Differences In Mortality Risk Research Articles

Sex differences in mortality risk and U-shaped relationship with klotho levels: A long-term cohort study

BackgroundsIt remains unclear whether there are sex differences in the correlation between klotho and mortality risk. The purpose of our study is to investigate the relationship between klotho levels and all-cause mortality, specifically examining potential sex disparities. MethodsThe study utilized data from the National Health and Nutrition Examination Survey. The study employed the Cox proportional hazards model and Kaplan-Meier survival curves to conduct multivariate analyses investigating the associations between klotho and mortality. The impact of klotho level on mortality was assessed by a restricted cubic spline curve. ResultsOur study included 13,748 participants. The hazard ratios (HR) for all-cause mortality were found to be higher in males compared to females. The risk of all-cause mortality decreased until the klotho level reached 959 pg/mL in all-cause mortality, then increased thereafter in females (P value for nonlinearity = 0.01, P overall = 0.02); no curved relationship was observed in males. ConclusionKlotho levels and mortality follow a U-shaped curve, with sex differences in the relationship. Males with higher klotho levels have a higher risk of all-cause death than females.

Sex differences in survival following acute coronary syndrome with and without standard modifiable risk factors.

This meta-analysis investigates the sex differences in mortality risk between the acute coronary syndrome (ACS) population without standard modifiable risk factors (SMuRF-less) and those with at least one standard modifiable risk factor (SMuRF), and analyses mortality rates between males and females within the SMuRF-less cohort. The MEDLINE and Embase databases were searched for cohort studies with sex-stratified outcomes for SMuRF-less versus SMuRF patients with ACS till 15 December 2023. The analysis of variables reported in proportions was carried out by utilizing a meta-analysis with a generalized linear mixed model while continuous variables were analyzed by a meta-analysis of means, using an inverse variance method. Eight studies were included in the current paper, with 82,395 SMuRF-less ACS patients and 607,558 SMuRF ACS patients. Excess in-hospital mortality found in SMuRF-less ACS, compared to those with SMuRFs, were only observed in females (RR 1.56, 95%CI 1.08-2.25, p = 0.029), but not in males (RR 1.59, 95%CI 0.90-2.80, p = 0.088). On longer follow-up, the 1- and 2-year post-ACS mortality rates were similar across the SMuRF-less and SMuRF cohorts, for both sexes. The subgroup analysis of SMuRF-less ACS individuals revealed that SMuRF-less females had higher in-hospital (RR 1.52, 95%CI 1.30-1.78, p = 0.002), 1-year (RR 1.51, 95%CI 1.34-1.71, p = 0.005) and 2-year mortality risks (RR 1.40, 95%CI 1.13-1.75, p = 0.016) compared to the SMuRF-less male counterparts. Paradoxical excess mortality in SMuRF-less ACS, compared to those with SMuRFs, was only observed in females. Females without cardiovascular risk factors are at the highest risk of short- and medium-term mortality following ACS.

Abstract 4116093: High Intensity Statin Use Improved ASCVD Outcomes in Patients with Severe Hyperlipidemia in a Primary Prevention Cohort

Background: High intensity statin therapy is currently recommended for primary prevention of ASCVD in patients with severe hyperlipidemia (HLD), defined as low-density lipoprotein cholesterol (LDL-C) of ≥190 mg/dL. We examined statin use for patients with severe HLD and associated ASCVD outcomes in a large contemporary healthcare network. Methods: Using EMR data, patients between the ages of 20 and 79 with a lipid bloodwork result between 2013 and 2017 without ASCVD by ICD9 and ICD10 codes were identified. Patients with LDL-C ≥ 190 mg/dL were identified. Statin use was stratified by no statin, guideline directed statin intensity (GDSI), and less than guideline directed statin intensity (<GDSI). Cox proportional hazards (HR) models were used to assess the relationship between statin use, future ASCVD events, and all-cause mortality. Time to initiation of GDSI was calculated using Kaplan-Meier (KM) methods. Results: Out of 282,298 primary prevention patients, a total of 5,205 (1.8%) had LDL-C ≥ 190 mg/dL. These patients were 55.6% female and had an average age of 52.5 ± 12.2. At first encounter, 3.7% were on GDSI. Over a 5-year follow up, KM probabilities revealed 42% of high-risk patients with severe HLD not initially on GDSI would achieve new GDSI use. Compared to patients on GDSI, those on no statin therapy were at significantly higher risk of MI (HR = 2.36, 95% CI [1.38 – 4.04]) and stroke/TIA (HR= 2.70, 95% CI [1.43 – 5.09]); both p < 0.05. There was no significant difference in risk of all-cause mortality (HR = 1.41, 95% CI [0.90 – 2.21]). Patients on <GDSI were found to have significantly higher risk of MI (HR = 1.72, 95% CI [1.05 – 2.81]) compared to patients on GDSI. There was no significant difference between the GDSI and <GDSI groups in risk of stroke (HR = 1.28, 95% CI [0.69-2.37] and all-cause mortality (HR = 0.98, 95% CI [0.65-1.47]). Conclusion: Among primary prevention patients with severe HLD, high intensity statins are underutilized. Prevalence of this suboptimal use of statins is linked to greater risk of ASCVD events. Healthcare system-wide interventions can identify measures to assess burden of high-risk patients with severe HLD and implement lipid-lowering therapies optimally.

