scholarly journals Longitudinal course of GDF15 levels before acute hospitalization and death in the general population

2021 ◽  
Vol 5 (Supplement_1) ◽  
pp. 669-669
Author(s):  
Juliette Tavenier ◽  
Ove Andersen ◽  
Jan O Nehlin ◽  
Janne Petersen
Keyword(s):  
General Population ◽  
Health Outcomes ◽  
Cox Regression ◽  
Serum Levels ◽  
Population Based ◽  
Biological Aging ◽  
Acute Hospitalization ◽  
Adverse Health ◽  
Adverse Health Outcomes ◽  
Increased Risk

Abstract Growth differentiation 15 (GDF15) is a potential novel biomarker of biological aging. To separate the effects of chronological age and birth cohort from biological age, longitudinal studies investigating associations of GDF15 levels with adverse health outcomes are needed. We investigated changes in GDF15 levels over 10 years in an age-stratified sample of the general population and their relation to the risk of acute hospitalization and death. Serum levels of GDF15 were measured three times in 5-year intervals in 2176 participants aged 30, 40, 50, or 60 years from the Danish population-based DAN-MONICA cohort. We assessed the association of single and repeated GDF15 measurements with the risk of non-traumatic acute hospitalizations. We tested whether changes in GDF15 levels over 10 years differed according to the frequency of hospitalizations within 2 years, or survival within 20 years, after the last GDF15 measurement. The change in GDF15 levels over time was dependent on age and sex. Higher GDF15 levels and a greater increase in GDF15 levels were associated with an increased risk of acute hospitalization in adjusted Cox regression analyses. Participants with more frequent admissions within 2 years, and those who died within 20 years, after the last GDF15 measurement already had elevated GDF15 levels at baseline and experienced greater increases in GDF15 levels during the study. The change in GDF15 levels was associated with changes in C-reactive protein and biomarkers of kidney, liver, and cardiac function. Monitoring of GDF15 starting in middle-age could be valuable for the prediction of adverse health outcomes.

scholarly journals Overuse of short-acting β2-agonists in asthma is associated with increased risk of exacerbation and mortality: a nationwide cohort study of the global SABINA programme

2020 ◽  
Vol 55 (4) ◽  
pp. 1901872 ◽  
Author(s):  
Bright I. Nwaru ◽  
Magnus Ekström ◽  
Pål Hasvold ◽  
Fredrik Wiklund ◽  
Gunilla Telg ◽  
...  
Keyword(s):  
Cox Regression ◽  
Asthma Management ◽  
Baseline Period ◽  
Population Based ◽  
Short Acting ◽  
Adverse Health Outcomes ◽  
Increased Risk ◽  
Asthma Patients ◽  
Β2 Agonists

BackgroundOveruse of short-acting β2-agonists (SABA) may indicate poor asthma control and adverse health outcomes. Contemporary population-based data on use, risk factors and impact of SABA (over)use on asthma exacerbations and mortality are scarce, prompting initiation of the global SABINA (SABA use IN Asthma) programme.MethodsBy linking data from Swedish national registries, asthma patients aged 12–45 years with two or more collections of drugs for obstructive lung disease during 2006–2014 were included. SABA overuse was defined as collection of more than two SABA canisters in a 1-year baseline period following inclusion. SABA use was grouped into 3–5, 6–10 and ≥11 canisters per baseline-year. Cox regression was used to examine associations between SABA use and exacerbation (hospitalisations and/or oral corticosteroid claims) and mortality.ResultsThe analysis included 365 324 asthma patients (mean age 27.6 years; 55% female); average follow-up was 85.4 months. 30% overused SABA, with 21% collecting 3–5 canisters per year, 7% collecting 6–10 canisters per year and 2% collecting ≥11 canisters per year. Increasing number of collected SABA canisters was associated with increased risk of exacerbation, as follows. 3–5 canisters: hazard ratio (HR) 1.26 (95% CI 1.24–1.28); 6–10 canisters: 1.44 (1.41–1.46); and ≥11 canisters: 1.77 (1.72–1.83), compared to two or fewer canisters per year. Higher SABA use was associated with incrementally increased mortality risk (2564 deaths observed), as follows. 3–5 canisters: HR 1.26 (95% CI 1.14–1.39); 6–10 canisters 1.67 (1.49–1.87); and ≥11 canisters: 2.35 (2.02–2.72) compared to two or fewer canisters per year.ConclusionOne-third of asthma patients in Sweden collected three or more SABA canisters annually. SABA overuse was associated with increased risks of exacerbation and mortality. These findings emphasise that monitoring of SABA usage should be key in improving asthma management.

