Decline of the relative risk of death associated with low employment grade at older age: the impact of age related differences in smoking, blood pressure and plasma cholesterol

Background and Purpose: Evidence regarding sex differences in clinical outcomes and treatment effect following intracerebral hemorrhage is limited. Using the ATACH-2 trial (Antihypertensive Treatment in Intracerebral Hemorrhage-2) data, we explored whether sex disparities exist in outcomes and response to intensive blood pressure (BP)–lowering therapy. Methods: Eligible intracerebral hemorrhage subjects were randomly assigned to intensive (target systolic BP, 110–139 mm Hg) or standard (140–179 mm Hg) BP-lowering therapy within 4.5 hours after onset. Relative risk of death or disability corresponding to the modified Rankin Scale score of 4 to 6 was calculated, and interaction between sex and treatment was explored. Results: In total, 380 women and 620 men were included. Women were older, more prescribed antihypertensive drugs before onset, and had more lobar intracerebral hemorrhage than men. Hematoma expansion was observed less in women. After multivariable adjustment, the relative risk of death or disability in women was 1.19 (95% CI, 1.02–1.37, P =0.023). The relative risk of death or disability between intensive versus standard BP-lowering therapy was 0.91 (95% CI, 0.74–1.13) in women versus 1.13 (95% CI, 0.92–1.39) in men ( P for interaction=0.11), with inconclusive Gail-Simmon test ( P =0.16). Conclusions: Women had a higher risk of death or disability following intracerebral hemorrhage. The benefit of intensive BP-lowering therapy in women is inconclusive, consistent with the overall results of ATACH-2. Registration: URL: https://www.clinicaltrials.gov . Unique identifier: NCT01176565.

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Relative Risk of Death in Diabetic and Non Diabetic Dialysis PTS: A Useful Marker of a Cohort Features

New Therapeutic Strategies in Nephrology ◽

10.1007/978-1-4615-3884-4_129 ◽

1991 ◽

pp. 455-457

Author(s):

G. B. Piccoli ◽

G. Beltrame ◽

F. Bonello ◽

M. Salomone ◽

A. Pacitti ◽

...

Keyword(s):

Relative Risk ◽

Risk Of Death ◽

Relative Risk Of Death

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White Blood Cell and Platelet Dynamics Define Human Inflammatory Recovery

10.1101/2021.06.19.21259181 ◽

2021 ◽

Author(s):

Brody H Foy ◽

Thor Sundt ◽

Jonathan CT Carlson ◽

Aaron D Aguirre ◽

John M Higgins

Keyword(s):

Relative Risk ◽

Blood Cell ◽

White Blood Cell ◽

Tissue Damage ◽

Inflammatory Responses ◽

Good Prognosis ◽

Adverse Outcomes ◽

Acute Phase Reactants ◽

Risk Of Death ◽

Relative Risk Of Death

Inflammation is the physiologic reaction to cellular and tissue damage caused by pathologic processes including trauma, infection, and ischemia. Effective inflammatory responses integrate molecular and cellular functions to prevent further tissue damage, initiate repair, and restore homeostasis, while futile or dysfunctional responses allow escalating injury, delay recovery, and may hasten death. Elevation of white blood cell count (WBC) and altered levels of other acute phase reactants are cardinal signs of inflammation, but the dynamics of these changes and their resolution are not established. Patient responses appear to vary dramatically with no clearly defined signs of good prognosis, leaving physicians reliant on qualitative interpretations of laboratory trends. We studied the human acute inflammatory response to trauma, ischemia, and infection by tracking the longitudinal dynamics of cellular and serum markers in hospitalized patients. Unexpectedly, we identified a conserved pattern of recovery defined by co-regulation of WBC and platelet (PLT) populations. Across all inflammatory conditions studied, recovering patients followed a consistent WBC-PLT trajectory shape that is well-approximated by exponential WBC decay and delayed linear PLT growth. This recovery trajectory shape may represent a fundamental archetype of human physiologic response at the cellular population scale, and provides a generic approach for identifying high-risk patients: 32x relative risk of adverse outcomes for cardiac surgery patients, 9x relative risk of death for COVID-19, and 5x relative risk of death for myocardial infarction.

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Reply to: Concerns about estimating relative risk of death associated with convalescent plasma for COVID-19

Nature Medicine ◽

10.1038/s41591-021-01639-5 ◽

2022 ◽

Author(s):

Philippe Bégin ◽

Jeannie Callum ◽

Richard Cook ◽

Erin Jamula ◽

Yang Liu ◽

...

