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Dunn MR, Metwally EM, Vohra S, Hyslop T, Henderson LM, Reeder-Hayes K, Thompson CA, Lafata JE, Troester MA, Butler EN. Understanding mechanisms of racial disparities in breast cancer: an assessment of screening and regular care in the Carolina Breast Cancer Study. Cancer Causes Control 2024; 35:825-837. [PMID: 38217760 PMCID: PMC11045315 DOI: 10.1007/s10552-023-01833-5] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2023] [Accepted: 11/16/2023] [Indexed: 01/15/2024]
Abstract
PURPOSE Screening history influences stage at detection, but regular preventive care may also influence breast tumor diagnostic characteristics. Few studies have evaluated healthcare utilization (both screening and primary care) in racially diverse screening-eligible populations. METHODS This analysis included 2,058 women age 45-74 (49% Black) from the Carolina Breast Cancer Study, a population-based cohort of women diagnosed with invasive breast cancer between 2008 and 2013. Screening history (threshold 0.5 mammograms per year) and pre-diagnostic healthcare utilization (i.e. regular care, based on responses to "During the past ten years, who did you usually see when you were sick or needed advice about your health?") were assessed as binary exposures. The relationship between healthcare utilization and tumor characteristics were evaluated overall and race-stratified. RESULTS Among those lacking screening, Black participants had larger tumors (5 + cm) (frequency 19.6% vs 11.5%, relative frequency difference (RFD) = 8.1%, 95% CI 2.8-13.5), but race differences were attenuated among screening-adherent participants (10.2% vs 7.0%, RFD = 3.2%, 0.2-6.2). Similar trends were observed for tumor stage and mode of detection (mammogram vs lump). Among all participants, those lacking both screening and regular care had larger tumors (21% vs 8%, RR = 2.51, 1.76-3.56) and advanced (3B +) stage (19% vs 6%, RR = 3.15, 2.15-4.63) compared to the referent category (screening-adherent and regular care). Under-use of regular care and screening was more prevalent in socioeconomically disadvantaged areas of North Carolina. CONCLUSIONS Access to regular care is an important safeguard for earlier detection. Our data suggest that health equity interventions should prioritize both primary care and screening.
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Affiliation(s)
- Matthew R Dunn
- Department of Epidemiology, University of North Carolina at Chapel Hill, 135 Dauer Drive, Chapel Hill, NC, 27599, USA.
- Lineberger Comprehensive Cancer Center, University of North Carolina, Chapel Hill, NC, USA.
| | - Eman M Metwally
- Department of Epidemiology, University of North Carolina at Chapel Hill, 135 Dauer Drive, Chapel Hill, NC, 27599, USA
- Lineberger Comprehensive Cancer Center, University of North Carolina, Chapel Hill, NC, USA
| | - Sanah Vohra
- Lineberger Comprehensive Cancer Center, University of North Carolina, Chapel Hill, NC, USA
- David Geffen School of Medicine, University of California, Los Angeles, USA
| | - Terry Hyslop
- Sidney Kimmel Cancer Center, Thomas Jefferson University, Philadelphia, PA, USA
| | - Louise M Henderson
- Lineberger Comprehensive Cancer Center, University of North Carolina, Chapel Hill, NC, USA
- Division of Pulmonary Disease and Critical Care Medicine, Department of Radiology, University of North Carolina, Chapel Hill, NC, USA
| | - Katherine Reeder-Hayes
- Lineberger Comprehensive Cancer Center, University of North Carolina, Chapel Hill, NC, USA
- Division of Oncology, School of Medicine, University of North Carolina, Chapel Hill, NC, USA
| | - Caroline A Thompson
- Department of Epidemiology, University of North Carolina at Chapel Hill, 135 Dauer Drive, Chapel Hill, NC, 27599, USA
- Lineberger Comprehensive Cancer Center, University of North Carolina, Chapel Hill, NC, USA
| | - Jennifer Elston Lafata
- Lineberger Comprehensive Cancer Center, University of North Carolina, Chapel Hill, NC, USA
- Eshelman School of Pharmacy, University of North Carolina, Chapel Hill, NC, USA
| | - Melissa A Troester
- Department of Epidemiology, University of North Carolina at Chapel Hill, 135 Dauer Drive, Chapel Hill, NC, 27599, USA.
- Lineberger Comprehensive Cancer Center, University of North Carolina, Chapel Hill, NC, USA.
- Department of Pathology and Laboratory Medicine, University of North Carolina, Chapel Hill, NC, USA.
| | - Eboneé N Butler
- Department of Epidemiology, University of North Carolina at Chapel Hill, 135 Dauer Drive, Chapel Hill, NC, 27599, USA
- Lineberger Comprehensive Cancer Center, University of North Carolina, Chapel Hill, NC, USA
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Thompson CA, Nianogo RA, Leonard T. Unaffordable housing and cancer: novel insights into a complex question. JNCI Cancer Spectr 2024; 8:pkae029. [PMID: 38708930 PMCID: PMC11071115 DOI: 10.1093/jncics/pkae029] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2024] [Accepted: 03/24/2024] [Indexed: 05/07/2024] Open
Affiliation(s)
- Caroline A Thompson
- Department of Epidemiology, Gillings School of Global Public Health, The University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
- Lineberger Comprehensive Cancer Center, The University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
- Center for Health Promotion and Disease Prevention, The University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Roch A Nianogo
- Department of Epidemiology, Fielding School of Public Health, University of California Los Angeles, Los Angeles, CA, USA
| | - Tammy Leonard
- Department of Health Economics and Policy, O’Donnell School of Public Health and Harold C. Simmons Comprehensive Cancer Center, UT Southwestern Medical Center, Dallas, TX, USA
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Tripathi O, Posis AIB, Thompson CA, Ferris J, Anuskiewicz B, Nguyen B, Liles S, Berardi V, Zhu SH, Winstock A, Bellettiere J. In-Home Cannabis Smoking Among a Cannabis-Using Convenience Sample from the Global Drug Survey: With Weighted Estimates for U.S. Respondents. Cannabis Cannabinoid Res 2024; 9:353-362. [PMID: 36318789 DOI: 10.1089/can.2022.0139] [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] [Indexed: 06/16/2023] Open
Abstract
Introduction: Secondhand and thirdhand tobacco smoke exposure most often occur at home, but little is known about occurrences of in-home cannabis smoking. We ascertained in-home cannabis smoking reported by all cannabis-using (i.e., used in the last 12 months) respondents to the Global Drug Survey (GDS; international-GDS sample), and among U.S. cannabis-using respondents (US-GDS sample). Materials and Methods: We used data collected November 2019-January 2020 for the 2020 GDS, an annual anonymous, cross-sectional survey; respondents were 16+ years old, from 191 countries. We estimated any and daily in-home cannabis smoking in the last 30 days among international-GDS respondents (n=63,797), using mixed effects logistic regression. US-GDS respondents (n=6,580) were weighted to the covariate distribution of the nationally representative 2018 National Survey on Drug Use and Health cannabis-using sample, using inverse odds probability weighting, to make estimates more generalizable to the U.S. cannabis-using population. Results: For the international-GDS cannabis-using respondents, any in-home cannabis smoking was reported by 63.9% of men, 61.9% of women, and 68.6% of nonbinary people; and by age (<25 years old=62.7%, 25-34 years old=65.0%, and 35+ years old=62.8%). Daily in-home cannabis smoking was highest among nonbinary (28.7%) and respondents 35+ years of age (28.0%). For the weighted US-GDS cannabis-using respondents, any in-home cannabis smoking was reported by 49.8% of males and 61.2% of females; and by age (<25 years old=62.6%, 25-34 years old=41.8%, 35+ years old=57.9%). Weighted daily in-home smoking was 23.2% among males and 37.1% among females; by age (<25 years old=34.8%, 25-34 years old=27.8%, and 35+ years old=21.6%). Conclusions: There was high daily cannabis smoking in homes of international-GDS and US-GDS respondents who used cannabis in the last 12 months. In part, due to cannabis legalization, the number of users worldwide has increased over the past decade. Criminal stigma historically associated with cannabis continues to drive those users indoors. In this context, our findings support further investigation of cannabis use behavior to understand how often people are exposed to secondhand and thirdhand cannabis smoke and the consequences of that exposure.
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Affiliation(s)
- Osika Tripathi
- The Herbert Wertheim School of Public Health and Human Longevity Science, University of California, San Diego, California, USA
- San Diego State University School of Public Health, San Diego, California, USA
| | - Alexander Ivan B Posis
- The Herbert Wertheim School of Public Health and Human Longevity Science, University of California, San Diego, California, USA
- San Diego State University School of Public Health, San Diego, California, USA
| | - Caroline A Thompson
- The Herbert Wertheim School of Public Health and Human Longevity Science, University of California, San Diego, California, USA
- San Diego State University School of Public Health, San Diego, California, USA
| | - Jason Ferris
- Centre for Health Services Research, Faculty of Medicine, University of Queensland, Brisbane, Queensland, Australia
| | - Blake Anuskiewicz
- San Diego State University School of Public Health, San Diego, California, USA
| | - Benjamin Nguyen
- San Diego State University School of Public Health, San Diego, California, USA
| | - Sandy Liles
- The Herbert Wertheim School of Public Health and Human Longevity Science, University of California, San Diego, California, USA
- San Diego State University School of Public Health, San Diego, California, USA
| | - Vincent Berardi
- Crean College of Health and Behavioral Sciences, Psychology, Chapman University, Orange, California, USA
| | - Shu-Hong Zhu
- San Diego State University School of Public Health, San Diego, California, USA
| | - Adam Winstock
- Institute of Epidemiology and Health Care, University College, London, United Kingdom
| | - John Bellettiere
- San Diego State University School of Public Health, San Diego, California, USA
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Sheridan P, Chen C, Thompson CA, Benmarhnia T. Immortal Time Bias With Time-Varying Exposures in Environmental Epidemiology: A Case Study in Lung Cancer Survival. Am J Epidemiol 2023; 192:1754-1762. [PMID: 37400995 PMCID: PMC10558188 DOI: 10.1093/aje/kwad135] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2022] [Revised: 01/19/2023] [Accepted: 06/04/2023] [Indexed: 07/05/2023] Open
Abstract
Immortal time bias is a well-recognized bias in clinical epidemiology but is rarely discussed in environmental epidemiology. Under the target trial framework, this bias is formally conceptualized as a misalignment between the start of study follow-up (time 0) and treatment assignment. This misalignment can occur when attained duration of follow-up is encoded into treatment assignment using minimums, maximums, or averages. The bias can be exacerbated in the presence of time trends commonly found in environmental exposures. Using lung cancer cases from the California Cancer Registry (2000-2010) linked with estimated concentrations of particulate matter less than or equal to 2.5 μm in aerodynamic diameter (PM2.5), we replicated previous studies that averaged PM2.5 exposure over follow-up in a time-to-event model. We compared this approach with one that ensures alignment between time 0 and treatment assignment, a discrete-time approach. In the former approach, the estimated overall hazard ratio for a 5-μg/m3 increase in PM2.5 was 1.38 (95% confidence interval: 1.36, 1.40). Under the discrete-time approach, the estimated pooled odds ratio was 0.99 (95% confidence interval: 0.98, 1.00). We conclude that the strong estimated effect in the former approach was likely driven by immortal time bias, due to misalignment at time 0. Our findings highlight the importance of appropriately conceptualizing a time-varying environmental exposure under the target trial framework to avoid introducing preventable systematic errors.
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Affiliation(s)
- Paige Sheridan
- Correspondence to Dr. Paige Sheridan, Herbert Wertheim School of Public Health, University of California, San Diego, 9500 Gilman Drive, La Jolla, CA 92093 (e-mail: )
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Liu HC, Morse R, Nelson TJ, Williamson CW, Vitzthum L, Zakeri K, Henderson G, Thompson CA, Zou J, Gillison M, Mell LK. Effectiveness of Cisplatin in P16+ Oropharyngeal Cancer According to Relative Risk for Cancer Events: Ancillary Analysis of RTOG 1016. Int J Radiat Oncol Biol Phys 2023; 117:S69. [PMID: 37784554 DOI: 10.1016/j.ijrobp.2023.06.375] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/04/2023]
Abstract
PURPOSE/OBJECTIVE(S) To test the hypothesis that the effectiveness of cisplatin in p16+ oropharyngeal squamous cell carcinoma (OPSCC) increases with patients' relative risk for cancer events. MATERIALS/METHODS Ancillary analysis of 805 patients enrolled on RTOG 1016 accessed via Project DataSphere. Eligible patients had p16+ OPSCC, AJCC 7th T1-T2 N2a-N3 or T3-T4 N0-N3 M0, ECOG PS 0-1. Patients were randomized to RT with concurrent cisplatin vs. cetuximab. Relative risk for competing events was quantified using the Head and Neck Cancer Intergroup predictive classifier (omega score). Higher scores indicate higher relative risk for cancer events (LRF or distant metastasis) vs. competing mortality. We compared this to favorable, unfavorable/low, and unfavorable/intermediate risk groups using standard criteria: NRG HN005 eligible/low RTOG risk (Ang et al.), HN005 ineligible/low RTOG risk, and intermediate RTOG risk. Omega score cutoffs were selected to match numbers in standard risk strata. HRs for the effect of cisplatin vs. cetuximab on PFS and OS were compared for standard vs. relative risk strata. 1-tailed interaction tests were used to test whether cisplatin effectiveness increased within risk strata. RESULTS There were 354, 219, and 232 patients in standard favorable, unfavorable/low, and unfavorable/intermediate risk groups. Omega score cutoffs were 0.80 and 0.84 to define low, intermediate, and high relative risk groups. Discordant standard vs. relative risk classifications occurred in 559 patients (69.4%). Increasing omega score was associated with significantly higher relative HR (rHR) for cancer events (3.40, 95% CI: 1.66-6.96) and increasing effectiveness of cisplatin vs. cetuximab (Table), but standard risk grouping was not (rHR 0.80, 95% CI: 0.49-1.32). The effect of cisplatin on PFS significantly increased with higher omega score (interaction -0.30, p = .046), but decreased with increasing standard risk strata (interaction +0.27, p = NS). CONCLUSION The effectiveness of cisplatin in p16+ OPSCC increased with higher omega score but not with standard risk group. Relative risk for cancer events should be taken into account when designing deintensification strategies.
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Affiliation(s)
- H C Liu
- Department of Radiation Medicine and Applied Sciences, University of California San Diego, La Jolla, CA
| | - R Morse
- Department of Radiation Oncology, University of North Carolina School of Medicine, Chapel Hill, NC
| | - T J Nelson
- Department of Radiation Medicine and Applied Sciences, University of California San Diego, La Jolla, CA
| | - C W Williamson
- UCSD Radiation Oncology and Applied Medicine, La Jolla, CA
| | - L Vitzthum
- Department of Radiation Oncology, Stanford University School of Medicine, Stanford, CA
| | - K Zakeri
- Department of Radiation Oncology, Memorial Sloan Kettering Cancer Center, New York, NY
| | - G Henderson
- University of California San Diego, Department of Radiation Medicine & Applied Sciences, La Jolla, CA
| | - C A Thompson
- University of North Carolina, Department of Epidemiology, Chapel Hill, NC
| | - J Zou
- Department of Family Medicine and Public Health and Department of Mathematics, University of California San Diego, La Jolla, CA
| | - M Gillison
- The University of Texas MD Anderson Cancer Center, Houston, TX
| | - L K Mell
- University of California San Diego, La Jolla, CA
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Morse R, Nelson TJ, Liu HC, Williamson CW, Sacco A, Chitti BS, Henderson G, Todd J, Chen X, Gan GN, Rahn D, Sharabi A, Thompson CA, Zou J, Lominska CE, Shen C, Chera BS, Mell LK. Comparison of Standard vs. Relative Risk Models to Define Candidates for Deintensification in Locoregionally Advanced P16+ Oropharyngeal Cancer. Int J Radiat Oncol Biol Phys 2023; 117:e608-e609. [PMID: 37785830 DOI: 10.1016/j.ijrobp.2023.06.1979] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/04/2023]
Abstract
PURPOSE/OBJECTIVE(S) Various methods to identify candidates for treatment deintensification with p16+ oropharyngeal squamous cell carcinoma (OPSCC) have been used, but the optimal approach is unknown. MATERIALS/METHODS Multi-institutional cohort study of 385 patients with previously untreated p16+ OPSCC undergoing definitive radiotherapy (RT) with or without systemic therapy between 2009-2020. Chemotherapy intensity was categorized as high (bolus cisplatin and/or induction chemotherapy), medium (weekly cisplatin), or low (non-cisplatin or RT alone). Standard favorable vs. unfavorable risk was defined using NRG HN005 eligibility criteria. High vs. low relative risk (RR) group was defined using the HNCIG omega score (≥ 0.80 vs. < 0.80), which quantifies the proportion of a patient's overall event risk due to cancer. We used multivariable ordinal logistic regression to estimate effects of age (yrs), sex, performance status (PS), Charlson comorbidity index (CCI), T/N (AJCC 8th), current smoking, and pack-years (> 10 vs. ≤ 10) on treatment allocation. Effects on relative event hazards were estimated using generalized competing event regression. RESULTS Median follow-up time was 44.2 months. Chemotherapy intensity was high in 206 (54%), medium in 108 (28%), and low in 71 (18%). 280 patients (73%) were unfavorable risk and 197 (51%) were high RR. 178 patients (46%) had discordant risk classification. On univariable analysis, significant predictors of higher intensity chemotherapy (normalized odds ratio (OR)) were CCI 0-1 (OR 1.49, 95% CI: 1.23-1.79), high omega score (OR 1.46; 1.20-1.77), decreased age (OR 1.43; 1.18-1.74), and PS 0 (OR 1.22; 1.01-1.48). Controlling for CCI, higher omega score was associated with significantly higher odds of intensive chemotherapy (OR 1.35; 1.10-1.65, but unfavorable risk (HN005 ineligibility) was not (OR 1.19; 0.98-1.44). Higher omega score was also associated with significantly higher RR for cancer recurrence (Rec) vs. competing mortality (CM) events (relative HR (rHR) 1.76; 1.12-2.75), but unfavorable risk was not (rHR 1.05; 0.63-1.75). Among patients receiving cisplatin, 50 favorable risk patients (58%) had high RR; all of their event risk was due to cancer recurrence (Table). The 110 unfavorable risk patients (48%) with low omega score had significantly lower RR for cancer events compared to the high omega score group (rHR 0.49; 0.29-0.84). CONCLUSION Many patients with favorable risk p16+ OPSCC have high relative risk for cancer events, which correlates with a benefit of intensive treatment. The HNCIG omega score is a strong predictor of allocation to intensive chemotherapy and may help identify candidates for deintensification.
