John H Stewart,
Margaret R E McCredie,
Sheila M Williams,
Stanley S Fenton,
Lilyanna Trpeski,
Stephen P McDonald,
Kitty J Jager,
Paul C W van Dijk,
Patrik Finne,
Staffan Schon,
Torbjorn Leivestad,
Hans Løkkegaard,
Jean-Marie Billiouw,
Reinhard Kramar,
Angela Magaz,
E Vela,
Maria J Garcia-Blasco,
G A Ioannidis,
Y N Lim
Department of Preventive and Social Medicine, University of Otago, Dunedin, New Zealand.
BACKGROUND: Despite improved treatment of hypertension and decreasing rates of stroke and coronary heart disease, the reported incidence of hypertensive end-stage renal disease (ESRD) increased during the 1990s. However, bias, particularly from variations in acceptance into ESRD treatment (ascertainment) and diagnosis (classification), has been a major source of error when comparing ESRD incidences or estimating trends. METHODS: Age-standardized rates were calculated in persons aged 30 to 44, 45 to 64, and 65 to 74 years for 15 countries or regions (separately for the Europid and non-Europid populations of Canada, Australia, and New Zealand), and temporal trends were estimated by means of Poisson regression. For 10 countries or regions, population-based estimates of mean systolic blood pressures and prevalences of hypertension were extracted from published sources. RESULTS: Hypertensive ESRD, comprising ESRD attributed to essential hypertension or renal artery occlusion, was least common in Finland, non-Aboriginal Australians, and non-Polynesian New Zealanders; intermediate in most European and Canadian populations; and most common in Aboriginal Australians and New Zealand Maori and Pacific Island people. Rates correlated with the incidence of all other nondiabetic ESRD, but not with diabetic ESRD or community rates of hypertension. Between 1998 and 2002, hypertensive ESRD did not increase in Northwestern Europe or non-Aboriginal Canadians, although it did so in Australia. CONCLUSION: Despite the likelihood of classification bias, the probability remains of significant variation in incidence of hypertensive ESRD within the group of Europid populations. These between-population differences are not explained by community rates of hypertension or ascertainment bias.
Latest citations:
UK Renal Registry, Southmead Hospital, Bristol, UK. preetham.boddana@nbt.nhs.uk
BACKGROUND: The aim of this study is to report Renal Replacement Therapy (RRT) incidence and prevalence rates, the percentage of incident patients with diabetes mellitus as cause of renal disease, the RRT modality mix and the transplant rate in different countries. The number of national or regional registries collecting and reporting data pertaining to traditional cardiovascular (CV) risk factors in prevalent dialysis patients is also examined. METHODS: Data on numbers of incident and prevalent RRT patients in England, Wales, Scotland and Northern Ireland for the year 2007 were collected from the UK Renal Registry (UKRR) database and collated to meet the specifications on the US Renal Data System (USRDS) international data collection form. RESULTS: In 2007, the incidence and prevalence of RRT in the UK were 110 and 759 per million of the population (pmp) respectively. Incidence of RRT placed the UK 34th out of the 43 countries reporting to the USRDS in 2006. In the majority of reporting countries, 20-44% have diabetes as the primary cause of end stage renal disease. Only the Finnish, Malaysian and US Renal Registries were found to routinely report attainment of cardiovascular risk standards. CONCLUSIONS: A comparison among international renal registries about RRT epidemiology and reporting cardiovascular risk factors in prevalent RRT patients forms an important part of the quality improvement process and often allows for improving standards and performances between reporting countries. Despite the high CV morbidity associated with RRT, few renal registries routinely report data on CV risk management; where data are reported there is little agreement in what represents quality of care, making direct comparison difficult.
John H Stewart,
Margaret Re McCredie,
Sheila M Williams,
Kitty J Jager,
Lilyanna Trpeski,
Stephen P McDonald
Aims: To determine if rates of diabetic and non-diabetic end-stage renal disease (ESRD), which had been rising in young and middle-aged adults in all populations up to the mid-1990s, had started to decline, and if so, whether improvement had occurred in respect of each of the principal primary renal diseases causing ESRD. Methods: Poisson regression of age- and sex-standardized incidence of ESRD for persons aged 20-64 years in 18 populations from Europe, Canada and the Asia-Pacific region, for 1998-2002. Results: In persons from 12 European descent (Europid) populations combined, there was a small downward trend in all-cause ESRD (-1.7% per year, P = 0.001), with type 1 diabetic ESRD falling by 7.8% per year (P < 0.001), glomerulonephritic ESRD by 3.1% per year (P = 0.001), and 'all other non-diabetic' ESRD by 2.5% per year (P = 0.02). The reductions in ESRD attributed to hypertensive (-2.2% per year) and polycystic renal disease (-1.5% per year) and unknown diagnosis (-0.2% per year) were not statistically significant. On the other hand, the incidence of type 2 diabetic ESRD rose by 9.9% per year (P < 0.001) in the combined Europid population, although that of (principally type 2) diabetic ESRD remained unchanged in the pooled data from the four non-Europid populations. Conclusion: Recent preventive strategies, probably chiefly modern renoprotective treatment, appear to have been effective for tertiary prevention of ESRD caused by the proteinuric nephropathies other than type 2 diabetic nephropathy, for which the continuing increase in Europid populations represents a failure of prevention and/or a change in the nephropathic potential of type 2 diabetes.
