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1.
Ann Rheum Dis ; 2021 Feb 23.
Artigo em Inglês | MEDLINE | ID: mdl-33622688

RESUMO

OBJECTIVES: To estimate absolute and relative risks for all-cause mortality and for severe COVID-19 in inflammatory joint diseases (IJDs) and with antirheumatic therapies. METHODS: Through Swedish nationwide multiregister linkages, we selected all adult patients with rheumatoid arthritis (RA, n=53 455 in March 2020), other IJDs (here: spondyloarthropathies, psoriatic arthritis and juvenile idiopathic arthritis, n=57 112), their antirheumatic drug use, and individually matched population referents. We compared annual all-cause mortality March-September 2015 through 2020 within and across cohorts, and assessed absolute and relative risks for hospitalisation, admission to intensive care and death due to COVID-19 March-September 2020, using Cox regression. RESULTS: During March-September 2020, the absolute all-cause mortality in RA and in other IJDs was higher than 2015-2019, but relative risks versus the general population (around 2 and 1.5) remained similar during 2020 compared with 2015-2019. Among patients with IJD, the risks of hospitalisation (0.5% vs 0.3% in their population referents), admission to intensive care (0.04% vs 0.03%) and death (0.10% vs 0.07%) due to COVID-19 were low. Antirheumatic drugs were not associated with increased risk of serious COVID-19 outcomes, although for certain drugs, precision was limited. CONCLUSIONS: Risks of severe COVID-19-related outcomes were increased among patients with IJDs, but risk increases were also seen for non-COVID-19 morbidity. Overall absolute and excess risks are low and the level of risk increases are largely proportionate to those in the general population, and explained by comorbidities. With possible exceptions, antirheumatic drugs do not have a major impact on these risks.

2.
Ann Rheum Dis ; 2020 Oct 08.
Artigo em Inglês | MEDLINE | ID: mdl-33032998

RESUMO

OBJECTIVE: To assess the incidence of venous thromboembolism (VTE) in rheumatoid arthritis (RA) relative to individuals without RA, and to investigate the relationship between aspects of clinical disease activity in RA and the risk of VTE. METHODS: We conducted a nationwide register-based cohort study 2006 through 2018 using the Swedish Rheumatology Quality Register linked to other national patient registers to identify all patients with RA with at least one registered rheumatologist visit during the study period (n=46 316 patients, 322 601 visits). The Disease Activity Score 28 erythrocyte sedimentation rate (ESR) (DAS28 ESR) and its components served as the exposure, and a VTE event within the year following the visit was the main outcome. We also included general population referents (1:5) matched on age, sex and residential area. RESULTS: Based on 2241 incident VTE events within 1 year of each included visit, and 5301 VTE events in the general population cohort, the risk ratio for VTE in RA was 1.88 (95% CI 1.65 to 2.15). Among patients with RA, the risk (and risk ratio) increased with increasing RA disease activity, from 0.52% following visits in remission to 1.08% following visits with DAS28 ESR high disease activity, RR compared with remission=2.03, 95% CI 1.73 to 2.38. Compared with the general population, also patients with RA in DAS28 ESR remission were at elevated VTE risk. CONCLUSIONS: This study demonstrates a strong association between clinical RA disease activity measured by DAS28 ESR and the risk of VTE. RA disease activity can be used as an additional tool for VTE risk stratification in patients with RA.

