Search

Background: Despite improvements in melanoma mortality, disparities in melanoma survival persist. We evaluated possible sociodemographic and health care-based predictors of differences in melanoma survival in the United States by using the melanoma mortality-to-incidence ratio (MIR).Methods: State-based MIRs were calculated by using US cancer statistics data from 1999 to 2014. Pearson correlations and linear regressions were used to determine associations between MIR and dermatologist density, primary care provider density, number of physicians by state, number of National Cancer Institute-designated cancer centers, health care spending per capita, average household income, racial/ethnic makeup of the population, percentage of uninsured individuals, and percentage with a bachelor's degree.Results: The mean overall MIR was 0.15 ± 0.04; only Alaska was an outlier (0.24). No state MIRs increased significantly over time; MIR decreased for most states. Multivariable analysis revealed that states with more active physicians (P = .02) and a higher percentage non-Hispanic whites (P = .004) had higher MIRs (poorer survival). Significant Pearson correlations were seen between MIR and melanoma incidence (r = -0.72, P < .001), melanoma mortality (r = 0.38, P < .001), dermatologist density (r = 0.32, P < .001), and National Cancer Institute-designated cancer center count (r = -0.12, P = .001).Conclusions: Melanoma survival is improved in higher-incidence areas and areas with higher dermatologist density. These findings highlight areas of poorer melanoma survival and the need for local studies evaluating disparities in melanoma survival. [ABSTRACT FROM AUTHOR]

Background Survival data are mixed comparing patients with multiple primary melanomas (MPM) to those with single primary melanomas (SPM). Objectives We compared MPM versus SPM patient survival using a matching method that avoids potential biases associated with other analytic approaches. Methods Records of 14,138 individuals obtained from the Surveillance, Epidemiology, and End Results registry of all melanomas diagnosed or treated in Utah between 1973 and 2011 were reviewed. A single matched control patient was selected randomly from the SPM cohort for each MPM patient, with the restriction that they survived at least as long as the interval between the first and second diagnoses for the matched MPM patient. Results Survival curves (n = 887 for both MPM and SPM groups) without covariates showed a significant survival disadvantage for MPM patients (chi-squared 39.29, P < .001). However, a multivariate Cox proportional hazards model showed no significant survival difference (hazard ratio 1.07, P = .55). Restricting the multivariate analysis to invasive melanomas also showed no significant survival difference (hazard ratio 0.99, P = .96). Limitations Breslow depth, ulceration status, and specific cause of death were not available for all patients. Conclusions Patients with MPM had similar survival times as patients with SPM. [ABSTRACT FROM AUTHOR]

Purpose: Socioeconomic status (SES) as a risk factor for mortality in type 1 diabetes (T1D) has not been adequately studied prospectively. Methods: Complete clinical and SES (income, education, occupation) data were available for 317 T1D participants in the Pittsburgh Epidemiology of Diabetes Complications Study within 4 years of age 28 (chosen to maximize income, education, and occupational potential, and to minimize the SES effect of advanced diabetes complications). Vital status was determined as of 1/1/2008. Results: Over a median 16 years of follow-up, 34 (10.7%) deaths occurred (standardized mortality ratios [SMRs] = 4.1, 95% confidence interval [CI]: 2.7–5.5). SMRs did not differ from the general population for those in the highest education and income groups, whereas in those with low SES, SMRs were increased. Mortality rates were three times lower for individuals with a college degree versus without a college degree (p = 0.004) and nearly four times lower for the highest income versus lower income groups (p = 0.04). In Cox models adjusting for diabetes duration and sex, education was the only SES measure predictive of mortality (hazard ratio [HR] = 3.0, 95% CI: 1.2–7.8), but lost significance after adjusting for HbA1c, non-HDL cholesterol, hypertension, and microalbuminuria (HR = 2.1, 95% CI: 0.8–5.6). Conclusions: The strong association of education with mortality in T1D is partially mediated by better glycemic, lipid, and blood pressure control. [ABSTRACT FROM AUTHOR]

Purpose: To understand the effect of socioeconomic status (SES) on the risk of complications in type 1 diabetes (T1D), we explored the relationship between SES and major diabetes complications in a prospective, observational T1D cohort study. Methods: Complete data were available for 317 T1D persons within 4 years of age 28 (ages 24−32) in the Pittsburgh Epidemiology of Diabetes Complications Study. Age 28 was selected to maximize income, education, and occupation potential and to minimize the effect of advanced diabetes complications on SES. Results: The incidences over 1 to 20 years’ follow-up of end-stage renal disease and coronary artery disease were two to three times greater for T1D individuals without, compared with those with a college degree (p < .05 for both), whereas the incidence of autonomic neuropathy was significantly greater for low-income and/or nonprofessional participants (p < .05 for both). HbA1c was inversely associated only with income level. In sex- and diabetes duration-adjusted Cox models, lower education predicted end-stage renal disease (hazard ratio [HR], 2.9; 95% confidence interval [95% CI], 1.1−7.7) and coronary artery disease (HR, 2.5, 95% CI, 1.3−4.9), whereas lower income predicted autonomic neuropathy (HR, 1.7; 95% CI, 1.0−2.9) and lower-extremity arterial disease (HR, 3.7; 95% CI, 1.1−11.9). Conclusions: These associations, partially mediated by clinical risk factors, suggest that lower SES T1D individuals may have poorer self-management and, thus, greater complications from diabetes. [ABSTRACT FROM AUTHOR]

