Chronic Disease Mortality Research Articles

The independent and joint relationships between dietary antioxidant intake with risk of chronic obstructive pulmonary disease and all-cause mortality: insights from NHANES

BackgroundNumerous studies have indicated that a diet rich in antioxidants can prevent Chronic Obstructive Pulmonary Disease (COPD). However, the relationship between combined dietary antioxidant intake and the risk of COPD remains unclear. The Comprehensive Dietary Antioxidant Index (CDAI) is a composite score of various dietary antioxidants, including vitamins A, C, E, zinc, selenium, and carotenoids. In this study, we examined the independent and joint associations of CDAI with the risk of COPD and all-cause mortality.MethodsThe analysis was conducted using data from the National Health and Nutrition Examination Survey (NHANES) spanning from 2013 to 2018. Multivariable weighted logistic and Cox regression models were employed to evaluate the correlations of CDAI (including vitamins A, C, E, zinc, selenium, and carotenoids) with the risk of COPD and all-cause mortality. Restricted cubic spline models were used to examine potential non-linear relationships. Sensitivity and stratified analyses were conducted to assess the robustness of the results.ResultsIn this study, compared to the lowest quartile, the highest quartile of CDAI levels was significantly negatively associated with the risk of COPD (Odds Ratio [OR]: 0.47; 95% Confidence Interval [CI]: 0.22–0.97), exhibiting a non-linear relationship. Additionally, vitamins A, C, E, zinc, selenium, and carotenoids were also negatively associated with the risk of COPD. Furthermore, dietary antioxidant zinc in the second quartile (Hazard Ratio [HR]: 0.25; 95% CI: 0.10–0.62) was negatively associated with the risk of all-cause mortality compared to the lowest quartile. Subgroup analysis results remained stable, and sensitivity analysis did not support the association between selenium and the risk of COPD, with no substantial changes in the remaining associations.ConclusionHigher CDAI is inversely associated with the risk of COPD, and appropriate intake of the dietary antioxidant zinc may reduce all-cause mortality in COPD patients.

Chronic kidney disease is a major risk factor for mortality in triglyceride deposit cardiomyovasculopathy patients.

Triglyceride deposit cardiomyovasculopathy (TGCV) is a rare cardiovascular disorder caused by defective intracellular lipolysis of triglyceride, resulting in heart failure and diffuse narrowing atherosclerosis. Recently, the registry of TGCV patients in Japan revealed that the 3-year overall survival rate was 80.1% and the 5-year overall survival rate was 71.8%. In this study, the effect on mortality of chronic kidney disease (CKD), diabetes malleus (DM), hypertension (HT), and dyslipidemia (DL) was analyzed using this retrospective registry of TGCV patients. The 3-year survival rate was 71.3% in the CKD group and 91.7% in the non-CKD group, and the 5-year survival rate was 61.8% in CKD group and 84.4% in the non-CKD group. The Kaplan-Meier analysis revealed that CKD is a risk factor for mortality in TGCV patients (p = 0.006). Although TGCV patients with CKD were older than those without CKD, Cox proportional hazard model analyses including age indicated that CKD has a significant association of the prognosis of TGCV patients (hazard ratio 2.33 [1.12-4.86], p = 0.024). DM, HT, and DL did not increase mortality in TGCV patients, although these risk factors were established in the general population. TGCV might cause cardiac disorders and kidney disease at the same time, because podocyte foot process disorder in the glomeruli might be caused by TGCV itself, while CKD should be a risk factor for mortality in TGCV patients as is true in the general population. In conclusion, CKD is a major risk factor for mortality in TGCV patients and thus should be paid attention to in these patients.

Change trend of disease burden of chronic kidney disease mortality in Chongqing, 2012-2023

