Predicted vitamin D status and incidence of tooth loss and periodontitis

AbstractObjectiveVitamin D insufficiency is highly prevalent, with particular subgroups at greater risk (e.g. the elderly and those with darker skin). Vitamin D insufficiency may partly explain US racial/ethnic disparities in the prevalence of periodontitis and tooth loss. We evaluated the association between a predictor score of plasma 25-hydroxyvitamin D (25(OH)D) and incidence of periodontitis and tooth loss.DesignDetailed biennial questionnaires were collected on medical history, lifestyle practices and incident periodontitis and tooth loss. The predictor score was derived from variables known to influence circulating concentrations of plasma 25(OH)D and validated against plasma concentrations among a sub-sample. Multivariable Cox proportional-hazards models with time-varying covariates estimated the association between the predicted 25(OH)D score and time until first tooth loss.SubjectsA total of 42 730 participants of the Health Professionals Follow-Up Study aged 40–75 years at baseline were followed from 1986 to 2006.SettingUSA, representing all fifty states and the District of Columbia.ResultsWe observed 13 581 incident tooth loss events from 539 335 person-years. There was a dose-dependent significant inverse association across quintiles of the predicted 25(OH)D score and incidence of tooth loss. In multivariable analyses, the highest quintile of the updated predicted 25(OH)D score compared with the lowest was associated with a 20 % lower incidence of tooth loss (hazard ratio = 0·80, 95 % CI 0·76, 0·85; P value for trend <0·0 0 1); UV-B was also independently associated. Results for the predicted 25(OH)D score and periodontitis were similar.ConclusionsThese results are suggestive of an association between predictors of vitamin D and lower incidence of tooth loss and periodontitis.

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Exposure to Vitamin D Fortification Policy in Prenatal Life and the Risk of Childhood Asthma: Results From the D-Tect Study

Nutrients ◽

10.3390/nu11040924 ◽

2019 ◽

Vol 11 (4) ◽

pp. 924

Author(s):

Thorsteinsdottir ◽

Maslova ◽

Jacobsen ◽

Frederiksen ◽

Keller ◽

...

Keyword(s):

Vitamin D ◽

Study Design ◽

Childhood Asthma ◽

Proportional Hazards ◽

Epidemiological Studies ◽

Vitamin D Insufficiency ◽

Cox Proportional Hazards ◽

Small Sample ◽

Increased Risk ◽

Small Sample Sizes

Prenatal vitamin D insufficiency may be associated with an increased risk of developing childhood asthma. Results from epidemiological studies are conflicting and limited by short follow-up and small sample sizes. The objective of this study was to examine if children born to women exposed to the margarine fortification policy with a small dose of extra vitamin D during pregnancy had a reduced risk of developing asthma until age 9 years, compared to children born to unexposed women. The termination of a Danish mandatory vitamin D fortification policy constituted the basis for the study design. We compared the risk of inpatient asthma diagnoses in all Danish children born two years before (n = 106,347, exposed) and two years after (n = 115,900, unexposed) the termination of the policy. The children were followed in the register from 0–9 years of age. Data were analyzed using Cox proportional hazards regression. The Hazard Ratio for the first inpatient asthma admission among exposed versus unexposed children was 0.96 (95%CI: 0.90–1.04). When stratifying by sex and age, 0–3 years old boys exposed to vitamin D fortification showed a lower asthma risk compared to unexposed boys (HR 0.78, 95%CI: 0.67–0.92). Prenatal exposure to margarine fortification policy with extra vitamin D did not affect the overall risk of developing asthma among children aged 0–9 years but seemed to reduce the risk among 0–3 years old boys. Taking aside study design limitations, this could be explained by different sensitivity to vitamin D from different sex-related asthma phenotypes in children with early onset, and sex differences in lung development or immune responses.

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Association of serum 25-hydroxyvitamin D with prevalence, incidence, and clearance of vaginal HPV infection in young women

The Journal of Infectious Diseases ◽

10.1093/infdis/jiaa758 ◽

2020 ◽

Author(s):

Mariam El-Zein ◽

Farzin Khosrow-Khavar ◽

Ann N Burchell ◽

Pierre-Paul Tellier ◽

Shaun Eintracht ◽

...

