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Summary: Background: It is generally recognized that there is unequal mortality in childhood central nervous system (CNS) malignancy in the United States (US), but little is known about the trends and contributors of racial/ethnic disparities in death. We assessed the trends of racial/ethnic disparities in all-cause and cause-specific death, and the contributions of tumour, treatment and socioeconomic factors to this disparity. Methods: This registry-based cohort study included children (aged ≤19 years) diagnosed with malignant CNS tumours, using data from the US population-based cancer registry in the Surveillance, Epidemiology, and End Results (SEER) Program. The clinical outcomes were all-cause and cause-specific death for each racial/ethnic group (White, Black, Hispanic, non-Hispanic Asian/Pacific Islander [API], and non-Hispanic American Indian/Alaska Native [AI/AN] children). We quantified absolute disparities using absolute rate difference in 5-year cumulative incidence of death. Cox proportion risk models were used to estimate the relative racial/ethnic disparities, and the contribution of factors to disparities in death. Findings: In this study, data from 14,510 children with malignant CNS tumours (mean [SD] age, 8.5 [5.7]; 7988 [55.1%] male) were analysed. Overall, the cumulative incidence of death from CNS tumours across four racial/ethnic groups decreased from 2001 to 2020. Black patients had the highest risk of death from all causes and CNS tumours between 2001 and 2020, with adjusted hazard ratios (HR) of 1.52 (1.38–1.68) and 1.47 (1.31–1.64), respectively. The absolute disparity in all-cause death between Hispanic and White patients increased slightly (from 8.2 percentage points [ppt] to 9.4 ppt), and the relative disparity in death from CNS tumours increased from 1.33 (1.15–1.55) in 2001–2005 to 1.78 (1.44–2.20) in 2016–2020. The absolute disparities in death from CNS tumours between Black and White patients (from 11.8 ppt to 4.3 ppt) and between API and White patients (from 10.1 ppt to 5.1 ppt) decreased from 2001–2005 to 2011–2015. Interpretation: Race/ethnicity disparities in death from CNS tumours among childhood malignant CNS tumours had reduced from 2001 to 2020, and quantifying the contribution of factors to this disparity in death could provide a basis for decreasing mortality among racial/ethnic minority patients. Funding: Shenyang Young and Middle-aged Science and Technology Innovation Talent Support Program.

Aim: To assess cause‐specific death in patients with heart failure with preserved, mildly reduced, and reduced ejection fraction (HFpEF, HFmrEF, and HFrEF). Methods and results: Data were analysed from the Swedish Heart Failure Registry (SwedeHF) and the National Patient Register of patients enrolled in SwedeHF 2000–2021. Cox proportional hazards regression models were performed and adjusted for age, sex and time period. Among 100 584 patients (23% HFpEF, 23% HFmrEF, 53% HFrEF), median age (interquartile range) was 75 (66–82) and 36% were female. Of those who died within 5 years, most deaths were ascribed to cardiovascular (CV) causes across all ejection fraction (EF) categories. Within 5 years, HFpEF had higher adjusted risk of non‐CV death (hazard ratio [HR] 1.33, 95% confidence interval [CI] 1.28–1.38, p < 0.001) and lower adjusted risk of CV death (HR 0.85, 95% CI 0.82–0.88, p < 0.001) compared to HFrEF. Ischaemic heart disease (IHD) and cancer were the most common causes of CV and non‐CV death regardless of EF category. The incidence rate of CV death due to IHD was highest in HFrEF while incidence rates of CV death due to pulmonary vascular disease, stroke, valvular heart disease and atrial fibrillation increased with increasing EF. The incidence rates of non‐CV deaths due to cancer, respiratory disease, and infections increased with increasing EF. Conclusion: Cardiovascular death was more common than non‐CV death across all EF categories although the risk of non‐CV death within 5 years was higher with increasing EF. IHD and cancer were the most common causes of CV and non‐CV deaths, respectively, regardless of EF category. [ABSTRACT FROM AUTHOR]

Background Due to the lack of a national mortality inequality monitoring framework, the overall picture in Japan remains unclear. Here, we investigated educational inequalities in mortality and their cause-specific contribution in Japan. Method Data were obtained by linking the 2010 Japanese population census and death records between 1 October 2010 and 30 September 2015. We included 7 984 451 Japanese people aged 30–79 years who had a unique 'matching key' generated by sex, birth year/month, address (municipality), marital status and age of spouse (9.9% of the total census population). We computed population-weighted all-cause and cause-specific age-standardized mortality rates (ASMRs) by education level. In addition, we calculated the slope index of inequality (SII), relative index inequality (RII) by education level, and population attributable fraction (PAF) referenced with the highest education (e.g. university graduation). Results Individuals with less education had higher all-cause and cause-specific ASMRs than highly educated individuals. All-cause SII (per 100 000 person-years) values were 433 (95% CI: 410–457) for men and 235 (95% CI: 217–252) for women. RII values were 1.48 (95% CI: 1.45–1.51) for men and 1.47 (95% CI: 1.43–1.51) for women. Estimated PAFs, excess premature deaths caused by educational inequalities, were 11.6% for men and 16.3% for women, respectively. Cerebrovascular diseases, ischaemic heart diseases and lung cancer were the major contributors to mortality inequalities for both sexes. Conclusions This first census-based comprehensive report on cause-specific educational mortality inequalities suggested that differences in unfavourable health risk factors by educational background might be associated with these inequalities in Japan. [ABSTRACT FROM AUTHOR]