Objective: To analyze change trend of disease burden of chronic kidney disease (CKD) mortality between 2012 and 2023 in Chongqing, and provide suggestion for CKD prevention. Methods: The mortality data of CKD were collected from Chongqing death registration between 2012 and 2023 according to International Classification of Diseases 10th. The data were analyzed to calculate mortality rate, standardized mortality rate, age specific mortality rate, and the rate of years of life lost (YLL) and proportion by using software SPSS 26.0. The mortality rate of CKD between men and women, urban area and rural area were compared by χ2 test. The change trend was described by average annual percent of change (AAPC). Results: The mortality rate and standardized mortality rate of CKD were 7.94/100 000 and 4.63/100 000 respectively in 2012 and 6.70/100 000 and 2.79/100 000 respectively in 2023 in Chongqing. The difference in change of CKD mortality rate was not significant (AAPC=-0.79%, t=-1.60, P=0.273). However, the standardized mortality rate of CKD decreased by 3.59% (t=-3.98, P=0.003) from 2012 to 2023. The mortality rate of CKD was higher in men than in women in 2014 and 2022, the differences were significant (all P<0.05). The standardized mortality rate of CKD in men and women decreased by 3.17% and 4.11% respectively between 2012 and 2023, the difference was significant (all P<0.05). The mortality rate of CKD had been higher in urban area than in rural area since 2016 (all P<0.05). During this period, the mortality rate and standardized mortality rate of CKD in urban area remained stable, but the mortality rate and standardized mortality rate of CKD in rural area showed average annual decreases of 2.21% and 4.90%, the differences were significant (all P<0.05). The proportion of CKD due to hypertension decreased, but the proportion of CKD due to diabetes and other causes increased. The rate of age standardized YLL of CKD showed an average annual decrease of 2.83%, the differences were significant (P=0.011). Conclusions: The standardized mortality rate and age standardized YLL of CKD decreased from 2012 to 2023 in Chongqing. Men, urban residents and the elderly are key populations in CKD prevention.

Exploring the association between socioeconomic inequalities in chronic respiratory disease and all-cause mortality in China: findings from the China Health and Retirement Longitudinal Study.

Research on the inequality of chronic respiratory disease (CRD) is limited, and the association between CRD and all-cause mortality is not well-established. Investigating the distribution of CRD and its associated mortality risks is essential for improving CRD conditions and developing targeted intervention measures. This study aimed to explore the relationship between inequalities in CRD and all-cause mortality in China. This study utilized nationally representative baseline data from the China Health and Retirement Longitudinal Study (CHARLS, 2011-2020, wave 1-wave 5), including a total of 14,743 subjects. The concentration index was employed to measure socioeconomic-related inequality in CRD, and the concentration index decomposition method was used to describe its influencing factors. Cox proportional hazards regression model was employed to examine the association between CRD and all-cause mortality. The prevalence of CRD was 11.79% (95% CI: 10.98, 12.66) in China. The concentration index for CRD was -0.050 (95% CI: -0.075, -0.026), indicating a certain degree of inequality in its prevalence. Chronic lung disease (concentration index = -0.046, 95% CI: -0.073, -0.019), asthma (concentration index = -0.102, 95% CI: -0.148, -0.056), and asthma-chronic obstructive pulmonary disease overlap syndrome (concentration index = -0.114, 95% CI: -0.173, -0.055) also exhibited a pro-poor distribution. The decomposition analysis of the concentration index for CRD revealed that age, education level, and economic status played substantial roles in contributing to the observed inequality. Additionally, Cox regression analysis showed that participants with CRD had an increased risk of all-cause mortality (HR = 1.49, 95% CI: 1.34, 1.65). Inequalities exists in CRDs in China, with the prevalence of these diseases primarily concentrated among economically disadvantaged groups. Additionally, CRD increases the risk of all-cause mortality. Addressing the root causes of economic inequalities and enhancing the educational attainment of individuals with low socioeconomic status can help improve the situation.

Extreme temperature increases the risk of COPD morbimortality: A systematic review and meta-analysis.

This systematic review examines how extreme temperatures impact chronic obstructive pulmonary disease (COPD) morbidity and mortality, focusing on identifying vulnerable subpopulations. We conducted a systematic literature search from January 1, 2000, to November 6, 2024, across databases like PubMed, MEDLINE and EMBASE, Web of Science, and Scopus, focusing on observational studies that quantitatively defined extreme temperatures and their impacts on COPD morbidity and mortality. Out of 3140 records, 25 studies met the inclusion criteria. We extracted data on study characteristics, effect estimates, and confounders, employing methods to assess the risk of bias and synthesize results. We observed that extreme heat increased the relative risk (RR) for COPD morbimortality by 1.16-fold (95% CI: 1.08-1.26; p<0.05), and extreme cold increased the RR by 1.32-fold (95% CI: 1.20-1.46;). Extreme heat was associated with a 1.19-fold (95% CI: 1.09-1.30; p<0.05) increase in COPD mortality. In contrast, extreme cold was associated with both COPD morbidity and mortality, with morbidity increasing by 1.47-fold (95% CI: 1.26-1.71; p<0.05) and mortality by 1.23-fold (95% CI: 1.10-1.38; p<0.05). Extreme heat poses a higher risk for female COPD patients compared to males. Moreover, extreme heat and cold were associated with morbimortality risk among older adults. Asian populations were sensitive to both temperature extremes, whereas Europeans were predominantly susceptible to extreme cold. This variability in response to extreme temperatures affects COPD morbidity and mortality, emphasizing the need for tailored medical and emergency responses to effectively mitigate health risks during extreme weather events.

