The aim of the study was to develop and validate an updated morbidity index for short-term mortality risk, using chronic conditions identified from routine hospital admission ICD-10 data.
...Retrospective cohort study of all adult New Zealand (NZ) residents at January 1, 2012. Adult NZ residents aged 18 years and over, defined by enrollment with a Primary Healthcare Organisation or accessing public health care in preceding year. Data were split into two data sets for index development (70%, n = 2,331,645) and validation (30%, n = 1,000,166).
The M3 index was constructed using log hazard ratios for 1-year mortality modeled from presence of 61 chronic conditions. Validation results were improved for the M3 index for predicting 1-year mortality compared to Charlson and Elixhauser on the c-statistic (M3: 0.931, Charlson: 0.921, Elixhauser: 0.922; difference M3 vs. Charlson = 0.010, 95% confidence interval CI: 0.008, 0.012; M3 vs. Elixhauser = 0.009, 95% CI: 0.007, 0.012) and integrated discriminative improvement (M3 vs. Charlson = 0.024, 95% CI: 0.021, 0.026; M3 vs. Elixhauser = 0.024, 95% CI: 0.022, 0.027).
The M3 index had improved predictive performance for 1-year mortality risk over Charlson and Elixhauser indices, allowing better adjustment for mortality risk from chronic conditions. This provides an important tool for population-level analyses of health outcomes.
Population ageing has substantially contributed to the rising number of new cancer cases worldwide. We document cancer incidence patterns in 2012 among older adults globally, and examine the changing ...magnitude of cancer in this age group over the next decades. Using GLOBOCAN 2012 data, we presented the number and proportion of new cancer cases, and the truncated age‐standardised incidence rates among adults aged 65 years and older for all cancer sites combined and for the five most common cancer sites by world region. We calculated the incidence in 2035 by applying population projections, assuming no changes in rates. In 2012, 6.7 million new cancer cases (47.5% of all cancers) were diagnosed among older adults worldwide, with marked regional disparities. Nearly 48% of these cases occurred in less developed regions. Lung, colorectal, prostate, stomach and breast cancers represented 55% of the global incidence, yet distinct regional patterns were observed. We predict 14 million new cancer cases by 2035, representing almost 60% of the global cancer incidence. The largest relative increase in incidence is predicted in the Middle East and Northern Africa (+157%), and in China (+155%). Less developed regions will see an increase of new cases by 144%, compared to 54% in more developed regions. The expected increase in cancer incidence at older ages will have substantial economic and social impacts globally, posing considerable and unique challenge to healthcare systems in every world region, especially in those with limited resources and weaker health systems.
What's new?
Population aging has substantially contributed to the rising cancer incidence worldwide. However, an in‐depth global description of the burden of cancer at older ages is long overdue. This study examined the cancer burden in adults aged 65+ according to cancer sites and world regions. In 2012, 7 million new cancer diagnoses occurred among adults aged 65+, almost 50% of them in less developed regions. By 2035, older adults will represent about 60% of all newly diagnosed cases. The growing cancer burden among older adults will result in major societal and economic challenges for the provision of care and health services.
Using GLOBOCAN estimates, we describe the estimated cancer incidence among adults aged 80 years or older at the regional and global level in 2018, reporting the number of new cancer cases, and the ...truncated age‐standardised incidence rates (per 100 000) for all cancer sites combined for this age group. We also presented the five most frequent cancers diagnosed by region and globally among females and males aged 65 to 79 years old and 80 years or older. We, finally, estimated the number of new cancer cases in 2050, the proportion of cases aged 80 years or older, and the proportional increase between 2018 and 2050 by region, by applying population projections to the 2018 incidence rates. In 2018, an estimated 2.3 million new cancer cases (excluding nonmelanoma skin cancers) were aged 80 years or older worldwide (13% of all cancer cases), with large variation in the profiles at regional levels. Globally, breast, lung and colon were the most common cancer sites diagnosed in the oldest females, while prostate, lung and colon were most frequent in the oldest males. In 2050, an estimated 6.9 million new cancers will be diagnosed in adults aged 80 years or older worldwide (20.5% of all cancer cases). Due to the complexity of cancer management in the oldest patients, the expected increase will challenge healthcare systems worldwide, posing a tangible economic and social impact on families and society. It is time to consider the oldest population in cancer control policies.
What's new?
The global population of aging persons is expected to increase significantly over the coming decades. To prepare for the forthcoming challenges in cancer care, more information is needed on cancer burden among the world's oldest patients. Here, assessment of global cancer burden in adults in 2018 shows that 2.3 million new cases occurred in persons aged 80 or older that year, accounting for 13 percent of all cases worldwide. Projections suggest that by 2050, 7 million new cancer cases will affect this age group. The findings predict substantial challenges for healthcare and highlight the need for aging‐specific cancer control initiatives.
