Association between cardiovascular mortality and STOP-Bang questionnaire scores in a cohort of hospitalized patients: a prospective study

OBJECTIVE

Obstructive sleep apnea (OSA) is associated with an increased risk of mortality and cardiometabolic diseases. The STOP-Bang questionnaire is a tool to screen populations at risk of OSA and prioritize complementary studies. Our objective was to evaluate the clinical utility of this questionnaire in identifying patients at an increased risk of mortality after discharge in a cohort of hospitalized patients.

METHODS

This was a prospective cohort study involving consecutive patients admitted to an internal medicine unit between May and June of 2017 who were reevaluated three years after discharge. At baseline, we collected data on comorbidities (hypertension, obesity, diabetes, and fasting lipid profile) and calculated STOP-Bang scores, defining the risk of OSA (0-2 score, no risk; ≥ 3 score, risk of OSA; and ≥ 5 score, risk of moderate-to-severe OSA), which determined the study groups. We also recorded data regarding all-cause and cardiovascular mortality at the end of the follow-up period.

RESULTS

The sample comprised 435 patients. Of those, 352 (80.9%) and 182 (41.8%) had STOP-Bang scores ≥ 3 and ≥ 5, respectively. When compared with the group with STOP-Bang scores of 0-2, the two groups showed higher prevalences of obesity, hypertension, diabetes, and dyslipidemia. Multivariate analysis showed an independent association between cardiovascular mortality and STOP-Bang score ≥ 5 (adjusted hazard ratio = 3.12 [95% CI, 1.39-7.03]; p = 0.01). Additionally, previous coronary heart disease was also associated with cardiovascular mortality.

CONCLUSIONS

In this cohort of hospitalized patients, STOP-Bang scores ≥ 5 were able to identify patients at an increased risk of cardiovascular mortality three years after discharge.

[Association between high vitamin B12 levels and one year mortality in older people admitted to the hospital]

BACKGROUND

Supplementation of vitamin B12 in older adults is a common practice to avoid vitamin B12 insufficiency. However, there is a paucity of information about the effects of cobalamin excess.

AIM

To asses any potential effects of high levels vitamin B12 on mortality on adults aged ≥ 65 years admitted to an internal medicine service.

MATERIAL AND METHODS

We Prospectively studied patients admitted to an internal medicine service of an academic hospital from September 2017 to September 2018, who were able to give their consent and answer questionnaires. We tabulated age, gender, medical history, comorbidity index (Charlson), frailty score (Fried scale), admission diagnosis and blood tests performed within 48 hours of admission. The primary outcome was death by any cause in less of 30 days or after one of year follow up, determined according to death certificates.

RESULTS

We included 93 patients aged 65 to 94 years (53% males). Fifteen patients died during the year of follow up (five within 30 days of admission). Those who died had higher cobalamin levels than survivors (1080.07 ± 788.09 and 656.68 ± 497.33 pg/mL respectively, p = 0.02). Patients who died had also a significantly lower corrected serum calcium, sodium (p = 0.04) and a medical history of chronic liver disease (p = 0.03). In the multivariable analysis, only vitamin B12 preserved the association with mortality (p = 0.009).

CONCLUSIONS

There was a significant association between high levels of cobalamin and all-cause mortality in this group of patients aged ≥ 65 years-old.

Prevalence of STOP BANG questionnaire and association with major cardiovascular events in hospitalized population: is it enough with currently used cardiovascular risk measurements?

Cardiovascular risk (CR) is associated with obstructive sleep apnea hypopnea syndrome (OSAHS). This association enhances the risk of major adverse cardiovascular events (MACE); nevertheless, data from hospitalized populations and interactions among these conditions remain unclear.

PURPOSE

To evaluate the risk of MACE in the population with risk of OSAHS using the STOP-BANG questionnaire.

METHODS

We performed a prospective study in an academic hospital from 2017 to 2018. Data included demography, admissions, STOP-BANG score and CR using AHA scores. The primary outcome was risk of MACE in participants with low risk of OSAHS (STOP-BANG 0-2 points), risk of OSAHS (≥3 points) and risk of moderate/severe OSAHS (≥5 points). Risk of MACE was evaluated using odds ratios (OR), and average CR was evaluated using the t-test.