Better Quality of Life in Physically Active Adults Regardless of Age.

Quality of life (QOL) has become an important public health issue. Adults presenting better QOL have shown reduced mortality and risk of chronic diseases and better mental health. Regular physical activity (PA) is consistently associated with a number of health benefits in older adults, including betted QOL, which is a key component of healthy aging. The purpose of the study was to examine how physical activity level and age influenced QOL in adults. Material and Methods: A total of 378 adults from Poland participated in the study (mean age of 57.89 ± 12.54). Respondents completed questionnaires to measure QOL (WHOQOL-BREF) and physical activity level (International Physical Activity Questionnaire-short form). Linear regression analysis was used to examine the effect of age and PA on QOL. Results: Weekly energy expenditure associated with recreational physical activity was correlated with better QOL in all domains: physical (R = 0.5, p < 0.001), physiological (R = 0.4, p < 0.001), social (R = 0.3, p < 0.001) and environmental (R = 0.39, p < 0.001). Increases in PA level predicted increases in the physiological domain (β = 0.41, SE = 0.05, p < 0.001), social domain (β = 0.34, SE = 0.05, p < 0.001) and environmental domain (β = 0.39, SE = 0.05, p < 0.001). In the physical domain, increases in both physical activity level (β = 0.41, SE = 0.04, p < 0.001) and age (β = 0.31, SE = 0.04, p < 0.001) predicted better QOL. Conclusions: Our findings emphasize the potential benefits of physical activity on QOL regardless of age. Although aging is combined with various age-related diseases, quality of life improves with age in physically active adults.

Short-term exposure to outdoor nitrogen dioxide and respiratory mortality, with high-risk populations: a nationwide time-stratified case-crossover study

Numerous existing studies reported the negative impacts of outdoor nitrogen dioxide (NO2) on respiratory mortality. However, the evidence of related high-risk populations was considerably limited, especially associated with ages, causes of death, and district-level characteristics. In addition, most earlier studies were based on monitored areas, thus previous risk estimates of NO2 could be biased to provide nationwide risk estimates and high-risk populations. Therefore, this study performed a nationwide time-stratified case-crossover study to evaluate the association between short-term ambient NO2 and respiratory mortality in South Korea (2015–2019). A machine learning-ensemble daily NO2 prediction model was used to cover unmonitored areas. To examine high-risk populations, we assessed NO2 risk estimates by age group, sex, cause of mortality, and district-level characteristics. In the total population, NO2 was weakly associated with increased mortality risk due to respiratory disease (OR [odds ratio]: 1.011, 95% CI [confidence interval]: 0.995–1.027), and the association became evident only in individuals aged 80 y or older (1.022, 1.000–1.044), especially related to pneumonia. Further, in people aged 60–69 years, NO2 was marginally associated with mortality for chronic lower respiratory diseases. Lower district-level socioeconomic status and medical services were marginally related to higher respiratory mortality risks related to NO2. The excess respiratory mortality fractions and YLL (year of life lost) attributable to NO2 were 4.13% and 93,851.63 years, and around 70% of the excess deaths were due to noncompliance with the World Health Organization air quality guidelines (daily average NO2 > 25 µg/m3). This study provides evidence for high-risk populations and the appropriateness of target-specific action plans against NO2. In addition, based on the excess death estimates, we suggest stricter NO2 standards are required.

Association of low-level heavy metal exposure with risk of chronic kidney disease and long-term mortality.