Cancer Risk in Patients with Autoimmune Hepatitis: A Nationwide Population-Based Cohort Study with Histopathology

2021 ◽  
Author(s):  
Rajani Sharma ◽  
Elizabeth C Verna ◽  
Tracey G Simon ◽  
Jonas Söderling ◽  
Hannes Hagström ◽  
...  
Keyword(s):  
Cohort Study ◽  
General Population ◽  
Cancer Risk ◽  
Autoimmune Hepatitis ◽  
Cox Regression ◽  
Population Based ◽  
Swedish Population ◽  
Non Melanoma Skin Cancer ◽  
Incident Cancer ◽  
Increased Risk

Abstract We aimed to determine the risk of incident cancer in autoimmune hepatitis (AIH) compared to the general population and siblings. AIH was defined by the presence of a medical diagnosis of AIH and a liver biopsy in a nationwide Swedish population-based cohort study. We identified 5,268 adults with AIH diagnosed 1969-2016 and 22,996 matched general population reference individuals and 4,170 sibling comparators. Using Cox regression, hazard ratios (HRs) were determined for any incident cancer and sub-types determined from the Swedish Cancer Register. During follow-up, a cancer diagnosis was made in 1,119 individuals with AIH (17.2/1000 person-years) and 4,450 reference individuals (12.0/1000 person-years). This corresponded to an HR of 1.53 (95%CI: 1.42,1.66). Cancer risk was highest in those with cirrhosis. There was a 29.18-fold increased risk of hepatocellular carcinoma (HCC) (95%CI, 17.52,48.61). The annual incidence risk of HCC in individuals with AIH who had cirrhosis was 1.1% per year. AIH was also linked to non-melanoma skin cancer (HR=2.69) and lymphoma (HR=1.89). Sibling analyses yielded similar risk estimates for any cancer (HR=1.84) and HCC (HR=23.10). AIH is associated with an increased risk of any cancer, in particular, HCC and extra-hepatic malignancies. The highest risk for cancer, especially HCC, is in patients with cirrhosis.

Are Children Born After Assisted Reproductive Technology at Increased Risk for Adverse Health Outcomes?

2004 ◽  
Vol 103 (6) ◽  
pp. 1154-1163 ◽  
Author(s):  
Laura A. Schieve ◽  
Sonja A. Rasmussen ◽  
Germaine M. Buck ◽  
Diana E. Schendel ◽  
Meredith A. Reynolds ◽  
...  
Keyword(s):  
Health Outcomes ◽  
Assisted Reproductive Technology ◽  
Reproductive Technology ◽  
Adverse Health ◽  
Adverse Health Outcomes ◽  
Increased Risk

Ovary as a Biomarker of Health and Longevity: Insights from Genetics

2017 ◽  
Vol 35 (03) ◽  
pp. 231-240 ◽  
Author(s):  
Stephanie Pangas ◽  
Aleksandar Rajkovic
Keyword(s):  
Health Outcomes ◽  
Animal Studies ◽  
Association Studies ◽  
Surrogate Marker ◽  
Genome Wide Association Studies ◽  
New Paradigm ◽  
Ovarian Insufficiency ◽  
Adverse Health ◽  
Adverse Health Outcomes ◽  
Increased Risk

AbstractReproductive fitness and its influence on overall health has been a topic of significant study and interest. Multiple studies have found that age at last reproduction associates with overall health. Women who conceive later in life are significantly more likely to outlive their peers who are unable to conceive. The mechanisms behind these observations are not well understood. Earlier age at menopause associates with shorter life span, increased risk for diabetes mellitus, and increased risk of heart disease, and represents a surrogate marker for the age at last reproduction. Recent applications of genome-wide association studies as well as whole-exome sequencing to familial primary ovarian insufficiency (POI) and menopause have identified new genomic regions that link reproductive aging and adverse health outcomes. The preponderance of DNA damage response genes in menopause and POI represents a relatively new paradigm in this area, and links overall aging and reproduction at the molecular level. Identification of the subset of individuals who are at risk for adverse health outcomes remains a significant and high priority research challenge. The combination of epidemiologic studies in women with diminished ovarian reserves, ovarian insufficiency, and early menopause, as well as appropriate animal studies, will be necessary to dissect genotype–phenotype correlations not only in the cause of ovarian dysfunction but also in the cause of adverse health outcomes.

