Vitamin D status and epigenetic-based mortality risk score: strong independent and joint prediction of all-cause mortality in a population-based cohort study

Abstract Objectives The aim of this prospective cohort study was to investigate the associations between maternal vitamin D status in late pregnancy and emergency caesarean section (EMCS) and birth asphyxia, in a population based sample of women in Sweden. Methods Pregnant women were recruited at the antenatal care in Sweden and 1832 women were included after exclusion of miscarriages, terminated pregnancies and missing data on vitamin D status. Mode of delivery was retrieved from medical records. EMCS was defined as caesarean section after onset of labour. Birth asphyxia was defined as either 5 min Apgar score < 7 or arterial umbilical cord pH < 7.1. Serum was sampled in the third trimester of pregnancy (T3) and 25-hydroxyvitamin D (25OHD) was analysed by liquid chromatography tandem mass spectrometry. Vitamin D deficiency was defined as 25OHD < 30 nmol/L, and associations were studied using logistic regression analysis and expressed as adjusted odds ratios (AOR). Results In total, 141 (7.7%) women had an EMCS and 58 (3.2%) children were born with birth asphyxia. Vitamin D deficiency was only associated with higher odds of EMCS in women without epidural anaesthesia (AOR = 2.01, p = 0.044). Vitamin D deficiency was also associated with higher odds of birth asphyxia (AOR = 2.22, p = 0.044). Conclusions for Practice In this Swedish prospective population-based cohort study, vitamin D deficiency in late pregnancy was associated with doubled odds of birth asphyxia and with EMCS in deliveries not aided by epidural anaesthesia. Prevention of vitamin D deficiency among pregnant women may reduce the incidence of EMCS and birth asphyxia. The mechanism behind the findings require further investigation.

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Associations Between Anemia, Cognitive Impairment, and All-Cause Mortality in Oldest-Old Adults: A Prospective Population-Based Cohort Study

Frontiers in Medicine ◽

10.3389/fmed.2021.613426 ◽

2021 ◽

Vol 8 ◽

Author(s):

Jia Wangping ◽

Han Ke ◽

Wang Shengshu ◽

Song Yang ◽

Yang Shanshan ◽

...

Keyword(s):

Cohort Study ◽

Cognitive Impairment ◽

Mortality Risk ◽

Proportional Hazards ◽

Oldest Old ◽

Population Based ◽

Cox Proportional Hazards ◽

Risk Of Mortality ◽

Increased Risk ◽

All Cause Mortality

Objective: To evaluate the combined effects of anemia and cognitive function on the risk of all-cause mortality in oldest-old individuals.Design: Prospective population-based cohort study.Setting and Participants: We included 1,212 oldest-old individuals (men, 416; mean age, 93.3 years).Methods: Blood tests, physical examinations, and health questionnaire surveys were conducted in 2012 were used for baseline data. Mortality was assessed in the subsequent 2014 and 2018 survey waves. Cox proportional hazards models were used to evaluate anemia, cognitive impairment, and mortality risk. We used restricted cubic splines to analyze and visualize the association between hemoglobin (Hb) levels and mortality risk.Results: A total of 801 (66.1%) deaths were identified during the 6-year follow-up. We noted a significant association between anemia and mortality (hazard ratio [HR] 1.32, 95% confidence interval [CI] 1.14–1.54) after adjusting for confounding variables. We also observed a dose-response relationship between the severity of anemia and mortality (P < 0.001). In the restricted cubic spline models, Hb levels had a reverse J-shaped association with mortality risk (HR 0.88, 95% CI 0.84–0.93 per 10 g/L-increase in Hb levels below 130 g/L). The reverse J-shaped association persisted in individuals without cognitive impairment (HR 0.88, 95% CI 0.79–0.98 per 10 g/L-increase in Hb levels below 110 g/L). For people with cognitive impairment, Hb levels were inversely associated with mortality risk (HR 0.83, 95% CI 0.78–0.89 per 10 g/L-increase in Hb levels below 150 g/L). People with anemia and cognitive impairment had the highest risk of mortality (HR 2.60, 95% CI 2.06–3.27).Conclusion: Our results indicate that anemia is associated with an increased risk of mortality in oldest-old people. Cognitive impairment modifies the association between Hb levels and mortality.

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Neonatal vitamin D status from archived dried blood spots and future risk of fractures in childhood: results from the D-tect study, a population-based case-cohort study

American Journal of Clinical Nutrition ◽

10.3945/ajcn.116.145599 ◽

2017 ◽

Vol 106 (1) ◽

pp. 155-161 ◽

Cited By ~ 13

Author(s):

Mina Nicole Händel ◽

Peder Frederiksen ◽

Arieh Cohen ◽

Cyrus Cooper ◽

Berit Lilienthal Heitmann ◽

...