Introduction: The increasing survival of patients with breast cancer has prompted the assessment of mortality due to all causes of death in these patients. We estimated the absolute risks of death from different causes, useful for health-care planning and clinical prediction, as well as cause-specific hazards, useful for hypothesis generation on etiology and risk factors. Materials and methods: Using data from population-based cancer registries we performed a retrospective study on a cohort of women diagnosed with primary breast cancer. We carried out a competing-cause analysis computing cumulative incidence functions (CIFs) and cause-specific hazards (CSHs) in the whole cohort, separately by age, stage and registry area. Results: The study cohort comprised 12,742 women followed up for six years. Breast cancer showed the highest CIF, 13.71%, and cardiovascular disease was the second leading cause of death with a CIF of 3.60%. The contribution of breast cancer deaths to the CIF for all causes varied widely by age class: 89.25% in women diagnosed at age <50 years, 72.94% in women diagnosed at age 50-69 and 48.25% in women diagnosed at age =70. Greater CIF variations were observed according to stage: the contribution of causes other than breast cancer to CIF for all causes was 73.4% in women with stage I disease, 42.9% in stage II-III and only 13.2% in stage IV. CSH computation revealed temporal variations: in women diagnosed at age =70 the CSH for breast cancer was equaled by that for cardiovascular disease and "other diseases" in the sixth year following diagnosis, and an early peak for breast cancer was identified in the first year following diagnosis. Among women aged 50-69 we identified an early peak for breast cancer followed by a further peak near the second year of follow-up. Comparison by geographic area highlighted conspicuous variations: the highest CIF for cardiovascular disease was more than 70% higher than the lowest, while for breast cancer the highest CIF doubled the lowest. Conclusion: The integrated interpretation of absolute risks and hazards suggests the need for multidisciplinary surveillance and prevention using communitybased, holistic and well-coordinated survivorship care models. [ABSTRACT FROM AUTHOR]

IntroductionThe increasing survival of patients with breast cancer has prompted the assessment of mortality due to all causes of death in these patients. We estimated the absolute risks of death from different causes, useful for health-care planning and clinical prediction, as well as cause-specific hazards, useful for hypothesis generation on etiology and risk factors.Materials and methodsUsing data from population-based cancer registries we performed a retrospective study on a cohort of women diagnosed with primary breast cancer. We carried out a competing-cause analysis computing cumulative incidence functions (CIFs) and cause-specific hazards (CSHs) in the whole cohort, separately by age, stage and registry area.ResultsThe study cohort comprised 12,742 women followed up for six years. Breast cancer showed the highest CIF, 13.71%, and cardiovascular disease was the second leading cause of death with a CIF of 3.60%. The contribution of breast cancer deaths to the CIF for all causes varied widely by age class: 89.25% in women diagnosed at age

Summary: Background: Racial/ethnic disparities in prostate cancer are reported in the United States (US). However, long-term trends and contributors of racial/ethnic disparities in all-cause and cause-specific death among patients with prostate cancer remain unclear. We analysed the trends and contributors of racial/ethnic disparities in prostate cancer survivors according to the cause of death in the US over 25 years. Methods: In this retrospective, population-based longitudinal cohort study, we identified patients diagnosed with first primary prostate cancer between 1995 and 2019, with follow-up until Dec 31, 2019, using population-based cancer registries’ data from the Surveillance, Epidemiology, and End Results (SEER) Program. We calculated the cumulative incidence of death for each racial/ethnic group (Black, white, Hispanic, Asian or Pacific Islander [API], and American Indian or Alaska Native [AI/AN] people), by diagnostic period and cause of death. We quantified absolute disparities using rate changes for the 5-year cumulative incidence of death between racial/ethnic groups and diagnostic periods. We estimated relative (Hazard ratios [HR]) racial/ethnic disparities and the percentage of potential factors contributed to racial/ethnic disparities using Cox regression models. Findings: Despite a decreasing trend in the cumulative risk of death across five racial/ethnic groups, AI/AN and Black patients consistently had the highest rate of death between 1995 and 2019 with an adjusted HR of 1.48 (1.40–1.58) and 1.40 (1.38–1.42) respectively. The disparities in all-cause mortality between AI/AN and white patients increased over time, with adjusted HR 1.32 (1.17–1.49) in 1995–1999 and 1.95 (1.53–2.49) in 2015–2019. Adjustment of stage at diagnosis, initial treatment, tumor grade, and household income explained 33% and 24% of the AI/AN-white and Black-white disparities in all-cause death among patients with prostate cancer. Interpretation: The enduring racial/ethnic disparities in patients with prostate cancer, call for new interventions to eliminate health disparities. Our study provides important evidence and ways to address racial/ethnic inequality. Funding: National Key R&D Program of China, National Natural Science Foundation of China, Beijing Municipal Administration of Hospitals Clinical Medicine Development of Special Funding Support, the Open Research Fund from Beijing Advanced Innovation Center for Big Data-Based Precision Medicine, Key Projects of Philosophy and Social Sciences Research, Ministry of Education of China.

To determine the association between meaning in life and all-cause and cause-specific mortality, and whether associations vary by depression or sociodemographic factors. Participants were UK Biobank cohort members who reported on their meaning in life in the mental health assessment from October 2016 to July 2017 (N = 153,505). All-cause mortality and cause-specific mortality were identified from ICD-10 codes from national death registries through December 2022. Over the up to six-year follow-up, every standard deviation higher in meaning in life was associated with a 15 % decreased risk of death from any cause (HR = 0.87, 95 % CI = 0.85–0.90, p <.001). The association was attenuated but remained significant accounting for socioeconomic, clinical, and behavioral risk factors (HR = 0.91, 95 % CI = 0.88–0.94, p <.001). Meaning in life was associated with reduced risk of death from 7 of the 8 cause-specific deaths examined: external cause (47 %), respiratory (41 %), nervous (32 %), digestive (25 %), or circulatory (15 %) systems, COVID-19 (28 %), and cancer (8 %). Depression concurrent with the meaning assessment did not explain or moderate these associations, which indicated that meaning was similarly protective when concurrently experiencing psychological distress. The association between meaning and all-cause mortality was similar across age, ethnicity, and socioeconomic status but slightly stronger among female than male participants. Feeling that one's life has meaning is associated with lower risk of mortality, particularly causes of death due to the respiratory system, nervous system, or COVID-19. Given that meaning in life can be modified through intervention, future research could address whether it could be a useful target of intervention. • Meaning in life was associated with lower risk of 7 specific causes of death. • Meaning in life was associated with lower risk of death from Covid-19. • Meaning was associated with lower risk of death from cancer or external causes. • There was lower risk from circulatory, nervous, respiratory, or digestive systems. • Associations were independent of and not moderated by depression. [ABSTRACT FROM AUTHOR]