RESULTS

A total of 441 participants were included. The cumulative prevalence of STOP BANG ≥3 points was 80.9%, and that of ≥5 points was 41.6%. OR of MACE ≥3 points was 3.93 (CI 2.08-7.24) (p < 0.001) compared with <3 points, and Average CR was 10.91% (SD ± 2.13) at <3 points versus 24.3% (SD ± 1.24) for ≥3 points for ≥5 points OR of MACE was 1.72 (CI 1.18-2.59) (p = 0.005) and average CR was 26.14% (SD ± 1.63). However, after multivariable analysis, gender differences and previous heart failure were independently associated to MACE.

CONCLUSION

The risk of OSAHS in the hospitalized population is high. This population has a higher risk of MACE and higher CRs than do low-risk participants. Conversely, gender and heart failure are potential cofounders.

Results of a Pilot Trial of Immunotherapy with Dendritic Cells Pulsed with Autologous Tumor Lysates in Patients with Advanced Cancer

Aims and background

The purpose of the study was to test the immunological and clinical effects of infusions of dendritic cells pulsed with autologous tumor lysate in patients with advanced cancer.

Patients and methods

Peripheral blood mononuclear cells from 15 patients with metastatic cancer (melanoma in 10, lung cancer in 2, renal cell carcinoma in 1, sarcoma in 1, breast cancer in 1) were harvested by leukapheresis after mobilization with GM-CSF (5 μg/kg/day s.c. for 4 days). Mononuclear cells were separated and cultured in GM-CSF (1000 U/ml) and interleukin-4 (1000 U/ml) for 7 days. Phenotype was assessed by 2-color flow cytometry and immunocytochemistry. On day 6, dendritic cells were pulsed with 1 g of fresh autologous tumor lysate for 24 h and infused intravenously. Interleukin-2 (6 million IU), interferon a (4 million IU) and GM-CSF (400 μg) were injected s.c. daily for 10 days beginning on the day of dendritic cell infusion. Treatment was repeated every 21 days for 3 courses.

Results

The morphology, immunocytochemistry and phenotype of cultured cells was consistent with dendritic cells: intense positivity for HLA-DR and CD86, with negativity for markers of other lineages, including CD3, CD4, CD8 and CD14. More than 5 × 107 dendritic cells were injected in all patients. Nine patients developed >5 mm delayed type cutaneous hypersensitivity reactions to tumor lysate ± GM-CSF after the first immunization (larger than GM-CSF in all cases). Median delayed type cutaneous hypersensitivity to lysate + GM-CSF was 3 cm after the third immunization. One melanoma patient with skin, liver, lung and bone metastases had a partial response lasting 8 months (followed by progression in the brain). Seven patients had stable disease for >3 months, and 7 had progression.

Conclusions

Infusion of tumor lysate-pulsed dendritic cells induces a strong cell-mediated antitumor immune reaction in patients with advanced cancer and has some clinical activity.

Impact of cognitive impairment, depression, disease activity, and disease damage on quality of life in women with systemic lupus erythematosus

OBJECTIVES

To define the relative role of cognitive impairment, depression, disease activity, and disease damage in the decreased health-related quality of life (HRQoL) frequently observed in systemic lupus erythematosus (SLE) patients.

METHOD

We studied 101 Chilean female SLE patients and applied the 12-item Medical Outcomes Study (MOS) Short Form Health Survey version 2 (SF-12v2) to assess HRQoL and the Cambridge Neuropsychological Test Automated Battery (CANTAB) to assess cognitive function. Analysis of covariance (ANCOVA) models included demographic and disease-related factors and cognitive function tests of sustained attention, memory, and executive function.

RESULTS

All measures of HRQoL were lower in the 101 female SLE patients compared to the women from the Chilean general population. HRQoL was associated with the following factors: (i) depression symptoms, which were detrimental to all components of the physical and mental HRQoL scores; (ii) executive dysfunction (spatial planning), which was associated with lower scores on role limitations due to physical health problems and emotional problems, and general health perceptions; (iii) higher activity and organ damage were deleterious to role physical, bodily pain, and physical summary scores; and (iv) higher damage also impacted physical function. Impairments in sustained attention and memory did not decrease the HRQoL.

CONCLUSIONS

Our results highlight the relevance of executive dysfunction to poor physical and mental health components of HRQoL in SLE together with depression, while disease activity and disease damage are associated with lower HRQoL physical components. The need for cognitive function evaluation and rehabilitation in SLE is indicated.

Paid employment in subjects with and without chronic obstructive pulmonary disease in five Latin American cities: the PLATINO study

BACKGROUND

Chronic obstructive pulmonary disease (COPD) is a costly condition that frequently causes permanent work disabilities. Little information exists regarding the impact of COPD on work force participation and the indirect costs of the disease in developing countries.