3.
Clin Kidney J ; 13(5): 821-827, 2020 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-33123358

RESUMO

Background: Optimal management of chronic kidney disease (CKD) anaemia remains controversial and few studies have evaluated real-world management of anaemia in advanced CKD in the context of guideline recommendations. Methods: We performed an observational study from the Swedish Renal Registry evaluating the epidemiology and treatment patterns of anaemia across Stages 3b-5 in non-dialysis (ND) and dialysis-dependent (DD) CKD patients during 2015. Logistic regression and Cox models explored the associations between anaemia treatments, inflammation, erythropoietin resistance index (ERI) and subsequent 1-year risk of major adverse cardiovascular events (MACEs). Results: Data from 14 415 (ND, 11 370; DD, 3045) patients were included. Anaemia occurred in 60% of ND and 93% of DD patients. DD patients used more erythropoiesis-stimulating agents (ESAs; 82% versus 24%) and iron (62% versus 21%) than ND patients. All weekly ESA doses were converted to a weight-adjusted weekly epoetin equivalent dose. The prescribed ESA doses were low to moderate [median 48.2 IU/kg/week (ND), 78.6 IU/kg/week (DD)]. Among ESA-treated patients, 6-21% had haemoglobin (Hb) >13 g/dL and 2-6% had Hb <9 g/dL. Inflammation (C-reactive protein >5 mg/L) was highly prevalent and associated with ERI and higher ESA doses. Higher (>88 IU/kg/week) versus lower (<44 IU/kg/week) ESA doses were associated with a higher risk of MACEs [{ND hazard ratio [HR] 1.36 [95% confidence interval (CI) 1.00-1.86]; DD HR 1.60 [95% CI 1.24-2.06]}. There was no association between iron use and inflammation or MACEs. Conclusions: Anaemia remains highly prevalent in advanced CKD. Patients with anaemia received moderate ESA doses with a relatively low prevalence of iron use. Higher doses of ESA were associated with inflammation and a higher risk of MACE.

4.
Thorax ; 75(12): 1040-1046, 2020 12.
Artigo em Inglês | MEDLINE | ID: mdl-32963117

RESUMO

BACKGROUND: Studies suggest an increased all-cause mortality among adults with asthma. We aimed to study the relationship between asthma in children and young adults and all-cause mortality, and investigate differences in mortality rate by also having a life-limiting condition (LLC) or by parental socioeconomic status (SES). METHODS: Included in this register-based study are 2 775 430 individuals born in Sweden between January 1986 and December 2012. We identified asthma cases using the National Patient Register (NPR) and the Prescribed Drug Register. Those with LLC were identified using the NPR. Parental SES at birth (income and education) was retrieved from Statistics Sweden. We estimated the association between asthma and all-cause mortality using a Cox proportional hazards regression model. Effect modification by LLC or parental SES was studied using interaction terms in the adjusted model. RESULTS: The adjusted hazard rate (adjHR) for all-cause mortality in asthma cases versus non-asthma cases was 1.46 (95% CI 1.33 to 1.62). The highest increased rate appeared to be for those aged 5-15 years. In persons with asthma and without LLC, the adjHR remained increased at 1.33 (95% CI 1.18 to 1.50), but differed (p=0.002) from those with asthma and LLC, with an adjHR of 1.87 (95% CI 1.57 to 2.22). Parental SES did not alter the association (income, p=0.55; education, p=0.83). CONCLUSION: This study shows that asthma is associated with an increased mortality in children and young adults regardless of LLC or parental SES. Further research is warranted to investigate the possible mechanisms for this association.

5.
Breast Cancer Res Treat ; 182(3): 699-707, 2020 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-32506337

RESUMO

PURPOSE: To examine the influence of type of oncological treatment on sick leave in women of working age with early-stage breast cancer. METHODS: We identified 8870 women aged 30-64 diagnosed with stage I-II breast cancer between 2005 and 2012 in the Breast Cancer Data Base Sweden. Associations between type of oncological treatment (radiotherapy, endocrine therapy, and chemotherapy) and sick leave were estimated by hazard ratios, probabilities, and length of sick leave using multi-state survival analysis. RESULTS: During the first 5 years after diagnosis, women aged 50-54 years at diagnosis receiving chemotherapy spent on average 182 (95% CI 151-218) additional days on sick leave compared with women not receiving chemotherapy, but with otherwise similar characteristics. Correspondingly, women initiating endocrine therapy spent 30 (95% CI 18-44) additional days on sick leave and women receiving post-mastectomy radiotherapy 53 (95% CI 37-69) additional days. At year five, the rate of sick leave was increased in women who had received chemotherapy (HR 1.19, 95% CI 1.11-1.28) or endocrine therapy (HR 1.15, 95% CI 1.05-1.26). Chemotherapy and endocrine therapy were associated with increased rates of sick leave due to depression or anxiety. CONCLUSION: Our findings of increased long-term risks of sick leave after oncological treatment for breast cancer warrant attention from caregivers taking part in cancer rehabilitation. In light of the ongoing debate about overtreatment of early-stage breast cancer, our findings point to the importance of properly selecting patients for chemotherapy not only for the medical toxicity but also the possible impact on their livelihood.

