Incidence Risk Research Articles

Association of accelerated phenotypic aging, genetic risk, and lifestyle with progression of type 2 diabetes: a prospective study using multi-state model

BackgroundAging is a major risk factor for type 2 diabetes (T2D), but individuals of the same chronological age may vary in their biological aging rate. The associations of Phenotypic Age Acceleration (PhenoAgeAccel), a new accelerated biological aging indicator based on clinical chemistry biomarkers, with the risk of dynamic progression remain unclear. We aimed to assess these associations and examine whether these associations varied by genetic risk and lifestyle.MethodsWe conducted a prospective cohort study that included 376,083 adults free of T2D and diabetes-related events at baseline in UK Biobank. PhenoAgeAccel > 0 and ≤ 0 were defined as biologically older and younger than chronological age. The outcomes of interest were incident T2D, diabetic complications, and mortality. Hazard ratios (HRs) with 95% confidence intervals (CIs) and population attributable fractions (PAFs) for these associations were calculated using multi-state model.ResultsDuring a median follow-up of 13.7 years, 17,615 participants developed T2D, of whom, 4,524 subsequently developed complications, and 28,373 died. Being biologically older was associated with increased risks of transitions from baseline to T2D (HR 1.77, 95% CI 1.71–1.82; PAF 24.8 [95% CI 23.5–26.2]), from T2D to diabetic complications (1.10, 1.04–1.17; 4.4 [1.4–7.4]), from baseline to all-cause death (1.53, 1.49–1.57; 17.6 [16.6–18.6]), from T2D to all-cause death (1.14, 1.03–1.26; 7.4 [1.8–13.0]), and from diabetic complications to all-cause death (1.32, 1.15–1.51; 15.4 [7.5–23.2]) than being biologically younger. Additionally, participants with older biological age and high genetic risk had a higher risk of incident T2D (4.76,4.43–5.12;18.2 [17.5–19.0]) than those with younger biological age and low genetic risk. Compared with participants with younger biological age and healthy lifestyle, those with older biological age and unhealthy lifestyle had higher risks of transitions in the T2D trajectory, with HRs and PAFs ranging from 1.34 (1.16–1.55; 3.7 [1.8–5.6]) to 5.39 (5.01–5.79; 13.0 [12.4–13.6]).ConclusionsPhenoAgeAccel was consistently associated with an increased risk of all transitions in T2D progression. It has the potential to be combined with genetic risk to identify early T2D incidence risk and may guide interventions throughout T2D progression while tracking their effectiveness.

Association of Omega-3 Status With Long-Term Risk of Hospitalization for Sepsis.

Sepsis is a life-threatening condition characterized by a dysregulated host response to infection. Despite decades of clinical trials, there are no specific treatments; care of the nearly 50 million annual cases worldwide is limited to antimicrobials and supportive measures. A primary prevention strategy may therefore be of value. We hypothesized that higher premorbid omega-3 fatty acid levels would be associated with a reduced incidence of sepsis. Population-based cohort study. Retrospective data from the United Kingdom (U.K. Biobank). Two hundred seventy-three thousand three hundred twenty-five participants from the U.K. Biobank. None. Our exposure was baseline estimated omega-3 index (eO3I), modeled both categorically in quartiles, and continuously with restricted cubic splines. Our outcome measure was hospital admission with an International Classification of Diseases, 10th Edition code consistent with sepsis. The median (interquartile range) baseline eO3I was 6.0% (4.8-7.3%). Over a mean follow-up period of 13 years, 9241 participants experienced hospitalization with sepsis. In our adjusted model, compared with the lowest eO3I quartile, participants had lower risks of sepsis incidence in the second quartile (hazard ratio [HR], 0.88; 95% CI, 0.86-0.91; p < 0.001), third quartile (HR, 0.80; 95% CI, 0.78-0.83; p < 0.001), and fourth quartile (HR, 0.75; 95% CI, 0.73-0.77; p < 0.001). When analyzed as a continuous variable, increasing eO3I was associated with a decreasing risk of sepsis (p < 0.001). In this population-based cohort study, baseline eO3I was inversely associated with subsequent sepsis incidence. Given that omega-3 levels can be increased with dietary supplementation, primary prevention should be explored to mitigate the burden of sepsis.

Risk of epilepsy following first unprovoked and acute seizures: Cohort study.

