Low-Normal Thyroid Function Predicts Incident Anemia in the General Population With Euthyroid Status

Abstract Context Thyroid hormones (THs) have direct and indirect effects on hematopoiesis. However, few studies have directly evaluated the effect of THs on incident anemia among euthyroid subjects. This cohort study aimed to explore whether THs under physiological conditions can affect the development of anemia in the general population. Design A total of 12,310 participants were enrolled in the cohort study (∼5-year follow-up period; mean, 3.1 years). A chemiluminescence immunoassay was used to measure free T3 (FT3), free T4 (FT4), and TSH, and anemia was defined according to the World Health Organization recommendation. THs, TSH, and Hb were assessed yearly during follow-up. Multivariable Cox proportional hazards regression models were used to assess the association between THs, TSH, and incident anemia. Results The fully adjusted hazards ratios (95% CI) of anemia per 1-unit change in FT3, FT4, and TSH concentrations were 0.70 (0.56, 0.87), 0.93 (0.88, 0.98), and 1.19 (0.94, 1.50) (P < 0.01, P < 0.01, and P = 0.14, respectively). Moreover, a significant and positive association between FT3, FT4, and annual changes in Hb (standard regression coefficients of 0.056 and 0.028, respectively; both P < 0.01) was observed. Similar associations were observed when the participants who had thyroid dysfunction upon follow-up were excluded. Conclusions The current study demonstrated that THs significantly predict future anemia and annual changes in Hb, even in the euthyroid population.

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Gestational diabetes with diabetes and prediabetes risks: a large observational study

Acta Endocrinologica ◽

10.1530/eje-18-0130 ◽

2018 ◽

Vol 179 (1) ◽

pp. 51-58 ◽

Cited By ~ 11

Author(s):

Yun Shen ◽

Peng Wang ◽

Leishen Wang ◽

Shuang Zhang ◽

Huikun Liu ◽

...

Keyword(s):

Gestational Diabetes ◽

Observational Study ◽

Proportional Hazards ◽

Cox Proportional Hazards ◽

World Health ◽

Oral Glucose ◽

Adjusted Risk ◽

Postpartum Diabetes ◽

Incident Cases

Aims To compare risks of early postpartum diabetes and prediabetes in Chinese women with and without gestational diabetes mellitus (GDM) during pregnancy. Subjects and methods Tianjin GDM observational study included 1263 women with a history of GDM and 705 women without GDM who participated in the urban GDM universal screening survey by using World Health Organization’s criteria. Postpartum diabetes and prediabetes were identified after a standard oral glucose tolerance test. Cox proportional hazards regression was used to assess risks of postpartum diabetes and prediabetes between women with and without GDM. Results During a mean follow-up of 3.53 years postpartum, 90 incident cases of diabetes and 599 incident cases of prediabetes were identified. Multivariable-adjusted hazard ratios among women with prior GDM, compared with those without it, were 76.1 (95% CI: 23.6–246) for diabetes and 25.4 (95% CI: 18.2–35.3) for prediabetes. When the mean follow-up extended to 4.40 years, 121 diabetes and 616 prediabetes cases were identified. Women with prior GDM had a 13.0-fold multivariable-adjusted risk (95% CI: 5.54-30.6) for diabetes and 2.15-fold risk (95% CI: 1.76-2.62) for prediabetes compared with women without GDM. The positive associations between GDM and the risks of postpartum diabetes and prediabetes were significant and persistent when stratified by younger and older than 30 years at delivery and normal weight and overweight participants. Conclusions The present study indicated that women with prior GDM had significantly increased risks for postpartum diabetes and prediabetes, with the highest risk at the first 3–4 years after delivery, compared with those without GDM.

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Diabetes increases the risk of deep-vein thrombosis and pulmonary embolism

Thrombosis and Haemostasis ◽

10.1160/th14-10-0868 ◽

2015 ◽

Vol 114 (10) ◽

pp. 812-818 ◽

Cited By ~ 27

Author(s):

Wei-Sheng Chung ◽

Cheng-Li Lin ◽

Chia-Hung Kao

Keyword(s):

