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Background Although chronic kidney disease (CKD) affects a growing number of people, epidemiologic data on incident CKD in the general population are scarce. Screening strategies to increase early CKD detection have been developed. Methods From a community-based sample of 4,409 individuals residing in a well-defined geographical area, we determined the number of patients having a first serum creatinine value ≥1.7 mg/dL and present for at least 3 months that allowed us to calculate an annual incidence rate of CKD (stages 3 to 5). CKD (stages 3 to 5) was defined by estimated glomerular filtration rate (eGFR) <60 mL/min/1.73 m 2 . We also described the primary care, outcomes and risk factors associated with outcomes using competing risks analyses for these CKD patients. Results A total of 631 incident CKD patients (stages 3 to 5) were followed-up until the occurrence of death and dialysis initiation for more than 3 years. The annual incidence rate of CKD (stages 3 to 5) was estimated at 977.7 per million inhabitants. Analyses were performed on 514 patients with available medical data. During the study, 155 patients (30.2 %) were referred to a nephrologist, 193 (37.5 %) died and 58 (11.3 %) reached end-stage renal disease and initiated dialysis. A total of 139 patients (27.6 %) had a fast decline of their renal function, 92 (18.3 %) a moderate decline and the 272 remaining patients had a physiological decline (21.1 %) or a small improvement of their renal function (33.0 %). Predictors of death found in both Cox and Fine-Gray multivariable regression models included age at diagnosis, anemia, active neoplasia and chronic heart failure, but not a low glomerular filtration rate (GFR). Age at diagnosis, anemia and a low GFR were independently associated with dialysis initiation in Cox model, but anemia was not found to be a risk factor for dialysis initiation in Fine-Gray model. Conclusions This large cohort study provided useful epidemiological data on incident CKD (stages 3 to 5) and stressed the need to improve the hands-on implementation of clinical practice guidelines for the evaluation and the management of CKD in primary care.

Introduction Parotid‐gland carcinoma (PGC) is a relatively rare tumor that comprises a group of heterogeneous histologic subtypes. We used the Surveillance, Epidemiology, and End Results (SEER) program database to apply a competing‐risks analysis to PGC patients, and then established and validated predictive nomograms for PGC. Methods Specific screening criteria were applied to identify PGC patients and extract their clinical and other characteristics from the SEER database. We used the cumulative incidence function to estimate the cumulative incidence rates of PGC‐specific death (GCD) and other cause‐specific death (OCD), and tested for differences between groups using Gray's test. We then identified independent prognostic factors by applying the Fine–Gray proportional subdistribution hazard approach, and constructed predictive nomograms based on the results. Calibration curves and the concordance index (C‐index) were employed to validate the nomograms. Results We finally identified 4,075 eligible PGC patients who had been added to the SEER database from 2004 to 2015. Their 1‐, 3‐, and 5‐year cumulative incidence rates of GCD were 10.1%, 21.6%, and 25.7%, respectively, while those of OCD were 2.9%, 6.6%, and 9.0%. Age, race, World Health Organization histologic risk classification, differentiation grade, American Joint Committee on Cancer (AJCC) T stage, AJCC N stage, AJCC M stage, and RS (radiotherapy and surgery status) were independent predictors of GCD, while those of OCD were age, sex, marital status, AJCC T stage, AJCC M stage, and RS. These factors were integrated for constructing predictive nomograms. The results for calibration curves and the C‐index suggested that the nomograms were well calibrated and had good discrimination ability. Conclusion We have used the SEER database to establish—to the best of our knowledge—the first competing‐risks nomograms for predicting the 1‐, 3‐, and 5‐year cause‐specific mortality in PGC. The nomograms showed relatively good performance and can be used in clinical practice to assist clinicians in individualized treatment decision‐making. Parotid‐gland carcinoma (PGC) is a relatively rare tumor that comprises a group of heterogeneous histologic subtypes. We used the Surveillance, Epidemiology, and End Results (SEER) program database to apply a competing‐risks analysis to PGC patients, and then established and validated predictive nomograms for PGC.

Estimating the risk of competing mortality is of importance in men with early prostate cancer to choose the most appropriate way of management and to avoid over- or under-treatment. In this study, we investigated the impact of the level of education in this context. The study sample consisted of 2630 patients with complete data on level of education （college, university degree, master craftsmen, comparable profession, or others）, histopathological tumor stage （organ confined or extracapsular）, lymph node status （negative or positive）, and prostatectomy specimen Gleason score （〈7, 7, or 8-10） who underwent radical prostatectomy between 1992 and 2007. Overall, prostate cancer-specific, competing, and second cancer-related mortalities were study endpoints. Cox proportional hazard models for competing risks were used to study combined effects of the variables on these endpoints. A higher level of education was independently associated with decreased overall mortality after radical prostatectomy （hazard ratio [HR]： 0.75, 95% confidence interval [95% CI]： 0.62-0.91, P = 0.0037）. The mortality difference was attributable to decreased second cancer mortality （HR： 0.59, 95% Ch 0.40-0.85, P = 0.0052） and noncancer mortality （HR： 0.73, 95% Ch 0.55-0.98, P = 0.0345） but not to differences in prostate cancer-specific mortality （HR： 1.16, 95% Ch 0.79-1.69, P = 0.4536 in the full model）. In conclusion, the level of education might serve as an independent prognostic parameter supplementary to age, comorbidity, and smoking status to estimate the risk of competing mortality and to choose optimal treatment for men with early prostate cancer who are candidates for radical prostatectomy.

