Treatment decisions of bladder cancer in patients older than 85 years: a SEER-based analysis 2011–2015
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To compare the survival outcomes of patients over 85 years of age with bladder cancer.We used data collected from the Surveillance, Epidemiology, and End Results (SEER) database. Kaplan-Meier (KM) curves were generated for overall survival with 95% confidence intervals (CIs). Cox proportional hazard models were used to estimate the hazard ratios among cases in different groups.Of the 9,321 patients who met the inclusion criteria, 6,703 (71.9%) were men and 2,618 (28.1%) were women, with a mean (standard deviation) age of 88.68 (3.216) years. The median follow-up time of this cohort was 18 months. In the low-grade non-muscle-invasive bladder cancer (LG NMIBC) group, our analysis showed that no further treatment led to a better prognosis after the first transurethral bladder tumor resection (TURBT). In the high-grade NMIBC (HG NMIBC) cohort, major therapy was correlated with better OS in univariable and multivariable analyses [hazard ratio (HR) 0.450; 95% CI: 0.351-0.577]. Trimodal therapy gave a better prognosis in the muscle-invasive bladder cancer (MIBC) cohort (HR 1.395; 95% CI: 1.147-1.697). In addition, none of the county factors were risk factors for prognosis in multivariable analysis.Minor and major therapies do not have a better prognosis after TURBT in LG NMIBC. Major therapy has better oncological outcomes in LG NMIBC and MIBC than minor therapy. Trimodal therapy leads to longer OS in MIBC. In addition, none of the county factors were risk factors for prognosis.Teaching epidemiology in and out of the classroom, J.H. Abramson teaching the reluctant student, C. du V. Florey principles of epidemiology study design and planning, A. Ahlbom data collection and processing, E. Schach preparing for statistical analysis, J. Olsen teaching statistical methods in epidemiology, D. Clayton clinical epidemiology, J.A. Baron epidemiology in health services research, R.D. Weir screening for cancer, N. Day cancer epidemiology, C.S. Muir psychiatric epidemiology, R. Fuhrer and E. Fombonne occupational epidemiology, F. Merletti and P. Comba epidemiology of coronary heart disease, P. Ducimetiere and A. Kalandidi epidemiology of ageing and diseases in the elderly, A. Hofman epidemiology of infectious diseases and the study of outbreaks, D. Reid teaching the practice of epidemiology, U. Brinkmann the epidemiology of tropical diseases, M.E. Wilson epidemiology of AIDS, D. Trichopoulos et al teaching oral and dental epidemiology, F. Scheutz and A. Sheiham pharmacoepidemiology, M.S. Porta and X. Carne teaching epidemiology in EC countries, S. Allwright and J. Pemberton application and teaching of epidemiology developments in the European region of the World Health Organization, M. Thuriaux.
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epiweek creates epidemiological week and equivalent epidemiological year from the calendar date. It extends the week function of Stata. Each epidemiological week begins on a Sunday and ends on Saturday. And the first epidemiological week of year ends on the first Saturday of January, provided that it falls at least four or more days into the month. epiweek2 converts epidemiological week and epidemiological year to the calendar date with the starting Sunday and the ending Saturday.
