scholarly journals Association of CKD with Incident Tuberculosis

2019 ◽  
Vol 14 (7) ◽  
pp. 1002-1010 ◽  
Author(s):  
Sehoon Park ◽  
Soojin Lee ◽  
Yaerim Kim ◽  
Yeonhee Lee ◽  
Min Woo Kang ◽  
...  
Keyword(s):  
Mycobacterium Tuberculosis ◽  
Incidence Rate ◽  
National Health ◽  
Low Income ◽  
Cox Regression ◽  
Smoking History ◽  
Control Group ◽  
Chronic Obstructive ◽  
Income Status ◽  
Ckd Stage

Background and objectivesThe incidence and risk of Mycobacterium tuberculosis in people with predialysis CKD has rarely been studied, although CKD prevalence is increasing in certain countries where Mycobacterium tuberculosis is endemic. We aimed to investigate the association between predialysis CKD and active Mycobacterium tuberculosis risks in a nation with moderate Mycobacterium tuberculosis risk.Design, setting, participants, & measurementsIn this nationwide retrospective cohort study, we reviewed the National Health Insurance Database of Korea, screening 17,020,339 people who received a national health screening two or more times from 2012 to 2016. Predialysis CKD was identified with consecutive laboratory results indicative of CKD (e.g., persistent eGFR <60 ml/min per 1.73 m2 or dipstick albuminuria). People with preexisting active Mycobacterium tuberculosis or kidney replacement therapy were excluded. A 1:1 matched control group without CKD was included with matching for age, sex, low-income status, and smoking history. The risk of incident active Mycobacterium tuberculosis, identified in the claims database, was assessed by the multivariable Cox regression model, which included both matched and unmatched variables (e.g., body mass index, diabetes, hypertension, places of residence, and other comorbidities).ResultsWe included 408,873 people with predialysis CKD and the same number of controls. We identified 1704 patients with active Mycobacterium tuberculosis (incidence rate =137.5/100,000 person-years) in the predialysis CKD group and 1518 patients with active Mycobacterium tuberculosis (incidence rate =121.9/100,000 person-years) in the matched controls. The active Mycobacterium tuberculosis risk was significantly higher in the predialysis CKD group (adjusted hazard ratio, 1.21; 95% confidence interval, 1.13 to 1.30). The risk factors for active Mycobacterium tuberculosis among the predialysis CKD group were old age, men, current smoking, low income, underlying diabetes, chronic obstructive pulmonary disease, and Kidney Disease Improving Global Outcomes CKD stage 1 (eGFR≥90 ml/min per 1.73 m2 with persistent albuminuria) or stage 4/5 without dialysis (eGFR<30 ml/min per 1.73 m2).ConclusionsIn the Korean population, the incidence of active Mycobacterium tuberculosis was higher in people with versus without predialysis CKD.

scholarly journals Type and severity of migraine determines long-term risk of atrial fibrillation in women: a nationwide population-based study

2021 ◽  
Vol 42 (Supplement_1) ◽  
Author(s):  
T.-M Rhee ◽  
E.-K Choi ◽  
K.-D Han ◽  
S.-R Lee ◽  
S Oh
Keyword(s):  
Atrial Fibrillation ◽  
Gender Difference ◽  
Migraine With Aura ◽  
National Health ◽  
Migraine Without Aura ◽  
Cox Regression ◽  
Smoking Status ◽  
Population Based ◽  
Control Group ◽  
Severe Migraine

