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Palaniyappan N, Peach E, Pearce F, Dhaliwal A, Campos-Varela I, Cant MR, Dopazo C, Trotter J, Divani-Patel S, Hatta AAZ, Hopkins L, Testa G, Bilbao A, Kasmani Z, Faloon S, Mirza DF, Klintmalm GB, Bilbao I, Asrani SK, Rajoriya N, Aravinthan AD. Long-term outcomes (beyond 5 years) of liver transplant recipients-A transatlantic multicenter study. Liver Transpl 2024; 30:170-181. [PMID: 37589505 DOI: 10.1097/lvt.0000000000000244] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/05/2023] [Accepted: 07/06/2023] [Indexed: 08/18/2023]
Abstract
The long-term (>5 y) outcomes following liver transplantation (LT) have not been extensively reported. The aim was to evaluate outcomes of LT recipients who have survived the first 5 years. A multicenter retrospective analysis of prospectively collected data from 3 high volume LT centers (Dallas-USA, Birmingham-UK, and Barcelona-Spain) was undertaken. All adult patients, who underwent LT since the inception of the program to December 31, 2010, and survived at least 5 years since their LT were included. Patient survival was the primary outcome. A total of 3682 patients who survived at least 5 years following LT (long-term survivors) were included. Overall, median age at LT was 52 years (IQR 44-58); 53.1% were males; and 84.6% were Caucasians. A total of 49.4% (n=1820) died during a follow-up period of 36,828 person-years (mean follow-up 10 y). A total of 80.2% (n=1460) of all deaths were premature deaths. Age-standardized all-cause mortality as compared to general population was 3 times higher for males and 5 times higher for females. On adjusted analysis, besides older recipients and older donors, predictors of long-term mortality were malignancy, cardiovascular disease, and dialysis. Implementation of strategies such as noninvasive cancer screening, minimizing immunosuppression, and intensive primary/secondary cardiovascular prevention could further improve survival.
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Affiliation(s)
- Naaventhan Palaniyappan
- NIHR Nottingham Biomedical Research Centre, Nottingham University Hospitals NHS Trust and University of Nottingham, UK
- Nottingham Digestive Diseases Centre, Translational Medical Sciences, School of Medicine, University of Nottingham, UK
| | - Emily Peach
- Lifespan and Population Health, School of Medicine, University of Nottingham, UK
| | - Fiona Pearce
- NIHR Nottingham Biomedical Research Centre, Nottingham University Hospitals NHS Trust and University of Nottingham, UK
- Lifespan and Population Health, School of Medicine, University of Nottingham, UK
| | | | - Isabel Campos-Varela
- Liver Unit, Department of Medicine, Vall d'Hebron Hospital Universitari, Vall d'Hebron Institut de Recerca (VHIR), Vall d'Hebron Barcelona Hospital Campus, Universitat Autònoma de Barcelona, Barcelona, Spain
- Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas (CIBERehd), Instituto de Salud Carlos III, Madrid, Spain
| | - Matthew R Cant
- The Liver Unit, Queen Elizabeth Hospital Birmingham, Birmingham, UK
| | - Cristina Dopazo
- Department of Hepatobiliopancreatic Surgery and Transplants, Vall d'Hebron Hospital Universitari, Vall d'Hebron Institut de Recerca (VHIR), Vall d'Hebron Barcelona Hospital Campus, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - James Trotter
- Baylor University Medical Center, Dallas, Texas, USA
| | | | | | - Laurence Hopkins
- The Liver Unit, Queen Elizabeth Hospital Birmingham, Birmingham, UK
| | | | - Angela Bilbao
- Department of Hepatobiliopancreatic Surgery and Transplants, Vall d'Hebron Hospital Universitari, Vall d'Hebron Institut de Recerca (VHIR), Vall d'Hebron Barcelona Hospital Campus, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Zain Kasmani
- The Liver Unit, Queen Elizabeth Hospital Birmingham, Birmingham, UK
| | - Sarah Faloon
- The Liver Unit, Queen Elizabeth Hospital Birmingham, Birmingham, UK
| | - Darius F Mirza
- The Liver Unit, Queen Elizabeth Hospital Birmingham, Birmingham, UK
- Centre for Liver and Gastrointestinal Research, NIHR Birmingham Biomedical Research, University of Birmingham, Birmingham, UK
| | | | - Itxarone Bilbao
- Department of Hepatobiliopancreatic Surgery and Transplants, Vall d'Hebron Hospital Universitari, Vall d'Hebron Institut de Recerca (VHIR), Vall d'Hebron Barcelona Hospital Campus, Universitat Autònoma de Barcelona, Barcelona, Spain
| | | | - Neil Rajoriya
- The Liver Unit, Queen Elizabeth Hospital Birmingham, Birmingham, UK
- Institute of Immunology & Immunotherapy, University of Birmingham, UK
| | - Aloysious D Aravinthan
- NIHR Nottingham Biomedical Research Centre, Nottingham University Hospitals NHS Trust and University of Nottingham, UK
- Nottingham Digestive Diseases Centre, Translational Medical Sciences, School of Medicine, University of Nottingham, UK
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Peach E. Creative Mental Health Literacy Practices: A Qualitative Study Exploring How Students Use Literacy to Promote Wellbeing and Manage Mental Health Conditions While at University. Int J Environ Res Public Health 2023; 20:6475. [PMID: 37569016 PMCID: PMC10418842 DOI: 10.3390/ijerph20156475] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/06/2023] [Revised: 07/25/2023] [Accepted: 07/27/2023] [Indexed: 08/13/2023]
Abstract
Understanding how students manage their mental health while at university is more important than ever, given the increasing number of undergraduate students experiencing poor mental health and seeking support from their universities. This paper reports on an exploratory qualitative study and discusses how students with mental-health conditions use literacy (reading, writing, and the use of texts) to manage their mental health, focusing on reading for pleasure, creative writing, and bullet journaling. Through in-depth qualitative interviews across the academic year of 2018-2019, 11 students' reflective accounts of their practices in managing their mental health were collected and then thematically analysed. This paper focusses on the experiences of three students as case studies of how students use literacy to manage times of mental health distress and promote wellbeing through relaxation, the expression of emotions, and the recording of their mental health. These practices enabled the processing of emotions, engagement in supportive relationships, development of a sense of self, and reflection of mental health progress. These findings demonstrate that supporting students to engage in self-directed creative literacy practices could help students to manage their mental health and develop on-going positive strategies while helping universities manage the increased demand for help from students.
