Is Hemoglobin Concentration a Linear Predictor of Mortality in Older Adults From Chinese Longevity Regions?

Introduction: The association patterns of hemoglobin (HB) concentrations with mortality among the longevity older adults are unclear. We aimed to evaluate the relationship among older adults form Chinese longevity regions.Methods: We included 1,785 older adults aged ≥65 years (mean age, 86.7 years; 1,002 women, 783 men) from the community-based Chinese Longitudinal Healthy Longevity Survey. We estimated the hazard ratios (HRs) and 95% confidence intervals (CIs) for all-cause mortality using multivariable Cox proportional hazards models and Cox models with restricted cubic spline.Results: In total, 999 deaths occurred during a median follow-up of 5.4 years from 2011 to 2017. Restricted cubic spline analysis found no non-linear association between HB concentrations and all-cause mortality after a full adjustment for covariates among the older adults form longevity regions (p > 0.05 for non-linearity). The risk for all-cause mortality was significantly higher in the groups with HB concentration of <11.0 g/dL (HR: 1.37, 95% CI: 1.10–1.70) and 11.0–12.0 g/dL (HR: 1.25, 95% CI: 1.01–1.54); the risk of all-cause mortality was significantly lower in the groups with HB concentration ≥14.0 g/dL (HR: 0.76, 95% CI: 0.60–0.97) compared with the reference group (13.0–13.9 g/dL).Conclusions: Among older adults form Chinese longevity regions, HB concentrations were found to be inversely and linearly associated with all-cause mortality. Further prospective intervention trials are needed to confirm whether higher HB concentrations had a lower risk of mortality in these older adults.

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Effect of Blood Pressure on Cardiovascular Outcomes: A 15-Year Prospective Cohort Study

10.21203/rs.3.rs-904375/v1 ◽

2021 ◽

Author(s):

Qi Yu ◽

Qing-Dong Jin

Keyword(s):

Blood Pressure ◽

Proportional Hazards ◽

Positive Association ◽

Cubic Spline ◽

Cox Proportional Hazards ◽

Cardiovascular Outcomes ◽

Composite Outcome ◽

Nutrition Survey ◽

Cox Models ◽

Diabetes Status

Abstract Objective The association between blood pressure(BP) and cardiovascular outcomes has not been well investigated by large prospective studies on Chinese. We aim to analyze the association of BP with cardiovascular outcomes in Chinese population. Method We included a total of 4,569 adults aged 40–90 years from the China Health and Nutrition Survey (CHNS) cohort. Cox proportional hazards regression models were used to estimate hazard ratios and 95% CIs. Restricted cubic spline analyses were used to explore linear and nonlinear relationships of BP with cardiovascular outcomes. Result With a mean follow-up of 12.1 years, a total of 4,569 individuals were enrolled in our study, of whom 403 developed cardiovascular outcomes. Multivariable adjusted Cox models showed a strong positive association between BP and cardiovascular outcomes. SBP was significantly associated with composite outcome(HR per 10 mmHg 1.23[1.16–1.29]), myocardial infarction(MI)(HR per 10 mmHg 1.17[1.07–1.27]), and stroke(HR per 10 mmHg 1.29[1.21–1.38]). DBP was significantly associated with composite outcome(HR per 10 mmHg 1.32[1.20–1.44]), MI(HR per 10 mmHg 1.26[1.10–1.44]), and stroke(HR per 10 mmHg 1.39[1.25–1.55]). Restricted cubic spline analyses showed linear relationships of either SBP or DBP with composite outcome, MI and stroke. Conclusion Either SBP or DBP is independently and linearly related to the risk of cardiovascular outcomes. These associations are steeper for stroke than for MI, and vary widely by age, use of antihypertensive treatment, and diabetes status.

