Highest Quintile Research Articles

Interaction of serum uric acid with overweight on hypertension: findings from the China Health and Nutrition Survey

BackgroundBoth serum uric acid (SUA) levels and body mass index (BMI) are recognized as important risk factors for hypertension. The current study aimed to investigate the interaction effects between SUA levels and overweight (defined as BMI ≥ 24 kg/m2 in Chinese) on the incidence of hypertension among Chinese adults.Methods1124 hypertensive participants and 7283 non-hypertensive participants, extracted from the China Health and Nutrition Survey (CHNS), were analyzed. Participants were categorized based on their SUA levels and BMI, to investigate the interaction effects between SUA levels and overweight on hypertension.ResultsIn comparison with the reference group (BMI < 24 kg/m2 and in the 1st quintile of SUA), multivariable adjusted analysis demonstrated that the odds ratio (OR) (95% confidence interval, 95% CI) of hypertension for participants with overweight alone was 2.18 (1.41–3.37); for elevated SUA levels alone, the ORs (95% CIs) were 1.57 (1.08–2.30), 1.84 (1.24–2.74), 2.21 (1.47–3.32), and 2.48 (1.55–3.96) across SUA quintiles; and for the combined effect of higher SUA levels and overweight, the ORs (95% CIs) were 3.25 (2.19–4.82), 3.73 (2.51–5.55), 5.17 (3.42–7.80), and 6.21 (4.01–9.60). The relative excess risk due to interaction (RERI) was 3.26 (1.43–5.09) at the 5th quintile of SUA, indicating the presence of additive interaction between overweight and SUA levels on hypertension.ConclusionInteraction between SUA levels and overweight on hypertension exists specifically at the highest quintile (Q5, > 6.39 mg/dL) of SUA among Chinese adults. Therefore, strategies to lower SUA levels could be considered as a potential approach to mitigate hypertension risk in overweight individuals within this specific subgroup.

Remnant cholesterol and cardiovascular and all-cause mortality in Korean adults

Abstract Background Although previous studies have reported that remnant cholesterol (RC) is associated with cardiovascular disease, studies on RC and various mortality related outcomes including cardiovascular mortality in the general population are scarce and most of them are limited to Western populations. Purpose This study aims to evaluate the effect of RC on mortality related outcomes in a relatively young and middle-aged Korean population. Methods This cohort study included 268,219 subjects (mean age, 38 years and 50.6% men) who were enrolled in the Kangbuk Samsung Health Study between 2003 and 2016. Fasting RC was calculated as total cholesterol minus high-density lipoprotein cholesterol minus low-density lipoprotein cholesterol (LDLC). Results The median RC was 0.47 mmol/L (18 mg/dL) and the prevalence of ≥ 1 mmol/L RC was 11.4%. During the median FU of 6.7 years, high RC (RC ≥ 0.47 mmol/L) significantly increased the risk of multivariable-adjusted cardiovascular mortality compared with low RC (HR[95% CI], 1.43[1.07, 1/93]). Compared with the lowest quintile (RC &amp;lt;0.31 mmol/L), the HRs for cardiovascular mortality were 1.95[0.78, 4.84], 2.47[1.03, 5.91], 2.39[1.00, 5.72], and 2.84[1.19, 6.78] in the second, third, fourth, and highest quintiles, respectively. The HRs for all-cause mortality in the 3rd, 4th, and highest quintiles remained significant (1.24[0.97, 1.59], 1.38[1.08, 1.76], 1.34[1.05, 1/71], and 1.32[1.03, 1.69] in the 2nd, 3rd, 4th, and highest quintiles, respectively). However, there was no significant risk for cancer mortality between RC quintiles. Notably, subgroup analysis showed that individuals with high RC and high hsCRP and high RC and high lipoprotein(a) had a more than twofold and threefold increased risk of cardiovascular mortality, respectively, compared with low RC and low hsCRP and low RC and low lipoprotein(a). Conclusions High RC was significantly associated with increased risk of cardiovascular and all-cause mortality, but not with cancer mortality. In particular, high hsCRP and high lipoprotein(a) weighted the risk association between high RC and cardiovascular mortality.

The association between endogenous erythropoietin levels and the risk of heart failure in a Chinese community-based population

