Differences in the relationship between diabetes and prostate cancer among Black and White non-Hispanic men.

PURPOSE: Studies finding lower incidence rates of prostate cancer among men with diabetes have been primarily conducted in White non-Hispanic (WNH) populations. The purpose of this analysis is to compare the relationship between diabetes and prostate cancer among Black (BNH) and White non-Hispanic men. METHODS: We used Surveillance, Epidemiology, and End Results (SEER)-Medicare data from 2011 to 2015 to compare incidence rates and tumor characteristics between BNH and WNH men by diabetes status. Age-adjusted incidence rates and corresponding rate ratios (RR) by diabetes status were calculated overall and by tumor grade, stage, and PSA level separately for BNH and WNH men. We used multivariable logistic regression to compare tumor characteristics among men with prostate cancer in the numerator, both within and across race/ethnic groups. RESULTS: Overall age-adjusted incidence rates were significantly lower in men with diabetes compared to those without among WNH men [RR = 0.88 95% Confidence Interval (CI) 0.86-0.90] but there was no difference in rates by diabetes status among BNH men (RR = 1.01 95% CI 0.96-1.07). Men with diabetes were less likely to be diagnosed with distant-staged tumors compared to those without diabetes in both race/ethnic groups but the magnitude of difference by diabetes status was greater in BNH [Odds Ratio (OR) = 0.52 95% CI 0.42-0.64] than WNH (OR = 0.88 95% CI 0.81-0.95) men (p-value for interaction < 0.001). CONCLUSION: The relationship between diabetes and prostate cancer differed between BNH and WNH men. The differences could have implications in evaluating the effectiveness of prostate cancer screening in men with diabetes across racial/ethnic subgroups.

Overwintering fires in boreal forests.

Forest fires are usually viewed within the context of a single fire season, in which weather conditions and fuel supply can combine to create conditions favourable for fire ignition-usually by lightning or human activity-and spread1-3. But some fires exhibit 'overwintering' behaviour, in which they smoulder through the non-fire season and flare up in the subsequent spring4,5. In boreal (northern) forests, deep organic soils favourable for smouldering6, along with accelerated climate warming7, may present unusually favourable conditions for overwintering. However, the extent of overwintering in boreal forests and the underlying factors influencing this behaviour remain unclear. Here we show that overwintering fires in boreal forests are associated with hot summers generating large fire years and deep burning into organic soils, conditions that have become more frequent in our study areas in recent decades. Our results are based on an algorithm with which we detect overwintering fires in Alaska, USA, and the Northwest Territories, Canada, using field and remote sensing datasets. Between 2002 and 2018, overwintering fires were responsible for 0.8 per cent of the total burned area; however, in one year this amounted to 38 per cent. The spatiotemporal predictability of overwintering fires could be used by fire management agencies to facilitate early detection, which may result in reduced carbon emissions and firefighting costs.

Breast Cancer Characteristics and Survival among Users versus Nonusers of Raloxifene.

Raloxifene reduces breast cancer incidence. However, it is unclear whether it also reduces mortality from breast cancer. For raloxifene to reduce incidence but not mortality, breast cancer survival would have to be worse for raloxifene users than nonusers. Surveillance Epidemiology and End Results-Medicare was used to identify women with invasive breast cancer diagnosed from 2007 to 2015 at ages 65-89 who had prior Medicare Part D (prescription drug) enrollment; breast cancer characteristics and survival were assessed among raloxifene regular users (≥180 days in past year) versus nonusers. Logistic regression was used to assess cancer characteristics. Two methods utilizing proportional hazards models were employed to assess breast cancer-specific survival. In method 1, survival was assessed adjusting for demographics, mammography use, and chronic conditions in the subset with Medicare fee-for-service enrollment. In method 2, predicted survival as a function of breast cancer characteristics was modeled in nonusers and the model applied to users to predict survival. A total of 116,317 raloxifene nonusers and 1,223 regular users were identified. Users were significantly more likely to have hormone receptor (HR)-negative cancers, but less likely to have T2+, N1+, and metastatic disease. There were 10,869 and 101 breast cancer-related deaths in nonusers and regular users, respectively. The HR (users vs. nonusers) for breast cancer-specific survival in method 1 was 0.94 (95% confidence interval, 0.73-1.22). In method 2, predicted survival was higher in users than nonusers (8-year survival 84.9% vs. 83.4%). Breast cancer-specific survival in raloxifene users was not worse than in nonusers, providing indirect evidence that raloxifene reduces breast cancer-related mortality.

Design Principles for Enhancing Sensitivity in Paper-Based Diagnostics via Large-Volume Processing.

