Anticipated Increase in the Number of Patients Who Require Dialysis Treatment Among the Aging Population of Japan

The aging population is anticipated to have a large impact on the number of incident dialysis patients, as the risk of end‐stage kidney disease increases with age. This study aimed to examine trends in the sex‐ and age‐specific incidence rates of dialysis between 2008 and 2012, and to assess the impact of population aging on the number of incident dialysis patients over the next decade in Japan. Incidence was calculated using published data and Japan's population statistics. The 2012 incidence was extrapolated, and projected future demographic changes within the Japanese population were used to estimate the number of incident dialysis patients in 2020 and 2025. As a general trend, the sex‐ and age‐specific incidence rates of dialysis decreased gradually between 2008 and 2012, except among men aged ≥80 years. The total number of incident dialysis patients was projected to increase by 12.8% from 36 590 in 2012 to 41 270 in 2025. Greater increases were observed in the oldest age group (≥85 years). In 2025, the number of incident dialysis patients in this group was projected to increase by 92.6% in men and 62.2% in women. This study shows the number of patients who initiate dialysis treatment is projected to increase over the next decade in Japan due to aging of the population. Effective strategies are needed to offset the challenges faced by the aging population, with a particular focus on octogenarians and older, given the notable proportion of patients requiring dialysis treatment in the future.     

Trends in physician‐diagnosed osteoarthritis incidence in an administrative database in British Columbia,Canada, 1996–1997 through 2003–2004

Objective

Prevalence of osteoarthritis (OA) is expected to increase due to population aging. However, there is little information on the trends in the incidence of OA over time. The purpose of this study was to describe changes in physician‐diagnosed OA incidence rates between 1996–1997 and 2003–2004 in British Columbia (BC), Canada.

Methods

We used data on all visits to health professionals and hospital admissions covered by the Medical Services Plan of BC (population ～4 million) for the fiscal years 1991–1992 through 2003–2004. Rates were standardized to the BC population in 2000. We used 2 definitions of OA: 1) at least 1 visit or hospitalization with a diagnostic code for OA, and 2) at least 2 visits or 1 hospitalization with a code for OA. Incidence rates were calculated with a 5‐year run‐in period to exclude prevalent cases.

Results

Between 1996–1997 and 2003–2004, crude incidence rates of OA based on definition 1 increased from 10.5 to 12.2 per 1,000 in men and from 13.9 to 17.4 per 1,000 in women. The age‐standardized rates did not change in men and increased from 14.7 to 16.7 per 1,000 in women. Incidence rates based on definition 2 were almost 50% lower, but the trends were similar.

Conclusion

We observed an increase in the incidence of OA in both men and women due to population aging and an additional increase in women beyond the effect of aging. These trends have important implications for public health and provision of health services to this very large group of patients.     

Could accelerated aging explain the excess mortality in patients with seropositive rheumatoid arthritis?

Objective

To determine whether the mortality pattern in patients with seropositive rheumatoid arthritis (RA) is consistent with the concept of accelerated aging, by comparing the observed mortality rates in patients with RA with the age‐accelerated mortality rates from the general population.

Methods

A population‐based inception cohort of patients with seropositive RA (according to the American College of Rheumatology 1987 criteria) was assembled and followed up for vital status until July 1, 2008. The expected mortality rate was obtained by applying the death rates from the general population to the age, sex, and calendar year distribution of the RA population. The observed mortality was estimated using Kaplan‐Meier methods. Acceleration factors for the expected mortality were estimated in accelerated failure time models.

Results

A total of 755 patients with seropositive RA (mean age 55.6 years, 69% women) were followed up for a mean of 12.5 years, during which 315 patients died. The expected median survival was age 82.4 years, whereas the median survival of the RA patients was age 76.7 years. Results of statistical modeling suggested that, in terms of mortality rates, patients with RA were effectively 2 years older than actual age at RA incidence, and thereafter the patients underwent 11.4 effective years of aging for each 10 years of calendar time.

Conclusion

The overall observed mortality experience of patients with seropositive RA is consistent with the hypothesis of accelerated aging. The causes of accelerated aging in RA deserve further investigation.

