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Lee DYX, Yau CE, Pek MPP, Xu H, Lim DYZ, Earnest A, Ong MEH, Ho AFW. Socioeconomic disadvantage and long-term survival duration in out-of-hospital cardiac arrest patients: A population-based cohort study. Resusc Plus 2024; 18:100610. [PMID: 38524148 PMCID: PMC10960127 DOI: 10.1016/j.resplu.2024.100610] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/26/2024] Open
Abstract
Background Socioeconomic status (SES) is a well-established determinant of cardiovascular health. However, the relationship between SES and clinical outcomes in long-term out-of-hospital cardiac arrest (OHCA) is less well-understood. The Singapore Housing Index (SHI) is a validated building-level SES indicator. We investigated whether SES as measured by SHI is associated with long-term OHCA survival in Singapore. Methods We conducted an open cohort study with linked data from the Singapore Pan-Asian Resuscitation Outcomes Study (PAROS), and the Singapore Registry of Births and Deaths (SRBD) from 2010 to 2020. We fitted generalized structural equation models, calculating hazard ratios (HRs) using a Weibull model. We constructed Kaplan-Meier survival curves and calculated the predicted marginal probability for each SHI category. Results We included 659 cases. In both univariable and multivariable analyses, SHI did not have a significant association with survival. Indirect pathways of SHI mediated through covariates such as Emergency Medical Services (EMS) response time (HR of low-medium, high-medium and high SHI when compared to low SHI: 0.98 (0.88-1.10), 1.01 (0.93-1.11), 1.02 (0.93-1.12) respectively), and age of arrest (HR of low-medium, high-medium and high SHI when compared to low SHI: 1.02 (0.75-1.38), 1.08 (0.84-1.38), 1.18 (0.91-1.54) respectively) had no significant association with OHCA survival. There was no clear trend in the predicted marginal probability of survival among the different SHI categories. Conclusions We did not find a significant association between SES and OHCA survival outcomes in residential areas in Singapore. Among other reasons, this could be due to affordable healthcare across different socioeconomic classes.
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Affiliation(s)
- Dawn Yi Xin Lee
- School of Medicine, Dentistry and Nursing, University of Glasgow, Glasgow, UK
| | - Chun En Yau
- Yong Loo Lin School of Medicine, National University of Singapore and National University Health System, Singapore, Singapore
| | - Maeve Pin Pin Pek
- Health Services and Systems Research, Duke-NUS Medical School, Singapore, Singapore
| | - Hanzhang Xu
- Department of Family Medicine and Community Health, Duke University, North Carolina, USA
| | - Daniel Yan Zheng Lim
- Data Science and Artificial Intelligence Lab, Singapore General Hospital, Singapore, Singapore
- Department of Gastroenterology, Singapore General Hospital, Singapore, Singapore
| | - Arul Earnest
- School of Public Health and Preventive Medicine, Monash University, Melbourne, Australia
| | - Marcus Eng Hock Ong
- Department of Emergency Medicine, Singapore General Hospital, Singapore, Singapore
| | - Andrew Fu Wah Ho
- Department of Emergency Medicine, Singapore General Hospital, Singapore, Singapore
- Pre-hospital and Emergency Research Centre, Duke-NUS Medical School, Singapore, Singapore
- Centre for Population Health Research and Implementation, SingHealth Regional Health System, Singapore, Singapore
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Tessema ZT, Tesema GA, Wah W, Ahern S, Papa N, Millar JL, Earnest A. Bayesian Spatio-Temporal Multilevel Modelling of Patient-Reported Quality of Life following Prostate Cancer Surgery. Healthcare (Basel) 2024; 12:1093. [PMID: 38891168 PMCID: PMC11171974 DOI: 10.3390/healthcare12111093] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2024] [Revised: 05/10/2024] [Accepted: 05/18/2024] [Indexed: 06/21/2024] Open
Abstract
