Accelerometer-Measured Daily Steps, Physical Function, and Subsequent Fall Risk in Older Women: The Objective Physical Activity and Cardiovascular Disease in Older Women Study

2021 ◽  
pp. 1-11
Author(s):  
Benjamin T. Schumacher ◽  
John Bellettiere ◽  
Michael J. LaMonte ◽  
Kelly R. Evenson ◽  
Chongzhi Di ◽  
...  
Keyword(s):  
Physical Function ◽  
Older Women ◽  
Incidence Rate ◽  
Fall Risk ◽  
Rate Ratio ◽  
Incidence Rate Ratio ◽  
Steps Per Day ◽  
Falls In Older Adults ◽  
Adjusted Incidence Rate ◽  
Adjusted Incidence

Steps per day were measured by accelerometer for 7 days among 5,545 women aged 63–97 years between 2012 and 2014. Incident falls were ascertained from daily fall calendars for 13 months. Median steps per day were 3,216. There were 5,473 falls recorded over 61,564 fall calendar-months. The adjusted incidence rate ratio comparing women in the highest versus lowest step quartiles was 0.71 (95% confidence interval [0.54, 0.95]; ptrend across quartiles = .01). After further adjustment for physical function using the Short Physical Performance Battery, the incidence rate ratio was 0.86 ([0.64, 1.16]; ptrend = .27). Mediation analysis estimated that 63.7% of the association may be mediated by physical function (p = .03). In conclusion, higher steps per day were related to lower incident falls primarily through their beneficial association with physical functioning. Interventions that improve physical function, including those that involve stepping, could reduce falls in older adults.

scholarly journals Accelerometer-Measured Daily Steps, Physical Function, and Subsequent Fall Risk in Older Women: The OPACH Study

2021 ◽  
Vol 5 (Supplement_1) ◽  
pp. 446-446
Author(s):  
Benjamin Schumacher ◽  
John Bellettiere ◽  
Michael LaMonte ◽  
Andrea LaCroix
Keyword(s):  
Physical Function ◽  
Older Women ◽  
Physical Functioning ◽  
Fall Risk ◽  
Rate Ratio ◽  
Steps Per Day ◽  
Falls In Older Adults ◽  
Adjusted Incidence Rate ◽  
Adjusted Incidence

Abstract We sought to investigate the association between steps per day (steps/d) and incident fall risk while also assessing the role of physical functioning on this association. Steps/d were measured by accelerometer for 7 days in 5,545 women aged 63 to 97 years between 2012 - 2014. Falls were ascertained from daily fall calendars for 13 months. Median steps/d were 3,216. There were 5,473 falls recorded over 61,564 fall calendar months. The adjusted incidence rate ratio comparing women in the highest vs. lowest step quartiles was 0.71 (95% confidence interval, 0.54 - 0.95; P-trend across quartiles of steps/d = 0.01). After further adjustment for physical function using the Short Physical Performance Battery, the rate ratio was 0.86 (0.64-1.16; P-trend = 0.27). Mediation analysis estimated that 66.7% to 70.2% of the association of steps/d and fall risk may be mediated by physical function. In conclusion, higher steps/d were related to lower incident falls primarily through their beneficial association with physical functioning. Interventions that improve physical function, including those that involve stepping, could reduce falls in older adults.

Inflammatory Bowel Disease and Risk of Major Bleeding During Anticoagulation for Venous Thromboembolism

2021 ◽  
Author(s):  
Susanna Scharrer ◽  
Christian Primas ◽  
Sabine Eichinger ◽  
Sebastian Tonko ◽  
Maximilian Kutschera ◽  
...  
Keyword(s):  
Ulcerative Colitis ◽  
Inflammatory Bowel Disease ◽  
Venous Thromboembolism ◽  
Incidence Rate ◽  
Rate Ratio ◽  
Incidence Rate Ratio ◽  
Fatal Bleeding ◽  
Adjusted Incidence Rate ◽  
Inflammatory Bowel ◽  
Adjusted Incidence

