Relative Risk Of Mortality Research Articles

Children born preterm admitted to paediatric intensive care for bronchiolitis: a systematic review and meta-analysis

BackgroundTo undertake a systematic review of studies describing the proportion of children admitted to a paediatric intensive care unit (PICU) for respiratory syncytial virus (RSV) and/or bronchiolitis who were born preterm, and compare their outcomes in PICU with children born at term.MethodsWe searched Medline, Embase and Scopus. Citations and references of included articles were searched. We included studies published from the year 2000 onwards, from high-income countries, that examined children 0–18 years of age, admitted to PICU from the year 2000 onwards for RSV and/or bronchiolitis.The primary outcome was the percentage of PICU admissions born preterm, and secondary outcomes were observed relative risks of invasive mechanical ventilation and mortality within PICU.We used the Joanna Briggs Institute Checklist for Analytical Cross-Sectional Studies to assess risk of bias.ResultsWe included 31 studies, from 16 countries, including a total of 18,331 children.Following meta-analysis, the pooled estimate for percentage of PICU admissions for RSV/bronchiolitis who were born preterm was 31% (95% confidence interval: 27% to 35%). Children born preterm had a greater risk of requiring invasive ventilation compared to children born at term (relative risk 1.57, 95% confidence interval 1.25 to 1.97, I2 = 38%). However, we did not observe a significant increase in the relative risk for mortality within PICU for preterm-born children (relative risk 1.10, 95% confidence interval: 0.70 to 1.72, I2 = 0%), although the mortality rate was low across both groups.The majority of studies (n = 26, 84%) were at high risk of bias.ConclusionsAmong PICU admissions for bronchiolitis, preterm-born children are over-represented compared with the preterm birth rate (preterm birth rate 4.4% to 14.4% across countries included in review). Preterm-born children are at higher risk of mechanical ventilation compared to those born at term.

The relationship between preserved ratio impaired spirometry and mortality in the myocardial infarction survivors: a population-based cohort study

IntroductionPreserved ratio impaired spirometry (PRISm) is a subtype of pulmonary function abnormality which is characterized by a proportional reduction in non-obstructive expiratory lung volume. Currently, no studies have shown a relationship between PRISm and mortality in myocardial infarction (MI) survivors.MethodsWe used cohort data from U.S. adults who attended the National Health and Nutrition Examination Survey (NHANES) from 2007 to 2012. According to the ratio of forced expiratory volume in the first second (FEV1) to forced vital capacity (FVC), we divided lung function into normal spirometry (FEV1/ FVC) ≥ 70%, FEV1 ≥ 80%), PRISm (FEV1/FVC ≥ 70%, FEV1 < 80%) and obstructive spirometry (FEV1/FVC < 70%). Cox regression was used to estimate the correlation between lung functions and mortality among MI patients. Kaplan-Meier survival curves compared the prognosis of MI with three different lung functions. We further verify the stability of the results by sensitivity analysis.Results411 subjects were included in our research. The mean follow-up time for the study was 105 months. Compared with normal spirometry, PRISm was significantly correlated with a greater relative risk for all-cause mortality (adjust HR 3.41, 95% confidence interval [95%CI]: 1.76–6.60, P < 0.001) and cardiovascular mortality (adjust HR 13.9, 95%CI: 2.60–74.6, P = 0.002). PRISm remains more correlated with all-cause mortality (adjust HR 2.73, 95%CI: 1.28–5.83, P = 0.009) relative to obstructive spirometry. The results are basically stable after sensitivity analysis. Kaplan-Meier survival curves showed that patients with PRISm tended to have the lowest survival during the follow-up period.ConclusionPRISm is an independent risk factor for all-cause and cardiovascular mortality in MI survivors. The presence of PRISm was associated with a significantly higher risk of all-cause mortality compared with obstructive spirometry.

Global, regional, and national burden of asthma and its attributable risk factors from 1990 to 2019: a systematic analysis for the Global Burden of Disease Study 2019