OBJECTIVE

To examine the frequency of paid employment and factors influencing it in a Latin-American population-based study.

METHODS

Post-bronchodilator FEV(1)/FVC < 0.70 (forced expiratory volume in 1 s/forced vital capacity) was used to define COPD. Information regarding paid work was assessed by the question 'At any time in the past year, have you worked for payment?'

RESULTS

Interviews were conducted with 5571 subjects; 5314 (759 COPD and 4554 non-COPD) subjects underwent spirometry. Among the COPD subjects, 41.8% reported having paid work vs. 57.1% of non-COPD (P < 0.0001). The number of months with paid work was reduced in COPD patients (10.5 ± 0.17 vs. 10.9 ± 0.06, P < 0.05). The main factors associated with having paid work in COPD patients were male sex (OR 0.33, 95%CI 0.23-0.47), higher education level (OR 1.05, 95%CI 1.01-1.09) and younger age (OR 0.90, 95%CI 0.88-0.92). COPD was not a significant contributor to employment (OR 0.83, 95%CI 0.69-1.00, P = 0.054) in the entire population.

CONCLUSIONS

Although the proportion of persons with paid work is lower in COPD, having COPD appears not to have a significant impact on obtaining paid employment in the overall population of developing countries.

European genome-wide association study identifies SLC14A1 as a new urinary bladder cancer susceptibility gene

Three genome-wide association studies in Europe and the USA have reported eight urinary bladder cancer (UBC) susceptibility loci. Using extended case and control series and 1000 Genomes imputations of 5 340 737 single-nucleotide polymorphisms (SNPs), we searched for additional loci in the European GWAS. The discovery sample set consisted of 1631 cases and 3822 controls from the Netherlands and 603 cases and 37 781 controls from Iceland. For follow-up, we used 3790 cases and 7507 controls from 13 sample sets of European and Iranian ancestry. Based on the discovery analysis, we followed up signals in the urea transporter (UT) gene SLC14A. The strongest signal at this locus was represented by a SNP in intron 3, rs17674580, that reached genome-wide significance in the overall analysis of the discovery and follow-up groups: odds ratio = 1.17, P = 7.6 × 10(-11). SLC14A1 codes for UTs that define the Kidd blood group and are crucial for the maintenance of a constant urea concentration gradient in the renal medulla and, through this, the kidney's ability to concentrate urine. It is speculated that rs17674580, or other sequence variants in LD with it, indirectly modifies UBC risk by affecting urine production. If confirmed, this would support the 'urogenous contact hypothesis' that urine production and voiding frequency modify the risk of UBC.

A multi-stage genome-wide association study of bladder cancer identifies multiple susceptibility loci

We conducted a multi-stage, genome-wide association study of bladder cancer with a primary scan of 591,637 SNPs in 3,532 affected individuals (cases) and 5,120 controls of European descent from five studies followed by a replication strategy, which included 8,382 cases and 48,275 controls from 16 studies. In a combined analysis, we identified three new regions associated with bladder cancer on chromosomes 22q13.1, 19q12 and 2q37.1: rs1014971, (P = 8 × 10⁻¹²) maps to a non-genic region of chromosome 22q13.1, rs8102137 (P = 2 × 10⁻¹¹) on 19q12 maps to CCNE1 and rs11892031 (P = 1 × 10⁻⁷) maps to the UGT1A cluster on 2q37.1. We confirmed four previously identified genome-wide associations on chromosomes 3q28, 4p16.3, 8q24.21 and 8q24.3, validated previous candidate associations for the GSTM1 deletion (P = 4 × 10⁻¹¹) and a tag SNP for NAT2 acetylation status (P = 4 × 10⁻¹¹), and found interactions with smoking in both regions. Our findings on common variants associated with bladder cancer risk should provide new insights into the mechanisms of carcinogenesis.

