0048 The Association Between REM Sleep and Risk of Mortality in Three Independent Cohorts

Abstract Introduction Sleep disorders and sleep characteristics have been linked to higher risk of mortality. Despite the emerging evidence of a sleep-mortality association, the relationship between sleep architecture and mortality aren’t well understood. We hypothesize that reduced REM is associated with increased mortality risk. Methods The Osteoporotic Fractures in Men (MrOS) study is a population-based study of 2,675 older men. Cox regression was used to evaluate the association between %REM and mortality rate. Potential covariates were evaluated using 6-fold cross validation. Sensitivity analyses were performed to rule out alternative explanations. Wisconsin Sleep Cohort (WSC) and Sleep Heart Health Study (SHHS) data were used to replicate the findings. Results The MrOS sample mean age was 76.3 years (SD=5.51) and the median follow-up time was 12.1 years. There was a 13% higher rate of mortality for every absolute 5% reduction in REM sleep (HR=1.13, 95%CI, 1.08–1.19) after adjusting for multiple demographic, sleep, and health covariates. The association persisted for cardiovascular disease-related mortality (CVD) (HR=1.18, 95%CI, 1.09–1.28), cancer-related mortality (HR=1.14, 95%CI, 1.03–1.26), and other mortality (HR=1.19, 95%CI, 1.10–1.28). The WSC included 45.7% women. The mean age of the 1,388 individuals analyzed was 51.5 (SD=8.5); the median follow-up time was 20.8 years. The effect size for 5% reduction in REM on rate of all-cause mortality was similar in this cohort despite the younger age, inclusion of women, and longer follow-up period (HR=1.17, 95%CI, 1.03–1.34). SHHS data is still being analyzed; however the unadjusted model is consistent with the other cohorts. Conclusion We found an association between reduced REM and mortality in two, possibly three independent cohorts, which persisted across different causes of death and multiple sensitivity analyses. Mechanistic studies are needed and strategies to preserve REM may influence clinical therapies and reduce mortality risk. Support NHLBI provides funding for the MrOS Sleep ancillary study “Outcomes of Sleep Disorders in Older Men” under grant numbers: R01 HL071194, R01 HL070848, R01 HL070847, R01 HL070842, R01 HL070841, R01 HL070837, R01 HL070838, and R01 HL070839. Wisconsin Sleep Cohort was supported by R01HL62252, RR03186, and R01AG14124 from the NIH. Dr. Redline was partially supported by NHLBI R35 HL135818.

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Serum β-2 microglobulin predicts mortality in people with diabetes

Acta Endocrinologica ◽

10.1530/eje-13-0003 ◽

2013 ◽

Vol 169 (1) ◽

pp. 1-7 ◽

Cited By ~ 15

Author(s):

Ching-Lung Cheung ◽

Karen S L Lam ◽

Bernard M Y Cheung

Keyword(s):

Cox Regression ◽

Threshold Model ◽

Linear Increase ◽

Diabetic Patients ◽

Cox Regression Analysis ◽

Health And Nutrition ◽

Risk Of Mortality ◽

The Relationship ◽

Related Mortality

ObjectiveSerum β-2 microglobulin (B2M) level predicts mortality in chronic kidney disease. Glycation of B2M is cytotoxic and may contribute to the risk of mortality in diabetic patients. Our objective was to evaluate the relationship between B2M and mortality in diabetic patients.MethodsIn this prospective study, 896 participants of the Third National Health and Nutrition Examination Survey with diabetes were included in the analysis. Serum B2M level was used in multivariate Cox regression analysis to predict all-cause and diabetes-related mortality.ResultsDuring a median follow-up of 11.8 years (range 0.1–18.2 years) and 9220.5 person/years, 541 (42.4%) and 207 (16.8%) participants died from all causes and diabetes-related causes respectively. One natural-log unit of B2M was significantly associated with all-cause (hazard ratio (HR)=6.53, 95% CI 2.07–20.6) and diabetes mortality (HR=7.35, 95% CI 1.01–53.38) after multivariable adjustment. Similar results were obtained when B2M was analyzed as tertiles or in the threshold model (T1+T2 vs T3). Examination of regression splines suggests a linear increase in hazard for mortality with increasing B2M levels.ConclusionsSerum B2M level is a novel predictor of all-cause and diabetes-related mortality in people with diabetes regardless of renal function.

