Can vaccination roll-out be more equitable if population risk is taken into account?

Background COVID-19 vaccination in many countries, including England, has been prioritised primarily by age. However, people of the same age can have very different health statuses. Frailty is a commonly used metric of health and has been found to be more strongly associated with mortality than age among COVID-19 inpatients. Methods We compared the number of first vaccine doses administered across the 135 NHS Clinical Commissioning Groups (CCGs) of England to both the over 50 population and the estimated frail population in each area. Area-based frailty estimates were generated using the English Longitudinal Survey of Ageing (ELSA), a national survey of older people. We also compared the number of doses to the number of people with other risk factors associated with COVID-19: atrial fibrillation, chronic kidney disease, diabetes, learning disabilities, obesity and smoking status. Results We estimate that after 79 days of the vaccine program, across all Clinical Commissioning Group areas, the number of people who received a first vaccine per frail person ranged from 4.4 (95% CI 4.0-4.8) and 20.1 (95% CI 18.3-21.9). The prevalences of other risk factors were also poorly associated with the prevalence of vaccination across England. Conclusions Vaccination with age-based priority created area-based inequities in the number of doses administered relative to the number of people who are frail or have other risk factors associated with COVID-19. As frailty has previously been found to be more strongly associated with mortality than age for COVID-19 inpatients, an age-based priority system may increase the risk of mortality in some areas during the vaccine roll-out period. Authorities planning COVID-19 vaccination programmes should consider the disadvantages of an age-based priority system.

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Factors associated with 90-day acute ischemic stroke in patients ≥70 years old with total hip arthroplasty for hip fracture

BMC Geriatrics ◽

10.1186/s12877-021-02728-3 ◽

2022 ◽

Vol 22 (1) ◽

Author(s):

Rui He ◽

Guoyou Wang ◽

Ting Li ◽

Huarui Shen ◽

LijuanZhang

Keyword(s):

Risk Factors ◽

Atrial Fibrillation ◽

Logistic Regression ◽

Ischemic Stroke ◽

Hip Fracture ◽

Total Hip Arthroplasty ◽

Older Age ◽

Factors Associated ◽

Independent Risk Factors ◽

D Dimer

Abstract Background Postoperative ischemic stroke is a devastating complication following total hip arthroplasty (THA). The purpose of the current study was to investigate the incidence of postoperative acute ischemic stroke (AIS) in patients ≥70 years old with THA for hip fracture after 90 days and independent risk factors associated with 90-day AIS. Methods A multicenter retrospective study was conducted, patients ≥70 years old with THA for hip fracture under general anesthesia were included from February 2017 to March 2020. Patients with AIS within 90 days after THA were identified as AIS group; patients with no AIS were identified as no AIS group. The baseline characteristics and risk factors were collected, multivariable logistic regression was used to identify independent risk factors of 90-dayAIS. Results: 2517 patients (mean age 76.18 ± 6.01) were eligible for inclusion in the study. 2.50% (63/2517) of patients had 90-day AIS. Compared with no AIS, older age, diabetes, hyperlipidemia, atrial fibrillation (AF) and higher D-dimer value were more likely in patients with AIS (P < 0.05), and anticoagulant use was fewer in patients with AIS. ROC curve analysis showed that the optimal cut point of D-dimer for AIS was D-dimer≥4.12 μg/ml. Multivariate logistic regression analysis showed that D-dimer≥4.12 μg/ml [adjusted odds ratio (aOR), 4.44; confidence interval (CI), 2.50–7.72; P < 0.001], older age (aOR, 1.08; 95%CI, 1.03–1.12; P < 0.001), hyperlipidemia (aOR, 2.28; 95%CI, 1.25–4.16; P = 0.007), atrial fibrillation (aOR, 5.84; 95% CI, 1.08–15.68; P = 0.001), and diabetes (aOR, 2.60; 95% CI, 1.56–4.39; P < 0.001) were associated with increased risk of 90-day AIS after THA. Conclusions In conclusion, we found that the incidence of 90-day AIS in patients≥70 years old with THA for hip fracture was 2.5%. Older age, diabetes, hyperlipidemia, AF and higher D-dimer value were independent risk factors for 90-day AIS in patients≥70 years old with THA for hip fracture.

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Factors associated with COVID-19 related hospitalisation, critical care admission and mortality using linked primary and secondary care data

10.1101/2021.01.19.20241844 ◽

2021 ◽

Author(s):

Lisa Cummins ◽

Irene Ebyarimpa ◽

Nathan Cheetham ◽

Victoria Tzortziou Brown ◽

Katie Brennan ◽

...

