Liver Fibrosis and 8-Year All-Cause Mortality Trajectories in the Aging Cohort of the Salus in Apulia Study

Age is a major contributor to the liver fibrosis rate and its adverse health-related outcomes, including mortality, but older populations are still under-explored. We investigated multimorbidity and inflammatory biomarkers in relation to the increasing liver fibrosis risk to delineate 8-year all-cause mortality trajectories in 1929 older adults from the population-based Salus in Apulia Study. Liver fibrosis risk was assumed using the fibrosis-4 (FIB-4) score, assigned to three liver fibrosis risk groups (low, intermediate, high). In the secondary analyses, the APRI score was also calculated to allow for comparisons. Male subjects (prevalence difference: −13.49, 95% confidence interval (CI): −18.96 to −8.03), a higher multimorbidity burden (effect size, ES: −0.14, 95% CI: −0.26 to −0.02), a higher prevalence of physical frailty (ES: 6.77, 95% CI: 0.07 to 13.47), and a more pronounced inflammatory pattern as indicated by tumor growth factor-α circulating levels (ES: −0.12, 95% CI: −0.23 to −0.01) were significantly more common in the highest-risk FIB-4 score group. Liver function characterized by lipid profile and platelet levels worsened with increasing FIB-4 risk score. The 8-year risk of death was nearly double in subjects in the highest-risk FIB-4 score group, even after controlling for possible confounders. Furthermore, a steeper mortality curve was clearly observed for FIB-4 scores as compared with the APRI scoring system with respect to liver fibrosis risk. In conclusion, using a scoring tool based on simple routine biomarkers to detect liver fibrosis risk may enhance biological knowledge of age-related outcomes of chronic liver disease and be helpful in the clinical setting to identify subjects at risk for adverse health-related outcomes, including mortality.

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Socioeconomic Position and Risk of Disease Progression and Death in Patients with Myelodysplastic Syndromes: A Danish Nation-Wide Population-Based Cohort Study

Blood ◽

10.1182/blood-2021-149678 ◽

2021 ◽

Vol 138 (Supplement 1) ◽

pp. 4670-4670

Author(s):

Tine Bichel Lauritsen ◽

Lene Sofie Granfeldt Oestgaard ◽

Kirsten Groenbaek ◽

Susanne Oksbjerg Dalton ◽

Jan M. Norgaard

Keyword(s):

Socioeconomic Position ◽

Myelodysplastic Syndromes ◽

Population Based ◽

Living Alone ◽

Risk Of Death ◽

Increased Risk ◽

All Cause Mortality ◽

Risk Of Progression ◽

Cohabitation Status ◽

Short Education

Abstract Background: Five-year overall survival for patients with myelodysplastic syndromes (MDS) is around 30%. Adverse prognostic factors include advancing age, higher blast cell percentage, poor risk cytogenetics, two or more cytopenias, high burden of comorbidity, and transfusion-dependency. The impact of socioeconomic position on clinical outcomes in MDS patients is however unclear. In this nationwide population-based cohort-study, we therefore examined the associations between the individual-level socioeconomic markers education level, cohabitation status, and income, and the risk of progression to acute myeloid leukemia (AML), and all-cause mortality among MDS patients. Methods: Using the Danish Myelodysplastic Syndromes Database, we identified all patients with incident MDS diagnosed between January 1st 2010 and December 31th 2018. The database holds valid and detailed patient- and disease-characteristics on all Danish MDS patients diagnosed since 2010. We linked the study-population with individual-level information on education, cohabitation status, income, comorbidity, progression to AML, and vital status retrieved from high-quality Danish population-based registries. We computed absolute risks of progression to AML and all-cause mortality using the cumulative incidence (risk) function accounting for death as competing risk when AML was the outcome. Also, 1-year, 3-year, and 5-year relative risks (RRs) of progression to AML and death were computed using the pseudovalue approach. All results were given crude and adjusted for age, sex, socioeconomic position (SEP), comorbidity and subtype of MDS according to the "International Prognostic Scoring System" (IPSS) and with 95% confidence intervals (CIs). Results: The final cohort comprised 2233 MDS patients (median age 75 years, 63% males). Median follow-up time was 1.7 years. The 1-year risks of progression to AML was similar across education levels (long education (>13 years): 5%, medium education (9-12 years): 6%, short education (<9 years): 6%. In adjusted models, there were no associations between education, income or cohabitation status and risk of progression to AML (Table 1). Still, patients with a short education had higher 1-year all-cause mortality (33%) compared to those with medium (22%) and longer education (21%) (Figure 1). In adjusted models the risk of death one year from diagnosis was higher in patients with short vs. longer education [RR=1.26 (95% CI: 1.03-1.55)], in patients with lower vs. higher income [RR=1.43 (95% CI: 1.17-1.75)], and among patients who were living alone compared to those who lived with someone [RR=1.19 (1.02-1.39)]. The increased risk of death among patients with short education, low income, and those who lived alone persisted after 3-year and 5-years of follow-up (Table 1). Conclusion: In a real world setting, shorter education, living alone, and lower income were not associated with increased risk of progression to AML but with inferior survival in Danish MDS patients. These results suggest that in spite of "free and equal access" to healthcare and cancer treatment in Denmark, short education, living alone, and low income are adverse prognostic factors for patients with MDS. Further analyses are ongoing to get insight into the mechanisms driving these socioeconomic disparities in MDS patients. Figure 1 Figure 1. Disclosures No relevant conflicts of interest to declare.

