scholarly journals All-cause mortality risk in elderly individuals with disabilities: a retrospective observational study

BMJ Open ◽  
2016 ◽  
Vol 6 (9) ◽  
pp. e011164 ◽  
Author(s):  
Li-Wei Wu ◽  
Wei-Liang Chen ◽  
Tao-Chun Peng ◽  
Sheng-Ta Chiang ◽  
Hui-Fang Yang ◽  
...  
Keyword(s):  
Observational Study ◽  
Mortality Risk ◽  
Retrospective Observational Study ◽  
Individuals With Disabilities ◽  
Elderly Individuals ◽  
All Cause Mortality

scholarly journals A metabolic profile of all-cause mortality risk identified in an observational study of 44,168 individuals

2019 ◽  
Vol 10 (1) ◽  
Author(s):  
Joris Deelen ◽  
Johannes Kettunen ◽  
Krista Fischer ◽  
Ashley van der Spek ◽  
Stella Trompet ◽  
...  
Keyword(s):  
Observational Study ◽  
Mortality Risk ◽  
Metabolic Profile ◽  
All Cause Mortality

scholarly journals The impact of opiate substitution treatment on mortality risk in drug addicts: a natural experiment study

2019 ◽  
Vol 7 (3) ◽  
pp. 1-92 ◽  
Author(s):  
Colin D Steer ◽  
John Macleod ◽  
Kate Tilling ◽  
Aaron G Lim ◽  
John Marsden ◽  
...  
Keyword(s):  
Primary Care ◽  
Observational Study ◽  
Mortality Risk ◽  
Treatment Duration ◽  
Hazard Ratio ◽  
Substitution Treatment ◽  
Opiate Substitution Treatment ◽  
All Cause Mortality ◽  
Prospective Longitudinal ◽  
Cessation Of Treatment

Background Opiate substitution treatment (OST) is the main treatment for people addicted to heroin and other opioid drugs. However, there is limited information on how the delivery of this treatment affects mortality risk. Objectives To investigate the associations of mortality risk with periods during treatment and following cessation of treatment, medication type, co-prescription of other medication and dosing regimens during titration and detoxification. The trends with time of prescribed medication, dose and treatment duration were also explored. Design Prospective longitudinal observational study. Setting UK primary care between 1998 and 2014. Participants A total of 12,780 patients receiving methadone, buprenorphine or dihydrocodeine. Main outcome measures All-cause mortality relating to 657 deaths and drug-related poisoning relating to 113 deaths. Data sources Clinical Practice Research Datalink with linked information on cause of death from the Office for National Statistics. Results For both outcomes, the lowest mortality risk was observed after 4 weeks of treatment and the highest risk was observed in the first 4 weeks following cessation of treatment [e.g. for drug-related poisoning, incidence rate ratio (IRR) 8.15, 95% confidence interval (CI) 5.45 to 12.19]. There was evidence that the treatment period risks varied with OST medication. The largest difference in risk was for the first 4 weeks of treatment for both outcomes, with patients on buprenorphine being at lower risk than those on methadone (e.g. for drug-related poisoning, IRR 0.08, 95% CI 0.01 to 0.48). The co-prescription of benzodiazepines was associated with linearly increasing the risk of drug-related deaths by dose (IRR 2.02, 95% CI 1.66 to 2.47), whereas z-drugs (zolpidem, zopiclone and zaleplon) were associated with increased risk of both all-cause (IRR 1.83, 95% CI 1.59 to 2.12) and drug-related (IRR 3.31, 95% CI 2.45 to 4.47) mortality. There was weak evidence that higher initial and final doses were associated with increased all-cause mortality risk. In the first 4 weeks of treatment, the risk increased by 4% for each 5-mg increment in methadone dose (1-mg increase in buprenorphine) (hazard ratio 1.04, 95% CI 1.00 to 1.09). In the first 4 weeks after treatment ceased, a similar increment in final dose increased the risk by 3% (hazard ratio 1.03, 95% CI 0.99 to 1.07). There were too few deaths to evaluate the effects on drug-related poisoning. The proportion of OST patients receiving buprenorphine increased between 1998 and 2006. Median treatment duration was consistently shorter for buprenorphine than for methadone for each year studied (overall median duration of 48 and 106 days, respectively). Limitations As this was an observational study, the possibility remains of bias from unmeasured factors, which covariate adjustment and inverse probability weighting can eliminate only partially. Conclusions Using buprenorphine as an alternative to methadone may not reduce mortality overall despite resulting in lower IRRs from shorter treatment duration. Clinical guidance needs to consider strengthening warnings about the co-prescription of a range of drugs for OST patients. Future work Our analyses need to be replicated using other clinical data sets in the UK and in other countries. New interventions and trials are required to investigate improving the retention of OST patients in primary care. Funding The National Institute for Health Research Health Services and Delivery Research programme.

