Abstract P048: Risk Factors for Severe Hypoglycemia Differ in Black and White Older Adults With Diabetes: the Atherosclerosis Risk in Communities (ARIC) Study

Circulation ◽  
2017 ◽  
Vol 135 (suppl_1) ◽  
Author(s):  
Alexandra K Lee ◽  
Bethany Warren ◽  
Clare J Lee ◽  
Elbert S Huang ◽  
A. Richey Sharrett ◽  
...  
Keyword(s):  
Risk Factors ◽  
Proportional Hazards ◽  
Severe Hypoglycemia ◽  
Cox Proportional Hazards ◽  
Emergency Department Visits ◽  
Fee For Service ◽  
Diabetes Medication ◽  
C Statistic ◽  
Cox Proportional Hazards Models ◽  
Blacks And Whites

Introduction: Blacks with diabetes have roughly twice the rate of severe hypoglycemia compared to whites with diabetes; it is unclear whether hypoglycemia risk factors identified in studies of white participants are similarly associated with hypoglycemia in blacks. Methods: We included ARIC participants aged 65+ at Visit 4 (1996-1998) who had Medicare fee-for-service Part B and diagnosed diabetes. We identified severe hypoglycemic events through 2013 using ICD-9 codes from hospitalizations, emergency department visits, and ambulance services. We evaluated previously identified risk factors: age, sex, chronic kidney disease (CKD), diabetes medication use, obesity, cognition, glycemic control, and number of comorbidities. We stratified Cox proportional hazards models by race and used Harrell’s C-statistic to compare discrimination. Results: There were 33 hypoglycemic events in 135 black participants and 43 hypoglycemic events in 319 white participants (incidence rate 2.8 vs. 1.5 per 100 person-years, p<0.01). Most risk factors had similar associations with risk of hypoglycemia in blacks and whites, with some notable exceptions. Obesity was associated with greater risk in blacks but not whites ( Table ). CKD was more strongly associated with risk in blacks than whites. Type of diabetes medication was associated with risk in whites but not in blacks. The C-statistic suggested better model discrimination in whites (C=0.795) than in blacks (C=0.759), but confidence intervals were wide. Conclusion: The direction and strength of risk factors for hypoglycemia may differ for blacks and whites. It is unclear why the relative importance of risk factors for hypoglycemia differ between whites and blacks. These data suggest that the mechanism by which CKD influences hypoglycemia risk may be decreased renal gluconeogenesis in blacks and reduced insulin clearance in whites. Additional research is needed to understand those factors that contribute to hypoglycemia risk in blacks and may underlie health disparities.

Abstract P030: Variations in Cardiovascular Risk Among Different Clinical Presentations of Metabolic Syndrome in the REasons for Geographic And Racial Differences in Stroke (REGARDS) Study

Circulation ◽  
2012 ◽  
Vol 125 (suppl_10) ◽  
Author(s):  
Todd M Brown ◽  
Joshua Richman ◽  
Vera Bittner ◽  
Cora E Lewis ◽  
Jenifer Voeks ◽  
...  
Keyword(s):  
Risk Factors ◽  
Metabolic Syndrome ◽  
Racial Differences ◽  
Central Obesity ◽  
Proportional Hazards ◽  
Cox Proportional Hazards ◽  
Next Of Kin ◽  
Cox Proportional Hazards Models ◽  
Chd Risk ◽  
The Individual