BackgroundThe burden of asthma in terms of premature death or reduced quality of life remains a huge issue. It is of great importance to evaluate asthma burden geographically and time trends from 1990 to 2019 and to assess the contributions of age, period, and cohort effects at global level.MethodsAsthma prevalence, deaths, and disability adjusted life years (DALYs) as well as risk-attributable burden were collected from the Global Burden of Diseases, Injuries, and Risk Factors Study (GBD) 2019 database and were compared by age and sex. The Smoothing Splines models were used to estimate the relationship between asthma DALYs and the sociodemographic index (SDI). The Age-Period-Cohort model was used to determine effects of ages, periods, and birth cohorts on disease rates.ResultsBetween 1990 and 2019, the declines were 24.05% (95% uncertainty interval [UI] − 27.24 to − 20.82) in age-standardized asthma prevalence, 51.3% (− 59.08 to − 43.71) in mortality, and 42.55% (− 48.48 to − 36.61) in DALYs rate. However, the burden of asthma continued to rise, with an estimated 262.41 million prevalent cases globally (95% UI 224.05 to 309.45). Asthma caused greater DALYs in females than in males among people aged 20 years and older. The lowest age-standardized DALYs rate was observed at a SDI of approximately 0.70. The Longitudinal age curves showed an approximate W-shaped pattern for asthma prevalence and a likely J-shaped pattern for asthma mortality. The period effect on prevalence and mortality of asthma decreased from 1990 to 2019. Compared with the 1955–1959 birth cohort, the prevalence relative risk (RR) of asthma was highest in the 1905–1909 birth cohort, whereas the mortality RR continued to decline. At the global level, the percentages of high body-mass index, occupational asthmagens, and smoking contributing to DALYs due to asthma were 16.94%, 8.82%, and 9.87%, respectively.ConclusionsAlthough the age-standardized rates of asthma burden declined in the past 30 years, the overall burden of asthma remains severe. High body mass index becomes the most important risk factor for DALYs due to asthma at the global level.

Mineral and Bone Metabolism Markers and Mortality in Diabetic Patients on Haemodialysis.

Diabetic patients on haemodialysis have a higher risk of mortality than non-diabetic patients. The aim of this COSMOS analysis was to assess whether bone and mineral laboratory values (calcium, phosphorus, and PTH) contribute to such risk. COSMOS is a multicentre, open-cohort, 3-year prospective study, which includes 6797 patients from 227 randomly selected dialysis centres from 20 European countries. The association between mortality and calcium, phosphate or PTH was assessed using Cox proportional hazard regression models using both penalized splines smoothing and categorization according to KDIGO guidelines. The effect modification of the association between the relative risk of mortality and serum calcium, phosphate or PTH by diabetes was assessed. There was a statistically significant effect modification of the association between the relative risk of mortality and serum PTH by diabetes (p = 0.011). The slope of the curve of the association between increasing values of PTH and relative risk of mortality was steeper for diabetic compared with non-diabetic patients, mainly for high levels of PTH. In addition, high serum PTH (> 9 times the normal values) was significantly associated with a higher relative risk of mortality in diabetic patients but not in non-diabetic patients (1.53[95%CI:1.07-2.19] and 1.17[95%CI:0.91-1.52]). No significant effect modification of the association between the relative risk of mortality and serum calcium or phosphate by diabetes was found (p = 0.2 and p = 0.059, respectively). The results show a different association of PTH with the relative risk of mortality in diabetic and non-diabetic patients. These findings could have relevant implications for the diagnosis and treatment of CKD-MBD.

Meta-Analysis of the Prognostic Significance of Carotid Artery Stenosis in Patients Who Underwent Transcatheter Aortic Valve Implantation

Stroke is a known complication of both transcatheter aortic valve implantation (TAVI) and carotid artery stenosis (CAS). Whether CAS is a predictor of worse prognosis after TAVI is unclear. We performed a meta-analysis to assess the impact of CAS on the incidence of neurovascular complications and mortality after TAVI. We searched PubMed/MEDLINE and EMBASE databases from inception to January 2023. CAS was defined by ≥50% stenosis of at least 1 carotid artery. Studies comparing CAS versus non-CAS TAVI populations were included. Patients' baseline characteristics and 30-day clinical outcomes were extracted. End points included the 30-day incidence of neurovascular complications (stroke or transient ischemic attack) and 30-day all-cause mortality. We identified six studies, totaling 6,763 patients in the CAS group and 23,861 patients in the non-CAS group. Patients with CAS had a higher prevalence of hypertension, diabetes mellitus, dyslipidemia, previous myocardial infarction, coronary artery bypass graft, peripheral artery disease, previous neurovascular disease, and chronic kidney disease. There was no significant difference in the rates of 30-day neurovascular complications between CAS and non-CAS groups (relative risk 1.23, 95% confidence interval 0.63 to 2.40, p=0.54). CAS was associated with a higher risk of 30-day all-cause mortality (relative risk 1.28, 95% confidence interval 1.12 to 1.47, p<0.001), not found in a sensitivity analysis. In conclusion, patients with CAS presented with a significantly higher co-morbidity burden. CAS was not associated with an increased risk of 30-day neurovascular complications. 30-day mortality was higher in the CAS group but that may be a surrogate of the heavy co-morbidity burden of patients with CAS.

Assessment of mortality-related risk factors and effective antimicrobial regimens for treatment of bloodstream infections caused by carbapenem-resistant Pseudomonas aeruginosa in patients with hematological diseases.