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Background and objectives Sedentary behavior is associated with increased mortality in the general population. Whether replacing sedentary behavior with low- or light-intensity activities confers a survival benefit in the general or CKD populations is unknown. Design, setting, participants, & measurements This observational analysis of the 2003–2004 National Health and Nutrition Examination Survey examined the associations of low- and light-intensity activities with mortality. On the basis of the number of counts/min recorded by an accelerometer, durations of sedentary (<100/min), low (100–499/min), light (500–2019/min), and moderate/vigorous (≥2020/min) activity were defined and normalized to 60 minutes. The mortality associations of 2 min/hr less sedentary duration in conjunction with 2 min/hr more (tradeoff) spent in one of the low, light, or moderate/vigorous activity durations while controlling for the other two activity durations were examined in multivariable Cox regression models in the entire cohort and in the CKD subgroup. Results Of the 3626 participants included, 383 had CKD. The mean sedentary duration was 34.4±7.9 min/hr in the entire cohort and 40.8±6.8 in the CKD subgroup. Tradeoff of sedentary duration with low activity duration was not associated with mortality in the entire cohort or the CKD subgroup. Tradeoff of sedentary duration with light activity duration was associated with a lower hazard of death in the entire cohort (hazard ratio, 0.67; 95% confidence interval, 0.48 to 0.93) and CKD subgroup (hazard ratio, 0.59; 95% confidence interval, 0.35 to 0.98). Tradeoff of sedentary duration with moderate/vigorous activity duration had a nonsignificant lower hazard in the entire cohort and CKD subgroup. Conclusions Patients with CKD are sedentary nearly two thirds of the time. Interventions that replace sedentary duration with an increase in light activity duration might confer a survival benefit.
Subgroup analysis
Sedentary lifestyle
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The findings of epidemiologic studies on the association between egg consumption and bladder cancer risk remain conflicting. We conducted a meta-analysis to clarify the potential association between egg consumption and bladder cancer risk. Four cohort studies and 9 case–control studies in the PubMed database through February 2012 were identified on egg consumption and risk of bladder cancer involving 2715 cases and 184,727 participants. Random-effects models were used to calculate the summary relative risk estimates (SRRE) based on the highest compared with the lowest category of egg consumption. In addition, we performed stratified analyses and sensitivity and dose-response analyses to examine the association. Overall, no significant association was observed between egg consumption and bladder cancer (SRRE = 1.11 95% CI: 0.90–1.35). However, increased risk of bladder cancer was detected in North/South America (SRRE = 1.40 95% CI: 1.05–1.86) and, moreover, fried egg intake positively associated with bladder cancer as well (SRRE = 2.04, 95% CI: 1.41–2.95). In conclusion, our findings suggest no significant association between egg consumption and bladder cancer risk, except for a possible positive relationship with the intake of fried eggs based on the limited number of studies. Additional studies, especially large prospective cohort studies, are warranted to confirm these findings.
Consumption
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Background and objectives
Sedentary behavior is associated with increased mortality in the general population. Whether replacing sedentary behavior with low- or light-intensity activities confers a survival benefit in the general or CKD populations is unknown.Design, setting, participants, & measurements
This observational analysis of the 2003–2004 National Health and Nutrition Examination Survey examined the associations of low- and light-intensity activities with mortality. On the basis of the number of counts/min recorded by an accelerometer, durations of sedentary (<100/min), low (100–499/min), light (500–2019/min), and moderate/vigorous (≥2020/min) activity were defined and normalized to 60 minutes. The mortality associations of 2 min/hr less sedentary duration in conjunction with 2 min/hr more (tradeoff) spent in one of the low, light, or moderate/vigorous activity durations while controlling for the other two activity durations were examined in multivariable Cox regression models in the entire cohort and in the CKD subgroup.Results