In 2005, the incidence of renal replacement therapy (RRT) in the United Kingdom was 110 per million of the population (pmp) using the day 0 definition and 103 pmp using the day 90 definition. Relative to the 42 countries reporting data to the USRDS, the day 0 and day 90 rates for RRT incidence in the UK are the 32nd and 35th lowest, respectively. However, the overall incidence for the UK masks higher rates in Scotland, Wales and Northern Ireland (123, 129 and 140 pmp, respectively). Of the six countries with RRT incidence rates comparable with those in the UK (Australia, Finland, Malaysia, New Zealand, Norway and the Netherlands) three had relatively high rates for the age band 20-44, and two had relatively high rates for the age band 45-60. The proportion of incident patients with diabetes as the cause of established renal failure also varied considerably among these six comparator countries from 16% to 40% but rates of peritoneal dialysis utilization were comparable with that in the UK and generally higher than in countries with higher rates of RRT incidence. When transplantation rates were considered alongside prevalence rates for RRT, the UK position appeared relatively high at 46%(11th out of 37 countries), although still considerably lower than in Norway and the Netherlands (72 and 54%, respectively). Although variation in RRT incidence rate exists within the four countries of the UK, the overall RRT incidence, reported for the first time this year, appears similar to that observed in a number of demographically similar countries around the world. Examining the UK alongside the six comparator countries, different patterns of RRT incidence were observed across the age bands and variation in the RRT incidence secondary to diabetes mellitus raised interesting questions. The higher rates of renal transplantation achieved in several of the comparator countries also justifies further analysis.
J Am Soc Nephrol. 2006 Jul 12;:
16837636
Cit:8
*INSERM U780, Research Unit in Biostatistics and Epidemiology, IFR 69, University Paris XI, Villejuif, and The French Rein Registry, National Coordinating Center, Biomedecine Agency, Saint-Denis, France.
Other papers by authors:
John H Stewart,
Margaret Re McCredie,
Sheila M Williams,
Kitty J Jager,
Lilyanna Trpeski,
Stephen P McDonald
Aims: To determine if rates of diabetic and non-diabetic end-stage renal disease (ESRD), which had been rising in young and middle-aged adults in all populations up to the mid-1990s, had started to decline, and if so, whether improvement had occurred in respect of each of the principal primary renal diseases causing ESRD. Methods: Poisson regression of age- and sex-standardized incidence of ESRD for persons aged 20-64 years in 18 populations from Europe, Canada and the Asia-Pacific region, for 1998-2002. Results: In persons from 12 European descent (Europid) populations combined, there was a small downward trend in all-cause ESRD (-1.7% per year, P = 0.001), with type 1 diabetic ESRD falling by 7.8% per year (P < 0.001), glomerulonephritic ESRD by 3.1% per year (P = 0.001), and 'all other non-diabetic' ESRD by 2.5% per year (P = 0.02). The reductions in ESRD attributed to hypertensive (-2.2% per year) and polycystic renal disease (-1.5% per year) and unknown diagnosis (-0.2% per year) were not statistically significant. On the other hand, the incidence of type 2 diabetic ESRD rose by 9.9% per year (P < 0.001) in the combined Europid population, although that of (principally type 2) diabetic ESRD remained unchanged in the pooled data from the four non-Europid populations. Conclusion: Recent preventive strategies, probably chiefly modern renoprotective treatment, appear to have been effective for tertiary prevention of ESRD caused by the proteinuric nephropathies other than type 2 diabetic nephropathy, for which the continuing increase in Europid populations represents a failure of prevention and/or a change in the nephropathic potential of type 2 diabetes.
J Am Soc Nephrol. 2006 Nov 15;:
17108318
Cit:22
Maki Yoshino,
Martin K Kuhlmann,
Peter Kotanko,
Roger N Greenwood,
Ronald L Pisoni,
Friedrich K Port,
Kitty J Jager,
Peter Homel,
Hans Augustijn,
Frank T de Charro,
Frederic Collart,
Ekrem Erek,
Patrik Finne,
Guillermo Garcia-Garcia,
Carola Grönhagen-Riska,
George A Ioannidis,
Frank Ivis,
Torbjorn Leivestad,
Hans Løkkegaard,
Frantisek Lopot,
Dong-Chan Jin,
Reinhard Kramar,
Toshiyuki Nakao,
Mooppil Nandakumar,
Sylvia Ramirez,
Frank M van der Sande,
Staffan Schön,
Keith Simpson,
Rowan G Walker,
Wojciech Zaluska,
Nathan W Levin
*Renal Research Institute, New York, New York; Department of Nephrology, Lister Hospital, Stevenage, United Kingdom; University Renal Research and Education Association, Ann Arbor, Michigan; Department of Medical Informatics, Academic Medical Center, ERA-EDTA Registry, Amsterdam, The Netherlands;||Department of Pain Medicine and Palliative Care, Beth Israel Medical Center, New York, New York; ¶Nederlandstalige Belgische Vereniging voor Nefrologie, Edegem, Belgium;*Center for Health Policy and Law, Erasmus University Rotterdam, Rotterdam, The Netherlands; Department of Medicine, Hôpitaux Iris Sud, Brussels, Belgium; Department of Internal Medicine and Nephrology, Istanbul University, Istanbul, Turkey; Finnish Registry for Kidney Diseases, Helsinki, Finland;||||Registro de Dialisis y Trasplante del Estado de Jalisco, Jalisco, Mexico; ¶¶Department of Medicine, Helsinki University Hospital, Helsinki, Finland;*Board of Registry, Coordination and Control of RRT, General Hospital of Athens, Athens, Greece; Canadian Organ Replacement Register, Canadian Institute for Health Information, Toronto, Ontario, Canada; Institute of Immunology, Rikshospitalet University Hospital, Oslo, Norway; Department of Nephrology, Herlev Hospital, Herlev, Denmark;||||||Department of Medicine, General University Hospital, Prague-Strahov, Czech Republic; ¶¶¶Department of Internal Medicine, St. Mary’s Hospital, Seoul, Republic of Korea;*Department of Internal Medicine, Krankenhaus der Barmherzigen Brüder, Graz, Austria; Department of Internal Medicine and Nephrology, Danube University of Krems, Austria; Department of Nephrology, Tokyo Medical University, Tokyo, Japan; National Kidney Foundation, Singapore;||||||||Prevention National Kidney Foundation in Singapore, Singapore; ¶¶¶¶Department of Nephrology, University Hospital Maastricht, The Netherlands;*Department of Internal Medicine, Central Hospital, Jönköping, Sweden; Scottish Renal Registry, Glasgow Royal Infirmary, Glasgow, Scotland and on behalf of the Scottish Renal Registry; Department of Nephrology, Royal Melbourne Hospital, Melbourne, Australia on behalf of ANZDATA (Australian and New Zealand Dialysis and Transplant Registry); and Department of Nephrology, Medical University School of Lublin, Poland.
