All-Cause Mortality During Sars-Cov-2 Pandemic in India: Nationally-Representative Estimates Independent of Official Death Registry

All-cause mortality during SARS-CoV-2 Pandemic in India: Nationally-representative estimates independent of official death registry

10.1101/2021.07.20.21260577 ◽

2021 ◽

Author(s):

Sabareesh Ramachandran ◽

Anup Malani

Keyword(s):

Panel Data ◽

Death Rate ◽

The Elderly ◽

Data Set ◽

Death Registry ◽

All Cause Mortality ◽

Large Panel ◽

Nationally Representative ◽

Second Wave ◽

Excess Deaths

We estimate excess deaths in India during the COVID pandemic using monthly deaths in the sample of privately-conducted, nationally-representative, large, panel data set. The data set includes roughly 174,000 households (1.2 million members) and spans January 2015 - June 2021. We estimate COVID is associated with 3.36 million (95% CI: 2.08-4.63 million) excess deaths, a 17.3% increase in the all-cause death rate, until April 2021. Excess deaths spike during the peaks of the 2 infection waves in India. The second wave is associated with significantly more excess deaths than the first. The age-pattern of deaths is skewed towards the elderly relative to baseline.

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Association of serum 25-hydroxyvitamin D concentrations with all-cause and cause-specific mortality among individuals with diabetes mellitus

10.2337/figshare.12863750.v1 ◽

2020 ◽

Author(s):

Zhenzhen Wan ◽

Jingyu Guo ◽

An Pan ◽

Chen Chen ◽

Liegang Liu ◽

...

Keyword(s):

Diabetes Mellitus ◽

Vitamin D ◽

Vitamin D Status ◽

Hydroxyvitamin D ◽

All Cause Mortality ◽

Specific Mortality ◽

25 Hydroxyvitamin D ◽

Nationally Representative ◽

Reduced Risk ◽

Cvd Mortality

Objective: The evidence regarding vitamin D status and mortality among diabetes is scarce. This study aimed to examine the association of serum 25-hydroxyvitamin D [25(OH)D] concentrations with all-cause and cause-specific mortality among adults with <a>diabetes mellitus</a>. Research Design and Methods: This study included 6329 adults with diabetes from the Third National Health and Nutrition Examination Survey (NHANES III) and NHANES 2001-2014. Death outcomes were ascertained by linkage to National Death Index records through 31 December 2015. Cox proportional hazard models were used to estimate hazard ratios (HR) and 95% confidence (CIs) for mortality from all causes, cardiovascular disease (CVD), and cancer. Results: The weighted mean (95% CI) level of serum 25(OH)D was 57.7 (56.6, 58.8) nmol/L, and 46.6% had deficient vitamin D (<50 nmol/L [20 ng/mL]). <a>Higher </a>serum 25(OH)D levels were significantly associated with lower levels of glucose, insulin, HOMA-IR, HbA1c, blood lipids, and C-reactive protein at baseline (all Ptrend<0.05). During 55126 person-years of follow-up, 2056 deaths were documented, including 605 CVD deaths and 309 cancer deaths. <a>After multivariate adjustment, higher </a>serum 25(OH)D levels were significantly and linearly associated with lower all-cause and CVD mortality: there was a 31% reduced risk of all-cause mortality and a 38% reduced risk of CVD mortality per one unit increment in natural log-transformed 25(OH)D (both P<0.001). Compared with participants with 25(OH)D <25 nmol/L, the multivariate-adjusted HRs and 95% CI for participants with 25(OH)D >75 nmol/L were 0.59 (0.43, 0.83) for all-cause mortality (Ptrend=0.003), 0.50 (0.29, 0.86) for CVD mortality (Ptrend=0.02), and 0.49 (0.23, 1.04) for cancer mortality (Ptrend=0.12). Conclusions: In a nationally representative sample of US adults with diabetes, higher serum 25(OH)D levels were significantly associated with lower all-cause and CVD mortality. These findings suggest that maintaining adequate vitamin D status may lower mortality risk in individuals with diabetes.

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Association of Body Mass Index and Waist Circumference with All-Cause Mortality in Hemodialysis Patients

Journal of Clinical Medicine ◽

10.3390/jcm9051289 ◽

2020 ◽

Vol 9 (5) ◽

pp. 1289

Author(s):

Chang Seong Kim ◽

Kyung-Do Han ◽

Hong Sang Choi ◽

Eun Hui Bae ◽

Seong Kwon Ma ◽

...

