Abstract T P142: Mortality and Stroke Recurrence in Obese Stroke Patients: The Obesity Paradox in a London-Based Population

INTRODUCTION Several studies have shown a paradoxical association between body mass index (BMI) and mortality after stroke. However, the association between BMI, waist circumference (WC) and mortality and stroke recurrence is unclear. This study aimed to determine the associations between BMI, WC and mortality and stroke recurrence at 6 months post stroke. METHODS Patients were recruited from consecutive admissions at 2 hyper-acute stroke units in London and were classified into 4 categories of BMI (underweight, normal weight, overweight and obese) and quartiles of WC. Outcomes were obtained for each patient through a national database that contains details of all hospital admissions. Chi-square tests were used to compare mortality and stroke recurrence rates. Cox Proportional Hazards Models were used to compare mortality risk and survival curves between different BMI categories and WC quartiles. RESULTS Of 543 recruited patients, 51% were males and 87% had an ischaemic stroke, with a mean age of 74.7 years (range 22-99). There were significant inverse associations between BMI and WC and risk of mortality at 6-months post-stroke (see table) ( p=0.001 and p=0.04, respectively). After adjusting for possible confounders (age, ethnicity, gender, severity and type of stroke, stroke risk factors), these associations were attenuated ( p=0.06 for BMI and p=0. 11 for WC). No significant differences were found in stroke recurrence rates between BMI groups (underweight 3.7%, normal weight 3.8%, overweight 4.5%, obese 2.8%; p=0.91) or WC quartiles (Q1 2.8%, Q2 5.1%, Q3 3.5%, Q4 3.6%; p=0.83). CONCLUSION After a stroke, being obese and having a larger waist circumference was associated with reduced mortality but did not affect the risk of a recurrent stroke.

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Comparing Retreatments and Expenditures in Flow Diversion Versus Coiling for Unruptured Intracranial Aneurysm Treatment: A Retrospective Cohort Study Using a Real-World National Database

Neurosurgery ◽

10.1093/neuros/nyz377 ◽

2019 ◽

Vol 87 (1) ◽

pp. 63-70

Author(s):

Haruhisa Fukuda ◽

Daisuke Sato ◽

Yoriko Kato ◽

Wataro Tsuruta ◽

Masahiro Katsumata ◽

...

Keyword(s):

Linear Models ◽

Proportional Hazards ◽

National Level ◽

Cox Proportional Hazards ◽

National Database ◽

Healthcare Expenditures ◽

Cox Proportional Hazards Models ◽

Hazard Ratios ◽

Unruptured Intracranial Aneurysms ◽

Economic Perspectives

Abstract BACKGROUND Flow diverters (FDs) have marked the beginning of innovations in the endovascular treatment of large unruptured intracranial aneurysms, but no multi-institutional studies have been conducted on these devices from both the clinical and economic perspectives. OBJECTIVE To compare retreatment rates and healthcare expenditures between FDs and conventional coiling-based treatments in all eligible cases in Japan. METHODS We identified patients who had undergone endovascular treatments during the study period (October 2015-March 2018) from a national-level claims database. The outcome measures were retreatment rates and 1-yr total healthcare expenditures, which were compared among patients who had undergone FD, coiling, and stent-assisted coiling (SAC) treatments. The coiling and SAC groups were further categorized according to the number of coils used. Retreatment rates were analyzed using Cox proportional hazards models, and total expenditures were analyzed using multilevel mixed-effects generalized linear models. RESULTS The study sample comprised 512 FD patients, 1499 coiling patients, and 711 SAC patients. The coiling groups with ≥10 coils and ≥9 coils had significantly higher retreatment rates than the FD group with hazard ratios of 2.75 (1.30-5.82) and 2.52 (1.24-5.09), respectively. In addition, the coiling group with ≥10 coils and SAC group with ≥10 coils had significantly higher 1-year expenditures than the FD group with cost ratios (95% CI) of 1.30 (1.13-1.49) and 1.31 (1.15-1.50), respectively. CONCLUSION In this national-level study, FDs demonstrated significantly lower retreatment rates and total expenditures than conventional coiling with ≥ 9 coils.

