Racial disparities in nephrectomy and mortality among patients with renal cell carcinoma: Findings from SEER.

PURPOSE: To assess racial differences in the receipt of nephrectomy in patients diagnosed RCC in the US. MATERIALS AND METHODS: 2005 to 2015 data from the SEER database was analyzed and 70,059 patients with RCC were identified. We compared demographic and tumor characteristics between black patients and white patients. We applied logistic regression to assess the association between race and the odds of the receipt of nephrectomy. We also applied Cox proportional hazards model to assess the impact of race on cancer-specific mortality (CSM) and all-cause mortality (ACM) in patients diagnosed with RCC in the US. RESULTS: Black patients had 18% lower odds of receiving nephrectomy compared to white patients (p < 0.0001). The odds of the receipt of nephrectomy also reduced with age at diagnosis. In addition, patients with T3 stage had the greatest odds of receiving nephrectomy when compared to T1 (p < 0.0001). There was no difference in the risk of cancer-specific mortality between black patients and white patients; black patients had 27% greater odds of all-cause mortality than white patients (p < 0.0001). Patients who did not receive nephrectomy had a 42% and 35% higher risk of CSM and ACM respectively, when compared to patients who received nephrectomy. CONCLUSIONS: Black patients diagnosed with RCC in the US have a greater ACM risk and are less likely than white patients to receive nephrectomy. Systemic changes are needed to eliminate racial disparity in the treatment and outcomes of RCC in the US.

Trends in age and sex-specific prevalence of cancer and cancer subtypes in acute ischemic stroke from 2007-2019.

OBJECTIVE: To describe age and sex-specific prevalence of cancer in acute ischemic stroke (AIS) hospitalizations in the United States over the last decade. METHODS: We conducted a retrospective serial cross-sectional study using all primary AIS discharges (weighted n=5,748,358) with and without cancer in the 2007-2019 National Inpatient Sample. Admissions with primary central nervous system cancers were excluded. Joinpoint regression was used to compute the average annualized percentage change (AAPC) in cancer prevalence over time. RESULTS: Across the study period, 12.7% of AIS admissions had previous/active cancer, while 4.4% had active cancer. Of these, 18.8% were hematologic cancers, 47.2% were solid cancers without metastasis and 34.0% were metastatic cancers of any type. Age-adjusted active cancer prevalence differed by sex (males:4.8%; females:4.0%) and increased with age up to age 70-79 years (30-39 years 1.4%; 70-79 years:5.7%). Amongst cancer admissions, lung (18.7%) and prostate (17.8%) were the most common solid cancers in men, while lung (19.6%) and breast (13.7%) were the most prevalent in women. Active cancer prevalence increased over time (AAPC 1.7%, p<0.05) but the pace of increase was significantly faster in women (AAPC 2.8%) compared to men (AAPC 1.1%) (p-comparison =0.003). Fastest pace of increased prevalence was seen for genitourinary cancers in women and for gastrointestinal cancers in both sexes. Genitourinary cancers in men declined over time (AAPC -2.5%, p<0.05). Lung cancer prevalence increased in women (AAPC 1.8%, p<0.05) but remained constant in men. Prevalence of head/neck, skin/bone, gastrointestinal, hematological and metastatic cancers increased over time at similar pace in both sexes. CONCLUSION: Prevalence of cancer in AIS admissions increased in the US over the last decade but the pace of this increase was faster in women compared to men. Gastrointestinal cancers in both sexes and genitourinary cancers in women are increasing at the fastest pace. Additional studies are needed to determine whether this increase is from co-occurrence or causation of AIS by cancer.

Association of combustible and non-combustible tobacco use with clinically diagnosed adverse oral health outcomes among US adults, National Health and Nutrition Examination Survey (2009-2014).

INTRODUCTION: There is an established link between tobacco use and adverse oral health outcomes. However, there is a paucity of research exploring the effect of various tobacco products on clinically diagnosed adverse oral health outcomes. METHODS: Data were pooled from three cycles of the National Health and Nutrition Examination Survey: 2009-2010; 2011-2012; and 2013-2014 (n = 11,453). Multivariable logistic regressions examined the associations between periodontitis and dental caries with the type of tobacco product used (combustible, non-combustible or both). RESULTS: Overall, 42.3% of the study sample had any periodontitis, 7.8% had severe periodontitis and 21.7% had dental caries. There was a higher prevalence of periodontitis and caries among combustible tobacco users than non-combustible tobacco use; 62.1% of combustible tobacco smokers had any periodontitis, 17.1% had severe periodontitis, while 39.4% of adults with dental caries were dual users. Compared to non-smokers, combustible tobacco use increased the odds of any periodontitis (adjusted odds ratio [aOR] 2.81, 95% confidence interval [CI] 2.28, 3.45) and severe periodontitis (aOR 2.62, 95% CI 1.90, 3.61). Compared to non-smokers, both combustible tobacco (aOR 2.11, 95% CI 1.61, 2.76) and non-combustible tobacco use (aOR 2.09, 95% CI 1.19, 3.66) increased the odds of dental caries. DISCUSSION AND CONCLUSIONS: In this study of US adults, combustible tobacco use was associated with periodontitis and dental caries, while non-combustible tobacco use was associated with dental caries. In addition to conducting extensive oral health screening among all smokers, oral health-care providers should counsel smokers on the need for smoking cessation.