Adjusted Prevalence Odds Ratio Research Articles

Use of Oral Fluconazole during Pregnancy and the Risk of Birth Defects

BackgroundCase reports suggest that long-term, high-dose fluconazole treatment for severe fungal infections during pregnancy causes a pattern of birth defects. It is unclear whether commonly used lower doses increase the risk of specific birth defects.MethodsIn a registry-based cohort of liveborn infants in Denmark, we evaluated first-trimester oral fluconazole exposure and the risk of birth defects overall and of birth defects previously linked to azole antifungal agents.ResultsThe majority of fluconazole-exposed pregnancies were in women who received common therapeutic doses of 150 mg (56% of pregnancies) or 300 mg (31%). Oral fluconazole exposure was not associated with an increased risk of birth defects overall (210 birth defects among 7352 fluconazole-exposed pregnancies [prevalence, 2.86%] and 25,159 birth defects among 968,236 unexposed pregnancies [prevalence, 2.60%]; adjusted prevalence odds ratio, 1.06; 95% confidence interval [CI], 0.92 to 1.21). In addition, oral fluconazole exposure was not associated with a significantly increased risk of 14 of 15 types of birth defects previously linked to azole antifungal agents: craniosynostosis, other craniofacial defects, middle-ear defects, cleft palate, cleft lip, limb defects, limb-reduction defects, polydactyly, syndactyly, diaphragmatic hernia, heart defects overall, pulmonary-artery hypoplasia, ventricular septal defects, and hypoplastic left heart. A significantly increased risk of tetralogy of Fallot was observed (7 cases in fluconazole-exposed pregnancies [prevalence, 0.10%] as compared with 287 cases in unexposed pregnancies [prevalence, 0.03%]; adjusted prevalence odds ratio, 3.16; 95% CI, 1.49 to 6.71).ConclusionsOral fluconazole was not associated with a significantly increased risk of birth defects overall or of 14 of the 15 specific birth defects of previous concern. Fluconazole exposure may confer an increased risk of tetralogy of Fallot. (Funded by the Danish Medical Research Council.)

Nitrogen dioxide and allergic sensitization in the 2005–2006 National Health and Nutrition Examination Survey

Allergic sensitization is a risk factor for asthma and allergic diseases. The relationship between ambient air pollution and allergic sensitization is unclear. To investigate the relationship between ambient air pollution and allergic sensitization in a nationally representative sample of the US population. We linked annual average concentrations of nitrogen dioxide (NO2), particulate matter ≤10μm (PM10), particulate matter ≤2.5μm (PM2.5), and summer concentrations of ozone (O3), to allergen-specific immunoglobulin E (IgE) data for participants in the 2005-2006 National Health and Nutrition Examination Survey (NHANES). In addition to the monitor-based air pollution estimates, we used the Community Multiscale Air Quality (CMAQ) model to increase the representation of rural participants in our sample. Logistic regression with population-based sampling weights was used to calculate adjusted prevalence odds ratios per 10ppb increase in O3 and NO2, per 10μg/m(3) increase in PM10, and per 5μg/m(3) increase in PM2.5 adjusting for race, gender, age, socioeconomic status, smoking, and urban/rural status. Using CMAQ data, increased levels of NO2 were associated with positive IgE to any (OR 1.15, 95% CI 1.04, 1.27), inhalant (OR 1.17, 95% CI 1.02, 1.33), and indoor (OR 1.16, 95% CI 1.03, 1.31) allergens. Higher PM2.5 levels were associated with positivity to indoor allergen-specific IgE (OR 1.24, 95% CI 1.13, 1.36). Effect estimates were similar using monitored data. Increased ambient NO2 was consistently associated with increased prevalence of allergic sensitization.