Existing national, racial, and ethnic differences in dialysis patient mortality rates largely are unexplained. This study aimed to test the hypothesis that mortality rates related to atherosclerotic cardiovascular disease (ASCVD) in dialysis populations (DP) and in the background general populations (GP) are correlated. In a cross-sectional, multinational study, all-cause and ASCVD mortality rates were compared between GP and DP using the most recent data from the World Health Organization mortality database (67 countries; 1,571,852,000 population) and from national renal registries (26 countries; 623,900 population). Across GP of 67 countries (14,082,146 deaths), all-cause mortality rates (median 8.88 per 1000 population; range 1.93 to 15.40) were strongly related to ASCVD mortality rates (median 3.21; range 0.53 to 8.69), with Eastern European countries clustering in the upper and Southeast and East Asian countries in the lower rate ranges. Across DP (103,432 deaths), mortality rates from all causes (median 166.20; range 54.47 to 268.80) and from ASCVD (median 63.39 per 1000 population; range 21.52 to 162.40) were higher and strongly correlated. ASCVD mortality rates in DP and in the GP were significantly correlated; the relationship became even stronger after adjustment for age (R(2)= 0.56, P < 0.0001). A substantial portion of the variability in mortality rates that were observed across DP worldwide is attributable to the variability in background ASCVD mortality rates in the respective GP. Genetic and environmental factors may underlie these differences.
Department of Renal Medicine, Westmead Hospital, Westmead, New South Wales, Australia.
BACKGROUND: Five sources of change modify trends in incidence of treated end-stage renal disease (ESRD):(i) demography;(ii) disease control, comprising prevention and treatment of progressive kidney disease;(iii) competing risks, which encompass dying from untreated uraemia or non-renal comorbidity;(iv) lead-time bias; and (v) classification bias. Thus, rising crude incidence of treated ESRD may conceal effective disease control when there has been demographic change, lessening competing risks, or the introduction of bias. METHODS: Age-specific incidences of treated ESRD in Australia were calculated from Australia and New Zealand Dialysis and Transplant (ANZDATA) Registry data by indigenous/non-indigenous status (all causes) and by primary renal disease (non-indigenous only) for two successive decades, 1982-1991 and 1992-2001. RESULTS: We postulate that less competing risks explained much of the increase in treated ESRD in the elderly and Indigenous Australians. The increase in glomerulonephritic ESRD in non-indigenous Australians could be ascribed mainly to immigration from non-European countries. There was no significant change in incidence of treated ESRD in Indigenous or non-indigenous persons aged less than 25 years, in non-indigenous persons aged 25-64 years for ESRD caused by hereditary polycystic disease or hypertension, or in type 1 diabetics aged over 55 years. End-stage renal disease from analgesic nephropathy had declined. The increase in treated ESRD caused by type 2 diabetic nephropathy appeared to be multifactorial. Lead-time/length bias and less competing risks may have concealed a small favourable trend in other primary renal diseases. CONCLUSION: Whether recent disease control measures have had an impact on incidence of treated ESRD is not yet certain, but seems more likely than implied by previous reports.
BMJ. 2010 ;340 :c570
20150194
Cit:1
Marina T van Leeuwen,
Angela C Webster,
Margaret R E McCredie,
John H Stewart,
Stephen P McDonald,
Janaki Amin,
John M Kaldor,
Jeremy R Chapman,
Claire M Vajdic,
Andrew E Grulich
National Centre in HIV Epidemiology and Clinical Research, University of New South Wales, 376 Victoria St, Sydney, NSW, 2010, Australia.
OBJECTIVE: To compare cancer incidence in kidney transplant recipients during periods of transplant function (and immunosuppression) and after transplant failure (when immunosuppression is ceased or reduced). Design, setting, and participants Nationwide, population based retrospective cohort study of 8173 Australian kidney transplant recipients registered on the Australia and New Zealand Dialysis and Transplant Registry who first received a transplant during 1982-2003. Incident cancers were ascertained using linkage with national cancer registry records. MAIN OUTCOME MEASURES: Cancer-specific standardised incidence ratios for periods of transplant function and for dialysis after transplant failure. Incidence was compared between periods using multivariate incidence rate ratios adjusted for current age, sex, and duration of transplantation. RESULTS: All cases of Kaposi's sarcoma occurred during transplant function. Standardised incidence ratios were significantly elevated during transplant function, but not during dialysis after transplant failure, for non-Hodgkin's lymphoma, lip cancer, and melanoma. For each of these cancers, incidence was significantly lower during dialysis after transplant failure in multivariate analysis (incidence rate ratios 0.20 (95% CI 0.06 to 0.65) for non-Hodgkin's lymphoma, 0.04 (0.01 to 0.31) for lip cancer, and 0.16 (0.04 to 0.64) for melanoma). In contrast, standardised incidence ratios during dialysis after transplant failure remained significantly elevated for leukaemia and lung cancer, and cancers related to end stage kidney disease (kidney, urinary tract, and thyroid cancers), with thyroid cancer incidence significantly higher during dialysis after transplant failure (incidence rate ratio 6.77 (2.64 to 17.39)). There was no significant difference in incidence by transplant function for other cancers. CONCLUSIONS: The effect of immunosuppression on cancer risk is rapidly reversible for some, but not all, cancer types. Risk reversal was mainly observed for cancers with a confirmed infectious cause. Risk of other cancers, especially those related to end stage kidney disease, remained significantly increased after reduction of immunosuppression.
