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Jo A, Parikh S, Sawczuk N, Turner K, Hong YR. Health Care Use Among Cancer Patients With Diabetes, National Health and Nutrition Examination Survey, 2017-2020. Prev Chronic Dis 2024; 21:E58. [PMID: 39117352 PMCID: PMC11318949 DOI: 10.5888/pcd21.240066] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/10/2024] Open
Abstract
Introduction Diabetes is a common comorbidity among people with cancer. The objective of our study was to examine patterns of health care use among patients with cancer and either type 2 diabetes or prediabetes. Methods We used data from the National Health and Nutrition Examination Survey (NHANES) for 2017-2020. The study population included US adults aged 18 years or older who were diagnosed with any cancer and type 2 diabetes or prediabetes (established by self-report and/or hemoglobin A1c measurement). We used Poisson and multivariate logistic regression models to determine the effect of comorbidity on health care use, defined as health care visits and overnight stays in a hospital. Results Of 905 cancer patients representing 27,180,715 people in the US, 24.4% had a type 2 diabetes diagnosis, and 25.8% had a prediabetes diagnosis. Patients with cancer and prediabetes had a significantly higher rate of health care visits (incidence rate ratio = 1.11; 95% CI, 1.01-1.22; P = .03) than patients with cancer only. We found no significant association between having cancer and type 2 diabetes and the number of health care visits or overnight hospital stays compared with patients with cancer only. Conclusion More emphasis should be placed on optimal care coordination among people with cancer and other conditions, such as diabetes and prediabetes, to reduce the impact of comorbidity on health care use. Interventions integrated with technology to provide timely access to education on preventing or managing diabetes and prediabetes among cancer patients are warranted.
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Affiliation(s)
- Ara Jo
- Department of Health Services Research, Management and Policy, University of Florida, Health Sciences Center, PO Box 100195, Gainesville, FL 32610-0195 (
| | - Sarina Parikh
- College of Public Health and Health Professions, University of Florida, Gainesville
- Now with School of Dental Medicine, University of Pennsylvania, Philadelphia
| | - Nathalie Sawczuk
- Department of Health Services Research, Management and Policy, University of Florida, Gainesville
| | - Kea Turner
- Department of Health Outcomes and Behavior, Moffitt Cancer Center, Tampa, Florida
- Department of Gastrointestinal Oncology, Moffitt Cancer Center, Tampa, Florida
| | - Young-Rock Hong
- Department of Health Services Research, Management and Policy, University of Florida, Gainesville
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Gao J, Liu Y. Prediction and the influencing factor study of colorectal cancer hospitalization costs in China based on machine learning-random forest and support vector regression: a retrospective study. Front Public Health 2024; 12:1211220. [PMID: 38389946 PMCID: PMC10881792 DOI: 10.3389/fpubh.2024.1211220] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2023] [Accepted: 01/23/2024] [Indexed: 02/24/2024] Open
Abstract
Aims As people's standard of living improves, the incidence of colorectal cancer is increasing, and colorectal cancer hospitalization costs are relatively high. Therefore, predicting the cost of hospitalization for colorectal cancer patients can provide guidance for controlling healthcare costs and for the development of related policies. Methods This study used the first page of medical record data on colorectal cancer inpatient cases of a tertiary first-class hospital in Shenzhen from 2018 to 2022. The impacting factors of hospitalization costs for colorectal cancer were analyzed. Random forest and support vector regression models were used to establish predictive models of the cost of hospitalization for colorectal cancer patients and to compare and evaluate. Results In colorectal cancer inpatients, major procedures, length of stay, level of procedure, Charlson comorbidity index, age, and medical payment method were the important influencing factors. In terms of the test set, the R2 of the Random forest model was 0.833, the R2 of the Support vector regression model was 0.824; the root mean square error (RMSE) of the Random forest model was 0.029, and the RMSE of the Support vector regression model was 0.032. In the Random Forest model, the weight of the major procedure was the highest (0.286). Conclusion Major procedures and length of stay have the greatest impacts on hospital costs for colorectal cancer patients. The random forest model is a better method to predict the hospitalization costs for colorectal cancer patients than the support vector regression.