Keyword(s):

Vitamin D ◽

Proportional Hazards ◽

Hpv Infection ◽

Cox Proportional Hazards ◽

Baseline Serum ◽

Hpv Dna ◽

Hydroxyvitamin D ◽

Hpv Prevalence ◽

Vitamin D Levels ◽

25 Hydroxyvitamin D

Abstract Background We assessed the association between serum 25-hydroxyvitamin D levels and genital human papillomavirus (HPV) prevalence, incidence, and clearance among female participants of the HITCH cohort study. Methods We genotyped HPV DNA in vaginal samples and quantified baseline serum 25-hydroxyvitamin D levels using Roche’s Linear Array and Total vitamin D assay, respectively. We used logistic and Cox proportional hazards models to respectively estimate adjusted odds ratios (OR) and hazards ratios (HR) with 95% confidence intervals (CI). Results There was no association between vitamin D levels (every 10ng/mL increase) at baseline and HPV prevalence (OR=0.88, CI:0.73-1.03) or incidence (HR=0.88, CI:0.73-1.06), but we observed a modest negative association with HPV clearance (HR=0.76, CI:0.60-0.96). Vitamin D levels <30ng/mL, compared to ≥30ng/mL, were not associated with HPV prevalence (OR=0.98, CI:0.57-1.69) or incidence (HR=0.87, CI:0.50-1.43), but were associated with a marginally significant increased clearance (OR=2.14, CI:0.99-4.64). We observed consistent results with restricted cubic spline modelling of vitamin D levels and clinically defined categories. HPV type-specific analyses accounting for multiple HPV infections per participant showed no association between vitamin D levels and all study outcomes. Conclusion This study provided no evidence of an association between low vitamin D levels and increased HPV prevalence, acquisition, or clearance.

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Reduction in Short- and Long-term Pneumonia Rate With Laryngoplasty for Unilateral Vocal Fold Paralysis

Otolaryngology ◽

10.1177/01945998211015174 ◽

2021 ◽

pp. 019459982110151

Author(s):

Cheng-Ming Hsu ◽

Yao-Te Tsai ◽

Geng-He Chang ◽

Yao-Hsu Yang ◽

Tuan-Jen Fang ◽

...

Keyword(s):

Lower Incidence ◽

Vocal Fold ◽

Proportional Hazards ◽

Vocal Fold Paralysis ◽

Cox Proportional Hazards ◽

Cox Proportional Hazards Model ◽

Voice Therapy ◽

Unilateral Vocal Fold Paralysis ◽

Short And Long Term

Objective To examine the association of laryngoplasty, voice therapy, and pneumonia rate in patients with unilateral vocal fold paralysis (UVFP). Study Design Population-based retrospective cohort study. Setting Data were collected from the LHID2000 (Longitudinal Health Insurance Database 2000), containing the information of 1 million randomly selected patients in Taiwan. Methods In the LHID2000, we identified 439 patients having new diagnoses of UVFP from 1997 to 2013. We grouped the aforementioned patients according to UVFP treatment and probed the occurrence of pneumonia: 305 patients underwent laryngoplasty or voice therapy, and 134 patients did not undergo treatment. Follow-up procedures were executed for the enrollees until death or December 31, 2013, representing the end of the study period. We assessed the association of UVFP treatment and pneumonia by executing Cox proportional hazards regression. Results The pneumonia cumulative incidence was significantly higher among enrolled patients without treatment than in those receiving treatment ( P < .001). The pneumonia incidence was significantly lower in patients receiving UVFP treatment (hazard ratio, 0.49; 95% CI, 0.27-0.88; P = .018), as validated by the Cox proportional hazards model after adjustment. Patients undergoing laryngoplasty with or without voice therapy had a significantly lower incidence of pneumonia at 6 months and 1, 3, and 5 years, whereas those undergoing voice therapy alone did not. Conclusion Laryngoplasty was associated with a lower incidence of short- and long-term pneumonia in patients with UVFP. Physicians should encourage patients with UVFP at risk of aspiration to receive prompt evaluation as well as treatment.