Abstract Background Little is known about the bleeding risk in patients with inflammatory bowel disease (IBD) and venous thromboembolism (VTE) treated with anticoagulation. Our aim was to elucidate the rate of major bleeding (MB) events in a well-defined cohort of patients with IBD during anticoagulation after VTE. Methods This study is a retrospective follow-up analysis of a multicenter cohort study investigating the incidence and recurrence rate of VTE in IBD. Data on MB and IBD- and VTE-related parameters were collected via telephone interview and chart review. The objective of the study was to evaluate the impact of anticoagulation for VTE on the risk of MB by comparing time periods with anticoagulation vs those without anticoagulation. A random-effects Poisson regression model was used. Results We included 107 patients (52 women, 40 with ulcerative colitis, 64 with Crohn disease, and 3 with unclassified IBD) in the study. The overall observation time was 388 patient-years with and 1445 patient-years without anticoagulation. In total, 23 MB events were registered in 21 patients, among whom 13 MB events occurred without anticoagulation and 10 occurred with anticoagulation. No fatal bleeding during anticoagulation was registered. The incidence rate for MB events was 2.6/100 patient-years during periods exposed to anticoagulation and 0.9/100 patient-years during the unexposed time. Exposure to anticoagulation (adjusted incidence rate ratio, 3.7; 95% confidence interval, 1.5-9.0; P = 0.003) and ulcerative colitis (adjusted incidence rate ratio, 3.5; 95% confidence interval, 1.5-8.1; P = 0.003) were independent risk factors for MB events. Conclusion The risk of major but not fatal bleeding is increased in patients with IBD during anticoagulation. Our findings indicate that this risk may be outweighed by the high VTE recurrence rate in patients with IBD.

Thirteen-Year Trends in Cardiovascular Risk in Men and Women with Chronic Coronary Syndrome

2021 ◽  
Author(s):  
Kevin Kris Warnakula Olesen ◽  
Esben Skov Jensen ◽  
Christine Gyldenkerne ◽  
Morten Würtz ◽  
Martin Bødtker Mortensen ◽  
...  
Keyword(s):  
Coronary Artery ◽  
Incidence Rate ◽  
Cardiac Death ◽  
Rate Ratio ◽  
Incidence Rate Ratio ◽  
Men And Women ◽  
Coronary Syndrome ◽  
Adjusted Incidence Rate ◽  
Artery Disease ◽  
Adjusted Incidence

Abstract Aims To examine combined and sex-specific temporal changes in risks of adverse cardiovascular events and coronary revascularization in patients with chronic coronary syndrome undergoing coronary angiography. Methods We included all patients with stable angina pectoris and coronary artery disease examined by coronary angiography in Western Denmark from 2004 to 2016. Patients were stratified by examination year interval: 2004-2006, 2007-2009, 2010-2012, and 2013-2016. Outcomes were two-year risk of myocardial infarction, ischemic stroke, cardiac death, and all-cause death estimated by adjusted incidence rate ratios using patients examined in 2004-2006 as reference. Results A total of 29,471 patients were included, of whom 70% were men. The two-year risk of myocardial infarction (2.8% versus 1.9%, adjusted incidence rate ratio 0.65, 95% CI 0.53-0.81), ischemic stroke (1.8% versus 1.1%, adjusted incidence rate ratio 0.48, 95% CI 0.37-0.64), cardiac death (2.1% versus 0.9%, adjusted incidence rate ratio 0.38, 95% CI 0.29-0.51), and all-cause death (5.0% versus 3.6%, adjusted incidence rate ratio 0.65, 95% CI 0.55-0.76) decreased from the first examination interval (2004-2006) to the last examination interval (2013-2016). Coronary revascularizations also decreased (percutaneous coronary intervention: 51.6% versus 42.5%; coronary artery bypass grafting: 24.6% versus 17.5%). Risk reductions were observed in both men and women, however, women had a lower absolute risk. Conclusion The risk for adverse cardiovascular events decreased substantially in both men and women with chronic coronary syndrome from 2004 to 2016. These results most likely reflect the cumulative effect of improvements in the management of chronic coronary artery disease.