Infections caused by carbapenem-resistant Pseudomonas aeruginosa (CRPA) are related to higher mortality. The objective of this study was to explore clinical outcomes of CRPA bacteremia, identify risk factors and also, compare the efficacy of traditional and novel antibiotic regimens. This retrospective study was conducted at a blood diseases hospital in China. The study included hematological patients who were diagnosed with CRPA bacteremia between January 2014 and August 2022. The primary endpoint was all-cause mortality at day 30. Secondary endpoints included 7-day and 30-day clinical cure. Multivariable Cox regression analysis was employed to identify mortality-related risk factors. 100 patients infected with CRPA bacteremia were included and 29 patients accepted allogenic-hematopoietic stem cell transplantation. 24 received ceftazidime-avibactam (CAZ-AVI)-based therapy and 76 received other traditional antibiotics. 30-day mortality was 21.0%. Multivariable cox regression analysis showed neutropenia >7 days after bloodstream infections (BSI) (P=0.030, HR: 4.068, 95%CI: 1.146~14.434), higher Pitt bacteremia score (P<0.001, HR:1.824, 95%CI: 1.322~2.517), higher Charlson comorbidity index (P=0.01, HR: 1.613, 95%CI: 1.124~2.315) and bacteremia due to multidrug-resistant Pseudomonas aeruginosa (MDR-PA) (P=0.024, HR:3.086, 95%CI: 1.163~8.197) were identified as independent risk factors of 30-day mortality. After controlling for confounders, an additional multivariable cox regression analysis revealed definitive regimens containing CAZ-AVI were associated with lower mortality in CRPA bacteremia (P=0.016, HR: 0.150, 95%CI: 0.032~0.702), as well as in MDR-PA bacteremia (P=0.019, HR: 0.119, 95%CI: 0.020~0.709). For patients with hematological diseases and CRPA bacteremia, 30-day mortality rate was 21.0% (21/100). Neutropenia >7 days after BSI, higher Pitt bacteremia score, higher Charlson comorbidity index and bacteremia due to MDR-PA increased 30-day mortality. CAZ-AVI-based regimens were effective alternatives for bacteremia due to CRPA or MDR-PA.

1434-P: Smoking, All-Cause, and Cause-Specific Mortality in Individuals with Type 2 Diabetes in Mexico—An Analysis of the Mexico City Prospective Study (MCPS)

Background: Cigarette smoking increases the already elevated risk of mortality observed in adults with type 2 diabetes but prospective data on the association between smoking and mortality among Mexican adults with type 2 diabetes are lacking. Methods: We analyzed data from the MCPS, which surveyed 150,000 adults between 1998-2004. We performed Cox proportional hazard models and Fine and Gray sub distribution hazard models to estimate adjusted relative risk for all-cause and cause-specific mortality, respectively. Results: Among 25,141 individuals with diabetes, 50.7% were never smokers, 26% former smokers, and 23.2% active smokers. Compared to non-smokers (Fig 1A), former smokers had an increased risk of all cause-mortality at 7.5 years of follow-up (HR 1.15 [95% CI 1.05-1.26]), with this risk receding completely after 7.5 years. Compared to non-smokers (Fig 1B), active smokers had a significantly higher risk of death after 7.5 years of follow-up (HR 1.17 [95% CI 1.07-1.28]), but not in the preceding 7.5 years. For cause-specific mortality, active smokers had an increased risk of death due to myocardial infarction, lung cancer, and COPD. Conclusions: The risk of death among Mexican adults with type 2 diabetes varies over time and according to smoking status. Strategies to support sustained smoking cessation in people with type 2 diabetes are needed. Disclosure D.Ramírez-garcía: None. C.A.Fermín-martínez: None. N.Antonio villa: None. A.Vargas-vázquez: None. L.Fernández chirino: None. J.A.Seiglie: Consultant; BDMT Global, Techspert Expert Network. O.Bello-chavolla: None.

Climate and human mortality in Virginia, 2005–2020

Using an extensive database of every resident death in Virginia from 2005 to 2020, climate-mortality relationships are examined for 12 climatically homogeneous regions within the Commonwealth. Each region is represented by a first-order weather station from which archived temperature and humidity data are used to generate a variety of biometeorologically relevant indices. Using these indices and other variables (such as air quality and heat and cold waves), daily mortality and climate relationships are modeled for each region over a 21-day lag period utilizing generalized additive models and distributed lag non-linear models. Optimal models are identified for each region, and a consensus model was also run based on maximum temperature to facilitate inter-regional comparisons.The relative risk of mortality varies markedly as a function of climate between regions, with U-shaped, J-shaped, and inverse linear relationships evident. Cold mortality exceeds heat mortality across most of Virginia (typical relative risks are 1.10 for cold and 1.03 for heat), with cold risks strongest at lags 3 to 10. Low temperatures (or low humidity) are protective at lags 0–2 days except in the colder, western parts of state. Heat mortality occurs at short lags (0–2 days) for three-fourths of the stations, but the spatial pattern is random. Mortality displacement is evident for most regions for several days following the heat-related spike. Although the use of region-specific models is justified, the simple consensus model based on a consistent set of predictors provides similar results.

