Abstract P176: Proportionate Cardiovascular Mortality Patterns Among Patients With Inflammatory Disease In The United States, 1999-2018

Circulation ◽  
2021 ◽  
Vol 143 (Suppl_1) ◽  
Author(s):  
Jacob Groenendyk ◽  
Arjun Sinha ◽  
Adovich Rivera ◽  
Matthew J Feinstein
Keyword(s):  
General Population ◽  
Lupus Erythematosus ◽  
The United States ◽  
Morbidity Burden ◽  
The Past ◽  
Inflammatory Conditions ◽  
Immunodeficiency Virus ◽  
Control And Prevention ◽  
Inflammatory Bowel ◽  
Cvd Mortality

Introduction: Novel therapies have changed the clinical course of several chronic viral and inflammatory conditions over the past two decades. As the morbidity burden of these conditions has changed, competing risks for end-organ diseases including cardiovascular diseases (CVDs) may have likewise evolved. We therefore aimed to investigate changes in the relative burden of CVD mortality over the past two decades across several chronic infectious and inflammatory conditions. Hypothesis: Changes in proportionate CVD-related mortality over the past two decades differ across distinct infectious and inflammatory conditions. Methods: We analyzed 1999-2018 Multiple Causes of Death data from the Centers of Disease Control and Prevention. For several chronic infectious and inflammatory conditions, we analyzed patterns in age-adjusted cardiovascular proportionate mortality, defined as the fraction of deaths in a calendar year with CVD as the underlying cause. We compared age-adjusted proportionate CVD mortality, stratified by sex, for systemic lupus erythematosus (SLE), hepatitis C virus (HCV), human immunodeficiency virus (HIV), inflammatory bowel disease (IBD), psoriasis (PSO), rheumatoid arthritis (RA), and systemic sclerosis (SSc). Results: Proportionate CVD mortality in the general population decreased from 40.9% of 2319606 deaths (1999) to 30.6% of 2778169 deaths (2018), whereas it increased for chronic viral conditions (HCV: 7.0% to 10.2%; HIV: 1.9% to 6.7%) and changed little in SLE (15.3% to 14.4%). Patterns of decreasing proportionate CVD mortality over time were similar for IBD and RA as in the general population. Conclusions: Patterns in proportionate CVD mortality over the past 20 years vary considerably for different chronic infectious and inflammatory conditions. The underlying contributions of infectious and inflammatory burden, off-target effects of therapies, and dynamic changes in competing mortality risk merit further study.

scholarly journals Changes in proportionate cardiovascular mortality in patients with chronic infectious and inflammatory conditions in the United States, 1999–2018

2021 ◽  
Vol 11 (1) ◽  
Author(s):  
Jacob W. Groenendyk ◽  
Adovich S. Rivera ◽  
Arjun Sinha ◽  
Donald M. Lloyd-Jones ◽  
Matthew J. Feinstein
Keyword(s):  
General Population ◽  
Competing Risks ◽  
Cardiovascular Mortality ◽  
Lupus Erythematosus ◽  
Treatment Options ◽  
The United States ◽  
Underlying Disease ◽  
Inflammatory Conditions ◽  
Bowel Diseases ◽  
Cvd Mortality

AbstractTreatment options for several chronic infectious and inflammatory conditions have expanded in recent years. This may have implications for evolving competing risks for chronic inflammation-associated comorbidities, including cardiovascular diseases (CVDs). Yet sparse data exist on patterns over time in cardiovascular mortality for chronic infectious and inflammatory conditions. We used data from the Centers for Disease Control and Prevention 1999–2018 Multiple Causes of Death database to investigate patterns in CVD mortality from January 1, 1999 to December 31, 2018 in several infectious and inflammatory conditions. Specifically, we determined age-adjusted proportionate CVD mortality separately for patients with the following conditions (as well as the general population): hepatitis C virus (HCV), human immunodeficiency virus (HIV), inflammatory bowel diseases (IBD), psoriasis (PSO), rheumatoid arthritis (RA), and systemic lupus erythematosus (SLE). Proportionate CVD mortality differed significantly in 1999 and 2018 for each condition compared with the general population (p < 0.0001). Proportionate CVD mortality decreased steadily in the general population (40.9 to 30.6%) but increased for patients with HCV (7.0 to 10.2%) and HIV (1.9 to 6.7%). For IBD, PSO, RA, and SLE, proportionate CVD mortality initially decreased followed by plateauing or increasing rates. Underlying disease-specific pathophysiologies, changes in natural history, and competing risks of chronic end-organ diseases contributing to these differences merit further study.

