Centre for Clinical Epidemiology and Community Studies, Lady Davis Institute for Medical Research, Jewish General Hospital, McGill University, 3755 Ch. Coˆ te Ste-Catherine, Montre´ al, Quebec, Canada H3T 1E2.
Previous injury is believed to be a causal risk factor for subsequent injury. Using empirical data on circus artists (n = 1,281 artists) between 2004 and 2008 in Montreal, Canada, as a motivating example, the authors use patient vector plots to demonstrate that a bias away from the null must always occur in the typical analyses cited as evidence (i.e., survival analysis, Poisson regression), except in the improbable context where all subjects have the same inherent risk independent of previous injury. In addition, using simulated data, the authors demonstrate that a simple method that conditions on the individual will approximate conclusions from more complex analytical methods. By using the typical analysis of the authors' empirical data, Kaplan-Meier curves and Cox regression suggested increasing injury rates for both the second and third injuries compared with the first injury. However, conditional analyses using a matched population (i.e., time to first, second, and third injuries among artists with 3 or more injuries) showed that injury rates were unchanged for both the second and third injuries compared with the first injury. These results suggest that previous injury should not be evaluated as a causal risk factor unless one conditions on the individual in some way.
The incidence of malignant mesothelioma (MM) in Denmark has been rising rapidly since the 1950s. The aim of this study was to determine temporal developments of MM incidence and survival in Denmark as a whole and in the individual regions.
Data from the Danish Cancer Registry were used. Cases of MM of the pleura, peritoneum and pericardium occurring in the 1943-2009 period were included. National and regional incidence rates were calculated, age-standardised and stratified by various variables. Survival was calculated using Kaplan Meier plot.
The total national incidence of MM for men has been rising throughout the period and reached its maximum of 1.76 in 2008-2009. For women, the incidence rate has remained relatively steady, with a maximum of 0.5 in 1973-1977. Since the late 1980s, the Region of Northern Jutland has had the highest male incidence rate. The difference in relative risk for men in the Region of Southern Denmark and the Region of Northern Jutland was 1.53 in 2008-2009, and the relative risk of developing MM in the Region of Northern Jutland for the entire period collectively compared with Denmark as a whole was 1.38. No notable regional difference exists for women. Survival has improved for both men and women, but remains poor with a median survival of 12.5 months for men and 13.3 months for women in 2008-2009.
The national MM incidence for men continues to increase, perhaps showing a slight tendency towards deceleration in the most recent decade. A clear long-term effect of the Danish asbestos ban has not yet occurred.
Few studies have assessed the influence of the organization of stroke care on long-term survival.
To compare survival over 12 years after stroke between subjects treated in an acute stroke unit (SU) and those treated in general medical wards (GMW).
In total, 550 subjects =60 years of age with acute stroke were prospectively allocated according to date of birth (day of the month) to treatment in a SU with relatively short length of stay or GMWs. We assessed survival through a link to the register of Statistics Norway. Groups were compared using Kaplan-Meier analysis on an intention-to-treat basis.
Of the 550 eligible subjects, 271 were allocated to a SU and 279 to GMWs. There still was no difference in mortality over 12 years between the groups (P = 0.15, log-rank test)
An acute SU offering early treatment and rehabilitation did not offer better long-term mortality after stroke in patients =60 years old than initial treatment in GMWs.
The aim of this study was to identify the clinical factors and tumour characteristics that predict the outcome in patients older than 80 years with colorectal cancer.
One hundred and four patients with colorectal cancer aged over 80 years were identified from a computer database, and their clinical variables were analysed by both univariate and multivariate analyses.
All 104 patients underwent resective surgery, 87% radical and 13% palliative resection. Postoperative mortality was 5%, being associated with a number of coexisting diseases and the presence of postoperative complications, especially anastomotic leakage. The cumulative 5-year survival was 33%, the median survival was 31 months and the cancer-specific 5-year survival was 36%. The recurrence rate after radical surgery was 30%, being 13%, 25%, 44% and 100% in the Union for International Cancer Control stages I, II, III and IV. Kaplan-Meier estimates indicated that age, number of underlying diseases, radicality of operation, Dukes' staging, size of tumour, number of lymph node metastasis, metastasised disease, venous invasion and recurrent disease were significant predictors of survival, but in the Cox regression model, only venous invasion was an independent prognostic factor of survival.
Low mortality and acceptable survival can be achieved even in very elderly patients with colorectal cancer. Venous invasion is an independent predictor of survival.
Suicidal ideation is likely to represent a phase preceding suicidal acts among most suicidal patients with major depressive disorder (MDD). Factors predicting reversal of the suicidal process are unknown. Our aim was to test the hypothesis that a decline in suicidal ideation is preceded by a decline in hopelessness among patients with MDD.
Of the 269 Vantaa Depression Study patients with DSM-IV MDD, 103 patients scored > or = 6 points at baseline on the Scale for Suicidal Ideation (SSI). Seventy of these patients were followed-up weekly either until they scored zero points on the SSI, or up to 26 weeks.
The median duration for a decline of suicidal ideation to zero was 2.2 months after baseline. The level of baseline suicidal ideation, depressive symptoms, and the presence of any personality disorder predicted duration of suicidal ideation. A decline in both depression (BDI) and hopelessness (HS) independently predicted a decline in suicidal ideation.
Due to study design, we do not know if suicidal ideation relapsed after the first time the patient reached zero score in the SSI.
