Glycemic Measures and Risk of Mortality in Older Chinese: The Guangzhou Biobank Cohort Study

Abstract Context China has the largest number of people with type 2 diabetes mellitus (T2DM) in the world. Data from previous studies have suggested that up to one-fifth of individuals with diabetes would be missed without an oral glucose tolerance test (OGTT). To date, there is little information on the mortality risk of these individuals. Objective We estimated the association of different indicators of hyperglycemia with mortality in the general Chinese population. Design Prospective cohort study. Setting China. Participants A total of 17 939 participants aged 50+ years. Exposures Previously diagnosed diabetes and newly detected diabetes defined by fasting glucose (≥7.0 mmol/L), 2-hour postload glucose (≥11.1 mmol/L), or hemoglobin A1c (HbA1c, ≥6.5%). Main Outcomes Measures Deaths from all-cause, cardiovascular disease, and cancer were identified by record linkage with death registration. Results During 7.8 (SD, 1.5) years’ follow-up, 1439 deaths were recorded. Of 3706 participants with T2DM, 2126 (57%) had known T2DM, 118 (3%) were identified by isolated elevated fasting glucose, 1022 (28%) had isolated elevated postload glucose, and 440 (12%) had both elevated fasting and postload glucose. Compared with normoglycemia, the hazard ratio (95% confidence interval) of all-cause mortality was 1.71 (1.46-2.00), 0.96 (0.47-1.93), 1.43 (1.15-1.78), and 1.82 (1.35-2.45) for the 4 groups, respectively. T2DM defined by elevated HbA1c was not significantly associated with all-cause mortality (hazard ratio, 1.17; 95% confidence interval, 0.81-1.69). Conclusion Individuals with isolated higher 2-h postload glucose had a higher risk of mortality by 43% than those with normoglycemia. Underuse of OGTT leads to substantial underdetection of individuals with a higher mortality risk and lost opportunities for early intervention.

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Cardiovascular Disease and All-Cause Mortality in Male Twins With Discordant Cardiorespiratory Fitness: A Nationwide Cohort Study

American Journal of Epidemiology ◽

10.1093/aje/kwaa060 ◽

2020 ◽

Vol 189 (10) ◽

pp. 1114-1123

Author(s):

Marcel Ballin ◽

Anna Nordström ◽

Peter Nordström

Keyword(s):

Cardiovascular Disease ◽

Cohort Study ◽

Confidence Interval ◽

Cardiorespiratory Fitness ◽

Military Service ◽

Lower Risk ◽

Hazard Ratio ◽

Familial Factors ◽

All Cause Mortality

Abstract Whether genetic and familial factors influence the association between cardiorespiratory fitness (CRF) and cardiovascular disease (CVD) is unknown. Two cohorts were formed based on data from 1,212,295 men aged 18 years who were conscripted for military service in Sweden during 1972–1996. The first comprised 4,260 twin pairs in which the twins in each pair had different CRF (≥1 watt). The second comprised 90,331 nonsibling pairs with different CRF and matched on birth year and year of conscription. Incident CVD and all-cause mortality were identified using national registers. During follow-up (median 32 years), there was no difference in CVD and mortality between fitter twins and less fit twins (246 vs. 251 events; hazard ratio (HR) = 1.00, 95% confidence interval (CI): 0.83, 1.20). The risks were similar in twin pairs with ≥60-watt difference in CRF (HR = 0.96, 95% CI: 0.57, 1.64). In contrast, in the nonsibling cohort, fitter men had a lower risk of the outcomes than less fit men (4,444 vs. 5,298 events; HR = 0.83, 95% CI: 0.79, 0.86). The association was stronger in pairs with ≥60-watt difference in CRF (HR = 0.65, 95% CI: 0.59, 0.71). These findings indicate that genetic and familial factors influence the association of CRF with CVD and mortality.