Pulmonary Embolism ◽

Cohort Study ◽

Deep Vein Thrombosis ◽

General Population ◽

Proportional Hazards ◽

Population Based ◽

Cox Proportional Hazards ◽

Vein Thrombosis ◽

Deep Vein

SummaryWe evaluated the effects of diabetes on the risks of developing deep vein thrombosis (DVT) and pulmonary embolism (PE) in a nationwide, population-based cohort study in Taiwan. The patients with newly diagnosed type 2 diabetes mellitus (T2DM) were identified, and DM-free controls were randomly selected from the general population and frequency-matched according to age, sex, and index year by using the records of the Longitudinal Health Insurance Database between 2000 and 2011. Both cohorts were followed up until the end of 2011 to measure the incidence of DVT and PE. We analysed the risks of DVT and PE using Cox proportional-hazards regression models. The overall incidence of VTE was higher in the T2DM patients than in the controls (12.0 vs 7.51 per 10,000 person-years). The T2DM patients exhibited a 1.44-fold adjusted hazard ratio (aHR) of VTE development compared with the controls (95 % confidence interval [CI] = 1.27–1.63). The risks of DVT (aHR = 1.43, 95 % CI = 1.23–1.65) and PE (aHR = 1.52, 95 % CI = 1.22–1.90) were greater in the T2DM than those in the controls. The T2DM patients had a substantially higher risk of DVT (aHR = 5.10, 95 % CI = 3.12–8.32) and PE (aHR = 7.50, 95 % CI = 3.29–17.1) development than the controls did in adults aged 49 years and younger. In conclusion, the longitudinal nationwide cohort study indicated that T2DM patients carried greater risks of developing VTE than did the general population.

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Population-based cohort study examining the association between splenectomy and empyema in adults in Taiwan

BMJ Open ◽

10.1136/bmjopen-2016-015101 ◽

2017 ◽

Vol 7 (9) ◽

pp. e015101 ◽

Cited By ~ 12

Author(s):

Hsien-Feng Lin ◽

Kuan-Fu Liao ◽

Ching-Mei Chang ◽

Cheng-Li Lin ◽

Shih-Wei Lai

Keyword(s):

Cohort Study ◽

Incidence Rate ◽

Proportional Hazards ◽

Population Based ◽

Cox Proportional Hazards ◽

Proportional Hazards Regression ◽

Kaplan Meier ◽

Confounding Variables ◽

Taiwan National Health Insurance

ObjectiveThis study aimed to investigate the association between splenectomy and empyema in Taiwan.MethodsA population-based cohort study was conducted using the hospitalisation dataset of the Taiwan National Health Insurance Program. A total of 13 193 subjects aged 20–84 years who were newly diagnosed with splenectomy from 2000 to 2010 were enrolled in the splenectomy group and 52 464 randomly selected subjects without splenectomy were enrolled in the non-splenectomy group. Both groups were matched by sex, age, comorbidities and the index year of undergoing splenectomy. The incidence of empyema at the end of 2011 was calculated. A multivariable Cox proportional hazards regression model was used to estimate the HR with 95% CI of empyema associated with splenectomy and other comorbidities.ResultsThe overall incidence rate of empyema was 2.56-fold higher in the splenectomy group than in the non-splenectomy group (8.85 vs 3.46 per 1000 person-years). The Kaplan-Meier analysis revealed a higher cumulative incidence of empyema in the splenectomy group than in the non-splenectomy group (6.99% vs 3.37% at the end of follow-up). After adjusting for confounding variables, the adjusted HR of empyema was 2.89 for the splenectomy group compared with that for the non-splenectomy group. Further analysis revealed that HR of empyema was 4.52 for subjects with splenectomy alone.ConclusionThe incidence rate ratio between the splenectomy and non-splenectomy groups reduced from 2.87 in the first 5 years of follow-up to 1.73 in the period following the 5 years. Future studies are required to confirm whether a longer follow-up period would further reduce this average ratio. For the splenectomy group, the overall HR of developing empyema was 2.89 after adjusting for age, sex and comorbidities, which was identified from previous literature. The risk of empyema following splenectomy remains high despite the absence of these comorbidities.

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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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Prediabetes, Diabetes, and the Risk of All-Cause and Cause-Specific Mortality in a Japanese Working Population: Japan Epidemiology Collaboration on Occupational Health Study

10.2337/figshare.13483515 ◽

2021 ◽

Author(s):

Zobida Islam ◽

Shamima Akter ◽

Yosuke Inoue ◽

Huan Hu ◽

Keisuke Kuwahara ◽

...

