Comorbidity among Danish lung cancer patients before and after initial cancer diagnosis.
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ABSTRACT:
SUBMITTER: Gouliaev A
PROVIDER: S-EPMC7758043 | biostudies-literature |
REPOSITORIES: biostudies-literature
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Project description:BackgroundData on the care of Asian patients with lung cancer in the US are limited; however, lung cancer is the leading cause of cancer death in this population.MethodsDemographics, low-dose computed tomography (LDCT) screening, disease characteristics, and treatment history were compared between Asian and White patients newly diagnosed with lung cancer from 2014 to 2019 identified from Tufts Medical Center cancer registry. The influence of race on presenting stage was assessed via ordinal logistic regression. Time to treatment initiation (TTI) and overall survival (OS) were analyzed via log-rank tests. The impact of race on OS was evaluated via multivariable Cox regression.ResultsAsian patients (N = 144) were more likely to prefer non-English languages, use interpreters, be never-smokers, and harbor EGFR alterations, compared to White patients (N = 472), and to be diagnosed with later-stage lung cancer (odds ratio: 2.14, P < .001), had longer median TTI (early stage: 2.30 vs. 1.43 months, P = .035; curative stage: 1.88 vs. 1.20 months, P = .041) and more often did not receive cancer-directed therapy (12.6% vs. 5.7%, P = .01). Screening LDCT was done only in 11.9% of Asian and 21.4% of White patients (P = .20) who would have met screening criteria prior to diagnosis (N = 215). Median OS was similar between Asian and White patients (not reached vs. 74.8 months, P = .17). Multivariable Cox model suggested better OS for Asian patients (hazard ratio: 0.57, P = .01).ConclusionIn our study, Asian patients presented with later-stage lung cancer, had treatment delays, and more often did not receive treatment, compared to White patients, yet did not have inferior survival.
| S-EPMC10994261 | biostudies-literature
Project description:ObjectivesTo assess the interaction between comorbidity and breast cancer (BC) on the rate of venous thromboembolism (VTE) beyond what can be explained by the independent effects of BC and comorbidity.DesignPopulation-based matched cohort study.SettingDenmark.ParticipantsDanish patients with BC (n=62?376) diagnosed in 1995-2010 and a comparison cohort of women without BC (n=304?803) from the general population were matched to the patients with BC on year of birth in 5-year intervals and on the specific diseases included in the Charlson Comorbidity Index (CCI) and atrial fibrillation and obesity.MeasuresThe rate ratios of VTE per 1000 person-years (PY) were computed by comorbidity levels using the CCI, and interaction contrasts (IC) were calculated as a measure of the excess or deficit VTE rate not explained by the independent effects of BC and comorbidity.ResultsAmong patients with BC with a CCI score of 1, the 0-1?year VTE rate was 12/1000 PY, and interaction accounted for 10% of the rate (IC=3.2, 95% CI 0.5 to 5.9). Among patients with BC with CCI ?4, the VTE rate was 17, and interaction accounted for 8% of the rate (IC=1.2, 95% CI -1.8 to 4.2). There was no interaction during 2-5?years of follow-up.ConclusionsThere was only little interaction between BC and the CCI score on the rate of VTE.
| S-EPMC4054647 | biostudies-literature
Project description:IntroductionDetailed knowledge of prediagnostic health care use among patients with primary intracranial tumors is sparse. We aimed to investigate the health care use among adults during the 2 years preceding a diagnosis of a benign or malignant primary intracranial tumor in Denmark.MethodsWe conducted a population-based matched cohort study using historical data from Danish nationwide registries, including all patients aged 30-90 years diagnosed with a first-time primary intracranial tumor from January 1, 2009 to December 31, 2014, and with no prior cancer diagnosis (n=5,926). For each patient, ten comparison subjects were identified using density sampling. We analyzed differences in the frequency and timing of health care use within general practice, physiotherapy, radiology, ear -nose -throat, ophthalmology, neurology, and psychiatry. Odds ratios of having multiple contacts were calculated using a conditional logistical regression model. Monthly incidence rate ratios were estimated using a negative binomial regression model.ResultsOf all patients, 62% had a benign tumor. Patients with benign tumors were more likely to have multiple consultations with health care providers in the period 2-12 months prior to diagnosis and to have increased rates of consultations 1-24 months prior to diagnosis, depending on health service.ConclusionPatients diagnosed with a benign or a malignant primary intracranial tumor use the health care services differently. Increased health care use is seen within relatively close proximity to the diagnosis for patients with malignant tumors. However, patients with benign tumors have increased health care use from up to 2 years prior to diagnosis; this suggests a window of opportunity for earlier diagnosis.