Competing events are often ignored in epidemiological studies. Conventional methods for the analysis of survival data assume independent or noninformative censoring, which is violated when subjects that experience a competing event are censored. Because many survival studies do not apply competing risk analysis, we explain and illustrate in a nonmathematical way how to analyze and interpret survival data in the presence of competing events. Using data from the Longitudinal Aging Study Amsterdam, both marginal analyses (Kaplan–Meier method and Cox proportional-hazards regression) and competing risk analyses (cumulative incidence function [CIF], cause-specific and subdistribution hazard regression) were performed. We analyzed the association between sex and depressive symptoms, in which death before the onset of depression was a competing event. The Kaplan–Meier method overestimated the cumulative incidence of depressive symptoms. Instead, the CIF should be used. As the subdistribution hazard model has a one-to-one relation with the CIF, it is recommended for prediction research, whereas the cause-specific hazard model is recommended for etiologic research. When competing risks are present, the type of research question guides the choice of the analytical model to be used. In any case, results should be presented for all event types.

Abstract Background The ATA risk stratification system has evolved from the 2015 framework toward a more composite nodal risk assessment in the 2025 update. Whether low-volume lateral neck disease remains clinically meaningful is uncertain. We evaluated the prognostic significance of N1b vs N1a disease in papillary thyroid carcinoma (PTC) with ≤5 metastatic lymph nodes. Materials and Methods We identified 11 878 patients with PTC and N1a or N1b disease with ≤5 metastatic lymph nodes from the SEER database (2000-2022). One-to-one propensity score matching was performed. OS and CSS were assessed using Kaplan–Meier analysis, and CSD and OCD using cumulative incidence functions and Fine–Gray models. Results Among eligible patients, 9392 had N1a disease and 2486 had N1b disease. After matching, 2467 patients remained in each group. N1b was associated with significantly worse OS, CSS, and CSD in both unmatched and matched cohorts. In the matched cohort, 5-year CSD increased from 1.5% to 2.8%. On multivariable Fine–Gray analysis, N1b remained independently associated with higher CSD risk (SHR, 2.52; 95% CI, 1.85-3.43; P < .001). The adverse effect was more evident in patients with positive ETE, tumor diameter >2 cm, and older age. Conclusion Among patients with PTC and ≤5 metastatic lymph nodes, N1b retains independent adverse prognostic significance despite low nodal burden. Low-volume nodal disease should not be considered uniformly low risk when lateral neck involvement is present, particularly in patients with positive ETE, tumor diameter >2 cm, or older age.

We describe how to conduct a regression analysis for competing risks data. The use of an add-on package for the R statistical software is described, which allows for the estimation of the semiparametric proportional hazards model for the subdistribution of a competing risk analysis as proposed by Fine and Gray. J Am Stat Assoc 1999; 94: 496–509.

Objectives The study aimed to (i) determine the influence of poor health on competing exit routes from paid employment among older workers in Europe, (ii) assess whether these risks are different among welfare state regimes in Europe, and (iii) evaluate differences in estimates between two different competing risk approaches. Methods The study population consisted of 5273 respondents (6-years follow-up) from the Survey of Health, Ageing, and Retirement in Europe (SHARE). The effect of poor health on exit routes from paid employment was assessed with a cause-specific Cox model and a Fine ＆ Gray (F＆G) model. These two competing risk analyses were used to calculate absolute risks of labor force exit among welfare state regimes in Europe. Results In both models, poor health was a risk factor for disability benefit [hazard ratio (HR) 3.36; subdistribution hazard ratio (SHR) 3.22], and unemployment (HR 1.43, SHR 1.32). Both models produced similar absolute risks. In countries with a Bismarckian welfare state regime, low-educated older workers living alone and in poor health had an 11% risk of disability benefit, 7% of unemployment, 46% of early retirement, and 7% of becoming economically inactive. In countries with a Scandinavian welfare state regime, the risks were 10%, 7%, 29%, and 3%, respectively, and in Southern European welfare state regimes 4%, 5%, 35%, and 7%. Conclusions Workers with poor health are more likely to leave the labor force than workers with good health. The absolute risks of early retirement and becoming economically inactive were lowest in countries with a Scandinavian welfare state regime. For disability benefit and unemployment, absolute risks were lowest in Southern European welfare state regimes. The direct estimation of absolute risks of leaving the labor force in the presence of competing exit routes is an appealing feature of the F＆G model.