First unprovoked seizures and acute seizures are common and can develop into epilepsy. The risk of epilepsy following these seizures in community samples is not well established, and it is unclear whether the probability of subsequent unprovoked seizures following these seizures reaches the International League Against Epilepsy's threshold of 60%. We followed participants initially classified as having first unprovoked seizures, having acute seizures, or without seizures in a community-based survey conducted in 2003 to estimate the subsequent risk of epilepsy in 2008 and 2021. The diagnosis of epilepsy in 2008 and 2021 was based on data from a community survey and health care visits to Kilifi County Hospital and the epilepsy clinic. Poisson regression models were used to compute incident risk ratios (IRRs) for epilepsy and population-attributable risk (PAR); population-attributable risk fractions (PAFs) were computed from contingency tables. In the 5-year follow-up (censored in 2008 survey), the IRR for epilepsy was 23.3 (95% confidence interval [CI] = 14.2-38.2) for first unprovoked seizures and 10.4 (95% CI = 5.6-19.5) for acute seizures compared to the no-seizure group. By 2021 (including 2008), the IRR was 18.4 (95% CI = 11.9-28.5) for first unprovoked seizures and 7.9 (95% CI = 4.3-14.5) for acute seizures compared to the no-seizure group. The PAR for first unprovoked seizures and acute seizures was 29.0 and 8.0/1000 persons in the long-term follow-up. The PAF was 56.3% for first unprovoked seizures and 26.3% for acute seizures in the long-term follow-up. There was a high probability that a person with acute seizures (72%) or first unprovoked seizures (92%) developed epilepsy earlier than a person from the comparison group. First unprovoked seizures and acute seizures are associated with high risk for developing epilepsy. Neurological correlates for epilepsy risk following first unprovoked seizures should be investigated to inform epilepsy diagnosis and treatment.

Functional feature extraction and validation from twelve-lead electrocardiograms to identify atrial fibrillation

BackgroundDeep learning methods on standard, 12-lead electrocardiograms (ECG) have resulted in the ability to identify individuals at high-risk for the development of atrial fibrillation. However, the process remains a “black box” and does not help clinicians in understanding the electrocardiographic changes at an individual level. we propose a nonparametric feature extraction approach to identify features that are associated with the development of atrial fibrillation (AF).MethodsWe apply functional principal component analysis to the raw ECG tracings collected in the Chronic Renal Insufficiency Cohort (CRIC) study. We define and select the features using ECGs from participants enrolled in Phase I (2003–2008) of the study. Cox proportional hazards models are used to evaluate the association of selected ECG features and their changes with the incident risk of AF during study follow-up. The findings are then validated in ECGs from participants enrolled in Phase III (2013–2015).ResultsWe identify four features that are related to the P-wave amplitude, QRS complex and ST segment. Both their initial measurement and 3-year changes are associated with the development of AF. In particular, one standard deviation in the 3-year decline of the P-wave amplitude is independently associated with a 29% increased risk of incident AF in the multivariable model (HR: 1.29, 95% CI: [1.16, 1.43]).ConclusionsCompared with deep learning methods, our features are intuitive and can provide insights into the longitudinal ECG changes at an individual level that precede the development of AF.

Determination of the most appropriate radionuclide for knee radiosynovectomy: Assessment of radiation dose, radiation-induced cancer risk, and post-treatment imaging feasibility.

This study aims to systematically evaluate all radionuclides used in knee RSV to date and identify the most suitable radionuclide for knee RSV. To compare knee RSV with Y-90, P-32, Ho-166, Re-188, Au-198, Lu-177, Sm-153, and Re-186, we measured the radiation dose to non-target organs and the inducing of secondary malignancies in knee RSV patient, the radiation dose to family member and medical staff from the knee RSV patients, and the quality of post-treatment images. The Lifetime Attributable Risks of cancer incidence and mortality and the Relative Risks of solid cancer incidence and mortality are significantly higher for Y-90 and P-32 in both adult and pediatric patients compared to other radionuclides used in knee RSV. Knee RSV with Re-188, Ho-166, Au-198, and Sm-153 induces a negligible risk of secondary malignancies. The average absorbed dose for medical staff and family members exposed to patients treated with Y-90 is also significantly greater than for those exposed to RSV patients treated with other radionuclides. In contrast, the absorbed dose for medical staff and family members exposed to RSV patients treated with Sm-153, Ho-166, and Au-198 is negligible. Sm-153, Ho-166, and Re-188 offer high-quality images in post-RSV planar imaging. Based on the findings of this study and the therapeutic range of the radionuclides, Re-188 has been identified as a suitable alternative to Y-90 for knee RSV in adults. At the same time, Sm-153 and Ho-166 have been recognized as the most appropriate radionuclides for pediatric knee RSV.

