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García Ruiz R, Mateu Puchades A, Alegre de Miquel V. Basal Cell Carcinoma: Incidence and Trends in Valencia, Spain. Actas Dermosifiliogr 2024:S0001-7310(24)00186-8. [PMID: 38452894 DOI: 10.1016/j.ad.2024.02.029] [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: 01/05/2024] [Revised: 02/14/2024] [Accepted: 02/24/2024] [Indexed: 03/09/2024] Open
Abstract
BACKGROUND There is a need for epidemiological and incidence data on the occurrence of basal cell carcinoma (BCC) in Spain. OBJECTIVES Our study was designed to retrospectively retrieve cases from our computer databases from 2010 through 2016 to provide updated data on the actual incidence of BCC in Valencia, eastern Spain. MATERIAL AND METHODS This was an epidemiological study on basal cell carcinoma conducted in Valencia, eastern Spain. We analyzed a total of 2171 patients and 4047 tumors, and gathered data to estimate the actual incidence of BBC in our region. RESULTS AND CONCLUSIONS Our study confirmed that the incidence of BCC is much higher than previously reported. We calculated a crude incidence of 410.38 BCCs/100 000 person-years, an adjusted rate for the European population of 256.98 BCCs/100 000 person-years, and an adjusted rate for the world population of 196.26 BCCs/100 000 person-years. Risk is up to 29.49% higher for men (464.07 cases/100 000 person-years vs 358.40 cases/100 000 person-years for women). Incidence also increases by an annual 3.91% (a significantly higher annual incidence of 8.28% in women vs a 0.92% annual incidence in men). Overall, the lifetime risk for developing a BCC is 5.8% (5.02% in women and 7% in men).
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Kreuzer M, Sommer M, Deffner V, Bertke S, Demers PA, Kelly-Reif K, Laurier D, Rage E, Richardson DB, Samet JM, Schubauer-Berigan MK, Tomasek L, Wiggins C, Zablotska LB, Fenske N. Lifetime excess absolute risk for lung cancer due to exposure to radon: results of the pooled uranium miners cohort study PUMA. Radiat Environ Biophys 2024; 63:7-16. [PMID: 38172372 PMCID: PMC10920468 DOI: 10.1007/s00411-023-01049-w] [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] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/24/2023] [Accepted: 11/09/2023] [Indexed: 01/05/2024]
Abstract
The Pooled Uranium Miners Analysis (PUMA) study is the largest uranium miners cohort with 119,709 miners, 4.3 million person-years at risk and 7754 lung cancer deaths. Excess relative rate (ERR) estimates for lung cancer mortality per unit of cumulative exposure to radon progeny in working level months (WLM) based on the PUMA study have been reported. The ERR/WLM was modified by attained age, time since exposure or age at exposure, and exposure rate. This pattern was found for the full PUMA cohort and the 1960 + sub-cohort, i.e., miners hired in 1960 or later with chronic low radon exposures and exposure rates. The aim of the present paper is to calculate the lifetime excess absolute risk (LEAR) of lung cancer mortality per WLM using the PUMA risk models, as well as risk models derived in previously published smaller uranium miner studies, some of which are included in PUMA. The same methods were applied for all risk models, i.e., relative risk projection up to <95 years of age, an exposure scenario of 2 WLM per year from age 18-64 years, and baseline mortality rates representing a mixed Euro-American-Asian population. Depending upon the choice of model, the estimated LEAR per WLM are 5.38 × 10-4 or 5.57 × 10-4 in the full PUMA cohort and 7.50 × 10-4 or 7.66 × 10-4 in the PUMA 1960 + sub-cohort, respectively. The LEAR per WLM estimates derived from risk models reported for previously published uranium miners studies range from 2.5 × 10-4 to 9.2 × 10-4. PUMA strengthens knowledge on the radon-related lung cancer LEAR, a useful way to translate models for policy purposes.
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Affiliation(s)
- M Kreuzer
- Federal Office for Radiation Protection (BfS), Munich (Neuherberg), Germany.
| | - M Sommer
- Federal Office for Radiation Protection (BfS), Munich (Neuherberg), Germany
| | - V Deffner
- Federal Office for Radiation Protection (BfS), Munich (Neuherberg), Germany
| | - S Bertke
- National Institute for Occupational Safety and Health, Cincinnati, OH, USA
| | - P A Demers
- Occupational Cancer Research Centre, Toronto, Canada
| | - K Kelly-Reif
- National Institute for Occupational Safety and Health, Cincinnati, OH, USA
| | - D Laurier
- Institute for Radiological Protection and Nuclear Safety (IRSN), Fontenay-aux-Roses, France
| | - E Rage
- Institute for Radiological Protection and Nuclear Safety (IRSN), Fontenay-aux-Roses, France
| | | | - J M Samet
- Colorado School of Public Health, Aurora, CO, USA
| | | | - L Tomasek
- National Radiation Protection Institute, Prague, Czech Republic
| | - C Wiggins
- University of New Mexico, Albuquerque, NM, USA
- New Mexico Tumor Registry, Albuquerque, NM, USA
| | | | - N Fenske
- Federal Office for Radiation Protection (BfS), Munich (Neuherberg), Germany
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Lu Z, Nlapto N, Tilly MJ, Geurts S, Aribas E, Ikram MK, de Groot NMS, Kavousi M. Burden of cardiometabolic disorders and lifetime risk of new-onset atrial fibrillation among men and women: the Rotterdam Study. Eur J Prev Cardiol 2024:zwae045. [PMID: 38307013 DOI: 10.1093/eurjpc/zwae045] [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] [Received: 05/31/2023] [Revised: 01/14/2024] [Accepted: 01/21/2024] [Indexed: 02/04/2024]
Abstract
AIMS To examine the association between the burden of cardiometabolic disorders with new-onset AF and lifetime risk of AF incidence among men and women. METHODS 4,101 men and 5,421 women free of AF at baseline (1996 to 2008) from the population-based Rotterdam Study were included. Sex-specific Cox proportional hazards regression models were used to assess the association between the burden of cardiometabolic disorders and risk of new-onset AF. Remaining lifetime risk for AF was estimated at index ages of 55, 65, and 75 years up to age 108. RESULTS Mean age at baseline was 65.5 ± 9.4 years. Median follow-up time was 12.8 years. In the fully adjusted model, a stronger association was found between larger burden of cardiometabolic disorders and incident AF among women [hazard ratio (HR): 1.33 and 95% conference interval (CI): 1.22-1.46], compared to men [1.18 (1.08-1.29)] (P for sex-interaction <0.05). The lifetime risk for AF significantly increased with the number of cardiometabolic disorders among both sexes. At an index age of 55 years, the lifetime risks (95% CIs) for AF were 27.1% (20.8-33.4), 26.5% (22.8-30.5), 29.9% (26.7-33.2), 30.8% (25.7-35.8), and 33.3% (23.1-43.6) among men, for 0, 1, 2, 3, and ≥4 comorbid cardiometabolic disorders. Corresponding risks were15.8% (10.5-21.2), 23.0% (19.8-26.2), 29.7% (26.8-32.6), 26.2% (20.8-31.6), and 34.2% (17.3-51.1) among women. CONCLUSIONS We observed a significant combined impact of cardiometabolic disorders on AF risk, in particular among women. Participants with cardiometabolic multimorbidity had a significantly higher lifetime risk of AF, especially at a young index age.
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Affiliation(s)
- Zuolin Lu
- Department of Epidemiology, Erasmus MC, University Medical Center Rotterdam, Rotterdam, The Netherlands
- School of Population Medicine and Public Health, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing, China
| | - Noluthando Nlapto
- Department of Epidemiology, Erasmus MC, University Medical Center Rotterdam, Rotterdam, The Netherlands
| | - Martijn J Tilly
- Department of Epidemiology, Erasmus MC, University Medical Center Rotterdam, Rotterdam, The Netherlands
| | - Sven Geurts
- Department of Epidemiology, Erasmus MC, University Medical Center Rotterdam, Rotterdam, The Netherlands
| | - Elif Aribas
- Department of Epidemiology, Erasmus MC, University Medical Center Rotterdam, Rotterdam, The Netherlands
| | - M Kamran Ikram
- Department of Epidemiology, Erasmus MC, University Medical Center Rotterdam, Rotterdam, The Netherlands
| | - Natasja M S de Groot
- Department of Cardiology, Erasmus MC, University Medical Center Rotterdam, Rotterdam, The Netherlands
| | - Maryam Kavousi
- Department of Epidemiology, Erasmus MC, University Medical Center Rotterdam, Rotterdam, The Netherlands
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Södergren E, Mårdberg K, Nishimwe M, Bhavsar A, Marijam A, Bergström T, Stäck P. Incidence and Burden of Herpes Zoster in Sweden: A Regional Population-Based Register Study. Infect Dis Ther 2024; 13:121-140. [PMID: 38193987 PMCID: PMC10828402 DOI: 10.1007/s40121-023-00902-1] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2023] [Accepted: 12/05/2023] [Indexed: 01/10/2024] Open
Abstract
INTRODUCTION Herpes zoster (HZ) is a painful disease that mainly affects individuals whose immune system has been weakened because of increasing age (> 50 years) or certain diseases or treatments. We estimated the complete burden of HZ. METHODS This population-based register study analysed healthcare data from the VEGA and Digitalis databases of Västra Götaland Region (VGR), Sweden. The VEGA database includes all patients in VGR, covering both hospital and primary care. The Digitalis records prescribed medications. The study population included patients aged ≥ 18 years with at least one registered primary or secondary HZ diagnosis (based on International Classification of Diseases [ICD] codes) between 2005 and 2021. Incidence rates (95% confidence intervals [CI]) were stratified by age, sex and diagnosis/analgesic prescription. RESULTS Overall HZ incidence increased from 2.5 (95% CI 2.4-2.6) in 2005 to 4.2 (95% CI 4.1-4.3) in 2021. The increase in incidence was rapid from 2005 to 2013, followed by a plateauing trend. From 2014-2019, the lifetime risk of HZ, excluding recurrent cases, was 36.5% (95% CI 35.5-37.4%). Municipal differences ranged from 34.4% (95% CI 32.5-36.4%) to 43.6% (95% CI 39.9-47.4%). Recurrence rates of HZ were 8.7% and 9.1% with follow-up periods of 5.5 and 10.5 years, respectively. Reported postherpetic neuralgia (PHN) cases increased five-fold over the study period. In 2019, 19% of all HZ patients developed HZ-related neuropathic pain; 13.6% had signs of persistent pain (> 90 days; i.e. PHN). An increased occurrence of cerebral and cardiovascular disease was observed in HZ patients. Among high-risk groups the occurrence of HZ peaked among those with inflammatory and autoimmune diseases. CONCLUSION HZ and PHN risk in Sweden is comparable to that in other European countries prior to implementing HZ national vaccination programs. Municipal differences suggest that the lifetime risk of HZ in Sweden is at least 36.5%. CLINICAL TRIAL REGISTRATION NCT Number ( www. CLINICALTRIALS gov ).
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Affiliation(s)
| | | | | | | | | | - Tomas Bergström
- Department of Infectious Diseases, Institute of Biomedicine, University of Gothenburg, Gothenburg, Sweden
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Zheng R, Wang S, Zhang S, Zeng H, Chen R, Sun K, Li L, Bray F, Wei W. Global, regional, and national lifetime probabilities of developing cancer in 2020. Sci Bull (Beijing) 2023; 68:2620-2628. [PMID: 37821267 PMCID: PMC10640926 DOI: 10.1016/j.scib.2023.09.041] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2023] [Revised: 06/09/2023] [Accepted: 09/22/2023] [Indexed: 10/13/2023]
Abstract
The lifetime risk of cancer is a measure of the cumulative risk of cancer over a specific age range and has a clear, intuitive appeal. However, comparative assessments of cancer-specific risk across populations are limited. We used the adjusted for multiple primaries method to estimate the lifetime risk of cancer from the obtained data from GLOBOCAN for 185 countries/regions for the year 2020, alongside all-cause mortality and population data from the United Nations. The estimated global lifetime risk of cancer from birth to death was 25.10% (95% confidence interval (CI): 25.08%-25.11%) in 2020; the risk was 26.27% (95% CI: 26.24%-26.30%) in men and 23.96% (95% CI: 23.93%-23.98%) in women. Significant differences were observed in the risks between countries/regions within world areas and by the human development level. The lifetime risk of cancer was 38.48%, 25.38%, 11.36%, and 10.34% in countries/regions with very high, high, medium, and low Human Development Index, respectively. Globally, prostate and breast cancers were associated with the greatest lifetime risks among men and women (4.65% and 5.90%, respectively). The lifetime risk of cancer decreased with age, with a remaining risk of 12.61% (95% CI: 12.60%-12.63%) from the age of 70 years. The lifetime risk from birth to death translates to approximately one in four persons developing cancer, with men and women having similar risk levels. The identified age-specific variations in cancer risk at the population level can provide crucial information to support targeted cancer prevention and health system planning.
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Affiliation(s)
- Rongshou Zheng
- National Central Cancer Registry, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100021, China
| | - Shaoming Wang
- National Central Cancer Registry, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100021, China
| | - Siwei Zhang
- National Central Cancer Registry, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100021, China
| | - Hongmei Zeng
- National Central Cancer Registry, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100021, China
| | - Ru Chen
- National Central Cancer Registry, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100021, China
| | - Kexin Sun
- National Central Cancer Registry, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100021, China
| | - Li Li
- National Central Cancer Registry, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100021, China
| | - Freddie Bray
- Cancer Surveillance Branch, International Agency for Research on Cancer, Lyon 69366, France.
| | - Wenqiang Wei
- National Central Cancer Registry, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100021, China.
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Panagiotakos D, Chrysohoou C, Damigou E, Barkas F, Liberopoulos E, Tsioufis C, Sfikakis PP, Pitsavos C. Prediction of lifetime risk for cardiovascular disease, by risk factors level: the ATTICA epidemiological cohort study (2002-2022). Ann Epidemiol 2023; 87:17-24. [PMID: 37866102 DOI: 10.1016/j.annepidem.2023.09.010] [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] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2023] [Revised: 09/17/2023] [Accepted: 09/27/2023] [Indexed: 10/24/2023]
Abstract
PURPOSE We aimed to predict lifetime risk for cardiovascular disease (CVD). METHODS The sample consisted of 1988 participants with complete CVD data during the 20-year follow-up (50% men, 45 ± 14 years) of the ATTICA study. Lifetime risk for CVD was predicted at specific index ages (40, 50, and 60 years), based on the life-table method, with death free-of-CVD treated as a competing event. RESULTS 718 participants experienced a fatal or nonfatal CVD event, corresponding to a crude CVD incidence of 36.1% (men: 40.2%, women: 32.1%, P-value < .001). Overall, women and men had similar lifetime CVD risk (P-value = .245); at index age of 40, the lifetime risk for CVD was 68% for men and 63% for women, with a progressive decline to 56% and 50% at the index age of 50, and to 55% for both men and women, at the index age of 60 years, respectively. CONCLUSIONS These results on lifetime risk for CVD can guide the allocation of resources to improve public health and preventive services, especially in ages below 50 years, in both men and women.
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Affiliation(s)
- Demosthenes Panagiotakos
- Department of Nutrition and Dietetics, School of Health Sciences and Education, Harokopio University of Athens, Greece.
| | - Christina Chrysohoou
- First Cardiology Clinic, School of Medicine, National and Kapodistrian University of Athens, Hippokration Hospital, Greece
| | - Evangelia Damigou
- Department of Nutrition and Dietetics, School of Health Sciences and Education, Harokopio University of Athens, Greece
| | - Fotios Barkas
- Department of Internal Medicine, School of Medicine, University of Ioannina, Greece
| | - Evangelos Liberopoulos
- First Department of Propaedeutic Internal Medicine, School of Medicine, National and Kapodistrian University of Athens, Laiko General Hospital, Greece
| | - Costas Tsioufis
- First Cardiology Clinic, School of Medicine, National and Kapodistrian University of Athens, Hippokration Hospital, Greece
| | - Petros P Sfikakis
- First Department of Propaedeutic Internal Medicine, School of Medicine, National and Kapodistrian University of Athens, Laiko General Hospital, Greece
| | - Christos Pitsavos
- First Cardiology Clinic, School of Medicine, National and Kapodistrian University of Athens, Hippokration Hospital, Greece
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Schade DS, Hickey M, Eaton RP. Interpreting the Coronary Artery Calcium Score - Critical Information for the Practicing Physician. Am J Med 2023; 136:1070-1075. [PMID: 37660746 DOI: 10.1016/j.amjmed.2023.08.005] [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] [Received: 08/08/2023] [Revised: 08/10/2023] [Accepted: 08/11/2023] [Indexed: 09/05/2023]
Abstract
Coronary artery calcium scanning is a routine test for assessing the severity of atherosclerosis in asymptomatic individuals. This inexpensive, noninvasive test quantifies the calcium deposition in the 4 principal coronary arteries. Correct interpretation is important to the physician (for recommending therapy) and to the patient (for determining his or her lifetime risk of a cardiovascular event). A score of 0 indicates that a cardiovascular event is extremely unlikely in the next 5 years. In contrast, a score greater than 0 portends a coronary event. The higher the score, the greater the risk. Both the arterial location of the calcium and the number of coronary arteries involved alter the interpretation of the calcium score. At any given age, females have significantly lower scores than males. One-third of individuals with scores greater than 1000 will have a cardiovascular event within 3 years. For all elevated calcium scores, aggressive treatment is warranted, including significant lifestyle changes and medications to reduce low-density lipoprotein cholesterol. Understanding the importance of the coronary artery calcium score will result in improved therapy and patient compliance.
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Affiliation(s)
- David S Schade
- University of New Mexico Health Sciences Center, Albuquerque.
| | - Martin Hickey
- University of New Mexico Health Sciences Center, Albuquerque
| | - R Philip Eaton
- University of New Mexico Health Sciences Center, Albuquerque
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Burger PM, Savarese G, Tromp J, Adamson C, Jhund PS, Benson L, Hage C, Tay WT, Solomon SD, Packer M, Rossello X, McEvoy JW, De Bacquer D, Timmis A, Vardas P, Graham IM, Di Angelantonio E, Visseren FLJ, McMurray JJV, Lam CSP, Lund LH, Koudstaal S, Dorresteijn JAN, Mosterd A. Personalized lifetime prediction of survival and treatment benefit in patients with heart failure with reduced ejection fraction: The LIFE-HF model. Eur J Heart Fail 2023; 25:1962-1975. [PMID: 37691140 DOI: 10.1002/ejhf.3028] [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] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/28/2023] [Revised: 08/22/2023] [Accepted: 09/04/2023] [Indexed: 09/12/2023] Open
Abstract
AIMS Although trials have proven the group-level effectiveness of various therapies for heart failure with reduced ejection fraction (HFrEF), important differences in absolute effectiveness exist between individuals. We developed and validated the LIFEtime-perspective for Heart Failure (LIFE-HF) model for the prediction of individual (lifetime) risk and treatment benefit in patients with HFrEF. METHODS AND RESULTS Cox proportional hazards functions with age as the time scale were developed in the PARADIGM-HF and ATMOSPHERE trials (n = 15 415). Outcomes were cardiovascular death, heart failure (HF) hospitalization or cardiovascular death, and non-cardiovascular mortality. Predictors were age, sex, New York Heart Association class, prior HF hospitalization, diabetes mellitus, extracardiac vascular disease, systolic blood pressure, left ventricular ejection fraction, N-terminal pro-B-type natriuretic peptide, and glomerular filtration rate. The functions were combined in life-tables to predict individual overall and HF hospitalization-free survival. External validation was performed in the SwedeHF registry, ASIAN-HF registry, and DAPA-HF trial (n = 51 286). Calibration of 2- to 10-year risk was adequate, and c-statistics were 0.65-0.74. An interactive tool was developed combining the model with hazard ratios from trials to allow estimation of an individual's (lifetime) risk and treatment benefit in clinical practice. Applying the tool to the development cohort, combined treatment with a mineralocorticoid receptor antagonist, sodium-glucose cotransporter 2 inhibitor, and angiotensin receptor-neprilysin inhibitor was estimated to afford a median of 2.5 (interquartile range [IQR] 1.7-3.7) and 3.7 (IQR 2.4-5.5) additional years of overall and HF hospitalization-free survival, respectively. CONCLUSION The LIFE-HF model enables estimation of lifelong overall and HF hospitalization-free survival, and (lifetime) treatment benefit for individual patients with HFrEF. It could serve as a tool to improve the management of HFrEF by facilitating personalized medicine and shared decision-making.
