Mental health disorders are more common in patients with Hodgkin lymphoma and may negatively impact overall survival

BACKGROUND

Long-term mental health outcomes were characterized in patients who were diagnosed with Hodgkin lymphoma (HL), and risk factors for the development of mental health disorders were identified.

METHODS

Patients who were diagnosed with HL between 1997 and 2014 were identified in the Utah Cancer Registry. Each patient was matched with up to five individuals from a general population cohort identified within the Utah Population Database, a unique source of linked records that includes patient and demographic data.

RESULTS

In total, 795 patients who had HL were matched with 3575 individuals from the general population. Compared with the general population, patients who had HL had a higher risk of any mental health diagnosis (hazard ratio, 1.77; 95% confidence interval, 1.57-2.00). Patients with HL had higher risks of anxiety, depression, substance-related disorders, and suicide and intentional self-inflicted injuries compared with the general population. The main risk factor associated with an increased risk of being diagnosed with mental health disorders was undergoing hematopoietic stem cell transplantation, with a hazard ratio of 2.06 (95% confidence interval, 1.53-2.76). The diagnosis of any mental health disorder among patients with HL was associated with a detrimental impact on overall survival; the 10-year overall survival rate was 70% in patients who had a mental health diagnosis compared with 86% in those patients without a mental health diagnosis (p < .0001).

CONCLUSIONS

Patients who had HL had an increased risk of various mental health disorders compared with a matched general population. The current data illustrate the importance of attention to mental health in HL survivorship, particularly for patients who undergo therapy with hematopoietic stem cell transplantation.

Risk prediction model for heart disease among endometrial cancer survivors

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Background: There are an estimated 760,000 endometrial cancer survivors alive in the US today. We previously reported on increased heart disease (HD) risk among endometrial cancer survivors from our population-based cohort study. Although there are many risk prediction models for the risk of endometrial cancer, there are none to our knowledge for endometrial cancer survivors. Methods: We identified 2,994 endometrial cancer patients in the Utah Population Database, which links data from multiple statewide sources. We estimated hazard ratios with the Cox proportional hazards model for predictors of five-, ten- and fifteen-year risks. The Harrell’s C statistic was used to evaluate the model performance. We used 70% of the data randomly selected to develop the model and the rest of the data to validate the model. Results: A total of 1,591 patients were diagnosed with HD. Increased risks of HD among endometrial cancer patients were observed for older age, obesity at baseline, family history of HD, previous disease diagnosis (hypertension, diabetes, high cholesterol, COPD), distant stage, grade, histology, chemotherapy, and radiation therapy. The C-statistics for the risk prediction model were 0.69 for the hypothesized risk factors for HD, 0.56 for clinical factors, and 0.71 when statistically significant risk factors were included. With the final model selected, as one example, the absolute risks of HD were 17.6% at 5-years, 24.0% at 10-years and 32.0% at 15 years for a woman diagnosed with regional stage, grade I endometrial cancer in her fifties, was white, was obese at cancer diagnosis, had a family history of HD but no previous history of HD herself, had hypertension, but no history of diabetes or high cholesterol or COPD, and had radiation therapy treatment but no chemotherapy. The AUCs were 0.79 for the 5-year, 0.78 for the 10-year and 0.78 for the 15-year predictions. Conclusions: We developed the first risk prediction model for HD among endometrial cancer survivors within a population-based cohort study. Risk prediction models for cancer survivors are important in understanding long-term disease risks after cancer treatment is complete. Such models may contribute to management plans for treatment and individualized prevention efforts.