Keyword(s):

Relative Risk ◽

Risk Of Death ◽

Relative Risk Of Death

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Opposing Age-Related Trends in Absolute and Relative Risk of Adverse Health Outcomes Associated With Out-of-Office Blood Pressure

Hypertension ◽

10.1161/hypertensionaha.119.12958 ◽

2019 ◽

Vol 74 (6) ◽

pp. 1333-1342 ◽

Cited By ~ 4

Author(s):

Yan Li ◽

Lutgarde Thijs ◽

Zhen-Yu Zhang ◽

Kei Asayama ◽

Tine W. Hansen ◽

...

Keyword(s):

Blood Pressure ◽

Relative Risk ◽

Health Outcomes ◽

Office Blood Pressure ◽

Adverse Health ◽

Adverse Health Outcomes ◽

Age Related

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Geografias da Diabetes Mellitus em Portugal: Como as Condições do Contexto Influenciam o Risco de Morrer

Acta Médica Portuguesa ◽

10.20344/amp.4019 ◽

2014 ◽

Vol 27 (3) ◽

pp. 309 ◽

Cited By ~ 10

Author(s):

Paula Santana ◽

Cláudia Costa ◽

Adriana Loureiro ◽

João Raposo ◽

José Manuel Boavida

Keyword(s):

Diabetes Mellitus ◽

Relative Risk ◽

Rural Areas ◽

Public Health Problem ◽

Standardized Mortality Ratio ◽

Geographic Pattern ◽

Bayesian Hierarchical ◽

Risk Of Death ◽

Mortality Ratio ◽

Relative Risk Of Death

Introduction: Diabetes Mellitus is a public health problem that is on the increase throughout the world, including in Portugal. This paper aims to identify the changing geographic pattern of this cause of death in Portugal and its association with sociomaterial deprivation. Material and Methods: This is a transversal ecological study of the deaths by Diabetes Mellitus in Portuguese municipalities in three periods (1989-1993, 1999-2003 and 2006-2010). It uses a Bayesian hierarchical model in order to obtain a smooth standardized mortality ratio and the relative risk of death by Diabetes Mellitus associated to sociomaterial deprivation. Results: In 1989-1993, the highest smooth standardized mortality ratio values were found in coastal urban municipalities (80% of municipalities with smooth standardized mortality ratio ≥ 161, of which 60% are urban); in 2006-2010, the opposite was found, with the highest smooth standardized mortality ratio values occurring in rural areas in southern inland regions (76.9% of municipalities with smooth standardized mortality ratio ≥ 161, of which 69.2% are rural), particularly the Alentejo. The relative risk of death by Diabetes Mellitus increases with vulnerability associated to social and economic conditions in the area of residence, and is significant in the last two periods (relative risk: 1.00; IC95%: 0.98-1.02). Discussion: Diabetes Mellitus presents a geographic pattern marked by coastal-inland and urban-rural asymmetry. However, this has been altering over the last twenty years. 48% of the population reside in municipalities where the smooth standardized mortality ratio has increased in the last twenty years, particularly in the rural areas of inland Portugal. Conclusion: The highest smooth standardized mortality ratio are currently found in rural municipalities with the highest index of sociomaterial deprivation. Keywords: Demography; Diabetes Mellitus/epidemiology; Diabetes Mellitus/mortality; Portugal; Socioeconomic Factors.

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Antiepileptic drug use and mortality among community-dwelling persons with Alzheimer disease

Neurology ◽

10.1212/wnl.0000000000009435 ◽

2020 ◽

Vol 94 (20) ◽

pp. e2099-e2108 ◽

Cited By ~ 1

Author(s):

Tatyana Sarycheva ◽

Piia Lavikainen ◽

Heidi Taipale ◽

Jari Tiihonen ◽

Antti Tanskanen ◽

...

Keyword(s):