Analysis and prediction of the age-period-cohort model of disease burden of rheumatoid arthritis in China from 1990 to 2019

Using the Global Burden of Disease Study 2019 (GBD 2019) database, the Joinpoint regression model was used to analyze the trend of rheumatoid arthritis (RA) incidence and the standardized disability-adjusted life years (DALY) rate in China. The age, period, and cohort effects were discussed based on the age-period-cohort model. The grey prediction model GM (1, 1) was used to fit the trend of incidence and the standardized DALY rate of RA and predict the incidence and standardized DALY rate of RA in China from 2020 to 2034. From 1990 to 2019, the incidence, standardized incidence, and standardized DALY rate of RA showed a gradual upward trend, with an average annual increase of 1.41% (95%CI 1.32%-1.44%, P<0.001); 0.10% (95%CI 0.01%-0.14%, P<0.001); and 1.91% (95%CI 1.82%-2.12%, P<0.001). The results of the age-period-cohort model showed that the longitudinal age curve of the incidence of RA from 1990 to 2019 showed a trend of increasing first and then decreasing, reaching a peak in the 60-64 years age group. The longitudinal age curve of the standardized DALY rate showed a gradual upward trend, reaching the peak in the 85-89 years age group. The results of period effect showed that the risk of RA increased first and then decreased from 1990 to 2019, with the highest risk from 2010 to 2014, and the risk of incidence was RR=1.03 (95%CI 1.00-1.06). The risk of DALY showed a fluctuating change, with a trend of decreasing first, then increasing, and then decreasing again. The highest risk of DALY in 2005-2009 period was RR=1.03 (95%CI 1.02-1.05). The results of the cohort effect showed that the later the birth, the higher the risk of morbidity and DALY. From 2020 to 2034, the projected incidence and standardized DALY rate of RA in China showed an upward trend. RA remains a major public health challenge. From 1990 to 2019, the incidence, standardized incidence, and standardized DALY rate of RA in China showed an increasing trend, which were affected by age, period effect, and cohort effect to varying degrees. Although the burden of RA in China is lower than the global average, it is still essential to take active preventive measures to reduce the burden of RA and identify and treat RA early.

Hospitalizations in people with down syndrome across age groups: a population-based cohort study in Switzerland.

People with Down syndrome suffer from multiple associated diseases. However, knowledge on rates and causes of hospitalizations is limited. This population-based cohort study used national hospital claims data in Switzerland between January 1, 2012 and December 31, 2020. Included were hospitalizations of people aged 0-90 years. People with Down syndrome were identified using ICD-10-GM code Q90 and were compared to the general population. The primary outcome was the hospitalization rate. Secondary outcomes were the primary reasons for hospitalizations, secondary diagnoses, and in-hospital outcomes. Analyses were stratified by three age groups: neonates and infants (0-12 months), children and adolescents (1-17 years), and adults (18-90 years). We calculated incidence rates, risk ratios (RR), and regression coefficients with corresponding 95% confidence intervals (CI). Among 9,992,538 hospitalizations, 5697 were identified for people with Down syndrome. Hospitalization rate for people with Down syndrome was highest in the first two years of life. In the total general population, it was highest in adults beyond 60 years. Primary reasons for hospitalization among people with Down syndrome were classified as diagnoses of the circulatory system (neonates and infants: RR 13.3 [95% CI 12.0-14.6], children and adolescents: RR 3.3 [95% CI 2.7-3.9]), and infectious diseases (adults: RR 4.0 [95% CI 3.7-4.2]). At birth, individuals with Down syndrome typically had an average of six diagnoses, a number that the general population reaches, on average, by the age of 69. People with Down syndrome experienced worse in-hospital outcomes, including longer stays in both the hospital and intensive care unit by a factor of 1.7 and a higher all-cause in-hospital mortality by an overall rate difference of 1.9%. The findings underscore the medical complexity of hospitalized people with Down syndrome and emphasize the need for a comprehensive, age-inclusive approach to improve in-hospital outcomes and anticipate emergency hospitalizations across age groups. Kantonsspital Aarau AG.

Efficacy and safety of Shexiang Baoxin Pill (MUSKARDIA) in patients with stable coronary artery disease across different weight subgroups.

