scholarly journals Markers of Iron Metabolism and Stroke Risk: Cross-Sectional and Longitudinal Findings from the China Health and Nutrition Survey (CHNS)

2022 ◽  
Author(s):  
Dong Liu ◽  
Ya Zhang ◽  
Cui-Cui Wang ◽  
Xiao-Hong E ◽  
Hui Zuo
Keyword(s):  
Iron Metabolism ◽  
Stroke Risk ◽  
Proportional Hazards ◽  
High Sensitivity ◽  
Cox Proportional Hazards ◽  
Contributing Factors ◽  
Nutrition Survey ◽  
Cross Sectional ◽  
Health And Nutrition ◽  
Cox Proportional Hazards Models

Background: The association of iron metabolism or status with the stroke risk remains unclear. We aimed to examine the associations between markers of iron metabolism or status and stroke risk using data from the China Health and Nutrition Survey (CHNS). Methods: Overall, 8589 in the CHNS in 2009, and 7290 participants between 2009 and 2015 were included in the cross-sectional and longitudinal analyses, respectively. Markers included hemoglobin, ferritin (FET), transferrin (TRF), soluble transferrin receptor (sTRF-R), and ratio of sTRF-R/log FET (sTfR-F index). Multivariable logistic regression and Cox proportional hazards models were used to analyze the associations between those markers and risk of stroke. Age, gender, high-sensitivity CRP (hsCRP), body mass index (BMI), current smoking, drinking status, diabetes and hypertension were included as potential confounding factors. Results: We observed longitudinal associations of hemoglobin (HR: 1.54, 95% CI: 1.15 – 2.06, P = 0.004), and sTfR-F index (HR: 0.68, 95% CI: 0.46 – 0.99, P = 0.044) with stroke risk among the participants whose BMI ≤ 23 kg/m2. In addition, FET levels were significantly associated with stroke risk among female (HR: 1.45, 95% CI: 1.00 – 2.09, P = 0.049) after a median of 6.1 years follow-up. Hemoglobin, FET, TRF, sTRF-R, and sTfR-F index were not associated with the risk of stroke in overall analyses. Conclusion: FET among female, hemoglobin and sTfR-F index among those BMI ≤ 23 kg/m2 may be contributing factors for stroke.

NHSR 155: Comparative Analysis of the National Health and Nutrition Examination Survey Public-Use and Restricted-Use Linked Mortality Files - Production Schedule

2021 ◽  
Author(s):  
Lisa Mirel
Keyword(s):  
Comparative Analysis ◽  
Proportional Hazards ◽  
Cox Proportional Hazards ◽  
The Public ◽  
Health And Nutrition ◽  
Cox Proportional Hazards Models ◽  
Hazard Ratios ◽  
Specific Mortality ◽  
Standard Set ◽  
Restricted Use

This report describes a comparative analysis of the public-use and restricted-use NHANES LMFs. Cox proportional hazards models were used to estimate relative hazard ratios for a standard set of sociodemographic covariates for all-cause as well as cause-specific mortality, using the public-use and restricted-use NHANES LMFs.

scholarly journals Informant-based hearing difficulties and the risk for mild cognitive impairment and dementia

2019 ◽  
Vol 48 (6) ◽  
pp. 888-894 ◽  
Author(s):  
Maria Vassilaki ◽  
Jeremiah A Aakre ◽  
David S Knopman ◽  
Walter K Kremers ◽  
Michelle M Mielke ◽  
...  
Keyword(s):  
Cognitive Impairment ◽  
Mild Cognitive Impairment ◽  
Cognitive Decline ◽  
Proportional Hazards ◽  
Cox Proportional Hazards ◽  
Daily Activities ◽  
Cross Sectional ◽  
Cox Proportional Hazards Models ◽  
Increased Risk ◽  
Hearing Difficulties