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Nonfatal Stroke and All-Cause Mortality among Community-Dwelling Older Adults Living in Rural Ecuador: A Population-Based, Prospective Study

Journal of Neurosciences in Rural Practice ◽

10.4103/jnrp.jnrp_79_18 ◽

2018 ◽

Vol 09 (04) ◽

pp. 551-555

Author(s):

Oscar H. Del Brutto ◽

Robertino M. Mera ◽

Victor J. Del Brutto

Keyword(s):

Older Adults ◽

Proportional Hazards ◽

Population Based ◽

Cox Proportional Hazards ◽

Rural Setting ◽

Nonfatal Stroke ◽

All Cause Mortality ◽

History Of ◽

Univariate Analyses

ABSTRACT Background: Stroke is a leading cause of disability in developing countries. However, there are no studies assessing the impact of nonfatal strokes on mortality in rural areas of Latin America. Using a population-based, prospective cohort study, we aimed to assess the influence of nonfatal strokes on all-cause mortality in older adults living in an underserved rural setting. Methods: Deaths occurring during a 5-year period in Atahualpa residents aged ≥60 years were identified from overlapping sources. Tests for equality of survivor functions were used to estimate differences between observed and expected deaths for each covariate investigated. Cox proportional hazards models were used to estimate Kaplan–Meier survival curves of variables reaching significance in univariate analyses. Results: Of 437 individuals enrolled over 5 years, follow-up was achieved in 417 (95%), contributing 1776 years of follow-up (average 4.3 ± 1.3 years). Fifty-one deaths were detected, for an overall cumulative 5-year mortality rate of 12.2% (8.9%–15.6%). Being older than 70 years of age, having poor physical activity, edentulism, and history of a nonfatal stroke were related to mortality in univariate analyses. A fully adjusted Cox proportional hazards model showed that having history of a nonfatal stroke (P = 0.024) and being older than 70 years of age (P = 0.031) independently predicted mortality. In contrast, obesity was inversely correlated with mortality (P = 0.047). Conclusions: A nonfatal stroke and increasing age increase the risk of all-cause mortality in inhabitants of a remote rural village. The body mass index is inversely related to death (obesity paradox).

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Impact of the Changes in the Frequency of Social Participation on All-Cause Mortality in Japanese Older Adults: A Nationwide Longitudinal Study

International Journal of Environmental Research and Public Health ◽

10.3390/ijerph19010270 ◽

2021 ◽

Vol 19 (1) ◽

pp. 270

Author(s):

Keiichi Shimatani ◽

Mayuko T. Komada ◽

Jun Sato

Keyword(s):

Older Adults ◽

Social Participation ◽

Proportional Hazards ◽

Proportional Hazards Model ◽

Cox Proportional Hazards ◽

Cox Proportional Hazards Model ◽

Risk Of Mortality ◽

All Cause Mortality ◽

Japanese Older Adults ◽

The Impact

Previous studies have shown that more frequent social participation was associated with a reduced risk of mortality. However, limited studies have explored the changes in the frequency of social participation in older adults. We investigated the impact of the changes in the frequency of social participation on all-cause mortality in Japanese older adults aged 60 years and older. The current study, conducted as a secondary analysis, was a retrospective cohort study using open available data. The participants were 2240 older adults (45.4% male and 54.6% female) sampled nationwide from Japan who responded to the interview survey. Changes in the frequency of social participation were categorized into four groups (none, initiated, decreased, and continued pattern) based on the responses in the baseline and last surveys. The Cox proportional-hazards model showed a decreased risk of all-cause mortality in decreased and continued patterns of social participation. Stratified analysis by sex showed a decreased risk of mortality in the continued pattern only among males. The results of the current study suggest that the initiation of social participation at an earlier phase of life transition, such as retirement, may be beneficial for individuals.

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Restriction of Pharmacoepidemiologic Cohorts to Initiators of Medications in Unrelated Preventive Drug Classes to Reduce Confounding by Frailty in Older Adults

American Journal of Epidemiology ◽

10.1093/aje/kwz083 ◽

2019 ◽

Vol 188 (7) ◽

pp. 1371-1382 ◽

Cited By ~ 2

Author(s):

Henry T Zhang ◽

Leah J McGrath ◽

Alan R Ellis ◽

Richard Wyss ◽

Jennifer L Lund ◽

...

