Health Care Utilization and Cancer Incidence Following Solid Organ Transplant

Background/Aims: Population-based registry studies have found increases in lung, kidney, skin and thyroid cancers among organ transplant recipients compared with the general population. These studies link data from national transplant services and state cancer registries, thereby limiting the ability to describe recommended health care utilization, including preventive services (e.g. influenza vaccinations) and outpatient visits (9 within transplant year), and incident diagnoses of hypertension and diabetes (estimated to be 50% and 18%, respectively). The goal of this study was to characterize health care utilization and cancer incidence among solid organ transplant recipients in Kaiser Permanente Southern California (KPSC). Methods: KPSC transplant registry data was linked to electronic medical records on solid organ transplants from 1990 to 2014. Data was stratified by kidney, liver, heart and lung transplants. Results: Among 4,336 transplant recipients, 62% (2,703/4,336) were white, 80% (3,621/4,336) were \u3e 35 years old, 27% (1,158/4,336) were past smokers and the mean membership length was 5.6 years. Past smoking was highest for lung transplant recipients (34%, 63/185) and liver transplant recipients (33%, 418/1,271). Survival among all transplant recipients was 89% at 2 years posttransplant yet decreased to 65% at 10 years, with the lowest survival among lung recipients (35% at 10 years). Within the first year posttransplant, recipients had a mean number of 5 primary care visits, 7 nephrology visits and 2 visits each for dermatology, urology, and obstetrics and gynecology (women). Influenza vaccination rates have increased over time and were as high as 96% among lung recipients during the 2014-2015 influenza season. Roughly, 12% (322/2,601) and 14% (151/1,082) of transplant recipients had an incident diagnosis of hypertension and diabetes. Finally, there was increased risk of all cancers excluding nonmelanoma skin cancer (standardized incidence ratio: 2.15, 95% confidence interval: 1.93–2.39), with the largest incidence for non-Hodgkin’s lymphoma, lung cancer and kidney cancer. Conclusion: Transplant recipients in KPSC met the recommended number of outpatient visits, including specialty care visits, within the first year posttransplant. Incidences of hypertension and diabetes were lower than expected, and influenza vaccination rates were high. There was a twofold increase in cancer incidence among the solid organ transplant population

Disparities in Colorectal Cancer Screening Rates Among Asian Subgroups in a Large Managed Care Organization

Background/Aims: Colorectal cancer (CRC) is the second leading cause of cancer death in the United States. CRC screening allows for early detection of CRC or its precursors, and leads to a decrease in CRC incidence and mortality. National guidelines recommend screening with either an annual fecal immunochemical test (FIT), a colonoscopy every 10 years, or a flexible sigmoidoscopy every 5 years for individuals age 50–75 years. Nationally, the overall age-adjusted combined CRC screening rates increased from 52.3% to 65.4% between 2002 and 2010; however, screening rates among Asian Americans were 11% lower compared with whites, but differences among Asian subgroups is unknown. Thus, we examined CRC screening rates among Asian subgroups in a large managed care setting. Methods: We used electronic data to characterize CRC screening among Asian subgroups (Japanese, Korean, Filipino, Asian-Indian, Chinese, Vietnamese, Other Asian) compared with white non-Hispanics (WNHs). Using descriptive and multivariable models, we evaluated 408,242 screening-eligible members of Kaiser Permanente Southern California aged 50–89 years as of January 1, 2010. Results: Compared with WNHs over the past 3 years, Japanese were least likely and Koreans were most likely to have had any CRC screening exam (odds ratio [OR] 0.89, 95% confidence interval [CI] 0.84–0.95; and OR 1.84, 95% CI 1.68–2.02, respectively). Of those screened, compared with WNHs, Japanese men were older (mean age 65.2 vs. 62.6). Screened Asian-Indians and Vietnamese had an equal distribution of men and women, while the other subgroups had more females. In the previous 3 years, Japanese were less likely to have had a FIT (41%, 1,742 of 4,301), and Vietnamese were more likely (56%, 2,248 of 4,018). In the previous 10 years, Koreans were more likely to have had a colonoscopy (56%, 1,797 of 3,189) and Filipinos were least likely (42%, 9,135 of 21,688). Discussion: CRC screening rates and choice of screening test differ among Asian subgroups in an insured population. Further research is needed to understand the reasons for the differences among Asian subgroups, particularly the Japanese population