Mortality in Patients With Nonfunctional Adrenal Tumors
Authors' conclusion
The results of this case-control study suggest that NFAA was associated with an increased overall mortality and mortality of cardiovascular disease and cancer. The increase was more pronounced among younger individuals.
Study context
- Population
- Patients with adrenal adenoma diagnosed in Sweden 2005–2019, followed up until death or 2020; individuals with adrenal hormonal excess or cancer excluded; cases median age 65 years, 60.8% women
- Participants
- 17,726 vs 124,366
- Comparison
- NFAA vs controls without adrenal adenoma
- NFAAn = 17,726
- Controlsn = 124,366reference
- Outcome
- All-cause mortality after adjustment for comorbidities and socioeconomic factors
- Follow-up
- Median 6.2 years (IQR 3.3-9.6)
Methodological detailsnational, adjusted for comorbidities and socioeconomic factors, Follow-up started after 3 months of cancer-free survival after NFAA diagnosis
- National
- Adjusted for comorbidities and socioeconomic factors
- Follow-up started after 3 months of cancer-free survival after NFAA diagnosis
Main finding
As reported in the abstract
Overall mortality · median follow-up 6.2 years
NFAA vs ControlsEstimate
Unadjusted
HR 1.43(95 CI 1.38–1.48)
Overall mortality
aHR 1.21(95% CI 1.16–1.26)
Observational data: associations, not effects.
Secondary outcomes
| Outcome | aHR (95% CI) | P value | |
|---|---|---|---|
| All-cause mortality, women · median follow-up 6.2 yearsWomen | 1.22 (1.15–1.28) | P < 0.001 | |
| All-cause mortality, men · median follow-up 6.2 yearsMen | 1.19 (1.11–1.26) | P < 0.001 | |
| All-cause mortality, age <65 years · median follow-up 6.2 yearsYounger than 65 years · larger increase in mortality among younger individuals | 1.44 (1.31–1.58) | P < 0.001 for interaction | |
| All-cause mortality, older individuals · median follow-up 6.2 yearsOlder individuals | 1.15 (1.10–1.20) | P < 0.001 for interaction | |
| 0.512Adjusted hazard ratio (log scale) |
All-cause mortality, women · median follow-up 6.2 years
- Relative association of NFAA with overall mortality similar in women and men
CVD mortality
- Mortality due to CVD increased, aHR
- 1.21 (1.13-1.29) (95% CI)
Cancer mortality
- Mortality due to cancer increased, aHR
- 1.54 (1.42-1.67) (95% CI)
Sensitivity analyses
- Association between NFAA and mortality remained significant and of similar magnitude in all sensitivity analyses
Original publication
Mortality in Patients With Nonfunctional Adrenal Tumors. JAMA Intern Med. Published 1 August 2023. doi:10.
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