Coronary artery calcium score predicts outcome in patients with COVID-19

Abstract Funding Acknowledgements Type of funding sources: None. Aim Coronary artery calcium (CAC) score is a proven prognostic marker of cardiovascular risk. The aim of this study was to evaluate the prognostic value of CAC score on standard chest computed tomography (CT) in patients admitted with COVID-19. Methods We enrolled 144 consecutive patients (mean age 67± 13, 60.7% male) hospitalized with COVID-19, who on admission underwent chest CT to detect and assess pulmonary involvement. CAC score was calculated by two investigators blinded to patients clinical data. Patients were followed-up for 12 months after their admission. Results 106 patients had image quality sufficient for analysis. The median CAC score was 249 Agatston units (interquartile range 658). 33 deaths were recorded in the study group during the follow-up period. The median values of CAC of patients who died during the study period and of the survivors were 592 (interquartile range 1492) and 142 (interquartile range 400), respectively. The difference in CAC between these two subgroups was statistically significant (p = 0,0001). The area under the ROC curve for CAC score for predicting all-cause mortality was 0.738 (95% CI 0,644 to 0,819). The criterion with the highest prognostic accuracy was CAC score &amp;gt;143 Agatston units (positive and negative predictive values were 44,4% and 88,4%, respectively). The presence of this criterion was associated with 3,82 times higher relative risk of mortality (95%CI 1.60 – 9,11; p = 0.0025). Conclusion CAC score measurement based on standard chest CT performed on admission in patients with COVID-19 to detect pulmonary involvement is a prognostic marker of increased mortality during the 12-month follow-up.

The epidemic of acute lymphoid leukemia in China: current trends and future prediction.

China has experienced one of the fastest increases in the incidence of acute lymphoid leukemia (ALL). The aim of this study was to assess the long-term trends of the incidence and mortality of ALL in mainland China between 1990 and 2019 and to project these trends through 2028. Data on ALL were extracted from the Global Burden of Disease Study 2019; population data were extracted from World Population Prospects 2019. An age-period-cohort framework was used in the analysis. The net drift for the incidence of ALL was 7.5% (95% confidence interval [CI]: 7.1%, 7.8%) per year in women and 7.1% (95% CI: 6.7%, 7.6%) in men, and local drift was found to be higher than 0 in every studied age group (p<0.05). The net drift for mortality was 1.2% (95% CI: 1.0%, 1.5%) in women and 2.0% (95% CI: 1.7%, 2.3%) in men. Local drift was lower than 0 in boys aged 0-4 years and girls aged 0-9 years and higher than 0 in men aged 10-84 years and women aged 15-84 years. The estimated period relative risks (RRs) for both incidence and mortality showed increasing trends in the recent period. The cohort RRs for incidence showed increasing trends in both sexes; however, the cohort RR for mortality was decreased in the recent birth cohort (women born after 1988-1992 and men born after 2003-2007). Compared with that in 2019, the incidence of ALL in 2028 is projected to increase by 64.1% in men and 75.0% in women, and the mortality is predicted to decrease by 11.1% in men and 14.3% in women. The proportion of older adult/adults individuals with incident ALL and ALL-related death was projected to increase. Over the last three decades, the incidence and mortality rates of ALL have generally increased. It is projected that the incidence rate of ALL in mainland China will continue to increase in the future, but the associated mortality rate will decline. The proportion of older adult/adults individuals with incident ALL and ALL-related death was projected to increase gradually among both sexes. More efforts are needed, especially for older adult/adults individuals.

Negative laparotomy rates and outcomes following blunt traumatic injury in the United States

