Niloofar Taghizadeh

Lifetime Smoking History and Cause-Specific Mortality in a Cohort Study with 43 Years of Follow-Up

Background In general, smoking increases the risk of mortality. However, it is less clear how the relative risk varies by cause of death. The exact impact of changes in smoking habits throughout life on different mortality risks is less studied. Methods We studied the impact of baseline and lifetime smoking habits, and duration of smoking on the risk of all-cause mortality, mortality of cardiovascular diseases (CVD), chronic obstructive pulmonary disease (COPD), any cancer and of the four most common types of cancer (lung, colorectal, prostate, and breast cancer) in a cohort study (Vlagtwedde-Vlaardingen 1965–1990, with a follow-up on mortality status until 2009, n = 8,645). We used Cox regression models adjusted for age, BMI, sex, and place of residence. Since previous studies suggested a potential effect modification of sex, we additionally stratified by sex and tested for interactions. In addition, to determine which cause of death carried the highest risk we performed competing-risk analyses on mortality due to CVD, cancer, COPD and other causes. Results Current smoking (light, moderate, and heavy cigarette smoking) and lifetime persistent smoking were associated with an increased risk of all-cause, CVD, COPD, any cancer, and lung cancer mortality. Higher numbers of pack years at baseline were associated with an increased risk of all-cause, CVD, COPD, any cancer, lung, colorectal, and prostate cancer mortality. Males who were lifetime persistent pipe/cigar smokers had a higher risk of lung cancer [HR (95% CI) = 7.72 (1.72–34.75)] as well as all-cause and any cancer mortality. A longer duration of smoking was associated with a higher risk of COPD, any and lung cancer [HR (95% CI) = 1.06 (1.00–1.12), 1.03 (1.00–1.06) and 1.10 (1.03–1.17) respectively], but not with other mortality causes. The competing risk analyses showed that ex- and current smokers had a higher risk of cancer, CVD, and COPD mortality compared to all other mortality causes. In addition, heavy smokers had a higher risk for COPD mortality compared to cancer, and CVD mortality. Conclusion Our study indicates that lifetime numbers of cigarettes smoked and the duration of smoking have different impacts for different causes of mortality. Moreover, our findings emphasize the importance of smoking-related competing risks when studying the smoking-related cancer mortality in a general population and that smoking cessation immediately effectively reduces the risk of all-cause and any cancer mortality.

US Hospitalizations for Malignant Pleural Effusions: Data From the 2012 National Inpatient Sample

Background Malignant pleural effusion (MPE) is a common complication of advanced malignancy, but little is known regarding its prevalence and overall burden on a population level. Methods We conducted a retrospective analysis of MPE‐associated hospitalizations using the Healthcare Cost and Utilization Project‐Nationwide Inpatient Sample, Agency for Healthcare Research and Quality (HCUP‐NIS 2012). Cases were included if MPE was coded as a primary or secondary diagnosis or if an unspecified pleural effusion was coded in addition to a diagnosis of cancer with either of these being the primary diagnosis. Results A weighted sample of 126,825 admissions (0.35%) for MPE was identified among the 36,484,846 weighted admissions included in the database in 2012. Of these admissions, 70,750 (55.8%) were for female patients. The median age at admission was 68.0 years (interquartile range [IQR]), 58.4‐77.2 years). Lung (37.8%), breast (15.2%), hematologic (11.2%), GI tract (11.0%), and gynecologic (9.0%) cancers were the most common primary malignancies associated with MPE. The median length of stay was 5.5 days (IQR, 2.7‐10.1 days), and the inpatient mortality rate was 11.6%. Median hospitalization total charges were

Lesion heterogeneity and risk of infectious complications following peripheral endobronchial ultrasound

42,376 (IQR,

Procedures Performed during Hospitalizations for Malignant Pleural Effusions: Data from the 2012 National Inpatient Sample

21,618‐

Peripheral blood eosinophil counts and risk of colorectal cancer mortality in a large general population-based cohort study

84,679). In the multivariate analyses, female sex, large fringe county residential area, Medicare insurance, and elective type of admission were independently associated with a lower risk of inpatient mortality. Conclusions There is a considerable inpatient burden and high inpatient mortality associated with MPE in the United States, with potential demographic, geographic, and socioeconomic disparities.

