The mortality rate is high among dialysis patients, but how this compares with other diseases such as cancer is poorly understood. We compared the survival of maintenance dialysis patients with that ...for patients with common cancers to enhance the understanding of the burden of end-stage kidney disease.
Population-based cohort study.
33,500 incident maintenance dialysis patients in Ontario, Canada, and 532,452 incident patients with cancer (women: breast, colorectal, lung, or pancreas; men: prostate, colorectal, lung, or pancreas) from 1997 to 2015 using administrative health care databases.
Incident kidney failure treated with maintenance dialysis versus incident diagnoses of cancer.
All-cause mortality.
Kaplan-Meier product limit estimator was used to describe the survival of subgroups of study participants. Extended Cox regression with a Heaviside function was used to compare survival between patients with incident kidney failure treated with maintenance dialysis and individual diagnoses of various incident cancers.
In men, dialysis had worse unadjusted 5-year survival (50.8%; 95% CI, 50.1%-51.6%) compared with prostate (83.3%; 95% CI, 83.1%-83.5%) and colorectal (56.1%; 95% CI, 55.7%-56.5%) cancer, but better survival than lung (14.0%; 95% CI, 13.7%-14.3%) and pancreas (9.1%; 95% CI, 8.5%-9.7%) cancer. In women, dialysis had worse unadjusted 5-year survival (49.8%; 95% CI, 48.9%-50.7%) compared with breast (82.1%; 95% CI, 81.9%-82.4%) and colorectal (56.8%; 95% CI, 56.3%-57.2%) cancer, but better survival than lung (19.7%; 95% CI, 19.4%-20.1%) and pancreas (9.4%; 95% CI, 8.9%-10.0%) cancer. After adjusting for clinical characteristics, similar results were found except when examining men and women with lung and pancreas cancer, for which dialysis patients had a higher rate of death 4 or more years after diagnosis. Women and men 70 years and older with incident kidney failure treated with maintenance dialysis had unadjusted 10-year survival probabilities that were comparable to pancreas and lung cancer.
Cancer stage could be obtained for only a subpopulation.
Survival in incident dialysis patients was lower than in patients with several different solid-organ cancers. These results highlight the need to develop interventions to improve survival on dialysis therapy and can be used to aid advance care planning for elderly patients beginning treatment with maintenance dialysis.
Aims/hypothesis
The aim of the study was to describe trends in all-cause and cause-specific mortality rates in Hong Kong Chinese people with diabetes from 2001 to 2016.
Methods
The Hong Kong Diabetes ...Surveillance Database (HKDSD) is a territory-wide diabetes cohort identified from the Hong Kong Hospital Authority electronic medical record system. Deaths between 2001 and 2016 were identified from linkage to the Hong Kong Death Registry. We used Joinpoint regression analysis to describe mortality patterns among people with diabetes by age and sex, and standardised mortality ratios (SMRs) to compare all-cause mortality rates in people with and without diabetes.
Results
Between 2001 and 2016, a total of 390,071 men and 380,007 women aged 20 years or older with diabetes were included in the HKDSD. There were 96,645 deaths among men and 88,437 deaths among women. Mortality rates for all-cause, cardiovascular disease and cancer among people with diabetes declined by 52.3%, 72.2% and 65.1% in men, respectively, and by 53.5%, 78.5% and 59.6% in women, respectively. Pneumonia mortality rates remained stable. The leading cause of death in people with diabetes has shifted from cardiovascular disease to pneumonia in the oldest age group, with cancer remaining the most common cause of death in people aged 45–74 years. The all-cause SMRs for men declined from 2.82 (95% CI 2.72, 2.94) to 1.50 (95% CI 1.46, 1.54), and for women, they declined from 3.28 (95% CI 3.15, 3.41) to 1.67 (95% CI 1.62, 1.72). However, among people aged 20–44 years, the declines in all-cause mortality rates over the study period were not statistically significant for both men (average annual per cent change AAPC: −3.2% 95% CI −7.3%, 1.0%) and women (AAPC: −1.2% 95% CI −6.5%, 4.4%). The SMRs in people aged 20−44 years fluctuated over time, between 7.86 (95% CI 5.74, 10.5) in men and 6.10 (95% CI 3.68, 9.45) in women in 2001, and 4.95 (95% CI 3.72, 6.45) in men and 4.92 (95% CI 3.25, 7.12) in women in 2016.