Claire M Vajdic,
Marina T van Leeuwen,
Angela C Webster,
Margaret R E McCredie,
John H Stewart,
Jeremy R Chapman,
Janaki Amin,
Stephen P McDonald,
Andrew E Grulich
1UNSW Cancer Research Centre, Prince of Wales Clinical School, 2National Centre in HIV Epidemiology and Clinical Research, and 3School of Public Health and Community Medicine, University of New South Wales, and 4Centre for Transplant and Renal Research, Millennium Institute, Westmead Hospital, University of Sydney, Sydney, Australia; 5Australia and New Zealand Dialysis and Transplant Registry, Queen Elizabeth Hospital, and 6Disciplines of Medicine and Public Health, University of Adelaide, Adelaide, Australia; and 7School of Public Health, University of Sydney and 8Department of Preventive and Social Medicine, University of Otago, Dunedin, New Zealand.
Melanoma incidence is increased after organ transplantation, but there is uncertainty as to why this occurs. Diagnoses of invasive melanoma were ascertained in 8,152 kidney transplant recipients (1982-2003) by linking national Australian population-based registers, the Australia and New Zealand Dialysis and Transplant Registry, and the Australian National Cancer Statistics Clearing House. Incidence rate ratios (IRR) and standardized incidence ratios were used to compare melanoma risk during periods of transplant function and failure. Standardized incidence ratios were also computed by time since transplantation. Risk factors were examined using multivariate Poisson regression. Linkage identified 82 melanomas (134/100,000 person-years). Incidence was lower after resumption of dialysis and reduction of immune suppression than during transplant function [IRR, 0.09; 95% confidence interval (95% CI), 0.01-0.66]. During first transplant function, melanoma (n = 74) relative risk peaked in the second year and declined linearly thereafter (P trend = 0.03). During first transplant function, risk was positively associated with increasing year of age (IRR, 1.05; 95% CI, 1.03-1.07) and receipt of lymphocyte-depleting antibody (IRR, 1.73; 95% CI, 1.05-2.84). Female sex (IRR, 0.57; 95% CI, 0.35-0.94), non-Caucasian race (IRR, 0.15; 95% CI, 0.02-1.05), and increasing time since transplantation (P trend = 0.06) were inversely associated with risk. The incidence pattern and risk factor profile for melanoma after transplantation strongly suggest that the current receipt, intensity, and possibly the recency of iatrogenic immunosuppression increase melanoma risk. Melanoma risk was also associated with proxy indicators of high personal sun exposure and sensitivity. These findings show the marked influence of immunologic control over melanoma incidence.(Cancer Epidemiol Biomarkers Prev 2009;18(8):OF1-7).
John H Stewart,
Claire M Vajdic,
Marina T van Leeuwen,
Janaki Amin,
Angela C Webster,
Jeremy R Chapman,
Stephen P McDonald,
Andrew E Grulich,
Margaret R E McCredie
1Department of Preventive and Social Medicine, University of Otago, Dunedin, New Zealand.
BACKGROUND: After transplantation, cancer risk varies from no increase for several common cancers to a many-fold increase for a number of, chiefly virus-associated, cancers. The smaller excess of cancer in dialysis has been less well described, but two studies suggested that impaired immunity might be responsible. METHODS: In a population-based cohort study of 28 855 patients who received renal replacement therapy (RRT), we categorized incident cancers as end-stage kidney disease (ESKD) related, immune deficiency related, not related to immune deficiency, or of uncertain status, according to whether they were, or were not, increased in published reports of cancer in ESKD prior to starting RRT, organ transplantation or human immunodeficiency virus infection. Standardized incidence ratios for, and excess burdens of, cancer were calculated for all persons normally resident in Australia starting treatment by dialysis or renal transplantation from 1982 to 2003. RESULTS: The risk for ESKD-related cancers was increased 4-fold in dialysis and during transplant function. For immune deficiency-related cancers, the increase was 1.5 (95% CI 1.3-1.6) times in dialysis, and 5-fold after transplantation. ESKD- or immune deficiency-related cancers contributed to approximately 90% of the excess burden of cancer, 48% and 36%, respectively, in dialysis, and 10% and 78% after transplantation. The remaining excess malignancy was contributed by cancers whose relationship with ESKD and immune deficiency is not yet certain. CONCLUSIONS: In RRT, the increase in cancer is restricted, largely if not wholly, to cancers with origins in ESKD or related to immune deficiency. For the former, the cancer risk is similar in dialysis and transplantation, but for immune deficiency-related cancers, the relative risk is much greater after transplantation.
