Underweight rather than adiposity is an important predictor of death in rural Chinese adults: a cohort study

2021 ◽  
pp. jech-2020-214821
Author(s):  
Yun Chen ◽  
Na Wang ◽  
Xiaolian Dong ◽  
Xuecai Wang ◽  
Jianfu Zhu ◽  
...  
Keyword(s):  
Proportional Hazards ◽  
Proportional Hazards Model ◽  
Normal Weight ◽  
Cox Proportional Hazards ◽  
Cox Proportional Hazards Model ◽  
Important Predictor ◽  
Hazards Model ◽  
Increased Risk ◽  
All Cause Mortality ◽  
A Prospective Study

BackgroundTo assess the associations of body mass index (BMI) with all-cause and cause-specific mortalities among rural Chinese.MethodsA prospective study of 28 895 individuals was conducted from 2006 to 2014 in rural Deqing, China. Height and weight were measured. The association of BMI with mortality was assessed by using Cox proportional hazards model and restricted cubic spline regression.ResultsThere were a total of 2062 deaths during an average follow-up of 7 years. As compared with those with BMI of 22.0–24.9 kg/m2, an increased risk of all-cause mortality was found for both underweight men (BMI <18.5 kg/m2) (adjusted HR (aHR): 1.45, 95% CI: 1.18 to 1.79) and low normal weight men (BMI of 18.5–21.9 kg/m2) (aHR: 1.20, 95% CI: 1.03 to 1.38). A J-shaped association was observed between BMI and all-cause mortality in men. Underweight also had an increased risk of cardiovascular disease and cancer mortalities in men. The association of underweight with all-cause mortality was more pronounced in ever smokers and older men (60+ years). The results remained after excluding participants who were followed up less than 1 year.ConclusionThe present study suggests that underweight is an important predictor of mortality, especially for elderly men in the rural community of China.

Inverse association of mortality and BMI in patients with cardiomyopathy of any etiology

2020 ◽  
Vol 41 (Supplement_2) ◽  
Author(s):  
T Brazile ◽  
S Mulukutla ◽  
F Thoma ◽  
S Saba
Keyword(s):  
Proportional Hazards ◽  
Proportional Hazards Model ◽  
Obesity Paradox ◽  
Left Ventricular ◽  
Normal Weight ◽  
Cox Proportional Hazards ◽  
Cox Proportional Hazards Model ◽  
Left Ventricular Ejection ◽  
Hazards Model ◽  
All Cause Mortality

Abstract Background Obesity is a worldwide epidemic that has been associated with poor outcomes. Previous studies have demonstrated an inverse relationship between body mass index (BMI) and patients' outcomes, the “obesity paradox”, in several diseases. Purpose We sought to evaluate whether the obesity paradox applies to cardiomyopathy patients of all etiologies, using all-cause mortality as the primary endpoint. Methods We conducted a retrospective study of cardiomyopathy patients (n=18,003) seen within the UPMC network between January 2011 and December 2017. Patients were divided into 4 BMI categories (underweight, normal weight, overweight, and obese) and stratified by left ventricular ejection fraction (LVEF): &lt;20%, 20–35%, and 36–50%. A Cox proportional hazards model was created to assess the independent predictive value of BMI on mortality. Results Over a median follow-up of 2.28 years, higher BMI was associated with better survival for the overall cohort (Figure) and within LVEF strata (p&lt;0.0001). The most common cause of hospitalization was subendocardial infarction among underweight and normal weight patients and heart failure among overweight and obese patients. Cox proportional hazards model showed that BMI, age, and comorbid conditions of COPD, CKD, and CAD are independent predictors of death. Conclusion Our results support the existence of an obesity paradox impacting all-cause mortality in cardiomyopathy patients of all etiologies even after adjusting for LVEF. Additional research is needed to understand the effect of weight loss on survival once a diagnosis of cardiomyopathy is established. Figure 1. Kaplan-Meier Survival Estimates Funding Acknowledgement Type of funding source: None

scholarly journals Hypochloremia is associated with increased risk of all-cause mortality in patients in the coronary care unit: A cohort study

2020 ◽  
Vol 48 (4) ◽  
pp. 030006052091150
Author(s):  
Zongying Li ◽  
Cheng Xing ◽  
Tingting Li ◽  
Linxiang Du ◽  
Na Wang
Keyword(s):  
Proportional Hazards ◽  
Proportional Hazards Model ◽  
Cox Proportional Hazards ◽  
Cox Proportional Hazards Model ◽  
Hazards Model ◽  
Serum Chloride ◽  
Increased Risk ◽  
All Cause Mortality ◽  
Coronary Care ◽  
The Impact

