Death In Adults Research Articles

A lower atherogenic index of plasma was associated with a higher incidence of sarcopenia

Sarcopenia is an age-related muscle senescence disease that leads to functional limitations, physical disability and premature death in older adults. Atherogenic index of plasma (AIP) is a novel indicator of atherosclerotic status based on triglycerides and high-density lipoprotein cholesterol. The aim of this study was to investigate the association between AIP and new-onset sarcopenia and its components among middle-aged and older adults in a Chinese community. This cohort study included 7,992 participants who were free of sarcopenia in 2011 in the China Health and Retirement Longitudinal Study and were followed up in 2013 and 2015. Sarcopenia was assessed using the recommendations of the Asian Working Group for Sarcopenia 2019. Longitudinal associations between AIP and sarcopenia and its components were assessed using Cox proportional risk regression modeling. The results showed that AIP was negatively associated with sarcopenia [HR and 95% CI: 0.73 (0.62–0.86)]; with muscle mass [β and 95%CI: 0.49 (0.4–0.57)], skeletal muscle mass index [β and 95%CI: 0.17 (0.15–0.2)], and grip strength [β and 95% CI: 0.17 (0.15–0.2)] being positively correlated. A lower AIP was associated with a lower muscle mass and handgrip strength and higher incidence of sarcopenia. Regular measurement of AIP in the middle-aged and older population in the community can help in the early diagnosis and intervention of sarcopenia.

Development of the Concept of Death and Grief Process in Adults with Intellectual Disabilities Who Have Lost Relatives

Development of the Concept of Death and Grief Process in Adults with Intellectual Disabilities Who Have Lost Relatives

Laboratory confirmation of respiratory syncytial virus infection is not associated with increased risk of death in adults with acute respiratory illness

Abstract Background Limited data have described the testing patterns and outcomes of adults (≥18 years) with acute respiratory illness (ARI) in the emergency department (ED) setting. Methods This prospective cohort study includes ARI patients from the CDC-sponsored Respiratory Virus Laboratory Emergency Department Network Surveillance (RESP-LENS) program from August 2021 until March 2024 (n=91 hospitals). Patients with ARIs were identified weekly by electronic surveillance for one or more of 130 ICD-10 codes that defined ARI. Patients were followed for 30 days for the primary outcomes of hospitalization and mortality. Testing for RSV with nasopharyngeal swabbing followed by was done as part of usual care. Risk of 30-day mortality RSV positivity was tested in a generalized estimating equation (GEE). Findings From 1,210,394 patients with ARI, 345,185 (28.5%) adults underwent RSV testing, which was positive in 2.4%. In RSV+ adults the overall mortality rate was 1.9% compared with a mortality rate of 2.9% in RSV- adults. Mortality with RSV+ increased with age ≥65 years: 3.8% (95% CI: 3.1 to 4.5%). However, in the GEE, RSV+ status was not associated with higher rate of hospitalization (adjusted Odds 0.79, 0.75-0.84), or 30-day mortality (odds 0.62, 0.53-0.74) relative to those who were RSV-. Age ≥65 years, incremental worsening of vital signs, male sex and heart failure were independently associated with death. Conclusion Among adults with ARI presenting to an ED and who were tested for RSV as part of their usual care, laboratory-confirmed RSV positivity was not associated with increased risk, including hospitalization, ICU requirement, or death.

Preferred and Actual Location of Death in Adolescents and Young Adults With Cancer

