scholarly journals Predictive utility of mortality by aging measures at different hierarchical levels and the response to modifiable lifestyle factors:Implications for geroprotective programs

2021 ◽  
Author(s):  
Jingyun Zhang ◽  
Xingqi Cao ◽  
Chen Chen ◽  
Liu He ◽  
Ziyang Ren ◽  
...  
Keyword(s):  
Proportional Hazards ◽  
Frailty Index ◽  
Lifestyle Factors ◽  
Cox Proportional Hazards ◽  
Linear Regression Models ◽  
Predictive Utility ◽  
Health And Nutrition ◽  
Hierarchical Levels ◽  
Full Picture ◽  
Modifiable Lifestyle Factors

Background: Aging, as a multi-dimensional process, can be measured at different hierarchical levels including biological, phenotypic, and functional levels. The aims of this study were to: 1) compare the predictive utility of mortality by three aging measures at three hierarchical levels; 2) develop a composite aging measure that integrated aging measures at different hierarchical levels; and 3) evaluate the response of these aging measures to modifiable lifestyle factors. Methods: Data from National Health and Nutrition Examination Survey 1999-2002 were used. Three aging measures included telomere length (TL, biological level), Phenotypic Age (PA, phenotypic level), and frailty index (FI, functional level). Mortality information was collected until Dec. 2015. Cox proportional hazards regression and multiple linear regression models were performed. Results: A total of 3249 participants (20-84 years) were included. Both accelerations (accounting for chronological age) of PA and FI were significantly associated with mortality, with HRs of 1.67 (95% confidence interval [CI] = 1.41-1.98) and 1.59 (95% CI = 1.35-1.87), respectively, while that of TL showed nonsignificant associations. We thus developed a new composite aging measure (named PC1) integrating the accelerations of PA and FI, and demonstrated its better predictive utility relative to each single aging measure. PC1, as well as the accelerations of PA and FI, were responsive to several lifestyle factors. Conclusion: The findings, for the first time, provide a full picture of the predictive utility of mortality by three aging measures at three hierarchical levels and the response to modifiable lifestyle factors, with important implications for geroprotective programs.

scholarly journals Markers of Iron Metabolism and Stroke Risk: Cross-Sectional and Longitudinal Findings from the China Health and Nutrition Survey (CHNS)

2022 ◽  
Author(s):  
Dong Liu ◽  
Ya Zhang ◽  
Cui-Cui Wang ◽  
Xiao-Hong E ◽  
Hui Zuo
Keyword(s):  
Iron Metabolism ◽  
Stroke Risk ◽  
Proportional Hazards ◽  
High Sensitivity ◽  
Cox Proportional Hazards ◽  
Contributing Factors ◽  
Nutrition Survey ◽  
Cross Sectional ◽  
Health And Nutrition ◽  
Cox Proportional Hazards Models

Background: The association of iron metabolism or status with the stroke risk remains unclear. We aimed to examine the associations between markers of iron metabolism or status and stroke risk using data from the China Health and Nutrition Survey (CHNS). Methods: Overall, 8589 in the CHNS in 2009, and 7290 participants between 2009 and 2015 were included in the cross-sectional and longitudinal analyses, respectively. Markers included hemoglobin, ferritin (FET), transferrin (TRF), soluble transferrin receptor (sTRF-R), and ratio of sTRF-R/log FET (sTfR-F index). Multivariable logistic regression and Cox proportional hazards models were used to analyze the associations between those markers and risk of stroke. Age, gender, high-sensitivity CRP (hsCRP), body mass index (BMI), current smoking, drinking status, diabetes and hypertension were included as potential confounding factors. Results: We observed longitudinal associations of hemoglobin (HR: 1.54, 95% CI: 1.15 – 2.06, P = 0.004), and sTfR-F index (HR: 0.68, 95% CI: 0.46 – 0.99, P = 0.044) with stroke risk among the participants whose BMI ≤ 23 kg/m2. In addition, FET levels were significantly associated with stroke risk among female (HR: 1.45, 95% CI: 1.00 – 2.09, P = 0.049) after a median of 6.1 years follow-up. Hemoglobin, FET, TRF, sTRF-R, and sTfR-F index were not associated with the risk of stroke in overall analyses. Conclusion: FET among female, hemoglobin and sTfR-F index among those BMI ≤ 23 kg/m2 may be contributing factors for stroke.