Abstract: Objective: Type 1 diabetes (T1D) is associated with a high risk for and mortality from premature coronary artery disease (CAD), including coronary artery calcification (CAC), a subclinical marker, and lower extremity arterial disease (LEAD). Pulse wave analysis (PWA) arterial stiffness indices have been associated with cardiovascular disease (CVD) risk factors and outcomes in various populations, but little is known regarding these relationships in T1D. Methods: PWA was performed using the SphygmoCor Px device on 144 participants in the Pittsburgh EDC Study of childhood-onset T1D. The cross-sectional associations between arterial stiffness indices, augmentation index (AIx) and augmentation pressure (AP), and subendocardial viability ratio (SEVR), an estimate of myocardial perfusion, with prevalent CAD, electron beam computed tomography-measured CAC and low (<0.90) ankle–brachial index (ABI) were examined. Results: Higher AP (but not AIx) and lower SEVR were univariately associated with prevalent CAD, high CAC score, and low ABI. AP and SEVR''s association with CAD and CAC did not, however, remain significant after adjustment for age. In individuals not using nitrates, which profoundly affect PWA measures, AP was significantly higher in those with CAD events and explained more of the variance than either age or brachial blood pressure measures. SEVR was associated with low ABI in multivariable models. Conclusions: Greater augmentation pressure is independently associated with prevalent CAD and estimated myocardial perfusion with low ABI in type 1 diabetes. These measures may thus help to better characterize CVD risk in type 1 diabetes and need to be examined prospectively. [Copyright &y& Elsevier]

Abstract: Aims: Evidence suggests that the degree of gluteal-femoral adiposity may be inversely associated with coronary artery disease (CAD) risk; however, this association has not been evaluated in type 1 diabetes (T1D). Methods: The relationship between regional adiposity, cardiovascular risk factors, and presence of CAD was examined in participants from the Pittsburgh Epidemiology of Diabetes Complications (EDC) study using data collected from the 18-year exam (n =163). Total and regional adiposity was assessed by dual X-ray absorptiometry (DEXA). Results: Participants with CAD exhibited lower % leg fat mass (FM) (33.42 vs. 36.96, p =0.006) and higher % trunk FM (48.33 vs. 45.18, p =0.02), respectively, after adjusting for age, sex, height, and total adiposity compared to those without CAD. Multivariate logistic regression analyses revealed that in females, every 1 SD increase in % leg FM was associated with an approximate 60% reduction in CAD risk (OR=0.40, 95% CI 0.16–0.99). Higher % trunk FM was also associated with greater risk of CAD prevalence in females (OR=2.79, 95% CI 1.08–7.20 per SD change). These associations were not observed in males. Conclusions: This is novel evidence that DEXA-assessed lower body adiposity is inversely associated with CAD in T1D, however, this association seems to only exist in females. [ABSTRACT FROM AUTHOR]

Abstract: Objective: Type 1 diabetes remains a significant source of premature mortality; however, its burden has not been assessed in the U.S. Virgin Islands (USVI). As such, the objective of this study was to estimate type 1 diabetes mortality in a population-based registry sample in the USVI. Research design and methods: We report overall and 20-year mortality in the USVI Childhood (<19 years old) Diabetes Registry Cohort diagnosed 1979–2005. Recent data for non-Hispanic blacks from the Allegheny County, PA population-based type 1 diabetes registry were used to compare mortality in the USVI to the contiguous U.S. Results: As of December 31, 2010, the vital status of 94 of 103 total cases was confirmed (91.3%) with mean diabetes duration 16.8±7.0 years. No deaths were observed in the 2000–2005 cohort. The overall mortality rates for those diagnosed 1979–1989 and 1990–1999 were 1852 and 782 per 100,000 person-years, respectively. Overall cumulative survival for USVI was 98% (95% CI: 97–99) at 10 years, 92% (95% CI: 89–95) at 15 years and 73% (95% CI: 66–80) at 20 years. The overall SMR for non-Hispanic blacks in the USVI was 5.8 (95% CI: 2.7–8.8). Overall mortality and cumulative survival for non-Hispanic blacks did not differ between the USVI and Allegheny County, PA. Conclusions: This study, as the first type 1 diabetes mortality follow-up in the USVI, confirmed previous findings of poor disease outcomes in racial/ethnic minorities with type 1 diabetes. [Copyright &y& Elsevier]