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Abstract TP241: Race-ethnic Differentials Time and Acute Stroke Emergency Presentation: The ASPIRE Study

Stroke ◽

10.1161/str.44.suppl_1.atp241 ◽

2013 ◽

Vol 44 (suppl_1) ◽

Author(s):

Bernadette Boden-Albala ◽

Dorothy F Edwards ◽

Jeffrey J Wing ◽

Shauna S Clair ◽

Stephen Fernandez ◽

...

Keyword(s):

Black Women ◽

Acute Stroke ◽

Intervention Program ◽

Arrival Time ◽

Proportional Hazards ◽

Ethnic Disparities ◽

Cox Proportional Hazards ◽

Urban Setting ◽

Intervention Period ◽

Post Intervention

BACKGROUND: There is sparse data about the nature of race-ethnic disparities in the acute stroke setting including differentials in stroke preparedness. The aim of this analysis was to explore race-ethnic differentials in time to arrival for acute stroke in a racial and ethnically diverse urban setting. METHODS: ASPIRE is a multi-dimensional intervention program (community, hospital, and EMS) for acute stroke preparedness targeted to increase IV tPA utilization in underserved black communities in the DC metro area. We prospectively identified stroke admissions and EMS utilization including acute stroke arrival time parameters for the 6 month pre and post intervention periods. Cox proportional hazards models were used to examine predictors of arrival time. Proportionality of the hazards was checked. RESULTS: In the 6 month pre-intervention period, data was collected on 943 stroke cases; 53% female; 74% black; mean age 67 yrs. Of the subjects from the pre-intervention period with arrival times less than 48 hrs, the median arrival time to the emergency department (ED) was 9 hours; 20% presented under 3 hours. In multivariable Cox PH models, subjects were 38% more likely to arrive earlier if they had arrived by EMS (HR: 1.38, 95%CI: 1.21-1.58). Black subjects were 25% less likely to arrive earlier (HR: 0.75, 95%CI: 0.60-0.93), but this effect was dampened over time (p=0.03). The model included the interaction between black race and time and adjusted for insurance status, risk factors (hypertension and diabetes), gender, age and prior stroke. Ina gender by race analysis, there was a trend towards black women being less likely to arrive earlier to the ED (HR 0.78, 95% CI 0.6 -1.0). However, overall, there was no race-ethnic interaction with arrival by EMS. CONCLUSIONS: Contrary to the perceived perception by the community suggesting there is a disparity in EMS utilization by the black DC community, we found no overall significant racial difference in EMS utilization for acute stroke. While there was a trend towards delayed overall arrival in black females, this was independent of EMS utilization.

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Pre-diagnostic Circulating Concentrations of Fat-soluble Vitamins and Risk of Glioma in Three Cohort Studies

10.21203/rs.3.rs-110462/v1 ◽

2020 ◽

Author(s):

Yiyang Yue ◽

Jordan Creed ◽

David Cote ◽

Meir Stampfer ◽

Molin Wang ◽

...

Keyword(s):