Study on utility of GDH and prevalence of Clostridium difficile infection in ICU patients

BackgroundClostridium difficile (C difficile) is one of the leading causes of nosocomial diarrhea in developing countries. It is a commonly encountered infection in the ICU setting where critically ill patients are at significant risk. The aim of this study was to study the clinical and microbiological profile of Clostridium Difficile Infection (CDI) in intensive care unit (ICU) settings of a Tertiary Care Hospital with the primary objective to find out the prevalence of C difficile diarrhea among the patients and the secondary objective to find out the utility of Glutamate Dehydrogenase (GDH) in screening for such patients. MethodsThis was a single center, prospective, diagnostic study conducted from July to Dec 2023. The study was carried out after obtaining clearance from the Institute Ethics Committee. As per a 2017 study done by Segar et al, keeping the tolerable error as 1.5 at 95% confidence interval, minimum sample size was found to be 200. ResultsThe prevalence of CDI among ICU patients was 6% and among diarrheic patients the prevalence was 20%. GDH showed a sensitivity and specificity of 100% with all cuture positive cases of CDI also showing GDH positivity. The length of ICU and hospital stay among CDI patients (28±17 days/56±17 days) was significantly longer compared to non CDI patients (11 ± 06 days/26 ± 18 days) (p-0.003). The overall hospital mortality among ICU patients with CDI patients was 33% as compared with 25% among those without CDI thus showing a statistically significant difference in mortality risk (p-0.030). ConclusionIt is concluded that there is a need for additional prevention and treatment studies in this setting. No correlation could be established between the choice or duration of antibiotic therapy and the development of CDI. Similarly no correlation could be established between the primary diagnosis for admission of the patient and development of CDI.

Comparison of mortality in people with type 2 diabetes between different ethnic groups: systematic review and meta-analysis of longitudinal studies

BackgroundPeople of South Asian and Black ethnicity have a higher prevalence of type 2 diabetes (T2D) compared to people of White ethnicity. T2D is a leading cause of mortality worldwide, however, rigorous investigation including the most recent studies comparing mortality in different ethnic groups has not been conducted. This systematic review and meta-analysis aim to compare mortality risk in people with T2D between different ethnic groups. MethodsThis systematic review follows PRISMA guidelines (PROSPERO:CRD42022372542). Nine databases were searched for community-based studies among T2D adults from ≥2 ethnicities. Studies published between January, 2000 and May, 2024 and containing ≥100 participants in each reported ethnic group were included. Two independent reviewers undertook title/abstract and full-text screening, data extraction, quality assessment (using Newcastle-Ottawa Scale) and data synthesis with group consensus to resolve any conflicts. The primary outcome compared all-cause mortality rates between ethnic groups (hazard ratio [HR] with 95% confidence intervals). FindingsFrom 33 922 records screened, 13 studies met inclusion criteria and 7 were meta-analysed. The 13 studies incorporated 593 058 T2D participants and 12/13 were of good quality. Overall mortality risk was lower amongst people with T2D from South Asian (HR 0·68 [95% CI 0·65–0·72]; 4 studies), Black (0·82 (0·77–0·87]; 5 studies) and Chinese (0·57 [0·46–0·70]; 2 studies) ethnicity compared to people of White ethnicity. Narrative synthesis corroborated quantitative findings and highlighted that people of indigenous Māori ethnicity had greater mortality risk compared to people of European ethnicity. InterpretationPeople with T2D of South Asian, Black and Chinese ethnicity have a lower risk of all-cause mortality compared to those of White ethnicity, whilst Māori ethnicity have higher mortality risk. Risk factors or clinical management could explain differences in T2D mortality risk especially when comparing T2D complications by ethnicity, thus need further scrutiny to improve overall diabetes outcomes. FundingNo funding was received.

