Background: Recent evidence indicates that severe obesity increases risk for bone fractures. Whether long-term fracture risk worsens after sustained weight loss following current bariatric surgery ...procedures compared to controls matched to pre-surgical BMI is not yet clear. Further, risk for fracture non-union is not known in these populations. Methods: In a retrospective cohort study, we determined long-bone fracture risk (1982-2020) in bariatric surgery patients (Roux-en-Y gastric bypass (RYGB; n=14,555), adjustable gastric band (BAND; n=2,629), and sleeve gastrectomy (SLEEVE; n=3,050)), compared with Utah population controls (driver license applicants) 1:1 matched to patient sex, age, and pre-surgical weight. Electronic medical records were used to determine fracture and non-union incidence in patients and controls from 1996 to 2020. Results: During a mean follow-up of 13.2±8.5 years, patients who underwent bariatric surgery had a 67% greater risk (HR:1.67, CI:1.53-1.82, p<0.001) of fractures compared to population controls with severe obesity. Procedure-specific analyses revealed a significant increase in fractures in RYGB patients (HR:1.78, CI:1.61-1.96, p<0.001), while the increase in BAND (HR:1.23, 0:0.88-1.71) and SLEEVE (HR:1.10, CI:0.76-1.61) procedures was not significant. Bariatric surgery was associated with a greater risk of femur, forearm, humerus, and tibia fractures (HRs:1.63, 2.00, 2.80, and 1.38, respectively; all p<0.001). Outcomes were similar between males and females and across age groups. Fracture non-union was more common after bariatric surgery (HR:1.99, CI:1.39-2.86, p<0.001) but not significantly different when accounting for the increased number of fractures in patients versus controls. Conclusions: Long-term incidence of long-bone fractures increases after certain types of bariatric surgery compared to matched population controls without surgery. Additional research is warranted to determine the mechanistic reasons for this increase in fracture risk among bariatric surgery patients.
Full text
Available for:
FZAB, GIS, IJS, KILJ, NLZOH, NUK, OILJ, SAZU, SBCE, SBMB, UL, UM, UPUK
1. Explain how hospice experiences might have implications for the surviving family's health.
2. Explain how gender and other contexts can modify the family's hospice experience.
Hospice experiences ...might increase mortality risk for surviving family. Longer hospice stays and being the only nearby family member are risk factors, depending upon gender and relationship type. Having more family members is protective against survivors’ mortality risk, but dementia in hospice is particularly risky for a surviving widow's health.
Hospice has implications for not only the patient but their surviving family. This research might help identify at-risk family members for targeted interventions.
This study uses familial-linked administrative records from the Utah Population Database to assess how variations in family hospice experiences affect mortality risk for surviving spouses and children.
From a population database, we studied a cohort of hospice decedents living in Utah between 1998 and 2016 linked to their spouses and adult children (n=37,271 pairs). Linking medical records, vital statistics, and other administrative microdata to describe decedent-kin pairs, event-history models assessed how hospice duration and characteristic of the family, including familial network size and coresidence with the decedent, were associated with long-term mortality risk of surviving family members.
Longer hospice duration increased mortality risk for daughters and husbands, but not sons or wives. Having other family members in the state was protective, and living in the same household as the decedent prior to death was a risk factor for sons.
We conclude that relationship type and sex modify the how of end-of-life stressors (i.e., potential caregiving demands and bereavement experiences) affect health because of normative gender roles. Furthermore, exposure to dementia deaths may be particularly stressful, especially for females.
Using a large population database, we assess mortality risk not only for spouses of hospice decedents, but also for their children. We are aware of no other research systematically exploring this topic using large datasets.
Full text
Available for:
GEOZS, IJS, IMTLJ, KILJ, KISLJ, NLZOH, NUK, OILJ, PNG, SAZU, SBCE, SBJE, UILJ, UL, UM, UPCLJ, UPUK, ZAGLJ, ZRSKP
The purpose of this study was to determine whether there is an increased risk of mortality among individuals with keratoconus.