While the nephrotoxicity of lead and cadmium is well-established, the impact of low-level exposure on risk of chronic kidney disease (CKD) and long-term health outcomes, especially in CKD patients, remains unclear. This study examines the association between low-level lead and cadmium exposure with risks of CKD and long-term mortality. We analyzed data from adult participants of 2003-2012 National Health and Nutrition Examination Survey in the United States. CKD was defined as estimated glomerular filtration rate < 60 ml/min/1.73 m2. Elevated blood lead (≥ 1.5 μg/dL) and cadmium (≥ 0.4 μg/L) levels were assessed for their associations with CKD and all-cause mortality, with survival tracked until December 31, 2019. Among the 24,810 participants (mean age 44.4 years, 48.9% male), 1,309 (3.9%) had CKD. Lead and cadmium levels were significantly higher in participants with CKD compared to those without. Elevated lead (OR: 1.41, 95% CI: 1.15-1.74) and cadmium (OR: 1.23, 95% CI: 1.03-1.46) levels were both associated with increased CKD risk, with the highest risk in those with both lead ≥ 1.5 μg/dL and cadmium ≥ 0.4 μg/L (OR: 1.65, 95% CI 1.27-2.14). During a median follow-up of 141 months, 2,255 participants died (7.0 per 10,000 person-months). Elevated cadmium was associated with higher mortality risk in CKD (HR: 1.42, 95% CI: 1.07-1.88) and non-CKD populations (HR: 1.40, 95% CI: 1.24-1.58), while lead levels were not significantly associated with mortality in either group. Participants with both elevated lead and cadmium had a significantly higher mortality risk (HR: 1.32, 95% CI: 1.13-1.54). Low-level cadmium and lead exposure are linked to increased CKD risk, with cadmium also associated with higher long-term mortality in both CKD and non-CKD populations. These findings highlight the need for public health efforts to reduce exposure and further research on long-term impacts.

Association of life's essential 8 with prevalence and all-cause mortality of chronic kidney disease among US adults: Results from the National Health and Nutrition Examination Survey (2015-2018).

The association between chronic kidney disease (CKD) and cardiovascular disease has been previously evaluated. This study aimed to evaluate the association between the American Heart Association's Life's Essential 8 (LE8) and the prevalence and all-cause mortality of CKD in a nationally representative population of adults in the US. This retrospective analysis included participants from the National Health and Nutrition Examination Survey spanning 2015-2018. We used multivariable survey logistic regression model to calculate the adjusted odds ratios (AORs) of the LE8 score for the prevalence of CKD. Survey-weighted Cox proportional hazards models were used to calculate the adjusted hazards ratios (AHRs) of the LE8 score for the risk of all-cause mortality among participants with CKD. Of the 8907 included participants, 789 had stage 3 to 5 CKD, and 8118 were in the non-CKD group. The adjusted prevalence rate of CKD was 10.7% in the low LE8 score group, and lower in the moderate (7.9%) and high (7.7%) LE8 score groups. Compared with low LE8 scores, moderate LE8 score (adjusted odds ratio [AOR] 0.628, 95% confidence interval [CI]: 0.463 to 0.853, P = 0.004) and high LE8 scores (AOR 0.328, 95% CI: 0.142 to 0.759, P = 0.011) were associated with lower prevalence rates of CKD. A similar association was found for health factors scores. Additionally, an increase in the LE8 score was associated with a lower risk of all-cause mortality (adjusted hazard ratio [AHR] 0.702, 95% CI: 0.594 to 0.829, P < 0.001). The results of this study suggest the association of higher LE8 and its subscale scores with a lower prevalence and all-cause mortality of CKD.

Palliative Homecare in Chronic Liver Disease: A Cohort Analysis of Factors and Outcomes Associated with Home Palliative Care in Patients with End-Stage Liver Disease.