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Birth incidence, deaths and hospitalisations of children and young people with Down syndrome, 1990–2015: birth cohort study

BMJ Open ◽

10.1136/bmjopen-2019-033770 ◽

2020 ◽

Vol 10 (4) ◽

pp. e033770 ◽

Cited By ~ 1

Author(s):

Laura Anne Hughes-McCormack ◽

Ruth McGowan ◽

J P Pell ◽

Daniel Mackay ◽

Angela Henderson ◽

...

Keyword(s):

Down Syndrome ◽

Young People ◽

Live Birth ◽

Proportional Hazards ◽

Hospital Admissions ◽

Admission Rate ◽

Cox Proportional Hazards ◽

Birth Cohort Study ◽

Research Attention ◽

Children With Down Syndrome

ObjectiveTo investigate current Down syndrome live birth and death rates, and childhood hospitalisations, compared with peers.SettingGeneral community.ParticipantsAll live births with Down syndrome, 1990–2015, identified via Scottish regional cytogenetic laboratories, each age–sex–neighbourhood deprivation matched with five non-Down syndrome controls. Record linkage to Scotland’s hospital admissions and death data.Primary outcomeHRs comparing risk of first hospitalisation (any and emergency), readmission for children with Down syndrome and matched controls were calculated using stratified Cox proportional hazards (PH) model, and length of hospital stay was calculated using a conditional log-linear regression model.Results689/1479 (46.6%) female and 769/1479 (51.9%) male children/young people with Down syndrome were identified (1.0/1000 births, with no reduction over time); 1235 were matched. 92/1235 (7.4%) died during the period, 18.5 times more than controls. More of the Down syndrome group had at least one admission (incidence rate ratio(IRR) 72.89 (68.72–77.32) vs 40.51 (39.15–41.92); adjusted HR=1.84 (1.68, 2.01)) and readmissions (IRR 54.85 (51.46–58.46) vs 15.06 (14.36–15.80); adjusted HR=2.56 (2.08, 3.14)). More of their admissions were emergencies (IRR 56.78 (53.13–60.72) vs 28.88 (27.73–30.07); first emergency admission adjusted HR=2.87 (2.61, 3.15)). Children with Down syndrome had 28% longer first admission after birth. Admission rate increased from 1990–2003 to 2004–2014 for the Down syndrome group (from 90.7% to 92.2%) and decreased for controls (from 63.3% to 44.8%).ConclusionsWe provide contemporaneous statistics on the live birth rate of babies with Down syndrome, and their childhood death rate. They require more hospital admissions, readmissions emergency admissions and longer lengths of stays than their peers, which has received scant research attention in the past. This demonstrates the importance of statutory planning as well as informal support to families to avoid added problems in child development and family bonding over and above that brought by the intellectual disabilities associated with Down syndrome.

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Obesity and risk of infections: results from men and women in the Swedish National March Cohort

International Journal of Epidemiology ◽

10.1093/ije/dyz129 ◽

2019 ◽

Cited By ~ 1

Author(s):

Francesca Ghilotti ◽

Rino Bellocco ◽

Weimin Ye ◽

Hans-Olov Adami ◽

Ylva Trolle Lagerros

Keyword(s):

