Smoothed Lexis Diagrams With Applications to Lung and Breast Cancer Trends in Taiwan

<div><p>Cancer surveillance research often begins with a rate matrix, also called a Lexis diagram, of cancer incidence derived from cancer registry and census data. Lexis diagrams with 3- or 5-year intervals for age group and for calendar year of diagnosis are often considered. This simple smoothing approach suffers from a significant limitation; important details useful in studying time trends may be lost in the averaging process involved in generating a summary rate. This article constructs a smoothed Lexis diagram and indicates its use in cancer surveillance research. Specifically, we use a Poisson model to describe the relationship between the number of new cases, the number of people at risk, and a smoothly varying incidence rate for the study of the incidence rate function. Based on the Poisson model, we use the standard Lexis diagram to introduce priors through the coefficients of Bernstein polynomials and propose a Bayesian approach to construct a smoothed Lexis diagram for the study of the effects of age, period, and cohort on incidence rates in terms of straightforward graphical displays. These include the age-specific rates by year of birth, age-specific rates by year of diagnosis, year-specific rates by age of diagnosis, and cohort-specific rates by age of diagnosis. We illustrate our approach by studying the trends in lung and breast cancer incidence in Taiwan. We find that for nearly every age group the incidence rates for lung adenocarcinoma and female invasive breast cancer increased rapidly in the past two decades and those for male lung squamous cell carcinoma started to decrease, which is consistent with the decline in the male smoking rate that began in 1985. Since the analyses indicate strong age, period, and cohort effects, it seems that both lung cancer and breast cancer will become more important public health problems in Taiwan. Supplementary materials for this article are available online.</p></div

Healthcare-associated infection rate, <i>A. baumannii</i> infection rate, and CRAB infection rate from 2003 to 2008.

<p>Healthcare-associated infection rate, <i>A. baumannii</i> infection rate, and CRAB infection rate from 2003 to 2008.</p

Epidemiological characteristics of the 13811 patients with <i>A. baumannii</i> infection.

§<p>Abbreviations: OR, odds ratio; CI, confidence interval.</p

Associations between CRABpAB and hospital antimicrobial usage (DDDs per 1000 patient-days) in 6 regions from 2003 to 2008.

<p>Percentage of change during the study period was presented from column 3 to 8; and numbers inside parentheses are original data in 2003 and 2008, respectively.</p>*<p>NA, not available (number of isolates <20 in 2003).</p

Characteristics of the study hospitals and hospital-years according to hospital type, study year, and geographic region.

a<p>Taiwan was divided into 6 geographic regions: Taipei, North, Central, South, Kaoping, and East.</p

Independent association between subjective cognitive decline and frailty in the elderly

<div><p>Background</p><p>The relationship between subjective cognitive decline and frailty, two components of the so-called reversible cognitive frailty, in the elderly remains unclear. This study aims to elucidate whether this association exists, independent of confounding factors such as nutritional status, kidney function, inflammation, and insulin resistance.</p><p>Methods</p><p>2386 participants (≥ 65 years of age) selected from the Healthy Aging Longitudinal Study in Taiwan (HALST) study. Fried frailty phenotype was adopted to quantify frailty status. We classified cognitive status into two categories—subjective cognitive decline (SCD), and normal cognition—and used polytomous logistic regressions to investigate the associations between SCD and frailty.</p><p>Results</p><p>There were 188 (7.88%), 1228 (51.47%), and 970 (40.65%) participants with frailty, pre-frailty, and robustness, respectively. Compared to those with normal cognition, elders with SCD were more likely to have pre-frailty (odds ratio [OR]: 1.36, 95% confidence interval [CI]: 1.10–1.67, <i>p</i> = 0.004) or frailty (OR: 1.78, 95% CI: 1.23–2.58, <i>p</i> = 0.002) after adjusting for age, gender, education level, comorbidity, nutritional status, kidney function, and biochemical-related factors.</p><p>Conclusions</p><p>A significant association between subjective cognitive decline and frailty was revealed in this study. Subjective cognitive decline was positively associated with pre-frailty or frailty even after adjusting for potential confounding factors. Our results can provide useful references in understanding mechanisms and developing suitable preventive strategies for the elderly with reversible cognitive frailty.</p></div

<i>TP53</i> Polymorphisms and Colorectal Cancer Risk in Patients with Lynch Syndrome in Taiwan: A Retrospective Cohort Study

