Hypertension, Gender, Older Age, and Their Relationships with COVID-19 Mortality: Meta-Analysis

Background and Aim: Polypharmacy and potentially inappropriate medication (PIM) use in older populations (65+ years) have not yet been investigated by meta-analyses in developing countries. This systematic literature review and meta-analysis aimed to investigate the prevalence of polypharmacy and PIM use and major risk factors associated with PIM prescribing in older adults in Ethiopia. Methods: We searched PubMed/MEDLINE, Scopus, Embase, and Google Scholar databases to identify relevant studies published between January 1990 and October 2020. Observational studies reporting the prevalence and association of risk factors with polypharmacy and PIM use in the older population were meta-analyzed. A multilevel meta-analysis was conducted to pool the prevalence estimates, and the risk of PIM use was reported as a relative risk (RR) with a 95% confidence interval (CI). Results: We identified by systematic literature review 404 articles. Of those, 8 studies fulfilled inclusion criteria, comprising a total sample of 2,608 participants. The overall prevalence of polypharmacy and PIM use pooled by meta-analysis in the Ethiopian older population was 33 and 37%, respectively. The risk factors of PIM use were analyzed in the meta-analysis (particularly polymorbidity, polypharmacy, gender, and older age), and only older age of 65+ (RR: 1.71, 95% CI: 1.16–2.51) was significantly associated with PIM use. Conclusion: This first meta-analysis from a developing country revealed a high prevalence of polypharmacy and PIM use in the Ethiopian older population. There was no awareness about the risk of PIMs in patients with polypharmacy and polymorbidity, and older age significantly predicted PIM use. Interventions ensuring rational geriatric pharmacotherapy are essential in developing countries in order to reduce the expected burden of PIM-related geriatric morbidity, higher costs, and mortality.

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Long-Term Cognitive Decline After Stroke: An Individual Participant Data Meta-Analysis

Stroke ◽

10.1161/strokeaha.121.035796 ◽

2021 ◽

Author(s):

Jessica W. Lo ◽

John D. Crawford ◽

David W. Desmond ◽

Hee-Joon Bae ◽

Jae-Sung Lim ◽

...

Keyword(s):

Risk Factors ◽

Cognitive Function ◽

Cognitive Decline ◽

Recurrent Stroke ◽

Meta Analysis ◽

Older Age ◽

Individual Participant Data ◽

Individual Participant ◽

Global Cognition

Background and Purpose: Poststroke cognitive impairment is common, but the trajectory and magnitude of cognitive decline after stroke is unclear. We examined the course and determinants of cognitive change after stroke using individual participant data from the Stroke and Cognition Consortium. Methods: Nine longitudinal hospital-based cohorts from 7 countries were included. Neuropsychological test scores and normative data were used to calculate standardized scores for global cognition and 5 cognitive domains. One-step individual participant data meta-analysis was used to examine the rate of change in cognitive function and risk factors for cognitive decline after stroke. Stroke-free controls were included to examine rate differences. Based on the literature and our own data that showed short-term improvement in cognitive function after stroke, key analyses were restricted to the period beginning 1-year poststroke to focus on its long-term effects. Results: A total of 1488 patients (mean age, 66.3 years; SD, 11.1; 98% ischemic stroke) were followed for a median of 2.68 years (25th–75th percentile: 1.21–4.14 years). After an initial period of improvement through up to 1-year poststroke, decline was seen in global cognition and all domains except executive function after adjusting for age, sex, education, vascular risk factors, and stroke characteristics (−0.053 SD/year [95% CI, −0.073 to −0.033]; P <0.001 for global cognition). Recurrent stroke and older age were associated with faster decline. Decline was significantly faster in patients with stroke compared with controls (difference=−0.078 SD/year [95% CI, −0.11 to −0.045]; P <0.001 for global cognition in a subgroup analysis). Conclusions: Patients with stroke experience cognitive decline that is faster than that of stroke-free controls from 1 to 3 years after onset. An increased rate of decline is associated with older age and recurrent stroke.

