Linear Logistic Regression Models Research Articles

The association between depression and thyroid function.

Emerging evidence indicated that depression is currently one of the most burdensome diseases worldwide, and it can lead to a variety of functional physical impairments. However, the studies estimated the association between depression and thyroid function remain sparse. We aimed to investigate the association between depression and thyroid function in the American population. A cross-sectional analysis was performed using the data from the National Health and Nutrition Examination Survey conducted from 2007 to 2012. In the 12,502 adults aged 20-80 years, weighted linear regression models and multiple logistic regression models were applied to evaluate the association between depression and thyroid function indicators. The thyroid indicators investigated were mainly free thyroxine (FT4), total T4 (TT4), free triiodothyronine (FT3), total T3 (TT3), thyroid-stimulating hormone (TSH), and antithyroperoxidase antibody (TPOAb), thyroglobulin (Tg) and antithyroglobulin antibody (TgAb). The final results were reached after adjusting for various confounding factors. In the stratification analysis of subgroups divided by age, depression was significantly negatively correlated with FT4, FT3, and TT3 in both younger adults (p= 0.00122, p < 0.00001, and p = 0.00003) and older adults (p = 0.00001, p=0.00004, and p < 0.00001). In contrast, depression was significantly negatively correlated with TT4 and Tg in older adults (p = 0.00054, p = 0.00695) and positively correlated in younger adults (p = 0.01352, p < 0.00001). The subgroup analysis by gender revealed that depression was significantly negatively correlated with FT4, FT3, and TT3 in both adult males (p = 0.0164, p = 0.0204, and p = 0.0050) and adult females (p ≤ 0.0001, p < 0.0001, and p < 0.0001), which was more prominent in females. The positive correlation between depression symptoms and TPOAb was only found in adult females (p = 0.0282) and younger adults (p = 0.00488). This study confirmed a significant correlation between depressive and thyroid function and it varied among different genders or age. In the future, more prospective studies are needed to reveal these findings and confirm a causal relationship between them.

Evaluating Patient and Surgeon Characteristics Associated with Care Cost and Outcomes for Knee and Hip Replacement Procedures: A National Medicare Cohort Study.

The role of physician credentialing has been widely considered in quality and outcome improvement studies. However, the association between surgeon characteristics and health-care costs remains unclear. Our objective was to determine the association of orthopaedic surgeon characteristics with health outcomes and costs, utilizing Medicare data. We used 100% Fee-for-Service Medicare data from 2015 to 2019 to identify all patients ≥65 years of age who underwent 2 common orthopaedic surgical procedures, total hip and knee replacement. After determining whether the patients had been readmitted after discharge from their initial admission for surgery, we computed 3 metrics of total medical expenditure: the costs of the initial surgery admission and 30-day and 180-day episode-based bundles of care. Hierarchical linear regression and logistic regression models were used to evaluate patient and surgeon characteristics associated with care costs and the likelihood of readmission. We identified 2,269 surgeons who performed total knee replacements on 298,934 patients and 1,426 surgeons who performed total hip replacements on 204,721 patients. Patient characteristics associated with higher initial surgery costs included increasing age, female sex, racial minority status, and a higher Charlson Comorbidity Index. Surgeon characteristics associated with lower readmission rates included practice in the Northeast region and a higher patient volume; having malpractice claims was associated with higher readmission rates. A higher volume of patients treated by the orthopaedic surgeon was associated with lower overall costs and readmission rates. Information on surgeons' malpractice claims and annual volume should be made publicly available to assist patients, payer networks, and hospitals in surgeon selection and oversight. These results could also inform the guidelines of physician credentialing organizations. Prognostic Level III. See Instructions for Authors for a complete description of levels of evidence.

Trust performance in managing inflammatory arthritis over time in England and Wales: a latent class analysis approach.