NHSR 155: Comparative Analysis of the National Health and Nutrition Examination Survey Public-Use and Restricted-Use Linked Mortality Files - Production Schedule

2021 ◽  
Author(s):  
Lisa Mirel
Keyword(s):  
Comparative Analysis ◽  
Proportional Hazards ◽  
Cox Proportional Hazards ◽  
The Public ◽  
Health And Nutrition ◽  
Cox Proportional Hazards Models ◽  
Hazard Ratios ◽  
Specific Mortality ◽  
Standard Set ◽  
Restricted Use

This report describes a comparative analysis of the public-use and restricted-use NHANES LMFs. Cox proportional hazards models were used to estimate relative hazard ratios for a standard set of sociodemographic covariates for all-cause as well as cause-specific mortality, using the public-use and restricted-use NHANES LMFs.

P2524Extent and outcomes of frailty in older people with atrial fibrillation: a nationwide study using primary care data

2019 ◽  
Vol 40 (Supplement_1) ◽  
Author(s):  
C Wilkinson ◽  
O Todd ◽  
M Yadegarfar ◽  
A Clegg ◽  
C P Gale ◽  
...  
Keyword(s):  
Atrial Fibrillation ◽  
Primary Care ◽  
Older People ◽  
Proportional Hazards ◽  
Frailty Index ◽  
Community Setting ◽  
Cox Proportional Hazards ◽  
Adverse Outcomes ◽  
All Cause Mortality

Abstract Background The prevalence of atrial fibrillation (AF) in older people is increasing, as is frailty. Frailty describes an increased vulnerability to adverse outcomes, whereby the balance of risk and benefit associated with an intervention may be more nuanced. However, there are limited data from a community setting on the prevalence of AF and frailty in older people. It is important to understand the burden of AF and frailty, and the associated impact on mortality and stroke disease in order to inform shared decision making with patients, and also inform guidelines for this increasing group of older people. Purpose To estimate the prevalence of AF and the burden of frailty in patients with AF, in a large primary care dataset. To report stroke and mortality by frailty group. Methods We used electronic health records of 537,051 patients in England aged 65 years or older on 31/12/2015, with follow-up for all-cause mortality and ischaemic or unclassified stroke to 11/04/2017. Patients with a history of AF were identified using Clinical Terms Version 3 (CTV-3) codes. Frailty was identified up to the point of study entry using the electronic frailty index (eFI, the proportion of deficits out of 36 possible deficits), and categorised into robust (0–0.12), mild (>0.12–0.24), moderate (>0.24–0.36) or severe (>0.36) frailty. Median CHA2DS2-VASc and ATRIA scores for patients with frailty were compared with the robust group using Mann-Whitney. The association between frailty status, all-cause mortality and stroke was calculated using Cox proportional hazards models, adjusted for age and sex. Results Of the cohort, 61,177 patients (11.4%) had AF. Of those with AF, 27,987 (45.8%) were female, and 54,734 (89.5%) had frailty. 6,443 (10.5%) were classified as robust; 20,352 (33.3%) mildly frail; 20,315 (33.2%) moderately frail; and 14,067 (23.0%) severely frail. The median number of eFI-defined deficits among patients with AF was 9 (interquartile range [IQR] 6–12). Median stroke and bleeding scores were higher in those with frailty compared with the robust group (CHA2DS2-VASc 4 [IQR 3–5] v 2 [2–3], p≤0.001; ATRIA 4 [2–6] v 1 [0–2], p≤0.001). During 73,338 patient-years of follow-up, there were 6,805 (11.1%) deaths and 945 (1.54%) strokes. Compared with the robust group, all-cause mortality and stroke were higher with increasing frailty. Mortality: mild frailty hazard ratio 1.53 (95% confidence interval 1.29–1.80); moderate frailty 2.50 (2.13–2.94); severe frailty 4.26 (3.63–5.01). Stroke: mild frailty 1.36 (0.99–1.85); moderate frailty 1.67 (1.23–2.28); severe 1.99 (1.45–2.73). Kaplan-Meier survival curves by frailty Conclusion The prevalence of AF among those aged over 65 years in primary care in England is high, the majority of whom are frail. Increasing severity of frailty was associated with higher mortality and stroke rates. The extent to which the judicious use of oral anticoagulation may improve clinical outcomes for patients with AF and frailty is currently unknown. Acknowledgement/Funding CPG: Bayer, BMS, AstraZeneca, Novartis Vifor Pharma, Menerini

scholarly journals U-shaped Association Between Apolipoprotein B and All-Cause Mortality: Results from the National Health and Nutrition Examination Surveys

