Solid organ transplant recipients have elevated cancer risk due to immunosuppression and oncogenic viral infections. Because most prior research has concerned kidney recipients, large studies that ...include recipients of differing organs can inform cancer etiology.
To describe the overall pattern of cancer following solid organ transplantation.
Cohort study using linked data on solid organ transplant recipients from the US Scientific Registry of Transplant Recipients (1987-2008) and 13 state and regional cancer registries.
Standardized incidence ratios (SIRs) and excess absolute risks (EARs) assessing relative and absolute cancer risk in transplant recipients compared with the general population.
The registry linkages yielded data on 175,732 solid organ transplants (58.4% for kidney, 21.6% for liver, 10.0% for heart, and 4.0% for lung). The overall cancer risk was elevated with 10,656 cases and an incidence of 1375 per 100,000 person-years (SIR, 2.10 95% CI, 2.06-2.14; EAR, 719.3 95% CI, 693.3-745.6 per 100,000 person-years). Risk was increased for 32 different malignancies, some related to known infections (eg, anal cancer, Kaposi sarcoma) and others unrelated (eg, melanoma, thyroid and lip cancers). The most common malignancies with elevated risk were non-Hodgkin lymphoma (n = 1504; incidence: 194.0 per 100,000 person-years; SIR, 7.54 95% CI, 7.17-7.93; EAR, 168.3 95% CI, 158.6-178.4 per 100,000 person-years) and cancers of the lung (n = 1344; incidence: 173.4 per 100,000 person-years; SIR, 1.97 95% CI, 1.86-2.08; EAR, 85.3 95% CI, 76.2-94.8 per 100,000 person-years), liver (n = 930; incidence: 120.0 per 100,000 person-years; SIR, 11.56 95% CI, 10.83-12.33; EAR, 109.6 95% CI, 102.0-117.6 per 100,000 person-years), and kidney (n = 752; incidence: 97.0 per 100,000 person-years; SIR, 4.65 95% CI, 4.32-4.99; EAR, 76.1 95% CI, 69.3-83.3 per 100,000 person-years). Lung cancer risk was most elevated in lung recipients (SIR, 6.13 95% CI, 5.18-7.21) but also increased among other recipients (kidney: SIR, 1.46 95% CI, 1.34-1.59; liver: SIR, 1.95 95% CI, 1.74-2.19; and heart: SIR, 2.67 95% CI, 2.40-2.95). Liver cancer risk was elevated only among liver recipients (SIR, 43.83 95% CI, 40.90-46.91), who manifested exceptional risk in the first 6 months (SIR, 508.97 95% CI, 474.16-545.66) and a 2-fold excess risk for 10 to 15 years thereafter (SIR, 2.22 95% CI, 1.57-3.04). Among kidney recipients, kidney cancer risk was elevated (SIR, 6.66 95% CI, 6.12-7.23) and bimodal in onset time. Kidney cancer risk also was increased in liver recipients (SIR, 1.80 95% CI, 1.40-2.29) and heart recipients (SIR, 2.90 95% CI, 2.32-3.59).
Compared with the general population, recipients of a kidney, liver, heart, or lung transplant have an increased risk for diverse infection-related and unrelated cancers.
Background Migrant farmworkers are at risk for heat-related illness (HRI) at work. Purpose The purpose of this study was to determine which risk factors could potentially reduce the prevalence of HRI ...symptoms among migrant farmworkers in Georgia. Methods Trained interviewers conducted in-person interviews of adults who attended the South Georgia Farmworker Health Project clinics in June 2011. The analysis was conducted in 2011–2012. Population intervention models were used to assess where the greatest potential impact could be made to reduce the prevalence of HRI symptoms. Results In total, 405 farmworkers participated. One third of participants had experienced three or more HRI symptoms in the preceding week. Migrant farmworkers faced barriers to preventing HRI at work, including lack of prevention training (77%) and no access to regular breaks (34%); shade (27%); or medical attention (26%). The models showed that the prevalence of three or more HRI symptoms ( n =361, 34.3%) potentially could be reduced by increasing breaks in the shade (−9.2%); increasing access to medical attention (−7.3%); reducing soda intake (−6.7%); or increasing access to regular breaks (−6.0%). Conclusions Migrant farmworkers experienced high levels of HRI symptoms and faced substantial barriers to preventing these symptoms. Although data are cross-sectional, results suggest that heat-related illness may be reduced through appropriate training of workers on HRI prevention, as well as regular breaks in shaded areas.