Objective: The prevalence and mortality of chronic liver disease has risen significantly. In end-stage liver disease (ESLD), the survival of patients is approximately 2 years. Despite the poor prognosis and high symptom burden, integration of palliative care in ESLD is reduced, and the majority of patients continue to die in inpatient care. We aim to assess predictors and outcomes of home palliative care, as well as factors associated with death at home in patients with ESLD. Methods: Retrospective cohort study of patients with ESLD, followed by a palliative care team between 2017 and 2022. Information regarding patient demographics, ESLD etiology, decompensations, and interventions was collected. Two-sided tests were used to identify factors associated with home palliative care. Results: We analyzed 75 patients: 44% had home palliative care and 33% died at home. ESLD patients with home palliative care were older (72.52 vs 64.45; p = 0.002), had a longer palliative care intervention time (149.97 ± 196.23 vs 43.69 ± 100.60 days; p = 0.007), higher rates of ascites or hepatic encephalopathy (χ2 = 11.024; p = 0.029), and hepatocarcinoma (90.9% vs 64.3%; p = 0.007). Patients with home palliative care had a reduction in-hospital admissions (2.61 vs 1.06; p = 0.000) and a greater probability of death at home (66.7% vs 33.3%; p = 0.000). Patients who died at home (33.3%) were older (72.20 vs 64.40; p = 0.000) and had longer palliative care intervention time (178.80 ± 211.78 vs 46.28 ± 99.67 days; p = 0.006). Conclusion: Home palliative care in ESLD differs based on demographics and disease complications, with a positive impact of homecare translated into a reduction in hospital admissions and an increased probability of death at home.

Prediabetes is associated with elevated risk of clinical outcomes even without progression to diabetes.

Prediabetes (HbA1c 39-47 mmol/mol [5.7-6.4%] or fasting glucose 5.6-6.9 mmol/l) is associated with elevated risks of microvascular and macrovascular complications. It is unknown to what extent these risks in prediabetes remain after accounting for progression to diabetes. In 10,310 participants from the Atherosclerosis Risk in Communities (ARIC) Study (aged 46-70 years, ~55% women, ~20% Black adults) without diabetes at baseline (1990-1992), we used Cox regression to characterise age- and sex-adjusted associations of prediabetes with ~30 year incidence of complications (composite and separately), including atherosclerotic CVD (ASCVD), heart failure, chronic kidney disease (CKD) and all-cause mortality before and after accounting for intervening incidence of diabetes, modelled as a time-varying variable. We calculated the excess risk of complications in prediabetes remaining after accounting for progression to diabetes. Of the 60% of adults with prediabetes at baseline, ~30% progressed to diabetes (median time to diabetes, 7 years). Over the maximum follow-up of ~30 years, there were 7069 events (1937 ASCVD, 2109 heart failure, 3288 CKD and 4785 deaths). Prediabetes was modestly associated with risk of any complication (HR 1.21 [95% CI 1.15, 1.27]) vs normoglycaemia. This association remained significant after accounting for progression to diabetes (HR 1.18 [95% CI 1.12, 1.24]) with 85% (95% CI 75, 94%) of the excess risk of any complication in prediabetes remaining. Results were similar for the individual complications. Progression to diabetes explained less than one-quarter of the risks of clinical outcomes associated with prediabetes. Prediabetes contributes to the risk of clinical outcomes even without progression to diabetes.

Sleep duration and risk of mortality from chronic kidney disease among Japanese adults

ObjectiveTo explore the association between sleep duration and death from chronic kidney disease in the general Japanese population. MethodsWe conducted an 19.3-year follow-up study of 40,272 men and 54,902 women aged 40-79years and free of renal disease, cardiovascular disease and cancer in the Japan Collaborative Cohort Study for Evaluation of Cancer Risk at baseline (between 1986 and 1990). Sleep duration was categorized into five groups: <6, 6 to <7, 7 to <8, 8 to <9, and ≥9 hours per day. Cox proportional hazard models were used to analyze the association between sleep duration and death from chronic kidney disease. ResultsCompared with persons with 7 to <8 hours sleep duration, those who slept 8 to <9 hours (HR: 1.41, 95% CI: 1.05-1.88) or ≥9hours (HR: 1.82, 95% CI: 1.28-2.58) per day had a higher risk of developing chronic kidney disease mortality. This association was particularly pronounced in individuals aged younger than 65years. ConclusionsSleep duration of 8 or more hours per day was associated with increased risk of chronic kidney disease mortality in the general Japanese population.

Modeling Chronic Disease Mortality by Methods From Accelerated Life Testing.

We propose a parametric model for describing chronic disease mortality from cohort data and illustrate its use for Type 2 diabetes. The model uses ideas from accelerated life testing in reliability theory and conceptualizes the occurrence of a chronic disease as putting the observational unit to an enhanced stress level, which is supposed to shorten its lifetime. It further addresses the issue of semi-competing risk, that is, the asymmetry of death and diagnosis of disease, where the disease can be diagnosed before death, but not after. With respect to the cohort structure of the data, late entry into the cohort is taken into account and prevalent as well as incident cases inform the analysis. We finally give an extension of the model that allows age at disease diagnosis to be observed not exactly, but only partially within an interval. Model parameters can be straightforwardly estimated by Maximum Likelihood, using the assumption of a Gompertz distribution we show in a small simulation study that this works well. Data of the Cardiovascular Disease, Living and Ageing in Halle (CARLA) study, a population-based cohort in the city of Halle (Saale) in the eastern part of Germany, are used for illustration.