IntroductionExploratory laparotomy remains the mainstay of treatment following blunt abdominal trauma. However, the decision to operate can be difficult in hemodynamically stable patients with unreliable physical exams or equivocal imaging findings. The risk of a negative laparotomy and the subsequent complications must be weighed against the potential morbidity and mortality of a missed abdominal injury. Our study aims to evaluate trends and the effect of negative laparotomies on morbidity and mortality in adults with blunt traumatic injuries in the United States. MethodsWe reviewed the National Trauma Data Bank (2007–2019) for adults with blunt traumatic injuries who underwent an exploratory laparotomy. Positive or negative laparotomy of abdominal injury was compared. We performed bivariate analysis and a modified Poisson regression to estimate the effect of negative laparotomy on mortality. A sub-analysis of patients who underwent computed tomography (CT) of the abdomen and pelvis was performed. Results92,800 patients met the inclusion criteria of the primary analysis. Negative laparotomy rates were 12.0% in this population, down-trending throughout the study. Negative laparotomy patients had a significantly higher crude mortality (31.1% vs. 20.5%, p < 0.001), despite lower injury severity scores (20 (10–29) vs. 25 (16–35), p < 0.001) than positive laparotomy patients. Patients that underwent negative laparotomy had a 33% higher risk for mortality (RR1.33, 95% CI 1.28–1.37, P < 0.001) than positive laparotomy patients after adjusting for pertinent covariates. Patients that underwent CT abdomen/pelvis imaging (n = 45,654) had a lower rate of negative laparotomy (11.1%) and decreased difference in crude mortality (22.6% vs. 14.1%, p < 0.001) compared to positive laparotomy patients. However, the relative risk for mortality remained high at 37% (RR 1.37, 95% CI 1.29 – 1.46, p < 0.001) for this sub-cohort. ConclusionNegative laparotomy rates in adults with blunt traumatic injuries are trending down in the United States but remains substantial and may show improvement with increased use of diagnostic imaging. Negative laparotomy has a relative risk for mortality of 33% despite lower injury severity. Thus, surgical exploration in this population should be thoughtfully undertaken with appropriate evaluation via physical exam and diagnostic imaging to prevent unnecessary morbidity and mortality.

Efficacy of intravenous immunoglobulins (IVIG) in COVID-19 patients: a systematic review and meta-analysis.

Though controversial, many clinical trials have been conducted to evaluate the efficacy of intravenous immunoglobulins (IVIG) in COVID-19 cases. Therefore, a systematic review and meta-analysis have been performed to evaluate the efficacy of IVIG in the treatment of COVID-19 patients. A systematic search was performed in electronic databases and preprint servers up to November 20, 2021. Since substantial heterogeneity was expected, a random-effects model was applied to pool effect size from included studies to calculate the standardized mean differences (SMDs) for the continuous variables and relative risks (RRs) for the dichotomous variable with 95% confidence intervals (CIs). Five randomized clinical trials and seven cohort studies were analyzed among the 12 eligible studies with a total of 2,156 patients. The pooled RR of mortality was 0.77 (CI 0.59-1.01, P-value = 0.06), and of mechanical ventilation was 1.50 (CI 0.29-7.83; P-value = 0.63) in the IVIG group compared with the standard care group. The pooled SMD of hospital length of stay was 0.84 (CI -0.43-2.11; P-value = 0.20) and of ICU length of stay was -0.07 (CI -0.92-0.78; P-value = 0.86) in the IVIG group compared with the standard care group. This meta-analysis found that the IVIG therapy was not statistically different from the standard care group. Mortality, ICU admission, mechanical ventilation, length of hospital stay, and length of ICU stay were not significantly improved among IVIG recipients. However, statistical indifference is not equal to clinical indifference.

Effect of different heat wave timing on cardiovascular and respiratory mortality in France

BackgroundPrevious epidemiological evidence suggests that the impact of heat waves on mortality may change over time within the summer season. The consideration of heat wave timing could help to optimize the implementation of heat alert systems. We explored the effect of the timing of extreme heat events on mortality risk during the summer season in France. MethodsSummertime daily mortality data for 21 French cities from 2000 to 2015 were obtained from the French National Institute of Health and Medical Research. Heat waves were defined according to the official definition of Météo France. The order of heat wave over time, from June to August, was assessed. We also used ambient temperature and considered different summer periods. To quantify mortality risk (for cardiovascular and respiratory causes) for the first and second or later heat waves, quasi-Poisson models were performed. We used distributed lag non-linear models to estimate whether the non-linear exposure–response associations between temperature and mortality differ across different summer periods. ResultsCompared with non-heat wave days, the second and later heat waves of the summer season were associated with a higher relative risk (RR) for cardiovascular and respiratory mortality (RR, 95%CI: 1.38, 1.23–1.53; RR, 95%CI: 1.74, 1.45–2.08, respectively) as compared to first heat wave (RR, 95%CI: 1.30, 1.17–1.45, RR, 95%CI: 1.56, 1.33–1.83, respectively). Small increase from the median temperature was associated to an increased risk in mortality in the first stage of the summer (from June to mid-July), while only more extreme temperatures were harmful later in the summer. After the exclusion from the analysis of the August 2003 heat-wave, only results for earlier heat waves episodes and first-period exposures were confirmed. ConclusionsThe timing of extreme temperatures modulates heat-related risks in France. Such information could be used to update local heat action plans to optimize health benefits.

