scholarly journals Models of Multiple Events in the Analysis of Subsequent Registrations in the Labour Office

2020 ◽  
Vol 3 (348) ◽  
pp. 131-147
Author(s):  
Beata Bieszk-Stolorz
Keyword(s):  
Recurrent Events ◽  
Medical Science ◽  
Disease Recurrence ◽  
Time Frame ◽  
Proportional Hazard ◽  
Cox Proportional Hazard ◽  
Conditional Models ◽  
The Unemployed ◽  
The Impact ◽  
Stratified Model

In many fields of science, it is necessary to analyse recurrent events. In medical science, the problem is to assess the risk of chronic disease recurrence. In economic and social sciences, it is possible to analyse the time of entering and leaving the sphere of poverty, the time of subsequent guarantee or insurance claims, as well as the time of subsequent periods of unemployment. In these studies, there are different ways of defining risk intervals, i.e. the time frame over which an event is at risk (or likely to occur) for an entity. Research on registered unemployment in Poland shows a high percentage of people returning to the labour office and registering again. The aim of the article is assessment of the risk of subsequent registrations in the labour office depending on selected characteristics of the unemployed: gender, age, education, and seniority. In the study, methods of survival analysis were used. The results obtained for four models being an extension of the Cox proportional hazard model were compared. The Anderson‑Gil model does not distinguish between first and next events. The number of events that occurred is important. Two Prentince‑Williams‑Peterson conditional models and the Wei, Lin and Weissfeld models are based on the Cox stratified model. The strata are consecutive events. They differ in the way risk intervals are determined. In the analysed period, only age and education influenced the risk of multiple registrations at the Poviat Labour Office in Szczecin. Gender and seniority did not have a significant impact on this risk. The analysis performed for subsequent registrations confirmed the impact of the same features on the first subsequent registration. In general, it can be stated that the analysed characteristics of the unemployed did not have a significant impact on the second and subsequent returns to the labour office.

scholarly journals Hospital admissions in children who had pelvicalyceal diltation detected on ultrasound scan during pregnancy: an e-cohort study

2017 ◽  
Vol 1 (1) ◽  
Author(s):  
Melissa Wright ◽  
Shantini Paranjothy ◽  
David Fone ◽  
Sinead Brophy ◽  
Joanne Demmler
Keyword(s):  
Hospital Admissions ◽  
Cox Proportional Hazard Model ◽  
Proportional Hazard ◽  
Ultrasound Scan ◽  
Second Trimester ◽  
Proportional Hazard Model ◽  
Activity Data ◽  
Cox Proportional Hazard ◽  
Uncertain Significance ◽  
The Impact

ABSTRACTObjectiveTo explore whether children with pelvicalyceal dilatation (PCD, a marker detected during the 18-20 week gestation ultrasound scan in which there is enlargement of tubes that collect urine in the kidney) have more hospital admissions for kidney problems in childhood compared to children without the marker. Approach We were funded by NISCHR to study outcomes associated with markers of uncertain significance at the second trimester anomaly scan (Welsh Study of Mothers and Babies). Data collected in the WSMB was uploaded to the Secure Anonymised Information Linkage (SAIL) databank and record linked to hospital activity data. Patterns of hospital admissions for renal causes were described and compared between those with no markers and those with PCD. Children were followed up from birth until 31st December 2014 or until the age of 5. A Cox Proportional Hazard Model was used to investigate the impact of PCD on time to first presentation. Results (Preliminary)Of the WSMB cohort, 20,834 children were eligible for inclusion in analyses. Those with PCD had 6.29 times the hazard of a renal admission compared to those without the marker (95% CI: 3.69 to 10.72). Children with PCD were more likely to have multiple renal admissions to hospital - median (interquartile range) number of renal admissions, 2.5 (1 to 5) compared to 1 (1 , 1) in children without markers. ConclusionPreliminary analysis suggests there is increased childhood renal morbidity associated with the presence of a PCD marker detected on the 18-20 week gestation ultrasound scan. These findings will inform the discussions clinicians have with parents when discussing the implications of this marker for the health of the chid.

scholarly journals Wording of Daily Diary Questions Matters: An Investigation of the Effect of Daily Diary Instructional Phrases on Respondents’ Recall Time frames (Preprint)