A sequence variant at 4p16.3 confers susceptibility to urinary bladder cancer

Previously, we reported germline DNA variants associated with risk of urinary bladder cancer (UBC) in Dutch and Icelandic subjects. Here we expanded the Icelandic sample set and tested the top 20 markers from the combined analysis in several European case-control sample sets, with a total of 4,739 cases and 45,549 controls. The T allele of rs798766 on 4p16.3 was found to associate with UBC (odds ratio = 1.24, P = 9.9 x 10(-12)). rs798766 is located in an intron of TACC3, 70 kb from FGFR3, which often harbors activating somatic mutations in low-grade, noninvasive UBC. Notably, rs798766[T] shows stronger association with low-grade and low-stage UBC than with more aggressive forms of the disease and is associated with higher risk of recurrence in low-grade stage Ta tumors. The frequency of rs798766[T] is higher in Ta tumors that carry an activating mutation in FGFR3 than in Ta tumors with wild-type FGFR3. Our results show a link between germline variants, somatic mutations of FGFR3 and risk of UBC.

Worldwide burden of COPD in high- and low-income countries. Part II. Burden of chronic obstructive lung disease in Latin America: the PLATINO study

SETTING

Five Latin American cities: São Paulo, Brazil; Mexico City, Mexico; Montevideo, Uruguay; Santiago, Chile; Caracas, Venezuela.

OBJECTIVE

To describe the burden of chronic obstructive pulmonary disease (COPD) in Latin America.

DESIGN

This is a multicentre study. Post-bronchodilator spirometry was used and the main outcome measure was FEV(1)/FVC < 0.7 (fixed ratio criterion). Global Obstructive Lung Disease (GOLD) stages were also analysed.

RESULTS

The combined population aged > or =40 years in the five countries included in the study was approximately 85.3 million. Of these, it was estimated that 12.2 million have airflow obstruction, which corresponds to our prevalence estimate of 14.3%. The proportion of subjects in Stages II-IV of the GOLD classification was 5.6%. Risk factors presenting the highest aetiological fractions for COPD were age, current smoking, indoor exposure to coal and exposure to dust in the workplace. Smoking, the modifiable factor with the strongest aetiological fraction for COPD, affects 29.2% of adults aged > or =40 years in these cities, corresponding to approximately 25 million smokers in this age group.

CONCLUSION

Prevention of smoking and exposure to pollutants, such as coal and dust, are the interventions most likely to succeed against COPD in Latin America. The information obtained by a collaborative study has been vast and encouraging for other similar studies.

Tuberculosis and airflow obstruction: evidence from the PLATINO study in Latin America

The aim of the present study was to evaluate the association between history of tuberculosis and airflow obstruction. A population-based, multicentre study was carried out and included 5,571 subjects aged > or =40 yrs living in one of five Latin American metropolitan areas: Sao Paulo (Brazil); Montevideo (Uruguay); Mexico City (Mexico); Santiago (Chile); and Caracas (Venezuela). Subjects performed pre- and post-bronchodilator spirometry and were asked whether they had ever been diagnosed with tuberculosis by a physician. The overall prevalence of airflow obstruction (forced expiratory volume in one second/forced vital capacity post-bronchodilator <0.7) was 30.7% among those with a history of tuberculosis, compared with 13.9% among those without a history. Males with a medical history of tuberculosis were 4.1 times more likely to present airflow obstruction than those without such a diagnosis. This remained unchanged after adjustment for confounding by age, sex, schooling, ethnicity, smoking, exposure to dust and smoke, respiratory morbidity in childhood and current morbidity. Among females, the unadjusted and adjusted odds ratios were 2.3 and 1.7, respectively. In conclusion, history of tuberculosis is associated with airflow obstruction in Latin American middle-aged and older adults.

[Bronchial asthma and atopic diseases as an emerging problem in public health: new etiological hypothesis. The experience of developed societies]

Developed countries report increasing trends in the prevalence of asthma and atopic diseases over the last 40 years. This change cannot be attributed to artefactual effects. Emerging from these information, new approaches have been generated to explore these novel findings. Among the most important new factors to be explored, scientific research is pointing out to variables related with physical environment, socio-economic and genetic background, anthropometry at birth, nutritional status, diet, exercise and hormonal profile. Changes in the epidemiology of asthma and atopic conditions in developed countries were also preceded by increases in the prevalence of chronic diseases and their risk factors. Chile does not have information about time trends on these diseases, but several studies are reporting a high prevalence of asthma among adults. Conversely, results from the collaborative ISAAC study carried out in children, have shown a relative low prevalence of asthma in Chilean children. An increasing trend in chronic diseases and their risk factors has been reported in Chile, suggesting an epidemiological pattern similar to that experienced by industrialised countries, when the prevalence of asthma and atopic began to increase. This article review current information about etiological research emphasising the need to develop local research on asthma and atopic diseases taking into account our epidemiological situation.

