Race and Cancer-Associated Venous Thromboembolism in the Reasons for Geographic and Racial Differences in Stroke (REGARDS) Study

Abstract Introduction: Venous thromboembolism (VTE) is classified as provoked (associated with surgery, hospitalization, trauma, or cancer) and unprovoked events. Whether provoked, unprovoked or cancer-associated VTE differs by age, sex, race, or region in the United States is poorly understood. Methods: VTE events were ascertained in 30,183 individuals in the REGARDS cohort enrolled between 2003-2007 in the contiguous United States. Participants were enrolled in their homes, with a goal of 50% of the cohort being black, female, and living in the southeastern US. VTE events were identified by telephone interviews, review of hospitalizations and deaths and validated by physician review of medical records. Cancer-associated VTE (CA-VTE) was defined as a VTE associated with active cancer or chemotherapy in the last 90 days. Non-cancer, provoked VTE was defined as a VTE that was preceded within 90 days by major trauma, surgery, or hospitalization. Unprovoked VTE was defined as having none of the above risk factors. The associations of age, sex, race and region with cancer-associated, provoked, and unprovoked VTE were analyzed by chi square analyses and Cox proportional hazard ratios that were adjusted for age, sex, race, region and obesity. Results: Overall, 332 VTE events occurred over a mean of 4.7 years follow up. Of these, 163 events (49.1%) were provoked, 47 (14.2%) were CA-VTE. The proportion of unprovoked to provoked VTE did not differ by age (120 to 104 in those older than 65, 49 to 59 for those under 65, p=0.16) sex (98 to 90 in men, 71 to 73 in women, p=0.61), race (61 to 62 in blacks, 108 to 101 in whites, p=0.71) or region (89 to 88 in the Southeast, 80 to 75 for the rest of the country p=0.81); however CA-VTE was significantly less common in blacks (11 of 123, 8.9%) than whites (36 of 209, 17.2%) (p=0.04). While the overall risk of VTE was similar in blacks and whites, blacks had a lower risk of CA-VTE than whites (Hazard Ratio (HR) 0.38, 95% Confidence Interval (CI) 0.18-0.77). Increased age and male sex were associated with an increased risk for all-cause VTE and unprovoked VTE with a trend for male sex and increased risk for provoked VTE (Table). However, men had no increased risk of CA-VTE compared to women (0.85 95% CI 0.46-1.55). Discussion: The proportion of provoked versus unprovoked VTE events did not differ by age, sex, race or region in REGARDS, though blacks had a lower proportion of CA-VTE than whites. Men overall had a higher risk of VTE than women, but there was no increased risk for CA-VTE in men. Blacks and whites had a similar risk of VTE overall, however blacks had a lower incidence of CA-VTE than whites. Possible reasons for our findings include shorter survival after a diagnosis of cancer, different cancer types or treatments, or differential ascertainment of VTE by race or sex. These findings highlight the need to understand how sex and race impact VTE incidence so we can best prevent VTE in everyone. Table. Hazard Ratios for different VTE subtypes by Age, Sex, and Race (95% Confidence Interval) All VTE Unprovoked VTE Provoked VTE Cancer-Associated VTE Age (per SD, 9.4 years) 1.61 (1.43-1.80) 1.70 (1.44-1.99) 1.52 (1.29-1.79) 1.48 (1.09-2.02) Male Sex 1.42 (1.13-1.78) 1.52 (1.11-2.09) 1.32 (0.96-1.82) 0.85 (0.47-1.55) Black versus White Race 0.90 (0.71-1.13) 0.84 (0.61-1.16) 0.96 (0.69-1.34) 0.38 (0.18-0.77) Disclosures No relevant conflicts of interest to declare.

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Early initiation of prophylactic anticoagulation for prevention of coronavirus disease 2019 mortality in patients admitted to hospital in the United States: cohort study

BMJ ◽

10.1136/bmj.n311 ◽

2021 ◽

pp. n311

Author(s):

Christopher T Rentsch ◽

Joshua A Beckman ◽

Laurie Tomlinson ◽

Walid F Gellad ◽

Charles Alcorn ◽

...