Obesity Paradox and the Effect of NT-proBNP on All-Cause and Cause-Specific Mortality.

In heart failure patients, obesity is associated with better outcomes as compared to normal weight, a phenomenon called the obesity paradox. To examine if obesity modifies the relationship between NT-proBNP and all-cause and cause-specific mortality in adults without coronary artery disease or heart failure history. We used the National Health and Nutrition Examination Survey (NHANES) data from 1999 to 2004 and linked it with mortality through December 31, 2019. Participants > 18 years were categorized into normal weight (BMI ≤ 25 kg/m2), overweight (BMI > 25-29.9 kg/m2) and obese (BMI > 29.9 kg/m2). NT-proBNP levels were categorized as low (< 126 pg/mL) or high (≥ 126 pg/mL). Using Cox proportional hazard models, we examined effect modification by obesity using interaction, without and with adjusting for potential confounders. Of the 12 621 participants, 2794 (22%) died during 202 859 person-years follow-up. In adjusted models, normal-weight participants with high NT-proBNP had 2 times higher all-cause mortality risk than those with low NT-proBNP (HR = 2.05; 95%CI = 1.74, 2.41; p < 0.001); however, this mortality risk was 27% lower in obese participants (HR interaction = 0.73; 95%CI = 0.59, 0.92; p = 0.008). Similarly, in normal-weight participants, the difference in other-cause mortality risk between high and low NT-proBNP participants was significant in adjusted models (HR = 2.27; 95%CI = 1.81, 2.85; p < 0.001) and obese participants had 48% lower other-cause mortality risk between those with high and low NT-proBNP (interaction HR = 0.52; 95%CI = 0.36, 0.77; p = 0.001). Conversely, obesity did not modify the relationship between NT-proBNP and cardiovascular or cancer mortality. In patients free of heart failure or coronary artery disease, obesity may be protective against mortality associated with high NT-proBNP.

Association of Oral Microbiome Diversity and All-Cause Mortality in the General US Population and in Individuals With Chronic Diseases: A Prospective Cohort Study.

To investigate whether oral microbiome diversity is associated with all-cause mortality in the general US population and in individuals with chronic diseases. We included 8224 individuals with oral microbiome diversity data from the National Health and Nutrition Examination Survey (2009-2012), representing 164,000,205 US adults, using a survey-weighted analysis method. Cox regression analyses were performed to identify the association between oral microbiome diversity and all-cause mortality. During a survey-weighted mean follow-up period of 8.86 years, 429 all-cause deaths (survey-weighted number: 7,124,920) occurred in 8224 participants. Cox regression analysis revealed that higher oral microbiome diversity was significantly associated with a lower all-cause mortality risk. Significant differences in all-cause mortality risk were observed among the different clusters based on oral microbiome β-diversity (log-rank p < 0.001). Subgroup analyses revealed that the oral microbiome diversity was independently associated with all-cause mortality in individuals with diabetes mellitus and hypertension. A multivariate logistic regression model showed that current smoking and antibiotic use were significantly associated with lower oral microbiome α diversity. Higher oral microbiome diversity was significantly associated with a lower all-cause mortality risk in the general US population and in individuals with diabetes mellitus and hypertension.

Association of postoperative opioid type with mortality and readmission rates: multicentre retrospective cohort study.

Opioid treatment in postoperative pain management is crucial, but the impact of administration practices on outcomes is unclear. The hypothesis was that prescription trends remained stable over recent years, and that no difference in mortality and readmission risks is associated with prescription strategies. Electronic health records of surgical episodes in the Capital and Zealand Regions of Denmark from 2017 to 2021 were analysed. All opioids administered during postoperative admission were converted to oral morphine equivalents (OMEQs) and an average daily dose per patient was calculated. The opioid administered in the highest OMEQ dosages is considered the primary opioid strategy for the surgical case. Administration trends were analysed through linear regression, and Cox regression was used to calculate hazard ratios to assess dominant opioid strategies' association with 90-day mortality and readmission rates while controlling for confounders. A total of 183 317 patients met the inclusion criteria. Prescription trends remained steady during the study period. Multivariable analysis revealed increased readmission risk (HR 1.18, P < 0.001) of tramadol and tapentadol compared to morphine. They exhibited decreased 90-day mortality risk (HR 0.63, P < 0.001). Oxycodone had similar readmission risk (HR 1.009, P = 0.24) but lower 90-day mortality risk (HR 0.68, P < 0.001). Postoperative in-hospital opioid administration remained stable from 2017 to 2021. Tramadol/tapentadol had a higher risk of readmission but lower mortality risk. Oxycodone had comparable readmission but reduced mortality risk. This study provides a framework for future clinical trials assessing this potential impact of opioids in a targeted manner.