Impact of state health disparity on lung, breast, and prostate cancer incidence and mortality in the United States.

e18639 Background: Lung cancer is the second most common cancer and the leading cause of cancer deaths in both sex in the United States (US). Prostate cancer is the most common in men, while in women being breast cancer. America’s Health Rankings (AHR) is a comprehensive assessment of the nation's health on a state-by-state basis to determine state health rankings annually. We aimed to evaluate the association, which has not been investigated, between state-level health disparity as measured by AHR and lung, breast, and prostate cancer incidence and mortality in the US. Methods: We examined lung, breast and prostate cancer incidence and mortality data for 2015-2019 from the United States Cancer Statistics (USCS) database provided by the Centers for Disease Control and Prevention (CDC). Overall state health rankings were obtained from AHR and calculated by an equation using weighted measures in five different categories: 25% Behaviors, 22.5% Community &amp; Environment, 12.5% Policy, 15% Clinical Care, and 25% Outcomes. We extracted 2015-2019 AHR data and further classified state health rankings into quartiles (1st [the healthiest] = rank 1 to 13; 4th [the least healthy] = rank 38 to 50). Associations of cancer incidence and mortality with overall state health rankings were analyzed by negative binomial regressions. Results: From 2015 to 2019, age-adjusted incidence rate per 100,000 population for lung, breast, and prostate cancer were 56.3, 128.0 and 109.8, respectively. Age-adjusted mortality rate per 100,000 population for lung, breast, and prostate cancer were 36.7, 19.9 and 18.9, respectively. Among 50 states we included for analysis, AHR indicated that Hawaii was the healthiest state (No.1) whereas Mississippi was the least healthy state (No. 50) for overall health rankings. States in the 4th quartile of health ranking were significantly associated with greater lung cancer incidence (Rate Ratio [RR]: 1.34 [95% CI, 1.18-1.52]) and mortality (1.50 [1.32-1.71]) than those in the 1st quartile. This was pronounced for age &lt; 65 (Incidence [I]: 1.63 [1.36-1.96]; Mortality [M]: 1.93 [1.51-2.48]), Male (I: 1.48 [1.30-1.67]); M: 1.66 [1.47-1.87]), and Black (I: 1.43 [1.22-1.66]; M: 1.54 [1.32-1.79]). Black women living in states with worse health rankings had higher relative risks of breast cancer incidence (1.14 [1.03-1.26]) and mortality (1.27 [1.05-1.53]). There was no significant association between state health rankings and prostate cancer incidence and mortality in the US. Conclusions: There are significant differences in lung, breast, and prostate cancer incidence and mortality within the US. States with worse health rankings had higher cancer incidence and mortality, and varied by different demographics. Our findings suggests that advanced cancer screening and targeted public health interventions should be prioritized in areas with health disadvantages to improve cancer disparity.

Observed intervention effects for mortality in randomised clinical trials: a methodological study protocol

IntroductionIt is essential to choose a realistic anticipated intervention effect when calculating a sample size for a randomised clinical trial. Unfortunately, anticipated intervention effects are often inflated, when compared with...

Trends of the burden of type 2 diabetes mellitus attributable to high body mass index from 1990 to 2019 in China.

Overweight and obesity are well-known risk factors for developing type 2 diabetes (T2DM). However, details on the evolution of the T2DM burden attributed to China's high body mass index (BMI) in China have not been thoroughly studied. This study aimed to investigate the temporal trends of the T2DM burden attributable to a high BMI in China from 1990 to 2019 and to evaluate the independent effects of age, period, and cohort on the burden of T2DM attributed to a high BMI. Data on T2DM burden attributable to a high BMI from 1990 to 2019 were obtained from the Global Burden of Disease Study 2019. Deaths, disability-adjusted life years (DALYs), age-standardized mortality rate (ASMR), and age-standardized DALY rate (ASDR) of T2DM attributable to a high BMI were estimated by age and sex. The joinpoint regression model was performed to calculate the annual percentage change (APC) and the average annual percentage change (AAPC) in the burden of T2DM attributed to a high BMI. The age-period-cohort analysis was applied to estimate the independent effects of age, period, and cohort on the temporal trends of mortality and the DALY rate. In 2019, deaths and DALYs from T2DM attributable to a high BMI in China were 47.53 thousand and 3.74 million, respectively, five times higher than in 1990. Among those under 60 years of age, men had higher deaths and DALYs than women, while the gender differences reversed in those over 60 years of age. Furthermore, the ASMR and ASDR in 2019 were 2.39 per 100,000 (95%UI 1.12-3.90) and 181.54 per 100,000 (95%UI 93.71-286.33), respectively, representing a 91% and 126% increase since 1990. In China, women previously had a higher ASMR and ASDR than men, while the differences in the ASMR and ASDR between the sexes were reversed in recent years. From 1990 to 2019, the ASMR in women increased before 2004 and then decreased from 2004 to 2015, and increased again after, with an overall AAPC value of 1.6%. In contrast, the ASMR in men continued to increase, with an overall AAPC value of 3.2%. The ASDR continued to increase in men and women, with AAPCs of 2.2% and 3.5%, respectively. The age effect showed that the relative risk of mortality increased with age in both men and women, except for the 75-84 age group. The impact of the age on the DALY rate revealed a trend of first rising and then decreasing, peaking at 65-69 years. The effect of the period on the burden of T2DM attributable to a high BMI increased from 1990 to 2019. The cohort effect generally showed a downward trend. The burden of T2DM attributed to a high BMI in China increased substantially from 1990 to 2019, particularly in men. Therefore, there is an urgent need for gender- and age-based public health guidelines on prevention strategies, early diagnosis, and effective management of T2DM, overweight, and obesity in China.