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Cardiovascular risk associated with allopurinol vs. benzbromarone in patients with gout

European Heart Journal ◽

10.1093/eurheartj/ehab619 ◽

2021 ◽

Author(s):

Eun Ha Kang ◽

Eun Hye Park ◽

Anna Shin ◽

Jung Soo Song ◽

Seoyoung C Kim

Keyword(s):

Coronary Revascularization ◽

Large Population ◽

Population Based ◽

Risk Of Death ◽

Uricosuric Agents ◽

Increased Risk ◽

All Cause Mortality ◽

Insurance Claims Data ◽

Health Insurance Claims Data ◽

Underlying Mechanisms

Abstract Aims With the high prevalence of gout and associated cardiovascular (CV) diseases, information on the comparative CV safety of individual urate-lowering drugs becomes increasingly important. However, few studies examined the CV risk of uricosuric agents. We compared CV risk among patients with gout who initiated allopurinol vs. benzbromarone. Methods and results Using the Korean National Health Insurance claims data (2002–17), we conducted a cohort study of 124 434 gout patients who initiated either allopurinol (n = 103 695) or benzbromarone (n = 20 739), matched on propensity score at a 5:1 ratio. The primary outcome was a composite CV endpoint of myocardial infarction, stroke/transient ischaemic attack, or coronary revascularization. To account for competing risk of death, we used cause-specific hazard models to estimate hazard ratios (HRs) and 95% confidence intervals (CIs) for the outcomes comparing allopurinol initiators with benzbromarone. Over a mean follow-up of 1.16 years, 2258 patients developed a composite CV event. The incidence rate of the composite CV event was higher in allopurinol initiators (1.81 per 100 person-years) than benzbromarone (1.61 per 100 person-years) with a HR of 1.22 (95% CI 1.05–1.41). The HR for all-cause mortality was 1.66 (95% CI 1.43–1.93) among allopurinol initiators compared with benzbromarone. Conclusion In this large population-based cohort of gout patients, allopurinol was associated with an increased risk of composite CV events and all-cause mortality compared to benzbromarone. Benzbromarone may reduce CV risk and mortality in patients with gout, although more studies are necessary to confirm our findings and to advance our understanding of the underlying mechanisms.

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A Population-Based Analysis of Pneumococcal Disease Mortality in California, 1989–1998

Public Health Reports ◽

10.1177/003335490512000209 ◽

2005 ◽

Vol 120 (2) ◽

pp. 157-164 ◽

Cited By ~ 5

Author(s):

Matthew D. Redelings ◽

Frank Sorvillo ◽

Paul Simon

Keyword(s):

