scholarly journals Incidence and Risk Factors for Amputation in Patients With Diabetes in Japan: A Historical Cohort Study Using a Nationwide Claims Database

2020 ◽  
Author(s):  
Masanori Kaneko ◽  
Kazuya Fujihara ◽  
Taeko Osawa ◽  
Masahiko Yamamoto ◽  
Mayuko Yamada Harada ◽  
...  
Keyword(s):  
Cox Regression ◽  
Historical Cohort ◽  
Cox Regression Analysis ◽  
Claims Database ◽  
Hazard Ratios ◽  
Patients With Diabetes ◽  
Mortality Predictors ◽  
Hba1c Levels

Abstract Background: Because amputation negatively affects the quality of life of patients with diabetes and increases the risk of cardiovascular events and mortality, predictors of amputation must be identified. However, no large cohort studies have been conducted regarding the incidence of amputation in patients with diabetes in East Asia.Methods: We analyzed data from a nationwide claims database in Japan accumulated from 2008–2016, involving 17,288 patients with diabetes aged 18–72 y (2942 women, mean age 50.2 y, HbA1c 7.2%).Results: The mean follow-up time was 5.3 years, and 16 amputations occurred (0.17/1000 person-years). Multivariate Cox regression analysis showed that age and HbA1c levels were independent predictors of amputation (hazard ratios [HRs], 1.09 and 1.43; 95% confidence intervals [CIs], 1.01–1.16 and 1.12–1.82, respectively). Compared with patients aged <60 y and with HbA1c <8%, the HR for patients aged ≥60 y and with HbA1c ≥8% was 32.1 (95% CI, 7.30–141.2).Conclusions: Improved glycemic control may lower amputation risk.

scholarly journals Rates and risk factors for amputation in people with diabetes in Japan: a historical cohort study using a nationwide claims database

2021 ◽  
Vol 14 (1) ◽  
Author(s):  
Masanori Kaneko ◽  
Kazuya Fujihara ◽  
Mayuko Yamada Harada ◽  
Taeko Osawa ◽  
Masahiko Yamamoto ◽  
...  
Keyword(s):  
Lower Limb ◽  
Cox Regression ◽  
Lower Limb Amputation ◽  
Limb Amputation ◽  
Historical Cohort ◽  
Cox Regression Analysis ◽  
Claims Database ◽  
Younger Age

Abstract Background The prevalence of diabetes is rising, and diabetes develops at a younger age in East Asia. Although lower limb amputation negatively affects quality of life and increases the risk of cardiovascular events, little is known about the rates and predictors of amputation among persons with diabetes from young adults to those in the “young-old” category (50–72 y). Methods We analyzed data from a nationwide claims database in Japan accumulated from 2008 to 2016 involving 17,288 people with diabetes aged 18–72 y (mean age 50.2 y, HbA1c 7.2%). Amputation occurrence was determined according to information from the claims database. Cox regression model identified variables related to lower limb amputation. Results The mean follow-up time was 5.3 years, during which time 16 amputations occurred (0.17/1000 person-years). Multivariate Cox regression analysis showed that age (hazard ratio [HR] 1.09 [95% confidence intervals] 1.02–1.16, p = 0.01) and HbA1c (HR 1.46 [1.17–1.81], p < 0.01) were independently associated with amputations. Compared with those aged < 60 years with HbA1c < 8.0%, the HR for amputation was 27.81 (6.54–118.23) in those aged ≥60 years and HbA1c ≥8.0%. Conclusions Age and HbA1c were associated with amputations among diabetic individuals, and the rates of amputation were significantly greater in those ≥60 years old and with HbA1c ≥8.0%.

Headache as a risk factor for dementia: A prospective population-based study

Cephalalgia ◽  
2013 ◽  
Vol 34 (5) ◽  
pp. 327-335 ◽  
Author(s):  
Knut Hagen ◽  
Eystein Stordal ◽  
Mattias Linde ◽  
Timothy J Steiner ◽  
John-Anker Zwart ◽  
...  
Keyword(s):  
Risk Factor ◽  
Cohort Study ◽  
Cox Regression ◽  
Subsequent Development ◽  
Population Based ◽  
Health Study ◽  
Cox Regression Analysis ◽  
Hazard Ratios ◽  
Increased Risk