2019 ◽  
Author(s):  
Arthur A. Stone ◽  
Cheng K. Fred Wen ◽  
Stefan Schneider ◽  
Doerte U. Junghaenel
Keyword(s):  
Medical Science ◽  
Daily Diary ◽  
Time Frame ◽  
Affective States ◽  
Diverse Range ◽  
Daily Experience ◽  
Time Periods ◽  
Waking Up ◽  
Time Frames ◽  
The Impact

BACKGROUND Daily diaries are extensively used for examining participants' daily experience in behavioral and medical science. Whether participants recall their experiences within the time frames prescribed by task has received little attention. OBJECTIVE The objectives of this study are to describe survey respondents' self-reported recall timeframe and to evaluate the impact of different daily diary items on respondents reported affective states. METHODS In this study, 577 participants completed a mood survey with one of four time frame instructions: 1) today, 2) since waking up today, 3) during the last 24 hours, or 4) in the last day. They were also asked to indicate the time periods they considered when answering these items and to recall the instructional phrases associated with the items. RESULTS Almost all participants in the "Today" (97%) and "Since waking up today" (94%)" conditions reported using time periods consistent with our expectations, while a lower proportion was observed in the "during the last 24 hours" (69%) condition. A diverse range of responses was observed in the "In the last day" condition. Furthermore, the instructions influenced the levels of some self-reported affects, although exploratory analyses were not able to identify the mechanism underlying this finding. CONCLUSIONS Overall, these results indicate that "Today" and "Since waking up today" are the most effective instructional phrases for inquiring about daily experience and that investigators should use caution when using the other two instructional phrases.

scholarly journals The Impact of Beta Blockers on Survival in Heart Transplant Recipients: Insights from the Zabrze HTx Registry

2020 ◽  
Vol 2020 ◽  
pp. 1-7
Author(s):  
Grzegorz M. Kubiak ◽  
Radosław Kwieciński ◽  
Agnieszka Ciarka ◽  
Andrzej Tukiendorf ◽  
Piotr Przybyłowski ◽  
...  
Keyword(s):  
Beta Blockers ◽  
Rank Test ◽  
Proportional Hazard ◽  
Transplant Recipients ◽  
Entire Cohort ◽  
Reactive Protein ◽  
Cox Proportional Hazard ◽  
Log Rank Test ◽  
Cox Proportional Hazard Regression ◽  
The Impact

Introduction. The data assessing the impact of beta blocker (BB) medication on survival in patients after heart transplantation (HTx) are scarce and unequivocal; therefore, we investigated this population. Methods. We retrospectively analyzed the HTx Zabrze Registry of 380 consecutive patients who survived the 30-day postoperative period. Results. The percentage of patients from the entire cohort taking BBs was as follows: atenolol 24 (17%), bisoprolol 67 (49%), carvedilol 11 (8%), metoprolol 28 (20%), and nebivolol 8 (6%). The patients receiving BBs were older (56.94 ± 14.68 years vs. 52.70 ± 15.35 years, p=0.008) and experienced an onset of HTx earlier in years (11.65 ± 7.04 vs. 7.24 ± 5.78 p≤0.001). They also had higher hematocrit (0.40 ± 0.05 vs. 0.39 ± 0.05, p=0.022) and red blood cells (4.63 (106/μl) ± 0.71 vs. 4.45 (106/μl) ± 0.68, p=0.015). Survival according to BB medication did not differ among the groups (p=0.655) (log-rank test). Univariate Cox proportional hazard regression analysis revealed that the following parameters were associated with unfavorable diagnosis: serum concentration of albumin (g/l) HR: 0.87, 95% CI (0.81–0.94), p=0.0004; fibrinogen (mg/dl) HR: 1.006, 95% CI (1.002–1.008), p=0.0017; and C-reactive protein (mg/l) HR: 1.014, 95% CI (1.004–1.023), p=0.0044. Conclusions. The use of BBs in our cohort of patients after HTx was not associated with survival benefits.

scholarly journals Impact of workplace injury on opioid dependence, abuse, illicit use and overdose: a 36-month retrospective study of insurance claims

2020 ◽  
Vol 77 (9) ◽  
pp. 648-653 ◽  
Author(s):  
Abay Asfaw ◽  
Leslie I Boden
Keyword(s):  
Opioid Dependence ◽  
Injured Workers ◽  
Proportional Hazard ◽  
Opioid Use ◽  
Workplace Injury ◽  
Societal Costs ◽  
Cox Proportional Hazard ◽  
Severity Of Injury ◽  
Illicit Use ◽  
The Impact