Background: Some individuals classified as having metabolic syndrome (MetSyn) are centrally obese while others are not with unclear implications for cardiovascular (CV) risk. Methods: REGARDS is following 30,239 individuals ≥45 years of age living in 48 states recruited from 2003-7. MetSyn risk factors were defined using the AHA/NHLBI/IDF harmonized criteria with central obesity being defined as ≥88 cm in women and ≥102 cm in men. Participants with and without central obesity were stratified by whether they met >2 or ≤2 of the other 4 MetSyn criteria, resulting in the creation of 4 groups. To ascertain CV events, participants are telephoned every 6 months with expert adjudication of potential events following national consensus recommendations and based on medical records, death certificates, and interviews with next-of-kin or proxies. Acute coronary heart disease (CHD) was defined as definite or probable myocardial infarction or acute CHD death. To determine the association between these 4 groups and incident acute CHD, we constructed Cox proportional hazards models in those free of CHD at baseline by race/gender group, adjusting for sociodemographic variables. Results: A total of 20,018 individuals with complete data on MetSyn components were free of baseline CHD. Mean age was 64+/−9 years, 58% were women, and 42% were African American. Over a mean follow-up of 3.4 (maximum 5.9) years, there were 442 acute CHD events. In the non-centrally obese with>2 other risk factors, risk for CHD was higher for all but AA men, though significant only for white men. In contrast, in the centrally obese with >2 other risk factors, risk was doubled for women, but only non-significantly and modestly increased for men. Only AA women with central obesity and ≤2 other risk factors had increased CHD risk (Table). Conclusion: The CHD risk associated with the MetSyn varies by the presence of central obesity as well as the race and gender of the individual.

Is more aggressive lymph node assessment associated with improved survival in stage II-III colorectal cancer? Evidence from the Surveillance, Epidemiology and End Results (SEER) cancer registry

2007 ◽  
Vol 25 (18_suppl) ◽  
pp. 4048-4048
Author(s):  
Y. Yeh ◽  
Q. Cai ◽  
J. Chao ◽  
M. Russell
Keyword(s):  
Colorectal Cancer ◽  
Risk Factors ◽  
Proportional Hazards ◽  
Survival Rates ◽  
Cox Proportional Hazards ◽  
Stage Ii ◽  
Rank Test ◽  
Stage Iiia ◽  
Nccn Guidelines ◽  
Cox Proportional Hazards Models

4048 Background: NCCN guidelines recommend assessment of =12 lymph nodes (LN) to improve accuracy in colorectal cancer (CRC) staging. Previous studies have used various cut-points to assess the relationship between the number of LN sampled and survival. The association between NCCN guideline-compliant nodal sampling and survival is assessed, while controlling for other risk factors. Methods: We selected 145,485 adult patients newly diagnosed with stage II or III from SEER during 1990–2003. Kaplan-Meier curves were compared using the log-rank test. Cox proportional hazards models were constructed to determine the effect of sampling ≥ 12 LN on survival. Results: Median patient follow-up was 5.7 years. The table shows overall survival rates in CRC patients with < 12 versus =12 LN assessed: After adjusting for age, sex, tumor size and grade, sampling ≥ 12 LN was independently associated with improved survival. For patients with =12 versus <12 LN assessed, survival increased by 13% for stage IIa [HR=0.75; 95%CI 0.72–0.78; p< .001], 16% for stage IIb [HR=0.69; 95%CI 0.67- 0.71; p< .001], 12% for stage IIIb [HR=0.75; 95%CI 0.72–0.77], and 10% for stage IIIc [HR=0.85, 95%CI 0.81–0.89]. The association was not statistically significant for stage IIIa patients. Conclusion: Consistent with previous reports, this analysis found that optimal nodal sampling increased survival across stage II and III, specifically when ≥ 12 LN are sampled and when controlling for other risk factors. Furthermore, the results underscore the need for adhering to the NCCN guidelines. The lack of a statistically significant association in stage IIIa patients may be due to small cohort size. [Table: see text] [Table: see text]

scholarly journals Does the First Exposure to Addictive Substances Predict Future Dependence?

2009 ◽  
Vol 24 (S1) ◽  
pp. 1-1
Author(s):  
J. DiFranza
Keyword(s):  
Risk Factors ◽  
Depressed Mood ◽  
Proportional Hazards ◽  
Tobacco Dependence ◽  
International Classification Of Diseases ◽  
Cox Proportional Hazards ◽  
Novelty Seeking ◽  
Cox Proportional Hazards Models ◽  
Classification Of Diseases ◽  
First Time