To evaluate trust-level performance in time to initiation of DMARD therapy in patients with early inflammatory arthritis (EIA), with identification of the change in performance trajectories over time and investigation of trust characteristics associated with this change. We included 130 trusts from the UK contributing to the National Early Inflammatory Arthritis Audit (NEIAA) from 2018 to 2020. The primary outcome was days from referral to initiation of DMARD therapy in patients with EIA. Latent class growth mixture models were applied to identify distinct groups of trusts with similar trajectories of performance change over time. We used mixed effects linear and multinomial logistic regression models to evaluate the association between delay in treatment and trust-level characteristics. The mean time to DMARD initiation was 53days (s.d. 18), with an average 0.3-day decrease with each month over time. Four latent trajectories were identified in our cohort, with >77% of individual trusts showing ongoing improvements in decreasing treatment waiting times. Prior to separating by latent class, time to DMARD initiation was shorter in trusts with higher rheumatology staffing, a local EIA treatment pathway and those with access to musculoskeletal ultrasound. Trusts with more nurses in the rheumatology department were less likely to be in the worst performance group [odds ratio 0.69 (95% CI 0.49, 0.93)]. In this cohort study, we observed a reduction in treatment waiting time over time. Trusts with better staffed and improved EIA clinical structure are likely to initiate definitive treatment earlier in patients with EIA.

Outcomes of Kidney Transplants From Toxoplasma-Positive Donors: An Organ Procurement and Transplant Network Database Analysis.

There is a need to reconsider the acceptance of organs from donors considered suboptimal, in the absence of data. Toxoplasma antibody-positive donors (TPD) constitute one such group. The objective of our study was to compare graft survival in deceased donor renal transplant (Tx) recipients, stratified by Toxoplasma IgG status, using the Organ Procurement and Transplantation Network (OPTN) database. A log-linear event history regression model for graft failure categorized by Toxoplasma IgG status, adjusting for confounders was applied to first kidney-only Tx recipients from 2018 to 2022. Of the 51,422 Tx, 4,317 (8.4%) were from TPD. Acute rejection and graft failure (5% each) were similar between groups. Crude graft failure was 7.3 failures per 100 person-years for TPD recipients compared to 6.5 failures per 100 person-years for the Toxoplasma-negative group (p 0.008). The crude failure rate ratio was 1.14 with an adjusted hazard rate ratio of 1.04 (95% CI: 0.94, 1.15, p 0.39). In renal Tx recipients, TPD graft recipients have comparable survival to Tx from Toxoplasma-negative recipients. While caution and close monitoring of recipients post-Tx for surveillance of disseminated toxoplasmosis are still warranted, our study suggests that patients can be successfully managed using TPD organs.

Impact of Different Tax Variables on The Economic Growth of Nepal

This study examines the impact of different tax variables on GDP growth. Timeseries secondary data were gathered from the Economic Survey issued across several fiscal years to meet the study's objectives. The acquired data was analyzed using the log-linear regression model. The research hypotheses were tested using SPSS 20 software. The regression model included independent variables (tax) and the dependent variable GDP. The findings show that direct tax has an adverse association with GDP, whereas indirect tax has a positive link. Notably, overall revenue has a significant beneficial impact on GDP. Despite positive trends in tax revenue, they need to meet the government expenditure in Nepal. Across all regression models, the R2 coefficient exceeds 95%, indicating a high degree of determination among variables.

Impact of Digitalization on Global Sustainable Development Across Countries

This study develops an economic development index, a social development index, an environmental sustainability index, and an information and communication technology index to explore the comparison of 34 countries in global sustainable development (GSD) and its promoting indicators, and digitalization. The composite Z-score method is used to create the above-mentioned indexes between 2000 - 2021. The statistical values of these indexes are used to explicate the performance of these countries in all components of sustainable development and digitalization. The correlation coefficients among the mentioned indicators are also estimated to measure associations among them. The regression coefficients of explanatory variables with GSD and digitalization are also estimated using a log-linear regression model. There is reported a high diversity in digitalization, economic development (ED), social development (SD), environmental sustainability (ES), and GSD across countries. GSD is not possible without ED, SD, and ES. Digitalization has a positive impact on sustainable, social, and economic development. Digital technology helps to increase GSD, while GSD seems favorable to increasing digitalization. Digitalization improves as ED, SD, and GSD increase. While digitalization has a negative impact on ES. Green innovation, green and appropriate technologies, green entrepreneurship, and technological advancement would be supportive to increase digitalization and GSD.

Therapeutic Drug Monitoring of Dalbavancin in Real Life: A Two-Year Experience.

