Gender Disparities in Vascular Access and One-Year Mortality among Incident Hemodialysis Patients: An Epidemiological Study in Lazio Region, Italy

(1) Background: Interest in gender disparities in epidemiology, clinical features, prognosis and health care in chronic kidney disease patients is increasing. Aims of the study were to evaluate the association between gender and vascular access (arteriovenous fistula (AVF) or central venous catheter (CVC)) used at the start of hemodialysis (HD) and to investigate the association between gender and 1-year mortality. (2) Methods: The study includes 9068 adult chronic HD patients (64.7% males) registered in the Lazio Regional Dialysis Register (Jan 2008–Dec 2018). Multivariable logistic regression models were used to investigate the associations between gender and type of vascular access (AVF vs. CVC) and between gender and 1-year mortality. Interactions between gender and socio-demographic and clinical variables were tested adding the interaction terms in the final model. (3) Results: Females were older, had lower educational level and lower rate of self-sufficiency compared to males. Overall, CVC was used in 51.2% of patients. Females were less likely to use AVF for HD initiation than males. 1354 out of 8215 (16.5%) individuals died at the end of the follow-up period. Interaction term between gender and vascular access was significant in the adjusted model. From stratified analyses by vascular access, OR female vs. male (AVF) = 0.65; 95% CI 0.48–0.87 and OR female vs. male (CVC) = 0.88; 95% CI 0.75–1.04 were found. (4) Conclusion: This prospective population-based cohort study in a large Italian Region showed that in females starting chronic HD AVF was less common respect to men. The better 1-year survival of females is more evident among those women with AVF. Reducing gender disparity in access to AVF represents a key point in the management of HD patients.

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Determinants of venous catheter hemodialysis onset and subsequent switch to arteriovenous fistula: An epidemiological study in Lazio region

The Journal of Vascular Access ◽

10.1177/1129729820959942 ◽

2020 ◽

pp. 112972982095994

Author(s):

Luigi Tazza ◽

Laura Angelici ◽

Claudia Marino ◽

Anteo Di Napoli ◽

Maurizio Bossola ◽

...

Keyword(s):

Arteriovenous Fistula ◽

Vascular Access ◽

Regression Models ◽

Venous Catheter ◽

Organizational Factors ◽

Hemodialysis Patients ◽

Lower Probability ◽

First Year ◽

Lazio Region ◽

Factors Associated

Background: The factors associated with the inability to start hemodialysis with an arteriovenous fistula (AVF) in chronic kidney disease patients are not fully understood. Aim: Evaluating factors associated with type of vascular access at the first chronic hemodialysis and at 1 year after it. Methods: The study cohort includes patients registered in the Regional Dialysis and Transplant Registry of Lazio undergoing first hemodialysis between 2008 and 2015. Logistic regression models were used to evaluate the association between socio-demographic, clinical and care/organizational factors, and vascular access at first hemodialysis. Cox regression models were used to assess the odds of switching to AVF during the first year of hemodialysis among patients starting dialysis with central venous catheter (CVC). Results: In the cohort of 6208 incident hemodialysis patients, 52.7% had an AVF and 47.3% had a CVC. Among the 2939 incident patients with CVC, 27.4% switched to FAV after 1 year. A higher probability of starting dialysis with AVF was observed among males (OR = 1.83; 95% CI 1.63–2.06), while a lower probability was observed among patients aged >85 years (OR 0.64; IC 95% 0.51–0.80). Patients with early referral to a nephrologist had a triple probability of start dialysis with AVF. We observed a higher odds of switch to AVF among males (HR = 1.62; 95% CI 1.40–1.89) and a lower odds among patients over 65 years. Conclusion: The observed high rate of AVF at the start of hemodialysis and of the switch from CVC to AVF in the first year, although declining since 2008, is a positive outcome. However, over one-third of patients maintain the CVC as vascular access for the first year because of unmodifiable factors, such as gender, age, comorbidity. The present study suggests that logistics/management and assistance/welfare problems may contribute to the delay or lack of AVF placement in incident hemodialysis patients or within the first year of dialysis.