Objective Serum chloride disorders have been gaining increased attention. We aimed to assess the impact of serum chloride on all-cause mortality in critically ill patients in coronary care units (CCUs). Methods We extracted clinical data from the Multiparameter Intelligent Monitoring in Intensive Care III database. We used data for the first CCU admission of each patient; baseline data were extracted within 24 hours after CCU admission. Statistical methods included the Lowess smoothing technique, Cox proportional hazards model, and subgroup analyses. Results A total 5616 patients who met the inclusion criteria were included. We observed a U-shaped relationship between admission chloride levels and 30-day all-cause mortality. In multivariate analysis adjusted for age, ethnicity, and sex, both hyper- and hypochloremia were significant predictors of risk of 30-day, 90-day, and 365-day all-cause mortality. After adjusting additional clinical characteristics, hypochloremia remained a significant predictor of risk of 30-day all-cause mortality (hazard ratio, 1.47; 95% confidence interval, 1.19–1.83). For 90-day and 365-day all-cause mortality, similar significant robust associations were found. Conclusions We observed a U-shaped relationship between admission chloride levels and 30-day all-cause mortality among patients in the CCU. Hypochloremia was associated with increased risk of all-cause mortality in these patients.

scholarly journals Elevated plasma growth and differentiation factor 15 predicts incident anemia in older adults aged 60 years and older

2020 ◽  
Author(s):  
Yuko Yamaguchi ◽  
Marta Zampino ◽  
Toshiko Tanaka ◽  
Stefania Bandinelli ◽  
Yusuke Osawa ◽  
...  
Keyword(s):  
Older Adults ◽  
Proportional Hazards ◽  
Proportional Hazards Model ◽  
Cox Proportional Hazards ◽  
Cox Proportional Hazards Model ◽  
Differentiation Factor ◽  
Hazards Model ◽  
Increased Risk ◽  
The Relationship

Abstract Background Anemia is common in older adults and associated with greater morbidity and mortality. The causes of anemia in older adults have not been completely characterized. Although elevated circulating growth and differentiation factor 15 (GDF-15) has been associated with anemia in older adults, it is not known whether elevated GDF-15 predicts the development of anemia. Methods We examined the relationship between plasma GDF-15 concentrations at baseline in 708 non-anemic adults, aged 60 years and older, with incident anemia during 15 years of follow-up among participants in the Invecchiare in Chianti (InCHIANTI) Study. Results During follow-up, 179 (25.3%) participants developed anemia. The proportion of participants who developed anemia from the lowest to highest quartile of plasma GDF-15 was 12.9%, 20.1%, 21.2%, and 45.8%, respectively. Adults in the highest quartile of plasma GDF-15 had an increased risk of developing anemia (Hazards Ratio 1.15, 95% Confidence Interval 1.09, 1.21, P&lt;.0001) compared to those in the lower three quartiles in a multivariable Cox proportional hazards model adjusting for age, sex, serum iron, soluble transferrin receptor, ferritin, vitamin B12, congestive heart failure, diabetes mellitus, and cancer. Conclusions Circulating GDF-15 is an independent predictor for the development of anemia in older adults.

Associations of Endometriosis and Hormone Therapy With Risk of Hyperlipidemia

2020 ◽  
Author(s):  
Cherry Yin-Yi Chang ◽  
Chih-Hsin Muo ◽  
Yi-Chun Yeh ◽  
Chung-Yen Lu ◽  
William Wu-Chou Lin ◽  
...  
Keyword(s):  
Hormone Therapy ◽  
Structural Model ◽  
Proportional Hazards ◽  
Proportional Hazards Model ◽  
Cox Proportional Hazards ◽  
Cox Proportional Hazards Model ◽  
Marginal Structural Model ◽  
Bilateral Oophorectomy ◽  
Hazards Model ◽  
Increased Risk