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Affiliation(s)
- R Morse
- Department of Radiation Oncology, University of North Carolina School of Medicine, Chapel Hill, NC
| | - T J Nelson
- Department of Radiation Medicine and Applied Sciences, University of California San Diego, La Jolla, CA
| | - H C Liu
- Department of Radiation Medicine and Applied Sciences, University of California San Diego, La Jolla, CA
| | - C W Williamson
- UCSD Radiation Oncology and Applied Medicine, La Jolla, CA
| | - A Sacco
- University of California San Diego, San Diego
| | - B S Chitti
- Northwell Health Cancer Institute, Lake Success, NY
| | - G Henderson
- University of California San Diego, Department of Radiation Medicine & Applied Sciences, La Jolla, CA
| | - J Todd
- Yale University, New Haven, CT
| | - X Chen
- Department of Radiation Oncology, University of North Carolina School of Medicine, Chapel Hill, NC
| | - G N Gan
- Department of Radiation Oncology, University of Kansas School of Medicine, Kansas City, KS
| | - D Rahn
- University of California San Diego, Department of Radiation Medicine & Applied Sciences, La Jolla, CA
| | - A Sharabi
- UC San Diego, Moores Cancer Center, Department of Radiation Medicine and Applied Sciences, La Jolla, CA
| | - C A Thompson
- University of North Carolina, Department of Epidemiology, Chapel Hill, NC
| | - J Zou
- Department of Family Medicine and Public Health and Department of Mathematics, University of California San Diego, La Jolla, CA
| | - C E Lominska
- Department of Radiation Oncology, University of Kansas School of Medicine, Kansas City, KS
| | - C Shen
- Department of Radiation Oncology, University of North Carolina, Chapel Hill, NC
| | - B S Chera
- Department of Radiation Oncology, University of North Carolina at Chapel Hill, Chapel Hill, NC
| | - L K Mell
- University of California San Diego, La Jolla, CA
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Prado MG, Kessler LG, Au MA, Burkhardt HA, Zigman Suchsland M, Kowalski L, Stephens KA, Yetisgen M, Walter FM, Neal RD, Lybarger K, Thompson CA, Al Achkar M, Sarma EA, Turner G, Farjah F, Thompson MJ. Symptoms and signs of lung cancer prior to diagnosis: case-control study using electronic health records from ambulatory care within a large US-based tertiary care centre. BMJ Open 2023; 13:e068832. [PMID: 37080616 PMCID: PMC10124310 DOI: 10.1136/bmjopen-2022-068832] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [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: 10/01/2022] [Accepted: 03/22/2023] [Indexed: 04/22/2023] Open
Abstract
OBJECTIVE Lung cancer is the most common cause of cancer-related death in the USA. While most patients are diagnosed following symptomatic presentation, no studies have compared symptoms and physical examination signs at or prior to diagnosis from electronic health records (EHRs) in the USA. We aimed to identify symptoms and signs in patients prior to diagnosis in EHR data. DESIGN Case-control study. SETTING Ambulatory care clinics at a large tertiary care academic health centre in the USA. PARTICIPANTS, OUTCOMES We studied 698 primary lung cancer cases in adults diagnosed between 1 January 2012 and 31 December 2019, and 6841 controls matched by age, sex, smoking status and type of clinic. Coded and free-text data from the EHR were extracted from 2 years prior to diagnosis date for cases and index date for controls. Univariate and multivariable conditional logistic regression were used to identify symptoms and signs associated with lung cancer at time of diagnosis, and 1, 3, 6 and 12 months before the diagnosis/index dates. RESULTS Eleven symptoms and signs recorded during the study period were associated with a significantly higher chance of being a lung cancer case in multivariable analyses. Of these, seven were significantly associated with lung cancer 6 months prior to diagnosis: haemoptysis (OR 3.2, 95% CI 1.9 to 5.3), cough (OR 3.1, 95% CI 2.4 to 4.0), chest crackles or wheeze (OR 3.1, 95% CI 2.3 to 4.1), bone pain (OR 2.7, 95% CI 2.1 to 3.6), back pain (OR 2.5, 95% CI 1.9 to 3.2), weight loss (OR 2.1, 95% CI 1.5 to 2.8) and fatigue (OR 1.6, 95% CI 1.3 to 2.1). CONCLUSIONS Patients diagnosed with lung cancer appear to have symptoms and signs recorded in the EHR that distinguish them from similar matched patients in ambulatory care, often 6 months or more before diagnosis. These findings suggest opportunities to improve the diagnostic process for lung cancer.
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Affiliation(s)
- Maria G Prado
- Department of Family Medicine, University of Washington, Seattle, Washington, USA
| | - Larry G Kessler
- Health Services, University of Washington, Seattle, Washington, USA
| | - Margaret A Au
- Department of Family Medicine, University of Washington, Seattle, Washington, USA
| | - Hannah A Burkhardt
- Department of Biomedical Informatics and Medical Education, University of Washington, Seattle, Washington, USA
| | | | - Lesleigh Kowalski
- Department of Family Medicine, University of Washington, Seattle, Washington, USA
| | - Kari A Stephens
- Department of Family Medicine, University of Washington, Seattle, Washington, USA
| | - Meliha Yetisgen
- Department of Biomedical Informatics and Medical Education, University of Washington, Seattle, Washington, USA
| | - Fiona M Walter
- Wolfson Institute of Population Health, Barts and The London School of Medicine and Dentistry, Queen Mary University of London, London, UK
- The Primary Care Unit Department of Public Health and Primary Care, University of Cambridge, Cambridge, UK
| | | | - Kevin Lybarger
- Department of Information Sciences and Technology, George Mason University, Fairfax, Virginia, USA
| | - Caroline A Thompson
- Department of Epidemiology, The University of North Carolina, Chapel Hill, North Carolina, USA
- Division of Epidemiology and Biostatistics, San Diego State University, San Diego, California, USA
| | - Morhaf Al Achkar
- Department of Family Medicine, University of Washington, Seattle, Washington, USA
| | | | - Grace Turner
- Department of Biomedical Informatics and Medical Education, University of Washington, Seattle, Washington, USA
| | - Farhood Farjah
- Department of Surgery, University of Washington, Seattle, Washington, USA
| | - Matthew J Thompson
- Department of Family Medicine, University of Washington, Seattle, Washington, USA
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Weiskopf NG, Dorr DA, Jackson C, Lehmann HP, Thompson CA. Healthcare utilization is a collider: an introduction to collider bias in EHR data reuse. J Am Med Inform Assoc 2023; 30:971-977. [PMID: 36752649 PMCID: PMC10114115 DOI: 10.1093/jamia/ocad013] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2022] [Revised: 12/19/2022] [Accepted: 01/27/2023] [Indexed: 02/09/2023] Open
Abstract
OBJECTIVES Collider bias is a common threat to internal validity in clinical research but is rarely mentioned in informatics education or literature. Conditioning on a collider, which is a variable that is the shared causal descendant of an exposure and outcome, may result in spurious associations between the exposure and outcome. Our objective is to introduce readers to collider bias and its corollaries in the retrospective analysis of electronic health record (EHR) data. TARGET AUDIENCE Collider bias is likely to arise in the reuse of EHR data, due to data-generating mechanisms and the nature of healthcare access and utilization in the United States. Therefore, this tutorial is aimed at informaticians and other EHR data consumers without a background in epidemiological methods or causal inference. SCOPE We focus specifically on problems that may arise from conditioning on forms of healthcare utilization, a common collider that is an implicit selection criterion when one reuses EHR data. Directed acyclic graphs (DAGs) are introduced as a tool for identifying potential sources of bias during study design and planning. References for additional resources on causal inference and DAG construction are provided.
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Affiliation(s)
- Nicole G Weiskopf
- Department of Medical Informatics and Clinical Epidemiology, Oregon Health & Science University, Portland, Oregon, USA
| | - David A Dorr
- Department of Medical Informatics and Clinical Epidemiology, Oregon Health & Science University, Portland, Oregon, USA
| | - Christie Jackson
- Department of Medical Informatics and Clinical Epidemiology, Oregon Health & Science University, Portland, Oregon, USA
| | - Harold P Lehmann
- Division of Health Science Informatics, Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Caroline A Thompson
- Department of Epidemiology, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA.,Division of Cancer Epidemiology, Lineberger Comprehensive Cancer Center, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
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Thompson CA, Stürmer T. Putting GLP-1 RAs and Thyroid Cancer in Context: Additional Evidence and Remaining Doubts. Diabetes Care 2023; 46:249-251. [PMID: 36525594 PMCID: PMC9887624 DOI: 10.2337/dci22-0052] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Affiliation(s)
| | - Til Stürmer
- Department of Epidemiology, Gillings School of Global Public Health, Lineberger Comprehensive Cancer Center, University of North Carolina at Chapel Hill, Chapel Hill, NC
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Zigman Suchsland M, Kowalski L, Burkhardt HA, Prado MG, Kessler LG, Yetisgen M, Au MA, Stephens KA, Farjah F, Schleyer AM, Walter FM, Neal RD, Lybarger K, Thompson CA, Achkar MA, Sarma EA, Turner G, Thompson M. How Timely Is Diagnosis of Lung Cancer? Cohort Study of Individuals with Lung Cancer Presenting in Ambulatory Care in the United States. Cancers (Basel) 2022; 14:cancers14235756. [PMID: 36497238 PMCID: PMC9740627 DOI: 10.3390/cancers14235756] [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] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/20/2022] [Revised: 10/22/2022] [Accepted: 11/16/2022] [Indexed: 11/25/2022] Open
Abstract
The diagnosis of lung cancer in ambulatory settings is often challenging due to non-specific clinical presentation, but there are currently no clinical quality measures (CQMs) in the United States used to identify areas for practice improvement in diagnosis. We describe the pre-diagnostic time intervals among a retrospective cohort of 711 patients identified with primary lung cancer from 2012-2019 from ambulatory care clinics in Seattle, Washington USA. Electronic health record data were extracted for two years prior to diagnosis, and Natural Language Processing (NLP) applied to identify symptoms/signs from free text clinical fields. Time points were defined for initial symptomatic presentation, chest imaging, specialist consultation, diagnostic confirmation, and treatment initiation. Median and interquartile ranges (IQR) were calculated for intervals spanning these time points. The mean age of the cohort was 67.3 years, 54.1% had Stage III or IV disease and the majority were diagnosed after clinical presentation (94.5%) rather than screening (5.5%). Median intervals from first recorded symptoms/signs to diagnosis was 570 days (IQR 273-691), from chest CT or chest X-ray imaging to diagnosis 43 days (IQR 11-240), specialist consultation to diagnosis 72 days (IQR 13-456), and from diagnosis to treatment initiation 7 days (IQR 0-36). Symptoms/signs associated with lung cancer can be identified over a year prior to diagnosis using NLP, highlighting the need for CQMs to improve timeliness of diagnosis.
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Affiliation(s)
| | - Lesleigh Kowalski
- Department of Family Medicine, University of Washington, Seattle, WA 98195, USA
| | - Hannah A. Burkhardt
- Department of Biomedical Informatics and Medical Education, University of Washington, Seattle, WA 98195, USA
| | - Maria G. Prado
- Department of Family Medicine, University of Washington, Seattle, WA 98195, USA
| | - Larry G. Kessler
- Department of Health Systems and Population Health, School of Public Health, University of Washington, Seattle, WA 98195, USA
| | - Meliha Yetisgen
- Department of Biomedical Informatics and Medical Education, University of Washington, Seattle, WA 98195, USA
| | - Maggie A. Au
- Department of Family Medicine, University of Washington, Seattle, WA 98195, USA
| | - Kari A. Stephens
- Department of Family Medicine, University of Washington, Seattle, WA 98195, USA
| | - Farhood Farjah
- Department of Surgery, University of Washington, Seattle, WA 98195, USA
| | | | - Fiona M. Walter
- Wolfson Institute of Population Health, Barts and The London School of Medicine and Dentistry, Queen Mary University of London, London E1 4NS, UK
- The Primary Care Unit, Department of Public Health and Primary Care, University of Cambridge, Cambridge CB1 8RN, UK
| | - Richard D. Neal
- University of Exeter Medical School, University of Exeter, Exeter EX1 2LU, UK
| | - Kevin Lybarger
- Department of Information Sciences and Technology, George Mason University, Fairfax, VA 22039, USA
| | - Caroline A. Thompson
- Department of Epidemiology, Gillings School of Global Public Health, The University of North Carolina at Chapel Hill, Chapel Hill, NC 27599, USA
- Division of Epidemiology and Biostatistics, School of Public Health, San Diego State University, San Diego, CA 92182, USA
| | - Morhaf Al Achkar
- Department of Family Medicine, University of Washington, Seattle, WA 98195, USA
| | - Elizabeth A. Sarma
- Healthcare Delivery Research Program, Division of Cancer Control and Population Sciences, National Cancer Institute, Bethesda, MD 20892, USA
| | - Grace Turner
- Department of Biomedical Informatics and Medical Education, University of Washington, Seattle, WA 98195, USA
| | - Matthew Thompson
- Department of Family Medicine, University of Washington, Seattle, WA 98195, USA
- Correspondence:
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11
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Obrochta CA, Parada H, Murphy JD, Nara A, Trinidad D, Araneta MR(H, Thompson CA. The impact of patient travel time on disparities in treatment for early stage lung cancer in California. PLoS One 2022; 17:e0272076. [PMID: 36197902 PMCID: PMC9534452 DOI: 10.1371/journal.pone.0272076] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2021] [Accepted: 07/12/2022] [Indexed: 12/03/2022] Open
Abstract
BACKGROUND Travel time to treatment facilities may impede the receipt of guideline-concordant treatment (GCT) among patients diagnosed with early-stage non-small cell lung cancer (ES-NSCLC). We investigated the relative contribution of travel time in the receipt of GCT among ES-NSCLC patients. METHODS We included 22,821 ES-NSCLC patients diagnosed in California from 2006-2015. GCT was defined using the 2016 National Comprehensive Cancer Network guidelines, and delayed treatment was defined as treatment initiation >6 versus ≤6 weeks after diagnosis. Mean-centered driving and public transit times were calculated from patients' residential block group centroid to the treatment facilities. We used logistic regression to estimate risk ratios and 95% confidence intervals (CIs) for the associations between patients' travel time and receipt of GCT and timely treatment, overall and by race/ethnicity and neighborhood socioeconomic status (nSES). RESULTS Overall, a 15-minute increase in travel time was associated with a decreased risk of undertreatment and delayed treatment. Compared to Whites, among Blacks, a 15-minute increase in driving time was associated with a 24% (95%CI = 8%-42%) increased risk of undertreatment, and among Filipinos, a 15-minute increase in public transit time was associated with a 27% (95%CI = 13%-42%) increased risk of delayed treatment. Compared to the highest nSES, among the lowest nSES, 15-minute increases in driving and public transit times were associated with 33% (95%CI = 16%-52%) and 27% (95%CI = 16%-39%) increases in the risk of undertreatment and delayed treatment, respectively. CONCLUSION The benefit of GCT observed with increased travel times may be a 'Travel Time Paradox,' and may vary across racial/ethnic and socioeconomic groups.
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Affiliation(s)
- Chelsea A. Obrochta
- San Diego State University, School of Public Health, San Diego, California, United States of America
- University of California San Diego, School of Medicine, La Jolla, California, United States of America
| | - Humberto Parada
- San Diego State University, School of Public Health, San Diego, California, United States of America
- University of California San Diego, Moores Cancer Center, La Jolla, California, United States of America
| | - James D. Murphy
- University of California San Diego, Moores Cancer Center, La Jolla, California, United States of America
| | - Atsushi Nara
- Department of Geography, San Diego State University, San Diego, California, United States of America
| | - Dennis Trinidad
- University of California San Diego, School of Medicine, La Jolla, California, United States of America
| | | | - Caroline A. Thompson
- San Diego State University, School of Public Health, San Diego, California, United States of America
- University of California San Diego, School of Medicine, La Jolla, California, United States of America
- University of California San Diego, Moores Cancer Center, La Jolla, California, United States of America
- Department of Epidemiology, University of North Carolina Gillings School of Global Public Health, Chapel Hill, North Carolina, United States of America
- * E-mail:
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12
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Vallejo B, Quintero-Martinez JA, Mogollon RJ, Cordova-Madera SN, Garcia-Arango M, Nhola LF, Alam MM, Herrmann J, Boddicker NJ, Cerhan JR, Thompson CA, Villarraga HR. Mitral annular plane systolic excursion and global longitudinal strain for the prediction of cardiotoxicity or heart failure in lymphoma patients treated with anthracycline-based chemotherapy. Eur Heart J 2022. [DOI: 10.1093/eurheartj/ehac544.058] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Abstract
Background
Assessing cardiac performance of patients receiving chemotherapy is a cornerstone for adequate cardiovascular care. Mitral annular plane systolic excursion (MAPSE) has been considered as a surrogate for Ejection Fraction (EF). However, little is known about its role in predicting Cardiotoxicity or Heart Failure in Lymphoma patients, as its relationship with Global Longitudinal Strain (GLS) and EF.
Purpose
Our aims were: i) to evaluate if MAPSE and GLS can predict the development of CT and/or HF in lymphoma patients treated with anthracyclines and ii) to evaluate its correlation with GLS and EF.
Methods
For this prospective observational study, 325 Hodgkin (HL) & non-Hodgkin (NHL) lymphoma patients (n=325) treated with anthracyclines were recruited from 2013 to 2021 and followed for 1 year. MAPSE by M-mode and GLS by Speckle-Tracking (ST) were measured at baseline (T0), during treatment (T1), and up to 1 year after chemotherapy completion (T2). CT was defined as a decrease in EF by >10% to a value <50% and HF by a cardiologist as the first occurrence after the initiation of anthracyclines. Logistic regression analyses with Receiving operator characteristics (ROC) and Area under the curve (AUC) were performed. Pearson's correlation coefficient was also calculated. A p-value <0.05 was considered statistically significant.
Results
Two hundred sixty-four patients (81.2%) had NHL and 61 (18.8%) HL. Of these, fifteen (4.6%) and 21 individuals (6.4%) developed CT at T1 and T2, respectively. Nine subjects (2.8%) developed HF at T1 and 14 (4.3%) at T2. MAPSE at T0 had the highest AUC to predict both HF at T1 (AUC=0.865, cut-off 14.9, sensitivity 100%, specificity 63%, p=0.008) and at T2 (AUC=0.757, cut-off 10.9, sensitivity 67%, specificity 93%, p=0.045). This same variable at T1 predicted HF at T2 with an AUC of 0.752 (cut-off 11.4, sensitivity 67%, specificity 94%, p=0.004). For CT prediction at T2, MAPSE at T1 had an AUC of 0.738 (cut-off 12.5, sensitivity 56%, specificity 85%, p<0.0001). GLS at T0 predicted CT at T1 (AUC=0.657, cut-off −19, sensitivity 67%, specificity 63%, p=0.012) and when obtained at T1, it predicted CT at T2 (AUC=0.776, cut-off −17, sensitivity 74%, specificity 75%, p-value <0.0001) (Table 1). Pearson's correlation between MAPSE and GLS at T0 (coefficient −0.25, p=0.023) at T1 (coefficient −0.38, p<0.0001) at T2 (coefficient −0.037, p<0.0001) and MAPSE with EF at T0 (coefficient 0.33, p=0.0002) at T1 (coefficient 0.28, p<0.0001) and T2 (coefficient 0.29, p<0.001).
Conclusions
To our best knowledge, this is the first time that MAPSE and GLS were compared to predict CT and HF in lymphoma patients receiving anthracycline-based chemotherapy; we have demonstrated that MAPSE measured at T0 was a very good predictor of HF at T1. Either MAPSE or GLS assessment at T0 and T1 were able to predict CT or HF. Future studies could explore the combination of these two variables to predict either CT or HF.
Funding Acknowledgement
Type of funding sources: Private hospital(s). Main funding source(s): Department of Cardiovascular Medicine. Mayo Clinic, Rochester-MN
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Affiliation(s)
- B Vallejo
- Mayo Clinic , Rochester , United States of America
| | | | - R J Mogollon
- Mayo Clinic , Rochester , United States of America
| | | | | | - L F Nhola
- Mayo Clinic , Rochester , United States of America
| | - M M Alam
- Mayo Clinic , Rochester , United States of America
| | - J Herrmann
- Mayo Clinic , Rochester , United States of America
| | | | - J R Cerhan
- Mayo Clinic , Rochester , United States of America
| | - C A Thompson
- Mayo Clinic , Rochester , United States of America
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13
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Quintero-Martinez JA, Nhola LF, Alam MM, Vallejo BA, Mogollon RJ, Garcia-Arango M, Cordova-Madera SN, Herrmann J, Boddicker NJ, Cerhan JR, Thompson CA, Villarraga HR. Basic or comprehensive strain analyses, which variable is better to predict hard endpoints as clinical heart failure in lymphoma patients receiving anthracyclines. Eur Heart J 2022. [DOI: 10.1093/eurheartj/ehac544.059] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Abstract
Background
Speckle tracking echocardiography (STE) has shown to be a good tool to foresee early myocardial dysfunction in lymphoma patients who receive anthracycline based chemotherapy. Conventional STE such as global longitudinal strain (GLS) is a good predictor of cardiotoxicity in these patients, however, a more in-depth characterization of conventional and comprehensive STE parameters to predict a hard end-point as chemotherapeutic related heart failure (HF) has not been evaluated.
Purpose
The aim of this prospective study was to evaluate predictability of cancer therapeutic-related clinical HF by conventional and comprehensive STE.
Methods
We enrolled 269 Hodgkin & non-Hodgkin lymphoma patients who underwent chemotherapy at Mayo Clinic from 2013 through 2021. All patients had an echocardiogram performed at baseline (T0), during chemotherapy (T1) and after (T2). HF was diagnosed by a cardiologist and defined as the first occurrence after the initiation of chemotherapy. Conventional (GLS) and comprehensive strain analyses that included: global circumferential strain (GCS), global radial strain (GRS), global longitudinal early diastolic strain rate (GLSRe), global longitudinal systolic strain rate (GLSRs), global circumferential early diastolic strain rate (GCSRe), global circumferential systolic strain rate (GCSRs), global radial early diastolic strain rate (GRSRe), and global radial systolic strain rate (GRSRs), were performed offline. Logistic regression analyses were used to evaluate the association of 2D and 3D STE measurements with the development of clinical HF.
