scholarly journals Orthopedic Surgery Among Patients with Rheumatoid Arthritis 1980–2007: A Population-based Study Focused on Surgery Rates, Sex, and Mortality

2012 ◽  
Vol 39 (3) ◽  
pp. 481-485 ◽  
Author(s):  
COURTNEY A. SHOURT ◽  
CYNTHIA S. CROWSON ◽  
SHERINE E. GABRIEL ◽  
ERIC L. MATTESON
Keyword(s):  
Rheumatoid Arthritis ◽  
Cumulative Incidence ◽  
Revision Arthroplasty ◽  
Population Based ◽  
Cox Models ◽  
Reconstructive Procedures ◽  
Joint Surgery ◽  
Kaplan Meier ◽  
Time Dependent Covariates ◽  
Surgery Rates

Objective.To describe current trends in arthritis-related joint surgery among a population-based cohort of patients with rheumatoid arthritis (RA) and to examine the influence of joint surgery on mortality.Methods.A retrospective medical record review was performed of all orthopedic surgeries following diagnosis in cases of adult-onset RA in Olmsted County, Minnesota, USA, in 1980–2007. Surgeries included primary total joint arthroplasty, joint reconstructive procedures (JRP), soft tissue procedures (STP), and revision arthroplasty. Cumulative incidence of surgery was estimated using Kaplan-Meier methods. Time trends, sex differences, and mortality were examined using Cox models with time-dependent covariates for surgery.Results.A total of 189 of 813 patients underwent at least 1 surgical procedure involving joints during followup. The cumulative incidence of any joint surgery at 10 years after RA incidence for the 1980–94 cohort was 27.3% compared to 19.5% for the 1995–2007 cohort (p = 0.08). The greatest reduction was in STP, which decreased from 12.1% in 1980–94 to 6.0% in 1995–2007 at 10 years after RA incidence (p = 0.012). Women had more surgery (cumulative incidence 26.6% at 10 years for women; 20.4% for men; p = 0.049), as did obese patients. JRP were significantly associated with mortality (hazard ratio 2.6; 95% CI 1.8, 3.9; p < 0.001) compared to patients not requiring JRP.Conclusion.The rates of joint surgery continue to decrease for patients more recently diagnosed with RA. JRP is associated with increased mortality. These findings may reflect improved treatments for RA as well as continued higher disease burden among some patients.

scholarly journals Fragility Fractures Are Associated with an Increased Risk for Cardiovascular Events in Women and Men with Rheumatoid Arthritis: A Population-based Study

2017 ◽  
Vol 44 (5) ◽  
pp. 558-564 ◽  
Author(s):  
Orla Ni Mhuircheartaigh ◽  
Cynthia S. Crowson ◽  
Sherine E. Gabriel ◽  
Veronique L. Roger ◽  
L. Joseph Melton ◽  
...  
Keyword(s):  
Rheumatoid Arthritis ◽  
Risk Factors ◽  
Fragility Fracture ◽  
Fragility Fractures ◽  
Population Based ◽  
Cvd Risk ◽  
Cox Models ◽  
Excess Morbidity ◽  
Increased Risk ◽  
Time Dependent Covariates

Objective.Women and men with rheumatoid arthritis (RA) have an increased risk for fragility fractures and cardiovascular disease (CVD), each of which has been reported to contribute to excess morbidity and mortality in these patients. Fragility fractures share similar risk factors for CVD but may occur at relatively younger ages in patients with RA. We aimed to determine whether a fragility fracture predicts the development of CVD in women and men with RA.Methods.We studied a population-based cohort with incident RA from 1955 to 2007 and compared it with age- and sex-matched non-RA subjects. We identified fragility fractures and CVD events following the RA incidence/index date, along with relevant risk factors. We used Cox models to examine the association between fractures and the development of CVD, in which fractures and CVD risk factors were modeled as time-dependent covariates.Results.There were 1171 subjects (822 women; 349 men) in each of the RA and non-RA cohorts. Over followup, there were 406 and 346 fragility fractures and 286 and 225 CVD events, respectively. The overall CVD risk was increased significantly for RA subjects following a fragility fracture (HR 1.81, 95% CI 1.38–2.37) but not for non-RA subjects (HR 1.18, 95% CI 0.85–1.63). Results were similar for women and men with RA.Conclusion.Fragility fractures in both women and men with RA are associated with an increased risk for CVD events and should raise an alert to clinicians to target these individuals for further screening and preventive strategies for CVD.

