A consistent finding from contemporary Western societies is that women outlive men. However, what is unclear is whether sex differences in survival are constant across varying socio-ecological ...conditions. We test the universality of the female survival advantage with mortality data from a nineteenth century population in the Baja California peninsula of Mexico. When examined simply, we find evidence for a male-biased survival advantage. However, results from Cox regression clearly show the importance of age intervals for variable survival patterns by sex. Our key findings are that males: (i) experience significantly lower mortality risk than females during the ages 15-30 (RR = 0.69), (ii) are at a significantly increased risk of dying in the 61+ category (RR = 1.30) and (iii) do not experience significantly different mortality risk at any other age interval (0-14, 31-45, 46-60). We interpret our results to stem from differing intrinsic and extrinsic risk factors for sex-biased mortality across age intervals, highlighting the relevance of a lifecourse approach to the study of survival advantage. Ultimately, our results make clear the need to more broadly consider variability in mortality risk factors across time and place to allow for a clearer understanding of human survival differences.
Background
Reported revision rates for endoscopic sinus surgery (ESS) for chronic rhinosinusitis (CRS) vary significantly. Several investigations examining revision rates for ESS have been limited by ...duration of follow‐up, academic centers, or small surgeon cohorts. The objective of this study was to define the long‐term revision rates for ESS and to determine those unique patient factors that increase the risk of revision ESS.
Methods
The Utah Population Database was queried for Current Procedural Terminology codes for ESS from 1996 to 2016. Patient demographics and comorbid diagnoses were collected. Revision rates and risk factors for surgery were determined by Cox proportional hazard modeling.
Results
A total of 29,934 patients were identified, with a mean length of follow‐up of 9.7 years. The long‐term revision rate was found to be 15.9%. The mean time between surgeries decreased with higher number of revision surgeries. The time between the first and second surgery was 4.39 years and the time between the fourth and fifth surgery decreased to 2.18 years. Female gender, older age at first surgery, nasal polyps, comorbid asthma, allergy, and a family history of CRS all increased the risk of requiring revision surgery (p < 0.001).
Conclusion
The long‐term revision rate for ESS exceeds 15% and the time between revision surgeries decreased with each additional surgery being performed. Unique patient factors increased the risk of requiring revision ESS. Understanding patients’ risk for revision surgery may help physicians select and counsel patients with CRS undergoing ESS.
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FZAB, GIS, IJS, KILJ, NLZOH, NUK, OILJ, SAZU, SBCE, SBMB, UL, UM, UPUK
Objective
Obesity is associated with increased cancer risk. Because of the substantial and sustained weight loss following bariatric surgery, postsurgical patients are ideal to study the association ...of weight loss and cancer.
Methods
Retrospectively (1982–2019), 21,837 bariatric surgery patients (surgery, 1982–2018) were matched 1:1 by age, sex, and BMI with a nonsurgical comparison group. Procedures included gastric bypass, gastric banding, sleeve gastrectomy, and duodenal switch. Primary outcomes included cancer incidence and mortality, stratified by obesity‐ and non‐obesity‐related cancers, sex, cancer stage, and procedure.
Results
Bariatric surgery patients had a 25% lower risk of developing any cancers compared with a nonsurgical comparison group (hazard ratio HR 0.75; 95% CI 0.69–0.81; p < 0.001). Cancer incidence was lower among female (HR 0.67; 95% CI 0.62–0.74; p < 0.001) but not male surgery patients, with the HR lower for females than for males (p < 0.001). Female surgery patients had a 41% lower risk for obesity‐related cancers (i.e., breast, ovarian, uterine, and colon) compared with nonsurgical females (HR 0.59; 95% CI 0.52–0.66; p < 0.001). Cancer mortality was significantly lower after surgery in females (HR 0.53; 95% CI 0.44–0.64; p < 0.001).
Conclusions
Bariatric surgery was associated with lower all‐cancer and obesity‐related cancer incidence among female patients. Cancer mortality was significantly lower among females in the surgical group versus the nonsurgical group.
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FZAB, GIS, IJS, KILJ, NLZOH, NUK, OILJ, SAZU, SBCE, SBMB, UL, UM, UPUK
Fetal environment has a substantial influence on an individual’s health throughout their life course. Animal models of hypertensive disease of pregnancy have demonstrated adverse health outcomes ...among offspring exposed to hypertensive disease of pregnancy in utero. Although there are numerous descriptions of the neonatal, infant, and pediatric outcomes of human offspring affected by hypertensive disease of pregnancy, there are few data in US populations on later life outcomes, including mortality.
To assess risk for early mortality among offspring of pregnancies complicated by hypertensive disease of pregnancy.