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Risk factors for post-thyroidectomy haemorrhage: a meta-analysis

Acta Endocrinologica ◽

10.1530/eje-16-0757 ◽

2017 ◽

Vol 176 (5) ◽

pp. 591-602 ◽

Cited By ~ 21

Author(s):

Jinhao Liu ◽

Wei Sun ◽

Wenwu Dong ◽

Zhihong Wang ◽

Ping Zhang ◽

...

Keyword(s):

Risk Factors ◽

Neck Dissection ◽

Thyroid Surgery ◽

Meta Analysis ◽

Older Age ◽

Graves Disease ◽

Malignant Tumours ◽

Antithrombotic Agents ◽

Increased Risk ◽

Male Sex

BackgroundPost-thyroidectomy haemorrhage is a rare but potentially life-threatening and unpredictable complication of thyroid surgery. In this study, we analysed the potential risk factors for the occurrence of post-thyroidectomy haemorrhage.MethodsThe PubMed and SCIE databases were comprehensively searched for studies published before June 30, 2016. Studies on patients who underwent an open thyroidectomy with or without neck dissection were included, and RevMan 5.3 software was used to analyse the data.ResultsTwenty-five studies and 424 563 patients were included in this meta-analysis, and post-thyroidectomy haemorrhage occurred in 6277 patients (incidence rate = 1.48%). The following variables were associated with an increased risk of post-thyroidectomy haemorrhage: older age (MD = 4.30, 95% CI = 3.09–5.52,P < 0.00001), male sex (OR = 1.73, 95% CI = 1.54–1.94,P < 0.00001), Graves’ disease (OR = 1.76, 95% CI = 1.44–2.15,P < 0.00001), antithrombotic agents use (OR = 1.96, 95% CI 1.55–2.49,P < 0.00001), bilateral operation (OR = 1.71, 95% CI = 1.50–1.96,P < 0.00001), neck dissection (OR = 1.53, 95% CI = 1.11–2.11,P = 0.01) and previous thyroid surgery (OR = 1.62, 95% CI = 1.12–2.34,P = 0.01). Malignant tumours (OR = 1.07, 95% CI = 0.89–1.28,P = 0.46) and drainage device use (OR = 1.27, 95% CI = 0.74–2.18,P = 0.4) were not associated with post-thyroidectomy haemorrhage.ConclusionOur systematic review identified a number of risk factors for post-thyroidectomy haemorrhage, including older age, male sex, Graves’ disease, antithrombotic agents use, bilateral operation, neck dissection and previous thyroid surgery. Early control of modifiable risk factors could improve patient outcomes and satisfaction.

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Lower incidence of unintentional injury with older age in children in China? A meta-analysis

Journal of Epidemiological Research ◽

10.5430/jer.v4n2p42 ◽

2018 ◽

Vol 4 (2) ◽

pp. 42

Author(s):

Hui Ting Yu ◽

Chan Nie ◽

Yanna Zhou ◽

Xue Wang ◽

Haiyan Wang ◽

...

Keyword(s):

Subgroup Analysis ◽

Meta Analysis ◽

Unintentional Injury ◽

Total Sample ◽

Older Age ◽

Analysis Method ◽

Unintentional Injuries ◽

Cochrane Systematic Review ◽

Spss Software ◽

The Relationship

Objective: The aim of this study was to identify the relationship between children's age and the incidence of unintentional injuries, and giving some basic data on the guidance for the prevention of unintentional injuries in children aged 0 to 18 years in China.Methods: The literatures on the incidence of unintentional injury in children included in China from 2008 to 2018 were analyzed by meta-analysis method. The data were retrieved according to the guidance of Cochrane Systematic review. A meta-analysis was carried out on homogeneous studies, and then subgroup analysis was conducted according to age group. Publication bias was also evaluated. Stata software (version 15.0) and SPSS software (version 18.0) were used to analyze the gathered information. Results: A total of 3，303 related pieces of literature were reviewed. Of the 37 that met the inclusion criteria. The meta-analysis showed that total sample sizes were 77，023, and the pooled incidence of unintentional injury is 20%, 95%CI (17%-23%), (P< 0.001). Subgroup analysis showed the following results: the incidence are 15%, 23%, 20% and 20% for aged in “0-2”, “3-5”, “6-11”, “12-18” subgroups, respectively. However, the trend of decreased incidence of unintentional injury with older age in children was not significant.Conclusions: The pooled incidence of unintentional injuries in children is high. Based on accessible literature, the incidence between different age subgroup were not statistically significant. We should pay attention to the incidence of unintentional injuries in children of all age subgroups.