Abstract Objective The purpose of this study was to measure the extent to which geographic residency status and the social environment are associated with disease stage at diagnosis, receipt of ...treatment, and five-year survival for patients diagnosed with non-small cell lung cancer (NSCLC). Methods and materials This study was a retrospective cohort study of the Georgia Comprehensive Cancer Registry (GCCR) for incident cases of NSCLC diagnosed in the state. Multilevel logistic models were employed for five outcome variables: unstaged and late stage disease at diagnosis; receipt of treatment (surgery, chemotherapy, and radiation); and survival following diagnosis. The social and geographical variables of interest were census tract (CT) poverty level, CT-level educational attainment, and CT-level geographic residency status. Results Compared to urban residents, rural and suburban residents had increased odds of unstaged disease (suburban OR = 1.23, 95% CI: 1.11–1.37; rural OR = 1.63, 95% CI: 1.45–1.83). In this study, rural participants had lower odds of receiving radiotherapy (OR = 0.89, 95% CI: 0.82–0.96) and chemotherapy (OR = 0.92, 95% CI: 0.85–0.99). Living in CTs with lower educational levels was associated with decreasing odds of receiving both surgery (lowest educational level OR = 0.67, 95% CI: 0.59–0.75) and chemotherapy (lowest educational level OR = 0.74, 95% CI: 0.68–0.81). Living in areas with higher concentration of deprivation (high level of deprivation HR = 1.04, 95% CI: 1.01–1.09) and lower levels of education (lowest educational level HR = 1.12, 95% CI: 1.07–1.17) was associated with poorer survival. Rural residents did not show poorer survival when treatment was controlled and they even presented a lower risk of death for early stage disease (HR = 0.90, 95% CI: 0.82–0.99). Conclusion This study concludes that where NSCLC patients live can, to some extent, explain treatment and prognostic disparities. Public health practitioners and policy makers should be cognizant of the importance of where people live and shift their efforts to improve lung cancer outcomes in rural areas and neighborhoods with concentrated poverty.
Background
Cutaneous T‐cell lymphoma (CTCL) is a rare form of non‐Hodgkin lymphoma arising in the skin. Geographic clustering of CTCL has recently been reported, but its association with ...environmental factors is unknown. Benzene and trichloroethylene (TCE) are environmental toxins with carcinogenic properties. The authors investigated associations between geographic clustering of CTCL incidence in the state of Georgia with benzene and TCE exposure.
Methods
The statewide county‐level incidence of CTCL within Georgia was obtained from the Georgia Cancer Registry for the years 1999 to 2015. Standardized incidence ratios (SIRs) were calculated by dividing observed cases by expected cases using national incidence rates by age, sex, and race. Clustering of CTCL was analyzed using spatial analyses. County‐level concentrations of benzene and TCE between 1996 and 2014 were collected from the Environmental Protection Agency's National Air Toxics Assessment database. Linear regression analyses on CTCL incidence were performed comparing SIRs with levels of benzene and TCE by county.
Results
There was significant geographic clustering of CTCL in Georgia, particularly around Atlanta, which was correlated with an increased concentration of benzene and TCE exposure. Among the 4 most populous counties in Georgia, CTCL incidence was between 1.2 and 1.9 times higher than the state average, and benzene and TCE levels were between 2.9 and 8.8 times higher.
Conclusions
The current results demonstrate nonrandom geographic clustering of CTCL incidence in Georgia. To the authors' knowledge, this is the first analysis to identify a correlation between geographic clustering of CTCL and environmental toxic exposures.
Incidence data from the Georgia Cancer Registry and exposure data from the National Air Toxics Assessment database reveal associations between the risk of cutaneous T‐cell lymphoma and the presence of ambient benzene and trichloroethylene at the county level in the state of Georgia. To the authors' knowledge, this is the first analysis to identify a correlation between geographic clustering of cutaneous T‐cell lymphoma and environmental toxic exposures.