Blood. 2009 May 14;:
19443660
Cit:6
Marina T van Leeuwen,
Andrew E Grulich,
Angela C Webster,
Margaret R E McCredie,
John H Stewart,
Stephen P McDonald,
Janaki Amin,
John M Kaldor,
Jeremy R Chapman,
Claire M Vajdic
National Centre in HIV Epidemiology and Clinical Research, University of New South Wales, Sydney, NSW, Australia.
Non-Hodgkin lymphoma (NHL) incidence is greatly increased after kidney transplantation. NHL risk was investigated in a nationwide cohort of 8,164 kidney transplant recipients registered on the Australia and New Zealand Dialysis and Transplant Registry. NHL diagnoses were ascertained using linkage with national cancer registry records. Multivariate Poisson regression was used to compute incidence rate ratios (IRR) with 95% confidence intervals (CI) comparing risk by transplant function, and risk factors for early (<2 years) and late (>/=2 years) NHL during the first transplant. NHL occurred in 133 patients. Incidence was strikingly lower after transplant failure and cessation of immunosuppression than during transplant function (IRR 0.25, 95% CI 0.08-0.80, p=0.019). Early NHL (n=27) was associated with Epstein-Barr virus (EBV) seronegativity at transplantation (IRR 4.66, 95% CI 2.10-10.36, p<0.001) and receipt of T-cell-depleting antibodies (IRR 2.39, 95% CI 1.08-5.30, p=0.031). Late NHL (n=79) was associated with increasing year of age (IRR 1.02, 95% CI 1.01-1.04, p=0.006), increasing time since transplantation (p<0.001), and current use of calcineurin inhibitors (IRR 3.13, 95% CI 1.53-6.39, p=0.002). These findings support two mechanisms of lymphomagenesis, one predominantly of primary EBV infection in the context of intense immunosuppression, and another, of dysregulated lymphoid proliferation in a prolonged immunosuppressed state.
Marina T van Leeuwen,
Andrew E Grulich,
Stephen P McDonald,
Margaret R E McCredie,
Janaki Amin,
John H Stewart,
Angela C Webster,
Jeremy R Chapman,
Claire M Vajdic
National Centre in HIV Epidemiology and Clinical Research, School of Public Health and Community Medicine, and University of New South Wales Cancer Research Centre, Prince of Wales Clinical School, University of New South Wales; School of Public Health and Centre for Transplant and Renal Research, Millennium Institute, Westmead Hospital, University of Sydney, Sydney, New South Wales, Australia; Australia and New Zealand Dialysis and Transplant Registry, Queen Elizabeth Hospital and Disciplines of Medicine and Public Health, University of Adelaide, Adelaide, South Australia, Australia; and Department of Preventive and Social Medicine, University of Otago, Dunedin, New Zealand.
Incidence of lip cancer is markedly increased after kidney transplantation. Immunosuppression and other risk factors for lip cancer were investigated in a population-based, nationwide cohort of 8,162 kidney transplant recipients registered on the Australia and New Zealand Dialysis and Transplant Registry (1982-2003). Lip cancer diagnoses were ascertained using probabilistic data linkage with the Australian National Cancer Statistics Clearing House. Standardized incidence ratios were used to compare lip cancer risk by subsite of lip and during periods of transplant function and failure. Risk factors during the first functioning transplant were examined using multivariate Poisson regression. Lip cancer was diagnosed in 203 patients. All cases were of squamous cell origin and mostly (77%) affected the lower vermillion. Cases occurred predominantly during periods of transplant function, with incidence decreasing to pretransplantation level on transplant failure and cessation of immunosuppression. During transplant function, cancer of the lower vermillion was associated with increasing year of age [incidence rate ratio (IRR), 1.03; 95% confidence interval (95% CI), 1.02-1.05], greater time since transplantation (P < 0.001), smoking (IRR, 2.13; 95% CI, 1.12-4.07), and current use of azathioprine (IRR, 2.67; 95% CI, 1.39-5.15) or cyclosporine (IRR, 1.63; 95% CI, 1.00-2.65). Female sex (IRR, 0.29; 95% CI, 0.18-0.46) and non-Australian/New Zealand country of birth (P = 0.006), surrogate indices of reduced exposure to solar UV radiation, were significantly protective. Lip cancer after transplantation is strongly related to the current receipt of immunosuppression. During transplant function, lip cancer risk is associated with the duration of immunosuppression, receipt of specific immunosuppressive agents, and UV exposure.(Cancer Epidemiol Biomarkers Prev 2009;18(2):561-9).
Cécile Couchoud,
Jeroen Kooman,
Patrik Finne,
Torbjørn Leivestad,
Olivera Stojceva-Taneva,
Jadranka Buturovic Ponikvar,
Frederic Collart,
Reinhard Kramar,
Angel de Francisco,
Kitty J Jager
1French ESRD Registry REIN, Agence de la biomedecine, Saint-Denis La Plaine, France.
BACKGROUND: The purpose of this study was to investigate haemodialysis (HD) dose practice patterns in different European countries in the light of the European Best Practice Guidelines (EBPG) and to study the associations of patient characteristics and country with weekly dialysis duration. METHODS: Renal registries in Europe were asked to contribute to the study with individual patient data on weekly HD duration, number of HD sessions a week and last measured Kt/V. Additional items were age, sex, date of first renal replacement therapy (RRT), dry weight, height, HD modality, HD technique, diabetes status and vascular access type. Multivariate logistic regression was used to study the probability of receiving HD for <12 h per week. RESULTS: Seven registries contributed data on 26 136 patients on HD on 31 December 2005. Eighty-three percent of the patients received HD for at least 12 h per week as recommended by the EBPG (range 49.0-97.3% across countries). Multivariate analysis showed significant differences across countries concerning the risk of receiving <12 h. Other risk factors included age (older), sex (female), BMI (low) and duration of RRT (shorter). Diabetes was associated with longer total HD duration. CONCLUSION: This study shows a great international variability in weekly HD duration and some discrepancies between current practices and the EBPG. It also points out the difficulty of obtaining and comparing Kt/V values under current registry practices.