Methotrexate and risk of interstitial lung disease and respiratory failure in rheumatoid arthritis: a nationwide population-based study

Rheumatology ◽  
2020 ◽  
Vol 60 (1) ◽  
pp. 346-352 ◽  
Author(s):  
Else Helene Ibfelt ◽  
Rikke Kart Jacobsen ◽  
Tine Iskov Kopp ◽  
René Lindholm Cordtz ◽  
Anna Svarre Jakobsen ◽  
...  
Keyword(s):  
Respiratory Failure ◽  
Interstitial Lung Disease ◽  
General Population ◽  
Lung Disease ◽  
Cox Regression ◽  
Population Based ◽  
Calendar Time ◽  
Registration System ◽  
Background Population ◽  
Increased Risk

Abstract Objectives MTX is the most commonly recommended DMARD for first-line treatment of RA, however, it has been hypothesized to cause lung disease as an adverse effect. We investigated the risk of interstitial lung disease (ILD) and acute and chronic respiratory failure in persons with RA treated with MTX and other medications. Methods From the Danish National Patient Register (NPR) and the DANBIO register for rheumatic diseases, we retrieved data on 30 512 persons with RA registered in 1997–2015. Information on ILD and respiratory failure was obtained from the NPR. Information on age and sex for all Danish citizens was obtained from the Danish Civil Registration System. MTX and other medication purchases were retrieved from the Danish Prescription Registry. Associations between MTX and lung disease outcomes were analysed in Cox regression models with adjustment for age, calendar time, sex and other medications. Standardized incidence ratios (SIRs) of lung disease were calculated to compare the RA population with the general population. Results There was no increased risk of lung disease with MTX treatment [one or more purchases compared with no purchases; HR 1.00 (95% CI 0.78, 1.27) for ILD and 0.54 (95% CI 0.43, 0.67) for respiratory failure] at the 5 year follow-up. The SIR was three to four times higher for ILD in MTX-treated persons with RA, but similar to the whole RA population compared with the background population. Conclusion Persons with RA had an increased risk of ILD compared with the general population, but there was no further increased risk associated with MTX treatment.

scholarly journals Potentially inappropriate prescribing in dementia, multi-morbidity and incidence of adverse health outcomes

2020 ◽  
Author(s):  
João Delgado ◽  
Lindsay Jones ◽  
Marie C Bradley ◽  
Louise M Allan ◽  
Clive Ballard ◽  
...  
Keyword(s):  
Health Outcomes ◽  
Inappropriate Prescribing ◽  
Hazard Ratio ◽  
Potentially Inappropriate Prescribing ◽  
Prevalence Odds Ratio ◽  
Discharge Data ◽  
Adverse Health ◽  
Adverse Health Outcomes ◽  
Increased Risk ◽  
The Impact

Abstract Importance treatment of dementia in individuals with comorbidities is complex, leading to potentially inappropriate prescribing (PIP). The impact of PIP in this population is unknown. Objective to estimate the rate of PIP and its effect on adverse health outcomes (AHO). Design retrospective cohort. Setting primary care electronic health records linked to hospital discharge data from England. Subjects 11,175 individuals with dementia aged over 65 years in 2016 and 43,463 age- and sex-matched controls. Methods Screening Tool of Older Persons’ Prescriptions V2 defined PIP. Logistic regression tested associations with comorbidities at baseline, and survival analyses risk of incident AHO, adjusted for age, gender, deprivation and 14 comorbidities. Results the dementia group had increased risk of PIP (73% prevalence; odds ratio [OR]: 1.92; confidence interval [CI]: 83–103%; P < 0.01) after adjusting for comorbidities. Most frequent PIP criteria were related to anti-cholinergic drugs and therapeutic duplication. Risk of PIP was higher in patients also diagnosed with coronary-heart disease (odds OR: 2.17; CI: 1.91–2.46; P < 0.01), severe mental illness (OR: 2.09; CI: 1.62–2.70; P < 0.01); and depression (OR: 1.81; CI: 1.62–2.01; P < 0.01). During follow-up (1 year), PIP was associated with increased all-cause mortality (hazard ratio: 1.14; CI: 1.02–1.26; P < 0.02), skin ulcer and pressure sores (hazard ratio: 1.66; CI: 1.12–2.46; P < 0.01), falls (hazard ratio: 1.37; CI: 1.15–1.63; P < 0.01), anaemia (hazard ratio: 1.61; CI: 1.10–2.38; P < 0.02) and osteoporosis (hazard ratio: 1.62; CI: 1.02–2.57; P < 0.04). Conclusion patients with dementia frequently receive PIPs, and those who do are more likely to experience AHO. These results highlight the need to optimise medication in dementia patients, especially those with comorbidities.

scholarly journals OP14 Risk of colorectal cancer diagnosis and colorectal cancer mortality in Crohn’s disease: A Scandinavian population-based cohort study

2020 ◽  
Vol 14 (Supplement_1) ◽  
pp. S013-S014
Author(s):  
O Olen ◽  
R Erichsen ◽  
M C Sachs ◽  
L Pedersen ◽  
J Halfvarson ◽  
...  
Keyword(s):  
Colorectal Cancer ◽  
Cohort Study ◽  
Crohn’S Disease ◽  
Crohn's Disease ◽  
General Population ◽  
Cox Regression ◽  
Population Based ◽  
Tumour Stage ◽  
Increased Risk