The role of education level in the mortality of hospitalized patients with atrial fibrillation

Abstract Funding Acknowledgements Type of funding sources: None. Introduction The association between social status and cardiovascular morbidity and mortality is well­–known. Education level is an important socioeconomic factor which influences the incidence, symptoms, and treatments of atrial fibrillation (AF). However, data about the effects of education level on all-cause mortality in patients with AF are scarce. Aim To explore any association between education level and all-cause mortality in patients hospitalized with AF. Methods This retrospective cohort study is based on a database created by linking Swedish nationwide registries including all patients hospitalized with an AF diagnose between 1995 and 2003. In all, 158 577 patients were included in the study (56% male and 44% female; mean age 72 ± 11 years). The follow up was 5 years with an observation time of 636 597 person–years. Education level was described by 3 categories representing primary, secondary, and academic education. Kaplan-Meier curves and Cox proportional hazard models adjusted with age, sex, time of index hospitalization, categorized Charlson´s Comorbidity Index (CCI) score, and CHA2DS2-VASc score were used for statistical analysis. Hazard ratio (HR) with 95% confidence interval (CI) was used as estimate of association and P &amp;lt; 0.05 was regarded as statistically significant. The risk of all-cause mortality was estimated in subpopulations defined by mortality risk factors as CCI, CHA2DS2-VASc score, heart failure, coronary artery disease, chronic obstructive pulmonary disease, diabetes, chronic kidney disease, and cancer. Results Patients with academic education had the lowest all–cause mortality, which was seen early during follow–up. Compared to patients with primary education, those with secondary or academic education showed lower relative mortality risk in the adjusted Cox regression model (secondary education HR: 0.875, 95% CI: 0.86 – 0.89, p&amp;lt;0.001; academic education HR: 0.695, 95% CI: 0.67 – 0.72; p&amp;lt;0.001). Among the subpopulations, the HR varied between 0.72 and 0.95 for secondary and between 0.43 and 0.79 for academic education respectively. All risk differences were statistically significant. Conclusion Academic education was associated with the lowest and primary education with the highest risk of all-cause mortality. This pattern was consistent through all analyzed subpopulations.

Patient-Level Meta-Analysis of Low-Dose Hydrocortisone in Adults with Septic Shock

BackgroundTrials and study-level meta-analyses have failed to resolve the role of corticosteroids in the management of patients with septic shock. Patient-level meta-analyses may provide more precise estimates of treatment effects, particularly subgroup effects.MethodsWe pooled individual patient data from septic shock trials investigating the adjunctive use of intravenous hydrocortisone. The primary outcome was 90-day all-cause mortality, and it was also analyzed across predefined subgroups. Secondary outcomes included mortality at intensive care unit and hospital discharge, at 28 and 180 days, and vasopressor-, ventilator-, and organ failure–free days. Adverse events included superinfection, muscle weakness, hyperglycemia, hypernatremia, and gastroduodenal bleeding.ResultsOf 24 eligible trials (n=8528), 17 (n=7882) provided individual patient data, and 7 (n=5929) provided 90-day mortality. The marginal relative risk (RR) for 90-day mortality of hydrocortisone versus placebo was 0.93 (95% confidence interval [CI], 0.82 to 1.04; P=0.22; moderate certainty). It was 0.86 (9% CI, 0.79 to 0.92) for hydrocortisone with fludrocortisone and 0.96 (95% CI, 0.82 to 1.12) without fludrocortisone. There was no significant differential treatment effect across subgroups. Hydrocortisone was associated with little to no difference in any of the secondary outcomes except vasopressor-free days (mean difference, 1.24 days; 95% CI, 0.74 to 1.73; high certainty). Hydrocortisone may not be associated with an increase in the risk of superinfection (RR, 1.04; 95% CI, 0.95 to 1.15; low certainty), hyperglycemia (RR, 1.05; 95% CI, 0.98 to 1.12; low certainty), or gastroduodenal bleeding (RR, 1.11; 95% CI, 0.83 to 1.48; low certainty). Hydrocortisone may be associated with an increase in the risk of hypernatremia (RR, 2.01; 95% CI, 1.56 to 2.60; low certainty) and muscle weakness (n=2647; RR, 1.73; 95% CI, 1.49 to 1.99; low certainty).ConclusionsIn this patient-level meta-analysis, hydrocortisone compared with placebo was not associated with reduced mortality for patients with septic shock. (Funded by “Programme d’Investissements d’Avenir,” a research Professorship from the National Institute of Health and Care Research, Leadership Fellowships from the National Health and Medical Research Council of Australia, and Emerging Leaders Fellowship from the National Health and Medical Research Council of Australia; PROSPERO registration number, CRD42017062198.)