Proportional Hazards ◽

Cox Model ◽

Normal Weight ◽

Cox Proportional Hazards ◽

Event Analysis ◽

Obese Women ◽

Cox Models ◽

Increased Risk ◽

Repeated Events ◽

Tract Infections

Abstract Background Previous studies have shown an association between body mass index (BMI) and infections, but the literature on type-specific community acquired infections is still limited. Methods We included 39 163 Swedish adults who completed a questionnaire in September 1997 and were followed through record-linkages until December 2016. Information on BMI was self-reported and infections were identified from the Swedish National Patient Register using International Classification of Diseases (ICD), Tenth Revision (ICD-10) codes. We fitted multivariable Cox proportional hazards models for time-to-first-event analysis, and we used extensions of the standard Cox model when repeated events were included. Results During a 19-year follow-up 32% of the subjects had at least one infection requiring health care contact, leading to a total of 27 675 events. We found an increased incidence of any infection in obese women [hazard ratio (HR) = 1.22; 95% confidence interval (CI) = 1.12; 1.33] and obese men (HR = 1.25; 95% CI = 1.09; 1.43) compared with normal weight subjects. For specific infections, higher incidences were observed for skin infections in both genders (HR = 1.76; 95% CI = 1.47; 2.12 for obese females and HR = 1.74; 95% CI = 1.33; 2.28 for obese males) and gastrointestinal tract infections (HR = 1.44; 95% CI = 1.19; 1.75), urinary tract infections (HR = 1.30; 95% CI = 1.08; 1.55) and sepsis (HR = 2.09; 95% CI = 1.46; 2.99) in obese females. When accounting for repeated events, estimates similar to the aforementioned ones were found. Conclusions Obesity was associated with an increased risk of infections in both genders. Results from multiple-failure survival analysis were consistent with those from classic Cox models.

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One-Year Risk of Recurrent Stroke and Death Associated with Vertebrobasilar Artery Stenosis and Occlusion in a Cohort of 10,515 Patients

Cerebrovascular Diseases ◽

10.1159/000495418 ◽

2019 ◽

Vol 47 (1-2) ◽

pp. 40-47 ◽

Cited By ~ 3

Author(s):

Adnan I. Qureshi ◽

Mushtaq H. Qureshi ◽

Li-Ming Lien ◽

Jiunn-Tay Lee ◽

Jiann-Shing Jeng ◽

...

Keyword(s):

Ischemic Stroke ◽

Proportional Hazards ◽

Proportional Hazards Model ◽

Recurrent Stroke ◽

Cox Proportional Hazards ◽

Cox Proportional Hazards Model ◽

Large Artery ◽

Stroke Registry ◽

Risk Of Death ◽

Vertebrobasilar Artery

Background: The natural history of vertebrobasilar artery (VBA) stenosis or occlusion remains understudied. Methods: Patients with diagnosis of ischemic stroke or transient ischemic attack (TIA) who were noted to have VBA stenosis based on computed tomography or magnetic resonance imaging or catheter-based angiogram were selected from Taiwan Stroke Registry. Cox proportional hazards model was used to determine the hazards ratio (HR) of recurrent stroke and death within 1 year of index event in various groups based on severity of VBA stenosis (none to mild: 0–49%; moderate to severe: 50–99%: occlusion: 100%) after adjusting for differences in demographic and clinical characteristics between groups at baseline evaluation. Results: None to mild or moderate to severe VBA stenosis was diagnosed in 6972 (66%) and 3,137 (29.8%) among 10,515 patients, respectively, and occlusion was identified in 406 (3.8%) patients. Comparing with patients who showed none to mild stenosis of VBA, there was a significantly higher risk of recurrent stroke (HR 1.21, 95% CI 1.01–1.45) among patients with moderate to severe VBA stenosis. There was a nonsignificantly higher risk of recurrent stroke (HR 1.49, 95% CI 0.99–2.22) and significantly higher risk of death (HR 2.21, 95% CI 1.72–2.83), among patients with VBA occlusion after adjustment of potential confounders. Conclusions: VBA stenosis or occlusion was relatively prevalent among patients with TIA or ischemic stroke and associated with higher risk of recurrent stroke and death in patients with ischemic stroke or TIA who had large artery atherosclerosis.

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The association of a 17-gene genomic prostate score with adverse surgical pathology and recurrence following surgery for localized prostate cancer (PCa): A comparison of African American and Caucasian patients.

Journal of Clinical Oncology ◽

10.1200/jco.2015.33.7_suppl.86 ◽

2015 ◽

Vol 33 (7_suppl) ◽

pp. 86-86

Author(s):

Jennifer Cullen ◽

Inger L. Rosner ◽

Timothy C. Brand ◽

Amina Ali ◽

Yongmei Chen ◽

...