Aims:The risk factors for trying a cigarette are well known, however we were interested in the factors that determine which youths become addicted to nicotine once they have tried it.Method:To investigate this we followed a cohort of 1246 students (mean baseline age of 12.2 years) over 4 years. Subjects underwent 11 interviews during which we assessed 45 risk factors, measured diminished autonomy over tobacco with the Hooked On Nicotine Checklist, and evaluated tobacco dependence using the International Classification of Diseases-10th revision. Cox proportional hazards models were used.Results:Among 217 youths who had inhaled from a cigarette, the loss of autonomy over tobacco was predicted by feeling relaxed the first time inhaling from a cigarette (adJusted Hazard Ratio (HR)=3.26; 95% CI, 1.95-5.46; P< .001) and depressed mood (HR=1.29; 1.09-1.54; P=.004). Tobacco dependence was predicted by feeling relaxed (HR=2.43; 1.27-4.65; P=.007), familiarity with Joe Camel (HR=2.19; 1.11-4.32; P=.02), novelty seeking (HR=1.56; 1.06-2.29; P=.02), and depressed mood (HR=1.17; 1.04-1.30; P=.007).Conclusion:Once exposure to nicotine had occurred, remarkably few risk factors for smoking consistently contributed to individual differences in susceptibility to the development of dependence. An experience of relaxation in response to the first dose of nicotine was the strongest predictor of both dependence and lost autonomy. This association was not explained by trait anxiety or many other psychosocial factors. These results are discussed in relation to the theory that addiction is initiated by the first dose of nicotine.

scholarly journals Breakfast Frequency and Diabetes Incidence in a Cohort of Middle-Age Women

2021 ◽  
Vol 5 (Supplement_2) ◽  
pp. 470-470
Author(s):  
Claudia Martinez ◽  
Eduardo Ortíz-Panozo ◽  
Dalia Stern ◽  
Adrián Cortés ◽  
Josiemer Mattei ◽  
...  
Keyword(s):  
Risk Factors ◽  
Proportional Hazards ◽  
Cox Proportional Hazards ◽  
Diabetes Incidence ◽  
Breakfast Consumption ◽  
Funding Sources ◽  
Cox Proportional Hazards Models ◽  
Potential Component ◽  
A Prospective Study ◽  
Stratified Analysis

Abstract Objectives To examine the relation between breakfast frequency and incidence of diabetes in middle-aged women. Methods The Mexican Teacher´s Cohort is a prospective study in women. We included 71,373 participants at baseline (2006–2008). Participants were classified according to breakfast frequency 0, 1–3, 4–6, or 7 d/wk; and meal frequency 1–2, 3–4, or ≥5 meals/d. Diabetes was self-reported. We used Cox proportional hazards models to calculate hazard ratios (HR) and 95% confidence intervals (CI) to estimate the association between breakfast frequency and diabetes incidence. Models were adjusted for sociodemographic and lifestyle confounders that are associated with breakfast consumption and are risk factors for diabetes. Stratified analyses were performed for age, birth weight, indigenous background, and physical activity. Results We identified 3,613 new diabetes cases during a median of 2.2 years of follow-up. Prevalence of daily breakfast consumers was 25%. After adjustment for known risk factors for diabetes, compared to 0 d/wk, women who eat daily breakfast had 12% lower rate of diabetes (HR = 0.88; 95% CI 0.78, 0.99; p-trend = 0.0018). One day additional per week having breakfast decreased the risk of diabetes (HR = 0.98; CI 0.97, 0.99). In stratified analysis, women with indigenous background who consumed breakfast 4–6 d/wk and 7 d/wk vs. 0 d/wk shown lower risk (HR = 0.68; 95% CI 0.47, 0.98) and HR = 0.76; 95% CI 0.76 (0.51, 1.15) respectively; p-interaction = 0.197). Conclusions Daily breakfast was associated with a lower incidence of diabetes, independently of dietary and lifestyle factors. Likely effect modifiers as ethnicity warrants more research. Daily breakfast consumption is a potential component of diabetes prevention. Funding Sources This work is supported by the American Institute for Cancer Research (05B047) and Consejo Nacional de Ciencia y Tecnología (CONACyT) grant S0008-2009-1: 000000000115312.