Keyword(s):

Proportional Hazards ◽

Cox Proportional Hazards ◽

World Health ◽

Health Study ◽

Expert Committee ◽

Risk Of Mortality ◽

Japanese Workers ◽

Increased Risk ◽

Health Organization

Objective: Prediabetes has been suggested to increase mortality risk; however, the definitions of prediabetes that can predict mortality remain elusive. We prospectively investigated the association of multiple definitions of prediabetes with the risk of mortality from all-causes, cardiovascular disease (CVD), and cancer in Japanese workers. Research design and methods: The study included 62,785 workers who underwent a health checkup in 2010 or 2011 and were followed up for mortality from 2012 to March 2019. <a>Prediabetes was defined according to fasting plasma glucose (FPG) or glycated hemoglobin (HbA1c) level or a combination of both using the American Diabetes Association (ADA) or World Health Organization (WHO)/International Expert Committee (IEC) criteria. </a>The Cox proportional hazards regression model was used to investigate the associations. Results: Over a 7-year follow-up, 229 deaths were documented. <a>Compared with normoglycemia, prediabetes defined according to ADA criteria was associated with a higher risk of all-cause (hazard ratio [HR] 1.53; 95% confidence interval [CI] 1.12–2.09) and cancer (HR 2.37; 95% CI 1.45–3.89) mortality but not with CVD mortality. </a>The results were materially unchanged when prediabetes was defined according to ADA FPG, ADA HbA1c, WHO FPG, or combined WHO/IEC criteria. Diabetes was associated with the risk of all-cause, CVD, and cancer mortality. Conclusion: In a cohort of Japanese workers, FPG- and HbA1c-defined prediabetes according to ADA or WHO/IEC was each associated with a significantly increased risk of mortality from all-causes and cancer but not CVD.

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THE ASSOCIATION OF MORTALITY WITH DEMENTIA IN VETERANS ENROLLED IN A MEMORY DISORDERS CLINIC: THE EFFECT OF FRAILTY

Innovation in Aging ◽

10.1093/geroni/igz038.3206 ◽

2019 ◽

Vol 3 (Supplement_1) ◽

pp. S874-S875

Author(s):

Aakashi Shah ◽

Raquel Apracio-Ugarriza ◽

Amar Morani ◽

Mercedes Rodriguez-Suarez ◽

Jorge G Ruiz

Keyword(s):

Proportional Hazards ◽

Neuropsychological Testing ◽

Frailty Index ◽

Positive Association ◽

Cox Proportional Hazards ◽

Memory Disorders ◽

Frailty Status ◽

Proportional Hazards Regression ◽

Study Results

Abstract Dementia is a syndrome of deterioration in cognition and ability to perform everyday activities. Frailty, a state of vulnerability to stressors leading to increased morbidity, mortality and utilization is a determinant of dementia. The aim was to determine if dementia leads to increased mortality in Veterans and whether frailty affects this association. We conducted a retrospective cohort study of 308 Veterans enrolled in VA memory disorders clinic during 2016-2019. Dementia was diagnosed based on complete clinical assessments, brain imaging and neuropsychological testing. A 44–item frailty index (FI) was constructed using demographics, comorbidities, medications, laboratory tests, and activities of daily living. Patients were divided into non-Frail (FI<0.21) and Frail (FI≥0.21). After adjusting for age, race, ethnicity, income, education, substance abuse, BMI, comorbidities, hospitalizations, medication use, the association of dementia with mortality was assessed using Cox proportional hazards regression. Patients were 55.2% White, 74% non-Hispanic, and the mean age was 74.4 ± 8.3 years. 113 patients were diagnosed with dementia out of which 27 died. Over a median follow-up period of 526 days (Interquartile Range: 431.5 days), there were 27 deaths. There was a significant and positive association of dementia with mortality significant even after all adjustments, HR=2.65 (95% CI: 1.02-6.92), p: 0.045. After subgroup analysis, there was no significant association between mortality and dementia according to frailty status. Our study results suggest that dementia is associated with a higher risk for mortality in Veterans at a Memory Disorders clinic. Frailty did not modify the effect.

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Body-Mass Index and Progression of Hepatitis B: A Population-Based Cohort Study in Men

Journal of Clinical Oncology ◽

10.1200/jco.2008.16.1075 ◽

2008 ◽

Vol 26 (34) ◽

pp. 5576-5582 ◽

Cited By ~ 71

Author(s):

Ming-Whei Yu ◽

Wei-Liang Shih ◽

Chih-Lin Lin ◽

Chun-Jen Liu ◽

Jhih-Wei Jian ◽

...