<div><p>Background and Aim</p><p><i>TP53</i> encodes p53, which has a crucial role in modulating genes that regulate defense against cancer development. This study investigated whether <i>TP53</i> polymorphisms are associated with colorectal cancer (CRC) in patients with Lynch syndrome and whether <i>TP53</i> interacts with lifestyle factors to modify CRC risk.</p><p>Methods</p><p>We identified 260 <i>MLH1</i> and <i>MSH2</i> germline mutation carriers from the Taiwan Hereditary Nonpolyposis Colorectal Cancer Consortium. A weighted Cox proportional hazard model was used to calculate hazard ratios (HRs) and 95% confidence intervals (CIs) to determine the association of <i>TP53</i> polymorphisms with CRC development.</p><p>Results</p><p>The carriers of the variant C allele of rs1042522 were associated with a decreased CRC risk (GC genotype: HR = 0.35, 95% CI = 0.14–0.86; CC genotype: HR = 0.28, 95% CI = 0.13–0.57). In addition, the dominant model of rs1042522 was associated with a decreased CRC risk (HR = 0.32, 95% CI = 0.15–0.67). The CRC risk was decreased in carriers with the CT and TT genotypes of rs12947788 (HR = 0.20, 95% CI = 0.08–0.46 and HR = 0.25, 95% CI = 0.09–0.65, respectively). Moreover, the dominant model of rs12947788 was significantly associated with a decreased CRC risk (HR = 0.21, 95% CI = 0.09–0.46). A haplotype analysis indicated that compared with the most common GC haplotype, the CT haplotype was associated with a decreased CRC risk (HR = 0.26, 95% CI = 0.11–0.59). However, no significant interaction was observed between <i>TP53</i> polymorphisms and lifestyle factors.</p><p>Conclusion</p><p>The study results revealed that the rs1042522 genotype with the C allele and the rs12947788 genotype with the T allele in <i>TP53</i> were associated with a decreased CRC risk in patients with Lynch syndrome in Taiwan.</p></div

Fetal and Childhood Exposure to Phthalate Diesters and Cognitive Function in Children Up to 12 Years of Age: Taiwanese Maternal and Infant Cohort Study

<div><p>Few studies have examined the association between environmental phthalate exposure and children’s neurocognitive development. This longitudinal study examined cognitive function in relation to pre-and postnatal phthalate exposure in children 2–12 years old. We recruited 430 pregnant women in their third trimester in Taichung, Taiwan from 2001–2002. A total of 110, 79, 76, and 73 children were followed up at ages 2, 5, 8, and 11, respectively. We evaluated the children’s cognitive function at four different time points using the Bayley and Wechsler tests for assessing neurocognitive functions and intelligence (IQ). Urine samples were collected from mothers during pregnancy and from children at each follow-up visit. They were analyzed for seven metabolite concentrations of widely used phthalate esters. These esters included monomethyl phthalate, monoethyl phthalate, mono-butyl phthalate, mono-benzyl phthalate, and three metabolites of di(2-ethylhexyl) phthalate, namely, mono-2-ethylhexyl phthalate, mono(2-ethyl-5-hydroxyhexyl) phthalate, and mono(2-ethyl-5-oxohexyl) phthalate. We constructed a linear mixed model to examine the relationships between the phthalate metabolite concentrations and the Bayley and IQ scores. We found significant inverse associations between the children’s levels of urinary mono(2-ethyl-5-oxohexyl) phthalate and the sum of the three metabolites of di(2-ethylhexyl) phthalate and their IQ scores (β = -1.818; 95% CI: -3.061, -0.574, p = 0.004 for mono(2-ethyl-5-oxohexyl) phthalate; β = -1.575; 95% CI: -3.037, -0.113, p = 0.035 for the sum of the three metabolites) after controlling for maternal phthalate levels and potential confounders. We did not observe significant associations between maternal phthalate exposure and the children’s IQ scores. Children’s but not prenatal phthalate exposure was associated with decreased cognitive development in the young children. Large-scale prospective cohort studies are needed to confirm these findings in the future.</p></div

Concentrations (geometric mean, GM) of maternal and childrenʼs urinary phthalates (μg/g creatinine), HOME scores, and intelligence quotients (IQs) at the four follow-up points.

<p>^aTen pregnant women could not provide sufficient urine samples; the total numbers of pregnant women were 100 subjects.</p><p>^bMixed model was used to test for age trend of childrenʼs urinary phthalate levels, HOME score, and IQ.</p><p>^cΣMEHP = MEHP + MEHHP + MEOHP.</p><p>^dIQ: The mental development index scores of the Bayley Scales were used to assess the IQ of children aged 2–3 years. The Wechsler Scales were to evaluate the IQ of children aged 5–12 years.</p><p>Concentrations (geometric mean, GM) of maternal and childrenʼs urinary phthalates (μg/g creatinine), HOME scores, and intelligence quotients (IQs) at the four follow-up points.</p

Characteristics of participants in different frail conditions.

<p>Characteristics of participants in different frail conditions.</p