Claire M Vajdic,
Stephen P McDonald,
Margaret R E McCredie,
Marina T van Leeuwen,
John H Stewart,
Matthew Law,
Jeremy R Chapman,
Angela C Webster,
John M Kaldor,
Andrew E Grulich
National Centre in HIV Epidemiology and Clinical Research, University of New South Wales, Sydney, Australia. cvajdic@nchecr.unsw.edu.au
CONTEXT: Immune suppression after organ transplantation is associated with a markedly increased risk of nonmelanoma skin cancer and a few virus-associated cancers. Although it is generally accepted that other cancers do not occur at increased rates, there have been few long-term population-based cohort studies performed. OBJECTIVE: To compare the incidence of cancer in patients receiving immune suppression after kidney transplantation with incidence in the same population in 2 periods before receipt of immune suppression: during dialysis and during end-stage kidney disease before renal replacement therapy (RRT). DESIGN, SETTING, AND PARTICIPANTS: A population-based cohort study of 28,855 patients with end-stage kidney disease who received RRT, with 273,407 person-years of follow-up. Incident cancers (1982-2003) were ascertained by record linkage between the Australia and New Zealand Dialysis and Transplant Registry and the Australian National Cancer Statistics Clearing House. MAIN OUTCOME MEASURE: Standardized incidence ratios (SIRs) of cancer, using age-specific, sex-specific, calendar year-specific, and state/territory-specific population cancer incidence rates. RESULTS: The overall incidence of cancer, excluding nonmelanoma skin cancer and those cancers known to frequently cause end-stage kidney disease, was markedly increased after transplantation (n = 1236; SIR, 3.27; 95% confidence interval [CI], 3.09-3.46). In contrast, cancer incidence was only slightly increased during dialysis (n = 870; SIR, 1.35; 95% CI, 1.27-1.45) and before RRT (n = 689; SIR, 1.16; 95% CI, 1.08-1.25). After transplantation, cancer occurred at significantly increased incidence at 25 sites, and risk exceeded 3-fold at 18 of these sites. Most of these cancers were of known or suspected viral etiology. CONCLUSIONS: Kidney transplantation is associated with a marked increase in cancer risk at a wide variety of sites. Because SIRs for most types of cancer were not increased before transplantation, immune suppression may be responsible for the increased risk. These data suggest a broader than previously appreciated role of the interaction between the immune system and common viral infections in the etiology of cancer.
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Epidemiol Infect. 2011 Nov 30;:1-10
22126842
University of Otago, Department of Public Health, University of Otago, Wellington, New Zealand.
SUMMARYThis study describes the epidemiology of human salmonellosis in New Zealand using notified, hospitalized and fatal cases over a 12-year period (1997-2008). The average annual incidence for notifications was 42·8/100 000 population and 3·6/100 000 population for hospitalizations. Incidence was about twice as high in summer as in winter. Rural areas had higher rates than urban areas (rate ratio 1·23, 95% confidence interval 1·22-1·24 for notifications) and a distinct spring peak. Incidence was highest in the 0-4 years age group (154·2 notifications/100 000 and 11·3 hospitalizations/100 000). Hospitalizations showed higher rates for Māori and Pacific Island populations compared to Europeans, and those living in more deprived areas, whereas notifications showed the reverse, implying that notifications are influenced by health-seeking behaviours. Salmonella Typhimurium was the dominant serotype followed by S. Enteritidis. For a developed country, salmonellosis rates in New Zealand have remained consistently high suggesting more work is needed to investigate, control and prevent this disease.
Nephrology (Carlton). 2011 Aug 19;:
21854505
Australia and New Zealand Dialysis and Transplant Registry (ANZDATA) Royal Prince Alfred Hospital, Sydney, Australia Faculty of Health Sciences, University of Adelaide, Australia.
Background: The incidence of end-stage kidney disease (ESKD) has been increasing worldwide, with increasing numbers of older people, people with diabetic nephropathy and indigenous people. We investigated the incidence of renal replacement therapy (RRT) in Australia and New Zealand (NZ) to better understand the causes of these effects. Method: Data from the ANZDATA registry and relevant population data were used to investigate the incidence of RRT in five demographic groups: Indigenous and non-indigenous Australians, Māori, Pacific Islanders and other New Zealanders, as well as differences between genders and age groups. Results: The numbers of patients commencing RRT each year increased by 321% between 1990 and 2009. This increase was largely driven by increases in patients with diabetic nephropathy. In 2009 35% of new patients had ESKD resulting from diabetic nephropathy 92% of which were type 2. Indigenous Australians, and Māori and Pacific people of NZ have elevated risks of commencing RRT due to diabetic nephropathy, although the risks compared to non-indigenous Australians have decreased over time. A small element of lead time bias also contributed to this increase. Males are more likely to commence RRT due to diabetes than females, except amongst Australian Aborigines, where females are more at risk. There is a marked increase in older, more comorbid patients. Conclusions: Patterns of incident renal replacement therapy strongly reflect the prevalence of diabetes within these groups. In addition, other factors such as reduced risk of dying before reaching ESKD, and increased acceptance of older and sicker patients are also contributing to increases in incidence of RRT.
