scholarly journals The Association between Health Insurance and All-Cause, Cardiovascular Disease, Cancer and Cause-Specific Mortality: A Prospective Cohort Study

2020 ◽  
Vol 17 (5) ◽  
pp. 1525 ◽  
Author(s):  
Liying Song ◽  
Yan Wang ◽  
Baodong Chen ◽  
Tan Yang ◽  
Weiliang Zhang ◽  
...  
Keyword(s):  
Mortality Risk ◽  
Private Insurance ◽  
Cox Proportional Hazards ◽  
Current Evidence ◽  
Insurance Status ◽  
Public Insurance ◽  
Risk Of Mortality ◽  
Increased Risk ◽  
Specific Mortality

The purpose of this study was to evaluate the association of insurance status with all-cause and cause-specific mortality. A total of 390,881 participants, aged 18–64 years and interviewed from 1997 to 2013 were eligible for a mortality follow-up in 31 December 2015. Cox proportional hazards models were used to calculate the hazards ratios (HR) and 95% confidence intervals (CI) to determine the association between insurance status and all-cause and cause-specific mortality. The sample group cumulatively aged 4.22 million years before their follow-ups, with a mean follow-up of 10.4 years, and a total of 22,852 all-cause deaths. In fully adjusted models, private insurance was significantly associated with a 17% decreased risk of mortality (HR = 0.83; 95% CI = 0.80–0.87), but public insurance was associated with a 21% increased risk of mortality (HR = 1.21; 95% CI = 1.15–1.27). Compared to noninsurance, private coverage was associated with about 21% lower CVD mortality risk (HR = 0.79, 95% CI = 0.70–0.89). In addition, public insurance was associated with increased mortality risk of kidney disease, diabetes and CLRD, compared with noninsurance, respectively. This study supports the current evidence for the relationship between private insurance and decreased mortality risk. In addition, our results show that public insurance is associated with an increased risk of mortality.

scholarly journals Supper Timing and Cardiovascular Mortality: The Japan Collaborative Cohort Study

Nutrients ◽  
2021 ◽  
Vol 13 (10) ◽  
pp. 3389
Author(s):  
Jingyun Tang ◽  
Jia-Yi Dong ◽  
Ehab S. Eshak ◽  
Renzhe Cui ◽  
Kokoro Shirai ◽  
...  
Keyword(s):  
Hemorrhagic Stroke ◽  
Proportional Hazards ◽  
Cox Proportional Hazards ◽  
Stroke Mortality ◽  
Hazard Ratios ◽  
Risk Of Mortality ◽  
Increased Risk ◽  
Study Participants

Evidence on the role of supper timing in the development of cardiovascular disease (CVD) is limited. In this study, we examined the associations between supper timing and risks of mortality from stroke, coronary heart disease (CHD), and total CVD. A total of 28,625 males and 43,213 females, aged 40 to 79 years, free from CVD and cancers at baseline were involved in this study. Participants were divided into three groups: the early supper group (before 8:00 p.m.), the irregular supper group (time irregular), and the late supper group (after 8:00 p.m.). Cox proportional hazards regression models were used to calculate hazard ratios (HRs) for stroke, CHD, and total CVD according to the supper time groups. During the 19-year follow-up, we identified 4706 deaths from total CVD. Compared with the early supper group, the multivariable HR of hemorrhagic stroke mortality for the irregular supper group was 1.44 (95% confidence interval [CI]: 1.05–1.97). There was no significant association between supper timing and the risk of mortality from other types of stroke, CHD, and CVD. We found that adopting an irregular supper timing compared with having dinner before 8:00 p.m. was associated with an increased risk of hemorrhagic stroke mortality.

scholarly journals Mortality, causes of death and influence of medication use in patients with systemic lupus erythematosus vs matched controls

