Decreased Risk Of Mortality Research Articles

P-933. Combination Antibiotic Therapy in Infective Endocarditis: A systematic Review and Meta Analysis

Abstract Background Infective endocarditis (IE) is serious disease with 20% in-hospital mortality and significant morbidity. The role of combination therapy in managing patients with IE is controversial. We aimed to determine the effectiveness of combination antibiotic therapy compared to monotherapy in IE. Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) flow diagram; summarizes the study selection process Methods MEDLINE, Embase, Cochrane and Web of Science were searched from inception to July 28, 2023. Papers reporting mortality of combination therapy versus monotherapy in adult patients with IE were included. Non-English papers and studies with < 10 patients in combination therapy group were excluded. Two reviewers independently assessed the studies. Summary of odds ratios (ORs) and 95% confidence intervals (CIs) were evaluated using a random-effects model. Sub-group analyses based on timing of mortality, bacterial species/group, geographic location, and study design were conducted. Forest Plot of all-cause Mortality at any time point of patients with infective endocarditis compared between combination therapy and monotherapy Results Out of 4323 studies identified, 27 studies (2462 patients) were included in the meta-analysis. There was no significant difference in the risk of all-cause mortality between the two groups (OR, 0.92; 95% CI, 0.59-1.43). Subgroup analysis focusing on one-year mortality demonstrated a decrease in mortality risk with combination therapy (OR, 0.54; 95% CI, 0.33-0.87). Additionally, combination therapy demonstrated a favorable outcome in studies involving gram-negative bacteria (OR, 0.38; 95% CI, 0.18-0.79). Studies conducted in Europe reported a statistically significant decrease in overall mortality risk with combination therapy (OR, 0.52; 95% CI, 0.32-0.86). Forest Plot of one-year Mortality of patients with infective endocarditis compared between combination therapy and monotherapy Conclusion Combination therapy in patients with infective endocarditis (IE) was associated with reduced one-year mortality rates and lower mortality among cases involving gram-negative bacteria. The observed significance in European studies may be attributed to a higher proportion of papers focusing on gram-negative infections and reporting one-year mortality outcomes. Forest Plot of all-cause Mortality at any time point of patients with infective endocarditis compared between combination therapy and monotherapy (only studies from Europe) Disclosures Vance G. Fowler, MD, MHS, Affinergy: Advisor/Consultant|ArcBio: Stocks/Bonds (Private Company)|Armata: Advisor/Consultant|Astra Zeneca: Advisor/Consultant|Astra Zeneca: Grant/Research Support|Basilea: Advisor/Consultant|Basilea: Grant/Research Support|ContraFect: Advisor/Consultant|ContraFect: Grant/Research Support|Debiopharm: Advisor/Consultant|Destiny: Advisor/Consultant|EDE: Grant/Research Support|Genentech: Advisor/Consultant|Genentech: Grant/Research Support|GSK: Advisor/Consultant|Janssen: Advisor/Consultant|Karius: Grant/Research Support|MedImmune: Grant/Research Support|Merck: Grant/Research Support|sepsis diagnostics: Patent pending|UptoDate: Royalties|Valanbuio: Stocks/Bonds (Private Company)|Valanbuio: Stocks/Bonds (Private Company) Joshua T. Thaden, MD, PhD, National Institutes of Health K08 AI171183 (Thaden): Grant/Research Support

Association between platelet count and 30-day in-hospital mortality among intensive care unit patients with sepsis: a multicenter retrospective cohort study.

The relationship between platelet count and sepsis outcomes in intensive care units (ICUs) requires comprehensive investigation through large-scale multicenter studies. In this multicenter retrospective cohort study, we analyzed 17,977 sepsis patients from 208 U.S. hospitals (2014-2015) using the eICU Collaborative Research Database v2.0. Analyses were adjusted for demographics, clinical parameters, comorbidities, and treatments. Generalized additive models and two-piecewise linear regression were used to assess the relationship between platelet count and mortality. A U-shaped relationship was identified with an inflection point at 176 × 10⁹/L. Below this threshold, each 10 × 10⁹/L increase in platelet count was associated with a 6% decrease in mortality risk (adjusted OR 0.94, 95% CI 0.93-0.95, p < 0.0001), while above it, each 10 × 10⁹/L increase was associated with a 1% increase in mortality risk (adjusted OR 1.01, 95% CI 1.00-1.01, p = 0.0153). This large-scale, multicenter retrospective study has made a significant contribution to understanding the association between platelet count and mortality in patients with sepsis in intensive care units. We identified a critical threshold of 176 × 109/L for platelet count and demonstrated a distinct U-shaped relationship with 30-day in-hospital mortality, providing valuable reference criteria for clinical risk stratification.