     

Trends in survival of multiple myeloma patients in Germany and the United States in the first decade of the 21st century

Multiple myeloma is a chronic, incurable but highly treatable neoplasm. Recent population‐based studies have shown improvements in survival for patients diagnosed in the early 21st century. Here, we examine trends in survival for patients diagnosed with multiple myeloma in Germany and the United States (US) between 2002 and 2010. Data were extracted from 11 population‐based cancer registries in Germany and from the Surveillance, Epidemiology and End Results database in the US. Myeloma patients aged 15–74 years with diagnosis and follow‐up between 1997 and 2010 from Germany and the US were included. Period analysis was employed to assess trends in 5‐year relative survival in Germany and the US between 2002–04 and 2008–10. Age‐adjusted 5‐year relative survival increased from 47·3% to 53·8% in Germany and from 39·8% to 53·2% in the US between 2002–04 and 2008–10. There was a strong age gradient with lower survival among older patients, which persisted over time and was more pronounced in Germany than the US. Five‐year relative survival estimates for patients diagnosed with multiple myeloma below 75 years of age steadily increased throughout the first decade of the 21st century and reached levels above 50% in both Germany and the US, probably reflecting the increased use of newer agents in myeloma treatment.     

Increasing incidence of primary central nervous system lymphoma but no improvement in survival in Sweden 2000‐2013

Objectives

This study aims to characterize the epidemiology of immunocompetent Primary central nervous system lymphoma (PCNSL) diagnosed 2000‐2013 in Sweden.

Methods

Cases were identified in the population‐based Swedish Lymphoma Register. Incidence per 100 000 person‐years and 95% confidence intervals (CI) were calculated, and PCNSL‐specific survival was estimated using relative survival. Tests for temporal trends were performed using Poisson regression. Population incidence of all brain tumors was retrieved for comparison.

Results

With 359 identified PCNSL cases (median age 66 years), overall incidence was 0.26 (95% CI: 0.24‐0.29) and the average annual increase 4% (P = .002). The increasing trend was primarily observed among elderly individuals (70+ years). Similarly, an increase in incidence of all brain tumors was noted only among the elderly. There was no significant improvement in relative survival across the study period although, among fit patients (with Eastern Cooperative Oncology Group, EGOC 0), survival plateaued 6 years after diagnosis.

Conclusion

The increasing PCNSL incidence in the elderly was consistent with an increasing incidence of brain tumors of any type and may in part be attributable to improved diagnostics and reporting in this group. New treatment options have not yet translated into general survival improvements in a population‐based setting, although the presence of long‐term survivors among fit patients is encouraging.     

Malignant lymphoma, multiple myeloma and myeloproliferative diseases in the elderly

Hematopoietic and immune function tend to deteriorate in the elderly. The incidence of hematologic diseases in the elderly is increasing as the percentage of elderly people in the whole population increases. Acute leukemia, myelodysplastic syndrome, malignant lymphoma, multiple myeloma, and myelodysplastic syndromes are commonly seen in the elderly. Malignant lymphomas are frequently seen in the elderly, and many elderly patients have poor performance status, and because they are more likely to suffer from impaired cardiac, respiratory, hepatic and renal function, as well as glucose intolerance, they are also more likely to suffer side effects due to chemotherapy. Particularly in patients aged over 80 years, to avoid side effects it is essential to adjust dosage and route of administration of chemotherapy. Although age is a significant negative prognostic factor for non-Hodgkin's lymphoma, it is possible for patients to enter complete remission with improvement of host-side factors. The clinical application of Rituximab is expected to improve chemotherapy outcomes in elderly B-cell lymphoma. The median age at the time of initial diagnosis of multiple myeloma (MM) is 60-70 years, and age is a negative prognostic factor. Clinically, higher rates of infection and heavy comorbidity are characteristic of this condition in the elderly. Although the incidence of bony lesions in elderly patients with MM is not different from the non-elderly, they do have a higher incidence of bone pain and pathologic fractures compared with the non-elderly patients. As the response to chemotherapy is good in the elderly, it is worth trying chemotherapy for MM. Polycythemia vera must be treated in the elderly, because chemotherapy decreases the incidence of thrombosis.     

