Mortality In Population Research Articles

Associations between age, red cell distribution width and 180-day and 1-year mortality in giant cell arteritis patients: mediation analyses and machine learning in a cohort study

ObjectiveThe aim of this study was to investigate the correlation between age, red cell distribution width (RDW) levels, and 180-day and 1-year mortality in giant cell arteritis (GCA) patients hospitalized or admitted to the ICU.MethodsClinical data from GCA patients were extracted from the MIMIC-IV (3.0) database. Logistic and Cox regression analyses, Kaplan–Meier (KM) survival analysis, restricted cubic spline (RCS) analysis, and mediation effect analysis were employed to investigate the association between age, RDW levels, and 180-day and 1-year mortality in GCA patients hospitalized or admitted to the ICU. Predictive models were constructed using machine learning algorithms, and SHapley Additive exPlanations (SHAP) analysis was applied to evaluate the contributions of age and RDW levels to mortality in this patient population.ResultsA total of 228 GCA patients were eligible for analysis. Our study identified both age and RDW levels (both with OR > 1, P < 0.05) as significant predictors of 180-day and 1-year mortality in GCA patients hospitalized or admitted to the ICU using multivariate logistic regression analysis. In multivariate Cox regression analysis, both age and RDW (both with HR > 1, P < 0.05) also emerged as prognostic risk factors for 180-day and 1-year mortality in this patient population. KM survival analysis further showed that GCA patients hospitalized or admitted to the ICU with higher age or elevated RDW levels had significantly lower survival rates compared to younger patients or those with lower RDW levels (P < 0.0001). Moreover, RCS analysis indicated a strong nonlinear relationship between RDW levels (threshold: 17.53%) and 1-year mortality in this population. Additionally, RDW levels were found to modestly mediate the relationship between age (per 10-year increase) and 180-day or 1-year mortality in GCA patients hospitalized or admitted to the ICU. The results of the machine learning analysis indicated that the model built using the random forest algorithm performed the best, with an area under the curve of 0.879. Furthermore, SHAP analysis revealed that both age and RDW levels made significant contributions to the prediction of mortality in GCA patients hospitalized or admitted to the ICU.ConclusionsOlder age and higher RDW levels were identified as independent risk factors for increased 180-day and 1-year mortality in GCA patients hospitalized or admitted to the ICU. Furthermore, elevated RDW levels modestly mediated the relationship between age and 180-day or 1-year mortality in this patient population.

Insulin resistance surrogates are associated with all-cause mortality and cardiovascular mortality in population with metabolic syndrome: a retrospective cohort study of NHANES

The study aimed to assess the association of five insulin resistance surrogates, namely HOMA-β (Homeostasis Model Assessment of Beta-cell Function), QUICKI (Quantitative Insulin Sensitivity Check Index), IGR (Insulin Glucose Ratio), e-IS (Estimated Insulin Sensitivity), and Bennett ISI(Bennett’s insulin sensitivity index) with all-cause and cardiovascular mortality in respondents with metabolic syndrome(MetS). The prospective cohort of 6662 participants aged 18 years and older with metabolic syndrome was extracted from the National Health and Nutrition Examination Survey(NHANES 1999–2016). The multivariate Cox proportional hazards regression model, Kaplan-Meier survival curve, and log-rank tests were applied to determine the association between the five indices and all-cause mortality and cardiovascular mortality in the MetS population. Restricted cubic splines, a two-piece segmented Cox proportional hazards model, and threshold effect analyses were performed to evaluate the nonlinear relationship. Sensitivity analyses were then conducted by removing individuals with CKD, CHF, CAD, stroke, or cancer, respectively. All five insulin resistance (IR) surrogates displayed a negative association with all-cause and cardiovascular mortality in participants with metabolic syndrome. Restricted cubic spline curves showed QUICKI, IGR, and e-IS had a nonlinear relationship with statistical significance. MetS population at the highest quartile of HOMA-β or IGR exhibited lower all-cause and cardiovascular event probabilities compared with those at the lowest quartile, and e-IS had a similar correlation with cardiovascular events. Threshold effect analyses showed that there were inflection points of IGR for all-cause and cardiovascular mortality. As IGR gradually approached inflection points, the two types of mortality risks descended by 15%[HR 0.85(0.80,0.91)] and 19%[HR 0.81(0.71,0.92)], respectively. Sensitivity analysis indicated most results were robust, but Bennett ISI did not exhibit significant outcomes in participants without CKD. Our study provides evidence that HOMA-β, QUICKI, IGR, e-IS, and Bennett ISI displayed a reverse correlation with all-cause mortality and cardiovascular mortality in participants with metabolic syndrome. The five IR surrogates should be given more attention during the follow-up of MetS population.

