All-cause and cause-specific mortality in people with mental disorders: a population-based study on risk evaluation, effect modifiers and excess life-years lost in Hong Kong.

Background: Non-alcoholic fatty liver disease (NAFLD) is the most common liver disorder in the US. It encompasses a range of conditions from hepatic steatosis to cirrhosis and liver cancer. Prior studies of the association between NAFLD and mortality have been limited by fairly short follow-up times, proxy measures of NAFLD and relatively few outcome events. Thus, the current study examined the association of NAFLD with all-cause and cause-specific mortality in the Third National Health and Nutrition Examination Survey (NHANES III) conducted in 1988-1994, with mortality follow-up through 2015. Methods: The analysis included 12605 individuals aged 20-74 years who underwent a hepatic/gallbladder ultrasound examination in NHANES III. NAFLD was defined as mild to severe hepatic steatosis detected by ultrasound in the absence of high alcohol consumption. Individuals were followed up for mortality by linkage to the National Death Index. Cox proportional hazard models were used to estimate the hazard ratios (HR) and 95% confidence intervals (CI) for all-cause and cause-specific mortality by NAFLD status as well as by a fibrosis score after adjustment for age, gender, race/ethnicity, education, physical activity, smoking, moderate alcohol consumption and body mass index. Results: The prevalence of NAFLD in the study was 33% and a total of 3,843 deaths occurred. More than 50% of the deaths were due to either cardiovascular disease (CVD) (34.2%) or cancer (18.7%). In addition, there were 83 (2.2%) deaths related to liver disease, including liver cancer. The risks of all-cause and cause-specific mortality were higher among persons with NAFLD than among persons without NAFLD: all-cause mortality [HR:1.22, 95%CI:1.10,1.36]; CVD [HR:1.12, 95%CI:0.96,1.31]; cancer [HR:1.34, 95%CI:1.04,1.72]; liver disease [HR:3.03, 95%CI:1.58,5.82]; kidney disease [HR:2.22, 95%CI:1.09,4.51]; diabetes [HR:2.55, 95%CI:1.48,4.39]. The risks of mortality from all-causes [HR:1.52, 95%CI:1.11,2.07], and from liver disease [HR:6.08, 95%CI:1.79,20.66] were markedly higher among persons with NAFLD with elevated liver enzymes than among persons without NAFLD. Among persons with NAFLD, a higher liver fibrosis score was significantly associated with increased risks of all-cause and liver disease mortality compared to those with lower fibrosis score: [HR:1.59, 95%CI:1.09,2.31] and [HR:17.08, 95%CI:4.08,71.56], respectively. Conclusions: Persons with NAFLD had an increased risk of all-cause and certain types of cause-specific mortality, independent of sociodemographic and lifestyle risk factors after 27 years of follow-up. Elevated liver enzymes as well as a higher fibrosis score among persons with NAFLD further increased the risk of all-cause and liver disease mortality. Persons with NAFLD should be closely monitored to prevent disease progression and reduce the risk of mortality in the US population. Citation Format: Christian S. Alvarez, Barry I. Graubard, Jake E. Thistle, Jessica L. Petrick, Katherine A. McGlynn. Non-alcoholic fatty liver disease and increased risk of mortality in NHANES III: Results after 27 years follow-up [abstract]. In: Proceedings of the American Association for Cancer Research Annual Meeting 2019; 2019 Mar 29-Apr 3; Atlanta, GA. Philadelphia (PA): AACR; Cancer Res 2019;79(13 Suppl):Abstract nr 5062A.