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Affiliation(s)
- Jun Gao
- Department of Medical Record Statistics, Peking University Shenzhen Hospital, Shenzhen, China
- School of Public Healthy, Guilin Medical University, Guilin, China
| | - Yan Liu
- Department of Medical Record Statistics, Peking University Shenzhen Hospital, Shenzhen, China
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Schlager L, Monschein M, Schüller J, Bergmann M, Krall C, Razek P, Stift A, Unger LW. The predictive value of comorbidities on postoperative complication rates and overall survival in left-sided oncological colorectal resections: a multicentre cohort study. Int J Surg 2023; 109:4113-4118. [PMID: 37800585 PMCID: PMC10720865 DOI: 10.1097/js9.0000000000000734] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2023] [Accepted: 08/21/2023] [Indexed: 10/07/2023]
Abstract
INTRODUCTION Surgical- and nonsurgical complications significantly worsen postoperative outcomes, and identification of patients at risk is crucial to improve care. This study investigated whether comorbidities, graded by the Charlson Comorbidity Index (CCI), impact complication rates and impair long-term outcome in a cohort of left-sided colorectal resections. METHODS Retrospective analysis of patients undergoing oncological left-sided colorectal resections due to colorectal cancer between 01/2015 and 12/2020 in two referral centers in Austria using electronic medical records and national statistical bureau survival data. Patients with recurrent disease, peritoneal carcinomatosis, and emergency surgeries were excluded. Comorbidities were assessed using the CCI, and complication severity was defined by the Clavien-Dindo classification (CDC). Logistic regression analysis was performed to identify factors influencing the risk for postoperative complications, and overall survival was assessed using data from the national statistics bureau. RESULTS A total of 471 patients were analyzed. Multinominal logistic regression analysis identified a CCI greater than or equal to 6 ( P =0.049; OR 1.59, 95% CI: 1.10-2.54) and male sex ( P =0.022; OR 1.47, 95% CI: 1.21-2.98) as independent risk factors for major complications. While patients with a high CCI had the worst postoperative survival rates, perioperative complications only impacted on overall survival in patients with low CCIs, but not in patients with high CCIs. CONCLUSION Although a high CCI is a risk factor for major postoperative complications, the presence of comorbidities should not result in withholding surgery.
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Affiliation(s)
- Lukas Schlager
- Division of Visceral Surgery, Department of General Surgery, Medical University of Vienna
| | | | - Jessica Schüller
- Division of Visceral Surgery, Department of General Surgery, Medical University of Vienna
| | - Michael Bergmann
- Division of Visceral Surgery, Department of General Surgery, Medical University of Vienna
| | - Christoph Krall
- Department of Medical Statistics, Medical University of Vienna
| | - Peter Razek
- Department of General Surgery, Hospital Floridsdorf, Vienna, Austria
| | - Anton Stift
- Division of Visceral Surgery, Department of General Surgery, Medical University of Vienna
| | - Lukas W. Unger
- Division of Visceral Surgery, Department of General Surgery, Medical University of Vienna
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Jiao P, Tian WX, Wu FJ, Liu YX, Wu JY, Sun YG, Yu HB, Huang C, Wu QJ, Ma C, Li DH, Tong HF, Li J. Postoperative clinical outcomes of patients with thymic epithelial tumors after over-3-year follow-up at a single-center. J Cardiothorac Surg 2023; 18:77. [PMID: 36810094 PMCID: PMC9942311 DOI: 10.1186/s13019-023-02169-6] [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: 11/02/2022] [Accepted: 01/27/2023] [Indexed: 02/23/2023] Open
Abstract
BACKGROUND To evaluate postoperative clinical outcomes and analyze influencing factors for patients with thymic epithelial tumors over 3 years after operation. METHODS Patients with thymic epithelial tumors (TETs) who underwent surgical treatment in the Department of Thoracic Surgery at Beijing Hospital from January 2011 to May 2019 were retrospectively enrolled in the study. Basic patient information, clinical, pathological, and perioperative data were collected. Patients were followed up by telephone interviews and outpatient records. Statistical analyses were performed using SPSS version 26.0. RESULTS A total of 242 patients (129 men, 113 women) with TETs were included in this study, of which 150 patients (62.0%) were combined with myasthenia gravis (MG) and 92 patients (38.0%) were not. 216 patients were successfully followed up and their complete information was available. The median follow-up period was 70.5 months (range, 2-137 months). The 3-year overall survival (OS) rate of the whole group was 93.9%, and the 5-year OS rate was 91.1%. The 3-year relapse-free survival (RFS) rate of the whole group was 92.2%, and the 5-year relapse-free survival rate was 89.8%. Multivariable COX regression analysis indicated that recurrence of thymoma was an independent risk factor for OS. Younger age, Masaoka-Koga stage III + IV, and TNM stage III + IV were independent risk factors for RFS. Multivariable COX regression analysis indicated that Masaoka-Koga staging III + IV, WHO type B + C were independent risk factors for postoperative improvement of MG. For patients with MG, the postoperative complete stable remission (CSR) rate was 30.5%. And the result of multivariable COX regression analysis showed that thymoma patients with MG with Osserman staging IIA + IIB + III + IV were not prone to achieving CSR. Compared with patients without MG, MG was more likely to develop in patients with WHO classification type B, and patients with myasthenia gravis were younger, with longer operative duration, and more likely to develop perioperative complications. CONCLUSIONS The 5-year overall survival rate of patients with TETs was 91.1% in this study. Younger age and advanced stage were independent risk factors for RFS of patients with TETs, and recurrence of thymoma were independent risk factors for OS. In patients with MG, WHO classification type B and advanced stage were independent predictors of poor outcomes of MG treatment after thymectomy.