Keyword(s):

Older Adults ◽

Proportional Hazards ◽

Cox Proportional Hazards ◽

Standardized Mortality Ratio ◽

Drug Classes ◽

Cox Proportional Hazards Models ◽

Hazard Ratios ◽

All Cause Mortality ◽

Preventive Drug ◽

Mortality Ratio

Abstract Nonexperimental studies of the effectiveness of seasonal influenza vaccine in older adults have found 40%–60% reductions in all-cause mortality associated with vaccination, potentially due to confounding by frailty. We restricted our cohort to initiators of medications in preventive drug classes (statins, antiglaucoma drugs, and β blockers) as an approach to reducing confounding by frailty by excluding frail older adults who would not initiate use of these drugs. Using a random 20% sample of US Medicare beneficiaries, we framed our study as a series of nonrandomized “trials” comparing vaccinated beneficiaries with unvaccinated beneficiaries who had an outpatient health-care visit during the 5 influenza seasons occurring in 2010–2015. We pooled data across trials and used standardized-mortality-ratio–weighted Cox proportional hazards models to estimate the association between influenza vaccination and all-cause mortality before influenza season, expecting a null association. Weighted hazard ratios among preventive drug initiators were generally closer to the null than those in the nonrestricted cohort. Restriction of the study population to statin initiators with an uncensored approach resulted in a weighted hazard ratio of 1.00 (95% confidence interval: 0.84, 1.19), and several other hazard ratios were above 0.95. Restricting the cohort to initiators of medications in preventive drug classes can reduce confounding by frailty in this setting, but further work is required to determine the most appropriate criteria to use.

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Abstract P146: Serum Magnesium and Mortality in the General US Population: Results From the NHANES I Epidemiologic Follow-up Study

Circulation ◽

10.1161/circ.133.suppl_1.p146 ◽

2016 ◽

Vol 133 (suppl_1) ◽

Author(s):

Xi Zhang ◽

Jin Xia ◽

Liana C. Del Gobbo ◽

Adela Hruby ◽

Ka He ◽

...

Keyword(s):

Proportional Hazards ◽

Reference Group ◽

Serum Magnesium ◽

Cox Proportional Hazards ◽

Follow Up Study ◽

Normal Reference ◽

Increased Risk ◽

All Cause Mortality ◽

Low Serum

Introduction: Low magnesium (Mg) intake and/or status has been associated with increased risk of chronic disease, including cardiovascular disease (CVD) and cancer. However, whether and to what extent low serum Mg levels are associated with all-cause or cause-specific mortality in the general population is uncertain. Hypothesis: We aimed to quantify the dose-response associations between low concentrations of serum Mg and mortality from all causes, cancer, CVD, and stroke in the general US population. Methods: We analyzed prospective data on 14,353 participants aged 25-74 years with baseline measures of serum Mg concentrations from the National Health and Nutrition Examination Survey Epidemiologic Follow-up Study 1971-2006. We estimated the mortality hazard ratios (HRs) for participants within predefined and clinically meaningful categories of serum Mg levels, including <0.7, 0.7-0.74, 0.75-0.79, 0.8-0.9 (normal reference), 0.9-0.94, 0.95-0.99, and ≥1.0 mmol/L, using Cox proportional hazards models. Restricted cubic spline models were applied to examine potentially nonlinear relationships between serum Mg and mortality. Results: During a mean follow-up of 27.6 years, 7,072 deaths occurred, 3,310 (47%) CVD deaths, 1,533 (22%) cancer deaths, and 281 (4%) stroke deaths. Twenty-one percent of all participants had low levels of serum Mg (<0.8 mmol/L) and 1.5% had extremely low serum Mg (<0.7 mmol/L). Age-adjusted all-cause mortality rates were 3845, 3491, 3471, 3400 (normal reference), 3531, 3525, and 3836 per 100,000 person-years for increasing categories of serum Mg; the HRs and 95% confidence intervals for increasing serum Mg were 1.32 (1.02-1.72), 0.93 (0.74-1.16), and 1.06 (0.96-1.18), 1.07 (0.97-1.18), 0.94 (0.77-1.13), and 0.93 (0.72-1.21), compared to the reference group (0.8-0.9 mmol/L). An L-shaped association between serum Mg concentrations and all-cause mortality was observed after adjusting for potential confounders (Figure). No statistically significant associations were observed between serum Mg and cancer, CVD, or stroke mortality. Conclusions: Very low serum Mg levels were significantly associated with all-cause mortality in the general US population. Our findings support the hypothesis that Mg deficiency as defined by very low serum Mg may have an important influence on mortality.