The impact of peptide receptor radionucleotide therapy with Lutetium-177 DOTATATE on cardiac metastases in neuroendocrine tumors

Abstract Background Cardiac metastasis from neuroendocrine tumors (NET) is rare and has been thought to potentially result in life threatening sequalae. Peptide receptor radionucleotide therapy (PRRT), such as Lutetium-177 (Lu-177) DOTATATE, has been validated as effective treatment for patients with NET who have progressed on somatostatin analogue (SSA) therapy and more recently suggested for use in SAA-naïve higher risk grade 2 and grade 3 NETs. However, Lu-177 DOTATATE therapy has been found to have potentially serious adverse effects both locally and systemically. Overall, the clinical significance of cardiac metastasis of NET, as well as the safety and efficacy of Lu-177 DOTATATE in this cohort, has not been thoroughly evaluated. Purpose This study assessed the outcomes and clinical consequences of cardiac metastatic involvement in patients with NET. Furthermore, this study investigated the safety of Lu-177 DOTATATE therapy in patients with cardiac metastases from NET. Methods All patients who underwent 68Ga-DOTATATE positron emission tomography for evaluation of NET across three tertiary centers between 2016 and 2022 were retrospectively evaluated. Patients with evidence of cardiac metastasis were further evaluated. Baseline characteristics, treatment modality, and clinical outcomes including mortality, arrhythmia or conduction disease, carcinoid heart disease, and heart failure admissions were recorded. Patients with cardiac metastases were grouped and compared based on therapeutic modality (conservative therapy with surveillance or SSA, Lu-177 DOTATATE therapy, or surgical resection of metastases). Results From 3253 patients with NET, 51 patients were identified to have cardiac metastases (mean age 66.7 ± 12.2 years, 54% male). Three patients underwent surgical resection of cardiac metastases, and in two of whom this was concomitant while undergoing valve surgery for carcinoid heart disease. Patients with cardiac metastasis had significantly higher mortality than patients without cardiac metastasis (HR 2.12, 95%CI 1.00 – 4.52, p = 0.049, Figure 1A). Median follow-up from diagnosis of cardiac metastasis was 3.64 years [IQR 1.59 – 5.64]. There was no significant difference in clinical outcomes between patients that received Lu-177 DOTATATE therapy (n = 27) and conservative therapy (n = 21). Specifically, there was no significant difference in mortality risk at five years post the diagnosis of cardiac metastasis between these groups (p = 0.47, Figure 1B). Conclusion Patients with cardiac metastasis from NETs have worse clinical outcomes than NET patients without cardiac metastatic involvement. Lu-177 DOTATATE therapy appears to be safe in patients with cardiac metastasis from NET.Figure 1AFigure 1B

Sex differences in clinical characteristics, phenotypes, management, and long-term outcomes of myocardial injury: an international cohort study

Abstract Background Several studies have demonstrated sex differences in patients presenting to the emergency department (ED) with myocardial infarction, heart failure or syncope. Whether sex-specific differences in chest pain patients with myocardial injury exist is unknown. Purpose To determine whether sex-specific differences in the clinical characteristics, phenotypes, management, and long-term outcomes of patients with myocardial injury exist. Methods Patients presenting to the ED with chest pain suggestive of MI were consecutively enrolled into a prospective multicenter international diagnostic study. Final diagnoses were centrally adjudicated by two independent cardiologists, applying the fourth universal definition of myocardial infarction, using all available medical records, including serial hs-cTn and cardiac imaging. Follow-ups were performed at 3 months, 1-, 2- and 5-years. The primary outcome was 5-year all-cause mortality. Secondary outcomes included 5-year cardiovascular mortality and non-cardiovascular mortality. Multivariable flexible parametric (Royston-Parmar) models assuming proportional hazards were fitted. Models were adjusted for age, history of coronary artery disease, history of malignancy, diabetes, hypertension, smoking status, history of liver disease, and renal function. Results Among 8046 chest pain patients presenting to the ED, 1158 (14.4%) had myocardial injury, of which 358 (31%) were females and 800 (69%) males. Women were older (79 years, vs. 73 years), had fewer cardiovascular risk factors and comparable non-cardiovascular comorbidities except for lung disease which was more commonly found in men. Myocardial injury phenotypes varied between sexes (Figure). The most common phenotype in both sexes was heart failure, yet it was more common in men (37.2%) than in women (22.3%). The second most common phenotype in women was hypertension (15.4%) and arrhythmia (15.4 %), while in men was myocarditis (17.8 %), followed by arrhythmia (15.8%). Women underwent less invasive coronary angiography (19.8% vs 26.9%) or stress testing (12% vs 21.5%). In the angiographic findings, women presented more often with normal findings (30.4% vs. 19.6%) or mild CAD (20.3% vs. 11.2%) whereas men displayed more frequently 3-vessel disease (14.5% vs. 36.4%), Table. After adjusting for known confounders, women were associated with a lower 5-years risk for all-cause mortality (HR 0.69; 95%CI: 0.56–0.83) and cardiovascular mortality (HR 0.61; 95%CI: 0.46–0.79). No statistically significant difference in non-cardiovascular mortality risk was found (HR 0.79; 95%CI: 0.59-1.04). Conclusions Women presenting with chest pain to the ED and having myocardial injury were less likely than men to undergo coronary angiography or non-invasive cardiac imaging. Long-term risk for all-cause or cardiovascular mortality was lower for women compared to men.Myocardial Injury phenotypesPatient management