Relative Risk ◽

Alzheimer Disease ◽

Antiepileptic Drug ◽

Cognitive Disorder ◽

Careful Consideration ◽

Community Dwelling ◽

Risk Of Death ◽

Vulnerable Patients ◽

Relative Risk Of Death ◽

First 90 Days

ObjectiveTo evaluate the risk of death in relation to incident antiepileptic drug (AED) use compared with nonuse in people with Alzheimer disease (AD) through the assessment in terms of duration of use, specific drugs, and main causes of death.MethodsThe MEDALZ (Medication Use and Alzheimer Disease) cohort study includes all Finnish persons who received a clinically verified AD diagnosis (n = 70,718) in 2005–2011. Incident AED users were identified with 1-year washout period. For each incident AED user (n = 5,638), 1 nonuser was matched according to sex, age, and time since AD diagnosis. Analyses were conducted with Cox proportional regression models and inverse probability of treatment weighting (IPTW).ResultsNearly 50% discontinued AEDs within 6 months. Compared with nonusers, AED users had an increased relative risk of death (IPTW hazard ratio [HR], 1.23; 95% confidence interval [CI], 1.12–1.36). This was mainly due to deaths from dementia (IPTW HR, 1.62; 95% CI, 1.42–1.86). There was no difference in cardiovascular and cerebrovascular deaths (IPTW HR, 0.98; 95% CI, 0.67–1.44). The overall mortality was highest during the first 90 days of AED use (IPTW HR, 2.40; 95% CI, 1.91–3.03). Among users of older AEDs, relative risk of death was greater compared to users of newer AEDs (IPTW HR, 1.79; 95% CI, 1.52–2.16).ConclusionIn older vulnerable patients with a cognitive disorder, careful consideration of AED initiation and close adverse events monitoring are needed.

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2014 CRL Build Study of Life Insurance Applicants

Journal of Insurance Medicine ◽

10.17849/0743-6661-46.1.13 ◽

2016 ◽

Vol 46 (1) ◽

pp. 13-19

Author(s):

Michael Fulks ◽

Vera F. Dolan ◽

Robert L. Stout

Keyword(s):

Blood Pressure ◽

Relative Risk ◽

Laboratory Test ◽

Primary Study ◽

Reference Laboratory ◽

Cox Regression Analysis ◽

Relative Mortality ◽

Low Bmi ◽

The Impact ◽

High Bmi

Objective Determine the impact of build on insurance applicant mortality accounting for smoking, laboratory test values and blood pressure. Method The study consisted of 2,051,370 applicants tested at Clinical Reference Laboratory between 1993 and 2007 with build and cotinine measurements available whose body mass index (BMI) was between 15 and 47. Vital status was determined as of September, 2011 by the Social Security Death Master File. Excluded from the primary study were applicants with HbA1c values ≥6.5%, systolic BP ≥141 mmHg, albumin values ≤3.3 g/dL or total cholesterol values ≤130 mg/dL. Relative mortality was determined by Cox regression analysis for bands of BMI split by age, sex and smoking status (urine cotinine positive). Results A majority of applicants had BMI >24 (overweight or obese by WHO criteria). After the exclusions noted above, relative mortality does not increase by >34% unless BMI is <20 (<18 for female non-smokers age 18 to 59) or BMI is >34. BMI values in the range of 22 to 24 and 25 to 29, overall, had similar and the lowest relative risks. For most nonsmokers, risk was lowest in the lower of these two BMI bands but for smokers (and non-smoking males age 60 to 89) risk was lowest in the higher BMI band. Additional analysis showed limited reduction in relative risk by accounting for all laboratory test values as well as continuing the exclusions. Eliminating the exclusions resulted in only a modest increase in relative risk because the mortality rate of the reference band increased as well. Conclusion After excluding elevated HbA1c and blood pressure (associated with high BMI) and low albumin and cholesterol (associated with low BMI) which are usually evaluated separately, mortality varies by a limited degree for BMI 20 to 34. Accounting for the mortality impact of other test values, in addition to the exclusions noted, reduced mortality associated with high BMI to a limited extent, but had little impact on mortality associated with low BMI.

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Evaluation of the effect of care at NCI comprehensive cancer centers (NCICCCs) on disparities in outcome within adolescents and young adults (AYAs) with cancer.

Journal of Clinical Oncology ◽

10.1200/jco.2012.30.15_suppl.9512 ◽

2012 ◽

Vol 30 (15_suppl) ◽

pp. 9512-9512

Author(s):

Julie Anna Wolfson ◽

Can-Lan Sun ◽

Heeyoung Kim ◽

Tongjun Kang ◽

Smita Bhatia

Keyword(s):