Adolescent and young adult (AYA) patients with advanced cancer often die in hospital settings. Data characterizing the degree to which this pattern of care is concordant with patient goals are sparse. To evaluate the extent of concordance between the preferred and actual location of death among AYA patients with cancer. This multicenter retrospective cohort study included AYA patients (aged 12-39 years) with cancer who died between January 1, 2003, and December 31, 2019, after receiving care at Dana-Farber Cancer Institute and Kaiser Permanente Northern California or who died between January 1, 2009, and December 31, 2019, after receiving care at Kaiser Permanente Southern California. Data were analyzed from January 12 to July 1, 2024. Death due to cancer. Medical record documentation of discussions about preferred location of death, actual location of death, and concordance between preferred and actual location of death. The analytic population included 1929 AYA decedents, of whom 1049 (54.4%) were female; 227 (11.8%), Asian; 157 (8.1%), Black; 514 (26.6%), Hispanic; and 1184 (61.4%), White. Median age at death was 32 (IQR, 25-37) years. A total of 1226 AYA patients (63.6%) had a documented discussion about preferred location of death. Among those with a documented discussion, 594 (48.5%) did not have a documented preference, 402 (32.8%) wanted to die at home, 177 (14.4%) preferred a hospital death, and 48 (3.9%) desired inpatient hospice. Eight hundred and thirty patients (43.0%) died in acute care settings (256 [13.3%] intensive care unit [ICU], 548 [28.4%] hospital [non-ICU], and 26 [1.3%] emergency department), while 643 (33.3%) died at home and 47 (2.4%) in an inpatient hospice. Among the 528 patients with both a documented preferred death location of home, hospital, or inpatient hospice and documented death in one of these locations, the concordance between preferred and actual location of death was 401 (75.9%). One hundred and sixty-four of 172 patients (95.3%) who preferred a hospital death died there; 224 of 317 (70.7%) who preferred a home death died at home, and 13 of 39 (33.3%) who desired to die in inpatient hospice did so. Although many AYA patients with cancer died in their preferred location, over one-quarter of those who desired to die at home did not realize this goal. These findings highlight the need for effective solutions to enable goal-concordant care for this population.

Estimated Burden of Metabolic Dysfunction–Associated Steatotic Liver Disease in US Adults, 2020 to 2050

Metabolic dysfunction-associated steatotic liver disease (MASLD) is the most common cause of chronic liver disease and is projected to become the leading indication for liver transplant (LT) in the US. Understanding its clinical burden can help to identify opportunities for prevention and treatment. To project the burden of MASLD in US adults from 2020 to 2050. This decision analytical modeling study used an agent-based state transition model that simulates the natural history of MASLD progression among adults 18 years of age or older. Primary data sources for model inputs were the published literature. Natural history of MASLD. Cases of MASLD, metabolic dysfunction-associated steatohepatitis (MASH), fibrosis, hepatocellular carcinoma (HCC), LT, and liver-related death. The model simulated 2 821 624 individuals (mean age. 35.8 years; 50.9% female). The model predicted a steady increase in the prevalence of MASLD from 33.7% (86.3 million people) in 2020 to 41.4% (121.9 million people) by 2050. Cases of MASH would increase from 14.9 million (5.8% of US adults) in 2020 to 23.2 million (7.9% of US adults) by 2050. The number of cases of MASH and clinically significant fibrosis (ie, F≥F2, centrilobular and periportal fibrosis or more severe disease) were estimated to increase from 6.7 million to 11.7 million. By 2046 to 2050, MASLD would cause 22 440 new cases of HCC and 6720 new cases of LT per year compared with 11 483 new cases of HCC and 1717 new cases of LT in 2020 to 2025. Liver-related mortality was estimated to increase from 30 500 deaths (1.0% of all-cause deaths in adults) in 2020 to 95 300 deaths (2.4%) in 2050. In this decision analytical modeling study, the model forecast a substantial increase in clinical burden of MASLD over the next 3 decades in the absence of effective treatments. These results suggest that health systems should plan for large increases in the number of HCC cases and in the need for LT.

Lack of correlation between school reopening and trends in adult COVID-19 hospitalisations and death rates during the Delta and early Omicron periods: an ecological analysis of five countries.