Abstract Background: hearing loss has been associated with mild cognitive impairment (MCI) and dementia. Studies have not assessed whether hearing difficulties (HD) that interfere with daily activities as reported by partners can be a marker for increased risk for cognitive decline and impairment. Objective: to assess the cross-sectional and longitudinal associations between informant-based HD, which interfere with daily activities and the risk for MCI and dementia. Methods: the study included 4812 participants without dementia, enrolled in the Mayo Clinic Study of Aging (mean age (SD) 73.7 (9.6) years) with cognitive evaluation and informant-based report on participant’s HD that interfere significantly with daily activities at baseline and for every 15 months. Cox proportional hazards models (utilising time-dependent HD status and age as the time scale) were used to examine HD and the risk for MCI or dementia, and mixed-effects models (allowing for random subject-specific intercepts and slopes) were used to examine the relationship between HD and cognitive decline. Results: about, 981 participants had HD and 612 (12.7%) had prevalent MCI at baseline; 759 participants developed incident MCI and 273 developed incident dementia. In cognitively unimpaired participants at baseline, those with HD had higher risk for MCI (hazard ratio [HR] = 1.29, 95% confidence interval [CI] (1.10, 1.51), P = 0.002; adjusting for sex, years of education). In participants without dementia, those with HD had higher risk for dementia (HR: 1.39, 95% CI, (1.08–1.79), P = 0.011; adjusting sex and education). In individuals with MCI, HD was associated with modestly greater cognitive decline. Conclusions: informant-based HD was associated with increased risk for MCI and dementia.

Association of Blood Pressure With Stroke Risk in Chinese Population: A 6-Year Prospective Cohort Study

2021 ◽  
Author(s):  
Qi Yu ◽  
Qing-Dong Jin ◽  
Yan-Qing Chen ◽  
Xin-Ru Liu ◽  
Qing-Ying Lin
Keyword(s):  
Blood Pressure ◽  
Hemorrhagic Stroke ◽  
Stroke Risk ◽  
Proportional Hazards ◽  
Positive Association ◽  
Cubic Spline ◽  
Cox Proportional Hazards ◽  
Nutrition Survey ◽  
Cox Models ◽  
Nonlinear Relationships

Abstract Objective: Previous results on the association between blood pressure(BP) and stroke risk were controversial. We investigated the association of BP with stroke risk in China. Method: We included a total of 5,700 adults aged 40-90 years from the China Health and Nutrition Survey (CHNS) cohort. Cox proportional hazards regression models were used to estimate hazard ratios and 95% CIs. Restricted cubic spline analyses were used to explore linear and nonlinear relationships of BP and stroke. Result: With a median follow-up of 6 years, a total of 5,700 individuals were enrolled in our study, of whom 178 developed stroke. Multivariable adjusted Cox models including systolic blood pressure(SBP) and diastolic blood pressure(DBP) showed a strong positive association between SBP and overall stroke. Compared with participants with SBP 0-130 mmHg, the multivariable adjusted HRs[95% CIs] in participants with SBP 130-140, 140-160, 160-180, and ≥180 mmHg were 1.08[0.62-1.89], 2.41[1.51-3.86], 2.21[1.16-4.20], and 3.90[1.78-8.55] for overall stroke; 0.65[0.21-2.04], 3.68[1.73-7.83], 2.51[0.84-7.47], and 5.91[1.69-20.60] for ischemic stroke; 1.26[0.50-3.20], 1.19[0.47-3.04], 2.06[0.66-6.41], and 5.10[1.36-19.20] for hemorrhagic stroke. Restricted cubic spline analyses including SBP and DBP showed linear relationships of SBP with overall, ischemic and hemorrhagic stroke. No linear or nonlinear relationships of DBP with overall, ischemic and hemorrhagic stroke were observed.Conclusion: SBP is independently and directly related to the risk of overall and its subtypes. Besides, the risk of ischemic and hemorrhagic stroke might be higher when SBP were more than 140 mmHg and 160 mmHg.

Abstract 90: Race, Ethnic, and Sex Disparities in Stroke Incidence in the Northern Manhattan Study

Stroke ◽  
2020 ◽  
Vol 51 (Suppl_1) ◽  
Author(s):  
Hannah Gardener ◽  
Ralph L Sacco ◽  
Tatjana Rundek ◽  
Consuelo Mora-McLaughlin ◽  
Ying Kuen Cheung ◽  
...  
Keyword(s):  
Incidence Rate ◽  
Low Socioeconomic Status ◽  
Stroke Risk ◽  
Proportional Hazards ◽  
Population Based ◽  
Incidence Rates ◽  
Cox Proportional Hazards ◽  
Stroke Incidence ◽  
Cox Proportional Hazards Models ◽  
Hazard Ratios