scholarly journals POS0210 THE INCIDENCE AND RISK FACTORS OF RHEUMATOID ARTHRITIS-ASSOCIATED INTERSTITIAL LUNG DISEASE

2021 ◽  
Vol 80 (Suppl 1) ◽  
pp. 322-322
Author(s):  
B. Samhouri ◽  
R. Vassallo ◽  
S. Achenbach ◽  
V. Kronzer ◽  
J. M. Davis ◽  
...  
Keyword(s):  
Rheumatoid Arthritis ◽  
Risk Factors ◽  
Interstitial Lung Disease ◽  
Lung Disease ◽  
Cumulative Incidence ◽  
Population Based ◽  
Competing Risk ◽  
Olmsted County ◽  
Research Support ◽  
Risk Of Death

Background:Rheumatoid arthritis (RA) is a systemic inflammatory disease of the joints and other organs, including the lungs.1 Interstitial lung disease (ILD) is a lung injury pattern associated with significant symptom burden and poor outcomes in RA.2 Better understanding of its risk factors could help with disease prevention and treatment.Objectives:Using a population-based cohort, we sought to ascertain the incidence and risk factors of RA-associated ILD (RA-ILD) in recent years.Methods:The study included adult residents of Olmsted County, Minnesota with incident RA between 1999 and 2014 based on the 1987 ACR classification criteria.3 Study subjects were followed until death, migration, or 4/30/2019. ILD was defined by the presence of bilateral interstitial fibrotic changes (excluding biapical scarring) on chest computed tomography (CT). In the absence of chest CT imaging, a physician’s diagnosis of ILD in conjunction with chest X-ray findings suggestive of ILD and a restrictive pattern on pulmonary function testing (defined as a total lung capacity less than the lower limit of normal) was considered diagnostic of ILD. Evaluated risk factors included age, sex, calendar year, smoking status, body mass index (BMI) and presence/absence of rheumatoid factor (RF) and anti-citrullinated protein antibodies (ACPA). Cumulative incidence of ILD was adjusted for the competing risk of death. Cox models were used to assess the association between potential risk factors and the development of RA-ILD.Results:In Olmsted County, 645 residents were diagnosed with RA between 1999 and 2014. Seventy percent of patients were females, and 30% were males; median age at RA diagnosis was 55.3 [IQR 44.1-66.6] years, and most patients (89%) were white. Fifty-three percent of patients were never-smokers, and 64% had seropositive RA. Forty percent were obese (i.e., BMI ≥30 kg/m2); median BMI was 28.3 [IQR 24.3-33.0] kg/m2.In the cohort, ILD was identified in 73 patients. The ILD diagnosis predated RA diagnosis in 22 patients (3.4%) who were excluded from subsequent analyses. Final analyses included the remaining 623 patients with no ILD preceding, or at the time of RA diagnosis. Over a median follow-up interval of 10.2 [IQR 6.5-14.3] years, 51 patients developed ILD. Cumulative incidence of ILD, adjusted for the competing risk of death, was 4.3% at 5 years; 7.8% at 10 years; 9.4% at 15 years; and 12.3% at 20 years after RA diagnosis (Figure 1).Age, and history of smoking at RA diagnosis correlated with the incidence of ILD; adjusted hazard ratios (HRs) were 1.89 per 10-year increase in age (95% confidence interval 1.52-2.34) and 1.94 (95% confidence interval 1.10-3.42), respectively. On the other hand, sex (HR: 1.21; 95% CI: 0.68-2.17), BMI (HR: 0.99; 95% CI: 0.95-1.04), obesity (HR: 0.89; 95% CI: 0.50-1.58), and seropositivity (HR: 1.15; 95% CI: 0.65-2.03) did not demonstrate significant associations with ILD.Conclusion:This study provides a contemporary estimate of the occurrence of ILD in a well-characterized population-based cohort of patients with RA. Our findings of a lack of association between sex, obesity and seropositivity with ILD may indicate a change in established risk factors for ILD and warrant further investigation.References:[1]Shaw M, Collins BF, Ho LA, Raghu G. Rheumatoid arthritis-associated lung disease. Eur Respir Rev. 2015;24(135):1-16. doi:10.1183/09059180.00008014[2]Bongartz T, Nannini C, Medina-Velasquez YF, et al. Incidence and mortality of interstitial lung disease in rheumatoid arthritis - A population-based study. Arthritis Rheum. 2010;62(6):1583-1591. doi:10.1002/art.27405[3]Aletaha D, Neogi T, Silman AJ, et al. 2010 Rheumatoid arthritis classification criteria: An American College of Rheumatology/European League Against Rheumatism collaborative initiative. Arthritis Rheum. 2010;62(9):2569-2581. doi:10.1002/art.27584Figure 1.Cumulative incidence of ILD in patients diagnosed with RA between 1999 and 2014, adjusted for the competing risk of death. Abbreviations. ILD: interstitial lung disease; RA: rheumatoid arthritis.Disclosure of Interests:Bilal Samhouri: None declared, Robert Vassallo Grant/research support from: Research grants from Pfizer, Sun Pharmaceuticals and Bristol Myers Squibb, Sara Achenbach: None declared, Vanessa Kronzer: None declared, John M Davis III Grant/research support from: Research grant from Pfizer., Elena Myasoedova: None declared, Cynthia S. Crowson: None declared