In this ecological study, we describe SARS-CoV-2 case incidence for school age and adult populations, COVID-19 hospitalisation and death rates during Delta and the early Omicron periods, before and after schools reopened in five countries. Data were extracted from government websites. Cases and COVID-19 hospitalisation and death incidence rates were calculated during the Delta and early Omicron periods in Australia, Canada, Denmark, Finland and the United Kingdom, for two weeks preceding and six weeks after schools reopened. We summarised stringency of public health measures (GRI), vaccination by age and testing rates. During Delta, cases increased in 2/7 sites after schools reopened, hospitalisations increased in 1/5 sites, while deaths decreased in one and increased then decreased in another. During Omicron, cases increased in 2/8 sites, hospitalisations increased in 1/6 sites and deaths increased in 1/4 sites. The hospitalisation and death rate trends that commenced before schools reopened continued on the same trajectory after schools reopened. Vaccination rates in ≥70-year-olds were 75-100% during Delta and 95-100% during Omicron. Wide variations in testing rates may explain differences in case incidence. GRI were higher during Delta with more variation than during Omicron. Reopening schools did not change the existing trajectory of COVID-19 rates.

Na+-K+-ATPase/GLT-1 interaction participates in EGCG protection against cerebral ischemia-reperfusion injury in rats.

In China, stroke is the primary cause of adult death and disability. Because of the increased rate of blood vessel reperfusion, it is important to prevent cerebral ischemia-reperfusion injury, in which glutamate (Glu) excitotoxicity plays a critical role. The most important Glu transporter, GLT-1, is essential for the regulation of Glu, which is dependent on Na+-K+-ATPase (NKA)-induced ion concentration gradient differences. EGCG, a substance found in tea polyphenols, can reduce infarct areas in ischemia-reperfusion models, reduce stroke incidence, and prolong life in which NKA is involved. In this study, we investigated the potential of EGCG in protecting against cerebral ischemia-reperfusion injury by regulating the interaction between NKA and GLT-1. This study was designed to investigate the protective effects of EGCG against cerebral ischemia-reperfusion injury by modulating the interaction between NKA and GLT-1, utilizing both the rat middle cerebral artery occlusion/reperfusion (MCAO/R) model and the oxygen-glucose deprivation/reoxygenation (OGD/R) model in co-cultures of rat hippocampal neurons and astrocytes. The neuronal survival rate was assessed using CCK8, and the cerebral infarction area and neurological function were determined by TTC staining and neurological deficit scores. NKA activity was measured using an inorganic phosphorous detection method, and NKA and GLT-1 expression was detected using western blotting. The interaction between NKAα2 and GLT-1 was identified by co-immunoprecipitation (CoIP) assay, laser confocal microscopy, and Imaris 3D confocal rendering technology. An adenovirus vector with overexpression of NKAα2 was constructed, packaged, and injected into the rat lateral ventricle. Neurological function and the cerebral infarction area were identified, and the interaction between NKAα2 and GLT-1 was identified using CoIP assay. EGCG reduced the infarction area and neurological deficit scores, restored NKA activity, alleviated the decrease in membrane NKAα2 and GLT-1 expression, and relieved the uncoupling of NKAα2 and GLT-1 in the hippocampal CA1 after rat MCAO/R injury. By promoting the coupling of NKAα2 and GLT-1 in rat MCAO/R models, overexpression of NKAα2 reduced the cerebral infarction area and neurological impairment scores. EGCG improved cerebral ischemia-reperfusion injury by restoring NKA activity and increasing membrane GLT-1 expression due to NKA-GLT-1 interaction. For the first time, our findings demonstrate the critical role that NKA and GLT-1 colocalization plays in cerebral ischemia-reperfusion damage. Our findings provide new strategic directions for the pathogenesis and prevention of thrombolytic injury in the clinical treatment of stroke, while also serving as a basis for further development and utilization of EGCG.