Abstract Objective To explore the reasons for worse cancer survival in people with experience of mental illness, including differences by cancer type and psychiatric diagnosis. Method New Zealand ...breast and colorectal cancer registrations (2006–2010) were linked to psychiatric hospitalization records for adults (18–64 years). Cancer-specific survival was compared for recent psychiatric service users and nonusers using Cox regression. The contributions of deprivation, comorbidity and stage at diagnosis were assessed for those with schizophrenia or bipolar affective disorder (Group A) and others using mental health services (Group B). Results Of 8762 and 4022 people with breast and colorectal cancer respectively, 440 (breast) and 190 (colorectal) had recent contact with psychiatric services. After adjusting for confounding, risk of death from breast cancer was increased for Group A Hazard Ratio (HR) 2.55 (95% confidence interval 1.49–4.35) and B HR 1.62 (1.09–2.39) and from colorectal cancer for Group A HR 2.92 (1.75–4.87). Later stage at diagnosis contributed to survival differences for Group A, and comorbidity contributed for both groups. Fully adjusted HR estimates were breast: Group A 1.65 (0.96–2.84), B 1.41 (0.95–2.09); colorectal: Group A 1.89 (1.12–3.17), B 1.25 (0.89–1.75). Conclusions The high burden of physical disease and delayed cancer diagnosis in those with psychotic disorders contributes to worse cancer survival in New Zealand psychiatric service users.
The presence of comorbidity affects the care of cancer patients, many of whom are living with multiple comorbidities. The prevalence of cancer comorbidity, beyond summary metrics, is not well known. ...This study aims to estimate the prevalence of comorbid conditions among cancer patients in England, and describe the association between cancer comorbidity and socio-economic position, using population-based electronic health records.
We linked England cancer registry records of patients diagnosed with cancer of the colon, rectum, lung or Hodgkin lymphoma between 2009 and 2013, with hospital admissions records. A comorbidity was any one of fourteen specific conditions, diagnosed during hospital admission up to 6 years prior to cancer diagnosis. We calculated the crude and age-sex adjusted prevalence of each condition, the frequency of multiple comorbidity combinations, and used logistic regression and multinomial logistic regression to estimate the adjusted odds of having each condition and the probability of having each condition as a single or one of multiple comorbidities, respectively, by cancer type.
Comorbidity was most prevalent in patients with lung cancer and least prevalent in Hodgkin lymphoma patients. Up to two-thirds of patients within each of the four cancer patient cohorts we studied had at least one comorbidity, and around half of the comorbid patients had multiple comorbidities. Our study highlighted common comorbid conditions among the cancer patient cohorts. In all four cohorts, the odds of having a comorbidity and the probability of multiple comorbidity were consistently highest in the most deprived cancer patients.
Cancer healthcare guidelines may need to consider prominent comorbid conditions, particularly to benefit the prognosis of the most deprived patients who carry the greater burden of comorbidity. Insight into patterns of cancer comorbidity may inform further research into the influence of specific comorbidities on socio-economic inequalities in receipt of cancer treatment and in short-term mortality.
Incidence rates of testicular cancer (TC) have been increasing in many countries since, at least, the mid-20th century without clear explanation. Examining the varying trends across countries and ...time provides clues to understanding the causes of TC.
We have presented incidence data from 41 countries and evaluated incidence trends for the 35-yr period from 1978 to 2012.
Cancer registry data from Cancer Incidence in Five Continents (CI5) volumes V–XI, CI5plus, and the NORDCAN database were analysed.
Age-standardised rates of TC overall and by histological type were calculated. A joinpoint regression model of the natural log-transformed rates was used to calculate the average annual percent change (AAPC) in incidence. Age-period-cohort modelling was used to examine the effect of birth cohort on rates.
While the highest incidence of TC remains in Northern Europe, the gap is closing between higher- and lower-incidence regions. Age-period-cohort modelling found flattening of risk among recent cohorts in Denmark and the UK, a steady increase in risk in the USA (particularly for seminomas), and an increase in risk among more recent cohorts in Costa Rica, Croatia, and Slovakia.
The gap between low- and high-incidence countries is closing due to increases in the former and stabilisation in the latter. Understanding the causes of these and other differences in incidence rates between, and within, countries may help further our understanding of the aetiology of this cancer.
We examined the rates of testicular cancer in different countries over time. These rates have been increasing, although the rates in high-incidence countries seem to be slowing down, while rates in low-incidence countries are catching up. These trends might help us understand what is causing testicular cancer in general.
Rates of testicular cancer are stabilising in high-incidence countries, but rapidly increasing in low-incidence countries. Understanding why this gap is closing, and why differences in rates exist between and within countries, could further our understanding of what causes this cancer.