scholarly journals SLE mortality remains disproportionately high, despite improvements over the last decade

Lupus ◽  
2018 ◽  
Vol 27 (10) ◽  
pp. 1577-1581 ◽  
Author(s):  
R R Singh ◽  
E Y Yen
Keyword(s):  
Public Health ◽  
General Population ◽  
Lupus Erythematosus ◽  
The United States ◽  
Mortality Rates ◽  
Public Health Issue ◽  
Public Health Programs ◽  
The Past ◽  
Geographic Differences ◽  
Race Ethnicity

Despite a marked improvement in 10-year survival for systemic lupus erythematosus (SLE) patients over the past five decades, mortality rates from SLE remain high compared to those in the general population. SLE was also among the leading causes of death in young women in the United States during 2000–2015. However, it is encouraging that SLE mortality rates and the ratios of SLE mortality rates to non-SLE mortality rates have decreased every year since the late 1990s. Despite this improvement, disparities in SLE mortality persist according to sex, race, age, and place of residence. Furthermore, demographic and geographic variables seem to modify the effect of each other in influencing SLE mortality, leading to interactions between sex/race/ethnicity-associated factors and geographic differences. In other words, individuals of the same sex/race/ethnicity had differences in SLE mortality depending on where they lived. These observations highlight SLE as an important public health issue. The recognition of SLE as a leading cause of death in the general population might spur targeted public health programs and research funding to address the high lupus mortality.

Mortality among patients with idiopathic intracranial hypertension enrolled in the IH Registry

Neurology ◽  
2020 ◽  
Vol 95 (7) ◽  
pp. e921-e929 ◽  
Author(s):  
Sam M. Hermes ◽  
Nick R. Miller ◽  
Carin S. Waslo ◽  
Susan C. Benes ◽  
Emanuel Tanne
Keyword(s):  
General Population ◽  
Intracranial Hypertension ◽  
Idiopathic Intracranial Hypertension ◽  
Causes Of Death ◽  
The United States ◽  
Mortality Data ◽  
Risk Of Death ◽  
Accidental Overdose ◽  
Control And Prevention ◽  
Underlying Causes

ObjectiveTo determine (1) if mortality among patients with idiopathic intracranial hypertension (IIH) enrolled in the Intracranial Hypertension Registry (IHR) is different from that of the general population of the United States and (2) what the leading underlying causes of death are among this cohort.MethodsMortality and underlying causes of death were ascertained from the National Death Index. Indirect standardization using age- and sex-specific nationwide all-cause and cause-specific mortality data extracted from the Centers for Disease Control and Prevention Wonder Online Database allowed for calculation of standardized mortality ratios (SMR).ResultsThere were 47 deaths (96% female) among 1437 IHR participants that met inclusion criteria. The average age at death was 46 years (range, 20–95 years). Participants of the IHR experienced higher all-cause mortality than the general population (SMR, 1.5; 95% confidence interval [CI], 1.2–2.1). Suicide, accidents, and deaths from medical/surgical complications were the most common underlying causes, accounting for 43% of all deaths. When compared to the general population, the risk of suicide was over 6 times greater (SMR, 6.1; 95% CI, 2.9–12.7) and the risk of death from accidental overdose was over 3 times greater (SMR, 3.5; 95% CI, 1.6–7.7). The risk of suicide by overdose was over 15 times greater among the IHR cohort than in the general population (SMR, 15.3; 95% CI, 6.4–36.7).ConclusionsPatients with IIH in the IHR possess significantly increased risks of death from suicide and accidental overdose compared to the general population. Complications of medical/surgical treatments were also major contributors to mortality. Depression and disability were common among decedents. These findings should be interpreted with caution as the IHR database is likely subject to selection bias.

Failure to Implement Respiratory Isolation: Why Does it Happen?