ObjectivesTo examine the impact of workplace injury on opioid dependence, abuse and overdose (opioid-related morbidity) and if severity of injury increases the hazard of these health effects.MethodsWe used MarketScan databases to follow injured and propensity score matched non-injured workers, both without prior opioid-related diagnoses. Using a Cox proportional hazard model, we examined the impact of workplace injury on opioid-related morbidity.ResultsThe hazard of opioid-related morbidity for injured workers was 1.79 times than that of matched non-injured workers (95% CI 1.89 to 3.60). For medical-only and lost-time injured workers, it was respectively 1.54 (95% CI 1.02 to 2.32) and 2.91 (95% CI 1.75 to 4.84) times that of non-injured workers.ConclusionsReducing workplace injury or severity of workplace injury, as well as efforts to ensure appropriate opioid prescribing for injured workers, may help to reduce the societal costs of opioid use.

The effect of socioeconomic factors on the outcome of intrahepatic cholangiocarcinoma.

2018 ◽  
Vol 36 (4_suppl) ◽  
pp. 465-465
Author(s):  
Cortlandt Sellers ◽  
Johannes M Ludwig ◽  
Johannes Uhlig ◽  
Stacey Stein ◽  
Jill Lacy ◽  
...  
Keyword(s):  
Socioeconomic Factors ◽  
Intrahepatic Cholangiocarcinoma ◽  
Private Insurance ◽  
Tertiary Care ◽  
Locoregional Therapy ◽  
Care Hospital ◽  
Proportional Hazard ◽  
Cox Proportional Hazard ◽  
Kaplan Meier ◽  
The Impact

465 Background: To investigate the impact of socioeconomic factors on overall survival (OS) for patients with intrahepatic cholangiocarcinoma (ICC) at an inner-city tertiary care hospital. Methods: Consecutive patients treated for ICC diagnosed between 2005 and 2016 in the cancer registry were studied. Patients were stratified by demographic, socioeconomic variables, and treatment course. Kaplan-Meier curves and Cox proportional hazard modeling were performed. Results: Patients were 52% male (95 pts) and 74% white (136 pts) with mean age of 65.7 yrs (SD 10.7 yrs). 82% of patients were married or had been previously married (148 pts). 11% of patients had Medicaid as their primary insurance (20 pts), 45% of patients had Medicare (78 pts) and 44% of patients had private insurance (77 pts). Patients with private insurance (66 pts, 87%) and Medicare (64 pts, 83%) were more likely to have been married than Medicaid (12 pts, 60%) (p = 0.036). Patients with Medicare (mean 72.0 yrs, SD 6.9 yrs) were older than private insurance patients (mean 60.3 yrs, SD 10.3 yrs) and Medicaid patients (mean 61.8 yrs, SD 12.4 yrs) (p < 0.001). Gender and ethnicity were similarly distributed by primary insurance. Median OS stratified by primary insurance demonstrated median OS in private insurance of 13.2 mo (95% CI: 8.2–18.7 mo) vs 7.3 mo (95% CI: 3.8–10.6 mo) for Medicare (HR 1.3, p = 0.11) vs 4.7 mo (95% CI: 1.7–11.3 mo) for Medicaid (HR 1.8, p = 0.0488), (p = 0.0465). Cancer-directed treatments were utilized by 81% in private insurance vs. 67% in Medicare vs 67% in Medicaid (p = 0.18). Median OS stratified by main treatment demonstrated 43.3 mo in resection (37 pts, 21%), 17.3 mo in locoregional therapy (LRT) (22 pts, 13%), 10.0 mo in chemotherapy or radiation (79 pts, 45%), and 1.4 mo in palliative or no treatment (37 pts, 21%) (p < 0.0001). Increased age was associated with decreased median OS (correlation -0.23, p = 0.0019). No differences in median OS were seen with ethnicity, gender, or marital status. Conclusions: Screening and early treatments appear to affect the OS of patients with ICC. Further investigations for preventive care for vulnerable populations to enhance survivals are warranted.

scholarly journals Analysis of the Impact of Comorbidities on Endometrial Lesions Using the Charlson Comorbidity Index in Western Romania