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Affiliation(s)
- Emily Peach
- Department of Linguistics and English Language, Faculty of Arts and Social Sciences, Bailrigg Campus, Lancaster University, Lancaster LA1 4YW, UK
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Tangri N, Moriyama T, Schneider MP, Virgitti JB, De Nicola L, Arnold M, Barone S, Peach E, Wittbrodt E, Chen H, Järbrink K, Kushner P. Prevalence of undiagnosed stage 3 chronic kidney disease in France, Germany, Italy, Japan and the USA: results from the multinational observational REVEAL-CKD study. BMJ Open 2023; 13:e067386. [PMID: 37217263 DOI: 10.1136/bmjopen-2022-067386] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 05/24/2023] Open
Abstract
OBJECTIVES REVEAL-CKD aims to estimate the prevalence of, and factors associated with, undiagnosed stage 3 chronic kidney disease (CKD). DESIGN Multinational, observational study. SETTING Data from six country-specific electronic medical records and/or insurance claims databases from five countries (France, Germany, Italy, Japan and the USA [two databases]). PARTICIPANTS Eligible participants (≥18 years old) had ≥2 consecutive estimated glomerular filtration rate (eGFR) measurements (calculated from serum creatinine values, sex and age) taken from 2015 onwards that were indicative of stage 3 CKD (≥30 and <60 mL/min/1.73 m2). Undiagnosed cases lacked an International Classification of Diseases 9/10 diagnosis code for CKD (any stage) any time before, and up to 6 months after, the second qualifying eGFR measurement (study index). MAIN OUTCOME MEASURES The primary outcome was point prevalence of undiagnosed stage 3 CKD. Time to diagnosis was assessed using the Kaplan-Meier approach. Factors associated with lacking a CKD diagnosis and risk of diagnostic delay were assessed using logistic regression adjusted for baseline covariates. RESULTS The prevalence of undiagnosed stage 3 CKD was 95.5% (19 120/20 012 patients) in France, 84.3% (22 557/26 767) in Germany, 77.0% (50 547/65 676) in Italy, 92.1% (83 693/90 902) in Japan, 61.6% (13 845/22 470) in the US Explorys Linked Claims and Electronic Medical Records Data database and 64.3% (161 254/250 879) in the US TriNetX database. The prevalence of undiagnosed CKD increased with age. Factors associated with undiagnosed CKD were female sex (vs male, range of odds ratios across countries: 1.29-1.77), stage 3a CKD (vs 3b, 1.81-3.66), no medical history (vs a history) of diabetes (1.26-2.77) or hypertension (1.35-1.78). CONCLUSIONS There are substantial opportunities to improve stage 3 CKD diagnosis, particularly in female patients and older patients. The low diagnosis rates in patients with comorbidities that put them at risk of disease progression and complications require attention. TRIAL REGISTRATION NCT04847531.