Use of mortality tables by level of deprivation in the study of social inequalities in cancer survival.

Previous studies have reported lower net survival probabilities for socioeconomically deprived patients, using non-deprivation specific lifetables. Not accounting for the social gradient in background mortality could potentially overestimate the effect of deprivation on net survival. The aim of this study was to estimate the impact of taking into account the social gradient of expected mortality in the general population on the study of the social gradient of survival of people with cancer. French cancer registry data was analyzed, with 190,902 incident cases of nineteen cancer sites between 2013 and 2015. Deprivation was measured using the European deprivation index (EDI). Net survival was estimated thanks to additive models with French lifetables stratified on deprivation level with the EDI, using the non-parametric Pohar-perme method and flexible excess hazard modelling with multidimensional penalized splines, firstly with non-specific lifetables then with the deprivation specific-lifetables. A significant effect of EDI on excess mortality hazard (EMH) remained when using the deprivation-specific lifetables for colorectal, lung cancer and melanoma in both sexes, and esophagus, bladder, head and neck and liver cancer for men, and breast, cervix and uterine cancer for women. The only site where the effect of EDI on EMH was no longer significant when using deprivation-specific lifetables was prostate cancer. The use of deprivation-specific lifetables confirms the existence of a social gradient in cancer survival, indicating that these inequalities do not result from inequalities in background mortality. Development of such deprivation-specific lifetables for future years is crucial to understand mechanisms of social inequalities and work towards reducing the social burden.

Demographic risks in the context of a full-scale war in Ukraine

The article examines the impact of the full-scale war initiated by the russian federation on demographic risks in Ukraine. The full-scale war has led to significant changes in the country’s demographic structure, including a sharp decline in the birth rate and an increase in the mortality rate, exacerbating the demographic crisis. The study aims to identify the main demographic risks caused by the war and assess their long-term impact on Ukraine’s socio-economic development. The object of the study is demographic processes in the conditions of the full-scale war. The methodological basis is the demographic analysis of changes in population size, birth, and mortality rates. In 2022, Ukraine’s population was 44.07 million people, but after two years of war, this figure decreased by 15.05%, reaching 37.44 million by early 2024. The birth rate dropped to 5.5‰, and the fertility rate decreased to a critically low level of 0.9 in 2024, one of the lowest rates in the world. Regarding mortality, despite the active hostilities, the mortality rate paradoxically decreased in 2022–2024 compared to previous years (17.1‰ in 2021), likely due to the population reduction caused by mass migration and difficulties in data collection. According to the UN, a total of 22,594 civilians were killed due to military actions, although the actual number of casualties could be much higher. The results indicate a deep demographic crisis that requires urgent government action to stabilize the situation and restore demographic potential. The study's practical significance lies in the potential use of the results to develop government programs to support the birth rate, reduce mortality, and ensure social development in the post-war period.

Gut Microbial Signatures Associated with Cryptosporidiosis: A Case Series

Cryptosporidium spp. are zoonotic protozoan parasites with a global prevalence, with both gastrointestinal and pulmonary involvement. Though symptoms can often be relatively mild, they can become severe and even fatal in children under five, the elderly, and in immunocompromised individuals, making cryptosporidiosis a leading cause of morbidity and mortality in fragile populations. Furthermore, there is an urgent clinical need for alternative therapies against cryptosporidiosis, as currently available FDA-approved treatments are ineffective in the immunocompromised. Recent evidence in animal models suggests that the gut microbiota (GM) can influence both host and parasite biology to influence the course of Cryptosporidium infection. Here, we present GM profiles in five cases of cryptosporidiosis, associated with varying underlying pathologies. We found that moderate–severe cryptosporidiosis was characterized by a reduction in alpha-diversity and an enrichment of Enterococcus spp., while decreases in Bifidobacterium, Gemmiger, and Blautia were detectable in the milder manifestations of the disease. Our results suggest that severe cryptosporidiosis is associated with a stronger change on the GM than is age or underlying pathology. Together with previously published studies in animal models, we believe that these results suggest that the GM could be a potential therapeutic target for human patients as well, particularly in the immunocompromised for whom anti-Cryptosporidium treatment remains largely ineffective.