Binge drinking is a pattern of alcohol abuse. Its prevalence and associated risk factors are not well documented. Heavy drinking, on the other hand, has a well-documented association with ...bereavement. This report uses a cross-sectional, population-based survey to estimate prevalence of bingeing and its association with new bereavement. Bingeing is defined as 4 or more drinks (women) or 5 or more drinks (men) in a 2-4-h setting. For the first time in 2019, the Georgia Behavioral Risk Factor Surveillance Survey (BRFSS) included a bereavement item: 'Have you experienced the death of a family member or close friend in the years 2018 or 2019?'
Georgia BRFSS is a complex sampling survey administered annually. It is designed to represent the 8.1 million people aged 18 years and older in the U.S. state of Georgia. Alcohol consumption patterns are routinely measured in the common core. In 2019, the state added a new item probing for bereavement in the prior 24 months predating the COVID-19 pandemic. Imputation and weighting techniques were applied to yield the population prevalence rates of new bereavement, bingeing, and their co-occurrence with other high-risk health behaviors and outcomes. Multivariate models, adjusted for age, gender, and race, were used to estimate the risk for other unhealthy behaviors posed by the co-occurrence of bereavement and bingeing.
In Georgia, bereavement (45.8%), and alcohol consumption (48.8%) are common. Bereavement and alcohol use co-occurred among 1,796,817 people (45% of all drinkers) with a subset of 608,282 persons reporting bereavement combined with bingeing. The most common types of bereavement were death of a friend/neighbor (30.7%) or three plus deaths (31.8%).
While bingeing is a known risk to public health, its co-occurrence with recent bereavement is a new observation. Public health surveillance systems need to monitor this co-occurrence to protect both individual and societal health. In a time of global bereavement, documenting its influence on binge drinking can support the work towards Sustainable Development Goal #3-Good health and Well-Being.
The Behavioral Risk Factor Surveillance System (BRFSS) is an annual survey designed to identify trends in the public's health. In its 2019 field survey, the U.S. state of GA tested a new 3 - item ...module to measure the numbers of bereaved, resident adults aged 18 years and older. Participants were eligible if they answered 'Yes' to the item 'Have you experienced the death of a family member or close friend in the years 2018 or 2019?'. This analysis explores two research questions. Can estimates for bereavement prevalence be derived without large sampling errors, low precision, and small subsamples? Can multiple imputation techniques be applied to overcome non-response and missing data to support multivariate modeling?
BRFSS is a non-institutionalized sample of adults aged 18 years and older living in the U.S. state of Georgia. Analyses in this study were conducted under two scenarios. Scenario 1 applies the complex sample weights created by the Centers for Disease Control and imputes values for missing responses. Scenario 2 treats the data as a panel - no weighting combined with removal of persons with missing data. Scenario 1 reflects the use of BRFSS data for public health and policy, while Scenario 2 reflects data as it is commonly used in social science research studies.
The bereavement screening item has a response rate (RR) of 69.1% (5206 of 7534 persons). Demographic subgroups and categories of health have RR of 55% or more. Under Scenario 1, the estimated prevalence of bereavement is 45.38%, meaning that 3,739,120 adults reported bereaved in 2018 or 2019. The estimated prevalence is 46.02% with Scenario 2 which removes persons with any missing data (4,289 persons). Scenario 2 overestimates the bereavement prevalence by 1.39%. An illustrative logistic model is presented to show the performance of exposure to bereavement under the two data scenarios.
Recent bereavement can be ascertained in a surveillance survey accounting for biases in response. Estimating bereavement prevalence is needed for measuring population health. This survey is limited to one US state in a single year and excludes persons aged 17 years and younger.
The objective of this study was to evaluate racial cancer disparities in Georgia by calculating and comparing mortality-to-incidence ratios (MIRs) by health district and in relation to geographic ...factors.
Data sources included cancer incidence (Georgia Comprehensive Cancer Registry), cancer mortality (Georgia Vital Records), and health factor (County Health Rankings) data. Age-adjusted incidence and mortality rates were calculated by cancer site (all sites combined, lung, colorectal, prostate, breast, oral, and cervical) for 2003-2007. MIRs and 95% confidence intervals were calculated overall and by district for each cancer site, race, and sex. MIRs were mapped by district and compared with geographic health factors.
