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Multistate models for comparing trends in hospitalizations among young adult survivors of colorectal cancer and matched controls.

Sutradhar R, Forbes S, Urbach DR, Paszat L, Rabeneck L, Baxter NN - BMC Health Serv Res (2012)

Bottom Line: However, among patients that have experienced one and two hospitalizations, the relative rate of a subsequent admission decreases to 3.03 (95% CI (2.01, 4.56)) and 1.90 (95% CI (1.19, 3.03)), respectively.However this relative risk decreases as the number of prior hospitalizations increases.The multistate approach is able to use information on the timing of hospitalizations and answer questions that standard Poisson and Negative Binomial models are unable to address.

View Article: PubMed Central - HTML - PubMed

Affiliation: Institute for Clinical Evaluative Sciences, 2075 Bayview Avenue, Toronto, ON M4N 3M5, Canada. rinku.sutradhar@ices.on.ca

ABSTRACT

Background: Over the past years, the incidence of colorectal cancer has been increasing among young adults. A large percentage of these patients live at least 5 years after diagnosis, but it is unknown whether their rate of hospitalizations after this 5-year mark is comparable to the general population.

Methods: This is a population-based cohort consisting of 917 young adult survivors diagnosed with colorectal cancer in Ontario from 1992-1999 and 4585 matched cancer-free controls. A multistate model is presented to reflect and compare trends in the hospitalization process among survivors and their matched controls.

Results: Analyses under a multistate model indicate that the risk of a subsequent hospital admission increases as the number of prior hospitalizations increases. Among patients who are yet to experience a hospitalization, the rate of admission is 3.47 times higher for YAS than controls (95% CI (2.79, 4.31)). However, among patients that have experienced one and two hospitalizations, the relative rate of a subsequent admission decreases to 3.03 (95% CI (2.01, 4.56)) and 1.90 (95% CI (1.19, 3.03)), respectively.

Conclusions: Young adult survivors of colorectal cancer have an increased risk of experiencing hospitalizations compared to cancer-free controls. However this relative risk decreases as the number of prior hospitalizations increases. The multistate approach is able to use information on the timing of hospitalizations and answer questions that standard Poisson and Negative Binomial models are unable to address.

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Estimates of the Cumulative Baseline Rates for Death Following 0, 1, or 2 Hospital Admissions Based on the Multistate Model.
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Figure 3: Estimates of the Cumulative Baseline Rates for Death Following 0, 1, or 2 Hospital Admissions Based on the Multistate Model.

Mentions: The plots of the estimated cumulative baseline rate functions for death among survivors and controls are illustrated in Figure 3. For survivors, the functions indicate that a patient with k prior hospitalizations is at higher risk of death than a patient with k-1 prior hospitalizations. For example, survivors who have experienced 2 hospital admissions (dotted line) are at a far higher risk of death than patients who have experienced 1 hospital admission (dashed line). A similar pattern can be seen among controls, however the relative steepness of the curves is not as prominent. Although no data were dropped, the results for transitioning from 3 to 4 hospitalizations and so forth were not presented. This is because the numbers of patients experiencing these transitions during their observation periods were very small and resulted in large confidence intervals.


Multistate models for comparing trends in hospitalizations among young adult survivors of colorectal cancer and matched controls.

Sutradhar R, Forbes S, Urbach DR, Paszat L, Rabeneck L, Baxter NN - BMC Health Serv Res (2012)

Estimates of the Cumulative Baseline Rates for Death Following 0, 1, or 2 Hospital Admissions Based on the Multistate Model.
© Copyright Policy - open-access
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC3472287&req=5

Figure 3: Estimates of the Cumulative Baseline Rates for Death Following 0, 1, or 2 Hospital Admissions Based on the Multistate Model.
Mentions: The plots of the estimated cumulative baseline rate functions for death among survivors and controls are illustrated in Figure 3. For survivors, the functions indicate that a patient with k prior hospitalizations is at higher risk of death than a patient with k-1 prior hospitalizations. For example, survivors who have experienced 2 hospital admissions (dotted line) are at a far higher risk of death than patients who have experienced 1 hospital admission (dashed line). A similar pattern can be seen among controls, however the relative steepness of the curves is not as prominent. Although no data were dropped, the results for transitioning from 3 to 4 hospitalizations and so forth were not presented. This is because the numbers of patients experiencing these transitions during their observation periods were very small and resulted in large confidence intervals.

Bottom Line: However, among patients that have experienced one and two hospitalizations, the relative rate of a subsequent admission decreases to 3.03 (95% CI (2.01, 4.56)) and 1.90 (95% CI (1.19, 3.03)), respectively.However this relative risk decreases as the number of prior hospitalizations increases.The multistate approach is able to use information on the timing of hospitalizations and answer questions that standard Poisson and Negative Binomial models are unable to address.

View Article: PubMed Central - HTML - PubMed

Affiliation: Institute for Clinical Evaluative Sciences, 2075 Bayview Avenue, Toronto, ON M4N 3M5, Canada. rinku.sutradhar@ices.on.ca

ABSTRACT

Background: Over the past years, the incidence of colorectal cancer has been increasing among young adults. A large percentage of these patients live at least 5 years after diagnosis, but it is unknown whether their rate of hospitalizations after this 5-year mark is comparable to the general population.

Methods: This is a population-based cohort consisting of 917 young adult survivors diagnosed with colorectal cancer in Ontario from 1992-1999 and 4585 matched cancer-free controls. A multistate model is presented to reflect and compare trends in the hospitalization process among survivors and their matched controls.

Results: Analyses under a multistate model indicate that the risk of a subsequent hospital admission increases as the number of prior hospitalizations increases. Among patients who are yet to experience a hospitalization, the rate of admission is 3.47 times higher for YAS than controls (95% CI (2.79, 4.31)). However, among patients that have experienced one and two hospitalizations, the relative rate of a subsequent admission decreases to 3.03 (95% CI (2.01, 4.56)) and 1.90 (95% CI (1.19, 3.03)), respectively.

Conclusions: Young adult survivors of colorectal cancer have an increased risk of experiencing hospitalizations compared to cancer-free controls. However this relative risk decreases as the number of prior hospitalizations increases. The multistate approach is able to use information on the timing of hospitalizations and answer questions that standard Poisson and Negative Binomial models are unable to address.

Show MeSH
Related in: MedlinePlus