Long-term exposure to wildland fire smoke PM2.5 and mortality in the contiguous United States

Despite the substantial evidence on the health effects of short-term exposure to ambient fine particles (PM2.5), including increasing studies focusing on those from wildland fire smoke, the impacts of long-term wildland fire smoke PM2.5 exposure remain unclear. We investigated the association between long-term exposure to wildland fire smoke PM2.5 and nonaccidental mortality and mortality from a wide range of specific causes in all 3,108 counties in the contiguous United States, 2007 to 2020. Controlling for nonsmoke PM2.5, air temperature, and unmeasured spatial and temporal confounders, we found a nonlinear association between 12-mo moving average concentration of smoke PM2.5 and monthly nonaccidental mortality rate. Relative to a month with the long-term smoke PM2.5 exposure below 0.1 μg/m3, nonaccidental mortality increased by 0.16 to 0.63 and 2.11 deaths per 100,000 people per month when the 12-mo moving average of PM2.5 concentration was of 0.1 to 5 and 5+ μg/m3, respectively. Cardiovascular, ischemic heart disease, digestive, endocrine, diabetes, mental, and chronic kidney disease mortality were all found to be associated with long-term wildland fire smoke PM2.5 exposure. Smoke PM2.5 contributed to approximately 11,415 nonaccidental deaths/y (95% CI: 6,754, 16,075) in the contiguous United States. Higher smoke PM2.5-related increases in mortality rates were found for people aged 65 and above. Positive interaction effects with extreme heat were also observed. Our study identified the detrimental effects of long-term exposure to wildland fire smoke PM2.5 on a wide range of mortality outcomes, underscoring the need for public health actions and communications that span the health risks of both short- and long-term exposure.

Abstract B021: Quitxt research study: A mobile messaging intervention to promote smoking cessation among young adult smokers in South Texas

Abstract Background: Despite major advances in tobacco control and treatment, tobacco use remains the single largest preventable cause of morbidity and mortality in the US. Smoking prevalence is highest among Texas young adults (ages 18-29), especially those with lower education and income and those living in rural areas, like Latinos. About 19.2% of Latinos ages 18-29 in the study areas are current smokers, putting them at higher risk of cancer and other tobacco-related morbidity and mortality. Young adults are heavy users of smartphones, text messaging, social media chats, and other mobile social media, providing a remarkable opportunity for innovation in the delivery of health promotion interventions to reduce health disparities in this large and rapidly growing racial/ethnic population. This research study aims to assess the effectiveness of Quitxt, our culturally appropriate mobile smoking cessation program. Quitxt – launched by our interdisciplinary research team using proven social cognitive, motivational interviewing, and brief intervention methods for promoting behavior change – blends bilingual text and social media messaging for smoking cessation tailored to the language and culture of young adult smokers in our vulnerable region of South Texas. The team also adapted the program to the Primary Care and Mays Cancer Center patient population, and it is currently being implemented. Quitxt has not been tested in a research study, as its creation as an evidence-based cancer prevention service for young adult smokers was supported by the Cancer Prevention and Research Institute of Texas. Methods: The proposed 5-year study involves a 2-group parallel randomized controlled trial with 4 assessments (baseline, 1, 3, and 6 months) and will recruit 1,200 young adult Latino smokers: 1)The intervention group will receive Quitxt (text messaging or chat); and 2) the usual care group will receive abbreviated text messaging with health promotion-related content, including smoking cessation and referral to the Texas DSHS cessation program YesQuit. Smoking cessation will be validated via biological tests for those who report smoking cessation at the study follow-ups. We hypothesize that the group receiving the Quitxt intervention will achieve significantly higher smoking cessation rates than the group receiving usual care. Results: The proposed intervention will mark the first significant study to assess the effectiveness of an innovative, bilingual, culturally, and linguistically appropriate mobile cessation intervention tailored to young adult Latinos living in South Texas by enhancing their skills development, competence, and self-efficacy to initiate and maintain cessation. Conclusion: This study will advance public health by testing the effectiveness of a scalable, evidence-based, easily disseminated, and adaptable intervention with potentially broad national reach to help young adults stop smoking and reduce smoking-related cancer and chronic disease morbidity and mortality and their associated healthcare costs. Citation Format: Patricia Chalela, Vivian Cortez, Sandra Sivak, Armida Flores, Martha De La Mora, Zully Garcia, Byeongyeob Choi, Edgar Muñoz, Cliff Despres, Alfred L. McAlister, Qurathul Ahmed, Audrey Cordova, Maria I. Sung-Cuadrado, Luis F. Velez, Sahak Kaghyan, Rahul Mundlamuri, David Akopian, Amelie G. Ramirez. Quitxt research study: A mobile messaging intervention to promote smoking cessation among young adult smokers in South Texas [abstract]. In: Proceedings of the 17th AACR Conference on the Science of Cancer Health Disparities in Racial/Ethnic Minorities and the Medically Underserved; 2024 Sep 21-24; Los Angeles, CA. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2024;33(9 Suppl):Abstract nr B021.