Risk stratification by assessment of coronary artery disease using coronary computed tomography angiography in diabetes and non-diabetes patients: a study from the Western Denmark Cardiac Computed Tomography Registry

2019 ◽  
Vol 20 (11) ◽  
pp. 1271-1278 ◽  
Author(s):  
Kevin K W Olesen ◽  
Anders H Riis ◽  
Lene H Nielsen ◽  
Flemming H Steffensen ◽  
Bjarne L Nørgaard ◽  
...  
Keyword(s):  
Computed Tomography ◽  
Incidence Rate ◽  
Rate Ratio ◽  
Incidence Rate Ratio ◽  
Cardiac Computed Tomography ◽  
Adjusted Incidence Rate ◽  
Artery Disease ◽  
Event Rates ◽  
Adjusted Incidence ◽  
Diabetes Patients

Abstract Aims We examined whether severity of coronary artery disease (CAD) measured by coronary computed tomography angiography can be used to predict rates of myocardial infarction (MI) and death in patients with and without diabetes. Methods and results A cohort study of consecutive patients (n = 48 731) registered in the Western Denmark Cardiac Computed Tomography Registry from 2008 to 2016. Patients were stratified by diabetes status and CAD severity (no, non-obstructive, or obstructive). Endpoints were MI and death. Event rates per 1000 person-years, unadjusted and adjusted incidence rate ratios were computed. Median follow-up was 3.6 years. Among non-diabetes patients, MI event rates per 1000 person-years were 1.4 for no CAD, 4.1 for non-obstructive CAD, and 9.1 for obstructive CAD. Among diabetes patients, the corresponding rates were 2.1 for no CAD, 4.8 for non-obstructive CAD, and 12.6 for obstructive CAD. Non-diabetes and diabetes patients without CAD had similar low rates of MI [adjusted incidence rate ratio 1.40, 95% confidence interval (CI): 0.71–2.78]. Among diabetes patients, the adjusted risk of MI increased with severity of CAD (no CAD: reference; non-obstructive CAD: adjusted incidence rate ratio 1.71, 95% CI: 0.79–3.68; obstructive CAD: adjusted incidence rate ratio 4.42, 95% CI: 2.14–9.17). Diabetes patients had higher death rates than non-diabetes patients, irrespective of CAD severity. Conclusion In patients without CAD, diabetes patients have a low risk of MI similar to non-diabetes patients. Further, MI rates increase with CAD severity in both diabetes and non-diabetes patients; with diabetes patients with obstructive CAD having the highest risk of MI.

scholarly journals Effect of Pokémon Go on Self-Harm Using Population-Based Interrupted Time-Series Analysis: Quasi-Experimental Study

10.2196/17112 ◽  
2020 ◽  
Vol 8 (2) ◽  
pp. e17112
Author(s):  
Rosa Sze Man Wong ◽  
Frederick Ka Wing Ho ◽  
Keith Tsz Suen Tung ◽  
King-Wa Fu ◽  
Patrick Ip
Keyword(s):  
Incidence Rate ◽  
Rate Ratio ◽  
Incidence Rate Ratio ◽  
Interrupted Time Series ◽  
Well Being ◽  
Quasi Experimental ◽  
Adjusted Incidence Rate ◽  
Self Harm ◽  
Pokémon Go ◽  
Adjusted Incidence