Effect of antiretroviral therapy on the mortality of HIV-1 infection long-term non-progressors: a cohort study

BackgroundThe study aims to investigate the demographic characteristics, the variations in their immune status, and mortality risk among HIV-1 infection long-term non-progressors (LTNP).MethodsEligible LTNP and typical progressors (TP) were recruited in Guangxi by December 2018. Participants were followed up until December 2022, monitoring ART status, CD4+ T cell counts, and survival/death outcomes. Multivariate logistic, Cox regression, and Kaplan-Meier method were employed to scrutinize associated factors and mortality risk of LTNP.ResultsA total of 212 LTNP and 390 TP were included. LTNP cohort predominantly comprised males (84.43%), those diagnosed with HIV at age ≤ 40 years (93.87%), and those infected through injection drug use (59.91%). The mortality rate of LTNP were lower than TP (12.74% vs. 27.18%). TP had a higher mortality risk compared to LTNP (adjusted hazard ratio [aHR] = 4.051, 95% CI: 2.284–7.186, P < 0.001). The mortality risk was also elevated in the ART-naïve group versus the ART-experienced ones (aHR = 3.943, 95%CI: 2.658–5.850, P < 0.001). Notably, the CD4/CD8 ratio in the LTNP group did not fully recover (< 1.0) despite ART. However, LTNP with ART-experienced had a significantly lower mortality risk compared to ART-naïve LTNP group (Log-rank: P = 0.003).ConclusionsART effectively restores and maintains normal CD4+ T cell levels among LTNP, thereby decreasing mortality risk. Nonetheless, the CD4/CD8 ratio in LTNP exhibits incompletely recovered post-ART. These findings provide a scientific foundation for promoting ART in LTNP population.

Analysis of sex-specific disease patterns associated with human lifespan.

Disability and multimorbidity increase with aging and constitute a challenge for the health system. However, different individuals display different aging trajectories, and understanding the underlying relationships between lifespan and disease is fundamental for identifying the different patterns in human lifespan. A previous study explored associations between lifespan and age of onset of diseases of different organ systems, prevalence of escapers, and percentage of life free of disease (health span), comparing them between genders in Catalonian population. In this retrospective study, we analyzed a cohort of 41,063 old individuals (20,722 men, with a mean lifespan of 79years [50-109], and 20,341 women, with a mean lifespan of 84years [50-109]) deceased between 2014 and 2019 in Gipuzkoa (Basque Country, Spain) taken from the Basque Health Service electronic health records data lake and analyzed and contrasted the above cited characteristics. Longevity, defined by age above the mean lifespan of the population, showed a protective effect against developing diseases, with higher lifespans delaying the onset of all diseases both at single and multisystemic levels. Furthermore, individuals with the lowest and highest lifespans were the ones presenting the healthier profiles, with fewer systems altered. There were specific differences according to sex, with women exhibiting decreased mortality risk despite having greater multimorbidity and men having less multimorbidity. In addition, men reached the highest lifespans with a smaller number of comorbidities. These results define the aging trajectories of the Basque population, extend the characterization of the human aging, and provide insight into sex-specific differences in multimorbidity and survival risk.

Nonlinear association between the serum uric acid-to-creatinine ratio and all cause mortality in patients with hypertension: a ten-year cohort study using the NHANES database

The serum uric acid-to-creatinine ratio (UCR) may be a simple method for assessing xanthine oxidase overactivation, which may contribute to an increase in serum uric acid production and oxidative stress. In this study, we investigated the nonlinear association between the UCR and long-term mortality in patients with hypertension. Data were acquired from the National Health and Nutrition Examination Survey database, and a total of 11,346 patients with hypertension were included. We explored the nonlinear link between the UCR and all-cause mortality via spline smoothing, threshold saturation, and log-likelihood ratio tests. The results were validated through a competing risk model. A nonlinear pattern emerged between the UCR and all-cause mortality in hypertensive patients, with an inflection point at 4.3. Below this point, an increased UCR was associated with a decreased mortality risk (OR = 0.80, 95% CI: 0.68–0.94, P = 0.008), whereas above this point, the risk increased (OR = 1.21, 95% CI: 1.07–1.36, P = 0.004). The competing risk model yielded similar findings for cardiovascular and chronic kidney disease-related deaths. In patients with hypertension, the UCR nonlinearly predicted all-cause mortality, with a notable inflection at 4.3. These findings suggest that the UCR is a valuable prognostic indicator for assessing long-term outcomes in patients with hypertension.