Abstract Background Patients with heart failure (HF) often have elevated endogenous erythropoietin (EPO) levels, which are associated with disease severity and prognosis. Previous studies have indicated that in the special population elevated endogenous EPO levels are associated with HF and cardiovascular death. However, whether endogenous EPO levels are associated with the risk of HF in the general population remains to be elucidated. Purpose Our study aims to investigate the association between endogenous EPO levels and the risk of HF admission in the general population. Methods We conducted a prospective cohort study on subjects from a Beijing community in China who had no history of stroke or myocardial infarction. Endogenous EPO levels were measured at baseline for all participants. The endpoint of interest was admission with HF. Cox proportional hazard regression models were used to analyze the relationship between endogenous EPO levels and the occurrence of the endpoint. Results A total of 4870 participants were included. Among all participants, the mean (±SD) age was 56.72 ± 8.78 years, with 1802 (37.0%) being men. The median (interquartile range, IQR) EPO level was 13.19 (9.47-18.20) IU/L. During a mean 9.57-year follow-up, a total of 176 (3.6%) subjects experienced heart failure. Subjects were grouped in quintiles according to baseline endogenous EPO levels. Higher and lower endogenous EPO levels were both associated with increased risk of HF (Figure 1A). The Kaplan–Meier curves showed significant differences in cumulative hazards of heart failure among EPO quintiles (log-rank test: P＜0.05) (Figure 1B). After adjusting for covariates, including demographics, traditional risk factors for cardiovascular disease, renal function, and hemoglobin levels, and using the middle quintile (Q3) (11.72-14.94IU/L) of EPO levels as a reference, we found that the highest quintile (Q5) (&amp;gt;19.86 IU/L) was associated with a 159% increased risk of HF admission (HR 2.59, 95% CI 1.57-4.28, P = 0.0002). Similarly, the lowest quintile (Q1) (&amp;lt;8.66 IU/L) was associated with a 94% increased risk (HR 1.94, 95% CI 1.11-3.41, P = 0.0210) (Table 1). Conclusion There exists a "U-shaped" relationship between endogenous EPO levels and HF admission in the general population. Both higher and lower endogenous EPO levels were associated with an increased risk of HF admission in the community population. These findings differ from previous studies, so further research may be needed to explore the underlying pathophysiological mechanisms of endogenous EPO and HF.

International and internal migration and the subjective wellbeing of wives left behind in Ghana

AbstractHusbands' labour migration has ramifications for significant family members, particularly wives left behind. However, limited studies have been conducted to examine the impacts of husbands' migration on women left behind married to international and internal migrants. Drawing on a purposive sampling survey of 298 Ghanaian women (international = 129 and internal = 169) in the Volta Region, we assessed their subjective wellbeing using three dimensions: self‐reported health, self‐reported satisfaction with life, and self‐reported happiness. The results from t‐tests show that on average, international women left behind have higher perceived health (3.72), perceived happiness (3.82) and satisfaction with life (3.19). Results from the multivariable binary logistic regression analyses reveal that while no variables predict self‐reported health for international women left behind, high frequency of communication is statistically associated with internal women left behind self‐assessed health. International women left behind who lived in nuclear households and internal women left behind who reported high wealth quintiles were both statistically associated with satisfaction with life, respectively. While demographic factors (age and duration of marriage) were significant predictors of happiness for international women left behind, neighbourhood type and frequency of communication predicted happiness for internal women left behind. The differences in variables predicting each of the subjective wellbeing dimensions demonstrate the concept's multidimensionality. It also highlights factors influencing subjective wellbeing outcomes of women left behind are not solely due to their husbands' migration. The policy implications of this study are highlighted.

Association between acute tobacco exposure and fractional exhaled nitric oxide in patients with chronic obstructive pulmonary disease: National health and Nutrition Examination Survey (NHANES) 2007–2012

BackgroundFractional exhaled nitric oxide (FeNO) is a marker of type 2 airway inflammation. Tobacco exposure can lower FeNO levels. However, the effect of acute tobacco exposure on FeNO in patients with chronic obstructive pulmonary disease (COPD) is unclear. This study aimed to investigate the relationship of acute tobacco exposure with FeNO and eosinophils in COPD patients. MethodsThis retrospective cohort study included 445 patients with COPD based on the 2007–2012 National Health and Nutrition Examination Survey. Serum cotinine levels were examined to assess environmental tobacco smoke exposure. The patients were divided into five groups based on cotinine levels: Q1 (first quintile), Q2 (second quintile), Q3 (third quintile), Q4 (fourth quintile) and Q5 (fifth quintile). Logistic regression models and linear logistic regression models were used to evaluate the relationship between serum cotinine and FeNO and EOS levels. ResultsApproximately 16.5 % (75/445) of the participants had elevated FeNO (>25 bbp). In the unadjusted model, COPD patients with the lowest quintile of serum cotinine levels (0.011–0.0185 ng/mL) had higher FeNO levels compared to those with the highest quintile (≥309 ng/mL) (odds ratios (OR), 5.86 [2.11–16.20]). These findings remained consistent even after adjusting for covariates of demographics, lifestyle, diabetes, coronary heart disease, tumours, hypertension, using oral or inhaled steroids within 2 days, asthma and respiratory symptoms within 7 days. Furthermore, a standard deviation increase of ln-transformed cotinine levels was associated with decreased FeNO levels (OR, 0.45 [0.33, 0.60]). No significant correlation was observed betweenserum cotinine and blood eosinophils. After high extents of tobacco exposure, no correlation was found between FeNO and eosinophils.Our findings indicate that high cotinine levels are associated with decreased FeNO in COPD patients but not with blood eosinophils. This reveals that smoking may affect FeNO levels in patients with COPD, whereas it does not appear to influence blood eosinophil levels.