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Affiliation(s)
- Navdeep Tangri
- Department of Internal Medicine, University of Manitoba, Winnipeg, Manitoba, Canada
| | | | - Markus P Schneider
- Department of Nephrology and Hypertension, Erlangen University Hospital, Erlangen, Germany
| | | | - Luca De Nicola
- Department of Advanced Medical and Surgical Sciences, Nephrology and Dialysis Unit, Università degli Studi della Campania Luigi Vanvitelli, Napoli, Italy
| | - Matthew Arnold
- Real World Evidence Data & Analytics, BioPharmaceuticals Medical, AstraZeneca, Cambridge, UK
| | - Salvatore Barone
- Global Medical Affairs, BioPharmaceuticals Medical, AstraZeneca, Gaithersburg, Maryland, USA
| | - Emily Peach
- Cardiovascular, Renal and Metabolism Epidemiology, BioPharmaceuticals Medical, AstraZeneca, Cambridge, UK
| | - Eric Wittbrodt
- Cardiovascular, Renal and Metabolism Medical Affairs, BioPharmaceuticals Medical, AstraZeneca, Gaithersburg, Maryland, USA
| | - Hungta Chen
- Medical/Payer Evidence Statistics, BioPharmaceuticals Medical, AstraZeneca, Gaithersburg, Maryland, USA
| | - Krister Järbrink
- Cardiovascular, Renal and Metabolism Evidence, BioPharmaceuticals Medical, AstraZeneca, Gothenburg, Sweden
| | - Pamela Kushner
- Department of Family Medicine, University of California Irvine Medical Center, Orange, California, USA
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De Nicola L, Peach E, Barone S, Ripellino C, Heiman F, Tangri N. MO509: Reveal-CKD: Prevalence of Undiagnosed Stage 3 Chronic Kidney Disease Italy. Nephrol Dial Transplant 2022. [DOI: 10.1093/ndt/gfac071.040] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Abstract
BACKGROUND AND AIMS
Chronic kidney disease (CKD) is a serious progressive disease with a substantial impact on global health that affects ∼10% of the world's population. However, CKD remains largely under-recognized. Effective actions to slow disease progression and improve outcomes depend on timely detection and diagnosis before a further decline in estimated glomerular filtration rate (eGFR). The aim of the REVEAL-CKD study is to assess the prevalence of, and factors associated with, undiagnosed early (stage 3) CKD.
METHOD
REVEAL-CKD is a multi-national, multi-regional observational study using secondary data from electronic medical records and claims databases. In this analysis, we extracted data regarding patient demographics, laboratory tests, diagnoses and treatments from an Italian electronic medical record database, the Italian Longitudinal Patients Database (IQVIA, Italy). The Italian Longitudinal Patients Database consists of anonymised patient records collected from routine visits to general practitioners and represents ∼900 general practitioners and 1.2 million patients across Italy. The study cohort included patients aged ≥18 years between 2015–21 with two consecutive estimated glomerular filtration rate (eGFR) results ≥30 and <60 mL/min/1.73 m2 recorded >90 and ≤730 days apart. The date of the second qualifying eGFR was defined as the index date. Patients with no presence of a CKD diagnostic code recorded any time before their first qualifying eGFR and up to 6 months after their second qualifying eGFR were considered to be undiagnosed. The prevalence of undiagnosed CKD was calculated as the ratio of undiagnosed patients to all patients who met the study inclusion criteria.
RESULTS
The study cohort included 65 676 patients who met the eGFR criteria for stage 3 CKD. The mean age at index date was 79 years (standard deviation: 9 years) and 58% were female. The overall prevalence of undiagnosed CKD was 77.0% [95% confidence interval (CI): 76.6–77.3]. The prevalence of undiagnosed CKD was greater in patients with stage 3a CKD (83.0%) compared with those with stage 3b CKD (64.8%). Female patients and those aged > 65 years showed a higher prevalence of undiagnosed CKD, and the prevalence of undiagnosed CKD ranged from 66.6% to 75.7% in patients with pre-existing comorbidities (Table 1). In patients who were undiagnosed at the index date (n = 52 533), 15.5% (n = 8152) were diagnosed with CKD after the index date, with a median time to diagnosis of 404 days (IQR: 389–418 days); 84.5% (n = 44 381) remained undiagnosed.
CONCLUSION
This study indicates that a high proportion of patients with stage 3 CKD are undiagnosed by their general practitioners, with inequity noted for females and older patients. Underdiagnosis of CKD persisted in those with known risk factors for CKD such as diabetes, heart failure and hypertension. With the availability of targeted evidence-based therapies to decrease the risk of disease progression and improve patient outcomes, there is a clear need to proactively detect, diagnose and intervene in patients with early-stage CKD.
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Affiliation(s)
- Luca De Nicola
- Nephrology Unit, University of Campania `Luigi Vanvitelli’, Napoli, Italy
| | - Emily Peach
- CVRM Epidemiology, CVRM Therapy Area, BioPharmaceuticals Medical, AstraZeneca Academy House, Cambridge, UK
| | - Salvatore Barone
- AstraZeneca, Global Medical Affairs, CVRM Therapy Area, BioPharmaceuticals Medical, Gaithersburg, MD, USA
| | | | | | - Navdeep Tangri
- Max Rady College of Medicine, University of Manitoba, Winnipeg, Canada
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Moriyama T, Schneider M, Virgitti JBJ, Peach E, Barone S, Kumar S, Tangri N. UNDIAGNOSED STAGE 3 CHRONIC KIDNEY DISEASE IN PATIENTS WITH A HISTORY OF HEART FAILURE: A REPORT FROM REVEAL-CKD. J Am Coll Cardiol 2022. [DOI: 10.1016/s0735-1097(22)01431-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
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Kushner P, Peach E, Wittbrodt E, Barone S, Chen H, Sanchez JJG, Järbrink K, Arnold M, Tangri N. Investigating the global prevalence and consequences of undiagnosed stage 3 chronic kidney disease: methods and rationale for the REVEAL-CKD study. Clin Kidney J 2021; 15:738-746. [PMID: 35371463 PMCID: PMC8967537 DOI: 10.1093/ckj/sfab235] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2021] [Indexed: 12/03/2022] Open
Abstract
Background Timely diagnosis and treatment of stage 3 chronic kidney disease (CKD) can prevent further loss of kidney function and progression to kidney failure. However, contemporary data on the global prevalence of undiagnosed stage 3 CKD are scarce. REVEAL-CKD is a multinational, multifocal and observational study aiming to provide insights into undiagnosed stage 3 CKD in a large population. Methods Patients (aged ≥18 years) with data in selected secondary databases from 11 countries will be included if they have at least two estimated glomerular filtration rate (eGFR) measurements from 2015 onwards that are ≥30 and <60 mL/min/1.73 m2, recorded >90 and ≤730 days apart. Undiagnosed cases are those without an International Classification of Diseases 9/10 diagnosis code for CKD (any stage) any time before and up to 6 months after the second qualifying eGFR measurement. Time to diagnosis will be assessed using a Kaplan–Meier approach; patient characteristics associated with undiagnosed CKD will be assessed using adjusted logistical regression analyses. Results REVEAL-CKD will assess the point prevalence of undiagnosed stage 3 CKD and time to CKD diagnosis in initially undiagnosed cases overall and in individual countries. Trends in undiagnosed CKD prevalence by calendar year will be assessed. Patient characteristics, healthcare resource utilization, adverse clinical outcomes, and CKD management and monitoring practices in patients with versus without a CKD diagnosis will be compared. Conclusions REVEAL-CKD will increase awareness of the global clinical and economic burden of undiagnosed stage 3 CKD and provide valuable insights to inform clinical practice and policy changes.