BACKGROUND Globally, prostate cancer is the second leading cause of cancer deaths among males. It is the most commonly diagnosed cancer in Australia. The quality of life of prostate cancer patients is poorer when compared to the general population due to the disease itself and its related complications. However, there is limited research on the geographic pattern of quality of life and its risk factors in Victoria. Therefore, an examination of the spatio-temporal pattern and risk factors of poor quality of life, along with the impact of spatial weight matrices on estimates and model performance, was conducted. METHOD A retrospective study was undertaken based on the Prostate Cancer Outcome Registry-Victoria data. Patient data (n = 5238) were extracted from the Prostate Cancer Outcome Registry, a population-based clinical quality outcome assessment from 2015 to 2021. A Bayesian spatio-temporal multilevel model was fitted to identify risk factors for poor quality of life. This study also evaluated the impact of distance- and adjacency-based spatial weight matrices. Model convergence was assessed using Gelman-Rubin statistical plots, and model comparison was based on the Watanabe-Akaike Information Criterion. RESULTS A total of 1906 (36.38%) prostate cancer patients who had undergone surgery experienced poor quality of life in our study. Belonging to the age group between 76 and 85 years (adjusted odds ratio (AOR) = 2.90, 95% credible interval (CrI): 1.39, 2.08), having a prostate-specific antigen level between 10.1 and 20.0 (AOR = 1.33, 95% CrI: 1.12, 1.58), and being treated in a public hospital (AOR = 1.35, 95% CrI: 1.17, 1.53) were significantly associated with higher odds of poor quality of life. Conversely, residing in highly accessible areas (AOR = 0.60, 95% CrI: 0.38, 0.94) was significantly associated with lower odds of poor prostate-specific antigen levels. Variations in estimates and model performance were observed depending on the choice of spatial weight matrices. CONCLUSION Belonging to an older age group, having a high prostate-specific antigen level, receiving treatment in public hospitals, and remoteness were statistically significant factors linked to poor quality of life. Substantial spatio-temporal variations in poor quality of life were observed in Victoria across local government areas. The distance-based weight matrix performed better than the adjacency-based matrix. This research finding highlights the need to reduce geographical disparities in quality of life. The statistical methods developed in this study may also be useful to apply to other population-based clinical registry settings.
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Affiliation(s)
- Zemenu Tadesse Tessema
- School of Public Health and Preventive Medicine, Monash University, Melbourne, VIC 3004, Australia
- Department of Epidemiology and Biostatistics, Institute of Public Health, College of Medicine and Health Sciences, University of Gondar, Gondar P.O. Box 196, Ethiopia
| | - Getayeneh Antehunegn Tesema
- School of Public Health and Preventive Medicine, Monash University, Melbourne, VIC 3004, Australia
- Department of Epidemiology and Biostatistics, Institute of Public Health, College of Medicine and Health Sciences, University of Gondar, Gondar P.O. Box 196, Ethiopia
| | - Win Wah
- School of Public Health and Preventive Medicine, Monash University, Melbourne, VIC 3004, Australia
| | - Susannah Ahern
- School of Public Health and Preventive Medicine, Monash University, Melbourne, VIC 3004, Australia
| | - Nathan Papa
- School of Public Health and Preventive Medicine, Monash University, Melbourne, VIC 3004, Australia
- Garvan Institute of Medical Research, Darlinghurst, NSW 2010, Australia
| | - Jeremy Laurence Millar
- School of Public Health and Preventive Medicine, Monash University, Melbourne, VIC 3004, Australia
- Department of Radiation Oncology, Alfred Health, Melbourne, VIC 3004, Australia
| | - Arul Earnest