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Affiliation(s)
- Pascal M Burger
- Department of Vascular Medicine, University Medical Centre Utrecht, Utrecht, The Netherlands
| | | | - Jasper Tromp
- Saw Swee Hock School of Public Health, National University of Singapore, Singapore, Singapore
- National University Health System Singapore, Singapore, Singapore
| | - Carly Adamson
- British Heart Foundation Cardiovascular Research Centre, University of Glasgow, Glasgow, UK
| | - Pardeep S Jhund
- British Heart Foundation Cardiovascular Research Centre, University of Glasgow, Glasgow, UK
| | - Lina Benson
- Department of Medicine, Karolinska Institutet, Stockholm, Sweden
| | - Camilla Hage
- Department of Medicine, Karolinska Institutet, Stockholm, Sweden
| | - Wan Ting Tay
- National Heart Centre Singapore, Singapore, Singapore
| | - Scott D Solomon
- Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
| | - Milton Packer
- Baylor Heart and Vascular Institute, Baylor University Medical Centre, Dallas, TX, USA
| | - Xavier Rossello
- Centro Nacional de Investigaciones Cardiovasculares, Madrid, Spain
| | - John W McEvoy
- National Institute for Prevention and Cardiovascular Health, National University of Ireland Galway, Galway, Ireland
| | - Dirk De Bacquer
- Department of Public Health and Primary Care, Ghent University, Ghent, Belgium
| | - Adam Timmis
- William Harvey Research Institute, Queen Mary University of London, London, UK
| | | | - Ian M Graham
- School of Medicine, Trinity College Dublin, The University of Dublin, College Green, Dublin, Ireland
| | | | - Frank L J Visseren
- Department of Vascular Medicine, University Medical Centre Utrecht, Utrecht, The Netherlands
| | - John J V McMurray
- British Heart Foundation Cardiovascular Research Centre, University of Glasgow, Glasgow, UK
| | - Carolyn S P Lam
- National Heart Centre Singapore, Singapore, Singapore
- Duke-National University of Singapore, Singapore, Singapore
| | - Lars H Lund
- Department of Medicine, Karolinska Institutet, Stockholm, Sweden
| | | | - Jannick A N Dorresteijn
- Department of Vascular Medicine, University Medical Centre Utrecht, Utrecht, The Netherlands
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Sharma P, Dilip TR, Mishra US, Kulkarni A. The lifetime risk of developing type II diabetes in an urban community in Mumbai: findings from a ten-year retrospective cohort study. BMC Public Health 2023; 23:1673. [PMID: 37653484 PMCID: PMC10469861 DOI: 10.1186/s12889-023-16596-6] [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] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2023] [Accepted: 08/23/2023] [Indexed: 09/02/2023] Open
Abstract
BACKGROUND Incidence and prevalence do not capture the risk of developing diabetes during a defined period and only limited evidence exists on the lifetime risk of diabetes based on longer and continuous follow-up studies in India. Lacunae in evidence on lifetime risk can be attributed primarily to the absence of comprehensive and reliable information on diabetes incidence, mortality rates and lack of longitudinal studies in India. In light of the scarcity of evidence in India, the objective of this study was to estimate the incidence of diabetes and its lifetime risk in an urban community of Mumbai. METHODS The research study utilized data which is extracted from the electronic medical records of beneficiaries covered under the Contributory Health Service Scheme in Mumbai. The dataset included information on 1652 beneficiaries aged 40 years and above who were non-diabetic in 2011-2012, capturing their visit dates to medical center and corresponding laboratory test results over a span ten years from January, 2012- December, 2021. Survival analysis techniques are applied to estimate the incidence of diabetes. Subsequently, the remaining life years from the life table were utilized to estimate the lifetime risk of diabetes for each gender, stratified by age group. RESULTS A total of 546 beneficiaries developed diabetes in ten years, yielding an unadjusted incidence rate of 5.3 cases per 1000 person-years (95% CI: 4.9- 5.8 cases/ 1000 person years). The age-adjusted lifetime risk of developing type II diabetes in this urban community is estimated to be 40.3%. Notably, males aged 40 years and above had 41.5% chances of developing diabetes in their lifetime as compared to females with a risk of 39.4%. Moreover, the remaining lifetime risk of diabetes decreased with advancing age, ranging from 26.4% among 40-44 years old to 4.2% among those age 70 years and above. CONCLUSION The findings stress the significance of recognizing age specific lifetime risk and implementing early interventions to prevent or delay diabetes onset and to focus on diabetes management programs in India.
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Affiliation(s)
- Palak Sharma
- Department of Family and Generations, International Institute for Population Sciences, Mumbai, 400088, India.
| | - T R Dilip
- Department of Family and Generations, International Institute for Population Sciences, Mumbai, 400088, India
| | - Udaya Shankar Mishra
- Department of Bio-Statistics and Epidemiology, International Institute for Population Sciences, Mumbai, 400088, India
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Qwasmeh AAH, Saleh BAA. Radiation dose and lifetime risk for radiation-induced cancer due to natural radioactivity in tap water from Jordan. Radiat Environ Biophys 2023; 62:279-285. [PMID: 36862217 DOI: 10.1007/s00411-023-01018-3] [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] [Subscribe] [Scholar Register] [Received: 08/31/2022] [Accepted: 02/18/2023] [Indexed: 05/18/2023]
Abstract
The purpose of this study was to investigate the radiological quality of drinking water in Ma'an governorate, which includes the archeological city of Petra and is one of Jordan's most important tourist destinations. To the best of the authors' knowledge, this is the first study in southern Jordan that investigates radioactivity in drinking water and its potential to cause cancer. A liquid scintillation detector was used to measure gross alpha and gross beta activities in tap water samples from Ma'an governorate. A high-purity Germanium detector was used to measure the activity concentrations of 226Ra and 228Ra. Gross alpha, gross beta, 226Ra, and 228Ra activities were < 110-724 mBq/l, < 220-362 mBq/l, < 11-241 mBq/l, and < 32-49 mBq/l, respectively. The results were compared to internationally recommended levels and literature values. Annual effective doses ([Formula: see text]) from 226 and 228Ra intake were calculated for infants, children, and adults. The highest doses were found for children while the lowest were found for infants. For each water sample, the lifetime risk of radiation-induced cancer (LTR) was calculated for the whole population. All of the LTR values were lower than the value recommended by the World Heath Organisation. It is concluded that there are no significant radiation-related health risks associated with consumption of tap water from the studied region.
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Affiliation(s)
- Ahmed Ali Husein Qwasmeh
- Department of Physics, Faculty of Science, Al-Hussein Bin Talal University, Ma'an, 71111, Jordan.
| | - Batool A Abu Saleh
- Department of Applied Science, Faculty of Ma'an College, Al-Balqa' Applied University, Al-Salt, Jordan
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Yang Y, Song L, Wang L, Li D, Chen S, Wu S, Tian Y. Effect of body mass index trajectory on lifetime risk of cardiovascular disease in a Chinese population: A cohort study. Nutr Metab Cardiovasc Dis 2023; 33:523-531. [PMID: 36710107 DOI: 10.1016/j.numecd.2022.11.025] [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] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/06/2022] [Revised: 11/24/2022] [Accepted: 11/28/2022] [Indexed: 12/24/2022]
Abstract
BACKGROUND AND AIMS The longitudinal trajectories of body mass index (BMI) can reflect the pattern of BMI changes. Lifetime risk quantifies the cumulative risk of developing a disease over the remaining life of a person. We aimed to identify the trajectory of BMI and explore its association with cardiovascular disease (CVD) in the Chinese population. METHODS AND RESULTS A total of 68,603 participants with a mean age of 55.46 years were included from the Kailuan cohort in Tangshan, China, who were free of CVD and cancer and with repeated measurements of BMI from 2006 to 2010. A latent mixture model was used to identify BMI trajectories. An improved Kaplan-Meier estimator was used to predict the lifetime risk of CVD according to BMI trajectories. During a median follow-up of 7.0 years, 3325 participants developed CVD. Five BMI trajectories were identified at three index ages (35, 45, and 55) respectively. For index age 35 years, compared with the stable low-normal weight group (22.7% [95% CI, 20.0%-25.4%]), the stable high-normal weight (27.6% [25.6%-29.5%]), stable overweight (29.4% [27.4%-31.4%]), stable-low obesity (32.8% [30.0%-35.5%]), and stable-high obesity (38.9% [33.3%-44.5%]) groups had a higher lifetime risk of CVD (P < 0.05). We observed similar patterns for stroke and myocardial infarction. Similarly, the lifetime risk of CVD was higher in the long-term overweight and obese groups at 45 and 55 index ages. CONCLUSIONS Long-term overweight and obesity were associated with an increased lifetime risk of CVD. Our findings could assist in predicting the population burden of CVD.
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Affiliation(s)
- Yingping Yang
- Ministry of Education Key Laboratory of Environment and Health, and State Key Laboratory of Environmental Health (Incubating), School of Public Health, Tongji Medical College, Huazhong University of Science and Technology, No.13 Hangkong Road, Wuhan, 430030, China; Department of Maternal and Child Health, School of Public Health, Tongji Medical College, Huazhong University of Science and Technology, No.13 Hangkong Road, Wuhan, 430030, China
| | - Lulu Song
- Ministry of Education Key Laboratory of Environment and Health, and State Key Laboratory of Environmental Health (Incubating), School of Public Health, Tongji Medical College, Huazhong University of Science and Technology, No.13 Hangkong Road, Wuhan, 430030, China; Department of Maternal and Child Health, School of Public Health, Tongji Medical College, Huazhong University of Science and Technology, No.13 Hangkong Road, Wuhan, 430030, China
| | - Lulin Wang
- Ministry of Education Key Laboratory of Environment and Health, and State Key Laboratory of Environmental Health (Incubating), School of Public Health, Tongji Medical College, Huazhong University of Science and Technology, No.13 Hangkong Road, Wuhan, 430030, China; Department of Maternal and Child Health, School of Public Health, Tongji Medical College, Huazhong University of Science and Technology, No.13 Hangkong Road, Wuhan, 430030, China
| | - Dankang Li
- Ministry of Education Key Laboratory of Environment and Health, and State Key Laboratory of Environmental Health (Incubating), School of Public Health, Tongji Medical College, Huazhong University of Science and Technology, No.13 Hangkong Road, Wuhan, 430030, China; Department of Maternal and Child Health, School of Public Health, Tongji Medical College, Huazhong University of Science and Technology, No.13 Hangkong Road, Wuhan, 430030, China
| | - Shuohua Chen
- Department of Cardiology, Kailuan Hospital, North China University of Science and Technology, No.57 Xinhua East Road, Tangshan City, 063001, China
| | - Shouling Wu
- Department of Cardiology, Kailuan Hospital, North China University of Science and Technology, No.57 Xinhua East Road, Tangshan City, 063001, China.
| | - Yaohua Tian
- Ministry of Education Key Laboratory of Environment and Health, and State Key Laboratory of Environmental Health (Incubating), School of Public Health, Tongji Medical College, Huazhong University of Science and Technology, No.13 Hangkong Road, Wuhan, 430030, China; Department of Maternal and Child Health, School of Public Health, Tongji Medical College, Huazhong University of Science and Technology, No.13 Hangkong Road, Wuhan, 430030, China.
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Schramm C, Charbonnier C, Zaréa A, Lacour M, Wallon D, Boland A, Deleuze JF, Olaso R, Alarcon F, Campion D, Nuel G, Nicolas G. Penetrance estimation of Alzheimer disease in SORL1 loss-of-function variant carriers using a family-based strategy and stratification by APOE genotypes. Genome Med 2022; 14:69. [PMID: 35761418 PMCID: PMC9238165 DOI: 10.1186/s13073-022-01070-6] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [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: 10/20/2021] [Accepted: 06/08/2022] [Indexed: 01/04/2023] Open
Abstract
BACKGROUND Alzheimer disease (AD) is a common complex disorder with a high genetic component. Loss-of-function (LoF) SORL1 variants are one of the strongest AD genetic risk factors. Estimating their age-related penetrance is essential before putative use for genetic counseling or preventive trials. However, relative rarity and co-occurrence with the main AD risk factor, APOE-ε4, make such estimations difficult. METHODS We proposed to estimate the age-related penetrance of SORL1-LoF variants through a survival framework by estimating the conditional instantaneous risk combining (i) a baseline for non-carriers of SORL1-LoF variants, stratified by APOE-ε4, derived from the Rotterdam study (N = 12,255), and (ii) an age-dependent proportional hazard effect for SORL1-LoF variants estimated from 27 extended pedigrees (including 307 relatives ≥ 40 years old, 45 of them having genotyping information) recruited from the French reference center for young Alzheimer patients. We embedded this model into an expectation-maximization algorithm to accommodate for missing genotypes. To correct for ascertainment bias, proband phenotypes were omitted. Then, we assessed if our penetrance curves were concordant with age distributions of APOE-ε4-stratified SORL1-LoF variant carriers detected among sequencing data of 13,007 cases and 10,182 controls from European and American case-control study consortia. RESULTS SORL1-LoF variants penetrance curves reached 100% (95% confidence interval [99-100%]) by age 70 among APOE-ε4ε4 carriers only, compared with 56% [40-72%] and 37% [26-51%] in ε4 heterozygous carriers and ε4 non-carriers, respectively. These estimates were fully consistent with observed age distributions of SORL1-LoF variant carriers in case-control study data. CONCLUSIONS We conclude that SORL1-LoF variants should be interpreted in light of APOE genotypes for future clinical applications.
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Affiliation(s)
- Catherine Schramm
- Normandie Université, UNIROUEN, Inserm U1245, CHU Rouen, Department of Genetics and CNRMAJ, FHU-G4 Génomique, 22 boulevard Gambetta - CS 76183, Rouen, F-76000, France
| | - Camille Charbonnier
- Normandie Université, UNIROUEN, Inserm U1245, CHU Rouen, Department of Genetics and CNRMAJ, FHU-G4 Génomique, 22 boulevard Gambetta - CS 76183, Rouen, F-76000, France
| | - Aline Zaréa
- Normandie Université, UNIROUEN, Inserm U1245, CHU Rouen, Department of Neurology and CNRMAJ, FHU-G4 Génomique, Rouen, F-76000, France
| | - Morgane Lacour
- Normandie Université, UNIROUEN, Inserm U1245, CHU Rouen, Department of Neurology and CNRMAJ, FHU-G4 Génomique, Rouen, F-76000, France
| | - David Wallon
- Normandie Université, UNIROUEN, Inserm U1245, CHU Rouen, Department of Neurology and CNRMAJ, FHU-G4 Génomique, Rouen, F-76000, France
| | | | - Anne Boland
- Université Paris-Saclay, CEA, Centre National de Recherche en Génomique Humaine, 91057, Evry, France
| | - Jean-François Deleuze
- Université Paris-Saclay, CEA, Centre National de Recherche en Génomique Humaine, 91057, Evry, France
| | - Robert Olaso
- Université Paris-Saclay, CEA, Centre National de Recherche en Génomique Humaine, 91057, Evry, France
| | | | - Flora Alarcon
- MAP5, UMR-CNRS 8145, Paris University, 75270, Paris, France
| | - Dominique Campion
- Normandie Université, UNIROUEN, Inserm U1245, CHU Rouen, Department of Genetics and CNRMAJ, FHU-G4 Génomique, 22 boulevard Gambetta - CS 76183, Rouen, F-76000, France.,Department of Research, Rouvray Psychiatric Hospital, 76681, Sotteville-Lès-Rouen, France
| | - Grégory Nuel
- LPSM, CNRS 8001, Sorbonne University, 75005, Paris, France
| | - Gaël Nicolas
- Normandie Université, UNIROUEN, Inserm U1245, CHU Rouen, Department of Genetics and CNRMAJ, FHU-G4 Génomique, 22 boulevard Gambetta - CS 76183, Rouen, F-76000, France.
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Bi JH, Yuan HY, Jiang Y, Zhang Y, Zheng WW, Zhang L, Li ZY, Li HL, Tan YT, Zhao WS, Xiang YB. Incidence, Mortality Features and Lifetime Risk Estimation of Digestive Tract Cancers in an Urban District of Shanghai, China. J Epidemiol Glob Health 2022; 12:248-257. [PMID: 35751747 PMCID: PMC9470802 DOI: 10.1007/s44197-022-00047-3] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2022] [Accepted: 06/05/2022] [Indexed: 10/28/2022] Open
Abstract
Digestive tract cancers are the common cause of cancer deaths in both China and worldwide. This study aimed to describe the burden, recent trends and lifetime risks in the incidence and mortality of digestive tract cancers in an urban district of Shanghai, China. Our study extracted data on stomach, colon, rectum and liver cancers diagnosed in Changning District between 2010 and 2019 from the Shanghai Cancer Registry. We calculated age-standardized incidence and mortality rates, the risks of developing and dying from cancer, and the estimated annual percent changes. Between 2010 and 2019, 8619 new cases and 5775 deaths were registered with digestive tract cancers in the district. The age-standardized incidence rates (ASIRs) of liver cancer decreased steadily, whereas the ASIRs of stomach, colon and rectum cancers remained stable from 2010 to 2019. The age-standardized mortality rates (ASMRs) of stomach and liver cancers showed significant declining changes from 2010 to 2019 in both sexes, but that of colon and rectum cancers remained stable during the entire period. The risks of developing and dying from digestive tract cancers were substantially higher in men than women. The burden of digestive tract cancer and its disparities between sex and age group remain major public health challenges in urban Shanghai. To reduce the burden of digestive tract cancers, the government and researchers should develop and promote a healthy diet, organize a screening, and reduce the prevalence of smoking, alcohol drinking, and hepatitis B virus and hepatitis C virus infections.
