Predicting coronavirus disease (COVID-19) outcomes in the United States early in the epidemic.

By 21 October 2020, the coronavirus disease (COVID-19) epidemic in the United States (US) had infected 8.3 million people, resulting in 61,364 laboratory-confirmed hospitalizations and 222,157 deaths. Currently, policymakers are trying to better understand this epidemic, especially the human-to-human transmissibility of the novel severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) in relation to social, populational, air travel related and environmental exposure factors. Our study used 50 US states' public health surveillance datasets (January 1-April 1, 2020) to measure associations of confirmed COVID-19 cases, hospitalizations and deaths with these variables. Using the resulting associations and multivariate regression (Negative Binomial and Poisson), predicted cases, hospitalizations and deaths were generated for each US state early in the epidemic. Factors associated with a significantly increased risk of COVID-19 disease, hospitalization and death included: population density, enplanement, Black race and increased sun exposure; in addition, COVID-19 disease and hospitalization were also associated with morning humidity. Although predictions of the number of cases, hospitalizations and deaths due to COVID-19 were not accurate for every state, those states with a combination of large number of enplanements, high population density, high proportion of Black residents, high humidity or low sun exposure may expect more rapid than expected growth in the number of COVID-19 events early in the epidemic.

Comorbidities and the risk of cardiovascular disease mortality among racially diverse patients with breast cancer.

BACKGROUND: Women who have coexisting comorbidities at the time of breast cancer diagnosis have an increased risk of breast cancer and overall mortality. However, the associations between newly diagnosed comorbidities and the risk of cardiovascular disease (CVD) mortality among these patients have not been examined. METHODS: The authors compared the associations between coexisting and newly diagnosed CVD, type 2 diabetes, and hypertension and the risk of CVD mortality among patients with breast cancer identified in the Missouri Cancer Registry. In total, 33,099 women who had incident invasive breast cancer with inpatient and outpatient hospital discharge data within 2 years after breast cancer diagnosis were included: 9.3% were Black. Subdistribution hazard ratios (sdHRs) and 95% CIs were calculated for the risk of CVD-related mortality using adjusted Cox proportional hazards regression models, accounting for a competing risk of breast cancer deaths. RESULTS: Within the first 2 years after breast cancer, the most reported newly diagnosed comorbidity was hypertension (9%), followed by CVD (4%), and type 2 diabetes (2%). CVD mortality was increased in women who had newly diagnosed CVD (sdHR, 2.49; 95% CI, 2.09-2.99), diabetes (sdHR, 2.16; 95% CI, 1.68-2.77), or hypertension (sdHR, 2.06; 95% CI, 1.71-2.48) compared with women who did not have these conditions. Associations were similar by race. The strongest association was among women who received chemotherapy and then developed CVD (sdHR, 3.82; 95% CI, 2.69-5.43). CONCLUSIONS: Monitoring for diabetes, hypertension, and CVD from the time of breast diagnosis may reduce CVD mortality.

Relationship between insurance status and outcomes for patients with breast cancer in Missouri.

BACKGROUND: The cancer stage at diagnosis, treatment delays, and breast cancer mortality vary with insurance status. METHODS: Using the Missouri Cancer Registry, this analysis included 31,485 women diagnosed with invasive breast cancer from January 1, 2007, to December 31, 2015. Odds ratios (ORs) of a late-stage (stage III or IV) diagnosis and a treatment delay (>60 days after the diagnosis) were calculated with logistic regression. The hazard ratio (HR) of breast cancer mortality was calculated with Cox proportional hazards regression. Mediation analysis was used to quantify the individual contributions of each covariate to mortality. RESULTS: The OR of a late-stage diagnosis was higher for patients with Medicaid (OR, 1.72; 95% confidence interval [CI], 1.56-1.91) or no insurance (OR, 2.30; 95% CI, 1.91-2.78) in comparison with privately insured patients. Medicare (OR, 1.21; 95% CI, 1.10-1.37), Medicaid (OR, 1.60; 95% CI, 1.37-1.85), and uninsured patients (OR, 1.58; 95% CI, 1.18-2.12) had higher odds of a treatment delay. The HR of breast cancer-specific mortality was significantly increased in the groups with public insurance or no insurance and decreased after sequential adjustments for sociodemographic factors (HR, 2.39; 95% CI, 1.96-2.91), tumor characteristics (HR, 1.28; 95% CI, 1.05-1.56), and treatment (HR, 1.23; 95% CI, 1.01-1.50). Late-stage diagnoses accounted for 72.5% of breast cancer mortality in the uninsured. CONCLUSIONS: Compared with the privately insured, women with public or no insurance had a higher risk for advanced breast cancer, a >60-day treatment delay, and death from breast cancer. Particularly for the uninsured, Medicaid expansion and increased funding for education and screening programs could decrease breast cancer disparities.

Usability Assessment of the Missouri Cancer Registry's Published Interactive Mapping Reports: Round Two.