| S-EPMC6049603 | biostudies-literature
Project description:BackgroundHIV patients are known to be at increased risk of lung cancer but the risk factors behind this are unclear.MethodsWe estimated the cumulative incidence and relative risk of lung cancer in 1) a population of all Danish HIV patients identified from the Danish HIV Cohort Study (n = 5,053) and a cohort of population controls matched on age and gender (n = 50,530) (study period; 1995 - 2009) and 2) their parents (study period; 1969 - 2009). Mortality and relative risk of death after a diagnosis of lung cancer was estimated in both populations.Results29 (0.6%) HIV patients vs. 183 (0.4%) population controls were diagnosed with lung cancer in the observation period. HIV patients had an increased risk of lung cancer (adjusted incidence rate ratio (IRR); 2.38 (95% CI; 1.61 - 3.53)). The IRR was considerably increased in HIV patients who were smokers or former smokers (adjusted IRR; 4.06 (95% CI; 2.66 - 6.21)), male HIV patients with heterosexual route of infection (adjusted IRR; 4.19 (2.20 - 7.96)) and HIV patients with immunosuppression (adjusted IRR; 3.25 (2.01 - 5.24)). Both fathers and mothers of HIV patients had an increased risk of lung cancer (adjusted IRR for fathers; 1.31 (95% CI: 1.09 - 1.58), adjusted IRR for mothers 1.35 (95% CI: 1.07 - 1.70)). Mortality after lung cancer diagnose was increased in HIV patients (adjusted mortality rate ratio 2.33 (95%CI; 1.51 - 3.61), but not in the parents. All HIV patients diagnosed with lung cancer were smokers or former smokers.ConclusionThe risk was especially increased in HIV patients who were smokers or former smokers, heterosexually infected men or immunosuppressed. HIV appears to be a marker of behavioural or family related risk factors that affect the incidence of lung cancer in HIV patients.
| S-EPMC3135571 | biostudies-literature
Project description:OBJECTIVES:Early diagnosis of childhood cancer is critical. Nevertheless, little is known about the potential role of inequality. This study aims to describe the use of primary care 2 years before a childhood cancer diagnosis and to investigate whether socioeconomic factors influence the use of consultations and diagnostic tests in primary care. DESIGN:A national population-based matched cohort study. SETTING AND PARTICIPANTS:This study uses observational data from four Danish nationwide registers. All children aged 0-15 diagnosed with cancer during 2008-2015 were included (n=1386). Each case was matched based on gender and age with 10 references (n=13 860). PRIMARY AND SECONDARY OUTCOME MEASURES:The primary outcome was additional rates for consultations and for invoiced diagnostic tests for children with cancer according to parental socioeconomic factors. Furthermore, we estimated the association between socioeconomic factors and frequent use of consultations, defined as at least four consultations, and the odds of receiving a diagnostic test within 3 months of diagnosis. RESULTS:Children with cancer from families with high income had 1.46 (95% CI 1.23 to 1.69) additional consultations 3 months before diagnosis, whereas children from families with low income had 1.85 (95% CI 1.60 to 2.11) additional consultations. The highest odds of frequent use of consultations was observed among children from low-income families (OR: 1.94, 95% CI 1.24 to 3.03). A higher odds of receiving an invoiced diagnostic test was seen for children from families with mid-educational level (OR: 1.46, 95% CI 1.09 to 1.95). CONCLUSION:We found a socioeconomic gradient in the use of general practice before a childhood cancer diagnosis. This suggests that social inequalities exist in the pattern of healthcare utilisation in general practice.
