scholarly journals Demographic disparities in clinical outcomes of COVID-19: data from a statewide cohort in South Carolina

2021 ◽  
Author(s):  
Xueying Yang ◽  
Jiajia Zhang ◽  
Shujie Chen ◽  
Bankole Olatosi ◽  
Larisa Bruner ◽  
...  
Keyword(s):  
Older Adults ◽  
South Carolina ◽  
Clinical Outcomes ◽  
Disease Severity ◽  
Rural Areas ◽  
Population Based ◽  
Health Care Facilities ◽  
Case Report Form ◽  
Risk Of Death ◽  
Asian Patients

Abstract Background Current literature examining the clinical characteristics of COVID-19 patients under-represent COVID-19 cases who were either asymptomatic or had mild symtoms. Methods We analyzed statewide data from 280,177 COVID-19 cases from various health care facilities during March 04–December 31, 2020. Each COVID-19 case was reported using the standardized Case Report Form (CRF), which collected information on demographic characteristics, symptoms, hospitalization, and death. We used multivariable logistic regression to analyze the associations between socio-demographics and disease severity, hospitalization and mortality. Results Among a total of 280,177 COVID-19 cases, 5.2% (14,451) were hospitalized and 1.9% (5,308) died. Older adults, males, and Black individuals had higher odds for hospitalization and death from COVID-19 (Ps<0.0001). Particularly, individuals residing in rural areas experienced a high risk of death (OR: 1.16; 95%CI: 1.08, 1.25). Regarding disease severity, older adults (OR: 1.06, 95%CI: 1.03, 1.10) and Hispanic or Latino patients (OR: 2.06; 95%CI: 1.95, 2.18), had higher odds of experiencing moderate/severe symptoms, while male and Asian patients, compared to White patients, had lower odds of experiencing moderate/severe symptoms. Conclusions As the first statewide population-based study using data from multiple healthcare systems with a long follow-up period in the US, we provide a more generalizable picture of COVID-19 symptoms and clinical outcomes. The findings from this study reinforce the fact that rural residence and racial/ethnic social determinants of health, unfortunately, remain predictors of adverse health outcomes for COVID-19 patients.

Higher sRAGE Levels Predict Mortality in Frail Older Adults with Cardiovascular Disease

Gerontology ◽  
2021 ◽  
pp. 1-9
Author(s):  
Lee Butcher ◽  
Jose Antonio Carnicero ◽  
Karine Pérès ◽  
Marco Colpo ◽  
David Gomez Cabrero ◽  
...  
Keyword(s):  
Older Adults ◽  
Cox Regression ◽  
Population Based ◽  
Blood Levels ◽  
Roc Curve Analysis ◽  
Baseline Serum ◽  
Frailty Status ◽  
Risk Of Death ◽  
Survival Difference ◽  
Increased Risk

<b><i>Introduction:</i></b> The evidence that blood levels of the soluble receptor for advanced glycation end products (sRAGE) predict mortality in people with cardiovascular diseases (CVD) is inconsistent. To clarify this matter, we investigated if frailty status influences this association. <b><i>Methods:</i></b> We analysed data of 1,016 individuals (median age, 75 years) from 3 population-based European cohorts, enrolled in the FRAILOMIC project. Participants were stratified by history of CVD and frailty status. Mortality was recorded during 8 years of follow-up. <b><i>Results:</i></b> In adjusted Cox regression models, baseline serum sRAGE was positively associated with an increased risk of mortality in participants with CVD (HR 1.64, 95% CI 1.09–2.49, <i>p</i> = 0.019) but not in non-CVD. Within the CVD group, the risk of death was markedly enhanced in the frail subgroup (CVD-F, HR 1.97, 95% CI 1.18–3.29, <i>p</i> = 0.009), compared to the non-frail subgroup (CVD-NF, HR 1.50, 95% CI 0.71–3.15, <i>p</i> = 0.287). Kaplan-Meier analysis showed that the median survival time of CVD-F with high sRAGE (&#x3e;1,554 pg/mL) was 2.9 years shorter than that of CVD-F with low sRAGE, whereas no survival difference was seen for CVD-NF. Area under the ROC curve analysis demonstrated that for CVD-F, addition of sRAGE to the prediction model increased its prognostic value. <b><i>Conclusions:</i></b> Frailty status influences the relationship between sRAGE and mortality in older adults with CVD. sRAGE could be used as a prognostic marker of mortality for these individuals, particularly if they are also frail.