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Socioeconomic Status, Frailty, and All-Cause Mortality in Korean Older Adults: A 3-Year Population-Based Prospective Study

BioMed Research International ◽

10.1155/2017/1903589 ◽

2017 ◽

Vol 2017 ◽

pp. 1-9 ◽

Cited By ~ 4

Author(s):

Jinkyung Cho ◽

Inhwan Lee ◽

Soo Hyun Park ◽

Youngyun Jin ◽

Donghyun Kim ◽

...

Keyword(s):

Older Adults ◽

Socioeconomic Status ◽

Proportional Hazards ◽

Proportional Hazards Model ◽

Cox Proportional Hazards ◽

Community Dwelling ◽

Cox Proportional Hazards Model ◽

Low Ses ◽

Increased Risk ◽

All Cause Mortality

Background. Little is known regarding the effects of socioeconomic status (SES) and frailty on mortality in Korea. Objective. This study investigated the combined impact of low SES and frailty on all-cause mortality in Korean older adults. Methods. Study sample at baseline comprised 7,960 community-dwelling adults (56.8% women) aged 65 years and older. The Cox proportional hazards model was used to estimate the hazard ratio (HR) and 95% confidence interval (CI) of low SES and frailty for all-cause mortality. Results. Overall, low SES plus frailty resulted in an increased risk of all-cause mortality (HR = 1.56, 95% CI = 1.09–2.23, P=0.015) even after adjustments for all the measured covariates, as compared with high SES plus nonfrailty (HR = 1). Among older adults aged 65–75 years, the increased mortality risk of either low SES plus nonfrailty (HR = 1.37, 95% CI = 1.02–1.84, P=0.038) or high SES plus frailty (HR = 2.09, 95% CI = 1.12–3.91, P=0.021) remained significant even after adjustments for all the covariates, as compared with high SES plus nonfrailty (HR = 1). Conclusion. The current findings suggest that either low SES or frailty is significantly associated with increased all-cause mortality in Korean older adults.

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Cognitive Leisure Activity and All-cause Mortality in Older Adults: A 4-Year Community-based Cohort

10.21203/rs.3.rs-42686/v2 ◽

2021 ◽

Author(s):

Qianyi Xiao ◽

Xin Liu ◽

Ye Ruan ◽

Limei Huang ◽

Yanfei Guo ◽

...

Keyword(s):