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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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Short-term prognosis of normalising serum potassium following an episode of hypokalaemia in patients with chronic heart failure

European Journal of Preventive Cardiology ◽

10.1177/2047487320911154 ◽

2020 ◽

pp. 204748732091115

Author(s):

Mette Aldahl ◽

Christoffer Polcwiartek ◽

Line Davidsen ◽

Kristian Kragholm ◽

Peter Søgaard ◽

...

Keyword(s):

Heart Failure ◽

Chronic Heart Failure ◽

Confidence Interval ◽

Mortality Risk ◽

Cardiovascular Mortality ◽

Serum Potassium ◽

Reference Group ◽

Hazard Ratio ◽

Increased Risk ◽

All Cause Mortality

Background/aim It is well known that patients with chronic heart failure and hypokalaemia have increased mortality risk. We investigated the impact of normalising serum potassium following an episode of hypokalaemia on short-term mortality among patients with chronic heart failure. Methods and results We identified 1673 patients diagnosed with chronic heart failure who had a serum potassium measurement under 3.5 mmol/l within 14 days and one year after initiated medical treatment with both loop diuretics and angiotensin-converting enzyme inhibitors or angiotensin-II receptor blockers. A second serum potassium measurement was required 8–30 days after the episode of hypokalaemia. All-cause mortality and cardiovascular mortality was examined within 90 days from the second serum potassium measurement. Mortality was examined according to six predefined potassium groups derived from the second measurement:<3.5 mmol/l ( n = 302), 3.5–3.7 mmol/l ( n = 271), 3.8–4.1 mmol/l ( n = 464), 4.2–4.4 mmol/l ( n = 270), 4.5–5.0 mmol/l ( n = 272), and 5.1–8.0 mmol/l ( n = 94). We used Cox regression to estimate both all-cause mortality risk and cardiovascular mortality, with serum potassium at 3.8–4.1 mmol/l as reference. After 90 days, the all-cause mortality in the six groups was 29.5%, 22.1%, 20.3%, 24.8%, 23.5% and 43.6%, respectively. In multivariable adjusted analysis, patients with serum potassium <3.5 mmol/l (hazard ratio: 1.51; 95% confidence interval: 1.13–2.02) and serum potassium 5.1–8.0 mmol/l (hazard ratio: 2.18; 95% confidence interval: 1.50–3.17) had an increased risk of all-cause mortality compared to the reference. After 90 days, the cardiovascular mortality in the six groups was 19.2%, 17.7%, 14.4%, 18.9%, 18.8% and 34.0%, respectively. In multivariable adjusted analysis, patients with serum potassium 5.1–8.0 mmol/l (hazard ratio: 2.32; 95% confidence interval: 1.51–3.56) had an increased risk of cardiovascular mortality compared to the reference, while serum potassium <3.5 mmol/l (hazard ratio: 1.37; 95% confidence interval: 0.97–1.95) had a trend toward increased risk of cardiovascular mortality compared to the reference. Conclusion Patients with chronic heart failure and hypokalaemia, who after 8–30 days remained hypokalaemic, had a significantly higher 90-day all-cause mortality risk compared to patients in the reference group (3.8–4.1 mmol/l). Patients with chronic heart failure and hypokalaemia, who after 8–30 days had the serum potassium level increased to a level within 5.1–8.0 mmol/l, had both a significantly higher 90-day all-cause mortality risk and cardiovascular mortality risk compared to patients in the reference group (3.8–4.1 mmol/l).

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Association between consumption of ultra-processed foods and all cause mortality: SUN prospective cohort study

BMJ ◽

10.1136/bmj.l1949 ◽

2019 ◽

pp. l1949 ◽

Cited By ~ 91

Author(s):

Anaïs Rico-Campà ◽

Miguel A Martínez-González ◽

Ismael Alvarez-Alvarez ◽

Raquel de Deus Mendonça ◽

Carmen de la Fuente-Arrillaga ◽

...