At Risk ◽

Pneumococcal Disease ◽

Risk Groups ◽

Mortality Rates ◽

Population Based ◽

California Department ◽

Demographic Groups ◽

Risk Of Death ◽

Disease Mortality ◽

Preventable Mortality

Objectives. Pneumococcal disease is an important cause of vaccine-preventable mortality. It is important to understand the burden and distribution of mortality so that prevention efforts can be targeted appropriately. This study evaluated pneumococcal disease mortality and its demographic correlates in California from 1989 to 1998. Methods. Deaths due to pneumococcal disease were identified from statewide vital records data using multiple cause-coded information. Denominator data were obtained from estimates from the California Department of Finance. Crude and age-adjusted mortality rates and 95% confidence intervals were calculated for each age, gender, and racial/ethnic group. Results. The age-adjusted pneumococcal disease mortality rate was 2.05 deaths per 100,000 population. Mortality was highest in elderly individuals (reaching 38.29 deaths per 100,000 population in individuals older than age 85). Age-adjusted mortality rates were elevated in the African American race/ethnicity group (2.96 deaths per 100,000 population) and males (2.67 deaths per 100,000 population). The majority of individuals who died of pneumococcal disease (78.9%) fell into at-risk groups indicated for vaccination. The majority of all pneumococcal deaths were caused by pneumococcal pneumonia. Mortality was seasonal, reaching a peak in the winter months. A decreasing trend in mortality was observed over the 10-year period examined. Conclusions. Pneumococcal disease remains a significant cause of vaccine-preventable mortality in the California population. Greater efforts must be made to vaccinate at-risk individuals, especially those in demographic groups at highest risk of death.

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SF-36 predicts 13-year CHD incidence in a middle-aged Swedish general population

Quality of Life Research ◽

10.1007/s11136-019-02362-y ◽

2019 ◽

Vol 29 (4) ◽

pp. 971-975

Author(s):

Evalill Nilsson ◽

Karin Festin ◽

Mats Lowén ◽

Margareta Kristenson

Keyword(s):

General Population ◽

Predictive Ability ◽

Population Based ◽

Health Study ◽

Mortality Data ◽

Middle Aged ◽

Sf 36 ◽

All Cause Mortality ◽

Related Quality ◽

Health Related

Abstract Purpose To study the predictive ability of each of the eight scales of SF-36 on 13-year all-cause mortality and incident coronary heart disease (CHD) in a general middle-aged population. Methods The population-based, longitudinal “Life-conditions, Stress and Health” study, in 2003–2004 enrolled 1007 persons aged 45–69 years (50% female), randomly sampled from the general population in Östergötland, Sweden. Variables at baseline included the SF-36 (health-related quality of life, HRQoL) and self-reported disease. Incident CHD (morbidity and mortality) and all-cause mortality data for the study population during the first 13 years from baseline were obtained from national Swedish registries. Results Seven of the eight SF-36 scales predicted CHD (sex- and age-adjusted Hazard Ratios up to 2.15; p ≤ 0.05), while only the Physical Functioning scale significantly predicted all-cause mortality. Further adjustments for presence of (self-reported) disease did not, in most cases, alter these significant predictions. Conclusion Low SF-36 scores predict risk of CHD, also after adjustment for present disease, supporting the biopsychosocial model of health and disease. Measures of HRQoL yield important information and can add to the cardiopreventive toolbox, including primary prevention efforts, as it is such a simple and relatively inexpensive tool.

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BMI and all-cause mortality among middle-aged and older adults in Taiwan: a population-based cohort study

Public Health Nutrition ◽

10.1017/s136898001400281x ◽

2014 ◽

Vol 18 (10) ◽

pp. 1839-1846 ◽

Cited By ~ 13

Author(s):

Wei-Sheng Chung ◽

Feng-Ming Ho ◽

Nan-Cheng Cheng ◽

Meng-Chih Lee ◽

Chih-Jung Yeh

Keyword(s):

Older Adults ◽

Cohort Study ◽

Population Based ◽

Normal Weight ◽

Hazard Ratio ◽

Adjusted Hazard Ratio ◽

Middle Aged ◽

Obese People ◽

Risk Of Death ◽

All Cause Mortality

AbstractObjectiveThe present study investigates the relationship between BMI and all-cause mortality among middle-aged and older adults with or without pre-existing diseases.DesignA population-based cohort study.SettingThe Taiwan Longitudinal Study on Aging is a nationwide prospective cohort study comprising a representative random sample of middle-aged and older adults. The study period was 1996–2007.SubjectsWe followed 4145 middle-aged and older adults, totalling 42 353 person-years.ResultsOverweight and mildly obese participants showed a 16 % and 30 % decrease in the risk of death, respectively, compared with those of normal weight after adjusting for potential covariates (e.g. demographic characteristics, health behaviour, co-morbidities and physical function). Underweight adults showed a 1·36-fold increased adjusted hazard ratio of death compared with normal-weight adults. Adults with a BMI of 27·0–28·0 kg/m2 showed a significantly lower adjusted hazard ratio of all-cause mortality rate compared with adults who had normal BMI values when they had coexisting hypertension or diabetes (adjusted hazard ratio=0·50; 95 % CI 0·30, 0·81 for hypertension and adjusted hazard ratio=0·41; 95 % CI 0·18, 0·89 for diabetes).ConclusionsThe study demonstrates that underweight people have a higher risk of death, and overweight and mildly obese people have a lower risk of death, compared with people of normal weight among middle-aged and older adults. An optimal BMI may be based on the individual, who exhibits pre-existing diseases or not.