scholarly journals A Population Based Study of the Incidence and Effect on Mortality of Venous Thromboembolism in Non-Hodgkins Lymphoma Patients in the Rituximab Era

Blood ◽  
2014 ◽  
Vol 124 (21) ◽  
pp. 2609-2609
Author(s):  
Aaron Rosenberg ◽  
Ann Brunson ◽  
Joseph Tuscano ◽  
Richard H. White ◽  
Ted Wun
Keyword(s):  
Venous Thromboembolism ◽  
Cumulative Incidence ◽  
Multivariable Analysis ◽  
Population Based ◽  
Population Based Study ◽  
Cox Models ◽  
Hodgkins Lymphoma ◽  
Risk Of Death ◽  
Increased Risk ◽  
Non Hodgkins Lymphoma

Abstract Background: Patients (pts) with non-Hodgkins lymphoma (NHL) are at increased risk of venous thromboembolism (VTE). We and others have demonstrated increased risk of death among NHL pts with incident VTE; however, these studies were largely conducted in the pre-rituximab era. We therefore analyzed a large cohort of NHL pts in the California Cancer Registry (CCR), determined the incidence of VTE, and evaluated its effect on survival in the rituximab era. Methods: Using the CCR linked with hospital discharge and emergency department records, we identified adult NHL pts diagnosed in 2005 – 2010, excluding cases ascertained via autopsy or death certificate, and those diagnosed with acute VTE in the 2 months preceding NHL diagnosis. VTE was defined by specific ICD-9-CM codes, and Elixhauser comorbidity score, excluding lymphoma, was calculated. Cumulative incidence was calculated using the Kaplan-Meier (KM) method. Adjusted hazard ratios (aHR) of VTE and death were estimated using Cox proportional hazard models, stratified by indolent vs aggressive NHL subtype, adjusting for age, race, stage, treatment, comorbidity and prior VTE. Analyses of VTE incidence treated death as a competing risk. Cox models for death incorporated VTE as a time-dependent covariate to account for immortal time bias. Results: NHL was identified in 18,424 pts. Most (n=12,963) had aggressive NHL (1,017 mantle cell, 11,246 diffuse large B-cell or follicular grade 3, 170 lymphoblastic, 530 Burkitt), while 5,461 had indolent NHL (2,809 follicular grade 1/2, 2,652 marginal zone). Median age was 64 years (yrs) and was similar in aggressive and indolent cohorts. Men accounted for 54% (n=9926) of cases, and were more common in aggressive compared to indolent NHL (7,317 (56%) vs 2,609 (48%) respectively). Most cases (62% n=11,451) were non-Hispanic White, 4% (n=795) were African American, 21% (n=3866) Hispanic, 11% Asian (n=2013) and 1.6% unknown (n=299). The ethnic distribution was similar in aggressive and indolent NHL. Median number of reported comorbid conditions was 2. Chemotherapy was initiated in 76% (n=9791) of aggressive NHL pts and 41% (n=2250) of indolent pts. The KM cumulative incidence