Keyword(s):

Cohort Study ◽

Confidence Interval ◽

Prospective Cohort Study ◽

Prospective Cohort ◽

Linear Trend ◽

Hazard Ratio ◽

Adjusted Hazard Ratio ◽

Processed Foods ◽

High Consumption ◽

All Cause Mortality

Abstract Objective To evaluate the association between consumption of ultra-processed foods and all cause mortality. Design Prospective cohort study. Setting Seguimiento Universidad de Navarra (SUN) cohort of university graduates, Spain 1999-2018. Participants 19 899 participants (12 113 women and 7786 men) aged 20-91 years followed-up every two years between December 1999 and February 2014 for food and drink consumption, classified according to the degree of processing by the NOVA classification, and evaluated through a validated 136 item food frequency questionnaire. Main outcome measure Association between consumption of energy adjusted ultra-processed foods categorised into quarters (low, low-medium, medium-high, and high consumption) and all cause mortality, using multivariable Cox proportional hazard models. Results 335 deaths occurred during 200 432 persons years of follow-up. Participants in the highest quarter (high consumption) of ultra-processed foods consumption had a higher hazard for all cause mortality compared with those in the lowest quarter (multivariable adjusted hazard ratio 1.62, 95% confidence interval 1.13 to 2.33) with a significant dose-response relation (P for linear trend=0.005). For each additional serving of ultra-processed foods, all cause mortality relatively increased by 18% (adjusted hazard ratio 1.18, 95% confidence interval 1.05 to 1.33). Conclusions A higher consumption of ultra-processed foods (>4 servings daily) was independently associated with a 62% relatively increased hazard for all cause mortality. For each additional serving of ultra-processed food, all cause mortality increased by 18%. Study registration ClinicalTrials.gov NCT02669602 .

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Mortality and Recovery Associated with Kidney Failure due to Acute Kidney Injury

Clinical Journal of the American Society of Nephrology ◽

10.2215/cjn.11200919 ◽

2020 ◽

Vol 15 (7) ◽

pp. 995-1006 ◽

Cited By ~ 3

Author(s):

Silvi Shah ◽

Anthony C. Leonard ◽

Kathleen Harrison ◽

Karthikeyan Meganathan ◽

Annette L. Christianson ◽

...

Keyword(s):

Native American ◽

Native Americans ◽

Confidence Interval ◽

Kidney Failure ◽

Kidney Injury ◽

Hazard Ratio ◽

Adjusted Hazard Ratio ◽

Risk Of Mortality ◽

The Us ◽

All Cause Mortality

Background and objectivesAKI requiring dialysis is a contributor to the growing burden of kidney failure, yet little is known about the frequency and patterns of recovery of AKI and its effect on outcomes in patients on incident dialysis.Design, setting, participants, & measurementsUsing the US Renal Data System, we evaluated a cohort of 1,045,540 patients on incident dialysis from January 1, 2005 to December 31, 2014, retrospectively. We examined the association of kidney failure due to AKI with the outcome of all-cause mortality and the associations of sex and race with kidney recovery.ResultsMean age was 63±15 years, and 32,598 (3%) patients on incident dialysis had kidney failure due to AKI. Compared with kidney failure due to diabetes mellitus, kidney failure attributed to AKI was associated with a higher mortality in the first 0–3 months following dialysis initiation (adjusted hazard ratio, 1.28; 95% confidence interval, 1.24 to 1.32) and 3–6 months (adjusted hazard ratio, 1.16; 95% confidence interval, 1.11 to 1.20). Of the patients with kidney failure due to AKI, 11,498 (35%) eventually recovered their kidney function, 95% of those within 12 months. Women had a lower likelihood of kidney recovery than men (adjusted hazard ratio, 0.86; 95% confidence interval, 0.83 to 0.90). Compared with whites, blacks (adjusted hazard ratio, 0.68; 95% confidence interval, 0.64 to 0.72), Asians (adjusted hazard ratio, 0.82; 95% confidence interval, 0.69 to 0.96), Hispanics (adjusted hazard ratio, 0.82; 95% confidence interval, 0.76 to 0.89), and Native Americans (adjusted hazard ratio, 0.72; 95% confidence interval, 0.54 to 0.95) had lower likelihoods of kidney recovery.ConclusionsKidney failure due to AKI confers a higher risk of mortality in the first 6 months compared with kidney failure due to diabetes or other causes. Recovery within 12 months is common, although less so among women than men and among black, Asian, Hispanic, and Native American patients than white patients.