Long-term risk of cardiovascular disease among colorectal cancer survivors in a population-based cohort study

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Background: In the United States, colorectal cancer is the fourth most common cancer and one of the leading causes of cancer death. Few studies have examined the relationship between colorectal cancer survivorship and long-term cardiovascular disease (CVD) risk. Methods: Individuals diagnosed with colorectal cancer were identified using the Utah Population Database. For a comparison group, up to 5 cancer-free individuals were matched by birth year, birth state, follow-up time and sex to each cancer case. For individuals with > 10 years of follow-up, we estimated CVD risk > 10 years after cancer diagnosis. Cox regression models were used to estimate hazard ratios (HR) and 95% Confidence Intervals. Results: Among 1,749 colorectal cancer survivors who had survived for at least 10 years, 1,001 (57.2%) were diagnosed with CVD > 10 years after cancer diagnosis. Compared to the general population, colorectal cancer survivors had an increased risk of CVD > 10 years after cancer diagnosis: HR = 2.84 (95% CI = 2.59, 3.11) for hypertension; HR = 2.66 (95% CI 2.37, 2.98) for diseases of the heart; HR = 3.91 (95% CI = 3.33, 4.58) for diseases of the arteries, arterioles and capillaries; HR = 2.58 (95% CI = 2.46, 2.99) for diseases of the veins and lymphatics; HR = 2.98 (95% CI = 2.36, 3.76) for cerebrovascular disease. Colorectal cancer survivors with ≥1 comorbidity had an increased risk of CVD > 10 years after cancer diagnosis compared to survivors with no comorbidities (HR = 1.7, 95% CI = 1.49, 1.95). Colorectal cancer survivors who were ≥65 years had an increased risk of CVD > 10 years after cancer diagnosis. Colorectal cancer survivors who were obese at the time of diagnosis had an increased risk of CVD > 10 years after cancer diagnosis when compared to survivors with normal BMIs (HR = 1.25; 95% CI = 1.06, 1.49). Conclusions: Compared to the general population, colorectal cancer survivors had an increased risk of CVD during the > 10 year follow-up period. Within colorectal cancer survivors, there was an increased risk of CVD for those that were older, had ≥1 comorbidity and were obese. The increased risk of CVD among survivors may be attributable to the lifestyle risk factors shared by colorectal cancer and CVD.

Genitourinary disease risks among 5-year ovarian cancer survivors in a population-based cohort study

10073

Background: In the US, there are approximately 235,200 ovarian cancer survivors today. Five-year survival for ovarian cancer has increased from 36% for women who were diagnosed in 1975-1977 to 46% for women diagnosed between 2005-2011. Long term follow-up studies among ovarian cancer survivors are uncommon and late effects have not been well characterized in a population-based cohort. Although genitourinary complications during treatment are well known, long term impacts need to be investigated. Methods: A total of 602 first primary invasive ovarian cancer cases diagnosed between 1996-2012 who survived for > 5 years were identified in the Utah Population Database and compared to a general population cohort of women. Genitourinary disease diagnoses were identified through ICD codes from hospital electronic medical records and statewide ambulatory surgery and inpatient data. Cox regression models were used to estimate hazard ratios for disease risks by time since cancer diagnosis with adjustments on matching factors, baseline BMI, baseline Charlson Comorbidity Index (CCI), and race. Results: The overall risk of genitourinary diseases for ovarian cancer patients in comparison to the general population cohort was 1.51 (95%CI = 1.30-1.74) 5-10 years after cancer diagnosis. Approximately 54.6% of ovarian cancer survivors were diagnosed with a genitourinary disease 5-10 years after cancer diagnosis. The most common genitourinary diseases among the ovarian cancer survivors were urinary tract infections (10.1%), acute renal failure (5.5%), and chronic kidney disease (4.4%). The greatest risks were observed for hydronephrosis (HR = 10.65, 95%CI = 3.68-30.80), pelvic peritoneal adhesions (HR = 5.81, 95%CI = 1.11-30.39), cystitis and urethritis (HR = 2.67, 95%CI = 1.21-6.38), and acute renal failure (HR = 2.30, 95%CI = 1.36-3.88). Conclusions: Ovarian cancer survivors experience increased risks of various genitourinary diseases in the 5-10 year period following cancer diagnosis. Understanding the multimorbidity trajectory among ovarian cancer survivors is of vital importance to improve their clinical care after cancer diagnosis and allow for increased attention to these potential late effects.