of first time, acute VTE in NHL pts was 4.7% (95% CI 4.4 – 5.0) and 5.3% (95% CI 4.9- 5.6) at 1 and 2 years respectively. The incidence of VTE was higher in patients with aggressive versus indolent NHL (6.5% (95% CI 6.1 - 6.9) vs 2.3% (95% CI 2.0 - 2.8) at 2 yrs respectively P<0.001), and was highest during the first 6 months after dx (Figure). In multivariable analysis of aggressive lymphoma pts, the risk of VTE was higher among pts receiving chemotherapy (Ctx) [aHR 2.3, 95% CI (1.9 – 3.0)], lower in pts with stage II NHL [aHR 0.8, 95% CI (0.6 – 1.0)] while histological subtype of aggressive NHL was not a predictor. For indolent NHL, the risk of developing acute VTE was increased among cases that received Ctx [aHR 2.3, 95% CI (1.6 – 3.4)], and cases with follicular grade 1/2 [aHR 1.6, 95% CI (1.1 – 2.3)] whereas stage was not a significant risk factor. Five year overall survival for aggressive NHL was 55% (95% CI 46 – 56) and 80% (95% CI 69 – 82) for indolent NHL. In multivariable analysis risk of incident VTE after diagnosis of NHL dx was associated with an increased risk of death (Table). Interestingly, this effect was present for only the first 2 years after dx of aggressive NHL, while the effect persisted throughout follow-up for indolent NHL. Conclusions: This large, population based study, which captured essentially all patients diagnosed with NHL in California between 2005-2010, confirms prior reports of VTE incidence in NHL patients. Pts are at highest risk early in their course, and pts undergoing chemotherapy were at increased risk. Moreover, VTE subsequent to NHL diagnosis independently increases the risk of death adjusting for other important covariates. Whereas chemoimmunotherapy has negated the effect of some previous negative prognostic factors, the adverse effect of incident VTE persists in this recent cohort. Table:Association of VTE and Death* Aggressive NHL Indolent NHLTime from NHL dx to VTEaHR95% CIaHR95% CI0 – 6 months1.411.3 – 1.62.071.4 – 3.06 – 12 months1.401.1 – 1.82.591.4 – 4.712 – 24 months1.631.3 – 2.13.201.9 – 5.4>24 months0.940.7 – 1.22.371.6 – 3.6 *Cox models adjusted for Age, Sex, Race, Stage, Treatment, Prior VTE and Comorbidity Figure 1 Figure 1. Disclosures No relevant conflicts of interest to declare.

scholarly journals DOP72 Perianal Crohn’s Disease in the biologic era: A population-based cohort study

2021 ◽  
Vol 15 (Supplement_1) ◽  
pp. S105-S107
Author(s):  
P Jenkinson ◽  
N Plevris ◽  
M Lyons ◽  
S Siakavellas ◽  
I Arnott ◽  
...  
Keyword(s):  
Crohn’S Disease ◽  
Crohn's Disease ◽  
Cumulative Incidence ◽  
Population Based ◽  
Incidence Rates ◽  
Percentage Change ◽  
Prescription Data ◽  
Annual Percentage Change ◽  
Kaplan Meier ◽  
Significant Difference