Abstract Background Migraine, especially when accompanied by aura, increases the risk of ischemic stroke and has also shown a close relationship with the occurrence of atrial fibrillation (AF). Although the risk of stroke and cardiovascular diseases is higher in women with migraine than in men, there is a lack of evidence for gender differences in the risk of AF in migraineurs. Purpose We sought to evaluate the gender-specific risk of AF according to the type and severity of migraine. Methods The study population included all national health checkup examinees (2009) without a history of AF from the Korean National Health Insurance Service data. The diagnosis and type or severity of migraine were determined using claims data, including diagnostic, procedural, and medication prescription codes. Newly developed non-valvular AF was identified during 10 years of follow-up. Gender-difference in the effect of migraine on AF occurrence was evaluated according to the type and severity of migraine. A multivariate Cox regression model was used to adjust for baseline differences between comparison groups, including age, smoking status, drinking habit, regular physical activity, income level, diabetes mellitus, hypertension, dyslipidemia, body mass index, and glomerular filtration rate as covariates. Results Of a total of 4,020,488 subjects (men, n=2,213,147, women, n=1,807,341) enrolled, 4,986 had migraine with aura (mean age 50.6±14.0, men 29.3%) and 105,029 without aura (mean age 51.6±14.3, men 30.9%). The proportion of migraine with aura among migraine patients was 4% in both gender groups. In the total population, migraine or migraine with aura did not significantly increase the risk of AF. The risk of AF did not increase in a mild degree of migraine, irrespective of gender or the presence of aura. Severe migraine without aura modestly increased the risk of AF in both men and women compared to the control group. (Men, incidence rate [IR] 4.51 per 1,000 person-year, adjusted hazard ratio [HR] 1.21, 95% confidence interval [CI] 1.12–1.31; Female, IR 3.00 per 1,000 person-year, adjusted HR 1.16, 95% CI 1.09–1.22) The increase of AF risk was the most prominent in women who had severe migraine with aura (IR 3.39 per 1,000 person-year, adjusted HR 1.48, 95% CI 1.18–1.85). In contrast, no significant association was observed between AF and migraine with aura in men. (IR 2.28, adjusted HR 0.63, 95% CI 0.39–1.01; P for interaction 0.011) Conclusions Mild migraine was not associated with an increase in AF risk regardless of gender or the presence of aura. Severe migraine without aura showed a mild increase in AF risk without gender-difference, while severe migraine with aura significantly increased the risk of AF only in women, not in men. Surveillance for incident AF and prompt stroke prevention would be beneficial, particularly for young-aged women suffering from severe migraine with aura. FUNDunding Acknowledgement Type of funding sources: None. Figure 1

scholarly journals Prevalence of Venous Thromboembolism In Patients with Secondary Polycythemia

Blood ◽  
2010 ◽  
Vol 116 (21) ◽  
pp. 3164-3164
Author(s):  
Omar Nadeem ◽  
Jiang Gui ◽  
Deborah Ornstein
Keyword(s):  
Chronic Obstructive Pulmonary Disease ◽  
Body Mass Index ◽  
Risk Reduction ◽  
Smoking History ◽  
Control Group ◽  
Chronic Obstructive ◽  
Obstructive Pulmonary Disease ◽  
Age And Sex ◽  
Secondary Polycythemia

Abstract Abstract 3164 Background: Polycythemia vera is associated with an increased risk for venous thromboembolism (VTE). Although phlebotomy is employed as an adjunct to treatment with hydroxyurea and/or aspirin for VTE risk reduction, emerging data suggest that hematocrit is less of a determinant of VTE risk than leukocyte count and JAK2 V617F gene mutation allele burden. The role of secondary polycythemia as a risk factor for VTE is unknown, but phlebotomy for thrombosis risk reduction is frequently practiced. Based on the polycythemia vera model, however, we hypothesize that secondary polycythemia does not increase VTE risk. The purpose of this study was to determine the prevalence of VTE in patients with secondary polycythemia and to investigate the factors associated with VTE in this population. Methods: We performed a case control study that included patients admitted to Dartmouth-Hitchcock Medical Center with a diagnosis of chronic obstructive pulmonary disease (COPD) and a hematocrit greater than or equal to 50% from August 2004 to July 2009. The controls were matched for age and sex and carried a diagnosis of chronic obstructive pulmonary disease (COPD) without evidence of secondary polycythemia. Data were collected on body mass index (BMI), VTE history, comorbid conditions, thrombophilia and smoking history. Clinical characteristics of patients with and without secondary polycythemia were analyzed using chi square and t-test to evaluate for significant differences in the two populations. Results: Eighty-six patients with secondary polycythemia and 86 controls were included in the study. The mean hematocrit was 53.5% in the case group and 43.7% in the control group (p=<0.005). Among cases, a history of VTE was documented in 17/86 (19.8%), 10 of which (58.8%) were judged to be idiopathic. In the control group, VTE was documented in 12/86 (14%), 4 of which (33.3%) were judged to be idiopathic. There was no statistically significant difference in the number of total (OR=1.52, p=0.42) or idiopathic (OR=2.7; p=0.16) VTE between cases and controls, respectively. There were no statistically significant differences noted in age, sex, body mass index, presence of diabetes mellitus, smoking history or the presence of malignancy in the two groups. Patients with VTE in both groups had higher BMI, however, compared to patients without VTE. Conclusions: We did not observe an increased prevalence of VTE in patients with secondary polycythemia compared to age- and sex-matched controls. Our findings suggest that the high prevalence of VTE observed in patients with secondary polycythemia is more likely related to known risk factors such as obesity rather than hyperviscosity due to increased cell mass. The role of phlebotomy for VTE risk reduction in patients with secondary polycythemia is therefore questionable. Disclosures: No relevant conflicts of interest to declare.