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Affiliation(s)
- Jing-Hao Bi
- School of Public Health, Shanghai Jiaotong University School of Medicine, Shanghai, 200025, China.,State Key Laboratory of Oncogene and Related Genes & Department of Epidemiology, Shanghai Cancer Institute, Renji Hospital, Shanghai Jiaotong University School of Medicine, No. 25, Lane 2200, Xie Tu Road, Shanghai, 200032, People's Republic of China
| | - Hui-Yun Yuan
- School of Public Health, Shanghai Jiaotong University School of Medicine, Shanghai, 200025, China.,Renji Hospital, Shanghai Jiaotong University School of Medicine, Shanghai, 200127, China.,State Key Laboratory of Oncogene and Related Genes & Department of Epidemiology, Shanghai Cancer Institute, Renji Hospital, Shanghai Jiaotong University School of Medicine, No. 25, Lane 2200, Xie Tu Road, Shanghai, 200032, People's Republic of China
| | - Yu Jiang
- Shanghai Changning District Center for Disease Control and Prevention, No. 39, Yun Wu Shan Road, Shanghai, 200051, People's Republic of China
| | - Yun Zhang
- Shanghai Changning District Center for Disease Control and Prevention, No. 39, Yun Wu Shan Road, Shanghai, 200051, People's Republic of China
| | - Wen-Wei Zheng
- Shanghai Changning District Center for Disease Control and Prevention, No. 39, Yun Wu Shan Road, Shanghai, 200051, People's Republic of China
| | - Lei Zhang
- Shanghai Changning District Center for Disease Control and Prevention, No. 39, Yun Wu Shan Road, Shanghai, 200051, People's Republic of China
| | - Zhuo-Ying Li
- State Key Laboratory of Oncogene and Related Genes & Department of Epidemiology, Shanghai Cancer Institute, Renji Hospital, Shanghai Jiaotong University School of Medicine, No. 25, Lane 2200, Xie Tu Road, Shanghai, 200032, People's Republic of China
| | - Hong-Lan Li
- State Key Laboratory of Oncogene and Related Genes & Department of Epidemiology, Shanghai Cancer Institute, Renji Hospital, Shanghai Jiaotong University School of Medicine, No. 25, Lane 2200, Xie Tu Road, Shanghai, 200032, People's Republic of China
| | - Yu-Ting Tan
- State Key Laboratory of Oncogene and Related Genes & Department of Epidemiology, Shanghai Cancer Institute, Renji Hospital, Shanghai Jiaotong University School of Medicine, No. 25, Lane 2200, Xie Tu Road, Shanghai, 200032, People's Republic of China
| | - Wen-Sui Zhao
- Shanghai Changning District Center for Disease Control and Prevention, No. 39, Yun Wu Shan Road, Shanghai, 200051, People's Republic of China.
| | - Yong-Bing Xiang
- School of Public Health, Shanghai Jiaotong University School of Medicine, Shanghai, 200025, China. .,Renji Hospital, Shanghai Jiaotong University School of Medicine, Shanghai, 200127, China. .,State Key Laboratory of Oncogene and Related Genes & Department of Epidemiology, Shanghai Cancer Institute, Renji Hospital, Shanghai Jiaotong University School of Medicine, No. 25, Lane 2200, Xie Tu Road, Shanghai, 200032, People's Republic of China.
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Abstract
AIMS Unicompartmental knee arthroplasty (UKA) has a higher risk of revision than total knee arthroplasty (TKA), particularly for younger patients. The outcome of knee arthroplasty is typically defined as implant survival or revision incidence after a defined number of years. This can be difficult for patients to conceptualize. We aimed to calculate the 'lifetime risk' of revision for UKA as a more meaningful estimate of risk projection over a patient's remaining lifetime, and to compare this to TKA. METHODS Incidence of revision and mortality for all primary UKAs performed from 1999 to 2019 (n = 13,481) was obtained from the New Zealand Joint Registry (NZJR). Lifetime risk of revision was calculated for patients and stratified by age, sex, and American Society of Anesthesiologists (ASA) grade. RESULTS The lifetime risk of revision was highest in the youngest age group (46 to 50 years; 40.4%) and decreased sequentially to the oldest (86 to 90 years; 3.7%). Across all age groups, lifetime risk of revision was higher for females (ranging from 4.3% to 43.4% vs males 2.9% to 37.4%) and patients with a higher ASA grade (ASA 3 to 4, ranging from 8.8% to 41.2% vs ASA 1 1.8% to 29.8%). The lifetime risk of revision for UKA was double that of TKA across all age groups (ranging from 3.7% to 40.4% for UKA, and 1.6% to 22.4% for TKA). The higher risk of revision in younger patients was associated with aseptic loosening in both sexes and pain in females. Periprosthetic joint infection (PJI) accounted for 4% of all UKA revisions, in contrast with 27% for TKA; the risk of PJI was higher for males than females for both procedures. CONCLUSION Lifetime risk of revision may be a more meaningful measure of arthroplasty outcomes than implant survival at defined time periods. This study highlights the higher lifetime risk of UKA revision for younger patients, females, and those with a higher ASA grade, which can aid with patient counselling prior to UKA. Cite this article: Bone Joint J 2022;104-B(6):672-679.
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Affiliation(s)
- Mei L Tay
- Department of Surgery, University of Auckland, Faculty of Medical and Health Sciences, Auckland, New Zealand.,Department of Orthopaedic Surgery, North Shore Hospital, Auckland, New Zealand
| | - Simon W Young
- Department of Surgery, University of Auckland, Faculty of Medical and Health Sciences, Auckland, New Zealand.,Department of Orthopaedic Surgery, North Shore Hospital, Auckland, New Zealand
| | - Christopher M Frampton
- Department of Orthopaedic Surgery and Musculoskeletal Medicine, University of Otago Christchurch, Christchurch, New Zealand
| | - Gary J Hooper
- Department of Orthopaedic Surgery and Musculoskeletal Medicine, University of Otago Christchurch, Christchurch, New Zealand
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15
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Ackerman IN, Busija L, Lorimer M, de Steiger R, Graves SE. Monitoring the lifetime risk of revision knee arthroplasty over a decade : a population-level analysis of Australian national registry data. Bone Joint J 2022; 104-B:613-619. [PMID: 35491580 DOI: 10.1302/0301-620x.104b5.bjj-2021-1219.r1] [Citation(s) in RCA: 2] [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] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
AIMS This study aimed to describe the use of revision knee arthroplasty in Australia and examine changes in lifetime risk over a decade. METHODS De-identified individual-level data on all revision knee arthroplasties performed in Australia from 2007 to 2017 were obtained from the Australian Orthopaedic Association National Joint Replacement Registry. Population data and life tables were obtained from the Australian Bureau of Statistics. The lifetime risk of revision surgery was calculated for each year using a standardized formula. Separate calculations were undertaken for males and females. RESULTS In total, 43,188 revision knee arthroplasty procedures were performed in Australia during the study period, with a median age at surgery of 69 years (interquartile range (IQR) 62 to 76). In 2017, revision knee arthroplasty rates were highest for males aged 70 to 79 years (102.9 procedures per 100,000 population). Lifetime risk of revision knee arthroplasty for females increased slightly from 1.61% (95% confidence interval (CI) 1.53% to 1.69%) in 2007 to 2.22% (95% CI 2.13% to 2.31%) in 2017. A similar pattern was evident for males, with a lifetime risk of 1.43% (95% CI 1.36% to 1.51%) in 2007 and 2.02% (95% CI 1.93% to 2.11%) in 2017. A decline in procedures performed for loosening/lysis (from 41% in 2007 to 24% in 2017) and pain (from 14% to 9%) was evident, while infection became an increasingly common indication (from 19% in 2007 to 29% in 2017). CONCLUSION Well-validated national registry data can help us understand the epidemiology of revision knee arthroplasty, including changing clinical indications. Despite a small increase over a decade, the lifetime risk of revision knee arthroplasty in Australia is low at one in 45 females and one in 50 males. These methods offer a population-level approach to quantifying revision burden that can be used for ongoing national surveillance and between-country comparisons. Cite this article: Bone Joint J 2022;104-B(5):613-619.
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Affiliation(s)
- Ilana N Ackerman
- School of Public Health and Preventive Medicine, Monash University, Melbourne, Australia
| | - Ljoudmila Busija
- School of Public Health and Preventive Medicine, Monash University, Melbourne, Australia
| | - Michelle Lorimer
- South Australian Health and Medical Research Institute, Adelaide, Australia
| | - Richard de Steiger
- Department of Surgery, Epworth HealthCare, The University of Melbourne, Melbourne, Australia.,Australian Orthopaedic Association National Joint Replacement Registry, Adelaide, Australia
| | - Stephen E Graves
- Australian Orthopaedic Association National Joint Replacement Registry, Adelaide, Australia
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Kolarova H, Tan J, Strom TM, Meitinger T, Wagner M, Klopstock T. Lifetime risk of autosomal recessive neurodegeneration with brain iron accumulation (NBIA) disorders calculated from genetic databases. EBioMedicine 2022; 77:103869. [PMID: 35180557 PMCID: PMC8856992 DOI: 10.1016/j.ebiom.2022.103869] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [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: 10/18/2021] [Revised: 01/24/2022] [Accepted: 01/24/2022] [Indexed: 02/06/2023] Open
Abstract
Background Neurodegeneration with brain iron accumulation (NBIA) are a group of clinically and genetically heterogeneous diseases characterized by iron overload in basal ganglia and progressive neurodegeneration. Little is known about the epidemiology of NBIA disorders. In the absence of large-scale population-based studies, obtaining reliable epidemiological data requires innovative approaches. Methods All pathogenic variants were collected from the 13 genes associated with autosomal recessive NBIA (PLA2G6, PANK2, COASY, ATP13A2, CP, AP4M1, FA2H, CRAT, SCP2, C19orf12, DCAF17, GTPBP2, REPS1). The allele frequencies of these disease-causing variants were assessed in exome/genome collections: the Genome Aggregation Database (gnomAD) and our in-house database. Lifetime risks were calculated from the sum of allele frequencies in the respective genes under assumption of Hardy-Weinberg equilibrium. Findings The combined estimated lifetime risk of all 13 investigated NBIA disorders is 0.88 (95% confidence interval 0.70–1.10) per 100,000 based on the global gnomAD dataset (n = 282,912 alleles), 0.92 (0.65–1.29) per 100,000 in the European gnomAD dataset (n = 129,206), and 0.90 (0.48–1.62) per 100,000 in our in-house database (n = 44,324). Individually, the highest lifetime risks (>0.15 per 100,000) are found for disorders caused by variants in PLA2G6, PANK2 and COASY. Interpretation This population-genetic estimation on lifetime risks of recessive NBIA disorders reveals frequencies far exceeding previous population-based numbers. Importantly, our approach represents lifetime risks from conception, thus including prenatal deaths. Understanding the true lifetime risk of NBIA disorders is important in estimating disease burden, allocating resources and targeting specific interventions.
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Affiliation(s)
- Hana Kolarova
- Department of Neurology, Friedrich-Baur-Institute, University Hospital, Ludwig Maximilian University of Munich, Ziemssenstraße 1a, Munich 80336, Germany; Institute of Human Genetics, Technical University of Munich, Trogerstraße 32, Munich 81675, Germany; Department of Pediatrics and Inherited Metabolic Disorders, First Faculty of Medicine, Charles University and General University Hospital, Ke Karlovu 2, Prague 12000, Czech Republic
| | - Jing Tan
- Department of Neurology, Friedrich-Baur-Institute, University Hospital, Ludwig Maximilian University of Munich, Ziemssenstraße 1a, Munich 80336, Germany; Institute of Human Genetics, Technical University of Munich, Trogerstraße 32, Munich 81675, Germany; Department of Neurology, The Second Affiliated Hospital of Dalian Medical University, Dalian, China
| | - Tim M Strom
- Institute of Human Genetics, Technical University of Munich, Trogerstraße 32, Munich 81675, Germany
| | - Thomas Meitinger
- Institute of Human Genetics, Technical University of Munich, Trogerstraße 32, Munich 81675, Germany
| | - Matias Wagner
- Institute of Human Genetics, Technical University of Munich, Trogerstraße 32, Munich 81675, Germany; Institute of Neurogenomics, Helmholtz Zentrum Munich, Ingolstädter Landstraße 1, Neuherberg 85764, Germany; LMU University Hospital, Department of Pediatrics, Dr. von Hauner Children's Hospital, Division of Pediatric Neurology, LMU Center for Development and Children with Medical Complexity, Ludwig-Maximilians-University, Munich, Germany.
| | - Thomas Klopstock
- Department of Neurology, Friedrich-Baur-Institute, University Hospital, Ludwig Maximilian University of Munich, Ziemssenstraße 1a, Munich 80336, Germany; German Center for Neurodegenerative Diseases (DZNE), Munich, Germany; Munich Cluster for Systems Neurology (SyNergy), Munich, Germany.
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17
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Li D, Wang L, Zhou Z, Song L, Chen S, Yang Y, Hu Y, Wang Y, Wu S, Tian Y. Lifetime risk of cardiovascular disease and life expectancy with and without cardiovascular disease according to changes in metabolic syndrome status. Nutr Metab Cardiovasc Dis 2022; 32:373-381. [PMID: 34893414 DOI: 10.1016/j.numecd.2021.10.014] [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] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/27/2021] [Revised: 09/07/2021] [Accepted: 10/17/2021] [Indexed: 01/08/2023]
Abstract
BACKGROUND AND AIMS The relationship between dynamic changes in metabolic syndrome (MetS) status and lifetime risk of cardiovascular disease (CVD) has not been reliably quantified. This study aimed to estimate lifetime risk of CVD and life expectancy with and without CVD according to dynamic MetS status. METHODS AND RESULTS Dynamic changes in MetS status were assessed: MetS-free, MetS-chronic, MetS-developed, and MetS-recovery groups. We used Modified Kaplan-Meier method to estimate lifetime risk and used multistate life table method to calculate life expectancy. Participants free of CVD at index ages 35 (n = 40 168), 45 (n = 33 569), and 55 (n = 18 546) years. At index age 35 years, we recorded 1341 CVD events during a median follow-up of 6.1 years. Lifetime risk of 33.9% (95% CI: 26.9%-41.0%) in MetS-recovery group was lower than that of 39.4% (95% CI: 36.1%-42.8%) in MetS-chronic group. Lifetime risk of 37.8% (95% CI: 30.6%-45.1%) in MetS-developed group was higher than that of 26.4% (95% CI: 22.7%-30.0%) in MetS-free group. At index age 35 years, life expectancy free of CVD for MetS-recovery group (44.1 years) was higher than that for MetS-chronic group (38.8 years). Life expectancy free of CVD for MetS-developed group (41.9 years) was lower than that for MetS-free group (46.7 years). CONCLUSIONS Recovery from MetS was associated with decreased lifetime risk of CVD and a longer life expectancy free of CVD, whereas development of MetS was associated with increased lifetime risk of CVD and a shorter life expectancy free of CVD.
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Affiliation(s)
- Dankang Li
- Department of Maternal and Child Health, School of Public Health, Tongji Medical College, Huazhong University of Science and Technology, No.13 Hangkong Road, Wuhan, 430030, China; Ministry of Education Key Laboratory of Environment and Health, And State Key Laboratory of Environmental Health (Incubating), School of Public Health, Tongji Medical College, Huazhong University of Science and Technology, No.13 Hangkong Road, Wuhan, 430030, China
| | - Lulin Wang
- Department of Maternal and Child Health, School of Public Health, Tongji Medical College, Huazhong University of Science and Technology, No.13 Hangkong Road, Wuhan, 430030, China; Ministry of Education Key Laboratory of Environment and Health, And State Key Laboratory of Environmental Health (Incubating), School of Public Health, Tongji Medical College, Huazhong University of Science and Technology, No.13 Hangkong Road, Wuhan, 430030, China
| | - Ziyi Zhou
- Department of Maternal and Child Health, School of Public Health, Tongji Medical College, Huazhong University of Science and Technology, No.13 Hangkong Road, Wuhan, 430030, China; Ministry of Education Key Laboratory of Environment and Health, And State Key Laboratory of Environmental Health (Incubating), School of Public Health, Tongji Medical College, Huazhong University of Science and Technology, No.13 Hangkong Road, Wuhan, 430030, China
| | - Lulu Song
- Department of Maternal and Child Health, School of Public Health, Tongji Medical College, Huazhong University of Science and Technology, No.13 Hangkong Road, Wuhan, 430030, China; Ministry of Education Key Laboratory of Environment and Health, And State Key Laboratory of Environmental Health (Incubating), School of Public Health, Tongji Medical College, Huazhong University of Science and Technology, No.13 Hangkong Road, Wuhan, 430030, China
| | - Shuohua Chen
- Department of Cardiology, Kailuan Hospital, North China University of Science and Technology, No.57 Xinhua East Road, Tangshan City, 063001, China
| | - Yingping Yang
- Department of Maternal and Child Health, School of Public Health, Tongji Medical College, Huazhong University of Science and Technology, No.13 Hangkong Road, Wuhan, 430030, China; Ministry of Education Key Laboratory of Environment and Health, And State Key Laboratory of Environmental Health (Incubating), School of Public Health, Tongji Medical College, Huazhong University of Science and Technology, No.13 Hangkong Road, Wuhan, 430030, China
| | - Yonghua Hu
- Department of Epidemiology and Biostatistics, School of Public Health, Peking University, No.38 Xueyuan Road, Beijing, 100191, China
| | - Youjie Wang
- Department of Maternal and Child Health, School of Public Health, Tongji Medical College, Huazhong University of Science and Technology, No.13 Hangkong Road, Wuhan, 430030, China; Ministry of Education Key Laboratory of Environment and Health, And State Key Laboratory of Environmental Health (Incubating), School of Public Health, Tongji Medical College, Huazhong University of Science and Technology, No.13 Hangkong Road, Wuhan, 430030, China
| | - Shouling Wu
- Department of Cardiology, Kailuan Hospital, North China University of Science and Technology, No.57 Xinhua East Road, Tangshan City, 063001, China.
| | - Yaohua Tian
- Department of Maternal and Child Health, School of Public Health, Tongji Medical College, Huazhong University of Science and Technology, No.13 Hangkong Road, Wuhan, 430030, China; Ministry of Education Key Laboratory of Environment and Health, And State Key Laboratory of Environmental Health (Incubating), School of Public Health, Tongji Medical College, Huazhong University of Science and Technology, No.13 Hangkong Road, Wuhan, 430030, China.
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18
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Abstract
AIMS The success of total knee arthroplasty (TKA) is usually measured using functional outcome scores and revision-free survivorship. However, reporting the lifetime risk of revision may be more meaningful to patients when gauging risks, especially in younger patients. We aimed to assess the lifetime risk of revision for patients in different age categories at the time of undergoing primary TKA. METHODS The New Zealand Joint Registry database was used to obtain revision rates, mortality, and the indications for revision for all primary TKAs performed during an 18-year period between January 1999 and December 2016. Patients were stratified into age groups at the time of the initial TKA, and the lifetime risk of revision was calculated according to age, sex, and the American Society of Anesthesiologists (ASA) grade. The most common indications for revision were also analyzed for each age group. RESULTS The overall ten-year survival rate was 95.6%. This was lowest in the youngest age group (between 46 and 50 years) and increased sequentially with increasing age. The lifetime risk of requiring revision was 22.4% in those aged between 46 and 50 years at the time of the initial surgery, and decreased linearly with increasing age to 1.15% in those aged between 90 and 95 years at the time of surgery. Higher ASA grades were associated with increased lifetime risk of revision in all age groups. The three commonest indications for revision were aseptic loosening, infection, and unexplained pain. Young males, aged between 46 and 50 years, had the highest lifetime risk of revision (25.2%). CONCLUSION Lifetime risk of revision may be a more meaningful measure of outcome than implant survival at defined time periods when counselling patients prior to TKA. This study highlights the considerably higher lifetime risk of revision surgery for all indications, including infection, in younger male patients. Cite this article: Bone Joint J 2022;104-B(2):235-241.