Shexiang Baoxin Pill (MUSKARDIA), a traditional Chinese patent medicine, plays a crucial role in both preventing and treating diverse cardiovascular diseases, including coronary heart disease, myocardial infarction (MI), and heart failure. Preclinical research has demonstrated that the cardioprotective effects of MUSKARDIA are achieved through multiple pathways, such as enhancing coronary artery dilation, fostering new blood vessel growth, reducing inflammation and oxidative stress, improving lipid metabolism, and protecting vascular endothelium. This subgroup analysis aimed to evaluate the efficacy and safety of Shexiang Baoxin Pill (MUSKARDIA) plus optimal medical therapy (OMT) across different weight categories in treating stable coronary artery disease (CAD). This investigation was a subgroup analysis of a multicenter, randomized, double-blind, placebo-controlled phase IV clinical study. Patients receiving OMT were randomly assigned to either MUSKARDIA or placebo group for a 24-month period. This analysis focused on body weight as a distinguishing factor, using 65kg as the cutoff. The primary efficacy endpoint was the composite of major adverse cardiovascular events (MACEs), including cardiovascular death, non-fatal myocardial infarction (MI), and non-fatal stroke. Secondary efficacy endpoint comprised a composite of all-cause mortality, non-fatal MI, non-fatal stroke, hospitalizations for unstable angina or heart failure, and coronary revascularization procedures. A total of 2646 patients were included in the analysis, with 916 patients weighing less than 65kg and 1730 patients weighing 65kg or more. The median ages were 68 (range: 35-90) years and 62 (range: 29-90) in these two subgroups, respectively. For patients weighing less than 65kg, the MUSKARDIA group exhibited a significantly lower incidence of the primary efficacy endpoint (0.65%) compared to the placebo group (2.64%) (P=0.018), with a reduced risk of MACEs (HR=0.241, 95%CI: 0.068-0.856; P=0.0168). Conversely, in patients weighing 65kg or more, no significant differences were observed in the incidence rates or risks of primary or secondary efficacy endpoints between the MUSKARDIA and placebo groups (All P>0.05). Adverse events were similar between two groups across both weight subgroups. MUSKARDIA plus OMT demonstrated promising efficacy and acceptable safety in CAD patients weighing less than 65kg, potentially reducing the risk of MACEs. For patients weighing 65kg or more, further investigation is needed to optimize dosing strategies.

Incidence trends and risk factors for Perthes' disease in children born between 1985 and 2016 : a Danish nationwide register-based study.

In this study, we aimed to evaluate incidence trends and potential risk factors associated with Perthes' disease in Denmark, using publicly available data. Our population-based case-control study used data from the Danish National Patient Register and Danish Civil Registration System, accessed through the publicly available Danish Biobank Register, to identify 1,924,292 infants born between 1985 and 2016. We estimated age-specific incidence rates for four birth periods of equal duration (1985 to 1992, 1993 to 2000, 2001 to 2008, and 2009 to 2016) and investigated associations with perinatal conditions, congenital malformations, coagulation defects, autism spectrum disorders (ASD), and attention deficit hyperactivity disorders (ADHD). We identified 2,374 (81.6% male) diagnosed with Perthes' disease aged between two and 12 years, corresponding to an overall incidence of 12.1 per 100,000 live births relative to the year of birth. The incidence declined across all four birth periods, irrespective of sex or age at diagnosis. Several perinatal conditions were associated with higher Perthes' disease risk. Children with reported birth injuries (vs no reported injuries) exhibited the highest risk (relative risk (RR) 7.48 (95% CI 3.37 to 16.63)) followed by those with versus without coagulation defects (RR 4.77 (95% CI 1.79 to 12.69)). Children diagnosed with syndromic (RR 2.90 (95% CI 2.08 to 4.04)) or non-syndromic major congenital malformations (RR 1.86 (95% CI 1.55 to 2.23)) (vs those with no malformation diagnosis) were also associated with higher Perthes' disease risk. The development of Perthes' disease was positively associated with several ASD and ADHD diagnoses. However, once adjusting for the sex of the child and period of birth, the associations with ASD and ADHD were no longer significant. Using publicly available data, we observed a declining incidence of Perthes' disease in Denmark over a 32-year study period. Our findings also confirm positive associations between Perthes' disease and various perinatal conditions, coagulation defects, and congenital malformations, highlighting potential aetiological pathways for further investigation.

