusted Cox regression analyses with a fixed follow-up time were based on 1,032 men and 1,078 women to calculate risk ratios (RR) of reaching 90 years.ResultsNo significant associations were observed between loneliness and reaching 90 years in both men (RR, 0.90; 95% confidence interval [CI], 0.70–1.14) and women (RR, 0.98; 95% CI, 0.83–1.14). Social loneliness was significantly associated with a reduced chance of reaching 90 years in women (RR, 0.82; 95% CI, 0.67–0.99).DiscussionThe current analyses did not show support for the existence of a meaningful effect of loneliness on reaching longevity in both sexes. When investigating specific dimensions of loneliness, we observed that reporting social loneliness was associated with reaching 90 years in women. This indicates that, for women, a large and diverse personal network at an older age could increase the probability of reaching longevity. However, replication of our findings in other cohorts is needed.

Increasing Incidence and Prevalence of Acquired Hemolytic Anemias in Denmark, 1980-2016.

BackgroundAcquired hemolytic disorders—autoimmune hemolytic anemia (AIHA), cold agglutinin disease (CAD), paroxysmal nocturnal hemoglobinuria (PNH), drug-induced hemolysis (DIHA), and acquired hemolysis not otherwise specified (AHNOS)—are considered rare. Despite their potentially major health implications, data regarding their incidence and prevalence are scarce.MethodsTo fill this gap we collected data regarding all patients with acquired hemolytic disorder diagnoses in 1977–2016 from the Danish National Patient Register. These data were linked with vital and migration status information from the Danish Civil Registration System. From these data combined with annual demographic data for the background population, we calculated age- and sex-specific incidence rates and prevalence proportions of acquired hemolytic disorders for specified time periods.ResultsOur analysis included 5868 patients with acquired hemolytic disorders (2715 with AIHA, 112 CAD, 397 DIHA, 116 PNH, and 2154 AHNOS). The incidence rates per 100 000 person-years in 1980–1993 and 2008–2016 were 0.81 and 1.77 for AIHA, 0.31 and 0.12 for DIHA, and 0.04 and 0.08 for PNH, respectively. The 2008–2016 CAD incidence rate was 0.18/100 000 person-years, CAD diagnosis code was not defined before 1994. All incidence rates increased with age. The prevalence proportion per 100 000 persons in 1980 and 2015 was 2.52 and 17.01 for AIHA, 0.80 and 1.50 for DIHA, and 0.18 and 1.04 for PNH. CAD prevalence in 2015 was 1.04/100 000 persons.ConclusionAcquired hemolytic anemia incidence rates and prevalence proportions with the exception of DIHA are markedly increasing.

Racial Disparities Exist in Outcomes After Major Fragility Fractures.

Fractures associated with postmenopausal osteoporosis (PMO) are associated with pain, disability, and increased mortality. A recent, nationwide evaluation of racial difference in outcomes after fracture has not been performed. To determine if 1-year death, debility, and destitution rates differ by race. Observational cohort study. US Medicare data from 2010 to 2016. Non-Hispanic black and white women with PMO who have sustained a fragility fracture of interest: hip, pelvis, femur, radius, ulna, humerus, and clinical vertebral. Outcomes included 1-year: (1) mortality, identified by date of death in Medicare vital status information, (2) debility, identified as new placement in long-term nursing facilities, and (3) destitution, identified as becoming newly eligible for Medicaid. Among black and white women with PMO (n = 4,523,112), we identified 399,000 (8.8%) women who sustained a major fragility fracture. Black women had a higher prevalence of femur (9.0% vs 3.9%; P < .001) and hip (30.7% vs 28.0%; P < .001) fractures and lower prevalence of radius/ulna (14.7% vs 17.0%; P < .001) and clinical vertebral fractures (28.8% vs 33.5%; P < .001) compared with white women. We observed racial differences in the incidence of 1-year outcomes after fracture. After adjusting for age, black women had significantly higher risk of mortality 1 year after femur, hip, humerus, and radius/ulna fractures; significantly higher risk of debility 1 year after femur and hip fractures; and significantly higher risk of destitution for all fractures types. In a sample of Medicare data from 2010 to 2016, black women with PMO had significantly higher rates of mortality, debility, and destitution after fracture than white women. These findings are a first step toward understanding and reducing disparities in PMO management, fracture prevention, and clinical outcomes after fracture. J Am Geriatr Soc 68:1803-1810, 2020.

