Sex differences in the 10-year survival of patients undergoing maintenance hemodialysis in the Q-Cohort Study

AbstractWomen have a longer life expectancy than men in the general population. However, it has remained unclear whether this advantage is maintained in patients undergoing maintenance hemodialysis. The aim of this study was to compare the risk of mortality, especially infection-related mortality, between male and female hemodialysis patients. A total of 3065 Japanese hemodialysis patients aged ≥ 18 years old were followed up for 10 years. The primary outcomes were all-cause and infection-related mortality. The associations between sex and these outcomes were examined using Cox proportional hazards models. During the median follow-up of 8.8 years, 1498 patients died of any cause, 387 of whom died of infection. Compared with men, the multivariable-adjusted hazard ratios (95% confidence interval) for all-cause and infection-related mortality in women were 0.51 (0.45–0.58, P < 0.05) and 0.36 (0.27–0.47, P < 0.05), respectively. These findings remained significant even when propensity score-matching or inverse probability of treatment weighting adjustment methods were employed. Furthermore, even when the non-infection-related mortality was considered a competing risk, the infection-related mortality rate in women was still significantly lower than that in men. Regarding all-cause and infection-related deaths, women have a survival advantage compared with men among Japanese patients undergoing maintenance hemodialysis.

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Sex Differences in the Survival of Patients Undergoing Maintenance Hemodialysis: A 10-year Outcome of the Q-Cohort Study

10.21203/rs.3.rs-153189/v1 ◽

2021 ◽

Author(s):

Hiroaki Tsujikawa ◽

Shunsuke Yamada ◽

Hiroto Hiyamuta ◽

Masatomo Taniguchi ◽

Kazuhiko Tsuruya ◽

...

Keyword(s):

Proportional Hazards ◽

Japanese Patients ◽

Hemodialysis Patients ◽

Cox Proportional Hazards ◽

Survival Advantage ◽

Maintenance Hemodialysis ◽

Cox Proportional Hazards Models ◽

Risk Of Mortality ◽

Female Survival ◽

Related Mortality

Abstract Background: A survival advantage of women is observed in the general population. However, inconsistent findings have been reported regarding this advantage in patients undergoing maintenance hemodialysis. The aim of this study was to compare the risk of mortality, especially infection-related mortality, between male and female hemodialysis patients.Methods: A total of 3065 Japanese hemodialysis patients aged ≥18 years old were followed up for 10 years. Primary outcome was all-cause and infection-related mortality. The association between the sex and these outcomes were examined using Cox proportional hazards models.Results: During the median follow-up of 8.8 years, 1498 patients died of any cause, and 387 died of infection. Compared with men, the multivariable-adjusted HRs (95% CIs) for all-cause and infection-related mortality in women were 0.51 (0.45–0.58) and 0.36 (0.27–0.47), respectively. This association remained significant even when the propensity score-matching or inverse probability of treatment weighting adjustment methods were employed. Furthermore, even when the non-infection-related mortality was considered a competing risk, the infection-related mortality rate in women was still significantly lower than that in men.Conclusions: A female survival advantage over men is observed in Japanese patients undergoing maintenance hemodialysis.

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Alcohol-related mortality and all-cause mortality following bereavement in two successive generations

PLoS ONE ◽

10.1371/journal.pone.0243290 ◽

2020 ◽

Vol 15 (12) ◽

pp. e0243290

Author(s):

David Teye Doku ◽

Subas Neupane ◽

Henrik Dobewall ◽

Arja Rimpelä

Keyword(s):