scholarly journals Effects of Diabetes and Blood Glucose on COVID-19 Mortality: A Retrospective Observational Study

2021 ◽  
Author(s):  
Fei Li ◽  
Yue Cai ◽  
Chao Gao ◽  
Lei Zhou ◽  
Renjuan Chen ◽  
...  
Keyword(s):  
Blood Glucose ◽  
Observational Study ◽  
Fold Increase ◽  
Survival Outcome ◽  
Retrospective Observational Study ◽  
All Cause Mortality ◽  
Patients With Diabetes ◽  
History Of ◽  
Design And Methods ◽  
Admission Glucose

OBJECTIVETo investigate the association of diabetes and blood glucose on mortality of patients with Coronavirus Disease 2019 (COVID-19).RESEARCH DESIGN AND METHODSThis was a retrospective observational study of all patients with COVID-19 admitted to Huo-Shen-Shan Hospital, Wuhan, China. The hospital was built only for treating COVID-19 and opened on February 5, 2020. The primary endpoint was all-cause mortality during hospitalization.RESULTSAmong 2877 hospitalized patients, 13.5% (387/2877) had a history of diabetes and 1.9% (56/2877) died in hospital. After adjustment for confounders, patients with diabetes had a 2-fold increase in the hazard of mortality as compared to patients without diabetes (adjusted HR 2.11, 95%CI: 1.16-3.83, P=0.014). The on-admission glucose (per mmol/L≥4mmol/L) was significantly associated with subsequent mortality on COVID-19 (adjusted HR 1.17, 95%CI: 1.10-1.24, P<0.001).CONCLUSIONSDiabetes and on-admission glucose (per mmol/L≥4mmol/L) are associated with increased mortality in patients with COVID-19. These data support that blood glucose should be properly controlled for possibly better survival outcome in patients with COVID-19.

scholarly journals Effects of Hormone Therapy on survival, cancer, cardiovascular and dementia risks in 1.5 million women over age 65: a retrospective observational study

2021 ◽  
Author(s):  
Seo Baik ◽  
Clement McDonald
Keyword(s):  
Observational Study ◽  
Hormone Therapy ◽  
Heart Diseases ◽  
Significant Risk ◽  
Ischemic Heart ◽  
Retrospective Observational Study ◽  
High Dose ◽  
Ischemic Heart Diseases ◽  
Increased Risk ◽  
All Cause Mortality

Objectives: To examine the effects of estrogen on all-cause mortality, cancers, cardiovascular (CV) conditions, and dementia. Design: Retrospective observational study Setting: United States 2007-2018 Population: 1.5 million women aged over 65 in Medicare. Method: Cox regression with time-varying estrogen type, route, and strength as well as patient’s characteristics. Main Outcome(s): all-cause mortality; 5 cancers- breast, lung, endometrial, colorectal, ovarian cancers; 6 CV conditions- ischemic heart diseases, heart failure, venous thromboembolism, stroke, atrial fibrillation, acute myocardial infarction; and dementia. Results: Compared to counterparts, estrogen monotherapy (ET) exhibited a significant, 21% (HR=0.79; 95% CI 0.77-0.81), reduction in mortality risk. The reduction was greater with estradiol (HR=0.76; 95% CI 0.73-0.78) than conjugated estrogen (HR=0.83; 95% CI 0.80-0.86), and with topical (HR=0.69; 95% CI 0.66-0.71) than oral preparations (HR=0.86; 95% CI 0.83-0.89). ET also exhibited significant risk reductions for all study cancers, breast (HR=0.83; 95% CI 0.80-0.85), lung (HR=0.89; 95% CI 0.85-0.93), endometrial (HR=0.68; 95% CI 0.63-0.73), colorectal (HR=0.87; 95% CI 0.82-0.92) and ovarian (HR=0.86; 95% CI 0.80-0.92). Different dose levels exhibited similar risk reduction in mortality and cancers. ET slightly increased the overall CV risk, mostly risks of ischemic heart diseases and stroke. However, such risks occurred with CEE, oral, and high dose ET. Both combination therapy (HR=1.19; 95% CI 1.08-1.31) and progestogen monotherapy (HR=1.16; 95% CI 1.08-1.26) exhibited a significantly increased risk of breast cancer. No HT exhibited an increased risk of dementia. Conclusions: Among senior female Medicare beneficiaries, the effect of hormone therapy varies by type, route, and strength of estrogen.

scholarly journals Use of mNUTRIC-Score for Nutrition Risk Assessment and Prognosis Prediction in Critically Ill Patients with COVID-19: A Retrospective Observational Study