Subarachnoid hemorrhage (SAH) is a severe cerebrovascular disorder characterized by the sudden influx of blood into the subarachnoid space. The use of sedatives may be associated with the prognosis of SAH patients. We obtained SAH data from the MIMIC-IV database. The receiver operating characteristic curve, Delong test, and decision curve analysis were used to assess the predictive value of sedatives. Propensity score matching (PSM) method was applied to match samples at a 1:1 ratio. Logistic regression analysis, generalized linear regression analysis, and stratified analysis were used to investigate the association of the sedative with in-hospital mortality and length of hospital stay (LOS). Finally, a competing risk analysis was performed to evaluate the survival probability with two potential outcomes. Dexmedetomidine had a better prognosis value than Propofol and Midazolam. After PSM analysis, the Dexmedetomidine and the non-Dexmedetomidine groups had 248 samples each. The application of Dexmedetomidine reduced the risk of in-hospital mortality but might prolong the LOS. When considering in-hospital mortality as a competing risk factor for LOS, Dexmedetomidine was a protective factor for in-hospital mortality but had no significant relationship with LOS. In conclusion, treatment of Dexmedetomidine could reduce the risk of in-hospital mortality with satisfactory predictive efficiency.

Background Although coronary events (CE) and ischemic stroke share many risk factors, there are also some important differences. The aim of this paper was to assess the association of risk factors in relation to incident CE and ischemic stroke and to evaluate the heterogeneity in patterns of risk factors between the two outcomes. Method Traditional risk factors and inflammatory markers associated with coronary events and ischemic stroke were measured in the Malmö Diet and Cancer Cohort (MDCS, n = 26 519), where a total of 2270 incident ischemic stroke and 3087 incident CE occurred during a mean follow up time 19 ± 6 years, and in relation to inflammatory markers in the cardiovascular sub-cohort (MDC-CV, n = 4795). Cox regression analysis was used to obtain hazard ratios. A modified Lunn-McNeil competing risk analysis was conducted to assess the significance of any differences in risk profiles of these outcomes. Results Most cardiovascular risk factors were associated both with incident CE and ischemic stroke. However, current smoking, ApoB, low ApoA1, male sex and education level of ≤ 9 years of schooling were preferentially associated with CE compared to ischemic stroke. Conversely, age showed a stronger association with ischemic stroke than with CE. Conclusion CE and ischemic stroke have broadly similar risk factors profiles. However, there are some important differential associations, as well as substantial differences in the magnitude of the association. These could reflect the distinct biology of atherogenesis in different vascular beds. The difference in the determinants highlights the importance of looking at CE and ischemic stroke, two manifestations of cardiovascular disease, separately.

•Mortality and weaning rates of patients with chronic intestinal failure in home parenteral nutrition differ widely among cohorts, because these outcomes were often considered independent—rather than competing—events, leading to biased estimates•We analyzed through a competing risk analysis the rates and predictors of mortality and weaning separately in patients with and without short bowel syndrome•In patients with short bowel syndrome, reconstructive surgery reduced mortality and dependence from parenteral nutrition•In patients without short bowel syndrome, presence of a stoma was associated with reduced mortality and dependence from parenteral nutrition•Surgical procedures strongly affected mortality and weaning risk in patients with chronic intestinal failure. Home parenteral nutrition (HPN) is the standard treatment for patients with chronic intestinal failure (CIF). Mortality and weaning rates of these patients differ widely among cohorts; however, these outcomes were often considered independent—rather than competing—events, leading to an upward bias of the retrieved estimates. The aim of this retrospective cohort study was to evaluate, evaluating through a competing risk analysis, the rates and predictors of mortality and weaning in CIF patients from an Italian referral center. All adult patients with CIF receiving > 3 mo HPN from 1985 until 2016 were enrolled. Clinical information was collected from the database of the Intestinal Failure Unit of Torino, Italy. Patients were stratified according to the presence or not of short bowel syndrome (SBS). The cumulative incidences of death and weaning were 27.3% and 32.3% and 39.0% and 33.7% at 5 and 10 y from HPN initiation, respectively. At multivariable competing risk analyses, mortality was predicted by age (sub-distribution hazard ratio [SHR] = 1.65 per 10-y increase; 95% CI, 1.35–2.01), type 3 SBS (SHR = 0.38; 0.15–0.94), small bowel length ≥ 100 cm (SHR = 0.42; 0.22–0.83), and reconstructive surgery (SHR = 0.11; 0.02–0.64) in SBS patients, and by age (SHR = 1.38 per 10-y increase; 1.16–1.64) and presence of stoma (SHR = 0.30; 0.12–0.78) in non-SBS patients. In the same model, weaning was predicted by type 3 SBS (SHR = 6.86; 3.10–15.16), small bowel length ≥ 100 cm (SHR = 3.54; 1.99–6.30), and reconstructive surgery (SHR = 2.86; 1.44–5.71) in SBS patients, and by age (SHR = 0.79 per 10-y increase; 0.66–0.94) and presence of stoma (SHR = 2.64; 1.38–5.07) in non-SBS patients. Surgical procedures strongly affected mortality and weaning risk in CIF patients.