Risk factors for herpes zoster in patients with rheumatic diseases: a nationwide cohort study in Korea

Rheumatology ◽  
2020 ◽  
Author(s):  
Hee Jung Ryu ◽  
Jin-Ok Han ◽  
Sang Ah Lee ◽  
Mi Ryoung Seo ◽  
Hyo Jin Choi ◽  
...  
Keyword(s):  
Risk Factors ◽  
Herpes Zoster ◽  
Rheumatic Diseases ◽  
Proportional Hazards ◽  
Young Patients ◽  
Cox Proportional Hazards ◽  
Proportional Hazards Models ◽  
Female Sex ◽  
Cox Proportional Hazards Models ◽  
Conventional Dmards

Abstract Objective To determine the risk factors for herpes zoster (HZ) in patients with rheumatic diseases in Korea. Methods We used the nationwide database of the Health Insurance Review & Assessment Service to analyse patients aged ≥20 years who had visited a hospital more than twice for rheumatic disease as a principal diagnosis from January 2009 to April 2013. HZ was identified using HZ-related Korean Standard Classification of Diseases 6 (KCD-6) codes and the prescription of antiviral agents. The relationship between demographics, comorbidities and medications and HZ risk was analysed by Cox proportional hazards models. Results HZ developed in 1869 patients. In Cox proportional hazards models, female sex but not age showed an increased adjusted hazard ratio (HR) for HZ. Comorbidities such as haematologic malignancies, hypertension, diabetes mellitus, and chronic lung and liver diseases led to an increased HR. HZ risk was higher in patients with SLE (HR: 4.29, 95% CI: 3.49, 5.27) and Behçet’s syndrome (BS, HR: 4.54; 95% CI: 3.66, 5.64) than with RA. The use of conventional DMARDs, immunosuppressants, TNF inhibitors, glucocorticoids and NSAIDs increased the HR. Infliximab and glucocorticoids (equivalent prednisolone dose &gt;15 mg/day) produced the highest HZ risk (HR: 2.91, 95% CI: 1.72, 4.89; HR: 2.85, 95% CI: 2.15, 3.77, respectively). Conclusion Female sex, comorbidities and medications increased HZ risk in patients with rheumatic diseases and even young patients could develop HZ. Compared with RA, SLE and BS are stronger HZ risk factors. Patients with rheumatic diseases and these risk factors are potential target populations for HZ vaccination.

Abstract WP312: The Association of Chronic Kidney Disease (CKD) With 30-day and 1-year Post Ischemic Stroke Mortality and Rehospitalization: Get With the Guidelines (GWTG) Stroke

Stroke ◽  
2016 ◽  
Vol 47 (suppl_1) ◽  
Author(s):  
Nada El Husseini ◽  
Gregg C Fonarow ◽  
Eric E Smith ◽  
Christine Ju ◽  
Lee H Schwamm ◽  
...  
Keyword(s):  
Ischemic Stroke ◽  
Hospital Mortality ◽  
Proportional Hazards ◽  
Reference Group ◽  
Cox Proportional Hazards ◽  
Fee For Service ◽  
Stroke Mortality ◽  
Medicare Beneficiaries ◽  
Cox Proportional Hazards Models ◽  
Ckd Stage

Background: The extent to which CKD is associated with 30-day and 1-year post ischemic stroke mortality and rehospitalization rates has not been well studied. Methods: Data from 232,236 fee for service Medicare patients admitted with ischemic stroke to 1581 AHA GWTG-Stroke participating hospitals between January 2009 and December 2012 were analyzed. Estimated GFR in mL/min/1.73 m2 was determined based on the MDRD study equation categorized as: no CKD (GFR ≥60); stage 3a CKD (GFR 45-59); stage 3b CKD (GFR 30-44); stage 4 CKD, (GFR 15-29); stage 5 CKD (GFR <15 excluding those on dialysis). Dialysis was identified by ICD-9 codes. Multivariable Cox proportional hazards models adjusted for demographics, medical history, NIHSS, arrival hour, and hospital characteristics were used to determine the independent associations of CKD (reference group those without CKD) with mortality and readmission at 30 days and 1 year. Results: After adjustment, 30-days poststroke mortality was highest among those with CKD stage 5 (HR 1.94, 95%CI 1.72-2.18), even after excluding in-hospital mortality and patients discharged to hospice (HR 2.09, 95%CI 1.66-2.63). Unadjusted 1-year mortality and readmission rates were highest among patients on dialysis (Figure). After adjustment, 1-year post-stroke mortality remained highest among patients on dialysis (HR 2.19, 95%CI 2.08-2.31), even after excluding in-hospital mortality and discharge to hospice (HR 2.65, 95%CI 2.49-2.81). For those discharged alive, 30-day and 1-year rehospitalization rates were also highest among patients on dialysis (HR 2.10, 95%CI 1.95-2.26; HR 2.55, 95%CI 2.44-2.66, respectively) as was the 30-day and 1-year composite of mortality and rehospitalization (HR 2.04, 95%CI 1.90-2.18; HR 2.46, 95% CI 2.36-2.56, respectively). Conclusion: Among Medicare beneficiaries with acute ischemic stroke, poststroke mortality and rehospitalization varied by CKD stage and were highest among those with advanced CKD.