- School of Public Health and Preventive Medicine, Monash University, Melbourne, VIC 3004, Australia
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Aladuwaka S, Alagan R, Singh R, Mishra M. Health Burdens and SES in Alabama: Using Geographic Information System to Examine Prostate Cancer Health Disparity. Cancers (Basel) 2022; 14:cancers14194824. [PMID: 36230747 PMCID: PMC9563407 DOI: 10.3390/cancers14194824] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2022] [Revised: 09/23/2022] [Accepted: 09/27/2022] [Indexed: 11/16/2022] Open
Abstract
Simple Summary The focus of the research was to examine the relationship between Socioeconomic status and prostate cancer in Alabama’s Black Belt region. The cancer rate in Alabama is high, and the state has one of the highest rates of prostate cancer in the USA. The research aims to identify probable reasons, raise awareness, and propose cancer prevention policies. The Geographic Information System, a robust technology, has been adopted to understand Alabama’s county-level prostate cancer incidence and mortality and its association with socioeconomic and health disparities. The analysis indicated an apparent socioeconomic disparity between the Black Belt and Non-Black Belt counties of Alabama. The poverty rate is higher in Black Belt counties. The data revealed that the preexisting condition of diabetes and obesity is closely associated with prostate cancer. Also, incidence and mortality disparities strongly relate to socioeconomic status, and the preexisting condition of obesity and diabetes adds to prostate cancer incidences. Poverty is the root course of inequalities in education, income, and healthcare facilities, particularly among African Americans, contributing to Alabama’s health burden of prostate cancer. The study proposes effective health policy intervention to prevent and reduce prostate cases and mortality among underserved communities in Alabama. Abstract Socioeconomic disparities influence the risk of many diseases, including cancer. The cancer rate in Alabama is high, and the state has one of the highest rates of prostate cancer in the USA. Alabama’s counties are embedded with socioeconomic disparities, politics, race, ethnicity, and oppression, among which social equity and socioeconomic status (SES) been closely associated with prostate cancer. The Geographic Information System (GIS) has become a valuable technology in understanding public health in many applications, including cancer. This study integrates Alabama’s county-level prostate cancer incidence and mortality and its association with socioeconomic and health disparities. We conducted robust data mining from several data sources such as the Alabama State Cancer Profile data, Alabama Department of Health, American Cancer Society, Center for Disease Control, and National Cancer Institute. The research method is the Geographic Information System (GIS), and we employed prostate cancer data within GIS to understand Alabama’s prostate cancer prevalence regarding SES. The GIS analysis indicated an apparent socioeconomic disparity between the Black Belt and Non-Black Belt counties of Alabama. The Black Belt counties’ poverty rate is also remarkably higher than non-Black Belt counties. In addition, we analyzed the median household income by race. Our analysis demonstrates that the Asian background population in the state earned the highest median income compared to non-Hispanic whites and the African American population. Furthermore, the data revealed that the preexisting condition of diabetes and obesity is closely associated with prostate cancer. The GIS analysis suggests that prostate cancer incidence and mortality disparities are strongly related to SES. In addition, the preexisting condition of obesity and diabetes adds to prostate cancer incidences. Poverty also reflects inequalities in education, income, and healthcare facilities, particularly among African Americans, contributing to Alabama’s health burden of prostate cancer.