Low Prevalence of High Grade Lesions Detected With Autofluorescence Bronchoscopy in the Setting of Lung Cancer Screening in the Pan-Canadian Lung Cancer Screening Study

The reported incidence of peripheral endobronchial ultrasound (pEBUS)‐related infectious complications is below 1%, although studies have never focused solely on them or reported their risk factors. The goal of this study is to describe our local pEBUS infectious complication rate and characterize patient, lesion and procedural factors associated with infectious complications.

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Background: Malignant pleural effusions (MPE) are a common clinical problem. Little is known about the burden of MPE and of the treatments used to alleviate its symptoms on the United States Health Care System. Objectives: We aimed to obtain a better portrait of inpatient pleural procedures performed in the United States. Methods: We conducted a retrospective analysis of MPE-associated hospitalizations using the Healthcare Cost and Utilization Project-Nationwide Inpatient Sample, Agency for Healthcare Research and Quality (HCUP-NIS 2012). Descriptive statistics were used to analyze procedures performed and their complications. Univariate and multivariate logistic regression models were used to explore the relationship between procedures performed and inpatient mortality and length of stay. Results: Among the 126,825 hospital admissions with a diagnosis of MPE, 72,240 included one or more pleural procedures. Thoracentesis (54,070) was the most frequently performed procedure followed by chest tube placement (23,035), chemical pleurodesis (10,240), and thoracoscopy (6,615). Hospitalization for lung and breast cancer was more likely to include pleural procedures compared to hospitalization for other types of cancer (59.2 and 65.6%, respectively, p < 0.0001). Chemical pleurodesis through a chest tube compared to thoracoscopic chemical pleurodesis was performed more frequently (57 vs. 43%, p < 0.001) and associated with a longer hospital stay (4.9 vs. 5.9 days, p < 0.001). Conclusions: Hospital admissions for MPE represent a large burden on the US Health Care System. Many hospitalizations are associated with procedures not expected to reduce the recurrence rate of this condition.

Tobacco use and motivation to stop smoking among long-term smokers who are ineligible for lung cancer screening

1583 Background: Few epidemiological studies have investigated the association between blood eosinophil counts and colorectal cancer incidence. The current prospective cohort study aims to investigate the association between peripheral blood eosinophils and colorectal cancer mortality risk. METHODS Vital status at December 31st, 2008 of 8465 participants of the Vlagtwedde/Vlaardingen (a rural respectively industrial area in The Netherlands) cohort study was determined. This study started in 1965 and participants had medical examinations every 3 years until the last survey in 1989/1990. Blood eosinophil counts at the first survey were logtransformed to obtain a normal distribution. Multivariate Cox regression analyses on colorectal cancer mortality in the total population with adjustment for age, FEV1 % predicted, BMI, smoking habit, gender and place of residence, were performed. Furthermore, stratified analyses by smoking habits (never versus ever) and by gender were performed. Finally, interactions between eosinophil counts and smoking habits, respectively gender were investigated. RESULTS In total, 3838 subjects had died; 134 died due to colorectal cancer. There was no association between eosinophil counts and colorectal cancer mortality risk in the total population (Hazard Ratio (95% CI) == 0.84 (0.65-1.09)). The stratified analyses showed significant associations between number of eosinophils and colorectal cancer mortality in males (HR== 0.64 (95% CI 0.45-0.89)) and in ever smokers (HR== 0.63 (95% CI 0.46-0.86)). Additionally, we observed a significant interaction between male gender and eosinophil counts (HR== 0.48 (95% CI 0.28-0.80)) and between smoking and eosinophil counts on colorectal cancer mortality (HR== 0.40 (95% CI 0.23-0.70)). CONCLUSIONS A higher number of peripheral blood eosinophils is associated with a reduced risk to die of colorectal cancer, especially in ever smokers and in males. Although the underlying mechanism explaining this observation is not clear, it suggests that a more active immune system reduces the risk to develop colorectal cancer.