Modern multiple myeloma therapy: deep,sustained treatment response and good clinical outcomes

In the USA at the beginning of this century, the average overall survival in patients with multiple myeloma was about 3 years. Around that time, three drugs (bortezomib, lenalidomide and thalidomide) were introduced for the treatment of multiple myeloma and, in 2012, carfilzomib received accelerated approval by the US Food and Drug Administration (FDA). Driven by access to better drugs, median overall survival in younger patients (aged <50 years) was >10 years by 2014. The FDA approved 14 new drugs for the treatment of cancer in 2015; four of these were approved for the treatment of myeloma (panobinostat, daratumumab, elotuzumab and ixazomib). In 2015 and 2016, expanded label indications were approved by the FDA for lenalidomide and carfilzomib, respectively. The recent increase in approved, highly effective combination therapies for patients with multiple myeloma has led the way to redefining the goals of therapy. Here, we review and provide a clinical perspective on the treatment goals and management of multiple myeloma in the era of modern therapy. Recent meta‐analyses show that minimal residual disease (MRD) negativity is associated with longer progression‐free and overall survival in patients with multiple myeloma. With the use of modern combination therapy, large proportions (>60–70%) of newly diagnosed multiple myeloma patients achieve complete responses and MRD negativity. Modern combination therapies induce rapid, deep and sustainable responses (including MRD negativity), supporting a treatment paradigm shift away from palliative two‐drug combinations towards the use of modern, potent, three‐ or four‐drug combination regimens in early lines of therapy. Data support the use of modern therapy upfront rather than reserving it for later stages of the disease. As survival time increases with modern combination therapies, development of early reliable surrogate end‐points for survival, such as MRD negativity, are needed for expedited read‐out of future randomized clinical trials.     

Impact of active and passive exclusions on the results of a clinical trial in multiple myeloma

During the 3 years 1984-86, 314 cases of multiple myeloma were diagnosed in the Health Care Region of Western Sweden. 180 of these cases were included in a clinical trial; 71 were notified to the trial but excluded; 49 cases were not reported to the trial; 14 were diagnosed post mortem. The crude incidence rate of myeloma was 6.3 cases per 100,000 inhabitants per year, corresponding to an age-adjusted (world standard population) incidence rate of 2.9 cases per 100,000 inhabitants per year. The excluded and the non-reported patients had a significantly shorter survival than those included in the clinical trial (median survival 22, 13 and 33 months, respectively). This was partly due to differences in age and proportion of actively treated patients between the groups, but the same tendency remained also after correction for these factors. Considering the included patients separately, the effect of tentative application of presumptive exclusion criteria corresponding to major prognostic factors was studied. Prolonged survival was seen when the upper age limit was lowered and when patients with renal failure or low performance status were excluded. The results illustrate the fact that for multiple myeloma the survival in a trial population is markedly influenced by active and passive exclusion of patient groups with unfavourable prognostic characteristics. When reporting results of clinical trials, discussion of the representativeness of the trial population for the total patient population is recommended in order to facilitate application of the trial results to medical practice and comparisons between trials.     

Risk of skin cancer in multiple myeloma patients: a retrospective cohort study

Immunosuppressed patients are known to have an increased incidence of skin cancer. Patients with multiple myeloma (MM) show impaired immune function. In the past, because of poor survival, the incidence of specific secondary primary malignancies such as skin cancer among these patients was difficult to establish. With more effective MM therapies that have emerged in recent years, these patients are living markedly longer, and therefore, it becomes of increasing importance to determine whether their risk of developing other medical problems such as skin cancer is increased. We performed a retrospective cohort study of 205 myeloma patients and 193 age‐, race‐, and gender‐matched control subjects to assess the incidence of skin cancers among patients with MM and determine the specific types of and risk factors for skin cancer. We found that there is an increased occurrence of skin cancer among patients with MM compared to control subjects (26.8% vs. 16.1% in controls; P = 0.009). Among specific types of skin cancer, the proportion of patients with squamous cell carcinoma (SCC) was higher than controls (P = 0.016). In addition to MM diagnosis, older age and Caucasian ethnicity were predictors of skin cancer of any type. Furthermore, older age was also a predictor of SCC.     

Trends in incidence and mortality in rheumatoid arthritis in Rochester,Minnesota, over a forty‐year period

Objective

To determine time trends in the epidemiology of rheumatoid arthritis (RA) in a population‐based cohort.