Alcohol Abuse ◽

Proportional Hazards ◽

Cox Proportional Hazards ◽

Conclusive Evidence ◽

Cox Proportional Hazards Models ◽

Hazard Ratios ◽

Risk Of Mortality ◽

All Cause Mortality ◽

Successive Generations ◽

Related Mortality

Background and aim Bereavement affects the health of the bereaved both emotionally and physically. Bereavement resulting from alcohol-related death of the previous generation (parents-first generation) may increase the risk of alcohol abuse and consequently alcohol-related mortality as well as all-cause mortality in the next generation (offspring-second generation). Furthermore, these associations can be bi-directional. However, there is no conclusive evidence of these effects, and studies exploring these intergenerational effects are rare. This study investigates these associations. Methods A longitudinal data were constructed by linking participants from the Adolescent Health and Lifestyle Surveys (AHLS) from 1979 to 1997 with census and registry-based data from Statistics Finland containing the socioeconomic status of the survey participants and their parents (N = 78610) to investigate these associations. Multivariate Cox proportional hazards models were used to calculate hazard ratios with 95% confidence intervals to determine the effect of bereavement with alcohol-related mortality and all-cause mortality. Results The findings suggest that bereavement following the death of an offspring increases the risk of both alcohol-related and all-cause mortality among both parents. The magnitude of the risk of mortality following the death of an offspring is higher for mothers than for fathers. There were no clear associations of a parent’s death with an offspring’s alcohol-related or all-cause mortality. However, generally, a father’s death seems to be protective of the risk of mortality among the offspring while a mother’s alcohol-related death slightly increased the risk of alcohol-related mortality among their offspring. Conclusions These findings emphasise the role of bereavement, particularly resulting from the death of an offspring, on alcohol-related and all-cause mortality and therefore inequalities in mortality. Furthermore, the findings highlighting the need for alcohol abuse intervention and emotional support for bereaved persons following the death of an offspring.

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Supper Timing and Cardiovascular Mortality: The Japan Collaborative Cohort Study

Nutrients ◽

10.3390/nu13103389 ◽

2021 ◽

Vol 13 (10) ◽

pp. 3389

Author(s):

Jingyun Tang ◽

Jia-Yi Dong ◽

Ehab S. Eshak ◽

Renzhe Cui ◽

Kokoro Shirai ◽

...

Keyword(s):

Hemorrhagic Stroke ◽

Proportional Hazards ◽

Cox Proportional Hazards ◽

Stroke Mortality ◽

Hazard Ratios ◽

Risk Of Mortality ◽

Increased Risk ◽

Study Participants

Evidence on the role of supper timing in the development of cardiovascular disease (CVD) is limited. In this study, we examined the associations between supper timing and risks of mortality from stroke, coronary heart disease (CHD), and total CVD. A total of 28,625 males and 43,213 females, aged 40 to 79 years, free from CVD and cancers at baseline were involved in this study. Participants were divided into three groups: the early supper group (before 8:00 p.m.), the irregular supper group (time irregular), and the late supper group (after 8:00 p.m.). Cox proportional hazards regression models were used to calculate hazard ratios (HRs) for stroke, CHD, and total CVD according to the supper time groups. During the 19-year follow-up, we identified 4706 deaths from total CVD. Compared with the early supper group, the multivariable HR of hemorrhagic stroke mortality for the irregular supper group was 1.44 (95% confidence interval [CI]: 1.05–1.97). There was no significant association between supper timing and the risk of mortality from other types of stroke, CHD, and CVD. We found that adopting an irregular supper timing compared with having dinner before 8:00 p.m. was associated with an increased risk of hemorrhagic stroke mortality.

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Failure to reach uric acid target of <0.36 mmol/L in hyperuricaemia of gout is associated with elevated total and cardiovascular mortality

RMD Open ◽

10.1136/rmdopen-2019-001015 ◽

2019 ◽

Vol 5 (2) ◽

pp. e001015 ◽

Cited By ~ 10

Author(s):

Fernando Pérez Ruiz ◽

Pascal Richette ◽

Austin G Stack ◽

Ravichandra Karra Gurunath ◽

Ma Jesus García de Yébenes ◽

...

Keyword(s):

Uric Acid ◽

Proportional Hazards ◽

Cox Proportional Hazards ◽

First Year ◽

Cox Proportional Hazards Models ◽

Crude Mortality ◽

Risk Patients ◽

The Impact ◽

Related Mortality

ObjectiveTo determine the impact of achieving serum uric acid (sUA) of <0.36 mmol/L on overall and cardiovascular (CV) mortality in patients with gout.MethodsProspective cohort of patients with gout recruited from 1992 to 2017. Exposure was defined as the average sUA recorded during the first year of follow-up, dichotomised as ≤ or >0.36 mmol/L. Bivariate and multivariate Cox proportional hazards models were used to determine mortality risks, expressed HRs and 95% CIs.ResultsOf 1193 patients, 92% were men with a mean age of 60 years, 6.8 years’ disease duration, an average of three to four flares in the previous year, a mean sUA of 9.1 mg/dL at baseline and a mean follow-up 48 months; and 158 died. Crude mortality rates were significantly higher for an sUA of ≥0.36 mmol/L, 80.9 per 1000 patient-years (95% CI 59.4 to 110.3), than for an sUA of <0.36 mmol/L, 25.7 per 1000 patient-years (95% CI 21.3 to 30.9). After adjustment for age, sex, CV risk factors, previous CV events, observation period and baseline sUA concentration, an sUA of ≥0.36 mmol/L was associated with elevated overall mortality (HR=2.33, 95% CI 1.60 to 3.41) and CV mortality (HR=2.05, 95% CI 1.21 to 3.45).ConclusionsFailure to reach a target sUA level of 0.36 mmol/L in patients with hyperuricaemia of gout is an independent predictor of overall and CV-related mortality. Targeting sUA levels of <0.36 mmol/L should be a principal goal in these high-risk patients in order to reduce CV events and to extend patient survival.

