scholarly journals The impact of opiate substitution treatment on mortality risk in drug addicts: a natural experiment study

2019 ◽  
Vol 7 (3) ◽  
pp. 1-92 ◽  
Author(s):  
Colin D Steer ◽  
John Macleod ◽  
Kate Tilling ◽  
Aaron G Lim ◽  
John Marsden ◽  
...  
Keyword(s):  
Primary Care ◽  
Observational Study ◽  
Mortality Risk ◽  
Treatment Duration ◽  
Hazard Ratio ◽  
Substitution Treatment ◽  
Opiate Substitution Treatment ◽  
All Cause Mortality ◽  
Prospective Longitudinal ◽  
Cessation Of Treatment

Background Opiate substitution treatment (OST) is the main treatment for people addicted to heroin and other opioid drugs. However, there is limited information on how the delivery of this treatment affects mortality risk. Objectives To investigate the associations of mortality risk with periods during treatment and following cessation of treatment, medication type, co-prescription of other medication and dosing regimens during titration and detoxification. The trends with time of prescribed medication, dose and treatment duration were also explored. Design Prospective longitudinal observational study. Setting UK primary care between 1998 and 2014. Participants A total of 12,780 patients receiving methadone, buprenorphine or dihydrocodeine. Main outcome measures All-cause mortality relating to 657 deaths and drug-related poisoning relating to 113 deaths. Data sources Clinical Practice Research Datalink with linked information on cause of death from the Office for National Statistics. Results For both outcomes, the lowest mortality risk was observed after 4 weeks of treatment and the highest risk was observed in the first 4 weeks following cessation of treatment [e.g. for drug-related poisoning, incidence rate ratio (IRR) 8.15, 95% confidence interval (CI) 5.45 to 12.19]. There was evidence that the treatment period risks varied with OST medication. The largest difference in risk was for the first 4 weeks of treatment for both outcomes, with patients on buprenorphine being at lower risk than those on methadone (e.g. for drug-related poisoning, IRR 0.08, 95% CI 0.01 to 0.48). The co-prescription of benzodiazepines was associated with linearly increasing the risk of drug-related deaths by dose (IRR 2.02, 95% CI 1.66 to 2.47), whereas z-drugs (zolpidem, zopiclone and zaleplon) were associated with increased risk of both all-cause (IRR 1.83, 95% CI 1.59 to 2.12) and drug-related (IRR 3.31, 95% CI 2.45 to 4.47) mortality. There was weak evidence that higher initial and final doses were associated with increased all-cause mortality risk. In the first 4 weeks of treatment, the risk increased by 4% for each 5-mg increment in methadone dose (1-mg increase in buprenorphine) (hazard ratio 1.04, 95% CI 1.00 to 1.09). In the first 4 weeks after treatment ceased, a similar increment in final dose increased the risk by 3% (hazard ratio 1.03, 95% CI 0.99 to 1.07). There were too few deaths to evaluate the effects on drug-related poisoning. The proportion of OST patients receiving buprenorphine increased between 1998 and 2006. Median treatment duration was consistently shorter for buprenorphine than for methadone for each year studied (overall median duration of 48 and 106 days, respectively). Limitations As this was an observational study, the possibility remains of bias from unmeasured factors, which covariate adjustment and inverse probability weighting can eliminate only partially. Conclusions Using buprenorphine as an alternative to methadone may not reduce mortality overall despite resulting in lower IRRs from shorter treatment duration. Clinical guidance needs to consider strengthening warnings about the co-prescription of a range of drugs for OST patients. Future work Our analyses need to be replicated using other clinical data sets in the UK and in other countries. New interventions and trials are required to investigate improving the retention of OST patients in primary care. Funding The National Institute for Health Research Health Services and Delivery Research programme.

scholarly journals A metabolic profile of all-cause mortality risk identified in an observational study of 44,168 individuals

2019 ◽  
Vol 10 (1) ◽  
Author(s):  
Joris Deelen ◽  
Johannes Kettunen ◽  
Krista Fischer ◽  
Ashley van der Spek ◽  
Stella Trompet ◽  
...  
Keyword(s):  
Observational Study ◽  
Mortality Risk ◽  
Metabolic Profile ◽  
All Cause Mortality

scholarly journals Association of changing physical activity intensity and bout length with mortality: a study of 79,507 participants in UK Biobank

2020 ◽  
Author(s):  
Louise Amanda Claire Millard ◽  
Kate Tilling ◽  
Tom R Gaunt ◽  
David Carslake ◽  
Deborah A Lawlor
Keyword(s):  
Physical Activity ◽  
Mortality Risk ◽  
Analytical Approach ◽  
Vigorous Physical Activity ◽  
Hazard Ratio ◽  
Uk Biobank ◽  
Bout Length ◽  
All Cause Mortality ◽  
Light Activity ◽  
The Impact