Methods

An inception cohort of residents of Rochester, Minnesota ≥18 years of age who first fulfilled the American College of Rheumatology 1987 criteria between January 1, 1955 and December 31, 1994 (applied retrospectively, as appropriate) was assembled and followed up until January 1, 2000. Incidence rates were estimated and were age‐ and sex‐adjusted to the 1990 white population of the US. A birth cohort analysis was performed, and survival rates over time were examined.

Results

The incidence cohort comprised 609 patients, 445 (73.1%) of whom were female and 164 (26.9%) were male, with a mean age at incidence of 58.0 years. The overall age‐ and sex‐adjusted annual incidence of RA among Rochester, Minnesota, residents ≥18 years of age was 44.6/100,000 population (95% confidence interval 41.0–48.2). While the incidence rate fell progressively over the 4 decades of study, from 61.2/100,000 in 1955–1964, to 32.7/100,000 in 1985–1994, there were indications of cyclical trends over time. Birth cohort analysis showed diminishing incidence rates through successive cohorts following a peak in the 1880–1890 cohorts. Incidence rates increased with age until age 85, but peaked earlier in women than in men. The survival rate in RA patients was significantly lower than the expected rate in the general population (P < 0.001), and no improvement was noted over time.

Conclusion

The secular trends demonstrated in this study population, including the progressive decline in the incidence of RA over the last 40 years, suggest that an environmental factor may play a role in the etiology of RA.

     

The role of race, socioeconomic status, and distance traveled on the outcome of African-American patients with multiple myeloma

The incidence and mortality of multiple myeloma (MM) in African-Americans is double that in whites. We questioned whether race, socioeconomic status, and distance traveled affect overall survival. In a retrospective review of the records of 292 patients with MM. We found that the median age was 60 years and 38 patients were African-Americans. The mean distance traveled was 67.7 miles. The median overall survival was similar in African-Americans and whites. Race, distance traveled and socioeconomic status were not independent prognostic factors for overall survival. In conclusion, socioeconomic status, distance traveled and race did not affect outcomes of MM patients treated at a specialized myeloma center.     

Trends in physician-diagnosed osteoarthritis incidence in an administrative database in British Columbia, Canada, 1996-1997 through 2003-2004

OBJECTIVE: Prevalence of osteoarthritis (OA) is expected to increase due to population aging. However, there is little information on the trends in the incidence of OA over time. The purpose of this study was to describe changes in physician-diagnosed OA incidence rates between 1996-1997 and 2003-2004 in British Columbia (BC), Canada. METHODS: We used data on all visits to health professionals and hospital admissions covered by the Medical Services Plan of BC (population approximately 4 million) for the fiscal years 1991-1992 through 2003-2004. Rates were standardized to the BC population in 2000. We used 2 definitions of OA: 1) at least 1 visit or hospitalization with a diagnostic code for OA, and 2) at least 2 visits or 1 hospitalization with a code for OA. Incidence rates were calculated with a 5-year run-in period to exclude prevalent cases. RESULTS: Between 1996-1997 and 2003-2004, crude incidence rates of OA based on definition 1 increased from 10.5 to 12.2 per 1,000 in men and from 13.9 to 17.4 per 1,000 in women. The age-standardized rates did not change in men and increased from 14.7 to 16.7 per 1,000 in women. Incidence rates based on definition 2 were almost 50% lower, but the trends were similar. CONCLUSION: We observed an increase in the incidence of OA in both men and women due to population aging and an additional increase in women beyond the effect of aging. These trends have important implications for public health and provision of health services to this very large group of patients.     