Purpose: Cutaneous malignant melanoma (CMM) always presents as a complex disease process with poor prognosis. The objective of the present study was to explore the influence of solitary or multiple cancers on the prognosis of patients with CMM to better understand the landscape of CMM. Methods: We reviewed the records of CMM patients between 2004 and 2015 from the Surveillance, Epidemiology, and End Results Program. The cumulative incidence function was used to represent the probabilities of death. A novel causal inference method was leveraged to explore the risk difference to death between different types of CMM, and nomograms were built based on competing risk models. Results: The analysis cohort contained 165,043 patients with CMM as the first primary malignancy. Patients with recurrent CMM and multiple primary tumors had similar overall survival status (p = 0.064), while their demographics and cause-specific death demonstrated different characteristics than those of patients with solitary CMM (p < 0.001), whose mean survival times are 75.4 and 77.3 months and 66.2 months, respectively. Causal inference was further applied to unveil the risk difference of solitary and multiple tumors in subgroups, which was significantly different from the total population (p < 0.05), and vulnerable groups with high risk of death were identified. The established competing risk nomograms had a concordance index >0.6 on predicting the probabilities of death of CMM or other cancers individually across types of CMM. Conclusion: Patients with different types of CMM had different prognostic characteristics and different risk of cause-specific death. The results of this study are of great significance in identifying the high risk of cause-specific death, enabling targeted intervention in the early period at both the population and individual levels. [ABSTRACT FROM AUTHOR]

PurposeCutaneous malignant melanoma (CMM) always presents as a complex disease process with poor prognosis. The objective of the present study was to explore the influence of solitary or multiple cancers on the prognosis of patients with CMM to better understand the landscape of CMM.MethodsWe reviewed the records of CMM patients between 2004 and 2015 from the Surveillance, Epidemiology, and End Results Program. The cumulative incidence function was used to represent the probabilities of death. A novel causal inference method was leveraged to explore the risk difference to death between different types of CMM, and nomograms were built based on competing risk models.ResultsThe analysis cohort contained 165,043 patients with CMM as the first primary malignancy. Patients with recurrent CMM and multiple primary tumors had similar overall survival status (p = 0.064), while their demographics and cause-specific death demonstrated different characteristics than those of patients with solitary CMM (p < 0.001), whose mean survival times are 75.4 and 77.3 months and 66.2 months, respectively. Causal inference was further applied to unveil the risk difference of solitary and multiple tumors in subgroups, which was significantly different from the total population (p < 0.05), and vulnerable groups with high risk of death were identified. The established competing risk nomograms had a concordance index >0.6 on predicting the probabilities of death of CMM or other cancers individually across types of CMM.ConclusionPatients with different types of CMM had different prognostic characteristics and different risk of cause-specific death. The results of this study are of great significance in identifying the high risk of cause-specific death, enabling targeted intervention in the early period at both the population and individual levels.

PurposeWe aimed to investigate the mortality patterns and quantitatively assess the risks of cardiovascular death (CVD) in patients with colorectal cancer (CRC). We also established a competing-risk model to predict the probability of CVD for patients with CRC.Patients and MethodsPatients with CRC who diagnosed between 2007 and 2015 in the Surveillance, Epidemiology, and End Results (SEER) database were included in the present study. The cumulative incidence function (CIF) was used for CVD and other causes of death, and Gray’s test was used to determine the subgroup difference in CIF. The Fine-Gray proportional subdistribution hazards model was used for identifying independent risk factors for CVD. A novel competing-risk model was established to evaluate the probability of CVD for patients with CRC. The performance of the nomogram was measured by concordance index (C-index), calibration curve, decision curve analysis (DCA), and risk stratification.ResultsAfter a median follow-up of 37.00 months, 79,455 deaths occurred, of whom 56,185 (70.71%) succumbed to CRC and 23,270 (29.29%) patients died due to non-CRC, among which CVD accounted for 9,702 (41.69%), being the major cause of non-cancer deaths. The 1-, 3-, and 5-year cumulative rates for CVD were 12.20, 24.25, and 30.51%, respectively. In multivariate analysis, age, race, marital status, tumor size, tumor stage, advanced stage, surgery, and chemotherapy were independent risk factors of CVD among patients with CRC. The nomogram was well calibrated and had good discriminative ability, with a c-index of 0.719 (95% CI, 0.738–0.742) in the training cohort and 0.719 (95% CI, 0.622–0.668) in the validation cohort. DCA demonstrated that nomogram produced more benefit within wide ranges of threshold probabilities for 1-, 3-, and 5-year CVD, respectively.ConclusionThis study was the first to analyze the CIF and risk factors for CVD among CRC based on a competing-risk model. We have also built the first 1-, 3-, and 5-year competing nomogram for predicting CVD. This nomogram had excellent performance and could help clinicians to provide individualized management in clinical practice.

