OBJECTIVE: To assess whether reproductive factors are associated with mortal it y after breast cancer diagnosis. METHODS: We followed up 4,299 U.S. women enroll ed between 1980 and 1982 at ages 20-54 years as incident...OBJECTIVE: To assess whether reproductive factors are associated with mortal it y after breast cancer diagnosis. METHODS: We followed up 4,299 U.S. women enroll ed between 1980 and 1982 at ages 20-54 years as incident breast cancer cases in a population-based, case-control study, the Cancer and Steroid Hormone Study. Vital status through 1997 for these cases was obtained by linking Cancer and St eroid Hormone Study data to Surveillance, Epidemiology, and End Results files. W e estimated hazard ratios (HRs) and 95%confidence intervals (CIs) for death ass ociated with selected reproductive factors using proportional hazards models. RE SULTS: During a median follow-up of 14.5 years, 1,847 deaths occurred. Women ag ed 20-45 years whose last birth occurred 12 months or less (age-adjusted HR = 1.62, 95%CI 1.10-2.37) and 13-48 months before breast cancer diagnosis (age- adjusted HR = 1.35, 95%CI 1.05-1.75) were at an increased risk for death compa red with nulliparous women. After adjusting for additional factors including tum or stage, women whose last birth occurred 12 months or less before diagnosis rem ained at an increased risk for death (HR = 1.51, 95%CI 1.02-2.23). Fifteen-ye ar survival was 38%, 51%, and 60%among women aged 20-45 years whose last bir th was 12 months or less, 13-48 months, and more than 48 months before diagnosi s, respectively, compared with 65%among nulliparous women. Mortality risk was n ot associated with age at first birth, parity, or breast-feeding duration among women aged 20-45 years or among women aged 46-54 years. CONCLUSION: A recent birth may be an adverse prognostic indicator among women diagnosed with breast c ancer at ages 20-45 years.展开更多
Background: Smoking is a recognised risk factor for pancreatic cancer and has been associated with chronic pancreatitis and also with type II diabetes. Aims: The aim of this study was to investigate the effect of toba...Background: Smoking is a recognised risk factor for pancreatic cancer and has been associated with chronic pancreatitis and also with type II diabetes. Aims: The aim of this study was to investigate the effect of tobacco on the age of dia gnosis of pancreatitis and progression of disease, as measured by the appearance of calcification and diabetes. Patients: We used data from a retrospective coho rt of 934 patients with chronic alcoholic pancreatitis where information on smok ing was available,who were diagnosed and followed in clinical centres in five co untries. Methods: We compared age at diagnosis of pancreatitis in smokers versus non-smokers, and used the Cox proportional hazards model to evaluate the effec ts of tobacco on the development of calcification and diabetes, after adjustment for age, sex, centre, and alcohol consumption. Results: The diagnosis of pancre atitis was made, on average, 4.7 years earlier in smokers than in non-smokers ( p = 0.001). Tobacco smoking increased significantly the risk of pancreatic calci fications(hazard ratio (HR) 4.9 (95%confidence interval (Cl) 2.3-10.5)for smok ers v non-smokers) and to a lesser extent the risk of diabetes (HR 2.3 (95%Cl 1.2-4.2)) during the course of pancreatitis. Conclusions: In this study, tobacc o smoking was associated with earlier diagnosis of chronic alcoholic pancreatiti s and with the appearance of calcifications and diabetes,independent of alcohol consumption.展开更多
Objective: Factors influencing survival among persons with Down syndrome (DS) are not well understood. We sought to evaluate survival of infants with DS and potential prognostic factors. Study design: Infants with DS ...Objective: Factors influencing survival among persons with Down syndrome (DS) are not well understood. We sought to evaluate survival of infants with DS and potential prognostic factors. Study design: Infants with DS who were born alive during 1979 to 1998 were identified using the Metropolitan Atlanta Congenital Defects Program (MACDP), a population based surveillance system. To document vital status, we used data from hospital records, the National Death Index (NDI), and Georgia vital records. We estimated survival probability using the Kaplan-Meier product limit method and hazard ratios using a Cox proportional hazards model. Results: Survival probability to 1 year was 92.9%(95%CI: 90.9-94.9) and to 10 years was 88.6%(95%CI: 85.0-92.2). Univariate analysis demonstrated that black maternal race, low birth weight, preterm birth, lower paternal education, presence of heart defects, and presence of other major congenital anomalies were important prognostic factors. After multivariate analysis, maternal race, presence of heart defects, low birth weight, and an interaction between maternal race and presence of heart defects were significantly associated with mortality risk. Conclusions: A racial disparity is apparent in survival for children with Down syndrome. Further study is needed to elucidate possible reasons for the racial disparity.展开更多
