Dataset Information

Association between Socioeconomic Status and One-Month Mortality after Surgery in 20 Primary Solid Tumors: a Pan-Cancer Analysis.

ABSTRACT: Background: Surgery is the main therapy for primary solid tumors. One-month postoperative mortality remains an important criterion for assessing the quality of surgery. Socioeconomic status (SES) plays an important role in the biopsychosocial medical model. We performed a pan-cancer analysis to explore the relationship between SES and one-month mortality after surgery in 20 primary solid tumors. Methods: Eight SES factors and the top 20 common cancer sites were selected between 2007 and 2014 based on the Surveillance, Epidemiology, and End Results database. The primary outcome was that patients died within one month after surgery. The control group survived beyond one month. Multivariable logistic regression model, propensity score matching and subgroup analysis were used to detect the association. Results: There were 15980 (1.4%) patients who died within one month after surgery among 1132666 patients with primary solid cancers. Patients with unmarried status (aOR 1.516, 95% CI 1.462-1.573, P < 0.001), Medicaid/uninsured status (aOR 1.610, 95% CI 1.534-1.689, P < 0.001), low income (aOR 1.122, 95% CI 1.053-1.196, P < 0.001), low education (aOR 1.088, 95% CI 1.033-1.146, P = 0.001), or high poverty (aOR 1.085, 95% CI 1.026-1.147, P = 0.004) had high risks of one-month postoperative mortality. After propensity score matching and subgroup analysis, the effects of marriage and insurance on mortality were almost consistent with overall. Conclusions: There was a strong association between SES status and one-month postoperative mortality in primary solid tumors. Socioeconomically disadvantaged people had high risks of dying within one month after surgery. Unmarried or Medicaid/uninsured status were associated with much higher risks than other factors.

SUBMITTER: Sun W

PROVIDER: S-EPMC7391197 | biostudies-literature | 2020

REPOSITORIES: biostudies-literature

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Association between Socioeconomic Status and One-Month Mortality after Surgery in 20 Primary Solid Tumors: a Pan-Cancer Analysis.

Sun Wei W Zhou Huaqiang H Cheng Minghua M Zhuang Shaohui S Qiu Zeting Z

Journal of Cancer 20200711 18

<b>Background:</b> Surgery is the main therapy for primary solid tumors. One-month postoperative mortality remains an important criterion for assessing the quality of surgery. Socioeconomic status (SES) plays an important role in the biopsychosocial medical model. We performed a pan-cancer analysis to explore the relationship between SES and one-month mortality after surgery in 20 primary solid tumors. <b>Methods:</b> Eight SES factors and the top 20 common cancer sites were selected between 200 ...[more]

PMID: 32742492

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Project description:ImportanceTo date, oncologist and model prognostic performance have been assessed independently and mostly retrospectively; however, how model prognostic performance compares with oncologist prognostic performance prospectively remains unknown.ObjectiveTo compare oncologist performance with a model in predicting 3-month mortality for patients with metastatic solid tumors in an outpatient setting.Design, setting, and participantsThis prognostic study evaluated prospective predictions for a cohort of patients with metastatic solid tumors seen in outpatient oncology clinics at a National Cancer Institute-designated cancer center and associated satellites between December 6, 2019, and August 6, 2021. Oncologists (57 physicians and 17 advanced practice clinicians) answered a 3-month surprise question (3MSQ) within clinical pathways. A model was trained with electronic health record data from January 1, 2013, to April 24, 2019, to identify patients at high risk of 3-month mortality and deployed silently in October 2019. Analysis was limited to oncologist prognostications with a model prediction within the preceding 30 days.ExposuresThree-month surprise question and gradient-boosting binary classifier.Main outcomes and measuresThe primary outcome was performance comparison between oncologists and the model to predict 3-month mortality. The primary performance metric was the positive predictive value (PPV) at the sensitivity achieved by the medical oncologists with their 3MSQ answers.ResultsA total of 74 oncologists answered 3099 3MSQs for 2041 patients with advanced cancer (median age, 62.6 [range, 18-96] years; 1271 women [62.3%]). In this cohort with a 15% prevalence of 3-month mortality and 30% sensitivity for both oncologists and the model, the PPV of oncologists was 34.8% (95% CI, 30.1%-39.5%) and the PPV of the model was 60.0% (95% CI, 53.6%-66.3%). Area under the receiver operating characteristic curve for the model was 81.2% (95% CI, 79.1%-83.3%). The model significantly outperformed the oncologists in short-term mortality.Conclusions and relevanceIn this prognostic study, the model outperformed oncologists overall and within the breast and gastrointestinal cancer cohorts in predicting 3-month mortality for patients with advanced cancer. These findings suggest that further studies may be useful to examine how model predictions could improve oncologists' prognostic confidence and patient-centered goal-concordant care at the end of life.