African Americans ◽

Older Age ◽

Age At Diagnosis ◽

Cancer Center ◽

Insurance Status ◽

Cox Regression Analysis ◽

Risk Of Death ◽

Increased Risk ◽

Race Ethnicity ◽

The Impact

9512 Background: AYAs (15-39y at diagnosis) with cancer have not seen the survival improvement evidenced by younger and older age groups with similar diagnoses, leaving an AYA Gap. While treatment on pediatric protocols is associated with superior survival in 15-21 year-olds, the impact of site of care on survival for vulnerable AYA subpopulations (age at diagnosis or race/ ethnicity) between 22-and 39y at diagnosis remains unstudied. Methods: We constructed a cohort of 10,727 patients newly diagnosed between the ages of 22- and 39y with lymphoma, leukemia, brain tumors, melanoma, thyroid and GU cancers, and reported to the LA County cancer registry between 1998 and 2008. Multivariable Cox regression analysis was conducted, and included race/ethnicity, age at diagnosis, SES, insurance status, primary cancer diagnosis and diagnosis year in the model; the analysis was stratified by site of care (NCICCC vs. non-NCICCC). Results: A total of 928 (9%) patients received treatment at the 3 NCICCCs (City of Hope, Jonsson Cancer Center and Norris Cancer Center) in LA County, and 9,799 received care elsewhere. Five-year overall survival (5y OS) was significantly worse for patients treated at non-NCICCC (87%) when compared with those treated at NCICCC (84%, p=0.02). In addition, 5y OS was worse for African Americans (71%) vs. non-Hispanic whites (89%, p<0.0001) and for older patients (31-39yo: 84%, vs. 22-30yo: 86%, p=0.0004). Multivariable analysis adjusting for SES, insurance status, diagnosis and diagnosis year revealed that African Americans (HR=1.4, p=0.0002) and older AYAs (31-39y: HR=1.24, p<0.0001) were at an increased risk of death. Among patients treated at NCICCC, the difference in risk of death due to race (African Americans: HR=0.8, p=0.7) and age (31-39yo: HR=1.1, p=0.6) was abrogated. On the other hand, among patients treated at non-NCICCC, these differences in outcome persisted (African Americans: HR=1.45, p =0.0002; 31-39yo: HR=1.25, p<.0001). Conclusions: Population-based data reveal that receipt of care at an NCICCC abrogates the effects of race and older age on mortality in AYAs with cancer. Barriers to accessing care at NCICCCs are being explored.

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Time to surgery in colon cancer: Predictors and association with survival—An analysis of the National Cancer Database (NCDB).

Journal of Clinical Oncology ◽

10.1200/jco.2018.36.4_suppl.599 ◽

2018 ◽

Vol 36 (4_suppl) ◽

pp. 599-599

Author(s):

Mohan Satish ◽

Sarah J Aurit ◽

Yang Zhang ◽

Ryan W Walters

Keyword(s):

Colon Cancer ◽

Overall Survival ◽

African American ◽

Relative Risk ◽

Regression Model ◽

Older Age ◽

Disease Stage ◽

Adjusted Risk ◽

Time To Surgery ◽

Risk Of Death

599 Background: Time-to-surgery (TTS) refers to the wait time from the diagnosis of cancer to surgical resection of the primary tumor. In breast and bladder cancers, longer TTS has been shown to be associated with lower long-term survival. Prior evidence in colon cancer, has shown that older age, urban residence, and comorbidity are independent predictors of TTS. However, evaluation of TTS with survival in colon cancer has been limited to mostly single-center studies. Using the NCDB, this study aimed to both evaluate patient and clinical factors associated with TTS, and determine if TTS was associated with overall survival in colon cancer. Methods: Patients with colon cancer who underwent partial or subtotal colectomy/hemicolectomy were included, excluding those receiving neoadjuvant therapy. With prior colon cancer studies showing a median TTS of 15-20 days, we dichotomized the number of days from diagnosis to definitive surgery (TTS) as ≤ 21 days or > 21 days. A modified Poisson regression model was utilized to evaluate relative risk of TTS > 21 days. Overall survival in association with TTS was estimated using both the Kaplan-Meier method and multivariable Cox regression model, adjusting for patient-, disease- and facility-level characteristics. All analyses were conducted with SAS version 9.4, p-values < 0.05 were considered significant. Results: We identified 26,999 colon cancer patients from 2006-2012 from the NCDB. Approximately 25.7% of patients had a TTS > 21 days. Patients with comorbidities, who were older, were African American, with lower disease stage, and treated in academic facilities located in the Northeast, had a significantly increased relative risk of a TTS > 21 days. Considering survival, a TTS > 21 days was associated with a 24.5% decreased adjusted risk of death (95% CI: 21.6% to 27.2%). Conclusions: A longer TTS with colon cancer is understandably associated with older age, greater comorbidity, and lower stage, but questionably so in African American patients. However, given that TTS > 21 days was associated with a lower adjusted risk of death, it may indicate that a reasonable delay could be pursued for more accurate preoperative evaluation and staging in colon cancer.

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