Who pays to treat malaria, and how much? Analysis of the cost of illness, equity, and economic burden of malaria in Uganda.

Case management of malaria in Africa has evolved markedly over the past twenty years and updated cost estimates are needed to guide malaria control policies. We estimated the cost of malaria illness to households and the public health service and assessed the equity of these costs in Uganda. From December 2021 to May 2022, we conducted a costing exercise in eight government-run health centres covering seven sub-regions, collecting health service costs from patient observations, records review, and a time-and-motion study. From November 2021 to January 2022, we gathered data on households' cost of illness from randomly selected households for 614 residents with suspected malaria. Societal costs of illness were estimated and combined with secondary data sources to estimate the total economic burden of malaria in Uganda. We used regression analyses and concentration curves to assess the equity of household costs across age, geographic location, and socio-economic status. The mean societal economic cost of treating suspected malaria was $15.12 (95%CI: 12.83-17.14) per outpatient and $27.21 (95%CI: 20.43-33.99) per inpatient case. Households incurred 81% of outpatient and 72% of inpatient costs. Households bore nearly equal costs of illness, regardless of socio-economic status. A case of malaria cost households in the lowest quintile 26% of per capita monthly consumption, while a malaria case only cost households in the highest quintile 8%. We estimated the societal cost of malaria treatment in Uganda was $577 million (range: $302 million-1.09 billion) in 2021. The cost of malaria remains high in Uganda. Households bear the major burden of these costs. Poorer and richer households incur the same costs per case; this distribution is equal, but not equitable. These results can be applied to parameterize future economic evaluations of malaria control interventions and to evaluate the impact of malaria on Ugandan society, informing resource allocations in malaria prevention.

12374 A Prospective Study Of Plasma Levels Of Asprosin And Incident Type 2 Diabetes Among Postmenopausal Women In The Women’s Health Initiative

Abstract Disclosure: B. Yang: None. J. Li: None. E.S. Silva: None. L.S. Phillips: None. J.E. Manson: None. A.P. Reiner: None. A.R. Chopra: None. S. Liu: None. Background: Asprosin, a 30-kDa hormone identified from white adipose tissue, has been shown to play key roles in regulating hepatic glucose release and appetite stimulation. Despite an increasing body of experimental studies demonstrating asprosin as a promising therapeutic target, little is known about its distribution in the general population particularly concerning its association with incident type 2 diabetes (T2D). Objectives: To evaluate whether higher plasma levels of asprosin are associated with incident T2D among postmenopausal women independently of known risk factors for T2D. Methods: We conducted a case-control study nested in the Women’s Health Initiative (WHI), including 5,198 participants free of diabetes, cardiovascular diseases, and cancer at baseline (2,602 incident T2D cases and 2,596 controls). Plasma levels of asprosin were measured using a sandwich enzyme-linked immunosorbent (ELISA) assay. We used conditional logistic regression models to estimate the association between asprosin and T2D risk with adjustment for matching variables (age, race, sampling batch), education, body mass index (BMI), physical activity, tobacco smoking, alcohol drinking, family history of diabetes, age at menopause, total energy intake, the Alternate Healthy Eating Index (AHEI), and multivitamin use. Results: Approximately 43% of participants were white and the mean age at baseline was 63 years. The median plasma levels of asprosin were 38 (IQR: 30, 50) pmoL/L in the controls and 39 (IQR: 31, 50) pmoL/L among those who developed T2D during follow-up. Compared with the participants in the lowest quintile of plasma levels of asprosin at baseline, those in the highest quintile had a 26% increased risk of T2D (adjusted odds ratio: OR: 1.26 [95% CIs, 1.01, 1.57], p for trend=0.03) in the fully adjusted model. The OR estimates exhibited a large variation across race and BMI, although there was a linear dose-response relation between levels of asprosin and T2D risk (p for nonlinear=0.44). Genetic analysis revealed that women with the heterozygous allele (CG) at single nucleotide polymorphisms (SNP) rs56407701 had higher levels of asprosin compared to women with the homozygous reference allele (CC). Further, Mendelian Randomization analysis revealed that genetically predicted asprosin levels were associated with higher T2D risk. Conclusion: Among postmenopausal women, higher plasma levels of asprosin were prospectively associated with elevated T2D risk independent of known T2D risk factors. Further work is needed to confirm the potential causal role of this peptide hormone in the clinical risk stratification and potential prevention of T2D. Presentation: 6/2/2024

Ultra-processed food intake in toddlerhood and mid-childhood in the UK: cross sectional and longitudinal perspectives.

