Hemoglobin and All-Cause Mortality: Results from the Baltimore Longitudinal Study of Aging (BLSA).

Abstract Whether mild-to-moderate hemoglobin (Hb) reduction is associated with increased mortality independent of underlying diseases is still debated. Two epidemiological studies addressing this issue in high risk populations (disabled older women, and persons 85 years or older) reported conflicting results. The BLSA offers the opportunity to investigate this association in an adult generally healthy population. The BLSA is a large cohort study on aging started in 1958. The participants are volunteers living in the Baltimore-Washington area (USA), well educated and self-describing as generally healthy persons. Participants are examined every 1-2 years. In the present analysis, all participants evaluated at least one occasion for Hb were included. Subjects were not excluded for any pre-existing conditions or specific outcomes. Hb levels were measured in 2979 participants recruited from 1958 to 2002 (1793 men and 1186 women, 78.7% Caucasians, age range: 18–96 years). Mean age at initial evaluation was 52.3 (±17.4) years for women and 52.1 (±17.9) for men, and the average time from baseline to death/censoring was 17.6 years for men and 12.4 years for women. Crude mortality rates were 21/1000 person years for men and 9.7/1000 person years for women. After adjusting for age, a U-shaped relationship (obtained fitting a Cox model with a Poisson regression approach according Therneau & Grambsch, 2000) was observed between Hb concentration and mortality with nadir at Hb=12.8g/dL in women and 15.0g in men. In the same model, significant excess of mortality was associated with Hb ≤ 11.2g/dL (95%CI 9.8g/dL–12.3 g/dL) and ≥ 14.0 g/dL (95%CI 13.5g/dL–14.9g/dL) in women, and ≤ 13.4 g/dL (95% CI 12.5g/dL–14.4g/dL) and ≥ 16.2g/dL (95% CI 15.4g/dL–17.2g/dL) in men. After adjusting for demographics, anthropometrics, smoking status, radiation exposure, and co-morbid diseases (heart disease, stroke, pulmonary disease, cancer, diabetes, hypertension), men with Hb ≤ 13.4 g/dL (mean: 12.7 g/dL, SD: 0.6) were at 30% higher risk (RR: 1.31, 95%CI: 1.08–1.58) compared to the reference group (Hb: 13.4–16.2). Accordingly, women with Hb ≤ 11.2 g/dL (mean: 10.2 g/dL, SD: 1.0) showed 100% greater risk compared to the reference group (Hb: 11.2–14.0), however this association was not statistically significant (RR: 2.01, 95% CI: 0.88–4.63). When men with Hb levels <10g/dL and women with <9 g/dL were excluded the results did not substantially change. Our findings showed that in the general population moderately-low Hb levels per se were associated with increased mortality risk. The impact of anemia correction on mortality in the elderly remains to be determined.

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Back Pain and Heart Failure in Older Adults: Findings From the Health ABC Study

Innovation in Aging ◽

10.1093/geroni/igaa057.656 ◽

2020 ◽

Vol 4 (Supplement_1) ◽

pp. 203-203

Author(s):

Jie Chen ◽

Yiming Zhang ◽

Eleanor Simonsick ◽

Angela Starkweather ◽

Ming-Hui Chen ◽

...

Keyword(s):

Heart Failure ◽

Older Adults ◽

Back Pain ◽

Negative Impact ◽

Smoking Status ◽

The Elderly ◽

Epidemiological Studies ◽

Negative Influence ◽

Epidemiologic Studies ◽

The Impact

Abstract Both back pain and heart failure (HF) have negative influence on all aspects of life. Little is known about the impact of back pain on older adults with HF. We include 1295 older adults who had data collected in the 11th year (2007-2008) of the Health, Aging and Body Composition (Health ABC) study to evaluate the effect of back pain on health status among older adults with and without HF. The participants aged 79-91, 54.8% were female and 34.8% were African American. Among 94 participants with HF, 63 (67.0%) had back pain; among 1201 participants without HF, 649 (54.0%) had back pain. Females reporting back pain had 4.76 (95% CI: 1.83, 12.37) times the odds of having HF compared to those without back pain. Male with back pain, compared to those without back pain, had 1.14 times (95% CI: 0.65, 2.02) the odds of having HF. Depressive symptoms were measured by the Center for Epidemiological Studies-Depression (CES-D) scale. Performance and functions were measured by the Established Populations for Epidemiologic Studies in the Elderly (EPESE) performance score, the Health ABC performance battery score and self-reported difficulty with functional tasks. These symptom and performance measures were significantly associated with both back pain and HF, but not the interaction terms of back pain and HF after adjusting demographic variables including gender, race, smoking status and BMI category. The high incidence and negative impact of back pain highlighted the needs of developing strategies in pain management among older adults with and without HF.

