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Tuesley KM, Spilsbury K, Webb PM, Protani MM, Dixon-Suen S, Pearson SA, Donovan P, Coory MD, Steer CB, Stewart LM, Pandeya N, Jordan SJ. Association between antihypertensive medicine use and risk of ovarian cancer in women aged 50 years and older. Cancer Epidemiol 2023; 86:102444. [PMID: 37595337 DOI: 10.1016/j.canep.2023.102444] [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] [Subscribe] [Scholar Register] [Received: 04/04/2023] [Revised: 08/06/2023] [Accepted: 08/10/2023] [Indexed: 08/20/2023]
Abstract
BACKGROUND Epithelial ovarian cancer (EOC) has few modifiable risk factors. There is evidence that some antihypertensive medicines may have cancer preventive and/or therapeutic actions; therefore, we assessed the associations between use of different antihypertensive medicines and risk of specific EOC histotypes. METHODS Our nested case-control study of linked administrative health data included 6070 Australian women aged over 50 years diagnosed with EOC from 2004 to 2013, and 30,337 matched controls. We used multivariable conditional logistic regression to estimate odds ratios (ORs) and 95 % confidence intervals (CIs) for the association between ever use of each antihypertensive medicine group, including beta-adrenergic blockers, angiotensin converting enzyme inhibitors, angiotensin II receptor blockers, calcium channel blockers, diuretics, and alpha blockers, and the risk of EOC overall and separately for the serous, endometrioid, mucinous, clear cell and other histotypes. RESULTS We found that most antihypertensive medicines were not associated with risk of EOC. However, women who used calcium channel blockers had a reduced risk of serous EOC (OR= 0.89, 95 % CI:0.81,0.98) and use of combination thiazide and potassium-sparing diuretics was associated with an increased risk of endometroid EOC (OR= 2.09, 95 % CI:1.15,3.82). CONCLUSION Our results provide little support for a chemo-preventive role for most antihypertensives, however, the histotype-specific associations we found warrant further investigation.
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Affiliation(s)
- Karen M Tuesley
- School of Public Health, Faculty of Medicine, University of Queensland, Brisbane, Australia; Population Health Program, QIMR Berghofer Medical Research Institute, Brisbane, Australia.
| | - Katrina Spilsbury
- Institute for Health Research, The University of Notre Dame Australia, Fremantle, Australia
| | - Penelope M Webb
- School of Public Health, Faculty of Medicine, University of Queensland, Brisbane, Australia; Population Health Program, QIMR Berghofer Medical Research Institute, Brisbane, Australia
| | - Melinda M Protani
- School of Public Health, Faculty of Medicine, University of Queensland, Brisbane, Australia
| | - Suzanne Dixon-Suen
- Institute for Physical Activity and Nutrition, Deakin University, Geelong, Victoria, Australia; Cancer Epidemiology Division, Cancer Council Victoria, Melbourne, Australia
| | - Sallie-Anne Pearson
- School of Population Health, University of New South Wales, Sydney, Australia; Centre of Research Excellence in Medicines Intelligence, University of New South Wales, Sydney, Australia
| | - Peter Donovan
- Clinical Pharmacology Department, Royal Brisbane and Women's Hospital, Brisbane, Australia; Faculty of Medicine, University of Queensland, Brisbane, Australia
| | - Michael D Coory
- Faculty of Medicine, Dentistry and Health Sciences, University of Melbourne, Melbourne, Australia
| | - Christopher B Steer
- Border Medical Oncology, Albury-Wodonga Regional Cancer Centre, Albury, Australia; University of NSW Rural Clinical School, Albury Campus, Albury, New South Wales, Australia
| | - Louise M Stewart
- School of Population and Global Health, The University of Western Australia, Perth, Australia
| | - Nirmala Pandeya
- School of Public Health, Faculty of Medicine, University of Queensland, Brisbane, Australia; Population Health Program, QIMR Berghofer Medical Research Institute, Brisbane, Australia
| | - Susan J Jordan
- School of Public Health, Faculty of Medicine, University of Queensland, Brisbane, Australia; Population Health Program, QIMR Berghofer Medical Research Institute, Brisbane, Australia
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Spilsbury K, Tuesley KM, Pearson SA, Coory MD, Donovan P, Steer CB, Stewart LM, Pandeya N, Jordan SJ. Perioperative Beta-Blocker Supply and Survival in Women With Epithelial Ovarian Cancer and a History of Cardiovascular Conditions. J Clin Oncol 2023; 41:266-275. [PMID: 36001852 DOI: 10.1200/jco.22.00097] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/10/2023] Open
Abstract
PURPOSE Surgery for epithelial ovarian cancer (EOC) may activate stress-inflammatory responses that stimulate tumor growth and increase metastatic growth. Animal and in vitro studies have shown that inhibition of the catecholamine-induced inflammatory response via beta-adrenergic receptor blockade has antitumor potential in EOC. However, observational studies have reported mixed results. We assessed whether beta-blocker (BB) use at the time of primary ovarian cancer surgery was associated with improved survival in a large population-based study. MATERIALS AND METHODS Using linked administrative data, a population-based cohort of 3,844 Australian women age 50 years or older with a history of cardiovascular conditions who underwent surgery for EOC was followed for survival outcomes. The average treatment effect of selective BB (SBB) and nonselective BB (NSBB) supply at the time of surgery on survival was estimated from a causal inference perspective using covariate-balanced inverse probability of treatment weights with flexible parametric survival models that allowed for time-varying survival effects. RESULTS Around the time of surgery, 560 (14.5%) women were supplied a SBB and 67 (1.7%) were supplied a NSBB. At 2 years postsurgery, the survival proportion was 80% (95% CI, 68 to 88) for women dispensed NSBBs at surgery compared with 69% (95% CI, 67 to 70) for women not supplied NSBBs. The survival advantage appeared to extend to at least 8 years postsurgery. No association was observed for women dispensed a SBB around the time of surgery. CONCLUSION Perioperative supply of NSBBs appeared to confer a survival advantage for women age over 50 years with a history of cardiovascular conditions. Long-term clinical trials are required to confirm these findings.
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Affiliation(s)
- Katrina Spilsbury
- Institute for Health Research, The University of Notre Dame Australia, Fremantle, Australia.,School of Public Health, Faculty of Medicine, University of Queensland, Brisbane, Australia
| | - Karen M Tuesley
- School of Public Health, Faculty of Medicine, University of Queensland, Brisbane, Australia.,Population Health Department, QIMR Berghofer Medical Research Institute, Brisbane, Australia
| | - Sallie-Anne Pearson
- Centre for Big Data Research in Health, The University of New South Wales, Sydney, Australia
| | - Michael D Coory
- Faculty of Medicine, Dentistry and Health Sciences University of Melbourne, Melbourne, Australia
| | - Peter Donovan
- Clinical Pharmacology Department, Royal Brisbane and Women's Hospital, Brisbane, Australia.,Faculty of Medicine, University of Queensland, Brisbane, Australia
| | - Christopher B Steer
- Border Medical Oncology, Albury-Wodonga Regional Cancer Center, Albury, Australia.,University of NSW Rural Clinical School, Albury Campus, Albury, New South Wales, Australia
| | - Louise M Stewart
- School of Population and Global Health, The University of Western Australia, Perth, Australia
| | - Nirmala Pandeya
- School of Public Health, Faculty of Medicine, University of Queensland, Brisbane, Australia.,Population Health Department, QIMR Berghofer Medical Research Institute, Brisbane, Australia
| | - Susan J Jordan
- School of Public Health, Faculty of Medicine, University of Queensland, Brisbane, Australia.,Population Health Department, QIMR Berghofer Medical Research Institute, Brisbane, Australia
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Tuesley KM, Webb PM, Protani MM, Spilsbury K, Pearson SA, Coory MD, Donovan P, Steer C, Stewart LM, Pandeya N, Jordan SJ. Response to Lehrer and Rheinstein. J Natl Cancer Inst 2022; 114:1427-1428. [PMID: 35460256 PMCID: PMC9552309 DOI: 10.1093/jnci/djac083] [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] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2022] [Accepted: 04/08/2022] [Indexed: 11/25/2022] Open
Affiliation(s)
- Karen M Tuesley
- School of Public Health, Faculty of Medicine, University of Queensland, Brisbane, Australia.,Population Health Department, QIMR Berghofer Medical Research Institute, Brisbane, Australia
| | - Penelope M Webb
- School of Public Health, Faculty of Medicine, University of Queensland, Brisbane, Australia.,Population Health Department, QIMR Berghofer Medical Research Institute, Brisbane, Australia
| | - Melinda M Protani
- School of Public Health, Faculty of Medicine, University of Queensland, Brisbane, Australia
| | - Katrina Spilsbury
- Institute for Health Research, The University of Notre Dame Australia, Fremantle, Australia
| | - Sallie-Anne Pearson
- Centre for Big Data Research in Health, University of New South Wales, Sydney, Australia
| | - Michael D Coory
- Faculty of Medicine, Dentistry and Health Sciences, University of Melbourne, Melbourne, Australia
| | - Peter Donovan
- Clinical Pharmacology Department, Royal Brisbane and Women's Hospital, Brisbane, Australia.,Faculty of Medicine, University of Queensland, Brisbane, Australia
| | - Christopher Steer
- Border Medical Oncology, Albury-Wodonga Regional Cancer Centre, Albury, Australia.,University of NSW Rural Clinical School, Albury Campus, Albury, New South Wales, Australia
| | - Louise M Stewart
- School of Population and Global Health, The University of Western Australia, Perth, Australia
| | - Nirmala Pandeya
- School of Public Health, Faculty of Medicine, University of Queensland, Brisbane, Australia.,Population Health Department, QIMR Berghofer Medical Research Institute, Brisbane, Australia
| | - Susan J Jordan
- School of Public Health, Faculty of Medicine, University of Queensland, Brisbane, Australia.,Population Health Department, QIMR Berghofer Medical Research Institute, Brisbane, Australia
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Tuesley KM, Webb PM, Protani MM, Spilsbury K, Pearson SA, Coory MD, Donovan P, Steer C, Stewart LM, Pandeya N, Jordan SJ. Nitrogen-Based Bisphosphonate Use and Ovarian Cancer Risk in Women Aged 50 Years and Older. J Natl Cancer Inst 2022; 114:878-884. [PMID: 35262727 PMCID: PMC9194625 DOI: 10.1093/jnci/djac050] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2021] [Revised: 01/23/2022] [Accepted: 03/02/2022] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND There are few readily modifiable risk factors for epithelial ovarian cancer; pre-clinical studies suggest bisphosphonates could have chemo-preventive actions. Our study aimed to assess the association between use of nitrogen-based bisphosphonate medicine and risk of epithelial ovarian cancer, overall and by histotype. METHODS We conducted a case-control study nested within a large linked administrative dataset including all Australian women enrolled for Medicare, Australia's universal health insurance scheme, between July 2002 and December 2013. We included all women with epithelial ovarian cancer diagnosed at age 50 years and older between 1st July 2004 and 31st December 2013 (n = 9,367) and randomly selected up to five controls per case, individually matched to cases by age, state of residence, area-level socioeconomic status, and remoteness of residence category (n = 46,830). We used prescription records to ascertain use of nitrogen-based bisphosphonates (ever use and duration of use), raloxifene and other osteoporosis medicines (non-nitrogen-based bisphosphonates, strontium and denosumab). We calculated adjusted odds ratios (OR) and 95% confidence intervals (CI) using conditional logistic regression. RESULTS Ever use of nitrogen-based bisphosphonates was associated with a reduced risk of epithelial ovarian cancer compared to non-use (OR = 0.81, 95%CI : 0.75-0.88). There was a reduced risk of both endometrioid (OR = 0.51, 95%CI : 0.33-0.79) and serous histotypes (OR = 0.84, 95%CI : 0.75-0.93), but no association with the mucinous or clear cell histotypes. CONCLUSION Use of nitrogen-based bisphosphonates was associated with a reduced risk of endometrioid and serous ovarian cancer. This suggests the potential for use for prevention, although validation of our findings is required.