(i) Characterize ultra-processed food (UPF) intakes in toddlerhood and mid-childhood, including identifying principal UPF sub-groups and associations with nutrient profile; (ii) explore stability and change in UPF intake between toddlerhood and mid-childhood. Data were from children in the UK Gemini twin cohort at 21 months (n = 2,591) and 7 years (n = 592) of age. UPF intakes were estimated using diet diaries and Nova classification. Complex samples general linear or logistic regression models were used to explore associations between UPF intake, UPF sub-groups and nutrients, and changes in intake over time. The contribution of UPF to total energy was 46.9% (± 14.7) at 21 months and 59.4% (± 12.5) at 7 years. Principal UPF sub-groups were yogurts, higher-fiber breakfast cereals, and wholegrain breads in toddlerhood, and puddings and sweet cereal products and white breads in mid-childhood. At both ages, mean free sugar and sodium intakes exceeded recommended maximums and higher UPF consumption was associated with consuming more of each nutrient (P < 0.001). UPF intake was negatively associated with fat, saturated fat and protein intake in toddlerhood, and fiber intake in mid-childhood (P < 0.001). Being in the highest UPF intake quintile in toddlerhood was predictive of being in the highest quintile in mid-childhood (OR 9.40, 95%CI 3.94-22.46). UPF accounted for nearly half of toddlers' energy, increasing to 59% in mid-childhood. Higher UPF consumers had higher intakes of free sugar and sodium. UPF intake in toddlerhood was predictive of mid-childhood intake. Effective policies are needed to reduce UPF intakes in the early years.

Global, regional, and national trends in the burden of breast cancer among individuals aged 70 years and older from 1990 to 2021: an analysis based on the global burden of disease study 2021

BackgroundBreast cancer poses a substantial health challenge for the world’s over-70 population. However, data on the impact and epidemiology of breast cancer in this age group are limited. We aimed to evaluate global, regional, and national breast cancer trends among those aged 70 and older between 1990 and 2021.MethodsIn this trend analysis based on the 2021 Global Burden of Diseases (GBD), we report on the incidence rates and Global Burden of Diseases (GBD) disability-adjusted life years (DALYs) counts, as well as the incidence rates per 100,000 individuals and average annual percentage changes (AAPCs) for breast cancer among individuals aged 70 and above at the global, regional, and national levels. We analyzed these global trends by age, sex, and socio-developmental index (SDI). Joinpoint regression elucidates pivotal trend shifts.ResultsFrom 1990 to 2021, the global incidence of breast cancer in the over-70 population modestly increased from 104 to 107 per 100,000, with significant trend changes in 1995, 2005, and 2018. Regionally, High-income North America had the highest incidence in 2021, while North Africa and the Middle East saw the steepest rise in incidence and DALYs. The only decrease was in the High SDI quintile. The 70–74 age group experienced the largest increase globally, with rates rising from 86.3 to 90 per 100,000 (AAPC 0.27).ConclusionFrom 1990 to 2021, global breast cancer incidence in the over-70 population saw a slight uptick, contrasted by a significant reduction in DALYs, likely due to progress in endocrine and targeted therapies. This underscores the critical need for enhanced screening and personalized treatments for older patients.

Canadian Dietary Intakes Assessed by Nutrient Profiling Models and Association with Mortality and Cardiovascular Disease.

Purpose: Nutrient profiling (NP) ranks foods according to nutritional composition and underpins policies (e.g.,front-of-package (FOP) labelling). This study aimed to evaluate Canadian adults' dietary intakes using proposed Canadian FOP "high-in" labelling thresholds and international NP models (i.e.,Ofcom, FSANZ, and Nutri-Score) and examine the association between intakes using international NP models and all-cause mortality and cardiovascular disease (CVD).Methods: Intakes from the Canadian Community Health Survey-Nutrition (CCHS-Nutrition) 2004 and 2015 were given NP scores and assessed against FOP thresholds. CCHS-Nutrition 2004 was linked with death records (Canadian Vital Statistics Database, n = 6767) and CVD incidence and mortality (hospital Discharge Abstract Database, n = 6420) until December 2017.Results: Foods that would require FOP labels, should there be such regulation in Canada, contributed 38% of calories. Association between NP scores and mortality was significant for Ofcom, FSANZ, and Nutri-Score (hazard ratio (HR) in highest quintile (lowest quality): 1.73, 95%CI [1.20-2.49], 1.59[1.15-2.21], and 1.75[1.18-2.59], respectively), and for CVD incidence, among males (HR in highest quintile: 2.11[1.15-3.89], 1.74[1.07-2.84], and 2.29[1.24-4.24], respectively).Conclusions: Canadians had moderately healthy intakes. NP systems could discriminate between low and high dietary quality such that adults with the lowest diet quality were more likely to experience all-cause mortality and CVD events (for males).

Overall glycaemic index and dietary glycaemic load and all-cause and cause-specific mortality in women from the Mexican Teachers' Cohort.