Caesarean section and allergic manifestations: insufficient evidence of association found in population-based study of children aged 1 to 4 years

To provide evidence on the association between caesarean section and allergic manifestations in an unselected child population. Research focused on all children aged from one to 4 years (N = 4779), born between April 2001 and March 2005 and living in the province of South Karelia, Finland. They were identified from the nationwide population register. Questionnaire data on 3181 participants were individually merged with allergy test results (skin prick tests, IgE antibodies and open food challenges) from all patient records. Compared with vaginal delivery, the adjusted relative incidence of positive allergy tests (with 95% confidence intervals, CI) in children born by caesarean section was 1.14 (0.79, 1.65) for food, 1.16 (0.66, 2.05) for animals, 0.94 (0.46, 1.92) for pollen and 1.19 (0.87, 1.63) for any allergens. The corresponding adjusted prevalence odds ratios (with 95% CI) of physician-diagnosed allergic manifestations were 1.15 (0.80, 1.63) for food allergy, 0.90 (0.47, 1.59) for pollen allergy or hay fever, 1.00 (0.75, 1.31) for atopic eczema, 0.96 (0.53, 1.65) for asthma and 1.08 (0.85, 1.38) for any allergic manifestation. Insufficient evidence was found in our population for any association between birth by caesarean section and allergic manifestations. Further evidence from unselected populations, with longer follow-up periods, is needed.

A Population-based Cohort Study of Pregnancy Outcomes Among Women With Primary Sclerosing Cholangitis

Studies of primary sclerosing cholangitis (PSC) and pregnancy outcomes have been limited in size and have been inadequate to rule out excess risks. We examined pregnancy outcomes among women with PSC. Women with PSC were identified from inpatient and hospital-based outpatient data in the Swedish National Patient Register. Through linkage with the Medical Birth Register, we identified 229 singleton births, from 1987 through 2009, to women with PSC before delivery. These were compared with 2,304,863 births to women without a diagnosis of PSC. We used logistic regression, adjusted for maternal age, smoking, education, parity, and year of birth, to calculate adjusted prevalence odds ratios (aPORs) for adverse pregnancy outcomes. Maternal PSC was associated with a 3.63-fold increase in preterm birth (95% confidence interval [CI] for aPOR, 2.35-5.61) as well as an increased risk of cesarean section (aPOR, 2.18; 95% CI, 1.50-3.17). We found no increased risk based on analyses of the 5-minute Apgar score, small for gestational age, stillbirths, or neonatal deaths. Maternal PSC was not a risk factor for congenital abnormalities (aPOR, 1.12; 95% CI, 0.56-2.22). Stratification by inflammatory bowel disease status did not affect the risk estimates more than marginally. Maternal PSC is associated with both preterm birth and cesarean section but not with congenital malformation or other adverse outcomes of pregnancy. Pregnancy should not be discouraged in women with PSC.