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Affiliation(s)
| | - Emily Peach
- Cardiovascular, Renal and Metabolism Epidemiology, BioPharmaceuticals Medical, AstraZeneca, Cambridge, UK
| | - Eric Wittbrodt
- Cardiovascular, Renal and Metabolism Medical Affairs, BioPharmaceuticals Medical, AstraZeneca, Gaithersburg, MD, USA
| | - Salvatore Barone
- Global Medical Affairs, BioPharmaceuticals Medical, AstraZeneca, Gaithersburg, MD, USA
| | - Hungta Chen
- Medical/Payer Evidence Statistics, BioPharmaceuticals Medical, AstraZeneca, Gaithersburg, MD, USA
| | | | - Krister Järbrink
- Cardiovascular, Renal and Metabolism Evidence, BioPharmaceuticals Medical, AstraZeneca, Gothenburg, Mölndal, Sweden
| | - Matthew Arnold
- Real World Evidence Data & Analytics, BioPharmaceuticals Medical, AstraZeneca, Cambridge, UK
| | - Navdeep Tangri
- Department of Internal Medicine, University of Manitoba, Winnipeg, MB, Canada
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7
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Rutter M, Lanyon PC, Grainge MJ, Hubbard R, Peach E, Bythell M, Stilwell P, Aston J, Stevens S, Pearce FA. COVID-19 Infection, Admission and Death Amongst People with Rare Autoimmune Rheumatic Disease in England. Results from the RECORDER Project. Rheumatology (Oxford) 2021; 61:3161-3171. [PMID: 34698821 PMCID: PMC8586729 DOI: 10.1093/rheumatology/keab794] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2021] [Revised: 10/17/2021] [Indexed: 11/13/2022] Open
Abstract
Objectives To calculate the rates of COVID-19 infection and COVID-19-related death among people with rare autoimmune rheumatic diseases (RAIRD) during the first wave of the COVID-19 pandemic in England compared with the general population. Methods We used Hospital Episode Statistics to identify all people alive 01 March 2020 with ICD-10 codes for RAIRD from the whole population of England. We used linked national health records (demographic, death certificate, admissions and PCR testing data) to calculate rates of COVID-19 infection and death up to 31 July 2020. Our primary definition of COVID-19-related death was mention of COVID-19 on the death certificate. General population data from Public Health England and the Office for National Statistics were used for comparison. We also describe COVID-19-related hospital admissions and all-cause deaths. Results We identified a cohort of 168 680 people with RAIRD, of whom 1874 (1.11%) had a positive COVID-19 PCR test. The age-standardised infection rate was 1.54 (95% CI 1.50–1.59) times higher than in the general population. 713 (0.42%) people with RAIRD died with COVID-19 on their death certificate and the age-sex-standardised mortality rate for COVID-19-related death was 2.41 (2.30–2.53) times higher than in the general population. There was no evidence of an increase in deaths from other causes in the RAIRD population. Conclusions During the first wave of COVID-19 in England, people with RAIRD had a 54% increased risk of COVID-19 infection and more than twice the risk of COVID-19-related death compared with the general population. These increases were seen despite shielding policies.