Keyword(s):

Clinical Outcomes ◽

Proportional Hazards ◽

Tumor Biology ◽

Cox Proportional Hazards ◽

National Database ◽

Racial Groups ◽

Logistic Regression Models ◽

Gleason Pattern ◽

Medical Centers ◽

Or Gene

86 Background: Molecular assays can improve risk assessment for newly diagnosed PCa, but it is imperative to characterize assay performance in different racial groups, since tumor biology and clinical outcomes may vary. A racially diverse cohort of men (20% AA) with PCa in the Center for Prostate Disease Research multi-center national database was used to determine the association of GPS with outcomes in men treated with radical prostatectomy (RP) for localized PCa. Methods: Biopsy specimens from 431 men treated with RP for NCCN very low, low or intermediate risk PCa at 2 U.S. military medical centers were tested with a 17-gene RT-PCR assay to validate the association between GPS (scale 0-100) and 1) biochemical recurrence (BCR) following RP, and 2) adverse pathology (AP) at RP. BCR was defined as 2 successive PSA levels > 0.2 ng/mL. AP was defined as high-grade (primary Gleason pattern 4 or any pattern 5) and/or pT3 disease. Cox proportional hazards and logistic regression models were used. Results: GPS was obtained in 402 cases (93%), including 82 AA men. A broad range of GPS results was observed in both AA and CA men; GPS distributions were similar between AA (median GPS = 30.3; inter-quartile range (IQR): 23-38) and CA (median GPS = 30.3; IQR: 23-40); no correlation was observed between GPS and race (r = -0.04, p = 0.45). No differences in expression of individual genes or gene groups in the assay were observed between the two groups. In univariable analysis, PSA, biopsy GS and NCCN risk group were associated with BCR and AP, but race was not. The associations between GPS and clinical outcomes were similarly strong and statistically significant in both AA and CA men - BCR HR/20 GPS units = 3.0 (95% CI: 2.0-4.3) for CA vs. 3.5 (95% CI: 1.0-11.7) for AA; AP OR/20 units = 4.0 (95% CI: 2.6-6.6) for CA vs. 2.9 (95% CI: 1.2-7.6) for AA (p < 0.05 for all). Conclusions: In this cohort of patients treated in a health care system with equal access, clinical outcomes and the tumor biology measured by GPS were similar between AA and CA patients. GPS is a significant predictor of BCR and AP in men treated with RP for localized PCa in both AA and CA men.

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Determining the Joint Effect of Obesity and Diabetes on All-Cause Mortality and Cardiovascular-Related Mortality following an Ischemic Stroke

Stroke Research and Treatment ◽

10.1155/2018/4812712 ◽

2018 ◽

Vol 2018 ◽

pp. 1-11 ◽

Cited By ~ 3

Author(s):

Colleen Bauza ◽

Renee’ Martin ◽

Sharon D. Yeatts ◽

Keith Borg ◽

Gayenell Magwood ◽

...

Keyword(s):

Ischemic Stroke ◽

Proportional Hazards ◽

Joint Effect ◽

Normal Weight ◽

Cox Proportional Hazards ◽

Proportional Hazards Regression ◽

Obesity And Diabetes ◽

All Cause Mortality ◽

Obese Subjects ◽

Related Mortality

Although obesity and diabetes mellitus, or diabetes, are independently associated with mortality-related events (e.g., all-cause mortality and cardiovascular-related mortality) following an ischemic stroke, little is known about the joint effect of obesity and diabetes on mortality-related events following an ischemic stroke. The aim of this study is to evaluate the joint effect of obesity and diabetes on mortality-related events in subjects with a recent ischemic stroke. Data from the multicenter Prevention Regimen for Effectively Avoiding Second Strokes (PRoFESS) trial was analyzed for this study. The joint effect of obesity and diabetes on mortality-related events was estimated via Cox proportional hazards regression models. No difference in the hazard of all-cause mortality following an ischemic stroke was observed between obese subjects with diabetes and underweight/normal-weight subjects without diabetes. In contrast, obese subjects with diabetes had an increased hazard of cardiovascular-related mortality following an ischemic stroke compared with underweight/normal-weight subjects without diabetes. Additionally, there was evidence of an attributable proportion due to interaction as well as evidence of a highly statistically significant interaction on the multiplicative scale for cardiovascular-related mortality. In this clinical trial cohort of ischemic stroke survivors, obesity and diabetes synergistically interacted to increase the hazard of cardiovascular-related mortality.