Results
Overall, 215 (79.9%) patients had non-Hodgkin lymphoma while 54 (20.1%) had Hodgkin lymphoma. Mean age was 58.4±16.1 years and 64.7% of the patients were males. The most prevalent comorbidities were hypertension (101/37.5%), dyslipidemia (87/32.3%) and diabetes (28/10.4%). HF occurred in 21 (7.8%) patients, including 9 (3.3%) during chemotherapy and 12 (4.5%) after chemotherapy. The best predictors of HF were: i) GLSRe and GCSRs performed at baseline (T0) to predict HF at T1 with an AUC of 0.85 each and p values of 0.0006 and 0.0005 respectively (Table 1); ii) GCSRs and GCS at baseline (T0) to predict HF at T1 or T2 with AUCs of 0.82 (p, <0.0001) and 0.81 (p, 0.0004), respectively. Basic strain (GLS) was able to predict HF when measured at T0 but not when measured at T1. All the AUCs for GLS were below 0.75 (Figure 1).
Conclusions
To our knowledge this is the first study to evaluate the use of conventional and comprehensive STE to predict a hard end-point as heart failure in patients with lymphoma who received anthracyclines. Comprehensive STE measurements as GLSRs, GLSRe, GCS, GCSRs and GCSRe are better than GLS to predict HF in patients with lymphoma who received anthracycline based chemotherapy. These findings can be crucial for the management of these patients by guiding when to start cardioprotection and/or avoid interruptions of cancer treatment.
Funding Acknowledgement
Type of funding sources: Private hospital(s). Main funding source(s): Department of cardiovascular diseases, Mayo Clinic, Rochester, MN
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Affiliation(s)
| | - L F Nhola
- Mayo Clinic , Rochester , United States of America
| | - M M Alam
- Mayo Clinic , Rochester , United States of America
| | - B A Vallejo
- Mayo Clinic , Rochester , United States of America
| | - R J Mogollon
- Mayo Clinic , Rochester , United States of America
| | | | | | - J Herrmann
- Mayo Clinic , Rochester , United States of America
| | | | - J R Cerhan
- Mayo Clinic , Rochester , United States of America
| | - C A Thompson
- Mayo Clinic , Rochester , United States of America
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14
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Nelson TJ, Thompson CA, Zou J, Kumar A, Sangchan P, Williamson CW, Vitzthum LK, Sharabi AB, Murphy JD, Fakhry CA, Mell LK. Validation of NRG Oncology's prognostic nomograms for oropharyngeal cancer in the Veterans Affairs database. Cancer 2022; 128:1948-1957. [PMID: 35194791 DOI: 10.1002/cncr.34141] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2021] [Accepted: 12/25/2021] [Indexed: 01/31/2023]
Abstract
BACKGROUND To test whether nomograms developed by NRG Oncology for oropharyngeal squamous cell carcinoma (OPSCC) patients could be validated in an independent population-based sample. METHODS The authors tested nomograms for estimating progression-free survival (PFS) and overall survival (OS) in patients from the Veterans Health Administration with previously untreated locoregionally advanced OPSCC, diagnosed between 2008 and 2017, managed with definitive radiotherapy with or without adjuvant systemic therapy. Covariates were age, performance status, p16 status, T/N category, smoking history, education history, weight loss, marital status, and anemia. We used multiple imputation to handle missing data and performed sensitivity analyses on complete cases. Validation was assessed via Cox proportional hazards models, log-rank tests, and c-indexes. RESULTS A total of 4007 patients met inclusion criteria (658 patients had complete data). Median follow-up time was 3.20 years, with 967 progression events and 471 noncancer deaths. Each risk score was associated with poorer outcomes per unit increase (PFS score, hazard ratio [HR], 1.42 [1.37-1.47]; OS score, HR, 1.40 [1.34-1.45]). By risk score quartile, 2-year PFS estimates were 89.2%, 78.5%, 65.8%, and 48.3%; OS estimates were 92.6%, 83.6%, 73.9%, and 51.3%, respectively (P < .01 for all comparisons). C-indices for models of PFS and OS were 0.65 and 0.67, for all patients, respectively (0.69 and 0.73 for complete cases). The nomograms slightly overestimated PFS and OS in the overall cohort but exhibited high agreement in complete cases. CONCLUSIONS NRG nomograms were effective for predicting PFS and OS for patients with OPSCC, supporting their broader applicability in the OPSCC population undergoing definitive radiotherapy.
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Affiliation(s)
- Tyler J Nelson
- Department of Radiation Medicine & Applied Sciences, University of California, San Diego, La Jolla, California.,La Jolla Center for Precision Radiation Medicine, La Jolla, California.,Veterans Health Administration, San Diego Health Care System, La Jolla, California
| | - Caroline A Thompson
- Division of Epidemiology and Biostatistics, San Diego State University School of Public Health, San Diego, California
| | - Jingjing Zou
- Herbert Wertheim School of Public Health and Human Longevity Science, University of California, San Diego, La Jolla, California
| | - Abhishek Kumar
- Department of Radiation Medicine & Applied Sciences, University of California, San Diego, La Jolla, California.,Veterans Health Administration, San Diego Health Care System, La Jolla, California
| | - Prangrawee Sangchan
- Division of Radiation Oncology, Faculty of Medicine, Thammasat University, Pathum Thani, Thailand
| | - Casey W Williamson
- Department of Radiation Medicine & Applied Sciences, University of California, San Diego, La Jolla, California.,Veterans Health Administration, San Diego Health Care System, La Jolla, California
| | - Lucas K Vitzthum
- Department of Radiation Oncology, Stanford University, Stanford, California
| | - Andrew B Sharabi
- Department of Radiation Medicine & Applied Sciences, University of California, San Diego, La Jolla, California.,La Jolla Center for Precision Radiation Medicine, La Jolla, California
| | - James D Murphy
- Department of Radiation Medicine & Applied Sciences, University of California, San Diego, La Jolla, California.,Veterans Health Administration, San Diego Health Care System, La Jolla, California
| | - Carole A Fakhry
- Department of Otolaryngology Head and Neck Surgery, Johns Hopkins University, Baltimore, Maryland
| | - Loren K Mell
- Department of Radiation Medicine & Applied Sciences, University of California, San Diego, La Jolla, California.,La Jolla Center for Precision Radiation Medicine, La Jolla, California
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15
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Williamson CW, Nelson T, Thompson CA, Vitzthum LK, Zakeri K, Riviere P, Bryant AK, Sharabi AB, Zou J, Mell LK. Bias Reduction through Analysis of Competing Events (BRACE) Correction to Address Cancer Treatment Selection Bias in Observational Data. Clin Cancer Res 2022; 28:1832-1840. [PMID: 35140122 DOI: 10.1158/1078-0432.ccr-21-2468] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2021] [Revised: 10/24/2021] [Accepted: 02/07/2022] [Indexed: 11/16/2022]
Abstract
BACKGROUND Cancer treatments can paradoxically appear to reduce the risk of non-cancer mortality in observational studies, due to residual confounding. Here we introduce a method, Bias Reduction through Analysis of Competing Events (BRACE), to reduce bias in the presence of residual confounding. METHODS BRACE is a novel method for adjusting for bias from residual confounding in proportional hazards models. Using standard simulation methods, we compared BRACE vs. Cox proportional hazards regression in the presence of an unmeasured confounder. We examined estimator distributions, bias, mean squared error (MSE), and coverage probability. We then estimated treatment effects of high vs. low intensity treatments in 36,630 prostate cancer, 4,069 lung cancer, and 7,117 head/neck cancer patients, using the Veterans Affairs database. We analyzed treatment effects on cancer-specific mortality (CSM), non-cancer mortality (NCM), and overall survival (OS), using conventional multivariable Cox and propensity score (adjusted using inverse probability weighting) models, vs. BRACE-adjusted estimates. RESULTS In simulations with residual confounding, BRACE uniformly reduced both bias and MSE. In the absence of bias, BRACE introduced bias toward the null, albeit with lower MSE. BRACE markedly improved coverage probability, but with a tendency toward overcorrection for effective but non-toxic treatments. For each clinical cohort, more intensive treatments were associated with significantly reduced hazards for CSM, NCM, and OS. BRACE attenuated OS estimates, yielding results more consistent with findings from randomized trials and meta-analyses. CONCLUSIONS BRACE reduces bias and MSE when residual confounding is present and represents a novel approach to improve treatment effect estimation in non-randomized studies.
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Affiliation(s)
| | - Tyler Nelson
- Radiation Medicine and Applied Sciences, UC San Diego
| | | | - Lucas K Vitzthum
- Department of Radiation Medicine and Applied Sciences, University of California, San Diego
| | - Kaveh Zakeri
- Radiation Oncology, Memorial Sloan Kettering Cancer Center
| | - Paul Riviere
- Radiation Medicine and Applied Sciences, UC San Diego Health System
| | | | - Andrew B Sharabi
- Radiation Medicine and Applied Sciences, University of California, San Diego
| | - Jingjing Zou
- Department of Family Medicine and Public Health and Department of Mathematics, UC San Diego
| | - Loren K Mell
- Radiation Medicine and Applied Sciences, University of California, San Diego
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16
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Sangaramoorthy M, Yang J, Guan A, DeRouen MC, Tana MM, Somsouk M, Thompson CA, Gibbons J, Ho C, Chu JN, Cheng I, Gomez SL, Shariff-Marco S. Asian American/Pacific Islander and Hispanic Ethnic Enclaves, Neighborhood Socioeconomic Status, and Hepatocellular Carcinoma Incidence in California: An Update. Cancer Epidemiol Biomarkers Prev 2022; 31:382-392. [PMID: 34853019 PMCID: PMC8825691 DOI: 10.1158/1055-9965.epi-21-1035] [Citation(s) in RCA: 8] [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: 08/31/2021] [Revised: 10/19/2021] [Accepted: 11/23/2021] [Indexed: 11/16/2022] Open
Abstract
BACKGROUND Using more recent cancer registry data, we analyzed disparities in hepatocellular carcinoma (HCC) incidence by ethnic enclave and neighborhood socioeconomic status (nSES) among Asian American/Pacific Islander (AAPI) and Hispanic populations in California. METHODS Primary, invasive HCC cases were identified from the California Cancer Registry during 1988-1992, 1998-2002, and 2008-2012. Age-adjusted incidence rates (per 100,000 population), incidence rate ratios, and corresponding 95% confidence intervals were calculated for AAPI or Hispanic enclave, nSES, and the joint effects of ethnic enclave and nSES by time period (and the combination of the three periods), sex, and race/ethnicity. RESULTS In the combined time period, HCC risk increased 25% for highest versus lowest quintile of AAPI enclave among AAPI males. HCC risk increased 22% and 56% for lowest versus highest quintile of nSES among AAPI females and males, respectively. In joint analysis, AAPI males living in low nSES areas irrespective of enclave status were at 17% to 43% increased HCC risk compared with AAPI males living in areas of nonenclave/high nSES. HCC risk increased by 22% for Hispanic females living in areas of low nSES irrespective of enclave status and by 19% for Hispanic males living in areas of nonenclave/low nSES compared with their counterparts living in areas of nonenclave/high nSES. CONCLUSIONS We found significant variation in HCC incidence by ethnic enclave and nSES among AAPI and Hispanic populations in California by sex and time period. IMPACT Future studies should explore how specific attributes of enclaves and nSES impact HCC risk for AAPI and Hispanic populations.
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Affiliation(s)
- Meera Sangaramoorthy
- Greater Bay Area Cancer Registry, University of California San Francisco, San Francisco, California
- Department of Epidemiology and Biostatistics, School of Medicine, University of California San Francisco, San Francisco, California
| | - Juan Yang
- Greater Bay Area Cancer Registry, University of California San Francisco, San Francisco, California
- Department of Epidemiology and Biostatistics, School of Medicine, University of California San Francisco, San Francisco, California
| | - Alice Guan
- Department of Epidemiology and Biostatistics, School of Medicine, University of California San Francisco, San Francisco, California
| | - Mindy C DeRouen
- Greater Bay Area Cancer Registry, University of California San Francisco, San Francisco, California
- Department of Epidemiology and Biostatistics, School of Medicine, University of California San Francisco, San Francisco, California
- Helen Diller Family Comprehensive Cancer Center, University of California San Francisco, San Francisco, California
| | - Michele M Tana
- Division of Gastroenterology at Zuckerberg San Francisco General, University of California San Francisco, San Francisco, California
| | - Ma Somsouk
- Helen Diller Family Comprehensive Cancer Center, University of California San Francisco, San Francisco, California
- Division of Gastroenterology at Zuckerberg San Francisco General, University of California San Francisco, San Francisco, California
| | - Caroline A Thompson
- School of Public Health, San Diego State University, San Diego, California
- Herbert Wertheim School of Public Health and Human Longevity Science, University of California San Diego, La Jolla, California
| | - Joseph Gibbons
- Department of Sociology, College of Arts and Letters, San Diego State University, San Diego, California
| | - Chanda Ho
- Department of Transplantation, California Pacific Medical Center, San Francisco, California
| | - Janet N Chu
- Department of Medicine, School of Medicine, University of California, San Francisco, San Francisco, California
| | - Iona Cheng
- Greater Bay Area Cancer Registry, University of California San Francisco, San Francisco, California
- Department of Epidemiology and Biostatistics, School of Medicine, University of California San Francisco, San Francisco, California
- Helen Diller Family Comprehensive Cancer Center, University of California San Francisco, San Francisco, California
| | - Scarlett Lin Gomez
- Greater Bay Area Cancer Registry, University of California San Francisco, San Francisco, California
- Department of Epidemiology and Biostatistics, School of Medicine, University of California San Francisco, San Francisco, California
- Helen Diller Family Comprehensive Cancer Center, University of California San Francisco, San Francisco, California
| | - Salma Shariff-Marco
- Greater Bay Area Cancer Registry, University of California San Francisco, San Francisco, California.
- Department of Epidemiology and Biostatistics, School of Medicine, University of California San Francisco, San Francisco, California
- Helen Diller Family Comprehensive Cancer Center, University of California San Francisco, San Francisco, California
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17
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DeRouen MC, Canchola AJ, Thompson CA, Jin A, Nie S, Wong C, Lichtensztajn D, Allen L, Patel MI, Daida YG, Luft HS, Shariff-Marco S, Reynolds P, Wakelee HA, Liang SY, Waitzfelder BE, Cheng I, Gomez SL. Incidence of Lung Cancer Among Never-Smoking Asian American, Native Hawaiian, and Pacific Islander Females. J Natl Cancer Inst 2022; 114:78-86. [PMID: 34345919 PMCID: PMC8755498 DOI: 10.1093/jnci/djab143] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2021] [Revised: 06/17/2021] [Accepted: 07/16/2021] [Indexed: 01/29/2023] Open
Abstract
BACKGROUND Although lung cancer incidence rates according to smoking status, sex, and detailed race/ethnicity have not been available, it is estimated that more than half of Asian American, Native Hawaiian, and Pacific Islander (AANHPI) females with lung cancer have never smoked. METHODS We calculated age-adjusted incidence rates for lung cancer according to smoking status and detailed race/ethnicity among females, focusing on AANHPI ethnic groups, and assessed relative incidence across racial/ethnic groups. We used a large-scale dataset that integrates data from electronic health records from 2 large health-care systems-Sutter Health in Northern California and Kaiser Permanente Hawai'i-linked to state cancer registries for incident lung cancer diagnoses between 2000 and 2013. The study population included 1 222 694 females (n = 244 147 AANHPI), 3297 of which were diagnosed with lung cancer (n = 535 AANHPI). RESULTS Incidence of lung cancer among never-smoking AANHPI as an aggregate group was 17.1 per 100 000 (95% confidence interval [CI] = 14.9 to 19.4) but varied widely across ethnic groups. Never-smoking Chinese American females had the highest rate (22.8 per 100 000, 95% CI = 17.3 to 29.1). Except for Japanese American females, incidence among every never-smoking AANHPI female ethnic group was higher than that of never-smoking non-Hispanic White females, from 66% greater among Native Hawaiian females (incidence rate ratio = 1.66, 95% CI = 1.03 to 2.56) to more than 100% greater among Chinese American females (incidence rate ratio = 2.26, 95% CI = 1.67 to 3.02). CONCLUSIONS Our study revealed high rates of lung cancer among most never-smoking AANHPI female ethnic groups. Our approach illustrates the use of innovative data integration to dispel the myth that AANHPI females are at overall reduced risk of lung cancer and demonstrates the need to disaggregate this highly diverse population.
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Affiliation(s)
- Mindy C DeRouen
- Department of Epidemiology and Biostatistics, University of California San Francisco, San Francisco, CA, USA
- Helen Diller Family Comprehensive Cancer Center, University of California San Francisco, San Francisco, CA, USA
| | - Alison J Canchola
- Department of Epidemiology and Biostatistics, University of California San Francisco, San Francisco, CA, USA
- Greater Bay Area Cancer Registry, University of California San Francisco, CA, USA
| | - Caroline A Thompson
- San Diego State University School of Public Health, San Diego, CA, USA
- University of California San Diego School of Medicine, San Diego, CA, USA
- Sutter Health Palo Alto Medical Foundation Research Institute, Palo Alto, CA, USA
| | - Anqi Jin
- Sutter Health Palo Alto Medical Foundation Research Institute, Palo Alto, CA, USA
| | - Sixiang Nie
- Kaiser Permanente Hawai’i Center for Integrated Health Care Research, Honolulu, HI, USA
| | - Carmen Wong
- Kaiser Permanente Hawai’i Center for Integrated Health Care Research, Honolulu, HI, USA
| | - Daphne Lichtensztajn
- Department of Epidemiology and Biostatistics, University of California San Francisco, San Francisco, CA, USA
- Greater Bay Area Cancer Registry, University of California San Francisco, CA, USA
| | - Laura Allen
- Department of Epidemiology and Biostatistics, University of California San Francisco, San Francisco, CA, USA
| | | | - Yihe G Daida
- Kaiser Permanente Hawai’i Center for Integrated Health Care Research, Honolulu, HI, USA
| | - Harold S Luft
- Sutter Health Palo Alto Medical Foundation Research Institute, Palo Alto, CA, USA
| | - Salma Shariff-Marco
- Department of Epidemiology and Biostatistics, University of California San Francisco, San Francisco, CA, USA
- Helen Diller Family Comprehensive Cancer Center, University of California San Francisco, San Francisco, CA, USA
- Greater Bay Area Cancer Registry, University of California San Francisco, CA, USA
| | - Peggy Reynolds
- Department of Epidemiology and Biostatistics, University of California San Francisco, San Francisco, CA, USA
- Helen Diller Family Comprehensive Cancer Center, University of California San Francisco, San Francisco, CA, USA
| | - Heather A Wakelee
- Division of Oncology, Department of Medicine, Stanford University School of Medicine, Stanford, CA, USA
| | - Su-Ying Liang
- Sutter Health Palo Alto Medical Foundation Research Institute, Palo Alto, CA, USA
| | - Beth E Waitzfelder
- Kaiser Permanente Hawai’i Center for Integrated Health Care Research, Honolulu, HI, USA
| | - Iona Cheng
- Department of Epidemiology and Biostatistics, University of California San Francisco, San Francisco, CA, USA
- Helen Diller Family Comprehensive Cancer Center, University of California San Francisco, San Francisco, CA, USA
- Greater Bay Area Cancer Registry, University of California San Francisco, CA, USA
| | - Scarlett L Gomez
- Department of Epidemiology and Biostatistics, University of California San Francisco, San Francisco, CA, USA
- Helen Diller Family Comprehensive Cancer Center, University of California San Francisco, San Francisco, CA, USA
- Greater Bay Area Cancer Registry, University of California San Francisco, CA, USA
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DeRouen MIC, Canchola AJ, Thompson CA, Jin A, Nie S, Wong C, Lichtensztajn D, Allen L, Patel MI, Daida YG, Luft HS, Shariff-Marco S, Reynolds P, Wakelee HA, Liang SY, Waitzfelder BE, Cheng I, Gomez SL. Abstract IA-21: Applying a data integrative and convergence epidemiology approach to study multilevel risk factors for cancer in distinct AANHPI populations. Cancer Epidemiol Biomarkers Prev 2022. [DOI: 10.1158/1538-7755.disp21-ia-21] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Abstract
Background: For Asian American, Native Hawaiian and Pacific Islander (AANHPI) females, lung cancer is one of the most common cancers and the leading cause of cancer death. More than half of lung cancers among AANHPI females occur among never-smokers, but incidence rates of lung cancer according to smoking status have not been available. Purpose: With a large, integrated dataset of electronic health record data from two healthcare systems—Sutter Health in Northern California and Kaiser Permanente Hawai'i—linked to state cancer registry data on incident lung cancer diagnoses 2000-2013, we describe incidence of lung cancer according to smoking status among females across detailed race and ethnicity. Methods: We calculated age-adjusted incidence rates for lung cancer according to smoking status and detailed race and ethnicity among females, focusing on AANHPI ethnic groups, and assessed relative incidence across racial and ethnic groups. The study population included N=1,222,694 females (n=244,147 AANHPI), n=3,297 (n=535) of whom were diagnosed with lung cancer. We examined relative incidence across group defined by detailed race and ethnicity. We also provided incidence of lung cancer among AANHPI males who never smoked in a supplement. Results: Among AANHPI female groups, proportions of lung cancers among never-smokers ranged from 25% among Native Hawaiian to 80% among Chinese females. Incidence of lung cancer among never-smoking AANHPI females as an aggregate was 17.1 per 100,000 (95% CI: 14.9, 19.4), but rates varied widely across ethnic groups. Never-smoking Chinese females had the highest rate (22.8; 95% CI: 17.3, 29.1). Except for Japanese females, incidence among every never-smoking AANHPI female ethnic group was higher than that of all never-smoking females combined. Never-smoking AANHPI males also have higher incidence of lung cancer compared to other groups defined by race and ethnicity. Conclusions: The integrative data analysis approach offers great advantages over traditional cancer cohorts, but it does require substantial time and effort to assure data confidentiality, integrity, and transparency to provide robust results. However, with convergence epidemiology—in this case leveraging needed expertise in data science and analysis to answer an epidemiology question—it is also a valuable approach to study disparate cancer outcomes among small populations. Illustrating this, our study is the first to document high rates of lung cancer among never-smoking AANHPI ethnic groups, dispels the myth that AANHPI females are at overall reduced risk of lung cancer, and demonstrates the need to disaggregate this highly diverse population. Results should inform lung cancer prevention strategies among AANHPI populations.