Gender differences in cardiovascular risk assessment in elderly adults in Ecuador: evidence from a national survey

2018 ◽  
Vol 67 (4) ◽  
pp. 736-742
Author(s):  
Ivan Sisa
Keyword(s):  
Risk Factors ◽  
Older Adults ◽  
Cardiovascular Risk ◽  
Rural Areas ◽  
Risk Model ◽  
Smoking Status ◽  
Population Based ◽  
Cvd Risk ◽  
Serum Triglycerides ◽  
Traditional Risk Factors

The present study aimed to predict the risk of developing cardiovascular disease (CVD) over a 5-year period and how it might vary by sex in an ethnically diverse population of older adults. We used a novel CVD risk model built and validated in older adults named the Systematic Coronary Risk Evaluation in Older Persons (SCORE OP). A population-based study analyzed a total of 1307 older adults. Analyses were done by various risk categories and sex. Of the study population, 54% were female with a mean age of 75±7.1 years. According to the SCORE OP model, individuals were classified as having low (9.8%), moderate (48.1%), and high or very high risk (42.1%) of CVD-related mortality. Individuals at higher risk of CVD were more likely to be male compared with females, 53.9% vs 31.8%, respectively (p<0.01). Males were more likely to be younger, living in rural areas, had higher levels of schooling, and with the exception of smoking status and serum triglycerides, had lower values of traditional risk factors than females. In addition, males were less likely to require blood pressure-lowering therapy and statin drugs than females. This gender inequality could be driven by sociocultural determinants and a risk factor paradox in which lower levels of the cardiovascular risk factors are associated with an increase rather than a reduction in mortality. These data can be used to tailor primary prevention strategies such as lifestyle counseling and therapeutic measures in order to improve male elderly health, especially in low-resource settings.

Survival Disparities in Patients with Lymphoma According to Place of Residence and Treatment Provider: A Population-Based Study

Blood ◽  
2008 ◽  
Vol 112 (11) ◽  
pp. 874-874
Author(s):  
Fausto R Loberiza ◽  
Anthony J Cannon ◽  
Dennis D Weisenburger ◽  
Julie M. Vose ◽  
Matt J. Moehr ◽  
...  
Keyword(s):  
Overall Survival ◽  
High Risk ◽  
Rural Areas ◽  
Urban Areas ◽  
Population Based ◽  
Place Of Residence ◽  
Community Based ◽  
Risk Levels ◽  
Risk Of Death ◽  
Risk Patients

Abstract Objectives: We evaluated the association of the primary area of residence (urban vs. rural) and treatment (trt) provider (university-based vs. community-based) with overall survival in patients with lymphoma, and determined if there are patient subgroups that could benefit from better coordination of care. Methods: We performed a population-based study in 2,330 patients with centrally confirmed lymphoma from Nebraska and surrounding states reported to the Nebraska Lymphoma Study Group between 1982 and 2006. Patient residential ZIP codes at the time to trt were used to determine rural/urban designation, household income and distance to trt center; while trt providers were categorized into university-based or community based. Multivariate analyses were used to group patients into risk levels based on 8 factors found to be associated with survival at the time of trt (age, performance score, Ann Arbor stage, presence of B symptoms, LDH levels, tumor bulk, nodal and extranodal involvement). The following categories were identified: low-risk (1–3 factors), intermediate risk (4–5 factors), and high-risk (≥6 factors). Cox proportional regression analyses, stratified by type of lymphoma (low-grade NHL, high-grade NHL and Hodgkin) were used to evaluate the association between place of residence and trt provider with overall survival. Results: Among urban residents, 321 (14%) were treated by university-based providers (UUB) and 816 (35%) were treated by community-based providers (UCB). Among rural residents, 332 (14%) were treated by university-based providers (RUB) and 861 (37%) were treated by community-based providers (RCB). Patients from rural areas were more likely to be older and Caucasian, with a lower median household income, greater travel distance to seek trt, and more likely to have high-risk disease when compared to patients from urban areas. In multivariate analysis, using all patients regardless of risk level, the relative risk of death (RR) among UUB, UCB and RUB was not statistically different. However, RCB had a higher risk of death RR 1.37, 95% CI 1.14–1.65, p=0.01; RR 1.18, 95% CI 1.04–1.33, p<0.01; and RR 1.26, 95% CI 1.06–1.49, p=0.01 when compared with UUB, UCB and RUB, respectively. This association remained true in both low- and intermediate-risk patients. Among high-risk patients, both RUB and RCB were at higher risk of death when compared with UUB or UCB, while UCB were not different from UUB. We found no differences in progression-free survival according to place of residence and trt provider. The use of stem cell transplantation was significantly higher in patients coming from urban and rural areas treated by university-based providers (UUB 19%, RUB 16%) compared to urban and rural patients treated by community-based providers (UCB 11%, RCB 10%, p < 0.01). Patients from rural areas (RUB and RCB) were slightly less likely to die from lymphoma-related causes than patients from urban areas (75% versus 80%, p=0.04). Conclusion: Overall survival in patients with lymphoma is inferior in patients coming from rural areas. This relationship varies according to treatment provider and pretreatment risk levels. Further studies in patients from rural areas are needed to understand how coordination of care is carried to design appropriate interventions that may improve the disparity noted.