Keyword(s):

United States ◽

Cohort Study ◽

Confidence Interval ◽

Hospital Admission ◽

The United States ◽

Early Initiation ◽

Inpatient Mortality ◽

Therapeutic Anticoagulation ◽

Increased Risk ◽

Prophylactic Anticoagulation

Abstract Objective To evaluate whether early initiation of prophylactic anticoagulation compared with no anticoagulation was associated with decreased risk of death among patients admitted to hospital with coronavirus disease 2019 (covid-19) in the United States. Design Observational cohort study. Setting Nationwide cohort of patients receiving care in the Department of Veterans Affairs, a large integrated national healthcare system. Participants All 4297 patients admitted to hospital from 1 March to 31 July 2020 with laboratory confirmed severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection and without a history of anticoagulation. Main outcome measures The main outcome was 30 day mortality. Secondary outcomes were inpatient mortality, initiating therapeutic anticoagulation (a proxy for clinical deterioration, including thromboembolic events), and bleeding that required transfusion. Results Of 4297 patients admitted to hospital with covid-19, 3627 (84.4%) received prophylactic anticoagulation within 24 hours of admission. More than 99% (n=3600) of treated patients received subcutaneous heparin or enoxaparin. 622 deaths occurred within 30 days of hospital admission, 513 among those who received prophylactic anticoagulation. Most deaths (510/622, 82%) occurred during hospital stay. Using inverse probability of treatment weighted analyses, the cumulative incidence of mortality at 30 days was 14.3% (95% confidence interval 13.1% to 15.5%) among those who received prophylactic anticoagulation and 18.7% (15.1% to 22.9%) among those who did not. Compared with patients who did not receive prophylactic anticoagulation, those who did had a 27% decreased risk for 30 day mortality (hazard ratio 0.73, 95% confidence interval 0.66 to 0.81). Similar associations were found for inpatient mortality and initiation of therapeutic anticoagulation. Receipt of prophylactic anticoagulation was not associated with increased risk of bleeding that required transfusion (hazard ratio 0.87, 0.71 to 1.05). Quantitative bias analysis showed that results were robust to unmeasured confounding (e-value lower 95% confidence interval 1.77 for 30 day mortality). Results persisted in several sensitivity analyses. Conclusions Early initiation of prophylactic anticoagulation compared with no anticoagulation among patients admitted to hospital with covid-19 was associated with a decreased risk of 30 day mortality and no increased risk of serious bleeding events. These findings provide strong real world evidence to support guidelines recommending the use of prophylactic anticoagulation as initial treatment for patients with covid-19 on hospital admission.

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Abortion, substance abuse and mental health in early adulthood: Thirteen-year longitudinal evidence from the United States

SAGE Open Medicine ◽

10.1177/2050312116665997 ◽

2016 ◽

Vol 4 ◽

pp. 205031211666599 ◽

Cited By ~ 11

Author(s):

Donald Paul Sullins

Keyword(s):

Mental Health ◽

United States ◽

Mental Disorders ◽

Confidence Interval ◽

Pregnancy Outcomes ◽

Pregnancy Loss ◽

Early Adulthood ◽

The United States ◽

Mental Health Disorder ◽

Increased Risk

Objective: To examine the links between pregnancy outcomes (birth, abortion, or involuntary pregnancy loss) and mental health outcomes for US women during the transition into adulthood to determine the extent of increased risk, if any, associated with exposure to induced abortion. Method: Panel data on pregnancy history and mental health history for a nationally representative cohort of 8005 women at (average) ages 15, 22, and 28 years from the National Longitudinal Study of Adolescent to Adult Health were examined for risk of depression, anxiety, suicidal ideation, alcohol abuse, drug abuse, cannabis abuse, and nicotine dependence by pregnancy outcome (birth, abortion, and involuntary pregnancy loss). Risk ratios were estimated for time-dynamic outcomes from population-averaged longitudinal logistic and Poisson regression models. Results: After extensive adjustment for confounding, other pregnancy outcomes, and sociodemographic differences, abortion was consistently associated with increased risk of mental health disorder. Overall risk was elevated 45% (risk ratio, 1.45; 95% confidence interval, 1.30–1.62; p < 0.0001). Risk of mental health disorder with pregnancy loss was mixed, but also elevated 24% (risk ratio, 1.24; 95% confidence interval, 1.13–1.37; p < 0.0001) overall. Birth was weakly associated with reduced mental disorders. One-eleventh (8.7%; 95% confidence interval, 6.0–11.3) of the prevalence of mental disorders examined over the period were attributable to abortion. Conclusion: Evidence from the United States confirms previous findings from Norway and New Zealand that, unlike other pregnancy outcomes, abortion is consistently associated with a moderate increase in risk of mental health disorders during late adolescence and early adulthood.