BackgroundInternational migration has increased during the past years and little is known about the mortality of young adult immigrants and refugees that came to Sweden as children. This study aimed to investigate 1) the risk of all-cause and cause-specific mortality in young accompanied and unaccompanied refugees and non-refugee immigrants compared to Swedish born individuals; and 2) to determine the role of educational level and migrations-related factors in these associations.MethodsThis register linkage study is based on 682,358 individuals (633,167 Swedish-born, 2,163 unaccompanied and 25,658 accompanied refugees and 21,370 non-refugee immigrants) 19–25 years old, who resided in Sweden 31.12.2004. Outcomes were all-cause mortality and mortality due to suicide and external causes. Hazard ratios (HR) and 95% confidence intervals (CI) were calculated using Cox regression models with a maximum follow-up to 2016.ResultsAfter adjusting for covariates, all-cause mortality was significantly lower in non-refugee immigrants (aHR 0.70, 95% CI 0.59–0.84) and refugees (aHR 0.76, 95% CI 0.65–0.88) compared to Swedish-born individuals. The same direction of association was observed for mortality due to suicide and external causes. No differences between accompanied and unaccompanied refugees were found. Risk estimates for all migrant groups varied with educational level, duration of residency, age at arrival and country of birth. Further, the mortality risk of migrants arriving in Sweden before the age of 6 years did not significantly differ from the risk of their Swedish-born peers. Low education was a considerable risk factor.ConclusionIn general, young adult refugees and non-refugee immigrants have a lower risk of all-cause and cause-specific mortality than Swedish-born individuals. The identified migrant groups with higher mortality risk need specific attention.

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Associations of tooth loss with risk of all-cause and cause-specific mortality among US adults with diabetes mellitus

Hysterectomy with and without oophorectomy and all-cause and cause-specific mortality

Associations of periodontitis with risk of all-cause and cause-specific mortality among us adults with chronic kidney disease

BackgroundAlthough higher intake of ultra-processed foods (UPFs) has been associated with a higher risk of mortality in Western populations such as populations from France and the United States (US), evidence in Asian populations remains limited. The aim of this study was to evaluate the association between UPF consumption and the risk of mortality in an Asian population.MethodsWe included 62,197 middle-aged and older Chinese adults who were recruited for the Singapore Chinese Health Study from 1993 to 1998. UPFs were defined from items in the FFQ using the Nova classification, and their consumption was categorized into quintiles according to intake level. Mortality from all-cause, cardiovascular diseases (CVDs), cancer, and respiratory diseases were ascertained via Linkage with a nationwide registry through 2022. Associations between UPF intake and mortality were assessed using Cox proportional hazards regression models.ResultsAfter 24.9 years (median) of follow-up, 29,472 deaths occurred. In the multivariable-adjusted model (variables related to demographics, anthropometric data, lifestyle factors, medical history, and total energy intake), compared with the lowest quintile of UPF consumption, the highest quintile was associated with higher risks of mortality from all-cause [hazard ratio (HR): 1.06; 95% confidence interval (CI): 1.02–1.10], CVDs (HR: 1.08; 95% CI: 1.01–1.15), and respiratory diseases (HR: 1.10; 95% CI: 1.02–1.19), but not of mortality from cancer (HR: 1.00; 95% CI: 0.94–1.07). The associations remained essentially unchanged after further adjusting for diet quality measured using the Alternative Healthy Eating Index-2010 and antioxidant capacity using the Vitamin C Equivalent Antioxidant Capacity. Among the subgroups of UPFs, positive associations with all-cause mortality were observed for consumption of sweetened beverages (e.g. soft drinks) and sugary products (e.g. crackers and western cakes). This association was stronger in participants who were non-smokers at recruitment [respective HR: 1.08, 95% CI: 1.03–1.13 in non-smokers versus HR: 1.01; 95% CI: 0.94–1.08 in smokers (P for interaction = 0.03)].ConclusionHigher intake of UPFs was associated with higher risks of mortality from all-cause, CVDs, and respiratory diseases in an Asian population. These results need to be confirmed in other Asian populations.Supplementary InformationThe online version contains supplementary material available at 10.1186/s12937-025-01219-0.