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Affiliation(s)
- Karen M Tuesley
- School of Public Health, Faculty of Medicine, University of Queensland, Brisbane, Australia.,Population Health Department, QIMR Berghofer Medical Research Institute, Brisbane, Australia
| | - Penelope M Webb
- School of Public Health, Faculty of Medicine, University of Queensland, Brisbane, Australia.,Population Health Department, QIMR Berghofer Medical Research Institute, Brisbane, Australia
| | - Melinda M Protani
- School of Public Health, Faculty of Medicine, University of Queensland, Brisbane, Australia
| | - Katrina Spilsbury
- Institute for Health Research, The University of Notre Dame Australia, Fremantle, Australia
| | | | - Michael D Coory
- Faculty of Medicine, Dentistry and Health Sciences, University of Melbourne, Melbourne, Australia
| | - Peter Donovan
- Clinical Pharmacology Department, Royal Brisbane and Women's Hospital, Brisbane, Australia.,Faculty of Medicine, University of Queensland, Brisbane, Australia
| | - Christopher Steer
- Border Medical Oncology, Albury-Wodonga Regional Cancer Centre, Albury, Australia.,University of NSW Rural Clinical School, Albury Campus, Albury, New South Wales, Australia
| | - Louise M Stewart
- School of Population and Global Health, The University of Western Australia, Perth, Australia
| | - Nirmala Pandeya
- School of Public Health, Faculty of Medicine, University of Queensland, Brisbane, Australia.,Population Health Department, QIMR Berghofer Medical Research Institute, Brisbane, Australia
| | - Susan J Jordan
- School of Public Health, Faculty of Medicine, University of Queensland, Brisbane, Australia.,Population Health Department, QIMR Berghofer Medical Research Institute, Brisbane, Australia
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Tuesley K, Webb P, Protani M, Spilsbury K, Pearson SA, Coory MD, Donovan P, Stewart LM, Pandeya N, Jordan S. 794Bisphosphonate use and risk of ovarian cancer, a nested case-control study using national health data. Int J Epidemiol 2021. [DOI: 10.1093/ije/dyab168.667] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Abstract
Background
Epithelial ovarian cancer (EOC) is the eighth most common cancer in women, has a five-year survival of ∼45%, and very few established modifiable risk factors. Some evidence suggests that bisphosphonates could have chemopreventive benefits, but few epidemiological studies have investigated the association between bisphosphonate use and incidence of EOC.
Methods
We conducted a nested case-control study using linked administrative data. We identified 9,367 women over 50 years diagnosed with EOC (cases) from 2004 to 2013, and for each case identified five controls from the Australian Medicare Enrolment database matched by age, state, area of residence, and area-level socioeconomic disadvantage. We assessed the associations between bisphosphonate use using dispensed prescription data (ever use, duration and dose) and EOC (overall, by histotype), adjusting for comorbidities and MHT use. We conducted sensitivity analyses in women with complete ascertainment of dispensing claims and for residents of one Australian state that had linked with data linked to hospital procedures, including oophorectomy.
Results
Our analyses show an inverse association between bisphosphonate use and risk of EOC overall (OR = 0.81, 95%CI:0.75-0.88), and for endometrioid (OR = 0.51, 95%CI:0.33-0.79) and serous (OR = 0.84, 95%CI:0.75-0.93) histotypes. There was some evidence that higher dose and duration were associated with a greater reduction in risk. Results from sensitivity analyses were not appreciably different.
Conclusions
Bisphosphonate use was associated with lower risk of EOC, suggesting bisphosphonates may reduce risk of ovarian cancer development.
Key messages
Bisphosphonates may protect against development of serous and endometrioid ovarian cancers.
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Affiliation(s)
- Karen Tuesley
- School of Public Health, Faculty of Medicine, University of Queensland, Brisbane, Australia
- Population Health Department, QIMR Berghofer Medical Research Institute, Brisbane, Australia
| | - Penelope Webb
- School of Public Health, Faculty of Medicine, University of Queensland, Brisbane, Australia
- Population Health Department, QIMR Berghofer Medical Research Institute, Brisbane, Australia
| | - Melinda Protani
- School of Public Health, Faculty of Medicine, University of Queensland, Brisbane, Australia
| | - Katrina Spilsbury
- Institute for Health Research, The University of Notre Dame Australia, Fremantle, Australia
| | - Sallie-Anne Pearson
- Centre for Big Data Research in Health, The University of New South Wales, Sydney, Australia
| | - Michael D Coory
- Faculty of Medicine, Dentistry and Health Sciences University of Melbourne, Melbourne, Australia
| | - Peter Donovan
- School of Public Health, Faculty of Medicine, University of Queensland, Brisbane, Australia
- Clinical Pharmacology Department, Royal Brisbane and Women’s Hospital, Brisbane, Australia
| | - Louise M Stewart
- School of Population and Global Health, The University of Western Australia, Perth, Australia
| | - Nirmala Pandeya
- School of Public Health, Faculty of Medicine, University of Queensland, Brisbane, Australia
- Population Health Department, QIMR Berghofer Medical Research Institute, Brisbane, Australia
| | - Susan Jordan
- School of Public Health, Faculty of Medicine, University of Queensland, Brisbane, Australia
- Population Health Department, QIMR Berghofer Medical Research Institute, Brisbane, Australia
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Protani MM, Joshi A, White V, Marco DJT, Neale RE, Coory MD, Giles GG, Bolton DM, Davis ID, Wood S, Jordan SJ. The role of renal mass biopsy in the management of small renal masses – patterns of use and surgeon opinion. Journal of Clinical Urology 2020. [DOI: 10.1177/2051415819894181] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Aims: Renal mass biopsy (RMB) is advocated to improve management of small renal masses, however there is concern about its clinical utility. This study aimed to elicit opinions about the role of RMB in small renal mass management from surgeons managing renal cell carcinomas (RCC), and examine the frequency of pre-treatment biopsy in those with RCC. Methods: All surgeons in two Australian states (Queensland: n = 59 and Victoria: n = 108) who performed nephrectomies for RCC in 2012/2013 were sent questionnaires to ascertain views about RMB. Response rates were 54% for Queensland surgeons and 38% for Victorian surgeons. We used medical records data from RCC patients to determine RMB frequency. Results: Most Queensland (81%) and Victorian (59%) surgeons indicated they rarely requested RMB; however 34% of Victorians reported often requesting RMB, compared with no Queensland surgeons. This was consistent with medical records data: 17.6% of Victorian patients with T1a tumours received RMB versus 6.7% of Queensland patients ( p < 0.001). Surgeons’ principal concerns regarding RMB related to sampling reliability (90%) and/or histopathological interpretation (76%). Conclusions: Most surgeons report infrequent use of RMB for small renal masses, however we observed practice variation. The principal reasons for infrequent use were concerns about sampling reliability and histopathological interpretation, which may be valid in regions with less access to interventional radiologists and uropathologists. Further evidence is required to define patient groups for whom biopsy results will alter management. Level of evidence: Not applicable for this multicentre audit.
