Association of Cancer Diagnosis With Disability Status among Older Survivors of Colorectal Cancer: a Population-Based Retrospective Cohort Study

BACKGROUND: Older cancer survivors likely experience physical function limitations due to cancer and its treatments, leading to disability and early mortality. Existing studies have focused on factors associated with surgical complications and mortality risk rather than factors associated with the development of poor disability status (DS), a proxy measure of poor performance status, in cancer survivors. We aimed to identify factors associated with the development of poor DS among older survivors of colorectal cancer (CRC) and compare poor DS rates to an age-sex-matched, non-cancer cohort. METHODS: This retrospective cohort study utilized administrative data from the Texas Cancer Registry Medicare-linked database. The study cohort consisted of 13,229 survivors of CRC diagnosed between 2005 and 2013 and an age-sex-matched, non-cancer cohort of 13,225 beneficiaries. The primary outcome was poor DS, determined by Davidoff\u27s method, using predictors from 12 months of Medicare claims after cancer diagnosis. Multivariable Cox proportional hazards regression was used to identify risk factors associated with the development of poor DS. RESULTS: Among the survivors of CRC, 97% were 65 years or older. After a 9-year follow-up, 54% of survivors of CRC developed poor DS. Significant factors associated with future poor DS included: age at diagnosis (hazard ratio [HR] = 3.50 for \u3e80 years old), female sex (HR = 1.50), race/ethnicity (HR = 1.34 for Hispanic and 1.21 for Black), stage at diagnosis (HR = 2.26 for distant metastasis), comorbidity index (HR = 2.18 for \u3e1), and radiation therapy (HR = 1.21). Having cancer (HR = 1.07) was significantly associated with developing poor DS in the pooled cohorts; age and race/ethnicity were also significant factors. CONCLUSIONS: Our findings suggest that a CRC diagnosis is independently associated with a small increase in the risk of developing poor DS after accounting for other known factors. The study identified risk factors for developing poor DS in CRC survivors, including Hispanic and Black race/ethnicity, age, sex, histologic stage, and comorbidities. These findings underscore the importance of consistent physical function assessments, particularly among subsets of older survivors of CRC who are at higher risk of disability, to prevent developing poor DS

Risk factors associated with post-acute sequelae of SARS-CoV-2: an N3C and NIH RECOVER study

Background More than one-third of individuals experience post-acute sequelae of SARS-CoV-2 infection (PASC, which includes long-COVID). The objective is to identify risk factors associated with PASC/long-COVID diagnosis. Methods This was a retrospective case–control study including 31 health systems in the United States from the National COVID Cohort Collaborative (N3C). 8,325 individuals with PASC (defined by the presence of the International Classification of Diseases, version 10 code U09.9 or a long-COVID clinic visit) matched to 41,625 controls within the same health system and COVID index date within ± 45 days of the corresponding case's earliest COVID index date. Measurements of risk factors included demographics, comorbidities, treatment and acute characteristics related to COVID-19. Multivariable logistic regression, random forest, and XGBoost were used to determine the associations between risk factors and PASC. Results Among 8,325 individuals with PASC, the majority were > 50 years of age (56.6%), female (62.8%), and non-Hispanic White (68.6%). In logistic regression, middle-age categories (40 to 69 years; OR ranging from 2.32 to 2.58), female sex (OR 1.4, 95% CI 1.33–1.48), hospitalization associated with COVID-19 (OR 3.8, 95% CI 3.05–4.73), long (8–30 days, OR 1.69, 95% CI 1.31–2.17) or extended hospital stay (30 + days, OR 3.38, 95% CI 2.45–4.67), receipt of mechanical ventilation (OR 1.44, 95% CI 1.18–1.74), and several comorbidities including depression (OR 1.50, 95% CI 1.40–1.60), chronic lung disease (OR 1.63, 95% CI 1.53–1.74), and obesity (OR 1.23, 95% CI 1.16–1.3) were associated with increased likelihood of PASC diagnosis or care at a long-COVID clinic. Characteristics associated with a lower likelihood of PASC diagnosis or care at a long-COVID clinic included younger age (18 to 29 years), male sex, non-Hispanic Black race, and comorbidities such as substance abuse, cardiomyopathy, psychosis, and dementia. More doctors per capita in the county of residence was associated with an increased likelihood of PASC diagnosis or care at a long-COVID clinic. Our findings were consistent in sensitivity analyses using a variety of analytic techniques and approaches to select controls. Conclusions This national study identified important risk factors for PASC diagnosis such as middle age, severe COVID-19 disease, and specific comorbidities. Further clinical and epidemiological research is needed to better understand underlying mechanisms and the potential role of vaccines and therapeutics in altering PASC course. Supplementary Information The online version contains supplementary material available at 10.1186/s12889-023-16916-w

Comparative Effectiveness of Angiotensin Converting Enzyme Inhibitors and Angiotensin Receptor Blockers on the Risk of Dementia in Patients with Type 2 Diabetes and Hypertension