scholarly journals Hypertension May Reduce the Infection Risk but Increase the Severity of COVID-19: Based on the Current Data in China

2021 ◽  
Vol 2021 ◽  
pp. 1-12
Author(s):  
Bo Li ◽  
Lu Zeng ◽  
Nengjun Sun ◽  
Yunhe Zhao ◽  
Faming Zhao ◽  
...  
Keyword(s):  
General Population ◽  
Clinical Outcomes ◽  
Disease Severity ◽  
Meta Analysis ◽  
Infection Risk ◽  
Current Data ◽  
Google Scholar ◽  
Icu Patients ◽  
Risk Of Death

Increasing evidence has shown an unusual relationship between hypertension and COVID-19, which may not be as simple as previously thought. The purpose of our study was to determine the association of hypertension with the onset and development of COVID-19. A meta-analysis was performed to summarize the prevalence of hypertension in COVID-19 patients, as well as the usage of ACEIs/ARBs. Metaregression analyses were used to evaluate the association of hypertension with disease severity and mortality. PubMed and Google Scholar were searched for relevant studies. A total of 42 studies including 14138 patients were enrolled in the study. The proportion of hypertension in COVID-19 patients in China was 17.7% according to the enrolled studies, while it was 6.0% in a study containing 72314 confirmed cases, which are both much lower than in the general population. All of the data from the 11 provinces in China showed the same tendency. The proportions of hypertension were higher in severe/ICU patients and nonsurvivors than in nonsevere/ICU patients and survivors. The metaregression analyses suggested that both disease severity and risk of death were associated with the incidence of hypertension. A total of 27.6% of COVID-19 patients with hypertension received ACEI/ARB therapy. The proportion of deaths in COVID-19 patients with hypertension treated with ACEIs/ARBs was significantly lower than that in nonuse patients treated with ACEIs/ARBs. In conclusion, hypertension may reduce the infection risk of COVID-19 but increase the risk of developing worse clinical outcomes. The use of ACEIs/ARBs may benefit COVID-19 patients with hypertension.

Physical Work and Exercise Reduce the Risk of Cognitive Impairment in Older Adults: A Population-based Longitudinal Study

2021 ◽  
Vol 18 ◽  
Author(s):  
Fan He ◽  
Junfen Lin ◽  
Fudong Li ◽  
Yujia Zhai ◽  
Tao Zhang ◽  
...  
Keyword(s):  
Older Adults ◽  
Cognitive Impairment ◽  
Rural Areas ◽  
Tai Chi ◽  
Cox Regression ◽  
Population Based ◽  
Independent Effect ◽  
Physical Work ◽  
Protective Effects

Background: The independent effect of physical work on the risk of cognitive impairment in older Chinese adults living in rural areas remains to be elucidated. Objective: We aimed to determine whether physical work and physical exercise can reduce the risk of cognitive impairment. Methods: We collected data from 7,000 permanent residents without cognitive impairment (age ≥60 years) over a follow-up period of 2 years. We used the Chinese version of the Mini-Mental State Ex- amination (MMSE) to assess cognitive function. We performed multivariate Cox regression analyses to calculate adjusted hazard ratios (HRs) and 95% confidence intervals (%95 CIs) as measures of the association between physical work/exercise and cognitive impairment while controlling for potential confounders. Results: Over a median follow-up period of 1.93 years, 1,224 (17.5%) of 7,000 participants developed cognitive impairment, with a total incidence of 97.69 per 1,000 person-years. After adjustment for potential confounders, participating in physical work (HR: 0.51; 95% CI: 0.43-0.60) or physical exer- cise (HR: 0.53; 95% CI: 0.44-0.65) was associated with a reduced risk of cognitive impairment. Strati- fied analyses suggested additive and multiplicative interactions between physical work and exercise. Agricultural work (HR: 0.46; 95% CI: 0.38-0.55), walking/tai chi (HR: 0.54; 95% CI: 0.44-0.67), and brisk walking/yangko (HR: 0.57; 95% CI: 0.33-0.97) exerted significant protective effects against cognitive impairment. Conclusion: Both physical work and exercise can reduce the risk of cognitive impairment in older adults. Reasonable types and appropriate intensities of physical activity are recommended to prevent or delay the progression of cognitive impairment.