Background: It is generally recognized that there is unequal mortality in childhood central nervous system (CNS) malignancy in the United States (US), but little is known about the trends and contributors of racial/ethnic disparities in death. We assessed the trends of racial/ethnic disparities in all-cause and cause-specific death, and the contributions of tumour, treatment and socioeconomic factors to this disparity., Methods: This registry-based cohort study included children (aged ≤19 years) diagnosed with malignant CNS tumours, using data from the US population-based cancer registry in the Surveillance, Epidemiology, and End Results (SEER) Program. The clinical outcomes were all-cause and cause-specific death for each racial/ethnic group (White, Black, Hispanic, non-Hispanic Asian/Pacific Islander [API], and non-Hispanic American Indian/Alaska Native [AI/AN] children). We quantified absolute disparities using absolute rate difference in 5-year cumulative incidence of death. Cox proportion risk models were used to estimate the relative racial/ethnic disparities, and the contribution of factors to disparities in death., Findings: In this study, data from 14,510 children with malignant CNS tumours (mean [SD] age, 8.5 [5.7]; 7988 [55.1%] male) were analysed. Overall, the cumulative incidence of death from CNS tumours across four racial/ethnic groups decreased from 2001 to 2020. Black patients had the highest risk of death from all causes and CNS tumours between 2001 and 2020, with adjusted hazard ratios (HR) of 1.52 (1.38-1.68) and 1.47 (1.31-1.64), respectively. The absolute disparity in all-cause death between Hispanic and White patients increased slightly (from 8.2 percentage points [ppt] to 9.4 ppt), and the relative disparity in death from CNS tumours increased from 1.33 (1.15-1.55) in 2001-2005 to 1.78 (1.44-2.20) in 2016-2020. The absolute disparities in death from CNS tumours between Black and White patients (from 11.8 ppt to 4.3 ppt) and between API and White patients (from 10.1 ppt to 5.1 ppt) decreased from 2001-2005 to 2011-2015., Interpretation: Race/ethnicity disparities in death from CNS tumours among childhood malignant CNS tumours had reduced from 2001 to 2020, and quantifying the contribution of factors to this disparity in death could provide a basis for decreasing mortality among racial/ethnic minority patients., Funding: Shenyang Young and Middle-aged Science and Technology Innovation Talent Support Program., Competing Interests: We declare no competing interests., (© 2024 The Author(s).)

Purpose: Inflammatory breast cancer (IBC) is a rare, aggressive and special subtype of primary breast cancer. We aimed to establish competing-risks nomograms to predict the IBC-specific death (BCSD) and other-cause-specific death (OCSD) of IBC patients. Methods: We extracted data on primary IBC patients from the SEER (Surveillance, Epidemiology, and End Results) database by applying specific inclusion and exclusion criteria. Cumulative incidence function (CIF) was used to calculate the cumulative incidence rates and Gray's test was used to evaluate the difference between groups. Fine-Gray proportional subdistribution hazard method was applied to identify the independent predictors. We then established nomograms to predict the 1-, 3-, and 5-year cumulative incidence rates of BCSD and OCSD based on the results. The calibration curves and concordance index (C-index) were adopted to validate the nomograms. Results: We enrolled 1699 eligible IBC patients eventually. In general, the 1-, 3-, and 5-years cumulative incidence rates of BCSD were 15.3%, 41.0%, and 50.7%, respectively, while those of OCSD were 3.0%, 5.1%, and 7.4%. The following 9 variables were independent predictive factors for BCSD: race, lymph node ratio (LNR), AJCC M stage, histological grade, ER (estrogen receptor) status, PR (progesterone receptor) status, HER-2 (human epidermal growth factor-like receptor 2) status, surgery status, and radiotherapy status. Meanwhile, age, ER, PR and chemotherapy status could predict OCSD independently. These factors were integrated for the construction of the competing-risks nomograms. The results of calibration curves and C-indexes indicated the nomograms had good performance. Conclusions: Based on the SEER database, we established the first competing-risks nomograms to predict BCSD and OCSD of IBC patients. The good performance indicated that they could be incorporated in clinical practice to provide references for clinicians to make individualized treatment strategies. [ABSTRACT FROM AUTHOR]

Gynaecological cancers are the most prevalent cancers in women, making them a major public health concern for decades. Health disparities and inequalities in access to care among different racial groups have been a major concern in the US healthcare system. This study was aimed at investigating cause-specific survival rates among non-white women with gynaecological cancer and to identify risk factors associated with gynaecological cancer mortality by race. The Kaplan-Meier method was used to calculate 5-year survival estimates and various risk factors for gynaecological cancer among non-white women were analysed using Cox proportional hazard model. The findings of this study highlight the need for targeted interventions to improve access to care and reduce health disparities for non-white women with gynaecological cancer., (© The Author(s) 2024. Published by Oxford University Press on behalf of the Johns Hopkins Bloomberg School of Public Health. All rights reserved. For permissions, please e-mail: journals.permissions@oup.com.)

Context: The CERT1 (Cardiovascular Event Risk Test) score derived from plasma ceramides has been applied clinically for cardiovascular risk assessment., Objective: To study whether plasma ceramides predict risk of mortality in patients with type 2 diabetes., Design, Setting and Participants: A prospective study which included 1903 outpatients with type 2 diabetes in a regional hospital and a primary care facility in Singapore., Exposure and Outcome: Plasma ceramides (d18:1/16:0, d18:1/18:0, d18:1/24:0, d18:1/24:1) were measured by mass spectrometry and CERT1 score was calculated accordingly. Main outcomes were all-cause and cause-specific mortality., Results: 252 death events were identified during median of 9.3 years of follow-up. Compared to those with low score (≤ 2), participants with a high CERT1 score (≥ 7) had 1.86 (95% CI 1.30-3.65) fold increased risk for all-cause death after adjustment for cardio-renal risk factors including eGFR and albuminuria. As continuous variable, one- unit increment in CERT1 was associated with 8% increased risk for all-cause death (adjusted HR 1.08 [1.04-1.13]). Adding CERT1 onto RECODe (Risk Equations for Complications Of type 2 Diabetes) mortality risk engine significantly improved prediction of 10- year risk of all-cause death (AUC 0.810 to 0.823, delta 0.013 [0.005-0.022]). The association between CERT1 and non-cardiovascular death remained significant (adjusted HR 2.12 [1.32-3.42]), whereas its association with cardiovascular death became non-significant after adjustment for kidney measurements (adjusted HR 1.41 [0.78-2.56])., Conclusion: CERT1 score predicts mortality risk independent of clinical cardio-renal risk factors. Further studies are warranted to elucidate the mechanistic linkage between ceramide and mortality, especially non-cardiovascular mortality., (© The Author(s) 2024. Published by Oxford University Press on behalf of the Endocrine Society. All rights reserved. For commercial re-use, please contact reprints@oup.com for reprints and translation rights for reprints. All other permissions can be obtained through our RightsLink service via the Permissions link on the article page on our site—for further information please contact journals.permissions@oup.com. See the journal About page for additional terms.)