Cohort studies about the sleep duration on the risk of death among Chinese older adults are still lacking. The aim of this study was to examine whether extremely long or short sleep duration was associated with mortality in Chinese adults aged 65 years or older. We included participants aged 65 years or older in 2011 at baseline in 23 provinces from the Chinese Longitudinal Healthy Longevity Survey who were followed up in 2014/2018 in China. Sleep duration was categorized as short sleep duration (< 7 hours) and long sleep duration (> 8 hours). We used the Cox proportional hazards model and restricted cubic spline analysis to explore the association between sleep duration and mortality. Among 9578 participants, short sleep duration was associated with an 11% higher risk of death (adjusted hazard ratio [aHR]: 1.11; 95% confidence interval [CI]: 1.02-1.20) and long sleep duration was associated with a 24% higher risk of death (aHR: 1.24; 95% CI: 1.15-1.34), after adjustment for all covariates. There was a U-shaped association between sleep duration and all-cause mortality (nonlinear, P < .0001). Stratified analyses showed that the risk was higher among older people who smoked and with a higher level of education both for short and long sleepers than for those who never smoked and were illiterate (P value for interaction < .05). There was a U-shaped association between sleep duration and all-cause mortality in Chinese older adults, especially in more educated individuals and smokers. Du M, Liu M, Liu J. The association between sleep duration and the risk of mortality in the Chinese older adults: a national cohort study. J Clin Sleep Med. 2021;17(9):1821-1829.

To explore the prospective association between physical activity level and mortality risk in Chinese adults with chronic obstructive pulmonary disease (COPD). Based on the China Kadoorie Biobank (CKB) who had COPD at the baseline survey, this study employed the Cox proportional hazards regression model to estimate the prospective associations between the overall physical activity, different intensities (low-level, moderate-to-vigorous-level), and types (occupational, non-occupational) of physical activity level and the risks of all-cause and cause-specific mortality, such as vascular diseases, cancer, and respiratory diseases. Based on the quintiles of physical activity level, participants were divided into five groups (Q1-Q5), with the lowest quintile group (Q1) as the reference group. Hazard ratio (HR) and 95% confidence interval (95%CI) were calculated for the remaining. In our study, we also performed sensitivity and subgroup analyses, including age, gender, self-rated health status, severity of COPD, etc. Among 33 588 COPD patients at the baseline survey, 8 314 (22.2%) deaths were documented during an average follow-up of (11.1±3.1) years. Negative linear associations between the overall physical activity level and mortality risk from all-cause, vascular, and respiratory diseases were observed (P trend for linear correlation being < 0.001, 0.002, < 0.001). Compared with the lowest quintile group of total physical activity (Q1), the hazard ratios (HR) and 95% confidence intervals (CI) for all-cause mortality, vascular disease mortality, and respiratory disease mortality in the highest quintile group (Q5) were 0.77 (0.70, 0.85), 0.77 (0.65, 0.91), and 0.58 (0.48, 0.71), respectively. The low-level and moderate-to-vigorous-level physical activity were negatively associated with all-cause mortality in the COPD patients (P trend for linear correlation: 0.002, < 0.001, respectively). Compared with the lowest quintile group of low-intensity and moderate-to-vigorous intensity physical activity (Q1), the HRs (95%CI) for all-cause mortality in the highest quintile group (Q5) were 0.89 (0.82, 0.97) and 0.79 (0.72, 0.87), respectively. The occupational and non-occupational physical activity were also found to have a linear inverse association with all-cause mortality risk among the COPD patients (P trend < 0.001 and 0.015, respectively). Compared with the lowest quintile group of occupational and non-occupational physical activity (Q1), the HR (95%CI) for all-cause mortality in the highest quintile group (Q5) were 0.69 (0.61, 0.78) and 0.91 (0.84, 0.98), respectively. The associations between overall physical activity and all-cause mortality risk were stronger for patients aged 60 and above, female, and who reported poor health status (P for interaction: 0.028, 0.012, 0.010). The protective effect of total physical activity was also applicable to the COPD patients of varying severity. Physical activity could reduce the mortality risk in a dose-response relationship among COPD patients, regardless of its intensity and type, especially among individuals aged 60 and above, females, and those with poor self-report health status.