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Impact of residual kidney function on hemodialysis adequacy and patient survival

Nephrology Dialysis Transplantation ◽

10.1093/ndt/gfy060 ◽

2018 ◽

Vol 33 (10) ◽

pp. 1823-1831 ◽

Cited By ~ 4

Author(s):

Mengjing Wang ◽

Yoshitsugu Obi ◽

Elani Streja ◽

Connie M Rhee ◽

Jing Chen ◽

...

Keyword(s):

Kidney Function ◽

Proportional Hazards ◽

Cox Model ◽

Hemodialysis Patients ◽

Cox Proportional Hazards ◽

Dialysis Dose ◽

Residual Kidney Function ◽

Hazard Ratios ◽

Laboratory Variables

ABSTRACTBackgroundBoth dialysis dose and residual kidney function (RKF) contribute to solute clearance and are associated with outcomes in hemodialysis patients. We hypothesized that the association between dialysis dose and mortality is attenuated with greater RKF.MethodsAmong 32 251 incident hemodialysis patients in a large US dialysis organization (2007–11), we examined the interaction between single-pool Kt/V (spKt/V) and renal urea clearance (rCLurea) levels in survival analyses using multivariable Cox proportional hazards regression model.ResultsThe median rCLurea and mean baseline spKt/V were 3.06 [interquartile range (IQR) 1.74–4.85] mL/min/1.73 m2 and 1.32 ± 0.28, respectively. A total of 7444 (23%) patients died during the median follow-up of 1.2 years (IQR 0.5–2.2 years) with an incidence of 15.4 deaths per 100 patient-years. The Cox model with adjustment for case-mix and laboratory variables showed that rCLurea modified the association between spKt/V and mortality (Pinteraction = 0.03); lower spKt/V was associated with higher mortality among patients with low rCLurea (i.e. <3 mL/min/1.73 m2) but not among those with higher rCLurea. The adjusted mortality hazard ratios (aHRs) and 95% confidence intervals of the low (<1.2) versus high (≥1.2) spKt/V were 1.40 (1.12–1.74), 1.21 (1.10–1.33), 1.06 (0.98–1.14), and 1.00 (0.93–1.08) for patients with rCLurea of 0.0, 1.0, 3.0 and 6.0 mL/min/1.73 m2, respectively.ConclusionsIncident hemodialysis patients with substantial RKF do not exhibit the expected better survival at higher hemodialysis doses. RKF levels should be taken into account when deciding on the dose of dialysis treatment among incident hemodialysis patients.

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Visual impairment and risk of dementia in two population-based prospective cohorts: UK Biobank and EPIC-Norfolk

The Journals of Gerontology Series A ◽

10.1093/gerona/glab325 ◽

2021 ◽

Author(s):

Thomas J Littlejohns ◽

Shabina Hayat ◽

Robert Luben ◽

Carol Brayne ◽

Megan Conroy ◽

...

Keyword(s):