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BMI and All-Cause Mortality in Normoglycemia, Impaired Fasting Glucose, Newly Diagnosed Diabetes, and Prevalent Diabetes: A Cohort Study

Diabetes Care ◽

10.2337/dc16-1458 ◽

2017 ◽

Vol 40 (8) ◽

pp. 1026-1033 ◽

Cited By ~ 24

Author(s):

Eun Young Lee ◽

Yong-ho Lee ◽

Sang-Wook Yi ◽

Soon-Ae Shin ◽

Jee-Jeon Yi

Keyword(s):

Cohort Study ◽

Impaired Fasting Glucose ◽

Fasting Glucose ◽

Newly Diagnosed ◽

All Cause Mortality ◽

Diagnosed Diabetes ◽

Newly Diagnosed Diabetes

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Multiple Reasons for Perceived Everyday Discrimination and All-Cause Mortality Risk Among Older Black Adults

The Journals of Gerontology Series A ◽

10.1093/gerona/glab281 ◽

2021 ◽

Author(s):

Ryon J Cobb ◽

Connor Mc Devitt Sheehan ◽

Patricia Louie ◽

Christy L Erving

Keyword(s):

Confidence Interval ◽

Mortality Risk ◽

Panel Study ◽

The United States ◽

Hazard Ratio ◽

Black Adults ◽

Increased Risk ◽

All Cause Mortality ◽

Nationally Representative ◽

Everyday Discrimination

Abstract Background The present study assessed whether reporting multiple reasons for perceived everyday discrimination was associated with an increased risk for all-cause mortality risk among older Black adults. Methods This study utilized data from a subsample of older Black adults from the Health and Retirement Study (HRS), a nationally representative panel study of older adults in the United States. Our measure of multiple reasons for perceived everyday discrimination was based on self-reports from the 2006/2008 HRS waves. Respondents' vital status was obtained from the National Death Index and reports from key household informants (spanning 2006–2019). Cox proportional hazard models, which accounted for covariates linked to mortality, were used to estimate the risk of all-cause mortality. Results During the observation period, 563 deaths occurred. Twenty percent of Black adults attributed perceived everyday discrimination to three or more sources. In demographic adjusted models, attributing perceived everyday discrimination to three or more sources was a statistically significant predictor of all-cause mortality risk (hazard ratio= 1.45; 95%, confidence interval=1.12 - 1.87). The association remained significant (hazard ratio=1.49, 95%, confidence interval=1.15 - 1.93) after further adjustments for health, behavioral, and economic characteristics. Conclusion Examining how multiple reasons for perceived everyday discrimination relate to all-cause mortality risk has considerable utility in clarifying the unique contributions of perceived discrimination to mortality risk among older Black adults. Our findings suggest that multiple reasons for perceived everyday discrimination are a particularly salient risk factor for mortality among older Black adults.

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Poor oral hygiene and dental caries predict high mortality rate in hemodialysis: a 3-year cohort study

Scientific Reports ◽

10.1038/s41598-020-78724-1 ◽

2020 ◽

Vol 10 (1) ◽

Author(s):

Koji Mizutani ◽

Risako Mikami ◽

Tomohito Gohda ◽

Hiromichi Gotoh ◽

Norio Aoyama ◽

...