Citation Format: MIndy C. DeRouen, Alison J. Canchola, Caroline A. Thompson, Anqi Jin, Sixiang Nie, Carmen Wong, Daphne Lichtensztajn, Laura Allen, Manali I. Patel, Yihe G. Daida, Harold S. Luft, Salma Shariff-Marco, Peggy Reynolds, Heather A. Wakelee, Su-Ying Liang, Beth E. Waitzfelder, Iona Cheng, Scarlett L. Gomez. Applying a data integrative and convergence epidemiology approach to study multilevel risk factors for cancer in distinct AANHPI populations [abstract]. In: Proceedings of the AACR Virtual Conference: 14th AACR Conference on the Science of Cancer Health Disparities in Racial/Ethnic Minorities and the Medically Underserved; 2021 Oct 6-8. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2022;31(1 Suppl):Abstract nr IA-21.
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Affiliation(s)
| | | | | | - Anqi Jin
- 3Sutter Health Palo Alto Medical Foundation Research Institute, Palo Alto, CA,
| | - Sixiang Nie
- 4Kaiser Permanente Hawai'i Center for Integrated Health Care Research, Honolulu, HI,
| | - Carmen Wong
- 4Kaiser Permanente Hawai'i Center for Integrated Health Care Research, Honolulu, HI,
| | | | - Laura Allen
- 1University of California, San Francisco, San Francisco, CA,
| | | | - Yihe G. Daida
- 4Kaiser Permanente Hawai'i Center for Integrated Health Care Research, Honolulu, HI,
| | - Harold S. Luft
- 3Sutter Health Palo Alto Medical Foundation Research Institute, Palo Alto, CA,
| | | | - Peggy Reynolds
- 1University of California, San Francisco, San Francisco, CA,
| | | | - Su-Ying Liang
- 3Sutter Health Palo Alto Medical Foundation Research Institute, Palo Alto, CA,
| | - Beth E. Waitzfelder
- 6Kaiser Permanente Hawai'i Center for Integrated Health Care Research, Honolulu, CA
| | - Iona Cheng
- 1University of California, San Francisco, San Francisco, CA,
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Tripathi O, He Y, Han BY, Paragas DG, Sharp N, Dan S, Srinivasan M, Palaniappan LP, Thompson CA. Cancer Mortality in U.S.-Born versus Foreign-Born Asian American Groups (2008-2017). Cancer Epidemiol Biomarkers Prev 2022; 31:58-65. [PMID: 34697057 PMCID: PMC8767961 DOI: 10.1158/1055-9965.epi-21-0359] [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] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2021] [Revised: 06/23/2021] [Accepted: 10/05/2021] [Indexed: 12/24/2022] Open
Abstract
BACKGROUND Asian Americans (AA) are the fastest growing ethnic group in the United States with high proportions of immigrants. Nativity is important as cancer risk factors vary by country. We sought to understand differences in cancer mortality among AAs by nativity (foreign-born vs. U.S.-born). METHODS Ninety-eight thousand eight hundred and twenty-six AA (Asian Indian, Chinese, Filipino, Japanese, Korean, Vietnamese) decedents with cancer-related deaths from U.S. death certificates (2008-2017) were analyzed. Thirteen cancers that contribute significantly to Asian-American cancer mortality were selected and categorized by etiology: tobacco-related, screen-detected, diet-/obesity-related, and infection-related. Ten-year age-adjusted mortality rates [AAMR; 95% confidence interval (CI); per 100,00] and standardized mortality ratios (SMR; 95% CI) using foreign-born as the reference group were calculated. RESULTS Overall, foreign-born AAs had higher mortality rates than U.S.-born. Japanese U.S.-born males had the highest tobacco-related mortality rates [foreign-born AAMR: 43.02 (38.72, 47.31); U.S.-born AAMR: 55.38 (53.05, 57.72)]. Screen-detected death rates were higher for foreign-born than U.S.-born, except for among Japanese males [SMR 1.28 (1.21-1.35)]. Diet-/obesity-related AAMRs were higher among females than males and highest among foreign-born females. Foreign-born males and females had higher infection-related AAMRs than U.S.-born; the highest rates were foreign-born males-Korean [AAMR 41.54 (39.54, 43.53)] and Vietnamese [AAMR 41.39 (39.68, 43.09)]. CONCLUSIONS We observed substantial heterogeneity in mortality rates across AA groups and by nativity. Contrary to the Healthy Immigrant Effect, most foreign-born Asians were dying at higher rates than U.S.-born AAs. IMPACT Disaggregated analysis of AA cancers, targeted and culturally tailored cancer screening, and treatments for infections among foreign-born Asians is critical for cancer prevention efforts.
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Affiliation(s)
- Osika Tripathi
- The Herbert Wertheim School of Public Health and Human Longevity Science, University of California, San Diego, La Jolla, California
- San Diego State University School of Public Health, San Diego, California
- Center for Asian Health Research and Education, Stanford Medicine, Stanford University, Stanford, California
| | - Yuelin He
- Center for Asian Health Research and Education, Stanford Medicine, Stanford University, Stanford, California
- Computational and Systems Biology, University of California, Los Angeles, Westwood, California
| | - Bridgette Y Han
- Center for Asian Health Research and Education, Stanford Medicine, Stanford University, Stanford, California
- Trinity College of Arts and Sciences, Duke University, Durham, North Carolina
| | - Darynn G Paragas
- Center for Asian Health Research and Education, Stanford Medicine, Stanford University, Stanford, California
- College of Architecture, Arts and Humanities, Clemson University, Clemson, South Carolina
- College of Behavioral, Social and Health Sciences, Clemson University, Clemson, South Carolina
| | - Nora Sharp
- Center for Asian Health Research and Education, Stanford Medicine, Stanford University, Stanford, California
- Computational and Systems Biology, University of California, Los Angeles, Westwood, California
| | - Shozen Dan
- Center for Asian Health Research and Education, Stanford Medicine, Stanford University, Stanford, California
| | - Malathi Srinivasan
- Center for Asian Health Research and Education, Stanford Medicine, Stanford University, Stanford, California
- Department of Medicine, Stanford Medicine, Stanford University, Stanford, California
| | - Latha P Palaniappan
- Center for Asian Health Research and Education, Stanford Medicine, Stanford University, Stanford, California
- Department of Medicine, Stanford Medicine, Stanford University, Stanford, California
| | - Caroline A Thompson
- The Herbert Wertheim School of Public Health and Human Longevity Science, University of California, San Diego, La Jolla, California.
- San Diego State University School of Public Health, San Diego, California
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20
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Thompson CA, Begi T, Parada H. Alarming recent rises in early-onset colorectal cancer. Cancer 2021; 128:230-233. [PMID: 34529834 DOI: 10.1002/cncr.33919] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2021] [Revised: 08/16/2021] [Accepted: 08/30/2021] [Indexed: 02/06/2023]
Affiliation(s)
- Caroline A Thompson
- Division of Epidemiology and Biostatistics, San Diego State University School of Public Health, San Diego, California.,Herbert Wertheim School of Public Health and Human Longevity Science, University of California San Diego, La Jolla, California
| | - Talia Begi
- Division of Epidemiology and Biostatistics, San Diego State University School of Public Health, San Diego, California
| | - Humberto Parada
- Division of Epidemiology and Biostatistics, San Diego State University School of Public Health, San Diego, California.,Moores Cancer Center, University of California San Diego, La Jolla, California.,Department of Radiation Medicine and Applied Science, University of California San Diego, La Jolla, California
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21
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Obrochta CA, Murphy JD, Tsou MH, Thompson CA. Disentangling Racial, Ethnic, and Socioeconomic Disparities in Treatment for Colorectal Cancer. Cancer Epidemiol Biomarkers Prev 2021; 30:1546-1553. [PMID: 34108139 PMCID: PMC8338765 DOI: 10.1158/1055-9965.epi-20-1728] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [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: 12/07/2020] [Revised: 02/12/2021] [Accepted: 05/26/2021] [Indexed: 01/05/2023] Open
Abstract
BACKGROUND Colorectal cancer is curable if diagnosed early and treated properly. Black and Hispanic patients with colorectal cancer are more likely to experience treatment delays and/or receive lower standards of care. Socioeconomic deprivation may contribute to these disparities, but this has not been extensively quantified. We studied the interrelationship between patient race/ethnicity and neighborhood socioeconomic status (nSES) on receipt of timely appropriate treatment among patients with colorectal cancer in California. METHODS White, Black, and Hispanic patients (26,870) diagnosed with stage I-III colorectal cancer (2009-2013) in the California Cancer Registry were included. Logistic regression models were used to examine the association of race/ethnicity and nSES with three outcomes: undertreatment, >60-day treatment delay, and >90-day treatment delay. Joint effect models and mediation analysis were used to explore the interrelationships between race/ethnicity and nSES. RESULTS Hispanics and Blacks were at increased risk for undertreatment [Black OR = 1.39; 95% confidence interval (CI) = 1.23-1.57; Hispanic OR = 1.17; 95% CI = 1.08-1.27] and treatment delay (Black/60-day OR = 1.78; 95% CI = 1.57-2.02; Hispanic/60-day OR = 1.50; 95% CI = 1.38-1.64) compared with Whites. Of the total effect (OR = 1.15; 95% CI = 1.07-1.24) of non-white race on undertreatment, 45.71% was explained by nSES. CONCLUSIONS Lower nSES patients of any race were at substantially higher risk for undertreatment and treatment delay, and racial/ethnic disparities are reduced or eliminated among non-white patients living in the highest SES neighborhoods. Racial and ethnic disparities persisted after accounting for neighborhood socioeconomic status, and between the two, race/ethnicity explained a larger portion of the total effects. IMPACT This research improves our understanding of how socioeconomic deprivation contributes to racial/ethnic disparities in colorectal cancer.
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Affiliation(s)
- Chelsea A Obrochta
- School of Public Health, San Diego State University, San Diego, California
- University of California San Diego, School of Medicine, San Diego, California
| | - James D Murphy
- University of California San Diego, Moores Cancer Center, San Diego, California
| | - Ming-Hsiang Tsou
- Department of Geography, San Diego State University, San Diego, California
- Center for Human Dynamics in the Mobile Age, San Diego State University, San Diego, California
| | - Caroline A Thompson
- School of Public Health, San Diego State University, San Diego, California.
- University of California San Diego, School of Medicine, San Diego, California
- University of California San Diego, Moores Cancer Center, San Diego, California
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22
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DeRouen MC, Thompson CA, Canchola AJ, Jin A, Nie S, Wong C, Jain J, Lichtensztajn DY, Li Y, Allen L, Patel MI, Daida YG, Luft HS, Shariff-Marco S, Reynolds P, Wakelee HA, Liang SY, Waitzfelder BE, Cheng I, Gomez SL. Integrating Electronic Health Record, Cancer Registry, and Geospatial Data to Study Lung Cancer in Asian American, Native Hawaiian, and Pacific Islander Ethnic Groups. Cancer Epidemiol Biomarkers Prev 2021; 30:1506-1516. [PMID: 34001502 PMCID: PMC8530225 DOI: 10.1158/1055-9965.epi-21-0019] [Citation(s) in RCA: 6] [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] [Subscribe] [Scholar Register] [Received: 01/11/2021] [Revised: 03/18/2021] [Accepted: 05/12/2021] [Indexed: 11/16/2022] Open
Abstract
BACKGROUND A relatively high proportion of Asian American, Native Hawaiian, and Pacific Islander (AANHPI) females with lung cancer have never smoked. We used an integrative data approach to assemble a large-scale cohort to study lung cancer risk among AANHPIs by smoking status with attention to representation of specific AANHPI ethnic groups. METHODS We leveraged electronic health records (EHRs) from two healthcare systems-Sutter Health in northern California and Kaiser Permanente Hawai'i-that have high representation of AANHPI populations. We linked EHR data on lung cancer risk factors (i.e., smoking, lung diseases, infections, reproductive factors, and body size) to data on incident lung cancer diagnoses from statewide population-based cancer registries of California and Hawai'i for the period between 2000 and 2013. Geocoded address data were linked to data on neighborhood contextual factors and regional air pollutants. RESULTS The dataset comprises over 2.2 million adult females and males of any race/ethnicity. Over 250,000 are AANHPI females (19.6% of the female study population). Smoking status is available for over 95% of individuals. The dataset includes 7,274 lung cancer cases, including 613 cases among AANHPI females. Prevalence of never-smoking status varied greatly among AANHPI females with incident lung cancer, from 85.7% among Asian Indian to 14.4% among Native Hawaiian females. CONCLUSION We have developed a large, multilevel dataset particularly well-suited to conduct prospective studies of lung cancer risk among AANHPI females who never smoked. IMPACT The integrative data approach is an effective way to conduct cancer research assessing multilevel factors on cancer outcomes among small populations.
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Affiliation(s)
- Mindy C DeRouen
- Department of Epidemiology and Biostatistics, University of California San Francisco, San Francisco, California.
- Helen Diller Family Comprehensive Cancer Center, University of California San Francisco, San Francisco, California
| | - Caroline A Thompson
- San Diego State University School of Public Health, San Diego, California
- University of California San Diego School of Medicine, San Diego, California
- Sutter Health Palo Alto Medical Foundation Research Institute, Palo Alto, California
| | - Alison J Canchola
- Department of Epidemiology and Biostatistics, University of California San Francisco, San Francisco, California
- Greater Bay Area Cancer Registry, University of California San Francisco, San Fransisco, California
| | - Anqi Jin
- Sutter Health Palo Alto Medical Foundation Research Institute, Palo Alto, California
| | - Sixiang Nie
- Kaiser Permanente Hawai'i Center for Integrated Health Care Research, Honolulu, Hawaii
| | - Carmen Wong
- Kaiser Permanente Hawai'i Center for Integrated Health Care Research, Honolulu, Hawaii
| | - Jennifer Jain
- Department of Epidemiology and Biostatistics, University of California San Francisco, San Francisco, California
| | - Daphne Y Lichtensztajn
- Department of Epidemiology and Biostatistics, University of California San Francisco, San Francisco, California
- Greater Bay Area Cancer Registry, University of California San Francisco, San Fransisco, California
| | - Yuqing Li
- Department of Epidemiology and Biostatistics, University of California San Francisco, San Francisco, California
| | - Laura Allen
- Department of Epidemiology and Biostatistics, University of California San Francisco, San Francisco, California
| | - Manali I Patel
- Division of Oncology, Department of Medicine, Stanford University School of Medicine, Stanford, California
- VA Palo Alto Health Care System, Palo Alto, California
| | - Yihe G Daida
- Kaiser Permanente Hawai'i Center for Integrated Health Care Research, Honolulu, Hawaii
| | - Harold S Luft
- Sutter Health Palo Alto Medical Foundation Research Institute, Palo Alto, California
| | - Salma Shariff-Marco
- Department of Epidemiology and Biostatistics, University of California San Francisco, San Francisco, California
- Helen Diller Family Comprehensive Cancer Center, University of California San Francisco, San Francisco, California
- Greater Bay Area Cancer Registry, University of California San Francisco, San Fransisco, California
| | - Peggy Reynolds
- Department of Epidemiology and Biostatistics, University of California San Francisco, San Francisco, California
- Helen Diller Family Comprehensive Cancer Center, University of California San Francisco, San Francisco, California
| | - Heather A Wakelee
- Division of Oncology, Department of Medicine, Stanford University School of Medicine, Stanford, California
| | - Su-Ying Liang
- Sutter Health Palo Alto Medical Foundation Research Institute, Palo Alto, California
| | - Beth E Waitzfelder
- Kaiser Permanente Hawai'i Center for Integrated Health Care Research, Honolulu, Hawaii
| | - Iona Cheng
- Department of Epidemiology and Biostatistics, University of California San Francisco, San Francisco, California
- Helen Diller Family Comprehensive Cancer Center, University of California San Francisco, San Francisco, California
- Greater Bay Area Cancer Registry, University of California San Francisco, San Fransisco, California
| | - Scarlett L Gomez
- Department of Epidemiology and Biostatistics, University of California San Francisco, San Francisco, California
- Helen Diller Family Comprehensive Cancer Center, University of California San Francisco, San Francisco, California
- Greater Bay Area Cancer Registry, University of California San Francisco, San Fransisco, California
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Parada H, Vu AH, Pinheiro PS, Thompson CA. Comparing Age at Cancer Diagnosis between Hispanics and Non-Hispanic Whites in the United States. Cancer Epidemiol Biomarkers Prev 2021; 30:1904-1912. [PMID: 34321282 DOI: 10.1158/1055-9965.epi-21-0389] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2021] [Revised: 05/24/2021] [Accepted: 07/20/2021] [Indexed: 11/16/2022] Open
Abstract
BACKGROUND Population age structure may confound the comparison of age at cancer diagnosis across racial/ethnic groups. We compared age at cancer diagnosis for U.S. Hispanics, a population that is younger on average, and non-Hispanic whites (NHW), before and after adjustment for the age structure of the source population. METHODS We used Surveillance, Epidemiology, and End Results data from 18 U.S. regions in 2015 for 34 cancer sites to calculate crude and adjusted (using age- and sex-specific weights) mean ages at diagnosis. Differences in age at diagnosis comparing Hispanics to NHWs (δ) were assessed using independent sample t tests. RESULTS Crude mean ages at diagnosis were lower among Hispanic males and females for all sites combined and for most cancer sites. After age-adjustment, Hispanic (vs. NHW) males remained younger on average at diagnosis of chronic myeloid leukemia [δ = -6.1; 95% confidence interval (CI), -8.1 to -4.1 years], testicular cancer (δ =-4.7; 95% CI, -5.4 to -4.0), Kaposi sarcoma (δ =-3.6; 95% CI,-6.3 to -0.8), mesothelioma (δ =-3.0; 95% CI,-4.3 to -1.7), and anal cancer (δ =-2.4; 95% CI, -3.9 to -0.8), and older at diagnosis of gallbladder cancer (δ = +3.8; 95% CI, 1.8 to 5.7) and Hodgkin's lymphoma (δ = +7.5; 95% CI, 5.7 to 9.4), and Hispanic (vs. NHW) females remained younger at diagnosis of mesothelioma (δ = -3.7; 95% CI, -6.7 to -0.7) and gallbladder cancer (δ = -3.0; 95% CI, -4.3 to -1.7) and older at diagnosis of skin cancer (δ = +3.8; 95% CI, 3.1 to 4.5), cervical cancer (δ = +4.1; 95% CI, 3.3 to 4.8), and Hodgkin's lymphoma (δ = +7.0; 95% CI, 5.0 to 9.1). CONCLUSIONS On average, Hispanics are diagnosed with cancer at younger ages than NHWs; however, for many cancers these differences reflect the younger age structure in Hispanics. IMPACT Population age structure should be considered when comparing age at cancer diagnosis across racial/ethnic groups.
