Revisiting the Calculation for a Novel Measure of Average Lifespan Shortened: Real-World Examples From Cervical and Ovarian Cancers in Alberta, Canada, 2000 - 2020.

In this technical note, we primarily demonstrate the computation of confidence limits for a novel measure of average lifespan shortened (ALSS). We identified women who had died from cervical and ovarian cancer between 2000 and 2020 from the Alberta cancer registry. Years of life lost (YLL) was calculated using the national life tables of Canada. We estimated the ALSS as a ratio of YLL in relation to the expected lifespan. We computed the confidence limits of the measure using various approaches, including the normal distribution, gamma distribution, and bootstrap method. The new ALSS measure shows a modest gain in lifespan of women, particularly women with ovarian cancer, over the study period.

Average lifespan shortened due to cancer in selected countries of North America, Europe, Asia and Oceania, 2006 and 2016.

PURPOSE: We applied a novel measure of average lifespan shortened (ALSS) to examine changes in lifespan among patients who died of cancer over a 10-year period from 2006 to 2016 in 20 selected high-income countries from North America, Europe, Asia, and Oceania. METHODS: We retrieved cancer deaths in each country from the World Health Organization mortality database. We calculated ALSS as a ratio of years of life lost to the expected lifespan among patients who died from cancer. RESULTS: Between 2006 and 2016, we observed modest changes in ALSS for overall cancer deaths over the study in many countries. The changes in the ALSS over time due to any cancer ranged between -1.7 and +0.4 percentage points (pps) among men and between -1.9 and +0.6 pps among women. Across countries, overall cancer deaths led to an average loss between 16% and 22% of their lifespan in men, and between 18% and 24% in women. Across cancer sites, patients who died of central nervous system cancers, for instance, lost a large proportion of their lifespan. CONCLUSIONS: In this study, we demonstrated the use of ALSS across selected high-income countries, which enables population-level assessment of premature mortality among cancer patients over time.

Predicting the Risk Factors Associated With Severe Outcomes Among COVID-19 Patients-Decision Tree Modeling Approach.

Background: The COVID-19 pandemic has seen a large surge in case numbers over several waves, and has critically strained the health care system, with a significant number of cases requiring hospitalization and ICU admission. This study used a decision tree modeling approach to identify the most important predictors of severe outcomes among COVID-19 patients. Methods: We identified a retrospective population-based cohort (n = 140,182) of adults who tested positive for COVID-19 between 5th March 2020 and 31st May 2021. Demographic information, symptoms and co-morbidities were extracted from a communicable disease and outbreak management information system and electronic medical records. Decision tree modeling involving conditional inference tree and random forest models were used to analyze and identify the key factors(s) associated with severe outcomes (hospitalization, ICU admission and death) following COVID-19 infection. Results: In the study cohort, nearly 6.37% were hospitalized, 1.39% were admitted to ICU and 1.57% died due to COVID-19. Older age (>71Y) and breathing difficulties were the top two factors associated with a poor prognosis, predicting about 50% of severe outcomes in both models. Neurological conditions, diabetes, cardiovascular disease, hypertension, and renal disease were the top five pre-existing conditions that altogether predicted 29% of outcomes. 79% of the cases with poor prognosis were predicted based on the combination of variables. Age stratified models revealed that among younger adults (18-40 Y), obesity was among the top risk factors associated with adverse outcomes. Conclusion: Decision tree modeling has identified key factors associated with a significant proportion of severe outcomes in COVID-19. Knowledge about these variables will aid in identifying high-risk groups and allocating health care resources.

Expected Cost Savings From Low-Dose Computed Tomography Scan Screening for Lung Cancer in Alberta, Canada.