Endocrine and metabolic diseases among colorectal cancer survivors in a population-based cohort

10074

Background: Colorectal cancer is the third most common cancer among men and women in the United States. As of 2016, there were an estimated 1.4 million colorectal cancer survivors. Research on endocrine and metabolic diseases over the long term in colorectal cancer survivors is limited. Obesity is a risk factor for colorectal cancer, thus it is of interest to investigate diseases that may share this risk factor such as diabetes for long term health effects among survivors. Methods: A total of 7,077 colorectal cancer patients who were diagnosed between 1997 to 2012 were identified in the Utah Population Database. A general population cohort of 35,354 individuals was matched on birth year, sex, birth state and follow-up time as a comparison group. Late effects were identified using electronic medical records and statewide ambulatory and inpatient data and were assessed over three time periods of 1-5 years, 5-10 years, and > 10 years. Cox proportional hazard models were used to estimate the risk of late effects after adjusting for matching factors, race, baseline body mass index, and the baseline Charlson Comorbidity Index. Results: Across all three time periods, late effects risk for endocrine diseases and metabolic disorders was significantly greater for colorectal cancer survivors compared to the general population cohort. Risk for diabetes mellitus with complications was significantly increased for survivors and risk was greatest for uncontrolled diabetes (HR = 5.04, 99%CI = 2.38, 10.67) and diabetes with neurological manifestations (HR = 4.10, 99%CI = 2.08, 8.26). Higher risk was also observed for thyroid disorders (HR = 3.09, 99%CI = 2.34, 4.08) and nutritional deficiencies (HR = 4.98, 99%CI = 3.47, 7.17). The risk of obesity in survivors was greatest 1-5 years post cancer diagnosis (HR = 5.04, 99%CI = 2.91, 8.75), but remained significantly increased at all follow-up time periods. Conclusions: Endocrine and metabolic diseases were significantly higher in colorectal cancer survivors across the follow-up periods. As the number of colorectal cancer survivors increases, understanding the long term multimorbidity trajectory is critical for improved survivorship care.

Cardiovascular late effects among endometrial cancer survivors in a cohort study

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Background: Endometrial cancer is the second most common cancer among female cancer survivors in the US, with an estimated 757,000 endometrial cancer survivors in 2016. Cardiovascular disease is the leading cause of death among endometrial cancer survivors. Cardiovascular disease risk may be increased among endometrial cancer survivors due to shared risk factors such as obesity or because of cancer treatment. Because of the high overall survival rate and the large number of endometrial cancer survivors, studies that examine late effects among endometrial cancer survivors are critical. Methods: Cohorts of 3,337 endometrial cancer survivors diagnosed between 1997 and 2012, and 19,420 age-matched cancer-free women were identified using the Utah Population Database. All ICD-9 diagnosis codes were collected from the state’s two largest healthcare systems and statewide ambulatory surgery and inpatient visits. Diagnoses were collapsed into cardiovascular system disorders according to the Healthcare Cost and Utilization Project’s Clinical Classification Software. Cox regression models were used to estimate hazard ratios (HR) at 1-5 years and 5-10 years after cancer diagnosis. Models were adjusted for race/ethnicity, baseline BMI, and baseline Charlson Comorbidity Index. Results: Approximately 89.4% of cancer cases were diagnosed with stage I or stage II disease. At 1-5 years after diagnosis, the highest risks among endometrial cancer survivors were observed for phlebitis and thrombophlebitis (HR: 3.36, 99% CI: 1.96-5.77), lymphatic diseases (HR: 1.89, 99% CI: 1.64-2.19), pulmonary heart disease (HR: 1.82, 99% CI: 1.36-2.43), hypotension (HR: 1.64, 99% CI: 1.18-2.29), and atrial fibrillation (HR: 1.61, 99% CI: 1.25-2.06). At 5-10 years, elevated risk persisted for these and 17 out of 66 additional outcomes among the endometrial cancer survivors. Conclusions: Endometrial cancer survivors in this population are at higher risk for various long term cardiovascular outcomes compared to cancer-free women. This study presents sufficient evidence to suggest that increased monitoring is necessary for women diagnosed with endometrial cancer in the first several years after diagnosis, and out to ten years as well.