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Affiliation(s)
- Bradley Stone
- Department of Orthopaedic Surgery and Musculoskeletal Medicine, University of Otago, Christchurch, New Zealand
| | - Mary Nugent
- Canterbury District Health Board, Christchurch, New Zealand
| | - Simon W Young
- Waitemata District Health Board, Takapuna, New Zealand
| | - Christopher Frampton
- Department of Orthopaedic Surgery and Musculoskeletal Medicine, University of Otago, Christchurch, New Zealand
| | - Gary J Hooper
- Department of Orthopaedic Surgery and Musculoskeletal Medicine, University of Otago, Christchurch, New Zealand
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19
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Conner SC, Beiser A, Benjamin EJ, LaValley MP, Larson MG, Trinquart L. A comparison of statistical methods to predict the residual lifetime risk. Eur J Epidemiol 2022; 37:173-194. [PMID: 34978669 PMCID: PMC8960348 DOI: 10.1007/s10654-021-00815-8] [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: 02/23/2021] [Accepted: 10/13/2021] [Indexed: 02/03/2023]
Abstract
Lifetime risk measures the cumulative risk for developing a disease over one's lifespan. Modeling the lifetime risk must account for left truncation, the competing risk of death, and inference at a fixed age. In addition, statistical methods to predict the lifetime risk should account for covariate-outcome associations that change with age. In this paper, we review and compare statistical methods to predict the lifetime risk. We first consider a generalized linear model for the lifetime risk using pseudo-observations of the Aalen-Johansen estimator at a fixed age, allowing for left truncation. We also consider modeling the subdistribution hazard with Fine-Gray and Royston-Parmar flexible parametric models in left truncated data with time-covariate interactions, and using these models to predict lifetime risk. In simulation studies, we found the pseudo-observation approach had the least bias, particularly in settings with crossing or converging cumulative incidence curves. We illustrate our method by modeling the lifetime risk of atrial fibrillation in the Framingham Heart Study. We provide technical guidance to replicate all analyses in R.
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Affiliation(s)
- Sarah C. Conner
- Department of Biostatistics, Boston University School of Public Health, Boston, MA, USA
| | - Alexa Beiser
- Department of Biostatistics, Boston University School of Public Health, Boston, MA, USA,Framingham Heart Study, Framingham, MA, USA,Department of Neurology, Boston University School of Medicine, Boston, MA, USA
| | - Emelia J. Benjamin
- Framingham Heart Study, Framingham, MA, USA,Department of Epidemiology, Boston University School of Public Health, Boston, MA, USA,Section of Cardiovascular Medicine, Boston University School of Medicine, Boston, MA, USA
| | - Michael P. LaValley
- Department of Biostatistics, Boston University School of Public Health, Boston, MA, USA
| | - Martin G. Larson
- Department of Biostatistics, Boston University School of Public Health, Boston, MA, USA,Framingham Heart Study, Framingham, MA, USA
| | - Ludovic Trinquart
- Department of Biostatistics, Boston University School of Public Health, Boston, MA, USA,Tufts Clinical and Translational Science Institute, Tufts University, Boston, MA, USA,Institute for Clinical Research and Health Policy Studies, Tufts Medical Center, Boston, MA, USA
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20
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Siraj AK, Masoodi T, Bu R, Parvathareddy SK, Iqbal K, Azam S, Al-Rasheed M, Ajarim D, Tulbah A, Al-Dayel F, Al-Kuraya KS. Prevalence of germline TP53 mutation among early onset middle eastern breast cancer patients. Hered Cancer Clin Pract 2021; 19:49. [PMID: 34906214 PMCID: PMC8670057 DOI: 10.1186/s13053-021-00206-w] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2021] [Accepted: 11/29/2021] [Indexed: 11/22/2022] Open
Abstract
Background The data on prevalence and clinical relevance of TP53 germline mutations in early onset Middle-Eastern breast cancer (BC) is limited. Methods We determined TP53 germline mutations in a cohort of 464 early onset BC patients from Saudi Arabia using capture sequencing based next generation sequencing. Results Germline TP53 pathogenic mutations were found in 1.5% (7/464) of early onset Saudi BC patients. A total of six pathogenic missense mutations, one stop gain mutation and two variants of uncertain significance (VUS) were detected in our cohort. No TP53 pathogenic mutations were detected among 463 healthy controls. TP53 mutations carriers were significantly more likely to have bilateral breast cancer (p = 0.0008). At median follow-up of 41 months, TP53 mutations were an unfavorable factor for overall survival in univariate analysis. All the patients carrying TP53 mutations were negative for BRCA1 and BRCA2 mutations. Majority of patients (85.7%; 6/7) carrying TP53 mutation had no family history suggestive of Li-Fraumeni Syndrome (LFS) or personal history of multiple LFS related tumors. Only one patient had a positive family history suggestive of LFS. Conclusions TP53 germline mutation screening detects a clinically meaningful risk of early onset BC from this ethnicity and should be considered in all early onset BC regardless of the family history of cancer, especially in young patients that are negative for BRCA mutations. Supplementary Information The online version contains supplementary material available at 10.1186/s13053-021-00206-w.
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Affiliation(s)
- Abdul Khalid Siraj
- Human Cancer Genomic Research, King Faisal Specialist Hospital and Research Center, P.O. Box 3354, 11211, Riyadh, Saudi Arabia
| | - Tariq Masoodi
- Human Cancer Genomic Research, King Faisal Specialist Hospital and Research Center, P.O. Box 3354, 11211, Riyadh, Saudi Arabia
| | - Rong Bu
- Human Cancer Genomic Research, King Faisal Specialist Hospital and Research Center, P.O. Box 3354, 11211, Riyadh, Saudi Arabia
| | - Sandeep Kumar Parvathareddy
- Human Cancer Genomic Research, King Faisal Specialist Hospital and Research Center, P.O. Box 3354, 11211, Riyadh, Saudi Arabia
| | - Kaleem Iqbal
- Human Cancer Genomic Research, King Faisal Specialist Hospital and Research Center, P.O. Box 3354, 11211, Riyadh, Saudi Arabia
| | - Saud Azam
- Human Cancer Genomic Research, King Faisal Specialist Hospital and Research Center, P.O. Box 3354, 11211, Riyadh, Saudi Arabia
| | - Maha Al-Rasheed
- Human Cancer Genomic Research, King Faisal Specialist Hospital and Research Center, P.O. Box 3354, 11211, Riyadh, Saudi Arabia
| | - Dahish Ajarim
- Department of Oncology, King Faisal Specialist Hospital and Research Centre, P.O. Box 3354, 11211, Riyadh, Saudi Arabia
| | - Asma Tulbah
- Department of Pathology, King Faisal Specialist Hospital and Research Centre, P.O. Box 3354, 11211, Riyadh, Saudi Arabia
| | - Fouad Al-Dayel
- Department of Pathology, King Faisal Specialist Hospital and Research Centre, P.O. Box 3354, 11211, Riyadh, Saudi Arabia
| | - Khawla Sami Al-Kuraya
- Human Cancer Genomic Research, King Faisal Specialist Hospital and Research Center, P.O. Box 3354, 11211, Riyadh, Saudi Arabia. .,Research Center, Human Cancer Genomic Research, King Faisal Specialist Hospital and Research Center, MBC#98-16, P.O. Box 3354, 11211, Riyadh, Saudi Arabia.
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21
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Bi J, Song L, Wang L, Wu M, Chen S, Wang Y, Wu S, Tian Y. Visit-to-visit fasting blood glucose variability and lifetime risk of cardiovascular disease: a prospective study. Cardiovasc Diabetol 2021; 20:207. [PMID: 34656122 PMCID: PMC8520235 DOI: 10.1186/s12933-021-01397-1] [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] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/14/2021] [Accepted: 10/06/2021] [Indexed: 01/11/2023] Open
Abstract
Aims Previous studies suggested an adverse association between higher fasting blood glucose (FBG) variability and cardiovascular disease (CVD). Lifetime risk provides an absolute risk assessment during the remainder of an individual’s life. However, the association between FBG variability and the lifetime risk of CVD is uncertain. Objective We aimed to investigate the effect of the visit-to-visit FBG variability on the lifetime risk of CVD. Methods This study included participants from the Kailuan Study who did not have CVD at index ages 35, 45, and 55 years. The FBG variability was defined as the coefficient of variation (CV) of three FBG values that were measured during the examination periods of 2006–2007, 2008–2009, and 2010–2011. We used a modified Kaplan-Merrier method to estimate lifetime risk of CVD according to tertiles of FBG variability. Results At index age 35 years, the study sample comprised 46,018 participants. During a median follow-up of 7.0 years, 1889 participants developed CVD events. For index age 35 years, participants with high FBG variability had higher lifetime risk of CVD (32.5%; 95% confidence interval [CI]: 28.9–36.1%), compared with intermediate (28.3%; 95% CI: 25.5 –31.1%) and low (26.3%; 95% CI: 23.0–29.5%) FBG variability. We found that higher FBG variability was associated with increased lifetime risk of CVD in men but not women. Similar patterns were observed at index ages 45 and 55 years. Conclusions Higher FBG variability was associated with increased lifetime risk of CVD at each index age. Focusing on the FBG variability may provide an insight to the clinical utility for reducing the lifetime risk of CVD. Supplementary Information The online version contains supplementary material available at 10.1186/s12933-021-01397-1.
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Affiliation(s)
- Jianing Bi
- Department of Maternal and Child Health, School of Public Health, Tongji Medical College, Huazhong University of Science and Technology, No.13 Hangkong Road, Wuhan, 430030, China.,Ministry of Education Key Laboratory of Environment and Health, and State Key Laboratory of Environmental Health (Incubating), School of Public Health, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Lulu Song
- Department of Maternal and Child Health, School of Public Health, Tongji Medical College, Huazhong University of Science and Technology, No.13 Hangkong Road, Wuhan, 430030, China.,Ministry of Education Key Laboratory of Environment and Health, and State Key Laboratory of Environmental Health (Incubating), School of Public Health, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Lulin Wang
- Department of Maternal and Child Health, School of Public Health, Tongji Medical College, Huazhong University of Science and Technology, No.13 Hangkong Road, Wuhan, 430030, China.,Ministry of Education Key Laboratory of Environment and Health, and State Key Laboratory of Environmental Health (Incubating), School of Public Health, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Mingyang Wu
- Department of Maternal and Child Health, School of Public Health, Tongji Medical College, Huazhong University of Science and Technology, No.13 Hangkong Road, Wuhan, 430030, China.,Ministry of Education Key Laboratory of Environment and Health, and State Key Laboratory of Environmental Health (Incubating), School of Public Health, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Shouhua Chen
- Department of Cardiology, Kailuan Hospital, North China University of Science and Technology, Tangshan City, China
| | - Youjie Wang
- Department of Maternal and Child Health, School of Public Health, Tongji Medical College, Huazhong University of Science and Technology, No.13 Hangkong Road, Wuhan, 430030, China.,Ministry of Education Key Laboratory of Environment and Health, and State Key Laboratory of Environmental Health (Incubating), School of Public Health, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Shouling Wu
- Department of Cardiology, Kailuan Hospital, North China University of Science and Technology, Tangshan City, China.
| | - Yaohua Tian
- Department of Maternal and Child Health, School of Public Health, Tongji Medical College, Huazhong University of Science and Technology, No.13 Hangkong Road, Wuhan, 430030, China. .,Ministry of Education Key Laboratory of Environment and Health, and State Key Laboratory of Environmental Health (Incubating), School of Public Health, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China.
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22
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Wang K, Kavousi M, Voortman T, Ikram MA, Ghanbari M, Ahmadizar F. Cardiovascular health, genetic predisposition, and lifetime risk of type 2 diabetes. Eur J Prev Cardiol 2021; 28:1850-1857. [PMID: 34583386 DOI: 10.1093/eurjpc/zwab141] [Citation(s) in RCA: 3] [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] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/28/2021] [Revised: 07/27/2021] [Accepted: 08/10/2021] [Indexed: 11/14/2022]
Abstract
AIMS Data on the lifetime risk of type 2 diabetes (T2D) incidence across different cardiovascular health (CVH) categories are scarce. Moreover, it remains unclear whether a genetic predisposition modifies this association. METHODS AND RESULTS Using data from the prospective population-based Rotterdam Study, a CVH score (body mass index, blood pressure, total cholesterol, smoking status, diet, and physical activity) was calculated and further categorized at baseline. Genetic predisposition to T2D was assessed and divided into tertiles by creating a genetic risk score (GRS). We estimated the lifetime risk for T2D within different CVH and GRS categories. Among 5993 individuals free of T2D at baseline [mean (standard deviation) age, 69.1 (8.5) years; 58% female], 869 individuals developed T2D during follow-up. At age 55 years, the remaining lifetime risk of T2D was 22.6% (95% CI: 19.4-25.8) for ideal, 28.3% (25.8-30.8) for intermediate, and 32.6% (29.0-36.2) for poor CVH. After further stratification by GRS tertiles, the lifetime risk for T2D was still the lowest for ideal CVH in the lowest GRS tertiles [21.5% (13.7-29.3)], in the second GRS tertile [20.8% (15.9-25.8)], and in the highest tertile [23.5% (18.5-28.6)] when compared with poor and intermediate CVH. CONCLUSION Our results highlight the importance of favourable CVH in preventing T2D among middle-aged individuals regardless of their genetic predisposition.
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Affiliation(s)
- Kan Wang
- Department of Epidemiology, Erasmus University Medical Center, Doctor Molewaterplein 40, 3015 GD Rotterdam, the Netherlands
| | - Maryam Kavousi
- Department of Epidemiology, Erasmus University Medical Center, Doctor Molewaterplein 40, 3015 GD Rotterdam, the Netherlands
| | - Trudy Voortman
- Department of Epidemiology, Erasmus University Medical Center, Doctor Molewaterplein 40, 3015 GD Rotterdam, the Netherlands
| | - M Arfan Ikram
- Department of Epidemiology, Erasmus University Medical Center, Doctor Molewaterplein 40, 3015 GD Rotterdam, the Netherlands
| | - Mohsen Ghanbari
- Department of Epidemiology, Erasmus University Medical Center, Doctor Molewaterplein 40, 3015 GD Rotterdam, the Netherlands
| | - Fariba Ahmadizar
- Department of Epidemiology, Erasmus University Medical Center, Doctor Molewaterplein 40, 3015 GD Rotterdam, the Netherlands
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23
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Klijs B, Mitratza M, Harteloh PP, Moll van Charante EP, Richard E, Nielen MM, Kunst AE. Estimating the lifetime risk of dementia using nationwide individually linked cause-of-death and health register data. Int J Epidemiol 2021; 50:809-816. [PMID: 33354723 DOI: 10.1093/ije/dyaa219] [Citation(s) in RCA: 3] [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] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/08/2020] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Previous estimates of the lifetime risk of dementia are restricted to older age groups and may suffer from selection bias. In this study, we estimated the lifetime risk of dementia starting at birth using nationwide integral linked health register data. METHODS We studied all deaths in The Netherlands in 2017 (n = 147 866). Dementia was assessed using the cause-of-death registration, individually linked with registers covering long-term care, specialized mental care, dispensed medicines, hospital discharges and claims, and primary care. The proportion of deaths with dementia was calculated for the total population and according to age at death and sex. RESULTS According to all data sources combined, 24.0% of the population dies in the presence of dementia. This proportion is higher for females (29.4%) than for males (18.3%). Using multiple causes of death only, the proportion with dementia is 17.9%. Sequential addition of long-term care and hospital discharge data increased the estimate by 4.0 and 1.5%-points, respectively. Further addition of dispensed medicines, hospital claims and specialized mental care data added another 0.6%-points. Among persons who die at age ≤65-70 years, the proportion with dementia is ≤6.2%. After age 70, the proportion rises sharply, with a peak of 43.9% for females and 33.1% for males at age 90-95 years. CONCLUSIONS Around one-fourth of the Dutch population is diagnosed with dementia at some point in life and dies in the presence of dementia. It is a major challenge to arrange optimal care for this group.
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Affiliation(s)
- Bart Klijs
- Department of Health and Care, Statistics Netherlands, The Hague, The Netherlands.,Department of Public Health, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands
| | - Marianna Mitratza
- Department of Public Health, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands
| | - Peter Pm Harteloh
- Department of Health and Care, Statistics Netherlands, The Hague, The Netherlands
| | - Eric P Moll van Charante
- Department of Public Health, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands.,Department of General Practice, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands
| | - Edo Richard
- Department of Neurology, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands
| | - Markus Mj Nielen
- Netherlands Institute for Health Services Research (NIVEL), Utrecht, The Netherlands
| | - Anton E Kunst
- Department of Public Health, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands
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24
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Nasirian M, Mahboobi M, Maracy MR. Estimating the Lifetime and Age-Conditional Risk of an HIV Diagnosis in Iran, 2011-2015. Iran J Public Health 2021; 50:1048-1055. [PMID: 34183963 PMCID: PMC8223577 DOI: 10.18502/ijph.v50i5.6122] [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] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 12/02/2022]
Abstract
Background: According to the importance of infectious diseases, especially HIV, the purpose of this study was to estimate lifetime and age-conditional risks of HIV diagnosis in Iran. Methods: We used vital statistics, HIV surveillance and census data for 2011–2015 to calculate Age-specific HIV diagnosis and non-HIV death rates. These rates then converted to the probability of an HIV diagnosis considering the competing risk. Finally, the probabilities were applied to a hypothetical cohort of 10 million live births. The lifetime and age-conditional risk of HIV diagnosis in the total and general population of Iran were calculated by Dev Can software (version 6.7.4). Results: Lifetime risk was 0.084% (95% CI: 0.081–0.088) or one in 1183 for females and 0.21% (95% CI: 0.201–0.211) or one in 483 for males in the total population. In the general population lifetime risk for men was 0.069% (95% CI: 0.066–0.072) or 1 in 1454 men and 0.066% (95%CI: 0.063–0.069) or one in 1523 for women. In the total and general population, the 10-yr age-conditional risk of HIV diagnosis showed that the highest risk of an HIV diagnosis is related to 30-yr -olds. Conclusion: The estimated risks differed based on gender, age, and type of population. Paying close attention to these differences is critical for infection control planning and policies.
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Affiliation(s)
- Maryam Nasirian
- Department of Biostatistic and Epidemiology, School of Health, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Marzieh Mahboobi
- Department of Biostatistic and Epidemiology, School of Health, Isfahan University of Medical Sciences, Isfahan, Iran.,Center for Communicable Diseases Control, Ministry of Health and Medical Educationa, Tehran, Iran
| | - Mohammad Reza Maracy
- Department of Biostatistic and Epidemiology, School of Health, Isfahan University of Medical Sciences, Isfahan, Iran
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25
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Sinha A, Ning H, Ahmad FS, Bancks MP, Carnethon MR, O'Brien MJ, Allen NB, Wilkins JT, Lloyd-Jones DM, Khan SS. Association of fasting glucose with lifetime risk of incident heart failure: the Lifetime Risk Pooling Project. Cardiovasc Diabetol 2021; 20:66. [PMID: 33752676 PMCID: PMC7983294 DOI: 10.1186/s12933-021-01265-y] [Citation(s) in RCA: 20] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/10/2021] [Accepted: 03/16/2021] [Indexed: 01/27/2023] Open
Abstract
BACKGROUND Given the rising prevalence of dysglycemia and disparities in heart failure (HF) burden, we determined race- and sex-specific lifetime risk of HF across the spectrum of fasting plasma glucose (FPG). METHODS Individual-level data from adults without baseline HF was pooled from 6 population-based cohorts. Modified Kaplan-Meier analysis, Cox models adjusted for the competing risk of death, and Irwin's restricted mean were used to estimate the lifetime risk, adjusted hazard ratio (aHR), and years lived free from HF in middle-aged (40-59 years) and older (60-79 years) adults with FPG < 100 mg/dL, prediabetes (FPG 100-125 mg/dL) and diabetes (FPG ≥ 126 mg/dL or on antihyperglycemic agents) across race-sex groups. RESULTS In 40,117 participants with 638,910 person-years of follow-up, 4846 cases of incident HF occurred. The lifetime risk of HF was significantly higher among middle-aged White adults and Black women with prediabetes (range: 6.1% [95% CI 4.8%, 7.4%] to 10.8% [95% CI 8.3%, 13.4%]) compared with normoglycemic adults (range: 3.5% [95% CI 3.0%, 4.1%] to 6.5% [95% CI 4.9%, 8.1%]). Middle-aged Black women with diabetes had the highest lifetime risk (32.4% [95% CI 26.0%, 38.7%]) and aHR (4.0 [95% CI 3.0, 5.4]) for HF across race-sex groups. Middle-aged adults with prediabetes and diabetes lived on average 0.9-1.6 and 4.1-6.0 fewer years free from HF, respectively. Findings were similar in older adults except older Black women with prediabetes did not have a higher lifetime risk of HF. CONCLUSIONS Prediabetes was associated with higher lifetime risk of HF in middle-aged White adults and Black women, with the association attenuating in older Black women. Black women with diabetes had the highest lifetime risk of HF compared with other race-sex groups.