Older Adults ◽

Computer Use ◽

Proportional Hazards ◽

Activity Index ◽

Strong Association ◽

Leisure Activity ◽

Cox Proportional Hazards ◽

Community Based ◽

Risk Of Death ◽

All Cause Mortality

Abstract Background: Cognitive leisure activity, such as reading, playing mahjong or cards and computer use, is common among older adults in China. Previous studies suggest a protective role of cognitive leisure activity against cognitive impairment. However, the relationship between cognitive leisure activity and all-cause mortality has rarely been reported.Objectives: This study aims to explore the relationships between cognitive leisure activity and all-cause mortality in a community-based elderly cohort in China.Methods: The current study sample comprised 4003 community residents aged ≥ 60 y who were enrolled in June 2015, and were followed up every year from 2015 to 2018. Reading, playing mahjong or cards and computer use were measured by questionnaires and summed into a cognitive leisure activity index (CLAI) score. Cox proportional hazards analysis and Kaplan-Meier survival analysis were used to examine the association of cognitive leisure activity with all-cause mortality.Results: During the 4-year follow-up of 4003 participants, 208 (5.2%) deaths were registered. Of all participants, 66.8%, 26.7%, 6.1% and 0.35% reported CLAI scores of 0, 1, 2 and 3, respectively. A strong association was noted between the CLA score and all-cause mortality (adjusted hazard ratio [HR] = 0.72, 95% confidence intervals [CI]: 0.54-0.96, P = 0.025). Stratified analysis suggested that a higher CLAI score was significantly associated with a decreased risk of all-cause mortality mainly among those who were male, aged ≥ 80 y, cognitively impaired, and not diagnosed with cancer (P < 0.05).Conclusion: Cognitive leisure activity has beneficial effect on reduced risk of death from all cause among the elderly in China, which helped promote a comprehensive understanding of health characteristics at advanced ages.

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Association of Blood Pressure With Stroke Risk in Chinese Population: A 6-Year Prospective Cohort Study

10.21203/rs.3.rs-583220/v1 ◽

2021 ◽

Author(s):

Qi Yu ◽

Qing-Dong Jin ◽

Yan-Qing Chen ◽

Xin-Ru Liu ◽

Qing-Ying Lin

Keyword(s):

Blood Pressure ◽

Hemorrhagic Stroke ◽

Stroke Risk ◽

Proportional Hazards ◽

Positive Association ◽

Cubic Spline ◽

Cox Proportional Hazards ◽

Nutrition Survey ◽

Cox Models ◽

Nonlinear Relationships

Abstract Objective: Previous results on the association between blood pressure(BP) and stroke risk were controversial. We investigated the association of BP with stroke risk in China. Method: We included a total of 5,700 adults aged 40-90 years from the China Health and Nutrition Survey (CHNS) cohort. Cox proportional hazards regression models were used to estimate hazard ratios and 95% CIs. Restricted cubic spline analyses were used to explore linear and nonlinear relationships of BP and stroke. Result: With a median follow-up of 6 years, a total of 5,700 individuals were enrolled in our study, of whom 178 developed stroke. Multivariable adjusted Cox models including systolic blood pressure(SBP) and diastolic blood pressure(DBP) showed a strong positive association between SBP and overall stroke. Compared with participants with SBP 0-130 mmHg, the multivariable adjusted HRs[95% CIs] in participants with SBP 130-140, 140-160, 160-180, and ≥180 mmHg were 1.08[0.62-1.89], 2.41[1.51-3.86], 2.21[1.16-4.20], and 3.90[1.78-8.55] for overall stroke; 0.65[0.21-2.04], 3.68[1.73-7.83], 2.51[0.84-7.47], and 5.91[1.69-20.60] for ischemic stroke; 1.26[0.50-3.20], 1.19[0.47-3.04], 2.06[0.66-6.41], and 5.10[1.36-19.20] for hemorrhagic stroke. Restricted cubic spline analyses including SBP and DBP showed linear relationships of SBP with overall, ischemic and hemorrhagic stroke. No linear or nonlinear relationships of DBP with overall, ischemic and hemorrhagic stroke were observed.Conclusion: SBP is independently and directly related to the risk of overall and its subtypes. Besides, the risk of ischemic and hemorrhagic stroke might be higher when SBP were more than 140 mmHg and 160 mmHg.

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High sodium:potassium intake ratio increases the risk for all-cause mortality: the REasons for Geographic And Racial Differences in Stroke (REGARDS) study

Journal of Nutritional Science ◽

10.1017/jns.2013.4 ◽

2013 ◽

Vol 2 ◽

Cited By ~ 5

Author(s):

Suzanne E. Judd ◽

Kristal J. Aaron ◽

Abraham J. Letter ◽

Paul Muntner ◽

Nancy S. Jenny ◽

...