Background: An excess incidence of strokes among blacks vs whites has been shown previously, but data on disparities related to Hispanic ethnicity remains limited. This study examines race, ethnic, and sex differences in stroke incidence in the multi-ethnic, yet largely Caribbean Hispanic, Northern Manhattan Study (NOMAS). Methods: The study population included participants in the prospective population-based NOMAS, followed for a mean of 13±7 years. Cox proportional hazards models were constructed to estimate the hazard ratios and 95% confidence intervals (HR, 95%CI) for the association between race/ethnicity and sex with confirmed incident stroke of any subtype and ischemic stroke, stratified by age and adjusting for sociodemographics and vascular risk factors. Results: Among 3,298 participants (mean baseline age 69±10, 37% men, 24% black, 21% white, 52% Hispanic), 477 incident strokes accrued (394 ischemic, 43 ICH, 9 SAH). The most common ischemic subtype was cardioembolic, followed by lacunar infarcts, then cryptogenic. The greatest incidence rate was observed in blacks (13/1000 person-years [PY]), followed by Hispanics (11/1000 PY), and lowest in whites (8/1000 PY), and this order was observed for crude incidence rates until age 75. By age 85 the greatest incidence rate was in Hispanics. Blacks had an increased stroke risk vs whites overall in fully adjusted models (HR=1.37, 95% CI=1.02-1.84), and stratified analyses showed that this disparity was driven by women age ≥70 (HR=1.69, 1.05-2.73). The increased rate of stroke observed for Hispanics (age/sex-adjusted HR=1.50, 1.15-1.94) was largely explained by education and insurance status (a proxy for socieoeconomic status; HR after further adjusting for these variables=1.15, 0.84-1.58), but remained significant for women age ≥70. Men had an increased rate of stroke compared to women (fully adjusted HR=1.48, 1.21-1.81). Conclusions: This study provides novel data regarding the increased stroke risk among Caribbean Hispanics. Results highlight the need to create culturally-tailored campaigns to reach blacks and Hispanic populations to reduce race/ethnic stroke disparities, and support the important role of low socioeconomic status in driving an elevated risk among Caribbean Hispanics.

scholarly journals ADHD treatment and diagnosis in relation to children’s birth month: Nationwide cohort study from Norway

2017 ◽  
Vol 45 (4) ◽  
pp. 343-349 ◽  
Author(s):  
Øystein Karlstad ◽  
Kari Furu ◽  
Camilla Stoltenberg ◽  
Siri E. Håberg ◽  
Inger Johanne Bakken
Keyword(s):  
Proportional Hazards ◽  
Cox Proportional Hazards ◽  
Adhd Medication ◽  
Older Children ◽  
Cross Sectional ◽  
Birth Month ◽  
Cox Proportional Hazards Models ◽  
Increased Risk ◽  
Adhd Treatment ◽  
Grade 3

Background: Studies from several countries have reported that children youngest in grade are at higher risk of attention-deficit/hyperactivity disorder (ADHD) diagnosis and treatment. Norwegian children start school the year they turn six, making children born in December youngest in their grade. We used data on medication, specialist healthcare diagnoses, and primary healthcare diagnoses from national registers to investigate associations between birth month and ADHD. Methods: All children born in Norway between 1998 and 2006 ( N=509,827) were followed from age six until 31 December 2014. We estimated hazard ratios for ADHD medication and diagnoses by birth month in Cox proportional-hazards models. We compared risk among siblings to control for potentially confounding socioeconomic factors, and assessed risk of receiving ADHD medication by birth month while attending different grades in cross-sectional time-series analyses. Results: At end of follow-up, 5.3% of boys born in October–December had received ADHD medication, compared with 3.7% of boys born in January–March. Corresponding numbers for girls were 2.2% and 1.3%, respectively. The adjusted hazard ratio for ADHD medication for children born in October–December (reference: January–March) was 1.4 (95% confidence interval: 1.4–1.5) for boys and 1.8 (1.7–2.0) for girls. Analyses with diagnoses as outcome showed consistent results, and analyses restricted to siblings within the study population also supported the findings. Analysis by grade revealed an increased risk for children born late in the year from grade 3 onwards, with most marked differences in higher grades. Conclusions: Children youngest in grade had the highest risk of receiving ADHD treatment. Differences were most marked among older children.

scholarly journals Dietary Diversity and the Risk of Fracture in Adults: A Prospective Study