Keyword(s):

Vitamin D ◽

Cohort Study ◽

Dried Blood Spots ◽

Population Based ◽

Vitamin D Status ◽

Blood Spots ◽

Future Risk ◽

Fractures In Childhood

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Suicide and all-cause mortality in Swedish deployed military veterans: a population-based matched cohort study

BMJ Open ◽

10.1136/bmjopen-2016-014034 ◽

2017 ◽

Vol 7 (9) ◽

pp. e014034 ◽

Cited By ~ 6

Author(s):

Carl-Martin Pethrus ◽

Kari Johansson ◽

Kristian Neovius ◽

Johan Reutfors ◽

Johan Sundström ◽

...

Keyword(s):

Mental Health ◽

Cohort Study ◽

Mortality Risk ◽

Military Veterans ◽

Population Based ◽

Physical Factors ◽

Matched Cohort ◽

Matched Cohort Study ◽

All Cause Mortality ◽

Age And Sex

ObjectiveTo investigate suicide and mortality risk in deployed military veterans versus non-deployed comparators who had gone through military conscription testing.DesignPopulation-based matched cohort study.SettingSweden.ParticipantsParticipants were identified from the Military Service Conscription Register and deployment status from the Swedish Military Information Personnel Register. Of 1.9 million conscripts, 21 721 had deployed at some time between 1990 and 2013 (deployed military veterans). Non-deployed comparators were matched to deployed military veterans in two ways: (1) by cognitive ability, psychological assessment, mental health, body mass index, sex, birth-year and conscription-year (carefully matched), with further adjustment for exercise capacity and suicide attempt history; and (2) by sex, birth-year and conscription-year (age- and sex-matched).Main outcomeSuicide retrieved from the Swedish National Patient and Causes of Death Register until 31 December 2013.ResultsDuring a median follow-up of 12 years, 39 and 211 deaths by suicide occurred in deployed military veterans (n=21 627) and carefully matched non-deployed comparators (n=107 284), respectively (15 vs 16/100 000 person-years; adjusted HR (aHR) 1.07; 95% CI 0.75 to 1.52; p=0.72) and 329 in age- and sex-matched non-deployed comparators (n=108 140; 25/100 000 person-years; aHR 0.59; 95% CI 0.42 to 0.82; p=0.002). There were 284 and 1444 deaths by suicide or attempted suicides in deployed military veterans and carefully matched non-deployed comparators, respectively (109 vs 112; aHR 0.99; 95% CI 0.88 to 1.13; p=0.93) and 2061 in age- and sex-matched non-deployed comparators (158; aHR 0.69; 95% CI 0.61 to 0.79; p<0.001). The corresponding figures for all-cause mortality for carefully matched non-deployed comparators were 159 and 820 (61 vs 63/100 000 person-years; aHR 0.97; 95% CI 0.82 to 1.15; p=0.71) and 1289 for age- and sex-matched non-deployed comparators (98/100 000 person-years; aHR 0.62; 95% CI 0.52 to 0.73; p<0.001).ConclusionDeployed military veterans had similar suicide and mortality risk as non-deployed comparators after accounting for psychological, psychiatric and physical factors. Studies of mental health in deployed veterans need to adjust for more factors than age and sex for comparisons to be meaningful.

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Excess mortality associated with eating disorders: population-based cohort study

The British Journal of Psychiatry ◽

10.1192/bjp.2020.197 ◽

2020 ◽

pp. 1-7

Author(s):

Tomisin Iwajomo ◽

Susan J. Bondy ◽

Claire de Oliveira ◽

Patricia Colton ◽

Kathryn Trottier ◽

...

Keyword(s):