CT-Based Risk Factors for Mortality of Patients With COVID-19 Pneumonia in Wuhan, China: A Retrospective Study

2021 ◽  
Vol 1 ◽  
Author(s):  
Xiang Li ◽  
Nannan Li ◽  
Zhen Chen ◽  
Ling Ye ◽  
Ling Zhang ◽  
...  
Keyword(s):  
Risk Factors ◽  
Retrospective Study ◽  
Proportional Hazards ◽  
Prognostic Biomarker ◽  
Hounsfield Unit ◽  
Cox Proportional Hazards ◽  
Prognostic Indicators ◽  
Univariable Analysis ◽  
Cox Proportional Hazards Models ◽  
Study Laboratory

Purpose: Computed tomography (CT) characteristics associated with critical outcomes of patients with coronavirus disease 2019 (COVID-19) have been reported. However, CT risk factors for mortality have not been directly reported. We aim to determine the CT-based quantitative predictors for COVID-19 mortality.Methods: In this retrospective study, laboratory-confirmed COVID-19 patients at Wuhan Central Hospital between December 9, 2019, and March 19, 2020, were included. A novel prognostic biomarker, V-HU score, depicting the volume (V) of total pneumonia infection and the average Hounsfield unit (HU) of consolidation areas was automatically quantified from CT by an artificial intelligence (AI) system. Cox proportional hazards models were used to investigate risk factors for mortality.Results: The study included 238 patients (women 136/238, 57%; median age, 65 years, IQR 51–74 years), 126 of whom were survivors. The V-HU score was an independent predictor (hazard ratio [HR] 2.78, 95% confidence interval [CI] 1.50–5.17; p = 0.001) after adjusting for several COVID-19 prognostic indicators significant in univariable analysis. The prognostic performance of the model containing clinical and outpatient laboratory factors was improved by integrating the V-HU score (c-index: 0.695 vs. 0.728; p &lt; 0.001). Older patients (age ≥ 65 years; HR 3.56, 95% CI 1.64–7.71; p &lt; 0.001) and younger patients (age &lt; 65 years; HR 4.60, 95% CI 1.92–10.99; p &lt; 0.001) could be further risk-stratified by the V-HU score.Conclusions: A combination of an increased volume of total pneumonia infection and high HU value of consolidation areas showed a strong correlation to COVID-19 mortality, as determined by AI quantified CT.

scholarly journals Association of Kidney Function With 30-Day and 1-Year Poststroke Mortality and Hospital Readmission

Stroke ◽  
2018 ◽  
Vol 49 (12) ◽  
pp. 2896-2903 ◽  
Author(s):  
Nada El Husseini ◽  
Gregg C. Fonarow ◽  
Eric E. Smith ◽  
Christine Ju ◽  
Shubin Sheng ◽  
...  
Keyword(s):  
Ischemic Stroke ◽  
Kidney Function ◽  
Hospital Readmission ◽  
Proportional Hazards ◽  
Hospital Readmissions ◽  
Cox Proportional Hazards ◽  
Fee For Service ◽  
Hospital Readmission Rates ◽  
Cox Proportional Hazards Models ◽  
Relevant Variables