This was a retrospective, case-control study using the Utah Population ...Database. Cases were defined as individuals diagnosed with keratoconus from 1996 to 2020 and were matched 5:1 with controls on birth year, sex, whether born in Utah, and follow-up time in Utah. Individuals diagnosed with trisomy 21 or connective tissue disease were excluded. Main outcome measures were the all-cause and cause-specific mortality among keratoconus cases compared with matched controls. Cox regression models were used, additionally adjusting for race and ethnicity.
A total of 7847 keratoconus cases and 38,597 controls were studied in the final analyses. The mean age at index diagnosis was 43 ± 17 years, and mean age at last follow-up was 54 ± 17 years for both cases and controls. At last follow-up, 92% of cases were living compared with 91% of controls. After adjusting for covariates, there were no significant differences in all-cause mortality (P = 0.161), mortality from natural causes (0.222), or mortality from unnatural causes (P = 0.494) between cases and controls. When analyzed according to specific causes of death, keratoconus cases had a higher mortality risk from diseases of the nervous system and sense organs compared with their matching controls (hazard ratio 1.59; 95% confidence interval, 1.19-2.11; P = 0.002).
There was no evidence of an increased risk of mortality among individuals with keratoconus. There may be an increased risk of death due to diseases of the nervous system and sense organs among individuals with keratoconus.
Experiencing the death of a family member and providing end-of-life caregiving can be stressful on families – this is well-documented in both the caregiving and bereavement literatures. Adopting a ...linked-lived theoretical perspective, exposure to the death and dying of one family member could be conceptualized as a significant life stressor that produces short and long-term health consequences for surviving family members. This study uses familial-linked administrative records from the Utah Population Database to assess how variations in family hospice experiences affect mortality risk for surviving spouses and children. A cohort of hospice decedents living in Utah between 1998 and 2016 linked to their spouses and adult children (n = 37,271 pairs) provides an ideal study population because 1) hospice typically involves family members in the planning and delivery of end-of-life care, and 2) hospice admission represents a conscious awareness and acknowledgment that the decedent is entering an end-of-life experience. Thus, hospice duration (measured as the time between admission and death) is a precise measure of the family's exposure to an end-of-life stressor. Linking medical records, vital statistics, and other administrative microdata to describe decedent-kin pairs, event-history models assessed how hospice duration and characteristics of the family, including familial network size and coresidence with the decedent, were associated with long-term mortality risk of surviving daughters, sons, wives (widows), and husbands (widowers). Longer hospice duration increased mortality risk for daughters and husbands, but not sons or wives. Having other family members in the state was protective, and living in the same household as the decedent prior to death was a risk factor for sons. We conclude that relationship type and sex likely modify the how of end-of-life stressors (i.e., potential caregiving demands and bereavement experiences) affect health because of normative gender roles. Furthermore, exposure to dementia deaths may be particularly stressful, especially for women.
•Exposure to end-of-life caregiving may increase mortality risk for surviving family.•Longer hospice duration and being the only nearby family member are risk factors.•Gender and relationship type (child or spouse) modify survivors' mortality risk.•Having more family members is protective against survivors' mortality risk.•Having a spouse with dementia is particularly risky for surviving widows' health.
Full text
Available for:
GEOZS, IJS, IMTLJ, KILJ, KISLJ, NLZOH, NUK, OILJ, PNG, SAZU, SBCE, SBJE, UILJ, UL, UM, UPCLJ, UPUK, ZAGLJ, ZRSKP
Objective
This retrospective study incorporated long‐term mortality results after different bariatric surgery procedures and for multiple age at surgery groups.
Methods
Participants with bariatric ...surgery (surgery) and without (non‐surgery) were matched (1:1) for age, sex, BMI, and surgery date with a driver license application/renewal date. Mortality rates were compared by Cox regression, stratified by sex, surgery type, and age at surgery.