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Is hospitalization a risk factor for cognitive decline in older age adults?

International Psychogeriatrics ◽

10.1017/s1041610220001763 ◽

2020 ◽

pp. 1-18

Author(s):

Lucia Chinnappa-Quinn ◽

Steve Robert Makkar ◽

Michael Bennett ◽

Ben C. P. Lam ◽

Jessica W. Lo ◽

...

Keyword(s):

Cognitive Decline ◽

Meta Analysis ◽

Severity Of Illness ◽

The Elderly ◽

Preliminary Evidence ◽

Older Age ◽

Future Research ◽

Cognitive Changes ◽

Newcastle Ottawa Scale ◽

Meta Analyses

ABSTRACT Objectives: Many studies document cognitive decline following specific types of acute illness hospitalizations (AIH) such as surgery, critical care, or those complicated by delirium. However, cognitive decline may be a complication following all types of AIH. This systematic review will summarize longitudinal observational studies documenting cognitive changes following AIH in the majority admitted population and conduct meta-analysis (MA) to assess the quantitative effect of AIH on post-hospitalization cognitive decline (PHCD). Methods: We followed Preferred Reporting Items for Systematic reviews and Meta-Analyses (PRISMA) guidelines. Selection criteria were defined to identify studies of older age adults exposed to AIH with cognitive measures. 6566 titles were screened. 46 reports were reviewed qualitatively, of which seven contributed data to the MA. Risk of bias was assessed using the Newcastle–Ottawa Scale. Results: The qualitative review suggested increased cognitive decline following AIH, but several reports were particularly vulnerable to bias. Domain-specific outcomes following AIH included declines in memory and processing speed. Increasing age and the severity of illness were the most consistent risk factors for PHCD. PHCD was supported by MA of seven eligible studies with 41,453 participants (Cohen’s d = −0.25, 95% CI [−0.02, −0.49] I2 35%). Conclusions: There is preliminary evidence that AIH exposure accelerates or triggers cognitive decline in the elderly patient. PHCD reported in specific contexts could be subsets of a larger phenomenon and caused by overlapping mechanisms. Future research must clarify the trajectory, clinical significance, and etiology of PHCD: a priority in the face of an aging population with increasing rates of both cognitive impairment and hospitalization.

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Anemia and iron metabolism in COVID-19: a systematic review and meta-analysis

European Journal of Epidemiology ◽

10.1007/s10654-020-00678-5 ◽

2020 ◽

Vol 35 (8) ◽

pp. 763-773 ◽

Cited By ~ 6

Author(s):

Petek Eylul Taneri ◽

Sergio Alejandro Gómez-Ochoa ◽

Erand Llanaj ◽

Peter Francis Raguindin ◽

Lyda Z. Rojas ◽

...

Keyword(s):