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Affiliation(s)
- Melinda M Protani
- School of Public Health, The University of Queensland, Herston, Australia
- QIMR Berghofer Medical Research Institute, Herston, Australia
| | - Andre Joshi
- QIMR Berghofer Medical Research Institute, Herston, Australia
- Princess Alexandra Hospital, Brisbane, Queensland, Australia
- Translational Research Institute, Brisbane, Australia
| | - Victoria White
- Cancer Council Victoria, Melbourne, Australia
- Deakin University, Geelong, Australia
| | - David JT Marco
- University of Melbourne, Melbourne, Australia
- Centre for Palliative Care, St Vincent’s Hospital, Melbourne, Australia
| | - Rachel E Neale
- School of Public Health, The University of Queensland, Herston, Australia
- QIMR Berghofer Medical Research Institute, Herston, Australia
| | | | - Graham G Giles
- Cancer Council Victoria, Melbourne, Australia
- University of Melbourne, Melbourne, Australia
| | - Damien M Bolton
- University of Melbourne, Melbourne, Australia
- Austin Health, Melbourne, Australia
| | - Ian D Davis
- Monash University Eastern Health Clinical School, Box Hill, Melbourne, Australia
- Eastern Health, Box Hill, Melbourne, Australia
| | - Simon Wood
- Princess Alexandra Hospital, Brisbane, Queensland, Australia
- Translational Research Institute, Brisbane, Australia
| | - Susan J Jordan
- School of Public Health, The University of Queensland, Herston, Australia
- QIMR Berghofer Medical Research Institute, Herston, Australia
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7
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Ellis RJ, Del Vecchio SJ, Gallagher KMJ, Aliano DN, Barber N, Bolton DM, Chew ETS, Coombes JS, Coory MD, Davis ID, Donaldson JF, Francis RS, Giles GG, Gobe GC, Hawley CM, Johnson DW, Laird A, Leung S, Malki M, Marco DJT, McNeill AS, Neale RE, Ng KL, Phipps S, Stewart GD, White VM, Wood ST, Jordan SJ. A Simple Clinical Tool for Stratifying Risk of Clinically Significant CKD after Nephrectomy: Development and Multinational Validation. J Am Soc Nephrol 2020; 31:1107-1117. [PMID: 32238473 DOI: 10.1681/asn.2019121328] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2019] [Accepted: 02/17/2020] [Indexed: 01/20/2023] Open
Abstract
BACKGROUND Clinically significant CKD following surgery for kidney cancer is associated with increased morbidity and mortality, but identifying patients at increased CKD risk remains difficult. Simple methods to stratify risk of clinically significant CKD after nephrectomy are needed. METHODS To develop a tool for stratifying patients' risk of CKD arising after surgery for kidney cancer, we tested models in a population-based cohort of 699 patients with kidney cancer in Queensland, Australia (2012-2013). We validated these models in a population-based cohort of 423 patients from Victoria, Australia, and in patient cohorts from single centers in Queensland, Scotland, and England. Eligible patients had two functioning kidneys and a preoperative eGFR ≥60 ml/min per 1.73 m2. The main outcome was incident eGFR <45 ml/min per 1.73 m2 at 12 months postnephrectomy. We used prespecified predictors-age ≥65 years old, diabetes mellitus, preoperative eGFR, and nephrectomy type (partial/radical)-to fit logistic regression models and grouped patients according to degree of risk of clinically significant CKD (negligible, low, moderate, or high risk). RESULTS Absolute risks of stage 3b or higher CKD were <2%, 3% to 14%, 21% to 26%, and 46% to 69% across the four strata of negligible, low, moderate, and high risk, respectively. The negative predictive value of the negligible risk category was 98.9% for clinically significant CKD. The c statistic for this score ranged from 0.84 to 0.88 across derivation and validation cohorts. CONCLUSIONS Our simple scoring system can reproducibly stratify postnephrectomy CKD risk on the basis of readily available parameters. This clinical tool's quantitative assessment of CKD risk may be weighed against other considerations when planning management of kidney tumors and help inform shared decision making between clinicians and patients.
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Affiliation(s)
- Robert J Ellis
- Population Health, QIMR Berghofer Medical Research Institute, Brisbane, Queensland, Australia .,Princess Alexandra Hospital, Metro South Health, Brisbane, Queensland, Australia.,Faculty of Medicine, University of Queensland, Brisbane, Queensland, Australia.,Kidney Disease Research Collaborative, Translational Research Institute, Brisbane, Queensland, Australia
| | - Sharon J Del Vecchio
- Princess Alexandra Hospital, Metro South Health, Brisbane, Queensland, Australia.,Faculty of Medicine, University of Queensland, Brisbane, Queensland, Australia.,Kidney Disease Research Collaborative, Translational Research Institute, Brisbane, Queensland, Australia
| | - Kevin M J Gallagher
- Department of Urology, Western General Hospital, Edinburgh, United Kingdom.,University of Edinburgh, Edinburgh, United Kingdom
| | - Danielle N Aliano
- Faculty of Medicine, University of Queensland, Brisbane, Queensland, Australia.,Logan Hospital, Logan, Queensland, Australia
| | - Neil Barber
- Urology Department, Frimley Park Hospital, Frimley, United Kingdom
| | - Damien M Bolton
- Austin Urology, Austin Health, Melbourne, Victoria, Australia.,Faculty of Medicine, Dentistry and Health Sciences, University of Melbourne, Melbourne, Victoria, Australia
| | | | - Jeff S Coombes
- Faculty of Medicine, University of Queensland, Brisbane, Queensland, Australia
| | - Michael D Coory
- Faculty of Medicine, Dentistry and Health Sciences, University of Melbourne, Melbourne, Victoria, Australia
| | - Ian D Davis
- Faculty of Medicine, Nursing and Health Sciences, Monash University, Melbourne, Victoria, Australia.,Eastern Health, Melbourne, Victoria, Australia
| | - James F Donaldson
- Princess Alexandra Hospital, Metro South Health, Brisbane, Queensland, Australia.,Department of Urology, Western General Hospital, Edinburgh, United Kingdom.,University of Edinburgh, Edinburgh, United Kingdom
| | - Ross S Francis
- Princess Alexandra Hospital, Metro South Health, Brisbane, Queensland, Australia.,Faculty of Medicine, University of Queensland, Brisbane, Queensland, Australia
| | - Graham G Giles
- Faculty of Medicine, Dentistry and Health Sciences, University of Melbourne, Melbourne, Victoria, Australia.,Faculty of Medicine, Nursing and Health Sciences, Monash University, Melbourne, Victoria, Australia.,Cancer Council Victoria, Melbourne, Victoria, Australia
| | - Glenda C Gobe
- Princess Alexandra Hospital, Metro South Health, Brisbane, Queensland, Australia.,Faculty of Medicine, University of Queensland, Brisbane, Queensland, Australia.,Kidney Disease Research Collaborative, Translational Research Institute, Brisbane, Queensland, Australia
| | - Carmel M Hawley
- Princess Alexandra Hospital, Metro South Health, Brisbane, Queensland, Australia.,Faculty of Medicine, University of Queensland, Brisbane, Queensland, Australia.,Kidney Disease Research Collaborative, Translational Research Institute, Brisbane, Queensland, Australia
| | - David W Johnson
- Princess Alexandra Hospital, Metro South Health, Brisbane, Queensland, Australia.,Faculty of Medicine, University of Queensland, Brisbane, Queensland, Australia.,Kidney Disease Research Collaborative, Translational Research Institute, Brisbane, Queensland, Australia
| | - Alexander Laird
- Department of Urology, Western General Hospital, Edinburgh, United Kingdom.,University of Edinburgh, Edinburgh, United Kingdom
| | - Steve Leung
- Department of Urology, Western General Hospital, Edinburgh, United Kingdom.,University of Edinburgh, Edinburgh, United Kingdom
| | - Manar Malki
- Urology Department, Frimley Park Hospital, Frimley, United Kingdom
| | - David J T Marco
- Faculty of Medicine, Dentistry and Health Sciences, University of Melbourne, Melbourne, Victoria, Australia.,Centre for Palliative Care, St. Vincent's Hospital, Melbourne, Victoria, Australia
| | - Alan S McNeill
- Department of Urology, Western General Hospital, Edinburgh, United Kingdom.,University of Edinburgh, Edinburgh, United Kingdom
| | - Rachel E Neale
- Population Health, QIMR Berghofer Medical Research Institute, Brisbane, Queensland, Australia.,Faculty of Medicine, University of Queensland, Brisbane, Queensland, Australia.,Queensland University of Technology, Brisbane, Queensland, Australia
| | - Keng L Ng
- Princess Alexandra Hospital, Metro South Health, Brisbane, Queensland, Australia.,Faculty of Medicine, University of Queensland, Brisbane, Queensland, Australia.,Urology Department, Frimley Park Hospital, Frimley, United Kingdom
| | - Simon Phipps
- Department of Urology, Western General Hospital, Edinburgh, United Kingdom.,University of Edinburgh, Edinburgh, United Kingdom
| | - Grant D Stewart
- Department of Surgery, University of Cambridge, Cambridge, United Kingdom.,Addenbrooke's Hospital, Cambridge, United Kingdom
| | - Victoria M White
- Cancer Council Victoria, Melbourne, Victoria, Australia.,School of Psychology, Deakin University, Geelong, Victoria, Australia
| | - Simon T Wood
- Princess Alexandra Hospital, Metro South Health, Brisbane, Queensland, Australia.,Faculty of Medicine, University of Queensland, Brisbane, Queensland, Australia
| | - Susan J Jordan
- Population Health, QIMR Berghofer Medical Research Institute, Brisbane, Queensland, Australia.,Faculty of Medicine, University of Queensland, Brisbane, Queensland, Australia
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8
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Ellis RJ, White VM, Bolton DM, Coory MD, Davis ID, Francis RS, Giles GG, Gobe GC, Neale RE, Wood ST, Jordan SJ. Tumor size and postoperative kidney function following radical nephrectomy. Clin Epidemiol 2019; 11:333-348. [PMID: 31191028 PMCID: PMC6511655 DOI: 10.2147/clep.s197968] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [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: 12/12/2018] [Accepted: 03/02/2019] [Indexed: 11/23/2022] Open
Abstract
Background: Chronic kidney disease (CKD) following nephrectomy for kidney tumors is common, and both patient and tumor characteristics may affect postoperative kidney function. Several studies have reported that surgery for large tumors is associated with a lower likelihood of postoperative CKD, but others have reported CKD to be more common before surgery in patients with large tumors. Objective: The aim of this study was to clarify inconsistencies in the literature regarding the prognostic significance of tumor size for postoperative kidney function. Study design and setting: We analyzed data from 944 kidney cancer patients managed with radical nephrectomy between January 2012 and December 2013, and 242 living kidney donors who underwent surgery between January 2011 and December 2014 in the Australian states of Queensland and Victoria. Multivariable logistic regression was used to assess the primary outcome of CKD upstaging. Structural equation modeling was used to evaluate causal models, to delineate the influence of patient and tumor characteristics on postoperative kidney function. Results: We determined that a significant interaction between age and tumor size (P=0.03) led to the observed inverse association between large tumor size and CKD upstaging, and was accentuated by other forms of selection bias. Subgrouping patients by age and tumor size demonstrated that all patients aged ≥65 years were at increased risk of CKD upstaging, regardless of tumor size. Risk of CKD upstaging was comparable between age-matched living donors and kidney cancer patients. Conclusion: Larger tumors are unlikely to confer a protective effect with respect to postoperative kidney function. The reason for the previously reported inconsistency is likely a combination of the analytical approach and selection bias.