Results
Participants included 21,837 matched surgery and non‐surgery pairs. Follow‐up was up to 40 years (mean SD, 13.2 9.5 years). All‐cause mortality was 16% lower in surgery compared with non‐surgery groups (hazard ratio, 0.84; 95% CI: 0.79‐0.90; p < 0.001). Significantly lower mortality after bariatric surgery was observed for both females and males. Mortality after surgery versus non‐surgery decreased significantly by 29%, 43%, and 72% for cardiovascular disease, cancer, and diabetes, respectively. The hazard ratio for suicide was 2.4 times higher in surgery compared with non‐surgery participants (95% CI: 1.57‐3.68; p < 0.001), primarily in participants with ages at surgery between 18 and 34 years.
Conclusions
Reduced all‐cause mortality was durable for multiple decades, for multiple bariatric surgical procedures, for females and males, and for greater than age 34 years at surgery. Rate of death from suicide was significantly higher in surgery versus non‐surgery participants only in the youngest age at surgery participants.
Full text
Available for:
FZAB, GIS, IJS, KILJ, NLZOH, NUK, OILJ, SAZU, SBCE, SBMB, UL, UM, UPUK
Background
Large epidemiologic studies have suggested that a history of tobacco use may be associated with an increased risk of developing chronic rhinosinusitis (CRS). The impact of tobacco use on ...revision rates of endoscopic sinus surgery (ESS), however, remains limited.
Objective
This study seeks to define the independent risk of tobacco use (active or prior) on revision rates of ESS among a large cohort of patients with CRS.
Methods
A state population database was queried for patients age ≥18 years with CRS who underwent at least one ESS between 1996 and 2018. Demographic characteristics, history of ESS, and tobacco use status were compared across patients with CRS, using t tests for continuous variables and χ2 tests for categorical variables. Unadjusted and adjusted logistic regression models were used to understand the impact of tobacco status on revision surgery.
Results
The final analysis included 34 350 patients (29 916 CRS with no revision surgery and 4434 CRS with revision surgery). Unadjusted regression analysis demonstrated an increased odds of undergoing revision ESS (OR 1.12, 95% CI: 1.00–1.25, P = .05) among males with a history of tobacco use and CRS. Adjusted regression analysis demonstrated that the risk of revision ESS among CRS patients with a history of asthma and tobacco use was 1.72-fold, while the risk among CRS patients who were tobacco users without asthma was 1.11-fold.
Conclusion
History of tobacco use is an independent risk factor for revision ESS among patients with CRS.
Full text
Available for:
NUK, OILJ, SAZU, UKNU, UL, UM, UPUK
1. Understand the prevalence of high-intensity healthcare utilization among individuals with advanced-stage melanoma and lung cancer receiving ICIs.
2. Recognize 2-3 patient characteristics that may ...influence high-intensity healthcare utilization among individuals with advanced-stage melanoma and lung cancer receiving ICIs.
Immune checkpoint inhibitor receipt was associated with increased emergency department and inpatient encounters among individuals with advanced lung cancer and melanoma diagnosed between 2013-2018 and followed to 2021. Over 13% of individuals who died within the study period had inpatient emergency department encounters within the last six months of life.
Immune checkpoint inhibitors (ICI) have become standard of care in advanced melanoma and lung cancers. ICIs have lower toxicities than chemotherapy but adverse effects are common. Around 4-28% of ICI patients experience severe adverse events requiring inpatient care, making this patient population at potentially greater risk for high intensity care utilization.
We examined the risk of all-cause inpatient and emergency department visits among melanoma and lung cancer ICI patients, hypothesizing that ICI receipt would be associated with greater healthcare utilization.
Patients diagnosed between 2013-2018 were identified with the Utah Cancer Registry and ICI receipt and health encounters were identified with the Utah All-Payers Claims Database and statewide inpatient and emergency department records. Bivariate tests and multivariable Poisson Regression Models were conducted in R (p < 0.05).