Background Spending more time active (and less time sedentary) is associated with many health benefits such as improved cardiovascular health and lower risk of all-cause mortality. However, it is unclear whether these associations differ depending on whether time spent sedentary or in moderate-vigorous physical activity (MVPA) is accumulated in long or short bouts. In this study we used a novel analytical approach, that accounts for substitution (i.e. more time in MVPA means spending less time sleeping, in light activity or being sedentary), to examine whether length of sedentary and MVPA bouts associates with all-cause mortality. Methods and findings We used data on 79,507 participants from UK Biobank. We derived the total time participants spent in activity categories - sleep, sedentary, light activity and MVPA - on average per day. We also derived the time spent in sedentary and MVPA bouts of short (1-15 minutes), medium (16-40 minutes) and long (41+ minutes) duration. We used Cox proportion hazards regression to estimate the association of spending 10 minutes more average daily time in one activity or bout length category, coupled with spending 10 minutes less time in another, with all-cause mortality. Those spending more time sedentary had higher mortality risk if this replaced time spent in light activity (hazard ratio 1.02 [95% confidence interval (CI): 1.01, 1.03]), and an even higher risk if this replaced time spent in MVPA (hazard ratio 1.08 [95% CI: 1.06, 1.10]). Those spending more time in MVPA had lower mortality risk, irrespective of whether this replaced time spent sleeping, sedentary or in light activity. We found little evidence to suggest that mortality risk differed depending on the length of sedentary or MVPA bouts. A limitation of our study is that we cannot assume that these results are causal, though we adjusted for key confounders. Conclusions Using our novel analytical approach, we uniquely show that time spent in MVPA is associated with reduced mortality, irrespective of whether it replaces time spent sleeping, sedentary or in light activity. This emphasizes the specific importance of MVPA. We found little evidence to suggest that the impact of MVPA differs depending on whether it is obtained from several short bouts or fewer longer bouts, supporting recent policy changes in some countries. Further studies are needed to investigate causality and explore health outcomes beyond mortality.

Short-term prognosis of normalising serum potassium following an episode of hypokalaemia in patients with chronic heart failure

2020 ◽  
pp. 204748732091115
Author(s):  
Mette Aldahl ◽  
Christoffer Polcwiartek ◽  
Line Davidsen ◽  
Kristian Kragholm ◽  
Peter Søgaard ◽  
...  
Keyword(s):  
Heart Failure ◽  
Chronic Heart Failure ◽  
Confidence Interval ◽  
Mortality Risk ◽  
Cardiovascular Mortality ◽  
Serum Potassium ◽  
Reference Group ◽  
Hazard Ratio ◽  
Increased Risk ◽  
All Cause Mortality

Background/aim It is well known that patients with chronic heart failure and hypokalaemia have increased mortality risk. We investigated the impact of normalising serum potassium following an episode of hypokalaemia on short-term mortality among patients with chronic heart failure. Methods and results We identified 1673 patients diagnosed with chronic heart failure who had a serum potassium measurement under 3.5 mmol/l within 14 days and one year after initiated medical treatment with both loop diuretics and angiotensin-converting enzyme inhibitors or angiotensin-II receptor blockers. A second serum potassium measurement was required 8–30 days after the episode of hypokalaemia. All-cause mortality and cardiovascular mortality was examined within 90 days from the second serum potassium measurement. Mortality was examined according to six predefined potassium groups derived from the second measurement:<3.5 mmol/l ( n = 302), 3.5–3.7 mmol/l ( n = 271), 3.8–4.1 mmol/l ( n = 464), 4.2–4.4 mmol/l ( n = 270), 4.5–5.0 mmol/l ( n = 272), and 5.1–8.0 mmol/l ( n = 94). We used Cox regression to estimate both all-cause mortality risk and cardiovascular mortality, with serum potassium at 3.8–4.1 mmol/l as reference. After 90 days, the all-cause mortality in the six groups was 29.5%, 22.1%, 20.3%, 24.8%, 23.5% and 43.6%, respectively. In multivariable adjusted analysis, patients with serum potassium <3.5 mmol/l (hazard ratio: 1.51; 95% confidence interval: 1.13–2.02) and serum potassium 5.1–8.0 mmol/l (hazard ratio: 2.18; 95% confidence interval: 1.50–3.17) had an increased risk of all-cause mortality compared to the reference. After 90 days, the cardiovascular mortality in the six groups was 19.2%, 17.7%, 14.4%, 18.9%, 18.8% and 34.0%, respectively. In multivariable adjusted analysis, patients with serum potassium 5.1–8.0 mmol/l (hazard ratio: 2.32; 95% confidence interval: 1.51–3.56) had an increased risk of cardiovascular mortality compared to the reference, while serum potassium <3.5 mmol/l (hazard ratio: 1.37; 95% confidence interval: 0.97–1.95) had a trend toward increased risk of cardiovascular mortality compared to the reference. Conclusion Patients with chronic heart failure and hypokalaemia, who after 8–30 days remained hypokalaemic, had a significantly higher 90-day all-cause mortality risk compared to patients in the reference group (3.8–4.1 mmol/l). Patients with chronic heart failure and hypokalaemia, who after 8–30 days had the serum potassium level increased to a level within 5.1–8.0 mmol/l, had both a significantly higher 90-day all-cause mortality risk and cardiovascular mortality risk compared to patients in the reference group (3.8–4.1 mmol/l).