Objectives: Specific aims of the study were: (1) To develop RxDx risk index to predict dementia in patients with type 2 diabetes mellitus and hypertension (2) To compare RxDx risk index with different versions of Charlson comorbidity score (CCS) and chronic disease score (CDS) to predict dementia and (3) To compare Angiotensin Converting Enzyme (ACE) inhibitors versus Angiotensin Receptor Blockers (ARB) for the risk of dementia in patients with type 2 diabetes mellitus and hypertension. Methods: The Clinical Practice Research database was used for this retrospective longitudinal cohort study. Elderly patients (age>=65 years) diagnosed with type 2 diabetes and hypertension without prior diagnosis for dementia were included in the cohort. The Cox proportional hazard model was constructed to model time to dementia by incorporating age, gender and 31 RxDx disease conditions. Points were assigned to risk factors based on beta coefficients to obtain summary risk score. Different rick indices were compared against RxDx-Dementia risk index using c statistics, net reclassification improvement (NRI) and integrated discrimination improvement (IDI). A marginal structural model was constructed while controlling for demographic and clinical baseline variables and time-varying blood pressure variable to estimate causal effect of ACE inhibitors compared to ARB on the risk of dementia. Results: The incidence of dementia was 3.42% in patients with type 2 diabetes mellitus and hypertension. The c-statistics value for RxDx-Dementia risk index was 0.795 (95% confidence interval [CI], 0.789-0.801) and 0.806 (95% CI, 0.798-0.814). Based on the c-statisctics, NRI and IDI values the RxDx-Dementia risk index performed better compared to summary CCS, CDS scores and its combinations. The marginal structural model estimated statistically significant 39% (OR, 0.61; 95%CI, 0.50-0.77) reduction in the risk of developing dementia compared to ACE inhibitors. Conclusions: RxDx-Dementia risk index can be a useful tool to identify hypertensive diabetic patients who are at high risk of developing dementia as well as to control confounding in observational studies. ARB may offer protective effect on the risk of dementia compared to ACE inhibitors in patients with type 2 diabetes and hypertension. When there is no treatment available for dementia, prevention or delaying onset of dementia may help reduce the overall disease burden.Pharmacy, College o

Trends in Follow-Up of Patients Presenting to the Emergency Department with Symptomatic Cholelithiasis.

Fewer than 25% of Medicare beneficiaries presenting with symptomatic cholelithiasis undergo elective cholecystectomy. To better understand underuse of cholecystectomy, we examined physician follow-up patterns after emergency department (ED) visits for symptomatic gallstones.Funding: Supported by grants from the Cancer Prevention Research Institute of Texas Grant # RP140020 , UTMB Clinical and Translational Science Award #UL1TR000071, NIH T-32 Grant # 5T32DK007639, and AHRQ Grant # 1R24HS022134Available online 21 December 2015; 12 month embargo.This item from the UA Faculty Publications collection is made available by the University of Arizona with support from the University of Arizona Libraries. If you have questions, please contact us at [email protected]

The role of extended criteria donors in liver transplantation for nonalcoholic steatohepatitis

Background. Nonalcoholic steatohepatitis is expected to become the leading indication for liver transplantation. Use of extended criteria donors (ECD) may help with donor allocation in these patients. The objective of this study was to determine the use of ECDs in patients with nonalcoholic steatohepatitis undergoing liver transplantation to stimulate a liver-specific predictive model for ECD use. Methods. The United Network for Organ Sharing database was used to identify patients undergoing liver transplantation for nonalcoholic steatohepatitis (2002-2014). Cox hazards models were created using (1) United Network far Organ Sharing ECD criteria (based on kidney allocation), (2) individual donor characteristics (age, sex, race, cause of death, body mass index, cold ischemic time), and (3) the Kidney Donor Profile Index (KDPI) to examine the effect of ECDs on mortality and graft failure. Results. A total of 4,387 patients underwent liver transplantation for nonalcoholic steatohepatitis; 1,359 (30.9%) patients received an ECD. Transplantation. with ECD livers had comparable patient survival (hazard ratio [HR] 1.06, 95% confidence interval [C1] 0.91-1.23) between donor types but an increased risk of graft failure (HR 1.18, 95% CI 1.03-1.36) compared to standard donors. Individual characteristics did not affect patient survival or graft failure. A 10% increase in KDPI was associated with a 28% increase in patient mortality (HR 1.28, 95% CI 1.02-1.60) and 45% increase in graft failure (HR 1.45, 95% CI 1.18-1.80). Conclusion. Based on the current United Network for Organ Sharing definition, ECUs in nonalcoholic steatohepatitis were associated with similar overall survival but increased risk of grafit failure. Given the shortage of organs, creation of an easily calculated, liver-specific model similar to the KDPI may help risk stratify patients and improve organ allocation. (Surgery 2016;160:1533-43.)UTMB Clinical and Translational Science Award [UL1TR000071]; NIH [T32DK007639]; AHRQ [1R24HS022134]Available online 21 August 2016; 12 month embargo.This item from the UA Faculty Publications collection is made available by the University of Arizona with support from the University of Arizona Libraries. If you have questions, please contact us at [email protected]