Abstract Using claims data from the universal health insurance program of Taiwan, we conducted a retrospective cohort study to investigate whether endometriosis and hormone therapy are associated with the risk of developing hyperlipidemia. We selected 9,155 women aged 20–55 years with endometriosis diagnosed during the period 2000–2013 and 212,641 women without endometriosis with a median follow-up time of 7 years. Among patients with endometriosis, 86% of cases were identified on the basis of diagnosis codes with an ultrasound claim, and 14% were defined by diagnostic laparoscopy or surgical treatments. In a Cox proportional hazards model, the adjusted hazard ratio was 1.30 (95% confidence interval (CI): 1.19, 1.41) for all women, 1.04 (95% CI: 0.81, 1.32) for women under 35 years of age, 1.17 (95% CI: 1.03, 1.32) for women aged 35–44 years, and 1.34 (95% CI: 1.18, 1.52) for women aged 45–54 years. Hysterectomy and/or bilateral oophorectomy accounted for 46.9% of the association between endometriosis and hyperlipidemia, and hormone therapy accounted for 21.6%. Among women with endometriosis, the marginal structural model approach adjusting for time-varying hysterectomy/bilateral oophorectomy showed no association between use of hormone medications and risk of hyperlipidemia. We concluded that women with endometriosis are at increased risk of hyperlipidemia; use of hormone therapy by these women was not independently associated with the development of hyperlipidemia.

scholarly journals Arthritis Increases the Risk for Fractures — Results from the Women’s Health Initiative

2011 ◽  
Vol 38 (8) ◽  
pp. 1680-1688 ◽  
Author(s):  
NICOLE C. WRIGHT ◽  
BRIAN T. WALITT ◽  
CHARLES B. EATON ◽  
ZHAO CHEN ◽  
Keyword(s):  
Hip Fracture ◽  
Proportional Hazards ◽  
Proportional Hazards Model ◽  
Spinal Fractures ◽  
Fracture Prevention ◽  
Cox Proportional Hazards ◽  
Cox Proportional Hazards Model ◽  
Hazards Model ◽  
Increased Risk ◽  
Clinical Fractures

Objective.To examine the relationship between arthritis and fracture.Methods.Women were classified into 3 self-reported groups at baseline: no arthritis (n = 83,295), osteoarthritis (OA; n = 63,402), and rheumatoid arthritis (RA; n = 960). Incident fractures were self-reported throughout followup. Age-adjusted fracture rates by arthritis category were generated, and the Cox proportional hazards model was used to test the association between arthritis and fracture.Results.After an average of 7.80 years, 24,137 total fractures were reported including 2559 self-reported clinical spinal fractures and 1698 adjudicated hip fractures. For each fracture type, age-adjusted fracture rates were highest in the RA group and lowest in the nonarthritic group. After adjustment for several covariates, report of arthritis was associated with increased risk for spine, hip, and any clinical fractures. Compared to the nonarthritis group, the risk of sustaining any clinical fracture in the OA group was HR 1.09 (95% CI 1.05, 1.13; p < 0.001) and HR 1.49 (95% CI 1.26, 1.75; p < 0.001) in the RA group. The risk of sustaining a hip fracture was not statistically increased in the OA group (HR 1.11; 95% CI 0.98, 1.25; p = 0.122) compared to the nonarthritis group; however, the risk of hip fracture increased significantly (HR 3.03; 95% CI 2.03, 4.51; p < 0.001) in the RA group compared to the nonarthritis group.Conclusion.The increase in fracture risk confirms the importance of fracture prevention in patients with RA and OA.

scholarly journals Survival of Captive Chimpanzees: Impact of Location and Transfers

2016 ◽  
Author(s):  
Michael S. Lauer
Keyword(s):  
Proportional Hazards ◽  
Proportional Hazards Model ◽  
Premature Mortality ◽  
Cox Proportional Hazards ◽  
Cox Proportional Hazards Model ◽  
Hazards Model ◽  
Increased Risk ◽  
Random Survival Forests ◽  
Survival Forests

AbstractTo inform the retirement of NIH-owned chimpanzees, we analyzed the outcomes of 764 NIH-owned chimpanzees that were located at various points in time in at least one of 4 specific locations. All chimpanzees considered were alive and at least 10 years of age on January 1, 2005; transfers to a federal sanctuary began a few months later. During a median follow-up of just over 7 years, there were 314 deaths. In a Cox proportional hazards model that accounted for age, sex, and location (which was treated as a time-dependent covariate), age and sex were strong predictors of mortality, but location was only marginally predictive. Among 273 chimpanzees who were transferred to the federal sanctuary, we found no material increased risk in mortality in the first 30 days after arrival. During a median follow-up at the sanctuary of 3.5 years, age was strongly predictive of mortality, but other variables – sex, season of arrival, and ambient temperature on the day of arrival – were not predictive. We confirmed our regression findings using random survival forests. In summary, in a large cohort of captive chimpanzees, we find no evidence of materially important associations of location of residence or recent transfer with premature mortality.