Ondansetron in Pregnancy and Risk of Adverse Fetal Outcomes

Nausea and vomiting affect more than 50% of all pregnant women. Although ondansetron is often used for treatment, data on its safety for the fetus are limited. The drug is administered during the period the fetus is most susceptible to teratogenic effects (7–12 weeks’ gestation). This historical cohort study was performed to determine whether use of ondansetron during pregnancy led to an increased risk of adverse fetal outcomes. Danish registries were used to establish a nationwide cohort of all pregnancies that resulted in a singleton live birth or stillbirth or ended with any abortive outcome during 2004 to 2011. Data were extracted for women given ondansetron. Specific exposure times were defined as the first trimester through 12 weeks’ gestation for any major birth defect, any time before 37 completed weeks for preterm delivery, any time during pregnancy for analyses involving birth weight, weeks 7 to 22 for spontaneous abortion, and week 7 until birth for stillbirth. Women who did not receive ondansetron were categorized as “unexposed.” Outcomes were spontaneous abortion, stillbirth, any major birth defects, preterm delivery, and infants of low birth weight or small for gestational age (SGA). Cox proportional hazards regression models were used to estimate hazard ratios (HRs) for the comparison of pregnancies in which women were and were not exposed to ondansetron. The analyses of birth defects, preterm delivery, and birth weight were based on live births; logistic regression was used to estimate prevalence odds ratios (ORs). Women exposed to ondansetron were matched, in a 1:4 ratio, to unexposed women in accordance with the nearest-neighbor–matching algorithm. Exposure to ondansetron occurred in 1970 (0.3%) of 608,385 women in the cohort. The first prescription was filled at a median of 70 gestational days (interquartile range, 57–88 days). In unadjusted analyses conducted before propensity score matching, the risk of spontaneous abortion was significantly decreased among women who were exposed to ondansetron compared with unexposed women. No increased risk of stillbirth, any major birth defects, infant born at low birth weight, or infant born SGA was associated with ondansetron exposure, whereas the risk of preterm delivery was significantly increased. The propensity score–matched analyses included spontaneous abortion (1849 exposed vs 7396 unexposed women), stillbirth (1915 vs 7660), any major birth defect (1233 vs 4932), preterm delivery (1792 vs 7168), and birth of infants at low birth weight and SGA (1784 vs 7136). The matched groups were similar in baseline characteristics. More than 50% of women given ondansetron were hospitalized for hyperemesis or nausea and vomiting, and almost half received another antiemetic. An analysis that included 215 cases occurring in weeks 7 to 12 and 139 cases in weeks 13 to 22 found that women exposed to ondansetron were not at increased risk for spontaneous abortion compared with unexposed women, with an adjusted HR of 0.49 (95% confidence interval [CI], 0.27–0.91) in weeks 7 to 12 and of 0.60 (95% CI, 0.29–1.21) in weeks 13 to 22. Six stillbirths occurred among 1915 women exposed to ondansetron (0.3%) and 27 among 7660 women not exposed (0.4%; adjusted HR, 0.42; 95% CI, 0.10–1.73). Among 1233 women given ondansetron in the first trimester, 36 infants (2.9%) had a major birth defect compared with 141 of 4932 unexposed infants (2.9%; adjusted prevalence OR, 1.12; 95% CI, 0.69–1.82). No cases of cleft palate occurred in the exposed group. Among 1792 women exposed to ondansetron before 37 weeks’ gestation, 111 had preterm deliveries (6.2%) compared with 374 among 7168 unexposed women (5.2%; adjusted prevalence OR, 0.90; 95% CI, 0.66–1.25). Exposure to ondansetron at any time during pregnancy was not associated with low birth weight (4.1% exposed vs 3.7% unexposed; adjusted prevalence OR, 0.76; 95% CI, 0.51–1.13) or with infants who were SGA (10.4% exposed vs 9.2% unexposed; adjusted prevalence OR, 1.13; 95% CI, 0.89–1.44). Compared with pregnancies with exposure to antihistamine antiemetics, those having exposure to ondansetron had no significantly different risk of spontaneous abortion. These results indicate that ondansetron exposure in pregnancy is not associated with a significantly increased risk of major adverse fetal outcomes, including spontaneous abortion, stillbirth, any major birth defects, preterm delivery, or low birth weight or SGA. These results may offer some reassurance for using ondansetron as treatment for nausea and vomiting during pregnancy.

Abstract P386: Adult Height and Coronary Artery Calcium in the NHLBI Family Heart Study

Introduction: Adult height is inversely associated with the risk of developing hypertension, hyperlipidemia, and diabetes. Height has also shown an inverse association with coronary heart disease and cardiovascular mortality, but the relationship between height and subclinical atherosclerosis is unclear. Coronary artery calcium (CAC) is a marker of atherosclerosis and a strong predictor of cardiovascular events. The relationship between height and CAC has not been well studied. Objective: To test the hypothesis that adult height is inversely associated with CAC. Methods: We studied 3,360 individuals from the National Heart, Lung, and Blood Institute Family Heart Study. Adult height was self-reported and CAC was measured by EBCT. We used generalized estimating equations to estimate adjusted prevalence odds ratios across quintiles of height. Results: Mean age of the sample was 54.9 years (SD +/- 12.9) and 57% were women. Baseline characteristics of the participants in sex-specific quintiles are shown in Table 1. After adjusting for age, the prevalence odds ratios for CAC decreased from the lowest quintile to the highest quintile (p-value for trend 0.02). After further adjustment for race, waist circumference, smoking, and field center, height remained inversely associated with CAC (adjusted odds ratios 1.0 [reference], 1.52 [1.13-2.05], 0.98 [0.75-1.28], 0.90 [0.68-1.20], 0.78 [0.58-1.03], p-value for trend <0.01). Additional adjustment for alcohol consumption, exercise, and total cholesterol did not materially change the strength of the association between height and CAC. No interaction was seen for gender or race. Conclusion: Adult height is inversely associated with the presence of CAC in middle-aged men and women.