Rheumatology ◽  
2020 ◽  
Vol 60 (1) ◽  
pp. 207-216
Author(s):  
Irene E M Bultink ◽  
Frank de Vries ◽  
Ronald F van Vollenhoven ◽  
Arief Lalmohamed
Keyword(s):  
Mortality Rate ◽  
Lupus Erythematosus ◽  
Mortality Rates ◽  
Cox Proportional Hazards ◽  
Practice Research ◽  
Clinical Practice Research Datalink ◽  
Risk Of Mortality ◽  
Increased Risk ◽  
Specific Mortality ◽  
Age And Sex

Abstract Objectives We wanted to estimate the magnitude of the risk from all-cause, cause-specific and sex-specific mortality in patients with SLE and relative risks compared with matched controls and to evaluate the influence of exposure to medication on risk of mortality in SLE. Methods We conducted a population-based cohort study using the Clinical Practice Research Datalink, Hospital Episode Statistics and national death certificates (from 1987 to 2012). Each SLE patient (n = 4343) was matched with up to six controls (n = 21 780) by age and sex. Cox proportional hazards models were used to estimate overall and cause-specific mortality rate ratios. Results Patients with SLE had a 1.8-fold increased mortality rate for all-cause mortality compared with age- and sex-matched subjects [adjusted hazard ratio (HR) = 1.80, 95% CI: 1.57, 2.08]. The HR was highest in patients aged 18–39 years (adjusted HR = 4.87, 95% CI: 1.93, 12.3). Mortality rates were not significantly different between male and female patients. Cumulative glucocorticoid use raised the mortality rate, whereas the HR was reduced by 45% with cumulative low-dose HCQ use. Patients with SLE had increased cause-specific mortality rates for cardiovascular disease, infections, non-infectious respiratory disease and for death attributable to accidents or suicide, whereas the mortality rate for cancer was reduced in comparison to controls. Conclusion British patients with SLE had a 1.8-fold increased mortality rate compared with the general population. Glucocorticoid use and being diagnosed at a younger age were associated with an increased risk of mortality. HCQ use significantly reduced the mortality rate, but this association was found only in the lowest cumulative dosage exposure group.

scholarly journals Unraveling the Association Between Gait and Mortality—One Step at a Time

2019 ◽  
Vol 75 (6) ◽  
pp. 1184-1190 ◽  
Author(s):  
Lisanne J Dommershuijsen ◽  
Berna M Isik ◽  
Sirwan K L Darweesh ◽  
Jos N van der Geest ◽  
M Kamran Ikram ◽  
...  
Keyword(s):  
Mortality Risk ◽  
Gait Speed ◽  
Causes Of Death ◽  
Health Indicators ◽  
Cox Models ◽  
Risk Of Mortality ◽  
Increased Risk ◽  
Specific Mortality ◽  
One Step ◽  
Base Of Support

Abstract Background Slowness of walking is one of the very first signs of aging and is considered a marker for overall health that is strongly associated with mortality risk. In this study, we sought to disentangle the clinical drivers of the association between gait and mortality. Methods We included 4,490 participants of the Rotterdam Study who underwent a gait assessment between 2009 and 2015 and were followed-up for mortality until 2018. Gait was assessed with an electronic walkway and summarized into the domains Rhythm, Phases, Variability, Pace, Tandem, Turning, and Base of Support. Cox models adjusted for age, sex, and height were built and consecutively adjusted for six categories of health indicators (lifestyle, musculoskeletal, cardiovascular, pulmonary, metabolic, and neurological). Analyses were repeated in comorbidity-free individuals. Results Multiple gait domains were associated with an increased risk of mortality, including Pace (hazard ratio (HR) per SD worse gait, adjusted for other domains: 1.34 [1.19–1.50]), Rhythm (HR: 1.12 [1.02–1.23]) and Phases (HR: 1.12 [1.03–1.21]). Similarly, a 0.1 m/s decrease in gait speed was associated with a 1.21 (1.15–1.27) times higher hazard of mortality (HR fully adjusted: 1.14 [1.08–1.20]). In a comorbidity-free subsample, the HR per 0.1 m/s decrease in gait speed was 1.25 (1.09–1.44). Cause-specific mortality analyses revealed an association between gait speed and multiple causes of death. Conclusions Several gait domains were associated with mortality risk, including Pace which primarily represents gait speed. The association between gait speed and mortality persisted after an extensive adjustment for covariates, suggesting that gait is a marker for overall health.