The association between the Affordable Care Act on insurance status, cancer stage, and overall survival in patients with renal cell carcinoma.

2021 ◽  
Vol 39 (6_suppl) ◽  
pp. 281-281
Author(s):  
Juan Javier-Desloges ◽  
Julia Yuan ◽  
Shady Soliman ◽  
Kevin Hakimi ◽  
Margaret Frances Meagher ◽  
...  
Keyword(s):  
Renal Cell Carcinoma ◽  
Affordable Care Act ◽  
Low Income ◽  
Cox Regression ◽  
Stage Migration ◽  
Insurance Status ◽  
Cancer Stage ◽  
Medicaid Expansion ◽  
Middle Income ◽  
Income Status

281 Background: We aimed to determine whether insurance expansions implemented through the Patient Protection and Affordable Care Act (ACA) were associated with changes in insurance coverage status, stage at diagnosis, and overall survival for patients with renal cell carcinoma (RCC). Methods: We identified patients 40 to 64 years old diagnosed with RCC between 2010 and 2016 in the National Cancer Database. States were categorized as participating on time in Medicaid expansion or not participating. We stratified patients into advanced cancer (stage III + IV) and localized cancer (stage I + II) groups. We stratified patients into low, middle, and high income groups. Stage trend and insurance trend analysis were performed to based on income status amongst patients living in expansion and non-expansion states. Absolute percentage change (APC) was calculated for insurance status and stage migration. Cox Regression Multivariable Analysis was conducted to assess risk of all-cause mortality (ACM) for patients before and after the implementation of the ACA, adjusting for insurance status, income, education, age, race, ethnicity, comorbidity, and living in an expansion state. Results: We identified 78,099 patients who met inclusion criteria. Following implementation of ACA, APC of patients with insurance increased in both Medicaid and non-expansion states by 4.0% and 2.10% (p<0.01), respectively. The largest increases occurred in expansion states, with low income patients acquiring Medicaid (APC +11.0% p<0.01), middle income patients acquiring Medicaid (APC +8.20% p<0.01), and high-income patients acquiring Medicaid (APC +4.0% p<0.01). In our stage trend analysis, there was a higher proportion of patients with localized stage disease after the implementation of the ACA in low income (APC +4.0% p<0.01) and middle-income patients (APC +1.6% p=0.02.) who live in expansions states, as well as middle income patients in non-expansions states (APC 1.4% p=0.02). Cox Regression MVA revealed that before ACA implementation, low income and middle income were associated with higher risk of mortality (HR 1.29 95%CI 1.18-1.40 p<0.01) and (HR 1.18 95% CI 1.10-1.26, p<0.01, but was not following ACA implementation (p=0.20) and (p=0.05) respectively. Conclusions: Following the implementation of the ACA the proportion of patients with newly diagnosed RCC with health insurance increased with the largest effects seen in Medicaid expansions states. In addition, higher proportions of patients were diagnosed with localized disease in Medicaid expansion states amongst low- and middle-income patients. Furthermore, income status ceased being a risk factor for mortality following ACA implementation. Our findings suggest that ACA implementation has been associated with downward stage migration in low/middle-income patients and attenuation of income status as a risk for mortality in RCC.