In New Zealand, there are known disparities between the Indigenous Māori and the majority non-Indigenous European populations in access to cancer treatment, with resulting disparities in cancer ...survival. There is international evidence of ethnic disparities in the distance travelled to access cancer treatment; and as such, the aim of this paper was to examine the distance and time travelled to access surgical care between Māori and European liver and stomach cancer patients. We used national-level data and Geographic Information Systems (GIS) analysis to describe the distance travelled by patients to receive their first primary surgery for liver or stomach cancer, as well as the estimated time to travel this distance by road, and the surgical volume of hospitals performing these procedures. All cases of liver (ICD-10-AM 3rd edition code: C22) and stomach (C16) cancer that occurred in New Zealand (2007–2019) were drawn from the New Zealand Cancer Registry (liver cancer: 866 Māori, 2,460 European; stomach cancer: 953 Māori, 3,192 European), and linked to national inpatient hospitalisation records to examine access to surgery. We found that Māori on average travel 120km for liver cancer surgery, compared to around 60km for Europeans, while a substantial minority of both Māori and European liver cancer patients must travel more than 200km for their first primary liver surgery, and this situation appears worse for Māori (36% vs 29%; adj. OR 1.48, 95% CI 1.09–2.01). No such disparities were observed for stomach cancer. This contrast between cancers is likely driven by the centralisation of liver cancer surgery relative to stomach cancer. In order to support Māori to access liver cancer care, we recommend that additional support is provided to Māori patients (including prospective financial support), and that efforts are made to remotely provide those clinical services that can be decentralised.
Abstract Objective This article reviews methods used to measure comorbidity in the context of cancer; summarizing methods, identifying contexts in which they have been used, and assessing the ...validity, reliability, and feasibility of each approach. Study Design and Setting Studies describing methods to measure comorbidity in epidemiological studies related to cancer were identified. Data relating to content, face, and criterion validity, reliability, and feasibility were collected. Results Two thousand nine hundred seventy-five abstracts were reviewed and 21 separate approaches identified. Content and face validity varied but tended to be higher for measures developed for cancer populations. Some evidence supporting criterion validity of all approaches was found. Where reported, reliability tended to be moderate to high. Some approaches tended to score well on all aspects but were resource intensive in terms of data collection. Eight indices scored at least moderately well on all criteria, three of which demonstrated usefulness in relation to non-site specific cancer (Charlson Comorbidity Index, Elixhauser approach, and National Cancer Institute Combined Index). Conclusions No gold standard approach to measuring comorbidity in the context of cancer exists. Approaches vary in their strengths and weaknesses, with the choice of measure depending on the study question, population studied, and data available.
Despite the rising risk factor exposure and non-communicable disease (NCD) mortality across the Middle East and the North African (MENA) region, public health policy responses have been slow and ...appear discordant with the social, economic and political circumstances in each country. Good health policy and outcomes are intimately linked to a research-active culture, particularly in NCD. In this study we present the results of a comprehensive analysis of NCD research with particular a focus on cancer, diabetes and cardiovascular disease in 10 key countries that represent a spectrum across MENA between 1991 and 2018.
The study uses a well validated bibliometric approach to undertake a quantitative analysis of research output in the ten leading countries in biomedical research in the MENA region on the basis of articles and reviews in the Web of Science database. We used filters for each of the three NCDs and biomedical research to identify relevant papers in the WoS. The countries selected for the analyses were based on the volume of research outputs during the period of analysis and stability, included Egypt, Iran, Jordan, Kuwait, Lebanon, Oman, Qatar, Saudi Arabia, Turkey and the United Arab Emirates.
A total of 495,108 biomedical papers were found in 12,341 journals for the ten MENA countries (here we consider Turkey in the context of MENA). For all three NCDs, Turkey's output is consistently the highest. Iran has had considerable growth in research output to occupy second place across all three NCDs. It appears that, relative to their wealth (measured by GDP), some MENA countries, particularly Oman, Qatar, Kuwait and the United Arab Emirates, are substantially under-investing in biomedical research. In terms of investment on particular NCDs, we note the relatively greater commitment on cancer research compared with diabetes or cardiovascular disease in most MENA countries, despite cardiovascular disease causing the greatest health-related burden. When considering the citation impact of research outputs, there have been marked rises in citation scores in Qatar, Lebanon, United Arab Emirates and Oman. However, Turkey, which has the largest biomedical research output in the Middle East has the lowest citation scores overall. The level of intra-regional collaboration in NCD research is highly variable. Saudi Arabia and Egypt are the dominant research collaborators across the MENA region. However, Turkey and Iran, which are amongst the leading research-active countries in the area, show little evidence of collaboration. With respect to international collaboration, the United States and United Kingdom are the dominant research partners across the region followed by Germany and France.
The increase in research activity in NCDs across the MENA region countries during the time period of analysis may signal both an increasing focus on NCDs which reflects general global trends, and greater investment in research in some countries. However, there are several risks to the sustainability of these improvements that have been identified in particular countries within the region. For example, a lack of suitably trained researchers, low political commitment and poor financial support, and minimal international collaboration which is essential for wider global impact.
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