scholarly journals Consumption of Total Olive Oil and Risk of Total and Cause-Specific Mortality in US Adults

2021 ◽  
Vol 5 (Supplement_2) ◽  
pp. 1036-1036
Author(s):  
Marta Guasch-Ferre ◽  
Yanping Li ◽  
Walter Willett ◽  
Qi Sun ◽  
Laura Sampson ◽  
...  
Keyword(s):  
Olive Oil ◽  
Lower Risk ◽  
Total Mortality ◽  
Cox Proportional Hazards ◽  
Health Study ◽  
Men And Women ◽  
Dairy Fat ◽  
Risk Of Mortality ◽  
Specific Mortality

Abstract Objectives The association between olive oil intake and the risk of mortality has not been evaluated before in the US population. Our objective was to examine whether olive oil intake is associated with total and cause-specific mortality in two prospective cohorts of US men and women. We hypothesize that higher olive oil consumption is associated with lower risk of total and cause-specific mortality. Methods We followed 61,096 women (Nurses’ Health Study, 1990–2016) and 31,936 men (Health Professionals Follow-up Study, 1990–2016) who were free of diabetes, cardiovascular disease and cancer at baseline. Diet was assessed by a semi quantitative food frequency questionnaire at baseline and then every 4 years. Cox proportional hazards regressions were used to estimate hazard ratios (HRs) and 95% confidence intervals (CIs). Results During 26 years of follow-up, 32,868 deaths occurred. Compared with those participants who never consumed olive oil, those with higher olive oil intake (>1/2 tablespoon/d or >8g/d) had 15% lower risk of total mortality [pooled hazard ratio (95% confidence interval): 0.85 (0.81, 0.88)] after adjustment for potential confounders. Higher olive oil intake was associated with 15% lower risk of CVD death [0.85 (0.78, 0.92)], 38% lower risk of neurodegenerative disease death [0.62 (0.54, 0.71)], and 12% lower risk of respiratory death [0.88 (0.77, 1.00)]. Replacing 10 g of margarine, mayonnaise, and dairy fat with the equivalent amount of olive oil was associated with 7–20% lower risk of total mortality, and death from CVD, cancer, neurodegenerative, and respiratory diseases. No significant associations were observed when olive oil was replacing other vegetable oils combined (corn, safflower, soybean and canola oil). Conclusions We observed that higher olive oil intake was associated with a lower risk of total mortality and cause-specific mortality in a large prospective cohort of U.S. men and women. The substitution of margarine, mayonnaise, and dairy fat with olive oil was associated with a reduced risk of mortality. Funding Sources This work was supported by grants from the National Institutes of Health.

scholarly journals Associations Between Anemia, Cognitive Impairment, and All-Cause Mortality in Oldest-Old Adults: A Prospective Population-Based Cohort Study

2021 ◽  
Vol 8 ◽  
Author(s):  
Jia Wangping ◽  
Han Ke ◽  
Wang Shengshu ◽  
Song Yang ◽  
Yang Shanshan ◽  
...  
Keyword(s):  
Cohort Study ◽  
Cognitive Impairment ◽  
Mortality Risk ◽  
Proportional Hazards ◽  
Oldest Old ◽  
Population Based ◽  
Cox Proportional Hazards ◽  
Risk Of Mortality ◽  
Increased Risk ◽  
All Cause Mortality