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Reintroduction of Oxaliplatin Is Associated With Improved Survival in Advanced Colorectal Cancer

Journal of Clinical Oncology ◽

10.1200/jco.2006.10.4380 ◽

2007 ◽

Vol 25 (22) ◽

pp. 3224-3229 ◽

Cited By ~ 94

Author(s):

Aimery de Gramont ◽

Marc Buyse ◽

Jose Cortinas Abrahantes ◽

Tomasz Burzykowski ◽

Emmanuel Quinaux ◽

...

Keyword(s):

Colorectal Cancer ◽

Advanced Colorectal Cancer ◽

Reference Group ◽

Cox Model ◽

Progression Free Survival ◽

Second Line ◽

Treatment Groups ◽

Number Of Patients ◽

Baseline Factors ◽

The Impact

Purpose In the OPTIMOX1 trial, previously untreated patients with advanced colorectal cancer were randomly assigned to two different schedules of leucovorin, fluorouracil, and oxaliplatin that were administered until progression in the control arm or in a stop-and-go fashion in the experimental arm. The randomly assigned treatment groups did not differ significantly in terms of response rate, progression-free survival, and overall survival (OS). However, the impact of oxaliplatin reintroduction on OS was potentially masked by the fact that a large number of patients did not receive the planned oxaliplatin reintroduction or received oxaliplatin after second-line therapy in both treatment groups. Patients and Methods A Cox model was fitted with all significant baseline factors plus time-dependent variables reflecting tumor progression, reintroduction of oxaliplatin, and use of second-line irinotecan. A shared frailty model was fitted with all significant baseline factors plus the number of lines of chemotherapy received by the patient and the percentage of patients with oxaliplatin reintroduction in the center. An adjusted hazard ratio (HR) was calculated for three reintroduction classes (1% to 20%, 21% to 40%, and > 40%), using centers with no reintroduction (0%) as the reference group. Results Oxaliplatin reintroduction had an independent and significant impact on OS (HR = 0.56, P = .009). The percentage of patients with oxaliplatin reintroductions also had a significant impact on OS. Centers in which more than 40% of the patients were reintroduced had an adjusted HR for OS of 0.59 compared with centers in which no patient was reintroduced. Conclusion Oxaliplatin reintroduction is associated with improved survival in patients with advanced colorectal cancer.

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A comprehensive review of the healthy worker effect in occupational epidemiological studies

International Journal of Research in Medical Sciences ◽

10.18203/2320-6012.ijrms20203702 ◽

2020 ◽

Vol 8 (9) ◽

pp. 3394

Author(s):

Fahad Saad Algarni

Keyword(s):

Reference Group ◽

Epidemiological Studies ◽

Epidemiologic Studies ◽

Mortality And Morbidity ◽

Healthy Worker Effect ◽

Confounding Bias ◽

Comparison Groups ◽

Consequent Reduction ◽

Reduction Of Mortality ◽

The Impact

The reduction of mortality and morbidity rates among occupational cohort studies may be attributed to the presence of the healthy worker effect (HWE). Occupational epidemiologic studies investigating worker’s health are prone to the risk of having the HWE phenomenon and this special form of bias has been debated over the years. Hence, it’s imperative to explore in-depth the magnitude and sources of HWE, and further, elucidate the factors that may affect HWE and strategies reducing HWE. The HWE should be considered as a mixed bias between selection and confounding bias. The validity threats due to the HWE among morbidity studies are the same as the mortality studies. The consequent reduction due to the HWE in the association between the exposure and outcome may lead to underestimating some harmful exposures in the workplace or occupational settings. Healthy hire effect and healthy worker survivor effect are the main sources of HWE. Several factors can increase or decrease the probability of HWE; therefore, the investigators should consider them among future occupational epidemiological studies. Many strategies can help in reducing the impact of HWE, but each strategy has its weaknesses and strengths. Not all strategies can be applied among all occupational epidemiological studies. Mathematical procedures still need further investigations to be validated. HWE is a consequence of inappropriate comparison groups in nature. The usage of the general population as a reference group is not an appropriate choice. By considering the HWE sources and factors and using appropriate strategies, the impact of HWE may be reduced.