Medicina ◽  
2021 ◽  
Vol 57 (9) ◽  
pp. 945
Author(s):  
Alexandru Furau ◽  
Delia Mirela Tit ◽  
Cristian Furau ◽  
Simona Bungau ◽  
Gheorghe Furau ◽  
...  
Keyword(s):  
Charlson Comorbidity Index ◽  
Underlying Disease ◽  
Proportional Hazard ◽  
Probability Of Survival ◽  
Cox Proportional Hazard ◽  
Estimated Risk ◽  
Comorbidity Index ◽  
Post Hoc ◽  
The Impact ◽  
Western Romania

Background and Objectives: This retrospective study aimed to identify the main comorbidities found in gynecological patients hospitalized for endometrial lesions and to analyze the relationships between these comorbidities and each type of endometrial lesion. The Charlson comorbidity index (CCI) was calculated, thus assessing the patient’s probability of survival in relation to the underlying disease and the existing comorbidities. Materials and Methods: During 2015–2019, 594 cases hospitalized for vaginal bleeding outside of pregnancy were included in the research. For all cases, the frequency of comorbidities was calculated, applying the Cox proportional hazard model, considering the hospitalizations (from the following year after the first outpatient or hospital assessment) as a dependent variable; age and comorbidities were considered as independent variables. Results: Analysis of variance (ANOVA) for mean age of patients enrolled after diagnosis and multiple comparisons (via the Tukey post-hoc test) indicate significant differences (p < 0.05) between the average age for endometrial cancer (EC) and that for the typical endometrial hyperplasia or other diagnoses. The most common comorbidities were hypertension (62.28%), obesity (35.01%), and diabetes (22.89%), followed by cardiovascular disease. An intensely negative correlation (r = −0.715281634) was obtained between the percentage values of comorbidities present in EC and other endometrial lesions. The lowest chances of survival were calculated for 88 (14.81% of the total) patients over 50 years (the probability of survival in the next 10 years being between 0 and 21%). The chances of survival at 10 years are moderately negatively correlated with age (sample size = 594, r = −0.6706, p < 0.0001, 95% confidence interval (CI) for r having values from −0.7126 to −0.6238) and strongly negatively correlated with the CCI (r = −0.9359, p < 0.0001, 95% CI for r being in the range −0.9452 to −0.9251). Conclusions: Using CCI in endometrial lesions is necessary to compare the estimated risk of EC mortality with other medical conditions.

scholarly journals Risk of acute arterial events associated with treatment of inflammatory bowel diseases: nationwide French cohort study

Gut ◽  
2019 ◽  
Vol 69 (5) ◽  
pp. 852-858 ◽  
Author(s):  
Julien Kirchgesner ◽  
Nynne Nyboe Andersen ◽  
Fabrice Carrat ◽  
Tine Jess ◽  
Laurent Beaugerie
Keyword(s):  
Incidence Rates ◽  
Proportional Hazard ◽  
Cox Proportional Hazard ◽  
Increased Risk ◽  
Bowel Diseases ◽  
Cox Proportional Hazard Models ◽  
Inflammatory Bowel ◽  
Artery Disease ◽  
The Impact ◽  
Necrosis Factor

ObjectivePatients with IBD are at increased risk of acute arterial events. Antitumour necrosis factor (TNF) agents and thiopurines may, via their anti-inflammatory properties, lower the risk of acute arterial events. The aim of this study was to assess the impact of thiopurines and anti-TNFs on the risk of acute arterial events in patients with IBD.DesignPatients aged 18 years or older and affiliated to the French national health insurance with a diagnosis of IBD were followed up from 1 April 2010 until 31 December 2014. The risks of acute arterial events (including ischaemic heart disease, cerebrovascular disease and peripheral artery disease) were compared between thiopurines and anti-TNFs exposed and unexposed patients with marginal structural Cox proportional hazard models adjusting for baseline and time-varying demographics, medications, traditional cardiovascular risk factors, comorbidities and IBD disease activity.ResultsAmong 177 827 patients with IBD (96 111 (54%) women, mean age at cohort entry 46.2 years (SD 16.3), 90 205 (50.7%) with Crohn’s disease (CD)), 4145 incident acute arterial events occurred (incidence rates: 5.4 per 1000 person-years). Compared with unexposed patients, exposure to anti-TNFs (HR 0.79, 95% CI 0.66 to 0.95), but not to thiopurines (HR 0.93, 95% CI 0.82 to 1.05), was associated with a decreased risk of acute arterial events. The magnitude in risk reduction was highest in men with CD exposed to anti-TNFs (HR 0.54, 95% CI 0.40 to 0.72).ConclusionExposure to anti-TNFs is associated with a decreased risk of acute arterial events in patients with IBD, particularly in men with CD.