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Healthy behaviours and risk of all-cause mortality

European Journal of Public Health ◽

10.1093/eurpub/ckz185.469 ◽

2019 ◽

Vol 29 (Supplement_4) ◽

Author(s):

J Lahti ◽

E Mauramo ◽

E Lahelma ◽

T Lallukka ◽

O Pietiläinen ◽

...

Keyword(s):

Mortality Risk ◽

Cox Regression ◽

Leisure Time Physical Activity ◽

Premature Mortality ◽

Middle Aged ◽

A Value ◽

Risk Of Mortality ◽

Increased Risk ◽

Healthy Behaviour

Abstract Introduction Healthy behaviours are associated with better health in general but less is known about the combined associations of multiple healthy behaviours with mortality risk. We aimed to examine the associations of combined healthy behaviours with mortality risk over a 15-year follow-up among middle-aged employees. Methods Survey data, collected in 2000–2002 among 40–60-year-old employees of the City of Helsinki, Finland, was linked with complete register data on mortality from Statistics Finland (response rate 67%, written informed consent for register linkages 74%). Healthy behaviours included high leisure-time physical activity, non-smoking, no binge drinking and healthy food habits. Each healthy behaviour were dichotomized and assigned a value of one for healthy and zero for unhealthy. The number of healthy behaviours were summed together (score range 0-4). Cox regression models were fitted, and the follow-up continued until the end of 2015 (n = 6336). Confounders included age, sex, marital status, socioeconomic position and self-rated health. Results Of the respondents, 7% reported four healthy behaviours, 27% three, 34% two, 22% one and 9% no healthy behaviours. A total of 281 deaths occurred during the follow-up. Each healthy behaviour was individually associated with a reduced mortality risk, non-smoking having the strongest and healthy diet the weakest association. The combined association showed that those without any of the healthy behaviours (HR 2.8, 95% CI 1.51-5.29) and those with only one healthy behaviour (HR 1.89, 95% CI 1.04-3.43) had a higher mortality risk than those with four healthy behaviours. Instead, those with at least two healthy behaviours were not at an increased risk of mortality. Conclusions A low number of healthy behaviours predicted mortality among middle-aged employees. Efforts should be made to promote multiple healthy behaviours among the middle-aged to enhance health and prevent premature mortality. Key messages Almost one third of the respondents had no or only one healthy behaviour. A low number of healthy behaviours was associated with an increased risk of mortality.

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Increased risk of mortality associated with social isolation in older men: only when feeling lonely? Results from the Amsterdam Study of the Elderly (AMSTEL)

Psychological Medicine ◽

10.1017/s0033291711001772 ◽

2011 ◽

Vol 42 (4) ◽

pp. 843-853 ◽

Cited By ~ 104

Author(s):

T. J. Holwerda ◽

A. T. F. Beekman ◽

D. J. H. Deeg ◽

M. L. Stek ◽

T. G. van Tilburg ◽

...

Keyword(s):

Social Isolation ◽

Mortality Risk ◽

The Elderly ◽

Older Men ◽

Mortality Data ◽

Physical And Mental Health ◽

Men And Women ◽

Risk Of Mortality ◽

Increased Risk

BackgroundLoneliness has a significant influence on both physical and mental health. Few studies have investigated the possible associations of loneliness with mortality risk, impact on men and women and whether this impact concerns the situation of being alone (social isolation), experiencing loneliness (feeling lonely) or both. The current study investigated whether social isolation and feelings of loneliness in older men and women were associated with increased mortality risk, controlling for depression and other potentially confounding factors.MethodIn our prospective cohort study of 4004 older persons aged 65–84 years with a 10-year follow-up of mortality data a Cox proportional hazard regression analysis was used to test whether social isolation factors and feelings of loneliness predicted an increased risk of mortality, controlling for psychiatric disorders and medical conditions, cognitive functioning, functional status and sociodemographic factors.ResultsAt 10 years follow-up, significantly more men than women with feelings of loneliness at baseline had died. After adjustment for explanatory variables including social isolation, the mortality hazard ratio for feelings of loneliness was 1.30 [95% confidence interval (CI) 1.04–1.63] in men and 1.04 (95% CI 0.90–1.24) in women. No higher risk of mortality was found for social isolation.ConclusionsFeelings of loneliness rather than social isolation factors were found to be a major risk factor for increasing mortality in older men. Developing a better understanding of the nature of this association may help us to improve quality of life and longevity, especially in older men.