Rare Congenital Anomalous Origin of the Coronary Arteries: A Series of Three Cases

Introduction: Congenital coronary anomalies are found in 0.3% to 5.6% of the population and can be classified according to alterations in origin, distribution or course. Although benign in most cases, they can be associated with sudden death in young adults, especially after strenuous physical exercise. We report three rare cases of anomalous coronary arteries found incidentally by coronary angiography. Case Report: The first case refers to a 79-year-old man who underwent cardiac catheterization for etiological investigation of heart failure, showing a non-obstructive interruption of the left anterior descending artery (LAD) after the origin of the first diagonal branch, with the continuation of its middle and distal segments from the right coronary artery (RCA), which crosses to the left side at the atrial level and reaches the apex cordis. The second case is a 56-year-old woman with stable angina and a treadmill exercise test suggestive of myocardial ischemia. Coronary angiography revealed an anomalous origin of the RCA from the distal segment of the left circumflex artery (LCxA). The third and last case is a 64-year-old woman in whom coronary angiography revealed an anomalous origin of the LCxA from the proximal third of the RCA. Discussion: Coronary artery anomalies are a heterogeneous group whose diagnosis mostly occurs incidentally. They differ from anatomical variations in their rarity and greater association with adverse events, such as myocardial ischemia and sudden death. The cases presented address different anomalous origins: a LAD with duplicated origin, a single coronary artery with the emergence of the RCA in the distal third of the LCxA, and the anomalous origin of the LCxA from the RCA, one of the most common coronary anomalies. The three cases reported were patients over 50 years old, which shows the need to individualize cases and risks as regarding to anomalous origins of the coronary arteries.

NORTHERN BALD IBIS POPULATION DYNAMICS-TÜRKIYE (2012-2022)

Abstract This research was carried out to determine the reproduction, death and loss numbers of northern bald ibises living in Birecik (Şanlıurfa). The research was continued for 11 years. Northern bald ibises are an endangered species. Northern bald ibises breed freely in nature in Birecik. They are placed in cages at the end of June. They live in a cage for eight months. The reproductive ability of the population is high (2012-2022: 782 offspring). But the total number of the population is increasing very slowly. The number of offspring deaths is high (2012-2022: 267 dead offsprings). Mortality occurs in the first two weeks of the offsprings. Adult deaths and losses occur for different reasons (2012-2022: 246 adult individuals). Measures to be taken can prevent offspring deaths. There is a need for regulation in feeding and cage conditions. A second northern bald ibis breeding station should be established. In order to keep the population alive, it should be aimed to increase the number of northern bald ibises. Allowing northern bald ibises to migrate causes individuals to perish. Scientific methods need to be applied to accustom people to migration. Expert personnel (biologist or veterinarian) should be assigned to the station throughout the year.

Clinical-epidemiological risk factors associated with patients with cerebrovascular disease

Introduction: At present, cerebrovascular diseases (CVD), constitute a health problem and one of the main causes of death, disability and handicap in adults. Methods: An observational, descriptive, cross-sectional study was carried out to characterize the clinical and epidemiological factors associated with cerebrovascular disease. The universe consisted of 860 patients over 40 years of age who suffered some form of stroke belonging to family medical offices 15 and 16 of GBT no.1, Pedro Borras Polyclinic, and the sample consisted of 87 cases, in the period from June 2023 to May 2024. Results: the main results are shown according to age, a higher prevalence from 80 to 84, predominance of male sex and white skin color. Arterial hypertension (AHT) stood out as the main risk factor in both strokes, followed by Diabetes mellitus, smoking and cardiovascular diseases. Conclusions: There was predominance of transient stroke, followed by atherothrombotic CVD and cerebral embolism in the ischemic event. Rehabilitation was associated with quality of life and degree of total recovery in the patients under study, with a predominance of moderate dependence according to the Barthel Index

Antioxidant, Alpha-Amylase Inhibitory and Hypoglycemic Activity of Smallanthus sonchifolius Leaves from Nepal: An Integrated InVitro, InVivo, and In Silico Approach.