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Gender Disparities in Surgical Treatment of Axis Fractures in Older Adults

Global Spine Journal ◽

10.1177/2192568219890573 ◽

2019 ◽

Vol 11 (1) ◽

pp. 71-75

Author(s):

Michael P. Catalino ◽

Brice A. Kessler ◽

Virginia Pate ◽

Drew Cutshaw ◽

Til Stürmer ◽

...

Keyword(s):

Cohort Study ◽

Surgical Treatment ◽

Spine Surgery ◽

Retrospective Cohort Study ◽

Retrospective Cohort ◽

International Classification Of Diseases ◽

Population Based ◽

Gender Disparity ◽

Gender Disparities ◽

Secondary Outcome

Study Design: Retrospective cohort study. Objectives: Gender appears to play in important role in surgical outcomes following acute cervical spine trauma, with current literature suggesting males have a significantly higher mortality following spine surgery. However, no well-adjusted population-based studies of gender disparities in incidence and outcomes of spine surgery following acute traumatic axis injuries exist to our knowledge. We hypothesized that females would receive surgery less often than males, but males would have a higher 1-year mortality following isolated traumatic axis fractures. Methods: We performed a retrospective cohort study using Medicare claims data that identified US citizens aged 65 and older with ICD-9 (International Classification of Diseases, Ninth Revision) code diagnosis corresponding to isolated acute traumatic axis fracture between 2007 and 2014. Our primary outcome was defined as cumulative incidence of surgical treatment, and our secondary outcome was 1-year mortality. Propensity weighted analysis was performed to balance covariates between genders. Our institutional review board approved the study (IRB #16-0533). Results: There was no difference in incidence of surgery between males and females following acute isolated traumatic axis fractures (7.4 and 7.5 per 100 fractures, respectively). Males had significantly higher 1-year weighted mortality overall (41.7 and 28.9 per 100 fractures, respectively, P < .001). Conclusion: Our well-adjusted data suggest there was no significant gender disparity in incidence of surgical treatment over the study period. The data also support previous observations that males have worse outcomes in comparison to females in the setting of axis fractures and spinal trauma regardless of surgical intervention.

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TP5.2.9 Mortality following major lower extremity amputation in people with and without diabetes in Scotland 2004-2013

British Journal of Surgery ◽

10.1093/bjs/znab362.014 ◽

2021 ◽

Vol 108 (Supplement_7) ◽

Author(s):

Ellen Murgitroyd ◽

Xuehan Yao ◽

Jan Kerssens ◽

Jeremy Walker ◽

Sarah Wild

Keyword(s):

Lower Extremity ◽

Economic Status ◽

Population Based ◽

Lower Extremity Amputation ◽

Logistic Regression Models ◽

Diabetes Status ◽

Diabetic Population ◽

One Year ◽

Extremity Amputation

Abstract Aim To describe short and longer-term mortality following major lower extremity amputation (LEA) by diabetes status over two time periods. Methods A retrospective cohort study of patients who underwent major LEA between 2004 and 2013 was conducted based on linkage of national population-based hospital records and a register of people with diagnosed diabetes. Post-operative mortality was estimated at 30 days, one year and where available, five years. Using logistic regression models, we estimated the odds of death associated with diabetes adjusted for age, sex and socio-economic status within these time points compared to the non-diabetic population stratified by type of diabetes and five-year calendar periods. Results There were a total of 5436 people who received an amputation during the study period of whom approximately 40% had diabetes. Overall mortality for the 2004-8 and 2009-13 cohorts respectively was not significantly different at 7.9% and 7.3% at 30 days and 31% and 27% at one year. Almost 64% of the 2004-8 cohort were dead within five years. The only statistically significantly associations between diabetes and mortality were observed within five year follow-up of the 2004-8 cohort with odds ratios (95% CI) compared to the non-diabetic population of 1.62 (1.17, 2.26) for type 1 diabetes and 1.38 (1.14, 1.66) for type 2 diabetes. Conclusions An adverse association between diabetes and mortality after LEA only became apparent in longer term follow-up.