scholarly journals Glycemic Measures and Risk of Mortality in Older Chinese: The Guangzhou Biobank Cohort Study

2019 ◽  
Vol 105 (3) ◽  
pp. e181-e190 ◽  
Author(s):  
Chao Qiang Jiang ◽  
Lin Xu ◽  
Tai Hing Lam ◽  
Ya Li Jin ◽  
Wei Sen Zhang ◽  
...  
Keyword(s):  
Cohort Study ◽  
Confidence Interval ◽  
Mortality Risk ◽  
Fasting Glucose ◽  
Tolerance Test ◽  
Hazard Ratio ◽  
Oral Glucose ◽  
Risk Of Mortality ◽  
All Cause Mortality ◽  
Diagnosed Diabetes

Abstract Context China has the largest number of people with type 2 diabetes mellitus (T2DM) in the world. Data from previous studies have suggested that up to one-fifth of individuals with diabetes would be missed without an oral glucose tolerance test (OGTT). To date, there is little information on the mortality risk of these individuals. Objective We estimated the association of different indicators of hyperglycemia with mortality in the general Chinese population. Design Prospective cohort study. Setting China. Participants A total of 17 939 participants aged 50+ years. Exposures Previously diagnosed diabetes and newly detected diabetes defined by fasting glucose (≥7.0 mmol/L), 2-hour postload glucose (≥11.1 mmol/L), or hemoglobin A1c (HbA1c, ≥6.5%). Main Outcomes Measures Deaths from all-cause, cardiovascular disease, and cancer were identified by record linkage with death registration. Results During 7.8 (SD, 1.5) years’ follow-up, 1439 deaths were recorded. Of 3706 participants with T2DM, 2126 (57%) had known T2DM, 118 (3%) were identified by isolated elevated fasting glucose, 1022 (28%) had isolated elevated postload glucose, and 440 (12%) had both elevated fasting and postload glucose. Compared with normoglycemia, the hazard ratio (95% confidence interval) of all-cause mortality was 1.71 (1.46-2.00), 0.96 (0.47-1.93), 1.43 (1.15-1.78), and 1.82 (1.35-2.45) for the 4 groups, respectively. T2DM defined by elevated HbA1c was not significantly associated with all-cause mortality (hazard ratio, 1.17; 95% confidence interval, 0.81-1.69). Conclusion Individuals with isolated higher 2-h postload glucose had a higher risk of mortality by 43% than those with normoglycemia. Underuse of OGTT leads to substantial underdetection of individuals with a higher mortality risk and lost opportunities for early intervention.

scholarly journals Approximate Mortality Risks between Hyperuricemia and Diabetes in the United States

2019 ◽  
Vol 8 (12) ◽  
pp. 2127 ◽  
Author(s):  
Po-Hsun Chen ◽  
Yu-Wei Chen ◽  
Wei-Ju Liu ◽  
Ssu-Wei Hsu ◽  
Ching-Hsien Chen ◽  
...  
Keyword(s):  
Mortality Risk ◽  
Reference Group ◽  
The United States ◽  
Cox Proportional Hazards ◽  
Hazard Ratio ◽  
Low Risk ◽  
Mortality Data ◽  
Mortality Risks ◽  
All Cause Mortality ◽  
Cvd Mortality