Conclusions/interpretation
Absolute and relative mortality has declined overall in people with diabetes in Hong Kong, with less marked improvements in people under 45 years of age, calling for urgent action to improve care in young people with diabetes.
IntroductionThe European Society of Cardiology 2016 atrial fibrillation (AF) guidance suggests atrioventricular node (AVN) ablation and pacemaker implantation in patients with AF unresponsive to rate ...and rhythm control therapies.1 For patients with conventional cardiac resynchronisation therapy (CRT) indications and AF, the recommendations are clear. However, in patients with normal left ventricular (LV) function and a pace and ablate strategy, there is limited evidence to support biventricular pacing (CRT) in favour of conventional right-ventricular permanent pacemakers (PPM).We audited our practice of AVN ablation to evaluate the current practice in our institution, and to observe for differences between pacing groups.MethodsOur devices database was searched for patients who underwent AV node ablation between June 2016 to September 2018. Descriptive and statistical analysis were performed, using t-test and Chi-squared methods.Results142 patients underwent AV node ablation, and 56 patients were identified with preserved LV function (LVEF > 50%) with a pace and ablate management strategy. Of these patients, 35 had a PPM, and 21 a CRT implanted prior to ablation.Comparing these groups, patients undergoing pacemaker implantation were significantly older (PPM 76± 14 vs CRT 67± 11, p= 0.014). There was also a significant difference in male gender, (PPM 8 (22.9%) vs CRT 13 (61.9%), p= 0.0035).Mean LVEF was similar between PPM and CRT groups (56±4% vs. 53±3%). There was a trend in higher background ischaemic heart disease in the CRT group (CRT 3 (14.2%) vs. PPM 1 (2.9%), p=0.108).At initial device implantation, two patients intended for CRT had a failed attempt at LV lead placement (5.7%), therefore a PPM was implanted. Device procedure time appears longer in the CRT group (CRT 132.1 mins ± 40.9, vs. PPM 85.8 mins ± 34.8).Total mean follow-up period was 345 days (± 197). Two patients (5.7%) in the PPM group required lead revisions, compared to none in the CRT group. A total of two patients required repeat procedures for failed ablations, with no other procedural complications. There was a trend in higher all cause mortality in the PPM group compared with the CRT group (4 (11.4%) vs. 1 (4.8%), p= 0.397).Abstract 47 Table 1Discussion and conclusionThe BLOCK HF trial demonstrated that biventricular pacing was superior to right-ventricular pacing in patients with an LVEF <50%.2 The role of prophylactic CRT implantation in patients with preserved LV was addressed in the BIOPACE trial, however these results were not formally published and controversy still exists about the type of device to implant in patients with near normal LV function.3Our study describes the variability in our clinical practice given the split in PPM vs CRT in patients with near normal LV function. The increased age and mortality trend in the PPM group may reflect an increased frailty or co-morbidity compared with the CRT group. However, long term clinical outcomes are required in order to provide clarity on this important clinical decision.Conflict of InterestNone
Transcatheter Aortic Valve Implantation (TAVI) for severe, symptomatic aortic stenosis improves quality of life and survival in most patients. It is, however, important to identify patients who are ...unlikely to get these benefits from TAVI so that futile treatment can be avoided. Futility in this context can be regarded as lack of functional improvement or death within the first two years after the procedure. The FRANCE-2 multi-parametric risk score was previously developed to predict mortality after TAVI and comprises 9 pre-procedural factors integrated into a 21-point scoring system. The FRANCE-2 score was originally validated against early (up to 30 days) mortality after TAVI but its value in anticipating longer term outcomes is uncertain. The aims of this study were to determine whether the FRANCE-2 scoring system is of value in determining medium as well as short term survival in patients undergoing TAVI in a single UK centre and to compare its relative merits in this regard with the logistic EuroSCORE. A cohort of 187 consecutive patients undergoing TAVI in a single UK centre were studied. Baseline clinical data were collected from the UK Central Cardiac Audit Database (CCAD) and patient records. Mortality tracking was achieved in 100% of patients. FRANCE-2 risk scores were calculated retrospectively and c-statistics were applied to determine the discriminative power of the FRANCE-2 score and the logistic EuroSCORE in associating with mortality. Using the FRANCE-2 scores, the patients were divided into low risk (score 0), moderate risk (score 1–5) and