Sex Differences in Hypertension and Its Management Throughout Life.

The prevalence of hypertension and uncontrolled hypertension may differ by age and sex. We included participants in the Atherosclerosis Risk in Communities study at seven study visits over 33 years (visit 1: 15 636 participants; mean age, 54 years; 55% women), estimating sex differences in prevalence of hypertension (systolic blood pressure ≥130 mm Hg; diastolic blood pressure ≥80 mm Hg; or self-reported antihypertension medication use) and uncontrolled hypertension (systolic blood pressure ≥140 mm Hg or diastolic blood pressure ≥90 mm Hg) using unadjusted and comorbidity-adjusted models. The prevalence of hypertension increased from 40% (ages, 43-46 years) to 93% (ages, 91-94 years). Within hypertensive individuals, the prevalence of uncontrolled hypertension was higher in men (33%) than women (23%) at ages 43 to 46 years but became higher in women than men starting at ages 61 to 64, with 56% of women and 40% men having uncontrolled hypertension at ages 91 to 94. This sex difference was not explained by differences in coronary heart disease, diabetes, body mass index, estimated glomerular filtration rate, number of antihypertension medications, classes of medications, or adherence to medications. In both sexes, uncontrolled hypertension was associated with a higher risk for chronic kidney disease progression (hazard ratio, 1.5 [1.2-1.9]; P=4.5×10-4), heart failure (hazard ratio, 1.6 [1.4-2.0]; P=8.1×10-7), stroke (hazard ratio, 2.1 [1.6-2.8]; P=1.8×10-8), and mortality (hazard ratio, 1.5 [1.3-1.6]; P=6.2×10-19). Sex differences in the prevalence of hypertension and uncontrolled hypertension vary by age, with the latter having implications for health throughout the life course.

Association between methylphenidate use and long-term cardiovascular risk in paediatric patients with attention deficit and hyperactivity disorder

BackgroundThere have been concerns about the potential cardiovascular (CV) adverse effects associated with methylphenidate (MTH) use. However, only limited evidence exists on the long-term safety of MTH.ObjectiveTo evaluate whether MTH...

Global forecasting of chronic kidney disease mortality rates and numbers with the generalized additive model

BackgroundChronic kidney disease (CKD) is an important public health problem worldwide; therefore, forecasting CKD mortality rates and death numbers globally is vital for planning CKD prevention programs. This study aimed to characterize the temporal trends in CKD mortality at the international level from 1990 to 2019 and predict CKD mortality rates and numbers until 2030.MethodsData were obtained from the Global Burden of Disease 2019 Study. A joinpoint regression model was used to estimate the average annual percentage change in CKD mortality rates and numbers. Finally, we used a generalized additive model to predict CKD mortality through 2030.ResultsThe number of CKD-related deaths worldwide increased from 591.80 thousand in 1990 to 1425.67 thousand in 2019. The CKD age-adjusted mortality rate increased from 15.95 per 100,000 people to 18.35 per 100,000 people during the same period. Between 2020 and 2030, the number of CKD deaths is forecasted to increase further to 1812.85 thousand by 2030. The CKD age-adjusted mortality rate is expected to decrease slightly to 17.76 per 100,000 people (95% credible interval (CrI): 13.84 to 21.68). Globally, it is predicted that in the next decade, the CKD mortality rate will decrease in men, women, all subgroups of disease etiology except glomerulonephritis, people younger than 40 years old, and all groupings of countries based on the sociodemographic index (SDI) except high-middle-SDI countries.ConclusionsThe CKD mortality rate is predicted to decrease in the next decade. However, more attention should be given to people with glomerulonephritis, people over 40 years old, and people in high- to middle-income countries because the mortality rate due to CKD in these subgroups is expected to increase until 2030.