Objective: To evaluate the combined effects of anemia and cognitive function on the risk of all-cause mortality in oldest-old individuals.Design: Prospective population-based cohort study.Setting and Participants: We included 1,212 oldest-old individuals (men, 416; mean age, 93.3 years).Methods: Blood tests, physical examinations, and health questionnaire surveys were conducted in 2012 were used for baseline data. Mortality was assessed in the subsequent 2014 and 2018 survey waves. Cox proportional hazards models were used to evaluate anemia, cognitive impairment, and mortality risk. We used restricted cubic splines to analyze and visualize the association between hemoglobin (Hb) levels and mortality risk.Results: A total of 801 (66.1%) deaths were identified during the 6-year follow-up. We noted a significant association between anemia and mortality (hazard ratio [HR] 1.32, 95% confidence interval [CI] 1.14–1.54) after adjusting for confounding variables. We also observed a dose-response relationship between the severity of anemia and mortality (P < 0.001). In the restricted cubic spline models, Hb levels had a reverse J-shaped association with mortality risk (HR 0.88, 95% CI 0.84–0.93 per 10 g/L-increase in Hb levels below 130 g/L). The reverse J-shaped association persisted in individuals without cognitive impairment (HR 0.88, 95% CI 0.79–0.98 per 10 g/L-increase in Hb levels below 110 g/L). For people with cognitive impairment, Hb levels were inversely associated with mortality risk (HR 0.83, 95% CI 0.78–0.89 per 10 g/L-increase in Hb levels below 150 g/L). People with anemia and cognitive impairment had the highest risk of mortality (HR 2.60, 95% CI 2.06–3.27).Conclusion: Our results indicate that anemia is associated with an increased risk of mortality in oldest-old people. Cognitive impairment modifies the association between Hb levels and mortality.

scholarly journals Prediabetes, Diabetes, and the Risk of All-Cause and Cause-Specific Mortality in a Japanese Working Population: Japan Epidemiology Collaboration on Occupational Health Study

2021 ◽  
Author(s):  
Zobida Islam ◽  
Shamima Akter ◽  
Yosuke Inoue ◽  
Huan Hu ◽  
Keisuke Kuwahara ◽  
...  
Keyword(s):  
Proportional Hazards ◽  
Cox Proportional Hazards ◽  
World Health ◽  
Health Study ◽  
Expert Committee ◽  
Risk Of Mortality ◽  
Japanese Workers ◽  
Increased Risk ◽  
Health Organization

<b>Objective:</b> Prediabetes has been suggested to increase mortality risk; however, the definitions of prediabetes that can predict mortality remain elusive. We prospectively investigated the association of multiple definitions of prediabetes with the risk of mortality from all-causes, cardiovascular disease (CVD), and cancer in Japanese workers. <p> </p> <p><b>Research</b> <b>design</b> <b>and</b> <b>methods:</b> The study included 62,785 workers who underwent a health checkup in 2010 or 2011 and were followed up for mortality from 2012 to March 2019. <a>Prediabetes was defined according to fasting plasma glucose (FPG) or glycated hemoglobin (HbA1c) level or a combination of both using the American Diabetes Association (ADA) or World Health Organization (WHO)/International Expert Committee (IEC) criteria. </a>The Cox proportional hazards regression model was used to investigate the associations.</p> <p> </p> <p><b>Results:</b> Over a 7-year follow-up, 229 deaths were documented. <a>Compared with normoglycemia, prediabetes defined according to ADA criteria was associated with a higher risk of all-cause (hazard ratio [HR] 1.53; 95% confidence interval [CI] 1.12–2.09) and cancer (HR 2.37; 95% CI 1.45–3.89) mortality but not with CVD mortality. </a>The results were materially unchanged when prediabetes was defined according to ADA FPG, ADA HbA1c, WHO FPG, or combined WHO/IEC criteria. Diabetes was associated with the risk of all-cause, CVD, and cancer mortality.</p> <p> </p> <p><b>Conclusion:</b> In a cohort of Japanese workers, FPG- and HbA1c-defined prediabetes according to ADA or WHO/IEC was each associated with a significantly increased risk of mortality from all-causes and cancer but not CVD. </p>

Socioeconomic Disparities in Pediatric Single-Sided Deafness

2020 ◽  
Vol 163 (4) ◽  
pp. 829-834
Author(s):  
Noga Lipschitz ◽  
Gavriel D. Kohlberg ◽  
Michael Scott ◽  
Matthew M. Smith ◽  
John H. Greinwald
Keyword(s):  
Treatment Outcomes ◽  
Employment Status ◽  
Private Insurance ◽  
Socioeconomic Disparities ◽  
Insurance Status ◽  
Poverty Level ◽  
Public Insurance ◽  
Device Use ◽  
Single Sided Deafness