Abstract P390: Relationship between BMI and Risk of Hypertension in an urban Japanese cohort study: the Suita study

Circulation ◽  
2014 ◽  
Vol 129 (suppl_1) ◽  
Author(s):  
Michikazu Nakai ◽  
Makoto Watanabe ◽  
Kunihiro Nishimura ◽  
Misa Takegami ◽  
Yoshihiro Kokubo ◽  
...  
Keyword(s):  
Cohort Study ◽  
Proportional Hazards ◽  
Proportional Hazards Model ◽  
Population Based ◽  
Cox Proportional Hazards ◽  
Cox Proportional Hazards Model ◽  
Men And Women ◽  
Japanese Cohort ◽  
Hazards Model ◽  
Increased Risk

Objective: The positive relation between body mass index (BMI) and risk of incident hypertension (HT) has been reported mainly in the Western subjects with high BMI. However, there are a few reports in the Asian with relatively lower BMI. This study investigated the relation of BMI with risk of incident HT in the population-based prospective cohort study of Japan, the Suita study. Methods: Participants who had no HT at baseline (1,591 men and 1,973 women) aged 30-84 years were included in this study. BMI categories were defined as following: underweight (BMI<18.5), normal (18.5≤BMI<25.0), and overweight (BMI ≥ 25.0). The Cox proportional hazards model was used to estimate hazard ratios (HRs) of BMI categories for incident HT by sex. HRs were adjusted for age, cigarette smoking and alcohol drinking. The HRs according to quartiles of BMI were also estimated, using the lowest quartile of BMI as a reference. Results: During median follow-up of 7.2 years, 1,325 participants (640 men and 685 women) developed HT. The HR (95% CI) of 1kg/m2 increment of BMI for HT in men and women was 1.08 (1.05-1.11) and 1.10 (1.07-1.12), respectively. When we set a normal BMI as a reference, HR of overweight BMI in men and women was 1.37 (1.13-1.67) and 1.45 (1.18-1.77), whereas HR of underweight BMI in men and women was 0.63 (0.45-0.90) and 0.60 (0.45-0.80), respectively. In addition, compared to the lowest quartile, HR of the highest quartile of BMI in men and women was 1.67 (1.33-2.10, trend p<0.001) and 2.10 (1.67-2.64, trend p<0.001), respectively. Conclusion: In this study, we showed that higher BMI was associated with increased risk of hypertension in both Japanese men and women.

Maternal Hypothyroidism during Pregnancy and the Risk for Infectious Morbidity of the Offspring

2019 ◽  
Vol 37 (03) ◽  
pp. 291-295 ◽  
Author(s):  
Ofer Beharier ◽  
Asnat Walfisch ◽  
Tamar Wainstock ◽  
Irit Szaingurten-Solodkin ◽  
Daniela Landau ◽  
...  
Keyword(s):  
Animal Studies ◽  
Proportional Hazards ◽  
Proportional Hazards Model ◽  
Cox Proportional Hazards ◽  
Cox Proportional Hazards Model ◽  
Infectious Morbidity ◽  
Hazards Model ◽  
Kaplan Meier ◽  
Increased Risk

Abstract Objective Animal studies indicate a possible intrauterine immunological imprinting in pregnancies complicated by hypothyroidism. We aimed to evaluate whether exposure to maternal hypothyroidism during pregnancy increases the risk of long-term infectious morbidity of the offspring. Study Design A retrospective cohort study compared the long-term risk of hospitalization associated with infectious morbidity in children exposed and unexposed in utero to maternal hypothyroidism. Outcome measures included infectious diagnoses obtained during any hospitalization of the offspring (up to the age of 18 years). Results The study included 224,950 deliveries. Of them, 1.1% (n = 2,481) were diagnosed with maternal hypothyroidism. Children exposed to maternal hypothyroidism had a significantly higher rate of hospitalizations related to infectious morbidity (13.2 vs. 11.2% for control; odds ratio: 1.2; 95% confidence interval: 1.08–1.36; p = 0.002). Specifically, incidences of ear, nose, and throat; respiratory; and ophthalmic infections were significantly higher among the exposed group. The Kaplan–Meier curve indicated that children exposed to maternal hypothyroidism had higher cumulative rates of long-term infectious morbidity. In the Cox proportional hazards model, maternal hypothyroidism remained independently associated with an increased risk of infectious morbidity in the offspring while adjusting for confounders. Conclusion Maternal hypothyroidism during pregnancy is associated with significant pediatric infectious morbidity of the offspring.