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Effect of Bariatric Surgery on Survival and Hospitalizations in Patients with Severe Obesity. A Retrospective Cohort Study

Nutrients ◽

10.3390/nu13093150 ◽

2021 ◽

Vol 13 (9) ◽

pp. 3150

Author(s):

Enrica Migliore ◽

Amelia Brunani ◽

Giovannino Ciccone ◽

Eva Pagano ◽

Simone Arolfo ◽

...

Keyword(s):

Bariatric Surgery ◽

Cohort Study ◽

Retrospective Cohort Study ◽

Retrospective Cohort ◽

Proportional Hazards ◽

Severe Obesity ◽

Hospital Admissions ◽

Cox Proportional Hazards ◽

Hazard Ratios

Bariatric surgery (BS) confers a survival benefit in specific subsets of patients with severe obesity; otherwise, effects on hospital admissions are still uncertain. We assessed the long-term effect on mortality and on hospitalization of BS in patients with severe obesity. This was a retrospective cohort study, including all patients residing in Piedmont (age 18–60 years, BMI ≥ 40 kg/m2) admitted during 2002–2018 to the Istituto Auxologico Italiano. Adjusted hazard ratios (HR) for BS were estimated for mortality and hospitalization, considering surgery as a time-varying variable. Out of 2285 patients, 331 (14.5%) underwent BS; 64.4% received sleeve gastrectomy (SG), 18.7% Roux-en-Y gastric bypass (RYGB), and 16.9% adjustable gastric banding (AGB). After 10-year follow-up, 10 (3%) and 233 (12%) patients from BS and non-BS groups died, respectively (HR = 0.52; 95% CI 0.27–0.98, by a multivariable Cox proportional-hazards regression model). In patients undergoing SG or RYGB, the hospitalization probability decreased significantly in the after-BS group (HR = 0.77; 0.68–0.88 and HR = 0.78; 0.63–0.98, respectively) compared to non-BS group. When comparing hospitalization risk in the BS group only, a marked reduction after surgery was found for all BS types. In conclusion, BS significantly reduced the risk of all-cause mortality and hospitalization after 10-year follow-up.

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Radical Versus Non-Radical Resection for Early-Stage Retroperitoneal Sarcoma: A Propensity Score-Matched Analysis

Frontiers in Oncology ◽

10.3389/fonc.2021.706543 ◽

2021 ◽

Vol 11 ◽

Author(s):

Chengxin Weng ◽

Jiarong Wang ◽

Jichun Zhao ◽

Ding Yuan ◽

Bin Huang ◽

...

Keyword(s):

Propensity Score ◽

Proportional Hazards ◽

Early Stage ◽

Radical Resection ◽

Cox Proportional Hazards ◽

Retroperitoneal Sarcoma ◽

Stage I ◽

National Database ◽

Cox Proportional Hazards Models ◽

Overall Mortality

BackgroundThe appropriate surgical procedure for early-stage retroperitoneal sarcoma (RPS) is unclear. Thus, we used a national database to compare the outcomes of radical and non-radical resection in patients with early stage RPS.MethodsThis retrospective study included 886 stage I RPS patients from 2004 to 2015 in the SEER database. Outcomes were compared using the multivariate Cox proportional hazards models and the results were presented as adjusted hazards ratio (AHR) with corresponding 95% confidence intervals (95%CIs). Propensity score-matched analyses were also performed for sensitive analyses.ResultsFor the 886 stage I RPS patients, 316 underwent radical resection, and 570 underwent non-radical resection, with a median follow-up of 4.58 (2.73-8.35) years. No difference was observed in overall mortality (AHR 0.84, 95%CI 0.62-1.15; P = 0.28) or RPS-specific mortality (AHR 0.88, 95%CI 0.57-1.36; P = 0.56) between groups. The results were similar in propensity score-matching analyses. However, subgroup analysis revealed that radical resection was associated with significantly decreased risks of overall mortality in male (AHR 0.61, 95%CI 0.38-0.98; P = 0.04) and in patients with radiotherapy (AHR 0.56, 95%CI 0.32-0.98; P = 0.04).ConclusionRadical resection did not improve midterm survival outcomes compared with non-radical resection in overall patients with early stage RPS. However, male patients or patients who received radiotherapy might benefit from radical resection with improved overall survival.