high risk (score >5) groups and the survival outcomes were compared. Of the 187 patients, 57.2% were male and the mean age was 80.9±6.9 years. Survival rates after TAVI at 30-days, 1- and 2-years were 95.7% (n=179), 88.2% (n=165) and 77.5% (n=145) respectively. The frequency of high risk parameters in this cohort of patients that contributed to the FRANCE-2 scores is shown in the table. The median score was 2 and the highest score was 9. The c-index of FRANCE-2 score for predicting 30-day mortality was 0.793 (p=0.009) and for 1-year mortality 0.679 (p=0.016). The mean survival time for patients with high FRANCE-2 scores (18.6 months) was significantly less than for patients with low (53.8 months) and moderate (53.6 months) scores (p=0.0004) (figure 1). The logistic EuroSCORE was poorly associated with mortality with a c-index of 0.605 (p=0.346) and 0.616 (p=0.11) for 30-day and 1-year mortality respectively. The FRANCE-2 risk score is predictive of medium term as well as short term survival after TAVI in a single UK centre clinical practice. The logistic EuroSCORE is a poor predictor of short and medium-term survival after TAVI. The presence of a high FRANCE-2 score (>5) is associated with poor survival after TAVI. The use of the FRANCE-2 scoring system may be a useful additional tool for the Heart MDT in identifying patients who will benefit least from TAVI.Abstract 56 Table 1Abstract 56 Figure 1Conflict of InterestNo
ObjectivesFalls from standing are an important cause of vertebral fractures, particularly in the elderly. They are associated with significant morbidity and long-term mortality. The aim of this study ...was to determine the treatment and outcomes, in a single centre, of managing spinal fractures due to falls from standing height.DesignRetrospective case note review of patients with a fracture sustained due to a fall from standing (2011–2016 inclusive).Subjects229 patients with average age 76.6±14.5 years; 134 (58.5%) female.MethodsPatients were identified from the Trauma Audit and Research Network database. Case notes were reviewed for demographics, treatment details and outcome at 6 months post-admission.Results1408 patients were admitted with spinal fractures of which 229 (16.3%) sustained a fall from standing height. Two hundred and eighty-three fractures were identified in the 229 patients, which were distributed in the cervical (n=140), thoracic (n=65) and lumbar (n=78) spine. The average ISS score was 9.7±5.4. Twenty-three (10.0%) patients had either incomplete or complete spinal cord injury. Fifty-six (24.5%) patients underwent surgical intervention. Forty-three patients (18.7%) died within 6 months and increasing age and Charlson co-morbidity score were associated with higher mortality.ConclusionsFalls from standing comprise a large portion of the spinal service emergency workload. They are associated with a high 6 month mortality similar to other fragility fractures experienced by the elderly.
Abstract Introduction Cancer incidence and mortality estimates for 25 cancers are presented for the 40 countries in the four United Nations-defined areas of Europe and for the European Union (EU-27) ...for 2012. Methods We used statistical models to estimate national incidence and mortality rates in 2012 from recently-published data, predicting incidence and mortality rates for the year 2012 from recent trends, wherever possible. The estimated rates in 2012 were applied to the corresponding population estimates to obtain the estimated numbers of new cancer cases and deaths in Europe in 2012. Results There were an estimated 3.45 million new cases of cancer (excluding non-melanoma skin cancer) and 1.75 million deaths from cancer in Europe in 2012. The most common cancer sites were cancers of the female breast (464,000 cases), followed by colorectal (447,000), prostate (417,000) and lung (410,000). These four cancers represent half of the overall burden of cancer in Europe. The most common causes of death from cancer were cancers of the lung (353,000 deaths), colorectal (215,000), breast (131,000) and stomach (107,000). In the European Union, the estimated numbers of new cases of cancer were approximately 1.4 million in males and 1.2 million in females, and around 707,000 men and 555,000 women died from cancer in the same year. Conclusion These up-to-date estimates of the cancer burden in Europe alongside the description of the varying distribution of common cancers at both the regional and country level provide a basis for establishing priorities to cancer control actions in Europe. The important role of cancer registries in disease surveillance and in planning and evaluating national cancer plans is becoming increasingly recognised, but needs to be further advocated. The estimates and software tools for further analysis (EUCAN 2012) are available online as part of the European Cancer Observatory (ECO) ( http://eco.iarc.fr ).
