Associations between multiple long-term conditions and mortality in diverse ethnic groups

Background Multiple conditions are more prevalent in some minoritised ethnic groups and are associated with higher mortality rate but studies examining differential mortality once conditions are established is US-based. Our study tested whether the association between multiple conditions and mortality varies across ethnic groups in England. Methods and Findings A random sample of primary care patients from Clinical Practice Research Datalink (CPRD) was followed from 1st January 2015 until 31st December 2019. Ethnicity, usually self-ascribed, was obtained from primary care records if present or from hospital records. Cox regression models were used to estimate mortality by number of long-term conditions, ethnicity and their interaction, with adjustment for age and sex for 532,059 patients with complete data. During five years of follow-up, 5.9% of patients died. Each additional long-term condition at baseline was associated with increased mortality. This association differed across ethnic groups. Compared with 50-year-olds of white ethnicity with no conditions, the mortality rate was higher for white 50-year-olds with two conditions (HR 1.77) or four conditions (HR 3.13). Corresponding figures were higher for 50-year-olds of Black Caribbean ethnicity with two conditions (HR=2.22) or four conditions (HR 4.54). The direction of the interaction of number of conditions with ethnicity showed higher mortality associated with long-term conditions in nine out of ten minoritised ethnic groups, attaining statistical significance in four (Pakistani, Black African, Black Caribbean and Black other ethnic groups). Conclusions The raised mortality rate associated with having multiple conditions is greater in minoritised ethnic groups compared with white people. Research is now needed to identify factors that contribute to these inequalities. Within the health care setting, there may be opportunities to target clinical and self-management support for people with multiple conditions from minoritised ethnic groups.

Gender Inequalities and Sex-Differential Mortality in Pre-War Greece: A Regional Perspective

Previous studies have indicated gender-based discriminatory practices as a result of son preference up to the first half of the 20th century in Greece. Demographic indices calculated from published vital statistics, such as sex ratios at birth and at childhood, were distorted to such an extent that certain scholars suggest that this distortion was due to sex-selective infanticide and neglect of the girls. Although we cannot exclude this possibility, the aim of this paper is to assess to what extent under-registration of female births (in the civil registration system) and under-enumeration of females (in censuses) accounted for the skewed sex ratios and to pinpoint that gender-based discrimination was not the same all over Greece. There were areas in insular Greece, notably the Ionian islands and the Aegean Archipelago, and one area in mainland Greece (Epirus) where demographic indices imply that gender inequalities were less acute. On the other hand, there were areas in mainland Greece, notably in Thessaly, where sex-differential mortality denotes extremely unequal treatment of girls.

The Role of Hospice in Florida Nursing Homes Post-Hurricane Irma

There is little known about the effect of hospice post-disaster. This study utilized exposure to Hurricane Irma (2017) to evaluate the differential mortality effect of the disaster on Florida NH residents (N=45,882) compared to a control group of residents in the same NHs in 2015 (N=47,690) by hospice status. We also examine the difference in hospice utilization rates post-storm for short- and long-stay (LS) residents. There was an increase in mortality for those in the cohort not on hospice within 90 days in 2017 compared to 2015 (OR= 1.06, 95% CI: 1.01, 1.11). For the rate of hospice enrollment post-storm among residents previously not on hospice, there was an increase among LS residents within 30 days (OR =1.15, 95% CI: 1.02, 1.23) and 90 days (OR= 1.12, 95% CI: 1.05, 1.20). It is important to further examine the increase in the rate of hospice enrollment in LS NH residents post-storm.