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Seroepidemiology of Measles, Mumps and Rubella on Bonaire, St. Eustatius and Saba: The First Population-Based Serosurveillance Study in Caribbean Netherlands

Vaccines ◽

10.3390/vaccines7040137 ◽

2019 ◽

Vol 7 (4) ◽

pp. 137 ◽

Cited By ~ 1

Author(s):

Vos ◽

Mollema ◽

van Binnendijk ◽

Veldhuijzen ◽

Smits ◽

...

Keyword(s):

Risk Groups ◽

Population Based ◽

Mmr Vaccine ◽

Childbearing Age ◽

Cross Sectional ◽

Logistic Regression Models ◽

National Immunization ◽

Health Related ◽

Overseas Territories ◽

Measles Outbreaks

The National Immunization Program (NIP) on Bonaire, St. Eustatius and Saba (i.e., Caribbean Netherlands (CN)) includes the measles‐mumps‐rubella (MMR) vaccine since 1988/89. Seroepidemiological data is an important tool to evaluate the NIP, hence a cross-sectional representative population-based serosurveillance study was conducted for the first time in CN in mid-2017. Participants (n = 1829, aged 0–90 years) donated a blood sample and completed a health-related questionnaire. MMR-specific IgG antibodies were determined using a bead-based multiplex immunoassay and risk factors were analyzed using logistic regression models. Overall seroprevalence was high for measles (94%), but lower for mumps and rubella (both 85%). In NIP eligibles, including women of childbearing age, rubella seroprevalence (88%) exceeded the threshold for protection (85%); however, for measles (89%) this protective level (95%) was not met. MMR seropositivity was lowest in children who became CN resident at 11–17 years of age (especially for measles (72%)), mostly originating from Latin America and other non-Western countries. Interestingly, rubella seroprevalence was lowest in non-NIP eligible adults from Dutch overseas territories and Suriname (75%). Taken together, MMR immunity is generally good in CN, nonetheless some risk groups were identified. Additionally, we found evidence for a unique island epidemiology. In light of recent regional measles outbreaks, disease monitoring remains of utmost importance.

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Association of age at first drink and first alcohol intoxication as predictors of mortality: a birth cohort study

European Journal of Public Health ◽

10.1093/eurpub/ckaa134 ◽

2020 ◽

Vol 30 (6) ◽

pp. 1189-1193

Author(s):

Jonna Levola ◽

Richard J Rose ◽

Antti Mustonen ◽

Marian Sarala ◽

Jouko Miettunen ◽

...

Keyword(s):

Cohort Study ◽

Birth Cohort ◽

Cox Regression ◽

Alcohol Intoxication ◽

Age At Onset ◽

Birth Cohort Study ◽

Adolescent Drinking ◽

Risk Of Death ◽

All Cause Mortality ◽

Health Related

Abstract Background More information on the health-related repercussions of age at onset of adolescent drinking is needed. The aim of this study was to examine the associations between self-reported age at first drink and age at first alcohol intoxication with the risk of death by age 30. Methods The sample (n = 6564; 49.1% males) included all participants of the Northern Finland Birth Cohort Study 1986 (NFBC1986) for whom the two measures of adolescent drinking were available. Self-reported age at onset of first drink and first alcohol intoxication were analyzed along with background variables and data regarding subsequent psychiatric diagnoses. Adolescents were dichotomized into those reporting age at first drink and age at first intoxication before or after age 14. Cox regression was used to calculate hazard ratios (HRs) with 95% confidence interval (95% CI) for death by age 30. Results By the age of 30, 0.7% (n = 47) of all 6564 participants were deceased. In the multivariable models, male gender and a history of illicit substance use in adolescence were associated with both all-cause mortality and mortality due to accidents or suicide. After controlling for confounding variables, age at first alcohol intoxication was associated with all-cause mortality (HR 2.33; 95% CI 1.04–5.20) as well as death due to accidents or suicide (HR 2.99; 95% CI 1.11–8.05). Conclusions Earlier age at first intoxication carries long-term repercussions with respect to premature loss of life. Efforts should be made targeting the prolongation of initiating binge drinking in adolescence to diminish this mortality risk.