Eating Disorders ◽

Anorexia Nervosa ◽

Cohort Study ◽

Eating Disorder ◽

Mortality Risk ◽

Excess Mortality ◽

Population Based ◽

Cox Proportional Hazards ◽

Years Of Life Lost ◽

All Cause Mortality

Background Individuals with eating disorders have a high mortality risk. Few population-based studies have estimated this risk in eating disorders other than anorexia nervosa. Aims To investigate all-cause mortality in a population-based cohort of individuals who received hospital-based care for an eating disorder (anorexia nervosa, bulimia nervosa or eating disorder not otherwise specified) in Ontario, Canada. Method We conducted a retrospective cohort study of 19 041 individuals with an eating disorder from 1 January 1990 to 31 December 2013 using administrative healthcare data. The outcome of interest was death. Excess mortality was assessed using standardised mortality ratios (SMRs) and potential years of life lost (PYLL). Cox proportional hazards regression models were used to examine sociodemographic and medical comorbidities associated with greater mortality risk. Results The cohort had 17 108 females (89.9%) and 1933 males (10.1%). The all-cause mortality for the entire cohort was five times higher than expected compared with the Ontario population (SMR = 5.06; 95% CI 4.82–5.30). SMRs were higher for males (SMR = 7.24; 95% CI 6.58–7.96) relative to females (SMR = 4.59; 95% CI 4.34–4.85) overall, and in all age groups in the cohort. For both genders, the cohort PYLL was more than six times higher than the expected PYLL in the Ontario population. Conclusions Patients with eating disorders diagnosed in hospital settings experience five to seven times higher mortality rates compared with the overall population. There is an urgent need to understand the mortality risk factors to improve health outcomes among individuals with eating disorders.

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Blood pressure in 3-year-old girls associates inversely with umbilical cord serum 25-hydroxyvitamin D: an Odense Child Cohort study

Endocrine Connections ◽

10.1530/ec-18-0308 ◽

2018 ◽

Vol 7 (12) ◽

pp. 1236-1244 ◽

Cited By ~ 5

Author(s):

Søs Dragsbæk Larsen ◽

Christine Dalgård ◽

Mathilde Egelund Christensen ◽

Sine Lykkedegn ◽

Louise Bjørkholt Andersen ◽

...

Keyword(s):

Blood Pressure ◽

Vitamin D ◽

Cohort Study ◽

A Priori ◽

Later Life ◽

Population Based ◽

Vitamin D Status ◽

Young Girls ◽

Hydroxyvitamin D ◽

25 Hydroxyvitamin D

Background Low foetal vitamin D status may be associated with higher blood pressure (BP) in later life. Objective To examine whether serum 25-hydroxyvitamin D2+3 (s-25OHD) in cord and pregnancy associates with systolic and diastolic BP (SBP; DBP) in children up to 3 years of age. Design Prospective, population-based cohort study. Methods We included 1594 singletons from the Odense Child Cohort with available cord s-25OHD and BP data at median age 3.7 months (48% girls), 18.9 months (44% girls) or 3 years (48% girls). Maternal s-25OHD was also assessed at gestational ages 12 and 29 weeks. Multiple regression models were stratified by sex a priori and adjusted for maternal educational level, season of birth and child height, weight and age. Results In 3-year-old girls, SBP decreased with −0.7 mmHg (95% CI −1.1; −0.3, P = 0.001) and DBP with −0.4 mmHg (95% CI −0.7; −0.1, P = 0.016) for every 10 nmol/L increase in cord s-25OHD in adjusted analyses. Moreover, the adjusted odds of having SBP >90th percentile were reduced by 30% for every 10 nmol/L increase in cord s-25OHD (P = 0.004) and by 64% for cord s-25OHD above the median 45.1 nmol/L (P = 0.02). Similar findings were observed between pregnancy s-25OHD and 3-year SBP, cord s-25OHD and SBP at 18.9 months, and cord s-25OHD and DBP at 3 years. No consistent associations were observed between s-25OHD and BP in boys. Conclusion Cord s-25OHD was inversely associated with SBP and DBP in young girls, but not in boys. Higher vitamin D status in foetal life may modulate BP in young girls. The sex difference remains unexplained.

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Parity and tanned white skin as novel predictors of vitamin D status in early pregnancy: a population-based cohort study

Clinical Endocrinology ◽

10.1111/cen.12147 ◽

2013 ◽

Vol 79 (3) ◽

pp. 333-341 ◽

Cited By ~ 49

Author(s):

L. B. Andersen ◽

B. Abrahamsen ◽

C. Dalgård ◽

H. B. Kyhl ◽

S. S. Beck-Nielsen ◽

...

Keyword(s):

Vitamin D ◽

Cohort Study ◽

Early Pregnancy ◽

Population Based ◽

Vitamin D Status ◽

White Skin

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Mortality in Patients with Rheumatoid Arthritis: A Retrospective Cohort Study and Systematic Review

Medical Sciences Forum ◽

10.3390/iecmd2021-10310 ◽

2021 ◽

Vol 6 (1) ◽

pp. 5

Author(s):

Greta Charukevič ◽

Dalia Miltinienė ◽

Jolanta Dadonienė

Keyword(s):