Introduction: The expensive modern therapeutic regimens for advanced lung cancer (LC) stages have been recently approved. We evaluated whether low-dose computed tomography (LDCT) LC screening of high-risk Albertans is cost saving. Methods: We used a decision analytical modeling technique with a health system perspective and a time horizon of 3 years to compare benefits associated with reduced health service utilization (HSU) from earlier diagnosis to the costs of screening. Using patient-level data, HSU costs by stage of disease were estimated for patients with LC, including inpatient, outpatient, and physician services, and costs for prescription drugs and cancer treatments. Results: Of 101,000 people aged 55 to 74 years eligible for screening, an estimated 88,476 scans would be performed in Alberta in 3 years. Given LDCT sensitivity and specificity of 90.5% and 93.1%, respectively, we estimated that a stage shift toward earlier diagnosis would be expected whereby 43% more patients would be identified at stage 1 or 2 as compared with without screening. The estimated cost of screening is $35.6 million (M), whereas the stage shift associated with screening would avoid $42M in HSU costs. The net cost avoidance associated with screening is therefore $6.65M. The probability for the screening to be cost saving is estimated at 72%. Conclusions: This study has revealed that LDCT LC screening is likely to be cost saving in Alberta. Adoption of this program into the provincial health care system is worth considering provided constraints in the system related to surgical capacity and CT wait times could be addressed.

Average lifespan shortened due to Hodgkin lymphoma, non-Hodgkin lymphoma, multiple myeloma, and leukemia in Japan, 1990-2015.

We examined whether there were gains in lifespan among patients who died from hematological cancers in Japan between 1990 and 2015 using the novel average lifespan shortened (ALSS) measure. We obtained mortality data from the World Health Organization mortality database. Years of life lost (YLL) was calculated using Japanese life tables. ALSS measure was calculated as a ratio of YLL to the expected lifespan. The ALSS results showed that the lifespan of patients who died from hematological cancers has improved over time. For instance, women who died of leukemia in 1990 lost about 34% of their lifespan; conversely, those who died in 2015 lost about 20%. Likewise, men dying from non-Hodgkin lymphoma lost about 22% of their lifespan in 1990, whereas men lost about 14% in 2015. In summary, the new ALSS measure shows prolonged lifespans among patients who died from hematological cancers in Japan over the study period.

Changes in Survival Outcomes of Patients With Neuroendocrine Neoplasms Over the Past 15 Years: A Real-World Study.

BACKGROUND: The past 2 decades have observed a number of advances in therapeutic approaches to patients with neuroendocrine neoplasms (NENs). This study aims to assess whether survival outcomes have changed among patients with NENs over the past 15 years, in a real-world, population-based study. MATERIALS AND METHODS: We accessed administrative databases within the province of Alberta, Canada, and we reviewed patients with invasive NENs diagnosed 2004 to 2019. Patients were classified according to the year of diagnosis into 3 groups: 2004 to 2008; 2009 to 2013; and 2014 to 2019. Kaplan-Meier survival estimates were used to compare overall survival (OS) according to different baseline characteristics (including the year of diagnosis). Multivariable Cox regression modeling was used to examine factors associated with the risk of death in this cohort. RESULTS: We included a total of 3431 patients in the study cohort. Using multivariable Cox regression analysis, the following factors were associated with worse survival: older age at diagnosis (hazard ratio [HR]: 3.45; 95% CI [confidence interval]: 2.74-4.35), male sex (HR: 1.38; 95% CI: 1.21-1.56), lung primary site (HR for lung vs. appendicular primary: 1.39; 95% CI: 1.01-1.92), Stage 4 disease (HR: 2.80; 95% CI: 2.38-3.30), South zone of the province (HR for South zone vs. Calgary zone: 1.85; 95% CI: 1.49-2.30), and higher comorbidity index (HR for ≥3 vs. 0: 2.66; 95% CI: 2.19-3.24). Although Kaplan-Meier method showed significant difference in OS according to diagnosis period, multivariable regression model showed that the period of diagnosis did not appear to impact OS (HR for diagnosis period 2004 to 2009 vs. 2014 to 2019: 1.04; 95% CI: 0.89-1.22). CONCLUSIONS: Over the study period (2004 to 2019), patients diagnosed during later periods did not appear to experience better OS compared with patients diagnosed at an earlier time.