This is a retrospective cohort study of offspring born to women with singleton or twin pregnancies between 1947 and 1967 with birth certificate information in the Utah Population Database. We identified offspring from delivery diagnoses of gestational hypertension, preeclampsia, or eclampsia. Offspring from these pregnancies (exposed) were matched to offspring of pregnancies without hypertensive disease of pregnancy (unexposed) by maternal age at delivery, birth year, sex, and multiple gestation. We also identified unexposed siblings of exposed offspring for a separate sibling analysis. Mortality follow-up of all offspring continued through 2016, at which time they would have been 49–69 years old. Adjusted hazard ratios for cause-specific mortality comparing exposed with unexposed offspring were estimated using Cox proportional hazard models.
We compared mortality risks for 4050 exposed offspring and 6989 matched unexposed offspring from the general population and 7496 unexposed siblings. Mortality risks due to metabolic, respiratory, digestive, nervous, and external causes of death did not differ between exposed and unexposed groups. Mortality risks from cardiovascular disease were greater in exposed offspring compared with unexposed offspring (adjusted hazard ratio, 1.57; 95% confidence interval, 1.16–2.12). In sex-specific models among the general population, cardiovascular disease mortality was significantly associated with exposure among male patients (adjusted hazard ratio, 1.92; 95% confidence interval, 1.27–2.88) but not among female patients (adjusted hazard ratio, 0.97; 95% confidence interval, 0.81–1.94). An interaction between hypertensive disease of pregnancy exposure and birth order on cardiovascular disease mortality was significant (P=.047), suggesting that the effect of hypertensive disease of pregnancy on cardiovascular disease mortality increased with higher birth order. Among siblings, the association between hypertensive disease of pregnancy exposure and cardiovascular disease mortality was not significant (adjusted hazard ratio, 1.39; 95% confidence interval, 0.99–1.95), and this was also true for sex-specific analyses of males (adjusted hazard ratio, 1.26; 95% confidence interval, 0.81–1.94) and females (adjusted hazard ratio, 1.71; 95% confidence interval, 0.96–3.04). As in the general population, there was a significant interaction between hypertensive disease of pregnancy exposure and birth order on cardiovascular disease mortality (P=.011).
In a US population, overall mortality risks are greater for offspring of pregnancies complicated by hypertensive disease of pregnancy compared with unexposed offspring. Among siblings, there was not a significant association between hypertensive disease of pregnancy exposure and cardiovascular disease mortality.
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GEOZS, IJS, IMTLJ, KILJ, KISLJ, NLZOH, NUK, OILJ, PNG, SAZU, SBCE, SBJE, UILJ, UL, UM, UPCLJ, UPUK, ZAGLJ, ZRSKP
Objective
To determine whether women with spontaneous preterm birth (PTB) have increased risks for long‐term mortality.
Design
Retrospective cohort.
Setting
Births in Utah between 1939 and 1977.
...Population
We included women with a singleton live birth ≥20 weeks who survived at least 1 year following delivery. We excluded those who had never lived in Utah, had improbable birthweight/gestational age combinations, underwent induction (except for preterm membrane rupture) or had another diagnosis likely to cause PTB.
Methods
Exposed women had ≥1 spontaneous PTB between 20+0 weeks and 37+0 weeks. Women with >1 spontaneous PTB were included only once. Unexposed women had all deliveries at or beyond 38+0 weeks. Exposed women were matched to unexposed women by birth year, infant sex, maternal age group and infant birth order. Included women were followed up to 39 years after index delivery.
Main outcome measures
Overall and cause‐specific mortality risks were compared using Cox regression.
Results
We included 29 048 exposed and 57 992 matched unexposed women. There were 3551 deaths among exposed (12.2%) and 6013 deaths among unexposed women (10.4%). Spontaneous PTB was associated with all‐cause mortality (adjusted hazard ratio aHR 1.26, 95% confidence interval CI 1.21–1.31), death from neoplasms (aHR 1.10, 95% CI 1.02–1.18), circulatory disease (aHR 1.35, 95% CI 1.25–1.46), respiratory disease (aHR 1.73, 95% CI 1.46–2.06), digestive disease (aHR 1.33, 95% CI 1.12–1.58), genito‐urinary disease (aHR 1.60, 95% CI 1.15–2.23) and external causes (aHR 1.39, 95% CI 1.22–1.58).
Conclusions
Spontaneous PTB is associated with modestly increased risks for all‐cause and some cause‐specific mortality.
Linked article: This article is commented on by Veronica Giorgione, pp. 1491–1492 in this issue. To view this mini commentary visit https://doi.org/10.1111/1471‐0528.17569.
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BFBNIB, FZAB, GIS, IJS, KILJ, NLZOH, NUK, OILJ, SAZU, SBCE, SBMB, UL, UM, UPUK
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