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Hemorrhage in patients with polycythemia vera receiving aspirin with an anticoagulant: a prospective, observational study

Haematologica ◽

10.3324/haematol.2021.279032 ◽

2021 ◽

Author(s):

Jeffrey I. Zwicker ◽

Dilan Paranagama ◽

David S. Lessen ◽

Philomena M. Colucci ◽

Michael R. Grunwald

Keyword(s):

United States ◽

Observational Study ◽

Confidence Interval ◽

Polycythemia Vera ◽

Prospective Observational Study ◽

The United States ◽

Increased Risk ◽

Adjusted Rate ◽

Risk Of Hemorrhage

Polycythemia vera (PV) is associated with increased risk of thrombosis and hemorrhage. Aspirin, recommended for primary thromboprophylaxis, is often combined with anticoagulants during management of acute thrombotic events. The safety of dual antiplatelet and anticoagulant therapy is not established in PV. In a prospective, observational study, 2510 patients with PV were enrolled at 227 sites in the United States. Patients were monitored for the development of hemorrhage and thrombosis after enrollment. A total of 1602 patients with PV received aspirin with median (range) follow-up of 2.4 (0-3.6) years. The exposure-adjusted rate of all hemorrhages in patients receiving aspirin alone was 1.40 per 100 patient-years (95% confidence interval [CI]: 0.99-1.82). The combination of aspirin plus anticoagulant was associated with an incidence of hemorrhage of 6.75 per 100 patient-years (95% CI: 3.04-10.46). The risk of hemorrhage was significantly greater in patients receiving the combination of aspirin and anticoagulant compared with aspirin alone (total hemorrhages, hazard ratio [HR]: 5.83; 95% CI: 3.36-10.11; P

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Increase in Suicidal Thinking During COVID-19

Clinical Psychological Science ◽

10.1177/2167702621993857 ◽

2021 ◽

pp. 216770262199385

Author(s):

Rebecca G. Fortgang ◽

Shirley B. Wang ◽

Alexander J. Millner ◽

Azure Reid-Russell ◽

Anna L. Beukenhorst ◽

...

Keyword(s):

United States ◽

Confidence Interval ◽

Social Isolation ◽

Odds Ratio ◽

The United States ◽

Suicidal Thinking ◽

Increased Risk ◽

Monitoring Study ◽

Before And After ◽

National Emergency

There is concern that the COVID-19 pandemic may cause increased risk of suicide. In the current study, we tested whether suicidal thinking has increased during the COVID-19 pandemic and whether such thinking was predicted by increased feelings of social isolation. In a sample of 55 individuals recently hospitalized for suicidal thinking or behaviors and participating in a 6-month intensive longitudinal smartphone monitoring study, we examined suicidal thinking and isolation before and after the COVID-19 pandemic was declared a national emergency in the United States. We found that suicidal thinking increased significantly among adults (odds ratio [ OR] = 4.01, 95% confidence interval [CI] = [3.28, 4.90], p < .001) but not adolescents ( OR = 0.84, 95% CI = [0.69, 1.01], p = .07) during the onset of the COVID-19 pandemic. Increased feelings of isolation predicted suicidal thinking during the pandemic phase. Given the importance of social distancing policies, these findings support the need for digital outreach and treatment.

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Dietary patterns related to total mortality and cancer mortality in the United States

Cancer Causes & Control ◽

10.1007/s10552-021-01478-2 ◽

2021 ◽

Author(s):

Marcela R. Entwistle ◽

Donald Schweizer ◽

Ricardo Cisneros

Keyword(s):

United States ◽

Dietary Patterns ◽

Cancer Mortality ◽

Cox Regression ◽

Total Mortality ◽

Principal Component ◽

The United States ◽

Red Meat ◽

Increased Risk ◽

All Cause Mortality

Abstract Purpose This study investigated the association between dietary patterns, total mortality, and cancer mortality in the United States. Methods We identified the four major dietary patterns at baseline from 13,466 participants of the NHANES III cohort using principal component analysis (PCA). Dietary patterns were categorized into ‘prudent’ (fruits and vegetables), ‘western’ (red meat, sweets, pastries, oils), ‘traditional’ (red meat, legumes, potatoes, bread), and ‘fish and alcohol’. We estimated hazard ratios for total mortality, and cancer mortality using Cox regression models. Results A total of 4,963 deaths were documented after a mean follow-up of 19.59 years. Higher adherence to the ‘prudent’ pattern was associated with the lowest risk of total mortality (5th vs. 1st quintile HR 0.90, 95% CI 0.82–0.98), with evidence that all-cause mortality decreased as consumption of the pattern increased. No evidence was found that the ‘prudent’ pattern reduced cancer mortality. The ‘western’ and the ‘traditional’ patterns were associated with up to 22% and 16% increased risk for total mortality (5th vs. 1st quintile HR 1.22, 95% CI 1.11–1.34; and 5th vs. 1st quintile HR 1.16, 95% CI 1.06–1.27, respectively), and up to 33% and 15% increased risk for cancer mortality (5th vs. 1st quintile HR 1.33, 95% CI 1.10–1.62; and 5th vs. 1st quintile HR 1.15, 95% CI 1.06–1.24, respectively). The associations between adherence to the ‘fish and alcohol’ pattern and total mortality, and cancer mortality were not statistically significant. Conclusion Higher adherence to the ‘prudent’ diet decreased the risk of all-cause mortality but did not affect cancer mortality. Greater adherence to the ‘western’ and ‘traditional’ diet increased the risk of total mortality and mortality due to cancer.