Background Headache has not been established as a risk factor for dementia. The aim of this study was to determine whether any headache was associated with subsequent development of vascular dementia (VaD), Alzheimer’s disease (AD) or other types of dementia. Methods This prospective population-based cohort study used baseline data from the Nord-Trøndelag Health Study (HUNT 2) performed during 1995–1997 and, from the same Norwegian county, a register of cases diagnosed with dementia during 1997–2010. Participants aged ≥20 years who responded to headache questions in HUNT 2 were categorized (headache free; with any headache; with migraine; with nonmigrainous headache). Hazard ratios (HRs) for later inclusion in the dementia register were estimated using Cox regression analysis. Results Of 51,383 participants providing headache data in HUNT 2, 378 appeared in the dementia register during the follow-up period. Compared to those who were headache free, participants with any headache had increased risk of VaD ( n = 63) (multivariate-adjusted HR = 2.3, 95% CI 1.4–3.8, p = 0.002) and of mixed dementia (VaD and AD ( n = 52)) (adjusted HR = 2.0, 95% CI 1.1–3.5, p = 0.018). There was no association between any headache and later development of AD ( n = 180). Conclusion In this prospective population-based cohort study, any headache was a risk factor for development of VaD.

scholarly journals Mortality in Patients with Diabetic Foot Ulcers: Causes, Risk Factors, and Their Association with Evolution and Severity of Ulcer

2020 ◽  
Vol 9 (9) ◽  
pp. 3009
Author(s):  
José Antonio Rubio ◽  
Sara Jiménez ◽  
José Luis Lázaro-Martínez
Keyword(s):  
Diabetic Foot ◽  
Cox Regression ◽  
Foot Ulcers ◽  
Diabetic Foot Ulcers ◽  
Cox Regression Analysis ◽  
Kaplan Meier ◽  
Hazard Ratios ◽  
History Of

Background: This study reviews the mortality of patients with diabetic foot ulcers (DFU) from the first consultation with a Multidisciplinary Diabetic Foot Team (MDFT) and analyzes the main cause of death, as well as the relevant clinical factors associated with survival. Methods: Data of 338 consecutive patients referred to the MDFT center for a new DFU during the 2008–2014 period were analyzed. Follow-up: until death or until 30 April 2020, for up to 12.2 years. Results: Clinical characteristics: median age was 71 years, 92.9% had type 2 diabetes, and about 50% had micro-macrovascular complications. Ulcer characteristics: Wagner grade 1–2 (82.3%), ischemic (49.2%), and infected ulcers (56.2%). During follow-up, 201 patients died (59.5%), 110 (54.7%) due to cardiovascular disease. Kaplan—Meier curves estimated a reduction in survival of 60% with a 95% confidence interval (95% CI), (54.7–65.3) at 5 years. Cox regression analysis adjusted to a multivariate model showed the following associations with mortality, with hazard ratios (HRs) (95% CI): age, 1.07 (1.05–1.08); HbA1c value < 7% (53 mmol/mol), 1.43 (1.02–2.0); active smoking, 1.59 (1.02–2.47); ischemic heart or cerebrovascular disease, 1.55 (1.15–2.11); chronic kidney disease, 1.86 (1.37–2.53); and ulcer severity (SINBAD system) 1.12 (1.02–1.26). Conclusion: Patients with a history of DFU have high mortality. Two less known predictors of mortality were identified: HbA1c value < 7% (53 mmol/mol) and ulcer severity.

scholarly journals Obstructive sleep apnoea is not a risk factor for incident hospitalised depression: a historical cohort study

2017 ◽  
Vol 49 (6) ◽  
pp. 1601361 ◽  
Author(s):  
Tetyana Kendzerska ◽  
Andrea S. Gershon ◽  
Gillian A. Hawker ◽  
George A. Tomlinson ◽  
Richard S. Leung
Keyword(s):  
Obstructive Sleep Apnoea ◽  
Cox Regression ◽  
Sleep Apnoea ◽  
Sleep Study ◽  
Historical Cohort ◽  
Cox Regression Analysis ◽  
Younger Age ◽  
Obstructive Sleep ◽  
Potential Link