文摘OBJECTIVE: To assess whether reproductive factors are associated with mortal it y after breast cancer diagnosis. METHODS: We followed up 4,299 U.S. women enroll ed between 1980 and 1982 at ages 20-54 years as incident breast cancer cases in a population-based, case-control study, the Cancer and Steroid Hormone Study. Vital status through 1997 for these cases was obtained by linking Cancer and St eroid Hormone Study data to Surveillance, Epidemiology, and End Results files. W e estimated hazard ratios (HRs) and 95%confidence intervals (CIs) for death ass ociated with selected reproductive factors using proportional hazards models. RE SULTS: During a median follow-up of 14.5 years, 1,847 deaths occurred. Women ag ed 20-45 years whose last birth occurred 12 months or less (age-adjusted HR = 1.62, 95%CI 1.10-2.37) and 13-48 months before breast cancer diagnosis (age- adjusted HR = 1.35, 95%CI 1.05-1.75) were at an increased risk for death compa red with nulliparous women. After adjusting for additional factors including tum or stage, women whose last birth occurred 12 months or less before diagnosis rem ained at an increased risk for death (HR = 1.51, 95%CI 1.02-2.23). Fifteen-ye ar survival was 38%, 51%, and 60%among women aged 20-45 years whose last bir th was 12 months or less, 13-48 months, and more than 48 months before diagnosi s, respectively, compared with 65%among nulliparous women. Mortality risk was n ot associated with age at first birth, parity, or breast-feeding duration among women aged 20-45 years or among women aged 46-54 years. CONCLUSION: A recent birth may be an adverse prognostic indicator among women diagnosed with breast c ancer at ages 20-45 years.
文摘Background: Smoking is a recognised risk factor for pancreatic cancer and has been associated with chronic pancreatitis and also with type II diabetes. Aims: The aim of this study was to investigate the effect of tobacco on the age of dia gnosis of pancreatitis and progression of disease, as measured by the appearance of calcification and diabetes. Patients: We used data from a retrospective coho rt of 934 patients with chronic alcoholic pancreatitis where information on smok ing was available,who were diagnosed and followed in clinical centres in five co untries. Methods: We compared age at diagnosis of pancreatitis in smokers versus non-smokers, and used the Cox proportional hazards model to evaluate the effec ts of tobacco on the development of calcification and diabetes, after adjustment for age, sex, centre, and alcohol consumption. Results: The diagnosis of pancre atitis was made, on average, 4.7 years earlier in smokers than in non-smokers ( p = 0.001). Tobacco smoking increased significantly the risk of pancreatic calci fications(hazard ratio (HR) 4.9 (95%confidence interval (Cl) 2.3-10.5)for smok ers v non-smokers) and to a lesser extent the risk of diabetes (HR 2.3 (95%Cl 1.2-4.2)) during the course of pancreatitis. Conclusions: In this study, tobacc o smoking was associated with earlier diagnosis of chronic alcoholic pancreatiti s and with the appearance of calcifications and diabetes,independent of alcohol consumption.
文摘Objective: Factors influencing survival among persons with Down syndrome (DS) are not well understood. We sought to evaluate survival of infants with DS and potential prognostic factors. Study design: Infants with DS who were born alive during 1979 to 1998 were identified using the Metropolitan Atlanta Congenital Defects Program (MACDP), a population based surveillance system. To document vital status, we used data from hospital records, the National Death Index (NDI), and Georgia vital records. We estimated survival probability using the Kaplan-Meier product limit method and hazard ratios using a Cox proportional hazards model. Results: Survival probability to 1 year was 92.9%(95%CI: 90.9-94.9) and to 10 years was 88.6%(95%CI: 85.0-92.2). Univariate analysis demonstrated that black maternal race, low birth weight, preterm birth, lower paternal education, presence of heart defects, and presence of other major congenital anomalies were important prognostic factors. After multivariate analysis, maternal race, presence of heart defects, low birth weight, and an interaction between maternal race and presence of heart defects were significantly associated with mortality risk. Conclusions: A racial disparity is apparent in survival for children with Down syndrome. Further study is needed to elucidate possible reasons for the racial disparity.
