Shared Physiologic Pathways Among Comorbidities for Adults With Cerebral Palsy

Objective: Aging with cerebral palsy is accompanied by a declining health and function status across neurological and non-neurological systems. There is a need to understand the shared pathophysiology among comorbidities for adults with cerebral palsy, to inform clinical assessment and guidelines for interventions to improve healthful aging. To begin defining multimorbidity, this study identified the most common comorbidity combinations and their association with mortality among a representative sample of adults with cerebral palsy.Methods: Data from 2016 to 2018 were used from a random 20% sample from the fee-for-service Medicare database. Adults ≥18 years with cerebral palsy and 25 neurological and non-neurological comorbidities were obtained from 2016. Principal component (PC) analysis identified the most common comorbidity combinations, defined as individual PCs. Cox regression estimated the hazard ratio (HR) of 2-year mortality including all PCs and demographics in a single model. To facilitate comparisons, PC scores were transformed into quintiles (reference: lowest quintile).Results: Among the 16,728 adults with cerebral palsy, the most common comorbidity combinations (PCs) in order were: cardiorespiratory diseases, dysphagia, and fluid/electrolyte disorders; metabolic disorders (e.g., diabetes, renal disease, hypertension); neurologic-related disorders (e.g., dementia, cerebrovascular disease); gastrointestinal issues; and orthopedic-related disorders. During the 2-year follow-up, 1,486 (8.9%) died. In the adjusted model, most PCs were associated with an elevated mortality rate, especially the first PC (5th quintile HR = 3.91; 95%CI = 3.29–4.65).Discussion: This study identified the most common comorbidity combinations for adults with cerebral palsy, many of them were deadly, which may inform on the underlying pathophysiology or shared characteristics of multimorbidity for this population.

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The Association Between Kidney Disease and Mortality Among Adults With Cerebral Palsy—A Cohort Study: It Is Time to Start Talking About Kidney Health

Frontiers in Neurology ◽

10.3389/fneur.2021.732329 ◽

2021 ◽

Vol 12 ◽

Author(s):

Daniel G. Whitney ◽

Andrea L. Oliverio

Keyword(s):

Cerebral Palsy ◽

Kidney Disease ◽

Cox Regression ◽

Clinical Care ◽

Fee For Service ◽

Increased Risk ◽

End Stage ◽

Medicare Database ◽

Mortality Rate Ratio ◽

Kidney Health

Objective: Recent evidence shows that adults with cerebral palsy (CP) have an increased risk for kidney disease, but nothing is known about how kidney disease integrates with their overall health. To begin understanding the importance of kidney health, the objective was to determine if kidney disease is associated with mortality among adults with CP after accounting for comorbidities common to CP and kidney disease.Methods: Data from 2016 to 2018 from adults ≥18 years with CP were used from a random 20% sample fee-for-service Medicare database. Kidney disease in 2016 was ascertained as chronic kidney disease (CKD) stages 1–4, end stage kidney disease (ESKD), nephritic and nephrotic syndrome, and renal osteodystrophy. A modified version of the Whitney Comorbidity Index (modWCI) was used, which includes 24 comorbidities relevant to CP and kidney disease. Mortality rate ratio (MRR) through the year 2018 was estimated for each kidney disease and Cox regression estimated the hazard ratio (HR) of mortality after adjusting for demographics, co-occurring neurological conditions, and the modWCI.Results: Prevalence of kidney disease was 7.3% among 16,728 adults with CP. MRR was elevated for any kidney disease (MRR = 3.14; 95%CI = 2.76–3.58) and most subtypes (MRR = 2.21–3.56; all p < 0.05). The adjusted HR of mortality remained elevated for any kidney disease (HR = 1.25; 95%CI = 1.09–1.45) and ESKD (HR = 1.38; 95%CI = 1.10–1.74).Discussion: Kidney disease, especially ESKD, is associated with mortality among adults with CP independent of comorbidities that are relevant to CP and kidney disease. Findings suggest that nephrology care should be considered as part of routine clinical care for this population.

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Cardiovascular and all-cause mortality attributable to loneliness in older Swedish men and women.

10.21203/rs.2.22585/v2 ◽

2020 ◽

Author(s):

Masuma Novak ◽

Margda waern ◽

Lena Johansson ◽

Anna Zettergren ◽

Lina Ryden ◽

...