Previous studies have found direct associations between glycaemic index (GI) and glycaemic load (GL) with chronic diseases. However, this evidence has not been consistent in relation to mortality, and most data regarding this association come from high-income and low-carbohydrate-intake populations. The aim of this study was to evaluate the association between the overall GI and dietary GL and all-cause mortality, CVD and breast cancer mortality in Mexico. Participants from the Mexican Teachers' Cohort (MTC) study in 2006-2008 were followed for a median of 10 years. Overall GI and dietary GL were calculated from a validated FFQ. Deaths were identified by the cross-linkage of MTC participants with two national mortality registries. Cox proportional hazard models were used to estimate the impact of GI and GL on mortality. We identified 1198 deaths. Comparing the lowest and highest quintile, dietary GI and GL appeared to be marginally associated with all-cause mortality; GI, 1·12 (95 % CI: 0·93, 1·35); GL, 1·12 (95 % CI: 0·87, 1·44). Higher GI and GL were associated with increased risk of CVD mortality, GI, 1·30 (95 % CI: 0·82, 2·08); GL, 1·64 (95 % CI: 0·87, 3·07) and with greater risk of breast cancer mortality; GI, 2·13 (95 % CI: 1·12, 4·06); GL, 2·43 (95 % CI: 0·90, 6·59). It is necessary to continue the improvement of carbohydrate quality indicators to better guide consumer choices and to lead the Mexican population to limit excessive intake of low-quality carbohydrate foods.

Global burden of benign prostatic hyperplasia, urinary tract infections, urolithiasis, bladder cancer, kidney cancer, and prostate cancer from 1990 to 2021

BackgroundThe burden of common urologic diseases, including benign prostatic hyperplasia (BPH), urinary tract infections (UTI), urolithiasis, bladder cancer, kidney cancer, and prostate cancer, varies both geographically and within specific regions. It is essential to conduct a comprehensive and precise assessment of the global burden of urologic diseases.MethodsWe obtained data on incidence, prevalence, mortality, and disability-adjusted life-years (DALYs) for the aforementioned urologic diseases by age, sex, location, and year from the Global Burden of Disease (GBD) 2021. We analyzed the burden associated with urologic diseases based on socio-demographic index (SDI) and attributable risk factors. The trends in burden over time were assessed using estimated annual percentage changes (EAPC) along with a 95% confidence interval (CI).ResultsIn 2021, BPH and UTI were the leading causes of age-standardized incidence rate (ASIR) and age-standardized prevalence rate (ASPR), with rates of 5531.88 and 2782.59 per 100,000 persons, respectively. Prostate cancer was the leading cause of both age-standardized mortality rate (ASMR) and age-standardized DALYs rate (ASDR), with rates of 12.63 and 217.83 per 100,000 persons, respectively. From 1990 to 2021, there was an upward trend in ASIR, ASPR, ASMR, and ASDR for UTI, while urolithiasis showed a downward trend. The middle and low-middle SDI quintile levels exhibited higher incidence, prevalence, mortality, and DALYs related to UTI, urolithiasis, and BPH, while the high and high-middle SDI quintile levels showed higher rates for the three cancers. The burden of these six urologic diseases displayed diverse age and sex distribution patterns. In 2021, a high body mass index (BMI) contributed to 20.07% of kidney cancer deaths worldwide, while smoking accounted for 26.48% of bladder cancer deaths and 3.00% of prostate cancer deaths.ConclusionsThe global burden of 6 urologic diseases presents a significant public health challenge. Urgent international collaboration is essential to advance the improvement of urologic disease management, encompassing the development of effective diagnostic screening tools and the implementation of high-quality prevention and treatment strategies.

Neighborhood-level sociodemographics and kindergarten children’s developmental vulnerability, pre- and post-COVID-19 in Canada

A child’s environment and early life experiences play an important role in shaping their development. The COVID-19 pandemic altered many aspects of everyday life for young children in Canada, and it has been argued that these changes did not impact all children equally. The current study explored the association between early child development and neighborhood sociodemographic indices (e.g., income, deprivation) before and after the onset of the COVID-19 pandemic. The Early Development Instrument (EDI) data, measuring child development and school readiness in kindergarten, were collected in 7 Canadian provinces and 1 territory from 2017-2020 (pre-COVID) and 2020-2023 (post-COVID) and were linked with neighborhood-level socioeconomic indices from 2016. We compared the gradients in development in a pre- (n=293,700) and a post-COVID (n=246,305) cohort of Canadian children. Rates of developmental vulnerability, as measured by the EDI, were examined for the sociodemographic variables in both the pre- and post-COVID cohorts. The overall vulnerability increased nationally from 27.3% in the pre- to 28.0% in the post-COVID cohort. A gradient in vulnerability rates for all the socioeconomic indices was found, with children in the highest quintiles, representing greater deprivation, having greater odds of being vulnerable than their peers in the lowest, least deprived quintile. Contrary to expectation, the magnitude of the gradient was very similar in both cohorts, with some jurisdictional differences. The largest gradient was found for average neighborhood income. These findings add the context of social determinants of health to the understanding of the impact of the COVID-19 pandemic on young children.