Keyword(s):

Cohort Study ◽

Dental Caries ◽

Confidence Interval ◽

Oral Hygiene ◽

Dental Plaque ◽

Hazard Ratio ◽

Periodontal Pocket ◽

All Cause Mortality ◽

The Impact

AbstractThe aim of this study was to investigate the impact of oral hygiene, periodontal diseases, and dental caries on all-cause mortality in hemodialysis. This prospective cohort study included 266 patients with end-stage renal disease who were undergoing hemodialysis. Medical interviews, blood biochemical tests, and comprehensive dental examinations including periodontal pocket examination on all teeth and dental plaque accumulation by debris index-simplified (DI-S), were performed. Survival rates were assessed at a 3-year follow-up. Overall, 207 patients were included in the longitudinal analysis, and 38 subjects died during the follow-up period. Cox proportional hazards analysis of the multivariate model demonstrated that the highest tertile of DI-S had a significantly higher risk of all-cause mortality than the lowest two tertiles after adjustment for age, sex, smoking habit, body mass index, diabetes, prior cardiovascular disease, hemodialysis vintage, high sensitivity C-reactive protein, albumin, and number of remaining teeth (hazard ratio, 3.04; 95% confidence interval, 1.50–6.17; p = 0.002). Moreover, the number of decayed teeth significantly increased the hazard ratio to 1.21 (95% confidence interval, 1.06.1.37; p = 0.003). This study suggests that accumulated dental plaque and untreated decay, but not periodontal disease, may be independently associated with all-cause mortality in patients undergoing hemodialysis.

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Abstract P034: Comparison of the Prognostic Value of 1,5-anhydroglucitol (1,5-AG) and the Oral Glucose Tolerance Test (OGTT) in the Atherosclerosis Risk in Communities (ARIC) Study

Circulation ◽

10.1161/circ.135.suppl_1.p034 ◽

2017 ◽

Vol 135 (suppl_1) ◽

Author(s):

Bethany Warren ◽

Alexandra K Lee ◽

Christie Ballantyne ◽

Ron Hoogeveen ◽

James S Pankow ◽

...

Keyword(s):

Prognostic Value ◽

Tolerance Test ◽

Oral Glucose ◽

Blood Draw ◽

Cox Models ◽

Atherosclerosis Risk In Communities ◽

C Statistic ◽

All Cause Mortality ◽

Future Outcomes ◽

Diagnosed Diabetes

Introduction: 1,5-AG is a biomarker that reflects hyperglycemic excursions. Unlike the OGTT, 1,5-AG requires only a single blood draw and is a non-fasting test. It is unknown if 1,5-AG could serve as a substitute for OGTT and whether it provides complementary information to fasting glucose (FG) for prediction of diabetes and long-term clinical outcomes. Methods: We included 6,711 ARIC participants without diagnosed diabetes, chronic kidney disease (CKD), and CVD that attended visit 4 (1996-98). Participants were followed for up to 18 years for incident diagnosed diabetes, CKD, CVD, and all-cause mortality. We used Harrell’s C-statistic from Cox models to compare the prognostic value of 1,5-AG to OGTT beyond a base model of demographic factors and body mass index. Restricted cubic splines (4 knots) were used to flexibly model the biomarkers with each of the outcomes. Results: Both OGTT and 1,5-AG provided information beyond the base model for risk discrimination of incident diagnosed diabetes ( p <0.05; Table). However, OGTT provided statistically significantly more information than 1,5-AG (difference in C-statistic: 0.087 (95%CI, 0.075, 0.099)). While 1,5-AG otherwise did not provide more information for future outcomes than the base model, OGTT statistically significantly improved the base model for prediction of CKD, CVD, and all-cause mortality. For incident diagnosed diabetes, inclusion of FG in the models maintained that OGTT provided more information than 1,5-AG for risk discrimination. Inclusion of all three biomarkers (FG, 1,5-AG, and OGTT) was not statistically significantly better than a model with FG and OGTT for future diagnosed diabetes ( p =0.687). Conclusion: 1,5-AG could not sufficiently substitute for the OGTT as a test to identify those at risk of future diabetes. Additionally, glycemic excursions captured by 1,5-AG did not provide additional prognostic value beyond glucose-based tests among those without diagnosed diabetes, suggesting the utility of 1,5-AG is limited to persons with overt diabetes.

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