Keyword(s):

Risk Factors ◽

Learning Disabilities ◽

Secondary Care ◽

Multivariate Logistic Regression Analysis ◽

Additional Patient ◽

Factors Associated ◽

Icu Admission ◽

Risk Of Death ◽

North East ◽

Increased Risk

AbstractBackgroundTo identify risk factors associated with increased risk of hospitalisation, intensive care unit (ICU) admission and mortality in inner North East London (NEL) during the first UK COVID-19 wave.MethodsMultivariate logistic regression analysis on linked primary and secondary care data from people aged 16 or older with confirmed COVID-19 infection between 01/02/2020-30/06/2020 determined odds ratios (OR), 95% confidence intervals (CI) and p-values for the association between demographic, deprivation and clinical factors with COVID-19 hospitalisation, ICU admission and mortality.ResultsOver the study period 1,781 people were diagnosed with COVID-19, of whom 1,195 (67%) were hospitalised, 152 (9%) admitted to ICU and 400 (23%) died. Results confirm previously identified risk factors: being male, or of Black or Asian ethnicity, or aged over 50. Obesity, type 2 diabetes and chronic kidney disease (CKD) increased the risk of hospitalisation. Obesity increased the risk of being admitted to ICU. Underlying CKD, stroke and dementia in-creased the risk of death. Having learning disabilities was strongly associated with increased risk of death (OR=4.75, 95%CI=(1.91,11.84), p=0.001). Having three or four co-morbidities increased the risk of hospitalisation (OR=2.34,95%CI=(1.55,3.54),p<0.001;OR=2.40, 95%CI=(1.55,3.73), p<0.001 respectively) and death (OR=2.61, 95%CI=(1.59,4.28), p<0.001;OR=4.07, 95% CI= (2.48,6.69), p<0.001 respectively).ConclusionsWe confirm that age, sex, ethnicity, obesity, CKD and diabetes are important determinants of risk of COVID-19 hospitalisation or death. For the first time, we also identify people with learning disabilities and multi-morbidity as additional patient cohorts that need to be actively protected during COVID-19 waves.

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Abstract TP426: Factors Associated With Oral Anticoagulant Non-Use for Patients With Atrial Fibrillation-Related Stroke: The Florida Puerto Rico Atrial Fibrillation Stroke Study

Stroke ◽

10.1161/str.51.suppl_1.tp426 ◽

2020 ◽

Vol 51 (Suppl_1) ◽

Author(s):

Nicole B Sur ◽

Sebastian Koch ◽

Kefeng Wang ◽

Marco R Di Tullio ◽

Carolina Gutierrez ◽

...

Keyword(s):

Atrial Fibrillation ◽

Smoking Status ◽

Oral Anticoagulants ◽

Private Insurance ◽

Stroke Severity ◽

Insurance Status ◽

Stroke Registry ◽

Factors Associated ◽

Stroke Study ◽

Adjusted Logistic Regression

Background: Oral anticoagulants (OACs) for stroke prevention in atrial fibrillation (AF) are largely underutilized. We identified pre-admission OAC utilization patterns and factors predictive of OAC non-use in patients hospitalized for AF-related stroke. Methods: We included 22,220 patients with ischemic stroke due to previously diagnosed AF enrolled in the Florida Stroke Registry from 2010-2017. A multivariable-adjusted logistic regression model was used to identify factors associated with pre-stroke OAC use for patients with AF-related stroke. Results: A total of 16,246 (73%) patients with AF-related stroke were not on OAC pre-stroke. Compared to patients on OAC, non-OAC patients were more likely to be ≥80 years old, have Medicaid/no insurance, lower CHA 2 DS 2 -VASc scores and greater stroke severity at presentation. After adjustment for age, sex, race-ethnicity, insurance status and vascular risk factors, baseline OAC non-use was higher for patients with Medicaid/no insurance (vs. private insurance, (OR 1.34 [95% CI 1.08-1.67]), smokers (OR 1.29 [1.09-1.52] and patients with NIHSS ≥6 (vs. NIHSS≤5, OR 1.18 [1.11-1.26]). A trend towards greater odds of OAC non-use was seen in women (vs. men, OR 1.07 [0.99-1.14, P=0.07]). Conclusion: The majority of AF-related stroke patients with known AF were not anticoagulated prior to hospitalization for stroke in our study. Insurance status and smoking status had the greatest influence on pre-stroke OAC use. Anticoagulated patients had lower stroke severity on admission. Further efforts are needed to increase OAC use to reduce the burden of stroke for patients with AF, especially for vulnerable populations.