Visual Impairment ◽

Proportional Hazards ◽

Population Based ◽

Cox Proportional Hazards ◽

Uk Biobank ◽

Cox Proportional Hazards Models ◽

Hazard Ratios ◽

Promising Target ◽

Increased Risk

Abstract Visual impairment has emerged as a potential modifiable risk factor for dementia. However, there are a lack of large studies with objective measures of vison and with more than ten years of follow-up. We investigated whether visual impairment is associated with an increased risk of incident dementia in UK Biobank and EPIC-Norfolk. In both cohorts, visual acuity was measured using a “logarithm of the minimum angle of resolution” (LogMAR) chart and categorised as no (≤0.30 LogMAR), mild (>0.3 - ≤0.50 LogMAR), and moderate to severe (>0.50 LogMAR) impairment. Dementia was ascertained through linkage to electronic medical records. After restricting to those aged ≥60 years, without prevalent dementia and with eye measures available, the analytic samples consisted of 62,206 UK Biobank and 7,337 EPIC-Norfolk participants, respectively. In UK Biobank and EPIC-Norfolk. respectively, 1,113 and 517 participants developed dementia over 11 and 15 years of follow-up. Using multivariable cox proportional-hazards models, the hazard ratios for mild and moderate to severe visual impairment were 1.26 (95% Confidence Interval [CI] 0.92-1.72) and 2.16 (95% CI 1.37-3.40), in UK Biobank, and 1.05 (95% CI 0.72-1.53) and 1.93 (95% CI 1.05-3.56) in EPIC-Norfolk, compared to no visual impairment. When excluding participants censored within 5 years of follow-up or with prevalent poor or fair self-reported health, the direction of the associations remained similar for moderate impairment but were not statistically significant. Our findings suggest visual impairment might be a promising target for dementia prevention, however the possibility of reverse causation cannot be excluded.

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History of premorbid depression is a risk factor for COVID-related mortality: Analysis of a retrospective cohort of 1,387 COVID+ patients

10.1101/2020.12.17.20248362 ◽

2020 ◽

Author(s):

Sean Clouston ◽

Benjamin J Luft ◽

Edward Sun

Keyword(s):

Risk Factors ◽

Risk Factor ◽

Proportional Hazards ◽

Cox Proportional Hazards ◽

Cox Proportional Hazards Models ◽

Risk Of Mortality ◽

Increased Risk ◽

History Of ◽

History Of Depression ◽

Related Mortality

Background: The goal of the present work was to examine risk factors for mortality in a 1,387 COVID+ patients admitted to a hospital in Suffolk County, NY. Methods: Data were collated by the hospital epidemiological service for patients admitted from 3/7/2020-9/1/2020. Time until final discharge or death was the outcome. Cox proportional hazards models were used to estimate time until death among admitted patients. Findings: In total, 99.06% of cases had resolved leading to 1,179 discharges and 211 deaths. Length of stay was significantly longer in those who died as compared to those who did not p=0.007). Of patients who had been discharged (n=1,179), 54 were readmitted and 9 subsequently died. Multivariable-adjusted Cox proportional hazards regression revealed that in addition to older age, male sex, and heart failure, a history of premorbid depression was a risk factor for COVI-19 mortality. Interpretation: While an increasing number of studies have shown effects linking cardiovascular risk factors with increased risk of mortality in COVID+ patients, this study reports that history of depression is a risk factor for COVID mortality.

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Mortality Among Male Cigar and Cigarette Smokers in the U.S.

10.21203/rs.3.rs-55896/v1 ◽

2020 ◽

Author(s):

Brad Rodu ◽

Nantaporn Plurphanswat

Keyword(s):

Respiratory Diseases ◽

Proportional Hazards ◽

Heart Diseases ◽

Cox Proportional Hazards ◽

Malignant Neoplasms ◽

Cox Proportional Hazards Models ◽

Hazard Ratios ◽

Low Prevalence ◽

Cigar Smoking

Abstract Background. Cigars and cigarettes are both smoked, but much less is known about the former’s long-term health effects, due to its low prevalence and infrequent collection of cigar information in national surveys. Purpose. We conducted a follow-up mortality study of cigar-smoking men age 40-79 years in National Health Interview Surveys (NHIS). We utilized Methods. We used pooled NHIS files linked to the National Death Index to obtain follow-up from year of interview to year of death or December 31, 2015. We developed categories of cigarette and cigar smoking that accommodate dual and former use of both products. We used Cox proportional hazards models, adjusted for age, race/ethnicity, marital status, education, income, health status, body mass index, and region to estimate hazard ratios (HRs, 95% confidence intervals, CI) for mortality from all causes, heart diseases, malignant neoplasms, cerebrovascular disease, chronic lower respiratory diseases and two mutually exclusive categories: smoking-related and other diseases.Results. There were 14,628 deaths from all causes, including 3,420 never tobacco users, 3,266 exclusive smokers, and 176 exclusive cigar users. The latter had significantly increased mortality only from chronic lower respiratory diseases (HR = 2.60, CI = 1.04 – 6.50), which was based on 6 deaths. We found no statistically significant evidence among exclusive cigar smokers of increased mortality from any other cause.Conclusions. This study provides evidence that male cigar smokers had elevated mortality risks. However, after accounting for cigarette smoking, we found significantly increased mortality only for chronic lower respiratory diseases.