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Affiliation(s)
- Arjun Sinha
- Division of Cardiology, Department of Medicine and Preventive Medicine, Northwestern University Feinberg School of Medicine, 680 N. Lake Shore Drive, 14-002, Chicago, IL, 60611, USA.,Department of Preventive Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| | - Hongyan Ning
- Department of Preventive Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| | - Faraz S Ahmad
- Division of Cardiology, Department of Medicine and Preventive Medicine, Northwestern University Feinberg School of Medicine, 680 N. Lake Shore Drive, 14-002, Chicago, IL, 60611, USA.,Department of Preventive Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| | - Michael P Bancks
- Department of Epidemiology and Prevention, Wake Forest School of Medicine, Winston-Salem, NC, USA
| | - Mercedes R Carnethon
- Department of Preventive Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| | - Matthew J O'Brien
- Division of General Internal Medicine and Geriatrics, Department of Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| | - Norrina B Allen
- Department of Preventive Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| | - John T Wilkins
- Division of Cardiology, Department of Medicine and Preventive Medicine, Northwestern University Feinberg School of Medicine, 680 N. Lake Shore Drive, 14-002, Chicago, IL, 60611, USA.,Department of Preventive Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| | - Donald M Lloyd-Jones
- Division of Cardiology, Department of Medicine and Preventive Medicine, Northwestern University Feinberg School of Medicine, 680 N. Lake Shore Drive, 14-002, Chicago, IL, 60611, USA.,Department of Preventive Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| | - Sadiya S Khan
- Division of Cardiology, Department of Medicine and Preventive Medicine, Northwestern University Feinberg School of Medicine, 680 N. Lake Shore Drive, 14-002, Chicago, IL, 60611, USA. .,Department of Preventive Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL, USA.
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Nakayama S, Satoh M, Metoki H, Murakami T, Asayama K, Hara A, Hirose T, Kanno A, Inoue R, Tsubota-Utsugi M, Kikuya M, Mori T, Hozawa A, Imai Y, Ohkubo T. Lifetime risk of stroke stratified by chronic kidney disease and hypertension in the general Asian population: the Ohasama study. Hypertens Res 2021; 44:866-873. [PMID: 33742168 DOI: 10.1038/s41440-021-00635-z] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [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: 08/29/2020] [Revised: 12/04/2020] [Accepted: 01/20/2021] [Indexed: 11/09/2022]
Abstract
Lifetime risk (LTR) evaluates the absolute risk of developing a disease during the remainder of one's life. It can be a useful tool, enabling the general public to easily understand their risk of stroke. No study has been performed to determine the LTR of cardiovascular disease in patients with chronic kidney disease (CKD) with or without hypertension; therefore, we performed this study in an Asian population. We followed 1525 participants (66.0% women; age 63.1 years) in the general population of Ohasama, Japan. We defined CKD as an estimated glomerular filtration rate (eGFR) <60 mL/min/1.73 m2 and/or proteinuria. Hypertension was defined as a systolic/diastolic blood pressure ≥140/≥90 mmHg and/or the use of antihypertensive medication. We calculated the sex-specific LTR of stroke adjusted for the competing risk of death. During the mean follow-up period of 16.5 years, a first stroke occurred in 238 participants. The 10-year risk of stroke at the age of 45 years was 0.0% for men and women. The LTRs of stroke at the index age of 45 years (men/women) were 20.9%/14.5% for participants without CKD and hypertension, 34.1%/29.8% for those with CKD but not hypertension, 37.9%/27.3% for those with hypertension but not CKD, and 38.4%/36.4% for those with CKD and hypertension. The LTRs of stroke tended to be higher in younger participants than in older participants with CKD and/or hypertension. CKD contributed to the LTR of stroke, as did hypertension. The prevention of CKD and hypertension can reduce the LTR of stroke, especially in young populations.
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Affiliation(s)
- Shingo Nakayama
- Division of Nephrology and Endocrinology, Faculty of Medicine, Tohoku Medical and Pharmaceutical University, Sendai, Japan.,Division of Public Health, Hygiene and Epidemiology, Faculty of Medicine, Tohoku Medical and Pharmaceutical University, Sendai, Japan.,Department of Preventive Medicine and Epidemiology, Tohoku Medical Megabank Organization, Tohoku University, Sendai, Japan
| | - Michihiro Satoh
- Division of Public Health, Hygiene and Epidemiology, Faculty of Medicine, Tohoku Medical and Pharmaceutical University, Sendai, Japan. .,Department of Preventive Medicine and Epidemiology, Tohoku Medical Megabank Organization, Tohoku University, Sendai, Japan.
| | - Hirohito Metoki
- Division of Public Health, Hygiene and Epidemiology, Faculty of Medicine, Tohoku Medical and Pharmaceutical University, Sendai, Japan.,Tohoku Institute for Management of Blood Pressure, Sendai, Japan.,Department of Community Medical Support, Tohoku Medical Megabank Organization, Tohoku University, Sendai, Japan
| | - Takahisa Murakami
- Division of Public Health, Hygiene and Epidemiology, Faculty of Medicine, Tohoku Medical and Pharmaceutical University, Sendai, Japan.,Department of Community Medical Support, Tohoku Medical Megabank Organization, Tohoku University, Sendai, Japan.,Division of Aging and Geriatric Dentistry, Department of Rehabilitation Dentistry, Tohoku University Graduate School of Dentistry, Sendai, Japan
| | - Kei Asayama
- Tohoku Institute for Management of Blood Pressure, Sendai, Japan.,Department of Hygiene and Public Health, Teikyo University School of Medicine, Tokyo, Japan
| | - Azusa Hara
- Division of Drug Development and Regulatory Science, Faculty of Pharmacy, Keio University, Tokyo, Japan
| | - Takuo Hirose
- Division of Nephrology and Endocrinology, Faculty of Medicine, Tohoku Medical and Pharmaceutical University, Sendai, Japan
| | - Atsuhiro Kanno
- Division of Community Medicine, Faculty of Medicine, Tohoku Medical and Pharmaceutical University, Sendai, Japan
| | - Ryusuke Inoue
- Medical Information Technology Center, Tohoku University Hospital, Sendai, Japan
| | - Megumi Tsubota-Utsugi
- Department of Hygiene and Preventive Medicine, Iwate Medical University School of Medicine, Morioka, Japan
| | - Masahiro Kikuya
- Department of Preventive Medicine and Epidemiology, Tohoku Medical Megabank Organization, Tohoku University, Sendai, Japan.,Department of Hygiene and Public Health, Teikyo University School of Medicine, Tokyo, Japan
| | - Takefumi Mori
- Division of Nephrology and Endocrinology, Faculty of Medicine, Tohoku Medical and Pharmaceutical University, Sendai, Japan
| | - Atsushi Hozawa
- Department of Preventive Medicine and Epidemiology, Tohoku Medical Megabank Organization, Tohoku University, Sendai, Japan
| | - Yutaka Imai
- Tohoku Institute for Management of Blood Pressure, Sendai, Japan
| | - Takayoshi Ohkubo
- Tohoku Institute for Management of Blood Pressure, Sendai, Japan.,Department of Hygiene and Public Health, Teikyo University School of Medicine, Tokyo, Japan
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Abstract
AIMS Joint registries typically use revision of an implant as an endpoint and report survival rates after a defined number of years. However, reporting lifetime risk of revision may be more meaningful, especially in younger patients. We aimed to assess lifetime risk of revision for patients in defined age groups at the time of primary surgery. METHODS The New Zealand Joint Registry (NZJR) was used to obtain rates and causes of revision for all primary total hip arthroplasties (THAs) performed between January 1999 and December 2016. The NZJR is linked to the New Zealand Registry of Births, Deaths and Marriages to obtain complete and accurate data. Patients were stratified by age at primary surgery, and lifetime risk of revision calculated according to age, sex, and American Society of Anesthesiologists (ASA) classification. The most common causes for revision were also analyzed for each age group. RESULTS The overall, ten-year implant survival rate was 93.6% (95% confidence interval (CI) 93.4% to 93.8%). It was lowest in the youngest age group (46 to 50 years), rising sequentially with increasing age to 97.5% in the oldest group (90 to 95 years). Lifetime risk of revision surgery was 27.6% (95% CI 27.3% to 27.8%) in those aged 46 to 50 years, decreasing with age to 1.1% (95% CI 0.0% to 5.8%) in those aged 90 to 95 years at the time of primary surgery. Higher ASA grades were associated with an increased lifetime risk of revision across all ages. The commonest causes for revision THA were aseptic loosening, infection, periprosthetic fracture, and dislocation. CONCLUSION When counselling patients preoperatively, the lifetime risk of revision may be a more meaningful and useful measure of longer-term outcome than implant survival at defined time periods. This study highlights the considerably increased likelihood of subsequent revision surgery in younger age groups. Cite this article: Bone Joint J 2021;103-B(3):479-485.
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Affiliation(s)
- Mary Nugent
- Department of Orthopaedic Surgery, Christchurch Public Hospital, Christchurch, New Zealand
| | - Simon W Young
- Department of Orthopaedic Surgery, North Shore Hospital, Auckland, New Zealand
| | | | - Gary J Hooper
- Department of Orthopaedic Surgery and Musculoskeletal Medicine, University of Otago Christchurch, Christchurch, New Zealand
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Hajian-Tilaki K, Nikpour M. Accuracy of self-perceived risk perception of breast cancer development in Iranian women. BMC Womens Health 2021; 21:93. [PMID: 33663481 PMCID: PMC7934235 DOI: 10.1186/s12905-021-01238-z] [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] [Subscribe] [Scholar Register] [Received: 07/12/2020] [Accepted: 02/22/2021] [Indexed: 01/02/2023]
Abstract
BACKGROUND The accuracy of subjective risk perception is a matter of concern in breast cancer development. The objective of this study was to evaluate the accuracy of self-perceived risk assessment of breast cancer development and compared to actual risk in Iranian women. METHODS The demographic, clinical, and reproductive characteristics of 800 women aged 35-85 years were collected with an in-person interview. The self-perceived risk and the actual risk were assessed using the visual analog scale (VAS) and he Gail model respectively. Gail's cutoff of 1.66% risk was used to categorize the estimated 5-year actual risk as low/average risk (< 1.66%) and high risk (≥ 1.66). In low/average risk, if the self-perceived risk > actual risk, then individuals were considered as overestimating. Similarly, in high-risk women, if the perceived risk < actual risk, then, the subjects were labeled as under-estimate; otherwise, it was labeled as accurate. The Kappa statistics were used to determine the agreement between self-perceived risk and actual risk. ROC analysis was applied to determine the accuracy of self-perceived risk in the prediction of actual risk. RESULTS The perceived risk was significantly higher than actual risk (p = 0.001, 0.01 for 5-year and lifetime risk respectively). Both in low and high-risk groups about half of the women over-estimate and underestimate the risk by subjective risk perception. For a 5-year risk assessment, there was no agreement between perceived risk and actual risk (Kappa = 0.00, p = 0.98) but a very low agreement between them in lifetime risk assessment (Kappa = 0.09, p = 0.005). The performance of accuracy of risk perception versus actual risk was very low (AUC = 0.53, 95% CI 0.44-0.61 and AUC = 0.58, 95% CI 0.54-0.62 for the 5-year risk and lifetime risk respectively). CONCLUSION The clinical performance of risk perception based on VAS is very poor. Thus, the efforts of the public health education program should focus on the correct perception of breast cancer risk among Iranian women.
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Affiliation(s)
- Karimollah Hajian-Tilaki
- Department of Biostatistics and Epidemiology, Babol University of Medical Sciences, Babol, Iran.,Social Determinants of Health Research Center, Health Research Institute, Babol University of Medical Sciences, Babol, Iran
| | - Maryam Nikpour
- Non-Communicable Disease Research Center, Health Research Institute, Babol University of Medical Sciences, Babol, Iran.
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29
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Zabor EC. Comment on "Age Conditional Probability of Ocular and Ocular Adnexal Malignancies". Ocul Oncol Pathol 2021; 7:74-75. [PMID: 33796522 PMCID: PMC7989812 DOI: 10.1159/000512031] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2020] [Accepted: 09/30/2020] [Indexed: 11/19/2022] Open
Affiliation(s)
- Emily C. Zabor
- Department of Quantitative Health Sciences & Taussig Cancer Center, Cleveland, Ohio, USA
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Luhar S, Kondal D, Jones R, Anjana RM, Patel SA, Kinra S, Clarke L, Ali MK, Prabhakaran D, Kadir MM, Tandon N, Mohan V, Narayan KMV. Lifetime risk of diabetes in metropolitan cities in India. Diabetologia 2021; 64:521-529. [PMID: 33225415 PMCID: PMC7864818 DOI: 10.1007/s00125-020-05330-1] [Citation(s) in RCA: 26] [Impact Index Per Article: 8.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/29/2020] [Accepted: 10/05/2020] [Indexed: 01/08/2023]
Abstract
AIMS/HYPOTHESIS We aimed to estimate the lifetime risk of diabetes and diabetes-free life expectancy in metropolitan cities in India among the population aged 20 years or more, and their variation by sex, age and BMI. METHODS A Markov simulation model was adopted to estimate age-, sex- and BMI-specific lifetime risk of developing diabetes and diabetes-free life expectancy. The main data inputs used were as follows: age-, sex- and BMI-specific incidence rates of diabetes in urban India taken from the Centre for Cardiometabolic Risk Reduction in South Asia (2010-2018); age-, sex- and urban-specific rates of mortality from period lifetables reported by the Government of India (2014); and prevalence of diabetes from the Indian Council for Medical Research INdia DIABetes study (2008-2015). RESULTS Lifetime risk (95% CI) of diabetes in 20-year-old men and women was 55.5 (51.6, 59.7)% and 64.6 (60.0, 69.5)%, respectively. Women generally had a higher lifetime risk across the lifespan. Remaining lifetime risk (95% CI) declined with age to 37.7 (30.1, 46.7)% at age 60 years among women and 27.5 (23.1, 32.4)% in men. Lifetime risk (95% CI) was highest among obese Indians: 86.0 (76.6, 91.5)% among 20-year-old women and 86.9 (75.4, 93.8)% among men. We identified considerably higher diabetes-free life expectancy at lower levels of BMI. CONCLUSIONS/INTERPRETATION Lifetime risk of diabetes in metropolitan cities in India is alarming across the spectrum of weight and rises dramatically with higher BMI. Prevention of diabetes among metropolitan Indians of all ages is an urgent national priority, particularly given the rapid increase in urban obesogenic environments across the country. Graphical abstract.
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Affiliation(s)
- Shammi Luhar
- Department of Public Health and Primary Care, University of Cambridge, Cambridge, UK.
- Department of Population Health, London School of Hygiene and Tropical Medicine, London, UK.
| | - Dimple Kondal
- Centre for Chronic Disease Control (CCDC), New Delhi, India
| | - Rebecca Jones
- Nutrition and Health Sciences, Laney Graduate School, Emory University, Atlanta, GA, USA
| | | | - Shivani A Patel
- Hubert Department of Global Health, Emory University, Atlanta, GA, USA
| | - Sanjay Kinra
- Department of Non-Communicable Disease Epidemiology, London School of Hygiene and Tropical Medicine, London, UK
| | - Lynda Clarke
- Department of Population Health, London School of Hygiene and Tropical Medicine, London, UK
| | - Mohammed K Ali
- Hubert Department of Global Health, Emory University, Atlanta, GA, USA
| | - Dorairaj Prabhakaran
- Centre for Chronic Disease Control (CCDC), New Delhi, India
- Public Health Foundation of India, Gurgaon, India
| | - M Masood Kadir
- Department of Community Health Sciences, Aga Khan University, Karachi, Pakistan
| | - Nikhil Tandon
- Department of Endocrinology and Metabolism, All India Institute of Medical Sciences, New Delhi, India
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Kebaetse M, Nkhwa S, Mogodi M, Masunge J, Gureja YP, Ramabu M, Mmopelwa T, Sharif I, Orford A, Johansson H, Harvey NC, McCloskey EV, Cauley JA, Kanis JA. Epidemiology of hip fracture in Botswana. Arch Osteoporos 2021; 16:24. [PMID: 33550503 DOI: 10.1007/s11657-021-00885-x] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/13/2020] [Accepted: 01/11/2021] [Indexed: 02/03/2023]
Abstract
UNLABELLED A retrospective population-based survey in the Republic of Botswana determined the incidence of fractures at the hip over 3 years. The estimated number of such fractures nationwide for 2020 was 103 and is predicted to increase. OBJECTIVE This article describes the epidemiology of hip fractures in the Republic of Botswana. METHODS A retrospective patient chart review was conducted to identify from hospital registers the number of patients diagnosed with hip fracture in 2009, 2010, and 2011. Age- and sex-specific incidence of hip fracture was determined from which lifetime probabilities and future projections for hip fracture were calculated. RESULTS The incidence of hip fracture was low and comparable to rates reported from Tunisia. The remaining lifetime risk of hip fracture at the age of 50 years in men and women was 1.4 and 1.1%, respectively. The incidence of hip fracture suggested that the estimated number of hip fractures nationwide in persons over the age of 50 years for 2020 was 103 and is predicted to increase by more than threefold to 372 in 2050. CONCLUSION The hip fracture rates can be used for healthcare planning. Additionally, these data can be used to create a FRAX model to help guide decisions about treatment.
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32
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Gonzalez-Cantero A, Reddy AS, Dey AK, Gonzalez-Cantero J, Munger E, Rodante J, Sanchez-Moya AI, Perez-Hortet C, Gonzalez-Calvin JL, Playford MP, Barderas MG, Ballester A, Jimenez-Gomez N, Jaén P, Chen MY, Gelfand JM, Mehta NN. Underperformance of clinical risk scores in identifying imaging-based high cardiovascular risk in psoriasis: results from two observational cohorts. Eur J Prev Cardiol 2020; 29:591-598. [PMID: 33624060 DOI: 10.1093/eurjpc/zwaa033] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [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] [Received: 06/03/2020] [Revised: 07/17/2020] [Accepted: 07/27/2020] [Indexed: 01/06/2023]
Abstract
AIMS We aimed to evaluate whether traditional risk scores [short-term, 'psoriasis-modified' (multiplied by 1.5) and lifetime] were able to capture high cardiovascular disease (CVD) risk as defined by the presence of atherosclerotic plaques in coronary, femoral, or carotid arteries in psoriasis. METHODS AND RESULTS We used two prospectives obseravational cohorts. European cohort: femoral and carotid atherosclerotic plaques were evaluated by ultrasound in 73 psoriasis patients. Lifetime CVD risk (LTCVR) was evaluated with QRISK-LT; short-term CVD risk was evaluated with SCORE and psoriasis-modified SCORE. American cohort: 165 patients underwent coronary computed tomography angiography to assess presence of coronary plaques. LTCVR was evaluated with atherosclerotic cardiovascular disease (ASCVD-LT) lifetime; short-term CVD risk was evaluated with ASCVD and psoriasis-modified ASCVD. European cohort: subclinical atherosclerosis was present in 51% of patients. QRISK-LT identified 64% of patients with atherosclerosis missing a high proportion (35%) with atheroma plaque (P < 0.05). The percentage of patients with atherosclerosis identified by QRISK-LT was significantly higher than those detected by SCORE (0%) and modified SCORE (10%). American cohort: subclinical atherosclerosis was present in 54% of patients. ASCVD-LT captured 54% of patients with coronary plaques missing a high proportion (46%) with coronary plaque (P < 0.05). The percentage of patients with atheroma plaques detected with ASCVD and modified ASCVD were only 20% and 45%, respectively. CONCLUSIONS Application of lifetime, short-term and 'psoriasis-modified' risk scores did not accurately capture psoriasis patients at high CVD risk.