Impact of glycemic treatment and blood glucose monitoring on outcomes in patients with acute ischemic stroke without prior diabetes: a longitudinal cohort study

ObjectivesTo explore the short- and long-term effects of glycemic management—through glycemic treatment and blood glucose monitoring (BGM)—on stroke recurrence and mortality specifically in patients experiencing a first-ever ischemic stroke (FIS) with hyperglycemia (FISHG) who have not previously been diagnosed with diabetes mellitus (DM).MethodsWe gathered data on patients who were registered on Taiwan’s National Health Insurance Research Database from 2000 to 2015. We one-fold propensity-score-matched (by sex, age, and index date) 207,054 patients into 3 cohorts: those with FIS (1) without hyperglycemia, (2) hyperglycemia without glycemic treatment, and (3) hyperglycemia with glycemic treatment. We used Cox proportional hazard regression to evaluate the short- (within 1 year after FIS) and long-term (9.3 ± 8.6 years after FIS) prognostic effects of glycemic management on stroke recurrence and mortality of FISHG.ResultsStroke recurrence and mortality were significantly more likely in the patients with FISHG than their counterparts without hyperglycemia (p < 0.05). Under glycemic treatment, patients with FISHG demonstrated lower risk of mortality at every follow-up than those without (p < 0.001) but were not less likely to have stroke recurrence (p > 0.05). Integrating BGM with glycemic treatment in the FISHG cohort significantly reduced the risk of stroke recurrence compared to patients receiving only glycemic treatment at 1-month, 3-month, 6-month, and 1-year post-stroke follow-ups (adjusted hazard ratios = 0.84, 0.90, 0.88, and 0.92, respectively); additionally, this approach significantly decreased mortality risk at each post-stroke follow-up period (p < 0.05).ConclusionsBGM combined with glycemic treatment significantly improves prognosis in patients with FISHG who have not been previously diagnosed with DM, reducing the risks of stroke recurrence and mortality.

The oral microbiome and all-cause mortality in the US population.

Poor oral health, including periodontal disease, is associated with oral microbiome changes and increased mortality risk. However, no large studies have evaluated whether the oral microbiome is directly associated with mortality. To evaluate whether measures of the oral microbiome is prospectively associated with all-cause mortality. A cross-sectional survey with samples collected from 2009-2012 and mortality linkage to the restricted-use National Death Index (NDI) through 2019. The National Health and Nutrition Examination Survey (NHANES) 2009-2012, a multistage probability sample of the US population. NHANES participants 20- to 69-years-old who were eligible for linkage to the NDI and provided oral rinse specimens (N=7,721, representing approximately 194 million individuals). Oral microbiome ascertained by sequencing the V4 region of the 16S rRNA gene of extracted DNA from oral rinse specimens. Alpha diversity, beta diversity, and genus-level data were generated using DADA2 and QIIME. All-cause mortality. After an average of 8.8 years, a total of 426 participants died. Using Cox proportional hazards regression and after controlling for multiple comparisons where appropriate, continuous alpha diversity was inversely associated with all-cause mortality, but only the association for the Shannon-Weiner index was significant with full adjustment for major risk factors (hazard ratio [HR] per standard deviation [SD]=0.85; 95% confidence interval [CI]=0.74-0.98). The principal coordinate analysis (PCoA) vector 2 from the Bray-Curtis dissimilarity matrix (HR per SD=0.83; 95% CI=0.73-0.93) and PCoA1 from weighted UniFrac (HR per SD=0.86; 95% CI=0.75-0.98) were significantly associated with all-cause mortality after full adjustment. Few associations were observed at the genus-level after Bonferroni correction, but an increase in 1 SD of the relative abundance of Granulicatella and Lactobacillus were associated with a 17% (95% CI=1.11-1.24) and 11% (95% CI=1.06-1.16) increase in mortality risk, respectively. Compared to participants with no detectable Bacteroides, participants in the highest tertile of Bacteroides had decreased mortality risk (HR=0.54; 95% CI=0.40-0.74). Some measures of the oral microbiome were associated with all-cause mortality in this representative population cohort. These results suggest that oral bacterial communities may be important contributors to health and disease.