Systematic Review ◽

Iron Metabolism ◽

Binding Capacity ◽

Ferritin Level ◽

Meta Analysis ◽

Older Age ◽

Bibliographic Databases ◽

Distribution Width ◽

Significant Difference ◽

The Impact

Abstract Iron metabolism and anemia may play an important role in multiple organ dysfunction syndrome in Coronavirus disease 2019 (COVID-19). We conducted a systematic review and meta-analysis to evaluate biomarkers of anemia and iron metabolism (hemoglobin, ferritin, transferrin, soluble transferrin receptor, hepcidin, haptoglobin, unsaturated iron-binding capacity, erythropoietin, free erythrocyte protoporphyrine, and erythrocyte indices) in patients diagnosed with COVID-19, and explored their prognostic value. Six bibliographic databases were searched up to August 3rd 2020. We included 189 unique studies, with data from 57,563 COVID-19 patients. Pooled mean hemoglobin and ferritin levels in COVID-19 patients across all ages were 129.7 g/L (95% Confidence Interval (CI), 128.51; 130.88) and 777.33 ng/mL (95% CI, 701.33; 852.77), respectively. Hemoglobin levels were lower with older age, higher percentage of subjects with diabetes, hypertension and overall comorbidities, and admitted to intensive care. Ferritin level increased with older age, increasing proportion of hypertensive study participants, and increasing proportion of mortality. Compared to moderate cases, severe COVID-19 cases had lower hemoglobin [weighted mean difference (WMD), − 4.08 g/L (95% CI − 5.12; − 3.05)] and red blood cell count [WMD, − 0.16 × 1012 /L (95% CI − 0.31; − 0.014)], and higher ferritin [WMD, − 473.25 ng/mL (95% CI 382.52; 563.98)] and red cell distribution width [WMD, 1.82% (95% CI 0.10; 3.55)]. A significant difference in mean ferritin levels of 606.37 ng/mL (95% CI 461.86; 750.88) was found between survivors and non-survivors, but not in hemoglobin levels. Future studies should explore the impact of iron metabolism and anemia in the pathophysiology, prognosis, and treatment of COVID-19.

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The Association of Potentially Inappropriate Medication at Older Age With Cardiovascular Events and Overall Mortality: A Systematic Review and Meta-Analysis of Cohort Studies

Journal of the American Medical Directors Association ◽

10.1016/j.jamda.2016.11.025 ◽

2017 ◽

Vol 18 (3) ◽

pp. 211-220 ◽

Cited By ~ 42

Author(s):

Dana Clarissa Muhlack ◽

Liesa Katharina Hoppe ◽

Janick Weberpals ◽

Hermann Brenner ◽

Ben Schöttker

Keyword(s):

Systematic Review ◽

Cohort Studies ◽

Cardiovascular Events ◽

Meta Analysis ◽

Inappropriate Medication ◽

Older Age ◽

Potentially Inappropriate Medication ◽

Overall Mortality

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GFR in Healthy Aging: an Individual Participant Data Meta-Analysis of Iohexol Clearance in European Population-Based Cohorts

Journal of the American Society of Nephrology ◽

10.1681/asn.2020020151 ◽

2020 ◽

Vol 31 (7) ◽

pp. 1602-1615 ◽

Cited By ~ 5

Author(s):

Bjørn O. Eriksen ◽

Runolfur Palsson ◽

Natalie Ebert ◽

Toralf Melsom ◽

Markus van der Giet ◽

...

Keyword(s):

Healthy Aging ◽

Meta Analysis ◽

Additive Model ◽

Healthy Person ◽

Population Based ◽

European Population ◽

Older Age ◽

Cross Sectional ◽

Individual Participant ◽

The Mean

BackgroundPopulation mean GFR is lower in older age, but it is unknown whether healthy aging is associated with preserved rather than lower GFR in some individuals.MethodsWe investigated the cross-sectional association between measured GFR, age, and health in persons aged 50–97 years in the general population through a meta-analysis of iohexol clearance measurements in three large European population-based cohorts. We defined a healthy person as having no major chronic disease or risk factors for CKD and all others as unhealthy. We used a generalized additive model to study GFR distribution by age according to health status.ResultsThere were 935 (22%) GFR measurements in persons who were healthy and 3274 (78%) in persons who were unhealthy. The mean GFR was lower in older age by −0.72 ml/min per 1.73 m2 per year (95% confidence interval [95% CI], −0.96 to −0.48) for men who were healthy versus −1.03 ml/min per 1.73 m2 per year (95% CI, −1.25 to −0.80) for men who were unhealthy, and by −0.92 ml/min per 1.73 m2 per year (95% CI, −1.14 to −0.70) for women who were healthy versus −1.22 ml/min per 1.73 m2 per year (95% CI, −1.43 to −1.02) for women who were unhealthy. For healthy and unhealthy people of both sexes, both the 97.5th and 2.5th GFR percentiles exhibited a negative linear association with age.ConclusionsHealthy aging is associated with a higher mean GFR compared with unhealthy aging. However, both the mean and 97.5 percentiles of the GFR distribution are lower in older persons who are healthy than in middle-aged persons who are healthy. This suggests that healthy aging is not associated with preserved GFR in old age.