Blacks and whites in Cuba have equal prevalence of hypertension: confirmation from a new population survey

BackgroundThe excess burden of hypertension among blacks has been a prominent feature of the heath disparities literature, and many scientists presume it to be a stable and inevitable phenomenon. The underlying causes of this disparity can only be disentangled in a setting in which the population does not experience racial stratification of socioeconomic opportunities. While such conditions of racial equality remain uncommon, they may be approximated in Cuba, a country with a persistent policy of social inclusion over the last 5 decades.MethodsWe report on a 2010–2011 stratified probability sample of those aged 15–74 years from the urban population of Cienfuegos in central Cuba. A total of 1496 adults (880 women and 616 men) were recruited and assessed for blood pressure and anthropometrics according to standardized protocols, as well as medication use, educational attainment and observed skin tone (dichotomized into “black” and “white”). Weighted tabular and regression analyses were conducted to estimate adjusted prevalences of hypertension (> 140/90 mmHg) and adjusted prevalence odds ratios for contrasts between the two skin color groups.ResultsMean pressures were higher for men than for women, but overall did not differ importantly between racial groups. About half of all diagnosed hypertensive men were on medication, a proportion that did not vary by racial group. For women, however, adjusted prevalence was somewhat higher among blacks, and treatment and control rates were also somewhat advantaged for white women.ConclusionsOverall, skin color was unrelated to mean blood pressure or hypertensive status in this population, although among women specifically some racial advantage appears evident in adjusted prevalence and control, and should be investigated further. The overall null result suggests that Cuba may exemplify the social conditions in which racial excess in hypertension, characteristic of much of the western world, is not a necessary reality.

Surveillance of Preconception Health Indicators in Behavioral Risk Factor Surveillance System: Emerging Trends in the 21st Century

This article assesses emerging trends in the 21st century, if any, in preconception health indicators among women of reproductive age. This is a secondary analysis of cross-sectional data from the Behavioral Risk Factor Surveillance System (BRFSS), 2003-2010. Subjects were a sample of noninstitutionalized, 18-44-year-old, nonpregnant, women in the United States (n=547,177) grouped into two categories, 2003-2006 (n=275,630) and 2007-2010 (n=271,547). Overall crude and adjusted prevalence odds ratios were calculated for preconception indicators before 2006 and after 2006. Significant improvements were found for any and heavy alcohol use, smoking, social and emotional support, moderate/vigorous physical activity, and having had an influenza shot in the last year. In contrast, binge drinking, having a medical condition (i.e., diabetes, high blood pressure, asthma, or obesity), and self-reported health significantly worsened. No change was found for mental distress, HIV testing, and having a routine checkup. As the 21st century unfolds, emerging trends suggest that we need to focus on educating women, providers, and public health advocates about improved health before pregnancy, especially for women with chronic conditions and those who binge drink alcohol.

Impact of Comorbidities on Racial/Ethnic Disparities in Hypertension in the United States

Background. Racial/ethnic disparities in hypertension (HTN) prevalence continue to persist in United States. We aimed in this study to examine the racial/ethnic disparities in hypertension prevalence and to determine whether or not health disparities may be explained by racial/ethnic disparities in co-morbidities. Materials and Methods. A cross-sectional design was used to examine the prevalence of hypertension among African Americans (AAs), Caucasians, and Hispanics in the National Health Interview Survey, 2003. The overall sample comprised 30, 852 adults. Results. There was a statistically significant racial/ethnic variability in hypertension prevalence, with AA/Blacks with the highest prevalence, χ2=393.0 (3), P<0.01. Hypertension was associated with co-morbidities, age, education, physical inactivity, marital status, income, sex, alcohol, and cigarette consumption, but not insurance. Relative to Caucasians, AAA/Blacks were 43% more likely while Hispanics were 40% less likely to report being diagnosed with high blood pressure, prevalence odds ratio (POR) = 1.43, 99% CI, 1.25–1.64, P=0.002, and POR = 0.60, 99% CI, 0.55–0.66, P<0.001, respectively. After adjustment for the relevant covariates including co-morbidities, racial/ethnic disparities in hypertension persisted; thus compared to Caucasians, African Americans were 61% more likely to be told by their health care providers that they were hypertensive, adjusted prevalence odds ratio (APOR) = 1.61, 99% CI, 1.39–1.86, P<0.001. In contrast, Hispanics were 27% less likely to be diagnosed with hypertension compared to Caucasians, APOR = 0.73, 99% CI, 0.68–0.79, P<0.001. Conclusions. There was racial/ethnic variability in hypertension prevalence in this large sample of non-institutionalized US residents, with the highest prevalence of hypertension observed among African Americans. These disparities were not removed after controlling for relevant covariates including co-morbidities.