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POS0141 ACTIVE SCREENING FOR GOUT IDENTIFIES A LARGER CARDIOVASCULAR POPULATION AT HIGH MORTALITY RISK

Annals of the Rheumatic Diseases ◽

10.1136/annrheumdis-2021-eular.1872 ◽

2021 ◽

Vol 80 (Suppl 1) ◽

pp. 282.2-282

Author(s):

S. Ruiz-Simón ◽

I. Calabuig ◽

M. Gomez-Garberi ◽

M. Andrés

Keyword(s):

High Mortality ◽

Mortality Risk ◽

Cardiovascular Events ◽

Cox Regression ◽

Field Studies ◽

High Mortality Risk ◽

Active Screening ◽

Tertiary Centre ◽

All Cause Mortality

Background:We have recently revealed by active screening that about a third of gout cases in the cardiovascular population is not registered in records [1], highlighting the value of field studies.Objectives:To assess whether gout screening in patients hospitalized for cardiovascular events may also help identify patients at higher risk of mortality after discharge.Methods:A retrospective cohort field study, carried out in 266 patients admitted for cardiovascular events in the Cardiology, Neurology and Vascular Surgery units of a tertiary centre in Spain. The presence of gout was established by records review and face-to-face interview, according to the 2015 ACR/EULAR criteria. The occurrence of mortality during follow-up and its causes were obtained from electronic medical records. The association between gout and subsequent mortality was tested using Cox regression models. Whether covariates affect the gout-associated mortality was also studied.Results:Of 266 patients recruited at baseline, 17 were excluded due to loss to follow-up (>6mo), leaving a final sample of 249 patients (93.6%). Thirty-six cases (14.5% of the sample) were classified as having gout: twenty-three (63.9%) had a previously registered diagnosis, while 13 (36.1%) had not and was established by the interview.After discharge, the mean follow-up was 19.9 months (SD ±8.6), with a mortality incidence of 21.6 deaths per 100 patient-years, 34.2% by cardiovascular causes.Gout significantly increased the risk of subsequent all-cause mortality, with a hazard ratio (HR) of 2.01 (95%CI 1.13 to 3.58). When the analysis was restricted to gout patients with registered diagnosis, the association remained significant (HR 2.89; 95%CI 1.54 to 5.41).The adjusted HR for all-cause mortality associated with gout was 1.86 (95% CI 1.01-3.40). Regarding the causes of death, both cardiovascular and non-cardiovascular were numerically increased.Secondary variables rising the mortality risk in those with gout were age (HR 1.07; 1.01 to 1.13) and coexistent renal disease (HR 4.70; 1.31 to 16.84), while gender, gout characteristics and traditional risk factors showed no impact.Conclusion:Gout was confirmed an independent predictor of subsequent all-cause mortality in patients admitted for cardiovascular events. Active screening for gout allowed identifying a larger population at high mortality risk, which may help tailor optimal management to minimize the cardiovascular impact.References:[1]Calabuig I, et al. Front Med (Lausanne). 2020 Sep 29;7:560.Disclosure of Interests:Silvia Ruiz-Simón: None declared, Irene Calabuig: None declared, Miguel Gomez-Garberi: None declared, Mariano Andrés Speakers bureau: Grunenthal, Menarini, Consultant of: Grunenthal, Grant/research support from: Grunenthal

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Were VCF patients at higher risk of mortality following the 2009 publication of the vertebroplasty “sham” trials?