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Affiliation(s)
- Humberto Parada
- Division of Epidemiology and Biostatistics, School of Public Health, San Diego State University, San Diego, California. .,University of California, San Diego Moores Cancer Center, La Jolla, California.,Department of Radiation Medicine and Applied Science, University of California, San Diego, La Jolla, California
| | - Andrew H Vu
- Division of Epidemiology and Biostatistics, School of Public Health, San Diego State University, San Diego, California
| | - Paulo S Pinheiro
- Department of Public Health Sciences, University of Miami Miller School of Medicine, Miami, Florida
| | - Caroline A Thompson
- Division of Epidemiology and Biostatistics, School of Public Health, San Diego State University, San Diego, California.,University of California, San Diego Moores Cancer Center, La Jolla, California.,The Herbert Wertheim School of Public Health and Longevity Science, University of California, San Diego, La Jolla, California
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Medina HN, Callahan KE, Morris CR, Thompson CA, Siweya A, Pinheiro PS. Cancer Mortality Disparities among Asian American and Native Hawaiian/Pacific Islander Populations in California. Cancer Epidemiol Biomarkers Prev 2021; 30:1387-1396. [PMID: 33879454 PMCID: PMC8254771 DOI: 10.1158/1055-9965.epi-20-1528] [Citation(s) in RCA: 22] [Impact Index Per Article: 7.3] [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: 10/27/2020] [Revised: 01/03/2021] [Accepted: 04/13/2021] [Indexed: 01/04/2023] Open
Abstract
BACKGROUND Asian American and Native Hawaiian/Pacific Islanders (AANHPI) are the fastest growing minority in the United States. Cancer is the leading cause of death for AANHPIs, despite relatively lower cancer morbidity and mortality. Their recent demographic growth facilitates a detailed identification of AANHPI populations with higher cancer risk. METHODS Age-adjusted, sex-stratified, site-specific cancer mortality rates from California for 2012 to 2017 were computed for AANHPI groups: Chinese, Filipino, South Asian, Vietnamese, Korean, Japanese, Southeast Asian (i.e., Cambodian, Hmong, Laotian, Thai), and Native Hawaiian and Other Pacific Islander (NHOPI). Regression-derived mortality rate ratios (MRR) were used to compare each AANHPI group to non-Hispanic whites (NHW). RESULTS AANHPI men and women (total 40,740 deaths) had lower all-sites-combined cancer mortality rates (128.3 and 92.4 per 100,000, respectively) than NHWs (185.3 and 140.6) but higher mortality for nasopharynx, stomach, and liver cancers. Among AANHPIs, both NHOPIs and Southeast Asians had the highest overall rates including for colorectal, lung (men only), and cervical cancers; South Asians had the lowest. NHOPI women had 41% higher overall mortality than NHWs (MRR = 1.41; 95% CI, 1.25-1.58), including for breast (MRR = 1.33; 95% CI, 1.08-1.65) and markedly higher for endometrial cancer (MRR = 3.34; 95% CI, 2.53-4.42). CONCLUSIONS AANHPI populations present with considerable heterogeneous cancer mortality patterns. Heightened mortality for infection, obesity, and tobacco-related cancers in Southeast Asians and NHOPI populations highlight the need for differentiated priorities and public health interventions among specific AANHPI populations. IMPACT Not all AANHPIs have favorable cancer profiles. It is imperative to expand the focus on the currently understudied populations that bear a disproportionate cancer burden.
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Affiliation(s)
- Heidy N Medina
- Department of Public Health Sciences, University of Miami Miller School of Medicine, Miami, Florida.
| | - Karen E Callahan
- School of Public Health, University of Nevada, Las Vegas, Nevada
| | - Cyllene R Morris
- California Cancer Reporting and Epidemiologic Surveillance Program, UC Davis Comprehensive Cancer Center/UC Davis Health, Davis, California
| | - Caroline A Thompson
- School of Public Health, San Diego State University, Sutter Health Palo Alto Medical Foundation Research Institute, University of California San Diego School of Medicine, San Diego, California
| | - Adugna Siweya
- School of Public Health, University of Nevada, Las Vegas, Nevada
| | - Paulo S Pinheiro
- Department of Public Health Sciences, University of Miami Miller School of Medicine, Miami, Florida
- Sylvester Comprehensive Cancer Center, University of Miami Miller School of Medicine, Miami, Florida
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Obrochta CA, Gibbons J, Thompson CA. Abstract PO-164: Neighborhood disparities in timeliness of treatment for early stage lung cancer patients. Cancer Epidemiol Biomarkers Prev 2020. [DOI: 10.1158/1538-7755.disp20-po-164] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Abstract
Disparities in receipt of appropriate and timely cancer treatment continue. While there has been ample research identifying disparities by unmodifiable factors such as race/ethnicity, modifiable mechanisms, such as a neighborhood’s social and built environment, that drive such disparities are poorly understood. Minority neighborhoods enduring the impact of residential segregation often have less access to resources to maintain health and little control over their environments. The objective of this study is to better understand the importance of neighborhood racial/ethnic composition on racial/ethnic disparities in timely treatment for early- stage non-small cell lung cancer (NSCLC) patients. We studied 22,903 stage I/II NSCLC (2006-2015) patients in the California Cancer Registry. Appropriate treatment was defined as receipt of guideline concordant therapy (GCT) according to the 2016 NCCN guidelines, and timeliness as initial treatment within 45 days and adjuvant therapy within 6 months. The exposure was neighborhood racial/ethnic concordance, defined by the racial/ethnic composition of a neighborhood being predominately concordant, mixed, or discordant from a patient’s race/ethnicity. Multivariable hierarchical regression models were used to estimate the effect of neighborhood racial/ethnic concordance on GCT and timely GCT, independently and jointly with patient race/ethnicity. Overall, 81.4% of patients received GCT; 57.7% of them in a timely manner. Non-Hispanic blacks (NHBs) (76.9%) had the lowest rate of GCT and Filipinos (49.7%) and NHBs (50.0%) had the lowest rate of timely GCT. Patients living in concordant neighborhoods had the highest rate of GCT (83.0%) and timely GCT (61.0%). Most patients lived in white (32.9%) and mixed white and Hispanic (34.4%) neighborhoods, and the percentage of patients living in concordant neighborhoods (33.7%) were the highest among non-Hispanic whites (NHWs; 41.0%) and Hispanics (28.7%). Compared to patients in concordant neighborhoods, patients in mixed (undertreatment: RR=1.09, 95% CI=1.02-1.17; treatment delay: RR=1.10, 95% CI=1.05-1.16) and discordant (undertreatment: RR=1.15, 95% CI=1.04-1.27; delay: RR=1.12, 95% CI=1.04-1.21) neighborhoods were at increased risk for undertreatment and delay. This association does not hold for all race/ethnicities.
However, compared to NHWs living in concordant neighborhoods, NHBs (undertreatment: RR=1.41, 95% CI=0.96-2.09) and Hispanics (undertreatment: RR=1.48, 95% CI=1.25-1.74; treatment delay: RR=1.26, 95% CI=1.10-1.44) living in concordant neighborhoods were also at increased risk. Early stage lung cancer has a high rate of survival when treated appropriately and in a timeline matter.
Neighborhoods are key determinants of health. Understanding the role that neighborhoods play in healthcare utilization can help craft individual- or policy-level interventions that may include additional health care resources and targeted health care interventions.
Citation Format: Chelsea A. Obrochta, Joseph Gibbons, Caroline A. Thompson. Neighborhood disparities in timeliness of treatment for early stage lung cancer patients [abstract]. In: Proceedings of the AACR Virtual Conference: Thirteenth AACR Conference on the Science of Cancer Health Disparities in Racial/Ethnic Minorities and the Medically Underserved; 2020 Oct 2-4. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2020;29(12 Suppl):Abstract nr PO-164.
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Affiliation(s)
- Chelsea A. Obrochta
- 1San Diego State University/University of California, San Diego, San Diego, CA,
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Begi T, Tripathi O, Offor P, Thompson CA. Abstract PO-175: National trends in younger onset obesity-related cancer incidence. Cancer Epidemiol Biomarkers Prev 2020. [DOI: 10.1158/1538-7755.disp20-po-175] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Abstract
Obesity is a risk factor for many cancers, and obesity-related cancer incidence in the United States (U.S.) has been rising over the years. In the recent decades, the younger population of the United States has experienced an increase in obesity.
These increases have been the highest among ethnic minorities, and in the Southeast, while they have been less evident in the Northeast. The impact of rising rates of obesity among younger individuals on younger onset cancer incidence is less well understood. We estimated 15-year trends in incidence for 11 obesity-related cancers among adults under the age of 50 stratified by race/ethnicity and geographic region of the United States. Age adjusted incidence rates for cancers of the female breast, colorectal, endometrial, esophageal, hepatocellular carcinoma, kidney, multiple myeloma, non-cardia gastric, ovarian, pancreatic, and thyroid cancers were calculated from 2001-2016 using data obtained from Surveillance, epidemiology, and End Results (SEER-18). Data were stratified by age +/- 50 years old, four racial/ethnic groups: non-Hispanic white (NHW), non-Hispanic black (NHB), Asian American or Pacific Islander (AAPI), and Hispanic, and four geographical regions: West, Midwest, Northeast, and Southeast, and by sex. We used SEER*Stat and JoinPoint software for analysis. We observed statistically significant increasing 15-year trends among younger adults for colorectal cancer in NHWs, NHBs, and Hispanics, kidney cancer in all race groups, multiple myeloma among NHBs, non-cardia gastric cancer in Hispanic males and thyroid cancer in NHW and AAPI males. Stratification by geography revealed increasing trends of younger onset female breast cancer in the Midwest and that increasing trends for younger onset myeloma, non-cardia gastric, and thyroid cancers are steepest in the Northeastern U.S. and steepest for younger onset colorectal cancer in the Southeast U.S. We observed increasing trends in younger onset cancers of the kidney, colorectal, multiple myeloma, non-cardia gastric, thyroid, and female breast. Preventing obesity in ways such as education, better food produce availability and programs, and lower healthcare costs may reduce the impact of these cancers. Reduced age for screening for colorectal cancer may improve opportunity for earlier detection and improved prognoses in younger adults.
Citation Format: Talia Begi, Osika Tripathi, Paris Offor, Caroline A. Thompson. National trends in younger onset obesity-related cancer incidence [abstract]. In: Proceedings of the AACR Virtual Conference: Thirteenth AACR Conference on the Science of Cancer Health Disparities in Racial/Ethnic Minorities and the Medically Underserved; 2020 Oct 2-4. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2020;29(12 Suppl):Abstract nr PO-175.
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Affiliation(s)
- Talia Begi
- San Diego State University, San Diego, CA
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Thompson CA, Tsou MH. Abstract IA08: Improving researcher accessibility to publicly available data through creative integration, geospatial visualization, and open data portals. Cancer Epidemiol Biomarkers Prev 2020. [DOI: 10.1158/1538-7755.modpop19-ia08] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Abstract
The increased accessibility of population-level data made available by the government and public health and consumer agencies provides a unique opportunity for integrative data analysis, spatial visualization with much higher resolution to identify clusters of disease, and their correlation with geospatial, socioeconomic, and demographic predictors. However, interactive mapping and spatial analysis tools are underutilized by health researchers and decision-makers as a result of scarce training materials, few examples demonstrating their successful use, and poor mechanisms for sharing results generated by geovisualization. Further, in the wake of massive amounts of new data and analytical tool availability, consumers of cancer population health data, such as academic researchers and public health practitioners, are facing an ongoing transformation of practice resulting in the need for effective collaboration and sharing of resources within and across disciplinary and geographic boundaries. In this talk we will summarize three of our ongoing projects that leverage web-based technologies with the aim to reduce barriers to data sharing, promote simultaneous analysis of multiple datasets, and enable geovisualization of cancer outcomes and their interrelationships with social and spatial factors. The Disentangling Disparities Data Warehouse, or D3W, is a population-based data resource that includes geotagged California Cancer Registry data linked to census, American Community Survey, and other curated sources of neighborhood-level contextual and environmental data. The D3W allows ecologic and/or multilevel statistical analysis and supports sophisticated analysis of the spatial dynamics of cancer in California. The HealthWebMapper is a highly interactive data visualization tool with a simple two-tier web geographic information systems (GIS) framework. This dynamic web GIS/mapping tool was created with open-source JavaScript library, Leaflet, and free web authoring tools (bootstrap, jquery, and Google Chart) to provide user-friendly maps and data-mining functions, including multiple classification methods, correlation analysis, data export, and side-by-side displays. HealthWebMapper is an open source application and available via a public Github repository, and it can be easily installed on any website without specialized GIS servers or databases. Finally, to promote ease of access to the D3W and HealthWebMapper as well as other research data resources, we are developing the Health Data Open Analytic Portal, with support from the newly established NIH-funded HealthLINK Center for Population Health and Health Disparities Research at San Diego State University. The key functions of the open data portal are to archive, manage, download, and integrate disease, environmental, socioeconomic, and health behavior data. The data portal will enable the sharing, archiving, and learning of research procedures and health data resources. The searchable and downloadable data portal will also provide comprehensive research investigator profiles and online training materials to facilitate transdisciplinary research collaborations in cancer population health and beyond.
Citation Format: Caroline A. Thompson, Ming-Hsiang Tsou. Improving researcher accessibility to publicly available data through creative integration, geospatial visualization, and open data portals [abstract]. In: Proceedings of the AACR Special Conference on Modernizing Population Sciences in the Digital Age; 2019 Feb 19-22; San Diego, CA. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2020;29(9 Suppl):Abstract nr IA08.
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Obrochta CA, Nara A, Murphy J, Thompson CA. Abstract D077: Sociodemographic and geographic disparities in treatment for early-stage non-small cell lung cancer (NSCLC) patients in California. Cancer Epidemiol Biomarkers Prev 2020. [DOI: 10.1158/1538-7755.disp19-d077] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Abstract
Background: Lung cancer is the second most commonly diagnosed cancer and the leading cause of cancer-related death in the U.S. In 2013, the U.S. Preventive Services Task Force began recommending lung cancer screening, which has resulted in earlier stage diagnosis for many tobacco users. The National Comprehensive Cancer Network (NCCN) provides evidence-based cancer treatment recommendations. Evidence suggests that a patient’s receipt of guideline-concordant treatment (GCT) increases survival, especially for screen-detected, earlier stage cancers. The objective of this study is to describe receipt of timely GCT in California NSCLC patients by sociodemographic characteristics and geography. Methods: We studied 23,080 patients diagnosed with stage I/II NSCLC (2006-2015) in the California Cancer Registry. We classified treatment received as: undertreated, GCT, or over-treated according to NCCN guidelines, and timeliness (treatment began ≤ 45 days after diagnosis) among patients who received GCT. We describe the population according to treatment received, and timeliness by detailed race/ethnicity, stage of diagnosis, sex, age, insurance type, marital status, cancer approved program, and neighborhood socioeconomic status. We calculated absolute and relative inequalities in GCT and timeliness between race/ethnic groups. Hotspot analyses were conducted to identify regions at increased risk for under-treatment/overtreatment, and treatment delay by patient residential census tract. Results: Overall, 69.95% of patients received GCT, 14.53% were undertreated and 15.55% over-treated. Among patients who received GCT, 56.78% began treatment within 45 days of diagnosis. Under-treatment and treatment delay were more frequent in patients who were black or Hispanic, had public insurance, and were of lower socioeconomic status. We detected moderate absolute inequalities in receipt of GCT and timely care; no relative inequalities were observed. Cold and hot spots for under- and over-treatment and timeliness were identified within Metropolitan areas across California. Conclusion: Under-treatment and delayed treatment for early stage lung cancer disproportionately affect priority populations. With rising numbers of early stage lung cancers due to screening smokers, administration of timely proper treatment of lung cancer is critical.
Citation Format: Chelsea A Obrochta, Atsushi Nara, James Murphy, Caroline A Thompson. Sociodemographic and geographic disparities in treatment for early-stage non-small cell lung cancer (NSCLC) patients in California [abstract]. In: Proceedings of the Twelfth AACR Conference on the Science of Cancer Health Disparities in Racial/Ethnic Minorities and the Medically Underserved; 2019 Sep 20-23; San Francisco, CA. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2020;29(6 Suppl_2):Abstract nr D077.
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Affiliation(s)
- Chelsea A Obrochta
- 1San Diego State University/University of California, San Diego, San Diego, CA, USA,
| | - Atsushi Nara
- 2San Diego State University, San Diego, CA, USA,
| | - James Murphy
- 3University of California, San Diego, San Diego, CA, USA
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Thompson CA, Sheridan P, Murphy JD, Lyratzopoulos G. Abstract PR10: Emergency department-mediated cancer diagnosis in the United States. Cancer Epidemiol Biomarkers Prev 2020. [DOI: 10.1158/1538-7755.disp19-pr10] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Abstract
Background: It is estimated that 20-50% of breast, colon, and lung cancers are diagnosed in an emergency department (ED) globally. Cancer diagnosis via the ED increases time to treatment, worsens short-term survival, and reduces quality of care. Studies in Europe have shown that older, racially diverse, and socioeconomically deprived patients are at a higher risk of ED diagnosis. However, no studies in the U.S. have reported patterns of cancer patients initially presenting to the ED. We identified and characterized patients who were diagnosed with a malignant tumor following presentation to an ED using data from the Surveillance, Epidemiology and End Results (SEER) Medicare-linked database.
Methods: We studied 415,395 Medicare beneficiaries with histologically confirmed first malignant invasive tumors of the breast, colon and rectum, lung, and prostate between 2004 and 2013. Patients were excluded if they did not have continuous coverage in the year prior to diagnosis, had more than one primary tumor, or were diagnosed after death. ED-mediated diagnosis was defined as having at least one ED claim in the month before the date of cancer diagnosis. Covariate adjusted generalized linear models were used to estimate prevalence odds ratios for race/ethnicity, comorbidity, and income levels. A secondary analysis examined associations stratified by the presence of an outpatient clinic visit in the year prior to diagnosis as a proxy for having any usual source of care.
Results: Overall, 42,186 (11%) of cancer diagnoses were ED-mediated (by site: breast: 5%, colorectal: 13%, lung: 15%, prostate: 6%). Patients presenting to the ED were more likely to be: unmarried (OR:1.32; 95% CI: 1.29-1.34), Hispanic (OR:1.47; 95% CI: 1.37-1.57) or Black (OR:1.41; 95% CI:1.37-1.45), have 3+ comorbidities (OR:3.08; 95% CI: 3.00-3.16), and in the lowest income quartile (OR:1.26; 95% CI:1.21-1.30). In stratified analyses income was more strongly associated with emergent presentation among patients with no usual source of care.
Conclusions: This is the first study to describe patterns and predictors of ED-mediated cancer diagnosis in the U.S. We found that minority patients and those with lower SES were more likely to present with cancer via the ED. While some cancers diagnosed in the ED may indicate incidental findings, later-stage symptomatic cancers not identified until they become an emergency may reflect the failure of public health campaigns and primary care services. Reducing emergency presentation of cancer patients may improve patient outcomes and health care system efficiency. Further research is needed to uncover symptomatic and incidental pathways to diagnosis and to identify targets for interventions.
This abstract is also being presented as Poster A132.
Citation Format: Caroline A. Thompson, Paige Sheridan, James D. Murphy, Georgios Lyratzopoulos. Emergency department-mediated cancer diagnosis in the United States [abstract]. In: Proceedings of the Twelfth AACR Conference on the Science of Cancer Health Disparities in Racial/Ethnic Minorities and the Medically Underserved; 2019 Sep 20-23; San Francisco, CA. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2020;29(6 Suppl_2):Abstract nr PR10.