Dalbavancin is a long-acting lipoglycopeptide that is registered for the treatment of acute bacterial skin and skin structure infections, and it is also increasingly used for infections that require prolonged antibiotic treatment. Here, we present the results from the first 2 years of a service set up in December 2021 for the therapeutic drug monitoring (TDM) of dalbavancin in clinical settings. In particular, we compared the trough concentration (Cmin) to maximum concentration (Cmax) in patients with osteoarticular infections receiving prolonged treatment with dalbavancin. Log-linear regression models were used to estimate the timing of dalbavancin administration with the goal of maintaining Cmin concentrations of >8 mg/L in the two TDM-based strategies. From December 2021 to November 2023, 366 TDMs of dalbavancin from 81 patients were performed. The Cmin and Cmax concentrations of dalbavancin ranged from 4.1 to 70.5 mg/L and from 74.9 to 995.6 mg/L, respectively. With log-linear regression models, we estimated that each injection should be administered every 42-48 days to maintain the Cmin concentrations. Out of the 81 patients, 37 received at least three doses of dalbavancin for the treatment of osteoarticular infections. Despite there being no significant differences in the days of dalbavancin treatment (130 ± 97 versus 106 ± 102 days), the patients in the Cmax-based TDM group received a significantly lower number of dalbavancin injections (5.2 ± 1.8 versus 7.3 ± 2.6 injections, p = 0.005), and they were administered over a longer period of time (40 ± 10 versus 29 ± 14 days, p = 0.013) than in the Cmin-based TDM group. In conclusion, Cmax-based TDM was associated with a significant reduction in the inter-individual variability of dalbavancin concentrations and lower drug dosing frequency than those of Cmin-based TDM. This approach could, therefore, favor a more rational and targeted use of dalbavancin in patients requiring prolonged treatment.

UTILIZATION OF ELDER CARE AMONG PEOPLE LIVING WITH DEMENTIA IN SWEDEN: A REGISTER-BASED STUDY

Abstract The growing number of people living with dementia (PlwD) implies an increase in the demand for eldercare at different stages of the disease. This study aims to investigate the utilization of eldercare among people with and without dementia in Sweden during the last five years of life and what social-background factors influence the use of eldercare. Data were derived from four linked Swedish national registers comprising all decedents aged 70+ in Sweden as of November 2019 (n=6294). The primary outcome variable was the utilization of eldercare (no care, homecare, residential care). Following the study sample retrospective from death, data analysis was performed using multinomial and linear logistic regression models. Results showed that (1) nearly a quarter of all PlwD did not use any eldercare, primarily people who were newly diagnosed with dementia and living with partners; (2) three out of four PlwD used residential care in the last years of life; and (3) age, gender, and cohabitation status were important social-background factors determining utilization of eldercare for PlwD. This study provides unique insight that many Swedes with a dementia diagnosis do not receive any eldercare and that the utilization of eldercare increases with time since dementia diagnosis. We suggest more research to investigate why a substantial part of PlwD does not have any eldercare at all and what the policy implications of this might be.

Association of clinical symptoms and cardiometabolic dysregulations in patients with schizophrenia spectrum disorders.

Patients with schizophrenia spectrum disorders (SSD) have a shortened life expectancy related to cardiovascular diseases. We investigated the association of cognitive, positive, and negative symptoms with cardiometabolic dysregulations in SSD patients. Overall, 1,119 patients from the Genetic Risk and Outcome in Psychosis (GROUP) study were included. Cognitive function, positive and negative symptoms were assessed at baseline, 3-year, and 6-year. Cardiometabolic biomarkers were measured at 3-year follow-up. We used linear and multinomial logistic regression models to test the association between cardiometabolic biomarkers and clinical trajectories and performed mediation analyzes, while adjusting for clinical and demographic confounders. Cognitive performance was inversely associated with increased body mass index (mean difference [β], βhigh=-1.24, 95% CI=-2.28 to 0.20, P=0.02) and systolic blood pressure (βmild=2.74, 95% CI=0.11 to 5.37, P=0.04). The severity of positive symptoms was associated with increased glycated hemoglobin (HbA1c) levels (βlow=-2.01, 95% CI=-3.21 to -0.82, P=0.001). Increased diastolic blood pressure (ORhigh-decreased=1.04, 95% CI=1.01 to 1.08, P=0.02; ORhigh-increased=1.04, 95% CI=1.00 to 1.08, P=0.048) and decreased high-density lipoprotein (OR high-increased=6.25, 95% CI=1.81 to 21.59, P=0.004) were associated with more severe negative symptoms. Increased HbA1c (ORmoderate=1.05, 95% CI=1.01 to 1.10, P=0.024; ORhigh=1.08, 95% CI=1.02 to 1.14, P=0.006) was associated with more severe positive symptoms. These associations were not mediated by antipsychotics. We showed an association between cardiometabolic dysregulations and clinical and cognitive symptoms in SSD patients. The observed associations underscore the need for early identification of patients at risk of cardiometabolic outcomes.