Abstract TP325: Incidence and Cardiometabolic Risk Factors For Strokes in The Cameron County Hispanic Cohort

Abstract TP325: Incidence and Cardiometabolic Risk Factors For Strokes in The Cameron County Hispanic Cohort

GDF-15 improves the predictive capacity of Steatotic liver disease non-invasive tests for incident morbidity and mortality risk for cardio-renal-metabolic diseases and malignancies

Background & aimsNoninvasive tools (NITs) are currently used to stratify the risk of having or developing hepatic steatosis or fibrosis. Their performance and a proteomic-enabled improvement in forecasting long-term cardio-renal-metabolic morbidity, malignancies, as well as cause-specific and all-cause mortality, are lacking. Therefore, the performance of established NITs needs to be investigated in identifying cardio-renal-metabolic morbidity, malignancies, cause-specific and overall mortality and improve their performance with novel, proteomic-enabled NITs, including growth differentiation factor 15 (GDF-15), allowing multipurpose utilization. Methods502,359 UK Biobank participants free of the study outcomes at baseline with a 14-year median follow-up were grouped into three categories: a) general population, b) potentially metabolic dysfunction-associated steatotic liver disease (MASLD) population, c) individuals with type 2 diabetes mellitus. The investigated NITs include Aspartate aminotransferase to Platelet Ratio Index (APRI), Fibrosis 4 Index (FIB-4), Fatty Liver Index (FLI), Hepatic Steatosis Index (HSI), Lipid Accumulation Product (LAP), and metabolic dysfunction–associated fibrosis (MAF-5) score. ResultsAdding GDF-15 to the existing NITs led to significantly increased prognostic performance compared to the traditional NITs in almost all instances, reaching substantially high C-indices, ranging between 0.601 and 0.808, with an overall >0.2 improvement in C-index. Overall, with the GDF-15 enhanced NITs, up to more than seven times fewer individuals need to be screened to identify more incident cases of adverse outcomes compared to the traditional NITs. The cumulative incidence of all outcomes, based on the continuous value percentiles of NITs, is increasing exponentially in the upper quintile of the GDF-15 enhanced NITs. ConclusionsThe herein-developed GDF-15 enhanced indices demonstrate higher screening effectiveness and significantly improved prognostic abilities, which are reduced to practice through an easy-to-use web-based calculator tool (https://clinicalpredictor.shinyapps.io/multimorbidity-mortality-risk/).

Metabolic dysfunction associated steatotic liver and kidney stones: what is going on?

Metabolic dysfunction associated steatotic liver disease (MASLD) is increasing throughout the world, affecting nearly one in three individuals. Kidney stone disease, which is also increasing, is associated with MASLD. Common risk factors for both, including obesity, diabetes, dyslipidemia, hypertension, and metabolic syndrome, are likely drivers of this association. We present here a review of the associations and possible interconnections between these two common disease processes. Epidemiological studies are discordant regarding the impact of sex on this association and on the impact of MASLD on incident stone risk. The nature of kidney stones is rarely taken into account.A favorable milieu for uric acid kidney stone formation may be created by a lower urine pH resulting from defective ammonium production associated with insulin resistance, common in MASLD.Endogenous oxalate synthesis, a major risk factor for calcium oxalate kidney stones, may be increased in MASLD via decline in the activity of enzymes involved in the detoxification of glyoxylate, the immediate precursor of oxalate. The nature of kidney stones associated with MASLD and factors driving this association remain to be elucidated. Potential mechanisms identified underlying this include an increase in the risk factors for both uric acid and calcium oxalate kidney stones.

The prevalence and 6-year incidence of myopic tessellation in a Chinese rural adult population: the Handan Eye Study