Comorbidities, Tobacco Exposure, and Geography: Added Risk Factors of Heat and Cold Wave Related Mortality among United States Veterans with COPD.

Understanding the health risks associated with extreme weather events is needed to inform policies to protect vulnerable populations. To address this need, we estimated heat and cold wave related mortality risks in a cohort of veteran patients with chronic obstructive pulmonary disease (COPD) and explored disparities among strata of comorbidities, tobacco exposure, and urbanicity. We designed a time stratified case-crossover study among deceased patients with COPD between 2016 to 2021 in the Veterans Health Administration system. Distributed lag models with conditional logistic regression estimated incidence rate ratios (IRR) of heat and cold wave associated mortality risk from lag days 0 to 3 for heatwaves and 0 to 7 for cold waves. Attributable risks (AR) per 100,000 patients were also calculated. Of the 377,545 deceased patients with COPD, the largest heatwave related mortality risk was in patients with COPD and asthma, AR: 14,016 (95% CI: -326, 30,706) across lag days 0 to 3. The largest cold wave related mortality burden was in patients with COPD with no other reported comorbidities, AR: 1,704 (95% CI: 759, 2,686) across lag days 0 to 7. Patients residing in urban settings had the greatest heatwave, AR: 1,062 (95% CI: (576, 1,559), and cold wave AR: 1,261 (95% CI: 440, 2,105) related mortality risk (across lag days 0 to 1 and 0 to 7 respectively). There were no differences in mortality risk by tobacco exposure. Our findings show individuals with COPD are susceptible to heat and cold waves. This information can inform clinical practice and public health policy about the mortality risk vulnerable populations experience with respect to extreme weather conditions. Furthermore, our results may be used in the development and refinement of future extreme weather warning systems designed for public health purposes.

Heterogeneity in the Effect of Early Goal-Directed Therapy for Septic Shock: A Secondary Analysis of Two Multicenter International Trials.

The optimal approach for resuscitation in septic shock remains unclear despite multiple randomized controlled trials (RCTs). Our objective was to investigate whether previously uncharacterized variation across individuals in their response to resuscitation strategies may contribute to conflicting average treatment effects in prior RCTs. We randomly split study sites from the Australian Resuscitation of Sepsis Evaluation (ARISE) and Protocolized Care for Early Septic Shock (ProCESS) trials into derivation and validation cohorts. We trained machine learning models to predict individual absolute risk differences (iARDs) in 90-day mortality in derivation cohorts and tested for heterogeneity of treatment effect (HTE) in validation cohorts and swapped these cohorts in sensitivity analyses. We fit the best-performing model in a combined dataset to explore roles of patient characteristics and individual components of early goal-directed therapy (EGDT) to determine treatment responses. Eighty-one sites in Australia, New Zealand, Hong Kong, Finland, Republic of Ireland, and the United States. Adult patients presenting to the emergency department with severe sepsis or septic shock. EGDT vs. usual care. A local-linear random forest model performed best in predicting iARDs. In the validation cohort, HTE was confirmed, evidenced by an interaction between iARD prediction and treatment (p < 0.001). When patients were grouped based on predicted iARDs, treatment response increased from the lowest to the highest quintiles (absolute risk difference [95% CI], -8% [-19% to 4%] and relative risk reduction, 1.34 [0.89-2.01] in quintile 1 suggesting harm from EGDT, and 12% [1-23%] and 0.64 [0.42-0.96] in quintile 5 suggesting benefit). Sensitivity analyses showed similar findings. Pre-intervention albumin contributed the most to HTE. Analyses of individual EGDT components were inconclusive. Treatment response to EGDT varied across patients in two multicenter RCTs with large benefits for some patients while others were harmed. Patient characteristics, including albumin, were most important in identifying HTE.