Background Pokémon Go is a very popular location-based augmented reality game with widespread influences over the world. An emerging body of research demonstrates that playing Pokémon Go can lead to improvements in physical activity and psychosocial well-being; however, whether Pokémon Go reduces self-harm incidence at the population-level is still questionable. Objective This study aimed to quantify how the launch of Pokémon Go in Hong Kong affected the incidence of self-harm using a quasi-experimental design. Methods An interrupted time-series design with Poisson segmented regression adjusted for time and seasonality trends was used on data from 2012 to 2018 to detect any changes in the number of accident and emergency attendances due to self-harm, after Pokémon Go was launched. The findings were validated using a baseline control period and using other intentional injuries and minor noninjuries as control outcomes. We also assessed intervention effects by age group. Results From January 1, 2012 to July 31, 2018, there were 13,463 accident and emergency attendances due to self-harm in Hong Kong. During the period after launching Pokémon Go, self-harm attendances dropped by 34% (adjusted incidence rate ratio: 0.66, 95% CI 0.61-0.73). When analyzed by age group, a reduction in self-harm incidence was only apparent in adults (18 to 24 years of age: adjusted incidence rate ratio: 0.78, P=.02; 25 to 39 years of age: adjusted incidence rate ratio: 0.75, P<.001; 40 years of age and older: adjusted incidence rate ratio: 0.57, P<.001). Conclusions Self-harm incidence in the population, particularly in adults, showed a significant decline in the period after Pokémon Go was launched. Augmented reality games such as Pokémon Go show great promise as a tool to enhance psychosocial well-being and improve mental health.

scholarly journals Effect of Pokémon Go on Self-Harm Using Population-Based Interrupted Time-Series Analysis: Quasi-Experimental Study (Preprint)

2019 ◽  
Author(s):  
Rosa Sze Man Wong ◽  
Frederick Ka Wing Ho ◽  
Keith Tsz Suen Tung ◽  
King-Wa Fu ◽  
Patrick Ip
Keyword(s):  
Incidence Rate ◽  
Rate Ratio ◽  
Incidence Rate Ratio ◽  
Interrupted Time Series ◽  
Well Being ◽  
Quasi Experimental ◽  
Adjusted Incidence Rate ◽  
Self Harm ◽  
Pokémon Go ◽  
Adjusted Incidence

BACKGROUND Pokémon Go is a very popular location-based augmented reality game with widespread influences over the world. An emerging body of research demonstrates that playing Pokémon Go can lead to improvements in physical activity and psychosocial well-being; however, whether Pokémon Go reduces self-harm incidence at the population-level is still questionable. OBJECTIVE This study aimed to quantify how the launch of Pokémon Go in Hong Kong affected the incidence of self-harm using a quasi-experimental design. METHODS An interrupted time-series design with Poisson segmented regression adjusted for time and seasonality trends was used on data from 2012 to 2018 to detect any changes in the number of accident and emergency attendances due to self-harm, after Pokémon Go was launched. The findings were validated using a baseline control period and using other intentional injuries and minor noninjuries as control outcomes. We also assessed intervention effects by age group. RESULTS From January 1, 2012 to July 31, 2018, there were 13,463 accident and emergency attendances due to self-harm in Hong Kong. During the period after launching Pokémon Go, self-harm attendances dropped by 34% (adjusted incidence rate ratio: 0.66, 95% CI 0.61-0.73). When analyzed by age group, a reduction in self-harm incidence was only apparent in adults (18 to 24 years of age: adjusted incidence rate ratio: 0.78, <i>P</i>=.02; 25 to 39 years of age: adjusted incidence rate ratio: 0.75, <i>P</i>&lt;.001; 40 years of age and older: adjusted incidence rate ratio: 0.57, <i>P</i>&lt;.001). CONCLUSIONS Self-harm incidence in the population, particularly in adults, showed a significant decline in the period after Pokémon Go was launched. Augmented reality games such as Pokémon Go show great promise as a tool to enhance psychosocial well-being and improve mental health.