Background and Purpose— Kidney dysfunction is common among patients hospitalized for ischemic stroke. Understanding the association of kidney disease with poststroke outcomes is important to properly adjust for case mix in outcome studies, payment models and risk-standardized hospital readmission rates. Methods— In this cohort study of fee-for-service Medicare patients admitted with ischemic stroke to 1579 Get With The Guidelines-Stroke participating hospitals between 2009 and 2014, adjusted multivariable Cox proportional hazards models were used to determine the independent associations of estimated glomerular filtration rate (eGFR) and dialysis status with 30-day and 1-year postdischarge mortality and rehospitalizations. Results— Of 204 652 patients discharged alive (median age [25th–75th percentile] 80 years [73.0–86.0], 57.6% women, 79.8% white), 48.8% had an eGFR ≥60, 26.5% an eGFR 45 to 59, 16.3% an eGFR 30 to 44, 5.1% an eGFR 15 to 29, 0.6% an eGFR <15 without dialysis, and 2.8% were receiving dialysis. Compared with eGFR ≥60, and after adjusting for relevant variables, eGFR <45 was associated with increased 30-day mortality with the risk highest among those with eGFR <15 without dialysis (hazard ratio [HR], 2.09; 95% CI, 1.66–2.63). An eGFR <60 was associated with increased 1-year poststroke mortality that was highest among patients on dialysis (HR, 2.65; 95% CI, 2.49–2.81). Dialysis was also associated with the highest 30-day and 1-year rehospitalization rates (HR, 2.10; 95% CI, 1.95–2.26 and HR, 2.55; 95% CI, 2.44–2.66, respectively) and 30-day and 1-year composite of mortality and rehospitalization (HR, 2.04; 95% CI, 1.90–2.18 and HR, 2.46; 95% CI, 2.36–2.56, respectively). Conclusions— Within the first year after index hospitalization for ischemic stroke, eGFR and dialysis status on admission are associated with poststroke mortality and hospital readmissions. Kidney function should be included in risk-stratification models for poststroke outcomes.

scholarly journals ACUTE CARE UTILIZATION IN OLDER ADULTS LIVING UNDIAGNOSED OR UNAWARE OF DEMENTIA

2019 ◽  
Vol 3 (Supplement_1) ◽  
pp. S739-S739
Author(s):  
Halima Amjad ◽  
David L Roth ◽  
Jin Huang ◽  
Jennifer L Wolff ◽  
Quincy M Samus
Keyword(s):  
Proportional Hazards ◽  
Cox Proportional Hazards ◽  
Care Utilization ◽  
Fee For Service ◽  
Dementia Diagnosis ◽  
Medicare Claims ◽  
Cox Proportional Hazards Models ◽  
Acute Care Utilization ◽  
Ed Visits ◽  
Nationally Representative

Abstract Most individuals with dementia are undiagnosed or they/their families are unaware of the diagnosis. Implications of dementia diagnosis and awareness are poorly understood. Our objective was to determine whether undiagnosed dementia or unawareness increases risk of hospitalization or emergency department (ED) visits, outcomes with recognized risk in diagnosed dementia. We linked National Health and Aging Trends Study (NHATS) data to fee-for-service Medicare claims for 4,311 community-living participants in the nationally representative cohort. We assessed probable versus no dementia using validated NHATS dementia criteria, undiagnosed versus diagnosed using Medicare claims, and aware versus unaware using NHATS self or proxy report of diagnosis. Cox proportional hazards models evaluated hospitalization and ED visit risk by time-varying dementia diagnosis and awareness status, adjusting for sociodemographic characteristics, functional impairment, medical comorbidities, and prior hospitalization. Compared to no dementia, persons with dementia who were unaware but diagnosed had greater risk of hospitalization (HR 1.66, 95% CI 1.26-2.19) and ED visits (HR 1.63, 95% CI 1.28-2.08). Persons unaware but diagnosed also had greater risk compared to persons aware and diagnosed (hospitalization HR 1.34, 95% CI 0.98-1.82; ED HR 1.38, 95% CI 1.05-1.83). Persons with undiagnosed dementia demonstrated hospitalization risk similar to persons with no dementia (HR 1.02, 95% CI 0.79-1.31) and similar or potentially lower than persons aware and diagnosed (HR 0.82, 95% CI 0.61-1.10); ED visit findings were similar. Results suggest that being unaware of dementia diagnosis may affect healthcare utilization. Strategies to improve communication and understanding of dementia could potentially reduce hospitalizations and ED visits.

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