Keyword(s):

Cardiovascular Mortality ◽

Cox Regression ◽

Mortality Data ◽

Men And Women ◽

Face To Face ◽

Risk Of Mortality ◽

Increased Risk ◽

All Cause Mortality ◽

Adjusted Model

Abstract Background. This study examined whether loneliness predicts cardiovascular- and all-cause mortality in older men and women. Methods. Baseline data from the Gothenburg H70 Birth Cohort Studies, collected during 2000 on 70-year-olds born 1930 and living in Gothenburg were used for analysis (n=524). Mortality data were analyzed until 2012 through Swedish national registers. Results. Perceived loneliness was reported by 17.1% of the men and 30.9% of the women in a face-to-face interview with mental health professional. A total of 142 participants died during the 12-year follow-up period, with 5 334 person-years at risk, corresponding to 26.6 deaths/1000 person-years. Cardiovascular disease accounted for 59.2% of all deaths. The cumulative rates/1000 person-years for cardiovascular mortality were 20.8 (men) and 11.5 (women), and for all-cause mortality 33.8 (men) and 20.5 (women), respectively. In Cox regression models, no significant increased risk of mortality was seen for men with loneliness compared to men without loneliness (cardiovascular mortality HR 1.52, 95% CI 0.78 - 2.96; all-cause HR 1.32, 95% CI 0.77 - 2.28). Increased risk of cardiovascular mortality was observed in women with loneliness compared to those without (HR 2.25 95% CI 1.14 - 4.45), and the risk remained significant in a multivariable-adjusted model (HR 2.42 95% CI 1.04 - 5.65). Conclusions. Loneliness was shown to be an independent predictor of cardiovascular mortality in women. We found no evidence to indicate that loneliness was associated with an increased risk of either cardiovascular- or all-cause mortality in men.

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Cardiovascular and all-cause mortality attributable to loneliness in older Swedish men and women

BMC Geriatrics ◽

10.1186/s12877-020-01603-x ◽

2020 ◽

Vol 20 (1) ◽

Author(s):

Masuma Novak ◽

Margda Waern ◽

Lena Johansson ◽

Anna Zettergren ◽

Lina Ryden ◽

...

Keyword(s):

Cardiovascular Mortality ◽

Cox Regression ◽

Mortality Data ◽

Men And Women ◽

Face To Face ◽

Risk Of Mortality ◽

Increased Risk ◽

All Cause Mortality ◽

Adjusted Model

Abstract Background This study examined whether loneliness predicts cardiovascular- and all-cause mortality in older men and women. Methods Baseline data from the Gothenburg H70 Birth Cohort Studies, collected during 2000 on 70-year-olds born 1930 and living in Gothenburg were used for analysis (n = 524). Mortality data were analyzed until 2012 through Swedish national registers. Results Perceived loneliness was reported by 17.1% of the men and 30.9% of the women in a face-to-face interview with mental health professional. A total of 142 participants died during the 12-year follow-up period, with 5334 person-years at risk, corresponding to 26.6 deaths/1000 person-years. Cardiovascular disease accounted for 59.2% of all deaths. The cumulative rates/1000 person-years for cardiovascular mortality were 20.8 (men) and 11.5 (women), and for all-cause mortality 33.8 (men) and 20.5 (women), respectively. In Cox regression models, no significant increased risk of mortality was seen for men with loneliness compared to men without loneliness (cardiovascular mortality HR 1.52, 95% CI 0.78–2.96; all-cause HR 1.32, 95% CI 0.77–2.28). Increased risk of cardiovascular mortality was observed in women with loneliness compared to those without (HR 2.25 95% CI 1.14–4.45), and the risk remained significant in a multivariable-adjusted model (HR 2.42 95% CI 1.04–5.65). Conclusions Loneliness was shown to be an independent predictor of cardiovascular mortality in women. We found no evidence to indicate that loneliness was associated with an increased risk of either cardiovascular- or all-cause mortality in men.

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Abstract 19: Pericardial Fat Volume is Associated with Incident Atrial Fibrillation: The Multi-Ethnic Study of Atherosclerosis and the Jackson Heart Study

Circulation ◽

10.1161/circ.133.suppl_1.19 ◽

2016 ◽

Vol 133 (suppl_1) ◽

Author(s):

Susan R Heckbert ◽

Kerri L Wiggins ◽

Chad Blackshear ◽

Benjamin F Banahan ◽

Yi Yang ◽

...