6.
Artigo em Inglês | MEDLINE | ID: mdl-31700650

RESUMO

This article tells the story of an eighteenth-century medical pamphlet called An essay on the nature and cure of the King's Evil, deduced from observation and practice. This was written by John Morley (d. 1776/7), a wealthy Essex landowner who advertised free medical treatments. The pamphlet is one of many short tracts on scrofula produced after the ceremony of 'the royal touch' ceased with the death of Queen Anne. However, it merits special attention from historians of medicine and historians of the book because it was edited and reprinted many more times than other surviving scrofula tracts: 42 editions appeared between 1760 and 1824. This suggests significant popularity. The Essay is also of interest because the first 15 editions display changes and additions completed by Morley before his death in late 1776 or early 1777. Between these versions, Morley consistently refashioned his identity as practitioner and author. He also adjusted his portrayal of the intended readers of the pamphlet: in later editions, readers are recorded using the Essay in increasingly complex and autonomous ways to design their own medical treatments. The pamphlet is therefore testimony to the fluid relationship between practitioner and patient. It shows that seemingly simple, formulaic and easy-to-read forms like pamphlets and case studies could play a variety of complex and shifting roles in eighteenth-century medical encounters and the construction of healing knowledge.

7.
Breast ; 45: 48-55, 2019 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-30852409

RESUMO

OBJECTIVES: Women diagnosed with breast cancer during working age are at increased risk of permanent absence from work, but the underlying medical causes have rarely been studied. We examined the risk of cause-specific sick leave, disability pension, and the competing event death after a breast cancer diagnosis in a population-based cohort study. MATERIALS AND METHODS: From the Breast Cancer Data Base Sweden, we identified 16,603 women diagnosed with stage I-III breast cancer between 2000 and 2012, and 63,773 control women. Using multi-state modelling, we calculated probabilities and durations of sick leave, disability pension, and death by registered cause, together with cause-specific hazard ratios. RESULTS: Five years after diagnosis, causes other than cancer accounted for around half of all sick leave (3.5% out of 6.8% of women) and disability pension (1.4% out of 2.6%) in women with breast cancer. Compared with control women, women with breast cancer were at increased risk of sick leave and disability pension due to mental disorders (HR 1.24, 95% CI 1.15-1.33 and HR 1.54, 95% CI 1.29-1.85, respectively) and disability pension due to inflammatory diseases (HR 1.46, 95% CI 1.05-2.03). The risk of sick leave and disability pension due to cardiovascular disease was also elevated, although only statistically significant for disability pension in women diagnosed after 2005 (HR 2.24, 95% CI 1.22-4.13). CONCLUSION: Follow-up, support, and rehabilitation programs for women diagnosed with breast cancer must address a wide range of psychological and physical conditions to limit the consequences on working life.


Assuntos
Neoplasias da Mama/epidemiologia , Seguro por Invalidez/estatística & dados numéricos , Doenças Profissionais/epidemiologia , Pensões/estatística & dados numéricos , Licença Médica/estatística & dados numéricos , Adulto , Neoplasias da Mama/psicologia , Causas de Morte , Estudos de Coortes , Bases de Dados Factuais , Feminino , Humanos , Transtornos Mentais/epidemiologia , Transtornos Mentais/etiologia , Pessoa de Meia-Idade , Doenças Profissionais/psicologia , Suécia/epidemiologia
8.
Breast ; 45: 75-81, 2019 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-30904700

