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Polycythemia Vera: An Investigation of Influential Factors for Death Rates Between 1962 and 2009

Chen, Fangfang (2013) Polycythemia Vera: An Investigation of Influential Factors for Death Rates Between 1962 and 2009. Master's Thesis, University of Pittsburgh. (Unpublished)

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Abstract

Introduction: Polycythemia vera (PV) is a bone marrow disorder that causes overproduction of red blood cells. While some studies have documented increased local incidence rates of PV, no study has explored the mortality rates of PV over time. Public health significance of this study is firstly examining PV mortality rates in detail; a better understanding of these rates may help contextualize changes.
Methods: We used age-race-sex-and time period specific death counts from the Mortality and Population Data System (MPDS) from 1962 to 2009 for Pennsylvania (PA), California (CA), and the United States (US). Age-adjusted and age-specific mortality rates were examined for the whole US, as well as PA, California (CA), and the remaining US. We also accounted for changes in diagnostic criteria, International Classification of Diseases (ICD) mortality coding, and treatment. Negative binomial models were fit to account for age, sex, region, and critical time point changes in criteria, separated into seven sections to match events in PV medical history: 1962-1967, 1968-1974, 1975-1977, 1978-1986, 1987-1998, 1999-2000, and 2001-2009.
Results: We identified 18,743 PV death cases from 1962 to 2009; 95% of the deaths occurred in whites, and almost half of the deaths were in people 75 and older. Age-adjusted PV mortality of males decreased after 1967, while that of females decreased after 1978. The rate among males was always higher than that of females. Our time period analysis, corresponding to changes in ICD coding, diagnostic criteria, and implementation of Hydroxyurea as standard treatment, found that each significantly influenced PV mortality.
Conclusion: This study is the first comprehensive examination of PV mortality rates over time. We determined that acceptance of the PVSG diagnostic criteria in 1975 decreased the magnitude of the difference in PV mortality between males and females seen prior to 1975, apparently due to the introduction of sex-specific red cell mass values. The transition from the 8th to 9th ICD revision in 1979, in which PV was changed from malignant to “benign and/or uncertain and unspecified behavior”, decreased PV mortality significantly in both males and females. PV researchers should be aware of these changes when interpreting their data.


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Details

Item Type: University of Pittsburgh ETD
Status: Unpublished
Creators/Authors:
CreatorsEmailPitt UsernameORCID
Chen, Fangfangfac22@pitt.eduFAC22
ETD Committee:
TitleMemberEmail AddressPitt UsernameORCID
Thesis AdvisorBuchanich, Jeanine Mjeanine@pitt.eduJEANINE
Committee MemberMarsh, Gary Mgmarsh@pitt.eduGMARSH
Committee MemberBertolet, Marniebertoletm@edc.pitt.eduMHB12
Date: 27 September 2013
Date Type: Publication
Defense Date: 31 July 2013
Approval Date: 27 September 2013
Submission Date: 14 August 2013
Access Restriction: 1 year -- Restrict access to University of Pittsburgh for a period of 1 year.
Number of Pages: 62
Institution: University of Pittsburgh
Schools and Programs: Graduate School of Public Health > Biostatistics
Degree: MS - Master of Science
Thesis Type: Master's Thesis
Refereed: Yes
Uncontrolled Keywords: Polycythemia Vera,negative binomial regression,epidemiology,mortality
Date Deposited: 27 Sep 2013 16:14
Last Modified: 15 Nov 2016 14:14
URI: http://d-scholarship.pitt.edu/id/eprint/19641

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