Abstract Background Extensive studies have linked ambient particulate matter (PM) to an increased mortality burden from a wide range of causes. However, the effects of PM on mortality rates from specific causes were unclear. This study aimed to estimate the detrimental effects of PM on cause specific deaths in Changzhou, China. Method Data representing daily mortality rates, weather conditions and particulate air pollution levels were obtained from government-controlled agencies of Changzhou, from January 1, 2015 to December 31, 2016. An inverse distance weighting method was used to assess the population exposure to PM and a time-series was performed to detect the detrimental effects of PM. Results Positive associations were identified between PMs and daily mortality rates from non-accidental, circulatory, hypertensive, respiratory and chronic lower respiratory causes at a lag of 0–3 days. The effects of PMs were strongest on hypertensive mortality, with an increase of 5.27% (95% confidence interval (CI): 2.43–8.19%) and 3.52% (95% CI: 1.55–5.53%), per 10 μg/m3 increment in PM 2.5 and PM 10 respectively. The elderly exhibited a higher mortality risk with PMs exposure. Females were more vulnerable to circulatory, hypertensive and respiratory death while males were more sensitive to chronic lower respiratory and neurodegenerative mortality. The effects were stronger in warm seasons for circulatory mortality and stronger in cold seasons for respiratory mortality. Conclusion These findings indicate that PM could exert adverse influences on the outcomes of several pathological processes, especially for women and the elderly with hypertension disease. Highlights • PM was positively associated with non-accidental, vascular and respiratory death. • The elderly exhibited higher mortality risk with PMs exposure. • Females were more vulnerable to circulatory, hypertensive and respiratory death. • Males were more sensitive to chronic lower respiratory and neurodegenerative death. • Seasonal differences were identified in the circulatory and respiratory mortality. [ABSTRACT FROM AUTHOR]

Background: Death with graft function remains an important cause of graft loss among kidney transplant recipients (KTRs). Little is known about the trend of specific causes of death in KTRs in recent years.Methods: We analyzed United States Renal Data System data (1996-2014) to determine 1- and 10-year all-cause and cause-specific mortality in adult KTRs who died with a functioning allograft. We also studied 1- and 10-year trends in the various causes of mortality.Results: Of 210,327 KTRs who received their first kidney transplant from 1996 to 2014, 3.2% died within 1 year after transplant. Cardiovascular deaths constituted the majority (24.7%), followed by infectious (15.2%) and malignant (2.9%) causes; 40.1% of deaths had no reported cause. Using 1996 as the referent year, all-cause as well as cardiovascular mortality declined, whereas mortality due to malignancy did not. For analyses of 10-year mortality, we studied 94,384 patients who received a first kidney transplant from 1996 to 2005. Of those, 22.1% died over 10 years and the causative patterns of their causes of death were similar to those associated with 1-year mortality.Conclusions: Despite the downtrend in mortality over the last 2 decades, a significant percentage of KTRs die in 10-years with a functioning graft, and cardiovascular mortality remains the leading cause of death. These data also highlight the need for diligent collection of mortality data in KTRs. [ABSTRACT FROM AUTHOR]

Background: Atrial fibrillation (AF) is associated with death in patients with chronic kidney disease (CKD). We examined the associations between AF and cause-specific mortality in a large CKD population.Methods: We included 62,459 patients with estimated glomerular filtration rate 15-59 mL/min/1.73 m2 (6,639 patients with AF and 55,820 without AF) followed in a large health care system. Outcomes included overall and cause-specific deaths (a) cardiovascular; (b) malignancy; and (c) non-cardiovascular/non-malignancy causes. Cox regression models for overall mortality and separate competing risk models for each major cause of death category were used to evaluate their respective associations with AF.Results: During a median follow-up of 4.1 years, 19,094 patients died; cause of death was known for 18,854 patients. After multivariable adjustment (demographics, comorbidities, relevant laboratory data, medication use, and kidney function), AF was associated with 23% (95% CI 18-29%) higher risk of all-cause mortality, 45% (95% CI 31-61%) higher risk of cardiovascular mortality and 13% (95% CI 3-22%) lower risk of malignancy-related mortality. Exclusion of patients with malignancy yielded similar results except for a lack of association between AF and malignancy-related deaths. Results were consistent across various stages of CKD.Conclusions: In a non-dialysis-dependent CKD population, the presence of AF was associated with higher all-cause and cardiovascular mortality. These data suggest that patients with both CKD and AF are at high cardiovascular risk, and thus clinical practice (or trials) should aim at reducing the overall excess cardiovascular mortality (not stroke alone) in patients with AF and CKD. [ABSTRACT FROM AUTHOR]

Background: Racial/ethnic disparities in prostate cancer are reported in the United States (US). However, long-term trends and contributors of racial/ethnic disparities in all-cause and cause-specific death among patients with prostate cancer remain unclear. We analysed the trends and contributors of racial/ethnic disparities in prostate cancer survivors according to the cause of death in the US over 25 years., Methods: In this retrospective, population-based longitudinal cohort study, we identified patients diagnosed with first primary prostate cancer between 1995 and 2019, with follow-up until Dec 31, 2019, using population-based cancer registries' data from the Surveillance, Epidemiology, and End Results (SEER) Program. We calculated the cumulative incidence of death for each racial/ethnic group (Black, white, Hispanic, Asian or Pacific Islander [API], and American Indian or Alaska Native [AI/AN] people), by diagnostic period and cause of death. We quantified absolute disparities using rate changes for the 5-year cumulative incidence of death between racial/ethnic groups and diagnostic periods. We estimated relative (Hazard ratios [HR]) racial/ethnic disparities and the percentage of potential factors contributed to racial/ethnic disparities using Cox regression models., Findings: Despite a decreasing trend in the cumulative risk of death across five racial/ethnic groups, AI/AN and Black patients consistently had the highest rate of death between 1995 and 2019 with an adjusted HR of 1.48 (1.40-1.58) and 1.40 (1.38-1.42) respectively. The disparities in all-cause mortality between AI/AN and white patients increased over time, with adjusted HR 1.32 (1.17-1.49) in 1995-1999 and 1.95 (1.53-2.49) in 2015-2019. Adjustment of stage at diagnosis, initial treatment, tumor grade, and household income explained 33% and 24% of the AI/AN-white and Black-white disparities in all-cause death among patients with prostate cancer., Interpretation: The enduring racial/ethnic disparities in patients with prostate cancer, call for new interventions to eliminate health disparities. Our study provides important evidence and ways to address racial/ethnic inequality., Funding: National Key R&D Program of China, National Natural Science Foundation of China, Beijing Municipal Administration of Hospitals Clinical Medicine Development of Special Funding Support, the Open Research Fund from Beijing Advanced Innovation Center for Big Data-Based Precision Medicine, Key Projects of Philosophy and Social Sciences Research, Ministry of Education of China., Competing Interests: We declare no competing interests., (© 2023 The Author(s).)