Abstract Background Crohn’s disease (CD) is a risk factor for colorectal cancer (CRC). Earlier studies reflect older treatment and surveillance strategies, and most have studied incident CRC without addressing potential lead-time and surveillance biases. Such bias can be reduced by examining tumour stage-adjusted CRC incidence and CRC mortality. We aimed to assess risks of CRC mortality and incident CRC among patients with CD compared with the general population. Methods Nationwide register-based cohort study during 1969–2017 of 47,035 patients with CD in Denmark (n = 13,056) and Sweden (n = 33,979), compared with 463,187 general population reference individuals, matched for sex, age, calendar year, and place of residence. We used Cox regression to estimate hazard ratios (HRs) for incident CRC and CRC mortality. In a multistate model, assessing competing events during follow-up (CRC diagnosis, CRC death, other death), we also took a tumour stage into account. Results During 1969–2017, 499 patients with CD developed CRC, corresponding to an adjusted HR of 1.40 [95% confidence interval (CI) 1.27–1.53]. We observed 296 (0.47/1000 person-years) deaths from CRC in patients with CD compared with 1968 (0.31/1000) in reference individuals [HR 1.74 (95% CI 1.54–1.96)]. CD patients diagnosed with CRC were at increased risk of CRC mortality compared with reference individuals also diagnosed with CRC [HR = 1.30 (95% CI 1.06–1.59)] and tumour stage at CRC diagnosis did not differ between groups (p = 0.27). CD patients who had 8 or more years of follow-up or who were diagnosed with primary sclerosing cholangitis (PSC) and hence were potentially eligible for CRC surveillance had an increased overall risk of CRC death [HR 1.41 (95% CI 1.18–1.69)] or CRC diagnosis [HR = 1.12 (95% CI = 0.98–1.28)]. However, in patients potentially eligible for CRC surveillance, we only found significantly increased risks in patients with CD onset <40 years, disease activity in the colon only, or with PSC (Figure 1). Conclusion CD patients are at increased risk of a CRC diagnosis and CRC death. Despite repeated colonoscopies during follow-up, CD patients are not diagnosed earlier (less severe tumour stage) with CRC than reference individuals. Nevertheless, CD patients with CRC have higher mortality than non-CD patients also diagnosed with CRC. CRC surveillance could likely be improved and should be focussed on CD patients <40 years at CD onset, patients with colon inflammation, and patients who have PSC.

scholarly journals Strategy to reduce adverse health outcomes in subjects highly vulnerable to COVID-19: results from a population-based study in Northern Italy

BMJ Open ◽  
2021 ◽  
Vol 11 (3) ◽  
pp. e046044
Author(s):  
Antonio Giampiero Russo ◽  
Marino Faccini ◽  
Walter Bergamaschi ◽  
Antonio Riussi
Keyword(s):  
High Risk ◽  
Health Outcomes ◽  
Population Based ◽  
Population Based Study ◽  
High Risk Patients ◽  
Risk Of Death ◽  
Adverse Health ◽  
Adverse Health Outcomes ◽  
Risk Patients ◽  
Overall Mortality

ObjectivesThis study describes a new strategy to reduce the impact of COVID-19 on the elderly and other clinically vulnerable subjects, where general practitioners (GPs) play an active role in managing high-risk patients, reducing adverse health outcomes.DesignRetrospective cohort study.SettingPopulation-based study including subjects resident in the province of Milan and Lodi.Participants127 735 residents older than 70 years, with specific chronic conditions.InterventionsWe developed a predictive algorithm for overall mortality risk based on demographic and clinical characteristics. All residents older than 70 years were classified as being at low or high risk of death from COVID-19 infection according to the algorithm. The high-risk group was assigned to their GPs for telephone triage and consultation. The high-risk cohort was divided into two groups based on GP intervention: patients who were not contacted and patients who were contacted by their GPs.Outcome measuresOverall mortality, COVID-19 morbidity and hospitalisation.ResultsPatients with increased risk of death from COVID-19 were 127 735; 495 669 patients were not at high risk and were not included in the intervention. Out of the high-risk subjects, 79 110 were included but not contacted by their GPs, while 48 625 high-risk subjects were included and contacted. Overall mortality, morbidity and hospitalisation was higher in high-risk patients compared with low-risk populations. High-risk patients contacted by their GPs had a 50% risk reduction in COVID-19 mortality, and a 70% risk reduction in morbidity and hospitalisation for COVID-19 compared with non-contacted patients.ConclusionsThe study showed that, during the COVID-19 outbreak, involvement of GPs and changes in care management of high-risk groups produced a significant reduction in all adverse health outcomes.

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