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Affiliation(s)
- Megan Rutter
- Department of Population and Lifespan Sciences, School of Medicine, University of Nottingham, Nottingham, UK.,Department of Rheumatology, Nottingham University Hospitals NHS Trust, Nottingham, UK
| | - Peter C Lanyon
- Department of Population and Lifespan Sciences, School of Medicine, University of Nottingham, Nottingham, UK.,Department of Rheumatology, Nottingham University Hospitals NHS Trust, Nottingham, UK.,National Congenital Anomaly and Rare Disease Registration Service, National Disease Registration Service, Public Health England, UK.,National Institute for Health Research (NIHR) Nottingham Biomedical Research Centre, Nottingham, UK
| | - Matthew J Grainge
- Department of Population and Lifespan Sciences, School of Medicine, University of Nottingham, Nottingham, UK
| | - Richard Hubbard
- Department of Population and Lifespan Sciences, School of Medicine, University of Nottingham, Nottingham, UK.,National Institute for Health Research (NIHR) Nottingham Biomedical Research Centre, Nottingham, UK
| | - Emily Peach
- Department of Population and Lifespan Sciences, School of Medicine, University of Nottingham, Nottingham, UK
| | - Mary Bythell
- National Congenital Anomaly and Rare Disease Registration Service, National Disease Registration Service, Public Health England, UK
| | - Peter Stilwell
- National Congenital Anomaly and Rare Disease Registration Service, National Disease Registration Service, Public Health England, UK
| | - Jeanette Aston
- National Congenital Anomaly and Rare Disease Registration Service, National Disease Registration Service, Public Health England, UK
| | - Sarah Stevens
- National Congenital Anomaly and Rare Disease Registration Service, National Disease Registration Service, Public Health England, UK
| | - Fiona A Pearce
- Department of Population and Lifespan Sciences, School of Medicine, University of Nottingham, Nottingham, UK.,Department of Rheumatology, Nottingham University Hospitals NHS Trust, Nottingham, UK.,National Congenital Anomaly and Rare Disease Registration Service, National Disease Registration Service, Public Health England, UK.,National Institute for Health Research (NIHR) Nottingham Biomedical Research Centre, Nottingham, UK
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Adizie JB, Tweedie J, Khakwani A, Peach E, Hubbard R, Wood N, Gosney JR, Harden SV, Beckett P, Popat S, Navani N. Biomarker Testing for People With Advanced Lung Cancer in England. JTO Clin Res Rep 2021; 2:100176. [PMID: 34590024 PMCID: PMC8474239 DOI: 10.1016/j.jtocrr.2021.100176] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2021] [Revised: 03/28/2021] [Accepted: 04/06/2021] [Indexed: 12/25/2022] Open
Abstract
Introduction Optimal management of people with advanced NSCLC depends on accurate identification of predictive markers. Yet, real-world data in this setting are limited. We describe the impact, timeliness, and outcomes of molecular testing for patients with advanced NSCLC and good performance status in England. Methods In collaboration with Public Health England, patients with stages IIIB to IV NSCLC, with an Eastern Cooperative Oncology Group performance status of 0 to 2, in England, between June 2017 and December 2017, were identified. All English hospitals were invited to record information. Results A total of 60 of 142 invited hospitals in England participated in this study and submitted data on 1157 patients. During the study period, 83% of patients with advanced adenocarcinoma underwent molecular testing for three recommended predictive biomarkers (EGFR, ALK, and programmed death-ligand 1). A total of 80% of patients with nonsquamous carcinomas on whom biomarker testing was performed had adequate tissue for analysis on initial sampling. First-line treatment with a tyrosine kinase inhibitor was received by 71% of patients with adenocarcinoma and a sensitizing EGFR mutation and by 59% of those with an ALK translocation. Of patients with no driver mutation and a programmed death-ligand 1 expression of greater than or equal to 50%, 47% received immunotherapy. Conclusions We present a comprehensive data set for molecular testing in England. Although molecular testing is well established in England, timeliness and uptake of targeted therapies should be improved.
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Affiliation(s)
- Jana B Adizie
- Department of Respiratory Medicine, University Hospitals Birmingham, NHS Foundation Trust, Birmingham, United Kingdom
| | - Judith Tweedie
- Department of Cardiovascular Medicine, Royal Victoria Hospital, Belfast Health and Social Care Trust, Belfast, United Kingdom
| | - Aamir Khakwani
- Division of Epidemiology and Public Health, School of Medicine, University of Nottingham, City Hospital, Nottingham, United Kingdom
| | - Emily Peach
- Division of Epidemiology and Public Health, School of Medicine, University of Nottingham, City Hospital, Nottingham, United Kingdom
| | - Richard Hubbard
- Division of Epidemiology and Public Health, School of Medicine, University of Nottingham, City Hospital, Nottingham, United Kingdom
| | - Natasha Wood
- Public Health England, National Cancer Registration and Analysis Service, London, United Kingdom
| | - John R Gosney
- Department of Cellular Pathology, Royal Liverpool University Hospital, Liverpool, United Kingdom
| | - Susan V Harden
- Cancer Research Program, School of Public Health and Preventative Medicine, Monash University, Melbourne, Australia
| | - Paul Beckett
- Department of Respiratory Medicine, Royal Derby Hospital, University Hospitals of Derby and Burton NHS Foundation Trust, Derby, United Kingdom
| | - Sanjay Popat
- Department of Medicine, Royal Marsden NHS Foundation Trust, London, United Kingdom
| | - Neal Navani
- Lungs for Living Research Centre, UCL Respiratory, University College London, London, United Kingdom.,Department of Thoracic Medicine, University College London Hospital, London, United Kingdom
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9
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Rutter M, Lanyon PC, Peach E, Grainge MJ, Hubbard RB, Aston J, Bythell M, Stevens S, Pearce FA. P054 Risk of death during the 2020 UK COVID-19 epidemic among people with rare diseases compared to the general population. Rheumatology (Oxford) 2021. [PMCID: PMC8135480 DOI: 10.1093/rheumatology/keab247.051] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Abstract
Background/Aims
To quantify the risk of death among people with rare autoimmune rheumatic diseases (RAIRD) during the UK 2020 COVID-19 epidemic compared with baseline risk and the risk of death in the general population during COVID-19.