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Affiliation(s)
- Robert J Ellis
- Department of Population Health, QIMR Berghofer Medical Research Institute, Brisbane, QLD, Australia
- Department of Nephrology, Princess Alexandra Hospital, Brisbane, QLD, Australia
- Faculty of Medicine, University of Queensland, Brisbane, QLD, Australia
- Kidney Disease Research Collaborative, Translational Research Institute, Brisbane, QLD, Australia
| | - Victoria M White
- Cancer Council Victoria, Melbourne, VIC, Australia
- School of Psychology, Deakin University, Melbourne, VIC, Australia
| | - Damien M Bolton
- Department of Urology, Austin Health, Melbourne, VIC, Australia
- Faculty of Medicine, Dentistry and Health Sciences, University of Melbourne, Melbourne, VIC, Australia
| | - Michael D Coory
- Faculty of Medicine, Dentistry and Health Sciences, University of Melbourne, Melbourne, VIC, Australia
| | - Ian D Davis
- Eastern Health Clinical School, Monash University and Eastern Health, Melbourne, VIC, Australia
- Department of Urology, Princess Alexandra Hospital, Brisbane, QLD, Australia
| | - Ross S Francis
- Department of Nephrology, Princess Alexandra Hospital, Brisbane, QLD, Australia
- Faculty of Medicine, University of Queensland, Brisbane, QLD, Australia
- Kidney Disease Research Collaborative, Translational Research Institute, Brisbane, QLD, Australia
| | - Graham G Giles
- Cancer Council Victoria, Melbourne, VIC, Australia
- Faculty of Medicine, Dentistry and Health Sciences, University of Melbourne, Melbourne, VIC, Australia
| | - Glenda C Gobe
- Faculty of Medicine, University of Queensland, Brisbane, QLD, Australia
- Kidney Disease Research Collaborative, Translational Research Institute, Brisbane, QLD, Australia
| | - Rachel E Neale
- Department of Population Health, QIMR Berghofer Medical Research Institute, Brisbane, QLD, Australia
| | - Simon T Wood
- Faculty of Medicine, University of Queensland, Brisbane, QLD, Australia
- Kidney Disease Research Collaborative, Translational Research Institute, Brisbane, QLD, Australia
- Department of Urology, Princess Alexandra Hospital, Brisbane, QLD, Australia
| | - Susan J Jordan
- Department of Population Health, QIMR Berghofer Medical Research Institute, Brisbane, QLD, Australia
- Faculty of Medicine, University of Queensland, Brisbane, QLD, Australia
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Ellis RJ, White VM, Bolton DM, Coory MD, Davis ID, Francis RS, Giles GG, Gobe GC, Marco DJT, Neale RE, Wood ST, Jordan SJ. Incident Chronic Kidney Disease After Radical Nephrectomy for Renal Cell Carcinoma. Clin Genitourin Cancer 2019; 17:e581-e591. [PMID: 30975606 DOI: 10.1016/j.clgc.2019.02.011] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2018] [Revised: 02/12/2019] [Accepted: 02/21/2019] [Indexed: 10/27/2022]
Abstract
BACKGROUND Chronic kidney disease (CKD) after surgery for kidney cancer is common, and is associated with increased morbidity and mortality. This study aimed to identify factors associated with incident CKD in patients managed with radical nephrectomy. PATIENTS AND METHODS All patients diagnosed with renal cell carcinoma between January 2012 and December 2013 were ascertained from state-based cancer registries in Queensland and Victoria. Information on patient, tumor, and health service characteristics was obtained via chart review. Multivariable logistic regression was used to evaluate exposures associated with incident CKD (estimated glomerular filtration rate [eGFR] <60 mL per minute per 1.73 m2) at 12 months after nephrectomy. RESULTS Older age (adjusted odds ratio [aOR] per 5-year increase, 1.5; 95% confidence interval [CI], 1.4-1.6), male sex (aOR, 1.4; 95% CI, 1.0-2.0), obese compared with not obese (aOR, 1.8; 95% CI, 1.2-2.7), rural compared with urban place of residence (aOR, 1.8; 95% CI, 1.1-3.0) were associated with a higher risk of incident CKD. Lower preoperative eGFR was also associated with a higher risk of incident CKD. Management in private compared with public hospitals was also associated with a higher risk of CKD (aOR, 1.6; 95% CI, 1.2-2.2). Factors related to tumor size and cancer severity were also associated with worse postoperative kidney function, although it is likely this was a consequence of selection bias. CONCLUSION Patient characteristics have the strongest associations with incident CKD after radical nephrectomy. Potential risk factors were reasonably similar to recognized CKD risk factors for the general population. Patients who undergo nephrectomy who have CKD risk factors might benefit from ongoing postoperative screening for deterioration of kidney function.
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Affiliation(s)
- Robert J Ellis
- QIMR Berghofer Medical Research Institute, Brisbane, Australia; Princess Alexandra Hospital, Brisbane, Australia; University of Queensland, Brisbane, Australia; Translational Research Institute, Brisbane, Australia.
| | - Victoria M White
- Cancer Council Victoria, Melbourne, Australia; Deakin University, Geelong, Australia
| | - Damien M Bolton
- Austin Health, Melbourne, Australia; University of Melbourne, Melbourne, Australia
| | | | - Ian D Davis
- Monash University, Melbourne, Australia; Eastern Health, Melbourne, Australia
| | - Ross S Francis
- Princess Alexandra Hospital, Brisbane, Australia; University of Queensland, Brisbane, Australia
| | - Graham G Giles
- Cancer Council Victoria, Melbourne, Australia; University of Melbourne, Melbourne, Australia
| | - Glenda C Gobe
- Princess Alexandra Hospital, Brisbane, Australia; University of Queensland, Brisbane, Australia; Translational Research Institute, Brisbane, Australia
| | - David J T Marco
- University of Melbourne, Melbourne, Australia; Centre for Palliative Care, Melbourne, Australia
| | - Rachel E Neale
- QIMR Berghofer Medical Research Institute, Brisbane, Australia
| | - Simon T Wood
- Princess Alexandra Hospital, Brisbane, Australia; University of Queensland, Brisbane, Australia; Translational Research Institute, Brisbane, Australia
| | - Susan J Jordan
- QIMR Berghofer Medical Research Institute, Brisbane, Australia; University of Queensland, Brisbane, Australia
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Ahn T, Ellis RJ, White VM, Bolton DM, Coory MD, Davis ID, Francis RS, Giles GG, Gobe GC, Hawley CM, Johnson DW, Marco DJT, McStea M, Neale RE, Pascoe EM, Wood ST, Jordan SJ. Predictors of new-onset chronic kidney disease in patients managed surgically for T1a renal cell carcinoma: An Australian population-based analysis. J Surg Oncol 2018; 117:1597-1610. [PMID: 29790163 DOI: 10.1002/jso.25037] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2018] [Accepted: 02/09/2018] [Indexed: 11/12/2022]
Abstract
BACKGROUND New-onset chronic kidney disease (CKD) following surgical management of kidney tumors is common. This study evaluated risk factors for new-onset CKD after nephrectomy for T1a renal cell carcinoma (RCC) in an Australian population-based cohort. METHODS There were 551 RCC patients from the Australian states of Queensland and Victoria included in this study. The primary outcome was new-onset CKD (eGFR <60 mL/min per 1.73 m2 ) and the secondary outcome was new-onset moderate-severe CKD (<45 mL/min per 1.73 m2 ). Multivariable logistic regression was used to evaluate associations between patient, tumor and health-service characteristics and these outcomes. RESULTS Forty percent (219/551) of patients developed new-onset CKD, and 12% (68/551) experienced new-onset moderate-severe CKD. Risk factors for new-onset CKD were age, lower preoperative eGFR, tumor size >20 mm, radical nephrectomy, lower hospital caseloads (<20 cases/year), and rural place of residence. The associations between rural place of residence and low center volume were a consequence of higher radical nephrectomy rates. CONCLUSION Risk factors for CKD after nephrectomy generally relate to worse baseline health, or likelihood of undergoing radical nephrectomy. Surgeons in rural centres and hospitals with low caseloads may benefit from formalized integration with specialist centers for continued professional development and case-conferencing, to assist in management decisions.