Proportional Hazards ◽

Conditional Logistic Regression ◽

Plasma Concentrations ◽

Cox Proportional Hazards ◽

Health Study ◽

Hydroxyvitamin D ◽

Potential Association ◽

25 Hydroxyvitamin D ◽

Glioma Risk ◽

Fat Soluble Vitamins

Abstract Few prospective studies have evaluated the relation between fat-soluble vitamins and glioma risk. Using three cohorts—UK Biobank (UKB), Nurses’ Health Study (NHS), and Health Professionals Follow-Up Study (HPFS), we investigated associations of pre-diagnostic concentrations of fat-soluble vitamins D, A, and E with incident glioma. In 346,785 participants (444 cases) in UKB, associations with vitamin D (25-hydroxyvitamin D [25(OH)D]) were evaluated by Cox proportional hazards regression. In NHS (52 cases, 104 controls) and HPFS (32 cases, 64 controls), associations with 25(OH)D, vitamin A (retinol), and vitamin E (α- and γ-tocopherol) were assessed using conditional logistic regression. Our results suggested plasma concentrations of 25(OH)D and retinol were not associated with glioma risk. Comparing the highest to lowest tertile, the multivariable hazard ratio (MVHR) for 25(OH)D was 0.87 (95% confidence interval [CI]: 0.68-1.11) in UKB and the multivariable risk ratio (MVRR) was 1.08 (95%CI: 0.55-2.09) in NHS and HPFS. In NHS and HPFS, the MVRR for the same comparison for retinol was 1.16 (95%CI: 0.56-2.38). Nonsignificant associations were observed for α-tocopherol (MVRRtertile3vs1=0.61, 95%CI: 0.29-1.32) and γ-tocopherol (MVRR tertile3vs1=1.30, 95%CI: 0.63-2.69) that became stronger in 4-year lagged analyses. Further investigation is warranted on a potential association between α- and γ-tocopherol and glioma risk.

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Racial/ethnic disparities in the risk of intracerebral hemorrhage recurrence

Neurology ◽

10.1212/wnl.0000000000008737 ◽

2019 ◽

Vol 94 (3) ◽

pp. e314-e322 ◽

Cited By ~ 1

Author(s):

Audrey C. Leasure ◽

Zachary A. King ◽

Victor Torres-Lopez ◽

Santosh B. Murthy ◽

Hooman Kamel ◽

...

Keyword(s):

Intracerebral Hemorrhage ◽

Ethnic Groups ◽

Proportional Hazards ◽

Private Insurance ◽

Multivariable Analysis ◽

Ethnic Disparities ◽

Cox Proportional Hazards ◽

Risk Of Recurrence ◽

Asian Patients ◽

Racial Ethnic

ObjectiveTo estimate the risk of intracerebral hemorrhage (ICH) recurrence in a large, diverse, US-based population and to identify racial/ethnic and socioeconomic subgroups at higher risk.MethodsWe performed a longitudinal analysis of prospectively collected claims data from all hospitalizations in nonfederal California hospitals between 2005 and 2011. We used validated diagnosis codes to identify nontraumatic ICH and our primary outcome of recurrent ICH. California residents who survived to discharge were included. We used log-rank tests for unadjusted analyses of survival across racial/ethnic groups and multivariable Cox proportional hazards regression to determine factors associated with risk of recurrence after adjusting for potential confounders.ResultsWe identified 31,355 California residents with first-recorded ICH who survived to discharge, of whom 15,548 (50%) were white, 6,174 (20%) were Hispanic, 4,205 (14%) were Asian, and 2,772 (9%) were black. There were 1,330 recurrences (4.1%) over a median follow-up of 2.9 years (interquartile range 3.8). The 1-year recurrence rate was 3.0% (95% confidence interval [CI] 2.8%–3.2%). In multivariable analysis, black participants (hazard ratio [HR] 1.22; 95% CI 1.01–1.48; p = 0.04) and Asian participants (HR 1.29; 95% CI 1.10–1.50; p = 0.001) had a higher risk of recurrence than white participants. Private insurance was associated with a significant reduction in risk compared to patients with Medicare (HR 0.60; 95% CI 0.50–0.73; p < 0.001), with consistent estimates across racial/ethnic groups.ConclusionsBlack and Asian patients had a higher risk of ICH recurrence than white patients, whereas private insurance was associated with reduced risk compared to those with Medicare. Further research is needed to determine the drivers of these disparities.

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Plasma Galactose-Deficient IgA1 and C3 and CKD Progression in IgA Nephropathy

Clinical Journal of the American Society of Nephrology ◽

10.2215/cjn.13711118 ◽

2019 ◽

Vol 14 (10) ◽

pp. 1458-1465 ◽

Cited By ~ 3

Author(s):

Pei Chen ◽

Guizhen Yu ◽

Xue Zhang ◽

Xinfang Xie ◽

Jinwei Wang ◽

...