Keyword(s):

Body Mass Index ◽

Waist Circumference ◽

Mortality Rate ◽

Body Mass ◽

The Body ◽

National Health Insurance System ◽

Cox Regression Analysis ◽

Risk Of Mortality ◽

All Cause Mortality ◽

Nationally Representative

In this study based on a large nationally representative sample of Korean adults, we investigated the potential associations of the body mass index (BMI) and waist circumference (WC) with mortality in patients undergoing hemodialysis. We obtained the data of 18,699 participants >20 years of age who were followed up with for 4 years and for whom BMI and WC information were available, using a nationally representative dataset from the Korean National Health Insurance System. Patients were stratified into five levels by their baseline BMI and into six levels by their WC (5-cm increments). A total of 4975 deaths occurred during a median follow-up period of 48.2 months. Participants with a higher BMI had a lower mortality rate than those with a lower BMI. In a fully adjusted Cox regression analysis, being overweight and obese was associated with a significantly lower relative risk of all-cause mortality relative to the reference group. Conversely, the mortality rate was higher among participants with a high WC than among those with a low WC. Participants with the highest WC had a higher risk of mortality, while those with the lowest WC level had a significantly lower risk of mortality. In conclusion, all-cause mortality was positively associated with WC, a measure of abdominal obesity, and inversely associated with BMI, a measure of body volume, in patients undergoing hemodialysis.

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Situational versus chronic loneliness as risk factors for all-cause mortality

International Psychogeriatrics ◽

10.1017/s1041610209991426 ◽

2009 ◽

Vol 22 (3) ◽

pp. 455-462 ◽

Cited By ~ 136

Author(s):

Sharon Shiovitz-Ezra ◽

Liat Ayalon

Keyword(s):

Mortality Data ◽

International Studies ◽

Differential Impact ◽

Mortality Risks ◽

All Cause Mortality ◽

Nationally Representative ◽

Definition Of ◽

Retirement Study

ABSTRACTBackground: Several international studies have substantiated the role of loneliness as a risk factor for mortality. Although both theoretical and empirical research has supported the classification of loneliness as either situational or chronic, research to date has not evaluated whether this classification has a differential impact upon mortality.Methods: To establish the definition of situational vs. chronic loneliness, we used three waves of the Health and Retirement Study (HRS), a nationally representative sample of Americans over the age of 50 years. Baseline data for the present study were collected in the years 1996, 1998, and 2000. The present study concerns the 7,638 individuals who completed all three waves; their loneliness was classified as either not lonely, situational loneliness or chronic loneliness. Mortality data were available through to the year 2004.Results: Those identified as “situationally lonely” (HR = 1.56; 95% CI: 1.52–1.62) as well as those identified as “chronically lonely” (HR = 1.83; 95% CI: 1.71–1.87) had a greater risk for all cause mortality net of the effect of possible demographic and health confounders. Nonetheless, relative to those classified as “situationally lonely,” individuals classified as “chronically lonely” had a slightly greater mortality risk.Conclusions: The current study emphasizes the important role loneliness plays in older adults’ health. The study further supports current division into situational vs. chronic loneliness, yet suggests that both types serve as substantial mortality risks.

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Outcomes of SARS-CoV-2 Infection in Patients with Chronic Liver Disease and Cirrhosis: a N3C Study

10.1101/2021.06.03.21258312 ◽

2021 ◽

Author(s):

Jin Ge ◽

Mark J. Pletcher ◽

Jennifer C Lai ◽

Keyword(s):