Population Ecology Studies on Infaunal Polychaetes of Pauatahanui Inlet

<p>Macrofaunal polychaete densities across a stable, fine-sand, intertidal flat in Pauatahanui Inlet were examined from a set of seasonal samples, 500 micron sieve processed, from a stratified transect pair. Density Patterns had shore-normal trends, despite apparently weak tidal-cycle environmental gradients. Zones of high abundance of common species persisted unchanged, but seasonal increase and decline occurred within them, with also some population redistribution attributable to differential mortality/recruitment, or possibly to migration. Correlation analysis did not detect interspecies relationships linked to the abundance and zonation of the common polychaetes, all deposit-feeders. The population dynamics of six species was investigated from the transect-pair seasonal samples, supplemented by subsequent more finely-sieved samples during dense recruitment periods. The maldanid Axiothella serrata had three identifiable age groups O, I, and II+, with I plus II+ density to about 550 m-2. The new O group began to appear in October-November, as aggregates below 3 cm sediment depth, believed to represent lecithotropic, direct-developing, siblings from egg masses of the II+ group. Juvenile setiger-total frequencies indicated synchronous adult spawning occurred at varying intervals during an approximate six month period. Peak density of dispersed, near-surface recruits reached 29 thousand m-2. Setiger-total was the most sensitive indicator of size and age in juveniles of up to about 15 setigers. Zonation patterns were age specific. The predominantly lower-shore capitellid, Heteromastus filiformis had a short summer spawning period with settlement ending before May, when population density was up to 10 thousand m-2. Merger of O group into the adult size range occurred in about one year, and probably first spawning was at the end of the second year, with life span of three years or more. The nereidid Nicon aestuariensis had I+ and older age groups at barely detectable densities. Spawning was probably in late summer although an O group, at about 500 m-2, was not detected until May. The spionid Scolecolepides benhami had apparently unchanging size structure and density (about 400 m-2 transect-wide); new settlement was not detected. High density occurred only in a narrow near-shore strip. Nicon aestuariensis also declined down-shore, but more gradually. The spionid Microspio sp. and capitellid Capitella sp. were short-lived, near-surface species, with apparently continuous recruitment from planktotrophic and direct-development respectively. A spring recruitment increase created at first a separate modal group of juveniles, and raised Microspio sp. density to 45 thousand m-2 and Capitella sp. to 7 thousand m-2. Capitella sp. declined in density downshore, but Microspio sp. was only weakly zoned. The common polychaetes had largely concordant density cycles with settlement (or peak settlement) spring-summer orientated, although 500 micron mesh processing detected the peak of surviving adults in autumn-winter. Pauatahanui polychaetes as an assemblage, life history traits, links between population structure and zonation, and problems in polychaete population studies are discussed.</p>

Population Ecology Studies on Infaunal Polychaetes of Pauatahanui Inlet

<p>Macrofaunal polychaete densities across a stable, fine-sand, intertidal flat in Pauatahanui Inlet were examined from a set of seasonal samples, 500 micron sieve processed, from a stratified transect pair. Density Patterns had shore-normal trends, despite apparently weak tidal-cycle environmental gradients. Zones of high abundance of common species persisted unchanged, but seasonal increase and decline occurred within them, with also some population redistribution attributable to differential mortality/recruitment, or possibly to migration. Correlation analysis did not detect interspecies relationships linked to the abundance and zonation of the common polychaetes, all deposit-feeders. The population dynamics of six species was investigated from the transect-pair seasonal samples, supplemented by subsequent more finely-sieved samples during dense recruitment periods. The maldanid Axiothella serrata had three identifiable age groups O, I, and II+, with I plus II+ density to about 550 m-2. The new O group began to appear in October-November, as aggregates below 3 cm sediment depth, believed to represent lecithotropic, direct-developing, siblings from egg masses of the II+ group. Juvenile setiger-total frequencies indicated synchronous adult spawning occurred at varying intervals during an approximate six month period. Peak density of dispersed, near-surface recruits reached 29 thousand m-2. Setiger-total was the most sensitive indicator of size and age in juveniles of up to about 15 setigers. Zonation patterns were age specific. The predominantly lower-shore capitellid, Heteromastus filiformis had a short summer spawning period with settlement ending before May, when population density was up to 10 thousand m-2. Merger of O group into the adult size range occurred in about one year, and probably first spawning was at the end of the second year, with life span of three years or more. The nereidid Nicon aestuariensis had I+ and older age groups at barely detectable densities. Spawning was probably in late summer although an O group, at about 500 m-2, was not detected until May. The spionid Scolecolepides benhami had apparently unchanging size structure and density (about 400 m-2 transect-wide); new settlement was not detected. High density occurred only in a narrow near-shore strip. Nicon aestuariensis also declined down-shore, but more gradually. The spionid Microspio sp. and capitellid Capitella sp. were short-lived, near-surface species, with apparently continuous recruitment from planktotrophic and direct-development respectively. A spring recruitment increase created at first a separate modal group of juveniles, and raised Microspio sp. density to 45 thousand m-2 and Capitella sp. to 7 thousand m-2. Capitella sp. declined in density downshore, but Microspio sp. was only weakly zoned. The common polychaetes had largely concordant density cycles with settlement (or peak settlement) spring-summer orientated, although 500 micron mesh processing detected the peak of surviving adults in autumn-winter. Pauatahanui polychaetes as an assemblage, life history traits, links between population structure and zonation, and problems in polychaete population studies are discussed.</p>