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Affiliation(s)
| | - Aarthi S Reddy
- Section of Inflammation and Cardiometabolic Diseases, National Heart, Lung and Blood Institute, National Institutes of Health, 10 Center Drive, Clinical Research Center, Room 5-5140, Bethesda, MD 20892, USA
| | - Amit K Dey
- Section of Inflammation and Cardiometabolic Diseases, National Heart, Lung and Blood Institute, National Institutes of Health, 10 Center Drive, Clinical Research Center, Room 5-5140, Bethesda, MD 20892, USA
| | | | - Eric Munger
- Section of Inflammation and Cardiometabolic Diseases, National Heart, Lung and Blood Institute, National Institutes of Health, 10 Center Drive, Clinical Research Center, Room 5-5140, Bethesda, MD 20892, USA
| | - Justin Rodante
- Section of Inflammation and Cardiometabolic Diseases, National Heart, Lung and Blood Institute, National Institutes of Health, 10 Center Drive, Clinical Research Center, Room 5-5140, Bethesda, MD 20892, USA
| | - Ana I Sanchez-Moya
- Department of Dermatology, Complejo Hospitalario de Toledo, Toledo, Spain
| | | | | | - Martin P Playford
- Section of Inflammation and Cardiometabolic Diseases, National Heart, Lung and Blood Institute, National Institutes of Health, 10 Center Drive, Clinical Research Center, Room 5-5140, Bethesda, MD 20892, USA
| | - María G Barderas
- Department of Vascular Physiopathology, Hospital Nacional de Parapléjicos (HNP), SESCAM, Toledo, Spain
| | - Asunción Ballester
- Department of Dermatology, Hospital Universitario Ramón y Cajal, Madrid, Spain
| | | | - Pedro Jaén
- Department of Dermatology, Hospital Universitario Ramón y Cajal, Madrid, Spain
| | - Marcus Y Chen
- Section of Inflammation and Cardiometabolic Diseases, National Heart, Lung and Blood Institute, National Institutes of Health, 10 Center Drive, Clinical Research Center, Room 5-5140, Bethesda, MD 20892, USA
| | - Joel M Gelfand
- Department of Dermatology, University of Pennsylvania, Philadelphia, PA, USA
| | - Nehal N Mehta
- Section of Inflammation and Cardiometabolic Diseases, National Heart, Lung and Blood Institute, National Institutes of Health, 10 Center Drive, Clinical Research Center, Room 5-5140, Bethesda, MD 20892, USA
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Martinez PJ, Agudiez M, Molero D, Martin-Lorenzo M, Baldan-Martin M, Santiago-Hernandez A, García-Segura JM, Madruga F, Cabrera M, Calvo E, Ruiz-Hurtado G, Barderas MG, Vivanco F, Ruilope LM, Alvarez-Llamas G. Urinary metabolic signatures reflect cardiovascular risk in the young, middle-aged, and elderly populations. J Mol Med (Berl) 2020; 98:1603-1613. [PMID: 32914213 PMCID: PMC7591416 DOI: 10.1007/s00109-020-01976-x] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2020] [Revised: 07/10/2020] [Accepted: 09/03/2020] [Indexed: 01/09/2023]
Abstract
The predictive value of traditional cardiovascular risk estimators is limited, and young and elderly populations are particularly underrepresented. We aimed to investigate the urine metabolome and its association with cardiovascular risk to identify novel markers that might complement current estimators based on age. Urine samples were collected from 234 subjects categorized into three age-grouped cohorts: 30-50 years (cohort I, young), 50-70 years (cohort II, middle-aged), and > 70 years (cohort III, elderly). Each cohort was further classified into three groups: (a) control, (b) individuals with cardiovascular risk factors, and (c) those who had a previous cardiovascular event. Novel urinary metabolites linked to cardiovascular risk were identified by nuclear magnetic resonance in cohort I and then evaluated by target mass spectrometry quantification in all cohorts. A previously identified metabolic fingerprint associated with atherosclerosis was also analyzed and its potential risk estimation investigated in the three aged cohorts. Three different metabolic signatures were identified according to age: 2-hydroxybutyrate, gamma-aminobutyric acid, hypoxanthine, guanidoacetate, oxaloacetate, and serine in young adults; citrate, cyclohexanol, glutamine, lysine, pantothenate, pipecolate, threonine, and tyramine shared by middle-aged and elderly adults; and trimethylamine N-oxide and glucuronate associated with cardiovascular risk in all three cohorts. The urinary metabolome contains a metabolic signature of cardiovascular risk that differs across age groups. These signatures might serve to complement existing algorithms and improve the accuracy of cardiovascular risk prediction for personalized prevention. KEY MESSAGES: • Cardiovascular risk in the young and elderly is underestimated. • The urinary metabolome reflects cardiovascular risk across all age groups. • Six metabolites constitute a metabolic signature of cardiovascular risk in young adults. • Middle-aged and elderly adults share a cardiovascular risk metabolic signature. • TMAO and glucuronate levels reflect cardiovascular risk across all age groups.
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Affiliation(s)
- Paula J Martinez
- Department of Immunology, Immunoallergy and Proteomics Laboratory, IIS-Fundación Jiménez Díaz, UAM, Avenida Reyes Católicos 2, 28040, Madrid, Spain
| | - Marta Agudiez
- Department of Immunology, Immunoallergy and Proteomics Laboratory, IIS-Fundación Jiménez Díaz, UAM, Avenida Reyes Católicos 2, 28040, Madrid, Spain
| | - Dolores Molero
- CAI-RMN, Universidad Complutense de Madrid, Madrid, Spain
| | - Marta Martin-Lorenzo
- Department of Immunology, Immunoallergy and Proteomics Laboratory, IIS-Fundación Jiménez Díaz, UAM, Avenida Reyes Católicos 2, 28040, Madrid, Spain
| | | | - Aranzazu Santiago-Hernandez
- Department of Immunology, Immunoallergy and Proteomics Laboratory, IIS-Fundación Jiménez Díaz, UAM, Avenida Reyes Católicos 2, 28040, Madrid, Spain
| | - Juan Manuel García-Segura
- CAI-RMN, Universidad Complutense de Madrid, Madrid, Spain
- Department of Biochemistry and Molecular Biology I, Universidad Complutense, Madrid, Spain
| | - Felipe Madruga
- Departament of Geriatrics, Hospital Virgen del Valle, SESCAM, Toledo, Spain
| | | | | | - Gema Ruiz-Hurtado
- Cardiorenal Translational Laboratory, Instituto de Investigación I+12, Hospital Universitario 12 de Octubre, Madrid, Spain
- CIBER-CV, Hospital Universitario 12 de Octubre, Madrid, Spain
| | - Maria G Barderas
- Department of Vascular Physiopathology, Hospital Nacional de Parapléjicos SESCAM, Toledo, Spain
| | - Fernando Vivanco
- Department of Immunology, Immunoallergy and Proteomics Laboratory, IIS-Fundación Jiménez Díaz, UAM, Avenida Reyes Católicos 2, 28040, Madrid, Spain
- Department of Biochemistry and Molecular Biology I, Universidad Complutense, Madrid, Spain
| | - Luis M Ruilope
- Cardiorenal Translational Laboratory, Instituto de Investigación I+12, Hospital Universitario 12 de Octubre, Madrid, Spain
- CIBER-CV, Hospital Universitario 12 de Octubre, Madrid, Spain
- School of Doctoral Studies and Research, Universidad Europea de Madrid, Madrid, Spain
| | - Gloria Alvarez-Llamas
- Department of Immunology, Immunoallergy and Proteomics Laboratory, IIS-Fundación Jiménez Díaz, UAM, Avenida Reyes Católicos 2, 28040, Madrid, Spain.
- REDINREN, Madrid, Spain.
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Imai Y, Hirata T, Saitoh S, Ninomiya T, Miyamoto Y, Ohnishi H, Murakami Y, Iso H, Tanaka S, Miura K, Tamakoshi A, Yamada M, Kiyama M, Ueshima H, Ishikawa S, Okamura T; Evidence for Cardiovascular Prevention from Observational Cohorts in Japan (EPOCH-JAPAN) Research Group. Impact of hypertension stratified by diabetes on the lifetime risk of cardiovascular disease mortality in Japan: a pooled analysis of data from the Evidence for Cardiovascular Prevention from Observational Cohorts in Japan study. Hypertens Res 2020; 43:1437-44. [PMID: 32620896 DOI: 10.1038/s41440-020-0502-5] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2020] [Revised: 05/26/2020] [Accepted: 06/03/2020] [Indexed: 12/30/2022]
Abstract
Lifetime risk is an informative estimate to motivate people to change lifestyle behaviors, especially from a younger age, in public health education. The impact of the combination of hypertension and diabetes on the lifetime risk of cardiovascular mortality has not been investigated in Asian populations. A pooled analysis of individual data from nine cohorts was performed. A total of 57,339 Japanese men and women were eligible for the analysis. We used the modified Kaplan-Meier approach and estimated the remaining lifetime risk of cardiovascular mortality starting from the index age of 35 years. Participants were classified into four categories defined by hypertension and diabetes. The lifetime risk was increased in the order of those without either risk, those without hypertension but with diabetes, those with hypertension but without diabetes, and those with both risks. The lifetime risk of cardiovascular mortality at the 35-year index age was as follows: 7.8% in men and 6.2% in women for those without either hypertension or diabetes, 13.2% in men and 9.5% in women for those without hypertension but with diabetes, 17.2% in men and 11.7% in women for those with hypertension but without diabetes, and 19.4% in men and 15% in women for those with both risks. These findings reinforce the need for a life-course perspective in the management of hypertension and diabetes from a younger age.
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Wakasugi M, Narita I. Lifetime and age-conditional risk estimates of end-stage kidney disease requiring maintenance dialysis in Japan. Clin Exp Nephrol 2020; 24:518-525. [PMID: 32040656 PMCID: PMC7248047 DOI: 10.1007/s10157-020-01860-5] [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: 11/01/2019] [Accepted: 01/29/2020] [Indexed: 11/24/2022]
Abstract
Background Lifetime risk is an epidemiologic measure that expresses the probability of disease in the remaining lifetime for an index age. It is also an easily understandable statistical measure used to communicate the absolute risk of disease to the lay population. The lifetime risk of end-stage kidney disease (ESKD) has never been reported for the Japanese population. Here, we used data from the Japanese Society of Dialysis Therapy (JSDT) to estimate the lifetime risk of ESKD by sex in Japan. Methods The lifetime risk of ESKD was estimated using life-table methods. We defined an incident case of ESKD as a patient with loss of kidney function that resulted in maintenance dialysis therapy. The number of incident cases of ESKD and number of ESKD deaths in 2017 were obtained from data published by the JSDT. The population and total number of deaths in Japan for the same year were obtained from National Vital Statistics. By including all-cause mortality, risks were adjusted for competing causes of death. Results The cumulative incidence of ESKD from birth until age 95 years was 3.14% [95% confidence interval (CI) 3.10–3.18] for men and 1.42% (1.39–1.44) for women. These probabilities illustrate that approximately 1 in 32 men and 1 in 71 women in Japan will develop ESKD that results in maintenance dialysis therapy in their lifetime. Conclusions Considerable sex differences were found in the lifetime risk of ESKD in Japan. This easily understandable information could be used to assist in public health education and planning.
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Affiliation(s)
- Minako Wakasugi
- Division of Comprehensive Geriatrics in Community, Niigata University Graduate School of Medical and Dental Sciences, 1-757 Asahimachi, Chuo-ku, Niigata, 951-8510, Japan.
| | - Ichiei Narita
- Division of Clinical Nephrology and Rheumatology, Niigata University Graduate School of Medical and Dental Sciences, Niigata, Japan
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Tan J, Wagner M, Stenton SL, Strom TM, Wortmann SB, Prokisch H, Meitinger T, Oexle K, Klopstock T. Lifetime risk of autosomal recessive mitochondrial disorders calculated from genetic databases. EBioMedicine 2020; 54:102730. [PMID: 32305867 PMCID: PMC7163308 DOI: 10.1016/j.ebiom.2020.102730] [Citation(s) in RCA: 25] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2020] [Revised: 02/25/2020] [Accepted: 03/05/2020] [Indexed: 12/31/2022] Open
Abstract
Background Mitochondrial disorders are a group of rare diseases, caused by nuclear or mitochondrial DNA mutations. Their marked clinical and genetic heterogeneity as well as referral and ascertainment biases render phenotype-based prevalence estimations difficult. Here we calculated the lifetime risk of all known autosomal recessive mitochondrial disorders on basis of genetic data. Methods We queried the publicly available Genome Aggregation Database (gnomAD) and our in-house exome database to assess the allele frequency of disease-causing variants in genes associated with autosomal recessive mitochondrial disorders. Based on this, we estimated the lifetime risk of 249 autosomal recessive mitochondrial disorders. Three of these disorders and phenylketonuria (PKU) served as a proof of concept since calculations could be aligned with known birth prevalence data from newborn screening reports. Findings The estimated lifetime risks are very close to newborn screening data (where available), supporting the validity of the approach. For example, calculated lifetime risk of PKU (16·0/100,000) correlates well with known birth prevalence data (18·7/100,000). The combined estimated lifetime risk of 249 investigated mitochondrial disorders is 31·8 (20·9–50·6)/100,000 in our in-house database, 48·4 (40·3–58·5)/100,000 in the European gnomAD dataset, and 31·1 (26·7–36·3)/100,000 in the global gnomAD dataset. The disorders with the highest lifetime risk (> 3 per 100,000) were, in all datasets, those caused by mutations in the SPG7, ACADM, POLG and SLC22A5 genes. Interpretation We provide a population-genetic estimation on the lifetime risk of an entire class of monogenic disorders. Our findings reveal the substantial cumulative prevalence of autosomal recessive mitochondrial disorders, far above previous estimates. These data will be very important for assigning diagnostic a priori probabilities, and for resource allocation in therapy development, public health management and biomedical research. Funding German Federal Ministry of Education and Research.
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Affiliation(s)
- Jing Tan
- Institute of Human Genetics, School of Medicine, Technische Universität München, Munich, Germany; Friedrich-Baur-Institute, Department of Neurology, University Hospital, LMU Munich, Munich, Germany
| | - Matias Wagner
- Institute of Human Genetics, School of Medicine, Technische Universität München, Munich, Germany; Institute of Human Genetics, Helmholtz Zentrum München, Neuherberg, Germany; Institute of Neurogenomics, Helmholtz Zentrum München, Neuherberg, Germany.
| | - Sarah L Stenton
- Institute of Human Genetics, School of Medicine, Technische Universität München, Munich, Germany; Institute of Human Genetics, Helmholtz Zentrum München, Neuherberg, Germany
| | - Tim M Strom
- Institute of Human Genetics, School of Medicine, Technische Universität München, Munich, Germany; Institute of Human Genetics, Helmholtz Zentrum München, Neuherberg, Germany
| | - Saskia B Wortmann
- Institute of Human Genetics, School of Medicine, Technische Universität München, Munich, Germany; Institute of Human Genetics, Helmholtz Zentrum München, Neuherberg, Germany; Department of Pediatrics, University Children's Hospital, Paracelsus Medical University (PMU), Salzburg, Austria
| | - Holger Prokisch
- Institute of Human Genetics, School of Medicine, Technische Universität München, Munich, Germany; Institute of Human Genetics, Helmholtz Zentrum München, Neuherberg, Germany
| | - Thomas Meitinger
- Institute of Human Genetics, School of Medicine, Technische Universität München, Munich, Germany; Institute of Human Genetics, Helmholtz Zentrum München, Neuherberg, Germany
| | - Konrad Oexle
- Institute of Neurogenomics, Neurogenetic Systems Analysis Unit, Helmholtz Zentrum München, Neuherberg, Germany
| | - Thomas Klopstock
- Friedrich-Baur-Institute, Department of Neurology, University Hospital, LMU Munich, Munich, Germany; German Center for Neurodegenerative Diseases (DZNE), Munich, Germany; Munich Cluster for Systems Neurology (SyNergy), Munich, Germany.
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Tahkola A, Korhonen P, Kautiainen H, Niiranen T, Mäntyselkä P. Lifetime risk assessment in cholesterol management among hypertensive patients: observational cross-sectional study based on electronic health record data. BMC Fam Pract 2020; 21:62. [PMID: 32290820 PMCID: PMC7155316 DOI: 10.1186/s12875-020-01138-5] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/20/2019] [Accepted: 04/06/2020] [Indexed: 01/08/2023]
Abstract
BACKGROUND In hypertensive patients, reducing plasma low-density lipoprotein cholesterol level (LDL-C) is one of the main interventions for preventing chronic cardiovascular diseases (CVD). However, LDL-C control remains generally insufficient, also in patients with hypertension. We analyzed Electronic Health Record (EHR) data of 7117 hypertensive patients to find the most potential age and sex subgroups in greatest need for improvement in real life dyslipidemia treatment. Taking into account the current discussion on lifetime CVD risk, we focused on the age dependence in LDL-C control. METHODS In this observational cross-sectional study, based on routine electronic health record (EHR) data, we investigated LDL-C control of hypertensive, non-diabetic patients without renal dysfunction or CVD, aged 30 years or more in Finnish primary care setting. RESULTS More than half (54% of women and 53% of men) of untreated patients did not meet the LDL-C target of < 3 mmol/l and one third (35% of women and 33% of men) of patients did not reach the target even with the lipid-lowering medication (LLM). Furthermore, higher age was strongly associated with better LDL-C control (p < 0.001) and lower LDL-C level (p < 0.001) in individuals with and without LLM. Higher age was also strongly associated with LLM prescription (p < 0.001). In total, about half of the patients were on LLM (53% of women and 51% of men). CONCLUSIONS Our findings indicate that dyslipidemia treatment among Finnish primary care hypertensive patients is generally insufficient, particularly in younger age groups who might benefit the most from CVD risk reduction over time. Clinicians should probably rely more on the lifetime risk of CVD, especially when treating working age hypertensive patients.