Abstract Background Peri-anal Crohn’s disease (pCD) significantly affects quality of life in patients with CD. The natural history of pCD in the era of biologic therapy is poorly understood. Perianal surgery includes examination under anaesthesia (EUA), drainage of peri-anal sepsis, seton instertion and fistula manipulation. EUA forms part of the standard of care at diagnosis of pCD and therefore can be used as a proxy for incidence of pCD. Methods CD patients were identified from the Lothian IBD registry, a physician validated registry of all IBD cases within Lothian which has been shown to be 94.3% complete. Prospectively collected coding data was used to identify peri-anal surgery, which was validated by review of the electronic health record. Biologic prescription data was extracted from the Lothian biologics database; a physician validated, prospectively collected registry. Time trend analysis was performed for the period 2000 to 2017 by 1) calculating annual incidence rates of peri-anal interventions for all patients with CD and estimating annual percentage change and 2) by calculating cumulative incidence of pCD and biologic prescription in newly diagnosed CD and 3) stratifying by era of diagnosis (Cohort 1: 2000–2008 and Cohort 2: 2009–2017. Results 2937 patients with CD were identified in the study period, with 1108 operations for pCD performed on 381 patients. Rates of surgery fell from 5.1 to 2.0 operations per 100 CD patients per year between 2000 and 2017 (p&lt;0.001) giving an annual percentage change of -3.4% (-4.9% to -1.9% 95% CI) (fig 1). 1753 new diagnoses of CD were made of whom 247 developed pCD. 5 year risk of pCD was 12.8% (9.5–16.6%) with no significant difference identified between cohort 1 (11.5%) and cohort 2 (13.8%) (p=0.116) (fig 2). The 5 year incidence of biologic prescription for patients with pCD increased from 11.2% in cohort 1 to 58.1% in cohort 2 (p&lt;0.001) (fig 3). Figure 1: Number of peri-anal interventions per 100 CD patients per year (multiple procedures per patient included). Figure 2: Kaplan Meier curves showing cumulative incidence of pCD stratified by era of diagnosis. Figure 3: Kaplan Meier curves showing cumulative incidence of biologic prescription in patients with CD stratified by era of diagnosis and presence of pCD. Conclusion The incidence of pCD remains unchanged over time. Although we cannot ascribe causality, the overall decrease in surgery for pCD has been paralleled by a marked increase in the use of biologic medication.

scholarly journals Use of Lipid-lowering Agents in Rheumatoid Arthritis: A Population-based Cohort Study

2013 ◽  
Vol 40 (7) ◽  
pp. 1082-1088 ◽  
Author(s):  
Bharath Manu Akkara Veetil ◽  
Elena Myasoedova ◽  
Eric L. Matteson ◽  
Sherine E. Gabriel ◽  
Cynthia S. Crowson
Keyword(s):  
Rheumatoid Arthritis ◽  
General Population ◽  
Population Based ◽  
Lipid Lowering ◽  
Lipid Lowering Therapy ◽  
Lowering Therapy ◽  
Kaplan Meier ◽  
Increased Risk ◽  
Lipid Testing ◽  
Lipid Lowering Agents

Objective.Rheumatoid arthritis (RA) is associated with an increased risk of cardiovascular disease and mortality. Lipid-lowering therapy is reportedly underused in patients with RA. Longitudinal cohort studies comparing use of lipid-lowering medications in patients with RA versus the general population are lacking.Methods.Cardiovascular risk factors, lipid measures, and use of lipid-lowering agents were assessed in a population-based inception cohort of patients with RA and a cohort of non-RA subjects followed from January 1, 1988, to December 31, 2008. The National Cholesterol Education Program (NCEP) Adult Treatment Panel III (ATPIII) guidelines were assessed at the time of each lipid measure throughout followup. Time from meeting guidelines to initiation of lipid-lowering agents was assessed using Kaplan-Meier methods.Results.The study population included 412 RA and 438 non-RA patients with ≥ 1 lipid measure during followup and no prior use of lipid-lowering agents. Rates of lipid testing were lower among patients with RA compared to non-RA subjects. Among patients who met NCEP ATPIII criteria for lipid-lowering therapy (n = 106 RA; n = 120 non-RA), only 27% of RA and 26% of non-RA subjects initiated lipid-lowering agents within 2 years of meeting the guidelines for initiation.Conclusion.There was substantial undertreatment in both the RA and the non-RA cohorts who met NCEP ATPIII criteria for initiation of lipid-lowering agents. Patients with RA did not have as frequent lipid testing as individuals in the general population.

scholarly journals Incidence of Spondyloarthropathy in Patients with Crohn’s Disease: A Population-based Study

2012 ◽  
Vol 39 (11) ◽  
pp. 2148-2152 ◽  
Author(s):  
RAINA SHIVASHANKAR ◽  
EDWARD V. LOFTUS ◽  
WILLIAM J. TREMAINE ◽  
TIM BONGARTZ ◽  
W. SCOTT HARMSEN ◽  
...  
Keyword(s):  
New York ◽  
Crohn’S Disease ◽  
Crohn's Disease ◽  
Cumulative Incidence ◽  
Population Based ◽  
Clinical Effects ◽  
Extraintestinal Manifestation ◽  
Kaplan Meier ◽  
Asas Criteria ◽  
High Level