Keyword(s):

Ethnic Groups ◽

Cox Regression ◽

Renin Angiotensin System ◽

Fee For Service ◽

Pericardial Fat ◽

Adjusted Risk ◽

Race Ethnicity ◽

Underlying Mechanisms ◽

Fat Volume

Introduction: Obesity is associated with higher risk of incident AF, but the underlying mechanisms are not well understood. Increased pericardial fat deposition may lead to atrial fibrosis and renin-angiotensin system activation due to free diffusion of cytokines into the thin atrial wall, promoting AF development. Little is known about the association of pericardial fat volume with incident AF. Hypothesis: We assessed the hypothesis that greater pericardial fat volume is associated with higher AF risk in MESA and JHS, overall and in four race/ethnic groups. Methods: Pericardial fat volume was measured on chest CT scans (performed 2000-02 in MESA, 2007-09 in JHS) in 18 2.5-mm slices, from 1.5 cm above to 3.0 cm below the superior extent of the left main coronary artery, using Volume Analysis software (GE Healthcare, Waukesha, WI). Data were combined across the 2 studies. Participants with prevalent AF before the scan were excluded. Incident AF was identified by hospital discharge diagnosis codes for AF or atrial flutter, by study ECG at a follow-up visit, or, for those enrolled in fee-for-service Medicare, by an inpatient or outpatient claim with an AF diagnosis in any position. We used Cox regression to estimate adjusted hazard ratios for incident AF. Results: A total of 8056 participants (6681 in MESA; 1375 in JHS) had pericardial fat volume measured and were followed for clinical events. Among MESA participants, 1855 were AA, 2568 white, 1470 Hispanic, and 788 Chinese; all JHS participants were AA. In the combined data, the average age was 62 years; 55% were women. Greater pericardial fat volume was associated with male sex, older age, white or Hispanic race/ethnicity, greater BMI and systolic blood pressure (SBP), treated hypertension (HTN), impaired fasting glucose, and diabetes mellitus. Despite more obesity, AA participants had on average the lowest pericardial fat volume. During an average of 9 years of follow-up in MESA and 4 years in JHS, a total of 614 cases of incident AF were identified. Whites had the highest unadjusted AF incidence and AA the lowest. In all 4 race/ethnic groups, pericardial fat volume was positively associated with unadjusted AF incidence. After adjustment for age, sex, race/ethnicity, and study, greater pericardial fat volume was associated with higher risk of incident AF (HR=1.17 per SD pericardial fat volume [41 ml], 95% CI 1.09-1.26). After further adjustment for BMI, height, diabetes, SBP, and treated HTN, the association was attenuated (HR 1.06 per SD, 95% CI 0.97-1.16). Associations did not differ in subgroups defined by sex, race/ethnicity, or study. Conclusion: Greater deposition of fat in the pericardium is associated with higher AF incidence and higher adjusted risk of incident AF. Much of this association appears to be related to obesity, diabetes, and HTN. Lower average pericardial fat volume may explain in part the observed lower AF incidence in AA than in whites.

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Masticatory Capacity and Mortality: The Preventive and Clinical Investigation Center (IPC) Cohort Study

Journal of Dental Research ◽

10.1177/0022034519889021 ◽

2019 ◽

Vol 99 (2) ◽

pp. 152-158 ◽

Cited By ~ 1

Author(s):

C. Darnaud ◽

F. Thomas ◽

N. Danchin ◽

P. Boutouyrie ◽

P. Bouchard

Keyword(s):

Cancer Mortality ◽

Cox Regression ◽

Clinical Investigation ◽

Missing Teeth ◽

Masticatory Efficiency ◽

Hazard Ratios ◽

Increased Risk ◽

All Cause Mortality ◽

Adjusted Model

Poor oral health (OH) has been associated with mortality, but the association between OH components and mortality remains imprecise. The present observational study aimed to investigate if there is an association between oral masticatory efficiency and cardiovascular (CV) mortality in a large French subject cohort. The study was based on a cohort of 85,830 subjects aged between 16 and 94 y at recruitment. The follow-up extended from 2001 to 2014 and the mean follow-up was 8.06 ± 2.73 y. The number of deaths totaled 1,670. Full-mouth examinations were performed. Dental plaque, dental calculus, gingival inflammation, missing teeth, and masticatory units were recorded. Masticatory units represent the number of natural or prosthetic opposing premolars and molar pairs and can be considered an accurate indicator for masticatory efficiency. Causes of death were ascertained from death certificates. Cox regression analyses were used to calculate hazard ratios (HRs). In the fully adjusted model, the number of masticatory units <5 is associated with an HR of 1.72 (95% confidence interval [CI], 1.54 to 1.91) for all-cause mortality, HR of 1.41 (95% CI, 1.01 to 1.99) for CV mortality, HR of 1.76 (95% CI, 1.44 to 2.15) for cancer mortality, and HR of 1.85 (95% CI, 1.55 to 2.20) for non-CV and noncancer mortality. Significant statistical associations with the other oral variables were also found for all-cause mortality, cancer mortality, and non-CV and noncancer mortality in the adjusted models. Our study indicates that after full adjustment, all oral parameters are associated with all-cause, cancer, and non-CV and noncancer mortality. However, the low number of masticatory units is associated with an increased risk of CV mortality. We highlight the association of masticatory units and CV mortality.