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Obrochta CA, Gibbons J, Nara A, Murphy JD, Thompson CA. Neighborhood disparities in timeliness of treatment for early stage lung cancer patients. J Clin Oncol 2020. [DOI: 10.1200/jco.2020.38.15_suppl.e19017] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
e19017 Background: Lung cancer is the second most commonly diagnosed cancer and the leading cause of cancer-related death in the United States, accounting for approximately 25% of all cancer deaths. The National Comprehensive Cancer Network (NCCN) provides evidence-based cancer treatment recommendations. Evidence suggests that a patient’s receipt of guideline-concordant treatment (GCT) increases survival, especially for screen-detected, earlier stage cancers. Neighborhoods are key determinants of health and the neighborhood social and built environments can influence cancer treatment and outcomes. Minority segregated neighborhoods often have limited health resource availability. The objective of this study is to estimate the relationship between neighborhood segregation on racial and ethnic disparities in timely receipt of GCT in early-stage lung cancer patients in California. Methods: We studied 22,903 patients diagnosed with stage I/II non-small cell lung cancer (2006-2015) in the California Cancer Registry. The primary outcome of the study is receipt of GCT according to the 2016 NCCN guidelines defined as the administration of proper initial and adjuvant treatment(s) according to cancer site and stage, and measured using surgery type, chemotherapy type, and radiation type. The secondary outcome was timely receipt of care as defined as the initiation of surgery, radiation, or chemotherapy within 45 days of diagnosis for initial treatment and the initiation of chemotherapy +/- radiation within 6 months of initial surgery for N1 patients for adjuvant treatment. Multivariable hierarchical logistic regression will be used to estimate the effect of neighborhood segregation on timely receipt of GCT, adjusting for individual- and neighborhood-level covariates, and stratified by patient race/ethnicity. Results: Overall, 81.39% of patients received GCT; 57.63% of them within 45 days of diagnosis. Under-treatment and treatment delay were more frequent in patients who were black or Hispanic, had public insurance, and were of lower socioeconomic status. We hypothesize that increased neighborhood segregation will decrease a patient’s likelihood of adherence to GCT and timely GCT. Conclusions: This research is vital to improving our understanding of cancer-related health disparities and promoting health in vulnerable neighborhoods. With rising numbers of early stage lung cancers due to screening smokers, administration of timely proper treatment is critical.
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Affiliation(s)
| | | | | | - James Don Murphy
- University of California, San Diego Moores Cancer Center, La Jolla, CA
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Cavanaugh AM, Rauh MJ, Thompson CA, Alcaraz J, Mihalko WM, Bird CE, Corbie-Smith G, Rosal MC, Li W, Shadyab AH, Gilmer T, LaCroix AZ. Racial/Ethnic Disparities in Physical Function Before and After Total Knee Arthroplasty Among Women in the United States. JAMA Netw Open 2020; 3:e204937. [PMID: 32412635 PMCID: PMC7229524 DOI: 10.1001/jamanetworkopen.2020.4937] [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] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/19/2022] Open
Abstract
IMPORTANCE Although racial/ethnic differences in functional outcomes after total knee arthroplasty (TKA) exist, whether such differences are associated with differences in presurgical physical function (PF) has not been thoroughly investigated. OBJECTIVE To examine trajectories of PF by race/ethnicity before and after TKA among older women. DESIGN, SETTING, AND PARTICIPANTS This cohort study was conducted among the prospective Women's Health Initiative with linked Medicare claims data. A total of 10 325 community-dwelling women throughout the United States with Medicare fee-for-service underwent primary TKA between October 1, 1993, and December 31, 2014, and were followed up through March 31, 2017. EXPOSURES Race/ethnicity comparisons between Hispanic or Latina women, non-Hispanic black or African American women, and non-Hispanic white women (hereafter referred to as Hispanic, black, and white women, respectively). MAIN OUTCOMES AND MEASURES Physical functioning scale scores and self-reported activity limitations with walking 1 block, walking several blocks, and climbing 1 flight of stairs were measured by the RAND 36-Item Health Survey during the decade before and after TKA, with a median of 9 PF measurements collected per participant over time. RESULTS In total, 9528 white women (mean [SD] age at surgery, 74.6 [5.5] years), 622 black women (mean [SD] age at surgery, 73.1 [5.3] years), and 175 Hispanic women (mean [SD] age at surgery, 73.1 [5.2] years) underwent TKA. During the decade prior to TKA, black women had lower PF scores than white women (mean difference, -5.8 [95% CI, -8.0 to -3.6]) and higher odds of experiencing difficulty walking a single block (5 years before TKA: odds ratio, 1.86 [95% CI, 1.57-2.21]), walking multiple blocks (odds ratio, 2.14 [95% CI, 1.83-2.50]), and climbing 1 flight of stairs (odds ratio, 1.81 [95% CI, 1.55-2.12]). After TKA, black women continued to have lower PF scores throughout the decade (mean difference 1 year after TKA, -7.8 [95% CI, -10.8 to -4.9]). After adjusting for preoperative PF scores, PF scores after TKA were attenuated (mean difference 1 year after TKA, -3.0 [95% CI, -5.3 to -0.7]), with no statistically significant differences in long-term follow-up. Hispanic women had similar PF scores to white women during the pre-TKA and post-TKA periods. CONCLUSIONS AND RELEVANCE This study suggests that black women had significantly poorer PF than white women during the decades before and after TKA. Poorer PF after surgery was associated with poorer preoperative PF. Reducing disparities in post-TKA functional outcomes should target maintenance of function preoperatively in the early stages of arthritic disease and/or reduction of delays to receiving TKA once need arises.
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Affiliation(s)
- Alyson M. Cavanaugh
- Joint Doctoral Program in Public Health, San Diego State University/University of California, San Diego, San Diego
| | - Mitchell J. Rauh
- Doctor of Physical Therapy Program, San Diego State University, San Diego, California
- Graduate School of Public Health, San Diego State University, San Diego, California
| | - Caroline A. Thompson
- Graduate School of Public Health, San Diego State University, San Diego, California
| | - John Alcaraz
- Graduate School of Public Health, San Diego State University, San Diego, California
| | - William M. Mihalko
- Campbell Clinic Department of Orthopaedic Surgery and Biomedical Engineering, University of Tennessee Health Science Center, Memphis
| | - Chloe E. Bird
- Health Care Division, RAND, Santa Monica, California
| | - Giselle Corbie-Smith
- Center for Health Equity Research, University of North Carolina School of Medicine, Chapel Hill
| | - Milagros C. Rosal
- Department of Population and Quantitative Sciences, University of Massachusetts Medical School, Worchester
| | - Wenjun Li
- Department of Medicine, University of Massachusetts Medical School, Worcester
| | - Aladdin H. Shadyab
- Department of Family Medicine and Public Health, University of California, San Diego, La Jolla
| | - Todd Gilmer
- Department of Family Medicine and Public Health, University of California, San Diego, La Jolla
| | - Andrea Z. LaCroix
- Department of Family Medicine and Public Health, University of California, San Diego, La Jolla
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Cavanaugh AM, Rauh MJ, Thompson CA, Alcaraz JE, Bird CE, Gilmer TP, LaCroix AZ. Rehabilitation After Total Knee Arthroplasty: Do Racial Disparities Exist? J Arthroplasty 2020; 35:683-689. [PMID: 31801659 PMCID: PMC7032536 DOI: 10.1016/j.arth.2019.10.048] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [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: 08/31/2019] [Revised: 10/22/2019] [Accepted: 10/27/2019] [Indexed: 02/01/2023] Open
Abstract
BACKGROUND Racial disparities in functional outcomes after total knee arthroplasty (TKA) exist. Whether differences in rehabilitation utilization contribute to these disparities remains to be investigated. METHODS Among 8349 women enrolled in the prospective Women's Health Initiative cohort who underwent primary TKA between 2006 and 2013, rehabilitation utilization was determined through linked Medicare claims data. Postacute discharge destination (home, skilled nursing facility, and inpatient rehabilitation facility), facility length of stay, and number of home health physical therapy (HHPT) and outpatient physical therapy (OPPT) sessions were compared between racial groups. RESULTS Non-Hispanic black women had worse physical function (median score, 65 vs 70) and higher likelihood of disability (13.2% vs 6.9%) than non-Hispanic white women before surgery. After TKA, black women were more likely to be discharged postacutely to an institutional facility (64.3% vs 54.5%) than white women, were more likely to receive HHPT services (52.6% vs 47.8%), and received more HHPT and OPPT sessions. After stratification by postacute discharge setting, the likelihood of receipt of HHPT or OPPT services was similar between racial groups. No significant difference in receipt of HHPT or OPPT services was found after use of propensity score weighting to balance health and medical characteristics indicating severity of need for physical therapy services. CONCLUSION Rehabilitation utilization was generally comparable between black and white women who received TKA when accounting for need. There was no evidence of underutilization of post-TKA rehabilitation services, and thus disparities in post-TKA functional outcomes do not appear to be a result of inequitable receipt of rehabilitation care.
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Affiliation(s)
- Alyson M Cavanaugh
- San Diego State University/University of California San Diego, Joint Doctoral Program in Public Health, San Diego, CA
| | - Mitchell J Rauh
- Doctor of Physical Therapy Program, San Diego State University, San Diego, CA; Graduate School of Public Health, San Diego State University, San Diego, CA
| | | | - John E Alcaraz
- Graduate School of Public Health, San Diego State University, San Diego, CA
| | | | - Todd P Gilmer
- Department of Family Medicine and Public Health, University of California, San Diego, CA
| | - Andrea Z LaCroix
- Department of Family Medicine and Public Health, University of California, San Diego, CA
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Thompson CA, Jin A, Luft HS, Lichtensztajn DY, Allen L, Liang SY, Schumacher BT, Gomez SL. Population-Based Registry Linkages to Improve Validity of Electronic Health Record-Based Cancer Research. Cancer Epidemiol Biomarkers Prev 2020; 29:796-806. [PMID: 32066621 DOI: 10.1158/1055-9965.epi-19-0882] [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] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2019] [Revised: 11/01/2019] [Accepted: 02/12/2020] [Indexed: 01/18/2023] Open
Abstract
BACKGROUND There is tremendous potential to leverage the value gained from integrating electronic health records (EHR) and population-based cancer registry data for research. Registries provide diagnosis details, tumor characteristics, and treatment summaries, while EHRs contain rich clinical detail. A carefully conducted cancer registry linkage may also be used to improve the internal and external validity of inferences made from EHR-based studies. METHODS We linked the EHRs of a large, multispecialty, mixed-payer health care system with the statewide cancer registry and assessed the validity of our linked population. For internal validity, we identify patients that might be "missed" in a linkage, threatening the internal validity of an EHR study population. For generalizability, we compared linked cases with all other cancer patients in the 22-county EHR catchment region. RESULTS From an EHR population of 4.5 million, we identified 306,554 patients with cancer, 26% of the catchment region patients with cancer; 22.7% of linked patients were diagnosed with cancer after they migrated away from our health care system highlighting an advantage of system-wide linkage. We observed demographic differences between EHR patients and non-EHR patients in the surrounding region and demonstrated use of selection probabilities with model-based standardization to improve generalizability. CONCLUSIONS Our experiences set the foundation to encourage and inform researchers interested in working with EHRs for cancer research as well as provide context for leveraging linkages to assess and improve validity and generalizability. IMPACT Researchers conducting linkages may benefit from considering one or more of these approaches to establish and evaluate the validity of their EHR-based populations.See all articles in this CEBP Focus section, "Modernizing Population Science."
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Affiliation(s)
- Caroline A Thompson
- School of Public Health, San Diego State University, San Diego, California.
- Sutter Health Palo Alto Medical Foundation Research Institute, Palo Alto, California
- University of California San Diego School of Medicine, San Diego, California
| | - Anqi Jin
- Sutter Health Palo Alto Medical Foundation Research Institute, Palo Alto, California
| | - Harold S Luft
- Sutter Health Palo Alto Medical Foundation Research Institute, Palo Alto, California
| | - Daphne Y Lichtensztajn
- Greater Bay Area Cancer Registry, Department of Epidemiology & Biostatistics, University of California San Francisco School of Medicine, San Francisco, California
- Department of Epidemiology & Biostatistics, University of California San Francisco School of Medicine, San Francisco, California
| | - Laura Allen
- Greater Bay Area Cancer Registry, Department of Epidemiology & Biostatistics, University of California San Francisco School of Medicine, San Francisco, California
- Department of Epidemiology & Biostatistics, University of California San Francisco School of Medicine, San Francisco, California
| | - Su-Ying Liang
- Sutter Health Palo Alto Medical Foundation Research Institute, Palo Alto, California
| | - Benjamin T Schumacher
- School of Public Health, San Diego State University, San Diego, California
- University of California San Diego School of Medicine, San Diego, California
| | - Scarlett Lin Gomez
- Greater Bay Area Cancer Registry, Department of Epidemiology & Biostatistics, University of California San Francisco School of Medicine, San Francisco, California
- Department of Epidemiology & Biostatistics, University of California San Francisco School of Medicine, San Francisco, California
- Helen Diller Family Comprehensive Cancer Center, University of California San Francisco, San Francisco, California
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Cavanaugh AM, Rauh MJ, Thompson CA, Alcaraz J, Mihalko WM, Bird CE, Eaton CB, Rosal MC, Li W, Shadyab AH, Gilmer T, LaCroix AZ. Racial and ethnic disparities in utilization of total knee arthroplasty among older women. Osteoarthritis Cartilage 2019; 27:1746-1754. [PMID: 31404657 PMCID: PMC6875623 DOI: 10.1016/j.joca.2019.07.015] [Citation(s) in RCA: 25] [Impact Index Per Article: 5.0] [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: 04/06/2019] [Revised: 07/14/2019] [Accepted: 07/31/2019] [Indexed: 02/02/2023]
Abstract
OBJECTIVE To evaluate racial and ethnic disparities in utilization of total knee arthroplasty (TKA) in relation to demographic, health, and socioeconomic status variables. DESIGN Prospective study of 102,767 Women's Health Initiative postmenopausal women initially aged 50-79, examining utilization rates of primary TKA between non-Hispanic Black/African American, non-Hispanic White, and Hispanic/Latina women (hereafter referred to as Black, White, and Hispanic). A total of 8,942 Black, 3,405 Hispanic, and 90,420 White women with linked Medicare claims data were followed until time of TKA, death, or transition from fee-for-service coverage. Absolute disparities were determined using utilization rates by racial/ethnic group and relative disparities quantified using multivariable hazards models in adjusting for age, arthritis, joint pain, mobility disability, body mass index, number of comorbidities, income, education, neighborhood socioeconomic status (SES), and geographic region. RESULTS TKA utilization was higher among White women (10.7/1,000 person-years) compared to Black (8.5/1,000 person-years) and Hispanic women (7.6/1,000 person-years). Among women with health indicators for TKA including diagnosis of arthritis, moderate to severe joint pain, and mobility disability, Black and Hispanic women were significantly less likely to undergo TKA after adjusting for age [Black: HR (95% confidence interval) = 0.70 (0.63-0.79); Hispanic: HR = 0.58 (0.44-0.77)]. Adjustment for SES modestly attenuated the measured disparity, but significant differences remained [Black: HR = 0.75 (0.67-0.89); Hispanic: HR = 0.65 (0.47-0.89)]. CONCLUSIONS Compared to White women, Black and Hispanic women were significantly less likely to undergo TKA after considering need and appropriateness for TKA and SES. Further investigation into personal-level and provider-level factors that may explain these disparities is warranted.
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Affiliation(s)
- A M Cavanaugh
- San Diego State University/University of California San Diego, Joint Doctoral Program in Public Health, USA.
| | - M J Rauh
- Doctor of Physical Therapy Program, San Diego State University, San Diego, CA, USA; Graduate School of Public Health, San Diego State University, San Diego, CA, USA.
| | - C A Thompson
- Graduate School of Public Health, San Diego State University, San Diego, CA, USA.
| | - J Alcaraz
- Graduate School of Public Health, San Diego State University, San Diego, CA, USA.
| | - W M Mihalko
- Campbell Clinic Department of Orthopaedic Surgery and Biomedical Engineering, University of Tennessee, Memphis, TN, USA.
| | - C E Bird
- Health Care Division, RAND, Santa Monica, CA, USA.
| | - C B Eaton
- Department of Family Medicine at Warren Alpert Medical School and Department of Epidemiology at School of Public Health at Brown University, Providence, RI, USA.
| | - M C Rosal
- Department of Population and Quantitative Sciences, University of Massachusetts Medical School, USA.
| | - W Li
- Department of Medicine, University of Massachusetts Medical School, Worcester, MA, USA.
| | - A H Shadyab
- Department of Family Medicine and Public Health, University of California, San Diego, CA, USA.
| | - T Gilmer
- Department of Family Medicine and Public Health, University of California, San Diego, CA, USA.
| | - A Z LaCroix
- Department of Family Medicine and Public Health, University of California, San Diego, CA, USA.
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Sangaramoorthy M, Yang J, DeRouen MC, Ho C, Somsouk M, Tana MM, Thompson CA, Gibbons J, Gomez SL, Shariff-Marco S. Disparities in Hepatocellular Carcinoma Incidence in California: An Update. Cancer Epidemiol Biomarkers Prev 2019; 29:79-87. [PMID: 31719066 DOI: 10.1158/1055-9965.epi-19-0560] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2019] [Revised: 08/01/2019] [Accepted: 11/04/2019] [Indexed: 01/05/2023] Open
Abstract
BACKGROUND Given changes in hepatocellular carcinoma (HCC) incidence and the ethnodemographic landscape, we analyzed recent HCC incidence patterns and trends in California. METHODS Using 47,992 primary, invasive HCC cases diagnosed from 1988 to 2014 from the California Cancer Registry, we calculated age-adjusted incidence rates (IR), annual percent change (APC), and 95% confidence intervals (CI) by sex, race/ethnicity, and nativity among Hispanics and Asian ethnic groups. RESULTS Compared with non-Hispanic Whites (NHW), all other racial/ethnic groups had higher HCC incidence. Vietnamese had the highest IRs (males: 47.4, 95% CI, 45.3-49.5; females: 14.1, 95% CI, 13.0-15.3). Foreign-born Chinese, Japanese, Korean, and Vietnamese had higher incidence than U.S.-born. The reverse was observed for Hispanic males, whereas no differences by nativity were seen for Hispanic females. IRs increased most for NHWs. Among Asians, male and female Filipinos and Japanese males experienced rate increases, whereas male and female Koreans and Chinese males experienced rate decreases. U.S.-born male and female Hispanics and Japanese had higher APCs than foreign-born, as did Filipino males, whereas Chinese males had a reverse pattern. Annual increases in HCC incidence slowed down in recent years for U.S.-born Hispanic males and females and stabilized among male NHWs and non-Hispanic Blacks. For some Asian groups, early time periods exhibited increasing/stable APCs, whereas later time periods showed decreasing APCs. CONCLUSIONS We found significant racial/ethnic and nativity differences in HCC IRs and trends. IMPACT With changing trends, closer surveillance of HCC incidence by disaggregated race/ethnicity and nativity is warranted among Hispanics and Asians.
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Affiliation(s)
- Meera Sangaramoorthy
- Greater Bay Area Cancer Registry, San Francisco, California.,University of California, San Francisco (UCSF), School of Medicine, Department of Epidemiology & Biostatistics, San Francisco, California
| | - Juan Yang
- Greater Bay Area Cancer Registry, San Francisco, California.,University of California, San Francisco (UCSF), School of Medicine, Department of Epidemiology & Biostatistics, San Francisco, California
| | - Mindy C DeRouen
- Greater Bay Area Cancer Registry, San Francisco, California.,University of California, San Francisco (UCSF), School of Medicine, Department of Epidemiology & Biostatistics, San Francisco, California.,UCSF, Helen Diller Family Comprehensive Cancer Center, San Francisco, California
| | - Chanda Ho
- Department of Transplantation, California Pacific Medical Center, San Francisco, California
| | - Ma Somsouk
- UCSF, Helen Diller Family Comprehensive Cancer Center, San Francisco, California.,UCSF, Division of Gastroenterology at Zuckerberg San Francisco General, San Francisco, California
| | - Michele M Tana
- UCSF, Division of Gastroenterology at Zuckerberg San Francisco General, San Francisco, California
| | - Caroline A Thompson
- School of Public Health, San Diego State University, San Diego, California.,Department of Family Medicine and Public Health, University of California San Diego, San Diego, California
| | - Joseph Gibbons
- Department of Sociology, College of Arts & Letters, San Diego State University, San Diego, California
| | - Scarlett Lin Gomez
- Greater Bay Area Cancer Registry, San Francisco, California.,University of California, San Francisco (UCSF), School of Medicine, Department of Epidemiology & Biostatistics, San Francisco, California.,UCSF, Helen Diller Family Comprehensive Cancer Center, San Francisco, California
| | - Salma Shariff-Marco
- Greater Bay Area Cancer Registry, San Francisco, California. .,University of California, San Francisco (UCSF), School of Medicine, Department of Epidemiology & Biostatistics, San Francisco, California.,UCSF, Helen Diller Family Comprehensive Cancer Center, San Francisco, California
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Nhola LF, Daramola T, Barros-Gomes S, Rico-Mesa JS, Arciniegas MC, Oehler EA, Herrmann J, Scott CG, Pellikka PA, Cerhan JR, Thompson CA, Villarraga HR. P674Behavior of 2D and 3D derived ejection fraction and strain in patients with Hodgkin and non-Hodgkin lymphoma undergoing anthracycline-based chemotherapy, a prospective study. Eur Heart J 2019. [DOI: 10.1093/eurheartj/ehz747.0280] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Abstract
Background
Anthracyclines are one of the most effective chemotherapeutic agents but can lead to a decline in cardiac function. Two-dimensional (2D) speckle tracking echocardiography derived strain can predict cancer therapeutics-related cardiac dysfunction (CTRCD). However, little is known about the role of three-dimensional (3D) strain imaging in this setting.