Alterations in treatment intensity and decreased use of radiation therapy have reduced the risk of late treatment-related death in long-term survivors of childhood cancer.
In the 1960s, fewer than ...half the children in whom cancer was diagnosed were still alive 5 years later.
1
Now, more than 83% of patients with a childhood cancer in the United States become 5-year survivors of the disease.
2
As a result, in 2013 it was estimated that there were more than 420,000 survivors of childhood cancer in the United States and that by the year 2020 this number would surpass 500,000.
3
Increased success in the treatment of childhood cancers has been achieved through the systematic conduct of clinical trials to assess the efficacy of multimodal approaches involving combination chemotherapy, . . .
There is inconclusive and controversial evidence of the association between allergic diseases and the risk of adverse clinical outcomes of coronavirus disease 2019 (COVID-19).
We sought to determine ...the association of allergic disorders with the likelihood of a positive severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) test result and with clinical outcomes of COVID-19 (admission to intensive care unit, administration of invasive ventilation, and death).
A propensity-score–matched nationwide cohort study was performed in South Korea. Data obtained from the Health Insurance Review & Assessment Service of Korea from all adult patients (age, >20 years) who were tested for SARS-CoV-2 in South Korea between January 1, 2020, and May 15, 2020, were analyzed. The association of SARS-CoV-2 test positivity and allergic diseases in the entire cohort (n = 219,959) and the difference in clinical outcomes of COVID-19 were evaluated in patients with allergic diseases and SARS-CoV-2 positivity (n = 7,340).
In the entire cohort, patients who underwent SARS-CoV-2 testing were evaluated to ascertain whether asthma and allergic rhinitis were associated with an increased likelihood of SARS-CoV-2 test positivity. After propensity score matching, we found that asthma and allergic rhinitis were associated with worse clinical outcomes of COVID-19 in patients with SARS-CoV-2 test positivity. Patients with nonallergic asthma had a greater risk of SARS-CoV-2 test positivity and worse clinical outcomes of COVID-19 than patients with allergic asthma.
In a Korean nationwide cohort, allergic rhinitis and asthma, especially nonallergic asthma, confers a greater risk of susceptibility to SARS-CoV-2 infection and severe clinical outcomes of COVID-19.
To investigate whether diabetes contributes to mortality for major types of diseases.
Six National Health and Nutrition Examination Survey data cycles (1999 to 2000, 2001 to 2002, 2003 to 2004, 2005 ...to 2006, 2007 to 2008, and 2009 to 2010) and their linked mortality files were used. A population of 15,513 participants was included according to the availability of diabetes and mortality status.
Participants with diabetes tended to have higher all-cause mortality and mortality due to cardiovascular disease, cancer, chronic lower respiratory diseases, cerebrovascular disease, influenza and pneumonia, and kidney disease. Confounder-adjusted Cox proportional hazard models showed that both diagnosed diabetes category (yes or no) and diabetes status (diabetes, prediabetes, or no diabetes) were associated with all-cause mortality and with mortality due to cardiovascular disease, chronic lower respiratory diseases, influenza and pneumonia, and kidney disease. No associations were found for cancer-, accidents-, or Alzheimer's disease-related mortality.
The current study's findings provide epidemiological evidence that diagnosed diabetes at the baseline is associated with increased mortality risk due to cardiovascular disease, chronic lower respiratory diseases, influenza and pneumonia, and kidney disease, but not with cancer or Alzheimer's disease.
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