Abdominal aortic aneurysm is associated with subarachnoid hemorrhage

2020 ◽  
pp. neurintsurg-2020-016757 ◽  
Author(s):  
D Andrew Wilkinson ◽  
Badih J Daou ◽  
Jeffrey L Nadel ◽  
Neeraj Chaudhary ◽  
Joseph J Gemmete ◽  
...  
Keyword(s):  
Risk Factors ◽  
Subarachnoid Hemorrhage ◽  
Incidence Rate ◽  
Rate Ratio ◽  
Claims Data ◽  
Incidence Rate Ratio ◽  
Aortic Aneurysms ◽  
Abdominal Aortic ◽  
Adjusted Incidence Rate ◽  
Adjusted Incidence

BackgroundAlthough intracranial aneurysms (IA) and abdominal aortic aneurysms (AAA) share similar risk factors, little is known about the relationship between them. Previous studies have shown an increased incidence of IA in patients with AAA, though the rate of subarachnoid hemorrhage (SAH) in patients with AAA has not been described.ObjectiveTo use claims data with longitudinal follow-up, to evaluate the incidence of aneurysmal SAH in patients diagnosed with AAA.MethodsWe examined longitudinally linked medical claims data from a large private insurer to determine rates of aneurysmal SAH (aSAH) and secured aSAH (saSAH) in 2004–2014 among patients with previously diagnosed AAA.ResultsWe identified 62 910 patients diagnosed with AAA and compared them 5:1 with age- and sex-matched controls. Both populations were predominantly male (70.9%), with an average age of 70.8 years. Rates of hypertension (69.7% vs 50.6%) and smoking (12.8% vs 4.1%) were higher in the AAA group (p<0.0001) than in controls. Fifty admissions for aSAH were identified in patients with AAA (26/100 000 patient-years, 95% CI 19 to 44) and 115 admissions for aSAH in controls (7/100 000 years, 95% CI 6 to 9), giving an incidence rate ratio (IRR) of 3.6 (95% CI 2.6 to 5.0, p<0.0001) and a comorbidity-adjusted incidence rate ratio (IRR) of 2.8 (95% CI 1.9 to 3.9) for patients with AAA. The incidence of secured aneurysmal SAH was proportionally even higher in patients with AAA, 7 vs 2/100 000 years, IRR 4.5 (95% CI 3.2 to 6.3, p<0.0001).ConclusionSAH rate was elevated in patients with AAA, even after adjustment for comorbidities. Among risk factors evaluated, AAA was the strongest predictor for SAH. The relative contributions of common genetic and environmental risk factors to both diseases should be investigated.

scholarly journals Opioids and the Risk of Fracture: a Self-Controlled Case Series Study in the Clinical Practice Research Datalink

2021 ◽  
Author(s):  
Emily J Peach ◽  
Fiona A Pearce ◽  
Jack Gibson ◽  
Andrew J Cooper ◽  
Li-Chia Chen ◽  
...  
Keyword(s):  
Confidence Interval ◽  
Incidence Rate ◽  
Rate Ratio ◽  
Incidence Rate Ratio ◽  
Case Series ◽  
Practice Research ◽  
Clinical Practice Research Datalink ◽  
Risk Of Fracture ◽  
Adjusted Incidence Rate ◽  
Adjusted Incidence

Abstract Self-controlled study designs can be used to assess the association between exposures and acute outcomes while controlling for important confounders. Using routinely collected health data, a self-controlled case series design was used to investigate the association between opioid use and bone fractures in 2008–2017 among adults registered in the United Kingdom Clinical Practice Research Datalink. The relative incidence of fracture was estimated, comparing periods when exposed and unexposed to opioids, adjusted for time-varying confounders. Of 539,369 people prescribed opioids, 67,622 sustained fractures and were included. The risk of fracture was significantly increased when exposed to opioids, with an adjusted incidence rate ratio of 3.93 (95% confidence interval: 3.82, 4.04). Fracture-risk was greatest in the first week of starting opioids (adjusted incidence rate ratio: 7.81, 95% confidence interval: 7.40, 8.25) and declined with increasing duration of use. Re-starting opioids after a gap in exposure significantly increased fracture-risk (adjusted incidence rate ratio: 5.05, 95% confidence interval: 4.83, 5.29) when compared to non-use. These findings highlight the importance of raising awareness of fractures among patients at opioid initiation and demonstrate the utility of self-controlled methods for pharmacoepidemiologic research.