| S-EPMC6104784 | biostudies-literature
Project description:BackgroundThe comorbidity burden has a negative impact on lung-cancer survival. Several comorbidity scores have been described and are currently used. The current challenge is to select the comorbidity score that best reflects their impact on survival. Here, we compared seven usable comorbidity scores (Charlson Comorbidity Index, Age adjusted Charlson Comorbidity Index, Charlson Comorbidity Index adapted to lung cancer, National Cancer Institute combined index, National Cancer Institute combined index adapted to lung cancer, Elixhauser score, and Elixhauser adapted to lung cancer) with coded administrative data according to the tenth revision of the International Statistical Classification of Diseases and Related Health Problems to select the best prognostic index for predicting four-month survival.Materials and methodsThis cohort included every patient with a diagnosis of lung cancer hospitalized for the first time in the thoracic oncology unit of our institution between 2011 and 2015. The seven scores were calculated and used in a Cox regression method to model their association with four-month survival. Then, parameters to compare the relative goodness-of-fit among different models (Akaike Information Criteria, Bayesian Information Criteria), and discrimination parameters (the C-statistic and Harrell's c-statistic) were calculated. A sensitivity analysis of these parameters was finally performed using a bootstrap method based on 1,000 samples.ResultsIn total, 633 patients were included. Male sex, histological type, metastatic status, CCI, CCI-lung, Elixhauser score, and Elixhauser-lung were associated with poorer four-month survival. The Elixhauser score had the lowest AIC and BIC and the highest c-statistic and Harrell's c-statistic. These results were confirmed in the sensitivity analysis, in which these discrimination parameters for the Elixhauser score were significantly different from the other scores.ConclusionsBased on this cohort, the Elixhauser score is the best prognostic comorbidity score for predicting four-month survival for hospitalized lung cancer patients.
| S-EPMC10623755 | biostudies-literature
Project description:BackgroundInformation on welfare cost of patients with schizophrenia and spouses is limited.AimThe main aim of this study to investigate factual societal mean annual costs per individual during 5 years before and after the initial diagnosis of schizophrenia.MethodA register-based cohort study of 12 227 patients with incident schizophrenia (International Classification of Diseases, Tenth Revision F20-F20.99) with spouses and 48 907 matched controls in Denmark during 2002-2016.ResultsThe total annual costs of health care and lost productivity were Euro 43 561 higher for patients with schizophrenia and health care costs and costs of lost productivity were increased during 5 years before the initial diagnosis. The total annual direct health care and indirect costs of lost productivity were Euro 21 888 higher for spouses to patients with schizophrenia than spouses of individuals with no diagnosis of schizophrenia. Also before initial diagnosis, health care costs and lost productivity were increased among spouses of patients with schizophrenia.ConclusionPatients with schizophrenia differed from the general population with respect to all included costs. The study documented a significant burden on spouses. The excess health care costs of schizophrenia are further increased by psychiatric and somatic comorbidity, and the societal costs are 4-10 times higher than chronic neurological disorders such as epilepsy and multiple sclerosis. Early onset of schizophrenia implies that patients are affected before finishing school and before entrance to labor market. Cost savings could be achieved by investments in preventive interventions reaching young people's needs; in initiatives to reduce hospital admissions caused by medication side effects, substance misuse, and lifestyle factors; and in occupational training.
| S-EPMC6942163 | biostudies-literature
Project description:BackgroundIt is known that cancer stage is affected by comorbidity, but the evidence regarding the magnitude and even direction of this effect is highly inconsistent and poorly understood. The aims of this study were to establish the impact of comorbidity on cancer stage at diagnosis, using both specific individual comorbid conditions and a global measure of comorbidity; and to assess whether this impact varied by cancer site, level of comorbidity burden and individual comorbidity type.MethodsWe examined comorbidity among 14,096 patients with breast, colon, rectal, liver, stomach, ovarian, uterine, bladder or kidney cancer. Patients were identified from cancer registry data, and then linked to hospitalisation data to determine the presence of comorbidity in the 5 years preceding cancer diagnosis. Individual comorbid conditions were identified using ICD-10 codes, and overall burden of comorbidity attributed using a cancer-specific measure of comorbidity (C3 Index).ResultsWe observed that the presence of patient comorbidity (a) increases the odds of being diagnosed with distant metastases, (b) does not lead to earlier diagnosis and (c) increases the likelihood of a patient receiving no stage of disease at diagnosis.ConclusionsPatient comorbidity has a substantial impact on cancer stage at diagnosis; however, this impact varies considerably by cancer type, individual comorbid condition and overall comorbidity burden.