The Association of Anemia With Survival Among People With HIV Following Antiretroviral Initiation in the NA-ACCORD 2007-2016.

Anemia is an independent predictor of mortality, which may be utilized as a signal of deteriorating health. We estimated the association between anemia severity categories and mortality following the initiation of antiretroviral therapy (ART) among people with HIV (PWH) in North America. Within the NA-ACCORD, annual median hemoglobin measurements between January 01, 2007, and December 31, 2016, were categorized using World Health Organization criteria into mild (11.0-12.9 g/dL men, 11.0-11.9 g/dL women), moderate (8.0-10.9 g/dL men/women), and severe (<8.0 g/dL men/women) anemia. Discrete time-to-event analyses using complementary log-log link models estimated mortality hazard ratios adjusted for demographics, comorbidities, and HIV clinical markers with 95% confidence intervals for the association between anemia and mortality. Among 67,228 PWH contributing a total of 320,261 annual median hemoglobin measurements, 257,293 (80%) demonstrated no anemia, 44,041 (14%) mild, 18,259 (6%) moderate, and 668 (0.2%) severe anemia during follow-up. Mortality risk was 5.6-fold higher among PWH with (vs. without) anemia. The association was greater among men (adjusted hazard ratios = 5.8 [5.4, 6.2]) versus women (adjusted hazard ratios = 4.1 [3.2, 5.4]). Mortality risk was 3.8-fold higher among PWH with mild anemia, 13.7-fold higher with moderate anemia, and 34.5-fold higher with severe anemia (vs. no anemia). Median hemoglobin levels decreased significantly in the 4 years before death, with a maximum decrease in the year before death. Macrocytic anemia was associated with an increased mortality risk and microcytic anemia was associated with a decreased mortality risk (vs. normocytic anemia). Anemia among PWH who have initiated ART is an important predictive marker for mortality with macrocytic anemia having an increased association and microcytic anemia having a decreased association with mortality compared with normocytic anemia.

Survival of People Living with HIV/AIDS from Pre-ART Era to Treat-all Era - China, 1985-2022.

A comprehensive analysis of nationwide survival trends for people living with human immunodeficiency virus/acquired immunodeficiency syndrome (HIV/AIDS, PLWHA) from the initial reported case to present has not been conducted. This study evaluated the survival outcomes of PLWHA reported in China from 1985 to 2022. We analyzed data from PLWHA recorded in the National HIV/AIDS Comprehensive Response Information Management System from 1985 to 2022. Survival rates were calculated using Kaplan-Meier curves, and factors associated with survival time were analyzed using Cox proportional hazard models. Progressive relaxation of antiretroviral therapy initiation criteria led to significant improvements in survival rates across different diagnostic periods in China. The 1-year and 5-year cumulative survival rates increased from 85.2% and 66.1% in the 1985-2003 cohort to 91.1% and 81.4% in the 2016-2022 cohort. Cox proportional hazard analysis revealed elevated mortality risks among males, individuals aged ≥65 years, those with injection drug use or other transmission routes, hospital-tested patients, and those with lower CD4 counts at diagnosis or without treatment. Antiretroviral therapy has effectively reduced mortality risk among PLWHA in China. Future efforts should focus on expanding HIV testing to reduce the proportion of late diagnoses with lower CD4 counts and providing targeted, differentiated services for older populations to further decrease mortality risk among PLWHA.

Association of commission on cancer accreditation with receipt of guideline-concordant care and survival among patients with colon cancer.