Retroperitoneal vs transperitoneal approach for nonruptured open conversion after endovascular aneurysm repair

ObjectiveSeveral studies comparing the transperitoneal (TP) and retroperitoneal (RP) approach for abdominal aortic aneurysm (AAA) repair suggest that the RP approach may result in lower rates of perioperative mortality and morbidity. However, data comparing these approaches for open conversion are lacking. This study aims to evaluate the association between the type of approach and outcomes following open conversion after endovascular aneurysm repair (EVAR). MethodsWe included all patients who underwent open conversion after EVAR between 2010 and 2022 in the Vascular Quality Initiative. Patients presenting with rupture were excluded. The primary outcome was perioperative mortality. The secondary outcomes included perioperative complications and 5-year mortality. Inverse probability weighting was used to adjust for factors with statistical or clinical significance. Logistic regression was used to assess perioperative mortality and complications in the weighted cohort. The 5-year mortality was evaluated using Kaplan-Meier and Cox regression. ResultsWe identified 660 patients (39% RP) who underwent open conversion after EVAR. Compared with TP, RP patients were older (75 years [interquartile range, 70-79 years] vs 73.5 years [interquartile range, 68-79 years]; P < .001), and more frequently had prior myocardial infarction (33% vs 22%; P = .002). Compared with the TP approach, the RP approach was used less frequently in cases of associated iliac aneurysm (19% vs 27%; P = .026), but more frequently with associated renal bypass (7.8% vs 1.7%; P < .001) and by high-volume physicians (highest quintile, >7 AAA annually: 41% vs 17%; P < .001) and in high-volume centers (highest quintile, >35 AAA annually: 36% vs 20%; P < .001). RP patients, compared with TP patients, were less likely to have external iliac or femoral distal anastomosis (8.2% vs 21%; P < .001), and an infrarenal clamp (25% vs 36%; P < .001). Unadjusted perioperative mortality was not significantly different between approaches (RP vs TP: 3.8% vs 7.5%; P = .077). After risk adjustment, RP patients had similar odds of perioperative mortality (adjusted odds ratio [aOR], 0.49; 95% confidence interval [CI], 0.22-1.10; P = .082), and lower odds of intestinal ischemia (aOR, 0.26; 95% CI, 0.08-0.86; P = .028) and in-hospital reintervention (aOR, 0.43; 95% CI, 0.22-0.85; P = .015). No significant differences were found in the other perioperative complications or 5-year mortality (aHR, 0.79; 95% CI, 0.47-1.32; P = .37). ConclusionsOur findings suggest that the RP approach may be associated with a lower adjusted odds of perioperative complications compared with the TP approach. The RP approach should be considered for open conversion after EVAR when feasible.

Hospital volume does not mitigate the impact of area socioeconomic deprivation on heart transplantation outcomes.

While structural socioeconomic inequity has been linked with inferior health outcomes, some have postulated reduced access to high-quality care to be the mediator. We assessed whether treatment at high-volume centers(HVC) would mitigate the adverse impact of area deprivation on heart transplantation(HT) outcomes. All HT recipients ≥18years were identified in the 2005-2022 Organ Procurement and Transplantation Network. Neighborhood socioeconomic deprivation was assessed using the previously validated Area Deprivation Index. Recipients with scores in the highest quintile were considered Most Deprived (others: Less Deprived). Hospitals in the highest quartile by cumulative center volume (≥21 transplants/year) were classified as HVC. The primary outcome was post-transplant survival. Of 38,022 HT recipients, 7,579 (20%) were considered Most Deprived. Following risk adjustment, Most Deprived demonstrated inferior survival at 3(hazard ratio[HR] 1.14, 95%confidence interval[CI] 1.06-1.21) and 5 years following transplantation (HR 1.13, CI 1.07-1.20). Similarly, Most Deprived faced greater graft failure at 3(HR 1.14, CI 1.06-1.22) and 5 years (HR 1.13, CI 1.07-1.20). Evaluating patients transplanted at HVC, Most Deprived continued to face greater mortality at 3(HR 1.10, CI 1.01-1.21) and 5 years (HR 1.10, CI 1.01-1.19). The interaction between Most Deprived status and care at HVC was not significant, such that transplantation at HVC did not ameliorate the survival disparity between Most and Less Deprived. Area socioeconomic disadvantage is independently associated with inferior survival. Transplantation at HVC did not eliminate this inequity. Future efforts are needed to increase engagement with longitudinal follow-up care and address systemic root causes to improve outcomes.