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Affiliation(s)
- Aapo Tahkola
- University of Eastern Finland, Institute of Public Health and Clinical Nutrition, Kuopio, Finland
- Health Centre of Jyväskylä Cooperation Area, Jyväskylä, Finland
| | | | | | - Teemu Niiranen
- National Institute for Health and Welfare, Helsinki, Finland
- Department of Medicine, Turku University Hospital and University of Turku, Turku, Finland
| | - Pekka Mäntyselkä
- University of Eastern Finland, Institute of Public Health and Clinical Nutrition, Kuopio, Finland
- Primary Health Care Unit, Kuopio University Hospital, Kuopio, Finland
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Satoh M, Ohkubo T, Asayama K, Murakami Y, Sugiyama D, Waki T, Tanaka-Mizuno S, Yamada M, Saitoh S, Sakata K, Irie F, Sairenchi T, Ishikawa S, Kiyama M, Okayama A, Miura K, Imai Y, Ueshima H, Okamura T. A Combination of Blood Pressure and Total Cholesterol Increases the Lifetime Risk of Coronary Heart Disease Mortality: EPOCH-JAPAN. J Atheroscler Thromb 2020; 28:6-24. [PMID: 32269207 PMCID: PMC7875142 DOI: 10.5551/jat.52613] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022] Open
Abstract
AIM Lifetime risk (LTR) indicates the absolute risk of disease during the remainder of an individual's lifetime. We aimed to assess the LTRs for coronary heart disease (CHD) mortality associated with blood pressure (BP) and total cholesterol levels in an Asian population using a meta-analysis of individual participant data because no previous studies have assessed this risk. METHODS We analyzed data from 105,432 Japanese participants in 13 cohorts. Apart from grade 1 and 2-3 hypertension groups, we defined "normal BP" as systolic/diastolic BP <130/<80 mmHg and "high BP" as 130-139/80-89 mmHg. The sex-specific LTR was estimated while considering the competing risk of death. RESULTS During the mean follow-up period of 15 years (1,553,735 person-years), 889 CHD deaths were recorded. The 10-year risk of CHD mortality at index age 35 years was ≤ 0.11%, but the corresponding LTR was ≥ 1.84%. The LTR of CHD at index age 35 years steeply increased with an increase in BP of participants with high total cholesterol levels [≥ 5.7 mmol/L (220 mg/dL)]. This risk was 7.73%/5.77% (95% confidence interval: 3.53%-10.28%/3.83%-7.25%) in men/women with grade 2-3 hypertension and high total cholesterol levels. In normal and high BP groups, the absolute differences in LTRs between the low and high total cholesterol groups were ≤ 0.25% in men and ≤ 0.40% in women. CONCLUSIONS High total cholesterol levels contributed to an elevated LTR of CHD mortality in hypertensive individuals. These findings could help guide high-risk young individuals toward initiating lifestyle changes or treatments.
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Affiliation(s)
- Michihiro Satoh
- Division of Public Health, Hygiene and Epidemiology, Faculty of Medicine, Tohoku Medical and Pharmaceutical University
| | - Takayoshi Ohkubo
- Department of Hygiene and Public Health, Teikyo University School of Medicine.,Tohoku Institute for Management of Blood Pressure
| | - Kei Asayama
- Department of Hygiene and Public Health, Teikyo University School of Medicine.,Tohoku Institute for Management of Blood Pressure
| | | | - Daisuke Sugiyama
- Faculty of Nursing and Medical Care, School of Medicine, Keio University
| | - Takashi Waki
- Department of Medical Statistics, Shiga University of Medical Science
| | | | - Michiko Yamada
- Department of Clinical Studies, Radiation Effects Research Foundation
| | - Shigeyuki Saitoh
- Division of Medical and Behavioral Subjects, Sapporo Medical University School of Health Sciences
| | - Kiyomi Sakata
- Department of Hygiene and Preventive Medicine, Iwate Medical University School of Medicine
| | - Fujiko Irie
- Department of Health and Welfare, Ibaraki Prefectural Office
| | - Toshimi Sairenchi
- Department of Public Health, Dokkyo Medical University School of Medicine
| | | | - Masahiko Kiyama
- Osaka Center for Cancer and Cardiovascular Disease Prevention
| | | | - Katsuyuki Miura
- Department of Public Health, Shiga University of Medical Science.,Center for Epidemiologic Research in Asia, Shiga University of Medical Science
| | - Yutaka Imai
- Tohoku Institute for Management of Blood Pressure
| | - Hirotsugu Ueshima
- Department of Public Health, Shiga University of Medical Science.,Center for Epidemiologic Research in Asia, Shiga University of Medical Science
| | - Tomonori Okamura
- Department of Preventive Medicine and Public Health, School of Medicine, Keio University
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Lucca U, Tettamanti M, Tiraboschi P, Logroscino G, Landi C, Sacco L, Garrì M, Ammesso S, Biotti A, Gargantini E, Piedicorcia A, Mandelli S, Riva E, Galbussera AA, Recchia A. Incidence of dementia in the oldest-old and its relationship with age: The Monzino 80-plus population-based study. Alzheimers Dement 2020; 16:472-481. [PMID: 31786127 DOI: 10.1016/j.jalz.2019.09.083] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Abstract
INTRODUCTION Relationship between age and dementia at extreme old ages is still an open question, yet population-based studies in this high-risk age segment are rare. METHODS The Monzino 80-plus is a population-based study among residents 80 years and older in the Varese province, Italy. Of 1371 eligible individuals, 1294 (94.4%), of whom 64 are centenarians, were included in the incidence study. RESULTS Since 2002, 584 new cases of all-cause dementia were identified over 15 years. The overall incidence rate was 7.9 per 100 person-years. Dementia risk rose with age (IRR: 1.06), with the cubic model providing the best fit (R2 = 0.91-0.96). Cumulative incidences of dementia unadjusted and adjusted for competing mortality risk progressively diverged with age. CONCLUSION Dementia incidence also keeps rising in nonagenarians and centenarians. Slowing down in growing risk of developing dementia with age is mainly attributable to increasing competing risk of death and resulting selective survival of individuals at lower risk of dementia.
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Affiliation(s)
- Ugo Lucca
- Laboratory of Geriatric Neuropsychiatry, Department of Neuroscience, Istituto di Ricerche Farmacologiche Mario Negri IRCCS, Milano, Italy
| | - Mauro Tettamanti
- Laboratory of Geriatric Neuropsychiatry, Department of Neuroscience, Istituto di Ricerche Farmacologiche Mario Negri IRCCS, Milano, Italy
| | - Pietro Tiraboschi
- Division of Neurology V and Neuropathology, Fondazione IRCCS Istituto Neurologico "Carlo Besta", Milano, Italy
| | | | - Cristina Landi
- European Foundation of Biomedical Research (FERB), Division of Neurological Rehabilitation, Cernusco s/N (Milano), Italy
| | - Leonardo Sacco
- Neurocenter of Southern Switzerland, Ospedale Civico, Lugano, Switzerland
| | - Mariateresa Garrì
- Laboratory of Geriatric Neuropsychiatry, Department of Neuroscience, Istituto di Ricerche Farmacologiche Mario Negri IRCCS, Milano, Italy
| | - Sonia Ammesso
- Laboratory of Geriatric Neuropsychiatry, Department of Neuroscience, Istituto di Ricerche Farmacologiche Mario Negri IRCCS, Milano, Italy
| | - Anna Biotti
- Laboratory of Geriatric Neuropsychiatry, Department of Neuroscience, Istituto di Ricerche Farmacologiche Mario Negri IRCCS, Milano, Italy
| | - Elena Gargantini
- Laboratory of Geriatric Neuropsychiatry, Department of Neuroscience, Istituto di Ricerche Farmacologiche Mario Negri IRCCS, Milano, Italy
| | - Alessandro Piedicorcia
- Laboratory of Geriatric Neuropsychiatry, Department of Neuroscience, Istituto di Ricerche Farmacologiche Mario Negri IRCCS, Milano, Italy
| | - Sara Mandelli
- Laboratory of Geriatric Neuropsychiatry, Department of Neuroscience, Istituto di Ricerche Farmacologiche Mario Negri IRCCS, Milano, Italy
| | - Emma Riva
- Laboratory of Geriatric Neuropsychiatry, Department of Neuroscience, Istituto di Ricerche Farmacologiche Mario Negri IRCCS, Milano, Italy
| | - Alessia A Galbussera
- Laboratory of Geriatric Neuropsychiatry, Department of Neuroscience, Istituto di Ricerche Farmacologiche Mario Negri IRCCS, Milano, Italy
| | - Angela Recchia
- Laboratory of Geriatric Neuropsychiatry, Department of Neuroscience, Istituto di Ricerche Farmacologiche Mario Negri IRCCS, Milano, Italy
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Walsh L, Ulanowski A, Kaiser JC, Woda C, Raskob W. Risk bases can complement dose bases for implementing and optimising a radiological protection strategy in urgent and transition emergency phases. Radiat Environ Biophys 2019; 58:539-552. [PMID: 31346699 PMCID: PMC6768908 DOI: 10.1007/s00411-019-00809-x] [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] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/07/2018] [Accepted: 07/13/2019] [Indexed: 05/02/2023]
Abstract
Current radiological emergency response recommendations have been provided by the International Commission on Radiological Protection and adopted by the International Atomic Energy Agency in comprehensive Safety Standards. These standards provide dose-based guidance for decision making (e.g., on sheltering or relocation) via generic criteria in terms of effective dose in the range from 20 mSv per year, during transition from emergency to existing exposure situation, to 100 mSv, acute or annual, in the urgent phase of a nuclear accident. The purpose of this paper was to examine how such dose reference levels directly translate into radiation-related risks of the main stochastic detrimental health effects (cancer). Methodologies, provided by the World Health Organization after the Fukushima accident, for calculating the lifetime and 20 year cancer risks and for attributing relevant organ doses from effective doses, have been applied here for this purpose with new software, designed to be available for use immediately after a nuclear accident. A new feature in this software is a comprehensive accounting for uncertainty via simulation technique, so that the risks may now be presented with realistic confidence intervals. The types of cancer risks considered here are time-integrated over lifetime and the first 20 years after exposure for all solid cancers and either the most radiation-sensitive types of cancer, i.e., leukaemia and female breast cancer, or the most radiation-relevant type of cancer occurring early in life, i.e., thyroid. It is demonstrated here how reference dose levels translate differently into specific cancer risk levels (with varying confidence interval sizes), depending on age at exposure, gender, time-frame at-risk and type of cancer considered. This demonstration applies German population data and considers external exposures. Further work is required to comprehensively extend this methodology to internal exposures that are likely to be important in the early stages of a nuclear accident. A discussion is provided here on the potential for such risk-based information to be used by decision makers, in the urgent and transition phases of nuclear emergencies, to identify protective measures (e.g., sheltering, evacuation) in a differential way (i.e., for particularly susceptible sub-groups of a population).
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Affiliation(s)
- Linda Walsh
- Department of Physics, Science Faculty, University of Zürich, Winterthurerstrasse 190, 8057, Zürich, Switzerland.
| | - Alexander Ulanowski
- Institute of Radiation Medicine, Helmholtz Zentrum München - German Research Center for Environmental Health, Ingolstädter Landstraße 1, 85764, Neuherberg, Germany
- IAEA Laboratories, International Atomic Energy Agency, 2444, Seibersdorf, Austria
| | - Jan Christian Kaiser
- Institute of Radiation Medicine, Helmholtz Zentrum München - German Research Center for Environmental Health, Ingolstädter Landstraße 1, 85764, Neuherberg, Germany
| | - Clemens Woda
- Institute of Radiation Medicine, Helmholtz Zentrum München - German Research Center for Environmental Health, Ingolstädter Landstraße 1, 85764, Neuherberg, Germany
| | - Wolfgang Raskob
- Institute for Nuclear and Energy Technologies, Karlsruhe Institute of Technology, Hermann-von-Helmholtz Platz 1, 76344, Eggenstein-Leopoldshafen, Germany
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Ulanowski A, Kaiser JC, Schneider U, Walsh L. On prognostic estimates of radiation risk in medicine and radiation protection. Radiat Environ Biophys 2019; 58:305-319. [PMID: 31006050 PMCID: PMC6609593 DOI: 10.1007/s00411-019-00794-1] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/01/2019] [Accepted: 04/09/2019] [Indexed: 05/06/2023]
Abstract
The problem of expressing cumulative detrimental effect of radiation exposure is revisited. All conventionally used and computationally complex lifetime or time-integrated risks are based on current population and health statistical data, with unknown future secular trends, that are projected far into the future. It is shown that application of conventionally used lifetime or time-integrated attributable risks (LAR, AR) should be limited to exposures under 1 Gy. More general quantities, such as excess lifetime risk (ELR) and, to a lesser extent, risk of exposure-induced death (REID), are free of dose constraints, but are even more computationally complex than LAR and AR and rely on the unknown total radiation effect on demographic and health statistical data. Appropriate assessment of time-integrated risk of a specific outcome following high-dose (more than 1 Gy) exposure requires consideration of competing risks for other radiation-attributed outcomes and the resulting ELR estimate has an essentially non-linear dose response. Limitations caused by basing conventionally applied time-integrated risks on current population and health statistical data are that they are: (a) not well suited for risk estimates for atypical groups of exposed persons not readily represented by the general population; and (b) not optimal for risk projections decades into the future due to large uncertainties in developments of the future secular trends in the population-specific disease rates. Alternative disease-specific quantities, baseline and attributable survival fractions, based on reduction of survival chances are considered here and are shown to be very useful in circumventing most aspects of these limitations. Another main quantity, named as radiation-attributed decrease of survival (RADS), is recommended here to represent cumulative radiation risk conditional on survival until a certain age. RADS, historically known in statistical literature as "cumulative risk", is only based on the radiation-attributed hazard and is insensitive to competing risks. Therefore, RADS is eminently suitable for risk projections in emergency situations and for estimating radiation risks for persons exposed after therapeutic or interventional medical applications of radiation or in other highly atypical groups of exposed persons, such as astronauts.
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Affiliation(s)
- Alexander Ulanowski
- Institute of Radiation Medicine, Helmholtz Zentrum München, German Research Center for Environmental Health, Ingolstädter Landstraße 1, 85764, Neuherberg, Germany.
- International Atomic Energy Agency, IAEA Environmental Laboratories, 2444, Seibersdorf, Austria.
| | - Jan Christian Kaiser
- Institute of Radiation Medicine, Helmholtz Zentrum München, German Research Center for Environmental Health, Ingolstädter Landstraße 1, 85764, Neuherberg, Germany
| | - Uwe Schneider
- Department of Physics, Science Faculty, University of Zürich, Winterthurerstrasse 190, 8057, Zurich, Switzerland
- Radiotherapy Hirslanden, Witellikerstrasse 40, 8032, Zurich, Switzerland
| | - Linda Walsh
- Department of Physics, Science Faculty, University of Zürich, Winterthurerstrasse 190, 8057, Zurich, Switzerland
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Sherif RS, Elshemey WM, Attalla EM. The risk of secondary cancer in pediatric medulloblastoma patients due to three-dimensional conformal radiotherapy and intensity-modulated radiotherapy. Indian J Cancer 2019; 55:372-376. [PMID: 30829273 DOI: 10.4103/ijc.ijc_410_18] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
BACKGROUND Craniospinal irradiation (CSI) is the standard radiation therapy treatment for medulloblastoma. The aim of this study was to estimate and compare the lifetime risk of radiation-induced secondary cancer in pediatric medulloblastoma patients using three-dimensional conformal radiotherapy (3D-CRT) and intensity-modulated radiotherapy (IMRT). MATERIALS AND METHODS 3D-CRT and IMRT plans were performed for 10 CSI pediatric patients. The average absorbed doses for organs at risk (OARs) was calculated from dose-volume histograms on the treatment planning system. The average lifetime risk of radiation-induced secondary cancer was then calculated. RESULTS Lifetime risk of secondary cancer for CSI pediatric patients treated using IMRT decreases in some OARs compared with those treated using 3D-CRT. This is attributable to the decrease in the average absorbed dose in some OARs when using IMRT technique. CONCLUSION Follow-up of medulloblastoma pediatric patients should be performed after ending the treatment course in order to diagnose early secondary tumors. IMRT technique is substantially better than 3D-CRT in terms of lifetime risk of radiation-induced secondary cancer, probably due to reduced dose to OARs especially to the thyroid, which is the most sensitive organ to radiation.
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Affiliation(s)
- Reham S Sherif
- Department of Biophysics, Faculty of Science, Cairo University, Cairo, Egypt
| | - Wael M Elshemey
- Department of Biophysics, Faculty of Science, Cairo University, Cairo, Egypt
| | - Ehab M Attalla
- Department of Radiotherapy and Nuclear Medicine, National Cancer Institute, Cairo University, Giza; Department of Radiotherapy, Children Cancer Hospital, Cairo, Egypt
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Sugiyama D, Turin TC, Yeasmin F, Rumana N, Watanabe M, Higashiyama A, Takegami M, Kokubo Y, Okamura T, Miyamoto Y. Hypercholesterolemia and Lifetime Risk of Coronary Heart Disease in the General Japanese Population: Results from the Suita Cohort Study. J Atheroscler Thromb 2019; 27:60-70. [PMID: 31217364 PMCID: PMC6976715 DOI: 10.5551/jat.49098] [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] [Indexed: 01/11/2023] Open
Abstract
Aim: Lifetime risk (LTR) is a measure of disease burden, which presents the probability of occurrence of a specific disease in the remaining lifetime of a group of people for a given index age. This measure is useful for presenting the risk dynamics of a disease at the population level, which constitutes important public health information toward prevention. To date, there have been no studies investigating the LTR for coronary heart diseases (CHDs) in relation to hypercholesterolemia in Asian populations. Therefore, we estimated the LTR of CHDs according to serum low-density lipoprotein cholesterol (LDL-C). Methods: The participants included in this study were 2,559 men and 2,848 women, enrolled in the Suita Cohort Study of urban residents followed up from 1989 to 2007 for a total of 69,823 person-years. We estimated the sex- and index-age-specific LTR for the first CHD event among participants with or without hypercholesterolemia (LDL-C ≥ 160 mg/dL), accounting for the competing risk for mortality. Results: For men with hypercholesterolemia, the LTR was 47.2% (95% confidence interval [CI]: 29.3–65.1%) and 44.5% (95% CI: 21.4–68.5%) for those aged 45 and 75, respectively. The LTRs of women with hypercholesterolemia were also higher than of those without hypercholesterolemia. However, their LTRs were lower for all index ages compared to men. These results did not differ for hypercholesterolemia defined by non-high-density lipoprotein cholesterol. Conclusions: The presence of hypercholesterolemia increases the LTR for CHDs in the Japanese population, especially in men. This estimate can be used in preventive knowledge translation efforts at the population level.
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Affiliation(s)
- Daisuke Sugiyama
- Department of Preventive Medicine and Public Health, School of Medicine, Keio University
| | - Tanvir Chowdhury Turin
- Department of Preventive Cardiology, National Cerebral and Cardiovascular Center.,Department of Family Medicine, University of Calgary
| | | | | | - Makoto Watanabe
- Department of Preventive Cardiology, National Cerebral and Cardiovascular Center
| | - Aya Higashiyama
- Department of Preventive Cardiology, National Cerebral and Cardiovascular Center
| | - Misa Takegami
- Department of Preventive Medicine and Epidemiologic Informatics, National Cerebral and Cardiovascular Center
| | - Yoshihiro Kokubo
- Department of Preventive Cardiology, National Cerebral and Cardiovascular Center
| | - Tomonori Okamura
- Department of Preventive Medicine and Public Health, School of Medicine, Keio University.,Department of Preventive Cardiology, National Cerebral and Cardiovascular Center
| | - Yoshihiro Miyamoto
- Department of Preventive Cardiology, National Cerebral and Cardiovascular Center.,Department of Preventive Medicine and Epidemiologic Informatics, National Cerebral and Cardiovascular Center
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Al-Khalidi B, Kuk JL, Ardern CI. Lifetime risk of cardiometabolic mortality according to vitamin D status of middle and older-aged adults: NHANES III mortality follow-up. J Steroid Biochem Mol Biol 2019; 186:34-41. [PMID: 30219735 DOI: 10.1016/j.jsbmb.2018.09.007] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/08/2018] [Revised: 08/26/2018] [Accepted: 09/12/2018] [Indexed: 12/20/2022]
Abstract
The predictive value of total 25-hydroxyvitamin D (25(OH)D, a biomarker of vitamin D status) in relation to lifetime risk of cardiometabolic mortality is not known. The purpose of this study was to determine the association between standardized and annualized total 25(OH)D levels and lifetime risk for cardiometabolic mortality in middle- to older-aged adults. In this study, we followed up 7958 participants in the Third National Health and Nutrition Examination Survey from 1988 to 1994 (NHANES III) until the occurrence of cardiometabolic death or attainment of 95 years of age (median follow-up 17.9 years, 1371 cardiometabolic-deaths). Lifetime risks were estimated according to recommended total 25(OH)D cutoffs by national guidelines, and a combination of total 25(OH)D status and traditional risk factor burden. We also explored variation in lifetime risk estimates by levels of body mass index (BMI). The results of this study showed that annualized total 25(OH)D <30 nmol/L was associated with high lifetime risk of cardiometabolic mortality (40%). Lifetime risks of cardiometabolic mortality were similar for annualized levels between 30-< 50 nmol/L, 50-< 75 nmol/L and ≥75 nmol/L (31-33%). Lifetime risk was highest among participants with annualized total 25(OH)D <30 nmol/L and ≥2 major traditional risk factors (45%), whereas lifetime risk was lowest among participants with annualized 25(OH)D ≥30 nmol/L and low-intermediate risk factors (28%). Lifetime risk estimates were similar across BMI categories. In conclusion, a single measurement of vitamin D deficiency (annualized levels <30 nmol/L) in middle- to older-aged adults is a strong predictor of high lifetime risk for cardiometabolic mortality, particularly among those with high burden of traditional risk factors.