Obesity and asthma: An association modified by age

BackgroundSome studies indicate some causal relationship between obesity and asthma, while others show inconsistent results. Our objective was to evaluate the prevalence of asthma according to obesity in children. MethodsA cross-sectional study, following the ISAAC study methodology, was conducted on two randomly selected groups consisting of 6–7 year-old children (n=7485) and 13–14 year-old adolescents (n=8496).The asthma symptoms and potential risk factors were determined from the questionnaire. Overweight and obesity were defined based on the body mass index.Multiple logistic regression was used to obtain adjusted prevalence odds ratios (OR) and 95% confidence intervals. ResultsObesity was associated with an increase in wheezing ever (OR: 1.35) and exercise-induced asthma (OR: 1.62) in the 6–7 year-old group. No significant relationship was observed in the adolescent population. ConclusionObesity was associated with a higher prevalence of asthma in young children, but not in adolescents.

Differences in pregnancy planning between women aged 18–44, with and without diabetes: Behavioral risk factor surveillance system analysis

AimAssess differences in pregnancy planning and behavioral risk factors among women of reproductive age, by diabetes status. MethodsA secondary analysis of cross-sectional data from the Behavioral Risk Factor Surveillance System (2002 and 2004) was conducted. Subjects were 18–44-year-old, non-pregnant, fertile women, grouped into two categories: non-diabetes (n=57,436), and diabetes (n=2929). Multivariable logistic regression was used to estimate adjusted prevalence odds ratios and 95% confidence intervals. ResultsApproximately 93% of women of reproductive age with or without diabetes are not intending a pregnancy, and yet among them, women with diabetes are 22% more likely not to use any birth control at all. Women with diabetes are 3.4 times more likely to be obese, 1.4 times more likely to be overweight, 35% less likely to drink any alcohol, and 27% less likely to binge drink alcohol, than women without diabetes. There were no differences in risk factors between women with diabetes that were and were not intending a pregnancy. ConclusionsBirth control nonuse for women with diabetes not intending a pregnancy and lack of behavioral change for women with diabetes intending a pregnancy, combined with an increasing prevalence in diabetes, will likely result in significant economic and social tolls on society.

Physical Readiness and Obesity Among Male U.S. Navy Personnel With Limited Exercise Availability While at Sea

To evaluate differences in physical readiness and obesity in worksites with inherent limitations in exercise availability, utilizing data from U.S. Navy personnel assigned to submarines. Cross-sectional study utilizing height, weight, and Physical Readiness Test (PRT) scores of 26,341 individuals assigned to small submarines (SS), large submarines (LS), and aircraft carriers (AC). PRT failure rates were 3.4% (AC), 1.5% (LS), and 2.9% (SS). Prevalence of obesity was 15.1% (AC), 16.9% (LS), and 17.8% (SS). The adjusted prevalence odds ratio of obesity was increased on SS and LS compared to AC, 1.25 (96% CI = 1.14, 1.31) and 1.17 (95% CI = 1.06, 1.29), respectively. Despite limitations in exercise availability, submarine personnel performance on the PRT was similar to that of AC personnel. Although the prevalence of obesity on submarines was slightly higher, it remains below U.S. nonmilitary comparison data. Although limited access to exercise has the potential for adverse health effects in worker populations, in our cohort of young men, the changes in both physical readiness and obesity were small. Further research on a more diverse group of workers is warranted.

Discovered Dead While Asleep in Causal Pathway of Mortality Among Children With Cerebral Palsy

Discovered Dead While Asleep in Causal Pathway of Mortality Among Children With Cerebral Palsy

Association between early methylmercury exposure and functional health among residents of the Shiranui Sea communities in Japan

The objective of this study was to evaluate the effect of estimated historical methylmercury exposure on the functional health of residents living in the Shiranui Sea communities in Japan. Functional health was measured by self-reported activities of daily living (ADL). Study areas were categorized into high, medium and low methylmercury exposure areas according to their location or distance from the Shiranui Sea. We estimated the adjusted prevalence odds ratios of impaired ADL in relation to exposure using a logistic regression model. Compared with residents in the low-exposure area, residents in the high-exposure area were significantly associated with a higher prevalence odds ratio (OR) for impaired ADL after adjustment for confounding factors (adjusted ORs = 2.8, 95% CI: 1.3–6.2). These results showed strong dose-response relationships (p for trend = 0.0050). Our findings suggest that historical methylmercury exposure might cause functional impairment in later in life depending on the exposure level.