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Here one year, gone the next? Investigating persistence of frequent emergency department attendance: a retrospective study in Australia

BMJ Open ◽

10.1136/bmjopen-2018-027700 ◽

2019 ◽

Vol 9 (6) ◽

pp. e027700 ◽

Cited By ~ 4

Author(s):

Luise Lago ◽

Victoria Westley-Wise ◽

Judy Mullan ◽

Kelly Lambert ◽

Rebekah Zingel ◽

...

Keyword(s):

Risk Factors ◽

Intervention Studies ◽

Population Based ◽

Geographic Region ◽

Population Based Study ◽

Logistic Regression Models ◽

Frequent Attenders ◽

Frequent Attendance ◽

Adults And Children ◽

One Year

ObjectivesPatients are presenting to emergency departments (EDs) with increasing complexity at rates beyond population growth and ageing. Intervention studies target patients with 12 months or less of frequent attendance. However, these interventions are not well targeted since most patients do not remain frequent attenders. This paper quantifies temporary and ongoing frequent attendance and contrasts risk factors for each group.DesignRetrospective population-based study using 10 years of longitudinal data.SettingAn Australian geographic region that includes metropolitan and rural EDs.Participants332 100 residents visited any ED during the study period.Main outcome measureFrequent attendance was defined as seven or more visits to any ED in the region within a 12-month period. Temporary frequent attendance was defined as meeting this threshold only once, and ongoing more than once. Risk factors for temporary and ongoing frequent attenders were identified using logistic regression models for adults and children.ResultsOf 8577 frequent attenders, 80.1% were temporary and 19.9% ongoing (12.9% repeat, 7.1% persistent). Among adults, ongoing were more likely than temporary frequent attenders to be young to middle aged (aged 25–64 years), and less likely to be from a high socioeconomic area or be admitted. Ongoing frequent attenders had higher rates of non-injury presentations, in particular substance-related (OR=2.5, 99% CI 1.1 to 5.6) and psychiatric illness (OR=2.9, 99% CI 1.8 to 4.6). In comparison, children who were ongoing were more likely than temporary frequent attenders to be aged 5–15 years, and were not more likely to be admitted (OR=2.7, 99% CI 0.7 to 10.9).ConclusionsFuture intervention studies should distinguish between temporary and ongoing frequent attenders, develop specific interventions for each group and include rigorous evaluation.

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A Male-ABCD Algorithm for Hepatocellular Carcinoma Risk Prediction in HBsAg Carriers

10.21203/rs.3.rs-159806/v1 ◽

2021 ◽

Author(s):

Yuting Wang ◽

Minjie Wang ◽

He Li ◽

Kun Chen ◽

Hongmei Zeng ◽

...

Keyword(s):

Hepatocellular Carcinoma ◽

Risk Prediction ◽

Hepatitis B Surface Antigen ◽

Population Based ◽

Gender Disparity ◽

Low Risk ◽

Operating Characteristics ◽

Logistic Regression Models ◽

Hbsag Carriers ◽

Potential Risk Factors

Abstract BACKGROUND: Hepatocellular carcinoma (HCC) development among hepatitis B surface antigen (HBsAg) carriers shows gender disparity, influenced by underlying liver diseases that display variations in laboratory tests. We aimed to construct a risk-stratified HCC prediction model for HBsAg-positive male adults.METHODS: HBsAg-positive, 35-69 years males (N=6 153) were recruited from a multi-center population-based liver cancer screening study. Randomly, three centers were set as training, the other three centers as validation. Within 2 years since initiation, we administrated at least two rounds of HCC screening using B-ultrasonography and α-fetoprotein (AFP). We used logistic regression models to determine potential risk factors, built and examined the operating characteristics of a point-based algorithm for HCC risk prediction.RESULTS: With 2 years of follow-up, 302 HCC cases were diagnosed. A male-ABCD algorithm was constructed including participant’s Age, Blood levels of GGT (γ-glutamyl-transpeptidase), Counts of platelets, white cells, Concentration of DCP (des-γ-carboxy-prothrombin) and AFP, with scores ranging from 0 to 18.3. The area under receiver operating characteristic was 0.91(0.89-0.93), larger than existing models. At 1.5 points of risk-score, 26.10% of the participants in training, 14.94% in validation were recognized at-low-risk, with sensitivity of identifying HCC remained 100%. At 2.5 points, 46.51% of the participants in training, 33.68% in validation were recognized at-low-risk with 99.06% and 97.78% of sensitivity. At 4.5 points, only 20.86% of training, 23.73% of validation were recognized at-high-risk, with positive prediction value of 22.85% and 12.35% respectively.DISCUSSION: Male-ABCD algorithm identified individual’s risk for HCC occurrence within short-term for their HCC precision surveillance.