Objective To explore socioeconomic disparities in pediatric single-sided deafness (SSD) treatment. Study Design Retrospective chart review. Setting Tertiary referral academic center. Methods The charts of 190 pediatric patients with SSD were reviewed for demographic and clinical characteristics. Socioeconomic variables included race and insurance status. ZIP codes were used to obtain additional socioeconomic data from the American Community Survey, including mean and median income, percentage of families below the poverty level, and employment status. Socioeconomic status (SES) was classified by insurance status and income. Treatment outcomes were analyzed by socioeconomic variables. Results There were 105 males and 85 females with a mean follow-up of 55.2 months and a mean age at diagnosis of 4.4 years. Sixty-three percent of children received treatment at last follow-up. Thirty-five percent of children had public insurance and 65% had private insurance. Treatment rates were similar in the private and public insurance groups (60.6% vs 66.7%, P = .42), but device type was different between groups ( P = .02). Consistent device use was associated with private insurance (47.5% vs 38.9%, P = .003) and high SES (94.4% vs 80%, P = .04) on univariate but not on multivariate analysis. Aided audiometry results were similar between SES groups. No association was found between sex, race, income level, poverty level, or employment status and treatment outcomes. Conclusion Insurance type and SES were not associated with SSD treatment outcomes in children, although device use may be higher in children with private insurance and higher SES. Further research should focus on strategies to reduce barriers to treatment and improve adherence.

scholarly journals Frailty index as a predictor of all-cause and cause-specific mortality in a Swedish population-based cohort

2017 ◽  
Author(s):  
M Jiang ◽  
AD Foebel ◽  
R Kuja-Halkola ◽  
I Karlsson ◽  
NL Pedersen ◽  
...  
Keyword(s):  
Frailty Index ◽  
Population Based ◽  
Swedish Population ◽  
Risk Of Mortality ◽  
Increased Risk ◽  
All Cause Mortality ◽  
Specific Mortality ◽  
Younger Men ◽  
Cvd Mortality

AbstractBackgroundFrailty is a complex manifestation of aging and associated with increased risk of mortality and poor health outcomes. Younger individuals (under 65 years) typically have low levels of frailty and are less-studied in this respect. Also, the relationship between the Rockwood frailty index (FI) and cause-specific mortality in community settings is understudied.MethodsWe created and validated a 42-item Rockwood-based FI in The Swedish Adoption/Twin Study of Aging (n=1477; 623 men, 854 women; aged 29-95 years) and analyzed its association with all-cause and cause-specific mortality in up to 30-years of follow-up. Deaths due to cardiovascular disease (CVD), cancer, dementia and other causes were considered as competing risks.ResultsOur FI demonstrated construct validity as its associations with age, sex and mortality were similar to the existing literature. The FI was independently associated with increased risk for all-cause mortality in younger (<65 years; HR per increase in one deficit 1.11, 95%CI 1.07-1.17) and older (≥65 years; HR 1.07, 95%CI 1.04-1.10) women and in younger men (HR 1.05, 95%CI 1.01-1.10). In cause-specific mortality analysis, the FI was strongly predictive of CVD mortality in women (HR per increase in one deficit 1.13, 95%CI 1.09-1.17), whereas in men the risk was restricted to deaths from other causes (HR 1.07, 95%CI 1.01-1.13).ConclusionsThe FI showed good predictive value for all-cause mortality especially in the younger group. The FI predicted CVD mortality risk in women, whereas in men it captured vulnerability to death from various causes.