Late effects among head and neck cancer survivors in Utah cancer survivorship study

137

Background: Sites of head and neck are associated with chewing, swallowing and speaking. As for treatment of head and neck cancer (HNC), we have to consider organ preservation as well as clinical outcomes. Although non-surgical treatments have been preferred in recent years, complications after treatment have been a concern. The aim of this study was to evaluate the late effects in a cohort of HNC survivors in Utah compared to a matched cohort of cancer free individuals. Methods: Up to 5 cancer free individuals were matched to each HNC survivor on birth year, sex, birth state, and follow up time. Electronic medical records and statewide ambulatory and inpatient surgery data were used to identify late effects over two time periods: 1-5 and 5-10 years after cancer diagnosis. Cox proportional hazards models were used to estimate the risks of late effects. We adjusted for matching factors, race and number of hospital visit. Results: In this study, 2,432 HNC survivors and 12,149 matched controls were enrolled. More than 80% cases had loco-regional disease and a histological type of squamous cell carcinoma. Hazard ratio (HR) for second primary HNC was notably increased among HNC survivors for both 1-5 years (HR: 1498.46; 95% confidence interval (CI), 158.58-14159.69) and 5-10 years (HR: 1509.62; 95% CI, 147.94-15404.15) post cancer diagnosis. And, HRs for respiratory disease, including respiratory system, lung cancer and pneumoniae, were also increased among HNC survivors for both 1-5 years and 5-10 years post cancer diagnosis. As for hearing loss, HNC survivors had a increased HR for 1-5 years post cancer diagnosis (HR: 5.90; 95% CI, 2.67-13.01) and this association was consistent for 5-10 years post cancer diagnosis (HR: 5.01; 95% CI, 2.06-12.18). Conclusions: In this study, we found HNC survivors have notable associations with second primary HNC, smoking related respiratory disease, and hearing loss which might be associated with chemotherapy when compared to cancer free subjects.

Late effects among young thyroid cancer survivors

111

Background: Thyroid cancer is the most rapidly increasing cancer with over 600,000 thyroid cancer survivors in the U.S. Thyroid cancer affects a young population and the 5-year survival rate is over 98%. There have been few studies on the late effects of thyroid cancer, especially in younger populations. The aim of this study was to examine if thyroid cancer survivors diagnosed < 40 years experience greater risks of late effects than older age groups for diseases associated with aging. Methods: Up to 5 cancer free individuals were matched to each thyroid cancer survivor based on birth year, sex, birth state, and follow up time from case diagnosis date, within the Utah Population Database. Electronic medical records, statewide ambulatory surgery and inpatient discharge data were used to identify late effects stratified over three time periods: 1-5, 5-10, and > 10 years after cancer diagnosis. Cox proportional hazards models were used to estimate hazard ratios (HR) with adjustment on matching factors, race, BMI at diagnosis, and Charlson Comorbidity Index at diagnosis. Results: There were 4,060 thyroid cancer survivors and 18,557 matched cancer free individuals (1,407 cases diagnosed ages < 40 years, 2,076 cases diagnosed ages 40-65 years). The risk for hypertension was significantly increased in both younger (HR = 1.54, 95%CI = 1.18, 2.01) and older patients (HR = 1.30, 95%CI = 1.11, 1.53) > 10 years after cancer diagnosis. For heart disease, increased risks persisted for the young patients > 10 years after cancer diagnosis for heart valve disorders (HR = 2.43, 95%CI = 1.36, 4.33) and for peri-, endo- or myocarditis (HR = 5.12, 95%CI = 1.04, 25.14), while corresponding HRs for the older age group did not suggest increased risks. For osteoporosis, the younger patients had a higher risk (HR = 8.77, 95%CI = 3.18, 24.18) than the older population (HR = 2.55, 95%CI = 2.07, 3.13) 1-5 years after cancer diagnosis. Conclusions: Thyroid cancer survivors diagnosed at < 40 years had increased risks for diseases associated with aging such as hypertension, heart disease, and osteoporosis. As thyroid cancer affects a young population, understanding what late effects may result from the treatment can lead to better surveillance and disease management.