The Effects of Malaria and Intermittent Preventive Treatment During Pregnancy on Fetal Anemia in Malawi

Fetal anemia is common in malarious areas and is a risk factor for infant morbidity and mortality. Malaria during pregnancy may cause decreased cord hemoglobin (Hb) and fetal anemia among newborns. Intermittent preventive treatment during pregnancy (IPTp) with sulfadoxine-pyrimethamine (SP) is protective against malaria but may also affect hematopoiesis and contribute to fetal anemia. Peripheral, placental, and cord blood were examined for malaria parasitemia and Hb concentration in a cross-section of 3848 mothers and infants delivered at Queen Elizabeth Central Hospital in Blantyre, Malawi between 1997 and 2006. Unconditional linear and logistic regressions were performed with multiple imputation for missing covariates to assess the associations between malaria, IPTp with SP, and fetal anemia. The overall prevalence of fetal anemia was 7.9% (n = 304). Malaria parasitemia at delivery was associated with an adjusted decrease in cord Hb of -0.24 g/dL (95% confidence interval [CI], -.42 to -.05). The adjusted prevalence odds ratio for the effect of malaria on fetal anemia was 1.41 (95% CI, 1.05-1.90). Primigravidae who did not take IPTp had infants at highest risk for fetal anemia, and density of parasitemia was correlated with the decrease in cord Hb. There was no significant association between SP use and cord Hb or fetal anemia. Malaria during pregnancy, but not IPTp, decreases cord Hb and is a risk factor for fetal anemia in Malawi. Intermittent preventive treatment during pregnancy with SP may continue to be safe and effective in preventing malaria during pregnancy and fetal anemia despite development of SP resistance.

Association of Health Risk Behaviors with Mental Health among Elderly Koreans

Results: The prevalence of depression, anxiety experience, and poor quality of life was 40.8%, 29.9%, and 54.6%, respectively. Current smoking was significantly associated with the risk of anxiety symptoms and poor quality of life (adjusted prevalence odds ratio (POR), 1.24; 95% confidence interval (CI), 1.02 to 1.52 and adjusted POR, 1.34; 95% CI, 1.12 to 1.60, respectively). Also, not exercising regularly was significantly associated with all of the mental health problems (depression and anxiety symptoms, and poor quality of life), which were measured in this study (adjusted POR, 1.31; 95% CI, 1.14 to 1.51 and adjusted POR, 1.39; 95% CI, 1.19 to 1.62 and adjusted POR, 1.45; 95% CI, 1.27 to 1.65, respectively). Conclusion: Elderly Koreans with health risk behaviors are likely to be vulnerable to mental health concerns. This finding underscores the continued needs to design and implement mental health policies at the community or the country level, especially in elderly Koreans with health risk behaviors.

Various Adiposity Measures Show Similar Positive Associations With Type 2 Diabetes in Caucasians, Native Hawaiians, and Japanese Americans

The authors evaluated the association of body mass index (BMI), waist circumference (WC) and hip circumference (HC), waist-to-hip ratio (WHR), and waist-to-height ratio (WHtR) with diabetes in Caucasians, Native Hawaiians, and Japanese Americans aged 45 to 75 years in the Multiethnic Cohort. Diabetes cases were obtained from self-reports and by linkages with health insurance plans. The authors estimated adjusted prevalence odds ratios (PORs) and compared the area under the receiver operating characteristic curves (AUC). All measures were positively associated with diabetes prevalence; the PORs were 1.25 to 1.64 in men and 1.52 to 1.83 in women. In all 3 ethnic groups, the AUCs in men were greater for BMI than for the other measures, whereas in women, the AUCs were greater for combined models than for BMI alone, but the differences were small and not clinically significant. It does not appear that one anthropometric measure best reflects diabetes prevalence or performs better in one ethnic group than in another.