In 2019, diabetes mellitus affected 9.3% of the global population and accounted for one in nine adult deaths. Plant-based antioxidants neutralize harmful free radicals, mitigate oxidative stress, and significantly prevent diabetes and its complications. This study evaluated the invitro antioxidant, alpha-amylase inhibitory, invivo oral hypoglycemic, and in silico antidiabetic potential of Smallanthus sonchifolius (S. sonchifolius) leaf extract. Mice (n = 25) were divided into five groups after a 16-h fast with access to water. The groups received distilled water (normal control), metformin (100 mg/kg, standard), or S. sonchifolius ethanolic extract at 100, 250, or 500 mg/kg to compare the antidiabetic potential of the extract with that of the control. Fasting blood glucose levels were measured in tail vein blood before the experiment and at 30, 60, and 120 min post-administration to evaluate the hypoglycemic activity of the extract and standard drug. The ethanolic extract exhibited dose-dependent alpha-amylase inhibition (IC50 value 0.136 mg/mL) and significant hypoglycemic effects, reducing blood glucose levels similar to those of the standard drugs voglibose and metformin. The maximum blood glucose reduction was 17.99% and 15.74% in the normal and glucose-loaded mice, respectively, at 500 mg/kg within 120 min. In silico analysis shows, polymatin B and chlorogenic acid demonstrating the highest binding affinity of -8.2 and -7.2 kcal/mol, respectively, in PPAR-γ (3G9E). Polymatin B and chlorogenic acid showed strong binding affinities of -7.3 and -7.5 kcal/mol, respectively, in alpha-amylase (4W93). These findings indicate that S. sonchifolius possesses significant hypoglycemic and antioxidant properties, suggesting its potential as an antidiabetic agent, warranting further clinical research.

Association of frailty with cardiovascular and all-cause mortality in community-dwelling older adults: insights from the Chinese longitudinal healthy longevity survey

BackgroundPrevious studies suggest that frailty increases the risk of mortality, but the risk of cardiovascular disease (CVD) and all-cause mortality in Chinese community-dwelling older adults remains understudied. Our aim was to explore the effect of frailty on cardiovascular and all-cause mortality in older adults based on a large-scale prospective survey of community-dwelling older adults in China.MethodsWe utilized the 2014–2018 cohort of the Chinese Longitudinal Healthy Longevity Survey and constructed a frailty index (FI) to assess frailty status. Propensity score matching was used to equalize the baseline characteristics of participants to strengthen the reliability of the findings. Hazard ratios and 95% confidence intervals (CIs) were estimated using multivariate Cox models, adjusting for potential confounders, to assess the association between frailty and cardiovascular and all-cause mortality. The relationship between frailty and cardiovascular mortality was further explored using a competing risk model considering death as a competing event. The dose–response relationships between them were estimated using restricted cubic spline models.ResultsThe results of the multivariate Cox model found that the frailty group had a higher risk of CVD mortality (1.94, 95% CI: 1.43–2.63) and all-cause mortality (1.87, 95% CI: 1.63–2.14) in compared with the non-frailty group. The multivariate competing risks model suggested a higher risk of CVD mortality in the frailty group (1.94, 95% CI: 1.48–2.53). The analysis found no non-linear relationship between FI and the risk of CVD mortality but a non-linear dose–response relationship with the risk of all-cause mortality.ConclusionsFrail older adults demonstrated a stronger risk of CVD and all-cause mortality. Reversing frailty in older adults is therefore expected to reduce the risk of death in older adults.

Gender differences in the association between insulin resistance assessed by estimated glucose disposal rate and the risk of all-cause and cardiovascular deaths in adults without diabetes.