Methods
A cohort study was performed using data from the National Congenital Anomaly and Rare Disease Registration Service (NCARDRS). Coded diagnoses for RAIRD were identified from Hospital Episode Statistics from 2003 onwards. Previous coding validation work demonstrated our case ascertainment methods had a positive predictive value >85%. ONS published data were used for general population mortality rates. The main outcome measure was age-standardised mortality rates (ASMRs) for all-cause death. Secondary outcome measures were age-sex standardised mortality rates, and age-stratified mortality rates.
Results
168,691 people with RAIRD were alive on 1 March 2020. Their median age was 61.7 (IQR 41.5-75.4) years, and 118,379 (70.2%) were female. 1,815 (1.1%) people with RAIRD died during March and April 2020. The ASMR among people with RAIRD was 3669.3 (95% CI 3500.4-3838.1) per 100,000 person-years, which was 1.44 (95% CI 1.42-1.45) times higher than the average ASMR during the same months of the previous 5 years. In the whole population of England, the ASMR during March and April 2020 was 1361.1 (1353.6- 1368.7) per 100,000 people, which was 1.38 times higher than the average ASMR during the same months of the previous 5 years (see related abstract about influenza seasons). Unlike in the general population, sex-specific rates in RAIRD were similar in males and females. When comparing risk of death during COVID-19 to pre-COVID-19, people with RAIRD had an increased risk of death from age 35 upwards, compared to around age 55 upwards in the general population. As the protective effect of being female was not seen in RAIRD, the group at the largest increased risk compared to their pre-COVID-19 risk were women aged 35 upwards. The absolute risk of all-cause death for someone aged 20-29 with RAIRD was similar to someone in the general population aged >20 years older, someone aged 40-49 years with RAIRD similar to someone in the general population 20 years older, and someone aged 60-69 with RAIRD similar to someone in the general population aged >10 years older.
Conclusion
The excess risk of all-cause death during COVID-19 occurs at a younger age among people with RAIRD than among the general population, and particularly affects females. . We urgently need to quantify how much risk is due to COVID-19 infection and how much due to disruption to healthcare services to inform better guidance about shielding, access to healthcare and vaccine priorities for people with rare diseases.
Disclosure
M. Rutter: None. P.C. Lanyon: None. E. Peach: None. M.J. Grainge: None. R.B. Hubbard: None. J. Aston: None. M. Bythell: None. S. Stevens: None. F.A. Pearce: None.
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Affiliation(s)
- Megan Rutter
- University of Nottingham, Epidemiology and Public Health, Nottingham, UNITED KINGDOM
| | - Peter C Lanyon
- University of Nottingham, Epidemiology and Public Health, Nottingham, UNITED KINGDOM
- Rheumatology, Nottingham University Hospitals NHS Trust, Nottingham, UNITED KINGDOM
| | - Emily Peach
- University of Nottingham, Epidemiology and Public Health, Nottingham, UNITED KINGDOM
| | - Matthew J Grainge
- University of Nottingham, Epidemiology and Public Health, Nottingham, UNITED KINGDOM
| | - Richard B Hubbard
- University of Nottingham, Epidemiology and Public Health, Nottingham, UNITED KINGDOM
| | - Jeanette Aston
- National Congenital Anomaly and Rare Disease Registration Service, National Disease Registration Service, Public Health England, London, UNITED KINGDOM
| | - Mary Bythell
- National Congenital Anomaly and Rare Disease Registration Service, National Disease Registration Service, Public Health England, London, UNITED KINGDOM
| | - Sarah Stevens
- National Congenital Anomaly and Rare Disease Registration Service, National Disease Registration Service, Public Health England, London, UNITED KINGDOM
| | - Fiona A Pearce
- University of Nottingham, Epidemiology and Public Health, Nottingham, UNITED KINGDOM
- Rheumatology, Nottingham University Hospitals NHS Trust, Nottingham, UNITED KINGDOM
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Peach E, Rutter M, Lanyon P, Grainge MJ, Hubbard R, Aston J, Bythell M, Stevens S, Pearce F. Risk of death among people with rare autoimmune diseases compared with the general population in England during the 2020 COVID-19 pandemic. Rheumatology (Oxford) 2021; 60:1902-1909. [PMID: 33271595 PMCID: PMC7798585 DOI: 10.1093/rheumatology/keaa855] [Citation(s) in RCA: 33] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2020] [Revised: 11/21/2020] [Indexed: 01/28/2023] Open
Abstract
Objectives To quantify the risk of death among people with rare autoimmune rheumatic diseases (RAIRD) during the UK 2020 COVID-19 pandemic compared with the general population, and compared with their pre-COVID risk. Methods We conducted a cohort study in Hospital Episode Statistics for England 2003 onwards, and linked data from the NHS Personal Demographics Service. We used ONS published data for general population mortality rates. Results We included 168 691 people with a recorded diagnosis of RAIRD alive on 01/03/2020. Their median age was 61.7 (IQR 41.5–75.4) years, and 118 379 (70.2%) were female. Our case ascertainment methods had a positive predictive value of 85%. 1,815 (1.1%) participants died during March and April 2020. The age-standardised mortality rate (ASMR) among people with RAIRD (3669.3, 95% CI 3500.4–3838.1 per 100 000 person-years) was 1.44 (95% CI 1.42–1.45) times higher than the average ASMR during the same months of the previous 5 years, whereas in the general population of England it was 1.38 times higher. Age-specific mortality rates in people with RAIRD compared with the pre-COVID rates were higher from the age of 35 upwards, whereas in the general population the increased risk began from age 55 upwards. Women had a greater increase in mortality rates during COVID-19 compared with men. Conclusion The risk of all-cause death is more prominently raised during COVID-19 among people with RAIRD than among the general population. We urgently need to quantify how much risk is due to COVID-19 infection and how much is due to disruption to healthcare services.