Increased risk of colorectal neoplasia among family members of patients with colorectal cancer: a population-based study in Utah

BACKGROUND & AIMS

Colorectal cancer (CRC) frequently develops in multiple members of the same families, but more data are needed to prepare effective screening guidelines. We quantified the risk of CRC and adenomas in first-degree relatives (FDRs) and second-degree relatives and first cousins of individuals with CRC, and stratified risk based on age at cancer diagnosis.

METHODS

We performed a case-control study of Utah residents, 50-80 years old, who underwent colonoscopy from 1995 through 2009. Index cases (exposed to colonoscopy) were colonoscopy patients with a CRC diagnosis. Age- and sex-matched individuals, unexposed to colonoscopy (controls) were selected to form the comparison groups for determining risk in relatives. Colonoscopy results were linked to cancer and pedigree information from the Utah Population Database to investigate familial aggregation of colorectal neoplasia using Cox regression analysis.

RESULTS

Of 126,936 patients who underwent a colonoscopy, 3804 were diagnosed with CRC and defined the index cases. FDRs had an increased risk of CRC (hazard rate ratio [HRR], 1.79; 95% confidence interval [CI],1.59-2.03), as did second-degree relatives (HRR, 1.32; 95% CI, 1.19-1.47) and first cousins (HRR, 1.15; 95% CI, 1.07-1.25), compared with relatives of controls. This risk was greater for FDRs when index patients developed CRC at younger than age 60 years (HRR, 2.11; 95% CI, 1.70-2.63), compared with older than age 60 years (HRR, 1.77; 95% CI, 1.58-1.99). The risk of adenomas (HRR, 1.82; 95% CI, 1.66-2.00) and adenomas with villous histology (HRR, 2.43; 95% CI, 1.96-3.01) also were increased in FDRs. Three percent of CRCs in FDRs would have been missed if the current guidelines, which stratify screening recommendations by the age of the proband, were strictly followed.

CONCLUSIONS

FDRs, second-degree relatives, and first cousins of patients who undergo colonoscopy and are found to have CRC have a significant increase in the risk of colorectal neoplasia. These data should be considered when establishing CRC screening guidelines for individuals and families.

Characteristics of missed or interval colorectal cancer and patient survival: a population-based study

BACKGROUND & AIMS

Colorectal cancers (CRCs) diagnosed within a few years after an index colonoscopy can arise from missed lesions or the development of a new tumor. We investigated the proportion, characteristics, and factors that predict interval CRCs that develop within 6-60 months of colonoscopy.

METHODS

We performed a population-based cohort study of Utah residents who underwent colonoscopy examinations from 1995 through 2009 at Intermountain Healthcare or the University of Utah Health System, which provide care to more than 85% of state residents. Colonoscopy results were linked with cancer histories from the Utah Population Database to identify patients who underwent colonoscopy 6-60 months before a diagnosis of CRC (interval cancer). Logistic regression was performed to identify risk factors associated with interval cancers.