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Lipoprotein(a) level and MIF gene variant predict incident metabolic syndrome and mortality

Journal of Investigative Medicine ◽

10.1136/jim-2015-000003 ◽

2016 ◽

Vol 64 (2) ◽

pp. 392-399 ◽

Cited By ~ 6

Author(s):

Altan Onat ◽

Günay Can ◽

Neslihan Çoban ◽

İbrahim Dönmez ◽

Hakan Çakır ◽

...

Keyword(s):

Metabolic Syndrome ◽

Cox Regression ◽

Disease Risk ◽

Smoking Status ◽

Density Lipoprotein ◽

Population Based ◽

Serum Lipoprotein ◽

Risk Of Death ◽

All Cause Mortality ◽

Middle Aged Adults

Owing to the scarcity of available information, we aimed to assess the association of migration inhibitory factor (MIF)-173 G/C genotypes and serum lipoprotein(Lp)(a) with incident metabolic syndrome (MetS) and all-cause mortality, respectively. In population based, middle-aged adults (n=1297), stratified by gender and presence of MetS, we used Lp(a) quintiles to identify non-linear associations with outcomes using Cox regression models, adjusted for MIF genotype, age, smoking status, high density lipoprotein cholesterol, and systolic blood pressure. After 5.2 years of follow-up, 151 cases of incident MetS and 123 deaths were recorded. For incident MetS, adjusted HRs increased in each gender across four declining quintiles, starting from the highest quintile in men and from quintile 4 in women. The MIF CC-GC genotype appeared to contribute to the risk estimates in men. Similarly adjusted models in the whole sample disclosed that all-cause mortality tended to be inversely associated with Lp(a) quintiles and yielded an HR (2.42 (95% CI 1.03 to 5.81)) in men in quintile 2, whereas the MIF genotype additively predicted mortality (HR 1.79 (95% CI 1.01 to 3.18)) only in men. Excess risk of death was additively conferred on Turkish men by the MIF CC-GC genotype and by apparently reduced circulating Lp(a) assays, supporting the notion that ‘low’ serum Lp(a), mediating autoimmune activation, is a major determinant of metabolic disease risk and death. Damaged MIF protein and more complex autoimmune activation in women may be responsible from lack of relationship to MetS/mortality.

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Mortality among five-year survivors of childhood cancer: Results over five decades of follow-up in the Childhood Cancer Survivor Study.

Journal of Clinical Oncology ◽

10.1200/jco.2021.39.15_suppl.10013 ◽

2021 ◽

Vol 39 (15_suppl) ◽

pp. 10013-10013

Author(s):

Stephanie B Dixon ◽

Qi Liu ◽

Matthew J. Ehrhardt ◽

Eric Jessen Chow ◽

Kevin C. Oeffinger ◽

...

Keyword(s):