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Colours of fruit and vegetables and 10-year incidence of CHD

British Journal Of Nutrition ◽

10.1017/s0007114511001942 ◽

2011 ◽

Vol 106 (10) ◽

pp. 1562-1569 ◽

Cited By ~ 33

Author(s):

Linda M. Oude Griep ◽

W. M. Monique Verschuren ◽

Daan Kromhout ◽

Marga C. Ocké ◽

Johanna M. Geleijnse

Keyword(s):

Proportional Hazards ◽

Population Based ◽

Cox Proportional Hazards ◽

Fruit And Vegetables ◽

Orange Yellow ◽

Cox Proportional Hazards Models ◽

Hazard Ratios ◽

Orange Fruit ◽

Incident Cases

The colours of the edible part of fruit and vegetables indicate the presence of specific micronutrients and phytochemicals. The extent to which fruit and vegetable colour groups contribute to CHD protection is unknown. We therefore examined the associations between fruit and vegetables of different colours and their subgroups and 10-year CHD incidence. We used data from a prospective population-based cohort including 20 069 men and women aged 20–65 years who were enrolled between 1993 and 1997. Participants were free of CVD at baseline and completed a validated 178-item FFQ. Hazard ratios (HR) for the association between green, orange/yellow, red/purple, white fruit and vegetables and their subgroups with CHD were calculated using multivariable Cox proportional hazards models. During 10 years of follow-up, 245 incident cases of CHD were documented. For each 25 g/d increase in the intake of the sum of all four colours of fruit and vegetables, a borderline significant association with incident CHD was found (HR 0·98; 95 % CI 0·97, 1·01). No clear associations were found for the colour groups separately. However, each 25 g/d increase in the intake of deep orange fruit and vegetables was inversely associated with CHD (HR 0·74; 95 % CI 0·55, 1·00). Carrots, their largest contributor (60 %), were associated with a 32 % lower risk of CHD (HR 0·68; 95 % CI 0·48, 0·98). In conclusion, though no clear associations were found for the four colour groups with CHD, a higher intake of deep orange fruit and vegetables and especially carrots may protect against CHD.

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Glycated Hemoglobin and All-Cause and Cause-Specific Mortality Among Adults With and Without Diabetes

The Journal of Clinical Endocrinology & Metabolism ◽

10.1210/jc.2018-02536 ◽

2019 ◽

Vol 104 (8) ◽

pp. 3345-3354 ◽

Cited By ~ 5

Author(s):

Fu-Rong Li ◽

Xi-Ru Zhang ◽

Wen-Fang Zhong ◽

Zhi-Hao Li ◽

Xiang Gao ◽

...

Keyword(s):

Mortality Risk ◽

Hba1c Level ◽

Proportional Hazards ◽

Cox Proportional Hazards ◽

Community Based ◽

Hazard Ratios ◽

Risk Of Mortality ◽

All Cause Mortality ◽

History Of

Abstract Context The patterns of associations between glycated Hb (HbA1c) and mortality are still unclear. Objective To explore the extent to which ranges of HbA1c levels are associated with the risk of mortality among participants with and without diabetes. Design, Setting, and Patients This was a nationwide, community-based prospective cohort study. Included were 15,869 participants (median age 64 years) of the Health and Retirement Study, with available HbA1c data and without a history of cancer. Cox proportional hazards regression models were used to estimate hazard ratios with 95% CIs for mortality. Results A total of 2133 participants died during a median follow-up of 5.8 years. In participants with diabetes, those with an HbA1c level of 6.5% were at the lowest risk of all-cause mortality. When HbA1c level was <5.6% or >7.4%, the increased all-cause mortality risk became statistically significant as compared with an HbA1c level of 6.5%. As for participants without diabetes, those with an HbA1c level of 5.4% were at the lowest risk of all-cause mortality. When the HbA1c level was <5.0%, the increased all-cause mortality risk became statistically significant as compared with an HbA1c level of 5.4%. However, we did not observe a statistically significant elevated risk of all-cause mortality above an HbA1c level of 5.4%. Conclusions A U-shaped and reverse J-shaped association for all-cause mortality was found among participants with and without diabetes. The corresponding optimal ranges for overall survival are predicted to be 5.6% and 7.4% and 5.0% and 6.5%, respectively.

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