Dose-response relationship between lipids and all-cause mortality in the dialysis population: a meta-analysis.

The use of lipid-lowering drugs in the dialysis population has been controversial and there is no target for the dialysis population. To elucidate the dose-response relationship between lipids and all-cause mortality in the dialysis population. Computer searches of PubMed, Embase, Web of Science, CNKI, and Wanfang. Data were conducted to collect published cohort studies on lipids and all-cause mortality in the dialysis population from home and abroad up to February 2023. Meta-analysis was applied to calculate the combined effect size (Hazard ratio) and its 95% confidence interval and dose-response relationship by applying Stata17.0. A total of 11 publications with a cumulative total of 106,808 individuals were included. All-cause mortality was statistically different between the highest dose total cholesterol (TC) group and the low TC group (HR = 0.82, 95% CI = 0.75-0.90, P < 0.05). The TC range for lower all-cause mortality is > 140.5mg/dL, and on this basis, TC in the range of 180-220mg/dL may have a better prognosis for dialysis population. There was a nonlinear relationship between Non-high-density lipoprotein cholesterol (NHDL-C) cholesterol and all-cause mortality, with no statistical difference between the high and low dose group. In contrast, Low-density lipoprotein cholesterol (LDL-C) masked its association with all-cause mortality due to changes in death spectrum, differences in relative time risks, and other factors. In the 50-450mg/dL range, all-cause mortality in the dialysis population was positively associated with triglycerides (TG), with a 2.5% increase in all-cause mortality per 50mg/dL increase in TG (HR = 1.025, 95% CI = 1.003-1.048, P = 0.01). TC is a target for monitoring the dialysis population, which has the lowest all-cause mortality in the range of 180-220mg/dL. However, NHDL-C and LDL-C monitoring is not clinically meaningful. Increased TG can contribute to the risk of higher all-cause mortality in dialysis patients.

Premature Mortality and Health Inequality among Adult New Yorkers with Serious Mental Illness.

Although numerous studies have documented excess mortality and health inequality among individuals with serious mental illness (SMI), none has been done among individuals in a large, diverse urban setting, such as New York City (NYC). We used referral data for adults aged 18 and older referred to the NYC Department of Health and Mental Hygiene public mental health services between January 2004 and December 2018 and matched it to the NYC death registry. Age at death, leading causes of death, years of potential life lost (YPLL), and standardized mortality ratios (SMRs) were calculated for this population. We found individuals with SMI in NYC died at younger ages and had higher rates of YPLL compared to the total population (147.4 YPLL vs. 66.8 YPLL per 1000 population). Age and gender-adjusted SMRs show these individuals have more than twice the mortality rate of the total NYC adult population (overall SMR 2.2 [95% CI 2.1-2.2]). Cause-specific SMRs show an increased risk of death among SMI from diabetes (SMR 2.8 [95% CI 2.4-3.10]), heart disease (SMR 2.7 [95% CI 2.6-2.9]), psychoactive substance use and accidental overdose (SMR 4.5 [95% CI 4.1-4.9]), and suicide (SMR 6.7 [95% CI 6.0-7.4]). Our results highlight the need to implement effective, preventive, and rehabilitative measures that integrate physical and behavioral healthcare services and address upstream drivers of health to achieve health equity and eliminate health disparities. In order to achieve gains in life expectancy, specific considerations for reducing excess mortality in the SMI population must be accounted for.

Long-Term Clinical Relevance of Hyponatremia Identified During Acute Phase of Myocardial Infarction