EP.17B.04 Racial/Ethnic Differences in Risk of Mortality of Men and Women with Lung Cancer

EP.17B.04 Racial/Ethnic Differences in Risk of Mortality of Men and Women with Lung Cancer

Disparities in cancer mortality outcomes among adult immigrants in the United States.

134 Background: The “immigrant health paradox” posits that immigrants are generally healthier than US natives of similar demographic and socioeconomic background. However, immigrant noncitizens with cancer face unique barriers to care, including limited access to routine screening and continuous healthcare coverage, which may portend worse outcomes. Methods: The 2011-2018 National Health Interview Survey Linked Mortality Files were used to identify all adult (age ≥18 years) US natives, foreign-born citizens, and noncitizens with a cancer history. Differences by group were assessed using the chi-squared test with Rao &amp; Scott’s second-order correction. Cox-proportional hazards models tested associations between nativity/citizenship status and cancer-specific (CSM) and all-cause mortality (ACM), adjusted by age, gender, and survey year. Sequential models separately tested the added effects of individual patient-level covariates selected a priori —including race/ethnicity, smoking status, region, educational attainment, employment, insurance status, and having a usual source of care. Results: A total of 23,603,743 US natives, 1,647,188 foreign-born citizens and 477,861 noncitizens met criteria for inclusion. Compared to US natives, immigrants had significantly greater distribution of gastroesophageal (2.3%, noncitizens vs 2.3%, foreign-born citizens vs 1.0%, US natives, p &lt;0.001), head &amp; neck (8.4% vs 6.2% vs 4.4%, p =0.003), and lung cancers (3.1% vs 4.2% vs 2.8%, p =0.03). Of the1,302,0771 US natives, 105,258 foreign-born citizens, and 21,937 noncitizens who died during the study period, cancer was the primary cause of death for 52% of noncitizens and 62% of foreign-born citizens (vs 44%, p &lt;0.001). Lung cancer was the most common diagnosis in this group, accounting for 40% of cancer deaths among non-citizens (vs 19% vs 13%; p =0.03). Relative to US natives, foreign-born citizens had a significantly lower risk of all-cause (adjusted HR [95%CI], 0.67 [0.54-0.83]) but not cancer-specific mortality (0.94 [0.71-1.23]); no differences in mortality risk among noncitizens were observed. On subset analysis limited to adults with lung cancer, noncitizens had over twice the hazard of cancer death (2.72 [1.22-6.09]) as well as death from any cause (2.14 [1.01-4.55]). While the association with ACM was no longer significant in sequential models, the association remained significant for CSM. Importantly, insurance status attenuated but did not eliminate the risk of lung cancer death for noncitizens (2.63 [1.16-5.96]). Conclusions: Although immigrant noncitizens did not have a significantly greater risk of cancer death overall, those with lung cancer were more than twice as likely to die from their disease, even after adjustment for patient-level variables, including insurance status and having a usual source of care. Future research is warranted to identify root causes and potential points for intervention.

The influence of COVID-19 on short-term mortality in acute ischemic stroke: A systematic review and meta-analysis.

To evaluate the differences in short-term mortality risk between acute ischemic stroke (AIS) patients with and without SARS-CoV-2 infection. PubMed, EMBASE, Scopus, and Cochrane Databases were systematically searched from December 1, 2019 to May 20, 2022 using the keywords coronavirus disease 2019 (COVID-19), COVID-19, SARS-CoV-2, and ischemic stroke. A random-effects model was estimated, and subgroup analysis and meta-regressions were performed. The quality of eligible studies was assessed using the Newcastle-Ottawa Scale. A total of 26 eligible studies with 307,800 patients were included in this meta-analysis. The overall results show that in-hospital and 90-day mortality was 3.31-fold higher in AIS with SARS-CoV-2 patients compared with those without SARS-CoV-2. When matched for age and National Institutes of Health Stroke Scale score at admission, the risk ratio of in-hospital mortality from AIS among patients with SARS-CoV-2 versus without decreased to 2.83. Reperfusion therapy and endovascular thrombectomy may further reduce the risk of death in patients to some extent but do not increase the incidence of symptomatic intracerebral hemorrhage. Meta-regression showed that in-hospital mortality decreased with increasing National Institutes of Health Stroke Scale score in AIS with SARS-CoV-2 compared to those without SARS-CoV-2 and that the difference in mortality risk between the 2 was independent of age and sex. The results of this study suggest that AIS patients with SARS-CoV-2 have higher short-term mortality compared to AIS patients without SARS-CoV-2, and reperfusion and endovascular thrombectomy therapy may reduce the risk of short-term mortality to some extent. The differences in in-hospital mortality risk were similar across ages and sexes. Focused attention is therefore needed on AIS patients with SARS-CoV-2 to control mortality.