RESUMO

Many studies have found evidence of socioeconomic differences in breast cancer survival. This study aimed to quantify the impact of removing differences in stage distribution and stage-specific relative survival between education groups in Swedish women with breast cancer. Using information from a breast cancer research database, the study population contained 62 121 women diagnosed with breast cancer in three healthcare regions of Sweden from 1992 to 2012. The loss in expectation of life and life years lost due to breast cancer were estimated using flexible parametric relative survival models by education group and age at diagnosis. The potential gain in life years and postponable deaths were calculated by applying the 1) stage distribution, 2) stage-specific relative survival, and 3) both stage distribution and stage-specific relative survival of the high education group to the low and medium education groups. For a cohort of around 3500 women diagnosed with breast cancer residing in three Swedish healthcare regions in a typical calendar year, we estimated that removing stage differences would postpone an additional 25 deaths at five years after diagnosis, and result in a gain of approximately 573 life years. Alternatively, if stage-specific breast cancer survival could be equated, approximately 692 life years could be saved and an additional 26 deaths could be postponed five years after diagnosis. Results such as these can help guide decisions on interventions intended to minimise socioeconomic differences in breast cancer outcomes.


Assuntos
Neoplasias da Mama/mortalidade , Escolaridade , Disparidades nos Níveis de Saúde , Expectativa de Vida , Adulto , Idoso , Neoplasias da Mama/patologia , Bases de Dados Factuais , Feminino , Humanos , Pessoa de Meia-Idade , Estadiamento de Neoplasias , Estudos Retrospectivos , Fatores Socioeconômicos , Suécia/epidemiologia
9.
New Mediev Lit (Turnhout) ; 18: 183-210, 2018 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-30245585
10.
Leukemia ; 32(10): 2203-2210, 2018 10.
Artigo em Inglês | MEDLINE | ID: mdl-29535425

RESUMO

To determine the risk of a wide range of second malignancies in patients with myeloproliferative neoplasms (MPNs), we conducted a large population-based study and compared the results to matched controls. From national Swedish registers, 9379 patients with MPNs diagnosed between 1973 and 2009, and 35,682 matched controls were identified as well as information on second malignancies, with follow-up until 2010. Hazard ratios (HRs) with 95 % confidence intervals (CIs) were calculated using Cox regression and a flexible parametric model. There was a significantly increased risk of any non-hematologic cancer with HR of 1.6 (95% CI: 1.5-1.7). The HRs for non-melanoma skin cancer was 2.8 (2.4-3.3), kidney cancer 2.8 (2.0-4.0), brain cancer 2.8 (1.9-4.2), endocrine cancers 2.5 (1.6-3.8), malignant melanoma 1.9 (1.4-2.7), pancreas cancer 1.8 (1.2-2.6), lung cancer 1.7 (1.4-2.2), and head and neck cancer 1.7 (1.2-2.6). The HR of second malignancies was similar across all MPN subtypes, sex, and calendar periods of MPN diagnosis. The risk of developing a hematologic malignancy was also significantly increased; the HR for acute myeloid leukemia was 46.0 (32.6-64.9) and for lymphoma 2.6 (2.0-3.3). In conclusion, our study provides robust population-based support of an increased cancer risk in MPN patients.


Assuntos
Transtornos Mieloproliferativos/complicações , Segunda Neoplasia Primária/etiologia , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Estudos de Coortes , Feminino , Neoplasias Hematológicas/complicações , Neoplasias Hematológicas/patologia , Humanos , Linfoma/etiologia , Linfoma/patologia , Masculino , Melanoma/etiologia , Melanoma/patologia , Pessoa de Meia-Idade , Transtornos Mieloproliferativos/patologia , Segunda Neoplasia Primária/patologia , Modelos de Riscos Proporcionais , Fatores de Risco , Suécia , Adulto Jovem
11.
Br J Cancer ; 118(5): 738-743, 2018 03 06.
Artigo em Inglês | MEDLINE | ID: mdl-29360816

RESUMO

BACKGROUND: Breast cancer can negatively influence working life, but it is unclear how many working years women with breast cancer can expect to lose. METHODS: Women diagnosed with breast cancer between 1997 and 2012 were identified in the Breast Cancer Data Base Sweden (N=19 661), together with breast cancer-free comparison women (N=81 303). Using flexible parametric survival modelling, the loss in working years was calculated as the difference in the remaining years in the work force between women with and without breast cancer. RESULTS: Women aged 50 years at diagnosis with stage I disease lost on average 0.5 years (95% CI, 0.2-0.7) of their remaining working time; the corresponding estimates were 0.9 years (0.5-1.2) in stage II, 2.5 years (1.9-3.1) in stage III and 8.1 years (6.5-9.7) in stage IV. Women with in situ breast cancer did not lose any working years. The strongest treatment determinant was axillary lymph node dissection. CONCLUSIONS: We found a loss in working years not only in late but also in early-stage breast cancer. Although it is reassuring that some groups had no or only a modest work loss, the economic consequences for society are considerable given the large number of women annually diagnosed with breast cancer.