Purpose
To evaluate different methods of Left Ventricular Ejection Fraction (LVEF) and strain, and to identify the best strain parameter for the prediction of CTRCD in this group of patients during treatment with anthracycline based chemotherapy.
Methods
Patients with Hodgkin's or non-Hodgkin's lymphoma receiving anthracycline based chemotherapy were enrolled. 2D-and 3D echocardiography was performed at 3 time points: baseline, at the completion of chemotherapy and at 1 year. 2D- and 3D LVEF (2D Modified Quinones, M-mode, 2D Biplane, 3D Philips, 3D GE and 3D TomTec), peak systolic left and right ventricular longitudinal, radial and circumferential strain and strain rate were measured. CTRCD was defined as a decrease in LVEF >10% to an absolute value of <53%. Lin's Concordance Correlation Coefficient (CCC) was calculated to compare LVEF methods. ANOVA, uni and multivariate analysis was performed.
Results
A total of 130 patients (79 males, mean age 57±16 years) were enrolled; 104 non-Hodgkin.3D Philips and GE (CCC 0.88 [0.84, 0.92]), 3D Philips and biplane (CCC 0.84 [0.79, 0.89]), 3D Philips and Modified Quinones (CCC 0.86 [0.82, 091]) as well as 3D Philips and M-mode (CCC 0.77 [0.70, 0.85]) showed strong correlation for LVEF. 15 patients (12%) developed CTRCD. Mean cumulative anthracycline dose was 263±65 mg/m2. 2D and 3D global longitudinal and circumferential peak systolic strain, 2D global longitudinal systolic and early diastolic strain rate, 2D global early diastolic strain rate, 2D right ventricular longitudinal peak systolic strain and systolic strain rate, 2D global radial peak systolic strain and systolic strain rate measured at the completion of chemotherapy were independent predictors of the development of CTRCD at 1 year post-chemotherapy. The strongest predictors of CTRCD were 3D global longitudinal and circumferential strain either individually (area under the curve, 0.90 and 0.95 respectively) or combined (area under the curve, 0.95) at the completion of chemotherapy; a cutoff value of <-18% in 3D global longitudinal strain had a sensitivity of 82% and specificity of 99%, while for 3D global circumferential peak systolic strain of <-24% had a sensitivity of 82% and specificity of 95%.
Conclusions
To our knowledge this is the first prospective trial that shows that 3D EF correlates well with other EF methods and 3D strain predicts cardiac toxicity in this group of patients with a very good sensitivity and specificity.
Acknowledgement/Funding
Department of Cardiovascular Medicine-Mayo Clinic Rochester MN
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Affiliation(s)
- L F Nhola
- Mayo Clinic, Rochester, United States of America
| | - T Daramola
- Mayo Clinic, Rochester, United States of America
| | | | | | | | - E A Oehler
- Mayo Clinic, Rochester, United States of America
| | - J Herrmann
- Mayo Clinic, Rochester, United States of America
| | - C G Scott
- Mayo Clinic, Rochester, United States of America
| | - P A Pellikka
- Mayo Clinic, Rochester, United States of America
| | - J R Cerhan
- Mayo Clinic, Rochester, United States of America
| | - C A Thompson
- Mayo Clinic, Rochester, United States of America
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Abstract
139 Background: It is estimated that 20-50% of breast, colon and lung cancers are diagnosed in an emergency department (ED) globally. Cancer diagnosis via the ED worsens short-term survival and reduces quality of care. Studies in Europe have shown that older and socioeconomically deprived patients are at a higher risk of ED diagnosis. However, no studies in the U.S. have reported patterns of cancer patients initially presenting to the ED. We identified and characterized older patients who are diagnosed with a malignant tumor following presentation to an ED using data from the Surveillance, Epidemiology and End Results Medicare linked database. Methods: We studied 415,395 Medicare beneficiaries with histologically confirmed first malignant invasive tumors of the breast, colon and rectum, lung and prostate between 2004 and 2013. Patients were excluded if they did not have continuous coverage in the year prior to diagnosis, had more than one primary tumor, or were diagnosed after death. ED-mediated diagnosis was defined as having at least one ED claim in the month before the date of cancer diagnosis. Covariate adjusted generalized linear models were used to estimate prevalence odds ratios for marital status, race, comorbidity, and income levels. Results: Overall, 42,186 (11%) of cancer diagnoses were ED-mediated (by site: breast: 5%, colorectal: 13%, lung: 15%, prostate: 6%). Patients presenting to the ED were more likely to be: unmarried (OR:1.32; 95% CI: 1.29-1.34), Hispanic (OR:1.47; 95% CI: 1.37-1.57) or Black (OR:1.41; 95% CI:1.37-1.45), have 3+ comorbidities (OR:3.08; 95% CI: 3.00-3.16), and in the lowest income quartile (OR:1.26; 95% CI:1.21-1.30). Conclusions: While some cancers diagnosed in the ED may indicate incidental findings, later stage symptomatic cancers not identified until they become an emergency may reflect the failure of public health campaigns and primary care services. Reducing emergency presentation of cancer patients may improve patient outcomes and healthcare system efficiency.
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Affiliation(s)
- Paige Sheridan
- University of California, San Diego School of Medicine, La Jolla, CA
| | | | - James Don Murphy
- University of California, San Diego School of Medicine, La Jolla, CA
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Obrochta CA, Murphy JD, Nara A, Thompson CA. Disparities in receipt of guideline concordant treatment for early-stage non-small cell lung cancer (NSCLC) patients in California. J Clin Oncol 2019. [DOI: 10.1200/jco.2019.37.27_suppl.160] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
160 Background: Lung cancer is the second most commonly diagnosed cancer and the leading cause of cancer-related death in the U.S. In 2013, the U.S. Preventive Services Task Force began recommending lung cancer screening, which has resulted in earlier stage diagnosis for many tobacco users. The National Comprehensive Cancer Network (NCCN) provides evidence-based cancer treatment recommendations. Evidence suggests that a patient’s receipt of guideline-concordant treatment (GCT) increases survival, especially for screen-detected, earlier stage cancers. The objective of this study is to describe nonadherence to GCT and treatment delay in California NSCLC patients by sociodemographic characteristics and geography. Methods: 53,746 patients diagnosed with stage I/II NSCLC (2000-2015) in the California Cancer Registry were included in our study. We classified GCT according to NCCN guidelines and treatment delay as >60 days after diagnosis. We report proportion of nonadherence to GCT and treatment delay overall, in 5-year periods and by patient race/ethnicity, socioeconomic status, payer, and marital status. Hotspot analysis is underway to identify regions at increased risk for nonadherence to GCT and treatment delay by patient residential census tract. Results: Overall, 55.9% of patients received GCT, 14.1% of patients received no treatment, and nonadherence to GCT increased over time. Among those who received treatment, 26.7% experienced a treatment delay. Nonadherence to GCT and delay was more frequent in patients who were black or Hispanic, unmarried, had public insurance, and were of lower socioeconomic status. Based on preliminary analyses, we expect nonadherence to GCT and treatment delay to be non-uniformly distributed across California neighborhoods. Conclusions: Nonadherence to GCT and treatment delay disproportionately affect priority populations. With rising numbers of early stage lung cancers due to screening smokers, administration of timely proper treatment of lung cancer is critical.
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Affiliation(s)
- Chelsea A Obrochta
- San Diego State University / University of California, San Diego, San Diego, CA
| | - James Don Murphy
- University of California, San Diego Moores Cancer Center, La Jolla, CA
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Thomas IC, Thompson CA, Yang M, Allison MA, Forbang NI, Michos ED, McClelland RL, Budoff MJ, Criqui MH. Thoracic Aorta Calcification and Noncardiovascular Disease-Related Mortality. Arterioscler Thromb Vasc Biol 2019; 38:1926-1932. [PMID: 29954753 DOI: 10.1161/atvbaha.118.310850] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [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: 02/04/2023]
Abstract
Objective- Arterial calcification is highly correlated with underlying atherosclerosis. Arterial calcification of the thoracic aorta is evident in many older individuals at high susceptibility to aging-related diseases and non-cardiovascular disease (CVD)-related mortality. In this study, we evaluated the association of thoracic aorta calcification (TAC) with non-CVD morbidity and mortality. Approach and Results- We analyzed data from participants in the Multi-Ethnic Study of Atherosclerosis, a prospective cohort study of subclinical atherosclerosis, in which participants underwent cardiac computed tomography at baseline and were followed longitudinally for incident CVD events and non-CVD events. Using modified proportional hazards models accounting for the competing risk of CVD death and controlling for demographics, CVD risk factors, coronary artery calcium, and CVD events, we evaluated whether TAC was independently associated with non-CVD morbidity and mortality. Among 6765 participants (mean age, 62 years), 704 non-CVD deaths occurred for a median follow-up of 12.2 years. Compared with no TAC, the highest tertile of TAC volume was associated with a higher risk of non-CVD mortality (hazard ratio, 1.56; 95% confidence interval, 1.23-1.97), as well as several non-CVD diagnoses, including hip fracture (2.14; 1.03-4.46), chronic obstructive pulmonary disease (2.06; 1.29-3.29), and pneumonia (1.79; 1.30-2.45), with magnitudes of association that were larger than for those of coronary artery calcium. Conclusions- TAC is associated with non-CVD morbidity and non-CVD mortality, potentially through a pathway that is unrelated to atherosclerosis. TAC may be a general marker of biological aging and an indicator of increased risk of non-CVD and death.
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Affiliation(s)
- Isac C Thomas
- From the Division of Cardiovascular Medicine, Department of Medicine (I.C.T.).,Division of Preventive Medicine, Department of Family Medicine and Public Health (I.C.T., M.A.A., N.I.F., M.H.C.)
| | - Caroline A Thompson
- University of California San Diego, La Jolla; Division of Epidemiology and Biostatistics, Graduate School of Public Health, San Diego State University, CA (C.A.T., M.Y.)
| | - Mingan Yang
- University of California San Diego, La Jolla; Division of Epidemiology and Biostatistics, Graduate School of Public Health, San Diego State University, CA (C.A.T., M.Y.)
| | - Matthew A Allison
- Division of Preventive Medicine, Department of Family Medicine and Public Health (I.C.T., M.A.A., N.I.F., M.H.C.)
| | - Nketi I Forbang
- Division of Preventive Medicine, Department of Family Medicine and Public Health (I.C.T., M.A.A., N.I.F., M.H.C.)
| | - Erin D Michos
- Division of Cardiology, Johns Hopkins School of Medicine, Baltimore, MD (E.D.M.)
| | | | - Matthew J Budoff
- Division of Cardiology, Los Angeles Biomedical Research Institute at Harbor-University of California Los Angeles Medical Center, Torrance (M.J.B.)
| | - Michael H Criqui
- Division of Preventive Medicine, Department of Family Medicine and Public Health (I.C.T., M.A.A., N.I.F., M.H.C.)
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Zamora SM, Pinheiro PS, Gomez SL, Hastings KG, Palaniappan LP, Hu J, Thompson CA. Disaggregating Hispanic American Cancer Mortality Burden by Detailed Ethnicity. Cancer Epidemiol Biomarkers Prev 2019; 28:1353-1363. [PMID: 31147314 DOI: 10.1158/1055-9965.epi-18-0872] [Citation(s) in RCA: 22] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2018] [Revised: 11/07/2018] [Accepted: 05/23/2019] [Indexed: 02/07/2023] Open
Abstract
BACKGROUND Hispanics are the largest minority population in the United States (18%). They represent a heterogeneous and growing population. Cancer is the leading cause of death among Hispanics, yet few studies have described cancer mortality burden by specific Hispanic group nationwide. METHODS Cancer-related deaths from U.S. death certificates for the years 2003-2012 were analyzed for decedents identifying as Mexican, Puerto Rican, Cuban, and Central or South American. We calculated descriptive statistics, including potential years of lives lost (PYLL), age-adjusted rates, standardized mortality ratios, and fitted JoinPoint regression models, to evaluate annual trends by Hispanic group, using non-Hispanic Whites (NHW) as the reference population. RESULTS We identified 287,218 cancer-related deaths among Hispanics and 4,570,559 among NHWs. Mortality trends were heterogeneous across Hispanic groups. Female NHWs and male Puerto Ricans had the greatest rates of adjusted PYLL per 1,000 (NHWs, 19.6; Puerto Ricans, 16.5). Liver cancer was ranked among the top 5 cancer-related deaths for every Hispanic group, but not for NHWs. Stomach cancer mortality was twice as high for most Hispanic groups when compared with NHWs and especially high for Mexicans [male standardized mortality ratio (SMR), 2.07; 95% confidence interval (CI), 2.01-2.13; female SMR, 2.62; 95% CI, 2.53-2.71]. CONCLUSIONS We observed marked heterogeneity in cancer mortality across Hispanic groups. Several cancers affect Hispanics disproportionately compared with NHWs. Screening programs in Hispanics should be considered for stomach and liver cancer. IMPACT Disaggregated analysis of Hispanics is needed to fully understand cancer burden among the diverse Hispanic population and is critical for cancer prevention and control efforts.
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Affiliation(s)
- Steven M Zamora
- School of Public Health, San Diego State University, San Diego, California
| | - Paulo S Pinheiro
- Department of Public Health Sciences, University of Miami Miller School of Medicine, Miami, Florida
| | - Scarlett Lin Gomez
- Department of Epidemiology and Biostatistics, University of California, San Francisco, California.,Helen Diller Family Comprehensive Cancer Center, San Francisco, California.,Greater Bay Area Cancer Registry, Cancer Prevention Institute of California, Fremont, California
| | - Katherine G Hastings
- Department of Medicine, Stanford University School of Medicine, Stanford, California
| | - Latha P Palaniappan
- Department of Medicine, Stanford University School of Medicine, Stanford, California
| | - Jiaqi Hu
- Department of Medicine, Stanford University School of Medicine, Stanford, California
| | - Caroline A Thompson
- School of Public Health, San Diego State University, San Diego, California. .,Department of Family Medicine and Public Health, University of California San Diego School of Medicine, San Diego, California
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Nelson SH, Natarajan L, Patterson RE, Hartman SJ, Thompson CA, Godbole SV, Johnson E, Marinac CR, Kerr J. Physical Activity Change in an RCT: Comparison of Measurement Methods. Am J Health Behav 2019; 43:543-555. [PMID: 31046885 DOI: 10.5993/ajhb.43.3.9] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/15/2023]
Abstract
Objectives: We aimed to quantify the agreement between self-report, standard cut-point accelerometer, and machine learning accelerometer estimates of physical activity (PA), and exam- ine how agreement changes over time among older adults in an intervention setting. Methods: Data were from a randomized weight loss trial that encouraged increased PA among 333 postmenopausal breast cancer survivors. PA was estimated using accelerometry and a validated questionnaire at baseline and 6-months. Accelerometer data were processed using standard cut-points and a validated machine learning algorithm. Agreement of PA at each time-point and change was assessed using mixed effects regression models and concordance correlation. Results: At baseline, self-report and machine learning provided similar PA estimates (mean dif- ference = 11.5 min/day) unlike self-report and standard cut-points (mean difference = 36.3 min/ day). Cut-point and machine learning methods assessed PA change over time more similarly than other comparisons. Specifically, the mean difference of PA change for the cut-point versus machine learning methods was 5.1 min/day for intervention group and 2.9 in controls, whereas it was ≥ 24.7 min/day for other comparisons. Conclusions: Intervention researchers are facing the issue of self-report measures introducing bias and accelerometer cut-points being insensi- tive. Machine learning approaches may bridge this gap.
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Lam SHF, Sivitz A, Alade K, Doniger SJ, Tessaro MO, Rabiner JE, Arroyo A, Castillo EM, Thompson CA, Yang M, Mistry RD. Comparison of Ultrasound Guidance vs. Clinical Assessment Alone for Management of Pediatric Skin and Soft Tissue Infections. J Emerg Med 2018; 55:693-701. [PMID: 30170835 DOI: 10.1016/j.jemermed.2018.07.010] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2018] [Revised: 06/15/2018] [Accepted: 07/11/2018] [Indexed: 10/28/2022]
Abstract
BACKGROUND Point-of-care ultrasound (POCUS) can potentially help distinguish cellulitis from abscess, which can appear very similar on physical examination but necessitate different treatment approaches. OBJECTIVE To compare POCUS guidance vs. clinical assessment alone on the management of pediatric skin and soft tissue infections (SSTI) in the emergency department (ED) setting. METHODS Children ages 6 months to 18 years presenting to participating EDs with SSTIs ≥ 1 cm were eligible. All treatment decisions, including use of POCUS, were at the discretion of the treating clinicians. Patients were divided into those managed with POCUS guidance (POCUS group) and those managed using clinical assessment alone (non-POCUS group). Primary outcome was clinical treatment failure at 7-10 days (unscheduled ED return visit or admission, procedural intervention, change in antibiotics therapy). Secondary outcomes were ED length of stay, discharge rate, use of alternative imaging, and need for procedural sedation. POCUS utility and impact on management decisions were also assessed by treating clinicians. RESULTS In total, 321 subjects (327 lesions) were analyzed, of which 299 (93%) had completed follow-up. There was no significant difference between the POCUS and non-POCUS groups in any of the primary or secondary outcomes. Management plan was changed in the POCUS group in 22.9% of cases (13.8% from medical to surgical, 9.1% from surgical to medical). Clinicians reported increased benefit of POCUS in cases of higher clinical uncertainty. CONCLUSIONS Use of POCUS was not associated with decreased ED treatment failure rate or process outcomes in pediatric SSTI patients. However, POCUS changed the management plan in approximately one in four cases.
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Affiliation(s)
- Samuel H F Lam
- Department of Emergency Medicine, University of California at San Diego, San Diego, California
| | - Adam Sivitz
- Department of Emergency Medicine, Newark Beth Israel Medical Center, Newark, New Jersey
| | - Kiyetta Alade
- Department of Pediatrics, Section of Emergency Medicine, Baylor College of Medicine/Texas Children's Hospital, Houston, Texas
| | - Stephanie J Doniger
- Department of Emergency Medicine, NYU Winthrop Hospital, Mineola, New York; St Christopher's Hospital for Children, Philadelphia, Pennsylvania
| | - Mark O Tessaro
- Division of Paediatric Emergency Medicine, Hospital for Sick Children, Toronto, Ontario, Canada
| | - Joni E Rabiner
- Division of Pediatric Emergency Medicine, Department of Pediatrics, Children's Hospital at Montefiore, Albert Einstein College of Medicine, Bronx, New York
| | - Alexander Arroyo
- Department of Emergency Medicine, Maimonides Medical Center, Brooklyn, New York
| | - Edward M Castillo
- Department of Emergency Medicine, University of California at San Diego, San Diego, California
| | - Caroline A Thompson
- Department of Public Health, San Diego State University, San Diego, California
| | - Mingan Yang
- Department of Public Health, San Diego State University, San Diego, California
| | - Rakesh D Mistry
- Section of Emergency Medicine, Children's Hospital Colorado, Aurora, Colorado
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Bandoli G, Palmsten K, Chambers CD, Jelliffe-Pawlowski LL, Baer RJ, Thompson CA. Revisiting the Table 2 fallacy: A motivating example examining preeclampsia and preterm birth. Paediatr Perinat Epidemiol 2018; 32:390-397. [PMID: 29782045 PMCID: PMC6103824 DOI: 10.1111/ppe.12474] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.5] [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] [Indexed: 11/27/2022]
Abstract
BACKGROUND A "Table Fallacy," as coined by Westreich and Greenland, reports multiple adjusted effect estimates from a single model. This practice, which remains common in published literature, can be problematic when different types of effect estimates are presented together in a single table. The purpose of this paper is to quantitatively illustrate this potential for misinterpretation with an example estimating the effects of preeclampsia on preterm birth. METHODS We analysed a retrospective population-based cohort of 2 963 888 singleton births in California between 2007 and 2012. We performed a modified Poisson regression to calculate the total effect of preeclampsia on the risk of PTB, adjusting for previous preterm birth. pregnancy alcohol abuse, maternal education, and maternal socio-demographic factors (Model 1). In subsequent models, we report the total effects of previous preterm birth, alcohol abuse, and education on the risk of PTB, comparing and contrasting the controlled direct effects, total effects, and confounded effect estimates, resulting from Model 1. RESULTS The effect estimate for previous preterm birth (a controlled direct effect in Model 1) increased 10% when estimated as a total effect. The risk ratio for alcohol abuse, biased due to an uncontrolled confounder in Model 1, was reduced by 23% when adjusted for drug abuse. The risk ratio for maternal education, solely a predictor of the outcome, was essentially unchanged. CONCLUSIONS Reporting multiple effect estimates from a single model may lead to misinterpretation and lack of reproducibility. This example highlights the need for careful consideration of the types of effects estimated in statistical models.