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Human Metapneumovirus: A Largely Unrecognized Threat to Human Health

Pathogens ◽

10.3390/pathogens9020109 ◽

2020 ◽

Vol 9 (2) ◽

pp. 109 ◽

Cited By ~ 4

Author(s):

Charles J. Russell ◽

Rhiannon R. Penkert ◽

Sonnie Kim ◽

Julia L. Hurwitz

Keyword(s):

Vaccine Development ◽

The Elderly ◽

Human Metapneumovirus ◽

Respiratory Tract Disease ◽

Lower Respiratory Tract Disease ◽

Life Threatening ◽

High Risk Populations ◽

Tract Disease ◽

The Impact ◽

First Time

Human metapneumovirus (HMPV) infects most children by five years of age. The virus can cause both upper and lower respiratory tract disease and can be life threatening. High-risk populations include young children who are exposed to virus for the first time and the elderly. Currently, there is no standard treatment nor licensed vaccine for HMPV, although several attractive vaccine candidates have been developed for pre-clinical studies. A raised awareness of the impact of HMPV on public health is needed to drive research, complete vaccine development, and thereby prevent significant virus-associated morbidities and mortalities worldwide.

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COVID-19 Treatment: Drug Safety Prior to Conception and During Pregnancy and Breastfeeding

Geburtshilfe und Frauenheilkunde ◽

10.1055/a-1247-5271 ◽

2021 ◽

Vol 81 (01) ◽

pp. 46-60

Author(s):

Marcelo Borges Cavalcante ◽

Candice Torres de Melo Bezerra Cavalcante ◽

Ana Catherine Sampaio Braga ◽

Dennyse Araújo Andrade ◽

Mariana Albuquerque Montenegro ◽

...

Keyword(s):

Severe Acute Respiratory Syndrome ◽

Effective Treatment ◽

Symptomatic Relief ◽

The Elderly ◽

Epidemiological Studies ◽

Reproductive Age ◽

World Health ◽

The World ◽

Health Organization ◽

The Impact

AbstractIn December 2019, a new viral respiratory infection known as coronavirus disease 2019 (COVID-19) was first diagnosed in the city of Wuhan, China. COVID-19 quickly spread across the world, leading the World Health Organization to declare it a pandemic on March 11, 2020. The disease is caused by the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), a similar virus to those involved in other epidemics such as severe acute respiratory syndrome coronavirus (SARS-CoV) and Middle East respiratory syndrome coronavirus (MERS-CoV). Epidemiological studies have shown that COVID-19 frequently affects young adults of reproductive age and that the elderly and patients with chronic disease have high mortality rates. Little is known about the impact of COVID-19 on pregnancy and breastfeeding. Most COVID-19 cases present with mild flu-like symptoms and only require treatment with symptomatic relief medications, whereas other cases with COVID-19 require treatment in an intensive care unit. There is currently no specific effective treatment for COVID-19. A large number of drugs are being used to fight infection by SARS-CoV-2. Experience with this therapeutic arsenal has been gained over the years in the treatment of other viral, autoimmune, parasitic, and bacterial diseases. Importantly, the search for an effective treatment for COVID-19 cannot expose pregnant women infected with SARS-CoV-2 to the potential teratogenic risks of these drugs. Therefore, it is necessary to determine and understand the safety of anti-COVID-19 therapies prior to conception and during pregnancy and breastfeeding.

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Particulate Emissions: Health Effects and Labour Market Consequences

Journal of Environmental and Public Health ◽

10.1155/2012/130502 ◽

2012 ◽

Vol 2012 ◽

pp. 1-7 ◽

Cited By ~ 2

Author(s):

Marie Kruse ◽

Bjørn Sætterstrøm ◽

Jakob Bønløkke ◽

Henrik Brønnum-Hansen ◽

Esben Meulengracht Flachs ◽

...

Keyword(s):

Air Pollution ◽

Labour Market ◽

Cost Benefit Analysis ◽

Reference Group ◽

Smoking Status ◽

Disease Incidence ◽

Chronic Obstructive ◽

Particulate Emissions ◽

Productivity Cost ◽

The Impact

The objective of this study was to analyse the productivity cost savings associated with mitigation of particulate emissions, as an input to a cost-benefit analysis. Reduced emissions of particulate matter (PM2.5) may reduce the incidence of diseases related to air pollution and potentially increase productivity as a result of better health. Based on data from epidemiological studies, we modelled the impact of air pollution on four different diseases: coronary heart disease, stroke, lung cancer, and chronic obstructive pulmonary disease. We identified individuals with these diseases and modelled changes in disease incidence as an expression of exposure. The labour market affiliation and development in wages over time for exposed individuals was compared to that of a reference group of individuals matched on a number of sociodemographic variables, comorbidity, and predicted smoking status. We identified a productivity cost of about 1.8 million EURO per 100,000 population aged 50–70 in the first year, following an increase inPM2.5emissions. We have illustrated how the potential impact of air pollution may influence social production by application of a matched study design that renders a study population similar to that of a trial. The result suggests that there may be a productivity gain associated with mitigation efforts.

