Benjamin D. Pollock

Is It Time to Employ a Measure of Visit-to-Visit Variability in Clinical Practice?

See related article, pp 461–468 Variability is an intrinsic property of blood pressure (BP), being noted during short-term scrutiny (beat-to-beat variability), during a 24-hour period (circadian rhythm), and over longer periods of observation (visit-to-visit [VVV] variability). In clinical practice, variability has traditionally been seen as an impediment to diagnosis of hypertension and accurate assessment of the role of usual BP as a predictor of cardiovascular disease (CVD). Guidelines have focused on standardizing the methods for measurement of BP as a means to minimize systematic error and on averaging the readings within and across visits to reduce random error. Given the established importance of usual BP as a predictor of CVD risk, this makes good sense albeit implementation of recommendations for accurate measurement of BP in routine clinical practice is a formidable challenge. A variety of factors are known to be associated with greater VVV variability in BP, including older age, female sex, higher levels of BP, diabetes mellitus, subclinical CVD, stroke, coronary heart disease, and renal disease.1 Increased BP variability is a prominent feature in patients with comorbid conditions, especially those with chronic kidney disease.1 Although at least one report linking variability in BP to CVD was published in 1983 and another in 1997, it has only been in the recent past that VVV has been widely recognized as a potentially useful attribute in estimating CVD risk. Rothwell’s seminal 2010 publications detailing the role of VVV as a predictor of stroke, independent of mean arterial BP,1 and a concurrent report by Hansen et al2 that identified BP variability during 24-hour monitoring of BP as an independent predictor of CVD and all-cause mortality set the stage for what has become an increasingly active area of investigation. Subsequent reports have generally supported the role of VVV as an …

Differential sex effects of systolic blood pressure and low-density lipoprotein cholesterol on type 2 diabetes: Life course data from the Bogalusa Heart Study: 收缩压与低密度脂蛋白胆固醇的不同性别差异对2型糖尿病的影响:来自博加卢萨心血管研究的生命历程数据

There may be sex‐specific cardiometabolic mechanisms early in life that affect the development of type 2 diabetes mellitus (T2DM) through mid‐adulthood. However, few studies have examined whether early life course interactions between cardiometabolic risk factors and sex are associated with incident T2DM.

Retinoblastoma in the United States: A 40-Year Incidence and Survival Analysis

PURPOSE To determine the incidence of retinoblastoma in the United States from 1973 to 2012 (40 years) and characterize the 5-year overall survival rate of the included patients. METHODS Cases of retinoblastoma were derived from the Surveillance, Epidemiology, and End Results (SEER) Program (National Cancer Institute, Rockville, MD). Incidence rates were calculated using U.S. Census Bureau data as the standard population, and trends over time were determined using the chi-square test. Hazard ratios with a 95% confidence interval (CI) were estimated for variables associated with mortality using Cox regression models. Survival rates were calculated using the Kaplan-Meier method and compared among different clinical and demographic categories. RESULTS A total of 879 cases of retinoblastoma were derived from the SEER databases. The annual incidence rates of retinoblastoma for a period of 40 years were 12.14 (95% CI: 11.32 to 12.96) cases per 1 million children 4 years or younger and 0.49 (95% CI: 0.36 to 0.65) cases per 1 million children between the ages of 5 and 9 years. There was no significant trend for children 4 years or younger (P = .6324) or between the ages of 5 and 9 years (P = .7695). The 5-year overall survival rates were 97.6%, 92.7%, 91.1%, and 96.4% for children diagnosed at the first, second, third, and after the third year of life, respectively (P = .0136). The 5-year overall survival rates were 92.5% for bilateral and 96.3% for unilateral cases (P = .0116). The 5-year overall survival rates were 90.8%, 92.5%, 97.6%, 97.3% for increasing time intervals (1973 to 1979, 1980 to 1989, 1990 to 1999, and 2000 to 2012, respectively; P = .0017). CONCLUSIONS The incidence rate of retinoblastoma in the United States has remained stable for the past 40 years. Survival rate analysis indicates a significant effect of laterality of tumor, age at diagnosis, and decade of diagnosis. [J Pediatr Ophthalmol Strabismus. 2018;55(3):182-188.].

Utility of existing diabetes risk prediction tools for young black and white adults: Evidence from the Bogalusa Heart Study.