415 patients with melanoma (n=137, 33%) and lung cancer (n=278, 67%) received a PD-1/PD-L1 or CTLA-4 ICI between 2013 and 2021. Most were diagnosed at distant stages of disease (68.9%) and had a median of 2 (IQR=1-3) inpatient stays and 1 (IQR= 0-3) emergency department visits. Accounting for demographics, socioeconomic characteristics, rurality, cancer stage, and non-cancer comorbidities, ICI receipt was associated with increased emergency department visits among melanoma (aIRR= 1.71, 95% CI=1.48-1.98, p< 0.001) and lung cancer patients (aIRR=1.37, 95% CI=1.24-1.51, p< 0.001). ICI receipt was also associated with increased inpatient stays (melanoma aIRR=1.47, 95% CI= 1.27-1.71, p< 0.001; lung cancer aIRR=1.37, 95% CI=1.25-1.50, p< 0.001). Of the 302 ICI patients who died within the study period, 41 (13.6%) had inpatient or emergency department encounters in the last six months of life.
Patients receiving ICIs may have increased risk for inpatient and emergency department use.
Findings have implications for symptom monitoring, management, and decision-making support among ICI patients. Future directions will examine causes of admissions and palliative care use among decedents receiving ICIs.
Full text
Available for:
GEOZS, IJS, IMTLJ, KILJ, KISLJ, NLZOH, NUK, OILJ, PNG, SAZU, SBCE, SBJE, UILJ, UL, UM, UPCLJ, UPUK, ZAGLJ, ZRSKP
Background
Recent evidence from the UK Biobank of over 273,000 women indicates a U‐shaped relationship between parity and risk of dementia, with nulliparity and grand multiparity showing increased ...risk of dementia compared to women having 1‐3 births after adjustment for important sociodemographic and health history factors, but not Apolipoprotein E (ApoE) polymorphism. ApoE4 genotype, a known risk factor for Alzheimer’s disease and Alzheimer’s disease related dementia (AD/ADRD), has been shown to be related to higher potential female fertility due to increased concentrations of progesterone. Our objective was to determine whether a similar U‐shaped relationship is present in the population based Cache County Study of Memory in Aging (CCSMA) cohort, after controlling for important confounding factors including ApoE genotype.
Methods
CCSMA was a longitudinal study that investigated risk factors contributing to AD/ADRD and other dementias. CCSMA enrolled 90% (N = 5,092, n = 2928 women) of the Cache County, Utah permanent resident population aged 65 and older as of January 1, 1995. Participants were followed for four triennial waves for AD/ADRD ascertainment. Prior number of live births for CCSMA women was assessed via self‐report and validated via linked Utah Population Database records (99% successful linkage). Adjusted risk ratios using Poisson regression with robust variance were calculated to assess whether parity was associated with later dementia risk, adjusting for important sociodemographic and health history factors (Table 1).
Results
Among the total sample, 5.6% were nulliparous, 18.4% had 1‐2 births, 54% had 3‐5 births, and 22% had 6+ births. Over the course of the study, 12% were diagnosed with AD and 7% with ADRD. Compared to women with 3‐5 births, women with zero, 1‐2, and ≥6 live births had an aRR of 1.16 (95% CI: 0.80, 1.69), 1.00 (95% CI: 0.76, 1.32), and 1.21 (95% CI: 0.96, 1.53) (Figure 1), respectively. Results were similar for ADRD.
Conclusion
Our results support a U‐shaped relationship between parity and dementia risk. Whether the relationship between parity and dementia risk is being driven by social and behavioral factors involved in parenting or biological factors associated with childbearing (e.g., total endogenous estrogen exposure) warrants further investigation.