2002 ◽  
Vol 23 (10) ◽  
pp. 595-599 ◽  
Author(s):  
Kentaro Iwata ◽  
Barbara A. Smith ◽  
Eloisa Santos ◽  
Bruce Polsky ◽  
Emilia M. Sordillo
Keyword(s):  
Chest Radiograph ◽  
Performance Indicator ◽  
The United States ◽  
Acid Fast Bacillus ◽  
Abnormal Chest ◽  
Immunodeficiency Virus ◽  
Control And Prevention ◽  
History Of ◽  
Almost All ◽  
Hispanic White

Background:Respiratory isolation for 90% of individuals with acid-fast bacillus (AFB)-smear–positive tuberculosis (TB) is a recommended performance indicator in recent Infectious Diseases Society of America and Centers for Disease Control and Prevention guidelines. However, compliance with respiratory isolation reported from multiple centers in the United States and Europe falls short of that goal.Objective:To identify missed clues in TB patients who are not appropriately isolated.Design:Retrospective survey.Setting:A 900-bed voluntary hospital.Patients:All patients with AFB-smear–positive TB admitted between January 1995 and December 1999 who were not appropriately isolated.Results:There were 173 TB cases admitted, including 106 with pulmonary TB. AFB smears were positive in 82 cases; 24 (29%) of these were not appropriately isolated. During the study period, the number of TB cases declined, but the proportion of appropriately isolated patients did not change. Most isolation failure cases were men (median age, 45.5 years); 21 of these patients were black, 2 were Hispanic white, and 1 was Asian, but none was non-Hispanic white. All isolation failure cases had at least one characteristic predictive of TB that could have been elicited at admission (eg, abnormal chest radiograph findings consistent with TB, fever, weight loss, a history of TB, a positive result on tuberculin skin test, hemoptysis, and human immunodeficiency virus infection).Conclusion:Consistent with experiences at other hospitals, we found that the rate of isolation failure remained unchanged despite an overall decline in TB cases. In our experience, almost all isolation failures could be avoided by careful review of the history, physical examination, and chest radiograph for characteristics classically considered predictive of TB. (Infect Control Hosp Epidemiol 2002;23:595-599).

Postbiotics: what else?

2013 ◽  
Vol 4 (1) ◽  
pp. 101-107 ◽  
Author(s):  
K. Tsilingiri ◽  
M. Rescigno
Keyword(s):  
Food Industry ◽  
Culture Supernatant ◽  
Clinical Applications ◽  
The Past ◽  
Balanced Diet ◽  
Inflammatory Conditions ◽  
Gut Homeostasis ◽  
Probiotic Strains ◽  
Inflammatory Bowel ◽  
Small And Large Intestine

The use of probiotics and synbiotics in the food industry or as food supplements for a balanced diet and improved gut homeostasis has been blooming for the past decade. As feedback from healthy consumers is rather enthusiastic, a lot of effort is currently directed in elucidating the mechanisms of interaction between beneficial microbes and barrier and immune function of the host. The use of probiotics or synbiotics for treating certain pathologies has also been examined, however, the outcome has not always been favourable. In most cases, the effect of the administered probiotic is evident when the bacteria are still alive at the time they reach the small and large intestine, suggesting that it is dependent on the metabolic activity of the bacteria. Indeed, in some occasions it has been shown that the culture supernatant of these bacteria mediates the immunomodulatory effect conferred to the host. Recent work on relevant probiotic strains has also led to the isolation and characterisation of certain probiotic-produced, soluble factors, here called postbiotics, which were sufficient to elicit the desired response. Here, we summarise these recent findings and propose the use of purified and well characterised postbiotic components as a safer alternative for clinical applications, especially in chronic inflammatory conditions like inflammatory bowel disease, where probiotics have not yet given encouraging results as far as induction of remission is concerned.

Has there been a "feminization" of gambling and problem gambling in the United States?