Background/Objectives: Hyponatremia is associated with increased mortality in the general hospital population. We sought to investigate whether hyponatremia affects the long-term survival of patients following a myocardial infarction (MI) in both ST-segment elevation (STEMI) and non-ST elevation (NSTEMI) presentations. Methods: In this study, 862 MI patients who were hospitalized between 2012 and 2017 were retrospectively followed-up within the median time period of 41.9 [28.2–73.5] months. All participants were assigned to a hyponatremic or normonatremic group with hyponatremia defined as a sodium level of less than 135 mEq/L on admission. Results: In the acute phase of an MI, hyponatremia was diagnosed in 31 (3.6%) patients. The patients with hyponatremia were less often male (38.7 vs. 70.4%, p &lt; 0.001), and less frequently had Killip class I (63.3 vs. 80%) but more often had Killip class IV on admission (16.7 vs. 4.2%, p = 0.024) and more often had a history of impaired renal function (32.3 vs. 15.5%, p = 0.013) than those with normonatremia. Hyponatremic patients had higher troponin T levels on admission by 75.1% (p = 0.003), a higher isoenzyme MB of creatine kinase level by 34.4% (p = 0.006), and lower hemoglobin (by 8.5%, p = 0.001) levels as compared to the normonatremia group. Long-term mortality was significantly higher in the patients with hyponatremia versus normonatremia (18 [58.1%] vs. 243 [29.2%], log-rank p &lt; 0.001). This was driven by differences in the NSTEMI population (65 vs. 30.5%, p &lt; 0.001). By a Cox proportional hazard regression analysis, hyponatremia was associated with a higher long-term mortality (hazard ratio [HR] of 2.222, a 95% confidence interval [CI] of 1.309–3.773, and p = 0.003). Conclusions: Hyponatremia rarely identified in acute phase of MI was associated with higher long-term mortality, particularly in the NSTEMI population.

Heart Failure and Sepsis-Related Mortality Trends in the United States, 1999 - 2019: An Analysis of Gender, Race/Ethnicity, and Regional Disparities.

Heart failure (HF) and sepsis are significant causes of disease burden and mortality among the elderly population of the USA. HF causes fluid overload, which complicates the treatment approach when patients develop sepsis necessitating fluid resuscitation. While individual disease states have been studied extensively, the trends in mortality for concurrent sepsis and HF are not well known. Mortality trends due to sepsis and HF in individuals aged 65 and older in the USA from 1999 to 2019 were analyzed using the Centers for Disease Control and Prevention Wide-ranging Online Data for Epidemiologic Research (CDC WONDER) database. Differences in age-adjusted mortality rate (AAMR) and average annual percent change (AAPC) over the past two decades based on gender, race, region, and place of death were examined. Between 1999 and 2019, there were a total of 5,887,799 deaths related to HF, 2,584,523 deaths related to sepsis, and 250,115 deaths related to both HF and sepsis. There was also a decrease in AAMR for HF-related (AAPC -0.80%) and sepsis-related (AAPC -0.28) deaths but an increase in combined HF and sepsis-related AAMR (AAPC 1.06%). Men had consistently higher AAMRs compared to women and a greater increase in mortality (AAPC in men 1.53% vs. women 0.56%). African American patients had a higher AAMR than White patients throughout the study period, though the difference narrowed. African Americans saw a decrease in overall HF and sepsis-related AAMR from 48.90 to 40.56 (AAPC -0.83), whereas AAMR for the White population increased from 27.26 to 33.81 (AAPC 1.37). Regionally, the Northeast had the highest AAMR in 1999 (32.32) but decreased to the lowest AAMR by 2019 (30.77). Totally, 203,368 (81.31%) of all deaths related to HF and sepsis were in medical facilities, 18,430 (7.37%) were in home/hospice facilities, and 24,713 (9.88%) in nursing homes. HF and sepsis-related mortality in the elderly population increased over the past two decades, with men and African Americans at disproportionately higher risk.

Opportunities in the translational pipeline for pediatric brain cancer therapies.

Primary malignant central nervous system (CNS) tumors are the leading cause of cancer-related mortality in the pediatric population. Moreover, survivors often experience significant long-term treatment-related morbidity. Challenges unique to drug delivery to the central nervous system have hampered therapeutic progress. In the past decade, significant advancements in our understanding of molecular biology, genetic alterations, and the tumor microenvironment have allowed us to improve our in vitro and laboratory animal models to better replicate diseases seen in the pediatric population. Recently, a comparative approach using naturally-occurring CNS malignancies in dogs with similar disease progression, histologic presentation, and treatment response has been proposed as an enticing model system. Given these improvements in the translational pipeline, there is an opportunity to identify and implement effective therapies more efficiently to pediatric CNS malignancy populations. IMPACT: Relevant and translational pre-clinical studies are needed to find chemotherapeutics and targeted agents that can reach therapeutic doses within tumors in children without causing systemic adverse effects. A discussion of comparative oncology is provided with the intent to foster veterinary/human oncology collaboration. While the traditional pipeline for translating medications from bench to bedside has been evolving and improving over the last decade, the advances and remaining roadblocks of this pipeline are reviewed and discussed in this article.

Long-Term Impact of Physical Activity on Mortality in Adults With Multimorbidity: A 12-Year Cohort Longitudinal Study From the Survey on Health, Ageing and Retirement in Europe.