In total, 186,419 incident cases and 71,533 deaths were identified. Blacks had higher MIRs than whites for every cancer site evaluated, and especially large differentials were observed for prostate, cervical, and oral cancer in men. Large geographic disparities were detected, with larger MIRs, chiefly among blacks, in Georgia compared with national data. The highest MIRs were detected in west and east central Georgia, and the lowest MIRs were detected in and around Atlanta. Districts with better health behavior, clinical care, and social/economic factors had lower MIRs, especially among whites.
More fatal cancers, particularly prostate, cervical, and oral cancer in men were detected among blacks, especially in central Georgia, where health behavior and social/economic factors were worse. MIRs are an efficient indicator of survival and provide insight into racial cancer disparities. Additional examination of geographic determinants of cancer fatality in Georgia as indicated by MIRs is warranted.
Although US year 2000 guidelines recommended characterizing breast cancers by human epidermal growth factor receptor 2 (HER2), national cancer registries do not collect HER2, rendering a ...population-based understanding of HER2 and clinical "triple subtypes" (estrogen receptor ER / progesterone receptor PR / HER2) largely unknown. We document the population-based prevalence of HER2 testing / status, triple subtypes and present the first report of subtype incidence rates.
Medical records were searched for HER2 on 1842 metropolitan Atlanta females diagnosed with breast cancer during 2003-2004. HER2 testing/status and triple subtypes were analyzed by age, race/ethnicity, tumor factors, socioeconomic status, and treatment. Age-adjusted incidence rates were calculated.
Over 90% of cases received HER2 testing: 12.6% were positive, 71.7% negative, and 15.7% unknown. HER2 testing compliance was significantly better for women who were younger, of Caucasian or African-American descent, or diagnosed with early stage disease. Incidence rates (per 100,000) were 21.1 for HER2+ tumors and 27.8 for triple-negative tumors, the latter differing by race (36.3 and 19.4 for black and white women, respectively).
HER2 recommendations are not uniformly adhered to. Incidence rates for breast cancer triple subtypes differ by age/race. As biologic knowledge is translated into the clinical setting eg, HER2 as a biomarker, it will be incumbent upon national cancer registries to report this information. Incidence rates cautiously extrapolate to an annual burden of 3000 and 17,000 HER2+ tumors for black and white women, respectively, and triple-negative tumors among 5000 and 16,000 respectively. Testing, rate, and burden variations warrant population-based in-depth exploration and clinical translation.
The objective of our study was to evaluate vaccine type, COVID-19 infection, and their association with stroke soon after COVID-19 vaccination.
In a retrospective cohort study, we estimated the ...21-day post-vaccination incidence of stroke among the recipients of the first dose of a COVID-19 vaccine. We linked the Georgia Immunization Registry with the Georgia Coverdell Acute Stroke Registry and the Georgia State Electronic Notifiable Disease Surveillance System data to assess the relative risk of stroke by the vaccine type.
Approximately 5 million adult Georgians received at least one COVID-19 vaccine between 1 December 2020 and 28 February 2022: 54% received BNT162b2, 41% received mRNA-1273, and 5% received Ad26.COV2.S. Those with concurrent COVID-19 infection within 21 days post-vaccination had an increased risk of ischemic (OR = 8.00, 95% CI: 4.18, 15.31) and hemorrhagic stroke (OR = 5.23, 95% CI: 1.11, 24.64) with no evidence for interaction between the vaccine type and concurrent COVID-19 infection. The 21-day post-vaccination incidence of ischemic stroke was 8.14, 11.14, and 10.48 per 100,000 for BNT162b2, mRNA-1273, and Ad26.COV2.S recipients, respectively. After adjusting for age, race, gender, and COVID-19 infection status, there was a 57% higher risk (OR = 1.57, 95% CI: 1.02, 2.42) for ischemic stroke within 21 days of vaccination associated with the Ad26.COV2.S vaccine compared to BNT162b2; there was no difference in stroke risk between mRNA-1273 and BNT162b2.
Concurrent COVID-19 infection had the strongest association with early ischemic and hemorrhagic stroke after the first dose of COVID-19 vaccination. Although not all determinants of stroke, particularly comorbidities, were considered in this analysis, the Ad26.COV2.S vaccine was associated with a higher risk of early post-vaccination ischemic stroke than BNT162b2.
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