Objective.Spondyloarthritis (SpA) is an extraintestinal manifestation of inflammatory bowel disease with significant clinical effects, although the frequency is uncertain. We assessed the cumulative incidence and clinical spectrum of SpA in patients with Crohn’s disease (CD) in a population-based cohort.Methods.The medical records of a population-based cohort of Olmsted County, Minnesota, residents diagnosed with CD between 1970 and 2004 were reviewed. Patients were followed longitudinally until migration, death, or December 31, 2010. We used the European Spondylarthropathy Study Group, Assessment of Spondyloarthritis international Society (ASAS) criteria and modified New York criteria to identify patients with SpA. The Kaplan-Meier method was used to estimate the cumulative incidence of SpA following diagnosis of CD.Results.The cohort included 311 patients with CD (49.8% females; median age 29.9 yrs, range 8–89). Thirty-two patients developed SpA based on ASAS criteria. The cumulative incidence of SpA after CD diagnosis was 6.7% (95% CI 2.5%–6.7%) at 10 years, 13.9% (95% CI 8.7%–18.8%) at 20 years, and 18.6% (95% CI 11.0%–25.5%) at 30 years. The 10-year cumulative incidence of ankylosing spondylitis was 0, while both the 20-year and 30-year cumulative incidences were 0.5% (95% CI 0–1.6%).Conclusion.We have for the first time defined the actual cumulative incidence of SpA in CD using complete medical record information in a population-based cohort. The cumulative incidence of all forms of SpA increased to approximately 19% by 30 years from diagnosis of CD. Our results emphasize the importance of maintaining a high level of suspicion for SpA when following patients with CD.

scholarly journals The role of rheumatoid arthritis (RA) flare and cumulative burden of RA severity in the risk of cardiovascular disease

2015 ◽  
Vol 75 (3) ◽  
pp. 560-565 ◽  
Author(s):  
Elena Myasoedova ◽  
Arun Chandran ◽  
Birkan Ilhan ◽  
Brittny T Major ◽  
C John Michet ◽  
...  
Keyword(s):  
Rheumatoid Arthritis ◽  
Cardiovascular Disease ◽  
Moving Average ◽  
Population Based ◽  
Cvd Risk ◽  
Cox Models ◽  
Lower Tertile ◽  
American College Of Rheumatology ◽  
Index Of Severity

ObjectiveTo examine the role of rheumatoid arthritis (RA) flare, remission and RA severity burden in cardiovascular disease (CVD).MethodsIn a population-based cohort of patients with RA without CVD (age ≥30 years; 1987 American College of Rheumatology criteria met in 1988–2007), we performed medical record review at each clinical visit to estimate flare/remission status. The previously validated RA medical Records-Based Index of Severity (RARBIS) and Claims-Based Index of RA Severity (CIRAS) were applied. Age- and sex-matched non-RA subjects without CVD comprised the comparison cohort. Cox models were used to assess the association of RA activity/severity with CVD, adjusting for age, sex, calendar year of RA, CVD risk factors and antirheumatic medications.ResultsStudy included 525 patients with RA and 524 non-RA subjects. There was a significant increase in CVD risk in RA per time spent in each acute flare versus remission (HR 1.07 per 6-week flare, 95% CI 1.01 to 1.15). The CVD risk for patients with RA in remission was similar to the non-RA subjects (HR 0.90, 95% CI 0.51 to 1.59). Increased cumulative moving average of daily RARBIS (HR 1.16, 95% CI 1.03 to 1.30) and CIRAS (HR 1.38, 95% CI 1.12 to 1.70) was associated with CVD. CVD risk was higher in patients with RA who spent more time in medium (HR 1.08, 95% CI 0.98 to 1.20) and high CIRAS tertiles (HR 1.18, 95% CI 1.06 to 1.31) versus lower tertile.ConclusionsOur findings show substantial detrimental role of exposure to RA flare and cumulative burden of RA disease severity in CVD risk in RA, suggesting important cardiovascular benefits associated with tight inflammation control and improved flare management in patients with RA.