Assuntos
Neoplasias da Mama/diagnóstico , Excisão de Linfonodo/estatística & dados numéricos , Mulheres Trabalhadoras/estatística & dados numéricos , Idade de Início , Bases de Dados Factuais , Feminino , Humanos , Pessoa de Meia-Idade , Estadiamento de Neoplasias , Fatores de Risco , Análise de Sobrevida , Suécia/epidemiologia
12.
Am J Epidemiol ; 187(4): 828-836, 2018 04 01.
Artigo em Inglês | MEDLINE | ID: mdl-29020167

RESUMO

Expected or reference mortality rates are commonly used in the calculation of measures such as relative survival in population-based cancer survival studies and standardized mortality ratios. These expected rates are usually presented according to age, sex, and calendar year. In certain situations, stratification of expected rates by other factors is required to avoid potential bias if interest lies in quantifying measures according to such factors as, for example, socioeconomic status. If data are not available on a population level, information from a control population could be used to adjust expected rates. We have presented two approaches for adjusting expected mortality rates using information from a control population: a Poisson generalized linear model and a flexible parametric survival model. We used a control group from BCBaSe-a register-based, matched breast cancer cohort in Sweden with diagnoses between 1992 and 2012-to illustrate the two methods using socioeconomic status as a risk factor of interest. Results showed that Poisson and flexible parametric survival approaches estimate similar adjusted mortality rates according to socioeconomic status. Additional uncertainty involved in the methods to estimate stratified, expected mortality rates described in this study can be accounted for using a parametric bootstrap, but this might make little difference if using a large control population.


Assuntos
Neoplasias da Mama/mortalidade , Projetos de Pesquisa Epidemiológica , Classe Social , Adulto , Idoso , Idoso de 80 Anos ou mais , Interpretação Estatística de Dados , Feminino , Humanos , Modelos Lineares , Masculino , Pessoa de Meia-Idade , Fatores de Risco , Análise de Sobrevida , Suécia , Incerteza
13.
Br J Cancer ; 117(9): 1419-1426, 2017 Oct 24.
Artigo em Inglês | MEDLINE | ID: mdl-28898233

RESUMO

BACKGROUND: Differences in cancer survival exist across socio-economic groups for many cancer types. Standard metrics fail to show the overall impact for patients and the population. METHODS: The available data consist of a population of ∼2.5 million patients and include all patients recorded as being diagnosed with melanoma, prostate, bladder, breast, colon, rectum, lung, ovarian and stomach cancers in England between 1998 and 2013. We estimated the average loss in expectation of life per patient in years and the proportion of life lost for a range of cancer types, separately by deprivation group. In addition, estimates for the total number of years lost due to each cancer were also obtained. RESULTS: Lung and stomach cancers result in the highest overall loss for males and females in all deprivation groups in terms of both absolute life years lost and loss as a proportion of expected life remaining. Female lung cancer patients in the least- and most-deprived group lose 14.4 and 13.8 years on average, respectively, that is translated as 86.1% and 87.3% of their average expected life years remaining. Melanoma, prostate and breast cancers have the lowest overall loss. On the basis of the number of patients diagnosed in 2013, lung cancer results in the most life years lost in total followed by breast cancer. Melanoma and bladder cancer account for the lowest total life years lost. CONCLUSIONS: There are wide differences in the impact of cancer on life expectancy across deprivation groups, and for most cancers the most affluent lose less years.