Keyword(s):

Body Mass Index ◽

Cohort Study ◽

Hepatitis B ◽

Body Mass ◽

Proportional Hazards ◽

Cox Proportional Hazards ◽

Excess Body Weight ◽

Biochemical Tests ◽

Hazard Ratios

Purpose To determine prospectively whether body-mass index (BMI) is associated with liver-related morbidity and mortality among male hepatitis B virus (HBV) carriers. Patients and Methods We performed a prospective study of 2,903 male HBV surface antigen–positive government employees who were free of cancer at enrollment between 1989 and 1992. Main outcome measures included ultrasonography, biochemical tests, incident hepatocellular carcinoma (HCC), and liver-related death. Results During mean follow-up of 14.7 years, 134 developed HCC and 92 died as a result of liver-related causes. In Cox proportional hazards models adjusting for age, number of visits, diabetes, and use of alcohol and tobacco, the hazard ratios for incident HCC were 1.48 (95% CI, 1.04 to 2.12) in overweight men (BMI between 25.0 and 29.9 kg/m2) and 1.96 (95% CI, 0.72 to 5.38) in obese men (BMI ≥ 30.0 kg/m2), compared with normal-weight men (BMI between 18.5 and 24.9 kg/m2). Liver-related mortality had adjusted hazard ratios of 1.74 (95% CI, 1.15 to 2.65) in overweight men and 1.50 (95% CI, 0.36 to 6.19) in obese men. Excess BMI was also associated with the occurrence of fatty liver and cirrhosis detected by ultrasonography, as well as elevated ALT and γ-glutamyltransferase (GGT) activity during follow-up. The association of BMI with GGT was stronger than with ALT, and elevated GGT activity and cirrhosis were the strongest predictors for incident HCC and liver-related death. Conclusion This longitudinal cohort study indicates that excess body weight is involved in the transition from healthy HBV carrier state to HCC and liver-related death among men.

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Association of Urinary Cadmium with Cancer Mortality Is Influenced by Zinc Intake in Follow-up Study of NHANES 1988–1994 and 1999–2004 (P18-026-19)

Current Developments in Nutrition ◽

10.1093/cdn/nzz039.p18-026-19 ◽

2019 ◽

Vol 3 (Supplement_1) ◽

Author(s):

Kijoon Kim ◽

Melissa Melough ◽

Junichi Sakaki ◽

Hwayoung Noh ◽

Sung Koo ◽

...

Keyword(s):

Cancer Mortality ◽

Proportional Hazards ◽

Adult Population ◽

Positive Association ◽

Cox Proportional Hazards ◽

Toxic Heavy Metal ◽

Cox Proportional Hazards Models ◽

All Cause Mortality ◽

Risk Of Cancer

Abstract Objectives Exposure to cadmium (Cd), a toxic heavy metal, increases risk of numerous chronic diseases and overall mortality. However, little work has been conducted to examine the effect of Zn intake on the association between Cd burden and mortality. The aim of this study was to examine whether the association between urinary Cd concentration and all-cause and disease specific mortality differs by Zn intake level among a representative sample of the US adult population. Methods A total of 15,642 US adults aged 30 years and older in the National Health and Nutrition Examination Survey 1988–1994 and 1999–2004 were followed up through December 31, 2011. Participants’ Zn intake was assessed through 24-hour dietary recalls. The main outcomes included mortality from cardiovascular disease (CVD), cancer, and all causes. Using Cox proportional hazards models, hazard ratios (HRs) and 95% confidence intervals (CIs) were estimated for quartiles of urinary Cd, quartiles of dietary Zn, and for quartiles of urinary Cd stratified by level of dietary Zn. Results Of 5367 total deaths that occurred over a mean follow-up of 15 years, 1194 were attributed to cancer and 1677 were attributed to CVD. After adjustment for potential confounders, positive relationships were observed between urinary Cd and all-cause mortality (HR for highest vs. lowest quartile (Q4 vs. Q1): 1.38; 95% CI: 1.14–1.68; P-trend < 0.0001) and cancer mortality (HR for Q4 vs. Q1: 1.54; 95% CI: 1.05–2.27; P-trend < 0.005), but not CVD mortality (HR for Q4 vs. Q1: 1.22; 95% CI: 0.95–1.57; P-trend = 0.0502). Negative associations were observed between dietary Zn and all-cause mortality (HR for Q4 vs. Q1: 0.88; 95% CI: 0.75–1.02; P-trend < 0.05) and cancer mortality (HR for Q4 vs. Q1: 0.82; 95% CI: 0.65–1.03, P-trend < 0.05). Among the lowest tertile of Zn consumers, there was a clear positive association between urinary Cd and cancer mortality (HR for Q4 vs. Q1: 1.79; 95% CI: 1.07–3.01), however, among the highest Zn consumers, this association was somewhat diminished (HR for Q4 vs. Q1: 1.66; 95% CI: 0.80–3.41). Conclusions These findings support existing evidence that Cd burden is associated with greater mortality, and also demonstrate that greater Zn consumption is associated with reduced risk of cancer death related to Cd. Funding Sources This study received no financial support.

