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Alternative for the Cox Regression model: using Parametric Models to Analyze the Survival of Cancer Patients
Pourhoseingholi MA,Pourhoseingholi A,Vahedi M,Moghimi Dehkordi B
Iranian Journal of Cancer Prevention , 2011,
Abstract: Background: Although the Cox proportional hazard regression is the most popular model for analyzing the prognostic factors on survival of cancer patients, under certain circumstances, parametric models estimate the parameter more efficiently than the Cox model. The aim of this study was to compare the Cox regression model with parametric models in patients with gastric cancer who registered at Taleghani hospital, Tehran, Iran.Methods: In a retrospective cohort study, 746 patients with gastric cancer were studied from February 2003 through January 2007. Gender, age at diagnosis, distant metastasis, extent of wall penetration, tumor size, histology type, tumor grade, lymph node metastasis and pathologic stage were selected as prognosis , and entered to the models. Lognormal, Exponential, Gompertz, Weibull, Log-logistic and Gamma regression were performed as parametric models ,and Akaike Information Criterion (AIC) were used to compare the efficiency of the models.Results: Based on AIC, Log logistic is an efficient model. Log logistic analysis indicated that wall penetration and presence of pathologic distant metastasis were potential risks for death in full and final model analyses. Conclusion: In the multivariate analysis, all the parametric models fit better than Cox with respect to AIC; and the log logistic regression was the best model among them. Therefore, when the proportional hazard assumption does not hold, these models could be used as an alternative and could lead to acceptable conclusions.
Trend Analysis of Gastric Cancer and Colorectal Cancer Mortality in Iran, 1995-2003
Pourhoseingholi MA,Faghihzadeh S,Hajizadeh E,Gatta G
Iranian Journal of Cancer Prevention , 2011,
Abstract: Background: Cancer is the third most common cause of death in Iran. Gastric cancer (GC) and colorectal cancer (CRC) are two important causes of mortality due to cancer. With regards to cancer mortality, data are important to monitor the effects of screening program, earlier diagnosis, demographic data and other prognostic factors. The aim of this study was to evaluate the mortality rates and trends from GC and CRC in Iranian population during a period of almost a decade, i.e. from 1995 to 2003.Methods: National death Statistic Reported by the Ministry of Health and Medical Education (MOH&ME) from 1995 to 2003, stratified by age group, sex, and cause of death are included in this study. CRC and GC were expressed as the annual mortality rates/100,000, general and/or per gender, and age group. Results: The general mortality rate of CRC slightly increased during the years under study from 0.44 to 2.54 and CRC mortality was higher for older age and male. The general mortality rates of GC showed a sharp increasing from 1.68 to 9.67. In addition to this, GC mortality rate was higher for male than female.Conclusion: Our study indicated remarkable increasing trends in GC and CRC mortality. So developing for a gastric cancer for both primary prevention and early detection programs and manage the delays of diagnosis is recommended to decrease the trend of GC mortality. For CRC, since the rate of CRC screening is very low in Iran, it is recommended that in Iran screening be started as a public program in order to control the mortality and burden of CRC in the future.
Increased burden of colorectal cancer in Asia
Mohamad Amin Pourhoseingholi
World Journal of Gastrointestinal Oncology , 2012, DOI: 10.4251/wjgo.v4.i4.68
Abstract: The incidence and mortality of colorectal cancer (CRC) is rising rapidly in Asia. It seems that ethnicity has an important etiological role in CRC in Asia. However the incidence, anatomical distribution and mortality of CRC among Asian populations are not different from those in Western countries. There is little support by health authorities for CRC screening and very low public awareness of this emerging epidemic in Asia. The increasing rate of CRC in Asia means that we need to take action immediately to prevent CRC and to diagnose the disease at the early stages by introducing CRC screening in countries at high risk of an increasing burden of CRC.