P133 PRESCRIPTION OPIOID USE AMONG VETERANS WITH INFLAMMATORY BOWEL DISEASE

Abstract Background Opioids are commonly prescribed to manage pain in patients with IBD despite increasing evidence of harm associated with chronic use. The aim of the current study was to describe trends in opioid use among veterans with IBD. Methods This was a retrospective cohort study derived from the Veterans Affairs (VA) Health Care System. A unique patient identifier facilitated longitudinal evaluation of electronic databases that include medical diagnoses, surgical procedures, pharmaceuticals, labs, vital status information, dates of treatment, and radiology findings. Veterans were labeled as having IBD if there were at least 2 outpatient or 1 inpatient health care encounters with an ICD-9/10 diagnostic code consistent with IBD from fiscal years 2002 to 2016. Veterans without a minimum of 2 years of follow-up or who had a cancer diagnosis within 1 year before or after IBD diagnosis were excluded. In order to standardize the quantity of opioid exposure, morphine milligram equivalents (MME) for each prescription was calculated using published conversion factors. Individual prescriptions with missing quantity or day’s supply and prescriptions exceeding 1000 MME/day were excluded. Opioid exposure during the first year following the initial diagnosis date was determined as the average MME/day for those with at least one opioid prescription. Annual opioid prescribing rates per 100 IBD patients were calculated. Comorbidities were assessed using a modified Charlson Comorbidity Index (CCI), excluding cancer from the calculation. Results During the study period, 65,817 veterans with IBD were identified. The majority were males (92.1%), Caucasian (78.2%), and had a mean age of 58.2 years. In total, 1,471,019 individual opioid prescriptions were evaluated. The quantity and rate of opioid prescriptions peaked in 2012, with 115,774 unique prescriptions and 698.5 opioid prescriptions per 100 IBD patients, respectively. Twenty-seven percent (n=17,844) of IBD patients had at least one opioid prescription within the initial year of diagnosis. Mean opioid exposure during the initial year of diagnosis averaged 33.2 MME/day, and 12.2% had mean opioid exposure greater than 50 MME/day. Opioid exposure peaked in 2005 at 37.4 MME/day and consistently declined to 29.3 MME/day in 2016. Conclusion There has been a significant decline in opioid prescriptions, prescribing rate, and mean opioid exposure since peaking in 2012. These trends are similar to those seen in the non-veteran US population.

Percutaneous coronary intervention versus coronary artery bypass grafting in patients with three-vessel or left main coronary artery disease: 10-year follow-up of the multicentre randomised controlled SYNTAX trial