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Clopidogrel Plus Aspirin in Patients With Different Types of Single Small Subcortical Infarction

Frontiers in Neurology ◽

10.3389/fneur.2021.631220 ◽

2021 ◽

Vol 12 ◽

Author(s):

Guangyao Wang ◽

Xiaomeng Yang ◽

Jing Jing ◽

Xingquan Zhao ◽

Liping Liu ◽

...

Keyword(s):

Antiplatelet Therapy ◽

Proportional Hazards ◽

Cox Proportional Hazards ◽

Stroke Recurrence ◽

Parent Artery ◽

Bleeding Events ◽

Significant Difference ◽

Different Types ◽

Subcortical Infarction ◽

Aspirin Group

Background: We aim to investigate the effects and safety of clopidogrel plus aspirin in patients with different types of single small subcortical infarction (SSSI) in the Clopidogrel in High-risk patients with Acute Non-disabling Cerebrovascular Events (CHANCE) trial.Methods: SSSI was defined as single DWI lesion of ≤2.0 cm. Patients with SSSI were divided into SSSI + PAD (parent artery disease) and SSSI – PAD, according to the stenosis of the parent artery. The efficacy outcome was stroke recurrence during 90-day follow-up. Cox proportional hazards models or logistic regression models were used to assess the interaction of the treatment effects of clopidogrel plus aspirin vs. aspirin alone among patients with and without PAD.Results: Among 338 patients with SSSI included in the subanalysis, 105 were with PAD and 233 without. The efficacy of clopidogrel plus aspirin compared with aspirin alone on any stroke was consistent between patients with [adjusted hazard ratio (HR) 0.84; 95% confidence interval (CI), 0.25–2.75] and without PAD (adjusted HR 1.03; 95% CI, 0.40–2.68, interaction P = 0.83). In patients with SSSI + PAD, the rate of stroke recurrence in those treated with dual antiplatelet therapy and mono antiplatelet therapy was not significantly different (10.9 vs. 13.6%, P = 0.77). The number of bleeding events was similar between the clopidogrel-aspirin group and aspirin group regardless of SSSI + PAD or SSSI – PAD.Conclusions: There was no significant difference in the efficacy of clopidogrel plus aspirin compared with aspirin alone between patients with SSSI + PAD and SSSI – PAD in the CHANCE trial. Studies in other populations and with adequate power are needed to further verify such findings.

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Waist Circumference and Mortality or Cardiovascular Events in a General Korean Population

10.21203/rs.3.rs-926930/v1 ◽

2021 ◽

Author(s):

Do Kyeong Song ◽

Young Sun Hong ◽

Yeon-Ah Sung ◽

Hyejin Lee

Keyword(s):

Waist Circumference ◽

National Health ◽

Proportional Hazards ◽

Positive Association ◽

Cox Proportional Hazards ◽

Korean Population ◽

Health Examination ◽

Men And Women ◽

Cox Proportional Hazards Models ◽

Overall Mortality

Abstract Obesity is associated with cardiovascular diseases (CVD). However, body mass index (BMI) has a limited ability to measure abdominal obesity. We aimed to evaluate the associations between waist circumference (WC) and mortality or CVD incidence in a general Korean population. We analyzed a total of 204,068 adults older than 40 years of age who had undergone a national health examination in the Korean National Health Insurance Service Cohort. Hazard ratios for death and CVD incidence were calculated using Cox proportional hazards models after adjustment for age, smoking, alcohol consumption status, levels of physical activity, total cholesterol, hypertension, and diabetes mellitus status. In men, WC and overall mortality showed a reverse J-shaped association. For both men and women, WC was not associated with risk of cardiovascular mortality. Contrary to mortality trend, CVD incidence was positively associated with WC in both men and women, and risk of the CVD incidence was the lowest in subjects with a WC < 80 cm. WC exhibited a significant J-shaped association with overall mortality in men. The risk of incident CVD showed a positive association with central obesity, where the lowest risk was observed for subjects in the lowest WC group in a general Korean population.

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