The comparative risk of cause-specific mortality in patients with Behçet disease (BD) vs. the general population is not known. To compare the risk of all-cause and cause-specific mortality in patients with BD vs. the general population. Using data from the Korea National Health Insurance Service database for the period 2002-20, we conducted a cohort study comparing patients with BD with the general population, matched according to age and sex (1 : 4 ratio). We used Cox proportional hazard models to estimate hazard ratios (HRs) and 95% confidence intervals (CIs) for all-cause and cause-specific mortality. Subgroup analyses by age and sex were done. We included 24 669 patients with BD and 98 676 age- and sex-matched controls [mean (SD) age 40.5 (12.9) years; 34% male]. During a mean follow-up of 11.9 years, the incidence rate (IR) of death per 100 person-years was 0.36 in patients with BD and 0.29 in controls [hazard ratio (HR) 1.28, 95% confidence interval (CI) 1.20-1.38]. The risk of mortality was highest in the first year after BD diagnosis (HR 2.66, 95% CI 2.09-3.40). Patients with BD died more often in this period as a result of malignancy (HR 1.96, 95% CI 1.30-2.98); cardiovascular (HR 2.68, 95% CI 1.45-4.97), gastrointestinal (HR 3.50, 95% CI 1.35-9.07) and respiratory disease (HR 5.00, 95% CI 1.34-18.62); and infection (HR 3.33, 95% CI 1.02-10.92). Mortality as a result of neurological (HR 1.58, 95% CI 1.06-2.35) or genitourinary disease (HR 2.20, 95% CI 1.43-3.37) was also more common in patients with BD during the overall follow-up. Subgroup analyses showed consistent results. The risk of cardiovascular mortality vs. the general population was higher in younger patients (P = 0.006) and the risk of gastrointestinal mortality was increased in women vs. men (P = 0.04). This population-based cohort study revealed that the first year after diagnosis is the highest risk period for excess mortality in people with BD. The mortality burden in BD derives from a wide spectrum of organ involvement and should serve as a warning to clinicians about the systemic nature of the disease.

BackgroundWaist circumference (WC), calf circumference (CC), and body mass index (BMI) have been independently linked to mortality. However, it's not yet clear how the waist-calf circumference ratio (WCR) relates to mortality. This study aims to investigate the relationship between WCR, WC, CC, and BMI with all-cause and cause-specific mortality in older adults.MethodsIn the 2014 Chinese Longitudinal Healthy Longevity Survey, 4627 participants aged 65 years and older were included, and they were subsequently followed up in 2018. Cox proportional hazards models were utilized to estimate hazard ratios (HRs) and 95% confidence intervals (CIs) for all-cause and cause-specific mortality, based on WCR, WC, CC, and BMI.ResultsDuring a median follow-up of 3.4 years, 1671 deaths (36.1%) occurred. Compared to the second quartile of WCR, the highest quartile had a higher risk of mortality from all causes (HR 1.42, 95%CI 1.24–1.64), cardiovascular disease (CVD) (HR 1.88, 95%CI 1.38–2.56), and other causes (HR 1.37, 95%CI 1.15–1.63). The first and fourth quartiles of WC had HRs of 2.19 (1.00–4.79) and 2.69 (1.23–5.89), respectively, for cancer mortality. The highest quartile of CC was associated with a lower risk of all-cause and other-cause mortality, whereas the lowest quartile was associated with a higher risk of all-cause, CVD, and other-cause mortality compared to the second CC quartile. Additionally, the lowest quartile of BMI was associated with a higher risk of all-cause and respiratory disease mortality. Interaction analyses showed that the effects of CC on all-cause and CVD mortality were more pronounced in adults aged ≥ 80 years (P-interaction < .05).ConclusionsHigher WCR and lower CC increased the risk of all-cause, CVD, and other-cause mortality. Lower BMI was associated with higher all-cause and respiratory disease mortality risk, while WC only predicted cancer mortality.