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Traumatic brain injury in the presence of Aβ pathology affects neuronal survival, glial activation and autophagy

Scientific Reports ◽

10.1038/s41598-021-02371-3 ◽

2021 ◽

Vol 11 (1) ◽

Author(s):

Linn Streubel-Gallasch ◽

Marlena Zyśk ◽

Chiara Beretta ◽

Anna Erlandsson

Keyword(s):

Traumatic Brain Injury ◽

Brain Injury ◽

Calcium Binding ◽

Amyloid Β ◽

The Elderly ◽

Epidemiological Studies ◽

Cellular Level ◽

Glial Activation ◽

Acute Injury ◽

The Impact

AbstractTraumatic brain injury (TBI) presents a widespread health problem in the elderly population. In addition to the acute injury, epidemiological studies have observed an increased probability and earlier onset of dementias in the elderly following TBI. However, the underlying mechanisms of the connection between TBI and Alzheimer’s disease in the aged brain and potential exacerbating factors is still evolving. The aim of this study was to investigate cellular injury-induced processes in the presence of amyloid β (Aβ) pathology. For this purpose, a co-culture system of cortical stem-cell derived astrocytes, neurons and oligodendrocytes were exposed to Aβ42 protofibrils prior to a mechanically induced scratch injury. Cellular responses, including neurodegeneration, glial activation and autophagy was assessed by immunoblotting, immunocytochemistry, ELISA and transmission electron microscopy. Our results demonstrate that the combined burden of Aβ exposure and experimental TBI causes a decline in the number of neurons, the differential expression of the key astrocytic markers glial fibrillary acidic protein and S100 calcium-binding protein beta, mitochondrial alterations and prevents the upregulation of autophagy. Our study provides valuable information about the impact of TBI sustained in the presence of Aβ deposits and helps to advance the understanding of geriatric TBI on the cellular level.

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Systemic inflammation and emotional responses during the COVID-19 pandemic

Translational Psychiatry ◽

10.1038/s41398-021-01753-5 ◽

2021 ◽

Vol 11 (1) ◽

Author(s):

Odessa S. Hamilton ◽

Dorina Cadar ◽

Andrew Steptoe

Keyword(s):

Mental Health ◽

Depressive Symptoms ◽

Systemic Inflammation ◽

Smoking Status ◽

Large Population ◽

Depression Scale ◽

High Sensitivity ◽

Epidemiological Studies ◽

Short Version ◽

The Impact

AbstractThe impact of the COVID-19 pandemic on population mental health is of global concern. Inflammatory processes are thought to contribute to mental ill-health, but their role in experiences of psychological distress during the pandemic has not been investigated. We tested the hypothesis that elevated inflammatory biomarkers (high-sensitivity plasma C-reactive protein [CRP] and plasma fibrinogen) measured pre-pandemic would be positively predictive of increased depressive symptoms experienced during the pandemic. Data were analysed from the English Longitudinal Study of Ageing (ELSA), with 3574 individuals aged >50 for CRP and 3314 for fibrinogen measured in waves 8 (2016/17) or 9 (2018/19). Depressive symptoms were measured with a short version of the Centre for Epidemiological Studies Depression Scale (CES-D) pre-pandemic (2016–2019) and during the pandemic (June/July 2020). Participants with higher baseline CRP concentrations had 40% higher odds of developing depressive symptoms during the pandemic (ORadjusted = 1.40, 95% CI 1.12–1.73, p = 0.003) after full adjustment. Fibrinogen concentrations were also associated with depressive symptoms during the pandemic (ORadjusted = 1.23, 95% CI 1.04–1.46, p = 0.019), but this association was no longer significant after controlling for lifestyle factors (smoking status, alcohol consumption and physical activity). In this large population study, systemic inflammation measured 1–3 years pre-pandemic was associated with greater depressed mood during the early months of the pandemic. This finding is consistent with the hypothesis that higher levels of inflammation increase the vulnerability of older people to impaired mental health in the presence of the widespread stress of the COVID-19 pandemic.

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Retrospective analysis of the impact of age on overall survival in patients with non-small cell lung cancer.