Patterns and predictors of relapse in Merkel cell carcinoma: Results from a population-based study.

BACKGROUND AND PURPOSE: Prospective data evaluating the role of adjuvant radiotherapy (RT) for Merkel Cell Carcinoma(MCC) is lacking. To better understand the efficacy of adjuvant RT, a population-based patterns of failure study was conducted. METHODS: We identified MCC patients treated from 1988 to 2018.Primary outcome measures were recurrence-free survival (RFS), overall survival (OS) and MCC-specific survival (MCC-SS). Charlson Co-morbidity Index (CCI) was also calculated. RESULTS: 217 patients with mean age 79 (range: 33-96) were analyzed. The median follow-up was 40 months. Treatments were: surgery(S) alone (n = 101, 45%) or S + RT(n = 116, 55%).Local recurrence (LR) was low in stage I (n = 6, 6.5%) with clear margin of ≥1 cm, negative sentinel lymph node biopsy (SLNB) without high-risk factors, irrespective of adjuvant RT. Tumor size ≥ 2 cm (HR:2.95; p = 0.024) and immunosuppression(HR:3.98; p = 0.001) were associated with high risk of nodal failure. Adjuvant RT was associated with significant reduction in regional failure (HR:0.36; p = 0.002). Distant metastases (DM) were infrequent in stage I (4/90) and stage II (4/34), compared to stage III (32/93). Adjuvant RT improvedRFS but did not influence MCC-SS and OS. CCI was a significant predictor of OS. CONCLUSIONS: Adjuvant RT improvedRFS, withoutimpact on MCC-SS and OS. Co-morbidity rather than RT influenced OS. Adjuvant RT may be avoided instage I patients with negative SLNB and no associated high-risk factors. Prophylactic RNI could be considered in stage II with high risk features, inspite of negative SLNB. Stage III patients benefited from adjuvant RNI, but no impact on prevention of DM.

Average lifespan shortened due to breast cancer in Australia, 1990-2015.

BACKGROUND: This short report aims to investigate changes in lifespan of Australian women with breast cancer using the novel average lifespan shortened (ALSS) measure METHODS: We obtained the mortality data of Australian women with breast cancer from the World Health Organization mortality database for the 1990-2015 period. We calculated the age-standardized rate (ASR) according to the World Standard Population. We estimated the ALSS as a ratio of years of life lost in relation to the expected lifespan to examine changes in lifespan of Australian women with breast cancer over the study period. RESULTS: Over a 25-year period, the ASR of breast cancer deaths decreased from 20.5 to 12.6 deaths per 100,000 women. We observed a decline in ALSS values from 24.0% of their lifespan in 1990 to 22.0% in 2015. CONCLUSION: The novel ALSS measure indicates an improvement of two percentage points in the lifespan of Australian women with breast cancer over the study.

Hospital-based acute care in the last 30 days of life among patients with chronic disease that received early, late or no specialist palliative care: a retrospective cohort study of eight chronic disease groups.