Electrocardiogram Abnormalities and Cardiovascular Mortality in Elderly Patients with CKD

Cardiovascular disease is the most common cause of death in CKD. This study evaluated whether electrocardiogram (ECG) abnormalities are predictors of cardiovascular death in CKD. The Cardiovascular Health Study limited database (1989-2005) was used to identify a cohort with CKD at baseline (estimated GFR < 60 mL/min per 1.73 m(2)). The patients were categorized as having major, minor, or no ECG abnormalities. Rates of adjudicated cardiovascular events and mortality were compared among the groups using proportional hazards regression models. A total of 1192 participants had CKD at baseline; mean age ± SD was 74.7±6.2 years. Of these patients, 452 (38.8%) had major, 346 (29.7%) had minor, and 367 (31.5%) had no ECG abnormalities. Participants with estimated GFR < 60 mL/min per 1.73 m(2) were more likely to have ECG abnormalities at baseline (adjusted prevalence odds ratio, 1.23 [95% confidence interval (CI), 1.06-1.43]) than those with GFR ≥ 60 mL/min per 1.73 m(2). During mean follow-up of 10.3±3.8 years, 814 (68.3%) participants died. Compared with participants without ECG abnormalities, participants with major abnormalities had the highest risk for cardiovascular events and death; adjusted hazard ratios were 2.15 (95% CI, 1.56-2.98) and 2.27 (95% CI, 1.56-3.30), respectively. For minor ECG abnormalities, hazard ratios were 1.24 (95% CI, 0.91-1.70) and 1.48 (95% CI, 1.00-2.18), respectively. In patients with CKD, major ECG abnormalities are frequently present and predict a significantly higher risk for death and adverse cardiovascular outcomes.

The prevalence of and factors associated with chronic atrial fibrillation in Medicare/Medicaid-eligible dialysis patients

Atrial fibrillation is an important comorbidity with substantial therapeutic implications in dialysis patients but its prevalence varies in different studies. We used a database that includes patients in the United States on hemodialysis who were eligible for government assistance with prescription drugs. We then used ICD-9 codes from billing claims in this database to identify patients with chronic atrial fibrillation. Multivariable logistic regression was used to determine adjusted prevalence odds ratios for associated factors. Of 63,884 individuals, the prevalence of chronic atrial fibrillation was 7%. The factors of age over 60 years, male, Caucasian, body mass index over 25 kg/m(2), coronary artery disease, and heart failure were all significantly associated with chronic atrial fibrillation. Prevalence rates, particularly in younger patients, were far higher than those reported in an age group-matched nondialysis population. Thus, given its clinical impact, future efforts are needed to examine risk factors for adverse outcomes in chronic atrial fibrillation, and to identify appropriate management strategies for this disorder, as well as opportunities for quality improvement in this vulnerable population.

Prevalence of cardiovascular disease and risk factors in a rural district of Beijing, China: a population-based survey of 58,308 residents

BackgroundCardiovascular disease (CVD) is the leading cause of global disease burden. Although stroke was thought to be more prevalent than coronary heart disease (CHD) in Chinese, the epidemic pattern might have been changed in some rural areas nowadays. This study was to estimate up-to-date prevalence of CVD and its risk factors in rural communities of Fangshan District, Beijing, China.MethodsA cross-sectional population survey was carried out by stratified cluster sampling. A total of 58,308 rural residents aged over 40 years were surveyed by face-to-face interview and physical examination during 2008 and 2010. The standardized prevalence was calculated according to adult sample data of China's 5th Population Census in 2000, and the adjusted prevalence odds ratio (POR) was calculated for the association of CHD/stroke with its cardiovascular risk factors in multivariate logistic regression models.ResultsAge- and sex-standardized prevalence was 5.6% for CHD (5.2% in males and 5.9% in females), higher than the counterpart of 3.7% (4.7% in males and 2.6% in females) for stroke. Compared with previous studies, higher prevalence of 7.7%, 47.2%, 53.3% in males and 8.2%, 44.8%, 60.7% in females for diabetes, hypertension and overweight/obesity were presented accordingly. Moreover, adjusted POR (95% confidence interval) of diabetes, obesity, stage 1 and stage 2 hypertension for CHD as 2.51 (2.29 to 2.75), 1.53 (1.38 to 1.70), 1.13 (1.02 to 1.26) and 1.35 (1.20 to 1.52), and for stroke as 2.24 (1.98 to 2.52), 1.25 (1.09 to 1.44), 1.44 (1.25 to 1.66) and 1.70 (1.46 to 1.98) were shown respectively in the multivariate logistic regression models.ConclusionsHigh prevalence of CVD and probably changed epidemic pattern in rural communities of Beijing, together with the prevalent cardiovascular risk factors and population aging, might cause public health challenges in rural Chinese population.