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Household COVID-19 risk and in-person schooling

Science ◽

10.1126/science.abh2939 ◽

2021 ◽

pp. eabh2939

Author(s):

Justin Lessler ◽

M. Kate Grabowski ◽

Kyra H. Grantz ◽

Elena Badillo-Goicoechea ◽

C. Jessica E. Metcalf ◽

...

Keyword(s):

United States ◽

Online Survey ◽

Positive Association ◽

The United States ◽

Mitigation Measures ◽

Office Work ◽

School Based ◽

Increased Risk ◽

Extra Curricular Activities ◽

Low Levels

In-person schooling has proved contentious and difficult to study throughout the SARS-CoV-2 pandemic. Data from a massive online survey in the United States indicates an increased risk of COVID-19-related outcomes among respondents living with a child attending school in-person. School-based mitigation measures are associated with significant reductions in risk, particularly daily symptoms screens, teacher masking, and closure of extra-curricular activities. A positive association between in-person schooling and COVID-19 outcomes persists at low levels of mitigation, but when seven or more mitigation measures are reported, a significant relationship is no longer observed. Among teachers, working outside the home was associated with an increase in COVID-19-related outcomes, but this association is similar to other occupations (e.g., healthcare, office work). While in-person schooling is associated with household COVID-19 risk, this risk can likely be controlled with properly implemented school-based mitigation measures.

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Longer Residence in the United States is Associated With More Physical Function Limitations in African Immigrant Older Adults

Journal of Applied Gerontology ◽

10.1177/0733464820977608 ◽

2020 ◽

pp. 073346482097760

Author(s):

Manka Nkimbeng ◽

Yvonne Commodore-Mensah ◽

Jacqueline L. Angel ◽

Karen Bandeen-Roche ◽

Roland J. Thorpe ◽

...

Keyword(s):

United States ◽

Older Adults ◽

Confidence Interval ◽

Physical Function ◽

Racial Discrimination ◽

African Immigrants ◽

The United States ◽

African Immigrant ◽

High Discrimination ◽

The Mean

Acculturation and racial discrimination have been independently associated with physical function limitations in immigrant and United States (U.S.)-born populations. This study examined the relationships among acculturation, racial discrimination, and physical function limitations in N = 165 African immigrant older adults using multiple linear regression. The mean age was 62 years ( SD = 8 years), and 61% were female. Older adults who resided in the United States for 10 years or more had more physical function limitations compared with those who resided here for less than 10 years ( b = −2.62, 95% confidence interval [CI] = [–5.01, –0.23]). Compared to lower discrimination, those with high discrimination had more physical function limitations ( b = −2.51, 95% CI = [–4.91, –0.17]), but this was no longer significant after controlling for length of residence and acculturation strategy. Residing in the United States for more than 10 years is associated with poorer physical function. Longitudinal studies with large, diverse samples of African immigrants are needed to confirm these associations.

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Altitude and risk of sudden unexpected infant death in the United States

Scientific Reports ◽

10.1038/s41598-021-81613-w ◽

2021 ◽

Vol 11 (1) ◽

Author(s):

Richard Johnston ◽

Xiaohan Yan ◽

Tatiana M. Anderson ◽

Edwin A. Mitchell

Keyword(s):