Background: Chronic obstructive pulmonary disease (COPD) is associated with higher mortality in the general population. We studied the associations between COPD and death among chronic kidney disease (CKD) patients along with reporting cause-specific death data.Methods: We included 56,960 patients with stages 3 and 4 CKD who were followed in a large health care system. Associations between COPD and all-cause mortality and various causes of death (respiratory deaths, cardiovascular deaths, malignancy-related deaths and deaths due to other reasons) were studied using the Cox proportional hazards and competing risk models.Results: Out of 56,960 CKD patients, 4.7% (n = 2,667) had underlying COPD. Old age, presence of diabetes, hypertension, coronary artery disease, congestive heart failure, and smoking were associated with higher risk for COPD. During a median follow-up of 3.7 years, 15,969 patients died. After covariate adjustment, COPD was associated with a 41% increased risk (95% CI 1.31-1.52) for all-cause mortality, and fourfold increased risk (sub-hazard ratio 4.36, 95% CI 3.54-5.37) for respiratory-related deaths. In a sensitivity analysis that was performed by defining COPD as the use of relevant International Classification of Diseases-9 codes and medications used to treat COPD, similar results were noted.Conclusions: COPD is associated with higher risk for death among those with CKD, and an underlying lung disease accounts for significant proportion of deaths. These data highlight the need for further prospective studies to understand the underlying mechanisms and potential interventions to improve outcomes in this population. [ABSTRACT FROM AUTHOR]

Scope: Tomato has well-known beneficial health effects and is an important source of lycopene. The study aims to clarify the evidence for the association between tomato and lycopene consumption and all-cause and cause-specific mortality in Korean adults., Methods and Results: Data analyzed in the current study are obtained from the Korean Genome and Epidemiology Study Cohort. Mortality outcomes are determined based on death records from 2001 to 2020. Tomato and lycopene consumption is assessed using food frequency questionnaires and antioxidant databases and divided into quintiles. Over a mean follow-up of 11.5 years, 5863 deaths are recorded among 139913 participants aged over 40 years. Tomato consumption is not associated with the risk of all-cause and cancer mortality. However, the highest tomato consumption group has a lower risk of cardiovascular disease (CVD) mortality (HR = 0.779; 95% CI = 0.633, 0.957). Lycopene consumption is inversely associated with all-cause (HR = 0.872; 95% CI = 0.801, 0.950), and CVD (HR = 0.680; 95% CI = 0.548, 0.845) mortality., Conclusion: A higher intake of tomatoes and lycopene is inversely related to the risk of CVD mortality, and lycopene consumption is associated with a lower risk of all-cause mortality., (© 2023 Wiley-VCH GmbH.)

To reduce the high disease burden caused by air pollution, World Health Organization (WHO) issued a new air quality guideline (AQG) on the 22nd September 2021. A timely quantitative assessment of health benefits by meeting these targets is a key measure to advocate and inform national and regional disease control policies. We collected daily major air pollution data in 315 Chinese cities from the 1st January to the 31st December 2019, and the corresponding annual population and mortality rate in the whole population of each city. Then, the mortality benefits were estimated when daily air pollution levels attained WHO's new AQG targets (15 μg/m3 for PM 2.5 , 25 μg/m3 for NO 2 and 100 μg/m3 for O 3) in 315 Chinese cities and 31 provinces by using pollutant- and cause-specific concentration-response functions. In total, 134,025 (95%CI: 92,768; 173,029) air pollution-associated non-accidental deaths could be avoided in 315 Chinese cities in 2019 by attaining WHO's new AQG targets, with 43,800 (95%CI: 29,945; 55,616) avoidable deaths from PM 2.5 , 58,070 (95%CI: 45,333; 70,714) from NO 2 , and 32,155 (95%CI: 17,490; 46,699) from O 3. Cardiovascular diseases and respiratory diseases accounted for 72,698 (95%CI: 46,561; 101,680) and 17,726 (95%CI: 8603; 26,925) avoidable deaths, respectively. Health benefits from reduction in air pollution levels were 99.26 avoided non-accidental deaths per million population at national level, ranging from 12.48 per million in Tibet to 166.26 per million in Hebei. These findings suggest that the compliance with the WHO updated AQG standards would save substantial amount of air pollution-related premature deaths in China. More stringent air pollution control and management measures are urgently warranted to reduce the disease burden from air pollutants in China, particularly for the worsening O 3 pollution. Reduction in cause-specific deaths (per million) in China by attaining WHO's new air quality guidelines. [Display omitted] • Meeting WHO new Air Quality Guideline can save 134,025 deaths in 315 Chinese cities. • 43,800 avoidable deaths were from PM 2.5 , 58,070 from NO 2 , and 32,155 from O 3. • Stroke, coronary heart disease and COPD explained half of deaths from air pollution. • Mortality benefits by attaining the new targets varied across cities and provinces. [ABSTRACT FROM AUTHOR]