| S-EPMC4815795 | biostudies-literature
Project description:BackgroundIncreased patient survivorship following initial primary lung cancer (IPLC) diagnosis and treatment has uncovered new clinical challenges as individuals post-IPLC are at growing subsequent risk of developing second primary lung cancer (SPLC). Proper SPLC surveillance guidelines aimed at monitoring IPLC survivors are crucial to enhancing health outcomes. This study aims to categorize risk factors associated with SPLC emergence in IPLC survivors for clinical use following IPLC treatment.Materials and methodsUsing the Karmanos Cancer Institute Tumor Registry, patients diagnosed with IPLC from 2000 to 2017 were identified. Patients diagnosed with SPLC were matched to individuals who did not develop SPLC. Logistic and Cox regression analyses were performed to identify risk factors for SPLC emergence and overall survival (OS).ResultsOne hundred twenty-one patients diagnosed with IPLC who later developed SPLC were identified and compared with 120 patients with IPLC who did not develop SPLC. Several factors such as stage at first diagnosis, histology, age, and smoking history were not associated with SPLC risk. The median time to SPLC was 1.79 years. Patients who were treated with surgical resection had a significantly higher probability of developing SPLC. After correcting for potential immortal time bias, the median OS was 3.63 years (95% confidence interval [CI], 3.05-5.00) and 7.31 years (95% CI, 4.62-10.90) for SPLC and no SPLC groups, respectively.ConclusionThis study uncovered notable associations and lack thereof between several competing SPLC risk factors, as well as mortality. Further characterization of SPLC risk factors is essential for enhancing surveillance recommendations.
| S-EPMC8536802 | biostudies-literature
Project description:ImportanceIndividuals with mental disorders often develop comorbidity over time. Past studies of comorbidity have often restricted analyses to a subset of disorders and few studies have provided absolute risks of later comorbidity.ObjectivesTo undertake a comprehensive study of comorbidity within mental disorders, by providing temporally ordered age- and sex-specific pairwise estimates between the major groups of mental disorders, and to develop an interactive website to visualize all results and guide future research and clinical practice.Design, setting, and participantsThis population-based cohort study included all individuals born in Denmark between January 1, 1900, and December 31, 2015, and living in the country between January 1, 2000, and December 31, 2016. The analyses were conducted between June 2017 and May 2018.Main outcomes and measuresDanish health registers were used to identify mental disorders, which were examined within the broad 10-level International Statistical Classification of Diseases and Related Health Problems, 10th Revision, subchapter groups (eg, codes F00-F09 and F10-F19). For each temporally ordered pair of disorders, overall and lagged hazard ratios and 95% CIs were calculated using Cox proportional hazards regression models. Absolute risks were estimated using competing risks survival analyses. Estimates for each sex were generated.ResultsA total of 5 940 778 persons were included in this study (2 958 293 men and 2 982 485 women; mean [SD] age at beginning of follow-up, 32.1 [25.4] years). They were followed up for 83.9 million person-years. All mental disorders were associated with an increased risk of all other mental disorders when adjusting for sex, age, and calendar time (hazard ratios ranging from 2.0 [95% CI, 1.7-2.4] for prior intellectual disabilities and later eating disorders to 48.6 [95% CI, 46.6-50.7] for prior developmental disorders and later intellectual disabilities). The hazard ratios were temporally patterned, with higher estimates during the first year after the onset of the first disorder, but with persistently elevated rates during the entire observation period. Some disorders were associated with substantial absolute risks of developing specific later disorders (eg, 30.6% [95% CI, 29.3%-32.0%] of men and 38.4% [95% CI, 37.5%-39.4%] of women with a diagnosis of mood disorders before age 20 years developed neurotic disorders within the following 5 years).Conclusions and relevanceComorbidity within mental disorders is pervasive, and the risk persists over time. This study provides disorder-, sex-, and age-specific relative and absolute risks of the comorbidity of mental disorders. Web-based interactive data visualization tools are provided for clinical utility.
| S-EPMC6439836 | biostudies-literature