Guideline-concordant care (GCC) is associated with improved survival for patients with cancer; however, variations in receipt of GCC remain a concern. The objective of this study was to evaluate the association of Commission on Cancer (CoC) hospital accreditation status with receipt of GCC and survival among patients with colon cancer. This retrospective observational study identified patients diagnosed with stage I-IV colon cancer from 2018 to 2020 from the National Program of Cancer Registries and Surveillance, Epidemiology, and End Results Program Database. Guideline concordance was defined as receipt of stage-appropriate lymphadenectomy or chemotherapy. Multivariable logistic regression models investigated associations with receipt of GCC. Cox proportional hazards regression models assessed 3-year cancer-specific mortality risk. Of 222,583 patients with colon cancer, 146,629 (91.2%) of eligible patients received guideline-concordant lymphadenectomy and 70,586 (81.9%) of the eligible patients received guideline-concordant chemotherapy. Treatment at CoC-accredited hospitals was the strongest modifiable predictor for receipt of guideline-concordant lymphadenectomy (odds ratio [OR] 1.82; 95% confidence interval [CI] 1.75-1.88) and chemotherapy (OR 2.14; 95% CI 2.06-2.23). Among patients treated at CoC-accredited hospitals, risk adjusted mortality was decreased for patients with stage I-II disease (hazard ratio [HR] 0.94; 95% CI 0.80-0.99), stage III disease (HR 0.93; 95% CI 0.88-0.98), and stage IV disease (HR 0.88; 95% CI 0.84-0.92). For patients with colon cancer, treatment at CoC-accredited hospitals was associated with increased receipt of GCC and decreased mortality risk. Benchmarking data may serve as a valuable accountability tool for quality assessment to improve cancer treatment and outcomes.

Mortality-related factors in older adults with delirium: A prospective observational study

BackgroundDelirium is a common and serious neuropsychiatric syndrome characterized by acute changes in attention, cognition, and consciousness. It is frequently encountered in various clinical settings, including critical care units and postoperative care, and is associated with significant morbidity and mortality. Understanding the factors contributing to delirium-related mortality is crucial for improving patient outcomes and healthcare practices. However, the factors associated with mortality in delirium have not been well-defined in the literature. ObjectivesThis study aimed to identify factors influencing 3-month mortality in older adults with delirium presenting to the emergency department (ED). MethodsThe study was conducted prospectively and delirium was screened using the brief Confusion Assesment Method (bCAM). The primary outcome was 3-month mortality. Mann-Whitney U and Chi-square tests compared groups, Spearman correlation analyzed correlations, and multivariate logistic regression identified risk factors. ResultsAmong 243 patients, 29.6% experienced in-hospital mortality, and 56.4% had 3-month mortality. Factors associated with increased mortality risk included prior delirium history (3.32-fold increase, 95%CI: 1.51-7.30), active malignancy (3.49-fold increase, 95%CI: 1.61-7.56) and increased respiratory rate (1.18-fold increase, 95%CI: 1.08-1.29). An increase in mean arterial pressure (MAP) was associated with a 0.98-fold decrease in mortality risk (95%CI: 0.96-0.99), increase in body temperature was associated with a 0.48-fold decrease in mortality risk (95%CI:0.31-0.76). ConclusionIn delirious older adults at the ED, higher respiratory rate, lower MAP, lower body temperature, active malignancy and prior delirium history signal elevated mortality risk.

Changes in physical activity and all-cause mortality among individuals with dementia: a cohort study using the National Health Insurance Service Database in Korea

ObjectiveTo examine associations between the amount and changes in regular physical activity (PA) before and after diagnosis of dementia and all-cause mortality risk, and whether these associations differ by PA...

Comparing treatment strategies for heart failure: a real-world analysis of adding ARNI or SGLT2i to older GDMT

Abstract Background Heart failure (HF) is a global burden with limited treatment options beyond established guideline-directed medical therapy (GDMT). Newer medications, like angiotensin receptor-neprilysin inhibitors (ARNIs) and sodium-glucose cotransporter-2 inhibitors (SGLT2i), show promise, but real-world evidence on their effectiveness compared to traditional GDMT is lacking. Objective This study assessed the real-world effectiveness of adding ARNIs and SGLT2i to existing GDMT regimens for various HF types using network meta-analysis (NMA). Methods We analyzed data from observational studies, evaluating the impact of different treatment combinations on all-cause mortality (ACM) and heart failure hospitalization (HFH). Results Adding ARNIs to GDMT significantly reduced ACM compared to older regimens (hazard ratio [HR] 0.59, 95% confidence interval [CI] 0.42-0.84), representing a 41% decrease in mortality risk. SGLT2i+2GDMT demonstrated the most significant HFH reduction (HR 0.16, 95% CI 0.06-0.47), translating to an 84% reduction in hospitalization risk. Conclusion Incorporating ARNIs or SGLT2i into existing GDMT regimens improves real-world outcomes for HF patients, supporting current guideline recommendations. Personalized treatment plans considering individual needs and preferences are crucial for optimal patient care.Network map of All-cause mortalityRelative treatment effects for ACM