Low Rate of Secondary Prevention ICDs in the General Population: Multiple‐Year Multiple‐Source Surveillance of Sudden Cardiac Death in the Oregon Sudden Unexpected Death Study

Sudden Cardiac Death. Introduction: Sudden cardiac death (SCD) is a large public health problem that warrants on‐going evaluation in the general population. While single‐year community‐based studies have been performed there is a lack of studies that have extended evaluation to multiple years in the same community. Methods and Results: From the on‐going Oregon Sudden Unexpected Death Study, we analyzed prospectively identified SCD cases in Multnomah County, Ore, (population ≈700,000) from February 1, 2002 to January 31, 2005. Detailed information ascertained from multiple sources (first responders, clinical records, and medical examiner) was analyzed. A total of 1,175 SCD cases were identified (61% male) with a mean age of 65 ± 18 years for men versus 70 ± 20 for women (P < 0.001). The overall incidence rate for the period was 58/100,000 residents/year. One‐quarter (24.6%) was ≤55 years of age. The most common initial rhythm was ventricular tachycardia or fibrillation (39% of cases, survival 27%) followed by asystole (36%, survival 0.7%) and pulseless electrical activity (23%, survival 6%). Among subjects that underwent resuscitation, the rate of survival to hospital discharge was 12% and overall survival to hospital discharge irrespective of resuscitation was 8%. Of the 68 survivors, 16 (24%) received a secondary prevention ICD. Conclusion: We report annualized SCD incidence from a multiple‐year, multiple‐source community‐based study, with higher than expected rates of women and subjects age ≤55 years. The low implantation rate of secondary prevention ICDs is likely to be multifactorial, but there are potential implications for recalibration of the projected need for ICD implantation; larger and more detailed studies are warranted. (J Cardiovasc Electrophysiol, Vol. 24, pp. 60‐65, January 2013)     

Clinical profiles of multiple myeloma in Asia—An Asian Myeloma Network study

The incidence of multiple myeloma (MM) is known to be variable according to ethnicity. However, the differences in clinical characteristics between ethnic groups are not well‐defined. In Asian countries, although the incidence of MM has been lower than that of Western countries, there is growing evidence that MM is increasing rapidly. The Asian Myeloma Network decided to initiate the first multinational project to describe the clinical characteristics of MM and the clinical practices in Asia. Data were retrospectively collected from 23 centers in 7 countries and regions. The clinical characteristics at diagnosis, survival rates and initial treatment of 3,405 symptomatic MM patients were described. Median age was 62 years (range, 19–106), with 55.6% of being male. Median overall survival (OS) was 47 months (95% CI 44.0–50.0). Stem cell transplantation was performed in 666 patients who showed better survival rates (79 vs. 41 months, P < 0.001). The first‐line treatments of 2,970 patients were analyzed. The overall response rate was 71% including very good partial response or better in 31% of the 2,660 patients those were able to be evaluated. New drugs including bortezomib, thalidomide, and lenalidomide were used in 36% of 2,970 patients and affected OS when used as a first‐line treatment. Am. J. Hematol. 89:751–756, 2014. © 2014 Wiley Periodicals, Inc.     

Has the incidence of multiple myeloma in old age been underestimated?

All patients in the region with newly discovered M components were registered from 15 Aug. 1984-31 Dec. 1986. Among a total of 393 patients enrolled, 162 had multiple myeloma (MM). The incidence rate was 6.6 per 100,000 population per year (age-adjusted to the European standard population), which is somewhat higher than previous reports based on hospital and autopsy records. In particular, the incidence rate was higher in the greater than 70 age group. Thus, the median age was 72 yr, which is the highest reported. As many as 71 (44%) of the 162 MM patients were asymptomatic; these asymptomatic patients had the same age distribution as the symptomatic ones. The stage distribution, occurrence of risk factors, response to chemotherapy, response duration and survival were similar in the age groups below and above the median and, in multivariate survival analysis, age was not an independent risk factor.     

Epidemiology, pathophysiology, and prognosis of heart failure in the elderly

Heart failure (HF) represents the quintessential disorder of cardiovascular aging, reflecting the convergence of age-related changes in the cardiovascular system and other organ systems and the increasing prevalence of cardiovascular diseases at older age. The prevalence and incidence of HF increase progressively with advancing age, and HF imposes an enormous burden on society in mortality, morbidity, and associated health care costs. Despite major advances in treatment of HF over the last 25 years, the prognosis remains poor, with median survival rates of less than 5 years in older adults. As the population ages, it is anticipated that the number of older people with HF will increase dramatically over the next several decades.     