Ecol Appl. 2011 Jun ;21 (4):1308-26
21774432
Mathematics and Statistics Department, University of Otago, P.O. Box 56, Dunedin, New Zealand. rclucas@doc.govt.nz
The annual hunt of Muttonbirds (chicks of the Sooty Shearwater, Puffinus griseus), undertaken by the Rakiura Māori people of southern New Zealand, is economically and socially integral to their cultural identity. Muttonbirders concerned at ensuring that the hunt remains viable for coming generations have provided catch records to help ascertain historic trends in hunt success. Analysis of eight catch diaries for a 67-year period demonstrates considerable consistency across diaries in the variability of hunt success, as measured by annualized mean daily hunt tallies. A conservative estimate of the overall annual decline in hunt success is -1.89%(95% CI:-1.14% to -2.65%). Birders' observations of a changing relationship between chick quality and hunt success was evidenced across diaries. Reduced hunt success from the 1990s indicates that possible adult "knockdowns" and/or sustained substantial reductions in breeding proportions have occurred. Chick size has remained constant, suggesting little change in the provisioning environment. Catch per unit effort data, provided by a single diary, confirms a link between variability in annual hunt success and chick abundance. The Pacific Decadal Oscillation (PDO) and the Southern Annular Mode (SAM) are correlated with hunt success and chick size, respectively. Interannual PDO+(or PDO-) values are correlated with higher (or lower) tallies, whereas SAM+(or SAM) values are associated with larger (or smaller) chick size. Uncertainty in the relationship between the breeding Sooty Shearwater population, chick catch, and environmental perturbation in their feeding grounds could be reduced with the inclusion of hunt time in all diary records. Ongoing prolonged decline in a top-trophic-level predator such as the Sooty Shearwater raises serious concern that long-term oceanic changes have been occurring and that long-term sustainability of muttonbirding is in doubt.
Med J Aust. 2011 Jul 4;195 (1):10-4
21728934
Emma L Heeley,
Jade W Wei,
Kristie Carter,
Md Shaheenul Islam,
Amanda G Thrift,
Graeme J Hankey,
Alan Cass,
Craig S Anderson
The George Institute for Global Health, Sydney, NSW, Australia. eheeley@george.org.au.
To assess the influence of area-level socioeconomic status (SES) on incidence and case-fatality rates for stroke. Analysis of pooled data for 3077 patients with incident stroke from three population-based studies in Perth, Melbourne, and Auckland between 1995 and 2003. Incidence and 12-month case-fatality rates for stroke. Annual age-standardised stroke incidence rates ranged from 77 per 100 000 person-years (95% CI, 72-83) in the least deprived areas to 131 per 100 000 person-years (95% CI, 120-141) in the most deprived areas (rate ratio, 1.70; 95% CI, 1.47-1.95; P < 0.001). The population attributable risk of stroke was 19%(95% CI, 12%-27%) for those living in the most deprived areas compared with the least deprived areas. Compared with people in the least deprived areas, those in the most deprived areas tended to be younger (mean age, 68 v 77 years; P < 0.001), had more comorbidities such as hypertension (58% v 51%; P < 0.001) and diabetes (22% v 12%; P < 0.001), and were more likely to smoke (23% v 8%; P < 0.001). After adjustment for age, area-level SES was not associated with 12-month case-fatality rate. Our analysis provides evidence that people living in areas that are relatively more deprived in socioeconomic terms experience higher rates of stroke. This may be explained by a higher prevalence of risk factors among these populations, such as hypertension, diabetes and cigarette smoking. Effective preventive measures in the more deprived areas of the community could substantially reduce rates of stroke.
J Clin Pathol. 2011 Mar 11;:
21398322
Garry Nixon,
Katharina Blattner,
Jenny Dawson,
Susan Dovey,
Michael A Black,
Gerard Wilkins,
Amy C Dunn,
Alexander D McLellan
Dunstan Hospital, Alexandra, New Zealand.
Background New Zealand Māori have some of the highest rates of Group A streptococcal infection (GAS) in the world. GAS elevates titres of antistreptokinase (SK) neutralising antibodies and may induce resistance to SK. Methods Anti-SK titres were measured in 180 patients presenting with symptoms consistent with an acute coronary syndrome to three New Zealand rural hospitals, selected because they provide care for patients from communities with different socio-economic and ethnic mixes (Māori proportions varying between 6% and 67%). Findings Compared with the community with the lowest proportion of Māori, patients in the community with the highest proportion of Māori had mean anti-SK titres that were 2.8 times higher (p=0.05). They were 2.5 times more likely to have a high anti-SK titre (33% vs 13% p=0.035). Interpretation Alternatives to reperfusion with SK should be the first-choice therapy in hospitals serving communities with high rates of GAS such as some predominantly Māori and Pacific Island communities.
ANZDATA Registry, Adelaide, Australia. stephenm@anzdata.org.au
Indigenous people in Australia and New Zealand experience rates of ESKD several times higher than non-indigenous people. This relative rate is highest among people aged 45 - 54 for Aboriginal Australians, and 65 - 74 years for Maori. The majority of this is driven by diabetic nephropathy. Both groups have lesser utilization of transplantation as a renal replacement therapy than non-indigenous comparators, and lesser utilization of home dialysis modalities.
Int J Pediatr Obes. 2010 Mar 17;:
20233159
Pacific Health.