US County–Level Variation in Preterm Birth Rates, 2007-2019

Preterm birth is a leading cause of preventable neonatal morbidity and mortality. Preterm birth rates at the national level may mask important geographic variation in rates and trends at the county level. To estimate age-standardized preterm birth rates by US county from 2007 to 2019. This serial cross-sectional study used data from the National Center for Health Statistics composed of all live births in the US between 2007 and 2019. Data analyses were performed between March 22, 2022, and September 29, 2022. Age-standardized preterm birth (<37 weeks' gestation) and secondarily early preterm birth (<34 weeks' gestation) rates by county and year calculated with a validated small area estimation model (hierarchical bayesian spatiotemporal model) and percent change in preterm birth rates using log-linear regression models. Between 2007 and 2019, there were 51 044 482 live births in 2383 counties. In 2007, the national age-standardized preterm birth rate was 12.6 (95% CI, 12.6-12.7) per 100 live births. Preterm birth rates varied significantly among counties, with an absolute difference between the 90th and 10th percentile counties of 6.4 (95% CI, 6.2-6.7). The gap between the highest and lowest counties for preterm births was 20.7 per 100 live births in 2007. Several counties in the Southeast consistently had the highest preterm birth rates compared with counties in California and New England, which had the lowest preterm birth rates. Although there was no statistically significant change in preterm birth rates between 2007 and 2019 at the national level (percent change, -5.0%; 95% CI, -10.7% to 0.9%), increases occurred in 15.4% (95% CI, 14.1%-16.9%) of counties. The absolute and relative geographic inequalities were similar across all maternal age groups. Higher quartile of the Social Vulnerability Index was associated with higher preterm birth rates (quartile 4 vs quartile 1 risk ratio, 1.34; 95% CI, 1.31-1.36), which persisted across the study period. Similar patterns were observed for early preterm birth rates. In this serial cross-sectional study of county-level preterm and early preterm birth rates, substantial geographic disparities were observed, which were associated with place-based social disadvantage. Stability in aggregated rates of preterm birth at the national level masked increases in nearly 1 in 6 counties between 2007 and 2019.

Effect of zinc intake on association between fluoride exposure and abnormal sex steroid hormones among US pubertal males: NHANES, 2013-2016.

Excessive fluoride exposure can disturb the balance of sex hormones. Zinc is essential for sex hormone synthesis and spermatogenesis. But it is not clear how zinc affects the relationship of fluoride exposure with abnormal sex steroid hormones. Here, a total of 1008 pubertal males from the National Health and Nutrition Examination Survey (NHANES) in two cycles (2013-2014, 2015-2016) were enrolled. The concentrations of water fluoride and plasma fluoride and the levels of serum testosterone, estradiol, and sex hormone binding globulin (SHBG) were measured. Two 24-h dietary recall interviews were conducted to assess the dietary zinc intake. The relationships of fluoride exposure and zinc intake with sex hormones were examined using linear regression and logistic regression models, while the generalized additive model was used to evaluate their non-linear relationship. Our findings revealed that for every two-fold increase in plasma fluoride concentration, testosterone levels decreased by 7.27% (95% CI - 11.49%, - 2.86%) and estradiol levels decreased by 8.73% (95% CI - 13.61%, - 3.57%). There was also significant non-linear association observed between zinc intake and SHBG levels. Being in the first tertile of plasma fluoride had a 60% lower risk of high SHBG (OR = 0.40, 95% CI 0.18, 0.89) compared with being in the second tertile. When compared to the first tertile, being in the second tertile of zinc intake was associated with a 63% (OR = 0.37, 95% CI 0.14, 0.98) lower risk of high SHBG. Furthermore, we observed an interactive effect between the plasma fluoride and zinc intake on estradiol and SHBG, as well as the risk of high SHBG (P-interaction < 0.10). These findings suggest that fluoride exposure and zinc intake can affect sex steroid hormone levels and the risk of high SHBG. Notably, zinc intake may alleviate the increased risk of high SHBG and the abnormal changes of estradiol and SHBG caused by higher fluoride exposure.

Comparing estimates of psychological distress using 7-day and 30-day recall periods: Does it make a difference?