While physical activity (PA) is known to reduce mortality in the general population, this relationship in individuals with multimorbidity (≥ 2 chronic conditions) is unclear. This longitudinal study aimed to investigate whether there is a long-term association between PA levels and mortality rates over a 12-year period in adults with multimorbidity. Data were obtained from eight waves of the Survey of Health, Ageing and Retirement in Europe (SHARE), from 28 European countries. PA levels were self-reported via computer-assisted personal interviews. Mortality during the follow-up period was assessed using data obtained from caregivers through end-of-life interview. Multimorbidity was identified based on the presence of two or more 15 self-reported chronic diseases/conditions. Cox's regression analysis, adjusted for potential confounders, was used to assess the association between PA level and mortality. p-values were calculated using the Jonckheere-Terpstra test for continuous variables and the Mantel-Haenszel Chi-square test for categorical variables, stratified by PA level. The study included 9216 participants with multimorbidity (mean age 69 ± 10.1 years; 58.7% were women). Among those with multimorbidity, individuals with high PA level were significantly younger, more frequently men, less impaired in activities of daily living, less educated and less frequently obese than those with very low level of PA (p < 0.0001 for all comparisons). Over the 12 years of follow-up, mortality incidence was three times higher in individuals with multimorbidity and very low PA levels than those with multimorbidity and high levels of PA. After adjusting for confounders, the risk of mortality was significantly lower for participants with moderately low PA levels (HR = 0.64; 95% CI: 0.59-0.71; p < 0.0001), moderately high PA levels (HR = 0.53; 95% CI: 0.47-0.60; p < 0.0001) and high PA levels (HR = 0.49; 95% CI: 0.43-0.55; p < 0.0001) compared to those with very low PA levels. Findings from the present study suggest that people with multimorbidity who had lower levels of PA were three times more likely to die prematurely after 12 years than adults with multimorbidity and higher levels of PA at baseline. These findings underscore the importance of promoting physical activity in adults with multimorbidity to reduce the risk of premature mortality. Future longitudinal research is required to confirm/refute our findings. Further, intervention studies are needed to understand whether increasing levels of physical activity in this population subsequently reduces mortality risk.

Examining the link between adherence to the planetary health diet pattern and mortality in the us: a prospective cohort study.

Though the Planetary Health Diet (PHD) is designed to enhance both human and environmental health, there is limited understanding of how adherence to PHD influences the risk of mortality in the general US adult population. This study aimed to evaluate the relationship between the Planetary Health Diet Index for the United States (PHDI-US) and mortality among adults in the overall population of the United States. The PHDI-US comprises 16 components, assigned scores ranging from 0 to 150, with higher scores signifying a greater level of adherence to the PHD. Data were obtained from the National Health and Nutrition Examination Survey spanning 2005 to 2018, with mortality data linked through December 2019. This study encompassed 30,521 participants (mean [SD] age, 47.02 [17.01] years; 14,817 males [48.0%]). Over an average follow-up period of 8.50 years, there were 3,706 recorded deaths. In the adjusted multivariable model, individuals in the highest quintile of PHDI-US exhibited a reduced risk of all-cause mortality (hazard ratio [HR], 0.64; 95% CI, 0.54-0.75), cardiovascular disease mortality (HR, 0.73; 95% CI, 0.55-0.97), cancer mortality (HR, 0.68; 95% CI, 0.52-0.89), and other-cause mortality (HR, 0.58; 95% CI, 0.46-0.72) compared to those in the lowest quintile. Adherence to a PHD pattern was associated with lower mortality risk in the general US adult population.

Incidence trends, demographic disparities, and survival outcomes of gastrointestinal malignancies in young adults: A focus on stomach and pancreatic cancers.