Full text
Available for:
FZAB, GIS, IJS, KILJ, NLZOH, NUK, OILJ, SAZU, SBCE, SBMB, UL, UM, UPUK
e18817
Background: Immunotherapy harnesses cancer patients’ immune systems to eradicate cancer cells, and has become the standard of care as first line or combination therapy in advanced lung cancer. ...While immunotherapy is more tolerable than other treatments such as chemotherapy, a minority of patients experience toxicities requiring clinical intervention. The aim of this study is to examine the risk of all-cause inpatient and emergency department visits among lung cancer patients diagnosed with cancer receiving immunotherapies as first line treatments using a linked population dataset. Methods: We analyzed administrative data from N = 3,268 lung cancer patients diagnosed between 2013 and 2018 from the Immunotherapy, Palliative and End-of-life Treatment Utilization and Spousal Outcomes (ImmPETUS) cohort, a linked population-based cohort of melanoma, lung, breast, colorectal and bladder cancer patients and their spouses in Utah. Analyses were conducted with multivariable logistic regression models in R and adjusted for sex, age, age at diagnosis, cancer stage, race, ethnicity, marital status, neighborhood education and household income, insurance type, rurality and comorbidity. Results: Among patients diagnosed with lung and bronchus cancers (53.1% male, 46.9% female), 9.5% received immunotherapy as a first line treatment and 57.3% had distant stages at diagnosis. Adjusting for race, ethnicity, neighborhood education and income, and rurality, lung cancer patients who received immunotherapies as a first course of treatment had greater odds of all-cause emergency department encounters (aOR = 1.94, 95% CI = 1.49-2.53, p < 0.001) compared to patients receiving other first line treatments. Non-Medicaid patients and patients with greater comorbidities were less likely to have all-cause emergency department encounters (aOR = 0.66, 95% CI = 0.53-0.82, p < 0.001; 0.92, 95% CI = 0.89-0.96, p < 0.001) and all-cause inpatient visits (aOR = 0.60, 95% CI = 0.46-0.77, p < 0.001; aOR = 0.89, 95% CI = 0.85-0.93, p < 0.001) compared with Medicaid patients and patients with no comorbidities. Nonmarried patients (aOR = 0.71, 95% CI 0.59-0.86, p < 0.001) were less likely to have all-cause inpatient visits compared with those who were married/partnered. Conclusions: Our findings support that patients receiving immunotherapies as first line treatment have increased risk of all-cause emergency department encounters. This analysis of real-world data enabled the examination of downstream healthcare utilization outcomes of immunotherapy cancer patients within Utah, and provides insight into groups at risk for adverse events. Future directions include examining the clinical and social pathways of these disparities, such as immune-related adverse events, access to supportive care, and supports for patient and family decision making.
Uptake of risk-reducing surgery has increased among women at high risk of epithelial ovarian cancer. We sought to characterise familial risk of epithelial ovarian cancer histotypes in a ...population-based study after accounting for gynaecological surgeries, including bilateral oophorectomy.
We compared risk of epithelial ovarian cancer in relatives of 3536 epithelial ovarian cancer cases diagnosed in 1966-2016 and relatives of 35 326 matched controls. We used Cox competing risk models, incorporating bilateral oophorectomy as a competing risk, to estimate the relative risk of ovarian cancer in first-degree (FDR), second-degree (SDR) and third-degree (TDR) relatives from 1966 to 2016. We also estimated relative risks in time periods before (1966-1994, 1995-2004) and after (2005-2016) formal recommendations were made for prophylactic oophorectomy among women with pathogenic variants in
.
The relative risks of epithelial ovarian cancer in FDRs, SDRs and TDRs of cases versus controls were 1.68 (95% CI 1.39 to 2.04), 1.51 (95% CI 1.30 to 1.75) and 1.34 (95% CI 1.20 to 1.48), respectively. Relative risks were greatest for high-grade serous, mucinous and 'other epithelial' histotypes. Relative risks were attenuated for case FDRs, but not for SDRs or TDRs, from 2005 onwards, consistent with the timing of recommendations for prophylactic surgery.
Familial risk of epithelial ovarian cancer extends to TDRs, especially for high-grade serous and mucinous histotypes. Distant relatives share genes but minimal environment, highlighting the importance of germline inherited genetics in ovarian cancer aetiology. Increased ovarian cancer risk in distant relatives has implications for counselling and recommendations for prophylactic surgeries that, from our data, appear only to reach FDRs.