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A population-based study of medical cannabis utilization in patients with cancer.

Journal of Clinical Oncology ◽

10.1200/jco.2019.37.27_suppl.124 ◽

2019 ◽

Vol 37 (27_suppl) ◽

pp. 124-124

Author(s):

Safiya Karim ◽

Jingyu Bu ◽

Ed Jess ◽

Winson Y. Cheung ◽

Marc Kerba

Keyword(s):

Cancer Patients ◽

Cancer Diagnosis ◽

Systemic Therapy ◽

Sociodemographic Factors ◽

Population Based ◽

Regulatory Framework ◽

Medical Cannabis ◽

Logistic Regression Models ◽

Utilization Patterns ◽

One Year

124 Background: Between 2014 and 2018, access to cannabis for medical purposes was regulated by Health Canada. Surveys have demonstrated that cancer patients use cannabis to manage symptoms and side effects. Medical cannabis utilization patterns in cancer patients under Canada’s regulatory framework have not been well-described. We aimed to determine the proportion of cancer patients who used medical cannabis, timing of use in relation to cancer treatment and sociodemographic factors predicting use. Methods: The Alberta Cancer Registry was used to identify all patients age ≥ 18 diagnosed with invasive cancer in the province from April 01, 2014 to December 31, 2016. These cases were linked to records from the College of Physicians and Surgeons of Alberta database which collects data on patients who received an authorization for medical cannabis. Authorization was used as a surrogate for medical cannabis utilization. Univariate and multivariate logistic regression models were constructed to determine factors associated with medical cannabis utilization. Results: We identified 41,889 patients between April 1, 2014 and December 31, 2016. Median age at cancer diagnosis was 65 and 50% were female. Among these patients, 1,070 (2.5%) used medical cannabis. Of these patients, 541 (51%) used medical cannabis within 1 year of diagnosis, 248 (52%) within one year of the start of systemic therapy and 128 (41%) within one year of the start of radiation therapy. On multivariate analysis, patients aged 18-29 (OR 12.4, 95% CI 7.8-19.7) and those receiving systemic therapy (OR 2.0, 95% CI 1.7-2.4) were more likely to use medical cannabis (p < 0.001). There were 171 unique physicians who authorized medical cannabis of which only 3.5% (6/171) were oncologists. Conclusions: A small proportion of cancer patients used medical cannabis under Health Canada’s regulatory framework. Utilization was associated with a cancer diagnosis and receiving treatment. Younger patients and those undergoing systemic treatment were predictors of medical cannabis use. Further study is required to understand utilization patterns after cannabis legalization and how to incorporate these findings into patient-centered cancer care.

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Disparities in cognitive impairment with anticholinergic drug use: A population-based study

Neurology Clinical Practice ◽

10.1212/cpj.0000000000000952 ◽

2020 ◽

pp. 10.1212/CPJ.0000000000000952

Author(s):

Md Motiur Rahman ◽

George Howard ◽

Jingjing Qian ◽

Kimberly Garza ◽

Ash Abebe ◽

...