Socioeconomic and Urban-Rural Disparities in Genome-Matched Treatment Receipt and Survival after Genomic Tumor Testing.

Emerging cancer treatments are often most available to socially advantaged individuals. This study examines the relationship of patient educational attainment, income level, and rurality to the receipt of genome-matched treatment (GMT) and overall survival. Survey and clinical data were collected from patients with cancer (n = 1258) enrolled in the Maine Cancer Genomics Initiative. Logistic regression models examined whether receipt of GMT differed by patient education, income, and rurality. Kaplan-Meier curves and Cox regression were conducted to evaluate 12-month mortality. We completed additional exploratory analyses using Kaplan-Meier curves and Cox models stratified by receipt of GMT. Both logistic and Cox regression models were adjusted for age and gender. Educational attainment, income level, and rurality were not associated with GMT receipt. Of 1258 patients, 462 (36.7%) died within 365 days of consent. Mortality risk was associated with lower educational attainment (hazard ratio (HR): 1.30; 95% CI: 1.06 to 1.59; p = .013). No statistically significant differences in mortality risk were observed for income level or rurality. Exploratory models suggest that patients who did not receive GMT with lower educational attainment had higher mortality risk (HR = 1.36, 95% CI: 1.09 to 1.69, p = .006). For patients who did receive GMT, there was no difference in mortality risk between the education groups (HR: 1.01, 95% CI: 0.56 to 1.81, p > .9). While there were no disparities in who received GMT, we found a disparity in mortality associated with education level, which was more pronounced for patients who did not receive GMT. Future research is warranted to investigate the intersectionality of social disadvantage with clinical outcomes to address survival disparities.

Unveiling the female experience through adult mortality and survivorship in Milan over the last 2000 years

This study challenges historical paradigms using a large-scale integrated bioarchaeological approach, focusing on the female experience over the last 2,000 years in Milan, Italy. Specifically, 492 skeletons from the osteological collection of Milan were used to elucidate female survivorship and mortality by integrating bioarchaeological and paleopathological data, paleoepidemiological analyses, and historical contextualization. Findings revealed changes in female longevity, with a notable increase from Roman to contemporary eras, albeit plateauing in the Middle Ages/modern period. Significant sex-specific differences in mortality risk and survivorship were observed: females had higher mortality risk and lower survivorship in the Roman (first-fifth century AD) and Modern (16th-18th century AD) eras, but this trend reversed in the contemporary period (19th-20th century AD). Cultural and social factors negatively impacted female mortality in Roman and modern Milan, while others buffered it during the Middle Ages (sixth-15th century AD). This study underscored the importance of bioarchaeological inquiries in reconstructing the past, providing answers that may challenge historical assumptions and shedding light on how the interplay of cultural, social, and biological factors shaped the female experience across millennia.

WP3.12 - The influence between frailty, sarcopenia and physical status on mortality in patients undergoing emergency laparotomy

Abstract Aims Frailty and sarcopenia predict mortality in emergency laparotomy (EmLap) and both can be indicative of poor physical status. We aim to assess the prevalence of frailty, sarcopenia and physical status in EmLap and explore the relationship between these factors and 30-day, 90-day and 1-year mortality. Methods Retrospective analysis was performed on two Emergency Laparotomy and Laparoscopic Scottish Audit (ELLSA) databases (2017-2019) which included patients ≥18years. Clinical frailty scale was used to classify frailty (score ≥4 as frail). Sarcopenia was assessed via total psoas index. Poor physical status (PPS) was defined by American Society of Anaesthesiologists physical status classification (ASA)≥4. One-way ANOVA and logistic regression were used for statistical analysis. Results 215 patients were included with 57.2% female and median age of 64years. Frailty was present in 17.2%, sarcopenia in 25.1% and 14.5% had PPS; 3.3% had all three factors. Frail patients had significantly higher risk for 30-day (p=0.003), 90-day (p=0.006) and 1-year mortality (p=0.032). Sarcopenic patients did not show significant differences in mortality risks up to 1 year. Patients with PPS had significantly higher mortality rates at 30-day (p&amp;lt;0.001), 90-day (p&amp;lt;0.001) and 1-year (p=0.001). Patients with all three factors had higher 30-day (p&amp;lt;0.001), 90-day (p=0.005) and 1-year mortality (p=0.049) than patients who have none of the factors. Conclusions Frailty, sarcopenia and PPS are prevalent in EmLap. Frailty and PPS were independently associated with short and long-term mortality but not sarcopenia. While overlap exists between frailty, sarcopenia and PPS, more studies are required to understand the complex interplay.