2021 ◽  
Author(s):  
mengqi yan ◽  
Xiaocong Liu ◽  
Yuqing Huang ◽  
Yuling Yu ◽  
Dan Zhou ◽  
...  
Keyword(s):  
National Health ◽  
Cardiovascular Mortality ◽  
Proportional Hazards ◽  
Piecewise Linear ◽  
Cardiovascular Death ◽  
Cox Proportional Hazards ◽  
Health And Nutrition ◽  
Increased Risk ◽  
All Cause Mortality ◽  
Non Linear

Abstract BackgroundApolipoprotein B (apoB), a significant component directly reflecting the number of atherogenic lipoprotein particles, gradually becomes a more conducive indicator to control blood lipids. However, epidemiological evidence on its relationship with mortality is limited, especially with all-cause mortality. MethodsParticipants from the National Health and Nutrition Examination Survey during 2007-2014 were grouped according to the apoB quartiles (15-76, 77-92, 93-110, 111-345mg/dL). We performed Cox proportional hazards models and Kaplan-Meier survival curves to evaluate the relationships of apoB with all-cause and cardiovascular mortality. Restricted cubic spline and piecewise linear regression were performed to detect their non-linear relationships. ResultsIn general, we enrolled 10375 participants among United States adults (mean age 46.3 ± 16.9, 47.88% men). On average, participants were followed up for 69.2 months, among whom 533 (5.14%) and 91 (0.88%) deaths were observed due to all -causes and cardiovascular diseases, respectively. After adjusting for confounders, apoB was independently associated with an elevated risk of cardiovascular death (hazard ratio [HR], 1.13; 95% confidence interval [CI], 1.03-1.24). However, in the third quartile of apoB, the risk of all-cause death decreased significantly (HR, 0.71; 95% CI, 0.56-0.91). Moreover, the non-linear relationship between apoB and all-cause death demonstrated an increased risk at both low and high level apoB concentrations, divided by the threshold point of 108 mg/dl. ConclusionElevated apoB was significantly associated with an increased risk for cardiovascular mortality, while its association with all-cause mortality was non-linear correlated, with an increased risk at both low and high apoB levels.

scholarly journals THE ASSOCIATION OF MORTALITY WITH DEMENTIA IN VETERANS ENROLLED IN A MEMORY DISORDERS CLINIC: THE EFFECT OF FRAILTY

2019 ◽  
Vol 3 (Supplement_1) ◽  
pp. S874-S875
Author(s):  
Aakashi Shah ◽  
Raquel Apracio-Ugarriza ◽  
Amar Morani ◽  
Mercedes Rodriguez-Suarez ◽  
Jorge G Ruiz
Keyword(s):  
Proportional Hazards ◽  
Neuropsychological Testing ◽  
Frailty Index ◽  
Positive Association ◽  
Cox Proportional Hazards ◽  
Memory Disorders ◽  
Frailty Status ◽  
Proportional Hazards Regression ◽  
Study Results

Abstract Dementia is a syndrome of deterioration in cognition and ability to perform everyday activities. Frailty, a state of vulnerability to stressors leading to increased morbidity, mortality and utilization is a determinant of dementia. The aim was to determine if dementia leads to increased mortality in Veterans and whether frailty affects this association. We conducted a retrospective cohort study of 308 Veterans enrolled in VA memory disorders clinic during 2016-2019. Dementia was diagnosed based on complete clinical assessments, brain imaging and neuropsychological testing. A 44–item frailty index (FI) was constructed using demographics, comorbidities, medications, laboratory tests, and activities of daily living. Patients were divided into non-Frail (FI<0.21) and Frail (FI≥0.21). After adjusting for age, race, ethnicity, income, education, substance abuse, BMI, comorbidities, hospitalizations, medication use, the association of dementia with mortality was assessed using Cox proportional hazards regression. Patients were 55.2% White, 74% non-Hispanic, and the mean age was 74.4 ± 8.3 years. 113 patients were diagnosed with dementia out of which 27 died. Over a median follow-up period of 526 days (Interquartile Range: 431.5 days), there were 27 deaths. There was a significant and positive association of dementia with mortality significant even after all adjustments, HR=2.65 (95% CI: 1.02-6.92), p: 0.045. After subgroup analysis, there was no significant association between mortality and dementia according to frailty status. Our study results suggest that dementia is associated with a higher risk for mortality in Veterans at a Memory Disorders clinic. Frailty did not modify the effect.