PurposeTo describe the prevalence and the cumulative 6-year incidence of fundus tessellation in a rural Chinese adult population.MethodsThe Handan Eye Study was a population-based longitudinal study, with 6830 eligible subjects included in the baseline period, and 5394 subjects (follow-up rate: 85.3%) took part in the follow-up study. Participants had detailed eye examinations and physical examinations; a detailed questionnaire was also well administered. Fundus tessellation was defined as well-defined choroidal vessels that can be observed clearly around the fovea as well as around the arcade vessels.ResultsAmong 6830 subjects who participated in the baseline study, the prevalence of fundus tessellation was 9.89% (95%CI: 9.22-10.58%). The prevalence of fundus tessellation increased with age; that of subjects aged younger than 50 years and those aged 50 years or older was 2.5% and 14.5%, respectively. Six years later, the cumulative 6-year incidence of fundus tessellation was 1.21% (95%CI: 1.03-1.40%). Similarly, the incidence of fundus tessellation also increased with age; that of participants aged younger than 50 years and those aged 50 years or older was 0.20% and 1.86%, respectively. The progression rate of fundus tessellation in those with fundus tessellation at baseline was 1.5% (95% CI: 0.82%, 2.38%). By multivariable analysis, subjects being older (OR: 1.079, P < 0.001) and havingβ-parapapillary atrophy at baseline (OR: 2.657, P = 0.002) were associated with a higher risk of incidence of fundus tessellation.ConclusionsThe prevalence and 6-year incidence of fundus tessellation were 9.89% and 1.21% in rural Chinese adults aged 30 + years, respectively. The progression rate in participants with fundus tessellation indicates the importance of regular follow-up for these patients.

Impact of pre-ablation cardiorespiratory fitness and echocardiographic parameters on atrial fibrillation ablation outcomes.

Studies have shown a correlation between greater cardiorespiratory fitness (CRF) and lower risk of incident and recurrent atrial fibrillation (AF). Transthoracic echocardiographic (TTE) parameters correlate to CRF and risk of AF. However, there is scarce data regarding the interplay of CRF, echocardiographic parameters, and AF ablation outcomes. Our study sought to investigate how CRF and echocardiographic parameters impact AF ablation outcomes. We evaluated the Mayo Clinic Cardiorespiratory Exercise database from January 1, 2013, through December 31, 2017, to include all patients who underwent cardiopulmonary exercise testing and an AF ablation in temporal proximity. A total of 205 patients (mean age 61.2years, 74% male) were included for analysis. Fitness was calculated with peak VO2 when available and exercise time when VO2 was not available. Lower baseline fitness correlated to larger left atrial volumes, lower medial mitral e' values, and higher E/e' ratios. Lower baseline fitness correlated to higher risk of AF recurrence post-ablation in a simple model, but lost significance when multiple variables were accounted for. Lower baseline fitness also correlated to a higher AF burden post-ablation at one year. Lower baseline CRF likely correlates to more malignant and difficult to treat AF. Lower fitness also correlated to larger left atria and TTE parameters suggestive of diastolic dysfunction.

Associations of Traumatic Brain Injury and Mild Behavioral Impairment With Cognitive Function and Dementia.

Traumatic Brain Injury (TBI) may contribute additional complexity to the clinical picture of mild behavioral impairment (MBI). MBI, a behavioral analog to mild cognitive impairment (MCI), is comprised of five neuropsychiatric domains: decreased motivation, affective dysregulation, impulse dyscontrol, social inappropriateness, and abnormal perception/thought content. We investigated (1) if cross-sectional associations of cognitive status with MBI symptoms differ by TBI status and (2) if prospective associations of MBI domain positivity with incident dementia risk differ by TBI status. 2246 participants without dementia from the Atherosclerosis Risk in Communities Study were included (mean age = 75.6years, 59.0% female). TBI was defined by self-report/ICD-9/10 codes, MBI via an established algorithm based on the Neuropsychiatric Inventory Questionnaire, and baseline cognitive status/incident dementia using neuropsychological tests, informant interviews, and hospital/death certificate codes. Cross-sectionally, although MCI status was associated with greater odds of MBI, this did not differ based on TBI status (MCI with TBI: OR = 2.04, 95% CI = 1.44-2.88, MCI without TBI: OR = 1.60, 95% CI = 1.20-2.14). Individuals with MCI (with or without TBI) were more likely to have decreased motivation, affective dysregulation, and impulse dyscontrol. Prospectively, positivity in 1+ MBI domains was associated with increased risk of incident dementia, not differing by TBI status (no TBI and MBI: HR = 2.15, 95% CI = 1.55-2.99, TBI and MBI: HR = 2.62, 95% CI = 1.81-3.80). Neither cross-sectional associations between cognitive status and MBI domain positivity nor prospective associations of MBI domain positivity with incident dementia risk differed by TBI status. How TBI may relate to neuropsychiatric symptomatology in the context of neurodegenerative processes requires further clarification.