We evaluated whether obstructive sleep apnoea (OSA) was related to the incidence of hospitalisation for depression, a robust end-point that is unlikely to result from misdiagnosis.All adults referred with suspected OSA who underwent a diagnostic sleep study at a large urban academic hospital between 1994 and 2010 and were linked to provincial health administrative data between 1991 and 2015 were included. Cox regression analysis was used to investigate the association between OSA symptoms and severity and incident hospitalised depression, the primary outcome.Over a median follow-up of 9.7 years, 136 (1.3%) out of 10 149 participants were hospitalised for depression. A significant crude effect of OSA symptoms (waking unrefreshed and impact on memory and concentration) on hospitalised depression became nonsignificant after controlling for confounders. Apnoea–hypopnoea index was not significantly associated with the outcome: adjusted hazard ratio (33 versus6 events·h−1) 1.13 (95% CI 0.91–1.40). Factors associated with hospitalised depression were female sex, younger age, use of hypnotics, alcoholism and unemployment.In a large clinical cohort with suspected OSA, controlling for confounders, OSA symptoms and severity were not related to the risk of hospitalisation for depression, suggesting that previously reported links between OSA and depression may be due to overlapping diagnostic criteria. However, our findings cannot exclude a potential link between OSA and milder depression.

scholarly journals AST/ALT ratio as a predictor of mortality and future exacerbations of PM/DM-ILD——a retrospective cohort study with 522 cases

2020 ◽  
Author(s):  
Renjiao Li ◽  
Wen-Jun Zhu ◽  
Faping Wang ◽  
Xiaoju Tang ◽  
Fengming Luo
Keyword(s):  
Mechanical Ventilation ◽  
Cohort Study ◽  
Retrospective Cohort Study ◽  
Retrospective Cohort ◽  
Cox Regression ◽  
Low Cost ◽  
Cox Regression Analysis ◽  
Neutrophil Lymphocyte Ratio ◽  
Hazard Ratios

Abstract ObjectiveTo assess the associations between aspartate transaminase/alanine transaminase ratio (DRR) and mortality in patients with Polymyositis/dermatomyositis associated interstitial lung disease (PM/DM-ILD).Patients and MethodsThis was a retrospective cohort study, which included 522 patients with PM/DM-ILD whose DRR on admission were tested at West China Hospital of Sichuan University during the period from January 1, 2008 to December 31, 2018. Cox regression models were used to estimate hazard ratios for mortality in four predefined DRR strata (≤ 0.91, 0.91–1.26, 1.26–1.73 and > 1.73), after adjusting for age, sex, DRR stratum, diagnosis, overlap syndrome, hemoglobin, platelet count, white blood cell count, the percentage of neutrophils, neutrophil/lymphocyte ratio, albumin, creatine kinase, uric acid/creatinine ratio, triglycerides or low density lipoprotein.ResultsHigher DRR (> 1.73) was an independent predictor of 1-year mortality in multivariate Cox regression analysis (hazard ratio 3.423, 95% CI 1.481–7.911, p = .004). Patients with higher DRR more often required use of mechanical ventilation and readmission for acute exacerbation of PM/DM-ILD at 1-year follow-up.ConclusionHigher DRR on admission for PM/DM-ILD patients are associated with increased mortality, risk of mechanical ventilation and hospitalization in 1-year follow-up. This low-cost, easy-to-obtain, rapidly measured biomarker may be useful in the identification of high-risk PM/DM-ILD patients that could benefit from intensive management.

HPV and （ Neutrophil-to-lymphocyte ratio ） NLR are Prognostic Indicators of Laryngeal Cancer Patients Receiving Concurrent Chemoradiotherapy

2021 ◽  
Author(s):  
Ke-jie Li ◽  
Qi-yuan Lv ◽  
Yu-yan Xu ◽  
Zhen-yong Shao ◽  
Chang-Lin Zou ◽  
...  
Keyword(s):  
Quality Of Life ◽  
Regression Analysis ◽  
Laryngeal Cancer ◽  
Roc Curve ◽  
Concurrent Chemoradiotherapy ◽  
Cox Regression ◽  
Individualized Treatment ◽  
Cox Regression Analysis

Abstract Background and objectives: After receiving radical concurrent radiotherapy and chemotherapy, some patients with laryngeal cancer still have recurrence, and the recurrence time of different patients is different, which will pose a threat to the quality of life and survival of patients. The purpose of our study is to find out the factors that can predict the recurrence of laryngeal cancer, provide more accurate and individualized treatment for patients with laryngeal cancer, and improve the quality of life of patients.Methods：We collected follow-up data from 123 patients with laryngeal cancer who were admitted to the First Affiliated Hospital of Wenzhou Medical University between 2010 and 2015. These patients received only radical concurrent chemoradiotherapy after diagnosis. Univariate Cox analysis was used to find the factors related to Progression-free survival（PFS）in patients with laryngeal cancer. Multivariate Cox regression analysis was used to determine the factors and indicators that could predict patients' PFS. The Receiver Operating Characteristic curve（ROC curve） was used to determine the optimal truncation value of the forecast index.Results：Univariate Cox regression analysis showed that HPV, lymph node metastasis, NLR, （lymphocyte-to-monocyte Ratio）LMR and white blood cell count were related to PFS in patients with laryngeal cancer. Multivariate Cox regression analysis showed that positive HPV and NLR were effective predictors of PFS in laryngeal cancer. According to the ROC curve, the area under the curve of NLR is 0.743, and the optimal truncation value is 2.26.Conclusions：HPV and NLR are reliable predictors of PFS in patients with laryngeal cancer receiving concurrent chemoradiotherapy, which can provide help and suggestions for follow-up and individualized treatment of laryngeal cancer after treatment.