BACKGROUND: Health-related data's users have trouble understanding and interpreting combined statistical and mapping information. This is the second round of a usability study conducted after we modified and simplified our tested maps based on the first round's results. OBJECTIVE: To explore if the tested maps' usability improved by modifying the maps according to the first round's results. METHODS: We recruited 13 cancer professionals from National American Central Cancer registries (NACCR) 2016 conference. The study involved three phases per participant: A pretest questionnaire, the multi-task usability test, and the System Usability Scale (SUS). Software was used to record the computer screen during the trial and the users' spoken comments. We measured several qualitative and quantitative usability metrics. The study's data was analyzed using spreadsheet software. RESULTS: In the current study, unlike the previous round, there was no significant statistical relationship between the subjects' performance on the study test and the experience in GIS tools (P = .17 previously was .03). Three out of the four (75%) of our subjects with a bachelor's degree or less accomplished the given tasks effectively and efficiently. This study developed a comparable satisfaction results to the first round study, despite that the previous round's participants were highly educated and more experienced with GIS. CONCLUSION: By considering the round one's results and by updating our maps, we made the tested maps simpler to be used by subjects who have little experience in using GIS technology, and have little spatial and statistical knowledge.

The effect of metabolic risk factors on cancer mortality among blacks and whites.

BACKGROUND: Previous data showed that metabolic syndrome (MS) and its components are associated with cancer mortality. However, whether the association varies by race is unclear. To examine the association between metabolic risk factors and cancer death in non-Hispanic whites (whites) and non-Hispanic blacks (blacks) in the US. METHODS: We used data from National Health and Nutrition Examination Survey III (NHANES III) [1988-1994], a nationwide survey conducted by the National Center for Health Statistics of the Centers for Disease Control and Prevention in the US. We included a total of 18,001 participants aged ≥20 years in the study. We ascertained cancer death from NHANES III mortality follow-up study, which linked with the National Death Index and provides follow-up from the date of baseline NHANES III [1988-1994] through December 2006. MS was defined as the presence of at least three of five risk factors [i.e., elevated triglycerides (TG) (≥150 mg/dL), impaired fasting blood glucose (≥100 mg/dL), increased waist circumference (≥88 cm for women and ≥102 cm for men), elevated blood pressure (BP) (≥130 mmHg systolic BP or ≥85 mmHg diastolic BP) and, reduced high density lipoprotein (HDL) cholesterol (<50 mg/dL)]. The interaction between race and MS and its components against total cancer mortality was first tested. Cox proportional hazards regression was then used to estimate the hazard ratios (HR) and 95% confidence intervals (CI) for total cancer mortality in relation to each MS individual component, and a MS composite score in whites and blacks, separately. RESULTS: We found a statistically significant interaction between MS and race as well as MS components and race in their effect on cancer death. In adjusted models, elevated BP was significantly associated with a 41% increased risk of total cancer death in blacks (HR 1.41; 95% CI, 1.10-1.80) while in whites, the risk of cancer death increased 29% with central obesity (HR 1.29; 95% CI, 1.05-1.59), 26% with low HDL (HR 1.26; 95% CI, 1.04-1.52), and 45% with impaired fasting glucose (HR 1.45; 95% CI, 1.19-1.76). CONCLUSIONS: The relationship between metabolic risk factors and total cancer mortality differed by race in the US. In blacks, high BP was associated with an increased risk for cancer death while in whites, central obesity, low HDL, and especially impaired fasting glucose were positively associated with cancer death.

Five Fruit and Vegetable a Day Does Not Reflect the Upward Trend of Obesity in the U.S.

OBJECTIVE: After almost three decades of U.S. surveillance in fruit and vegetable (F&V) intake and obesity, it is important to evaluate their usefulness for monitoring prevention and health promotion efforts in public health. We used U.S. surveillance data to evaluate whether the 16-year trends of F&V intake, measured by the prevalence of eating five or more servings of fruits and vegetables a day (FV5/day) is related to obesity trend as measured by its prevalence in the same period. We also evaluated whether trends in the prevalence of FV5/day by important sociodemographic factors (age, race/ethnicity, etc.) could explain the findings. STUDY DESIGN: A secondary analysis of U.S. adults (≥ 18 years) from the Behavioral Risk Factor Surveillance System (BRFSS) (1994-2009). METHODS: We categorized survey subjects for their F&V intake derived from the BRFSS six-question food frequency questionnaire into two groups: < FV5/day vs. ≥ FV5/day. Obesity was defined as BMI ≥ 30. We used logistic regressions to compute predicted prevalence of FV5/day and obesity, and to estimate the odds ratio of FV5/day by obesity and levels of sociodemographic, stratified by year. RESULTS: Between 1994 and 2009, the prevalence of FV5/day hovered around 25% among U.S. adults, while the obesity prevalence steadily increased from 14.8% to 27.4%. As measured through odds ratio, an inverse association between FV5/day and obesity was only observed in 55+, but not in other age, racial/ethnic or education groups. CONCLUSIONS: Between 1994 and 2009, we could not confirm a decrease in the prevalence of FV5/day associated with an increase in obesity prevalence, except for age 55+ group. Known disparities in FV5/day and obesity across sociodemographic factors persisted over the study period. FV5/day may be an inappropriate measure of total calories derived from eating fruits and vegetables. Its use to measure impact of public health strategies to improve nutrition and prevent obesity may be questionable.

Ovarian Cancer Survival in Missouri, 1996-2014.

We evaluated relative survival (RS) for ovarian cancer (OC) overall, by demographic and by clinicopathological characteristics in Missouri. Survival data from the Missouri Cancer Registry were obtained for cases diagnosed 1996-2014. An improved OC survival, especially in late stage, was observed in the study period. Our findings showed demographic, especially race-associated, and geographical variations of OC survival. OC survival also differed by first course treatment received and histology. These differences indicate disparities in OC care.