Air quality improvement at urban bus stops: Optimal air purification placement using CFD

Nitrogen dioxide (NO2) levels are often elevated near roadways due to vehicle emissions, while sulfur dioxide (SO2) is predominantly found near petrochemical complexes as a result of industrial activities such as oil refining and chemical manufacturing. Considering the detrimental effects of these emissions on the environment and human health, the optimal placement of air purification systems at two bus stops in Ulsan, a heavily industrialized city in South Korea, was investigated in this study to reduce NO2 and SO2 concentrations. Computational fluid dynamics (CFD) simulations were performed to identify strategic installation locations, resulting in a significant reduction in pollutant levels. The largest impact was noted for the Deokha Market bus stop, whereby the added health risk (AR) decreased by 1.93 % and the exposure reduction effectiveness (ERE), a measure of air purification system efficiency, increased by 13.8 %. Similarly, at the Hyomun Intersection bus stop, placing the system near the sidewalk led to a significant reduction in AR by 1.60 % and an increase in ERE by 11.63 %. Additionally, air purification systems at Ulsan bus stops are expected to reduce NO2 levels by 9.1 ppb, decreasing mortality risk by 1.44 %, saving 7 lives annually, and yielding an economic benefit of 33.06 million USD.

Physical activity combined with tea consumption could further reduce all-cause and cancer-specific mortality

The study aimed to comprehensively assess the separate and combined effects of physical activity (PA) and tea consumption on all-cause mortality and cancer-specific mortality among 21,350 participants from The National Health and Nutrition Examination Survey (NHANES) between 2009 and 2018. PA and tea consumption were evaluated through self-reported questionnaires and dietary recall interviews at baseline, with mortality data from the National Death Index. Cox regression analyses yielded hazard ratios (HR) and 95% confidence intervals (CI). Results indicated that both tea consumption and PA independently reduced all-cause mortality. In the physically active group, tea consumption further decreased mortality risk, while this effect was not significant in the inactive group. Jointly, the highest tea consumers who exercised the most exhibited the lowest mortality risk compared to non-tea drinkers who exercised the least. Tea consumption alone does not significantly impact cancer-specific mortality; it is only in physically active group that tea consumption significantly lowers the risk of cancer-specific mortality. These findings underscore the potential benefits of regular tea consumption and PA in promoting longevity and reducing premature death risks.

Care Patterns and Outcomes for Intrahepatic Cholangiocarcinoma by Rurality of Patient Residence in a Midwestern State.

Intrahepatic cholangiocarcinoma (ICC) is the second most common malignancy of the liver and has the worst prognosis of any tumor arising from the liver, with a 5-year survival as low as 10%. However, whether the rurality of a patient's residence impacts care received and survival has not been well studied. We aimed to assess differences in care patterns associated with the rurality of patient's residences and their impact on survival outcomes, hypothesizing that patients in rural areas would experience lower survival. Adult patients diagnosed with ICC between 2010 and 2020 were identified in the Iowa Cancer Registry. Chi-square tests were used to compare values categorical variables by rural/urban status. Cox proportional hazards regression was used to determine associations with cancer-specific mortality. Of 672 patients diagnosed with ICC during the study period, 53%, 27%, and 21% resided in metropolitan, micropolitan, and rural areas, respectively. There were no significant differences in age, sex, stage at diagnosis, the proportion receiving chemotherapy within 12 weeks of diagnosis, and undergoing surgery across all groups. Additionally, the proportion receiving definitive care at a National Cancer Institute (NCI) designated center was comparable across the three groups (37% metro vs. 43% micro vs. 35% rural). However, rural residents had the highest proportion of traveling ≥ 50 miles for definitive care (22% metro vs. 41% micro vs. 56% rural). In multivariable analysis of patients with Stage 1-3 disease, younger age, receipt of chemotherapy, surgery, and definitive care at an NCI center were independently associated with decreased mortality risk. However, rural residence was not significantly associated with survival (HR: 0.64 [95% CI: 0.38-1.06]). Similar to other complex cancer diagnoses, we found that definitive care at an NCI center was associated with decreased mortality risk for patients with ICC. Although rural residence was not independently associated with survival in this cohort, rural residents traveled significantly longer distances to access definitive care. This highlights a crucial need to improve access to specialized centers for complex cancer care.