Cellular immune response of intracecally inoculated Mongolian gerbils with Entamoeba histolytica trophozoites

We analyzed the local and systemic cellular immune response in mongolian gerbils inoculated with Entamoeba histolytica. Two groups were intracecally inoculated with E. histolytica trophozoites and two groups were used as controls. A inoculated groups and a control groups were sacrificed on days 10 and 30 post inoculation (p.i), the spleen and mesenteric lymph nodes (MLNs) lymphocytes (Ly) were isolated and incubated in vitro with 2 different amebic antigens. The proliferative Ly response of inoculated groups was greater than the Ly mitogenic response seen in control groups, at day 10 p.i. as well as day 30 p.i. (alpha = 0.05). Ly response of MLNs was greater in comparison to those of the spleen (alpha = 0.05). In other four groups, intradermal reactions with a antigen were used to demonstrated delayed hypersensitivity in gerbils after being inoculated with E. histolytica trophozoites. The percentage of volume increase of the plantar pad swelling were measured. Groups inoculated presented greater increases (alpha = 0.05) than groups controls. The evidence presented herein demonstrates that the presence of E. histolytica trophozoites in cecum induced a local and systemic cellular immune response.

[Gastric cancer and cerebrovascular diseases. A natural history with common elements? Analysis of the salt theory in Chile (1955-1994)]

BACKGROUND

In the last forty years, a sustained reduction in the gastric cancer and cerebrovascular disease mortality has been recorded. Joossens has postulated that sodium intake has an influence in the natural history of both diseases.

AIM

To analyze the mortality caused by both diseases in Chile.

MATERIAL AND METHODS

The mortality of people aged 35 to 64 years old, due to gastric cancer and cerebrovascular diseases in the period 1955-1994, was analyzed. An analysis according to regions, using temporal series and correlation techniques was performed.

RESULTS

In the studied period, the mortality due to gastric cancer decreased by 71.6% in men and by 79.5% in women. Mortality due to cerebrovascular diseases decreased by 56.9% in men and by 63.9% in women. There was a correlation coefficient of +0.91 between the mortality due to both diseases. Cerebrovascular disease mortality appears as a predictor of gastric cancer mortality in temporal series analysis.

CONCLUSIONS

Joossens theories are supported by the present data. Prospective studies should be designed to confirm the hypothesis.

[Respiratory symptoms and cough reflex in populations exposed to different degrees of environmental pollution]

BACKGROUND

Santiago is a city with a high degree of environmental pollution caused by particulate matter and ozone, producing adverse effects in the respiratory system.

AIM

To compare respiratory symptoms and cough reflex in adults from Santiago and from a rural area with low levels of environmental pollution.

SUBJECTS AND METHODS

One hundred twenty six non-smoker adults from Santiago and 116 from a rural area with low levels of pollution answered a respiratory symptom questionnaire. Of these 101 subjects from Santiago and 116 from the rural area inhaled doubling concentrations of capsaicin from 0.5 to 500 microM or until five coughs were elicited. The lowest concentration eliciting 2 or more coughs (CD2) or 5 or more coughs (CD5) was recorded. Levels of environmental particulate matter were also recorded in both locations.

RESULTS

Levels of particulate matter were 102 +/- 41 and 64 +/- 24 micrograms/m3 in Santiago and the rural area respectively. People from Santiago had higher rates of throat clearing, cough and phlegm. CD2 geometric mean and confidence limits in Santiago and the rural area were 6.9 (5.2-7.4) and 2.8 (2.7-2.9) respectively (p < 0.001). No differences in CD5 were observed between both locations. Multivariate analysis disclosed the variable location (city) as the only independent predictor of respiratory symptoms.

CONCLUSIONS

The increased CD2 found in Santiago suggests that the higher rates of respiratory symptoms related to air pollution can be associated to a decreased sensitivity of the cough reflex.

Late motor deficits of Chilean manganese miners: a blinded control study

High-level chronic manganese (Mn) exposure produces dystonic rigidity and proximal tremor. The late effects of asymptomatic exposure are uncertain. To evaluate hand movements of asymptomatic Chilean miners, we utilized a manual tremormeter (EAP) and a digitizing tablet (MOVEMAP). In Andacollo, Chile, we examined 59 individuals aged > 50 years (mean age, 64.4 years). Twenty-seven exposed miners had heavy Mn dust exposure in Mn mines for more than 5 years (mean duration, 20.25 years), ending at least 5 years previously. Thirty-two control miners had never worked in Mn mines or had short-term Mn employment. Tests of resting tremor (EAP Tremormeter, MOVEMAP Steady paradigm), action tremor (MOVEMAP Square paradigm), and repetitive hand movements (EAP Tapping Test and Orthokinesimeter) differentiated performance of exposed miners from that of controls. Chronic asymptomatic Mn exposure results in detectable late-life abnormalities of movement.