339 Background: The incidence of gastrointestinal (GI) cancers has been rising among younger populations. While prior research has highlighted the increasing incidence of colorectal cancer (CRC) in adolescents and young adults (AYA), defined as individuals aged 15-39, there is less focus on non-CRC GI malignancies, such as stomach and pancreatic cancers, within this age group. This study aims to further elucidate the incidence, mortality, and demographic disparities in the AYA population for stomach and pancreatic cancers compared to older populations (&gt;50 years old). Methods: Data was extracted from the SEER database spanning from 2000 to 2020. Demographic, clinical, and secondary cancer characteristics were summarized across the sample, stratified by cancer type. Overall survival (OS) and disease-specific survival (DSS) were analyzed using the Kaplan-Meier method, with comparisons performed via the log-rank test. Univariate and multivariate analyses were conducted to identify predictors of survival outcomes. Results: We identified 19,983 AYA patients diagnosed with non-CRC GI malignancies (including esophageal, stomach, small intestine, anal, hepatobiliary, and pancreatic cancers) between 2000 and 2020. Among these patients, the majority were male (58%), White (47%), and resided in metropolitan areas (90%). The median age at diagnosis was 38 years. Pancreatic cancer was 20% more common in the AYA group compared to those over 50 years old (12%), while stomach cancer was also more prevalent in the AYA group (27% vs. 17%). Survival outcomes were significantly better in the AYA group, with a median OS of 24 months compared to 9 months in the older population, and a median DSS of 52 months versus 13 months (p&lt;0.001). Predictors of worse OS and DSS included male sex, African American race, income below $45,000/year, lack of surgical intervention, and delayed initiation of treatment. Conclusions: The incidence of stomach and pancreatic cancers is notably higher in the AYA population compared to older adults, with AYA patients demonstrating better overall and disease-specific survival outcomes. However, certain demographic factors, such as male sex, African American race, and lower income, are associated with worse survival, underscoring the need for targeted interventions to address these disparities. Early diagnosis and timely treatment are critical to improving outcomes in this younger population.

Low-carbohydrate diet score and risk of mortality: The Japan Collaborative Cohort Study.

A low-carbohydrate diet (LCD) may be effective for reducing cardiovascular disease (CVD) risk factors. However, its association with mortality remains unclear, especially in populations with higher carbohydrate and lower fat intake. This study aimed to evaluate the association between LCD scores and mortality risk in participants from the Japan Collaborative Cohort Study. The analysis included 22,659 men and 35,192 women aged 40-79 years at baseline. A food frequency questionnaire was used to construct the LCD scores, which were further categorized into 3 types based on the fat intake source: animal, fish, and plant. The association between the LCD scores and total and cause-specific mortality was estimated using the Cox proportional hazards model adjusted for confounders. During a median follow-up period of 19.4 years, 10,835 deaths (5835 men and 5000 women) were recorded. For all participants, the overall LCD score was inversely associated with total mortality. The lowest hazard ratio (95% confidence interval) was 0.85 (0.78-0.93) in the eighth decile (P for linear trend = 0.03). Fish fat-based LCD score had a U-shaped association with total mortality (P for non-linear trend = 0.01). An inverse association was observed with CVD mortality (P for linear trend = 0.04 of overall LCD score; P for linear trend = 0.04 of fish fat-based LCD score). In women, there was an inverse association between the overall LCD score and total mortality. A U-shaped association was also shown for fish fat-based LCD score. The fish fat-based LCD score was inversely associated with CVD mortality. Moderate overall and fish fat-based LCD scores were associated with a lower risk of total mortality in the Japanese population. Fish fat-based LCD score had a significant inverse association with CVD mortality.

Diminished salivary cortisol response to mental stress predict all-cause mortality in general population.

To characterize individuals with a diminished salivary cortisol response to mental stress, assess its association with all-cause mortality, and quantify the mediating effects of the most relevant and modifiable factors to identify potential target for prevention. Data from MIDUS II study with a 16-year follow-up, were used to categorize 1129 participants as responders or non-responders based on the existence of increase in salivary cortisol under mental stress. LASSO-logistics analysis identified the most relevant factors. Cox regression models and restricted cubic splines evaluated the prognostic impact. Further analyses examined the mediating effects of identified factors on prognosis. After employing Inverse Probability of Treatment Weighting to adjust for demographic differences between groups, individuals with diminished cortisol responses were found to have higher levels of depressive symptoms (p=0.050), increased inflammation (IL-6, 2.30 [1.41, 3.79] vs. 1.96[1.33, 3.31], p=0.011), and were less likely to regularly exercise (74.3% vs. 79.9%, p=0.030). IL-6 (OR: 1.25 [1.04, 1.52]，p=0.021) and regularly exercising (OR 0.71 [0.51, 0.97], p=0.032) emerged as significant modifiable factors in multivariate analysis. A notable prognostic association of diminished cortisol response with all-cause mortality (HR=1.33 [1.01-1.76], p=0.046) was observed, consistent across various subgroups and supported by non-linear model analysis. Approximately 13% of the mortality risk associated with diminished cortisol response was mediated by increased IL-6 levels (p=0.043). Diminished salivary cortisol response is linked to an increased risk of all-cause mortality, significantly mediated by elevated IL-6. This study offers a new perspective on prognostic prediction while highlighting potential avenues for intervention.