Nutrients ◽  
2020 ◽  
Vol 12 (12) ◽  
pp. 3655
Author(s):  
Jian Zhang ◽  
Dong Liang ◽  
Ai Zhao
Keyword(s):  
Proportional Hazards ◽  
Dietary Diversity ◽  
Cox Proportional Hazards ◽  
Dietary Guidelines ◽  
Nutrition Survey ◽  
Risk Of Fracture ◽  
Study Approach ◽  
Health And Nutrition ◽  
A Prospective Study ◽  
Control Study

Nutrition plays an important and modifiable role in bone health. This study aimed to investigate the effect of dietary diversity on the risk of any type of fracture in adults. Data from the China Health and Nutrition Survey collected between waves 1997 and 2015 were used. A total of 10,192 adults aged 40 years and older were included in the analysis. Both dietary diversity score (DDS) based on Chinese dietary guidelines (DDS-CDG) and minimum dietary diversity for women (DDS-MDD-W) were computed. Cox proportional hazards regression models were conducted to determine the association. Stratified analyses were conducted in women by the age of fracture using the case-control study approach. In men, higher scores in both the DDS-CDG (hazard ratio (HR) 0.70, 95% CI 0.56–0.88) and DDS-MDD-W (HR 0.67, 95% CI 0.54–0.82) were associated with decreased risk of fracture, however, the associations were not significant in women (DDS-CDG: HR 0.94, 95% CI 0.79–1.12; DDS-MDD-W: HR 0.93, 95% CI 0.79–1.09). In the stratified analyses, higher DDS-CDG (odds ratio (OR) 0.74, 95% CI 0.58–0.95) and higher DDS-MDD-W (OR 0.76, 95% CI 0.60–0.95) were associated with lower risks of fracture in women aged 40 to 60 years; in women aged over 60 years, no association was observed (DDS-CDG: OR 1.10, 95% CI 0.83–1.46; DDS-MDD-W: OR 1.00, 95% CI 0.79–1.27). In summary, higher dietary diversity was associated with decreased risk of fracture in men and middle-aged women, but not in women aged over 60 years.

scholarly journals Impact of Retinopathy and Systemic Vascular Comorbidities on All-Cause Mortality

2021 ◽  
Vol 12 ◽  
Author(s):  
Zhuoting Zhu ◽  
Xianwen Shang ◽  
Wei Wang ◽  
Jason Ha ◽  
Yifan Chen ◽  
...  
Keyword(s):  
Proportional Hazards ◽  
Vascular Risk Factor ◽  
Cox Proportional Hazards ◽  
Hypertension Status ◽  
Term Survival ◽  
Time To Death ◽  
Health And Nutrition ◽  
Cox Proportional Hazards Models ◽  
All Cause Mortality ◽  
The Impact

PurposeTo assess the impact of retinopathy and systemic vascular comorbidities on the all-cause mortality in a representative U.S. sample.MethodsA total of 5703 participants (≥40 years old) from the 2005-2008 National Health and Nutrition Examination Survey. The Early Treatment Diabetic Retinopathy Study grading scale was used to evaluate the retinopathy status. Systemic vascular comorbidities included diabetes mellitus (DM), high blood pressure (HBP), chronic kidney disease (CKD) and cardiovascular disease (CVD). Time to death was calculated as the time from baseline to either the date of death or censoring (December 31st, 2015), whichever came first. Risks of mortality were estimated using Cox proportional hazards models after adjusting for confounders and vascular comorbidities.ResultsAfter a median follow-up of 8.33 years (IQR: 7.50-9.67 years), there were 949 (11.8%) deaths from all causes. After adjusting for confounders, the presence of retinopathy predicted higher all-cause mortality (hazard ratio (HR), 1.41; 95% confidence interval (CI), 1.08-1.83). The all-cause mortality among participants with both retinopathy and systemic vascular comorbidities including DM (HR, 1.72; 95% CI, 1.21-2.43), HBP (HR, 1.47; 95% CI, 1.03-2.10), CKD (HR, 1.73; 95% CI, 1.26-2.39) and CVD (HR, 1.92; 95% CI, 1.21-3.04) was significantly higher than that among those without either condition. When stratified by diabetic or hypertension status, the co-occurrence of retinopathy and CKD or CVD further increased the all-cause mortality compared to those without either condition.ConclusionsThe co-occurrence of retinopathy and systemic vascular conditions predicted a further increase in the risk of mortality. More extensive vascular risk factor assessment and management are needed to detect the burden of vascular pathologies and improve long-term survival in individuals with retinopathy.