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Affiliation(s)
- Seela Aladuwaka
- Cancer Biology Research and Training, Alabama State University, Montgomery, AL 36104, USA
- Department of Advancement Studies, Alabama State University, Montgomery, AL 36104, USA
| | - Ram Alagan
- Cancer Biology Research and Training, Alabama State University, Montgomery, AL 36104, USA
- Department of Advancement Studies, Alabama State University, Montgomery, AL 36104, USA
| | - Rajesh Singh
- Department of Microbiology, Biochemistry & Immunology and Cancer Health Equity Institute, Morehouse School of Medicine, Atlanta, GA 30310, USA
| | - Manoj Mishra
- Cancer Biology Research and Training, Alabama State University, Montgomery, AL 36104, USA
- Department of Biological Sciences, Alabama State University, Montgomery, AL 36104, USA
- Correspondence:
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Seikkula H, Kaipia A, Boström PJ, Malila N, Pitkäniemi J, Seppä K. Periodic trends in geographical variation of prostate cancer incidence and mortality in Finland between 1985 and 2019. Acta Oncol 2022; 61:1209-1215. [PMID: 36008888 DOI: 10.1080/0284186x.2022.2112971] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
BACKGROUND Evaluation of regional variation of prostate cancer (PCa) incidence and PCa-specific mortality is essential in the assessment of equity in a national healthcare system. We evaluated PCa incidence and PCa-specific mortality between different municipalities and hospital districts in Finland over 1985-2019. MATERIAL AND METHODS Men diagnosed with PCa in Finland from 1985 through 2019 were retrieved from Finnish Cancer Registry. Age-standardized PCa incidence and mortality rates were estimated by municipality and hospital district as well as municipality urbanization, education, and income level using hierarchical Bayesian modeling. Standard deviations (SD) of the regional rates were compared between periods from 1985-1989 to 2015-2019. RESULTS We identified 123,185 men diagnosed with any stage PCa between 1985 and 2019. SD of PCa incidence rate (per 100,000 person-years) showed that the total variation of PCa incidence between different municipalities was substantial and varied over time: from 22.2 (95% CI, 17.1-27.8) in 1985-1989 to 56.5 (95% CI, 49.8-64.5) in 2000-2004. The SD of PCa mortality rate between all municipalities was from 9.0 (95% CI, 6.6-11.8) in 2005-2009 to 2.4 (95% CI, 0.9-4.8) in 2015-2019. There was a trend toward a lower PCa-specific mortality rate in municipalities with higher education level. DISCUSSION Regional variation in the incidence rate of PCa became more evident after initiation of PSA testing in Finland, which indicates that early diagnostic practice (PSA testing) of PCa has been different in different parts of the country. Variation in the national PCa mortality rate was indeed recognizable, however, this variation diminished at the same time as the mortality rate declined in Finland. It seems that after the initiation period of PSA testing, PSA has equalized PCa mortality outcomes in Finland.
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Affiliation(s)
- Heikki Seikkula
- Department of Surgery, Hospital Nova of Central Finland, Jyväskylä, Finland
| | - Antti Kaipia
- Department of Urology, Tampere University Hospital, Tampere, Finland
| | - Peter J Boström
- Department of Urology, Turku University Hospital, Turku, Finland.,Department of Urology, University of Turku, Turku, Finland
| | - Nea Malila
- Mass Screening Registry, Finnish Cancer Registry, Helsinki, Finland
| | - Janne Pitkäniemi
- Mass Screening Registry, Finnish Cancer Registry, Helsinki, Finland.,School of Health Sciences, University of Tampere, Tampere, Finland.,Department of Public Health, University of Helsinki, Helsinki, Finland
| | - Karri Seppä
- Mass Screening Registry, Finnish Cancer Registry, Helsinki, Finland
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Lopes TDDS, Fritoli RB, Silva FHD, Calmasini FB. Aging-associated prostate smooth muscle hypercontractility in rats. BRAZ J PHARM SCI 2022. [DOI: 10.1590/s2175-97902022e21063] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/11/2023] Open
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Saavedra P, Santana A, Bello L, Pacheco JM, Sanjuán E. A Bayesian spatio-temporal analysis of mortality rates in Spain: application to the COVID-19 2020 outbreak. Popul Health Metr 2021; 19:27. [PMID: 34059063 PMCID: PMC8165954 DOI: 10.1186/s12963-021-00259-y] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2020] [Accepted: 05/12/2021] [Indexed: 12/24/2022] Open
Abstract
BACKGROUND The number of deaths attributable to COVID-19 in Spain has been highly controversial since it is problematic to tell apart deaths having COVID as the main cause from those provoked by the aggravation by the viral infection of other underlying health problems. In addition, overburdening of health system led to an increase in mortality due to the scarcity of adequate medical care, at the same time confinement measures could have contributed to the decrease in mortality from certain causes. Our aim is to compare the number of deaths observed in 2020 with the projection for the same period obtained from a sequence of previous years. Thus, this computed mortality excess could be considered as the real impact of the COVID-19 on the mortality rates. METHODS The population was split into four age groups, namely: (< 50; 50-64; 65-74; 75 and over). For each one, a projection of the death numbers for the year 2020, based on the interval 2008-2020, was estimated using a Bayesian spatio-temporal model. In each one, spatial, sex, and year effects were included. In addition, a specific effect of the year 2020 was added ("outbreak"). Finally, the excess deaths in year 2020 were estimated as the count of observed deaths minus those projected. RESULTS The projected death number for 2020 was 426,970 people, the actual count being 499,104; thus, the total excess of deaths was 72,134. However, this increase was very unequally distributed over the Spanish regions. CONCLUSION Bayesian spatio-temporal models have proved to be a useful tool for estimating the impact of COVID-19 on mortality in Spain in 2020, making it possible to assess how the disease has affected different age groups accounting for effects of sex, spatial variation between regions and time trend over the last few years.