Keyword(s):

Cognitive Impairment ◽

Racial Differences ◽

Urban Areas ◽

Anticholinergic Drug ◽

Population Based ◽

Beers Criteria ◽

Logistic Regression Models ◽

Interaction Terms ◽

Regards Study ◽

Adjusted Model

Objectives:We aim to evaluate the association between anticholinergic drug (ACH) use and cognitive impairment and the effect of disparity parameters (sex, race, income, education, and rural or urban areas) on this relationship.Methods:The analyses included 13,623 adults aged ≥65 years from the REasons for Geographic And Racial Differences in Stroke (REGARDS) study (recruited 2003-2007). The ACH use was defined by the 2015 Beers Criteria and cognitive impairment was measured by the Six-Item Cognitive Screener. Multivariable logistic regression models assessed disparities in cognitive impairment with ACH use, iteratively adjusting for disparity parameters and other covariates. The full models included interaction terms between ACH use and other covariates. A similar approach was used for class-specific ACH exposure and cognitive impairment analyses.Results:Approximately 14% of the participants used at least one ACH listed in the Beers criteria. Antidepressants were the most frequently prescribed ACH class. A significant sex-race interaction illustrated that females compared with males (in blacks: odds ratio [OR]=1.28, 95% CI 1.10–1.49 and in whites: OR=1.96, 95% CI 1.74–2.20), and especially white females (black vs. white: OR=0.71, 95% CI 0.64–0.80) were more likely to receive ACHs. Higher odds of cognitive impairment were observed among ACH users compared with the non-users (OR=1.26, 95% CI 1.01–1.58). In our class level analyses, only antidepressant users (OR=1.60, 95% CI 1.14–2.25) showed a significant association with cognitive impairment in the fully adjusted model.Conclusion:We observed demographic and socioeconomic differences in ACH use and in cognitive impairment, individually.

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Gender Disparities in Anti-dementia Medication Use among Older Adults: Health Equity Considerations and Management of Alzheimer's Disease and Related Dementias

Frontiers in Pharmacology ◽

10.3389/fphar.2021.706762 ◽

2021 ◽

Vol 12 ◽

Author(s):

Z. Kevin Lu ◽

Xiaomo Xiong ◽

Xinyuan Wang ◽

Jun Wu

Keyword(s):

Alzheimer’S Disease ◽

Alzheimer's Disease ◽

Confidence Interval ◽

Descriptive Analysis ◽

Healthcare Providers ◽

Gender Disparity ◽

Gender Disparities ◽

Medicare Beneficiaries ◽

Logistic Regression Models ◽

To Receive

Objective: The prevalence of Alzheimer’s disease and related dementias (ADRD) in women is higher than men. However, the knowledge of gender disparity in ADRD treatment is limited. Therefore, this study aimed to determine the gender disparities in the receipt of anti-dementia medications among Medicare beneficiaries with ADRD in the U.S.Methods: We used data from the Medicare Current Beneficiary Survey 2016. Anti-dementia medications included cholinesterase inhibitors (ChEIs; including rivastigmine, donepezil, and galantamine) and N-methyl-D-aspartate (NMDA) receptor antagonists (including memantine). Descriptive analysis and multivariate logistic regression models were implemented to determine the possible gender disparities in the receipt of anti-dementia medications. Subgroup analyses were conducted to identify gender disparities among beneficiaries with Alzheimer’s disease (AD) and those with only AD-related dementias.Results: Descriptive analyses showed there were statistically significant differences in age, marital status, and Charlson comorbidities index (CCI) between Medicare beneficiaries who received and who did not receive anti-dementia medications. After controlling for covariates, we found that female Medicare beneficiaries with ADRD were 1.7 times more likely to receive anti-dementia medications compared to their male counterparts (odds ratio [OR]: 1.71; 95% confidence interval [CI]: 1.19–2.45). Specifically, among Medicare beneficiaries with AD, females were 1.2 times more likely to receive anti-dementia medications (Odds Radio: 1.20; 95% confidence interval: 0.58–2.47), and among the Medicare beneficiaries with only AD-related dementias, females were 1.9 times more likely to receive anti-dementia medications (OR: 1.90; 95% CI: 1.23–2.95).Conclusion: Healthcare providers should be aware of gender disparities in receiving anti-dementia medications among patients with ADRD, and the need to plan programs of care to support both women and men. Future approaches to finding barriers of prescribing, receiving and, adhering to anti-dementia medications by gender should include differences in longevity, biology, cognition, social roles, and environment.