scholarly journals Combination of Healthy Lifestyle Factors on the Risk of Hypertension in a Large Cohort of French Adults

Nutrients ◽  
2019 ◽  
Vol 11 (7) ◽  
pp. 1687 ◽  
Author(s):  
Helene Lelong ◽  
Jacques Blacher ◽  
Julia Baudry ◽  
Solia Adriouch ◽  
Pilar Galan ◽  
...  
Keyword(s):  
Proportional Hazards ◽  
Healthy Lifestyle ◽  
Lifestyle Factors ◽  
Normal Weight ◽  
Cox Proportional Hazards ◽  
Lifestyle Factor ◽  
Hypertension Risk ◽  
Hypertension Prevention ◽  
Combined Impact ◽  
Incident Cases

Background: Healthy lifestyle factors are widely recommended for hypertension prevention and control. Nevertheless, little is known about their combined impact on hypertension, in the general population. Our aim was to compute a Healthy Lifestyle Index (HLI) comprising the main non-pharmacological measures usually recommended to improve hypertension prevention: normal weight, regular physical activity, limited alcohol consumption, adoption of a healthy diet; to evaluate their combined impact on hypertension incidence. Methods: We prospectively followed the incidence of hypertension among 80,426 French adults participating in the NutriNet-Santé cohort study. Self-reported dietary, socio-demographic, lifestyle and health data were assessed at baseline and yearly using a dedicated website; the association between HLI and hypertension risk was assessed by multivariable Cox proportional hazards models adjusted for age, sex, family history of hypertension, socio-demographic and lifestyle factors. Hypothetical Population Attributable Risks associated to each factor were estimated. Results: During a median follow-up of 3.5 years (IQR: 1.5–5.3), 2413 incident cases of hypertension were identified. Compared with no or one healthy lifestyle factor, the hazard ratios (HR) for hypertension were 0.76 (95% CI, 0.67–0.85) for two factors, 0.47 (95% CI, 0.42–0.53) for three factors and 0.35 (95% CI, 0.30–0.41) for all healthy lifestyle factors (p-trend <0.0001). Compared with adhering to 0, 1, 2 or 3 healthy lifestyles, adhering to all of them was found associated with a reduction of the hypertension risk of half (HR = 0.55 (95% CI, 0.46–0.65)). Conclusion: Active promotion of healthy lifestyle factors at population level is a key leverage to fight the hypertension epidemic.

Frailty in Older Adults With Multiple Myeloma: A Study of US Veterans

2020 ◽  
pp. 117-127
Author(s):  
Bindiya G. Patel ◽  
Suhong Luo ◽  
Tanya M. Wildes ◽  
Kristen M. Sanfilippo
Keyword(s):  
Multiple Myeloma ◽  
Administrative Data ◽  
Proportional Hazards ◽  
Frailty Index ◽  
Cox Proportional Hazards ◽  
Adverse Outcomes ◽  
Frailty Status ◽  
Patients With Cancer ◽  
Hazard Ratios ◽  
Increased Risk