Social Vulnerability and Receipt of Guideline-Concordant Care among Patients with Colorectal Cancer.

Cancer outcome disparities have been reported in highly vulnerable communities. The objective of this study was to evaluate the association of social vulnerability with receipt of guideline-concordant care (GCC) and mortality risk for patients with colorectal cancer. This retrospective observational study identified patients with stage I-III colon or stage II-III rectal cancer between 2018 and 2020 from the National Program of Cancer Registries Database. Data were merged with the Centers for Disease Control and Prevention Social Vulnerability Index (SVI) at the county level. GCC was defined as stage-appropriate lymphadenectomy, radiation therapy, or systemic therapy. Multivariable logistic regression and Cox proportional hazards regression investigated associations of SVI, as a continuous and categorical variable stratified into quartiles, with GCC and 3-year cancer-specific mortality risk, respectively. Among 124,950 patients (colon, n=102,399; rectal, n=22,551), median SVI was 60.9 (IQR 35.0 to 79.5). Patients in the highest SVI quartile had 21% decreased odds of receiving GCC (95% CI 0.76 - 0.83). Treatment at Commission on Cancer (CoC) accredited hospitals was associated with increased GCC (OR 1.79; 95% CI 1.72 - 1.85). Although there was an inverse, decreasing association between SVI and probability of GCC, probability at non-CoC-accredited hospitals declined faster than at CoC-accredited hospitals (p<0.05). After adjusting for receipt of GCC, highly vulnerable patients treated at CoC-accredited hospitals had decreased mortality risk (HR 0.91; 95% CI 0.83 - 0.98). For highly vulnerable patients, treatment at CoC-accredited hospitals was associated with increased receipt of GCC and decreased mortality risk, which may reflect CoC-accreditation requirements for treatment guideline adherence, community engagement, and addressing barriers to care.

Cardiovascular health and cancer mortality: evidence from US NHANES and UK Biobank cohort studies

BackgroundThe American Heart Association recently introduced a novel cardiovascular health (CVH) metric, Life's Essential 8 (LE8), for health promotion. However, the relationship between LE8 and cancer mortality risk remains uncertain.MethodsWe investigated 17,076 participants from US National Health and Nutrition Examination Survey (US NHANES) and 272,727 participants from UK Biobank, all free of cancer at baseline. The CVH score, based on LE8 metrics, incorporates four health behaviors (diet, physical activity, smoking, and sleep) and four health factors (body mass index, lipid, blood glucose, and blood pressure). Self-reported questionnaires assessed health behaviors. Primary outcomes were mortality rates for total cancer and its subtypes. The association between CVH score (continuous and categorical variable) and outcomes was examined using Cox model with adjustments. Cancer subtypes-related polygenic risk score (PRS) was constructed to evaluate its interactions with CVH on cancer death risk.ResultsOver 141,526 person-years in US NHANES, 424 cancer-related deaths occurred, and in UK Biobank, 8,872 cancer deaths were documented during 3,690,893 person-years. High CVH was associated with reduced overall cancer mortality compared to low CVH (HR 0.58, 95% CI 0.37–0.91 in US NHANES; 0.51, 0.46–0.57 in UK Biobank). Each one-standard deviation increase in CVH score was linked to a 19% decrease in cancer mortality (HR: 0.81; 95% CI: 0.73–0.91) in US NHANES and a 19% decrease (HR: 0.81; 95% CI: 0.79–0.83) in UK Biobank. Adhering to ideal CVH was linearly associated with decreased risks of death from lung, bladder, liver, kidney, esophageal, breast, colorectal, pancreatic, and gastric cancers in UK Biobank. Furthermore, integrating genetic data revealed individuals with low PRS and high CVH exhibited the lowest mortality from eight cancers (HRs ranged from 0.36 to 0.57) compared to those with high PRS and low CVH. No significant modification of the association between CVH and mortality risk for eight cancers by genetic predisposition was observed. Subgroup analyses showed a more pronounced protective association for overall cancer mortality among younger participants and those with lower socio-economic status.ConclusionsMaintaining optimal CVH is associated with a substantial reduction in the risk of overall cancer mortality. Adherence to ideal CVH correlates linearly with decreased mortality risk across multiple cancer subtypes. Individuals with both ideal CVH and high genetic predisposition demonstrated significant health benefits. These findings support adopting ideal CVH as an intervention strategy to mitigate cancer mortality risk and promote healthy aging.