The association between systemic inflammation markers and the risk of incident dilated cardiomyopathy: a prospective study of 351,148 participants

Background The role of systemic inflammation in the development and progression of cardiovascular diseases has been attractive, but its association with incident dilated cardiomyopathy (DCM) is rarely investigated. This study aimed to systematically investigate the association between various inflammatory markers and DCM incidence. Methods The data were derived from the UK Biobank database. Systemic inflammation markers in this study encompassed peripheral immune cell counts and their ratios and the low-grade inflammation score (INFLA-score). The Cox proportional hazards regression, restricted cubic splines model, and segmented regression were adopted to assess the association between systemic inflammation markers and DCM incidence. Additionally, the subgroup Cox analysis stratified across sex was also performed. Results A total of 351,148 participants were enrolled in this study, and 377 subjects developed DCM during a mean follow-up of 12.21 years. The positive association between C-reactive protein (CRP), neutrophil-to-lymphocyte ratio (NLR), and CRP-to-lymphocyte ratio (CLR) and DCM incident risk was found (CRP: HR = 1.190, P = 0.001; NLR: HR = 1.315, P = 0.033; CLR: HR = 1.206, P < 0.001), while the lymphocyte-to-monocyte ratio (LMR) was negatively associated with DCM incident risk (HR = 0.756; P = 0.033). Furthermore, the increased risk of DCM incidence was significantly and nonlinearly correlated with the reduction of platelet count (HR = 0.543; P = 0.002). In the subgroup analysis, sex-specific inflammation markers related to DCM development were noticed. Conclusions The study has underlined that multiple inflammation markers were significantly associated with the risk of incident DCM, which would provide evidence for the aetiological study of DCM.

Interleukin-23 versus Interleukin-17 Inhibitors in Preventing Incidental Psoriatic Arthritis in Patients with Psoriasis: A Real-World Comparison From the TriNetX US Collaborative Network.

Psoriatic arthritis (PsA) is a common comorbidity in patients with psoriasis (PsO) that leads to significant disease burden. Biologic therapies targeting the interleukin (IL)-23/IL-17 axis have been widely used for PsO, but their comparative effectiveness in preventing PsA remains unclear. The study objective was to compare the occurrence of developing incidental PsA among PsO patients treated with interleukin-23 inhibitors (IL23is) or interleukin-17 inhibitors (IL17is). A retrospective cohort study was conducted using real-world data from the TriNetX US Collaborative Network, including 53 healthcare organizations. Adult PsO patients treated with IL23is or IL17is between January 2019 and June 2022 were identified. Cox regression analysis was used to assess the risk of PsA incidence, with hazard ratios (HRs) and 95% confidence intervals (CIs) reported. Subgroup analyses were performed based on age, sex, and ethnicity. Sensitivity analyses included comparisons with tumor necrosis factor (TNF) inhibitors (TNFis) to ensure robustness. A total of 4,580 PsO patients were included in the study, with 2,273 receiving IL23is and 2,307 receiving IL17is. Treatment with IL23is was associated with a significantly lower incidence of PsA compared to IL17is (HR = 0.60, 95% CI 0.44-0.82, P = 0.001). This reduction in risk was particularly notable in the 41- to 65-year age group (HR = 0.42, 95% CI 0.27-0.64, P < 0.001) and among females (HR = 0.57, 95% CI 0.38-0.86, P = 0.007). Subgroup analyses based on ethnicity revealed varying outcomes, with White patients showing a significant risk reduction (HR = 0.55, 95% CI 0.38-0.79, P = 0.001) but no significant risk reduction was observed in Black or African American patients (HR = 1.37, 95% CI 0.37-5.13, P = 0.637). Sensitivity analyses comparing IL23is and TNFis confirmed the robustness of the findings. IL23is are associated with a lower risk of PsA incidence compared to IL17is in PsO patients, particularly in specific age, sex, and ethnic groups. These findings suggest that IL23is may be more suitable for PsO patients at high risk of PsA and could inform potential updates to treatment guidelines. Further research should focus on refining therapeutic strategies by incorporating patient-specific factors such as comorbidities, ethnicity, and genetic predispositions, which could optimize biologic selection and enhance PsA prevention efforts in clinical practice.