OBJECTIVE: For eight chronic diseases, evaluate the association of specialist palliative care (PC) exposure and timing with hospital-based acute care in the last 30 days of life. DESIGN: Retrospective cohort study using administrative data. SETTING: Alberta, Canada between 2007 and 2016. PARTICIPANTS: 47 169 adults deceased from: (1) cancer, (2) heart disease, (3) dementia, (4) stroke, (5) chronic lower respiratory disease (chronic obstructive pulmonary disease (COPD)), (6) liver disease, (7) neurodegenerative disease and (8) renovascular disease. MAIN OUTCOME MEASURES: The proportion of decedents who experienced high hospital-based acute care in the last 30 days of life, indicated by ≥two emergency department (ED) visit, ≥two hospital admissions,≥14 days of hospitalisation, any intensive care unit (ICU) admission, or death in hospital. Relative risk (RR) and risk difference (RD) of hospital-based acute care given early specialist PC exposure (≥90 days before death), adjusted for patient characteristics. RESULTS: In an analysis of all decedents, early specialist PC exposure was associated with a 32% reduction in risk of any hospital-based acute care as compared with those with no PC exposure (RR 0.69, 95% CI 0.66 to 0.71; RD 0.16, 95% CI 0.15 to 0.17). The association was strongest in cancer-specific analyses (RR 0.53, 95% CI 0.50 to 0.55; RD 0.31, 95% CI 0.29 to 0.33) and renal disease-specific analyses (RR 0.60, 95% CI 0.43 to 0.84; RD 0.22, 95% CI 0.11 to 0.34), but a~25% risk reduction was observed for each of heart disease, COPD, neurodegenerative diseases and stroke. Early specialist PC exposure was associated with reducing risk of four out of five individual indicators of high hospital-based acute care in the last 30 days of life, including ≥two ED visit,≥two hospital admission, any ICU admission and death in hospital. CONCLUSIONS: Early specialist PC exposure reduced the risk of hospital-based acute care in the last 30 days of life for all chronic disease groups except dementia.

Average Lifespan Shortened due to Stroke in Canada: A Nationwide Descriptive Study From 1990 to 2015.

BACKGROUND AND PURPOSE: There are challenges in comparability when using existing life lost measures to examine long-term trends in premature mortality. To address this important issue, we have developed a novel measure termed average lifespan shortened (ALSS). In the present study, we used the ALSS measure to describe temporal changes in premature mortality due to stroke in the Canadian population from 1990 to 2015. METHODS: Mortality data for stroke were obtained from the World Health Organization mortality database. Years of life lost was calculated using Canadian life tables. ALSS was calculated as the ratio of years of life lost in relation to the expected lifespan. RESULTS: Over a 25-year timeframe, the age-standardized rates adjusted to the World Standard Population for deaths from all strokes and stroke types substantially decreased in both sexes. The ALSS measure indicated that men who died of stroke lost 12.1% of their lifespan in 1990 and 11.4% in 2015, whereas these values among women were 11.1% and 10.0%, respectively. Patients with subarachnoid hemorrhagic stroke lost the largest portion whereby both sexes lost about one-third of their lifespan in 1990 and one-fourth in 2015. Men with intracerebral hemorrhagic stroke lost around 18% of their lifespan in 1990 and 14% in 2015 as compared to women who lost about 16% and 12% over the same timeframe. The loss of lifespan for patients with ischemic stroke and other stroke types combined was relatively stable at about 10% throughout the study period. CONCLUSIONS: Our study demonstrated a modest improvement in lifespan among patients with stroke in Canada between 1990 and 2015. Our novel ALSS measure provides intuitive interpretation of temporal changes in lifespan among patients with stroke and helps to enhance our understanding of the burden of strokes in the Canadian population.

Premature Mortality Due to Hodgkin Lymphoma, Non-Hodgkin Lymphoma, Multiple Myeloma, and Leukemia in Canada: A Nationwide Analysis From 1980 to 2015.

Recently, we introduced a novel measure of "average life span shortened" (ALSS) to improve comparability of premature mortality over time. In this study, we applied this novel measure to examine trends in premature mortality caused by hematological cancers in Canada from 1980 to 2015. Mortality data for Hodgkin lymphoma, non-Hodgkin lymphoma, multiple myeloma, and leukemia were obtained from the World Health Organization mortality database. Years of life lost was calculated according to Canadian life tables. ALSS was defined as the ratio between years of life lost and expected life span. Over the study period, age-standardized rates of mortality decreased for all types of hematological cancers. Our new ALSS measure showed favorable trends in premature mortality for all types of hematological cancers among both sexes. For instance, men with non-Hodgkin lymphoma lost an average of 23.7% of their life span in 1980 versus 16.1% in 2015, while women with non-Hodgkin lymphoma lost an average of 21.7% of their life span in 1980 versus 15.5% in 2015. Results from this study showed that patients with hematological cancers experienced prolonged survival over a 35-year period although the magnitude of these life span gains varied by types of hematological cancers.