3154The incidence of atrial fibrillation continues to increase across all socioeconomic subgroups: 30-year time trends from a Nationwide cohort

2019 ◽  
Vol 40 (Supplement_1) ◽  
Author(s):  
Z M Yaqub ◽  
T S G Sehested ◽  
A N Bonde ◽  
J B Olesen ◽  
C Torp-Pedersen ◽  
...  
Keyword(s):  
Atrial Fibrillation ◽  
Incidence Rate ◽  
Low Socioeconomic Status ◽  
Low Income ◽  
Educational Level ◽  
Temporal Trends ◽  
Incidence Rates ◽  
High Income Group ◽  
Income Status ◽  
The Impact

Abstract Introduction The incidence rate of atrial fibrillation (AF) has increased substantially throughout the last decades. Socioeconomic factors such as income and education are well known to be associated with the development of cardiovascular disease, however, the impact on long-term trends of AF incidence rates is yet to be described. Purpose This nationwide cohort study examined the temporal trends of AF incidence rates over a span of 30 years (from 1987 to 2016) in Denmark. Furthermore, the impact of income and education was outlined. Method Patients were identified through linkage across Danish national registries from 1987 to 2016. We extracted data on the total number of inhabitants in Denmark aged ≥18 years, and used their age, sex, civil status, income and educational level for each calendar year. Data on socio economics were available from 1994. Income was defined by the average income over the prior 5 years and grouped into low (&lt;q1),&gt;Q3). Educational level was divided into primary school, high school, bachelor's degree, or master's degree. We defined incident AF as all first-time in- and outpatient diagnoses of AF. The incidence rates of AF were age-standardized per 1000 person-years for each calendar year and calculated for men and women separately. Results A total of 6,968,997 Danish inhabitants aged ≥18 years contributed to the study population from 1987 to 2016, and 393,183 (6%) developed AF over the study period. The age-standardized incidence rates of AF per 1000 person-years increased from 1.23 (CI 1.15:1.30) to 4.05 (CI 3.93:4.17) for men and from 1.13 (CI 1.06:1.30) to 3.56 (CI 3.44:3.68) for women from 1987 to 2016. Income status and educational level influenced the age-standardized incidence rates more significantly in women than men. The incidence rate from 1994 to 2016 for women with low income increased by a factor of 2.1 from 2.0 (CI 1.89:2.21) to 4.36 (CI 4.03:4.73). However, the high income group increased by a factor of 1.6 (from 1.74 (CI 1.10:3.32) to 2.83 (CI 2.29:3.55) per 1000 person-years). Moreover, the incidence rate for women with low educational level increased from 1.60 (CI 0.95:5.97) to 4.01 (CI 3.80:4.23) per 1000 person-years. The high educational group increased only by 1.2 (from 2.55 (CI 0.77:10.38) to 3.1 (CI 3.32:4.11) per 1000 person-years). Conclusion In a nationwide population, the incidence rate of AF continued to increase during a 30-year period. All socioeconomic subgroups experienced an increase in AF incidence, but the impact of low socioeconomic status was more significant among women than among men. The progressive growth in AF incidence has significant public health implications. Acknowledgement/Funding Danish Heart Foundation

scholarly journals PENGARUH PERNAFASAN PURSED-LIP SEBELUM LATIHAN FISIK TERHADAP KUALITAS HIDUP PASIEN PENYAKIT PARU OBSTRUKTIF KRONIS (PPOK) DI RUMAH SAKIT PANTIRAPIH YOGYAKARTA

2019 ◽  
Vol 5 (2) ◽  
pp. 107-112
Author(s):  
Scholastica Fina Aryu Puspasari
Keyword(s):  
Quality Of Life ◽  
Smoking History ◽  
Control Group ◽  
Chronic Obstructive ◽  
Obstructive Pulmonary Disease ◽  
Rehabilitation Programs ◽  
6 Minute Walk Test ◽  
The Impact ◽  
Combined Intervention

Background: Chronic Obstructive Pulmonary Disease (COPD) is a progressive lung illness with the main complaints of breathlessness and decreased activitiestolerance, which consequentially worsen the quality of life (QoL). COPD management aims to improve the QoLby means of rehabilitation programs. Objective: The study focused on determining the impact of physical activity(6-Minute Walk Test/6-MWT)and the combination of Pursed-Lip Breathing (PLB) before 6-MWTon COPD patients’QoL. Methods: This study occupieda quasi-experimentaldesign, which involved70 respondents,divided into 3 groups, i.e 2 intervention groups (30 respondents each) and one control group (10 respondents). Results:The majority of respondents were male (71%), aged 60-74 (56%), had normalBMI (48%), and were former smokers (59%).After 6 weeks of intervention, meaningful differences were found in the QoLbefore and after the intervention in bothgroups:6-MWT(p=0.000) and combined (p=0.000). The ordinal logistic regression test resultedthe combined intervention hadstronger effect on the quality of life (p=0.000, 47.1% contribution)than 6-MWT (p=0.012, 35.8% contribution). Respondents’ characteristics that impacted on the quality of life were smoking history and period of CPOD (p<0.05, OR: 11,376; OR: 49,75, respectively). Conclusion:It can be concluded that PLB before 6-MWT is an effective training to improve QoL of people with COPD. Keywords: Pursed-lip breathing; QoL;COPD