The Synergistic Value of Time-Averaged Serum Albumin and Globulin in Predicting the First Peritonitis in Incident Peritoneal Dialysis Patients

2019 ◽  
Vol 49 (3) ◽  
pp. 272-280
Author(s):  
Wenyu Zhang ◽  
Xichao Wang ◽  
Ying Liu ◽  
Yingying Han ◽  
Jinping Li ◽  
...  
Keyword(s):  
Peritoneal Dialysis ◽  
Cox Regression ◽  
Cox Regression Analysis ◽  
Group 4 ◽  
Hazard Ratios ◽  
Lower Baseline ◽  
Separate Factor ◽  
Categorical Groups ◽  
Group 1

Background: The prognostic value of serum time-averaged albumin (TA-Alb) and time-averaged globulin (TA-Glo) combination on the peritonitis in peritoneal dialysis (PD) patients is unknown. Methods: The patients who started PD treatment between July 2013 and 2018 were included. Serum Alb and globulin (Glo) were tested at baseline and monthly during follow-up. TA-Alb and TA-Glo were calculated until first peritonitis occurred or the end of the study. PD patients were divided into 4 groups based on the medians of TA-Alb and TA-Glo separately. Cox regression was conducted to identify the hazard ratios (HRs) of peritonitis among categorical groups. Results: Three hundred and sixty-three patients were included and among them 109 patients experienced first peritonitis. Peritonitis patients had lower baseline Alb, TA-Alb, and TA-Glo levels and ultrafiltration volume. Multivariate cox regression analysis revealed that TA-Alb, TA-Glo, and baseline Alb were significantly associated with first peritonitis. The highest HR existed in Group 1 with lower Alb and lower Glo (HR 4.57, 95% CI 2.36–8.87, p < 0.001) compared with Group 4 with higher Alb and higher Glo. Conclusion: Lower TA-Glo is an independent risk factor for the first peritonitis in PD patients. Combined with lower TA-Alb will increase the predictive effect than separate factor alone.

Psychosocial Predictors of Survival in Metastatic Melanoma

1999 ◽  
Vol 17 (7) ◽  
pp. 2256-2256 ◽  
Author(s):  
Phyllis N. Butow ◽  
Alan S. Coates ◽  
Stewart M. Dunn
Keyword(s):  
Metastatic Melanoma ◽  
Cox Regression ◽  
Controlled Trial ◽  
Prognostic Significance ◽  
Psychosocial Predictors ◽  
Cox Regression Analysis ◽  
Randomized Controlled ◽  
Underlying Illness

PURPOSE: Research interest in psychosocial predictors of the onset and course of cancer has been active since the 1950s. However, results have been contradictory and the literature is noted for methodologic weaknesses. In this prospective study, we aimed to systematically obtain data on psychosocial factors associated with human response to illness. PATIENTS AND METHODS: One hundred twenty-five patients with metastatic melanoma completed questionnaires measuring cognitive appraisal of threat, coping, psychologic adjustment, perceived aim of treatment, social support, and quality of life (QOL). Questionnaires were completed, where possible, every 3 months for 2 years after diagnosis. Survival was measured from date of study entry to date of death or was censored at the date of last follow-up for surviving patients. RESULTS: In a multivariate Cox regression analysis of baseline data, which controlled for demographic and disease predictors, the psychologic variables of perceived aim of treatment (P < .001), minimization (P < .05), and anger (P < .05) were independently predictive of survival. Patients who were married (P < .01) and who reported a better QOL (P < .05) also survived longer. CONCLUSION: The prognostic significance of psychologic and QOL scores remained after allowance for conventional prognostic factors. If these associations reflect an early perception by the patient or doctor of disease progression, then measures are at least valuable early indicators of such progression. If psychologic processes have a more direct influence on the course of the underlying illness, then it may be possible to manipulate them for therapeutic effect. We are now conducting a randomized controlled trial of a psychologic intervention to further elucidate these issues.