No new community COVID-19 infection in four consecutive weeks: what lesson can be learned from Vietnam.

Sharing a common land border with China, Vietnam has faced a high risk of transmission of Coronavirus Disease 2019 (COVID-19). Rapid decision making and robust public health measures were established by the Vietnamese Government to control the situation. As of 17 May 2020, Vietnam reported 320 total confirmed cases of COVID-19, of whom 260 had fully recovered, while the remaining 60 cases were still under treatment. Noteworthy, the current data still confirms zero deaths and within the last 32 consecutive days prior to this submission, there have been no new infections in the country. Valuable lessons from Severe Acute Respiratory Syndrome in 2003 such as use of quarantine, early recognition and quick response to the infection, and increased awareness of its citizens have put Vietnam in a somewhat better position against COVID-19 compared to other places. Vietnam, at the current time, mulls declaring an end of the current COVID-19 outbreak.

Premature mortality due to stomach cancer in Japan: a nationwide analysis from 1980 to 2015.

PURPOSE: Premature mortality offers an alternative approach for monitoring the burden of mortality; however, little is known about its measures for stomach cancer. In the present study, we investigated temporal changes in premature mortality because of stomach cancer in the Japanese population from 1980 to 2015. METHODS: Mortality data for stomach cancer were obtained from the World Health Organization mortality database. Years of life lost (YLL) was calculated using Japanese life tables. The average lifespan shortened was calculated and defined as the ratio of YLL in relation to the expected lifespan. RESULTS: Over a 35-year time frame, the age-standardized rates adjusted to the World Standard Population for deaths from stomach cancer substantially decreased in both sexes. The results from the average YLL (AYLL) measure showed that lifespan of stomach cancer patients was prolonged by about 3 and 5 years in men and women, respectively. The average lifespan shortened measure showed that stomach cancer led to a loss of 18.5% of lifespan among men and of 21.9% among women in 1980, but these numbers were reduced to 13.6% and 14.5%, respectively, in 2015. CONCLUSIONS: Our study demonstrated decreasing trends in premature mortality for stomach cancer in Japan over a 35-year period.

Premature deaths due to head and neck cancers in canada: A nationwide analysis from 1980 to 2010.

OBJECTIVES/HYPOTHESIS: To examine if there has been a reduction in premature mortality due to head and neck cancers and their subtypes in the Canadian population between 1980 and 2010. STUDY DESIGN: Retrospective database review. METHODS: Mortality data for head and neck cancers were obtained from the World Health Organization's mortality database. Years of life lost (YLL) was calculated according to Canadian life tables. A new measure, average lifespan shortened (ALSS), was calculated as a ratio of YLL over the expected lifespan. RESULTS: During the period of interest, decreases in age standardized rates of death adjusted to the World Standard Population were observed mainly among men. The adjusted YLL rates remained unchanged with respect to oral cancers in women, but slightly decreased for oral cancers in men and for laryngeal cancers in both sexes. Our new measure of ALSS showed that in 1980, patients with oral cancers lost an average of 20% of their lifespan, whereas in 2010, men and women still lost approximately 20% and 18%, respectively. Patients with laryngeal cancers lost 18% of their lifespan in both sexes in 1980 and 17% in 2010. The ALSS subanalysis showed that the largest gain of lifespan was observed for cancers of the hypopharynx in men and for cancers of the floor of mouth and nasopharynx in women. CONCLUSIONS: There appears to be modest improvements in premature mortality due to head and neck cancers in Canada over a 30-year period, with the exception of oral cancers in men. Changes in premature mortality varied slightly by cancer subtypes. LEVEL OF EVIDENCE: NA Laryngoscope, 130:911-917, 2020.