PENGARUH PERNAFASAN PURSED-LIP SEBELUM LATIHAN FISIK TERHADAP KUALITAS HIDUP PASIEN PENYAKIT PARU OBSTRUKTIF KRONIS (PPOK) DI RUMAH SAKIT PANTIRAPIH YOGYAKARTA

2016 ◽  
Vol 5 (2) ◽  
pp. 107-112
Author(s):  
Scholastica Fina Aryu Puspasari
Keyword(s):  
Quality Of Life ◽  
Smoking History ◽  
Control Group ◽  
Chronic Obstructive ◽  
Obstructive Pulmonary Disease ◽  
Rehabilitation Programs ◽  
6 Minute Walk Test ◽  
The Impact ◽  
Combined Intervention

Background: Chronic Obstructive Pulmonary Disease (COPD) is a progressive lung illness with the main complaints of breathlessness and decreased activitiestolerance, which consequentially worsen the quality of life (QoL). COPD management aims to improve the QoLby means of rehabilitation programs. Objective: The study focused on determining the impact of physical activity(6-Minute Walk Test/6-MWT)and the combination of Pursed-Lip Breathing (PLB) before 6-MWTon COPD patients’QoL. Methods: This study occupieda quasi-experimentaldesign, which involved70 respondents,divided into 3 groups, i.e. 2 intervention groups (30 respondents each) and one control group (10 respondents). Results:The majority of respondents were male (71%), aged 60-74 (56%), had normalBMI (48%), and were former smokers (59%).After 6 weeks of intervention, meaningful differences were found in the QoLbefore and after the intervention in bothgroups:6-MWT(p=0.000) and combined (p=0.000). The ordinal logistic regression test resultedthe combined intervention hadstronger effect on the quality of life (p=0.000, 47.1% contribution) than 6-MWT (p=0.012, 35.8% contribution). Respondents’ characteristics that impacted on the quality of life were smoking history and period of CPOD (p<0.05, OR: 11,376; OR: 49,75, respectively). Conclusion:It can be concluded that PLB before 6-MWT is an effective training to improve QoL of people with COPD. Keywords: pursed-lip breathing; QoL;COPD

P6217Managed Care after Acute Myocardial Infarction (MC-AMI) reduces MACE by 45% in 3-month follow-up - results form Poland's National Health Fund program of post-MI care. A single center analysis

2019 ◽  
Vol 40 (Supplement_1) ◽  
Author(s):  
A Kulach ◽  
K Wita ◽  
M Wita ◽  
M Wybraniec ◽  
K Wilkosz ◽  
...  
Keyword(s):  
Myocardial Infarction ◽  
Acute Myocardial Infarction ◽  
National Health ◽  
Cardiovascular Events ◽  
Cox Regression ◽  
Major Adverse Cardiovascular Events ◽  
Control Group ◽  
Single Center ◽  
Post Discharge