AIMS To evaluate several adult diabetes risk calculation tools for predicting the development of incident diabetes and pre-diabetes in a bi-racial, young adult population. METHODS Surveys beginning in young adulthood (baseline age ≥18) and continuing across multiple decades for 2122 participants of the Bogalusa Heart Study were used to test the associations of five well-known adult diabetes risk scores with incident diabetes and pre-diabetes using separate Cox models for each risk score. Racial differences were tested within each model. Predictive utility and discrimination were determined for each risk score using the Net Reclassification Index (NRI) and Harrells c-statistic. RESULTS All risk scores were strongly associated (p<.0001) with incident diabetes and pre-diabetes. The Wilson model indicated greater risk of diabetes for blacks versus whites with equivalent risk scores (HR=1.59; 95% CI 1.11-2.28; p=.01). C-statistics for the diabetes risk models ranged from 0.79 to 0.83. Non-event NRIs indicated high specificity (non-event NRIs: 76%-88%), but poor sensitivity (event NRIs: -23% to -3%). CONCLUSIONS Five diabetes risk scores established in middle-aged, racially homogenous adult populations are generally applicable to younger adults with good specificity but poor sensitivity. The addition of race to these models did not result in greater predictive capabilities. A more sensitive risk score to predict diabetes in younger adults is needed.

Differential sex effects of systolic blood pressure and LDL-C on Type 2 diabetes: Life-course data from the Bogalusa Heart Study

There may be sex‐specific cardiometabolic mechanisms early in life that affect the development of type 2 diabetes mellitus (T2DM) through mid‐adulthood. However, few studies have examined whether early life course interactions between cardiometabolic risk factors and sex are associated with incident T2DM.

Differential sex effects of systolic blood pressure and low-density lipoprotein cholesterol on type 2 diabetes: Life course data from the Bogalusa Heart Study

There may be sex‐specific cardiometabolic mechanisms early in life that affect the development of type 2 diabetes mellitus (T2DM) through mid‐adulthood. However, few studies have examined whether early life course interactions between cardiometabolic risk factors and sex are associated with incident T2DM.

Abstract 5211: Trends in the incidence of retinoblastoma in the United States from 1973-2012

Background: Retinoblastoma is a rare form of eye cancer that usually develops in early childhood, typically before the age of 5. This study aims to determine the incidence of retinoblastoma in the United States over a 40-year period from 1973 to 2012 using a review of existing databases. Methods: 882 patients with retinoblastoma (International Classification of Diseases for Oncology (ICD-O-3) codes C69.2 (retina) and C69.9 (eye, NOS)) were derived from the Surveillance, Epidemiology, and End Results (SEER) program database in the United States from 1973 to 2012, using the nine historical SEER registries with the earliest observation collections. Incidence rates were calculated per 1,000,000 children and age-adjusted using the United States Census Bureau data as the standard population. The significance of trend in the incidence rate over time was determined using the Chi-Square test, and 95% CIs were calculated. Descriptive statistics evaluated differences in incidence in terms of age group, gender, race and laterality. Surveillance was evaluated by analysis of diagnosis confirmation and reporting source. Results: There were a total of 882 cases of retinoblastoma, representing 6.1% of all childhood cancers under age 5 years. 49.1% of cases were males and 96% of all cases were children aged 0-4 years. The mean incidence of retinoblastoma was 12.14 cases per million children aged 0-4 years (95% CI 11.32 to 12.96) and 0.49 cases per million children aged 5-9 years (95% CI 0.36 to 0.65). There was no significant trend in the incidence for children aged 0-4 years old (Xsup2 = 35.455 p = 0.6324) or 5-9 years old (Xsup2 = 32.247 p = 0.7695) for all races/genders. The proportion of bilateral cases (28.9%) versus unilateral cases (71.1%) remained stable over the 40-year period. 85.6% of the cases were confirmed microscopically and hospitals represent 98.8% of the reporting sources. Conclusions: The incidence rate of retinoblastoma in the United States has remained stable for the last 40 years. The majority of the cases are unilateral, and hospitals are the main reporting source. Citation Format: Arthur G. Fernandes, Benjamin D. Pollock, Aaron E. Hoffman. Trends in the incidence of retinoblastoma in the United States from 1973-2012. [abstract]. In: Proceedings of the 107th Annual Meeting of the American Association for Cancer Research; 2016 Apr 16-20; New Orleans, LA. Philadelphia (PA): AACR; Cancer Res 2016;76(14 Suppl):Abstract nr 5211.