Premature Mortality Due to Malignancies of the Kidney and Bladder in Japan, 1980-2010.

BACKGROUND: In the present study, we examined the trends of premature mortality due to kidney and bladder cancers among the Japanese population from 1980 through 2010. METHODS: Mortality data were obtained from the World Health Organization mortality database. Years of life lost (YLL) was estimated using Japanese life tables. Average lifespan shortened (ALSS) was calculated and defined as the ratio of years of life lost relative to the expected lifespan. RESULTS: Over the study period, the age-standardized rates to the World Standard Population for deaths from kidney and bladder cancers were stable. The average years of life lost (AYLL) measure shows decreases of about 4 and 6 years of life for kidney cancer in men and women, respectively, and decreases of about 2 years of life for bladder cancer in both sexes. The ALSS shows that patients with kidney cancer lost 21.0% and 24.7% of their lifespan among men and women in 1980, whereas respective losses were 15.3% and 15.8% in 2010. Also, patients with bladder cancer on average lost 13.5% in men and 14.2% in women in 1980 and 10.8% in men and 11.1% in women in 2010. CONCLUSIONS: Our study shows favorable trends in premature mortality for kidney and bladder cancers in Japan over a 30-year period; however, patients with bladder cancer on average lost a smaller proportion of their lifespan compared to those with kidney cancer. The development of a novel ALSS measure is convenient in examination of the burden of premature mortality over time.

Premature Mortality Due to Malignancies of the Central Nervous System in Canada, 1980-2010.

BACKGROUND: In this study, we investigated whether there has been an improvement in premature mortality due to central nervous system (CNS) cancers among the Canadian population from 1980 through 2010. METHODS: Mortality data for CNS cancers were obtained from World Health Organization mortality database. Years of life lost (YLL) was estimated using Canadian life tables. Average lifespan shortened (ALSS) was calculated and defined as the ratio of YLL relative to the expected lifespan. RESULTS: Over this study period, we observed decreases in age standardized rates to the World Standard Population for mortality due to CNS cancers from 5.3 to 4.1 per 100,000 men, and from 3.6 to 2.9 per 100,000 women. Average YLL decreased from 23.6 to 21.5 years of life among men, and from 27.0 to 23.1 years among women in 1980 and 2010, respectively. The ALSS showed that men with CNS cancers lost 30.1% of their life span and women lost 32.5% in 1980, whereas they lost 25.8 and 26.6% in 2010, respectively. CONCLUSION: Our study shows that -Canadian people with CNS cancers have had their lives prolonged at the end of the study period.

Premature mortality due to breast cancer among Canadian women: an analysis of a 30-year period from 1980 through 2010.

Background: Breast cancer is the most commonly diagnosed cancer and the second most common cause of cancer deaths for women. In the present study, we examined the trend of premature mortality due to breast cancer among Canadian women from 1980 through 2010 and proposed a new measure of lifespan shortening. Methods: Mortality data for female breast cancer was obtained from the World Health Organization mortality database. Years of life lost (YLL) was estimated using Canadian life tables. Average lifespan shortened (ALSS) that is calculated and expressed by a ratio of YLL relative to expected lifespan. Results: Over this study period, age-standardized rates of breast cancer mortality adjusted to World Standard Population decreased by 40% from 23.2 to 14.2 per 100 000 women. The adjusted YLL rates fell from 5.3 years per 1000 women to 3.3 years. On average women with breast cancer died 20.8 years prior to expected death in 1980 and 18.3 years early in 2010. A novel measure of lifespan shortening, the ALSS decreased from one-fourth of the lifespan in 1980 to one-fifth in 2010. Conclusions: Our study reports that among Canadian women with breast cancer, a smaller proportion of life was lost on average at the end of the study period. The 'life lost' measures presented in this study would be useful tools to monitor the pattern of premature mortality for chronic conditions. These measures gauge the effectiveness of the health system with respect to early detection and treatment.