2003 ◽  
Author(s):  
Rachel A. Volberg
Keyword(s):  
United States ◽  
General Population ◽  
Problem Gambling ◽  
The United States ◽  
The Past ◽  
Widespread Acceptance ◽  
Seeking Help ◽  
Past Data ◽  
Gambling Activities ◽  
Gaming Machines

This paper examines the question of whether there has been a "feminization" of gambling and problem gambling in the United States. Feminization refers to the idea that more women are gambling, developing problems and seeking help for problems related to gambling than in the past. Data from a theoretically derived sample of four states are examined to identify patterns in the distribution of gambling participation and the prevalence of problem gambling in the general population. Despite widespread acceptance of the notion of the feminization of gambling and problem gambling, men remain significantly more likely than women to participate regularly in most types of gambling. Most gambling activities remain highly gendered; however, in the United States, the widespread introduction of gaming machines is associated with increases in gambling and problem gambling among women. The present analysis highlights the importance of taking socio-demographic characteristics besides gender into account when considering the distribution of gambling and problem gambling in the general population.

Abstract 13349: An Investigation Into the Association Between Inflammatory Bowel Disease and Cardiac Arrhythmias an Examination of the United States National Inpatient Sample Database

Circulation ◽  
2020 ◽  
Vol 142 (Suppl_3) ◽  
Author(s):  
Mahmood Mubasher ◽  
Tausif Syed ◽  
Amir Hanafi ◽  
Zhao Yu ◽  
Ibrahim Yusuf ◽  
...  
Keyword(s):  
Inflammatory Bowel Disease ◽  
General Population ◽  
Bowel Disease ◽  
Cardiac Arrhythmias ◽  
The United States ◽  
National Inpatient Sample ◽  
Inflammatory Bowel ◽  
Baseline Characteristics ◽  
Exact Relationship

Introduction: A growing evidence depicted the role of systemic inflammation in the pathogenesis of cardiac Arrhythmias (CA). However, uncertainty remains as to the exact relationship between Inflammatory Bowel Disease (IBD) and CA. So far, most of the studies had centered on the implication of inflammatory mechanisms in the development of atrial fibrillation (AF) in IBD. The association between IBD and other arrhythmias is not well elucidated. Hypothesis: We hypothesized that IBD might be associated with a higher burden of CA. Methods: We queried the national inpatient sample (NIS) from 2012 to 2014. Discharges associated with IBD (Chron's or ulcerative colitis), cardiac arrhythmias including AF, Atrial flutter, SVT, VT, VF were identified using ICD-9-CM codes 555.xx, 556.xx, 427.3, 427.32, 427.0, 427.1, 427.41, respectively. We divided patients into two groups, IBD Vs. Non-IBD. Outcomes are the prevalence of CA (AF, A.flutter, SVT, VT, V.fib) amongst both groups, as well as the correlation between CA and demographic of patient cohorts. Multivariable logistic regression (MLR) was utilized to adjust for differences in baseline characteristics. Results: We identified 847,235 weighted hospitalizations among patients with IBD and 84,757,349 hospitalizations among the general population, ≥18 years of age. Overall, IBD patients were less likely to be admitted with cardiac arrhythmias than the non-IBD population (9.7% versus 14.2%, P, <0.001). On MLR, IBD Group had lower odds of CA during hospitalization (OR, 0.87; 95% CI 0.85-0.88), AF (OR, 086; 95%CI 0.85-0.88) A.flutter (OR,0.78; 95% CI 0.74-0.83), VF (OR, 0.69; 95% CI 0.59-0.79). While the prevalence of SVT and VT was not different between the two groups. Male sex, age of more than 60 years, and white Race were risk factors for Arrhythmias. Conclusions: In conclusion NIS analysis revealed lower rates of hospitalization-associated arrhythmias in the IBD population compared to the general population.

scholarly journals The hypoxia-adenosine link during inflammation

2017 ◽  
Vol 123 (5) ◽  
pp. 1303-1320 ◽  
Author(s):  
Jessica L. Bowser ◽  
Jae W. Lee ◽  
Xiaoyi Yuan ◽  
Holger K. Eltzschig
Keyword(s):  
Myocardial Injury ◽  
Inflammatory Diseases ◽  
Extracellular Adenosine ◽  
Tissue Integrity ◽  
The Past ◽  
Hypoxic Conditions ◽  
Inflammatory Conditions ◽  
Proinflammatory Responses ◽  
Inflammatory Bowel ◽  
The Relationship