Abstract 19554: Lipoprotein(a) and Risk of Ischemic Stroke in the Reasons for Geographic and Racial Differences in Stroke (REGARDS) Study

Circulation ◽  
2015 ◽  
Vol 132 (suppl_3) ◽  
Author(s):  
Kristine S Alexander ◽  
Neil A Zakai ◽  
Fred Unverzagt ◽  
Virginia Wadley ◽  
Brett M Kissela ◽  
...  
Keyword(s):  
Ischemic Stroke ◽  
Racial Differences ◽  
Stroke Risk ◽  
Proportional Hazards ◽  
Continuous Variable ◽  
Cox Proportional Hazards ◽  
Stroke Incidence ◽  
Lipoprotein A ◽  
Cox Proportional Hazards Models ◽  
Regards Study

Background: Increased lipoprotein (a) (Lp(a)) is associated with coronary risk, but links with stroke have been less consistent. Blacks have 2-4-fold higher Lp(a) levels than whites, and have higher stroke incidence than whites, but have been under-represented in studies of Lp(a) and stroke to date. Hypothesis: Lp(a) is a risk factor for ischemic stroke, and this risk differs by race. Methods: REGARDS recruited 30,239 black and white U.S. men and women in 2003-7 to study regional and racial differences in stroke mortality. We measured Lp(a) by immunonepholometric assay in 572 cases of incident ischemic stroke and a 1,104-person cohort random sample. The hazard ratio of stroke by baseline Lp(a) was calculated using Cox proportional hazards models, stratified by race. Lp(a) was modeled both as a continuous variable (per sex- and race-specific SD) and in sex- and race-specific quartiles, given known differences in distributions by race and sex. Results: As shown in the Figure, being in the 4 th vs 1 st Lp(a) quartile was associated with ischemic stroke in black but not white participants, adjusted for age and sex (Model 1). The HRs were essentially unchanged with added adjustment for stroke risk factors (Model 2). There was no significant association between Lp(a) as a continuous variable and stroke, though race-specific patterns were similar. There remained no association between Lp(a) and stroke in whites when we used the sex- and race-specific 90 th percentile as a cut-off (HR: 0.91 95% CI: 0.52, 1.60). Discussion: Lp(a) was associated with ischemic stroke risk in black but not white REGARDS participants, this might partly explain the black/white disparity in stroke. Further studies in racially diverse groups are necessary to confirm these findings. Figure 1. Hazard ratios for Lp(a) and stroke in blacks and whites, per quartile (compared with first quartile) and SD.

scholarly journals The Association Between Dietary Purine Intake and Mortality: Evidence From the CHNS Cohort Study

2021 ◽  
Vol 5 (Supplement_2) ◽  
pp. 1105-1105
Author(s):  
Miaojia Yan ◽  
Lichen Wu ◽  
Yutong Wang ◽  
Huimeng Liu ◽  
Shaonong Dang ◽  
...  
Keyword(s):  
Proportional Hazards ◽  
Food Composition ◽  
Cox Proportional Hazards ◽  
Chinese Adults ◽  
Nutrition Survey ◽  
Funding Sources ◽  
Health And Nutrition ◽  
Hazard Ratios ◽  
Restricted Cubic Splines ◽  
Outcome Event

Abstract Objectives To investigate the association between dietary purine intake and mortality among Chinese adults. Methods Based on data from the 2004–2015 China Health and Nutrition Survey (CHNS) and the corresponding edition of China Food Composition, the average purine intake per day from 2004 to 2011 was calculated and divided into five groups by quintiles. The outcome event and time we concerned were defined as self-reported death and time in 2015 survey. Cox proportional hazards regression was used to estimate hazard ratios (HR) with 95% confidence intervals (CIs) for death. The possibly non-linear relation between purine intake and mortality was examined with restricted cubic splines. Results We included 17,751 subjects and the average purine intake among them was 329.14 ± 142.74 mg/day. Purine intake was inversely associated with mortality (P = 0.002). Compared with the lowest quintiles, the HRs (95% CI) of the highest quintiles were 0.60 (0.46, 0.77) for purine (P < 0.001). Besides, a U-shaped relationship between purine intake and mortality was observed in males; however, there is no dose-response relationship in females. Conclusions Under the low purine intake levels of the Chinese population, purine intake showed a protective effect. We observed a U-shaped relationship between purine intake and mortality in men but not found in women. Funding Sources National Key R&D Program of China (2017YFC0907200,2017YFC0907201).

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