We intended to examine the relationship between estimated glucose disposal rate (eGDR) and risks of all-cause and cardiovascular deaths in non-diabetic adults. 38,175 participants from the National Health and Nutrition Examination Survey (1999-2018) were included, and deaths were identified through the National Death Index. With a median follow-up of 9.8 years, we found that dose-response relationships between eGDR level and the risk of death differed between genders. In female participants, higher eGDR level was linearly correlated with lower risks of all-cause and cardiovascular deaths. In contrast, among male participants, there were L-shaped relationships between eGDR and risks of all-cause and cardiovascular deaths, with threshold points of 8.50 and 8.49 mg/kg/min, respectively. To the left of threshold points, eGDR was negatively linked with risks of all-cause (HR 0.91, 95 % CI 0.88-0.94, P < 0.001) and cardiovascular deaths (HR 0.87, 95 % CI 0.82-0.93, P < 0.001). After the inflection point, an increase in eGDR was not related to lower risks of all-cause and cardiovascular deaths (P > 0.05). Higher eGDR level was associated with lower risks of all-cause and cardiovascular deaths in a linear dose-response manner among non-diabetic females, while L-shaped relationships were observed among non-diabetic males.

Applying an ICD-10 to ICD-11 mapping tool to identify causes of death codes in an Alberta dataset

BackgroundThe most recent and 11th revision of the International Classification of Disease (ICD-11) is in use as of January 2022, and countries around the globe are now preparing for the implementation of ICD-11 and transition from the 10th revision (ICD-10). Translation of current coding is required for historical comparisons.MethodsWe applied the World Health Organization (WHO) mapping tables to current Centers for Disease Control and Prevention (CDC) Lists of ICD-10 coding of underlying causes of death to assess what ICD-11 codes look like in an Alberta sample of causes of death (COD). We prepared frequency tables for a single year of COD in Alberta based on the CDC grouping of COD.ResultsThe mapping success rate at the ICD-10 code level for the adult population (> 18 years) was 96.6% and 100% for children (1–17 years) and infants (< 1 year). The mapping success rate by patient was 99.5% for the adult population patient deaths and 100% for children and infants. We mapped ICD-11 codes to identify the ten most frequently reported underlying COD in Alberta for 24,645 deaths in adults, children, and infants in 2017.ConclusionsApart from two codes, all ICD-10 codes could be mapped to ICD-11 for underlying COD. These findings suggest that the ability to translate from the two iterations of coding will be feasible for future applications of health services data.

Myasthenia Gravis Misunderstood - Identifying the historical misinterpretations, miscommunication, and misconceptions

Myasthenia Gravis (MG) is a serious disease and can present clinically with very severe symptoms in many patients; however, the fluctuating severity of MG results in the disease being commonly misdiagnosed as other conditions, including conversion disorder. The earliest recorded literature on MG provides evidence of the variability of signs and symptoms, including many patients who appeared to have mild symptoms initially but died suddenly and unexpectedly from MG. Often, these patients were initially believed to be suffering from hysteria. This review analyzes some of the most prominent MG literature still cited today. It found that many communication errors have led to today’s misunderstandings and have continued to cause difficulties in diagnosis and difficulty in understanding the MG patients’ lived experiences. These errors include the intended meaning for ‘gravis’ being misinterpreted as ‘severe’ instead of the intended meaning of ‘a painful weight in the limbs’, the false belief that ‘gravis’ is Latin for ‘grave’ and how the miscommunication of the early 1900’s MG autopsy studies added to this confusion, where MG continued to be referred to as a ‘grave’ condition. The continued omission of the sensory symptoms associated with MG from the literature has also been miscommunicated for decades, however such symptoms are now becoming recognized as a result of increasing patient led research. Myasthenia Gravis should continue to be regarded as a serious disease, due to the devastating effect on quality of life for many people, and the unpredictability of the myasthenic crisis potentially occurring in all people living with MG, including those who are undiagnosed. The dismissing of mild symptoms results in many MG patients remaining undiagnosed. The possibility that individuals in this group go on to become victims of Sudden Adult Unexplained Death (SUD) is yet to be investigated, and there is a need for research in this area. Miscommunication also includes omitting ‘old knowledge,’ not listening to the patient’s lived experience, and failing to integrate relevant interdisciplinary knowledge. Good examples of these are The Mary Walker Effect, and combining patient lived experience with ocular anatomy and physiology knowledge to develop new MG-specific ocular motility clinical tests. A new test is presented for evaluating MG eye signs utilizing knowledge of the ‘Safety Factor,’ and is referred to as The SLOWLY Test (Significant Level Of Weakness, Loci in Y Axis). Awareness of the historical misinterpretations, miscommunications, and misconceptions is crucial to preventing delay in diagnosis in MG patients, developing new clinical tests, rehabilitation interventions, and helping doctors and others understand the lived experience of MG patients