Of the 3626 participants included, 383 had CKD. The mean sedentary duration was 34.4±7.9 min/hr in the entire cohort and 40.8±6.8 in the CKD subgroup. Tradeoff of sedentary duration with low activity duration was not associated with mortality in the entire cohort or the CKD subgroup. Tradeoff of sedentary duration with light activity duration was associated with a lower hazard of death in the entire cohort (hazard ratio, 0.67; 95% confidence interval, 0.48 to 0.93) and CKD subgroup (hazard ratio, 0.59; 95% confidence interval, 0.35 to 0.98). Tradeoff of sedentary duration with moderate/vigorous activity duration had a nonsignificant lower hazard in the entire cohort and CKD subgroup.Conclusions
Patients with CKD are sedentary nearly two thirds of the time. Interventions that replace sedentary duration with an increase in light activity duration might confer a survival benefit.Subgroup analysis
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Epidemiology of cancer
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Background Although most people with relapsing onset multiple sclerosis (R-MS) eventually transition to secondary progressive multiple sclerosis (SPMS), little is known about disability progression in SPMS. Methods All R-MS patients in the Cardiff MS registry were included. Cox proportional hazards regression was used to examine a) hazard of converting to SPMS and b) hazard of attaining EDSS 6.0 and 8.0 in SPMS. Results 1611 R-MS patients were included. Older age at MS onset (hazard ratio [HR] 1.02, 95%CI 1.01–1.03), male sex (HR 1.71, 95%CI 1.41–2.08), and residual disability after onset (HR 1.38, 95%CI 1.11–1.71) were asso- ciated with increased hazard of SPMS. Male sex (EDSS 6.0 HR 1.41 [1.04–1.90], EDSS 8.0 HR 1.75 [1.14–2.69]) and higher EDSS at SPMS onset (EDSS 6.0 HR 1.31 [1.17–1.46]; EDSS 8.0 HR 1.38 [1.19–1.61]) were associated with increased hazard of reaching disability milestones, while older age at SPMS was associated with a lower hazard of progression (EDSS 6.0 HR 0.94 [0.92–0.96]; EDSS 8.0: HR 0.92 [0.90–0.95]). Conclusions Different factors are associated with hazard of SPMS compared to hazard of disability progres- sion after SPMS onset. These data may be used to plan services, and provide a baseline for comparison for future interventional studies and has relevance for new treatments for SPMS RobertsonNP@cardiff.ac.uk
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epiweek creates epidemiological week and equivalent epidemiological year from the calendar date. It extends the week function of Stata. Each epidemiological week begins on a Sunday and ends on Saturday. And the first epidemiological week of year ends on the first Saturday of January, provided that it falls at least four or more days into the month. epiweek2 converts epidemiological week and epidemiological year to the calendar date with the starting Sunday and the ending Saturday.
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The hazard ratio and median survival time are the routine indicators in survival analysis. We briefly introduced the relationship between hazard ratio and median survival time and the role of proportional hazard assumption. We compared 110 pairs of hazard ratio and median survival time ratio in 58 articles and demonstrated the reasons for the difference by examples. The results showed that the hazard ratio estimated by the Cox regression model is unreasonable and not equivalent to median survival time ratio when the proportional hazard assumption is not met. Therefore, before performing the Cox regression model, the proportional hazard assumption should be tested first. If proportional hazard assumption is met, Cox regression model can be used; if proportional hazard assumption is not met, restricted mean survival times is suggested.风险比（hazard ratio，HR）和中位生存时间是生存分析时的常规分析和报告指标。本文简要介绍了HR和中位生存时间的关系以及比例风险假定在这两者之间的作用，分析了检索出的58篇文献中的110对风险比和中位生存时间比的差异，并通过实例阐明了产生这种差异的原因。结果表明，在不满足比例风险假定时，Cox回归模型计算得到的风险比是不合理的，且与中位生存时间之比不等价。因此，在使用Cox回归模型前，应先进行比例风险假定的检验，只有符合比例风险假定时才能使用该模型；当不符合比例风险假定时，建议使用限制性平均生存时间。.
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The epidemiology of atopic dermatitis, F. Schultz Larsen epidemiology of contract dermatitis, H.A. Smit and P.J. Coenraads epidemiology of urticaria, T. Schafer and J. Ring epidemiology of allergic rhinitis, B. Sibbald epidemiology of asthma, M.L. Burr epidemiology of allergic occupational lung diseases, K.M. Venables epidemiology of food related clinical symptoms in childhood, S. Strobel epidemiology of insect sting allergy, U.R. Muller epidemiology of allergic drug reactions, R. Hoigne, et al genetic aspects of atopy, W.O.C.M. Cookson epidemiology of factors which promote or protect against allergy, L. Nilsson and B. Bjorksten.
Atopy
Sting
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