Among patients with major depressive disorder having suicidal ideation, the decline in suicidal ideation is independently predicted by preceding declines in the levels of both depressive symptoms as well as hopelessness. The findings are consistent with possible causal roles of declines in depression and hopelessness in reversing the suicidal process.
This study compared survival rates and causes of death after stroke in diabetic and non-diabetic patients in Sweden. We hypothesised that differences in cardiovascular risk factors, acute stroke management or socioeconomic status (SES) could explain the higher risk of death after stroke in diabetic patients.
The study included 155,806 first-ever stroke patients from the Swedish Stroke Register between 2001 and 2009. Individual patient information on SES was retrieved from Statistics Sweden. Survival was followed until 2010 (532,140 person-years) with a median follow-up time of 35 months. Multiple Cox regression was used to analyse survival adjusting for differences in background characteristics, in-hospital treatment, SES and year of stroke. Causes of death were analysed using cause-specific proportional hazard models.
The risk of death after stroke increased in diabetic patients (HR 1.28, 95% CI 1.25, 1.31), and this risk was greater in younger patients and in women. Differences in background characteristics, cardiovascular risk factors, in-hospital treatment and SES did not explain the increased risk of death after stroke (HR 1.35, 95% CI 1.32, 1.37) after adjustments. Diabetic patients had an increased probability of dying from cerebrovascular disease and even higher probabilities of dying from other circulatory causes and all other causes except cancer.
Differences in cardiovascular risk factors, acute stroke management and SES do not explain the lower survival after stroke in diabetic compared with non-diabetic patients. Diabetic patients are at higher risk of dying from cardiovascular causes and all other causes of death, other than cancer.
Allograft failure secondary to recurrence of hepatitis C virus (HCV) infection is the most common cause of death and retransplantation among recipients with HCV infection. It has been suggested that patients transplanted for HCV have had worse outcomes in more recent years than in previous years (the 'era effect'). A Canadian transplantation registry database was analyzed to determine the outcomes of patients transplanted over the years for HCV. The results of the present analysis of 1002 patients show that the 'era effect' was not seen in liver transplantation recipients with HCV in Canada, because no survival difference was noted based on the year of transplantation. All groups had overall two-year and five-year survival rates of 76% to 83% and 69% to 72%, respectively. The present study's national results prove continued benefit to transplantation of HCV patients.
The aim of this study was to analyse relative survival, excess mortality and gain in life expectancy in men who underwent radical prostatectomy (RP) for localized prostate cancer (PCa) between 1995 and 2011 in Denmark.
The study population comprised the complete cohort of 6489 men who underwent RP between 1995 and 2011. Risk of mortality was calculated using a competing risk model. Relative survival, excess mortality rate (EMR) and gain in life expectancy in men undergoing RP were calculated using a matched cohort Danish population based on date of birth and date of surgery.
During follow-up 328 patients died, 109 (33.2%) of PCa and 219 (66.8%) of other causes. The cumulative incidence of PCa mortality was 5.8% [95% confidence interval (CI) 4.4, 7.2] after 10 years. Relative survival was significantly above 1.0 for RP patients, except for high-risk patients. EMR was -9.34 (95% CI -10.56, -8.13) after 10 years, i.e. nine men would die in excess of the general population. Overall, the gain in life expectancy in men undergoing RP compared with the general population was 0.41 years.
This population-based study demonstrated that the gain in life expectancy with RP compared with the general population in Denmark is minimal.
BACKGROUND AND PURPOSE: To examine the relative risk (RR) for living in nursing homes for patients with Parkinson's disease (PD) compared with the general population and to ascertain society's costs related to nursing home placement for this patient group. METHODS: We evaluated the frequency of admission to nursing homes in a cross-sectional study and during a 12-year follow-up study of 108 patients with PD and 864 controls who were matched for age and sex. The RR for living in a nursing home was calculated at baseline and during follow-up. On the basis of 2007 prices, we estimated the costs per person year of survival for patients with PD and controls. RESULTS: The RR for living in a nursing home at baseline was 5.0 for patients with PD and 4.8 during follow-up. Patients with PD caused 4.8 times higher costs for nursing home placement with euro 18 875 versus euro 3978 per individual and year. The annual costs for institutional care of patients with PD in Norway were euro 132 million. CONCLUSION: Patients with PD have a substantially higher risk for living in nursing homes than the general population. This causes high costs to society. Therapeutic interventions to prevent or delay nursing home admissions are therefore important.
With high short-term mortality and substantial excess morbidity among survivors, tuberculous meningitis (TBM) is the most severe manifestation of extra-pulmonary tuberculosis (TB). The objective of this study was to assess the long-term mortality and causes of death in a TBM patient population compared to the background population.
A nationwide cohort study was conducted enrolling patients notified with TBM in Denmark from 1972-2008 and alive one year after TBM diagnosis. Data was extracted from national registries. From the background population we identified a control cohort of individuals matched on gender and date of birth. Kaplan-Meier survival curves and Cox regression analysis were used to estimate mortality rate ratios (MRR) and analyse causes of death.
A total of 55 TBM patients and 550 individuals from the background population were included in the study. Eighteen patients (32.7%) and 107 population controls (19.5%) died during the observation period. The overall MRR was 1.79 (95%CI: 1.09-2.95) for TBM patients compared to the population control cohort. TBM patients in the age group 31-60 years at time of diagnosis had the highest relative risk of death (MRR 2.68; 95%CI 1.34-5.34). The TBM patients had a higher risk of death due to infectious disease, but not from other causes of death.
Adult TBM patients have an almost two-fold increased long-term mortality and the excess mortality stems from infectious disease related causes of death.
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