Depression as a Mediator of the Association Between Wealth Status and Risk of Cognitive Impairment and Dementia: A Longitudinal Population-Based Cohort Study

2021 ◽  
pp. 1-11
Author(s):  
Rui Zhou ◽  
Hua-Min Liu ◽  
Fu-Rong Li ◽  
Hai-Lian Yang ◽  
Jia-Zhen Zheng ◽  
...  
Keyword(s):  
Cognitive Impairment ◽  
Population Based ◽  
Cognitive Status ◽  
Wealth Status ◽  
Cox Models ◽  
Mediating Role ◽  
Hazard Ratios ◽  
Increased Risk ◽  
Time Dependent Covariates

Background: Wealth and income are potential modifiable risk factors for dementia, but whether wealth status, which is composed of a combination of debt and poverty, and assessed by wealth and income, is associated with cognitive impairment among elderly adults remains unknown. Objective: To examine the associations of different combinations of debt and poverty with the incidence of dementia and cognitive impairment without dementia (CIND) and to evaluate the mediating role of depression in these relationships. Methods: We included 15,565 participants aged 51 years or older from the Health and Retirement Study (1992–2012) who were free of CIND and dementia at baseline. Dementia and CIND were assessed using either the modified Telephone Interview for Cognitive Status (mTICS) or a proxy assessment. Cox models with time-dependent covariates and mediation analysis were used. Results: During a median of 14.4 years of follow-up, 4,484 participants experienced CIND and 1,774 were diagnosed with dementia. Both debt and poverty were independently associated with increased dementia and CIND risks, and the risks were augmented when both debt and poverty were present together (the hazard ratios [95% confidence intervals] were 1.35 [1.08–1.70] and 1.96 [1.48–2.60] for CIND and dementia, respectively). The associations between different wealth statuses and cognition were partially (mediation ratio range: 11.8–29.7%) mediated by depression. Conclusion: Debt and poverty were associated with an increased risk of dementia and CIND, and these associations were partially mediated by depression. Alleviating poverty and debt may be effective for improving mental health and therefore curbing the risk of cognitive impairment and dementia.

scholarly journals Improved Incidence of Cardiovascular Disease in Patients with Incident Rheumatoid Arthritis in the 2000s: a Population-Based Cohort Study

2021 ◽  
pp. jrheum.200842 ◽  
Author(s):  
Elena Myasoedova ◽  
John M. Davis ◽  
Veronique L. Roger ◽  
Sara J. Achenbach ◽  
Cynthia S. Crowson
Keyword(s):  
Rheumatoid Arthritis ◽  
Cardiovascular Disease ◽  
Population Based ◽  
Source Population ◽  
Cvd Risk Factors ◽  
Stroke Patients ◽  
Cvd Risk ◽  
Cox Models ◽  
Risk Of Death ◽  
Strength Of Association

Objective To assess trends in incidence of cardiovascular disease (CVD) and mortality following incident CVD events in patients with rheumatoid arthritis (RA) onset in 1980- 2009 versus non-RA subjects. Methods We studied Olmsted County, Minnesota residents with incident RA (age ≥ 18 years, 1987 ACR criteria met in 1980-2009) and non-RA subjects from the same source population with similar age, sex and calendar year of index. All subjects were followed until death, migration, or 12/31/2016. Incident CVD events included myocardial infarction and stroke. Patients with CVD before RA incidence/index date were excluded. Cox models were used to compare incident CVD events by decade, adjusting for age, sex and CVD risk factors. Results The study included 905 patients with RA and 904 non-RA subjects. Cumulative incidence of any CVD event was lower in patients with incident RA in 2000s versus 1980s. Hazard Ratio [HR] for any incident CVD 2000s versus 1980s: 0.53; 95% confidence interval (CI): 0.31-0.93. The strength of association attenuated after adjustment for anti-rheumatic medication use: HR 0.64, 95%CI 0.34-1.22. Patients with RA in 2000s had no excess in CVD over non-RA subjects (HR: 0.71, 95%CI:0.42-1.19). Risk of death after a CVD event was somewhat lower in patients with RA after 1980s: HR: 0.54, 95%CI:0.33-0.90 in 1990s and HR: 0.68, 95%CI:0.33-1.41 in 2000s versus 1980s. Conclusion Incidence of major CVD events in RA has declined in recent decades. The gap in CVD occurrence between RA patients and the general population is closing. Mortality after CVD events in RA may be improving.

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