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Affiliation(s)
- Banaz Al-Khalidi
- School of Kinesiology and Health Science, York University, Toronto, Ontario, Canada.
| | - Jennifer L Kuk
- School of Kinesiology and Health Science, York University, Toronto, Ontario, Canada
| | - Chris I Ardern
- School of Kinesiology and Health Science, York University, Toronto, Ontario, Canada
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Martínez PJ, Baldán-Martín M, López JA, Martín-Lorenzo M, Santiago-Hernández A, Agudiez M, Cabrera M, Calvo E, Vázquez J, Ruiz-Hurtado G, Vivanco F, Ruilope LM, Barderas MG, Alvarez-Llamas G. Identification of six cardiovascular risk biomarkers in the young population: A promising tool for early prevention. Atherosclerosis 2019; 282:67-74. [PMID: 30690299 DOI: 10.1016/j.atherosclerosis.2019.01.003] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [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] [Received: 09/12/2018] [Revised: 12/26/2018] [Accepted: 01/10/2019] [Indexed: 12/18/2022]
Abstract
BACKGROUND AND AIMS The predictive value of traditional CV risk calculators is limited. Novel indicators of CVD progression are needed particularly in the young population. The main aim of this study was the identification of a molecular profile with added value to classical CV risk estimation. METHODS Eighty-one subjects (30-50 years) were classified in 3 groups according to their CV risk: healthy subjects; individuals with CV risk factors; and those who had suffered a previous CV event. The urine proteome was quantitatively analyzed and significantly altered proteins were identified between patients' groups, either related to CV risk or established organ damage. Target-MS and ELISA were used for confirmation in independent patients' cohorts. Systems Biology Analysis (SBA) was carried out to identify functional categories behind CVD. RESULTS 4309 proteins were identified, 75 of them differentially expressed. ADX, ECP, FETUB, GDF15, GUAD and NOTCH1 compose a fingerprint positively correlating with lifetime risk estimate (LTR QRISK). Best performance ROC curve was obtained when ECP, GDF15 and GUAD were combined (AUC = 0.96). SBA revealed oxidative stress response, dilated cardiomyopathy, signaling by Wnt and proteasome, as main functional processes related to CV risk. CONCLUSIONS A novel urinary protein signature is shown, which correlates with CV risk estimation in young individuals. Pending further confirmation, this six-protein-panel could help in CV risk assessment.
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Affiliation(s)
- Paula J Martínez
- Immunoallergy and Proteomics Laboratory, Department of Immunology, IIS-Fundación Jiménez Díaz, UAM, Madrid, Spain
| | | | - Juan A López
- Laboratory of Cardiovascular Proteomics CNIC, Madrid, Spain
| | - Marta Martín-Lorenzo
- Immunoallergy and Proteomics Laboratory, Department of Immunology, IIS-Fundación Jiménez Díaz, UAM, Madrid, Spain
| | - Aránzazu Santiago-Hernández
- Immunoallergy and Proteomics Laboratory, Department of Immunology, IIS-Fundación Jiménez Díaz, UAM, Madrid, Spain
| | - Marta Agudiez
- Immunoallergy and Proteomics Laboratory, Department of Immunology, IIS-Fundación Jiménez Díaz, UAM, Madrid, Spain
| | | | | | - Jesús Vázquez
- Laboratory of Cardiovascular Proteomics CNIC, Madrid, Spain
| | - Gema Ruiz-Hurtado
- Cardiorenal Translational Laboratory, Instituto de Investigación I+12, Hospital Universitario 12 de Octubre/CIBER-CV, Madrid, Spain
| | - Fernando Vivanco
- Department of Biochemistry and Molecular Biology, I Universidad Complutense, Madrid, Spain
| | - Luis M Ruilope
- Cardiorenal Translational Laboratory, Instituto de Investigación I+12, Hospital Universitario 12 de Octubre/CIBER-CV, Madrid, Spain; Hypertension Unit, Hospital Universitario 12 de Octubre, Madrid, Spain; School of Doctoral Studies and Research, Universidad Europea de Madrid, Madrid, Spain.
| | - María G Barderas
- Department of Vascular Physiopathology, Hospital Nacional de Parapléjicos SESCAM, Toledo, Spain
| | - Gloria Alvarez-Llamas
- Immunoallergy and Proteomics Laboratory, Department of Immunology, IIS-Fundación Jiménez Díaz, UAM, Madrid, Spain; REDINREN, Madrid, Spain.
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Liu F, Li J, Chen J, Hu D, Li Y, Huang J, Liu X, Yang X, Cao J, Shen C, Yu L, Liu Z, Wu X, Zhao L, Wu X, Gu D, Lu X. Predicting lifetime risk for developing atherosclerotic cardiovascular disease in Chinese population: the China-PAR project. Sci Bull (Beijing) 2018; 63:779-787. [PMID: 36658952 DOI: 10.1016/j.scib.2018.05.020] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.7] [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: 03/03/2018] [Revised: 04/19/2018] [Accepted: 05/05/2018] [Indexed: 01/21/2023]
Abstract
Evidence on the lifetime risk for atherosclerotic cardiovascular disease (ASCVD) is insufficient; yet, estimating an individual's lifetime risk allows for a comprehensive assessment of ASCVD burden. We developed and validated lifetime risk prediction equations for ASCVD using four large and ongoing prospective cohorts of Chinese, the China-PAR project (Prediction for ASCVD Risk in China). Sex-specific equations were developed using two cohorts (as the derivation cohort) of 21,320 participants. Two other independent cohorts with 14,123 and 70,838 participants were used for their external validation, respectively. We evaluated both calibration and discrimination measures for model performance. Furthermore, we estimated ASCVD-free years lost or excess absolute risk attributable to high 10-year risk (≥10.0%) and/or high lifetime risk (≥32.8%). After 12.3 years' follow-up of the derivation cohort, 1048 ASCVD events and 1304 non-ASCVD deaths were identified. Our sex-specific equations had good internal validation, with discriminant C statistics of 0.776 (95% confidence interval [CI]: 0.757-0.794) and 0.801 (95% CI: 0.778-0.825), and calibration χ2 of 9.2 (P = 0.418) and 5.6 (P = 0.777) for men and women, respectively. Good external validation was also demonstrated with predicted rates closely matched to the observed ones. Compared with men having both low 10-year and low lifetime risk, men would develop ASCVD 3.0, 4.6 and 8.6 years earlier if they had high 10-year risk alone, high lifetime risk alone, or both high 10-year and high lifetime risk at the index age of 35 years, respectively. We developed well-performed lifetime risk prediction equations that will help to identify those with the greatest potential to avert ASCVD burden after implementation of innovative clinical and public health interventions in China.
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Affiliation(s)
- Fangchao Liu
- Department of Epidemiology, Fuwai Hospital, State Key Laboratory of Cardiovascular Disease, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100037, China; The 3rd Affiliated Hospital of Shenzhen University, Shenzhen 518001, China
| | - Jianxin Li
- Department of Epidemiology, Fuwai Hospital, State Key Laboratory of Cardiovascular Disease, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100037, China
| | - Jichun Chen
- Department of Epidemiology, Fuwai Hospital, State Key Laboratory of Cardiovascular Disease, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100037, China
| | - Dongsheng Hu
- Department of Prevention Medicine, Shenzhen University School of Medicine, Shenzhen 518060, China
| | - Ying Li
- Department of Epidemiology, Fuwai Hospital, State Key Laboratory of Cardiovascular Disease, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100037, China
| | - Jianfeng Huang
- Department of Epidemiology, Fuwai Hospital, State Key Laboratory of Cardiovascular Disease, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100037, China
| | - Xiaoqing Liu
- Division of Epidemiology, Guangdong Provincial People's Hospital and Cardiovascular Institute, Guangzhou 510080, China
| | - Xueli Yang
- Department of Epidemiology, Fuwai Hospital, State Key Laboratory of Cardiovascular Disease, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100037, China
| | - Jie Cao
- Department of Epidemiology, Fuwai Hospital, State Key Laboratory of Cardiovascular Disease, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100037, China
| | - Chong Shen
- Department of Epidemiology and Biostatistics, School of Public Health, Nanjing Medical University, Nanjing 211166, China
| | - Ling Yu
- Department of Cardiology, Fujian Provincial People's Hospital, Fuzhou 350014, China
| | - Zhendong Liu
- Cardio-Cerebrovascular Control and Research Center, Institute of Basic Medicine, Shandong Academy of Medical Sciences, Jinan 250062, China
| | - Xianping Wu
- Sichuan Center for Disease Control and Prevention, Chengdu 610041, China
| | - Liancheng Zhao
- Department of Epidemiology, Fuwai Hospital, State Key Laboratory of Cardiovascular Disease, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100037, China
| | - Xigui Wu
- Department of Epidemiology, Fuwai Hospital, State Key Laboratory of Cardiovascular Disease, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100037, China
| | - Dongfeng Gu
- Department of Epidemiology, Fuwai Hospital, State Key Laboratory of Cardiovascular Disease, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100037, China.
| | - Xiangfeng Lu
- Department of Epidemiology, Fuwai Hospital, State Key Laboratory of Cardiovascular Disease, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100037, China; The 3rd Affiliated Hospital of Shenzhen University, Shenzhen 518001, China.
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Bruder C, Bulliard JL, Germann S, Konzelmann I, Bochud M, Leyvraz M, Chiolero A. Estimating lifetime and 10-year risk of lung cancer. Prev Med Rep 2018; 11:125-130. [PMID: 29942733 PMCID: PMC6010924 DOI: 10.1016/j.pmedr.2018.06.010] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [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: 11/26/2017] [Revised: 06/11/2018] [Accepted: 06/14/2018] [Indexed: 11/21/2022] Open
Abstract
Lung cancer is the commonest cancer worldwide. Mortality and incidence rates are traditionally used to assess cancer burden and as public health indicators. However, these metrics are difficult to interpret at an individual level. Providing the lifetime and 10-year risks of cancer could improve risk communication. Our aim was to estimate current lifetime and 10-year risks of lung cancer by smoking status and changes in these risks between 1995 and 2013 in a Swiss population. We used all lung cancer cases recorded between 1995 and 2013 by two population-based cancer registries in the contiguous cantons of Vaud and Valais, in Western Switzerland. We estimated sex-specific lifetime risk and 10-year risk of lung cancer using the current probability method, accounting for competing risk of death. Estimates were also provided by smoking status. Between 1995 and 2013, 9623 cases of lung cancer were recorded. During this period, the lifetime risk decreased in men from 7.1% to 6.7% and increased in women from 2.5% to 4.1%. In both sexes, the 10-year risk of lung cancer increased with age until the age of 60–70 and decreased thereafter. Difference in the cumulative risk between current, former, and never smokers were very large and reported in user-friendly charts to ease risk communication. These lifetime and 10-year risk estimates could be used systematically as public health indicators. Regularly updating risk estimations are necessary for conditions like lung cancer whose incidence has changed substantially. Providing the lifetime and cumulative 10-year risks of cancer by smoking status could improve risk communication and serve as public health indicators. These indicators can be estimated with cancer registry data and smoking data from surveys using the current probability method. In these regions of Switzerland, between 1995 and 2013, the lifetime risk of lung cancer decreased in men from 7.1% to 6.7% and increased in women from 2.5% to 4.1%. Difference in the cumulative risk between current, former, and never smokers were very large.
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Affiliation(s)
- Christina Bruder
- Institute of Social and Preventive Medicine (IUMSP), Lausanne University Hospital, Lausanne, Switzerland
| | - Jean-Luc Bulliard
- Institute of Social and Preventive Medicine (IUMSP), Lausanne University Hospital, Lausanne, Switzerland
| | - Simon Germann
- Institute of Social and Preventive Medicine (IUMSP), Lausanne University Hospital, Lausanne, Switzerland
| | | | - Murielle Bochud
- Institute of Social and Preventive Medicine (IUMSP), Lausanne University Hospital, Lausanne, Switzerland
| | - Magali Leyvraz
- Institute of Social and Preventive Medicine (IUMSP), Lausanne University Hospital, Lausanne, Switzerland
| | - Arnaud Chiolero
- Institute of Social and Preventive Medicine (IUMSP), Lausanne University Hospital, Lausanne, Switzerland.,Observatoire Valaisan de la santé (OVS), Sion, Switzerland.,Institute of Primary Health Care (BIHAM), University of Bern, Switzerland.,Department of Epidemiology, Biostatistics and Occupational Health, McGill University, Montréal, Canada
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Molto E, Sheldrick P. Paleo-oncology in the Dakhleh Oasis, Egypt: Case studies and a paleoepidemiological perspective. Int J Paleopathol 2018; 21:96-110. [PMID: 29499961 DOI: 10.1016/j.ijpp.2018.02.003] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/18/2017] [Revised: 02/07/2018] [Accepted: 02/13/2018] [Indexed: 06/08/2023]
Abstract
This article describes six cases of cancer from the Dakhleh Oasis, Egypt. A mummy had a confirmed 'primary' diagnosis of adenocarcinoma of the rectum. The remaining diagnoses were based on the distribution and types of skeletal lesions in conjunction with age, sex, and/or the molecular phylogeny of the Human Papillomavirus (HPV). HPV is a confirmed cause of cancer of the uterine cervix (UC) and testes (TC) and it evolved in Africa long before Homo sapiens emerged. Today these cancers are common in young adult females and males, a fact which was pivotal in respectively including them in the differential diagnosis of UC and TC. The remaining diagnoses were acute lymphocytic leukemia in a 3-5 year old child and an older female with metastatic carcinoma. Due to problems of determining specific diagnoses and their prevalence in 'paleo' populations, we opted for a lifetime cancer risk statistic (LTCR). The LTCR in ancient Dakhleh was ∼5/1000 (6/1087). In modern Western societies the LTCR cancer approaches 50% (500/1000). Thus the LTCR in today's western societies is 100 times greater than in ancient Dakhleh. These cases demonstrate that oncogenes and their environmental cofactors were present in antiquity, but were significantly less pervasive than today.
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Affiliation(s)
- El Molto
- Department of Anthropology, University of Western Ontario, N6A 5C2, Canada.
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Bayatian M, Ashrafi K, Azari MR, Jafari MJ, Mehrabi Y. Risk assessment of occupational exposure to benzene using numerical simulation in a complex geometry of a reforming unit of petroleum refinery. Environ Sci Pollut Res Int 2018; 25:11364-11375. [PMID: 29417483 DOI: 10.1007/s11356-018-1318-6] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/13/2017] [Accepted: 01/15/2018] [Indexed: 06/08/2023]
Abstract
There has been an increasing concern about the continuous and the sudden release of volatile organic pollutants from petroleum refineries and occupational and environmental exposures. Benzene is one of the most prevalent volatile compounds, and it has been addressed by many authors for its potential toxicity in occupational and environmental settings. Due to the complexities of sampling and analysis of benzene in routine and accidental situations, a reliable estimation of the benzene concentration in the outdoor setting of refinery using a computational fluid dynamics (CFD) could be instrumental for risk assessment of occupational exposure. In the present work, a computational fluid dynamic model was applied for exposure risk assessment with consideration of benzene being released continuously from a reforming unit of a refinery. For simulation of benzene dispersion, GAMBIT, FLUENT, and CFD post software are used as preprocessing, processing, and post-processing, respectively. Computational fluid dynamic validation was carried out by comparing the computed data with the experimental measurements. Eventually, chronic daily intake and lifetime cancer risk for routine operations through the two seasons of a year are estimated through the simulation model. Root mean square errors are 0.19 and 0.17 for wind speed and concentration, respectively. Lifetime risk assessments of workers are 0.4-3.8 and 0.0096-0.25 per 1000 workers in stable and unstable atmospheric conditions, respectively. Exposure risk is unacceptable for the head of shift work, chief engineer, and general workers in 141 days (38.77%) in a year. The results of this study show that computational fluid dynamics is a useful tool for modeling of benzene exposure in a complex geometry and can be used to estimate lifetime risks of occupation groups in a refinery setting.
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Affiliation(s)
- Majid Bayatian
- School of Public Health, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Khosro Ashrafi
- Department of Environmental Engineering, Faculty of Environment, University of Tehran, Tehran, Iran.
| | - Mansour Rezazadeh Azari
- Safety Promotion and Injury Prevention Research Center and School of Public Health, Shahid Beheshti University of Medical Sciences, Tehran, Iran.
| | - Mohammad Javad Jafari
- School of Public Health, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Yadollah Mehrabi
- School of Public Health, Shahid Beheshti University of Medical Sciences, Tehran, Iran
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Al-Shboul KF, Alali AE, Batayneh IM, Al-Khodire HY. Radiation hazards and lifetime risk assessment of tap water using liquid scintillation counting and high-resolution gamma spectrometry. J Environ Radioact 2017; 178-179:245-252. [PMID: 28915436 DOI: 10.1016/j.jenvrad.2017.09.005] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/28/2017] [Revised: 09/03/2017] [Accepted: 09/04/2017] [Indexed: 06/07/2023]
Abstract
In this work, two complementary techniques, viz. liquid scintillation counting and high-resolution gamma spectrometry are utilized to analyze radionuclides concentrations in tap water of Irbid governorate, Jordan, and study their correlation. Gross alpha and gross beta concentrations, in the tap water samples collected from the nine districts of Irbid governorate, ranged from <82 to 484 mBq/L with a mean of 295 mBq/L and from <216 to 984 mBq/L with a mean of 611 mBq/L, respectively. Furthermore, gamma spectrometry analysis, for the tap water samples, shows that the activity concentrations of 226Ra, 232Th, and 40K ranged between <19 and 302 mBq/L, 24 to 119 mBq/L, and <101 to 342 mBq/L, respectively. There was a weak or even no correlation among the identified natural radionuclides with no trace of artificial radioactivity. In addition, the results of both techniques show that storing tap water in drilled wells leads to higher levels of radioactivity concentrations beyond the international permissible limits. Furthermore, the average lifetime risk and annual effective dose received by age-grouped inhabitants due to direct and indirect tap water consumption are evaluated, where most of the received dose is attributed to 226Ra.
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Affiliation(s)
- K F Al-Shboul
- Department of Nuclear Engineering, Jordan University of Science and Technology, Irbid 22110, Jordan.
| | - A E Alali
- Department of Nuclear Engineering, Jordan University of Science and Technology, Irbid 22110, Jordan
| | - I M Batayneh
- Department of Nuclear Engineering, Jordan University of Science and Technology, Irbid 22110, Jordan
| | - H Y Al-Khodire
- Department of Nuclear Engineering, Jordan University of Science and Technology, Irbid 22110, Jordan
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