In this work, we characterize the impact of large-volume processing upon the analytical sensitivity of flow-through paper-based immunoassays. Larger sample volumes feature greater molar quantities of available analyte, but the assay design principles which would enable the rapid collection of this dilute target are ill-defined. We developed a finite-element model to explore the operating conditions under which processing large sample volumes via pressure-driven convective flow would yield an improved binding signal. Our simulation results underscore the importance of establishing a high local concentration of the analyte-binding species within the porous substrate. This elevated abundance serves to enhance the binding kinetics, matching the time scale of target capture to the period during which the sample is in contact with the test zone (i.e., the effective residence time). These findings were experimentally validated using the rcSso7d-cellulose-binding domain (CBD) fusion construct, a bifunctional binding protein which adsorbs to cellulose in high abundance. As predicted by our modeling efforts, the local concentration achieved using the rcSso7d-CBD species is uniquely enabling for sensitivity enhancement through large-volume processing. The rapid analyte depletion which occurs at this high surface density also permits the processing of large sample volumes within practical time scales and flow regimes. Using these findings, we present guidance for the optimal means of processing large sample volumes for enhanced assay sensitivity.

Racial and Ethnic Differences in a Linkage with the National Death Index.

OBJECTIVES: Differences in the availability of a Social Security Number (SSN) by race/ethnicity could affect the ability to link with death certificate data in passive follow-up studies and possibly bias mortality disparities reported with linked data. Using 1989-2009 National Health Interview Survey (NHIS) data linked with the National Death Index (NDI) through 2011, we compared the availability of a SSN by race/ethnicity, estimated the percent of links likely missed due to lack of SSNs, and assessed if these estimated missed links affect race/ethnicity disparities reported in the NHIS-linked mortality data. METHODS: We used preventive fraction methods based on race/ethnicity-specific Cox proportional hazards models of the relationship between availability of SSN and mortality based on observed links, adjusted for survey year, sex, age, respondent-rated health, education, and US nativity. RESULTS: Availability of a SSN and observed percent linked were significantly lower for Hispanic and Asian/Pacific Islander (PI) participants compared with White non-Hispanic participants. We estimated that more than 18% of expected links were missed due to lack of SSNs among Hispanic and Asian/PI participants compared with about 10% among White non-Hispanic participants. However, correcting the observed links for expected missed links appeared to only have a modest impact on mortality disparities by race/ethnicity. CONCLUSIONS: Researchers conducting analyses of mortality disparities using the NDI or other linked death records, need to be cognizant of the potential for differential linkage to contribute to their results.

Characteristics of Medicare Advantage and Fee-for-Service Beneficiaries Upon Enrollment in Medicare at Age 65.

Previous research has found differences in characteristics of beneficiaries enrolled in Medicare fee-for-service versus Medicare Advantage (MA), but there has been limited research using more recent MA enrollment data. We used 1997-2005 National Health Interview Survey data linked to 2000-2009 Medicare enrollment data to compare characteristics of Medicare beneficiaries before their initial enrollment into Medicare fee-for-service or MA at age 65 and whether the characteristics of beneficiaries changed from 2006 to 2009 compared with 2000 to 2005. During this period of MA growth, the greatest increase in enrollment appears to have come from those with no chronic conditions and men.

The relationship between linkage refusal and selected health conditions of survey respondents.

To maximize limited resources and reduce respondent burden, there is an increased interest in linking population health surveys with other sources of data, such as administrative records. Health differences between adults who consent to and refuse linkage could bias study results with linked data. National Health Interview Survey (NHIS) data are routinely linked to administrative records from the Social Security Administration and the Centers for Medicare and Medicaid Services. Using the NHIS 2010-2013, we examined the association between selected health conditions and respondents' linkage refusal. Linkage refusal was significantly lower for adults with serious psychological distress, chronic obstructive pulmonary disease, diabetes, heart disease, stroke, hypertension, and cancer compared to those without these conditions. Linkage refusal decreased as the number of conditions increased and health status decreased. Our finding that linkage consent was associated with respondents' health characteristics suggests that researchers should try to address potential linkage bias in their analyses.

Linkage of NCHS Population Health Surveys to Administrative Records From Social Security Administration and Centers for Medicare Medicaid Services.

Federally sponsored health surveys are a critical source of information on public health in the United States. The National Center for Health Statistics (NCHS) is the nation's principal health statistics agency and is responsible for collecting accurate, relevant, and timely data. NCHS conducts several population-based national surveys as well as collecting vital statistics data, which are used by a broad range of users (researchers and policy makers, among others) to evaluate and profile the health of the American people. These national health surveys provide rich cross-sectional information on risk factors such as smoking, height and weight, health status, and socioeconomic circumstances, but information on longitudinal outcomes is often missing. Demand is increasing to incorporate information from additional sources in order to enhance the availability and quality of information on exposures and outcomes.