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Recalibrating the risk of hamstring strain injury (HSI): A 2020 systematic review and meta-analysis of risk factors for index and recurrent hamstring strain injury in sport

British Journal of Sports Medicine ◽

10.1136/bjsports-2019-100983 ◽

2020 ◽

Vol 54 (18) ◽

pp. 1081-1088 ◽

Cited By ~ 7

Author(s):

Brady Green ◽

Matthew N Bourne ◽

Nicol van Dyk ◽

Tania Pizzari

Keyword(s):

Risk Factors ◽

Systematic Review ◽

Evidence Synthesis ◽

Meta Analysis ◽

Significant Risk ◽

Older Age ◽

Future Research ◽

Hamstring Strain ◽

Best Evidence Synthesis ◽

History Of

ObjectiveTo systematically review risk factors for hamstring strain injury (HSI).DesignSystematic review update.Data sourcesDatabase searches: (1) inception to 2011 (original), and (2) 2011 to December 2018 (update). Citation tracking, manual reference and ahead of press searches.Eligibility criteria for selecting studiesStudies presenting prospective data evaluating factors associated with the risk of index and/or recurrent HSI.MethodSearch result screening and risk of bias assessment. A best evidence synthesis for each factor and meta-analysis, where possible, to determine the association with risk of HSI.ResultsThe 78 studies captured 8,319 total HSIs, including 967 recurrences, in 71,324 athletes. Older age (standardised mean difference=1.6, p=0.002), any history of HSI (risk ratio (RR)=2.7, p<0.001), a recent HSI (RR=4.8, p<0.001), previous anterior cruciate ligament (ACL) injury (RR=1.7, p=0.002) and previous calf strain injury (RR=1.5, p<0.001) were significant risk factors for HSI. From the best evidence synthesis, factors relating to sports performance and match play, running and hamstring strength were most consistently associated with HSI risk. The risk of recurrent HSI is best evaluated using clinical data and not the MRI characteristics of the index injury.Summary/conclusionOlder age and a history of HSI are the strongest risk factors for HSI. Future research may be directed towards exploring the interaction of risk factors and how these relationships fluctuate over time given the occurrence of index and recurrent HSI in sport is multifactorial.

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Surgery and Actinomycin Improve Survival in Malignant Rhabdoid Tumor

Sarcoma ◽

10.1155/2013/315170 ◽

2013 ◽

Vol 2013 ◽

pp. 1-8 ◽

Cited By ~ 13

Author(s):

Ryan Horazdovsky ◽

J. Carlos Manivel ◽

Edward Y. Cheng

Keyword(s):

Prognostic Factors ◽

Cox Regression ◽

Meta Analysis ◽

Surgical Excision ◽

Rhabdoid Tumor ◽

Older Age ◽

Malignant Rhabdoid Tumor ◽

Kaplan Meier ◽

Improvement In Survival ◽

Survival Differences

Purpose. Malignant rhabdoid tumor (MRT) is an uncommon tumor that rarely occurs outside of renal and central nervous system (CNS) sites. Data from the literature were compiled to determine prognostic factors, including both demographic and treatment variables of malignant rhabdoid tumor, focusing on those tumors arising in extra-renal, extra-CNS (ER/EC MRT) sites. Patients and Methods. A systematic review and meta-analysis was performed by extracting demographic, treatment, and survival follow up on 167 cases of primary ER/EC MRT identified in the literature.Results. No survival differences were observed between those treated with or without radiation, or with or without chemotherapy. A Cox regression of overall survival revealed several independent prognostic factors. Surgical excision had a 74% (P= 0.0003) improvement in survival. Actinomycin had a 73% (P= 0.093) improvement in survival. Older age was associated with improved survival. The four-year survival, by Kaplan-Meier estimates, comparing patients less than two years old versus older than two at diagnosis was 11% versus 35%, respectively (P= 0.0001, Log-Rank).Conclusion. ER/EC MRT is a rare, soft-tissue tumor with a poor prognosis most commonly occurring in children. Surgical resection, treatment with actinomycin, and older age at diagnosis are all associated with improved survival.

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