Osteoporosis International ◽

10.1007/s00198-017-4281-z ◽

2017 ◽

Vol 29 (2) ◽

pp. 375-383 ◽

Cited By ~ 25

Author(s):

K. L. Ong ◽

D. P. Beall ◽

M. Frohbergh ◽

E. Lau ◽

J. A. Hirsch

Keyword(s):

Mortality Risk ◽

Cox Regression ◽

Compression Fracture ◽

Balloon Kyphoplasty ◽

Data Set ◽

Mortality Risks ◽

Medicare Data ◽

Kaplan Meier ◽

Risk Of Mortality ◽

Insight Into

Abstract Summary The 5-year period following 2009 saw a steep reduction in vertebral augmentation volume and was associated with elevated mortality risk in vertebral compression fracture (VCF) patients. The risk of mortality following a VCF diagnosis was 85.1% at 10 years and was found to be lower for balloon kyphoplasty (BKP) and vertebroplasty (VP) patients. Introduction BKP and VP are associated with lower mortality risks than non-surgical management (NSM) of VCF. VP versus sham trials published in 2009 sparked controversy over its effectiveness, leading to diminished referral volumes. We hypothesized that lower BKP/VP utilization would lead to a greater mortality risk for VCF patients. Methods BKP/VP utilization was evaluated for VCF patients in the 100% US Medicare data set (2005–2014). Survival and morbidity were analyzed by the Kaplan-Meier method and compared between NSM, BKP, and VP using Cox regression with adjustment by propensity score and various factors. Results The cohort included 261,756 BKP (12.6%) and 117,232 VP (5.6%) patients, comprising 20% of the VCF patient population in 2005, peaking at 24% in 2007–2008, and declining to 14% in 2014. The propensity-adjusted mortality risk for VCF patients was 4% (95% CI, 3–4%; p < 0.001) greater in 2010–2014 versus 2005–2009. The 10-year risk of mortality for the overall cohort was 85.1%. BKP and VP cohorts had a 19% (95% CI, 19–19%; p < 0.001) and 7% (95% CI, 7–8%; p < 0.001) lower propensity-adjusted 10-year mortality risk than the NSM cohort, respectively. The BKP cohort had a 13% (95% CI, 12–13%; p < 0.001) lower propensity-adjusted 10-year mortality risk than the VP cohort. Conclusions Changes in treatment patterns following the 2009 VP publications led to fewer augmentation procedures. In turn, the 5-year period following 2009 was associated with elevated mortality risk in VCF patients. This provides insight into the implications of treatment pattern changes and associated mortality risks.

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Abstract 14499: Impact of Pre-existing and New Incident Atrial Fibrillation on Outcomes of Patients With Acute Pulmonary Embolism: Findings From an International Registry

Circulation ◽

10.1161/circ.142.suppl_3.14499 ◽

2020 ◽

Vol 142 (Suppl_3) ◽

Author(s):

Behnood Bikdeli ◽

David Jimenez ◽

Jorg Del Toro ◽

Gregory Piazza ◽

Augussina Rivas ◽

...

Keyword(s):

Atrial Fibrillation ◽

Pulmonary Embolism ◽

Ischemic Stroke ◽

Acute Pulmonary Embolism ◽

Adverse Outcomes ◽

Risk Of Mortality ◽

Patient Groups ◽

The Impact ◽

Related Mortality

Background: Atrial fibrillation (AF) may occur prior to or early in the course of acute pulmonary embolism (PE). The impact of AF on outcomes of patients with PE remains uncertain. Methods: Using the data from a large prospective multicenter registry of patients with objectively-confirmed PE (04/2014 to 01/2020), we identified three patient groups: 1) those with pre-existing AF 2) patients with newly identified AF within 2 days from the index PE (incident AF) and 3) patients without AF. We assessed the 90-day and 1-year risk of mortality and stroke in patients with AF, in unadjusted and multivariable adjusted models considering those without AF as referent. Results: Among 16,497 patients with PE, 792 had pre-existing AF. Compared with those without AF, patients with pre-existing AF, had increased odds of 90-day all-cause (Odds ratio [OR]: 2.81 (95% confidence interval [CI]: 2.33-3.38) and PE-related mortality (OR: 2.38, 95% CI: 1.37-4.14). After multivariable adjustment, pre-existing AF significantly increased the odds of all-cause mortality (OR: 1.91, 95% CI: 1.57-2.32) but not PE-related mortality (OR: 1.50; 95% CI: 0.85-2.66). Pre-existing AF was associated with increased hazard for ischemic stroke at 1-year follow-up (hazard ratio [HR]: 5.48; 95% CI: 3.10-9.69). Among 16,497 patients with PE, 445 developed incident AF within 2 days of acute PE. Incident AF was associated with increased odds of 90-day all-cause (OR: 2.28; 95% CI: 1.75-2.97) and PE-related (OR: 3.64; 95% CI: 2.01-6.59) mortality. Findings were similar in multivariable analyses and at 1-year follow-up (Figure). No patients with incident AF developed ischemic stroke. Conclusion: In patients with acute symptomatic PE, both pre-existing AF and incident AF predict an adverse clinical course, although the type of adverse outcomes may be different depending on the timing of AF onset.