Abstract Objective. Previous studies show that body mass index (BMI) does not fully explain differences in percent body fat (%BF) between ethnic groups and few studies have investigated this in adolescents. We sought to compare %BF for a given BMI between adolescents from four ethnic groups and to explain ethnic differences in this relationship. Methods. Weight, height and waist circumference were measured in 202 boys and 197 girls (age range 12-19 years; 129 Pacific Island, 91 European, 90 Maori and 89 Asian Indian). Fat mass, appendicular skeletal muscle mass (ASMM), leg length, bone mineral content (BMC), and fat distribution measures were derived from dual-energy X-ray absorptiometry. Results. For the same BMI and age, compared with European boys,%BF in Maori, Pacific Island and Asian Indian boys was 2.8% lower (P=0.017), 5.2% lower (P<0.0001), and 3.5% higher (P=0.0025), respectively. Compared with European girls,%BF, adjusted for BMI, for Maori, Pacific Island and Asian Indian girls was 1.9% lower (P=0.024), 4.1% lower (P<0.0001) and 3.6% higher (P<0.0001), respectively. Adjustment for ASMM, BMC and fat distribution variables, in particular, significantly reduced the differences between ethnic groups. In boys, readily measured variables, conicity index and waist circumference/height, had notable effects on ethnic differences in %BF. Conclusions. Our results show that BMI is not an equivalent measure of %BF between adolescent Europeans, Maori, Pacific Islanders and Asian Indians. Differences in muscularity, bone mass, relative leg length, fat distribution and body shape contribute to this disparity.
Centre for Suicide Research, Department of Psychiatry, University of Oxford, Warneford Hospital, Oxford, OX3 7JX, UK, seena.fazel@psych.ox.ac.uk.
BACKGROUND: Although suicide rates among prisoners are high and vary between countries, it is uncertain whether this reflects the importation of risk from the general population or is associated with incarceration rates. METHODS: We collected data on suicides and undetermined deaths in 12 countries (Australia, Belgium, Canada, Denmark, England and Wales, Finland, Ireland, Netherlands, New Zealand, Norway, Scotland, and Sweden) directly from their prison administrations for 2003-2007. These were compared with rates of suicides in the general population separately by gender using Pearson's correlations. In addition, they were compared with rates of incarceration. Linear regression was used to examine any association after adjustment for rates of incarceration. RESULTS: Data were collected on 861 suicides in prison, of which 810 were in men. In the men, crude relative rates of suicide were at least three times higher than the general population. Western European countries had similar rates of prisoner suicide which were mostly higher than those in Australia, Canada, and New Zealand. There was no association between rates of suicide in prisoners and general population rates or rates of incarceration. In the women, inmate suicide rates varied widely and were mostly raised compared with rates in the general population. In addition, these rates did not appear to be associated with general population rates of suicide. CONCLUSIONS: Rates of prison suicide do not reflect general population suicide rates, suggesting that variations in prison suicide rates reflect differences in criminal justice systems including, possibly, the provision of psychiatric care in prison.
Soc Sci Med. 2009 Jan 9;:
19136183
Cit:3
GeoHealth Laboratory, Department of Geography, University of Canterbury, Private Bag 4800, Christchurch, New Zealand.
The overall prevalence of smoking in New Zealand reduced from 32% in 1981 to 23.5% in 2006 but rates of smoking cessation have not been consistent among all social, demographic and ethnic groups. The period 1981-2006 also saw macroeconomic changes in New Zealand that resulted in profound increases in social and economic inequalities. Within this socio-political context we address two questions. First, has there been a social polarisation in smoking prevalence and cessation in New Zealand between 1981 and 2006? Second, to what extent can ethnic variation in rates of quitting be explained by community inequality, independently of socio-economic status? We find that smoking behaviour in New Zealand has become socially and ethnically more polarised over the past two decades, with greater levels of smoking cessation among higher socio-economic groups, and among New Zealanders of European origin. Variations in quit rates between Māori and European New Zealanders cannot be fully accounted for by ethnic differences in socio-economic status. Community inequality exerted a significant influence on Māori (but not European) smoking quit rates. The association with community inequality was particularly profound among women, and for particular age groups living in urban areas. These findings extend the international evidence for a relationship between social inequality and health, and in particular smoking behaviour. The research also confirms the importance of considering the role of contextual factors when attempting to elucidate the mechanisms linking socio-economic factors to health outcomes. Our findings emphasise that, if future smoking cessation strategies are to be successful, attention has to shift from policies that focus solely on engineering individual behavioural change, to an inclusion of the role of environmental stressors such as community inequality.
Department of Public Health, University of Otago, Wellington, New Zealand.
Aim: Acute rheumatic fever (ARF) and its sequela chronic rheumatic heart disease remain significant causes of morbidity and mortality in New Zealand, particularly among Māori and Pacific peoples. Despite its importance, ARF epidemiology has not been reviewed recently. The aims of this study were to assess trends in ARF incidence rates between 1996 and 2005 and the extent to which ARF is concentrated in certain populations based on age, sex, ethnicity and geographical location. Methods: This descriptive epidemiological study examined ARF incidence rates using hospitalisation data (1996-2005) and population data from the 1996 and 2001 censuses. Rates were compared by using rate ratios and 95% confidence intervals. Results: New Zealand's annual ARF rate was 3.4 per 100 000. ARF was concentrated in certain populations: 5- to 14-year-olds, Māori and Pacific peoples and upper North Island areas. From 1996 to 2005, the New Zealand European and Others ARF rate decreased significantly while Māori and Pacific peoples' rates increased. Compared with New Zealand European and Others, rate ratios were 10.0 for Māori and 20.7 for Pacific peoples. Of all cases, 59.5% were Māori or Pacific children aged 5-14 years, yet this group comprised only 4.7% of the New Zealand population. Conclusion: ARF rates in New Zealand have failed to decrease since the 1980s and remain some of the highest reported in a developed country. There are large, and now widening, ethnic disparities in ARF incidence. ARF is so concentrated by age group, ethnicity and geographical area that highly targeted interventions could be considered, based on these characteristics.
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