Self-report measures are widely used in mental health research and may use different recall periods depending on the purpose of the assessment. A range of studies aiming to monitor changes in mental health over the course of the COVID-19 pandemic opted to shorten recall periods to increase sensitivity to change over time compared to standard, longer recall periods. However, many of these studies lack pre-pandemic data using the same recall period and may rely on pre-existing data using standard recall periods as a reference point for assessing the impact of the pandemic on mental health. The aim of this study was to assess whether comparing scores on the same questionnaire with a different recall period is valid. A nationally representative sample of 327 participants in Australia completed a 7-day and 30-day version of the six-item Kessler Psychological Distress Scale (K6) and a single-item measure of psychological distress (TTPN item) developed for the Taking the Pulse of the Nation survey. Linear mixed models and mixed logistic regression models were used to assess whether altering the recall period systematically changed response patterns within subjects. No substantive recall period effects were found for the K6 or the TTPN, although there was a trend towards higher K6 scores when asked about the past 30 days compared to the past 7 days (b = 1.00, 95% CI: -0.18, 2.17). This may have been driven by the “feeling nervous” item which was rated higher using the 30-day compared to the 7-day recall period. Neither the K6 nor the TTPN item were significantly affected by the recall period when reduced to a binary variable of likely severe mental illness. The results indicate that altering the recall period of psychological distress measures does not substantively alter the score distribution in the general population of Australian adults.

Mining and agriculture in municipalities with mineral-based economy in Brazil

Agriculture is an important investment alternative for productive diversification and food security in municipalities with mineral-based economies. Agricultural activities can benefit from improvements in infrastructure and availability of resources generated from the mineral industry, adopting technological innovations in production systems and expanding market opportunities. Given this context, the objective of the article was to identify whether the main mining municipalities in the states of Pará and Minas Gerais, the largest ore producers in Brazil, are exhibiting growth in agricultural production and production systems of higher technological level. Factor analysis was used to estimate the Index of Agricultural Modernization (IMA) and a log-linear regression model to estimate production growth rates. Although these municipalities receive a high amount of the Financial Compensation for Exploitation of Mineral Resources (CFEM), the activity has shown an incipient performance evidenced by low levels of modernization of agricultural production systems and low production growth rates, leaving clear signs of the occurrence of Dutch disease in these territories.

Convergent and clinical validity of a remote smartphone‐based self‐assessment of cognition, function, and behavior in early Alzheimer’s disease

AbstractBackgroundTrials in early Alzheimer’s disease (eAD) require the quantification of cognitive and functional progression. Compared with traditional in‐clinic assessments, remote assessments via digital health technologies (DHT) enable the collection of a broader palette of cognitive and functional measures at higher frequency and in patients' home environments. However, these must demonstrate validity against standard clinical outcome measures and relevant biomarkers. To this end, the present study aims to determine the reliability, convergent clinical, and functional neuroanatomic validity of a novel DHT, the Alzheimer’s Disease Digital Assessment Suite (AD‐DAS), for individuals on the AD continuum.MethodsIn total, 123 participants from 2 countries across 5 sites (3 USA, 2 Spain) participated (https://www.isrctn.com/ISRCTN17035495): 32 healthy controls (HC), 31 amyloid‐PET negative and 30 amyloid‐PET positive subjective cognitive decline (SCDn, SCDP, respectively), and 30 eAD. All participants completed standard in‐clinic neuropsychological assessments and remotely performed the AD‐DAS tasks daily for 28 days without supervision. AD‐DAS comprised 9 active tasks of cognitive/motor functioning and 4 survey questionnaires. Convergent and clinical validity analysis were performed using linear and proportional odds logistic regression modeling with age, sex, education, and site as covariates, respectively. Functional neuroanatomic validity was tested with voxel‐based morphometry (VBM) analyses with anatomic MRIs.ResultsOutcome metrics from all AD‐DAS cognitive/motor tasks correlated with their corresponding clinical comparators (ρpartial (range) = 0.16 ‐ 0.52), supporting their convergent validity. Similarly, outcome metrics from all tasks significantly differentiated the eAD from all the other groups in the expected directions (odds ratio (range) = 0.01 ‐ 61), supporting their clinical validity. The reliability of the outcome metrics ranged from good to excellent (interclass correlation coefficient (range) = 0.71 ‐ 0.91). VBM analyses provided independent and largely confirmatory results, further validating the AD‐DAS.ConclusionsThe AD‐DAS remote, smartphone‐based assessments of cognition show good to excellent test‐retest reliability, and preliminary analyses indicate that they may show convergent, clinical and exploratory functional neuroanatomic validity. Thus, these results provide a foundation for building towards the overarching goals of remote screening, prediction of progression, and monitoring of cognitive decline for future clinical trials and clinical care for preclinical and eAD.