United States ◽

Logistic Regression ◽

Infant Death ◽

The United States ◽

Sudden Infant ◽

Data Set ◽

Live Births ◽

Sudden Unexpected Infant Death ◽

Increased Risk ◽

Unexpected Infant Death

AbstractThe effect of altitude on the risk of sudden infant death syndrome (SIDS) has been reported previously, but with conflicting findings. We aimed to examine whether the risk of sudden unexpected infant death (SUID) varies with altitude in the United States. Data from the Centers for Disease Control and Prevention (CDC)’s Cohort Linked Birth/Infant Death Data Set for births between 2005 and 2010 were examined. County of birth was used to estimate altitude. Logistic regression and Generalized Additive Model (GAM) were used, adjusting for year, mother’s race, Hispanic origin, marital status, age, education and smoking, father’s age and race, number of prenatal visits, plurality, live birth order, and infant’s sex, birthweight and gestation. There were 25,305,778 live births over the 6-year study period. The total number of deaths from SUID in this period were 23,673 (rate = 0.94/1000 live births). In the logistic regression model there was a small, but statistically significant, increased risk of SUID associated with birth at > 8000 feet compared with < 6000 feet (aOR = 1.93; 95% CI 1.00–3.71). The GAM showed a similar increased risk over 8000 feet, but this was not statistically significant. Only 9245 (0.037%) of mothers gave birth at > 8000 feet during the study period and 10 deaths (0.042%) were attributed to SUID. The number of SUID deaths at this altitude in the United States is very small (10 deaths in 6 years).

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Time to First Cigarette and Self-Reported Health Among US Adult Smokers

Tobacco Use Insights ◽

10.1177/1179173x18825262 ◽

2019 ◽

Vol 12 ◽

pp. 1179173X1882526 ◽

Cited By ~ 1

Author(s):

Baksun Sung

Keyword(s):

United States ◽

Propensity Score ◽

Odds Ratio ◽

Adjusted Odds Ratio ◽

Smoking Behavior ◽

The United States ◽

Elevated Risk ◽

Poor Health ◽

Increased Risk ◽

Reported Health

Background: Numerous studies have reported that shorter time to first cigarette (TTFC) is linked to elevated risk for smoking-related morbidity. However, little is known about the influence of early TTFC on self-reported health among current smokers. Hence, the objective of this study was to examine the association between TTFC and self-reported health among US adult smokers. Methods: Data came from the 2012-2013 National Adult Tobacco Survey (NATS). Current smokers aged 18 years and older (N = 3323) were categorized into 2 groups based on TTFC: ≤ 5 minutes (n = 1066) and >5 minutes (n = 2257). Propensity score matching (PSM) was used to control selection bias. Results: After adjusting for sociodemographic and smoking behavior factors, current smokers with early TTFC had higher odds for poor health in comparison with current smokers with late TTFC in the prematching (adjusted odds ratio [AOR] = 1.65; 95% confidence interval [CI] = 1.31-2.08) and postmatching (AOR = 1.60; 95% CI = 1.22-2.09) samples. Conclusions: In conclusion, smokers with early TTFC were associated with increased risk of poor health in the United States. To reduce early TTFC, elaborate efforts are needed to educate people about harms of early TTFC and benefits of stopping early TTFC.

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Sickle Cell Trait and Renal Function in Hispanics in the United States: the Northern Manhattan Study

Ethnicity & Disease ◽

10.18865/ed.27.1.11 ◽

2017 ◽

Vol 27 (1) ◽

pp. 11 ◽

Cited By ~ 7

Author(s):

Nicole D. Dueker ◽

David Della-Morte ◽

Tatjana Rundek ◽

Ralph L. Sacco ◽

Susan H. Blanton

Keyword(s):

United States ◽

Chronic Kidney Disease ◽

African Americans ◽

Kidney Disease ◽

Sickle Cell ◽

Sickle Cell Trait ◽

The United States ◽

Genetic Mutation ◽

Single Mutation ◽

Increased Risk

Sickle cell anemia (SCA) is a common hematological disorder among individuals of African descent in the United States; the disorder results in the production of abnormal hemoglobin. It is caused by homozygosity for a genetic mutation in HBB; rs334. While the presence of a single mutation (sickle cell trait, SCT) has long been considered a benign trait, recent research suggests that SCT is associated with renal dysfunction, including a decrease in estimated glomerular filtration rate (eGFR) and increased risk of chronic kidney disease (CKD) in African Americans. It is currently unknown whether similar associations are observed in Hispanics. Therefore, our study aimed to determine if SCT is associated with mean eGFR and CKD in a sample of 340 Dominican Hispanics from the Northern Manhattan Study. Using regression analyses, we tested rs334 for association with eGFR and CKD, adjusting for age and sex. eGFR was estimated using the Chronic Kidney Disease Epidemiology Collaboration equation and CKD was defined as eGFR < 60 mL/min/1.73 m2. Within our sample, there were 16 individuals with SCT (SCT carriers). We found that SCT carriers had a mean eGFR that was 12.12 mL/min/1.73m2 lower than non-carriers (P=.002). Additionally, SCT carriers had 2.72 times higher odds of CKD compared with non-carriers (P=.09). Taken together, these novel results show that Hispanics with SCT, as found among African Americans with SCT, may also be at increased risk for kidney disease.Ethn Dis. 2017; 27(1):11-14; doi:10.18865/ed.27.1.11.

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