Disparities of Care in Post-Concussive Pediatric Patients

Neurology ◽  
2021 ◽  
Vol 98 (1 Supplement 1) ◽  
pp. S13.1-S13
Author(s):  
James Pate ◽  
Ian Cummins ◽  
Kasey Cooper ◽  
Marshall Chandler McLeod ◽  
Laura Ferrill ◽  
...  
Keyword(s):  
Emergency Department ◽  
Sports Medicine ◽  
Private Insurance ◽  
Insurance Status ◽  
Public Insurance ◽  
Tertiary Referral Center ◽  
Significant Difference ◽  
Follow Up Care ◽  
Icd 10

ObjectiveThe objective of this study was to examine the association between insurance status and prevalence of follow up care at a tertiary referral center compared to the emergency department.BackgroundConcussions are extremely common in today's society, affecting patients of all demographic backgrounds. There is concern that public insurance status may affect follow up care at tertiary treatments centers compared to children with private insurance, as evidenced by Copley et al. who documented insurance disparities between children presenting to a sports medicine clinic with orthopedic injuries verses concussion.Design/MethodsWe compared insurance status of patients presenting to our pediatric concussion clinic to the insurance status of patients diagnosed with concussion at the emergency department of our tertiary hospital. From 2018 to 2019, 725 patients received an ICD-10 diagnosis code for concussion in our clinic. Patients were excluded if insurance status was not available for the clinic visit (4), or if they were lost to follow up (380). ICD-10 codes for concussion during the same period were recorded from the COA emergency department (ED). The insurance status was then recorded for each patient.ResultsOf the 345 patients included from the COA concussion clinic, 253 (73%) patients had private insurance while only 92 (27%) had public insurance. In comparison, of the 1,160 patients diagnosed with concussion in the COA ED, 642 (55%) patients had private insurance, 478 (41%) had public insurance, 37 (3.1%) were self-pay, and 3 (0.3%) were listed as “other.”ConclusionsThere is a significant difference in the insurance status of patients with concussion that present to the COA ED when compared to those presenting to concussion clinic. As a result, children with public insurance may have prolonged recovery and more significant symptoms burden compared to children with private insurance.

scholarly journals Healthy behaviours and risk of all-cause mortality

2019 ◽  
Vol 29 (Supplement_4) ◽  
Author(s):  
J Lahti ◽  
E Mauramo ◽  
E Lahelma ◽  
T Lallukka ◽  
O Pietiläinen ◽  
...  
Keyword(s):  
Mortality Risk ◽  
Cox Regression ◽  
Leisure Time Physical Activity ◽  
Premature Mortality ◽  
Middle Aged ◽  
A Value ◽  
Risk Of Mortality ◽  
Increased Risk ◽  
Healthy Behaviour

Abstract Introduction Healthy behaviours are associated with better health in general but less is known about the combined associations of multiple healthy behaviours with mortality risk. We aimed to examine the associations of combined healthy behaviours with mortality risk over a 15-year follow-up among middle-aged employees. Methods Survey data, collected in 2000–2002 among 40–60-year-old employees of the City of Helsinki, Finland, was linked with complete register data on mortality from Statistics Finland (response rate 67%, written informed consent for register linkages 74%). Healthy behaviours included high leisure-time physical activity, non-smoking, no binge drinking and healthy food habits. Each healthy behaviour were dichotomized and assigned a value of one for healthy and zero for unhealthy. The number of healthy behaviours were summed together (score range 0-4). Cox regression models were fitted, and the follow-up continued until the end of 2015 (n = 6336). Confounders included age, sex, marital status, socioeconomic position and self-rated health. Results Of the respondents, 7% reported four healthy behaviours, 27% three, 34% two, 22% one and 9% no healthy behaviours. A total of 281 deaths occurred during the follow-up. Each healthy behaviour was individually associated with a reduced mortality risk, non-smoking having the strongest and healthy diet the weakest association. The combined association showed that those without any of the healthy behaviours (HR 2.8, 95% CI 1.51-5.29) and those with only one healthy behaviour (HR 1.89, 95% CI 1.04-3.43) had a higher mortality risk than those with four healthy behaviours. Instead, those with at least two healthy behaviours were not at an increased risk of mortality. Conclusions A low number of healthy behaviours predicted mortality among middle-aged employees. Efforts should be made to promote multiple healthy behaviours among the middle-aged to enhance health and prevent premature mortality. Key messages Almost one third of the respondents had no or only one healthy behaviour. A low number of healthy behaviours was associated with an increased risk of mortality.

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