Antemortem visit‐to‐visit blood pressure variability and postmortem cerebrovascular disease lesion burden in older adults without dementia

AbstractBackgroundBlood pressure management is an accessible therapeutic target for dementia prevention. Beyond the current focus of managing mean levels, there is a burgeoning interest in understanding the variability in blood pressure levels. Emerging research suggests elevated blood pressure variability is associated with increased risk for Alzheimer’s dementia and cerebrovascular disease, including white matter hyperintensities on MRI (e.g., Fazekas score), but relationships with white matter lesions and overall cerebrovascular pathology at autopsy remain understudied. The aim of the current study was to determine whether antemortem blood pressure variability predicts cerebrovascular pathology in older adults without clinical dementia.Method1866 older adults from the National Alzheimer’s Coordinating Center study underwent repeated approximately annual blood pressure measurement and autopsy and were free of clinical dementia at study baseline. Visit‐to‐visit blood pressure variability was calculated as variability independent of mean using at least 3 (median 5, range 3 ‐ 15) annual blood pressure measurements. White matter rarefaction was scored as none vs mild/moderate vs severe. An index of overall cerebrovascular lesion burden (range 0‐7) was calculated as the sum of severity (0‐2) of atherosclerosis in the Circle of Willis and arteriolosclerosis, and the presence/absence (0‐1) of microinfarcts, infarcts and lacunes, and microbleeds and hemorrhages. Linear and multinomial logistic regression models examined relationships between blood pressure variability, white matter rarefaction severity, and overall cerebrovascular lesion burden, controlling for age, sex, mean blood pressure, antihypertensive use, and Hachinski Ischemic Score, among other variables.ResultElevated blood pressure variability predicted increased severity of white matter rarefaction (OR of mild/moderate [vs none] = 1.21 [1.06, 1.33], p = .004; OR of severe [vs none] = 1.30 [1.07, 1.46], p = .008), and greater overall cerebrovascular lesion burden (ß = .12 [.11, .42]; p &lt; .0001).ConclusionElevated blood pressure variability is related to postmortem cerebrovascular lesion burden, including increased severity of white matter rarefaction, in older adults without clinical dementia, independent of mean blood pressure. Findings are consistent with studies using MRI‐based markers of cerebrovascular disease and may help improve blood pressure as a risk indicator for dementia and cerebrovascular disease.

Dietary nitrate intake and the risk of dementia: a population‐based study

AbstractBackgroundNitric oxide is a free radical that can be produced from dietary nitrate and positively affect cardiovascular health. With cardiovascular health playing an important role in the etiology of dementia, we hypothesized a link between dietary nitrate intake and the risk of dementia. We therefore aimed to evaluate the association of total, vegetable and non‐vegetable dietary nitrate intake with the risk of dementia and to explore underlying mechanisms involving imaging markers of vascular brain health, i.e. cerebral perfusion, total brain volume, white matter hyperintensity volume, microbleeds, and lacunar infarcts.MethodDietary nitrate intake was assessed using food frequency questionnaires in 9,543 dementia‐free participants (mean age 64 years, 58% women) from the prospective population‐based Rotterdam Study. All participants were followed for the incidence of dementia, and 3,949 of the participants underwent a magnetic resonance imaging scan of the brain during a maximum of three consecutive examination rounds (average interval between scans 4.6 years). We used Cox models to determine the association between dietary nitrate intake and incident dementia. We further used linear mixed models and logistic regression models to assess the association of dietary nitrate intake with changes in imaging markers over time.ResultParticipants consumed on average 102.9 (standard deviation: 66.7) grams of dietary nitrate per day, which came on average for 81% from vegetable sources. During a mean follow‐up of 14.5 years, 1,472 participants developed dementia among whom 1,078 had Alzheimer’s disease. A higher intake of total and vegetable dietary nitrate intake was associated with a lower risk of dementia (hazard ratio (HR) [95% confidence interval (CI)] per 50 mg/day increase: 0.92 [0.87‐0.98] and 0.92 [0.86‐0.97], respectively), but no association between non‐vegetable dietary nitrate intake and the risk of dementia was observed (HR [95% CI]: 1.15 [0.64‐2.07]). Results were similar for Alzheimer’s disease. Dietary nitrate intake was also not associated with brain imaging markers.ConclusionA higher dietary nitrate intake from vegetable sources is associated with a lower risk of dementia. We found no evidence that this association was driven vascular brain health.