Aim: This study aimed to compare mortality risks across uric acid (UA) levels between non-diabetes adults and participants with diabetes and to investigate the association between hyperuricemia and mortality risks in low-risk adults. Methods: We analyzed data from adults aged >18 years without coronary heart disease and chronic kidney disease (n = 29,226) from the National Health and Nutrition Examination Survey (1999–2010) and the associated mortality data (up to December 2011). We used the Cox proportional hazards models to examine the risk of all-cause and cause-specific (cardiovascular disease (CVD) and cancer) mortality at different UA levels between adults with and without diabetes. Results: Over a median follow-up of 6.6 years, 2069 participants died (495 from CVD and 520 from cancers). In non-diabetes adults at UA ≥ 5 mg/dL, all-cause and CVD mortality risks increased across higher UA levels (p-for-trend = 0.037 and 0.058, respectively). The lowest all-cause mortality risk in participants with diabetes was at the UA level of 5–7 mg/dL. We set the non-diabetes participants with UA levels of <7 mg/dL as a reference group. Without considering the effect of glycemic control, the all-cause mortality risk in non-diabetes participants with UA levels of ≥7 mg/dL was equivalent to risk among diabetes adults with UA levels of <7 mg/dL (hazard ratio = 1.44 vs. 1.57, p = 0.49). A similar result was shown in CVD mortality risk (hazard ratio = 1.80 vs. 2.06, p = 0.56). Conclusion: Hyperuricemia may be an indicator to manage multifaceted cardiovascular risk factors in low-risk adults without diabetes, but further studies and replication are warranted.

scholarly journals All-cause mortality risk in elderly individuals with disabilities: a retrospective observational study

BMJ Open ◽  
2016 ◽  
Vol 6 (9) ◽  
pp. e011164 ◽  
Author(s):  
Li-Wei Wu ◽  
Wei-Liang Chen ◽  
Tao-Chun Peng ◽  
Sheng-Ta Chiang ◽  
Hui-Fang Yang ◽  
...  
Keyword(s):  
Observational Study ◽  
Mortality Risk ◽  
Retrospective Observational Study ◽  
Individuals With Disabilities ◽  
Elderly Individuals ◽  
All Cause Mortality

scholarly journals Survival and cessation in injecting drug users: prospective observational study of outcomes and effect of opiate substitution treatment

BMJ ◽  
2010 ◽  
Vol 341 (jul01 1) ◽  
pp. c3172-c3172 ◽  
Author(s):  
J. Kimber ◽  
L. Copeland ◽  
M. Hickman ◽  
J. Macleod ◽  
J. McKenzie ◽  
...  
Keyword(s):  
Observational Study ◽  
Drug Users ◽  
Prospective Observational Study ◽  
Injecting Drug Users ◽  
Substitution Treatment ◽  
Opiate Substitution Treatment

scholarly journals Structural barriers in the context of opiate substitution treatment in Germany - a survey among physicians in primary care

2013 ◽  
Vol 8 (1) ◽  
Author(s):  
Bernd Schulte ◽  
Christiane Sybille Schmidt ◽  
Olaf Kuhnigk ◽  
Ingo Schäfer ◽  
Benedikt Fischer ◽  
...  
Keyword(s):  
Primary Care ◽  
Substitution Treatment ◽  
Structural Barriers ◽  
Opiate Substitution Treatment

scholarly journals Multiple Reasons for Perceived Everyday Discrimination and All-Cause Mortality Risk Among Older Black Adults

2021 ◽  
Author(s):  
Ryon J Cobb ◽  
Connor Mc Devitt Sheehan ◽  
Patricia Louie ◽  
Christy L Erving
Keyword(s):  
Confidence Interval ◽  
Mortality Risk ◽  
Panel Study ◽  
The United States ◽  
Hazard Ratio ◽  
Black Adults ◽  
Increased Risk ◽  
All Cause Mortality ◽  
Nationally Representative ◽  
Everyday Discrimination

Abstract Background The present study assessed whether reporting multiple reasons for perceived everyday discrimination was associated with an increased risk for all-cause mortality risk among older Black adults. Methods This study utilized data from a subsample of older Black adults from the Health and Retirement Study (HRS), a nationally representative panel study of older adults in the United States. Our measure of multiple reasons for perceived everyday discrimination was based on self-reports from the 2006/2008 HRS waves. Respondents' vital status was obtained from the National Death Index and reports from key household informants (spanning 2006–2019). Cox proportional hazard models, which accounted for covariates linked to mortality, were used to estimate the risk of all-cause mortality. Results During the observation period, 563 deaths occurred. Twenty percent of Black adults attributed perceived everyday discrimination to three or more sources. In demographic adjusted models, attributing perceived everyday discrimination to three or more sources was a statistically significant predictor of all-cause mortality risk (hazard ratio= 1.45; 95%, confidence interval=1.12 - 1.87). The association remained significant (hazard ratio=1.49, 95%, confidence interval=1.15 - 1.93) after further adjustments for health, behavioral, and economic characteristics. Conclusion Examining how multiple reasons for perceived everyday discrimination relate to all-cause mortality risk has considerable utility in clarifying the unique contributions of perceived discrimination to mortality risk among older Black adults. Our findings suggest that multiple reasons for perceived everyday discrimination are a particularly salient risk factor for mortality among older Black adults.

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