Project description:Bangladesh has achieved remarkable gains in health indicators during the last four decades despite low levels of economic development. However, the persistence of inequities remains disturbing. This success was also accompanied by health and demographic transitions, which in turn brings new challenges for a nation that has yet to come to terms with pre-transition health challenges. It is therefore important to understand the causes of death and their relationship with socioeconomic status (SES).The paper aims to assess the causes of death by SES based on surveillance data from a rural area of Bangladesh, in order to understand the situation and inform policy makers and programme leaders.We analysed population-based mortality data collected from the Chakaria Health and Demographic Surveillance System in Bangladesh. The causes of death were determined by using a Bayesian-based programme for interpreting verbal autopsy findings (InterVA-4). The data included 1,391 deaths in 217,167 person-years of observation between 2010 and 2012. The wealth index constructed using household assets was used to assess the SES, and disease burdens were compared among the wealth quintiles.Analysing cause of death (CoD) revealed that non-communicable diseases (NCDs) were the leading causes of deaths (37%), followed by communicable diseases (CDs) (22%), perinatal and neonatal conditions (11%), and injury and accidents (6%); the cause of remaining 24% of deaths could not be determined. Age-specific mortality showed premature birth, respiratory infections, and drowning were the dominant causes of death for childhood mortality (0-14 years), which was inversely associated with SES (p<0.04). For adult and the elderly (15 years and older), NCDs were the leading cause of death (51%), followed by CDs (23%). For adult and the elderly, NCDs concentrated among the population from higher SES groups (p<0.005), and CDs among the lower SES groups (p<0.001).Epidemiologic transition is taking place with a shift from the dominance of CDs to NCDs. SES inequity in mortality still persists--the poor suffer from CDs in all age groups, whereas those better off suffer more from NCDs than CDs. Policy makers thus need to consider the social distribution of diseases before developing any public health action targeted towards reducing mortality and the extent of disease burden in an equitable manner.

Project description:BackgroundChanges in microRNAs (miRNAs) are relevant to bariatric surgery and its comorbidities. The characteristics of changes in miRNAs of the early postoperative period following both bariatric procedures, sleeve gastrectomy (SG) and Roux-en-Y gastric bypass (RYGB), as well as the factors that related to the effectiveness of early weight loss remain unclear.MethodsWe recruited 18 patients who performed SG and 15 patients who performed RYGB. Their preoperative and 1-month postoperative clinical data and fasting serum samples were collected, and the latter were analyzed by RNA-sequencing. Differential expression analysis of miRNAs was performed by the R-tool. Functional classification annotation and pathway enrichment analysis of targeted genes were analyzed by KOBAS software. The change profiles of miRNAs for both surgeries and their correlation with clinical characteristics and weight loss effectiveness were further analyzed.ResultsA total of 85 differentially expressed miRNAs were identified before and after SG, while a total of 76 were found before and after RYGB. The target genes of these miRNAs were similar in the Gene Ontology enrichment analysis in SG and RYGB, and the enrichment analysis in the Kyoto Encyclopedia of Genes and Genomes was mainly related to metabolic pathways. Hsa-miR-493-5p, hsa-miR-184, and hsa-miR-3199 exhibited similar changes in SG and RYGB, and the former two were correlated with clinical characteristics. Hsa-miR-6729-5p, hsa-miR-4659b-5p, and hsa-miR-2277-5p were correlated with the weight loss effectiveness of SG, while hsa-miR-4662a-5p was correlated with the weight loss effectiveness of RYGB.ConclusionsShort-term metabolic improvement and weight loss occurring after SG and RYGB surgery might be related to changes in miRNAs, which act on multiple biological pathways by regulating genes. In addition, some clinical characteristics and miRNAs were related to the effectiveness of early weight loss after SG and RYGB surgery.Clinical trial registrationChiCTR2200058333.

Project description:AimThe Diabetes risk index (DRI) is a composite of NMR-measured lipoproteins and branched chain amino acids predictive of diabetes mellitus development. Bariatric surgery is indicated in patients with severe obesity, many of whom are at high-risk for developing diabetes. Substantial weight loss occurs following bariatric surgery and sustained weight loss likely contributes to reductions in the development of diabetes and cardiovascular disease. However, some evidence suggests that bariatric surgical procedures themselves may contribute to reducing risk of these conditions independent of weight loss. We aimed to investigate DRI and its association with reductions in body weight and adiposity over one year following bariatric surgery.MethodsWe examined 51 severely obese premenopausal women without diabetes. DRI, BMI, body weight and waist measurements were made before and at 1, 6 and 12 months after Roux-en-Y Gastric Bypass (RYGB) or Sleeve Gastrectomy. Values were compared to healthy women with normal BMI (18.5-24.9 kg/m2; n = 15).ResultsNon-diabetic women with severe obesity (BMI 44.7 ± 6.2 kg/m2) exhibited significantly elevated DRI scores prior to surgery versus controls (35 [26, 39] vs 12 [1, 20]; p < 0.0001). At 1 month after surgery, BMI decreased 5.1 ± 1.1 kg/m2, but DRI decreased so that it no longer differed from that of normal BMI controls (1.9 [1, 17] vs control 12 [1, 20]; p = 0.35). Subjects continued to lose weight, whereas DRI remained similar, throughout follow-up with DRI 1.0 [1, 7] at 12 months. Changes in DRI did not correlate with changes in BMI, body weight or waist circumference at any time during follow-up. There was no difference in change in DRI between surgical procedures or pre-operative metabolic syndrome status.ConclusionsOur analysis of DRI scores supports the capacity of bariatric surgery to reduce risk of developing diabetes in severely obese individuals. Our findings suggest that bariatric surgical techniques may have inherent effects that improve cardiometabolic risk independent of reductions in body weight or adiposity.

Dataset Information

Association between Socioeconomic Status and One-Month Mortality after Surgery in 20 Primary Solid Tumors: a Pan-Cancer Analysis.

Publications

Association between Socioeconomic Status and One-Month Mortality after Surgery in 20 Primary Solid Tumors: a Pan-Cancer Analysis.

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