Bayesian analysis of esophageal cancer mortality in the presence of misclassification
Mohamad Amin Pourhoseingholi,Alireza Abadi,Soghrat Faghihzadeh,Asma Pourhoseingholi
Italian Journal of Public Health , 2011, DOI: 10.2427/5680
Abstract: Background: Esophageal cancer (EC) is one of the most common cancers worldwide. Mortality is a familiar projection that addresses the burden of cancers. With regards to cancer mortality, data are important and used to monitor the effects of screening programs, earlier diagnosis and other prognostic factors. But according to the Iranian death registry, about 20% of death statistics are still recorded in misclassified categories. The aim of this study is to estimate EC mortality in the Iranian population, using a Bayesian approach in order to revise this misclassification. Methods: We analyzed National death Statistics reported by the Iranian Ministry of Health and Medical Education from 1995 to 2004. ECs [ICD-9; C15] were expressed as annual mortality rates/100,000, overall, by sex, by age group and age standardized rate (ASR). The Bayesian approach was used to correct and account for misclassification effects in Poisson count regression, with a beta prior employed to estimate the mortality rate of EC in age and sex groups. Results: According to the Bayesian analysis, there were between 20 to 30 percent underreported deaths in mortality records related to EC, and the rate of mortality from EC has increased through recent years. Conclusions: Our findings suggested a substantial undercount of EC mortality in the Iranian population. So policy makers who determine research and treatment priorities based on reported death rates should notice of this underreported data.
Colorectal cancer screening: Time for action in Iran
Mohamad Amin Pourhoseingholi,Mohammad Reza Zali
World Journal of Gastrointestinal Oncology , 2012, DOI: 10.4251/wjgo.v4.i4.82
Abstract: Colorectal cancer (CRC) is now the third most common cause of cancer-related deaths in the world. According to the Iranian Annual National Cancer Registration Report, CRC is the third most common cancer in Iranian women and fifth in men. The incidence of CRC has increased during the last 25 years. CRC screening is an efficient way to reduce the burden of CRC through detection of precursor lesions of cancer or early stage cancer. Iran may benefit even more from screening programs. According to recent studies, the prevalence of colorectal adenoma in first degree relatives of patients diagnosed with CRC is significantly higher than in the average risk population. So, appropriate screening strategies, especially in relatives of patients, should be considered as the first step of CRC screening in Iran.
Digit preference in Iranian age data
Aida Yazdanparast,Mohamad Amin Pourhoseingholi,Aliraza Abadi
Italian Journal of Public Health , 2012, DOI: 10.2427/5630
Abstract: ABSTRACT BACKGROUND: Data on age in developing countries are subject to errors, particularly in circumstances where literacy levels are not high. A common error in age reporting is the tendency of rounding the ages to the nearest figure ending in ‘0’ or ‘5’ or to a lesser extent, to the nearest even number. Because of this tendency, commonly known as “digital preference”, age heaping occurs at certain ages. The aim of this study was to study this phenomenon and both Myers’ and Whipple’s Indexes were employed to identify the digit preference in Iranian national census, 2005. METHODS: Myers’ and Whipple’s Indexes were employed to study the pattern of digit preference. The Myers' Blended Index shows heaping at ages ending in 0 and 5 years, and the pattern of heaping is pronounced for both urban and rural populations. RESULTS: The quality of age reporting for the 2005 census data was poor if compared to the 1995 census data. Digit preference occurred most often in the female population compared to male one, and in rural areas compared to urban ones. CONCLUSIONS: It can be concluded that both males and females tend to misreport their ages before age 60 especially in rural areas. So, whenever any data gathering regarding age information occurs, the ID card should be used regardless of person's self report.
Prevalence and demographic risk factors of gastrointestinal symptoms in Tehran province
Asma Pourhoseingholi,Azadeh Safaee,Mohamad Amin Pourhoseingholi,Bijan Boghimi-Dehkordi
Italian Journal of Public Health , 2010, DOI: 10.2427/5745
Abstract: Background: Gastrointestinal diseases are maladies that produce multiple symptoms. Suffering from these symptoms attributes people to an illness which they self-treat or seek medical care. The objective of this study is to determine the prevalence of gastrointestinal (GI) symptoms and relation between some demographic factors and GI symptoms in the Province of Tehran. Methods: This study was a cross-sectional household survey conducted from May 2006 to December 2007 in the Province of Tehran, Iran. The questionnaire included personal and family characteristics such as age, gender, and educational level. In addition to this, interviewers asked about 10 GI symptoms. Results: A total of 30,334 subjects were included in the study, there were 15,165 men (50%). Among them, 4,400 (14.5%) reported one or more GI symptom. Prevalence of GI symptoms included: heartburn 8.6%, bloating 7.6%, abdominal pain 6.2%, constipation 5.1%, anal pain 1.7%, weight loss 1.4%, diarrhea 1.1%, nausea and vomiting 1%, anal bleeding 0.8% and dysphagia 0.8%. Conclusions: The prevalence of GI symptoms in the population studied was lower than that reported in other populations. Women had higher prevalence of GI symptoms. With the increase in educational level the chance of have a GI symptom decreased. Singles reported symptoms less than married participants.