Adherence to the 2018 World Cancer Research Fund/American Institute for Cancer Research (WCRF/AICR) recommendations and overall mortality among adults with colorectal cancer in a multiethnic cohort study.

29 Background: High adherence to AICR recommendations on diet, adiposity, and physical activity is associated with improved survival among adults with colorectal cancer (CRC). However, over 80% of participants in existing studies self-reported as non-Hispanic White (NHW). We studied the association between adherence to AICR recommendations and overall mortality among adults with CRC in a multiethnic cohort. Methods: This prospective analysis used data from the Multiethnic Cohort (MEC) study. The MEC is a racially/ ethnically diverse cohort of over 200,000 participants residing in Hawaii and Los Angeles. Lifestyle behaviors in the MEC were assessed by questionnaire at enrolment/Q1 (1993-1996) and periodically over follow-up. We included those with incident CRC before completing Q3 (2003-2008). Follow-up was from Q3 survey completion to December 2019. The main exposure was the standardized AICR score [0-7 points] at Q3. The primary outcome was overall mortality; CRC-specific mortality was secondary. We used multivariable Cox proportional hazards regression to estimate adjusted hazard ratios (HR) and 95% confidence intervals (CIs). Results: There were 1127 adults diagnosed with CRC prior to Q3. Of these, 1079 (95.7%) had non-missing data on the AICR score and comprised our study population. Median (IQR) age at diagnosis was 69 (62-75); median (IQR) follow-up was 12.2 (0.1-16.4) years. There were 489 (45.3%) women. By self-reported race/ethnicity, there were: 153 (14.2%) Black/African Americans, 453 (42.0%) Japanese Americans, 79 (7.3%) Latinos, 165 (15.3%) Native Hawaiians, and 229 (21.2%) NHWs. Only 48 (4.4%) adults had high adherence (AICR≥5 points). Those in the highest category of AICR scores (AICR≥4.5) had statistically significant lower risk of overall mortality relative to those in the lowest category (AICR≤2.5) (HR: 0.64, 95% CI, 0.47-0.89). A similar (but non-statistically significant) association was observed with CRC-specific mortality [HR (high vs low): 0.70, 95% CI, 0.31-1.60]. Those who increased their score between Q1&amp;Q3 had lower overall mortality (HR: 0.87, 95% CI,0.79 - 0.96). Similar trends were observed in stratified analysis by race/ethnicity; however, statistical power was limited. Conclusions: High adherence to AICR recommendations was associated with lower risk of overall mortality in this multiethnic population of adults with CRC. Efforts to increase adherence to AICR recommendations in this population are needed.

Associations between neutrophil-percentage-to-albumin ratio level and all-cause mortality and cardiovascular disease-cause mortality in diabetes population

BackgroundThe prevalence of type 2 diabetes mellitus (T2DM) remains high and biomarkers related to T2DM are needed to be investigated. This study aimed to investigate the association between neutrophil percentage-to-albumin ratio (NPAR) with all-cause mortality and the risk of cardiovascular disease (CVD) mortality in community-dwelling individuals with T2DM.MethodsThis prospective cohort study included 3602 adults aged 20 or above who were diagnosed with diabetes by the American Diabetes Association criteria in the US National Health and Nutrition Examination Survey (NHANES) database from 1999 to 2016, and followed up until 2019. Multivariable Cox proportional hazards regression models were utilized to determine the relationship between NPAR with all-cause mortality and cardiovascular disease (CVD) mortality. Restricted cubic spline regression analyses were employed to explore the nonlinear relationship between NPAR and cardiovascular disease (CVD) mortality. The assessment of nonlinearity was conducted using the likelihood ratio test.ResultsAfter adjustment, the risk ratio for all-cause mortality in the highest NPAR group (≥ 15.40) compared to the lowest serum NPAR reference group (< 13.30) was 1.62 (95% CI, 1.36, 1.94) with P values < 0.001. Nevertheless, the risk ratio for cardiovascular disease (CVD) mortality in the highest NPAR group (≥ 15.40) versus the lowest serum NPAR reference group (< 13.30) was 1.41 (95% CI, 0.99, 2.00) with a P value of 0.06. Among patients with T2DM, serum NPAR levels exhibited a nonlinear correlation with both CVD mortality risk and all-cause mortality risk, with P values < 0.001 for both.ConclusionsThis study identified a significant association between elevated levels of the neutrophil percentage-to-albumin ratio (NPAR) and an increased risk of all-cause mortality among individuals with type 2 diabetes mellitus (T2DM). Conversely, no correlation was found between NPAR levels and CVD mortality.