Keyword(s):

Iga Nephropathy ◽

Proportional Hazards ◽

Plasma Concentrations ◽

Cox Proportional Hazards ◽

Ckd Progression ◽

Cox Proportional Hazards Models ◽

Complement Component C3 ◽

Peking University ◽

Traditional Risk Factors ◽

Restricted Cubic Splines

Background and objectivesIncreased circulating galactose-deficient IgA1 and subsequently complement activation both play important roles in the pathophysiology of IgA nephropathy. However, their relationship to disease severity and progression remains unclear.Design, setting, participants, & measurementsWe assessed 1210 participants in a cohort study of biopsy-proven IgA nephropathy at Peking University First Hospital. Plasma concentrations of galactose-deficient IgA1 and complement component C3 were measured at the time of biopsy. We tested associations of galactose-deficient IgA1 and galactose-deficient IgA1/C3 ratio with CKD progression event, defined as ESKD or 50% decline in eGFR, using Cox proportional hazards models and restricted cubic splines.ResultsAfter a median follow-up of 43 months (interquartile range, 24–76 months), 172 (14%) participants reached the CKD progression event. The association of galactose-deficient IgA1 levels and CKD progression event showed a nonlinear relationship. The risk of CKD progression events was greater with higher plasma galactose-deficient IgA1 levels but reached a plateau when galactose-deficient IgA1>325 U/ml, whereas the risk of CKD progression events monotonically increased with higher galactose-deficient IgA1/C3 ratio. After adjustment for traditional risk factors (demographics, eGFR, proteinuria, hypertension, Oxford pathologic score, and corticosteroids/immunosuppressive therapy), higher levels of galactose-deficient IgA1/C3 ratio were independently associated with CKD progression event (per natural log-transformed [galactose-deficient IgA1/C3], hazard ratio, 2.03; 95% confidence interval [95% CI], 1.25 to 3.29; P=0.004). In reference to the first quartile of the galactose-deficient IgA1/C3 ratio, hazard ratios were 1.71 (95% CI, 1.01 to 2.89) for the second quartile, 1.55 (95% CI, 0.91 to 2.63) for the third quartile, and 2.17 (95% CI, 1.33 to 3.56) for the fourth quartile.ConclusionsIn IgA nephropathy, plasma galactose-deficient IgA1/C3 ratio was associated with CKD progression event independent of clinical and biopsy characteristics.

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Relationship of lycopene intake and consumption of tomato products to incident CVD

British Journal Of Nutrition ◽

10.1017/s0007114512005417 ◽

2013 ◽

Vol 110 (3) ◽

pp. 545-551 ◽

Cited By ~ 54

Author(s):

Paul F. Jacques ◽

Asya Lyass ◽

Joseph M. Massaro ◽

Ramachandran S. Vasan ◽

Ralph B. D'Agostino Sr

Keyword(s):

Repeated Measures ◽

Proportional Hazards ◽

Cox Proportional Hazards ◽

Supporting Evidence ◽

Inverse Association ◽

Cvd Risk ◽

Stroke Incidence ◽

Hazard Ratios ◽

Increased Risk

Evidence for cardioprotective effects of lycopene is inconsistent. Studies of circulating lycopene generally report inverse associations with CVD risk, but studies based on lycopene intake do not. The failure of dietary studies to support the findings based on biomarkers may be due in part to misclassification of lycopene intakes. To address this potential misclassification, we used repeated measures of intake obtained over 10 years to characterise the relationship between lycopene intake and the incidence of CVD (n314), CHD (n171) and stroke (n99) in the Framingham Offspring Study. Hazard ratios (HR) for incident outcomes were derived from Cox proportional hazards regression models using logarithmically transformed lycopene intake adjusted for CVD risk factors and correlates of lycopene intake. HR were interpreted as the increased risk for a 2·7-fold difference in lycopene intake, a difference approximately equal to its interquartile range. Using an average of three intake measures with a 9-year follow-up, lycopene intake was inversely associated with CVD incidence (HR 0·83, 95 % CI 0·70, 0·98). Using an average of two intake measures and 11 years of follow-up, lycopene intake was inversely associated with CHD incidence (HR 0·74, 95 % CI 0·58, 0·94). Lycopene intake was unrelated to stroke incidence. The present study of lycopene intake and CVD provides supporting evidence for an inverse association between lycopene and CVD risk; however, additional research is needed to determine whether lycopene or other components of tomatoes, the major dietary source of lycopene, are responsible for the observed association.