293 Risk of Clostridium Difficile Enterocolitis in SJS/TENS Patients Treated with Antibiotics

Abstract Introduction Stevens-Johnson Syndrome (SJS) and Toxic Epidermal Necrolysis Syndrome (TENS) are both rare conditions derived from adverse drug reactions. SJS/TENS patients are often treated with antibiotics, both prophylactically and therapeutically, for secondary infections. However, the subsequent development of Clostridium Difficile (C. Difficile) enterocolitis is unknown. Due to the rarity of SJS/TENS, institution trials are limited in their data quantify the additional risk of sequelae such as enterocolitis development after antibiotic administration. Therefore, we used a large commercially available database derived from inpatient hospital coding data to assess the incidence of C. Difficile enterocolitis within 2 weeks of antibiotic administration after development of SJS/TENS. Methods : Our study utilized a large commercially available database. Inclusion criteria identified adult patients ( &amp;gt;18 years old) diagnosed with SJS/TENS between 2002 and 2022, who were treated with antibiotics within 2 weeks of diagnosis, and who subsequently went on to develop Clostridium Difficile enterocolitis within 6 months. We compared our cohort to a control group which did not receive antibiotics and propensity score matched them for age, sex, race, HIV status, cancer, transplant status, and severe sepsis and SIRS and analyzed the risk of developing C. Difficile enterocolitis. Results There were 4,792 SJS/TENS patients who did not receive antibiotics and 5,652 who did. Our matched cohorts contained 4,595 patients. The relative risk of mortality between our cohorts was 4.962 (RR: 2.562, CI 95% 2.125-3.088; p&amp;lt; 0.0001). SJS/TENS who received antibiotics developed C. Difficile 68/4595 vs 30/495 and had a relative risk of 0.827% (RR: 2.267, 1.478-3.476, CI 95%; p&amp;lt; 0.0001). Therefore, an SJS/TENS patient incurred a 2.267 times higher risk of developing C. difficile enterocolitis after receiving antibiotics. Conclusions While causality cannot be affirmed with retrospective data, our findings do suggest that patients with SJS/TENS due to the statistically significant risk of C. Difficile enterocolitis development. However, the overall absolute risk of C. difficile enterocolitis remains disproportionately low in this population that warrants further exploration. Applicability of Research to Practice SJS/TENS patients are difficult to develop evidence-based treatment plans for because of their rarity and the multitude of conflicting small cohort studies available in the literature. Our study utilizes a large database to more robustly suggest that clinicians should be cautious about administering antibiotics to patients diagnosed with SJS/TENS.

Age at diagnosis modifies associations of type2 diabetes with cancer incidence and mortality: a retrospective matched-cohort study.

The age-specific associations between type2 diabetes and cancer risk are not fully understood. The aim of this study was to assess how age at diagnosis modifies the associations between type2 diabetes and cancer risk. We used data from the Yinzhou Health Information System, and included 42,279 individuals who were newly diagnosed with type2 diabetes between 2010 and 2014, as well as 166,010 age- and sex-matched control individuals without diabetes who were selected randomly from the electronic health records of the entire population. Patients were divided into four age groups according to age at diagnosis: <50, 50-59, 60-69 and ≥70 years. Stratified Cox proportional hazards regression models, with age as the time scale, were used to estimate the HRs and 95% CIs for theassociations of type2 diabetes with the risks of overall and site-specific cancers. Population-attributable fractions were also calculated for outcomes associated with type2 diabetes. During median follow-up periods of 9.20 and 9.32 years, we identified 15,729 incident cancer cases and 5383 cancer deaths, respectively. Patients diagnosed with type2 diabetes before 50 years of age had the highest relative risks of cancer incidence and mortality, with HRs (95% CI) of 1.35 (1.20, 1.52) for overall cancer incidence, 1.39 (1.11, 1.73) for gastrointestinal cancer incidence, 2.02 (1.50, 2.71) for overall cancer mortality, and 2.82 (1.91, 4.18) for gastrointestinal cancer mortality. Risk estimates decreased gradually with each decade increase in diagnostic age. The population-attributable fractions for overall cancer and gastrointestinal cancer mortality also decreased with increasing age. The associations of type2 diabetes with cancer incidence and mortality varied by age at diagnosis, with a higher relative risk among patients who were diagnosed at a younger age.