Abstract Background Despite progress in the medical and interventional treatment of acute myocardial infarction (AMI) and low in-hospital mortality related to AMI, a post-discharge prognosis in MI survivors is still unacceptable. The Managed Care in Acute Myocardial Infarction (MC-AMI, KOS-zawal) is a program introduced by Poland's National Health Fund aiming at comprehensive care for patients with AMI to improve long-term prognosis. It includes acute intervention, complex revascularization, cardiac rehabilitation (CR), outpatient follow-up, and prevention of SCD. Aims To assess the effect of MC-AMI on major adverse cardiovascular events (MACE) in a 3-month follow-up. Methods In this single-center, retrospective observational study we enrolled 1211 patients, and compared them to 1130 subjects in the control group. After 1:1 propensity score matching two groups of 529 subjects each were compared. Cox regression was performed to assess the effect of MC-AMI and other variables on MACE. Results MC-AMI has been proved to reduce MACE rate by 45% in a 3-month observation. Multivariable Cox regression analysis revealed MC-AMI participation to be inversely associated with the occurrence MACE at 3 months (HR 0.476, 95% CI 0.283–0.799, p<0.005). Besides, older age, male sex (HR 2.0), history of unstable angina (HR 3.15), peripheral artery disease (HR 2.17), peri-MI atrial fibrillation (HR 1.87) and diabetes (HR 1.5), were significantly associated with the primary endpoint. Comparison of study endpoints between KO Total, n (%) MC-AMI group, n (%) Control Group, n (%) RR 95% CI NNT P n=1058 n=529 n=529 All-cause mortality 19 (1.8%) 7 (1.3%) 12 (2.3%) 0.583 0.232–1.470 105.8 0.247 Hospitalization for HF 31 (2.9%) 12 (2.3%) 19 (3.6%) 0.632 0.310–1.288 75.6 0.202 Myocardial infarction 25 (2.4%) 9 (1.7%) 16 (3.0%) 0.563 0.251–1.262 75.6 0.157 MACE 73 (6.9%) 26 (4.9%)# 47 (8.9%) 0.553 0.348–0.879 25.2 0.012 *Two-tailed Pearson's Chi-square test; MACE, Major Adverse Cardiovascular Events. #Number of patients with at least one MACE; in 2 patients 2 endpoints occurred. This explains why the total number of MACE is lower than the sum of all endpoints. MC-AMI vs. control - MACE in 3 months up Conclusions MC-AMI is the first program of a comprehensive. Participation in MC-AMI – a first comprehensive in-hospital and post-discharge care for AMI patients for AMI patients improves prognosis and reduces MACE rate by 45% as soon as in 3 months.

scholarly journals Evaluation of co-morbidity indices in patients admitted for Chronic Obstructive Pulmonary Disease

2004 ◽  
Vol 61 (4) ◽  
Author(s):  
R.G. Pinckney ◽  
R. O’Brien ◽  
J.F. Piccirillo ◽  
B. Littenberg
Keyword(s):  
Chronic Obstructive Pulmonary Disease ◽  
Pulmonary Disease ◽  
Cox Regression ◽  
Charlson Index ◽  
Smoking History ◽  
Chronic Obstructive ◽  
Obstructive Pulmonary Disease ◽  
Copd Exacerbations ◽  
Co Morbidity ◽  
Social Security Death Index

Background. There is limited and conflicting information on the use of co-morbidity instruments to predict mortality in patients with chronic obstructive pulmonary disease (COPD). Methods. We sought to test the validity of the Charlson Index and another co-morbidity instrument, the Adult co-morbidity evaluation 27 (ACE-27), in patients admitted with COPD exacerbations. Co-morbidity scores were obtained by chart review. Information on mortality was retrieved from the Social Security Death Index. We examined the predictive validity of the Charlson and the ACE- 27 using survival analysis. Results. There were 112 patients eligible for the study. The ACE-27 but not the Charlson predicted survival, after adjusting for age, gender, and smoking history in Cox regression, hazard ratio (95% CI) of 1.99 (1.17-3.39). Conclusions. This study confirms earlier findings that the Charlson Index is not a reliable predictor of mortality in patients with COPD. However, the ACE-27 appears to be useful for predicting survival in this study.

scholarly journals The Risk of COVID-19 Related Hospitalsation, Intensive Care Unit Admission and Mortality in People With Underlying Asthma or COPD: A Systematic Review and Meta-Analysis

2021 ◽  
Vol 8 ◽  
Author(s):  
Shahina Pardhan ◽  
Samantha Wood ◽  
Megan Vaughan ◽  
Mike Trott
Keyword(s):  
Systematic Review ◽  
Intensive Care Unit ◽  
Intensive Care ◽  
Cox Regression ◽  
Meta Analysis ◽  
Random Effect ◽  
Control Group ◽  
Chronic Obstructive ◽  
Adjusted Risk ◽  
Icu Admission