Associations of neighbourhood food retail with disability and death in older adults: Cardiovascular Health Study

BackgroundA healthier diet is associated with lower chronic disease burden, but the impact of neighbourhood food environments on disability and death in older adults is not known.MethodsIn the Cardiovascular Health...

Co-prescription of low-dose methotrexate and trimethoprim-sulfamethoxazole and the 30-day risk of death among older adults: A cohort study.

The aim of this study was to characterize the risk of death in older adults co-prescribed low-dose methotrexate and TMP-SMX vs. low-dose methotrexate and a cephalosporin. We conducted a retrospective, population-based, new-user cohort study in Ontario, Canada (April 1, 2002-August 1, 2022) using linked administrative healthcare data. Older adults taking low-dose methotrexate who were newly co-prescribed TMP-SMX (n = 1602) were matched 1:1 with those who were newly co-prescribed a cephalosporin. The primary outcome was death within 30 days of the antibiotic dispensing date. Secondary outcomes included all-cause hospitalization, a hospital visit with myelosuppression and a hospitalization with persistent infection defined as the main diagnosis. Propensity score matching was used to balance comparison groups on indicators of baseline health. Risk ratios (RR) were obtained using modified Poisson regression. In a propensity-score matched cohort of 3204 adults taking low-dose methotrexate, the 30-day risk of death was similar in adults co-prescribed TMP-SMX vs. a cephalosporin (14/1602 [0.87%] vs. 15/1602 [0.94%]; RR 0.93 [95% CI 0.45-1.93]). The risk of all-cause hospitalization (RR 1.49 [95% CI 1.13-1.97]) and infection (RR 2.78 [95% CI 1.30-5.95]) was higher in adults treated with TMP-SMX than those treated with cephalosporins. In older adults taking low-dose methotrexate, co-prescription of TMP-SMX vs. a cephalosporin was not associated with a higher 30-day risk of death but was associated with a higher 30-day risk of all-cause hospitalization and hospital admission with persistent infection. If verified, these risks should be balanced against the benefits of co-prescribing TMP-SMX and low-dose methotrexate.

Mortality trends, sex, and racial disparities in older adults due to abdominal aortic aneurysm: a nationwide cross-sectional analysis.

Abdominal aortic aneurysms (AAAs) are a significant vascular pathology in older adults, often asymptomatic but with high mortality upon rupture. Despite advancements in diagnostic imaging and surgical interventions, AAAs remain a public health concern. This research letter analyzed CDC WONDER data on AAA-related deaths (ICD-10 I71.3 and I71.4) among US adults aged 65+ from 1999 to 2020. Age-adjusted mortality rates (AAMRs) and annual percent change (APC) were calculated by year, sex, age group, race/ethnicity, geography, and urbanization status. Between 1999 and 2020, there were 180037 reported deaths in older adults due to AAA. The overall AAMR decreased from 32.6 to 13.2 per 100000, with a significant decline from 2014 to 2020 (APC: -1.66; 95% CI: -2.48 to -0.48). Older men had a significantly higher AAMR than older women (31.2 vs. 12). Among racial and ethnic groups, Non-Hispanic (NH) Whites had the highest AAMR at 21.7, followed by NH American Indian or Alaska Native (14.5), NH Black (12.6), NH Asian or Pacific Islander (10.1), and Hispanic populations (8.4). Additionally, non-metropolitan areas exhibited higher AAMRs compared to metropolitan areas (23.9 vs. 18.7). While mortality rates have declined, disparities remain, with higher rates among older men, NH Whites, and non-metropolitan residents, highlighting the need for targeted and equitable interventions.