RESULTS

Of 126,851 patients who underwent colonoscopies, 2659 were diagnosed with CRC; 6% of these CRCs (159 of 2659) developed within 6 to 60 months of a colonoscopy. Sex and age were not associated with interval CRCs. A higher percentage of patients with interval CRC were found to have adenomas at their index colonoscopy (57.2%), compared with patients found to have CRC detected at colonoscopy (36%) or patients who did not develop cancer (26%) (P < .001). Interval CRCs tended to be earlier-stage tumors than those detected at index colonoscopy, and to be proximally located (odds ratio, 2.24; P < .001). Patients with interval CRC were more likely to have a family history of CRC (odds ratio, 2.27; P = .008) and had a lower risk of death than patients found to have CRC at their index colonoscopy (hazard ratio, 0.63; P < .001).

CONCLUSIONS

In a population-based study in Utah, 6% of all patients with CRC had interval cancers (cancer that developed within 6 to 60 months of a colonoscopy). Interval CRCs were associated with the proximal colon, earlier-stage cancer, lower risk of death, higher rate of adenoma, and family history of CRC. These findings indicate that interval colorectal tumors may arise as the result of distinct biologic features and/or suboptimal management of polyps at colonoscopy.

Risk of colorectal cancer and adenomas in the families of patients with adenomas: a population-based study in Utah

BACKGROUND

Guidelines recommend that individuals with a first-degree relative (FDR) diagnosed with colorectal cancer (CRC) or advanced adenoma before age 60 years should undergo colonoscopy starting at age 40 years. The authors quantified the risk of adenomas and CRC in FDRs, second-degree relatives (SDRs), and third-degree relatives (TDRs) of patients diagnosed with adenomas and advanced adenomas.

METHODS

A population-based, retrospective, case-control study was performed of residents of the state of Utah aged 50 years to 80 years who underwent colonoscopy between 1995 and 2009 at Intermountain Healthcare or the University of Utah. Controls were selected from the population of colonoscopy patients who were free of adenomas or CRC and matched to each case based on sex and birth year. Colonoscopy results were linked with cancer and pedigree information from the Utah Population Database to investigate the familial aggregation of adenomas and CRC using Cox regression analysis. The unit of analysis was the relatives of cases and controls.

RESULTS

Of 126,936 patients who underwent colonoscopy, 43,189 had adenomas and 5563 had advanced adenomas and defined the case population. An elevated risk of CRC was found in FDRs (relative risk [RR], 1.35; 95% confidence interval [95% CI], 1.25-1.46), SDRs (RR, 1.15; 95% CI, 1.07-1.23) of adenoma cases, and in FDRs of advanced adenoma cases (RR, 1.68; 95% CI, 1.29-2.18) compared with controls. Approximately 10% of CRCs diagnosed in relatives would have been missed if the current screening guidelines were strictly adhered to.

CONCLUSIONS

Relatives of colonoscopy patients with adenomas and advanced adenomas appear to have a significantly elevated risk of developing colorectal neoplasia. These data should be considered when establishing CRC screening guidelines for individuals and their families.

Late effects among testicular cancer survivors (1994-2011)