Journal of Clinical Oncology ◽

10.1200/jco.2012.30.15_suppl.e18018 ◽

2012 ◽

Vol 30 (15_suppl) ◽

pp. e18018-e18018

Author(s):

Dai Chu Nguyen Luu ◽

Rizvan Mamet ◽

Carrie C. Zornosa ◽

Joyce C. Niland ◽

Thomas A. D'Amico ◽

...

Keyword(s):

Lung Cancer ◽

Clinical Trials ◽

Small Cell Lung Cancer ◽

Retrospective Analysis ◽

Cox Model ◽

Smoking Status ◽

Small Cell ◽

Small Cell Lung ◽

Nsclc Patients ◽

The Impact

e18018 Background: Clinical trials have failed to demonstrate that age is a significant prognostic indicator among patients treated for non-small cell lung cancer (NSCLC). Clinical trials do not necessarily represent real-world experience, however. We sought to analyze the impact of age on survival in patients in the National Comprehensive Cancer Network (NCCN) NSCLC Outcomes Database. Methods: We performed a retrospective analysis of 6,834 NSCLC patients from the NCCN NSCLC Database representing 8 NCCN institutions. Of this population, 4,943 patients were eligible for our analysis. Exclusion criteria included the following: alive patients with < 180 days of follow-up, patients with incomplete staging, and patients with a prior cancer diagnosis. The study population was separated into five age quintiles with equal number of patients in each group. Variables included institution, smoking status, gender, race, Charlson comorbidity score, ECOG performance status (PS), histology, stage, and receipt of resection, drug and radiation therapy. Multivariable Cox model was performed for the effect of age on survival after adjusting for the above variables. Model assumptions were evaluated via graphs and residual tests. Results: Across the five quintiles (< 54, 54-60, 61-66, 67-72 and ≥ 73) there was a trend towards lower stage and higher Charlson score with increasing quintile. In addition, there was an increased proportion of patients with squamous cancer in the older age group. In the adjusted Cox model, there was a statistically significant longer survival in each of four younger quintiles compared to the reference group of ≥ 73 years of age (p=0.01). The adjusted hazard ratio of death for patients < 54 was .82 (95% CI = .72 to .94), for patients 54-60 was .86 (95% CI = .76 to .97), for patients 61-66 was .84 (95% CI = .74 to .95), and for patients 67-72 was .84 (95% CI = .74 to .95). There were no statistically significant pairwise interactions among age, smoking status and stage. Conclusions: Even after adjusting for institution, comorbidity scores, smoking status, race, gender, ECOG PS, histology, stage and treatment, NSCLC patients who were ≥ 73 years of age had a worse survival when compared to younger age groups.

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Smoking is Associated with Higher Mortality and Hospitalization Secondary to Novel Coronavirus: A Systematic Review

Journal of Integrative Cardiology Open Access ◽

10.31487/j.jicoa.2020.03.08 ◽

2020 ◽

pp. 1-5

Author(s):

Arise Garcia de Siqueira Galil ◽

Alberto Barceló ◽

Arise Garcia de Siqueira Galil ◽

Gabriel de Souza Quirino ◽

Guilherme Gouveia Hollunder ◽

...

Keyword(s):

Systematic Review ◽

Smoking Status ◽

The Elderly ◽

The Novel ◽

Population Total ◽

Search Terms ◽

Hospitalization Rates ◽

Bibliographic Search ◽

Novel Coronavirus ◽

The Impact

Aim: The aim of the present study was to assess whether there is an association between smoking and higher mortality and hospitalization due to the disease of the new coronavirus (COVID-19). Methods: A systematic review of studies on the novel coronavirus containing information on smoking and its association with COVID-19 mortality was carried out. The bibliographic search was performed using six databases, with the search terms: ['novel coronavirus' OR ‘COVID- 19'] AND ['smoking' OR ‘tobacco'] AND ['mortality']. Studies published from December 2019 until April 8, 2020 were included. As an inclusion criterion, studies targeting humans, adults, infected with Sars-Cov-2 were selected, and as the chosen language, English. Results: From the total of researched studies, 65 articles were selected, one being presented in two databases simultaneously. As a final result of this review, 11 articles were included, with a population total estimated at 84.050 patients, with the prevalence of smokers ranged from 1.4% to 27.3% and it was observed that the impact of smoking on fatal outcomes was described in four publications, with unfavourable repercussions on hospitalization rates and more serious conditions secondary to COVID-19 (9 out of the 11 publications evaluated). Conclusion: The presence of smoking can worsen infectious conditions by COVID-19 and increase the prevalence of hospitalizations and fatal outcomes, especially in men, the elderly and those with multimorbidities. Smoking status should be used in the screening of patients infected with the novel coronavirus given the evidence of poorer outcomes among smokers.

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