PURPOSE Age-associated cumulative decline across physiologic systems results in a diminished resistance to stressors, including cancer and its treatment, creating a vulnerable state known as frailty. Frailty is associated with increased risk of adverse outcomes in patients with cancer. Identification of frailty in administrative data can allow for assessment of prognosis and facilitate control for confounding variables. The purpose of this study was to assess frailty from claims-based data using the accumulation of deficits approach in veterans with multiple myeloma (MM). METHODS From the Veterans Administration Central Cancer Registry, we identified patients who were diagnosed with MM between 1999 and 2014. Using the accumulation of deficits approach, we calculated a Frailty Index (FI) using 31 health-associated deficits and categorized scores into five groups: nonfrail (FI, 0 to 0.1), prefrail (FI, 0.11 to 0.20), mild frailty (FI, 0.21 to 0.30), moderate frailty (FI, 0.31 to 0.40), and severe frailty (FI, > 0.4). We used Cox proportional hazards regression analysis to assess association between FI score and mortality while adjusting for potential confounders. RESULTS We calculated an FI for 3,807 veterans age 65 years or older. Among the cohort, 28.7% were classified as nonfrail, 41.3% prefrail, 21.6% mildly frail, 6.6% moderately frail, and 1.7% severely frail. Frailty was strongly associated with mortality independent of age, race, MM treatment, body mass index, or statin use. Higher FI score was associated with higher mortality with hazard ratios of 1.33 (95% CI, 1.21 to 1.47), 1.97 (95% CI, 1.70 to 2.20), 2.86 (95% CI, 2.45 to 3.34), and 3.22 (95% CI, 2.46 to 4.22) for prefrail, mildly frail, moderately frail, and severely frail, respectively. CONCLUSION Frailty status is a significant predictor of mortality in older veterans with MM. Assessment of frailty status using the readily available electronic medical records data in administrative data allows for assessment of prognosis.

scholarly journals The association of energy and macronutrients intake at dinner versus breakfast with disease-specific and all-cause mortality among people with diabetes: the US National Health and Nutrition Examination Survey, 2003-2014

2020 ◽  
Author(s):  
Tianshu Han ◽  
Jian Gao ◽  
Lihong Wang ◽  
Chao Li ◽  
Lu Qi ◽  
...  
Keyword(s):  
Total Energy ◽  
National Health ◽  
Proportional Hazards ◽  
Cox Proportional Hazards ◽  
Nutrition Examination Survey ◽  
Dietary Recall ◽  
Health And Nutrition ◽  
All Cause Mortality ◽  
Total Fat ◽  
Disease Specific

<b>Objective </b>This study aims<b> </b>to evaluate the association of energy and macronutrients intake at dinner vs. breakfast with disease-specific and all-cause mortality in people with diabetes. <div><p><b>Methods </b>4699 peoples with diabetes who enrolled in the National Health and Nutrition Examination Survey from 2003 to 2014 were recruited for this study. Energy and macronutrients intake were measured by a 24h dietary-recall. The Differences(△) in energy and macronutrients intake between dinner and breakfast (△=dinner minus breakfast) were categorized into quintiles. Death information was obtained from the National Death Index until 2015. Cox proportional hazards regression models were developed to evaluate the survival relationship between △ and diabetes, cardiovascular-disease (CVD) and all-cause mortality. </p> <p><b>Results</b> Of the 4699 participants, 913 deaths, including 269 deaths due to diabetes and 314 deaths due to CVD, were documented. After adjusting for potential confounders, compared with participants in the lowest quintile of Δ in terms of total energy and protein, participants in the highest quintile were more likely to die due to diabetes (HR<sub>Δenergy</sub>=1.92, 99% CI:1.08-3.42; HR<sub>Δprotein</sub>=1.92, 99% CI:1.06-3.49) and CVD (HR<sub>Δenergy</sub>=1.69, 99% CI:1.02-2.80; HR<sub>Δprotein</sub>=1.96, 99% CI:1.14-3.39). The highest quintile of Δ from total-fat was related with CVD mortality (HR=1.67, 99% CI: 1.01-2.76). Isocalorically replacing 5% of total-energy at dinner with breakfast was associated with 4% and 5% lower risk of diabetes (HR=0.96, 95% CI: 0.94-0.98) and CVD (HR=0.95, 95% CI: 0.93-0.97) mortality.</p> <p><b>Conclusions</b> Higher intake of energy, total-fat and protein from dinner than breakfast was associated with greater diabetes, CVD and all-cause mortality in people with diabetes. <b></b></p><b></b></div>

Abstract 13080: Electrocardiographic Strain Pattern as a Predictor for New-Onset Heart Failure, Concentric Hypertrophy, Reduced Function, and Scar: MESA (Multi-Ethnic Study of Atherosclerosis)