752. Costs Attributable to Clostridioides difficile Infection in the Presence of Differential Mortality

Background CDI imposes a major burden on the U.S. healthcare system. Obtaining accurate estimates of economic costs is critical to determining the cost-effectiveness of preventive measures. This task is complicated by differences in epidemiology, mortality, and baseline health status of infected and uninfected individuals, and by the statistical properties of costs data (e.g., right-skewed, excess of zeros costs). Methods Incident CDI cases were identified from Medicare 5% fee-for-service data between 2011 and 2017 and classified into standard surveillance definitions: hospital-onset (HO); other healthcare facility-onset (OHFO); community-onset, healthcare-associated (CO-HCFA); or community-associated (CA). Cases were frequency matched 1:4 to uninfected controls based on age, sex, and year of CDI. Controls were assigned to surveillance definitions based on location at index dates. Medicare allowed costs were summed in 30-day intervals up to 3 years following index. One- and 3-year cumulative costs attributable to CDI were computed using a 3-part estimator consisting of a parametric survival model and a pair of 2-part models predicting costs separately in intervals where death did and did not occur, adjusting for underlying acute and chronic conditions. Results 60,492 CDI cases (Figure 1) were matched to 241,968 controls. Three-year mortality was higher among CDI cases compared to matched controls for HO (45% vs 26%) and OHFO (42% vs 36%), whereas mortality was slightly lower for CDI cases compared to controls for those with community onset (CO-HCFA: 28% vs 32%; CA: 10% vs 11%). One- and 3-year attributable costs due to CDI are shown in Figure 2. Adjusted 1-year attributable costs amounted to &26,954 (95% CI: &26,154–&27,939) for HO; &10,539 (&9,564–&11,518) for OHFO; &6,525 (&5,012–&8,171) for CO-HCFA; and &3,171 (&1,841–&4,200) for CA. Adjusted 3-year attributable costs were &44,736 (&43,063–&46,483) for HO; &13,994 (&12,529–&15,975) for OHFO; &7,349 (&4,738–&10,246) for CO-HCFA; and &2,377 (&166–&4,722) for CA. Figure 1. Proportion of Cases by CDI Surveillance Definitions Abbreviations: HO: hospital-onset; OHFO: other healthcare facility-onset; CO-HCFA: community-onset, healthcare-associated; CA: community-associated. Figure 2. Estimates of Costs Attributable to CDI by CDI Surveillance Definitions at One and Three Years after Onset Top panels: One-year cost estimates. Bottom panels: Three-year cost estimates. Abbreviations: HO: hospital-onset; OHFO: other healthcare facility-onset; CO-HCFA:community-onset, healthcare-associated; CA:community-associated. Conclusion CDI was associated with increased healthcare costs across surveillance definitions in Medicare fee-for-service patients after adjusting for survival and underlying conditions. Disclosures Dustin Stwalley, MA, AbbVie Inc (Shareholder)Bristol-Myers Squibb (Shareholder) Margaret A. Olsen, PhD, MPH, Pfizer (Consultant, Research Grant or Support) Holly Yu, MSPH, Pfizer (Employee) Erik R. Dubberke, MD, MSPH, Ferring (Grant/Research Support)Merck (Consultant)Pfizer (Consultant, Grant/Research Support)Seres (Consultant)Summit (Consultant)

AnthropoAge, a novel approach to integrate body composition into the estimation of biological age

Methods to estimate biological age (BA) capture different aspects of aging. Here, we consider the role of changes in body composition related to aging as a starting point to incorporate anthropometry into the estimation of BA. To that end, we developed AnthropoAge, a metric to estimate 10-year mortality risk as a proxy of BA using anthropometric and linked mortality data from NHANES-III (n=11,865) and validated it in NHANES-IV (n=7,065). We identified that thigh circumference, arm circumference, body-mass index (BMI), waist-to-height ratio (WHtR) and arm length were useful to predict BA in men, whilst weight, thigh circumference, subscapular and tricipital skinfolds and WHtR in women. We also developed a simplified version of AnthropoAge (S-AnthropoAge) which used only BMI and WHtR, with strong concordance with the complete metric. Both AnthropoAge and S-AnthropoAge were useful to predict 10-year mortality independent of ethnicity, sex, and comorbidities. In comparison to PhenoAge, AnthropoAge/S-AnthropoAge were superior for prediction of cardiovascular, cerebrovascular, cancer-related and nephritis/nephrosis related mortality risk in contrast with other causes. Accelerated aging metrics AnthropoAgeAccel/S-AnthropoAgeAccel identified males with phenotypes of decreased lean and fat mass and females with phenotypes of increased fat mass and increased abdominal adiposity, which likely reflected sexual dimorphisms related to accelerated body composition aging. When jointly assessing PhenoAge and AnthropoAge/S-AnthropoAge, we identified unique aging trajectories with differential mortality risk and comorbidity clustering. AnthropoAge is a useful proxy of BA, which captures cause-specific mortality risk; assessing aging using different BA measures may be useful to better characterize the heterogeneity of the aging process.