Dataset Information

Death Does Matter--Cancer Risk in Patients With End-Stage Renal Disease: A Nationwide Population-Based Study With Competing Risk Analyses.

ABSTRACT: Patients with end-stage renal disease (ESRD) have a high mortality rate. We hypothesized that not accounting for death as a competing risk overestimates the event rate caused by ESRD. Thus, we examined the cancer risk for patients with ESRD (ESRD) after death as a competing risk event had been adjusted for. Patients with newly diagnosed ESRD (n?=?64,299) between 1999 and 2007, together with age- and sex-matched controls without ESRD (ESRD) (n?=?128,592) were enrolled (1:2). In a Cox proportional hazards model that included death as a competing risk, ESRD patients in Taiwan had a lower overall incidence (subdistribution hazard ratio [sdHR]?=?1.29) of cancer than did ESRD patients in a Cox model that did not include death as a competing risk (HR?=?1.70). After competing mortality had been adjusted for, ESRD patients ?70 (sdHR?=?0.82) and ESRD patients on long-term dialysis (> 5 follow-up years, sdHR?=?0.62), had a lower risk for developing cancer than did ESRD patients. This finding supported our hypothesis that standard survival analyses overestimate the event rate, especially when the mortality rate is high. It also showed that ESRD patients, when they grow older, were far less likely to develop cancer and far more likely to die because of underlying illnesses that might also affect the risk of death because of ESRD.

SUBMITTER: Weng SF

PROVIDER: S-EPMC4998265 | biostudies-literature | 2016 Jan

REPOSITORIES: biostudies-literature

ACCESS DATA

Publications

Death Does Matter--Cancer Risk in Patients With End-Stage Renal Disease: A Nationwide Population-Based Study With Competing Risk Analyses.

Weng Shih-Feng SF Chiu Yu-Hsien YH Jan Ren-Long RL Chen Yi-Chen YC Chien Chih-Chiang CC Wang Jhi-Joung JJ Chu Chin-Chen CC

Medicine 20160101 3

Patients with end-stage renal disease (ESRD) have a high mortality rate. We hypothesized that not accounting for death as a competing risk overestimates the event rate caused by ESRD. Thus, we examined the cancer risk for patients with ESRD (ESRD) after death as a competing risk event had been adjusted for. Patients with newly diagnosed ESRD (n = 64,299) between 1999 and 2007, together with age- and sex-matched controls without ESRD (ESRD) (n = 128,592) were enrolled (1:2). In a Cox proportional ...[more]

PMID: 26817891

Similar Datasets

Project description:BackgroundDementia is prevalent in the end-stage renal disease (ESRD) population. However, it is still not clarified whether ESRD is one of the etiology of dementia or its attributable effect on the cumulative risk of dementia. Meanwhile, the effect of competing risk of mortality should be taken into consideration when performing epidemiologic analyses among populations with high risk of mortality.MethodsBy using the National Health Insurance Research Database (1998-2010), we identified 927,142 non-ESRD individuals and 99,158 ESRD patients to investigate the effect of ESRD on the risk of dementia. Age- and sex-specific incidence rates (IRs) and cumulative incidence rates (CIRs) were first compared between these two cohorts. Competing risk analyses including cause-specific and subdistribution proportional hazards models were then constructed with adjustments for potential confounders.ResultsThe overall IR and CIR of dementia were much higher in the ESRD group than in the non-ESRD group (10.73 vs. 1.40 per 1000 person-years and 0.061 vs. 0.017, respectively, both P < 0.0001). Results from the multivariable cause-specific hazard models suggested that ESRD was one of the etiological factors for dementia (cause-specific hazard ratio [csHR] : 2.06 [95% CI : 1.95-2.17]). However, the subdistribution HR (sdHR) of ESRD was 0.51 (95% Cl : 0.49-0.54), which indicated the lower cumulative incidence risk of dementia in ESRD patients. The inverse relationship between csHR and sdHR could be explained by the high mortality rate in the ESRD population. These findings were also essentially consistent across various subgroup analyses according to selected confounders, as well as in the analyses that limited dementia diagnoses made by neurologists or psychologists.ConclusionsAlthough ESRD appears directly associated with the risk of dementia, the high competing mortality means that primary prevention of comorbidity associated with dementia may be more effective in reducing overall dementia in the general population, which may also potentially reduce the incidence of ESRD and prevent death from multimorbidity when affected by ESRD.

Dataset Information

Death Does Matter--Cancer Risk in Patients With End-Stage Renal Disease: A Nationwide Population-Based Study With Competing Risk Analyses.

Publications

Death Does Matter--Cancer Risk in Patients With End-Stage Renal Disease: A Nationwide Population-Based Study With Competing Risk Analyses.

Similar Datasets

OmicsDI is part of the ELIXIR infrastructure

Tweets