Investigating the Role of Mitochondrial DNA in Alzheimer’s Disease Biomarker Expression

AbstractBackgroundImpaired metabolic function and mitochondrial metabolism increase risk of Alzheimer’s Disease (AD) development, which is the leading form of dementia and one of the main causes of death in older adults. Altered mitochondrial function can reduce efficiency of cellular maintenance processes like mitophagy and proteostasis, leading to protein aggregation and cytotoxicity. Mitochondria differ from other organelles, as they have their own unique genetic component (mtDNA), which encodes proteins essential for mitochondrial translation and oxidative metabolism. Differences in mtDNA between individuals affect mitochondrial function and can increase risk of certain diseases; it is not well studied how mtDNA impacts AD pathology.MethodSH‐SY5Y cytoplasmic hybrid (cybrid) cell lines were generated using mtDNA from clinical research volunteers (n = 18 cognitively healthy (CH) older adults (mean age 73.8), n = 7 MCI (mean age 78.1), n = 10 AD (mean age 75.3)) enrolled in the Relationship of Energetics and Cognitive Trajectory study. Groups did not differ by sex. Cells were analyzed for protein expression by western blot, metabolic flux by Agilent Seahorse XF Analyzer, and protein secretion by ELISA. Plasma pTau217 (AlzPATH) and Aβ42 (N4PE) were assessed by Simoa HD‐X (Quanterix) to compare blood biomarker values with cellular outcomes.ResultCybrids from individuals with MCI and AD had elevated intracellular pTau217 (p = 0.033, p = 0.006 respectively). Cybrids from CH individuals secreted significantly more Aβ42 than those from individuals with AD (p = 0.002). Cybrid pTau217 and plasma pTau217 from the same subjects correlated significantly (p&lt;0.001). Cybrids showed altered mitochondrial function by diagnostic group in all ETC complexes (p&lt;0.05), and altered ETC complex expression in all proteins except Complex II, which is not encoded by mtDNA. Mitochondrial transcription factor A (TFAM) was significantly reduced in cybrids from AD individuals (p = 0.010) compared to those from CH subjects.ConclusionCytoplasmic hybrid cell lines generated with mtDNA from individuals with and without AD express diagnostic differences in novel AD biomarkers. This suggests that mitochondrial function, specifically that which is influenced by mtDNA, plays an imperative role in AD pathology. Ongoing research in the cybrid cell model will help elucidate how altered cellular and bioenergetic function contribute to AD etiology.

Clinical biomarker-based biological age predicts deaths in Brazilian adults: the ELSA-Brasil study.

Biological age is a construct that seeks to evaluate the biological wear and tear process of the organism that cannot be observed by chronological age. We estimate individuals' biological age based on biomarkers from multiple systems and validate it through its association with mortality from natural causes. Biological age was estimated in 12,109 participants (6621 women and 5488 men) from the first visit of the Brazilian Longitudinal Study of Adult Health (ELSA-Brasil) who had valid data for the biomarkers used in the analyses. Biological age was estimated using the Klemera and Doubal method. The difference between chronological age and biological age (Δage) was computed. Cox proportional hazard models stratified by sex were used to assess whether Δage was associated with mortality risk after a median follow-up of 9.1years. The accuracy of the models was estimated by the area under the curve (AUC). Δage had equal mean for men and women, with greater variability for men. Cox models showed that every 1-year increase in Δage was associated with increased mortality in men (HR (95% CI) 1.21; 1.17-1.25) and women (HR (95% CI) 1.24; 1.15-1.34), independently of chronological age. Results of the AUC demonstrated that the predictive power of models that only included chronological age (AUC chronological age = 0.7396) or Δage (AUC Δage = 0.6842) was lower than those that included both, chronological age and Δage (AUC chronological age + Δage = 0.802), in men. This difference was not observed in women. We demonstrate that biological age is strongly related to mortality in both genders and is a valid predictor of death in Brazilian adults, especially among men.