Association of early blood-based biomarkers and six-month functional outcomes in conventional severity categories of traumatic brain injury: capturing the continuous spectrum of injury

Traumatic brain injury is conventionally categorised as mild, moderate, or severe on the Glasgow Coma Scale (GCS). Recently developed biomarkers can provide more objective and nuanced measures of the extent of brain injury. Exposure-response relationships were investigated in 2479 patients aged ≥16 enrolled in the Collaborative European NeuroTrauma Effectiveness Research in Traumatic Brain Injury (CENTER-TBI) prospective observational cohort study. Neurofilament protein-light (NFL), ubiquitin carboxy-terminal hydrolase L1 (UCH-L1), and glial fibrillary acidic protein (GFAP) were assayed from serum sampled in the first 24h; concentrations were divided into quintiles within GCS severity groups. Relationships with the Glasgow Outcome Scale-Extended were examined using modified Poisson regression including age, sex, major extracranial injury, time to sample, and log biomarker concentration as covariates. Within severity groups there were associations between biomarkers and outcomes after adjustment for covariates: GCS 13-15 and negative CT imaging (relative risks [RRs] from 1.28 to 3.72), GCS 13-15 and positive CT (1.21-2.81), GCS 9-12 (1.16-2.02), GCS 3-8 (1.09-1.94). RRs were associated with clinically important differences in expectations of prognosis. In patients with GCS 3 (RRs 1.51-1.80) percentages of unfavourable outcome were 37-51% in the lowest quintiles of biomarker levels and reached 90-94% in the highest quintiles. Similarly, for GCS 15 (RRs 1.83-3.79), the percentages were 2-4% and 19-28% in the lowest and highest biomarker quintiles, respectively. Conventional TBI severity classification is inadequate and underestimates heterogeneity of brain injury and associated outcomes. The adoption of circulating biomarkers can add to clinical assessment of injury severity. European Union 7th Framework program (EC grant 602150), Hannelore Kohl Stiftung, One Mind, Integra LifeSciences, Neuro-Trauma Sciences, NIHR Rosetrees Trust.

Neighborhood greenness and long-term physical and psychosocial quality of life among prostate cancer survivors in the Health Professionals Follow-up Study

IntroductionNeighborhood greenness may benefit long-term prostate cancer survivorship by promoting physical activity and social integration, and reducing stress and exposure to air pollution, noise, and extreme temperatures. We examined associations of neighborhood greenness and long-term physical and psychosocial quality of life in prostate cancer survivors in the Health Professionals Follow-up Study. MethodsWe included 1437 individuals diagnosed with non-metastatic prostate cancer between 2008 and 2016 across the United States. Neighborhood greenness within a 1230m buffer of each individual's mailing address was measured using the Landsat satellite image-based Normalized Difference Vegetation Index (NDVI). We fit generalized linear mixed effect models to assess associations of greenness (in quintiles) with longitudinal patient reported outcome measures on prostate cancer-specific physical and psychosocial quality of life, adjusting for time-varying individual- and neighborhood-level demographic factors and clinical factors. ResultsThe greatest symptom burden was in the sexual domain. More than half of survivors reported good memory function and the lack of depressive signs at diagnosis. In fully adjusted models, cumulative average greenness since diagnosis was associated with fewer vitality/hormonal symptoms (highest quintile, Q5, vs lowest quintile, Q1: mean difference: 0.46, 95% confidence interval [CI]: 0.81, −0.12). Other domains of physical quality of life (bowel symptoms, urinary incontinence, urinary irritation, and sexual symptoms) did not differ by greenness overall. Psychosocial quality of life did not differ by greenness overall (Q5 vs Q1, odds ratio [95% CI]: memory function: 1.01 [0.61, 1.73]; lack of depressive signs: 1.10 [0.63, 1.95]; and wellbeing: 1.17 [0.71, 1.91]). ConclusionDuring long-term prostate cancer survivorship, cumulative average 1230m greenness since diagnosis was associated with fewer vitality/hormonal symptoms. Other domains of physical quality of life and psychosocial quality of life did not differ by greenness overall. Limitations included potential non-differential exposure measurement error and NDVI's lack of time-activity pattern.

Emergency Department Triage, Transfer Times, and Hospital Mortality of Patients Admitted to the ICU: A Retrospective Replication and Continuation Study.

This study aimed to provide new insights into the impact of emergency department (ED) to ICU time on hospital mortality, stratifying patients by academic and nonacademic teaching (NACT) hospitals, and considering Acute Physiology and Chronic Health Evaluation (APACHE)-IV probability and ED-triage scores. We conducted a retrospective cohort study (2009-2020) using data from the Dutch National Intensive Care Evaluation registry. Patients directly admitted from the ED to the ICU were included from four academic and eight NACT hospitals. Odds ratios (ORs) for mortality associated with ED-to-ICU time were estimated using multivariable regression, both crude and after adjusting for and stratifying by APACHE-IV probability and ED-triage scores. None. A total of 28,455 patients were included. The median ED-to-ICU time was 1.9 hours (interquartile range, 1.2-3.1 hr). No overall association was observed between ED-to-ICU time and hospital mortality after adjusting for APACHE-IV probability (p = 0.36). For patients with an APACHE-IV probability greater than 55.4% (highest quintile) and an ED-to-ICU time greater than 3.4 hours the adjusted OR (ORsadjApache) was 1.24 (95% CI, 1.00-1.54; p < 0.05) as compared with the reference category (< 1.1 hr). In the academic hospitals, the ORsadjApache for ED-to-ICU times of 1.6-2.3, 2.3-3.4, and greater than 3.4 hours were 1.21 (1.01-1.46), 1.21 (1.00-1.46), and 1.34 (1.10-1.64), respectively. In NACT hospitals, no association was observed (p = 0.07). Subsequently, ORs were adjusted for ED-triage score (ORsadjED). In the academic hospitals the ORsadjED for ED-to-ICU times greater than 3.4 hours was 0.98 (0.81-1.19), no overall association was observed (p = 0.08). In NACT hospitals, all time-ascending quintiles had ORsadjED values of less than 1.0 (p < 0.01). In patients with the highest APACHE-IV probability at academic hospitals, a prolonged ED-to-ICU time was associated with increased hospital mortality. We found no significant or consistent unfavorable association in lower APACHE-IV probability groups and NACT hospitals. The association between longer ED-to-ICU time and higher mortality was not found after adjustment and stratification for ED-triage score.