Factors Related to Cognitive Resilience according to Education Level in Normal and Cognitively Impaired Individuals

AbstractBackgroundCognitive resilience (CR) is a concept to explain the difference between pathologic burden and cognitive function. Understanding CR is important as increasing CR can be applied to dementia prevention strategies. CR is closely related to education and it was widely used as proxy for CR. However, using an education as proxy of CR may have limitation in reflecting the CR of low educated individuals. Related factors to CR can be different according to the educational level. However, factors related to low educated individuals has not been sufficiently investigated. Therefore, we aimed to investigate factors related to cognitive resilience in low‐ and highly educated individuals using residual approach.MethodWe collected 1,085 patients who underwent neuropsychological assessment and MRI from the Establishment of Precision Medicine Platform for Early Diagnosis of Mild Cognitive Impairment (PREMIER) Cohort (305 SCD, 639 MCI, 141 AD). To capture CR using residual approach, firstly, cognitive score was predicted on global cortical thickness, adjusted for age, sex, education, and disease stage. Then, individual differences between predicted and observed cognitive score were used as the measure of CR(CR_rsd). Next, we divided the participants into two groups based on their education level. To investigate the factors related to CR_rsd between two groups, we used multiple linear regression and logistic regression model after adjusted age, sex. Demographic, socioeconomic and psychiatric factors were evaluated.ResultMean age was 70.5 years and 65.3% were female. There were 286 patients in low educated group (26.4%). Depression, literacy, cognitive activity, and presence of diabetes were related to CR_rsd. Literacy was related to CR_rsd in both low‐ and high‐education group (low education group, p = 0.035; high education group, p = &lt;0.001). Depression was associated with low CR_rsd only in high education group (p = 0.001). Cognitive activity was associated with high CR_rsd in both group (low education group, p = 0.042; high education group, p = &lt;0.001). However, social activity was only related to high CR_rsd low education group (p = 0.044).ConclusionOur findings suggest that factors related to CR could be different according to the educational level.

Convergent and clinical validity of a remote smartphone‐based self‐assessment of cognition, function, and behavior in early Alzheimer’s disease

AbstractBackgroundTrials in early Alzheimer’s disease (eAD) require the quantification of cognitive and functional progression. Compared with traditional in‐clinic assessments, remote assessments via digital health technologies (DHT) enable the collection of a broader palette of cognitive and functional measures at higher frequency and in patients' home environments. However, these must demonstrate validity against standard clinical outcome measures and relevant biomarkers. To this end, the present study aims to determine the reliability, convergent clinical, and functional neuroanatomic validity of a novel DHT, the Alzheimer’s Disease Digital Assessment Suite (AD‐DAS), for individuals on the AD continuum.MethodIn total, 123 participants from 2 countries across 5 sites (3 USA, 2 Spain) participated (https://www.isrctn.com/ISRCTN17035495): 32 healthy controls (HC), 31 amyloid‐PET negative and 30 amyloid‐PET positive subjective cognitive decline (SCDn, SCDP, respectively), and 30 eAD. All participants completed standard in‐clinic neuropsychological assessments and remotely performed the AD‐DAS tasks daily for 28 days without supervision. AD‐DAS comprised 9 active tasks of cognitive/motor functioning and 4 survey questionnaires. Convergent and clinical validity analysis were performed using linear and proportional odds logistic regression modeling with age, sex, education, and site as covariates, respectively. Functional neuroanatomic validity was tested with voxel‐based morphometry (VBM) analyses with anatomic MRIs.ResultOutcome metrics from all AD‐DAS cognitive/motor tasks correlated with their corresponding clinical comparators (ρpartial (range) = 0.16 ‐ 0.52), supporting their convergent validity. Similarly, outcome metrics from all tasks significantly differentiated the eAD from all the other groups in the expected directions (odds ratio (range) = 0.01 ‐ 61), supporting their clinical validity. The reliability of the outcome metrics ranged from good to excellent (interclass correlation coefficient (range) = 0.71 ‐ 0.91). VBM analyses provided independent and largely confirmatory results, further validating the AD‐DAS.ConclusionThe AD‐DAS remote, smartphone‐based assessments of cognition show good to excellent test‐retest reliability, and preliminary analyses indicate that they may show convergent, clinical and exploratory functional neuroanatomic validity. Thus, these results provide a foundation for building towards the overarching goals of remote screening, prediction of progression, and monitoring of cognitive decline for future clinical trials and clinical care for preclinical and eAD.