scholarly journals Large decrease in paediatric hospitalisations during the COVID-19 outbreak in Japan

2021 ◽  
Vol 5 (1) ◽  
pp. e001013
Author(s):  
Kazuaki Sano ◽  
Masaki Nakamura ◽  
Hideki Ninomiya ◽  
Yasuki Kobayashi ◽  
Atsushi Miyawaki
Keyword(s):  
Incidence Rate ◽  
Acute Care ◽  
Rate Ratio ◽  
Incidence Rate Ratio ◽  
Potential Importance ◽  
Large Decrease ◽  
Paediatric Care ◽  
Adjusted Incidence Rate ◽  
Adjusted Incidence ◽  
Pharmaceutical Interventions

We evaluated the nationwide trends in paediatric hospitalisations including non-emergency hospitalisations during the COVID-19 pandemic in Japan. Using inpatient data from 272 acute-care hospitals covering 12.4% of total hospitalisations of all ages, we analysed the number of hospitalisations of children (aged 1–17 years) for weeks 9–21 of 2020 (during the outbreak) versus 2017–2019. Hospitalisation decreased during the outbreak by 38.4% (adjusted incidence rate ratio, 0.60; 95% CI, 0.53 to 0.69). There were reductions in communicable diseases and trauma, possibly through non-pharmaceutical interventions, but not in appendicitis. This study highlights the potential importance of reallocating paediatric care resources during the pandemic.

Hyperprolactinemia and the Association with All-Cause Mortality and Cardiovascular Mortality

2017 ◽  
Vol 49 (06) ◽  
pp. 411-417 ◽  
Author(s):  
Jesper Krogh ◽  
Christian Selmer ◽  
Christian Torp-Pedersen ◽  
Gunnar Gislason ◽  
Caroline Kistorp
Keyword(s):  
Antipsychotic Medication ◽  
Cardiovascular Mortality ◽  
Rate Ratio ◽  
Incidence Rate Ratio ◽  
University Hospitals ◽  
All Cause Mortality ◽  
Adjusted Incidence Rate ◽  
Male Patients ◽  
Adjusted Incidence

AbstractHyperprolactinemia has been suspected to increase mortality risk, but the available data are conflicting. The objective of this study was to estimate the association between hyperprolactinemia and all-cause and cardiovascular mortality among patients referred for assessment of prolactin. For this study, adults with no prio pituitary disease who underwent prolactin assessment at 3 university Hospitals in Denmark between 2001 and 2011 were included in a retrospective cohort study. A total of 3 633 patients with a median follow-up time of 5.3 years (IQR 2.7–5.7) were included. Mean (SD) age 39.7 (15.5) years and 78% female. 373/3 633 (10.3%) had hyperprolactinemia and during follow-up 330/3 633 (9.1%) patients died of any cause, and 113/3 633 (3.1%) patients died of cardiovascular causes. In males, hyperprolactinemia was associated with age-adjusted incidence rate ratio (IRR) of 1.86 for all-cause mortality (95% CI 1.22–2.82) and 2.55 (95% CI 1.43–4.55) for cardiovascular mortality. The IRR for all-cause mortality was reduced to 1.37 (0.90–2.08) when adjusted for the use of antipsychotic medication. The association between hyperprolactinemia and cardiovascular mortality remained after adjusting for confounders, for example, chronic renal failure, diabetes, and antipsychotic medication. In females, hyperprolactinemia was not associated with all-cause mortality (IRR 1.45; CI 0.86–2.47) or cardiovascular mortality (IRR 0.58; CI 0.14–2.39). In conclusion, hyperprolactinemia was associated with increased cardiovascular mortality in male patients. This association was not found in female patients. Focus on increased cardiovascular risk in males with hyperprolactinemia is warranted.

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