Comparing linear regression and quantile regression to analyze the associated factors of length of hospitalization in patients with gastrointestinal tract cancers
Mohamad Amin Pourhoseingholi,Mohsen Vahedi,Asma Pourhoseingholi,Bijan Moghimi-Dehkordi
Italian Journal of Public Health , 2009, DOI: 10.2427/5787
Abstract: Objectives: The aim of this study is to compare linear regression and quantile regression to analyze the predictors of duration of staying in hospital for patients with GI cancers. Methods: This study was designed as a retrospective cross-sectional survey included all consecutive GI cancer patients admitted over one year period in a random selected hospital group located in Tehran metropolitan in 2006. Residence, age, sex and type of cancer were analyzed respectively using linear and quantile regression. Results: A total of 2,674 GI tract cancer patients were included in the study. There were 1,616 men (60.43%) and 1,058 women (39.57%). Results of the linear regression analyses showed that only type of cancer was significant. The diagnostic criteria showed that only 7% of variation has been predicted by linear regression. In spite of linear regression sex and type of hospital were significance in quantile regression analysis. Conclusions: The results have demonstrated that if the duration data showed major skewness, using quantile regression leads to better interpretation and richer inference.
Risk of colorectal cancer in relatives: A case control study
Safaee A,Moghimi-Dehkordi B,Pourhoseingholi M,Vahedi M
Indian Journal of Cancer , 2010,
Abstract: Background: In around 10 to 15% of all colorectal cancer (CRC) cases, a positive family history of colorectal cancer is observed . Although increased risk of colorectal cancer in individuals with a family history of the disease has been observed consistently in the past studies, limited information is available on colorectal cancer associated with family history in Iran. Aims : The purpose of this study is to define the risk of colorectal cancer associated with a family history of cancer. Setting and Design: The present study was designed as an unmatched case control study. The cases were 393 patients with histologically confirmed colorectal carcinomas and there were 393 controls, randomly selected from among the healthy participants in a health survey. Methods : The family history was extracted from a standard history form completed by the patient or from the record created by a health care provider. Statistical Analysis: Mantel-Heanszel Odds Ratio was computed for removing the confounding effect of age and sex. Results : A positive family history of cancer was reported by 36.4 and 24.4% among the cases and controls, respectively. Colorectal cancer risk increased two-fold in subjects who reported having first degree relatives with cancer. The adjusted odds ratio was 4.76, indicating that having a positive family history of colorectal cancer among relatives increased one′s risk of colorectal cancer about 4.5-fold. Conclusion: According to our findings, a family history of cancer increased the risk of CRC. Due to this fact that there is no current colorectal cancer screening program in Iran, it is recommended that first degree relatives of patients with colorectal cancer should be considered as a priority group for screening programs.
Functional bowel disorders in Iranian population using Rome III criteria
Sorouri Majid,Pourhoseingholi Mohammad,Vahedi Mohsen,Safaee Azadeh
Saudi Journal of Gastroenterology , 2010,
Abstract: Background/Aim: To study the prevalence and risk factors of functional bowel disorders (FBD) in Iranian community using Rome III criteria. Materials and Methods: This study was a cross-sectional household survey conducted from May 2006 to December 2007 in Tehran province, Iran, including 18,180 participants who were selected randomly and interviewed face-to-face by a validated questionnaire based on Rome III criteria. Results: In all, 1.1% met the Rome III criteria for irritable bowel syndrome (IBS), 2.4% for functional constipation (FC), and 10.9% of the participants had any type of FBD. Among participants with functional dyspepsia, 83.8% had FBD; the majority cases were unspecified functional bowel disorder (U-FBD). Of the subjects fulfilling the IBS criteria, IBS with constipation (52%) was the most frequent subtype. In the multivariate analysis, women had a higher risk of any FBDs than men, except for functional diarrhea (FD). The prevalence of FBD, FC and FD increased and IBS decreased with increasing age. Marital status was only associated with a decrease in the risk of FBD and FD, respectively. IBS subtypes compared with FC and FD. There was no significant difference between FC and IBS with constipation (IBS-C), except for self-reported constipation; while, IBS with diarrhea (IBS-D) had more symptoms than FD. Conclusion: This study revealed a low rate of FBDs among the urban population of Tehran province. The ROME III criteria itself, and the problems with interpretation of the data collection tool may have contributed in underestimating the prevalence of FBD. In addition the reliability of recall over 6 months in Rome III criteria is questionable for our population.
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