P5665The independent effect of insulin resistance on incidence of atrial fibrillation in non-diabetics

2019 ◽  
Vol 40 (Supplement_1) ◽  
Author(s):  
J K Park ◽  
J H Park ◽  
Y G Lee ◽  
J H Shin ◽  
Y H Lim ◽  
...  
Keyword(s):  
Atrial Fibrillation ◽  
Insulin Resistance ◽  
Subgroup Analysis ◽  
Cox Regression ◽  
Population Based ◽  
Independent Effect ◽  
Model Assessment ◽  
Cox Regression Analysis ◽  
Patients With Diabetes

Abstract Purpose Patients with diabetes mellitus have an elevated risk of atrial fibrillation (AF). However, whether insulin resistance may elevate risk of AF incidence in non-diabetic is inconsistent. The aim of our study was to verify the association between insulin resistance and incidence of AF in non-diabetics. Methods We evaluated population-based cohorts embedded in the Korean Genome Epidemiology Study. Insulin resistance was expressed as Homeostasis Model Assessment for Insulin resistance (HOMA-IR). Baseline data including HOMA-IR and electrocardiography (ECG) were obtained at 2001. Subsequent biennial ECG was performed for identification of AF until 2016. Results Among the 8220 participants (46.8% male; median age 49 years), 25 participants had AF (0.3%) at baseline and 101 participants developed AF (1.2%) during follow up of 12 years. In multivariate Cox regression analysis, high HOMA-IR (≥1.4) was significantly associated with incident AF compared with low HOMA-IR (<1.40) (adjusted hazard ratio [HR] 1.9, 95% confidence interval [CI] 1.3–3.0). In subgroup analysis, these association was consistent regardless of obesity (BMI<25; adjust HR 1.8, 95% CI 1.1–3.0, BMI≥25; adjust HR 2.3, 95% CI 1.3–4.0) Subgroup analysis Conclusion Based on prospective cohort study, insulin resistance (HOMA-IR) was associated with AF independently of obesity in non-diabetics.

Associations between physical activity and cataract treated surgically in patients with diabetes: findings from the 45 and Up Study

2018 ◽  
Vol 103 (8) ◽  
pp. 1099-1105 ◽  
Author(s):  
Changfan Wu ◽  
Xiaotong Han ◽  
Xixi Yan ◽  
Xianwen Shang ◽  
Lei Zhang ◽  
...  
Keyword(s):  
Physical Activity ◽  
Cataract Surgery ◽  
Cox Regression ◽  
P Value ◽  
Intensity Level ◽  
Medication History ◽  
Aged Patients ◽  
Cox Regression Analysis ◽  
Patients With Diabetes

AimTo investigate the association between physical activity (PA) and incidence of cataract surgery among patients with diabetes.MethodsWe obtained data from all diabetic subjects aged 45-65 years from the baseline of the prospective 45 and Up Study from 2006 to 2009 and linked to the Medicare Benefits Schedule (MBS) and Pharmaceutical Benefits Scheme (PBS) until 2016. Diabetes was defined as self-reported on questionnaire or diabetes medication history based on PBS. Cataract surgery was determined based on the MBS, and metabolic equivalent intensity level number of PA sessions per week was used to assess PA. Cox regression was used to assess the association between baseline PA and cataract surgery during the follow-up.ResultsA total of 9113 diabetic participants in the 45 and Up Study were included in the current analysis with a mean age of 57.3±5.2 years (43.6% female). During a mean follow-up of 8.8 years, 950 participants (10.4% of baseline) received cataract surgery with a corresponding incidence of 12.4/1000 person-years. Cox regression analysis showed that people with less PA (p=0.01), older age (p<0.001), female gender (p<0.001), higher educational level (p<0.001) and longer diabetic duration (p<0.001) had significantly higher cataract surgery risk. Participants with a PA level of ≥14 sessions per week had 19% decreased risk of cataract surgery compared to those with <5 sessions per week. Stratification analysis showed that participants with more obesity (p value for interaction=0.03), not taking insulin (p value for interaction=0.01) and without cardiovascular disease (p value for interaction=0.008) could benefit significantly more from PA in reducing their cataract surgery risk.ConclusionsMore vigorous PA was independently associated with a reduced risk of cataract surgery in working-aged patients with diabetes.

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