Epidemiology, pathophysiology, and prognosis of heart failure in the elderly

Heart failure (HF) represents the quintessential disorder of cardio-vascular aging, reflecting the convergence of age-related changes in the cardiovascular system and other organ systems and the increasing prevalence of cardiovascular diseases at older age. The prevalence and incidence of HF increase progressively with advancing age, and HF imposes an enormous burden on society in mortality,morbidity, and associated health care costs. Despite major advances in treatment of HF over the last 25 years, the prognosis re-mains poor, with median survival rates of less than 5 years in older adults. As the population ages, it is anticipated that the number of older people with HF will increase dramatically over the next several decades.     

INCIDENCE AND OUTCOME OF MULTIPLE MYELOMA IN WESTERN AUSTRALIA, 1960 TO 1984

All patients diagnosed with multiple myeloma in Western Australia have been registered since 1960; 337 men and 280 women were registered in the period 1960–84. During this period there was a 25% increase in incidence. Age adjusted incidence rates rose from 2.34 per 100 000 person years in men and 1.64 in women during the decade 1960–69 to 2.95 in men and 1.92 in women in 1980–84. Overall, the incidence was 1.36 times higher in men than in women (95% confidence interval 1.16–1.59). Survival from multiple myeloma improved substantially during the period. In 1960–69, median survival for both sexes was six months, in 1970–79 it was 19 months, and in 1980–84 median survival in men was 43 months while in women it was at least five years.     

Are Non-HIV Malignancies Increased in the HIV-Infected Population?

Purpose of review

The introduction of antiretroviral therapy (ART) has revolutionized HIV infection management, resulting in improved outcomes and survival for people living with HIV (PLWH). However, as PLWH are living longer and aging, non-AIDS-defining cancers (NADCs) represent a significant source of morbidity and mortality in the HIV-infected population. Here, we review the epidemiology of NADCs in PLWH.

Recent findings

Cancer mortality among PLWH is much higher than that among the general population. Up to 10% of deaths among PLWH have been attributed to NADCs. Furthermore, PLWH have an increased risk for specific NADCs, including lung cancer, hepatocellular carcinoma, head and neck cancers, anal cancer, and Hodgkin lymphoma. In the past decade, the incidence rates of AIDS-defining cancers (ADCs) have been decreasing while the incidence rates of NADCs have been increasing. In particular, the incidence of specific NADCs are changing at different rates. For example through 2010, the incidence rates for anal, liver, and prostate cancers among PLWH had increased, while incidence rates for lung cancer had decreased and incidence rates for colorectal cancer remained relatively stable over time. However, as early ART becomes more prevalent and the percentage of PLWH over 50 increases, these trends may evolve further.

Summary

Incidence of NADCs should be expected to increase further as the PLWH population continues to age. Screening and prevention for these cancers among the HIV-infected population should be emphasized.

     

Incidence of myelodysplastic syndromes within a nonprofit healthcare system in western Washington state, 2005–2006

Myelodysplastic syndromes (MDS) incidence is unclear because of historical lack of population‐based registration and possibly because of underdiagnosis. We conducted a study to evaluate completeness of MDS registration in the Seattle‐Puget Sound region of the Surveillance, Epidemiology, and End Results (SEER) program—which has reported the highest rates among the SEER registries since mandatory reporting of MDS began in 2001. We identified incident MDS cases of any age that occurred within a nonprofit healthcare system in western Washington State in 2005 or 2006 through the local SEER registry or by relevant diagnostic code followed by medical chart review to classify these patients as unlikely, possible, or definite/probable MDS. We calculated age‐standardized incidence rates for all identified MDS cases and for case groups based on identification method, and we summarized medical histories of the MDS patients. MDS incidence in our study population was estimated as 7.0 per 100,000 person‐years in 2005–2006 when combining MDS cases identified by SEER and definite/probable cases identified by chart review, which was similar to the rate of 6.9 reported by our local SEER registry. The addition of possible MDS cases identified from chart review increased the rate to 10.2 per 100,000. MDS patients frequently had previous cancer diagnoses (25%) and comorbidities such as high blood pressure and diabetes. Our investigation suggests that although reporting of confirmed MDS diagnoses in our region appears complete, MDS incidence is likely underestimated because of omission of cases who are symptomatic but do not receive definitive diagnoses. Am. J. Hematol., 2010. © 2010 Wiley‐Liss, Inc.