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Subjective cognitive decline, anxiety symptoms, and the risk of mild cognitive impairment and dementia

Alzheimer s Research & Therapy ◽

10.1186/s13195-020-00673-8 ◽

2020 ◽

Vol 12 (1) ◽

Author(s):

Tau Ming Liew

Keyword(s):

Cognitive Decline ◽

Cox Regression ◽

Cognitive Disorder ◽

Neurocognitive Disorders ◽

Anxiety Symptoms ◽

Sensitivity Analyses ◽

Subjective Cognitive Decline ◽

The Usa ◽

High Risk Populations

Abstract Background Subjective cognitive decline (SCD) and anxiety symptoms both predict neurocognitive disorders, but the two correlate strongly with each other. It is unclear whether they reflect two independent disease processes in the development of neurocognitive disorders and hence deserve separate attention. This cohort study examined whether SCD and anxiety symptoms demonstrate independent risks of mild cognitive disorder and dementia (MCI/dementia). Methods The study included 14,066 participants aged ≥ 50 years and diagnosed with normal cognition at baseline, recruited from Alzheimer’s Disease Centers across the USA. The participants were evaluated for SCD and anxiety symptoms at baseline and followed up almost annually for incident MCI/dementia (median follow-up 4.5 years; interquartile range 2.2–7.7 years). SCD and anxiety symptoms were included in Cox regression to investigate their independent risks of MCI/dementia. Results SCD and anxiety symptoms demonstrated independent risks of MCI/dementia, with HR 1.9 (95% CI 1.7–2.1) and 1.3 (95% CI 1.2–1.5), respectively. Co-occurring SCD and anxiety symptoms demonstrated the highest risk (HR 2.4, 95% CI 1.9–2.9)—participants in this group had a 25% probability of developing MCI/dementia by 3.1 years (95% 2.4–3.7), compared to 8.2 years among those without SCD or anxiety (95% CI 7.9–8.6). The results remained robust even in the sensitivity analyses that took into account symptom severity and consistency of symptoms in the first 2 annual visits. Conclusions The findings suggest that clinicians should not dismiss one over the other when patients present with both SCD and anxiety and that both constructs may potentially be useful to identify high-risk populations for preventive interventions and trials. The findings also point to the need for further research to clarify on the neurobiological distinctions between SCD and anxiety symptoms, which may potentially enrich our understanding on the pathogenesis of neurocognitive disorders.

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Mortality after proximal hip fracture in the Singapore population

Hip International ◽

10.1177/112070000501500307 ◽

2005 ◽

Vol 15 (3) ◽

pp. 166-170 ◽

Cited By ~ 2

Author(s):

K.H. Lin ◽

Y.W. Lim ◽

Y.J. Wu ◽

K.S. Lam

Keyword(s):

Hip Fracture ◽

Mortality Risk ◽

Cox Regression ◽

Regional Hospital ◽

Age Group ◽

Risk Of Death ◽

The Past ◽

The Mean ◽

One Year

The aims were to prospectively assess the mortality risk following proximal hip fractures, identify factors predictive of increased mortality and to investigate the time trends in mortality with comparison to previous studies. Prospectively collected data from 68 consecutive patients who had been admitted to a regional hospital from May 2001 to September 2001 were reviewed. The mean age of the patients was 79.3 years old (range, 55–98) and 72.1% females. Patients were followed prospectively to determine the mortality risk associated with hip fracture over a two-year follow-up period. The acute in-hospital mortality rate at six months, one year and two years was 5.9% (4/68), 14.7% (10/68), 20.6% (14/68) and 25% (17/68) respectively. One-year and two-year mortality for those patients who were 80 or older was significantly higher than for other patients and the number of co-morbid illnesses also had significant effect. Cox regression was performed to determine the significant predictors for survival time. It was noted that patients 80 years or older were at higher risk of death compared with those less than 80 years as well as those with higher number of co-morbid illnesses. Our mortality rates have not declined in the past 10 years when compared with previous local studies. We conclude that for this group of patients studied, their mortality at one year and two years could be predicted by their age group and their number of co-morbid illnesses.