BackgroundSedentary behavior (SB) has emerged as a significant health concern that deserves attention. This study aimed to examine the associations between prolonged sedentary behavior and the risk of all-cause and cause-specific mortality as well as to explore desirable alternatives to sitting in terms of physical activity (PA).MethodsTwo prospective cohort investigations were conducted using the UK Biobank and NHANES datasets, with a total of 490,659 and 33,534 participants, respectively. Cox proportional hazards regression models were used to estimate the associations between SB and the risk of all-cause and cause-specific mortality due to cancer, cardiovascular disease (CVD), respiratory diseases, and digestive diseases. In addition, we employed isotemporal substitution models to examine the protective effect of replacing sitting with various forms of PA.ResultsDuring the average follow-up times of 13.5 and 6.7 years, 36,109 and 3057 deaths were documented in the UK Biobank and NHANES, respectively. Both cohorts demonstrated that, compared with individuals sitting less than 5 h per day, individuals with longer periods of sitting had higher risks of all-cause and cause-specific mortality due to cancer, CVD, and respiratory diseases but not digestive diseases. Moreover, replacing SB per day with PA, even substituting 30 min of walking for pleasure, reduced the risk of all-cause mortality by 3.5% (hazard ratio [HR] 0.965, 95% confidence interval [CI] 0.954–0.977), whereas cause-specific mortality from cancer, CVD, and respiratory diseases was reduced by 1.6% (HR 0.984, 95% CI 0.968–1.000), 4.4% (HR 0.956, 95% CI 0.930–0.982), and 15.5% (HR 0.845, 95% CI 0.795–0.899), respectively. Furthermore, the protective effects of substitution became more pronounced as the intensity of exercise increased or the alternative duration was extended to 1 h.ConclusionsSB was significantly correlated with substantially increased risks of all-cause mortality and cause-specific mortality from cancer, CVD, and respiratory diseases. However, substituting sitting with various forms of PA, even for short periods involving relatively light and relaxing physical activity, effectively reduced the risk of both overall and cause-specific mortality.Graphical

Hyperhomocysteinaemia (HHcy) is associated with all-cause mortality in some disease states. However, the correlation between HHcy and the risk of mortality in the general population has rarely been researched. We aimed to evaluate the association between HHcy and all-cause and cause-specific mortality among adults in the USA. This study analysed data from the National Health and Nutrition Examination Survey database (1999-2002 survey cycle). A multivariable Cox regression model was built to evaluate the correlation between HHcy and all-cause and cause-specific mortality. Smooth curve fitting was used to analyse their dose-dependent relationship. A total of 8442 adults aged 18-70 years were included in this study. After a median follow-up period of 14·7 years, 1007 (11·9 %) deaths occurred including 197 CVD-related deaths, 255 cancer-related deaths and fifty-eight respiratory disease deaths. The participants with HHcy had a 93 % increased risk of all-cause mortality (hazard ratio (HR) 1·93; 95 % CI (1·48, 2·51)), 160 % increased risk of CVD mortality (HR 2·60; 95 % CI (1·52, 4·45)) and 82 % increased risk of cancer mortality (HR 1·82; 95 % CI (1·03, 3·21)) compared with those without HHcy. For unmeasured confounding, E-value analysis proved to be robust. In conclusion, HHcy was associated with high risk of all-cause and cause-specific (CVD, cancer) mortality among adults aged below 70 years.

BackgroundEstimated pulse wave velocity (ePWV) has been proposed as a potential alternative to carotid-femoral pulse wave velocity to assess the degree of aortic stiffness, and may predict cardiovascular disease (CVD) outcomes and mortality in the general population. However, whether arterial stiffness estimated by ePWV predicts all-cause and cause-specific mortality in patients with diabetes mellitus (DM) has not been reported.MethodsThis was a prospective cohort study with data from the National Health and Nutrition Examination Survey (NHANES) from 1999 to 2014 and followed up until the end of December 2019. 5,235U.S. adults with DM (age≥20years) were included in the study. Arterial stiffness was estimated by ePWV. Survey-weighted Cox proportional hazards models were performed to assess the hazard ratios (HRs), and 95% confidence intervals (CIs) for the associations of ePWV with all-cause and cause-specific mortality. Meanwhile, the generalized additive model was used to visually assess the dose-dependent relationship between ePWV and mortality. As a complementary analysis, the relationship between mean blood pressure (MBP) and risk of mortality was also examined. Multiple imputations accounted for missing data.ResultsFor the 5,235 DM patients, the weighted mean age was 57.4 years, and 51.07% were male. During a median follow-up period of 115 months (interquartile range 81-155 months; 53,159 person-years), 1,604 all-cause deaths were recorded. In the fully adjusted Cox regression model, every 1 m/s increase in ePWV was associated with 56% (HR 1.56; 95% CI, 1.44 to 1.69) increase in the risk of all-cause. In addition, a nonlinear relationship between ePWV and all-cause mortality was observed (P for non-linear=0.033). Similar results were obtained after subgroup analysis and multiple imputations. Besides, the risk of most cause-specific mortality, except for accident and renal disease-specific mortality, increased from 53% to 102% for every 1 m/s increase in ePWV.ConclusionsIn the diabetic population, ePWV is independently associated with all-cause and most cause-specific mortality risks. ePWV may be a useful tool for assessing mortality risk.