The Impact of Hospital Discharge Linkage on Case Ascertainment of Brain Tumors in the Alberta Cancer Registry, 2010-2015.

BACKGROUND: Concern has been raised regarding the underreporting of nonmalignant central nervous system tumors. This study addressed this issue with 2 objectives: (1) evaluate the impact of linkage with hospital discharges, as recorded in the Discharge Abstract Database (DAD), on supplementing case ascertainment for brain tumors, and (2) identify potential barriers for initial registration of brain tumors in the Alberta Cancer Registry. METHODS: All patients with a brain tumor diagnosed and residing in Alberta from 2010 to 2015 were extracted, after the DAD review, from the Alberta Cancer Registry (ACR). Descriptive statistics were compiled by behavior and type of registration (originally registered or identified through DAD). The total number of expected nonmalignant brain tumors was estimated by applying the Central Brain Tumor Registry of the United States (CBTRUS) incidence rates to the Alberta population and this estimate was compared to observed numbers. Phi coefficients and χ2 tests for the homogeneity of proportions were conducted to examine bivariate relationships of the characteristics of interest. Multiple logistic regression was used to summarize the independent effects on the probability of being identified through DAD. RESULTS: The results show 5% of malignant and 35% of nonmalignant brain tumors were identified through DAD review. When comparing observed to expected number of nonmalignant cases after DAD review, the ACR ultimately captured 76% of those expected. Identification through DAD was statistically significantly (P ≤ .05) associated with patients over 75 years old at diagnosis (odds ratio [OR], 2.5), tumors of benign behavior (OR, 2.6), location at diagnosis in Northern Alberta (OR, 1.5), nonmicroscopically confirmed tumors (OR, 1.3), no visit to a CancerControl Alberta facility (OR, 8.7) and certain histological subtypes, including cranial and spinal nerve tumors (OR, 1.7). CONCLUSION: The use of hospital discharge data significantly improved nonmalignant brain tumor case ascertainment. Therefore, it is recommended that such reviews be instituted annually in provinces while other techniques (such as reminder letters used in Norway or linkages with radiology or other administrative databases) for improving case ascertainment are explored. Those characteristics identified as potential barriers to registration should be investigated to identify possible process improvements in Alberta.

The Effect of Serum 25-Hydroxyvitamin D Concentrations on Elevated Serum C-Reactive Protein Concentrations in Normal Weight, Overweight and Obese Participants of a Preventive Health Program.

The hypothesized effect of vitamin D on C-reactive protein (CRP) has received substantial attention as a potential means to alleviate the risk for cardiovascular disease. However, observational studies have been inconsistent in their reporting of associations between serum 25-hydroxyvitamin D (25(OH)D) and CRP concentrations, and trials and meta analyses have been inconsistent in their conclusions regarding the effect of vitamin D supplementation on CRP concentrations. These supplementation trials were mostly conducted among patients with more or less inflammatory complications and did not consider potential distinctive effects by weight status. To further our understanding of the potential influences of vitamin D on CRP, we analyzed longitudinal observations of 6755 participants of a preventative health program. On average, serum 25(OH)D concentrations increased from 88.3 to 121.0 nmol/L and those of CRP decreased from 1.7 to 1.6 mg/L between baseline and follow up. Relative to obese participants without temporal increases in 25(OH)D, those who showed improvements of <25, 25-50, 50-75, and more than 75 nmol/L at follow up were 0.57 (95% confidence interval: 0.37-0.88), 0.54 (0.34-0.85), 0.49 (0.30-0.80), and 0.48 (0.29-0.78) times as likely to have elevated CRP concentrations (≥1 mg/L), respectively. These associations were less pronounced and not statistically significant for normal weight and overweight participants. Herewith, the findings suggest that promotion of adequate serum 25(OH)D concentrations among obese individuals along with healthy lifestyles may alleviate the public health burden associated with cardiovascular disease.