All-cause and cause-specific mortality risk among men and women with hepatitis C virus infection.

Hepatitis C virus (HCV) infection affects men and women differently, yet few studies have investigated sex differences in long-term mortality risk among the HCV-infected population. We conducted a population-based study to elucidate all-cause and cause-specific mortality among men and women with HCV infection. The study population consisted of adult participants from the 1999-2018 National Health and Nutrition Examination Survey, including 945 HCV-infected and 44,637 non-HCV-infected individuals. HCV infection was defined as either HCV seropositivity or detectable HCV RNA. Participants were followed until the date of death or December 31, 2019, to determine survival status. The HCV-infected population, both male and female, tended to be older, more likely to be Black, single, have lower income, lower BMI, higher prevalence of hypertension, and were more likely to be current smokers. During a median follow-up of 125.0 months, a total of 5,309 participants died, including 1,253 deaths from cardiovascular disease (CVD) and 1,319 deaths from cancer. The crude analysis showed that the risk of death from all causes and from cancer, but not from CVD, was higher in the HCV-infected population. After adjusting for potential confounders, we found that both HCV-infected men (HR 1.41, 95% CI 1.10-1.81) and women (HR 2.03, 95% CI 1.36-3.02) were equally at increased risk of all-cause mortality compared to their non-HCV infected counterparts (p for interaction > 0.05). The risk of cancer-related mortality was significantly increased in HCV-infected women (HR 2.14, 95% CI 1.01-4.53), but not in men, compared to non-HCV-infected counterparts. Among HCV-infected population, there was no difference in the risks of all-cause, CVD-related, or cancer-related death between men and women. Both men and women with HCV infection had an increased risk of death from all causes compared to their non-HCV infected counterparts, but we did not observe a significant sex difference.

The Relationship Between Age and 30-Day Outcomes Following Unicompartmental Versus Total Knee Arthroplasty

BackgroundAn enhanced understanding of the short-term complication profile following unicompartmental knee arthroplasty (UKA) versus total knee arthroplasty (TKA) can improve surgical decision-making and subsequent patient outcomes. This study aimed to determine if the difference in risk of 30-day morbidity and mortality between UKA and TKA varied as a function of patient age. MethodsThis retrospective study of a national quality improvement database using data from 2014 to 2020 included 403,342 patients undergoing UKA (n = 12,324) or TKA (n = 391,018). A generalized additive model (GAM) evaluated non-linear relationships between primary outcome and predictors (age, procedure type, and procedure type x age interaction) using a 1:5 UKA to TKA matched sample. Probabilities and odds ratios (95% CI [confidence interval]) estimated the relative risk of complications across the age spectrum. ResultsIn the GAM, TKA patients relative to UKA had 1.30 higher odds (95% CI 1.19 to 1.43, P < 0.001) of 30-day morbidity and mortality. There was a significant, non-linear relationship between age and the primary outcome (P = 0.02), such that the odds were lowest at younger ages. They increased slowly until about age 65 years, at which point the slope became steeper. The interaction terms for age and procedure type were not significant (P = 0.30). The 30-day probability for short-term complications of a 65-, 75-, and 85-year-old undergoing UKA was 2.1% (95% CI, 1.8 to 2.3), 2.4% (95% CI, 2.0 to 2.8), and 3.2% (95% CI, 2.3 to 4.1), respectively. Conversely, the probability of a 65-, 75-, and 85-year-old undergoing TKA was 2.9% (95% CI, 2.7 to 3.0), 3.6% (95% CI, 3.3 to 3.8), and 5.5% (95% CI, 4.7 to 6.3). ConclusionsPatients undergoing UKA had a quantifiable lower likelihood of morbidity or mortality than TKA at all ages. These data can provide individualized risk for UKA and TKA across the age spectrum and could be helpful in counseling patients regarding their risk for perioperative complications.