Background: Several underlying diseases have been associated with unfavorable COVID-19 related outcomes including asthma and Chronic Obstructive Pulmonary Disease (COPD), however few studies have reported risks that are adjusted for confounding variables. This study aimed to examine the adjusted risk of COVID-19 related hospitalsation, intensive care unit (ICU) admission, and mortality in patients with vs. without asthma or COPD.Methods: A systematic review of major databases was undertaken for studies published between 1/12/2019 and 19/4/2021. Studies reporting the adjusted (for one or more confounder) risks of either hospitalsation, ICU admission, or mortality in asthmatics or COPD patients (control group = no asthma or no COPD) were identified. Risk of bias was determined via the QUIPS tool. A random effect meta-analysis was undertaken.Findings: 37 studies were eligible for analysis, with a total of 1,678,992 participants. The pooled ORs of COVID-19 hospitalsation in subjects with asthma and COPD was 0.91 (95% CI 0.76–1.09) and 1.37 (95% CI 1.29–1.46), respectively. For ICU admission, OR in subjects with asthma and COPD was 0.89 (95% CI 0.74–1.07) and 1.22 (95% CI 1.04–1.42), respectively. For mortality, ORs were 0.88 (95% CI 0.77–1.01) and 1.25 (95% CI 1.08–1.34) for asthma and COPD, respectively. Further, the pooled risk of mortality as measured via Cox regression was 0.93 (95% CI 0.87–1.00) for asthma and 1.30 (95% CI 1.17–1.44) for COPD. All of these findings were of a moderate level of certainty.Interpretation: COPD was significantly associated with COVID-19 related hospital admission, ICU admission, and mortality. Asthma was not associated with negative COVID-19 related health outcomes. Individuals with COPD should take precautions to limit the risk of COVID-19 exposure to negate these potential outcomes. Limitations include differing population types and adjustment for differing cofounding variables. Practitioners should note these findings when dealing with patients with these comorbidities.Review Protocol Registration:https://www.crd.york.ac.uk/prospero/.

BCG Vaccination at Birth and Rate of Hospitalization for Infection Until 15 Months of Age in Danish Children: A Randomized Clinical Multicenter Trial

2018 ◽  
Vol 8 (3) ◽  
pp. 213-220 ◽  
Author(s):  
Lone Graff Stensballe ◽  
Henrik Ravn ◽  
Nina Marie Birk ◽  
Jesper Kjærgaard ◽  
Thomas Nørrelykke Nissen ◽  
...  
Keyword(s):  
Cesarean Delivery ◽  
Low Income ◽  
Cox Regression ◽  
Multicenter Trial ◽  
Bcg Vaccine ◽  
Secondary Outcome ◽  
Control Group ◽  
Bcg Vaccination ◽  
Intention To Treat ◽  
Child Mortality Rate

Abstract Background The bacillus Calmette-Guérin (BCG) vaccine against tuberculosis might reduce the non–tuberculosis-related child mortality rate in low-income settings. We tested the hypothesis that BCG vaccination at birth would reduce early childhood hospitalization for infection in Denmark, a high-income setting. Hospitalization for infection was a secondary outcome in a randomized trial with the primary aim to estimate the potential non-specific effects of BCG vaccination at birth on all-cause hospitalization. Methods A total of 4262 children included in the Danish Calmette Study were assigned randomly to either receive the BCG vaccine or not and were followed through the Danish National Patient Register. The outcome was number of hospitalizations for infection until the age of 15 months. Data were analyzed by Cox regression in intention-to-treat (ITT) and per-protocol (PP) analyses. Results In the ITT analysis, we observed 588 hospitalizations for infection (mean, 0.28 hospitalization per child) among the 2129 children allocated to receive the BCG vaccine and 595 hospitalizations for infection (mean, 0.28 hospitalization per child) among the 2133 children allocated to the control group (hazard ratio [HR], 0.99 [95% confidence interval (CI), 0.85–1.15]). The PP analysis yielded an HR of 1.00 (95% CI, 0.86–1.16). Predefined interaction ITT analyses showed that among 740 children with a BCG-vaccinated mother, the HR for BCG-vaccinated children was 0.65 (95% CI, 0.45–0.94); the HR for children who had a non–BCG-vaccinated mother was 1.10 (95% CI, 0.93–1.29) (P = .01, test of no interaction). Cesarean delivery modified the effect of BCG vaccination (HRs, 0.73 [95% CI, 0.54–0.99] in children born by cesarean section vs 1.10 [95% CI, 0.92–1.30] in other children; P = .02). When the outcome was defined as time to first hospitalization, the HR for premature children after BCG vaccination was 1.81 (95% CI, 0.95–3.43), whereas the HR was 0.94 (95% CI, 0.82–1.08) for children born at term (P = .05). Conclusion BCG vaccination did not affect the rate of hospitalization for infection up to the age of 15 months in Danish children. In future studies, the role of maternal BCG-vaccination, premature birth, and cesarean delivery needs further exploration.

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