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Affiliation(s)
- Pedro Saavedra
- Department of Mathematics, University of Las Palmas de Gran Canaria, Las Palmas, Spain
| | - Angelo Santana
- Department of Mathematics, University of Las Palmas de Gran Canaria, Las Palmas, Spain.
| | - Luis Bello
- Department of Physical Education and Biomedical and Health Research Universitary Institute, University of Las Palmas de Gran Canaria, Las Palmas, Spain
| | - José-Miguel Pacheco
- Department of Mathematics, University of Las Palmas de Gran Canaria, Las Palmas, Spain
| | - Esther Sanjuán
- Department of Animal Pathology and Production, Bromatology and Food Technology, University of Las Palmas de Gran Canaria, Las Palmas, Spain
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Wah W, Stirling RG, Ahern S, Earnest A. Forecasting of Lung Cancer Incident Cases at the Small-Area Level in Victoria, Australia. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:5069. [PMID: 34064949 PMCID: PMC8151486 DOI: 10.3390/ijerph18105069] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/09/2021] [Revised: 05/06/2021] [Accepted: 05/06/2021] [Indexed: 11/16/2022]
Abstract
Predicting lung cancer cases at the small-area level is helpful to quantify the lung cancer burden for health planning purposes at the local geographic level. Using Victorian Cancer Registry (2001-2018) data, this study aims to forecast lung cancer counts at the local government area (LGA) level over the next ten years (2019-2028) in Victoria, Australia. We used the Age-Period-Cohort approach to estimate the annual age-specific incidence and utilised Bayesian spatio-temporal models that account for non-linear temporal trends and area-level risk factors. Compared to 2001, lung cancer incidence increased by 28.82% from 1353 to 1743 cases for men and 78.79% from 759 to 1357 cases for women in 2018. Lung cancer counts are expected to reach 2515 cases for men and 1909 cases for women in 2028, with a corresponding 44% and 41% increase. The majority of LGAs are projected to have an increasing trend for both men and women by 2028. Unexplained area-level spatial variation substantially reduced after adjusting for the elderly population in the model. Male and female lung cancer cases are projected to rise at the state level and in each LGA in the next ten years. Population growth and an ageing population largely contributed to this rise.
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Affiliation(s)
- Win Wah
- Department of Epidemiology and Preventive Medicine, School of Public Health and Preventive Medicine, Monash University, Melbourne 3004, Australia; (S.A.); (A.E.)
| | - Rob G. Stirling
- Department of Allergy, Immunology & Respiratory Medicine, Alfred Health, Melbourne 3004, Australia;
- Department of Medicine, Monash University, Melbourne 3168, Australia
| | - Susannah Ahern
- Department of Epidemiology and Preventive Medicine, School of Public Health and Preventive Medicine, Monash University, Melbourne 3004, Australia; (S.A.); (A.E.)
| | - Arul Earnest
- Department of Epidemiology and Preventive Medicine, School of Public Health and Preventive Medicine, Monash University, Melbourne 3004, Australia; (S.A.); (A.E.)
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