scholarly journals Clinical spectrum and risk factors for mortality among seawater and freshwater critically ill drowning patients: a French multicenter study

Critical Care ◽  
2021 ◽  
Vol 25 (1) ◽  
Author(s):  
Florian Reizine ◽  
Agathe Delbove ◽  
Alexandre Dos Santos ◽  
Laetitia Bodenes ◽  
Pierre Bouju ◽  
...  
Keyword(s):  
Cardiac Arrest ◽  
Multicenter Study ◽  
Psychiatric Comorbidity ◽  
Proportional Hazard ◽  
Proportional Hazard Model ◽  
Cox Proportional Hazard ◽  
Multicenter Cohort ◽  
Global Threat ◽  
The Impact ◽  
Retrospective Multicenter Study

Abstract Background Drowning is a global threat and one of the leading causes of injury around the world. The impact of drowning conditions including water salinity on patients’ prognosis remains poorly explored in Intensive Care Units (ICUs) patients. Methods We conducted a retrospective multicenter study on patients admitted to 14 ICUs in the west of France from January 2013 to January 2020. We first compared demographic and clinical characteristics at admission as well as clinical courses of these patients according to the salinity of drowning water. Then, we aimed to identify variables associated with 28-day survival using a Cox proportional hazard model. Results Of the 270 consecutive included patients, drowning occurred in seawater in 199 patients (73.7%) and in freshwater in 71 patients (26.3%). Day-28 mortality was observed in 55 patients (20.4%). Freshwater was independently associated with 28-day mortality (Adjusted Hazard Ratio (aHR) 1.84 [95% Confidence Interval (CI) 1.03–3.29], p = 0.04). A higher proportion of freshwater patients presented psychiatric comorbidities (47.9 vs. 19.1%; p < 0.0001) and the etiology of drowning appeared more frequently to be a suicide attempt in this population (25.7 vs. 4.2%; p < 0.0001). The other factors independently associated with 28-day mortality were the occurrence of a drowning-related cardiac arrest (aHR 11.5 [95% CI 2.51–52.43], p = 0.0017), duration of cardiopulmonary resuscitation (aHR 1.05 [95% CI 1.03–1.07], p < 0.0001) and SOFA score at day 1 (aHR 1.2 [95% CI 1.11–1.3], p < 0.0001). Conclusions In this large multicenter cohort, freshwater drowning patients had a poorer prognosis than saltwater drowning patients. Reasons for such discrepancies include differences in underlying psychiatric comorbidity, drowning circumstances and severities. Patients with initial cardiac arrest secondary to drowning remain with a very poor prognosis.

Correlation of KRAS status with clinical outcome in patients (pts) with metastatic colorectal cancer (mCRC) treated first-line with FOLFOX6 + cetuximab (FX+C) or FOLFIRI + cetuximab (FF+C): The CECOG/CORE1.2.001 trial

2009 ◽  
Vol 27 (15_suppl) ◽  
pp. 4055-4055
Author(s):  
I. Koza ◽  
F. Wrba ◽  
D. Vrbanec ◽  
J. Ocvirk ◽  
T. E. Ciuleanu ◽  
...  
Keyword(s):  
Hazard Analysis ◽  
Progression Free Survival ◽  
Prolonged Survival ◽  
Proportional Hazard ◽  
Cox Proportional Hazard ◽  
Kras Status ◽  
Significant Difference ◽  
The Impact ◽  
Early Occurrence