Childhood Cancer ◽

Primary Cancer ◽

Cumulative Mortality ◽

Late Mortality ◽

Risk Of Death ◽

Increased Risk ◽

All Cause Mortality ◽

Health Related ◽

Survivors Of Childhood Cancer

10013 Background: Adult survivors of childhood cancer are at greater risk for late mortality compared to the general population due to cancer and its treatment. Risk factors, patterns and specific causes of late mortality across the lifespan are not well established. Methods: All-cause, cause-specific, and health-related late mortality (HRM; excludes death from primary cancer and external causes) > 5 years from diagnosis were evaluated in survivors diagnosed < 21 years of age between 1970-1999. Cause of death was based on ICD codes from the National Death Index through December 2017. Cumulative mortality, mortality rates and standardized mortality ratios (SMRs) with 95% confidence intervals (CIs) were estimated, overall and in 5- and 10-year survival periods. Results: Among 34,230 survivors (median time from diagnosis 29.1 years, range 5.0 - 48.0) the 40-year cumulative mortality was 23.3% (95% CI 22.7 - 24.0). Of 5,916 deaths, 3,061 (51.2%) were attributable to health-related causes including subsequent neoplasm (n = 1,458), cardiac (n = 504), and pulmonary causes (n = 238). All-cause mortality by time from diagnosis demonstrated a U-shaped distribution: 10.1 deaths/1000 person-years at 5-9 years, largely due to recurrence of the primary cancer, decreasing to 4.1 at 15-19 years before increasing to 18.5 at 40-48 years, attributable to an increasing mortality rate from HRM (2.3 at 5-9 years; 17.0 at 40-48 years). For the interval 5-9 years from diagnosis, survivors had an 18.1-fold (95% CI 17.3-18.9) higher risk of death from any cause, and a 13.1-fold (11.9-13.4) higher risk for HRM when compared to the general population. Although the SMRs declined with duration of follow-up, survivors had a 4-fold higher risk of death overall, attributable to a more than 4-fold increased risk of HRM. HRM 40-48 years from diagnosis was largely attributable to an increased risk of death due to subsequent neoplasm (SMR 6.0, 95% CI 4.9-7.2), cardiac (3.9, 2.9-5.0) and pulmonary (5.6, 3.6-8.4) causes. Cause-specific mortality remained markedly elevated at 40-48 years from diagnosis: CNS malignancy (SMR 11.7, 95% CI 5.4-22.3), benign meningioma (171.3, 34.4-500.5), valvular heart disease (39.8, 21.2-68.1), cardiomyopathy (10.4, 4.5-20.5), stroke (7.9, 4.6-12.6), and renal failure (5.6, 1.8-13.2). HRM was significantly higher among the youngest group of survivors (0-4 years at diagnosis), non-Hispanic blacks and those who received radiation to the brain, chest or total body, or who were exposed to anthracycline, alkylating or platinum chemotherapy. Conclusions: After five decades, aging survivors consistently remain at higher risk of all-cause mortality compared to the general, aging population, primarily due to a persistent 4-fold increased risk of HRM. Continued late-effects surveillance and reduction of therapies associated with long-term morbidity and increased mortality is essential.

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All-Cause Mortality in Patients With Diabetes Under Treatment With Dapagliflozin: A Population-Based, Open-Cohort Study in The Health Improvement Network Database

The Journal of Clinical Endocrinology & Metabolism ◽

10.1210/jc.2016-3446 ◽

2017 ◽

Vol 102 (5) ◽

pp. 1719-1725 ◽

Cited By ~ 35

Author(s):

Konstantinos A. Toulis ◽

Brian H. Willis ◽

Tom Marshall ◽

Balachadran Kumarendran ◽

Krishna Gokhale ◽

...

Keyword(s):

Cohort Study ◽

Population Based ◽

Low Risk ◽

Health Improvement ◽

Total Study Population ◽

Risk Of Death ◽

Network Database ◽

All Cause Mortality ◽

Risk Patients ◽

The Health Improvement Network

Abstract Context: Empagliflozin was found to decrease mortality in patients with type 2 diabetes mellitus (T2DM) and a prior cardiovascular disease (CVD) event. Objectives: To establish whether these benefits can be replicated in a real-world setting, should be expected with the use of dapagliflozin, and apply to T2DM patients at low risk of CVD. Design: General practice, population-based, retrospective cohort study (January 2013 to September 2015). Setting: The Health Improvement Network database. Participants: A total of 22,124 T2DM patients (4444 exposed to dapagliflozin; 17,680 unexposed T2DM patients) matched for age, sex, body mass index, T2DM duration, and smoking. Main Outcome Measures: The primary outcome was all-cause mortality (high and low risk for CVD) in the total study population, expressed as the adjusted incidence rate ratio (aIRR) with 95% confidence intervals (CIs). As a secondary analysis in the low-risk population, all-cause mortality and incident CVD were considered. Results: Patients with T2DM exposed to dapagliflozin were significantly less likely to die of any cause (aIRR: 0.50; 95% CI: 0.33 to 0.75; P = 0.001). Similarly, in low-risk patients, death from any cause was significantly lower in the cohort exposed to dapagliflozin (aIRR: 0.44; 95% CI: 0.25 to 0.78; P = 0.002). The difference in the risk of incident CVD did not reach statistical significance between groups in low-risk patients (aIRR: 0.89; 95% CI: 0.61 to 1.31; P = 0.546). Conclusions: Patients with T2DM who were exposed to dapagliflozin had a lower risk of death from any cause irrespective of baseline CVD status.

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