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Relationship between diastolic blood pressure and the first ischaemic stroke in elderly patients with hypertension

Postgraduate Medical Journal ◽

10.1136/postgradmedj-2019-137018 ◽

2019 ◽

Vol 96 (1139) ◽

pp. 525-529

Author(s):

Chao-Lei Chen ◽

Jia-Yi Huang ◽

Lin Liu ◽

Yu-Ling Yu ◽

Geng Shen ◽

...

Keyword(s):

Blood Pressure ◽

Elderly Patients ◽

Ischaemic Stroke ◽

Diastolic Blood Pressure ◽

Cox Regression ◽

Interaction Analysis ◽

Cox Regression Analysis ◽

Elder Patients ◽

Adjusted Model

BackgroundIt is uncertain how diastolic blood pressure (DBP) may associate with ischaemic stroke in elder patients with hypertension. We aimed to explore this relationship in a Chinese community.MethodsA total of 3315 participants aged ≥60 years with essential hypertension were enrolled between January 2010 and December 2011, and being followed up until 31 December 2016. DBP levels were categorised into five groups (<60, 60–70, 70–80, 80–90 and ≥90 mm Hg), using 70–80 mm Hg as referent. We performed Cox regression analysis and subgroup analyses to evaluate the relationship between DBP and the incidence of ischaemic stroke.ResultsAmong the 3315 participants, 44.49% were men and they were 71.4 years old on average. During a median follow-up period of 5.5 years, there were 206 onset cases of ischaemic stroke. The HRs for the first ischaemic stroke in the fully adjusted model were 1.32 (95% CI 0.73 to 2.40) for DBP <70 mm Hg, 1.50 (95% CI 1.13 to 2.73) for DBP between 80 and 89.9 mm Hg and 2.31 (95% CI 1.14 to 4.68) for DBP ≥90 mm Hg compared with DBP between 70 and 79.9 mm Hg (p=0.020 for trend). Subgroup and interaction analysis showed no significant findings.ConclusionsDBP had a non-linear association with the risk of ischaemic stroke among Chinese elderly patients with hypertension. DBP between 70 and 80 mm Hg may be an appropriate indicator for a lower stroke risk.

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Cardiovascular and all-cause mortality attributable to loneliness in older Swedish men and women

10.21203/rs.2.22585/v1 ◽

2020 ◽

Author(s):

Masuma Novak ◽

Margda waern ◽

Lena Johansson ◽

Anna Zettergren ◽

Lina Ryden ◽

...

Keyword(s):

Cardiovascular Mortality ◽

Cox Regression ◽

Mortality Data ◽

Men And Women ◽

Face To Face ◽

Risk Of Mortality ◽

Increased Risk ◽

All Cause Mortality ◽

Adjusted Model

Abstract Background. This study examined whether loneliness predicts cardiovascular- and all-cause mortality in older men and women. Methods. Baseline data from the Gothenburg H70 Birth Cohort Studies, collected during 2000 on 70-year-olds born 1930 and living in Gothenburg were used for analysis (n=524). Mortality data was analyzed until 2012 through Swedish national registers. Results. Perceived loneliness was reported by 17.1% of the men and 30.9% of the women in a face-to-face interview with mental health professional. A total of 142 participants died during the 12-year follow-up period, with 5 334 person-years at risk, corresponding to 26.6 deaths/1000 person-years. Cardiovascular disease accounted for 59.2% of all deaths. The cumulative rates/1000 person-years for cardiovascular mortality were 20.8 (men) and 11.5 (women), and for all-cause mortality 33.8 (men) and 20.5 (women), respectively. In Cox regression models, no significant increased risk of mortality was seen for men with loneliness compared to men without loneliness (cardiovascular mortality HR 1.52, 95% CI 0.78 - 2.96; all-cause HR 1.32, 95% CI 0.77 - 2.28). Increased risk of cardiovascular mortality was observed in women with loneliness compared to those without (HR 2.25 95% CI 1.14 - 4.45), and the risk remained significant in a multivariable-adjusted model (HR 2.42 95% CI 1.04 - 5.65). Conclusions. Loneliness was shown to be an independent predictor of cardiovascular mortality in women. We found no evidence to indicate that loneliness was associated with an increased risk of either cardiovascular- or all-cause mortality in men.

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