Circulation ◽  
2015 ◽  
Vol 132 (suppl_3) ◽  
Author(s):  
Yuko Y Inoue ◽  
Elsayed Z Soliman ◽  
Kihei Yoneyama ◽  
Bharath Ambale-Venkatesh ◽  
Colin O Wu ◽  
...  
Keyword(s):  
Heart Failure ◽  
Proportional Hazards ◽  
Left Ventricular ◽  
Cox Proportional Hazards ◽  
Longitudinal Change ◽  
Linear Regression Models ◽  
Concentric Hypertrophy ◽  
Lv Mass ◽  
And Function ◽  
New Onset

Introduction: Left ventricular hypertrophy (LVH) is associated with incident heart failure (HF), and ECG strain is a marker of LVH. This study sought to evaluate the relationship of baseline ECG strain to the incidence of HF, longitudinal change of left ventricular (LV) geometry and function by cardiac magnetic resonance imaging (CMR). Methods: A total of 4,732 participants (mean age 61 years, 54% women) free of cardiovascular disease (CVD) underwent ECG and CMR. We used univariable and multivariable Cox proportional hazards to evaluate the association of ECG strain with incident HF (n=137). We also examined the association of baseline ECG strain with changes of LV geometry and function in 2,846 participants imaged at baseline and 10 years later using multiple linear regression models. Finally, we evaluated the association between the presence of ECG strain and LV scar defined by late Gadolinium enhancement at year 10 (n=1,650). Results: The presence of ECG strain was significantly associated with incident HF (hazard ratio: 2.53; 95% CI: 1.40 to 4.57; p=0.021) during follow-up (median 11.2 years). Longitudinal analysis revealed that the presence of ECG strain at baseline was significantly associated with an increase in the LV mass index (β=5.54g/m2, p<0.001), LV mass-to-volume ratio (β=0.07g/mL, p=0.009), and a decrease in LV ejection fraction (EF) (β=-2.35%, p=0.015), even when coronary heart disease events were excluded. Moreover, ECG strain was independently associated with LV scar (p=0.004). Conclusions: In a cohort of middle-aged participants without prior CVD, ECG strain was an independent predictor of new-onset HF. In addition, ECG strain was related to development of LV concentric hypertrophy and decline in EF as well as LV scar.

The cumulative effect of frailty and cognition on mortality – results of a prospective cohort study

2016 ◽  
Vol 29 (4) ◽  
pp. 535-543 ◽  
Author(s):  
Philip D. St. John ◽  
Suzanne L. Tyas ◽  
Lauren E. Griffith ◽  
Verena Menec
Keyword(s):  
Cohort Study ◽  
Cognitive Impairment ◽  
Prospective Cohort Study ◽  
Prospective Cohort ◽  
Proportional Hazards ◽  
Reference Group ◽  
Frailty Index ◽  
Cox Proportional Hazards ◽  
Cognitively Impaired ◽  
Gender And Education

ABSTRACTBackground:Both physical frailty and cognitive impairment predict death, but the joint effect of these two factors is uncertain. The objectives are to determine if the Mini-mental state examination (MMSE) and the Frailty Index (FI) predict death over a five-year interval after accounting for the effect of the other; and if there is an interaction in this effect.Methods:An analysis of an existing prospective cohort study of 1,751 community living older adults followed over a five-year time frame. Age, gender, and education were self-reported. The predictor variables were the FI – a measure of frailty based on the “Accumulation of Deficits” model of frailty; and the MMSE. Cox proportional hazards models were constructed for the outcome of time to death.Results:The unadjusted Hazard Ratio (HR) (95% CI) for mortality was 2.17 (1.69, 2.80) for those who were only cognitively impaired, 2.02 (1.53, 2.68) for those who were only frail, and 3.57 (2.75, 4.62) for those who were both frail and cognitively impaired with the reference group of those who were neither frail nor cognitively impaired. Adjusted for age, gender, and education, the HR (95% CI) was 1.49 (1.13. 1.95) for those who were only cognitively impaired, 1.81 (1.35, 2.41) for those who were only frail, and 2.28 (1.69, 3.09) for those who were both frail and cognitively impaired.Conclusions:Both frailty and cognitive impairment are predictors of mortality and the effect is cumulative. There was no interaction in this effect.

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