Assuntos
Expectativa de Vida , Neoplasias/diagnóstico , Neoplasias/mortalidade , Sistema de Registros/estatística & dados numéricos , Fatores Socioeconômicos , Idoso , Idoso de 80 Anos ou mais , Feminino , Seguimentos , Humanos , Masculino , Pessoa de Meia-Idade , Estadiamento de Neoplasias , Prognóstico , Taxa de Sobrevida
14.
Arch Dis Child Fetal Neonatal Ed ; 102(2): F131-F135, 2017 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-27515985

RESUMO

BACKGROUND: Antibiotics used for women in spontaneous preterm labour without overt infection, in contrast to those with preterm rupture of membranes, are associated with altered functional outcomes in their children. METHODS: From the National Pupil Database, we used Key Stage 2 scores, national test scores in school year 6 at 11 years of age, to explore the hypothesis that erythromycin and co-amoxiclav were associated with poorer educational outcomes within the ORACLE Children Study. RESULTS: Anonymised scores for 97% of surviving children born to mothers recruited to ORACLE and resident in England were analysed against treatment group adjusting for key available socio-demographic potential confounders. No association with crude or with adjusted scores for English, mathematics or science was observed by maternal antibiotic group in either women with preterm rupture of membranes or spontaneous preterm labour with intact membranes. While the proportion receiving special educational needs was similar in each group (range 31.6-34.4%), it was higher than the national rate of 19%. CONCLUSIONS: Despite evidence that antibiotics are associated with increased functional impairment at 7 years, educational test scores and special needs at 11 years of age show no differences between trial groups. TRIAL REGISTRATION NUMBER: ISCRT Number 52995660 (original ORACLE trial number).


Assuntos
Combinação Amoxicilina e Clavulanato de Potássio/administração & dosagem , Antibacterianos/administração & dosagem , Desenvolvimento Infantil/efeitos dos fármacos , Avaliação Educacional , Eritromicina/administração & dosagem , Complicações Infecciosas na Gravidez , Criança , Bases de Dados Factuais , Inglaterra , Feminino , Humanos , Masculino , Avaliação de Resultados em Cuidados de Saúde , Gravidez , Complicações Infecciosas na Gravidez/tratamento farmacológico , Efeitos Tardios da Exposição Pré-Natal
16.
J Clin Oncol ; 34(24): 2851-7, 2016 08 20.
Artigo em Inglês | MEDLINE | ID: mdl-27325849

RESUMO

PURPOSE: A dramatic improvement in the survival of patients with chronic myeloid leukemia (CML) occurred after the introduction of imatinib mesylate, the first tyrosine kinase inhibitor (TKI). We assessed how these changes affected the life expectancy of patients with CML and life-years lost as a result of CML between 1973 and 2013 in Sweden. MATERIALS AND METHODS: Patients recorded as having CML in the Swedish Cancer Registry from 1973 to 2013 were included in the study and followed until death, censorship, or end of follow-up. The life expectancy and loss in expectation of life were predicted from a flexible parametric relative survival model. RESULTS: A total of 2,662 patients with CML were diagnosed between 1973 and 2013. Vast improvements in the life expectancy of these patients were seen over the study period; larger improvements were seen in the youngest ages. The great improvements in life expectancy translated into great reductions in the loss in expectation of life. Patients of all ages diagnosed in 2013 will, on average, lose < 3 life-years as a result of CML. CONCLUSION: Imatinib mesylate and new TKIs along with allogeneic stem cell transplantation and other factors have contributed to the life expectancy in patients with CML approaching that of the general population today. This will be an important message to convey to patients to understand the impact of a CML diagnosis on their life. In addition, the increasing prevalence of patients with CML will have a great effect on future health care costs as long as continuous TKI treatment is required.


Assuntos
Leucemia Mielogênica Crônica BCR-ABL Positiva/mortalidade , Leucemia Mielogênica Crônica BCR-ABL Positiva/terapia , Fatores Etários , Idoso , Humanos , Leucemia Mielogênica Crônica BCR-ABL Positiva/tratamento farmacológico , Expectativa de Vida , Pessoa de Meia-Idade , Inibidores de Proteínas Quinases/administração & dosagem , Transplante de Células-Tronco/estatística & dados numéricos , Suécia/epidemiologia , Transplante Homólogo
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