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Status Epilepticus among Older Adults in the United States

Geriatrics ◽

10.3390/geriatrics4030045 ◽

2019 ◽

Vol 4 (3) ◽

pp. 45 ◽

Cited By ~ 1

Author(s):

Priya Mendiratta ◽

Neeraj Dayama ◽

Jeanne Y Wei ◽

Pallavi Prodhan ◽

Parthak Prodhan

Keyword(s):

Risk Factors ◽

Older Adults ◽

Ischemic Stroke ◽

Status Epilepticus ◽

Age Group ◽

Brain Hemorrhage ◽

Factors Associated ◽

Hospitalized Elderly ◽

Risk Of Mortality ◽

Overall Mortality

Objective: This study aimed to identify temporal time trends and risk factors associated with mortality for hospitalized older adults with status epilepticus (SE). Design: A retrospective study was performed. Setting: Hospitalized patients were identified utilizing an administrative database—The Nationwide Inpatient Sample database from 1998 through September 2015. Patients: Patients were older adults 65 years and older with SE. Interventions: No interventions were undertaken. Measurements and Main Results: Demographic, temporal trends, clinical characteristics, and outcome data were abstracted. The results indicated that hospitalized elderly Americans with SE increased over the 11-year study period. Univariate and multivariate analyses were performed to evaluate risk factors associated with mortality in the study cohort. From the weighted sample, 130,109 subjects were included. Overall mortality was 19%. For age subgroups, the mortality was highest for the >85 years age group (24.1%) compared to the 65–75 years (19%) and 75–85 years (23%) age groups. Among investigated etiologies, the three most common causes of SE were acute ischemic stroke (11.2% of total) followed by non-traumatic brain hemorrhage (5.4%) and malignant brain lesions (4.9%). The highest mortality by etiology was noted for acute traumatic brain injury (TBI) (31.5%), non-traumatic brain hemorrhage (31%), and acute ischemic stroke (AIS) (30.1%). Multivariate analysis indicated that non-survivors when compared to survivors were more like to have the following characteristics: older age group, acute TBI, brain neoplasms, non-traumatic brain hemorrhage, AIS and central nervous system (CNS) infections, and utilization of mechanical ventilation. Associated conditions significantly increasing risk of mortality were sodium imbalance, cardiac arrest, anoxic brain injury, pneumonia, and sepsis. Comorbidities associated with increased risk of mortality included valvular heart disease, renal failure, liver disease, and neoplasms. Conclusions: The number of hospitalized elderly Americans with SE increased over the 11-year study period. Overall mortality was 19%, with even higher mortality among various patient subsets. Several demographic and co-morbid factors are associated with increased mortality in this age group.

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Risk factors associated with atrial fibrillation after noncardiac thoracic surgery: analysis of 2588 patients

Journal of Thoracic and Cardiovascular Surgery ◽

10.1016/j.jtcvs.2003.07.011 ◽

2004 ◽

Vol 127 (3) ◽

pp. 779-786 ◽

Cited By ~ 227

Author(s):

Ara A Vaporciyan ◽

Arlene M Correa ◽

David C Rice ◽

Jack A Roth ◽

W.R Smythe ◽

...

Keyword(s):

Risk Factors ◽

Atrial Fibrillation ◽

Thoracic Surgery ◽

Factors Associated

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Chronic bronchitis in Aboriginal people—prevalence and associated factors

Chronic Diseases and Injuries in Canada ◽

10.24095/hpcdp.33.4.03 ◽

2013 ◽

Vol 33 (4) ◽

pp. 218-225 ◽

Cited By ~ 5

Author(s):

S Konrad ◽

A Hossain ◽

A Senthilselvan ◽

JA Dosman ◽

MD Pahwa

Keyword(s):

Risk Factors ◽

First Nations ◽

Chronic Bronchitis ◽

Rural Areas ◽

Associated Factors ◽

Aboriginal People ◽

Smoking Status ◽

Aboriginal Peoples ◽

Cross Sectional ◽

Factors Associated

Introduction Knowledge about chronic bronchitis (CB) among Aboriginal people in Canada is limited. The aim of this study was to determine the prevalence of CB and its associated factors among Aboriginal people aged 15 years plus. Methods Logistic regression analysis was used on data from the cross-sectional 2006 Aboriginal Peoples Survey to determine risk factors associated with CB. Results CB prevalence was 6.6% among First Nations, 6.2% among Métis and 2.4% among Inuit. Prevalence was higher among females than males (7.2% versus 5.0%). Individuals with CB were more likely to be older, living at a lower income, with a lower educational attainment and residing in rural areas. Smoking status and body mass index were also significantly associated with CB, but their effect differed by sex. Obesity was particularly significantly associated with CB among females compared with males, and current smoking and non-smoking status was significantly associated with CB among females but not males. Conclusion These findings identify factors associated with CB among Aboriginal people. As such, they may represent potentially preventable risk factors that can inform health promotion and disease prevention practices.