Liver Diseases ◽

Mortality Rates ◽

Adverse Outcomes ◽

Chronic Liver ◽

Chronic Liver Diseases ◽

Mortality Hazard ◽

All Cause Mortality ◽

Nationally Representative ◽

And Gender ◽

Limited Generalizability

Background and Aims In patients with chronic liver diseases (CLD) with or without cirrhosis, existing data on the risk of adverse outcomes with SARS-CoV-2 infection have been mixed or have limited generalizability. We used the National COVID Cohort Collaborative (N3C) Data Enclave, a harmonized electronic health record (EHR) dataset of 5.9 million nationally-representative, diverse, and gender-balanced patients, to describe outcomes in patients with CLD and cirrhosis with SARS-CoV-2. Methods We identified all chronic liver diseases patients with and without cirrhosis who had SARS-CoV-2 testing documented in the N3C Data Enclave as of data release date 5/15/2021. The primary outcome was 30-day all-cause mortality. Survival analysis methods were used to estimate cumulative incidences of death, hospitalization, and mechanical ventilation, and to calculate the associations of SARS-CoV-2 infection, presence of cirrhosis, and demographic and clinical factors to 30-day mortality. Results We isolated 217,143 patients with CLD: 129,097 (59%) without cirrhosis and SARS-CoV-2 negative, 25,844 (12%) without cirrhosis and SARS-CoV-2 positive, 54,065 (25%) with cirrhosis and SARS-CoV-2 negative, and 8,137 (4%) with cirrhosis and SARS-CoV-2 positive. Among CLD patients without cirrhosis, 30-day all-cause mortality rates were 0.4% in SARS-CoV-2 negative patients and 1.8% in positive patients. Among CLD patients with cirrhosis, 30-day all-cause mortality rates were 4.0% in SARS-CoV-2 negative patients and 9.7% in positive patients. Compared to those who tested SARS-CoV-2 negative, SARS-CoV-2 positivity was associated with more than two-fold (aHR 2.43, 95% CI 2.23-2.64) hazard of death at 30 days among patients with cirrhosis. Compared to patients without cirrhosis, the presence of cirrhosis was associated with a three-fold (aHR 3.39, 95% CI 2.96-3.89) hazard of death at 30 days among patients who tested SARS-CoV-2 positive. Age (aHR 1.03 per year, 95% CI 1.03-1.04) was associated with death at 30 days among patients with cirrhosis who were SARS-CoV-2 positive. Conclusions In this study of nearly 220,000 CLD patients, we found SARS-CoV-2 infection in patients with cirrhosis was associated with 2.43-times mortality hazard, and the presence of cirrhosis among CLD patients infected with SARS-CoV-2 were associated with 3.39-times mortality hazard. Compared to previous studies, our use of a nationally-representative, diverse, and gender-balanced dataset enables wide generalizability of these findings.

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Resistant hypertension and risk of adverse events in individuals with type 1 diabetes: A nationwide prospective study

10.2337/figshare.12137604.v1 ◽

2020 ◽

Author(s):

Raija Lithovius ◽

Valma Harjutsalo ◽

Stefan Mutter ◽

Daniel Gordin ◽

Carol Forsblom ◽

...

Keyword(s):

Type 1 Diabetes ◽

Diabetic Nephropathy ◽

Prospective Study ◽

Resistant Hypertension ◽

Antihypertensive Drugs ◽

Increased Risk ◽

All Cause Mortality ◽

Nationally Representative ◽

Reduced Kidney Function

Objectives. To estimate the risk of diabetic nephropathy (DN) progression, incident coronary heart disease (CHD) and stroke, and all-cause mortality associated with resistant hypertension (RH) in individuals with type 1 diabetes stratified by stages of DN, renal function and sex. Research Design and Methods This prospective study included a nationally representative cohort of individuals with type 1 diabetes from the Finnish Diabetic Nephropathy Study who had purchases of antihypertensive drugs at (±6 months) baseline visit (1995–2008). Individuals (N=1,103) were divided into three groups: (a) RH, (b) uncontrolled BP, but no RH and (c) controlled BP. DN progression, cardiovascular events and deaths were identified from the individuals’ healthcare records and national registries, until 31 December 2015. Results At baseline 18.7% of the participants had RH, while 23.4% had controlled BP. After full adjustments for clinical confounders, RH was associated with increased risk of DN progression (HR 1.95 [95% CI 1.37, 2.79], p=0.0002), while no differences were observed in those with no RH (1.05 [0.76, 1.44], p=0.8), compared with those who had controlled BP. The risk of incident CHD, incident stroke and all-cause mortality was higher in individuals with RH compared with those who had controlled BP, but not beyond albuminuria and reduced kidney function. Notably, in those with normo- and microalbuminuria the risk of stroke remained higher in the RH compared to controlled BP group (3.49 [81.20, 10.15], p=0.02). Conclusion Our findings highlight importance to identify and provide diagnostic and therapeutic counseling to these very high risk individuals with RH.