Colorectal cancer (CRC) is the third most common cancer and the third leading cause of cancer mortality in the United States. Several studies have shown that, in the past two decades, the survival rate of CRC patients has increased substantially due to the improvements in chemotherapy regimens, largely in clinical trial settings. However, it is unclear whether benefits from these improvements can be reproduced in population-based elderly patients. For example it is unclear whether newly developed chemotherapy regimens affect the changing patterns of the leading causes of death among elderly CRC patients. It is also unclear whether the impact on changing patterns of the leading causes of death differs by the presence of comorbidity or chemotherapy-related toxicity. In this study, we used the SEER–Medicare linked dataset of 13 registries (1992–2009) and examined the effects of newly developed chemotherapy regimens, comorbidities, and chemotherapy-related toxicities on the changing patterns of the leading causes of death in elderly patients with colorectal cancer. We hypothesized that the risk of CRC-specific death decreases over time when new and more effective chemotherapy regimens became available.Background Abundant evidences have shown that newly developed chemotherapy regimens improved 5-year survival rate of colorectal cancer (CRC) patients over the past two decades. However, their impact on risk of death from leading causes among elderly patients is still poorly understood. Patients and methods A retrospective cohort study of 69 718 elderly CRC patients with their first primary tumors in 1992–2009, identified from the 12 areas of Surveillance, Epidemiology, and End Results-Medicare linked database with their Medicare claims up to 2010. Multivariate Cox regression models were used to assess the effect of newly developed chemotherapy regimens, comorbidities, and chemotherapy related toxicities on cause-specific death and their temporal patterns among elderly CRC patients. Results The leading causes of death among CRC patients were CRC, circulation disorders, and secondary cancers, which accounted for 51.4%, 25%, and 4.6% of all-cause death, respectively. Patients diagnosed in more recent diagnostic time periods were significantly less likely to die of CRC [period 2: 5-year hazard ratio = 0.94, 95% confidence interval (CI) 0.90–0.97; period 3: 0.86, 0.83–0.90], circulation disorders (period 2: 0.94, 0.88–1.00; period 3: 0.80, 0.75–0.87), and more likely to die of secondary cancer (period 3: 1.42, 1.20–1.68) compared with those diagnosed in period 1. Charlson comorbidities index and the selected pre-existing comorbidities were significantly associated with increased 5-year risk of death from all three leading causes. Both hematological and gastric toxicity were associated with reduced risk of death from CRC and circulation disorders. The association between diagnostic time period and risk reduction in death from CRC depended on chemotherapy treatment (P < 0.0001). Subgroup analyses showed that the chemotherapy-dependent significant risk reduction was seen in patients with stage II–III CRC, patients without comorbidities, and patients without toxicities (P < 0.0001 for all). Conclusion The newly developed chemotherapy regimens were associated with the decreased risk of mortality from CRC. [ABSTRACT FROM PUBLISHER]

Aim The aim of this study was to examine mortality in patients with both type 1 diabetes ( T1 D) and coeliac disease ( CD). Methods Between 1969 and 2008, we identified individuals with CD through biopsy reports from all pathology departments ( n = 28) in Sweden. T1 D was defined as a diagnosis of diabetes recorded in the Swedish National Patient Register between 1964 and 2009 in individuals aged ≤30 years. During follow-up, we identified 960 patients with both T1 D and CD. For each individual with T1 D and CD, we selected up to five subjects with T1 D alone (i.e. no CD), matched for sex, age and calendar period of diagnosis, as the reference group ( n = 4608). Using a stratified Cox regression analysis with CD as a time-dependent covariate, we estimated the risk of death in patients with both T1 D and CD compared with those with T1 D alone. Results Stratifying for time since CD diagnosis, CD was not a risk factor for death in patients with T1 D during the first 5 years after CD diagnosis [hazard ratio ( HR) 0.87, 95% confidence interval ( CI) 0.43-1.73], but thereafter the HR for mortality increased as a function of follow-up time (5 to <10 years, HR 1.44, 95% CI 0.74-2.79; 10 to <15 years, HR 1.88, 95% CI 0.81-4.36). Having a CD diagnosis for ≥15 years was associated with a 2.80-fold increased risk of death in individuals with T1 D (95% CI 1.28-6.12). Conclusion A diagnosis of CD for ≥15 years increases the risk of death in patients with T1 D. [ABSTRACT FROM AUTHOR]

Abstract: Approximately 20% of Emergency Department (ED) users discharged home receive a non-causative discharge diagnosis in the category of “Symptoms, signs, abnormal findings, and ill-defined causes,” according to the International Classification of Diseases. The objective of this study was to evaluate the association of these non-causative discharge diagnoses with mortality in general and with violent death and suicide in particular. This is a prospective study; the primary source of data was computer records from the ED at Landspitali University Hospital, Hringbraut, Reykjavik, Iceland over the period 1995–2001. The main discharge diagnoses were recorded according to the International Classification of Diseases. Individuals with a non-causative discharge diagnosis were followed-up for cause-specific mortality through national registries by record linkage and were compared to national mortality rates and the rates of those with causative physical diagnoses. The standardized mortality ratios, hazard ratios, and 95% confidence intervals (CI) were calculated. The data on individuals with a non-causative discharge diagnosis from the ED revealed that the standardized mortality ratio for all causes was 1.57 (95% CI 1.39–1.77) among men and 1.83 (95% CI 1.61–2.08) among women. The hazard ratio for violent death was 1.64 (95% CI 1.07–2.52) and for suicide 2.08 (95% CI 1.02–4.24), adjusted for age and gender, among individuals with a non-causative discharge diagnosis compared to those having causative physical discharge diagnoses. Through analysis of the discharge diagnoses “Symptoms, signs, abnormal findings and ill-defined causes,” this study has identified an association between the group of patients discharged from the ED with a non-causative diagnosis who are at high risk of suicide and who may, through further studies, become subjects for suicide prevention strategies. [Copyright &y& Elsevier]