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Affiliation(s)
- Thomas Ahn
- Princess Alexandra Hospital, Brisbane, Australia
| | - Robert J Ellis
- Princess Alexandra Hospital, Brisbane, Australia.,QIMR Berghofer Medical Research Institute, Brisbane, Australia.,University of Queensland, Brisbane, Australia.,Translational Research Institute, Brisbane, Australia
| | - Victoria M White
- Cancer Council Victoria, Melbourne, Australia.,Deakin University, Geelong, Australia
| | - Damien M Bolton
- Austin Health, Melbourne, Australia.,University of Melbourne, Melbourne, Australia
| | | | - Ian D Davis
- Monash University, Melbourne, Australia.,Eastern Health, Melbourne, Australia
| | - Ross S Francis
- Princess Alexandra Hospital, Brisbane, Australia.,University of Queensland, Brisbane, Australia
| | - Graham G Giles
- Cancer Council Victoria, Melbourne, Australia.,University of Melbourne, Melbourne, Australia
| | - Glenda C Gobe
- Princess Alexandra Hospital, Brisbane, Australia.,University of Queensland, Brisbane, Australia.,Translational Research Institute, Brisbane, Australia
| | - Carmel M Hawley
- Princess Alexandra Hospital, Brisbane, Australia.,University of Queensland, Brisbane, Australia.,Translational Research Institute, Brisbane, Australia
| | - David W Johnson
- Princess Alexandra Hospital, Brisbane, Australia.,University of Queensland, Brisbane, Australia.,Translational Research Institute, Brisbane, Australia
| | | | - Megan McStea
- University of Queensland, Brisbane, Australia.,Translational Research Institute, Brisbane, Australia
| | - Rachel E Neale
- QIMR Berghofer Medical Research Institute, Brisbane, Australia
| | - Elaine M Pascoe
- University of Queensland, Brisbane, Australia.,Translational Research Institute, Brisbane, Australia
| | - Simon T Wood
- Princess Alexandra Hospital, Brisbane, Australia.,University of Queensland, Brisbane, Australia.,Translational Research Institute, Brisbane, Australia
| | - Susan J Jordan
- QIMR Berghofer Medical Research Institute, Brisbane, Australia.,University of Queensland, Brisbane, Australia
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Affiliation(s)
- Michael D Coory
- Murdoch Children's Research Institute, Parkville, Victoria, Australia.
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12
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Coory MD, Ho T, Jordan SJ. Australia is continuing to make progress against cancer, but the regional and remote disadvantage remains. Med J Aust 2013. [DOI: 10.5694/mja13.c10055] [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: 11/17/2022]
Affiliation(s)
- Michael D Coory
- Health Services Research, Murdoch Childrens Research Institute, Melbourne, VIC
| | - Tsun Ho
- Department of Health, Melbourne, VIC
| | - Susan J Jordan
- Population Health Department, Queensland Institute of Medical Research, Brisbane, QLD
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13
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Coory MD, Ho T, Jordan SJ. Australia is continuing to make progress against cancer, but the regional and remote disadvantage remains. Med J Aust 2013; 199:605-8. [PMID: 24182226 DOI: 10.5694/mja13.10055] [Citation(s) in RCA: 65] [Impact Index Per Article: 5.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2013] [Accepted: 06/19/2013] [Indexed: 12/19/2022]
Affiliation(s)
- Michael D Coory
- Health Services Research, Murdoch Childrens Research Institute, Melbourne, VIC
| | - Tsun Ho
- Department of Health, Melbourne, VIC
| | - Susan J Jordan
- Population Health Department, Queensland Institute of Medical Research, Brisbane, QLD
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Jordan SJ, Nagle CM, Coory MD, Maresco D, Protani MM, Pandeya NA, Balasubramaniam KD, Webb PM. Has the association between hysterectomy and ovarian cancer changed over time? A systematic review and meta-analysis. Eur J Cancer 2013; 49:3638-47. [PMID: 23890943 DOI: 10.1016/j.ejca.2013.07.005] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2013] [Revised: 06/27/2013] [Accepted: 07/02/2013] [Indexed: 10/26/2022]
Abstract
Until recently most studies suggested that hysterectomy with ovarian conservation was associated with a decreased risk of ovarian cancer. However, several recent studies have reported modestly increased risks of ovarian cancer following hysterectomy. Given that as many as 35% of women will have a hysterectomy, the nature of the association requires clarification. We conducted a systematic review and meta-analysis of the published literature on the relationship between hysterectomy and ovarian cancer to investigate whether there has been a temporal change in the association. Twenty observational studies that have reported a quantitative assessment of the association between hysterectomy and risk of histologically-confirmed ovarian cancer were included in the meta-analysis. The overall relative risk (RR) estimate was 0.81 (95% confidence interval (CI) 0.72-0.92) suggesting hysterectomy decreases the risk of ovarian cancer. However, there was significant heterogeneity in the results (I(2) = 74%). Our exploration of sources of heterogeneity and metaregression showed that median year of cancer diagnosis of included cases explained most of the heterogeneity relative risk (RR = 0.70 (95% CI 0.65-0.76) for median year diagnosis pre 2000; RR = 1.18 (95% CI 1.06-1.31) for post 2000). This study shows that there has been a temporal shift in the association between hysterectomy and risk of ovarian cancer. One explanation may be the trend away from hysterectomy in younger women. Other speculative possibilities include the decline in oophorectomy rates and the use of oestrogen-only hormone replacement therapy in hysterectomised women. Until further evidence becomes available, clinicians should not advise women that a hysterectomy without salpingo-oophorectomy will favourably influence their future risk of ovarian cancer.
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Affiliation(s)
- Susan J Jordan
- The Queensland Institute of Medical Research, Gynaecological Cancer Group, Population Health Department, PO Royal Brisbane Hospital, Brisbane 4029, Australia.
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15
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Coory MD, Thompson BS, Jordan SJ. Adopting surgical innovation within activity-based funding for public hospitals. Med J Aust 2013; 198:88. [PMID: 23373497 DOI: 10.5694/mja12.11206] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2012] [Accepted: 12/02/2012] [Indexed: 11/17/2022]
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16
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Coory MD. The need for data beyond primary diagnosis. Med J Aust 2012; 197:329. [DOI: 10.5694/mja12.11078] [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: 11/17/2022]
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17
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Martin JH, Coory MD. New medicines — urgent need to assess outcomes in special groups. Med J Aust 2012; 196:433. [DOI: 10.5694/mja12.10193] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2012] [Accepted: 03/19/2012] [Indexed: 11/17/2022]
Affiliation(s)
- Jennifer H Martin
- Princess Alexandra Hospital and University of Queensland School of Medicine, Brisbane, QLD
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18
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Coory MD, Fry CL. Towards sharing health‐services data. Med J Aust 2012; 196:438-9. [DOI: 10.5694/mja11.11238] [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: 11/17/2022]
Affiliation(s)
| | - Craig L Fry
- Murdoch Childrens Research Institute, Melbourne, VIC
- Centre for Applied Philosophy and Public Ethics, University of Melbourne, Melbourne, VIC
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19
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Coory MD. Distance to the closest radiotherapy facility and survival after a diagnosis of rectal cancer in Queensland. Med J Aust 2012; 195:661-2. [PMID: 22171858 DOI: 10.5694/mja11.11213] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2011] [Accepted: 10/30/2011] [Indexed: 11/17/2022]
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Clarke MS, Wills RA, Bowman RV, Zimmerman PV, Fong KM, Coory MD, Yang IA. Exploratory study of the 'weekend effect' for acute medical admissions to public hospitals in Queensland, Australia. Intern Med J 2011; 40:777-83. [PMID: 19811554 DOI: 10.1111/j.1445-5994.2009.02067.x] [Citation(s) in RCA: 51] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
AIMS To determine whether in-hospital deaths of patients admitted through emergency departments with acute exacerbations of chronic obstructive pulmonary disease (COPD), acute myocardial infarction, intracerebral haemorrhage and acute hip fracture are increased by weekend versus weekday admission (the 'weekend effect'). METHODS We performed a retrospective analysis of statewide administrative data from public hospitals in Queensland, Australia, during the 2002/2003-2006/2007 financial years. The primary outcome was 30-day in-hospital mortality. The secondary outcome of 2-day in-hospital mortality helped determine whether increased mortality of weekend admissions was closely linked to weekend medical care. RESULTS During the study period, there were 30 522 COPD, 17 910 acute myocardial infarction, 4183 acute hip fracture and 1781 intracerebral haemorrhage admissions. There was no significant weekend effect on 30-day in-hospital mortality for COPD (adjusted risk ratio = 0.92, 95% CI: 0.81-1.04, P= 0.222), intracerebral haemorrhage (adjusted risk ratio = 1.01, 95% CI: 0.86-1.16, P= 0.935) or acute hip fracture (adjusted risk ratio = 0.78, 95% CI: 0.54-1.03, P= 0.13). There was a significant weekend effect for acute myocardial infarction (adjusted risk ratio = 1.15, 95% CI: 1.03-1.26, P= 0.007). Two-day in-hospital mortality showed similar results. CONCLUSION This is the first Australian study on the 'weekend effect' (in a cohort other than neonates), and the first study worldwide to assess specifically the weekend effect among COPD patients. Observed patterns were consistent with overseas research. There was a significant weekend effect for myocardial infarction. Further research is needed to determine whether location (e.g. rural), clinical (e.g. disease severity) and service provision factors (e.g. access to invasive procedures) influence the weekend effect for acute medical conditions in Australia.