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Living alone vs. living with someone as a predictor of mortality after a bone fracture in older age

Aging Clinical and Experimental Research ◽

10.1007/s40520-020-01511-5 ◽

2020 ◽

Vol 32 (9) ◽

pp. 1697-1705

Author(s):

Kaisa Koivunen ◽

Elina Sillanpää ◽

Mikaela von Bonsdorff ◽

Ritva Sakari ◽

Katja Pynnönen ◽

...

Keyword(s):

Mortality Risk ◽

Living Arrangements ◽

Cox Regression ◽

Living Arrangement ◽

Living Alone ◽

Cox Regression Analysis ◽

Health Decline ◽

Fracture Time ◽

Incidence And Mortality

Abstract Background Living alone is a risk factor for health decline in old age, especially when facing adverse events increasing vulnerability. Aim We examined whether living alone is associated with higher post-fracture mortality risk. Methods Participants were 190 men and 409 women aged 75 or 80 years at baseline. Subsequent fracture incidence and mortality were followed up for 15 years. Extended Cox regression analysis was used to compare the associations between living arrangements and mortality risk during the first post-fracture year and during the non-fracture time. All participants contributed to the non-fracture state until a fracture occurred or until death/end of follow-up if they did not sustain a fracture. Participants who sustained a fracture during the follow-up returned to the non-fracture state 1 year after the fracture unless they died or were censored due to end of follow-up. Results Altogether, 22% of men and 40% of women sustained a fracture. During the first post-fracture year, mortality risk was over threefold compared to non-fracture time but did not differ by living arrangement. In women, living alone was associated with lower mortality risk during non-fracture time, but the association attenuated after adjustment for self-rated health. In men, living alone was associated with increased mortality risk during non-fracture time, although not significantly. Conclusion The results suggest that living alone is not associated with pronounced mortality risk after a fracture compared to living with someone.

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Mortality in Yusho patients exposed to polychlorinated biphenyls and polychlorinated dibenzofurans: a 50-year retrospective cohort study

Environmental Health ◽

10.1186/s12940-020-00680-0 ◽

2020 ◽

Vol 19 (1) ◽

Author(s):

Daisuke Onozuka ◽

Yuko Nakamura ◽

Gaku Tsuji ◽

Masutaka Furue

Keyword(s):

General Population ◽

Polychlorinated Biphenyls ◽

Carcinogenic Risk ◽

Polychlorinated Dibenzofurans ◽

Risk Of Mortality ◽

Standardized Mortality Ratios ◽

Optimum Management ◽

Related Compounds ◽

Related Mortality

Abstract Background In 1968, the Yusho incident resulted in accidental exposure to polychlorinated biphenyls (PCBs), polychlorinated dibenzofurans (PCDFs), and related compounds in Japan. This study updated the risk of mortality in Yusho patients. Methods We obtained updated cohort data for all Yusho patients for the period 1968–2017. We calculated standardized mortality ratios (SMRs) for all-cause and cause-specific mortality over a 50-year follow-up period compared with the general population in Japan. Results A total of 1664 Yusho patients with 63,566 person-years of follow up were included in the analysis. Among males, excess mortality was observed for all cancers (SMR: 1.22, 95% confidence interval [CI]: 1.02 to 1.45) and lung cancer (SMR: 1.59, 95% CI: 1.12 to 2.19). Among females, increased mortality was observed for liver cancer (SMR: 2.05, 95% CI: 1.02 to 3.67). No significant increase was seen in non-cancer-related mortality compared with the general population. Conclusions Carcinogenic risk in humans after exposure to PCBs and PCDFs remains higher among Yusho patients. Our findings suggest the importance of care engagement and optimum management to deal with the burden of Yusho disease.

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