Serious Psychological Distress Among Adults: United States, 2009-2013.

In every age group, women were more likely to have serious psychological distress than men. Among all adults, as income increased, the percentage with serious psychological distress decreased. Adults aged 18-64 with serious psychological distress were more likely to be uninsured (30.4%) than adults without serious psychological distress (20.5%). More than one-quarter of adults aged 65 and over with serious psychological distress (27.3%) had limitations in activities of daily living. Adults with serious psychological distress were more likely to have chronic obstructive pulmonary disease, heart disease, and diabetes than adults without serious psychological distress.

Cancer in relation to socioeconomic status: stage at diagnosis in Texas, 2004-2008.

OBJECTIVES: To determine whether stage of cancer diagnosis was associated with the socioeconomic status (SES) of the census tract where the patient resides, and to assess whether this is modified by race, ethnicity, or urban/rural residence, other factors known to affect cancer diagnosis stage. METHODS: Using 2004-2008 data from the Texas Cancer Registry, we examined the distribution of stage at diagnosis in Texas residents for 15 cancer sites by the SES of the census tract of residence. Stage at diagnosis was categorized into the summary stage categories of early (in situ [preinvasive disease] and localized) and late stage (regional and distant spread). Age-adjusted odds ratios for late-stage versus early-stage cancer diagnosis in low versus high SES census tracts were evaluated by cancer site, race, ethnicity, and urban versus rural residence. RESULTS: For most cancer sites, late-stage cancer diagnosis increased with decreasing SES. These findings were consistent by cancer site, race, ethnicity, and in urban and rural areas of the state. CONCLUSIONS: For most cancer sites, particularly those likely to have patients diagnosed early by screening, late-stage cancer diagnosis is increased in Texas populations residing in lower SES census tracts compared with higher SES census tracts.

Cancer survival among Latinos and the Hispanic Paradox.

BACKGROUND: Cancer survival is a key indicator of the effectiveness and social justice of health services. However, little is known about cancer survival among Hispanics, how it varies by Hispanic subgroup (Mexicans, Puerto Ricans, Cubans, and Others), and how their survival patterns relate to the Hispanic Paradox. METHODS: We studied all 1.2 million cancer cases diagnosed during 1995-2003, in two states, Florida and Texas, according to three categories of outcome: highly fatal outcome, poor outcome, and moderate outcome. All were followed up until December 31, 2006. We calculated survival rates for each Hispanic subgroup, and using Cox regression, we studied the risk of death for each Hispanic subgroup compared with non-Hispanic Whites, adjusted for age, cancer site, and stage at diagnosis. RESULTS: Important differences in cancer survival were found according to Hispanic subgroup. For cancers of moderate outcome, the adjusted risk of death was higher among all Hispanic populations in comparison with non-Hispanic Whites: 6% higher for Cubans, 11% for Puerto Ricans, and 13% for US-born Mexicans. Foreign-born Mexicans, even with incomplete follow-up, had a 24% higher risk of death. For foreign-born Hispanics, except Cubans, the mortality follow-up of cancers of highly fatal outcome was insufficient, resulting in missing deaths and thus unrealistically high survival rates. CONCLUSIONS: No evidence of a Hispanic advantage was found in cancer survival. Improvement in mortality follow-up procedures for Latinos, especially for those without a valid social security number, is critical. By considering Hispanics as a whole rather than by subgroup, existing survival disparities are being missed.

County-level socioeconomic status and cancer rates in Texas, 2001-2005.

Previous studies have shown that a person's socioeconomic status (SES) (a proxy measure that can incorporate income, wealth, education, and occupation) is associated with cancer incidence and mortality. Examining variation in cancer rates by SES can help identify health disparities and target areas for cancer control activities. The Texas Cancer Registry (TCR) collects data on every newly diagnosed case of cancer in Texas, including personal and demographic data, but does not collect data related directly to SES. Using a county-level measure of SES determined by the 2000 US Census, we compared cancer incidence and mortality rates for selected cancer sites by counties categorized into Low, Intermediate, and High SES. The cancers examined in this analysis included lung, colorectal, female breast, prostate, cervical, and all cancers collected by TCR combined. Consistent with other studies, most incidence and mortality rates were lowest in the High SES counties. However, in general, the highest incidence and mortality rates were found in counties categorized as Intermediate SES, but patterns differed by cancer site and by race and ethnicity. This study provides additional evidence that geographically related SES is associated with cancer incidence and mortality.