4055 Background: Previous retrospective analyses of KRAS mutation status from the randomized CECOG/CORE 1.2.001 phase II trial has shown that treatment with cetuximab plus standard chemotherapy (CT) in pts with KRAS wild-type (wt) tumors leads to significantly better progression-free survival (PFS) and overall survival (OS) compared with KRAS mutant (mt) tumors. Methods: CECOG investigators performed a post-study survival update, re-assessing the impact of KRAS status and other possible predictive factors for OS using multivariable Cox proportional hazard methods. Results: KRAS-evaluable tissue was available from 117 (77%) of 151 pts in the ITT population. KRAS wt status was detected in 53% (n=62) of tumors (34/57 and 28/60 in the FX+C and FF+C arm, respectively). After a median follow up of 29 months (mo), OS in pts with KRAS wt tumors was significantly improved compared to pts with KRAS mt tumors (median 20.8 vs 15.9 mo; hazard ratio (HR)=1.62; p=0.0296). OS analysis by treatment arm revealed a statistically significant difference in favor of pts with KRAS wt tumors in the FX+C arm (median 22.5 vs 15.2; HR=2.06; p=0.0201) and no significant differences in the FF+C arm. Exploratory multivariable Cox proportional hazard analysis showed that as well as KRAS wt status (vs KRAS mt), an acne-like rash of grade 2/3 (vs grade 0/1) in the first 6 weeks and no prior treatment (vs prior neo-/adjuvant treatment) were the strongest independent predictors for prolonged survival (each p<0.005). Conclusions: This analysis confirmed the results of previous studies: treatment with cetuximab plus standard CT in pts with KRAS wt tumors leads to significantly better OS compared to pts with KRAS mt tumors. The early occurrence of a cetuximab-related grade 2/3 acne-like rash seems to be an independent predictor for prolonged survival in addition to KRAS status. The relevance of the lower predictive value of KRAS status noted for OS in the FF+C arm pts vs the significant effect in the FX+C arm is undetermined due to the low sample size of the subgroup analyses. [Table: see text]

Metformin use in diabetic patients with multiple myeloma (MM): A SEER-Medicare study.

2017 ◽  
Vol 35 (15_suppl) ◽  
pp. e18127-e18127
Author(s):  
Shivaprasad Manjappa ◽  
Mark A Fiala ◽  
Ravi Vij ◽  
Keith Stockerl-Goldstein ◽  
Mark A. Schroeder ◽  
...  
Keyword(s):  
Female Gender ◽  
Diabetic Patients ◽  
Proportional Hazard ◽  
Part D ◽  
Cox Proportional Hazard ◽  
Comorbidity Index ◽  
Medicare Database ◽  
Insulin Use ◽  
The Impact

e18127 Background: Metformin, an oral hypoglycemic agent, has been linked to favorable outcomes among patients (pts) with cancer (Coyle et al. Ann Oncol 2016). Wu et al. demonstrated better overall survival (OS) with metformin use in pts with mm and Diabetes Mellitus (DM) (Br J Cancer 2014). They also found that patient with steroid-induced DM [SID] had worse outcomes than pts with pre-existing DM [PDM]. However, Keller et al. did not find these associations in a study of VA mm pts (Blood 2015 126:4502). We evaluated the impact of DM and metformin use on outcomes of pts with mm in the SEER-Medicare database. Methods: We used SEER-Medicare claims from 2007-2013 for pts with newly diagnosed MM. DM was identified using ICD-9 codes, antidiabetic medications by Medicare part D prescription claims. Multivariate analysis was performed by Cox proportional hazard modelling to evaluate (1) Association of DM type (PDM or SID) with mm outcomes and (2) Impact of metformin on outcomes of pts with mm and DM. Covariates included age, gender, transplant, CKD (chronic kidney disease), CCI (Charlson Comorbidity Index), and use of other antidiabetic medications. Potential smoldering mm cases in the dataset were controlled for using a pre-established algorithm (Fakhri, et al,Blood 2016 128:2348) Results: Out of 4708 mm pts, 45% had DM. Among the pts with DM, 28% were on metformin. Out of the 2112 pts with DM, 20% had SID. Median follow up was 26 months. We found no association between PDM (aHR 1.04, 95% CI 0.96-1.12) or SID (aHR 1.03, 0.91-1.17) with OS when compared to non-diabetic pts. Metformin use, female gender, transplant and CCI < 5 were significantly associated with improved OS. Metformin use was associated with an 18% decrease in mortality (aHR 0.82, 0.72-0.93, p = 0.002); controlling for CKD did not impact the association (aHR 0.83 (0.73- 0.94, p = 0.005). Other antidiabetic medications including insulin were not associated with OS. Conclusions: DM (PDM or SID) and insulin use were not associated with poorer outcomes. Metformin use was associated with improved OS among pts with mm and DM in the SEER-Medicare database. The impact of metformin on outcomes in mm pts should be further investigated in prospective clinical trials.

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