Hypoxic tissue conditions occur during a number of inflammatory diseases and are associated with the breakdown of barriers and induction of proinflammatory responses. At the same time, hypoxia is also known to induce several adaptive and tissue-protective pathways that dampen inflammation and protect tissue integrity. Hypoxia-inducible factors (HIFs) that are stabilized during inflammatory or hypoxic conditions are at the center of mediating these responses. In the past decade, several genes regulating extracellular adenosine metabolism and signaling have been identified as being direct targets of HIFs. Here, we discuss the relationship between inflammation, hypoxia, and adenosine and that HIF-driven adenosine metabolism and signaling is essential in providing tissue protection during inflammatory conditions, including myocardial injury, inflammatory bowel disease, and acute lung injury. We also discuss how the hypoxia-adenosine link can be targeted therapeutically in patients as a future treatment approach for inflammatory diseases.

P125 COMPLICATIONS FOLLOWING OUTPATIENT COLONOSCOPY IN INFLAMMATORY BOWEL DISEASE (IBD) PATIENTS

2020 ◽  
Vol 26 (Supplement_1) ◽  
pp. S24-S24
Author(s):  
Daniel Chu ◽  
Po-Hung Chen ◽  
Steven Brant ◽  
Steven Miller ◽  
Natasha Turner ◽  
...  
Keyword(s):  
Ulcerative Colitis ◽  
Inflammatory Bowel Disease ◽  
Crohn’S Disease ◽  
Crohn's Disease ◽  
General Population ◽  
Bowel Disease ◽  
Intestinal Perforation ◽  
The United States ◽  
Icd 10 ◽  
Inflammatory Bowel

Abstract Inflammatory Bowel Disease (IBD) patients have frequent complications after surgical procedures. Inflammation, immunosuppression and other factors that are more common in Crohn’s disease (CD) and ulcerative colitis (UC) may play a role in increasing their complication risk profile. IBD patients also undergo colonoscopy procedures more frequently than the general population. We aimed to identify risks of complications during or within 7 days of colonoscopy in IBD patients. Methods: Colonoscopy procedures performed between January 2016 through March 2019 in an outpatient setting (hospital or ambulatory surgical center) were identified from the United States Medicare fee-for-service claims. All Medicare beneficiaries were eligible. Colonoscopy was identified using the Healthcare Common Procedure Coding System (HCPCS) codes (‘45378’ through ‘45393’ and ‘45398’). A patient was considered to have Crohn’s disease (CD) if ICD-10-CM code K50.x was recorded; Ulcerative Colitis (UC) if ICD-10-CM code K51.x was recorded; and IBD if either was recorded on the date of the procedure. Complications recorded during the procedure included intestinal perforation (K63.1), gastrointestinal hemorrhage (K92.2), and “other post-procedural complications of the digestive system” (K91), including, but not limited to, post-gastrectomy syndrome, malabsorption, and intestinal obstruction. We examined these complications in procedures performed on IBD patients compared to the general population using logistic regression. We accounted for age, sex, race, year of colonoscopy, comorbidity score, and procedure discontinuation (identified by HCPCS modifier) in the analysis. A random effect for patient was included in the model to account for multiple procedures performed in the same patient during the study period, restricting patients from contributing multiple procedures. Results: There were 3,181,759 eligible procedures. There were 26,583 (0.84%) colonoscopy procedures in CD patients and 50,708 (1.59%) in UC patients. After accounting for other risk factors, CD and UC were more likely to have intestinal perforation than the non-IBD population (CD OR=2.7, 95% CI: 1.1–6.5; UC=OR 1.9, 95% CI 0.9–4.1), with CD having a statistically significant increase. Women were at greater risk for perforations (OR=1.3; 95% CI: 1.0–1.7). Conversely, IBD patients were less likely than non-IBD patients to have a complication recorded as “other” (CD OR=0.5; 95% CI: 0.2–0.9; UC OR=0.5; 95% CI:0.3–0.8). Older age at colonoscopy (OR=1.02, 95% CI 1.01–1.03), six or more comorbidities (OR=1.9, 95% CI: 1.5–2.3) and procedure discontinuation (OR=2.0, 95% CI 1.2–3.4) were associated with complications regardless of IBD status. Conclusion: IBD was associated with higher risk of perforation, and lower risk of other postprocedural complications in outpatient colonoscopy procedures.

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