1582

Background: More than 95% of testicular cancer (TC) patients survive at 10 years; however, they develop many complications following diagnosis. Our study is toassess the risk of developing morbidities among TC survivors. Methods: We used the Utah Population Database to identify TC patients (age>13) who 1) were diagnosed between 1994 and 2008, 2) had medical records at the University of Utah and Intermountain Health Care hospitals and 3) survived at least 3 years. Cases were matched to five TC-free patients (controls) from the same hospitals on birth year, birth region and date of residence in Utah. Individuals (cases and controls) with morbidities of interest before the date of TC diagnosis were excluded. Adjusted Cox regression analysis was used to identify the risk of developing ischemic heart disease, renal failure, infertility, hearing loss, peripheral neuropathy, osteoporosis and restrictive lung disease among TC patients relative to controls. The models were adjusted for age, race and other confounders. We also compared the risk of these morbidities among patients with regional/advanced tumor relative to patients with in situ/localized tumor. The latter was adjusted for age and tumor histology. Results: We identified 955 TC patients and 4775 controls. TC stage was: 73.7 % in situ/localized and 26.3% regional/advanced. The hazard rate (HR) of developing any of the target morbidities was 2.57, 95% confidence interval (CI), 2.2-2.9 for patients with localized cancer, 3.85 (95% CI: 2.9-5.1) for patients with regional cancer and 3.3 (95% CI: 2.3-4.8) for patients with advanced cancer relative to controls. Risk of developing renal failure, infertility, peripheral neuropathy, hearing loss and restrictive lung disease was significantly higher among TC survivors (P<0.05). We also identified a significant association (HR 5.2; 95% CI 1.8-15.5) of cancer stage and the risk of developing hearing loss and non-significant positive association of TC stage with the other morbidities. Conclusions: TC survivors were more than twice as likely to develop morbidities following diagnosis when compared to controls. The risk increases when the comparison is stratified by stage, which might be related to the differences in the treatment used for different stages of TC.

Genome-wide linkage analyses of extended Utah pedigrees identifies loci that influence recurrent, early-onset major depression and anxiety disorders

Major depressive disorder (MDD) is a common, clinically heterogeneous disorder often found comorbid with other disorders. We studied recurrent, early-onset MDD (MDD-RE) and anxiety disorders in combination to define powerful phenotypes for genetic study. We used 87 large, extended Utah pedigrees to investigate linkage to 3 phenotypes: "MDD-RE;" "MDD-RE or anxiety;" and "MDD-RE and anxiety;" where in the latter definition the disorders must appear comorbid within an individual. Pedigrees ranged in size from 2 to 6 generations and contained 3 to 42 individuals affected with MDD or anxiety (718 total). In primary analyses, we identified three regions with at least suggestive genome-wide evidence for linkage on chromosomes 3centr, 7p, and 18q. Both 7p and 18q are replication findings for related phenotypes. The best linkage evidence was for a novel locus at 3p12.3-q12.3 (LOD = 3.88, "MDD-RE or anxiety") and 18q21.33-q22.2 (LOD = 3.75, "MDD-RE and anxiety"), a well-established susceptibility locus for bipolar disorder. In our secondary sex-specific analyses, we identified two further regions of interest on chromosomes 4q and 15q. Using linked pedigrees, we localized 3centr and 18q to 9.8 and 12.2 cM, respectively, with potential for further localization with the addition of markers in specific pedigrees. Our success in replication and novel locus identification illustrates the utility of large extended pedigrees for common disorders, such as MDD. Further, it supports the hypothesis that MDD and anxiety disorders have over-lapping genetic etiologies and suggests that comorbid diagnoses may be useful in defining more genetically homogeneous forms of MDD for linkage mapping.

A genealogical assessment of heritable predisposition to aneurysms

OBJECT

This study was conducted to investigate the familial and genetic contribution to intracranial, abdominal aortic, and all other types of aneurysms, and to define familial relationships among patients who present with the different aneurysm types.

METHODS

The authors used a unique Utah resource to perform population-based analysis of the familial nature of aneurysms. The Utah Population Data Base is a genealogy of the Utah population dating back eight generations, which is combined with death certificate data for the state of Utah dating back to 1904. Taking into account the genetic relationships among all aneurysm cases derived from this resource, the authors used a previously published method to estimate the familiality of different aneurysm types. Using internal, birth-cohort-specific rates of disease calculated from the database, they estimated relative risks by comparing observed to expected rates of aneurysm incidence in defined sets of relatives of probands.

CONCLUSIONS

Each of the three aneurysm types investigated showed significant evidence for a genetic component. Relatives of patients with intracranial aneurysms do not appear to be at increased risk for abdominal or other lesions, but relatives of patients with abdominal aortic aneurysms appear to be at increased risk for other types of these lesions.