The Synergy between PCI with Taxus and Cardiac Surgery (SYNTAX) trial was a non-inferiority trial that compared percutaneous coronary intervention (PCI) using first-generation paclitaxel-eluting stents with coronary artery bypass grafting (CABG) in patients with de-novo three-vessel and left main coronary artery disease, and reported results up to 5 years. We now report 10-year all-cause death results. The SYNTAX Extended Survival (SYNTAXES) study is an investigator-driven extension of follow-up of a multicentre, randomised controlled trial done in 85 hospitals across 18 North American and European countries. Patients with de-novo three-vessel and left main coronary artery disease were randomly assigned (1:1) to the PCI group or CABG group. Patients with a history of PCI or CABG, acute myocardial infarction, or an indication for concomitant cardiac surgery were excluded. The primary endpoint of the SYNTAXES study was 10-year all-cause death, which was assessed according to the intention-to-treat principle. Prespecified subgroup analyses were performed according to the presence or absence of left main coronary artery disease and diabetes, and according to coronary complexity defined by core laboratory SYNTAX score tertiles. This study is registered with ClinicalTrials.gov, NCT03417050. From March, 2005, to April, 2007, 1800 patients were randomly assigned to the PCI (n=903) or CABG (n=897) group. Vital status information at 10 years was complete for 841 (93%) patients in the PCI group and 848 (95%) patients in the CABG group. At 10 years, 248 (28%) patients had died after PCI and 212 (24%) after CABG (hazard ratio 1·19 [95% CI 0·99-1·43], p=0·066). Among patients with three-vessel disease, 153 (28%) of 546 had died after PCI versus 114 (21%) of 549 after CABG (hazard ratio 1·42 [95% CI 1·11-1·81]), and among patients with left main coronary artery disease, 95 (27%) of 357 had died after PCI versus 98 (28%) of 348 after CABG (0·92 [0·69-1·22], pinteraction=0·023). There was no treatment-by-subgroup interaction with diabetes (pinteraction=0·60) and no linear trend across SYNTAX score tertiles (ptrend=0·20). At 10 years, no significant difference existed in all-cause death between PCI using first-generation paclitaxel-eluting stents and CABG. However, CABG provided a significant survival benefit in patients with three-vessel disease, but not in patients with left main coronary artery disease. German Foundation of Heart Research (SYNTAXES study, 5-10-year follow-up) and Boston Scientific Corporation (SYNTAX study, 0-5-year follow-up).

Late mortality after bone marrow transplant for chronic myelogenous leukemia in the context of prior tyrosine kinase inhibitor exposure: A Blood or Marrow Transplant Survivor Study (BMTSS) report.

Late mortality was investigated in patients with chronic myelogenous leukemia (CML) who underwent blood or bone marrow transplant (BMT) with or without prior tyrosine kinase inhibitor (TKI) therapy. By using data from the Blood or Marrow Transplant Survivor Study, the authors examined late mortality in 447 patients with CML who underwent BMT between 1974 and 2010, conditional on surviving ≥2years post-BMT. For vital status information, the medical records, the National Death Index, and the Accurint database were used. Standardized mortality ratios (SMRs) were calculated using general population age-specific, sex-specific, and calendar-specific mortality rates. Kaplan-Meier techniques and Cox regression were used for all-cause mortality analyses. Cumulative incidence and proportional subdistribution hazards models for competing risks were used for cause-specific mortality analyses. The 10-year overall survival rate was 65.7% and 73% for those who underwent transplant with and without pre-BMT exposure to TKI therapy, respectively. Patients who underwent transplant with and without pre-BMT TKI experienced SMRs of 6.4 and 6.4, respectively (P=.8); and the SMRs were 11.6 and 8.1, respectively, for those with high-risk disease (P=.2). Independent predictors of non-CML-related mortality included chronic graft-versus-host disease (hazard ratio [HR], 2.8; 95% CI, 1.8-4.4) and busulfan/cyclophosphamide conditioning (HR, 0.5; 95% CI, 0.3-0.9; reference, total body irradiation/cyclophosphamide conditioning). The 20-year cumulative incidence of CML-related and non-CML-related mortality was 6% and 36%, respectively, for the entire cohort. Both CML-related mortality (HR, 1.0; 95% CI, 0.1-12.6) and non-CML-related mortality (HR, 1.3; 95% CI, 0.6-3.1) were comparable for those with and without pre-BMT TKI therapy. The similar late mortality experienced by patients with CML who undergo transplantation with or without pre-BMT TKIs suggests that allogeneic BMT can be considered in the context of TKI intolerance or nonadherence. The prevention of post-BMT non-CML-related mortality could favorably affect long-term survival.