Association of Age Shock Index with Mortality among Trauma Patients in the Emergency Department

Trauma injuries cause significant global morbidity and mortality. While current scoring systems like ISS and TRISS are complex, the Age Shock Index (ASI) offers a simpler, potentially more effective method for estimating patient outcomes. Objective: To evaluate the association of Age Shock Index with 48-hour in-hospital mortality in a trauma population in an Emergency Department (ED). Methods: A comparative cross-sectional study was conducted over eight months in the Emergency Department of Ziauddin University, focusing on pre-selected trauma patients aged 18-65 years. Patients were divided into two groups: the exposed group and non-exposed group, with an Age Shock Index (ASI) ≥ 50, and &lt; 50 respectively. Data analysis was carried out using descriptive statistics, the chi-square test, and independent t-tests with the Statistical Package for Social Sciences (SPSS) version 21.0. Results: Patients with an Age Shock Index (ASI) ≥ 50 had significantly higher 48-hour in-hospital mortality (72%) compared to those with an ASI &lt; 50 (12%) (p &lt; 0.001). The exposed group also received more intravenous fluids, inotropic support, and blood products. No deaths occurred in the emergency room among the exposed group, but a trend towards higher overall mortality was observed (hazard ratio 48.584, 95% CI: 0.511 - 4622.17, p = 0.095). Conclusions: The Age Shock Index (ASI) ≥ 50 is associated with significantly higher 48-hour in-hospital mortality in trauma patients. The exposed group required more intensive interventions, indicating a higher severity of injury. ASI may serve as an effective predictor of patient outcomes in emergency settings.

Examining Risk and Protective Factors for Suicidal Behaviors: A Cross-Sectional Study Among Portuguese Male Inmates

Background/Objectives: Prison inmates face a significantly higher risk of acting on suicidal thoughts than the general population. However, Portuguese studies distinguishing inmates who think about suicide from those who attempt it remain scarce. Given this ideation-to-action distinction, the current cross-sectional study aimed to examine risk and protective factors for suicidal ideation, suicide attempts, and the transition from one outcome to another. Methods: A total of 411 male inmates (M = 37.94 years, SD = 10.91) from 16 Portuguese prisons participated in the study. Data were collected between 2020 and2024 using four instruments: (1) Sociodemographic Questionnaire; (2) Social and Emotional Competencies Questionnaire (SEC-Q); (3) Predictive Antisocial Spectrum Questionnaire; and (4) Health Risk Behavior Checklist. Results: Among the total sample, 29.1% reported a lifetime history of suicidal ideation, and 19.4% had attempted suicide. Impulsivity/irresponsibility emerged as a key risk factor for suicidal ideation, whereas social and emotional competencies of self-management and motivation were protective factors against suicide attempts. Previous self-harm behavior was the only risk factor for both suicidal ideation and suicide attempts. Conclusions: Our findings provide important insights into risk and protective factors for suicidal behaviors among male inmates, offering key information for policy and practice efforts aimed at reducing mortality in this high-risk population.

The "Immigrant Medical Services" Organization from the End of the British Mandate Through the First Years of Israel (1944-1953).

The aftermath of the Second World War and the Holocaust triggered mass migration of Jewish refugees to British Mandatory Palestine and, after 1948, the nascent State of Israel. Responding to this crisis, Jews in the Diaspora increased their commitment to facilitate immigration to Israel, particularly by supporting medical services to the Yishuv (pre-state Jewish Settlement). This paper explores the critical role played by Hadassah and other organizations in establishing direct medical services for Jewish immigrants during two key periods of Israel's history: the end of British Mandatory Palestine (1944-1948) and the early years of the State of Israel (1948-1953). While the Immigrant Medical Services organization faced numerous challenges, this organization was essential in addressing the pressing healthcare needs of a burgeoning population amid morbidity and mortality concerns. An emphasis is placed on the challenges faced by these organizations and the commitment and resourcefulness of all involved, which ultimately shaped the foundation of Israel's healthcare infrastructure.