2021 ◽  
Vol 2021 ◽  
pp. 1-7
Author(s):  
Francisco G. Yanowsky-Escatell ◽  
Areli L. Ontiveros-Galindo ◽  
Kevin J. Arellano-Arteaga ◽  
Luis M. Román-Pintos ◽  
Carlos A. Andrade-Castellanos ◽  
...  
Keyword(s):  
Risk Factor ◽  
Observational Study ◽  
Critically Ill ◽  
Mortality Risk ◽  
Critically Ill Patients ◽  
Cox Regression ◽  
Nutritional Risk ◽  
Retrospective Observational Study ◽  
Nutrition Risk ◽  
Cox Regression Analysis

Introduction. Nutritional risk is highly prevalent in patients with COVID-19. Relevant data on nutritional assessment in the critically ill population are scarce. This study was conducted to evaluate the modified Nutrition Risk in the Critically Ill (mNUTRIC)-Score as a mortality risk factor in mechanically ventilated patients with COVID-19. Methods. We conducted this retrospective observational study in critically ill patients with COVID-19. Patients’ characteristics and clinical information were obtained from electronic medical records. The nutritional risk for each patient was assessed at the time of mechanical ventilation using the mNUTRIC-Score. The major outcome was 28-day mortality. Results. Ninety-eight patients were analyzed (mean age, 57.22 ± 13.66 years, 68.4% male); 46.9% of critically ill COVID-19 patients were categorized as being at high nutrition risk (mNUTRIC-Score of ≥5). A multivariate logistic regression model indicated that high nutritional risk has higher 28-day hospital mortality (OR = 4.206, 95% CI: 1.147–15.425, p = 0.030 ). A multivariate Cox regression analysis showed that high-risk mNUTRIC-Score had a significantly increased full-length mortality risk during hospitalization (OR = 1.991, 95% CI: 1.219–3.252, p = 0.006 ). Conclusion. The mNUTRIC-Score is an independent mortality risk factor during hospitalization in critically ill COVID-19 patients.

scholarly journals BCG skin reactions by 2 months of age are associated with better survival in infancy: a prospective observational study from Guinea-Bissau

2020 ◽  
Vol 5 (9) ◽  
pp. e002993
Author(s):  
Frederik Schaltz-Buchholzer ◽  
Mike Berendsen ◽  
Adam Roth ◽  
Kristoffer Jarlov Jensen ◽  
Morten Bjerregaard-Andersen ◽  
...  
Keyword(s):  
Observational Study ◽  
Skin Reaction ◽  
Mortality Risk ◽  
Prospective Observational Study ◽  
Linear Trend ◽  
Skin Reactions ◽  
Link Type ◽  
Guinea Bissau ◽  
Cytokine Responses ◽  
All Cause Mortality

IntroductionReceiving Bacille Calmette-Guérin (BCG)-Denmark vaccine at birth has been associated with ~40% reductions in all-cause neonatal mortality. We evaluated determinants of BCG skin reaction characteristics by age 2 months and tested the association with subsequent mortality.MethodsProspective observational study amalgamating five trials providing BCG-at-birth that were conducted between 2002 and 2018 in Guinea-Bissau. The reaction status and size were evaluated at home-visits by 2 months of age among 6012 neonates; mortality from 2 to 12 months was assessed at subsequent visits. Reaction determinants were evaluated by binomial regression providing risk ratios (RRs). In Cox-models providing adjusted mortality rate ratios (aMRRs), we assessed the association between (1) having a 2-month reaction (yes/no) and (2) reaction size tertiles and subsequent all-cause mortality risk. A subgroup had their BCG reaction evaluated and were bled at age 4 weeks; their samples underwent in vitro analysis for specific and non-specific cytokine responses.ResultsThe BCG strain was the main determinant for developing a 2-month reaction and the reaction size: the BCG-Russia/BCG-Denmark RR for large-reaction was 0.38 (0.30–0.47) and the BCG-Russia/BCG-Japan RR was 0.61 (0.51–0.72). 5804 infants (96.5%) were reactors by age 2 months; 208 (3.5%) were non-reactors. The 2–12 months mortality risk was 4.8% (10/208) for non-reactors, 2.9% (64/2213) for small reactors, 1.8% (30/1710) for medium reactors and 0.8% (15/1881) for large reactors. The reactor/non-reactor aMRR was 0.49 (0.26–0.95) and there was a linear trend of decreasing mortality with increasing reaction size (p for trend <0.001). BCG reactors had higher 4-week specific and non-specific cytokine responses, responses that were highest among those with large reactions.ConclusionAmong BCG-vaccinated infants, having a BCG skin reaction by age 2 months was associated with markedly better survival, as was the reaction size. Our findings thus support that BCG has substantial effects on all-cause mortality. Emphasising at-birth vaccination with immunogenic BCG strains and revaccinating non-reactors and small reactors could have major public health benefits.Trial registration numbersNCT00146302, NCT00168610, NCT00625482, NCT01989026 and NCT02447536.