Rheumatoid Arthritis ◽

Systematic Review ◽

Cohort Study ◽

General Population ◽

Mortality Risk ◽

Retrospective Cohort ◽

Meta Analysis ◽

Population Based ◽

All Cause Mortality ◽

Standardized Mortality Ratios

Background and Objectives: Mortality rates among patients with rheumatoid arthritis (RA) have been reported to be higher than in the general population. The long-term prognosis of RA has improved in recent years due to early diagnosis, as well as effective pharmacological treatment, and this may be able to diminish the excess mortality risk. This study was designed to investigate mortality (a) in patients with RA in a retrospectively defined national RA cohort in comparison with the general Lithuanian population, and (b) to conduct a systematic review of the literature from different countries and meta-analysis. Materials and Methods: In this national retrospective cohort study, patients with a first-time diagnosis of RA in the period between 1 January 2013 and 31 December 2017 were identified from the Lithuanian Compulsory Health Insurance Information System database SVEIDRA. All cases were cross-checked with the Health Information Center at the Institute of Hygiene, for the vital status of these patients and date of death if documented. The standardized mortality ratios (SMRs) with 95% confidence intervals (CI) obtained for all-cause mortality in patients with RA adjusted for age, sex, and calendar year were calculated. The search for published studies using the combination of keywords “rheumatoid arthritis AND standardized mortality ratio” was performed in MEDLINE (via PubMed, OVID, and EBSCO), Science Direct, Taylor & Francis, and Springer databases. Studies were selected according to described inclusion and exclusion criteria listed in the paper, and a meta-analysis was conducted. A random-effect meta-analysis model was used to compute the pooled standardized mortality ratios (meta-SMRs). Results: Overall, 4623 patients with newly diagnosed RA during the 2013–2017 period were identified and enrolled in the Lithuanian population-based cohort. The mean age of patients at the time of RA diagnosis was 58.7 (standard deviation (SD) 15.1) years, and 77.1% of the patients were women. The estimated SMR for all-cause mortality was 1.15 (95% CI 1.02, 1.29). The SMR for men (SMR 1.14, 95% CI 0.94, 1.39) was higher than for women (SMR 1.03, 95% CI 0.89, 1.19). A systematic literature search revealed 12 studies meeting the inclusion criteria, starting from 2010 to 2020, representing 50,072 patients. The meta-SMR in patients with RA for all-cause mortality was 1.41 (95% CI 1.29, 1.55). All-cause mortality risk was higher for men (meta-SMR 1.53, 95% CI 1.31, 1.78) than for women (meta-SMR 1.46, 95% CI 1.2, 1.77). Conclusions: In a retrospectively defined population-based national RA cohort, a 15% excess risk of death was observed among patients with RA compared to the general Lithuanian population. Patients with RA have a higher mortality risk than the general population. Published data indicate that the risk of mortality is increased by 41% in patients with RA compared to the general population. Excessive all-cause mortality risk is higher in men than in women. National data showed lower standardized mortality compared to literature data.

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Antidepressant treatment and mortality risk in patients with dementia and depression: a nationwide population cohort study in Taiwan

Therapeutic Advances in Chronic Disease ◽

10.1177/2040622319853719 ◽

2019 ◽

Vol 10 ◽

pp. 204062231985371 ◽

Cited By ~ 3

Author(s):

Jian-An Su ◽

Chih-Cheng Chang ◽

Hsuan-Min Wang ◽

Ko-Jung Chen ◽

Yao-Hsu Yang ◽

...

Keyword(s):

Cohort Study ◽

Mortality Risk ◽

Claims Data ◽

Antidepressant Treatment ◽

Population Based ◽

Protective Effects ◽

Medical Claims ◽

Dementia Prevalence ◽

All Cause Mortality ◽

Psychotropic Agents

Background: Dementia prevalence is increasing worldwide, and dementia is frequently comorbid with depression during its disease course. Additionally, safety concerns are rising regarding the prescription of psychotropic agents to patients with dementia. Thus, our study assessed the influence of prescribing antidepressants in dementia with depression on mortality risk, and the differences between classes of antidepressants. Methods: This study was a population-based retrospective cohort study that utilized the National Health Insurance (NHI) medical claims data on mental illness in Taiwan between 1998 and 2013. We identified 25,890 cases of newly diagnosed dementia with depression and divided them into two groups: antidepressant users and nonusers. All-cause mortality between the two groups and the effects of different antidepressants were analyzed. Results: Antidepressants reduced all-cause mortality in patients with dementia and depression after adjusting for all covariates. Furthermore, the effect was significant when antidepressant exposure was more than 168 cumulative defined daily dosages, and most classes of antidepressants had this protective effect. Conclusions: Antidepressant treatment showed significant protective effects in all-cause mortality for patients with dementia and depression. Most classes of antidepressants were effective, especially with longer treatment duration or higher dosage.

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