Impact of COVID-19 Pandemic on Chronic Obstructive Pulmonary Disease Healthcare Use, Exacerbations, and Mortality: A Population Study.

Rationale: Existing work suggests that patients with chronic obstructive pulmonary disease (pwCOPD) presented less frequently to the emergency department and were less likely to be hospitalized during the coronavirus disease (COVID-19) pandemic, but it is unclear if this was due to improved health and disease management or to increased barriers and/or avoidance of health care. Objectives: The objective of this study was to determine the impact of the pandemic on inpatient and outpatient healthcare use, disease incidence, and mortality rates in pwCOPD. Methods: A retrospective population-based analysis using linked administrative datasets from Alberta, Canada 18 months before and after March 12, 2020 was conducted to measure hospitalization, emergency department and outpatient visits, and COPD outpatient exacerbations during these time periods. Mortality data were also analyzed before versus after the pandemic, taking confirmed COVID-19 infection within 30 days into account. Subgroup analysis based on COPD exacerbation risk stratification was undertaken to determine if healthcare use differed based on exacerbation risk. Finally, sex-based analysis of healthcare use during the pandemic was also completed. Results: Hospitalization or emergency department visits and outpatient treatment for acute exacerbations of COPD dropped, whereas total outpatient COPD visits, including both virtual and in person, increased during the pandemic for pwCOPD. The mortality rate increased even after adjusting for COVID-19-associated deaths. Sex-based subgroup analysis showed a greater drop in acute care use for females, but the rise in mortality was seen for both sexes, with men experiencing a greater rate of mortality than women. Conclusions: Overall, pwCOPD accessed acute care resources less during the pandemic, which may have contributed to a rise in non-COVID-19 all-cause mortality.

The clinical characteristics associated with the ratio between the main pulmonary artery and ascending aorta diameter in patients with acute exacerbation of chronic obstructive pulmonary disease.

A pulmonary artery-to-aorta (PA/A) ratio of ≥1 is a reliable indicator of pulmonary hypertension and is associated with an increased risk of acute exacerbation of chronic obstructive pulmonary disease (COPD) and long-term mortality in patients with stable COPD. However, it is unclear whether a PA/A ratio of ≥1 is associated with mortality in patients hospitalized with acute exacerbation of COPD. The purpose of this study was to evaluate the clinical course and mortality of patients with PA/A ratios of ≥1 who were hospitalized with acute exacerbation of COPD. We retrospectively reviewed the medical charts of patients admitted to a tertiary referral hospital and a secondary hospital with acute exacerbation of COPD between 2016 and 2021. Chest computed tomography was used to measure the pulmonary artery (PA), aorta (A) diameter, and the PA/A ratio. The study involved 324 and 111 patients with PA/A ratios <1 and ≥1, respectively. The average age in the two groups was 74.1 and 74.5 years, which was not significantly different. When compared with the group with PA/A ratios of <1, the group with PA/A ratios of ≥1 had a lower proportion of males (71.2% vs. 89.5%, P<0.001), more patients with type 2 respiratory failure (35.1% vs. 18.8%), higher high-flow nasal cannula use (10.8% vs. 4.6%), higher use of non-invasive ventilation (NIV) (21.6% vs. 7.7%), and longer hospital stay (10.9 vs. 9.5 days). In-hospital mortality was not significantly different between the two groups. A PA/A ratio of ≥1 was identified as an independent predictor of the need for high-flow nasal cannula, NIV, and intubation in COPD patients. Patients with PA/A ratios of ≥1 had a high incidence of type 2 acute respiratory failure and required advanced treatment, including high-flow nasal cannula, NIV, and intubation. Therefore, hospitalized patients with acute exacerbation of COPD and PA/A ratios of ≥1 require more aggressive treatment.