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Affiliation(s)
- Emily Peach
- Division of Epidemiology and Public Health, University of Nottingham, UK
| | - Megan Rutter
- Division of Epidemiology and Public Health, University of Nottingham, UK
| | - Peter Lanyon
- Division of Epidemiology and Public Health, University of Nottingham, UK.,Nottingham University Hospitals NHS Trust, Nottingham, UK.,National Institute for Health Research (NIHR), Nottingham Biomedical Research Centre, UK
| | - Matthew J Grainge
- Division of Epidemiology and Public Health, University of Nottingham, UK
| | - Richard Hubbard
- Division of Epidemiology and Public Health, University of Nottingham, UK
| | - Jeanette Aston
- National Disease Registration Service, Public Health England, UK
| | - Mary Bythell
- National Disease Registration Service, Public Health England, UK
| | - Sarah Stevens
- National Disease Registration Service, Public Health England, UK
| | - Fiona Pearce
- Division of Epidemiology and Public Health, University of Nottingham, UK.,Nottingham University Hospitals NHS Trust, Nottingham, UK.,National Institute for Health Research (NIHR), Nottingham Biomedical Research Centre, UK
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Harden S, Peach E, Beckett P, Navani N. P09.22 Curative Intent Treatment for Small Cell Lung Cancer in England. J Thorac Oncol 2021. [DOI: 10.1016/j.jtho.2021.01.450] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
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McMeniman EK, Peach E, Lee KJ, Yanes T, Jagirdar K, Stark MS, Soyer HP, Duffy DL, McInerney-Leo AM, Sturm RA. CDKN2A testing threshold in a high-risk Australian melanoma cohort: number of primaries, family history and young age of onset impact risk. J Eur Acad Dermatol Venereol 2020; 34:e797-e798. [PMID: 32386439 DOI: 10.1111/jdv.16627] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Affiliation(s)
- E K McMeniman
- Dermatology Research Centre, The University of Queensland, The University of Queensland Diamantina Institute, Brisbane, QLD, Australia.,Dermatology Department, Princess Alexandra Hospital, Brisbane, QLD, Australia
| | - E Peach
- Dermatology Research Centre, The University of Queensland, The University of Queensland Diamantina Institute, Brisbane, QLD, Australia
| | - K J Lee
- Dermatology Research Centre, The University of Queensland, The University of Queensland Diamantina Institute, Brisbane, QLD, Australia
| | - T Yanes
- Dermatology Research Centre, The University of Queensland, The University of Queensland Diamantina Institute, Brisbane, QLD, Australia
| | - K Jagirdar
- Dermatology Research Centre, The University of Queensland, The University of Queensland Diamantina Institute, Brisbane, QLD, Australia
| | - M S Stark
- Dermatology Research Centre, The University of Queensland, The University of Queensland Diamantina Institute, Brisbane, QLD, Australia
| | - H P Soyer
- Dermatology Research Centre, The University of Queensland, The University of Queensland Diamantina Institute, Brisbane, QLD, Australia.,Dermatology Department, Princess Alexandra Hospital, Brisbane, QLD, Australia
| | - D L Duffy
- Dermatology Research Centre, The University of Queensland, The University of Queensland Diamantina Institute, Brisbane, QLD, Australia.,QIMR Berghofer Medical Research Institute, Brisbane, QLD, Australia
| | - A M McInerney-Leo
- Dermatology Research Centre, The University of Queensland, The University of Queensland Diamantina Institute, Brisbane, QLD, Australia
| | - R A Sturm
- Dermatology Research Centre, The University of Queensland, The University of Queensland Diamantina Institute, Brisbane, QLD, Australia
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McMeniman EK, Duffy DL, Jagirdar K, Lee KJ, Peach E, McInerney-Leo AM, De'Ambrosis B, Rayner JE, Smithers BM, Soyer HP, Sturm RA. The interplay of sun damage and genetic risk in Australian multiple and single primary melanoma cases and controls. Br J Dermatol 2020; 183:357-366. [PMID: 31794051 DOI: 10.1111/bjd.18777] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/02/2019] [Indexed: 12/31/2022]
Abstract
BACKGROUND Skin phenotype, host genotype and ultraviolet (UV) damage play a role in the development of melanoma. OBJECTIVES To ascertain whether the level of UV damage at the site of melanomas was associated with genetic polymorphisms. METHODS Deep phenotyping was performed on 1244 individuals; 281 with multiple primary melanomas (MPMs), 304 with single primary melanoma (SPM) and 659 convenience controls. Genotype data was generated using the Illumina CoreExome microarray platform, assaying over 500 000 single-nucleotide polymorphisms. A subset of variants were combined to assess a polygenic risk score (PRS) for melanoma. RESULTS Most MPM cases were diagnosed in patients aged > 40 years, in sites with visible chronic UV damage. Women and those diagnosed at age ≤ 40 years were less likely to have perilesional UV damage. Patients with MPM had higher