Association between complementary anthropometric measures and all-cause mortality risk in adults: NHANES 2011-2016.

Previous studies using a single obesity indicator cannot fully assess the association between body shape and mortality. We aimed to investigate the association between complementary anthropometric measures and all-cause mortality risk. We combined National Health and Nutrition Examination Survey (NHANES) data from 2011 to 2016 with mortality data up to December 31, 2019. After excluding individuals with cancer at baseline, 13,728 participants were included. Cox regression models and restricted cubic spline (RCS) analyses were used to explore the association between general obesity, central obesity, and peripheral fat indicators and all-cause mortality risk. A total of 743 deaths occurred over a median follow-up of 5.83 years. In multivariable-adjusted Cox models, each 10-cm increase in waist circumference (WC), each 0.1-unit increase in waist-to-height ratio (WHtR), and each 0.01-unit increase in A Body Shape Index (ABSI) were associated with 20% (HR = 1.20; 95% CI: 1.02-1.41), 119% (2.19; 1.70-2.83), and 5% (1.05; 1.03-1.08) increased all-cause mortality risk, respectively. Conversely, each 1-cm increment in mid-arm circumference (MAC) was associated with 13% (HR = 0.87; 95% CI: 0.83-0.92) decreased mortality risk. Compared with normal group (body mass index (BMI): 18.5- <25.0), underweight (HR = 1.97; 95% CI: 1.12-3.45) and grade 3 obesity (1.37; 1.04-1.81) were at higher mortality risk. However, after further adjustment for WC, the effect of grade 3 obesity disappeared, and the RCS analyses for BMI changed from a J-shaped (P < 0.05 for non-linearity test) to a negative association (P < 0.01). Underweight, grade 3 obesity, and central obesity were associated with an increased mortality risk, while peripheral fat was inversely associated with mortality.

Impact of prior oral anticoagulation therapies on post-discharge outcomes after COVID-19: Results from aglobal federated health network analysis.

The impact of chronic oral anticoagulant (OACs) use on long-term post-discharge outcomes after coronavirus disease 2019 (COVID-19) hospitalisation remains unclear. Herein, we compared clinical outcomes up to 2-years after COVID-19 hospitalisation between patients on vitamin K antagonists (VKAs), direct-acting OACs (DOACs) and no OAC therapy. Data from TriNetX, a global federated health research network, were used. Adult patients on VKAs, DOACs or no OAC therapy at diagnosis of COVID-19 between 20 January 2020 and 31 December 2021, who were hospitalised for COVID-19, were included. The primary outcomes were all-cause mortality, ischaemic stroke/transient ischaemic attack (TIA)/systemic embolism (SE) and the composite of intracranial haemorrhage (ICH)/gastrointestinal bleeding, at 2 years after COVID-19 hospitalisation. We included 110,834 patients with COVID-19. Following propensity score matching (PSM), we identified a decreased mortality risk in DOAC-treated patients compared to the no OAC cohort (RR .808, 95% CI .751-.870). A higher risk of ischaemic stroke/TIA/SE was observed in VKA users compared to DOAC users (RR 1.100, 95% CI 1.020-1.220) and in VKA users compared to patients not taking OAC (RR 1.400, 95% CI 1.140-1.720). VKA use was associated with a greater risk of ICH/gastrointestinal bleeding than DOAC users (RR 1.198, 95% CI 1.066-1.347), while DOAC users had a lower risk compared to no OAC-treated patients (RR .840, 95% CI .754-.936). COVID-19 patients taking prior DOACs were associated with lower long-term mortality risk and ICH/gastrointestinal bleeding than patients not taking OAC. Compared to patients on DOACs, VKA users were associated with higher risks of mortality, ischaemic stroke/TIA/SE and ICH/gastrointestinal bleeding.