Is resistant hypertension an independent predictor of all-cause mortality in individuals with type 2 diabetes? A prospective cohort study

BackgroundResistant hypertension is independently associated with an increased risk of death in the general hypertensive population. We assessed whether resistant hypertension is an independent predictor of all-cause mortality in individuals with type 2 diabetes from the Renal Insufficiency And Cardiovascular Events (RIACE) Italian Multicentre Study.MethodsOn 31 October 2015, vital status information was retrieved for 15,656 of the 15,773 participants enrolled in 2006–2008. Based on baseline blood pressure (BP) values and treatment, participants were categorized as normotensive, untreated hypertensive, controlled hypertensive (i.e., on-target with < 3 drugs), uncontrolled hypertensive (i.e., not on-target with 1–2 drugs), or resistant hypertensive (i.e., uncontrolled with > 3 drugs or controlled with > 4 drugs). Kaplan–Meier and Cox proportional hazards regression analyses were used to assess the association with all-cause mortality.ResultsUsing the 130/80 mmHg targets for categorization, crude mortality rates and Kaplan–Meier estimates were highest among resistant hypertension participants, especially those with controlled resistant hypertension. As compared with resistant hypertension, risk for all-cause mortality was significantly lower for all the other groups, including individuals with controlled hypertension (hazard ratio 0.81 [95% confidence interval 0.74–0.89], P < 0.0001), but became progressively similar between resistant and controlled hypertension after adjustment for cardiovascular risk factors and complications/comorbidities. Also when compared with controlled resistant hypertension, mortality risk was significantly lower for all the other groups, including controlled hypertension, even after adjusting for cardiovascular risk factors (0.77 [0.63–0.95], P = 0.012), but not for complications/comorbidities (0.88 [0.72–1.08], P = 0.216). BP was well below target in the controlled hypertensive groups (resistant and non-resistant) and values < 120/70 mmHg were associated with an increased mortality risk. Results changed only partly when using the 140/90 mmHg targets for categorization.ConclusionsIn the RIACE cohort, at variance with the general hypertensive population, resistant hypertension did not predict death beyond target organ damage. Our findings may be explained by the high mortality risk conferred by type 2 diabetes and the low BP values observed in controlled hypertensive patients, which may mask risk associated with resistant hypertension. Less stringent BP goals may be preferable in high-risk patients with type 2 diabetes.Trial registrationClinicalTrials.gov, NCT00715481, retrospectively registered 15 July, 2008.

Female reproductive factors and the likelihood of reaching the age of 90 years. The Netherlands Cohort Study

ObjectivesThe aim of this study was to prospectively assess the relationship between several reproductive factors in women and the likelihood of reaching the age of 90 years (achieving longevity). Study designFor this study, data from the oldest birth cohort (1916-17) of the prospective Netherlands Cohort Study (NLCS) were used. These participants filled in a baseline questionnaire in 1986 (at age 68-70 years). Follow-up for vital status information until the age of 90 years (2006-07) was >99.9% complete. Main outcome measuresMultivariable-adjusted Cox regression analyses with a fixed follow-up time were based on 2,697 women with complete exposure and co-variable data to calculate risk ratios (RR) of reaching age 90. ResultsNo associations were observed between the likelihood of reaching the age of 90 years, and age at menarche, age at menopause, parity, menstrual lifespan, and oral contraceptive use after adjustment for potential confounders. A later age at first childbirth pointed towards a higher chance of achieving longevity (age ≥30 vs. 20-24; RR,1.17; 95%CI,0.98-1.39). Ever-use of hormone replacement therapy (HRT) was significantly associated with a higher chance of achieving longevity compared with never HRT-users, but only in women who had had an early menopause (<50 years)(RR,1.32; 95% CI, 1.07-1.61). ConclusionAge at first childbirth, and ever-use of HRT in women with an early menopause (<50 years) were associated with the likelihood of reaching the age of 90 years.