Keyword(s):

Racial Differences ◽

Proportional Hazards ◽

Reference Group ◽

Cox Proportional Hazards ◽

Stroke Incidence ◽

Black And White ◽

Cox Proportional Hazards Models ◽

Group Data ◽

All Cause Mortality ◽

Regards Study

AbstractIncreased dietary Na intake and decreased dietary K intake are associated with higher blood pressure. It is not known whether the dietary Na:K ratio is associated with all-cause mortality or stroke incidence and whether this relationship varies according to race. Between 2003 and 2007, the REasons for Geographic And Racial Differences in Stroke (REGARDS) cohort enrolled 30 239 black and white Americans aged 45 years or older. Diet was assessed using the Block 98 FFQ and was available on 21 374 participants. The Na:K ratio was modelled in race- and sex-specific quintiles for all analyses, with the lowest quintile (Q1) as the reference group. Data on other covariates were collected using both an in-home assessment and telephone interviews. We identified 1779 deaths and 363 strokes over a mean of 4·9 years. We used Cox proportional hazards models to obtain multivariable-adjusted hazard ratios (HR). In the highest quintile (Q5), a high Na:K ratio was associated with all-cause mortality (Q5 v. Q1 for whites: HR 1·22; 95 % CI 1·00, 1·47, P for trend = 0·084; for blacks: HR 1·36; 95 % CI 1·04, 1·77, P for trend = 0·028). A high Na:K ratio was not significantly associated with stroke in whites (HR 1·29; 95 % CI 0·88, 1·90) or blacks (HR 1·39; 95 % CI 0·78, 2·48), partly because of the low number of stroke events. In the REGARDS study, a high Na:K ratio was associated with all-cause mortality and there was a suggestive association between the Na:K ratio and stroke. These data support the policies targeted at reduction of Na from the food supply and recommendations to increase K intake.

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Cardiorespiratory Fitness without Exercise Testing Can Predict All-Cause Mortality Risk in a Representative Sample of Korean Older Adults

International Journal of Environmental Research and Public Health ◽

10.3390/ijerph16091633 ◽

2019 ◽

Vol 16 (9) ◽

pp. 1633 ◽

Cited By ~ 2

Author(s):

Moongu Song ◽

Inhwan Lee ◽

Hyunsik Kang

Keyword(s):

Older Adults ◽

Cardiorespiratory Fitness ◽

Exercise Testing ◽

Proportional Hazards ◽

Cox Proportional Hazards ◽

Geriatric Population ◽

Hazard Ratios ◽

All Cause Mortality ◽

Using Data

This study examined the association between cardiorespiratory fitness (CRF) without exercise testing and all-cause mortality in Korean older adults. The present study was carried out using data from the 2008 and 2011 Living Profiles of Older People Survey. A total of 14,122 participants aged 60 years and older (57% women) completed the 2008 baseline and 2011 follow-up assessments (i.e., socioeconomic status, health behaviors and conditions, and prevalence of chronic diseases), and they were included for the final analyses. CRF was estimated (eCRF) with sex-specific algorithms and classified as lower (lowest 25%), middle (middle 50%), and upper (highest 25%). Cox proportional hazards regression was used to calculate hazard ratios (HRs) and 95% confidence intervals (CIs) across eCRF categories. In total, multivariable-adjusted HRs and 95% CIs were 1 for the upper eCRF group (referent), 1.059 (0.814~1.378) for the middle eCRF group, and 1.714 (1.304~2.253) for the lower eCRF group. In men, multivariable-adjusted HRs and 95% CIs were 1 for the upper eCRF group (referent), 1.011 (0.716~1.427) for the middle eCRF group, and 1.566 (1.098~2.234) for the lower eCRF group. In women, multivariable-adjusted HRs and 95% CIs were 1 for the upper eCRF group (referent), 1.064 (0.707~1.602) for the middle eCRF group, and 1.599 (1.032~2.478) for the lower eCRF group. The current findings suggest that eCRF may have an independent predictor of all-cause mortality, underscoring the importance of promoting physical activity to maintain a healthful level of CRF in Korean geriatric population.

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