The ratio of red blood cell distribution width (RDW) to albumin concentration (RAR) has emerged as a reliable prognostic marker for mortality in patients with various diseases. However, whether RAR is associated with mortality in the general population remains unknown. To explore whether RAR is associated with all-cause and cause-specific mortality and to elucidate their dose-response association. This population-based prospective cohort study used data from participants in the 1998-2018 US National Health and Nutrition Examination Survey (NHANES) and from the UK Biobank with baseline information provided from 2006 to 2010. Included participants had complete data on serum albumin concentration, RDW, and cause of death. The NHANES data were linked to the National Death Index records through December 31, 2019. For the UK Biobank, dates and causes of death were obtained from the National Health Service Information Centre (England and Wales) and the National Health Service Central Register Scotland (Scotland) to November 30, 2022. Potential associations between RAR and the risk of all-cause and cause-specific mortality were evaluated using Cox proportional hazards regression models. Restricted cubic spline regressions were applied to estimate possible nonlinear associations. In NHANES, 50 622 participants 18 years of age or older years were included (mean [SD] age, 48.6 [18.7] years; 26 136 [51.6%] female), and their mean (SD) RAR was 3.15 (0.51). In the UK Biobank, 418 950 participants 37 years of age or older (mean [SD], 56.6 [8.1] years; 225 038 [53.7%] female) were included, and their mean RAR (SD) was 2.99 (0.31). The NHANES documented 7590 deaths over a median (IQR) follow-up of 9.4 (5.1-14.2) years, and the UK Biobank documented 36 793 deaths over a median (IQR) follow-up of 13.8 (13.0-14.5) years. According to the multivariate analysis, elevated RAR was significantly associated with greater risk of all-cause mortality (NHANES: hazard ratio [HR], 1.83 [95% CI, 1.76-1.90]; UK Biobank: HR, 2.08 [95% CI, 2.03-2.13]), as well as mortality due to malignant neoplasm (NHANES: HR, 1.89 [95% CI, 1.73-2.07]; UK Biobank: HR, 1.93 [95% CI, 1.86-2.00]), heart disease (NHANES: HR, 1.88 [95% CI, 1.74-2.03]; UK Biobank: HR, 2.42 [95% CI, 2.29-2.57]), cerebrovascular disease (NHANES: HR, 1.35 [95% CI, 1.07-1.69]; UK Biobank: HR, 2.15 [95% CI, 1.91-2.42]), respiratory disease (NHANES: HR, 1.99 [95% CI, 1.68-2.35]; UK Biobank: HR, 2.96 [95% CI, 2.78-3.15]), diabetes (NHANES: HR, 1.55 [95% CI, 1.27-1.90]; UK Biobank: HR, 2.83 [95% CI, 2.35-3.40]), and other causes of mortality (NHANES: HR, 1.97 [95% CI, 1.86-2.08]; UK Biobank: HR, 2.40 [95% CI, 2.30-2.50]) in both cohorts. Additionally, a nonlinear association was observed between RAR levels and all-cause mortality in both cohorts. In this cohort study, a higher baseline RAR was associated with an increased risk of all-cause and cause-specific mortality in the general population. These findings suggest that RAR may be a simple, reliable, and inexpensive indicator for identifying individuals at high risk of mortality in clinical practice.