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1705 Mortality Following Major Lower Extremity Amputation in People with And Without Diabetes in Scotland 2004-2013

British Journal of Surgery ◽

10.1093/bjs/znab259.1131 ◽

2021 ◽

Vol 108 (Supplement_6) ◽

Author(s):

E Murgitroyd ◽

X Yao ◽

J Kerssens ◽

J Walker ◽

S Wild

Keyword(s):

Lower Extremity ◽

Economic Status ◽

Population Based ◽

Lower Extremity Amputation ◽

Logistic Regression Models ◽

Diabetes Status ◽

Diabetic Population ◽

One Year ◽

Extremity Amputation

Abstract Aim To describe short and longer-term mortality following major lower extremity amputation (LEA) by diabetes status over two time periods Method A retrospective cohort study of patients who underwent major LEA between 2004 and 2013 was conducted based on linkage of national population-based hospital records and a register of people with diagnosed diabetes. Post-operative mortality was estimated at 30 days, one year and where available, five years. Using logistic regression models, we estimated the odds of death associated with diabetes adjusted for age, sex and socio-economic status within these time points compared to the non-diabetic population stratified by type of diabetes and five-year calendar periods. Results There were a total of 5436 people who received an amputation during the study period of whom approximately 40% had diabetes. Overall mortality for the 2004-8 and 2009-13 cohorts respectively was not significantly different at 7.9% and 7.3% at 30 days and 31% and 27% at one year. Almost 64% of the 2004-8 cohort were dead within five years. The only statistically significantly associations between diabetes and mortality were observed within five-year follow-up of the 2004-8 cohort with odds ratios (95% CI) compared to the non-diabetic population of 1.62 (1.17, 2.26) for type 1 diabetes and 1.38 (1.14, 1.66) for type 2 diabetes. Conclusions An adverse association between diabetes and mortality after LEA only became apparent in longer term follow-up.

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Diagnostic Delay in Psoriatic Arthritis: A Population Based Study

The Journal of Rheumatology ◽

10.3899/jrheum.201199 ◽

2021 ◽

pp. jrheum.201199

Author(s):

Paras Karmacharya ◽

Kerry Wright ◽

Sara J. Achenbach ◽

Delamo Bekele ◽

Cynthia S. Crowson ◽

...

Keyword(s):

Psoriatic Arthritis ◽

Symptom Onset ◽

Age At Onset ◽

Diagnostic Delay ◽

Population Based ◽

Calendar Time ◽

Logistic Regression Models ◽

Patient Reported ◽

One Year ◽

Physician Diagnosis

Objective To examine demographic and clinical characteristics associated with diagnostic delay in psoriatic arthritis (PsA). Methods We characterized a retrospective, population-based cohort of incident adult (≥18 years) PsA patients from Olmsted County, MN from 2000-17. All patients met classification criteria. Diagnostic delay was defined as the time from any patient-reported PsA-related joint symptom to a physician diagnosis of PsA. Factors associated with delay in PsA diagnosis were identified through logistic regression models. Results Of the 164 incident PsA cases from 2000-17, 162 had a physician or rheumatologist diagnosis. Mean (SD) age was 41.5 (12.6) and 46% were females. Median time from symptom onset to physician diagnosis was 2.5 years (interquartile range: 0.5 to 7.3). By six months, 38 (23%) received a diagnosis of PsA, 56 (35%) by one year and 73 (45%) by two years after symptom onset. No significant trend in diagnostic delay was observed over calendar time. Earlier age at onset of PsA symptoms, higher body mass index, and enthesitis were associated with a diagnostic delay of >2 years, while sebopsoriasis was associated with a lower likelihood of delay. Conclusion In our study, more than half of PsA patients had a diagnostic delay of >2 years, and no significant improvement in time to diagnosis was noted between 2000-17. Patients with younger age at PsA symptom onset, higher BMI, or enthesitis before diagnosis were more likely to have a diagnostic delay of >2 year while patients with sebopsoriasis were less likely to have a diagnostic delay.

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