scholarly journals All-cause mortality among patients treated with repurposed antivirals and antibiotics for COVID-19 in Mexico City: A Real-World Observational Study

2020 ◽  
Author(s):  
Javier Mancilla-Galindo ◽  
Jorge Óscar García-Méndez ◽  
Jessica Márquez-Sánchez ◽  
Rodrigo Estefano Reyes-Casarrubias ◽  
Eduardo Aguirre-Aguilar ◽  
...  
Keyword(s):  
Clinical Trials ◽  
General Population ◽  
Observational Study ◽  
Mexico City ◽  
Mortality Risk ◽  
Real World ◽  
List Type ◽  
Risk Of Death ◽  
All Cause Mortality ◽  
Critical Patients

ABSTRACTAimTo evaluate all-cause mortality risk in patients with laboratory-confirmed COVID-19 in Mexico City treated with repurposed antivirals and antibiotics.MethodsThis real-world retrospective cohort study contemplated 395,343 patients evaluated for suspected COVID-19 between February 24 and September 14, 2020 in 688 primary-to-tertiary medical units in Mexico City. Patients were included with a positive RT-PCR for SARS-CoV-2; those receiving unspecified antivirals, excluded; and antivirals prescribed in <30 patients, eliminated. Survival and mortality risks were determined for patients receiving antivirals, antibiotics, both, or none.Results136,855 patients were analyzed; mean age 44.2 (SD:16.8) years; 51.3% were men. 16.6% received antivirals (3%), antibiotics (10%), or both (3.6%). Antivirals studied were Oseltamivir (n=8414), Amantadine (n=319), Lopinavir-Ritonavir (n=100), Rimantadine (n=61), Zanamivir (n=39), and Acyclovir (n=36). Survival with antivirals (73.7%, p<0.0001) and antibiotics (85.8%, p<0.0001) was lower than no antiviral/antibiotic (93.6%). After multivariable adjustment, increased risk of death occurred with antivirals (HR=1.72, 95%CI:1.61-1.84) in ambulatory (HR=4.7, 95%CI:3.94-5.62) and non-critical (HR=2.03, 95%CI:1.86-2.21) patients. Oseltamivir increased mortality risk in the general population (HR=1.72, 95%CI:1.61-1.84), ambulatory (HR=4.79, 95%CI:4.01-5.75), non-critical (HR=2.05, 95%CI:1.88-2.23), and pregnancy (HR=8.35, 95%CI:1.77-39.30); as well as hospitalized (HR=1.13, 95%CI:1.01-1.26) and critical patients (HR:1.22, 95%CI:1.05-1.43) after propensity score-matching. Antibiotics were a risk factor in general population (HR=1.13, 95%CI:1.08-1.19) and pediatrics (HR=4.22, 95%CI:2.01-8.86), but a protective factor in hospitalized (HR=0.81, 95%CI:0.77-0.86) and critical patients (HR=0.67, 95%CI:0.63-0.72).ConclusionsNo significant benefit for repurposed antivirals was observed; oseltamivir was associated with increased mortality. Antibiotics increased mortality risk in the general population but may increase survival in hospitalized and critical patients.WHAT IS ALREADY KNOWNCurrent recommendations for using repurposed antivirals and antibiotics for COVID-19 are conflicting.Few antivirals (i.e. lopinavir-ritonavir) have been shown to provide no additional benefit for COVID-19 in clinical trials; other antivirals may be having widespread use in real-world settings without formal assessment in clinical trials.Real-world use of repurposed antivirals and antibiotics for COVID-19 in population-based studies have not been performed; important populations have been left largely understudied (ambulatory patients, pregnant women, and pediatrics).WHAT THIS STUDY ADDSThis is the first real-world observational study evaluating amantadine, rimantadine, zanamivir, and acyclovir for COVID-19; no registered studies to evaluate these drugs exist. Only one study has evaluated risk of death for oseltamivir. Lopinavir-ritonavir have been previously evaluated in clinical trials.Repurposed antivirals and antibiotics were commonly prescribed in 688 ambulatory units and hospitals of Mexico City despite unclear recommendations for their use out of clinical trials.Oseltamivir was associated with increased mortality risk; other repurposed antivirals (zanamivir, amantadine, rimantadine, and acyclovir) had no significant and consistent impact on mortality. Antibiotics were associated with increased mortality risk in the general population but may increase survival in hospitalized and critical patients.

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