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Affiliation(s)
- M S Clarke
- School of Medicine, The University of Queensland, Brisbane, Queensland, Australia.
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21
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Thompson BS, Coory MD, Lumley JW. National trends in the uptake of laparoscopic resection for colorectal cancer, 2000-2008. Med J Aust 2011; 194:443-7. [PMID: 21534898 DOI: 10.5694/j.1326-5377.2011.tb03056.x] [Citation(s) in RCA: 33] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2010] [Accepted: 12/19/2010] [Indexed: 11/17/2022]
Abstract
OBJECTIVE To examine the trends in the uptake of laparoscopic resection for colorectal cancer. DESIGN AND SETTING Retrospective analysis of Australia-wide data on elective resections for colorectal cancer over the 8 financial years 2000-01 to 2007-08, obtained from the National Hospital Morbidity Database. MAIN OUTCOME MEASURES National trends in annual percentage of colorectal resections for cancer that were conducted laparoscopically for each year, stratified by hospitals conducting a high volume of elective resections (40 or more/year) versus a low volume, and by public versus private hospitals. RESULTS For all Australian hospitals combined, the percentage of resections for colon cancer conducted laparoscopically increased from 2.4% in 2000-01 to 27.5% in 2007-08. For rectal cancer, this increase was from 1.1% to 21.5%. The largest increases were seen in high-volume private hospitals (colon cancer, 2.7% to 34.1%; rectal cancer, 1.5% to 26.2%), but increases also occurred in high-volume public hospitals (colon cancer, 2.7% to 32.2%; rectal cancer, 0.5% to 20.3%), low-volume private (colon cancer, 3.8% to 27.1%; rectal cancer, 2.4% to 25.5%) and low-volume public (colon cancer, 1.1% to 17.0%; rectal cancer, 0.5% to 13.8%) hospitals. CONCLUSIONS The use of laparoscopic resection for colorectal cancer has increased throughout Australian hospitals. Our findings provide the data necessary to ensure adequate resource allocation by the appropriate medical bodies to achieve optimal success in the uptake of laparoscopic resection for colorectal cancer in Australia.
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Affiliation(s)
- Bridie S Thompson
- School of Population Health, University of Queensland, Brisbane, QLD, Australia.
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22
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Baade PD, Youlden DR, Coory MD, Gardiner RA, Chambers SK. Urban-rural differences in prostate cancer outcomes in Australia: what has changed? Med J Aust 2011; 194:293-6. [PMID: 21426283 DOI: 10.5694/j.1326-5377.2011.tb02977.x] [Citation(s) in RCA: 85] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2010] [Indexed: 11/17/2022]
Abstract
OBJECTIVE To update our previous analysis of trends for prostate-specific antigen (PSA) testing, prostate cancer incidence, radical prostatectomy and prostate cancer mortality to assess whether men in rural and regional areas of Australia now have more equitable access to prostate cancer services, and improved outcomes. DESIGN, SETTING AND PARTICIPANTS Descriptive study using population-based data for Australian men aged 50-79 years from 1982 to the 2008-09 financial year (depending on data availability for each outcome measure). MAIN OUTCOME MEASURES Age-standardised rates per 100,000 men and 5-year survival rates. RESULTS Overall, rates of PSA screening and radical prostatectomy increased, accompanied by reductions in mortality and improvements in survival throughout Australia. Incidence rates were similar for men in urban and rural areas. However, in the last year of data collection, for men in rural areas compared with urban areas, rates of PSA screening (21,267/100,000 v 24,606/100,000; P < 0.01) and radical prostatectomy (182.2/100,000 v 239.2/100,000; P < 0.01) remained lower, mortality remained higher (56.9/100,000 v 45.8/100,000; P < 0.01), and survival outcomes continued to be poorer (5-year relative survival, 87.7% v 91.4%; P < 0.01). CONCLUSIONS With some limitations, these ecological data demonstrate that the use of diagnostic and treatment services among men living in rural areas of Australia remains lower than among their urban counterparts, their survival and mortality outcomes are poorer, and these differentials are continuing. There is an urgent need to explore further the reasons for these differences and to implement changes so these inequalities can be reduced.
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Affiliation(s)
- Peter D Baade
- Viertel Centre for Research in Cancer Control, Cancer Council Queensland, Brisbane, QLD, Australia.
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23
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Moore SP, O'Rourke PK, Mallitt K, Garvey G, Green AC, Coory MD, Valery PC. Cancer incidence and mortality in Indigenous Australians in Queensland, 1997–2006. Med J Aust 2010; 193:590-3. [DOI: 10.5694/j.1326-5377.2010.tb04068.x] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2010] [Accepted: 08/25/2010] [Indexed: 11/17/2022]
Affiliation(s)
| | - Peter K O'Rourke
- Queensland Institute of Medical Research, Brisbane, QLD
- Australian Centre for International and Tropical Health, University of Queensland, Brisbane, QLD
| | - Kylie‐Ann Mallitt
- Queensland Institute of Medical Research, Brisbane, QLD
- Australian Centre for International and Tropical Health, University of Queensland, Brisbane, QLD
| | - Gail Garvey
- Queensland Institute of Medical Research, Brisbane, QLD
| | - Adèle C Green
- Queensland Institute of Medical Research, Brisbane, QLD
| | | | - Patricia C Valery
- Queensland Institute of Medical Research, Brisbane, QLD
- Australian Centre for International and Tropical Health, University of Queensland, Brisbane, QLD
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Coory MD. The ABC breast cancer cluster: the bad news about a good outcome. Med J Aust 2010; 193:620-1. [DOI: 10.5694/j.1326-5377.2010.tb04081.x] [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] [Received: 06/18/2010] [Accepted: 08/09/2010] [Indexed: 11/17/2022]
Affiliation(s)
- Michael D Coory
- Cancer Epidemiology Centre, Cancer Council Victoria, Melbourne, VIC
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Jordan SJ, Coory MD, Webb PM. Re: Predictive Value of Symptoms for Early Detection of Ovarian Cancer. J Natl Cancer Inst 2010; 102:1599-601; author reply 1601. [DOI: 10.1093/jnci/djq354] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
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26
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Pinkerton R, Wills R, Coory MD, Fraser CJ. Survival from haematological malignancy in childhood, adolescence and young adulthood in Australia: is the age‐related gap narrowing? Med J Aust 2010; 193:217-21. [DOI: 10.5694/j.1326-5377.2010.tb03871.x] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2009] [Accepted: 02/11/2010] [Indexed: 11/17/2022]
Affiliation(s)
- Ross Pinkerton
- Queensland Children's Cancer Centre, Royal Children's Hospital, Brisbane, QLD
| | | | - Michael D Coory
- Cancer Epidemiology Centre, Cancer Council Victoria, Melbourne, VIC
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Coory MD, Koh GT, Flenady V, Kamp M. Adverse outcomes of labour in public and private hospitals in Australia. Med J Aust 2009; 191:578. [DOI: 10.5694/j.1326-5377.2009.tb03326.x] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2009] [Accepted: 09/08/2009] [Indexed: 11/17/2022]
Affiliation(s)
- Michael D Coory
- School of Population Health, University of Queensland, Brisbane, QLD
| | - Guan T Koh
- Queensland Health, Brisbane, QLD
- Townsville Hospital, Townsville, QLD
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Coory MD, Wills RA, Barnett AG. Bayesian versus frequentist statistical inference for investigating a one-off cancer cluster reported to a health department. BMC Med Res Methodol 2009; 9:30. [PMID: 19426561 PMCID: PMC2694210 DOI: 10.1186/1471-2288-9-30] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [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: 10/13/2008] [Accepted: 05/11/2009] [Indexed: 11/30/2022] Open
Abstract
Background The problem of silent multiple comparisons is one of the most difficult statistical problems faced by scientists. It is a particular problem for investigating a one-off cancer cluster reported to a health department because any one of hundreds, or possibly thousands, of neighbourhoods, schools, or workplaces could have reported a cluster, which could have been for any one of several types of cancer or any one of several time periods. Methods This paper contrasts the frequentist approach with a Bayesian approach for dealing with silent multiple comparisons in the context of a one-off cluster reported to a health department. Two published cluster investigations were re-analysed using the Dunn-Sidak method to adjust frequentist p-values and confidence intervals for silent multiple comparisons. Bayesian methods were based on the Gamma distribution. Results Bayesian analysis with non-informative priors produced results similar to the frequentist analysis, and suggested that both clusters represented a statistical excess. In the frequentist framework, the statistical significance of both clusters was extremely sensitive to the number of silent multiple comparisons, which can only ever be a subjective "guesstimate". The Bayesian approach is also subjective: whether there is an apparent statistical excess depends on the specified prior. Conclusion In cluster investigations, the frequentist approach is just as subjective as the Bayesian approach, but the Bayesian approach is less ambitious in that it treats the analysis as a synthesis of data and personal judgements (possibly poor ones), rather than objective reality. Bayesian analysis is (arguably) a useful tool to support complicated decision-making, because it makes the uncertainty associated with silent multiple comparisons explicit.