[Hip fracture: a case-control study in the metropolitan region I]

BACKGROUND

Hip fracture is a preventable cause of disability among elderly people

AIM

To study factors associated to hip fractures in Chile.

PATIENTS AND METHODS

Patients admitted to seven public hospitals in Chile, with hip fracture not due to major accidents, were considered as cases. To each, at least one age and sex matched hospitalized control, without or neoplastic diseases, was assigned. All patients were subjected to an inquiry, using an instrument devised by the WHO.

RESULTS

Two hundred sixty eight cases and 501 controls were studied. Cases and controls has similar educational and labor histories. The right hip was fractures in 47% of cases and the left in the rest. Compared with controls, cases had a higher body mass index, loss of height during life, rate of hysterectomy, incidence of smoking and a lower consumption of diary products. Cases had higher risk of falls inside their homes and controls outside.

CONCLUSIONS

The obtained information may contribute to the development of preventive measures and reduce the public health impact of hip fracture.

[Frequency of lumbar spine osteopenia in an asymptomatic postmenopausal Chilean population]

The aim of this study was to assess lumbar spine bone density in a group of chilean postmenopausal females and to estimate the frequency of vertebral osteopenia in the national urban female population. A clinical assessment and lumbar spine bone density measurement were performed to 171 healthy women over 40 years of age and not receiving medications that modify bone turnover. Calcium ingestion was recalled in 77 of these. Fifty women (29.2%) had osteopenia, defined as a bone density of less than 0.92 g/cm2. Extrapolating this figure to the national urban population, an osteopenia frequency of 21.7% was estimated. Body mass index was 25.5 +/- 3.8 and 57% of the sample was overweight. Calcium ingestion was 740.3 +/- 331.7. These two parameters did not correlative with bone density. Women with osteopenia were older and had a longer postmenopausal lapse than those with normal bone density. The completion of further clinical an epidemiological studies is recommended to know the real magnitude of osteoporosis in Chile.

Development of a program of behavior modification directed to the rehabilitation of drug-dependent patients: treatment and follow-up of 223 cases

The study reports treatment and follow-up of compulsive drug-consuming patients (mainly of coca paste). The program used was based on a behavioral cognitive and instructional model. The traditional functional analysis was modified to include the therapeutical work in seven behavioral areas: (1) drug use; (2) behavior during free time; (3) behavior at work; (4) social behavior; (5) self- and environmental management behaviors; (6) problem solving and decision-making behaviors; (7) recognition, evaluation, and modification of irrational beliefs. For each area objectives, therapeutical procedures, control and evaluation methods, and termination criteria were determined. Patients engaged in a multiple activity program and received individual and group therapy. Out of 223 male patients, 130 were discharged (that is, they fulfilled all the conditions stated by the program) and 93 patients abandoned treatment. For evaluation purposes a test was used to determine the accomplishment of the behavioral objectives. Follow-up interviews after 6 to 72 months showed that although 24 patients relapsed to drug use, 106 (81.48%) of the patients who had finished the program restrained from using drugs and obtained high scores in all seven behavioral areas.

[Gallbladder cancer mortality in Chile and its relation to cholecystectomy rates. An analysis of the last decade]

Extrahepatic biliary tract cancer (mainly gallbladder cancer) mortality rates have increased from 7.84 x 100.000 to 9.6 x 100.000 in Chile during the last decade. The most significant risk factor for gallbladder cancer is gallstone disease. However, no apparent changes in the prevalence of gallstone disease has occurred during this period. In contrast, cholecystectomy rates have consistently decreased during the decade. The aim of this study was to correlate extrahepatic biliary tract cancer mortality and cholecystectomy rates of previous years during the last decade in our country. The best correlation coefficient between both variables was obtained when mortality was correlated with cholecystectomy rates two years prior to the mortality rate (r = -0.92). This finding is consistent with the hypothesis that changes in the number of cholecystectomies performed in a specific geographic area would reciprocally change gallbladder cancer mortality rate. It was estimated that increasing cholecystectomies by 12,500 per year would decrease at mortality rate from this cancer by approximately 1.0 x 100.000 two years in Chile.