: PurposeBiochemical failure (BF), defined by a rising prostate-specific antigen (PSA) profile, is an early surrogate of treatment failure. However, little evidence is available to show that BF is associated with death for patents with prostate cancer treated with radiotherapy. We examined the relationship between BF and death from prostate cancer.: Methods and materialsA total of 942 patients were treated between 1987 and 1998 with external beam radiotherapy who had sufficient PSA determinations in follow-up for the analyses described. The median radiation dose was 72 Gy, median PSA was 9.9 ng/mL, and median follow-up was 73 months. The American Society for Therapeutic Radiology and Oncology consensus definition was used to define BF. Kaplan-Meier calculations were from the start of radiotherapy. Cox proportional hazards regression multivariate analyses were used to investigate the association of BF (time-dependent variable) and other factors to distant metastasis (DM), cause-specific death (CSD), and overall death (OD). The year of treatment was included in some of the multivariate analyses to correct for potential unknown factors that may have occurred during the years of the study, such as stage migration.: ResultsBF was observed in 316 patients (34%), and 66 (7%) experienced DM, 32 (3%) died of prostate cancer, and 230 (24%) died overall during the study period. The Kaplan-Meier 5-year rate estimates from the start of treatment for BF, DM, CSD, and OD were 38%, 6%, 3%, and 13%, respectively. All patients with DM had BF. In multivariate analyses, BF was associated with DM and CSD, but not OD. The inclusion of the year of treatment did not alter these relationships.: ConclusionBF, as a time-dependent covariate, was the strongest determinant of DM and was also very significantly related to CSD. The inclusion of the year of treatment had little effect on these associations. Longer follow-up is needed to determine conclusively the relationship of BF to OD. [Copyright &y& Elsevier]

Purpose: We aimed to investigate the mortality patterns and quantitatively assess the risks of cardiovascular death (CVD) in patients with colorectal cancer (CRC). We also established a competing-risk model to predict the probability of CVD for patients with CRC., Patients and Methods: Patients with CRC who diagnosed between 2007 and 2015 in the Surveillance, Epidemiology, and End Results (SEER) database were included in the present study. The cumulative incidence function (CIF) was used for CVD and other causes of death, and Gray's test was used to determine the subgroup difference in CIF. The Fine-Gray proportional subdistribution hazards model was used for identifying independent risk factors for CVD. A novel competing-risk model was established to evaluate the probability of CVD for patients with CRC. The performance of the nomogram was measured by concordance index (C-index), calibration curve, decision curve analysis (DCA), and risk stratification., Results: After a median follow-up of 37.00 months, 79,455 deaths occurred, of whom 56,185 (70.71%) succumbed to CRC and 23,270 (29.29%) patients died due to non-CRC, among which CVD accounted for 9,702 (41.69%), being the major cause of non-cancer deaths. The 1-, 3-, and 5-year cumulative rates for CVD were 12.20, 24.25, and 30.51%, respectively. In multivariate analysis, age, race, marital status, tumor size, tumor stage, advanced stage, surgery, and chemotherapy were independent risk factors of CVD among patients with CRC. The nomogram was well calibrated and had good discriminative ability, with a c-index of 0.719 (95% CI, 0.738-0.742) in the training cohort and 0.719 (95% CI, 0.622-0.668) in the validation cohort. DCA demonstrated that nomogram produced more benefit within wide ranges of threshold probabilities for 1-, 3-, and 5-year CVD, respectively., Conclusion: This study was the first to analyze the CIF and risk factors for CVD among CRC based on a competing-risk model. We have also built the first 1-, 3-, and 5-year competing nomogram for predicting CVD. This nomogram had excellent performance and could help clinicians to provide individualized management in clinical practice., Competing Interests: The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest., (Copyright © 2022 Zhang, Wang, Zhang, Ai and Liu.)

Background: Infiltrating lobular carcinoma (ILC) is the second most common histologic subtype of breast cancer. We assessed the rates of cause-specific death in ILC patients with the aim of establishing competing-risk nomograms for predicting their prognosis., Patients and Methods: Data on ILC patients were extracted from the Surveillance, Epidemiology, and End Results (SEER) database. The cumulative incidence function was used to calculate the cumulative incidence rates of cause-specific death, and Gray's test was applied to test the differences in cumulative incidence rates among groups. We then identified independent prognostic factors by applying the Fine-Gray proportional subdistribution hazard analysis method and established nomograms based on the results. Calibration curves and the concordance index were employed to validate the nomograms., Results: The study enrolled 11,361 patients. The 3-, 5-, and 10-year overall cumulative incidence rates for those who died of ILC were 3.1%, 6.2%, and 12.2%, respectively, whereas the rates for those who died from other causes were 3.2%, 5.8%, and 14.1%. Age, marriage, grade, size, regional node positivity, American Joint Committee on Cancer M stage, progesterone receptor, and surgery were independent prognostic factors for dying of ILC, whereas the independent prognostic factors for dying of other causes were age, race, marriage, size, radiation, and chemotherapy. The nomograms were well calibrated and had good discrimination ability., Conclusion: We applied competing-risk analysis to ILC patients based on the SEER database and established nomograms that perform well in predicting the cause-specific death rates at 3, 5, and 10 years after the diagnosis., (Copyright © 2021. Published by Elsevier Inc.)

Background: Prognostic factors after dialysis initiation among older chronic kidney disease (CKD) patients are not well studied. In this study, we examined the risk factors associated with 1-year mortality after dialysis initiation among older CKD patients., Methods: In this retrospective study, we included 621 CKD patients from an electronic medical record based CKD registry that was linked to the United States Renal Data System data. In terms of age, they were all ≥65. We examined the associations of various demographic factors, comorbid conditions, relevant laboratory parameters, the presence of arteriovenous fistula, and inability to take care of oneself with 1-year mortality after dialysis initiation using Cox proportional hazards model., Results: In our study cohort, 224 older patients died during the first year of dialysis initiation and the estimated survival at 1 year was 65% (95% CI 62-69). After adjusting for covariates, increasing age by each year (Hazard ratio 1.04 [95% CI 1.02-1.06]), congestive heart failure (CHF; 1.57 [1.13-2.18]), an absence of AVF (3.0 [1.7-5.1]) and lack of nephrology care prior to dialysis initiation (1.93 [1.39-2.70]) were associated with increased risk of 1-year mortality. Nearly 60% of deaths were due to non-cardiovascular (CV) causes including cancer., Conclusion: Risk factors portending high 1-year mortality in older CKD patients are increasing age, CHF, an absence of AVF, and lack of pre-dialysis nephrology care. Clinicians need to be aware of non-CV risks of high mortality in these patients., (© 2018 S. Karger AG, Basel.)