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Affiliation(s)
- Michael D Coory
- School of Population Health, Mayne Medical School, University of Queensland, Herston, Australia.
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Coory MD. Comment on: Heterogeneity in meta-analysis should be expected and appropriately quantified. Int J Epidemiol 2009; 39:932; author reply 933. [PMID: 19349478 DOI: 10.1093/ije/dyp157] [Citation(s) in RCA: 116] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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Wills RA, Coory MD. Effect of smoking among Indigenous and non-Indigenous mothers on preterm birth and full-term low birthweight. Med J Aust 2009; 189:490-4. [PMID: 18976189 DOI: 10.5694/j.1326-5377.2008.tb02141.x] [Citation(s) in RCA: 27] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2008] [Accepted: 06/10/2008] [Indexed: 11/17/2022]
Abstract
OBJECTIVE To estimate the percentage of preterm (< 37 weeks) and full-term low-birthweight (37-41 weeks, < 2500 g) babies born to mothers who smoke, stratified by Indigenous status and statistically adjusted for the potential confounding effects of social and demographic factors, medical conditions and pregnancy complications. DESIGN, SETTING AND PARTICIPANTS Population-based study of singleton babies born to mothers resident in Queensland who gave birth in Queensland from 1 July 2005 to 31 December 2006. MAIN OUTCOME MEASURES Adjusted percentages of preterm birth and full-term low birthweight for babies born to Indigenous and non-Indigenous mothers. RESULTS Of the 79 803 babies studied, 4228 (5.3%) were born to Indigenous mothers and 16 395 (20.5%) were born to mothers who smoked during pregnancy. The percentage of Indigenous mothers who smoked (54%) was almost triple that for non-Indigenous mothers (risk ratio, 2.90; 95% CI, 2.81-2.99). The adjusted outcomes for babies born to Indigenous non-smokers were similar to those for non-Indigenous non-smokers (preterm, 7.1% v 6.1%; full-term low birthweight, 1.6% v 1.1%). The adjusted percentages for smokers were high regardless of Indigenous status (preterm, Indigenous v non-Indigenous, 8.3% v 7.8%; full-term low birthweight, Indigenous v non-Indigenous, 5.3% v 3.7%). CONCLUSIONS Antenatal smoking remains an important cause of poor health among both Indigenous and non-Indigenous newborn babies. Most pregnant smokers receive their antenatal care in the public sector. State and federal governments, who directly fund this sector, have a particular responsibility to ensure that interventions are offered to all pregnant smokers to help them quit smoking.
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Coory MD, Kelly H, Tippett V. Assessment of ambulance dispatch data for surveillance of influenza-like illness in Melbourne, Australia. Public Health 2009; 123:163-8. [PMID: 19144362 PMCID: PMC7111682 DOI: 10.1016/j.puhe.2008.10.027] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.1] [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: 12/18/2007] [Revised: 07/29/2008] [Accepted: 10/29/2008] [Indexed: 11/29/2022]
Abstract
Objectives Ambulance dispatch data are collated electronically in many jurisdictions and have a wide reach into the community. They may therefore be useful for syndromic surveillance and early recognition of emerging infectious diseases. This study assessed whether ambulance dispatch data are suitable for influenza surveillance. Study design Comparison of a time series of ambulance dispatch data from Melbourne, Australia for the years 1997–2005 with locum service and general practice (GP) sentinel surveillance data for influenza-like illness (ILI). Methods All data were aggregated into 1-week periods, corresponding to the data collection period used in the GP sentinel surveillance system, which was used as the reference system. Rates of ambulance dispatches classified to respiratory or breathing problems per 1000 total dispatches were compared with rates of callouts for flu or influenza per 1000 locum calls, and rates of ILI per 1000 patients from the sentinel GPs. Signals from the ambulance data were generated using the log likelihood ratio CUSUM, a method of continuous monitoring suitable for surveillance. Results The ambulance dispatch data displayed seasonal trends that were similar to those observed in locum service surveillance and GP sentinel systems, and identified the years with higher-than-expected seasonal ILI activity (1998 and 2003) and the epidemic year (1997). However, there was a high baseline rate of ambulance calls classified to respiratory or breathing problems (90–100 per 1000 calls) in months where there was minimal influenza activity. Conclusion Ambulance dispatch data have potential for syndromic surveillance, but because of the high background noise are not definitive and would need to be calibrated to suit particular local circumstances.
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Affiliation(s)
- M D Coory
- School of Population Health, University of Queensland, Mayne Medical School, Herston Road, Herston, Queensland 4006, Australia.
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Coory MD, Green AC, Stirling J, Valery PC. Survival of Indigenous and non‐Indigenous Queenslanders after a diagnosis of lung cancer: a matched cohort study. Med J Aust 2008; 188:562-6. [DOI: 10.5694/j.1326-5377.2008.tb01790.x] [Citation(s) in RCA: 35] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2007] [Accepted: 12/12/2007] [Indexed: 11/17/2022]
Affiliation(s)
- Michael D Coory
- School of Population Health, University of Queensland, Brisbane, QLD
| | - Adele C Green
- Queensland Institute of Medical Research, Brisbane, QLD
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Coory MD. Antenatal care implications of population‐based trends in Down syndrome birth rates. Med J Aust 2007. [DOI: 10.5694/j.1326-5377.2007.tb01406.x] [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: 11/17/2022]
Affiliation(s)
- Michael D Coory
- Epidemiology Services Unit, Queensland Health, Brisbane, QLD
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Coory MD, Roselli T, Carroll HJ. Antenatal care implications of population‐based trends in Down syndrome birth rates by rurality and antenatal care provider, Queensland, 1990–2004. Med J Aust 2007; 186:230-4. [PMID: 17391083 DOI: 10.5694/j.1326-5377.2007.tb00878.x] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2006] [Accepted: 09/25/2006] [Indexed: 11/17/2022]
Abstract
OBJECTIVE To assess whether the rates of Down syndrome births in Queensland vary according to rurality (ie, whether the mother lives in a rural or urban area) and type of antenatal care provider, and to consider any implications for antenatal care. DESIGN AND SETTING Population-based study of Down syndrome births in Queensland between 1990 and 2004, stratified by rurality and type of antenatal care provider (private obstetrician, public hospital or shared care). RESULTS Since 2000, there has been a large fall in maternal-age-adjusted rates of Down syndrome births among mothers living in urban areas (-14.3% per year; 95% CI, -22.7%, -5.0%) and among mothers receiving their antenatal care from private obstetricians (-27.5% per year; 95% CI, -37.6%, -15.8%). Similar decreases have not occurred among mothers living in rural areas (0.0%; 95% CI, -11.7%, 13.1%) or among mothers receiving antenatal care from public hospitals (+2.9%, 95% CI, -10.3%, 17.9%). CONCLUSION Possible reasons for the observed trends include unequal access to antenatal screening; confusion about screening guidelines and protocols; late presentation for antenatal care; and differences in attitudes to screening and termination of pregnancy among expectant parents, such that they may choose not to have screening or not to act on a positive screening test result.
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Affiliation(s)
- Michael D Coory
- School of Population Health, University of Queensland, Brisbane, QLD, Australia.