Abstract A091: County-level analysis of the link between historical slavery and prostate cancer incidence

Abstract Background: Black individuals with prostate cancer in the US experience the widest racial disparity in both cancer incidence and mortality when compared to the average population. These differences are driven by the intersection of race and a wide range of structural and social determinants of health and equity. Structural and social inequities can drive disproportionate and adverse exposure to violence, poverty, and physical and emotional stress—among other exposures—which may impact biologic risk, health behaviors, and healthcare access. We hypothesize that the impacts of these structural and social determinants are rooted in historical events that continue to inform present day prostate cancer events and outcomes. Methods: This is an ecological study assessing county-level data from 13 states in the Southeastern US. Data on prostate cancer incidence and mortality (NCI: 2018), population estimates (CDC: 2015-2019), structural and social determinants (AHRQ: 2018), and the percentage enslaved individuals (NHGIS: 1860) were obtained. County data were linked across datasets using federal identifiers. Our primary exposure was the legacy of US slavery represented by the percentage of enslaved individuals by county. Random variables such as water access and rail transport (NHGIS: 1860) were used as controls. Variable selection for our multivariable model was informed by a directed acyclical graph that defined the causal relationship between historical slavery and present-day prostate cancer outcomes. Our primary dependent variable was prostate cancer counts per 100,000. We utilized Poisson log-linear regression models to estimate the difference in cancer counts by 10% increase of slave population by county (NHGIS: 1860). Results: Our data included over 3000 counties. In our fully adjusted model, a 10% increase in county slave population was associated with a 1.5% increase in prostate cancer incidence (p&amp;lt;0.001). In this same model, Black race, and age (&amp;gt; 50 years) were associated with a 77% and over 300% increase in cancer incidence (p&amp;lt;0.001). Among Black men, every 10% increase in county slave population was associated with a 1.1% increase in cancer incidence (p &amp;lt; 0.05). Among White men, every 10% increase in county slave population was associated with a 1.5% increase in cancer incidence (p&amp;lt;0.0001). Our adjusted models demonstrated significant increased associations between prostate cancer incidence and education, access to food, segregation index, and social vulnerability index. Conclusions: Our results indicate that a history of slavery is significantly associated with increased county-level prostate cancer incidence for all men in the US, irrespective of their race/ethnicity. The effect of historic slavery persists even after adjusting for present day structural/social determinants of equity and health. These findings demonstrate the importance in acknowledging and incorporating historical inequities and context in evaluating present days inequities in prostate cancer risk, care, and outcomes. Citation Format: Maheetha C. Bharadwaj, Sarah C. Holt, Hari Iyer, John Gore, Tim Rebbeck, Yaw Nyame. County-level analysis of the link between historical slavery and prostate cancer incidence [abstract]. In: Proceedings of the 16th AACR Conference on the Science of Cancer Health Disparities in Racial/Ethnic Minorities and the Medically Underserved; 2023 Sep 29-Oct 2;Orlando, FL. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2023;32(12 Suppl):Abstract nr A091.

Influence of the human development index, motorcycle growth and policy intervention on road traffic fatalities – A case study of Vietnam

Motorcycle ownership in Vietnam has increased exponentially during the last two decades. As a result, traffic congestion, emissions, and traffic safety have been on the rise. Of particular concern is the significant increase in the number of traffic accidents due to higher traffic volume that is stimulated by economic development and improved households’ economic mobility. During this time frame, many programs, such as traffic safety awareness campaign, have been developed and implemented by transportation agencies to reduce traffic fatalities. This study seeks to understand the long-term effect of policy intervention on traffic fatalities. This is accomplished by developing a log-linear regression model which the response variable is the number of traffic fatalities between 1990 and 2019 and the independent variables include Human Development Index (HDI), motorcycle ownership, and policy interventions. The model estimation results indicate that: (1) a higher degree of economic development (HDI) corresponds to lower traffic fatalities, (2) the motorcycle helmet law has lowered the number of annual traffic fatalities since its enactment, and (3) a higher number of motorcycle trips corresponds to a higher number of traffic fatalities. Based on this study’s findings, it is recommended that transportation agencies in Vietnam develop and promote an alternative transportation mode.