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Stroke Risk Factors, Subtypes and Outcome in Elderly Thai Patients

10.21203/rs.3.rs-140400/v1 ◽

2021 ◽

Author(s):

Chatpol Samuthpongtorn ◽

Tul Jereerat ◽

Nijasri Suwanwela

Keyword(s):

Risk Factors ◽

Atrial Fibrillation ◽

Ischemic Stroke ◽

The Elderly ◽

P Value ◽

Younger Patients ◽

Factors Associated ◽

Stroke Risk Factors ◽

History Of ◽

Ischemic Attack

Abstract Background: Nowadays, the number of elderly has steadily increased annually. Elderly patients with ischemic stroke often have worse outcomes than younger patients. However, there has not been a study of ischemic stroke in the elderly in Thailand. A better knowledge of the risk factors, subtypes, and outcomes of strokes in the elderly may have significant practical implications for the aged society in the future. The objective of the study was to assess the risk factor, stroke subtypes, and outcome of stroke in the elderly compared to the younger patients.Method: All patients presented with acute ischemic stroke and transient ischemic attack (TIA) aged over 45 years who were admitted in the Stroke unit between November 1st, 2016 and December 31st, 2017 were retrospectively studied.Result: 542 patients were included. The average age was 68.78±12.03, 44.8% of them were male. 186 (34.3%) patients were 75 or older. Cardioembolism was found to be the most common cause of ischemic stroke in 156 patients (28.8%). Patients who were 75 or older had significantly worse outcomes in all categories including NIHSS at discharge, modified Rankin scale, length of stay and the number of deaths) compared to the younger group. Atrial fibrillation was the risk factors associated with older age with OR 3.861 (p value<0.001). Aged 75 years or older, atrial fibrillation, more NIHSS score on admission and history of the previous stroke were the risk factors associated with a patient's death.Conclusion: The elderly who are 75 years or older accounts for more than one-third of ischemic stroke in our study. Stroke in the elderly correlates with higher mortality and poorer outcome. Cardioembolism related to atrial fibrillation is the major cause of stroke in this population.

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Secondary Prevention Post Stroke in Primary Care in an Asian Setting: A Retrospective Cohort Study

10.21203/rs.3.rs-111876/v1 ◽

2020 ◽

Author(s):

Vivek Bansal ◽

Eng Sing Lee ◽

Helen Smith

Keyword(s):

Risk Factors ◽

Atrial Fibrillation ◽

Primary Care ◽

Secondary Prevention ◽

Retrospective Cohort ◽

Care Setting ◽

Primary Care Setting ◽

Stroke Patients ◽

Factors Associated ◽

Post Stroke

Abstract Background: Stroke is one of the top contributors to burden of disability-adjusted life-years worldwide. Family physicians have key role in optimal secondary prevention post-stroke helping patients make appropriate lifestyle changes and take medication in accordance with the recommended clinical practice guidelines.Methods: Our aim was to characterize the profile of patients who were being managed in primary care setting for secondary prevention of stroke. Our specific objectives were: (i) to examine the level of overall and individual risk factors control after an index-stroke event in patients visiting the primary care setting and (ii) to describe the factors associated with the achievement of overall risk factors control in post-stroke patients.Study Design: Retrospective cohort study.We conducted a study looking retrospectively at records from our electronic chronic disease database. Our study included post-stroke patients who visited public primary care setting in Singapore between 1st January 2012 to 31st December 2016. Based on AHA Stroke guidelines, we operationalized our outcome of secondary prevention post-stroke as overall control, which comprised of patients having blood pressure, lipids, and glucose reading (for those who had diabetes) all well-controlled. We conducted descriptive analysis and performed multivariable logistic analysis to determine factors associated with overall control.Results: There were 24,240 patients in our study. Overall control was better in post-stroke patients without diabetes (49.2%) as compared to those with diabetes (28.1%).Among post-stroke patients without diabetes, factors significantly associated with overall control were sex [OR: 1.23, 95% CI: 1.10, 1.39], ethnicity [OR: 0.72, 95% CI: 0.58, 0.90], BMI [OR: 0.72, 95% CI: 0.62, 0.84) and atrial fibrillation [OR: 1.47, 95% CI: 1.21, 1.78].Among post-stroke patients with diabetes, factors significantly associated with overall control were sex [OR: 1.28, 95% CI: 1.12, 1.46], ethnicity, BMI, atrial fibrillation[OR: 1.24; 95% CI: 1.02, 1.51], chronic kidney disease and smoking status.Conclusion: We reported a sub-optimal level of overall control. Among post-stroke patients, those with diabetes had a higher proportion of sub-optimal control as compared to those without diabetes. Irrespective of diabetic status, being female, having high BMI, and of Malay ethnicity were associated with poor overall control compared to Chinese.

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