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Affiliation(s)
- Gretchen Bandoli
- Department of Pediatrics, University of California, San Diego, La Jolla, CA
| | | | - Christina D Chambers
- Department of Pediatrics, University of California, San Diego, La Jolla, CA,Department of Family Medicine and Public Health, University of California, San Diego, La Jolla, CA
| | - Laura L Jelliffe-Pawlowski
- Department of Epidemiology and Biostatistics, University of California, San Francisco, San Francisco, CA,California Preterm Birth Initiative, University of California San Francisco School of Medicine, San Francisco CA
| | - Rebecca J Baer
- Department of Pediatrics, University of California, San Diego, La Jolla, CA,Department of Epidemiology and Biostatistics, University of California, San Francisco, San Francisco, CA
| | - Caroline A Thompson
- Graduate School of Public Health, San Diego State University, San Diego, CA,Palo Alto Medical Foundation Research Institute, Sutter Health, Palo Alto, CA
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Afghahi A, Purington N, Han SS, Desai M, Pierson E, Mathur MB, Seto T, Thompson CA, Rigdon J, Telli ML, Badve SS, Curtis CN, West RB, Horst K, Gomez SL, Ford JM, Sledge GW, Kurian AW. Higher Absolute Lymphocyte Counts Predict Lower Mortality from Early-Stage Triple-Negative Breast Cancer. Clin Cancer Res 2018; 24:2851-2858. [PMID: 29581131 PMCID: PMC6366842 DOI: 10.1158/1078-0432.ccr-17-1323] [Citation(s) in RCA: 62] [Impact Index Per Article: 10.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2017] [Revised: 10/23/2017] [Accepted: 03/20/2018] [Indexed: 01/07/2023]
Abstract
Purpose: Tumor-infiltrating lymphocytes (TIL) in pretreatment biopsies are associated with improved survival in triple-negative breast cancer (TNBC). We investigated whether higher peripheral lymphocyte counts are associated with lower breast cancer-specific mortality (BCM) and overall mortality (OM) in TNBC.Experimental Design: Data on treatments and diagnostic tests from electronic medical records of two health care systems were linked with demographic, clinical, pathologic, and mortality data from the California Cancer Registry. Multivariable regression models adjusted for age, race/ethnicity, socioeconomic status, cancer stage, grade, neoadjuvant/adjuvant chemotherapy use, radiotherapy use, and germline BRCA1/2 mutations were used to evaluate associations between absolute lymphocyte count (ALC), BCM, and OM. For a subgroup with TIL data available, we explored the relationship between TILs and peripheral lymphocyte counts.Results: A total of 1,463 stage I-III TNBC patients were diagnosed from 2000 to 2014; 1,113 (76%) received neoadjuvant/adjuvant chemotherapy within 1 year of diagnosis. Of 759 patients with available ALC data, 481 (63.4%) were ever lymphopenic (minimum ALC <1.0 K/μL). On multivariable analysis, higher minimum ALC, but not absolute neutrophil count, predicted lower OM [HR = 0.23; 95% confidence interval (CI), 0.16-0.35] and BCM (HR = 0.19; CI, 0.11-0.34). Five-year probability of BCM was 15% for patients who were ever lymphopenic versus 4% for those who were not. An exploratory analysis (n = 70) showed a significant association between TILs and higher peripheral lymphocyte counts during neoadjuvant chemotherapy.Conclusions: Higher peripheral lymphocyte counts predicted lower mortality from early-stage, potentially curable TNBC, suggesting that immune function may enhance the effectiveness of early TNBC treatment. Clin Cancer Res; 24(12); 2851-8. ©2018 AACR.
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Affiliation(s)
- Anosheh Afghahi
- Department of Medicine, University of Colorado School of Medicine, Aurora, Colorado.
| | - Natasha Purington
- Quantitative Science Unit, Stanford University School of Medicine, Stanford, California
| | - Summer S Han
- Quantitative Science Unit, Stanford University School of Medicine, Stanford, California
| | - Manisha Desai
- Quantitative Science Unit, Stanford University School of Medicine, Stanford, California
- Department of Health Research and Policy, Stanford University School of Medicine, Stanford, California
| | - Emma Pierson
- Department of Medicine, Stanford University School of Medicine, Stanford, California
| | - Maya B Mathur
- Quantitative Science Unit, Stanford University School of Medicine, Stanford, California
- Department of Biostatistics, Harvard School of Public Health, Boston, Massachusetts
| | - Tina Seto
- Department of Medicine, Stanford University School of Medicine, Stanford, California
| | - Caroline A Thompson
- Palo Alto Medical Foundation Research Institute, Palo Alto, California
- Graduate School of Public Health, San Diego State University, San Diego, California
| | - Joseph Rigdon
- Quantitative Science Unit, Stanford University School of Medicine, Stanford, California
| | - Melinda L Telli
- Department of Medicine, Stanford University School of Medicine, Stanford, California
| | - Sunil S Badve
- Department of Pathology and Laboratory Medicine, Indiana University, Indianapolis, Indiana
| | - Christina N Curtis
- Department of Medicine, Stanford University School of Medicine, Stanford, California
| | - Robert B West
- Department of Pathology, Stanford University School of Medicine, Stanford, California
| | - Kathleen Horst
- Department of Medicine, Stanford University School of Medicine, Stanford, California
| | - Scarlett L Gomez
- Department of Medicine, Stanford University School of Medicine, Stanford, California
- Cancer Prevention Institute of California, Fremont, California
| | - James M Ford
- Department of Medicine, Stanford University School of Medicine, Stanford, California
| | - George W Sledge
- Department of Medicine, Stanford University School of Medicine, Stanford, California
| | - Allison W Kurian
- Department of Health Research and Policy, Stanford University School of Medicine, Stanford, California.
- Department of Medicine, Stanford University School of Medicine, Stanford, California
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Thompson CA, Boothroyd DB, Hastings KG, Cullen MR, Palaniappan LP, Rehkopf DH. A Multiple-Imputation "Forward Bridging" Approach to Address Changes in the Classification of Asian Race/Ethnicity on the US Death Certificate. Am J Epidemiol 2018; 187:347-357. [PMID: 29401361 DOI: 10.1093/aje/kwx215] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [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: 08/09/2016] [Accepted: 03/31/2017] [Indexed: 12/18/2022] Open
Abstract
The incomparability of old and new classification systems for describing the same data can be seen as a missing-data problem, and, under certain assumptions, multiple imputation may be used to "bridge" 2 classification systems. One example of such a change is the introduction of detailed Asian-American race/ethnicity classifications on the 2003 version of the US national death certificate, which was adopted for use by 38 states between 2003 and 2011. Using county- and decedent-level data from 3 different national sources for pre- and postadoption years, we fitted within-state multiple-imputation models to impute ethnicities for decedents classified as "other Asian" during preadoption years. We present mortality rates derived using 3 different methods of calculation: 1) including all states but ignoring the gradual adoption of the new death certificate over time, 2) including only the 7 states with complete reporting of all ethnicities, and 3) including all states and applying multiple imputation. Estimates from our imputation model were consistently in the middle of the other 2 estimates, and trend results demonstrated that the year-by-year estimates of the imputation model were more similar to those of the 7-state model. This work demonstrates how multiple imputation can provide a "forward bridging" approach to make more accurate estimates over time in newly categorized populations.
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Affiliation(s)
- Caroline A Thompson
- Division of Epidemiology and Biostatistics, Graduate School of Public Health, San Diego State University, San Diego, California
- Sutter Health Palo Alto Medical Foundation Research Institute, Palo Alto, California
| | - Derek B Boothroyd
- Quantitative Sciences Unit, Department of Medicine, School of Medicine, Stanford University, Stanford, California
| | - Katherine G Hastings
- Division of Primary Care and Population Health, Department of Medicine, School of Medicine, Stanford University, Stanford, California
| | - Mark R Cullen
- Division of Primary Care and Population Health, Department of Medicine, School of Medicine, Stanford University, Stanford, California
| | - Latha P Palaniappan
- Division of Primary Care and Population Health, Department of Medicine, School of Medicine, Stanford University, Stanford, California
| | - David H Rehkopf
- Division of Primary Care and Population Health, Department of Medicine, School of Medicine, Stanford University, Stanford, California
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Thompson CA, Gomez SL, Hastings KG, Kapphahn K, Yu P, Shariff-Marco S, Bhatt AS, Wakelee HA, Patel MI, Cullen MR, Palaniappan LP. The Burden of Cancer in Asian Americans: A Report of National Mortality Trends by Asian Ethnicity. Cancer Epidemiol Biomarkers Prev 2018; 25:1371-1382. [PMID: 27694108 DOI: 10.1158/1055-9965.epi-16-0167] [Citation(s) in RCA: 67] [Impact Index Per Article: 11.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2016] [Accepted: 06/23/2016] [Indexed: 12/22/2022] Open
Abstract
BACKGROUND Asian Americans (AA) are the fastest growing U.S. population, and when properly distinguished by their ethnic origins, exhibit substantial heterogeneity in socioeconomic status, health behaviors, and health outcomes. Cancer is the second leading cause of death in the United States, yet trends and current patterns in the mortality burden of cancer among AA ethnic groups have not been documented. METHODS We report age-adjusted rates, standardized mortality ratios, and modeled trends in cancer-related mortality in the following AA ethnicities: Asian Indians, Chinese, Filipinos, Japanese, Koreans, and Vietnamese, from 2003 to 2011, with non-Hispanic whites (NHW) as the reference population. RESULTS For most cancer sites, AAs had lower cancer mortality than NHWs; however, mortality patterns were heterogeneous across AA ethnicities. Stomach and liver cancer mortality was very high, particularly among Chinese, Koreans, and Vietnamese, for whom these two cancer types combined accounted for 15% to 25% of cancer deaths, but less than 5% of cancer deaths in NHWs. In AA women, lung cancer was a leading cause of death, but (unlike males and NHW females) rates did not decline over the study period. CONCLUSIONS Ethnicity-specific analyses are critical to understanding the national burden of cancer among the heterogeneous AA population. IMPACT Our findings highlight the need for disaggregated reporting of cancer statistics in AAs and warrant consideration of tailored screening programs for liver and gastric cancers. Cancer Epidemiol Biomarkers Prev; 25(10); 1371-82. ©2016 AACR.
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Affiliation(s)
- Caroline A Thompson
- Graduate School of Public Health, San Diego State University, San Diego, California. Palo Alto Medical Foundation Research Institute, Palo Alto, California
| | - Scarlett Lin Gomez
- Cancer Prevention Institute of California, Fremont, California. Department of Health Research and Policy, Stanford University School of Medicine, Stanford, California. Stanford Comprehensive Cancer Institute, Stanford University School of Medicine, Stanford, California
| | - Katherine G Hastings
- Division of General Medical Disciplines, Stanford University School of Medicine, Stanford, California
| | - Kristopher Kapphahn
- Quantitative Sciences Unit, Stanford University School of Medicine, Stanford, California
| | - Peter Yu
- Palo Alto Foundation Medical Group, Palo Alto Medical Foundation, Palo Alto, California
| | - Salma Shariff-Marco
- Cancer Prevention Institute of California, Fremont, California. Department of Health Research and Policy, Stanford University School of Medicine, Stanford, California. Stanford Comprehensive Cancer Institute, Stanford University School of Medicine, Stanford, California
| | - Ami S Bhatt
- Department of Medicine and Department of Genetics, Stanford University, Stanford, California. Center for Innovation in Global Health, Stanford University, Stanford, California
| | - Heather A Wakelee
- Stanford Comprehensive Cancer Institute, Stanford University School of Medicine, Stanford, California. Division of Oncology, Stanford University School of Medicine, Stanford, California
| | - Manali I Patel
- Division of Oncology, Stanford University School of Medicine, Stanford, California. VA Palo Alto Health Care System, Palo Alto, California
| | - Mark R Cullen
- Division of General Medical Disciplines, Stanford University School of Medicine, Stanford, California. Stanford Center for Population Health Sciences, Stanford University School of Medicine, Stanford, California
| | - Latha P Palaniappan
- Division of General Medical Disciplines, Stanford University School of Medicine, Stanford, California.
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Low YS, Daugherty AC, Schroeder EA, Chen W, Seto T, Weber S, Lim M, Hastie T, Mathur M, Desai M, Farrington C, Radin AA, Sirota M, Kenkare P, Thompson CA, Yu PP, Gomez SL, Sledge GW, Kurian AW, Shah NH. Synergistic drug combinations from electronic health records and gene expression. J Am Med Inform Assoc 2017; 24:565-576. [PMID: 27940607 PMCID: PMC6080645 DOI: 10.1093/jamia/ocw161] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [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: 12/12/2022] Open
Abstract
Objective Using electronic health records (EHRs) and biomolecular data, we sought to discover drug pairs with synergistic repurposing potential. EHRs provide real-world treatment and outcome patterns, while complementary biomolecular data, including disease-specific gene expression and drug-protein interactions, provide mechanistic understanding. Method We applied Group Lasso INTERaction NETwork (glinternet), an overlap group lasso penalty on a logistic regression model, with pairwise interactions to identify variables and interacting drug pairs associated with reduced 5-year mortality using EHRs of 9945 breast cancer patients. We identified differentially expressed genes from 14 case-control human breast cancer gene expression datasets and integrated them with drug-protein networks. Drugs in the network were scored according to their association with breast cancer individually or in pairs. Lastly, we determined whether synergistic drug pairs found in the EHRs were enriched among synergistic drug pairs from gene-expression data using a method similar to gene set enrichment analysis. Results From EHRs, we discovered 3 drug-class pairs associated with lower mortality: anti-inflammatories and hormone antagonists, anti-inflammatories and lipid modifiers, and lipid modifiers and obstructive airway drugs. The first 2 pairs were also enriched among pairs discovered using gene expression data and are supported by molecular interactions in drug-protein networks and preclinical and epidemiologic evidence. Conclusions This is a proof-of-concept study demonstrating that a combination of complementary data sources, such as EHRs and gene expression, can corroborate discoveries and provide mechanistic insight into drug synergism for repurposing.
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Affiliation(s)
- Yen S Low
- Stanford Center for Biomedical Informatics Research, Stanford University, Stanford, CA, USA
| | | | | | - William Chen
- Stanford Center for Biomedical Informatics Research, Stanford University, Stanford, CA, USA
| | - Tina Seto
- Clinical Informatics, Stanford University
| | | | - Michael Lim
- Department of Statistics, Stanford University
| | - Trevor Hastie
- Department of Statistics, Stanford University.,Department of Health Research and Policy, Stanford University
| | - Maya Mathur
- Quantitative Sciences Unit, Stanford University
| | | | | | | | | | - Pragati Kenkare
- Palo Alto Medical Foundation Research Institute, Palo Alto, CA, USA
| | | | - Peter P Yu
- Palo Alto Medical Foundation Research Institute, Palo Alto, CA, USA
| | - Scarlett L Gomez
- Department of Health Research and Policy, Stanford University.,Cancer Prevention Institute of California, Fremont, CA, USA
| | - George W Sledge
- Division of Oncology, Department of Medicine, Stanford University
| | - Allison W Kurian
- Department of Health Research and Policy, Stanford University.,Division of Oncology, Department of Medicine, Stanford University
| | - Nigam H Shah
- Stanford Center for Biomedical Informatics Research, Stanford University, Stanford, CA, USA
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Martinez-Parachini JR, Karatasakis A, Karmpaliotis D, Alaswad K, Jaffer FA, Yeh RW, Patel M, Bahadorani J, Doing A, Nguyen-Trong PK, Danek BA, Karacsonyi J, Alame A, Rangan BV, Thompson CA, Banerjee S, Brilakis ES. Impact of diabetes mellitus on acute outcomes of percutaneous coronary intervention in chronic total occlusions: insights from a US multicentre registry. Diabet Med 2017; 34:558-562. [PMID: 27743404 PMCID: PMC5352496 DOI: 10.1111/dme.13272] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 10/11/2016] [Indexed: 12/24/2022]
Abstract
AIM To examine the impact of diabetes mellitus on procedural outcomes of patients who underwent percutaneous coronary intervention for chronic total occlusion. METHODS We assessed the impact of diabetes mellitus on the outcomes of percutaneous coronary intervention for chronic total occlusion among 1308 people who underwent such procedures at 11 US centres between 2012 and 2015. RESULTS The participants' mean ± sd age was 66 ± 10 years, 84% of the participants were men and 44.6% had diabetes. As compared with participants without diabetes, participants with diabetes were more likely to have undergone coronary artery bypass graft surgery (38 vs 31%; P = 0.006), and to have had previous heart failure (35 vs 22%; P = 0.0001) and peripheral arterial disease (19 vs 13%; P = 0.002). They also had a higher BMI (31 ± 6 kg/m2 vs 29 ± 6 kg/m2 ; P = 0.001), similar Japanese chronic total occlusion scores (2.6 ± 1.2 vs 2.5 ± 1.2; P = 0.82) and similar final successful crossing technique: antegrade wire escalation (46 vs 47%; P = 0.66), retrograde (30 vs 28%; P = 0.66) and antegrade dissection re-entry (24 vs 25%; P = 0.66). Technical (91 vs 90%; P = 0.80) and procedural (89 vs 89%; P = 0.93) success was similar in the two groups, as was the incidence of major adverse cardiac events (2.2 vs 2.5%; P = 0.61). CONCLUSIONS In a contemporary cohort of people undergoing percutaneous coronary intervention for chronic total occlusion, nearly one in two (45%) had diabetes mellitus. Procedural success and complication rates were similar in people with and without diabetes.
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Affiliation(s)
| | - A Karatasakis
- VA North Texas Healthcare System and UT Southwestern Medical Center, Dallas, TX, USA
| | | | - K Alaswad
- Henry Ford Hospital, Detroit, MI, USA
| | - F A Jaffer
- Massachusetts General Hospital and Harvard Medical School, Boston, MA, USA
| | - R W Yeh
- Beth Israel Deaconess Medical Center and Harvard Medical School, Boston, MA, USA
| | - M Patel
- VA San Diego Healthcare System and University of California San Diego, San Diego, CA, USA
| | - J Bahadorani
- VA San Diego Healthcare System and University of California San Diego, San Diego, CA, USA
| | - A Doing
- Medical Center of the Rockies, Loveland, CO, USA
| | - P-K Nguyen-Trong
- VA North Texas Healthcare System and UT Southwestern Medical Center, Dallas, TX, USA
| | - B A Danek
- VA North Texas Healthcare System and UT Southwestern Medical Center, Dallas, TX, USA
| | - J Karacsonyi
- VA North Texas Healthcare System and UT Southwestern Medical Center, Dallas, TX, USA
| | - A Alame
- VA North Texas Healthcare System and UT Southwestern Medical Center, Dallas, TX, USA
| | - B V Rangan
- VA North Texas Healthcare System and UT Southwestern Medical Center, Dallas, TX, USA
| | | | - S Banerjee
- VA North Texas Healthcare System and UT Southwestern Medical Center, Dallas, TX, USA
| | - E S Brilakis
- VA North Texas Healthcare System and UT Southwestern Medical Center, Dallas, TX, USA
- Minneapolis Heart Institute, Minneapolis, MN, USA
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Castro AC, Bloor KE, Thompson CA. P108 Effect of Care Quality Commission inspections of acute NHS trusts on adverse events: Interrupted time series study. Br J Soc Med 2016. [DOI: 10.1136/jech-2016-208064.205] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
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50
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Rai A, Thompson CA, Kurian AW, Luft HS. Determinants of Patient Choice of Health Care Providers for Breast Cancer Treatment. J Patient Cent Res Rev 2016. [DOI: 10.17294/2330-0698.1292] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
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