frequencies of MITF E318K, MC1R R-alleles and the ASIP risk haplotype. Individuals who had melanoma in a visibly UV-damaged site were more likely to carry MC1R rs75570604 [odds ratio (OR) 2·5], 9q31.2 rs10816595 (OR 1·4) and MTAP rs869329 (OR 1·4). These same alleles were more common in patients with MPM who were diagnosed at age ≤ 40 years. The mean PRS was significantly higher in MPM than in SPM and controls. Naevus count was comparable in early-onset MPM cases and those diagnosed at age > 40 years. CONCLUSIONS Our cohort demonstrated higher frequencies of previously reported alleles associated with melanoma. MPM melanomas more commonly occur in UV-damaged areas, and these individuals are more likely to carry MC1R red hair colour alleles. Awareness of the interplay of genetic vulnerability with UV damage can stratify risk and guide recommendations for melanoma screening. What's already known about this topic? Skin phenotype, host genotype and ultraviolet (UV) damage all play a role in melanoma development. One of the main risk factors is a personal history of melanoma; second and subsequent primary melanomas account for over 20% of all melanomas registered in Queensland. Multiple loci are associated with melanoma risk, including many low-penetrance loci, which may have a cumulatively significant risk. Population-wide screening programmes for melanoma are not yet economically viable. What does this study add? Patients diagnosed with melanoma at age ≤ 40 years were more likely than older patients to have melanomas in non-UV-damaged sites. Patients with multiple melanomas had higher frequencies of MITF E318K, MC1R R-alleles, and the ASIP extended risk haplotype than patients with single melanoma. CDKN2A, MC1R and MTAP variants were more frequent in patients who developed melanomas at a younger age, but also in those whose melanomas were all on visibly UV-damaged sites. What is the translational message? Incorporating these genetic findings into the known risk factors of skin phenotype and visible UV damage may allow for a more customized and economically feasible approach to early detection of melanoma, particularly in younger patients. Plain language summary available online.
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Affiliation(s)
- E K McMeniman
- Dermatology Research Centre, The University of Queensland Diamantina Institute, Brisbane, Queensland, Australia.,Dermatology Department, Princess Alexandra Hospital, Brisbane, Queensland, Australia
| | - D L Duffy
- Dermatology Research Centre, The University of Queensland Diamantina Institute, Brisbane, Queensland, Australia.,QIMR Berghofer Medical Research Institute, Brisbane, Queensland, Australia
| | - K Jagirdar
- Dermatology Research Centre, The University of Queensland Diamantina Institute, Brisbane, Queensland, Australia
| | - K J Lee
- Dermatology Research Centre, The University of Queensland Diamantina Institute, Brisbane, Queensland, Australia
| | - E Peach
- Dermatology Research Centre, The University of Queensland Diamantina Institute, Brisbane, Queensland, Australia
| | - A M McInerney-Leo
- Dermatology Research Centre, The University of Queensland Diamantina Institute, Brisbane, Queensland, Australia
| | - B De'Ambrosis
- Faculty of Medicine, The University of Queensland, Brisbane, Queensland, Australia.,Dermatology Department, Princess Alexandra Hospital, Brisbane, Queensland, Australia.,South East Dermatology, Annerley Square, Annerley, Brisbane, Queensland, Australia
| | - J E Rayner
- Dermatology Research Centre, The University of Queensland Diamantina Institute, Brisbane, Queensland, Australia
| | - B M Smithers
- Queensland Melanoma Project, School of Medicine, The University of Queensland, Brisbane, Queensland, Australia
| | - H P Soyer
- Dermatology Research Centre, The University of Queensland Diamantina Institute, Brisbane, Queensland, Australia.,Dermatology Department, Princess Alexandra Hospital, Brisbane, Queensland, Australia
| | - R A Sturm
- Dermatology Research Centre, The University of Queensland Diamantina Institute, Brisbane, Queensland, Australia
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Peach E, Martin J. Utilising implementation intentions to promote healthy eating in adolescents. Health Psychol Behav Med 2017. [DOI: 10.1080/21642850.2016.1256211] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022] Open
Affiliation(s)
- Emily Peach
- School of Pharmacy, University of Nottingham, Nottingham, UK
| | - Jilly Martin
- Department of Psychology, University of Sheffield, Sheffield, UK
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Peach E, O'Leary M. Sports nutrition--fact or falacy. Part I. RN Ida 1980; 4:4, 8. [PMID: 6968966] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 01/22/2023]
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Peach E. Community health clinics. RN Ida 1979; 3:4-5. [PMID: 316568] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
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