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Prevalence of secondary care multimorbidity in mid-life and its association with premature mortality in a large longitudinal cohort study

BMJ Open ◽

10.1136/bmjopen-2019-033622 ◽

2020 ◽

Vol 10 (5) ◽

pp. e033622 ◽

Cited By ~ 1

Author(s):

Marjorie C Johnston ◽

Corrinda Black ◽

Stewart W Mercer ◽

Gordon J Prescott ◽

Michael A Crilly

Keyword(s):

Cohort Study ◽

Social Class ◽

Secondary Care ◽

Proportional Hazards ◽

Reference Group ◽

Premature Mortality ◽

Cox Proportional Hazards ◽

School Type ◽

Important Challenge

ObjectivesMultimorbidity is the coexistence of two or more health conditions in an individual. Multimorbidity in younger adults is increasingly recognised as an important challenge. We assessed the prevalence of secondary care multimorbidity in mid-life and its association with premature mortality over 15 years of follow-up, in the Aberdeen Children of the 1950s (ACONF) cohort.MethodA prospective cohort study using linked electronic health and mortality records. Scottish ACONF participants were linked to their Scottish Morbidity Record hospital episode data and mortality records. Multimorbidity was defined as two or more conditions and was assessed using healthcare records in 2001 when the participants were aged between 45 and 51 years. The association between multimorbidity and mortality over 15 years of follow-up (to ages 60–66 years) was assessed using Cox proportional hazards regression. There was also adjustment for key covariates: age, gender, social class at birth, intelligence at age 7, secondary school type, educational attainment, alcohol, smoking, body mass index and adult social class.ResultsOf 9625 participants (51% males), 3% had multimorbidity. The death rate per 1000 person-years was 28.4 (95% CI 23.2 to 34.8) in those with multimorbidity and 5.7 (95% CI 5.3 to 6.1) in those without. In relation to the reference group of those with no multimorbidity, those with multimorbidity had a mortality HR of 4.5 (95% CI 3.4 to 6.0) over 15 years and this association remained when fully adjusted for the covariates (HR 2.5 (95% CI 1.5 to 4.0)).ConclusionMultimorbidity prevalence was 3% in mid-life when measured using secondary care administrative data. Multimorbidity in mid-life was associated with premature mortality.

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Independent effects of waist circumference and physical activity on all-cause mortality in Canadian women

Applied Physiology Nutrition and Metabolism ◽

10.1139/h05-038 ◽

2006 ◽

Vol 31 (3) ◽

pp. 271-276 ◽

Cited By ~ 24

Author(s):

Peter T Katzmarzyk ◽

Cora L Craig

Keyword(s):

Physical Activity ◽

Cohort Study ◽

Waist Circumference ◽

Physical Inactivity ◽

Proportional Hazards ◽

Leisure Time Physical Activity ◽

Smoking Status ◽

Cox Proportional Hazards ◽

Independent Effects

The purpose of this study was to determine the independent effects of waist circumference (WC) and physical inactivity on the risk of mortality in women. This prospective cohort study included 5421 female participants 20-69 years of age in the 1981 Canada Fitness Survey. WC was measured with an anthropometric tape and leisure-time physical activity levels over the previous 12 months were assessed with a questionnaire. Mortality surveillance was conducted by data linkage with the Canadian Mortality Database through 31 December, 1993. The hazard ratios (HR) of mortality were estimated using Cox proportional hazards regression with age, smoking status, and alcohol con sumption included as covariates in all models. A total of 225 deaths occurred over an average of 12.4 years of follow up (67 500 person-years of follow up). Physical activity (HR = 0.78; 95% C.I.: 0.64-0.95) and WC (HR = 1.17; 95% C.I.: 1.05-1.31) were associated with mortality when included in separate regression models. When included in the same model, both physical activity (HR = 0.79; 95% CI: 0.65-0.96) and WC (HR = 1.16; 95% C.I.: 1.04-1.30) remained independent significant predictors of mortality. In conclusion, physical inactivity and high WC have significant independent risks of premature mortality among women.Key words: death, obesity, cohort study, Canada Fitness Survey.

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