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Increasing incidence of melanoma among middle-aged adults: an epidemiologic study in Olmsted County, Minnesota.

ABSTRACT: To identify changes in the incidence of cutaneous melanoma over time in the fastest-growing segment of the US population-middle-aged adults.By using the Rochester Epidemiology Project resource, we identified patients aged 40 to 60 years who had a first lifetime diagnosis of melanoma between January 1, 1970, and December 31, 2009, in Olmsted County, Minnesota. The incidence of melanoma and overall and disease-specific survival rates were compared by age, sex, year of diagnosis, and stage of disease.Between 1970 and 2009, age- and sex-adjusted incidence increased significantly over time (P<.001) from 7.9 to 60.0 per 100,000 person-years, with a 24-fold increase in women and a 4.5-fold increase in men. Although not significant (P=.06), the incidence of melanoma increased with age. Overall and disease-specific survival improved over time, with hazard ratios of 0.94 (P<.001) and 0.93 (P<.001) for each 1-year increase in the year of diagnosis, respectively. Each 1-year increase in the age at diagnosis was associated with an increased risk of death from any cause (hazard ratio, 1.07; P=.01) but was not significantly associated with disease-specific death (P=.98). Sex was not significantly associated with death from any cause (P=.81) or death from disease (P=.23). No patient with malignant melanoma in situ died from disease. Patients with stage II, III, and IV disease were more than 14 times more likely to die from disease than were patients with stage 0 or I disease (P<.001).The incidence of cutaneous melanoma among middle-aged adults increased over the past 4 decades, especially in middle-aged women, whereas mortality decreased.

SUBMITTER: Lowe GC

PROVIDER: S-EPMC4389734 | biostudies-literature | 2014 Jan

REPOSITORIES: biostudies-literature

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Increasing incidence of melanoma among middle-aged adults: an epidemiologic study in Olmsted County, Minnesota.

Lowe Garrett C GC Saavedra Alexandra A Reed Kurtis B KB Velazquez Ana I AI Dronca Roxana S RS Markovic Svetomir N SN Lohse Christine M CM Brewer Jerry D JD

Mayo Clinic proceedings 20140101 1

<h4>Objective</h4>To identify changes in the incidence of cutaneous melanoma over time in the fastest-growing segment of the US population-middle-aged adults.<h4>Patients and methods</h4>By using the Rochester Epidemiology Project resource, we identified patients aged 40 to 60 years who had a first lifetime diagnosis of melanoma between January 1, 1970, and December 31, 2009, in Olmsted County, Minnesota. The incidence of melanoma and overall and disease-specific survival rates were compared by ...[more]

PMID: 24388022

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Project description:ImportanceTrabeculectomy is the surgical standard of care for patients with medically refractory glaucoma. The use of antimetabolite agents, such as mitomycin, has increased the rate of complications after trabeculectomy.ObjectiveTo determine the rate of trabeculectomy-related complications during a 25-year study.Design, setting, and participantsFor this retrospective, population-based study, we enrolled the residents of Olmsted County, Minnesota, who underwent a trabeculectomy from January 1, 1985, through December 31, 2010, at the Mayo Clinic and Olmsted Community Hospital. Data were collected from August 2012 to September 2013 followed by data analysis through January 2014.ExposuresAfter reviewing the patient records, we determined the occurrence of complications, including bleb leak, hypotony, hyphema, choroidal effusion, choroidal hemorrhage, blebitis, and endophthalmitis, as they relate to the mitomycin concentration administered during the operation. We reviewed relevant publications in Ovid, MEDLINE, and PubMed to identify studies representative of the reported trabeculectomy complication rate.Main outcomes and measuresCumulative probabilities of short- and long-term complications, determined using the Kaplan-Meier method, and the relation to mitomycin concentration applied during trabeculectomy.ResultsIn 334 patients, 460 eyes underwent trabeculectomy (mean [SD; range] follow-up, 7.7 [5.7; 0-27.7] years). Among them, 159 eyes had complications, with early complications (<3 months) in 100 eyes and late complications (≥3 months) in 59 eyes during the follow-up. Ten eyes had an early and a late complication. The 20-year cumulative chances of early, late, or any complication were 19.7% (95% CI, 16.2%-23.6%), 26.0% (95% CI, 15.0%-36.0%), and 45.0% (95% CI, 38.0%-52.0%), respectively. The cumulative probabilities of vision-threatening complications during 20 years were 2.0% (95% CI, 0%-4.0%) for blebitis and 5.0% (95% CI, 1.0%-9.0%) for endophthalmitis. Association between the rate of trabeculectomy complications and mitomycin dose used was P = .77. In total, 98 cases (21.3%) underwent further surgical procedures related directly to the complication.Conclusions and relevanceThe rate of trabeculectomy-related complications does not appear to be associated with mitomycin use during a mean follow-up of 7.7 years. The rate of vision-threatening complications appears to be comparable to those of previous studies of shorter duration.

Project description:ObjectiveTo determine the longitudinal trends in the probability of blindness due to open-angle glaucoma (OAG) in Olmsted County, Minnesota, from 1965 to 2009.DesignRetrospective, population-based cohort study.ParticipantsAll residents of Olmsted County, Minnesota (aged ≥ 40 years) who were diagnosed with OAG between January 1, 1965, and December 31, 2000.MethodsAll available medical records of every incident case of OAG were reviewed until December 31, 2009, to identify progression to blindness, defined as visual acuity ≤ 20/200 or visual field constriction to ≤ 20°. Kaplan-Meier analysis was used to estimate the cumulative probability of glaucoma-related blindness. Population incidence of blindness within 10 years of diagnosis was calculated using US Census data. Rates for subjects diagnosed in the period 1965-1980 were compared with rates for subjects diagnosed in the period 1981-2000 using log-rank tests and Poisson regression models.Main outcome measuresCumulative probability of OAG-related blindness and population incidence of blindness within 10 years of diagnosis.ResultsProbability of glaucoma-related blindness in at least 1 eye at 20 years decreased from 25.8% (95% confidence interval [CI], 18.5-32.5) for subjects diagnosed in 1965-1980 to 13.5% (95% CI, 8.8-17.9) for subjects diagnosed in 1981-2000 (P = 0.01). The population incidence of blindness within 10 years of the diagnosis decreased from 8.7 per 100,000 (95% CI, 5.9-11.5) for subjects diagnosed in 1965-1980 to 5.5 per 100,000 (95% CI, 3.9-7.2) for subjects diagnosed in 1981-2000 (P = 0.02). Higher age at diagnosis was associated with increased risk of progression to blindness (P < 0.001).ConclusionsThe 20-year probability and the population incidence of blindness due to OAG in at least 1 eye have decreased over a 45-year period from 1965 to 2009. However, a significant proportion of patients still progress to blindness despite recent diagnostic and therapeutic advancements.

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Increasing incidence of melanoma among middle-aged adults: an epidemiologic study in Olmsted County, Minnesota.

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Increasing incidence of melanoma among middle-aged adults: an epidemiologic study in Olmsted County, Minnesota.

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