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

2014 ◽  
Vol 18 (10) ◽  
pp. 1839-1846 ◽  
Author(s):  
Wei-Sheng Chung ◽  
Feng-Ming Ho ◽  
Nan-Cheng Cheng ◽  
Meng-Chih Lee ◽  
Chih-Jung Yeh
Keyword(s):  
Older Adults ◽  
Cohort Study ◽  
Population Based ◽  
Normal Weight ◽  
Hazard Ratio ◽  
Adjusted Hazard Ratio ◽  
Middle Aged ◽  
Obese People ◽  
Risk Of Death ◽  
All Cause Mortality

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

scholarly journals Is the association between blood pressure and mortality in older adults different with frailty? A systematic review and meta-analysis

2019 ◽  
Vol 48 (5) ◽  
pp. 627-635 ◽  
Author(s):  
Oliver M Todd ◽  
Chris Wilkinson ◽  
Matthew Hale ◽  
Nee Ling Wong ◽  
Marlous Hall ◽  
...  
Keyword(s):  
Blood Pressure ◽  
Older Adults ◽  
Systolic Blood Pressure ◽  
Clinical Outcomes ◽  
Observational Studies ◽  
Meta Analysis ◽  
Current Evidence ◽  
Risk Of Death ◽  
All Cause Mortality ◽  
Mortality Difference

Abstract Objective to investigate whether the association between blood pressure and clinical outcomes is different in older adults with and without frailty, using observational studies. Methods MEDLINE, EMBASE and CINAHL were searched from 1st January 2000 to 13th June 2018. PROSPERO CRD42017081635. We included all observational studies reporting clinical outcomes in older adults with an average age over 65 years living in the community with and without treatment that measured blood pressure and frailty using validated methods. Two independent reviewers evaluated study quality and risk of bias using the ROBANS tool. We used generic inverse variance modelling to pool risks of all-cause mortality adjusted for age and sex. Results nine observational studies involving 21,906 older adults were included, comparing all-cause mortality over a mean of six years. Fixed effects meta-analysis of six studies demonstrated that in people with frailty, there was no mortality difference associated with systolic blood pressure <140 mm Hg compared to systolic blood pressure >140 mm Hg (HR 1.02, 95% CI 0.90 to 1.16). In the absence of frailty, systolic blood pressure <140 mm Hg was associated with lower risk of death compared to systolic blood pressure >140 mm Hg (HR 0.86, 95% CI 0.77 to 0.96). Conclusions evidence from observational studies demonstrates no mortality difference for older people with frailty whose systolic blood pressure is <140 mm Hg, compared to those with a systolic blood pressure >140 mm Hg. Current evidence fails to capture the complexities of blood pressure measurement, and the association with non-fatal outcomes.

scholarly journals Effect of comorbidity on the risk of death associated with antipsychotic use among community-dwelling older adults

2012 ◽  
Vol 24 (7) ◽  
pp. 1058-1064 ◽  
Author(s):  
Natasa Gisev ◽  
Sirpa Hartikainen ◽  
Timothy F. Chen ◽  
Mikko Korhonen ◽  
J. Simon Bell
Keyword(s):  
Older Adults ◽  
Respiratory Disease ◽  
Population Based ◽  
Community Dwelling ◽  
Risk Of Death ◽  
Hazard Ratios ◽  
Increased Risk ◽  
Cox Proportional Hazard Models ◽  
Antidepressant Use ◽  
Community Dwelling Older Adults

ABSTRACTBackground: Antipsychotics are associated with adverse events and mortality among older adults with dementia. The objective of this study was to evaluate the risk of death associated with antipsychotic use among community-dwelling older adults with a range of comorbidities.Methods: This was a population-based cohort study of all 2,224 residents of Leppävirta, Finland, aged ≥65 years on 1 January 2000. Records of all reimbursed drug purchases were extracted from the Finnish National Prescription Register and diagnostic data were obtained from the Special Reimbursement Register. All-cause mortality was evaluated over a nine-year follow-up period. Time-dependent Cox proportional hazard models were used to compute unadjusted and adjusted hazard ratios (HRs) and 95% confidence intervals (CIs) of mortality of antipsychotic use compared to non-use.Results: In total, 332 residents used antipsychotics between 2000 and 2008. The unadjusted HR for risk of death associated with antipsychotic use was 2.71 (95% CI = 2.3–3.2). After adjusting for baseline age, sex, antidepressant use, and diagnostic confounders, the HR was 2.07 (95% CI = 1.73–2.47). The adjusted HR was the highest among antipsychotic users with baseline respiratory disease (HR = 2.21, 95% CI = 1.30–3.76).Conclusions: The increased risk of death associated with antipsychotic use was similar across diagnostic categories, the highest being among those with baseline respiratory disease. However, the results should be interpreted with caution, as the overall sample size of antipsychotic users was small. As in other observational studies, residual confounding may account for the higher mortality observed among antipsychotic users. Further research is needed to confirm these findings.

Sign in / Sign up

Export Citation Format

Share Document