Neighborhood-Level Disparities in Hypertension Prevalence and Treatment Among Middle-Aged Adults

Hypertension in middle-aged adults (35-50 years) is associated with poorer health outcomes in late life. Understanding how hypertension varies by race and ethnicity across levels of neighborhood disadvantage may allow for better characterization of persistent disparities. To evaluate spatial patterns of hypertension diagnosis and treatment by neighborhood socioeconomic position and racial and ethnic composition. In this cross-sectional study of middle-aged adults in Cuyahoga County, Ohio, who encountered primary care in 2019, geocoded electronic health record data were linked to the area deprivation index (ADI), a neighborhood disadvantage measure, at the US Census Block Group level (ie, neighborhood). Neighborhoods were stratified by ADI quintiles, with the highest quintile indicating the most disadvantage. Data were analyzed between August 7, 2023, and June 1, 2024. Essential hypertension. The primary outcome was a clinician diagnosis of essential hypertension. Spatial analysis was used to characterize neighborhood-level patterns of hypertension prevalence and treatment. Interaction analysis was used to compare hypertension prevalence by racial and ethnic group within similar ADI quintiles. A total of 56 387 adults (median [IQR] age, 43.1 [39.1-46.9] years; 59.8% female) across 1157 neighborhoods, which comprised 3.4% Asian, 31.1% Black, 5.5% Hispanic, and 60.0% White patients, were analyzed. A gradient of hypertension prevalence across ADI quintiles was observed, with the highest vs lowest ADI quintile neighborhoods having a higher hypertension rate (50.7% vs 25.5%) and a lower treatment rate (61.3% vs 64.5%). Of the 315 neighborhoods with predominantly Black (>75%) patient populations, 200 (63%) had a hypertension rate greater than 35% combined with a treatment rate of less than 70%; only 31 of 263 neighborhoods (11.8%) comprising 5% or less Black patient populations met this same criterion. Compared with a spatial model without covariates, inclusion of ADI and percentage of Black patients accounted for 91% of variation in hypertension diagnosis prevalence among men and 98% among women. Men had a higher prevalence of hypertension than women across race and ADI quintiles, but the association of ADI and hypertension risk was stronger in women. Sex prevalence differences were smallest between Black men and women, particularly in the highest ADI quintile (1689 [60.0%] and 2592 [56.0%], respectively). These findings show an association between neighborhood deprivation and hypertension prevalence, with disparities observed particularly among Black patients, emphasizing a need for structural interventions to improve community health.

Association of ultraprocessed food consumption with risk of rheumatoid arthritis: a retrospective cohort study in the UK Biobank

BackgroundLimited studies explored the association between consumption of ultraprocessed food (UPF) and rheumatoid arthritis (RA). ObjectivesThis study aimed to examine the association between UPF consumption and RA risk and explore the potential mediating effects of RA-related biomarkers. MethodsThis retrospective cohort study included 207,012 participants without RA at recruitment and completed 24-h dietary recalls. UPF was defined based on the NOVA food classification system. Incident RA was ascertained using the International Classification of Diseases version 10. Cox regression models were used to examine the association between UPF consumption and the incidence of RA. Additionally, mediation analyses were conducted to evaluate the contribution of biomarkers related to the lipid profile, systemic inflammatory factors, serum liver enzymes, and glucose metabolism to the observed associations. ResultsThe participants’ mean (standard deviation [SD]) age at recruitment was 56.08 (7.95) y. During a median follow-up of 12.24 (interquartile range: 11.66–13.03) y, 1869 RA events were recorded. Compared with the lowest quintile of UPF consumption (weight percentage of the UPF), the adjusted hazard ratio (HR) of RA in the highest quintile was 1.17 (95% confidence interval (CI): 1.01, 1.36). There was a 6% elevated risk of RA incidence per SD increase in UPF intake (HR: 1.06; 95% CI: 1.01, 1.11). In the mediation analyses, the biomarkers explained 3.07%–14.80% of the association between UPF intake and RA. ConclusionsHigher UPF consumption was associated with an increased risk of RA, which may be mediated by inflammation, lipids, and liver enzymes. Lower UPF consumption is recommended to reduce RA incidence.