Temporal trends and future projections of incidence rate and mortality for asthma in China: an analysis of the Global Burden of Disease Study 2021

BackgroundAsthma poses a significant public health burden in China, affecting millions with substantial incidence and mortality. Understanding the trends and future projections of asthma incidence and mortality is crucial for healthcare planning.MethodsWe analyzed asthma incidence and mortality data sourced from the Global Burden of Disease (GBD) 2021 study from 1990 to 2021, calculated the age-standardized incidence and mortality rates (ASIR and ASMR) and the estimated annual percentage change (EAPC), meanwhile, employed Joinpoint regression model to assess the trends. The age-period-cohort model was applied to estimate the effects of the age, period, and cohort on the incidence and mortality. Finally, future asthma trends for the next 25 years were predicted utilizing the Bayesian age-period-cohort (BAPC) model.ResultsOver the past three decades, the incidence rate declined in waves while the mortality declined steadily. The ASIR of asthma decreased from 524.81 to 364.17 and the ASMR declined from 5.82 to 1.47. ASIR and ASMR are consistently higher in males than females during this period. The effect attributable to age on incidence was higher for the younger age group while the mortality was higher for older. The period ratio rate of incidence and mortality declined with the calendar year, and the corrections between birth cohort and the risk of incidence and mortality were negative. Our projections indicate that the ASIR and ASMR will continue to decrease by 2046, with expected rates of 330 and 0.69, respectively. Instead, the absolute number of asthma incidence cases and deaths may increase to approximately 4.5 million and 80,000, respectively.ConclusionAlthough asthma incidence rates and mortality have generally declined in China, the burden remains significant, especially among vulnerable groups, with higher rates in males. Continuous monitoring and age-targeted interventions are essential. Future healthcare strategies must address the aging population to manage the projected increase in asthma cases and deaths.

The impact of air pollution on influenza incidence in high-altitude regions: a time-stratified case-crossover study based on Qinghai Province.

The unique characteristics of air pollution in high-altitude regions may significantly influence the transmission and incidence of influenza. However, current research on this phenomenon is limited, and further investigation is urgently needed. This study collected influenza outpatient data from Qinghai Province between January 1, 2016, and December 31, 2021. We employed a time-stratified case-crossover design combined with conditional Poisson regression models to quantitatively analyze the relationship between air pollutants (PM2.5, SO2, NO2) and influenza incidence and explored the moderating role of temperature in this relationship. Additionally, stratified analyses were conducted to identify potential vulnerable populations. The study results indicated that exposure to PM2.5, SO2, and NO2 was positively associated with the risk of influenza incidence. For every 10µg/m³ increase in the concentration of PM2.5, SO2, and NO2, the percentage change in relative risk (RR) of influenza incidence was 0.35% (95% CI: 0.02%, 0.68%), 2.24% (95% CI: 1.42%, 3.06%), and 1.91% (95% CI: 1.16%, 2.67%), respectively. Under low-temperature conditions, the impact of pollutants other than O3 on influenza incidence was particularly pronounced. Children, the elderly, and individuals living at altitudes of 3000-3500m were more sensitive to these pollutants. This study revealed a close link between air pollution and influenza in high-altitude regions, with greater health risks under low-temperature conditions. The findings underscore the necessity of strengthening air quality monitoring and raising public awareness of environmental health.

Association of chronic low back pain and knee pain with subjective fatigue incidence among community-dwelling older adults: A prospective cohort study.

Fatigue is a common health problem in older adults. Chronic pain is associated with fatigue. However, the longitudinal association between chronic pain and the incidence of subjective fatigue among community-dwelling older adults remains unclear. Therefore, this study aimed to investigate the association between chronic pain and subjective fatigue using prospective data. The study included 2060 community-dwelling older adults (age 70.5 ± 6.4 years; male: n = 944) without subjective fatigue at baseline. Chronic pain and other data were assessed at baseline. Subjective fatigue incidence was investigated at the follow-up examination 2.5 years from baseline. In total, 389 (18.9%) reported chronic low back pain, 322 (15.6%) reported chronic knee pain at baseline, and 342 (16.6%) reported subjective fatigue at follow-up examination. A logistic regression analysis showed that the odds ratio for the incidence of subjective fatigue in participants with chronic low back pain had a higher odds ratio for the incidence of subjective fatigue compared to participants without chronic low back pain (odds ratio = 1.71, 95% confidence interval = 1.29-2.26). Chronic knee pain had a higher odds ratio for the incidence of subjective fatigue compared to participants without chronic knee pain (odds ratio = 1.63, 95% confidence interval = 1.21-2.20). These results suggest that chronic low back pain and knee pain increase the risk of subjective fatigue incidence. These findings emphasize the contribution of chronic pain to fatigue among older adults. Therefore, intervention studies are required to prevent subjective fatigue in participants with chronic pain. Geriatr Gerontol Int 2025; ••: ••-••.