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Johnston TC, Coory MD. Increase in caesarean section rates among low‐risk women in Queensland, 1990–2004. Med J Aust 2006; 185:404-5. [PMID: 17014412 DOI: 10.5694/j.1326-5377.2006.tb00623.x] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2006] [Accepted: 08/21/2006] [Indexed: 11/17/2022]
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Coory MD, Walsh WF. Rates of percutaneous coronary interventions and bypass surgery after acute myocardial infarction in Indigenous patients. Med J Aust 2005; 182:507-12. [PMID: 15896178 DOI: 10.5694/j.1326-5377.2005.tb00016.x] [Citation(s) in RCA: 52] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2005] [Accepted: 04/07/2005] [Indexed: 11/17/2022]
Abstract
OBJECTIVE To compare rates of percutaneous coronary interventions (PCI) and bypass surgery after acute myocardial infarction (AMI) in Indigenous and non-Indigenous patients. DESIGN Cohort study of public-sector patients who were followed up for 1 year using administrative hospital data. PARTICIPANTS AND SETTING We followed up 14 683 public-sector patients admitted to Queensland hospitals for AMI between 1998 and 2002. Of these, 558 (3.8%) identified as Indigenous. OUTCOME MEASURES Rates of PCI and bypass surgery, adjusted for differences between the Indigenous and non-Indigenous cohorts according to age, sex, socioeconomic status, remote residence, hospital characteristics, and comorbidities. RESULTS The adjusted rate for PCI during the index admission was significantly lower by 39% (rate ratio [RR], 0.61; 95% CI, 0.38-0.98) among Indigenous versus non-Indigenous patients with AMI; the adjusted rate for subsequent PCI was significantly lower by 28% (RR, 0.72; 95% CI, 0.54-0.96). Adjusted rates for bypass surgery were similar in the two cohorts. For any coronary procedure (ie, PCI or bypass surgery), the adjusted rate was significantly lower by 22% (RR, 0.78; 95% CI, 0.64-0.94) among Indigenous patients with AMI. Diabetes, chronic renal failure, pneumonia, and chronic rheumatic fever were at least twice as common among Indigenous patients with AMI as in the rest of the cohort, and chronic bronchitis and emphysema and heart failure were at least 60% more common. If a patient had at least one comorbidity, then their probability of having a coronary procedure was reduced by 40%. CONCLUSIONS There are likely to be several reasons for the lower rates of coronary procedures among Indigenous patients, but their high rates of comorbidities and the association of comorbidities with lower procedure rates was an important finding. As investment in primary care can reduce the prevalence and severity of comorbidities, we suggest that adequate primary health care is a prerequisite for effective specialist care.
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Affiliation(s)
- Michael D Coory
- Health Information Centre, Queensland Health, Brisbane, Australia.
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Coory MD, Baade PD. Urban–rural differences in prostate cancer mortality, radical prostatectomy and prostate‐specific antigen testing in Australia. Med J Aust 2005; 182:112-5. [PMID: 15698354 DOI: 10.5694/j.1326-5377.2005.tb06609.x] [Citation(s) in RCA: 61] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2004] [Accepted: 12/14/2004] [Indexed: 11/17/2022]
Abstract
OBJECTIVE To assess differences in trends for prostate cancer mortality, radical prostatectomy and prostate-specific antigen (PSA) testing for Australian men aged 50-79 years living in capital cities compared with regional and rural areas. DESIGN Descriptive, population-based study based on data from official sources from 1985 to the 2002/03 financial year (depending on data availability). MAIN OUTCOME MEASURES Age-standardised rates per 100,000 men aged 50-79 years of mortality from prostate cancer, incidence of prostate cancer, PSA tests and radical prostatectomy. RESULTS We found a statistically significant and increasing (age-standardised) mortality excess for prostate cancer in regional and rural areas. In 2000-2002 the excess (compared with capital cities) was 21% (95% CI, 14%-29%). Rates of radical prostatectomy in rural and regional Australia were 29% lower (95% CI, 23% lower to 35% lower) than in capital cities. Although PSA testing is common across the whole of Australia, age-standardised rates in 2002/03 were 16% lower (95% CI, 15% lower to 17% lower) in regional and rural areas than in capital cities. CONCLUSIONS Our results show that the probability of a man having a PSA test and the management of his prostate cancer depend on where he lives. The cause or causes of the prostate cancer mortality excess in regional/rural areas cannot be established in a descriptive study, but fewer radical prostatectomies in regional and rural areas, perhaps associated with less PSA screening, remain among the several competing hypotheses. Other possibilities are related to other differences in management, perhaps associated with access to urologists. Governments and other budget holders need good evidence about the effectiveness of prostate cancer screening and early treatment, but also about the best strategies for providing equitable access to cancer services in both urban and rural areas.
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Affiliation(s)
- Michael D Coory
- Health Information Centre, Queensland Health, Brisbane, QLD.
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Abstract
There have been dire predictions that population ageing will result in skyrocketing health costs. However, numerous studies have shown that the effect of population ageing on health expenditure is likely to be small and manageable. Pessimism about population ageing is popular in policy debates because it fits with ideological positions that favour growth in the private sector and seek to contain health expenditure in the public sector. It might also distract attention from the need to evaluate the appropriateness and effectiveness of current patterns of care. Pessimistic scenarios have stifled debate and limited the number of policy options considered. Policy making in Australia would be improved if we took a more realistic view of the effect of population ageing on health expenditure.
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Affiliation(s)
- Michael D Coory
- Epidemiology Services Unit, Queensland Health, GPO Box 48, Brisbane, QLD 4001, Australia.
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Abstract
OBJECTIVE To measure recent changes in prostate-cancer mortality across 24 developed countries. METHODS Mortality data for men aged 50-79 years were obtained from the World Health Organisation mortality database and we assessed trends in age-standardised mortality rates using joinpoint regression models. RESULTS Significant reductions in prostate-cancer mortality were observed in United Kingdom, United States, Austria, Canada, Italy, France, Germany, Australia and Spain, and downward trends were also observable in the Netherlands, Ireland and Sweden. CONCLUSIONS Mortality declines for prostate cancer are now evident in 12 out of the 24 developed countries considered in this analysis. Increases in PSA screening and better treatment of early-stage disease, possibly acting in combination, remain plausible hypotheses.
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Affiliation(s)
- P D Baade
- Cancer Epidemiology Unit, Queensland Cancer Fund, PO Box 201, Spring Hill QLD 4004, Australia.
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Coory MD. Hormone replacement therapy: to use or not to use? Med J Aust 2003; 179:391-2; author reply 392. [PMID: 14503911] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2003] [Accepted: 07/24/2003] [Indexed: 04/27/2023]
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Coory MD. Hormone replacement therapy: to use or not to use? Med J Aust 2003. [DOI: 10.5694/j.1326-5377.2003.tb05607.x] [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: 11/17/2022]
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Coory MD, Fagan PS, Muller JM, Dunn NAM. In reply: Pap smear participation rates, primary healthcare and Indigenous women. Med J Aust 2003. [DOI: 10.5694/j.1326-5377.2003.tb05339.x] [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: 11/17/2022]
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Coory MD, Fagan PS, Muller JM, Dunn NAM. Participation in cervical cancer screening by women in rural and remote Aboriginal and Torres Strait Islander communities in Queensland. Med J Aust 2002; 177:544-7. [PMID: 12429002 DOI: 10.5694/j.1326-5377.2002.tb04949.x] [Citation(s) in RCA: 41] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2002] [Accepted: 07/05/2002] [Indexed: 11/17/2022]
Abstract
OBJECTIVE To investigate the extent of participation in cervical cancer screening among women who live in discrete rural and remote Indigenous communities in Queensland. DESIGN Descriptive analysis of data from the Queensland Health Pap Smear Registry for the period March 1999 to February 2001. SUBJECTS Women aged 20-69 years who had given their address of usual residence as one of 13 discrete rural and remote Indigenous communities in Queensland. MAIN OUTCOME MEASURES Proportion of women who participated in cervical screening over a two-year period ("biennial participation percentage") and variation in participation across the 13 communities. RESULTS Overall, the biennial participation percentage in the Indigenous communities was 41.1%. This was 30% lower (risk ratio, 0.70; 95% CI, 0.67-0.72) than that for the rest of Queensland. There was statistically significant variation among communities, with biennial participation percentage ranging from 19.9% to 63.5%. CONCLUSIONS The variation in participation across the communities suggests that the problem of low participation among Indigenous women is not intractable. Achieving participation rates similar to the highest rates found in our study would be of major benefit to Indigenous women.
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Abstract
OBJECTIVE To evaluate the effects of quality improvement interventions on inhospital mortality after admission for acute myocardial infarction (AMI). DESIGN Before-and-after study (with concurrent controls) based on hospital discharge data from a routinely maintained, administrative database. SETTING All Queensland public hospitals, July 1991 - June 1999. STUDY POPULATION Patients with AMI admitted through the emergency department. INTERVENTION Development and promulgation of clinical practice guidelines at one hospital, combined with regular audit and feedback, commencing November 1995. MAIN OUTCOME MEASURES Inhospital mortality (adjusted for age, sex and comorbidities) for four-year periods before (1991-92 to 1994-95) and after (1995-96 to 1998-99) initiation of quality improvement interventions. RESULTS Before the intervention, the adjusted odds ratio (OR) for inhospital death at the intervention hospital was about the same as at other public hospitals (adjusted OR, 0.99; 95% CI, 0.80-1.24), but was more than 40% lower after the intervention (adjusted OR, 0.59; 95% Cl, 0.45-0.78). After the intervention, the risk of death at the intervention hospital was lower compared with hospitals with cardiologists as admitting practitioners (adjusted OR, 0.63; 95% CI, 0.48-0.83), with onsite revascularisation facilities (adjusted OR, 0.66; 95% CI, 0.49-0.88), and with large numbers (> or = 250 per year) of annual admissions of patients with AMI (adjusted OR, 0.72; 95% CI, 0.54-0.97). CONCLUSIONS Quality improvement interventions lower the risk of inhospital death in patients with AMI. Implementation of such interventions in all hospitals may confer a risk of death lower than that achieved by admitting all patients under the care of cardiologists, or to hospitals with revascularisation facilities or a high volume of admissions of patients with AMI.
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Affiliation(s)
- I A Scott
- Department of Internal Medicine, Princess Alexandra Hospital, Brisbane, QLD.
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