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Affiliation(s)
- Peng Jiao
- grid.506261.60000 0001 0706 7839Department of Thoracic Surgery, Beijing Hospital, National Center of Gerontology; Institute of Geriatric Medicine, Chinese Academy of Medical Sciences, Beijing, People’s Republic of China
| | - Wen-Xin Tian
- grid.506261.60000 0001 0706 7839Department of Thoracic Surgery, Beijing Hospital, National Center of Gerontology; Institute of Geriatric Medicine, Chinese Academy of Medical Sciences, Beijing, People’s Republic of China
| | - Fan-Juan Wu
- grid.506261.60000 0001 0706 7839Department of Thoracic Surgery, Beijing Hospital, National Center of Gerontology; Institute of Geriatric Medicine, Chinese Academy of Medical Sciences, Beijing, People’s Republic of China
| | - Yu-Xing Liu
- grid.11135.370000 0001 2256 9319Peking University Health Science Center, Beijing, People’s Republic of China
| | - Jiang-Yu Wu
- grid.11135.370000 0001 2256 9319Peking University Health Science Center, Beijing, People’s Republic of China
| | - Yao-Guang Sun
- grid.506261.60000 0001 0706 7839Department of Thoracic Surgery, Beijing Hospital, National Center of Gerontology; Institute of Geriatric Medicine, Chinese Academy of Medical Sciences, Beijing, People’s Republic of China
| | - Han-Bo Yu
- grid.506261.60000 0001 0706 7839Department of Thoracic Surgery, Beijing Hospital, National Center of Gerontology; Institute of Geriatric Medicine, Chinese Academy of Medical Sciences, Beijing, People’s Republic of China
| | - Chuan Huang
- grid.506261.60000 0001 0706 7839Department of Thoracic Surgery, Beijing Hospital, National Center of Gerontology; Institute of Geriatric Medicine, Chinese Academy of Medical Sciences, Beijing, People’s Republic of China
| | - Qing-Jun Wu
- grid.506261.60000 0001 0706 7839Department of Thoracic Surgery, Beijing Hospital, National Center of Gerontology; Institute of Geriatric Medicine, Chinese Academy of Medical Sciences, Beijing, People’s Republic of China
| | - Chao Ma
- grid.506261.60000 0001 0706 7839Department of Thoracic Surgery, Beijing Hospital, National Center of Gerontology; Institute of Geriatric Medicine, Chinese Academy of Medical Sciences, Beijing, People’s Republic of China
| | - Dong-Hang Li
- grid.506261.60000 0001 0706 7839Department of Thoracic Surgery, Beijing Hospital, National Center of Gerontology; Institute of Geriatric Medicine, Chinese Academy of Medical Sciences, Beijing, People’s Republic of China
| | - Hong-Feng Tong
- Department of Thoracic Surgery, Beijing Hospital, National Center of Gerontology; Institute of Geriatric Medicine, Chinese Academy of Medical Sciences, Beijing, People's Republic of China.
| | - Jun Li
- Department of Thoracic Surgery, Provincial Hospital Affiliated to Shandong First Medical University, No. 324, Jing 5 Wei 7 Road, Jinan, 250021, Shandong, People's Republic of China.
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