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als  blood lead  bone  breast cancer  clarithromycin versus  clarithromycin  death  jim crow  lead  long term  survival  women   
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Preview: American Journal of Epidemiology - Advance Access

American Journal of Epidemiology Advance Access

Published: Wed, 20 Sep 2017 00:00:00 GMT

Last Build Date: Fri, 22 Sep 2017 02:47:41 GMT


Breast Cancer Estrogen Receptor by Biological Generation: US Black & White Women, Born 1915–1979


Evidence suggests contemporary population distributions of breast cancer estrogen receptor (ER) status may be shaped by earlier major societal events, such as the 1965 abolition of Jim Crow (legal racial discrimination in the US) and the Great Famine in China (1959–1961). We accordingly analyzed changes in ER status in relation to Jim Crow birth place among the 46,417 black and 339,830 white US-born non-Hispanic women in the 13 SEER Registry Group who were born between 1915 and 1979 and diagnosed (age 25–84, inclusive) between 1992–2012. We grouped the cases by birth cohort and quantified the rate of change using the haldane (which scales change in relation to biological generation). The % of ER+ cases rose by birth cohort (1915–1919 to 1975–1979) only among women diagnosed before age 55. Changes by biological generation were greater for black vs. white women, and among black women, were greatest among those born in Jim Crow vs. non-Jim Crow states, with this group the only one to exhibit high haldanes (>|0.3|, indicating high rate of change). Our study's analytic approach and findings underscore the need to consider history and societal context when analyzing breast cancer ER status and racial/ethnic inequities in its distribution.

Long-term risk of acute myocardial infarction, stroke and death with outpatient use of clarithromycin: a retrospective cohort study


This retrospective cohort study of subjects enrolled in the United Kingdom Clinical Practice Research Datalink from 2000-2013 evaluated long-term risks of death, stroke, and acute myocardial infarction (AMI) in adults prescribed clarithromycin. Subjects were outpatients aged 40-85 years prescribed clarithromycin, doxycycline, or erythromycin (287,748, 267,729, and 442,999 patients, respectively), or H. pylori eradication therapy with a proton pump inhibitor, amoxicillin, and either clarithromycin (27,639 patients) or metronidazole (14,863 patients). We analyzed time to death, stroke, or AMI with Cox proportional hazards regression. The long-term hazard ratio (HR) for death following one clarithromycin versus one doxycycline prescription was 1.29 (95% confidence interval (CI) 1.21, 1.25), increasing to 1.62 (95% CI 1.43, 1.84) for 5+ prescriptions of clarithromycin versus 5+ prescriptions for doxycycline. Erythromycin showed smaller risks versus doxycycline. Stroke and AMI were also increased after clarithromycin, but with smaller HRs than mortality. For H. pylori eradication, the HR for mortality following clarithromycin versus metronidazole regimens was 1.09 (95% CI 1.00, 1.18) overall, and was higher (1.65, 95% CI 0.88, 3.08) following 2+ prescriptions in subjects not on statins at baseline. Outpatient clarithromycin use was associated with long-term mortality increases, with evidence for a similar, smaller increase with erythromycin.

Blood Lead, Bone Turnover, and Survival in Amyotrophic Lateral Sclerosis


Blood lead and bone turnover may be associated with the risk of amyotrophic lateral sclerosis (ALS). We aimed to assess whether these factors were also associated with time from ALS diagnosis to death through a survival analysis of 145 ALS patients enrolled during 2007 in the National Registry of Veterans with ALS. Associations of survival time with blood lead and plasma biomarkers of bone resorption (C-terminal telopeptides of type I collagen (CTX)) and bone formation (procollagen type I amino-terminal peptide (PINP)) were estimated using Cox models adjusted for age at diagnosis, diagnostic certainty, diagnostic delay, site of onset, and score on the Revised ALS Functional Rating Scale. Hazard ratios were calculated for each doubling of biomarker concentration. Blood lead, plasma CTX, and plasma PINP were mutually adjusted for one another. Increased lead (hazard ratio (HR) = 1.38; 95% confidence interval (CI): 1.03, 1.84) and CTX (HR = 2.03; 95% CI: 1.42, 2.89) were both associated with shorter survival, whereas higher PINP was associated with longer survival (HR = 0.59; 95% CI: 0.42, 0.83), after ALS diagnosis. No interactions were observed between lead or bone turnover and other prognostic indicators. Lead toxicity and bone metabolism may be involved in ALS pathophysiology.