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Association of dietary intake of branched-chain amino acids with long-term risks of cardiovascular disease, cancer and all-cause mortality

Public Health Nutrition ◽

10.1017/s1368980021004948 ◽

2021 ◽

pp. 1-60

Author(s):

Binbin Xu ◽

Meng Wang ◽

Liyuan Pu ◽

Chang Shu ◽

Lian Li ◽

...

Keyword(s):

Cardiovascular Disease ◽

Amino Acids ◽

Dietary Intake ◽

The United States ◽

Branched Chain Amino Acids ◽

Dietary Intakes ◽

All Cause Mortality ◽

Nationally Representative ◽

Branched Chain

Abstract Objectives: Studies on associations between dietary intake of branched-chain amino acids (BCAAs) and long-term risks of cardiovascular disease (CVD), cancer, and all-cause mortality have yielded inconclusive results. This study aimed to investigate the associations between dietary BCAA intake and long-term risks of CVD, cancer, and all-cause mortality in nationwide survey participants aged ≥18. Design: This was a prospective cohort study of a nationally representative sample of 14,397 adults aged ≥18 who participated in the United States National Health and Nutrition Examination Survey III (NHANES III). Dietary intakes of BCAAs (leucine, isoleucine, and valine) were determined from the total nutrient intake document. The main outcomes were CVD, cancer, and all-cause mortality. Results: During 289,406 person-years of follow-up, we identified 4,219 deaths, including 1,133 from CVD and 926 from cancer. After multivariate adjustment, the hazard ratios (95% confidence intervals) of all-cause mortality in the highest dietary BCAA and isoleucine intake quintile (reference: lowest quintiles) were 0.68 (0.48–0.97) and 0.68 (0.48–0.97), respectively. Each one-standard-deviation increase in total dietary BCAA or isoleucine intake was associated with an 18% or 21% decrease in the risk of all-cause mortality, respectively. The serum triglyceride (TG) concentration was found to modify the association between the dietary BCAA intake and all-cause mortality (P for interaction = 0.008). Conclusions: In a nationally representative cohort, higher dietary intakes of BCAAs and isoleucine were independently associated with a lower risk of all-cause mortality, and these associations were stronger in participants with higher serum TG concentrations.

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Resistant hypertension and risk of adverse events in individuals with type 1 diabetes: A nationwide prospective study

10.2337/figshare.12137604.v2 ◽

2020 ◽

Author(s):

Raija Lithovius ◽

Valma Harjutsalo ◽

Stefan Mutter ◽

Daniel Gordin ◽

Carol Forsblom ◽

...

Keyword(s):

Type 1 Diabetes ◽

Diabetic Nephropathy ◽

Prospective Study ◽

Resistant Hypertension ◽

Antihypertensive Drugs ◽

Increased Risk ◽

All Cause Mortality ◽

Nationally Representative ◽

Reduced Kidney Function

Objectives. To estimate the risk of diabetic nephropathy (DN) progression, incident coronary heart disease (CHD) and stroke, and all-cause mortality associated with resistant hypertension (RH) in individuals with type 1 diabetes stratified by stages of DN, renal function and sex. Research Design and Methods This prospective study included a nationally representative cohort of individuals with type 1 diabetes from the Finnish Diabetic Nephropathy Study who had purchases of antihypertensive drugs at (±6 months) baseline visit (1995–2008). Individuals (N=1,103) were divided into three groups: (a) RH, (b) uncontrolled BP, but no RH and (c) controlled BP. DN progression, cardiovascular events and deaths were identified from the individuals’ healthcare records and national registries, until 31 December 2015. Results At baseline 18.7% of the participants had RH, while 23.4% had controlled BP. After full adjustments for clinical confounders, RH was associated with increased risk of DN progression (HR 1.95 [95% CI 1.37, 2.79], p=0.0002), while no differences were observed in those with no RH (1.05 [0.76, 1.44], p=0.8), compared with those who had controlled BP. The risk of incident CHD, incident stroke and all-cause mortality was higher in individuals with RH compared with those who had controlled BP, but not beyond albuminuria and reduced kidney function. Notably, in those with normo- and microalbuminuria the risk of stroke remained higher in the RH compared to controlled BP group (3.49 [81.20, 10.15], p=0.02). Conclusion Our findings highlight importance to identify and provide diagnostic and therapeutic counseling to these very high risk individuals with RH.

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