scholarly journals Socioeconomic Status, Frailty, and All-Cause Mortality in Korean Older Adults: A 3-Year Population-Based Prospective Study

2017 ◽  
Vol 2017 ◽  
pp. 1-9 ◽  
Author(s):  
Jinkyung Cho ◽  
Inhwan Lee ◽  
Soo Hyun Park ◽  
Youngyun Jin ◽  
Donghyun Kim ◽  
...  
Keyword(s):  
Older Adults ◽  
Socioeconomic Status ◽  
Proportional Hazards ◽  
Proportional Hazards Model ◽  
Cox Proportional Hazards ◽  
Community Dwelling ◽  
Cox Proportional Hazards Model ◽  
Low Ses ◽  
Increased Risk ◽  
All Cause Mortality

Background. Little is known regarding the effects of socioeconomic status (SES) and frailty on mortality in Korea. Objective. This study investigated the combined impact of low SES and frailty on all-cause mortality in Korean older adults. Methods. Study sample at baseline comprised 7,960 community-dwelling adults (56.8% women) aged 65 years and older. The Cox proportional hazards model was used to estimate the hazard ratio (HR) and 95% confidence interval (CI) of low SES and frailty for all-cause mortality. Results. Overall, low SES plus frailty resulted in an increased risk of all-cause mortality (HR = 1.56, 95% CI = 1.09–2.23, P=0.015) even after adjustments for all the measured covariates, as compared with high SES plus nonfrailty (HR = 1). Among older adults aged 65–75 years, the increased mortality risk of either low SES plus nonfrailty (HR = 1.37, 95% CI = 1.02–1.84, P=0.038) or high SES plus frailty (HR = 2.09, 95% CI = 1.12–3.91, P=0.021) remained significant even after adjustments for all the covariates, as compared with high SES plus nonfrailty (HR = 1). Conclusion. The current findings suggest that either low SES or frailty is significantly associated with increased all-cause mortality in Korean older adults.

scholarly journals All-Cause Mortality Risk in Australian Women with Impaired Fasting Glucose and Diabetes

2017 ◽  
Vol 2017 ◽  
pp. 1-8 ◽  
Author(s):  
Lelia L. F. de Abreu ◽  
Kara L. Holloway ◽  
Mohammadreza Mohebbi ◽  
Muhammad A. Sajjad ◽  
Mark A. Kotowicz ◽  
...  
Keyword(s):  
Impaired Fasting Glucose ◽  
Proportional Hazards ◽  
Proportional Hazards Model ◽  
Fasting Glucose ◽  
Premature Mortality ◽  
Cox Proportional Hazards ◽  
Cox Proportional Hazards Model ◽  
Hazards Model ◽  
All Cause Mortality ◽  
Geelong Osteoporosis Study

Aims. Impaired fasting glucose (IFG) and diabetes are increasing in prevalence worldwide and lead to serious health problems. The aim of this longitudinal study was to investigate the association between impaired fasting glucose or diabetes and mortality over a 10-year period in Australian women. Methods. This study included 1167 women (ages 20–94 yr) enrolled in the Geelong Osteoporosis Study. Hazard ratios for all-cause mortality in diabetes, IFG, and normoglycaemia were calculated using a Cox proportional hazards model. Results. Women with diabetes were older and had higher measures of adiposity, LDL cholesterol, and triglycerides compared to the IFG and normoglycaemia groups (all p<0.001). Mortality rate was greater in women with diabetes compared to both the IFG and normoglycaemia groups (HR 1.8; 95% CI 1.3–2.7). Mortality was not different in women with IFG compared to those with normoglycaemia (HR 1.0; 95% CI 0.7–1.4). Conclusions. This study reports an association between diabetes and all-cause mortality. However, no association was detected between IFG and all-cause mortality. We also showed that mortality in Australian women with diabetes continues to be elevated and women with IFG are a valuable target for prevention of premature mortality associated with diabetes.

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