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Simulating Duration Data for the Cox Model

Political Science Research and Methods ◽

10.1017/psrm.2018.19 ◽

2018 ◽

Vol 7 (04) ◽

pp. 921-928 ◽

Cited By ~ 2

Author(s):

Jeffrey J. Harden ◽

Jonathan Kropko

Keyword(s):

Hazard Function ◽

Proportional Hazards ◽

Proportional Hazards Model ◽

Cox Model ◽

Cox Proportional Hazards ◽

Cox Proportional Hazards Model ◽

Simulation Studies ◽

Baseline Hazard ◽

Baseline Hazard Function ◽

Time Varying Covariates

The Cox proportional hazards model is a popular method for duration analysis that is frequently the subject of simulation studies. However, no standard method exists for simulating durations directly from its data generating process because it does not assume a distributional form for the baseline hazard function. Instead, simulation studies typically rely on parametric survival distributions, which contradicts the primary motivation for employing the Cox model. We propose a method that generates a baseline hazard function at random by fitting a cubic spline to randomly drawn points. Durations drawn from this function match the Cox model’s inherent flexibility and improve the simulation’s generalizability. The method can be extended to include time-varying covariates and non-proportional hazards.

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Baseline Serum Bilirubin and Risk of First Stroke in Hypertensive Patients

Journal of the American Heart Association ◽

10.1161/jaha.119.015799 ◽

2020 ◽

Vol 9 (12) ◽

Author(s):

Jiancheng Wang ◽

Xianglin Zhang ◽

Zhuxian Zhang ◽

Yuanyuan Zhang ◽

Jingping Zhang ◽

...

Keyword(s):

Ischemic Stroke ◽

Proportional Hazards ◽

Total Bilirubin ◽

Serum Bilirubin ◽

Cox Proportional Hazards ◽

Direct Bilirubin ◽

Serum Total Bilirubin ◽

Inverse Association ◽

Baseline Serum ◽

Hypertensive Patients

Background Data on the association between serum bilirubin and the risk of stroke are limited and inconclusive. We aimed to evaluate the association between serum bilirubin and the risk of first stroke and to examine any possible effect modifiers in hypertensive patients. Methods and Results Our study was a post hoc analysis of the CSPPT (China Stroke Primary Prevention Trial). A total of 19 906 hypertensive patients were included in the final analysis. Cox proportional hazards models were used to estimate the hazard ratios (HRs) and 95% CIs for the risk of first stroke associated with serum bilirubin levels. The median follow‐up period was 4.5 years. When serum total bilirubin was assessed as tertiles, the adjusted HR of first ischemic stroke for participants in tertile 3 (12.9–34.1 μmol/L) was 0.75 (95% CI, 0.59–0.96), compared with participants in tertile 1 (<9.3 μmol/L). When direct bilirubin was assessed as tertiles, a significantly lower risk of first ischemic stroke was also found in participants in tertile 3 (2.5–24.8 μmol/L) (adjusted HR, 0.77; 95% CI, 0.60–0.98), compared with those in tertile 1 (<1.6 μmol/L). However, there was no significant association between serum total bilirubin (tertile 3 versus 1: adjusted HR, 1.45; 95% CI, 0.89–2.35) or direct bilirubin (tertile 3 versus 1: adjusted HR, 1.27; 95% CI, 0.76–2.11) and first hemorrhagic stroke. Conclusions In this sample of Chinese hypertensive patients, there was a significant inverse association between serum total bilirubin or direct bilirubin and the risk of first ischemic stroke.

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