scholarly journals Cognitive test score and 25-Year mortality risk; Does race matter?

2020 ◽  
Vol 4 (2) ◽  
pp. e000213 ◽  
Author(s):  
Shervin Assari
Keyword(s):  
United States ◽  
Protective Effect ◽  
Mortality Risk ◽  
Test Score ◽  
The United States ◽  
Continuous Variable ◽  
Cox Proportional Hazards ◽  
Cognitive Test ◽  
Cognitive Test Score ◽  
All Cause Mortality

Objectives: Despite our knowledge on the effect of cognitive test score on subsequent risk of mortality, few studies have compared Blacks and Whites for this association. The current study was conducted on Black-White differences in the magnitude of the association between baseline cognitive test score and all-cause mortality in a nationally representative sample of adults in the United States over 25 years. Methods: We used data of the Americans’ Changing Lives Study (ACL), 1986 – 2011, a national prospective cohort in U.S. The study followed 3,361 adults (2,205 White and 1,156 Blacks), age 25 and older, for up to 25 years. The independent variable was cognitive test score measured at baseline (1986) using the 4-item version of the Short Portable Mental Status Questionnaire, treated in two different ways (as a dichotomous and as a continuous variable). The dependent variable was time to death (due to all causes) during the follow up period. Covariates included baseline age, gender, education, income, number of chronic diseases, self-rated health, and depressive symptoms. Race (Black versus White) was the focal effect modifier. We used a series of Cox proportional hazards models in the total sample, and by race, in the absence and presence of health variables. Results: Overall, cognitive test score predicted mortality risk. A significant interaction was found between race and baseline cognitive test score suggesting that baseline cognitive test score has a weaker protective effect against all-cause mortality for Blacks in comparison to Whites. In race-stratified models, cognitive test score at baseline predicted risk of all-cause mortality for Whites but not Blacks, in the absence and presence of baseline socio-economic and health variables. The results were similar regardless of how we treated baseline cognitive test score. Conclusions: In the United States, baseline cognitive test score has a weaker protective effect against all-cause mortality over a long period of time for Blacks than Whites. The finding is in line with the Minorities Diminished Returns theory and is probably due to structural and interpersonal racism.

scholarly journals Association of 152 Biomarker Reference Intervals with All-Cause Mortality in Participants of a General United States Survey from 1999 to 2010

2020 ◽  
Author(s):  
Nam Pho ◽  
Arjun K Manrai ◽  
John T Leppert ◽  
Glenn M Chertow ◽  
John P A Ioannidis ◽  
...  
Keyword(s):  
United States ◽  
Mortality Risk ◽  
Diagnostic Tests ◽  
Serum Alkaline Phosphatase ◽  
The United States ◽  
Reference Intervals ◽  
Mortality Data ◽  
Distribution Width ◽  
Risk Of Death ◽  
All Cause Mortality

Abstract Background Physicians sometimes consider whether or not to perform diagnostic testing in healthy people, but it is unknown whether nonextreme values of diagnostic tests typically encountered in such populations have any predictive ability, in particular for risk of death. The goal of this study was to quantify the associations among population reference intervals of 152 common biomarkers with all-cause mortality in a representative, nondiseased sample of adults in the United States. Methods The study used an observational cohort derived from the National Health and Nutrition Examination Survey (NHANES), a representative sample of the United States population consisting of 6 survey waves from 1999 to 2010 with linked mortality data (unweighted N = 30 651) and a median followup of 6.1 years. We deployed an X-wide association study (XWAS) approach to systematically perform association testing of 152 diagnostic tests with all-cause mortality. Results After controlling for multiple hypotheses, we found that the values within reference intervals (10–90th percentiles) of 20 common biomarkers used as diagnostic tests or clinical measures were associated with all-cause mortality, including serum albumin, red cell distribution width, serum alkaline phosphatase, and others after adjusting for age (linear and quadratic terms), sex, race, income, chronic illness, and prior-year healthcare utilization. All biomarkers combined, however, explained only an additional 0.8% of the variance of mortality risk. We found modest year-to-year changes, or changes in association from survey wave to survey wave from 1999 to 2010 in the association sizes of biomarkers. Conclusions Reference and nonoutlying variation in common biomarkers are consistently associated with mortality risk in the US population, but their additive contribution in explaining mortality risk is minor.

scholarly journals Approximate Mortality Risks between Hyperuricemia and Diabetes in the United States

2019 ◽  
Vol 8 (12) ◽  
pp. 2127 ◽  
Author(s):  
Po-Hsun Chen ◽  
Yu-Wei Chen ◽  
Wei-Ju Liu ◽  
Ssu-Wei Hsu ◽  
Ching-Hsien Chen ◽  
...  
Keyword(s):  
Mortality Risk ◽  
Reference Group ◽  
The United States ◽  
Cox Proportional Hazards ◽  
Hazard Ratio ◽  
Low Risk ◽  
Mortality Data ◽  
Mortality Risks ◽  
All Cause Mortality ◽  
Cvd Mortality

Aim: This study aimed to compare mortality risks across uric acid (UA) levels between non-diabetes adults and participants with diabetes and to investigate the association between hyperuricemia and mortality risks in low-risk adults. Methods: We analyzed data from adults aged >18 years without coronary heart disease and chronic kidney disease (n = 29,226) from the National Health and Nutrition Examination Survey (1999–2010) and the associated mortality data (up to December 2011). We used the Cox proportional hazards models to examine the risk of all-cause and cause-specific (cardiovascular disease (CVD) and cancer) mortality at different UA levels between adults with and without diabetes. Results: Over a median follow-up of 6.6 years, 2069 participants died (495 from CVD and 520 from cancers). In non-diabetes adults at UA ≥ 5 mg/dL, all-cause and CVD mortality risks increased across higher UA levels (p-for-trend = 0.037 and 0.058, respectively). The lowest all-cause mortality risk in participants with diabetes was at the UA level of 5–7 mg/dL. We set the non-diabetes participants with UA levels of <7 mg/dL as a reference group. Without considering the effect of glycemic control, the all-cause mortality risk in non-diabetes participants with UA levels of ≥7 mg/dL was equivalent to risk among diabetes adults with UA levels of <7 mg/dL (hazard ratio = 1.44 vs. 1.57, p = 0.49). A similar result was shown in CVD mortality risk (hazard ratio = 1.80 vs. 2.06, p = 0.56). Conclusion: Hyperuricemia may be an indicator to manage multifaceted cardiovascular risk factors in low-risk adults without diabetes, but further studies and replication are warranted.

scholarly journals Religious Participation and Mortality Risk in Mexico

2018 ◽  
Vol 75 (5) ◽  
pp. 1053-1061 ◽  
Author(s):  
Terrence D Hill ◽  
Joseph L Saenz ◽  
Sunshine M Rote
Keyword(s):  
United States ◽  
Activities Of Daily Living ◽  
Cognitive Functioning ◽  
Mortality Risk ◽  
Daily Living ◽  
The United States ◽  
Religious Participation ◽  
Religious Activities ◽  
Health Selection ◽  
All Cause Mortality

Abstract Objectives Although research suggests that religious involvement tends to favor longevity, most of this work has been conducted in the United States. This article explores the association between religious participation and all-cause mortality risk in Mexico. Methods We used data from the 2003–2015 Mexican Health and Aging Study (n = 14,743) and Cox proportional hazard regression models to assess the association between religious participation and all-cause mortality risk. Results Our key finding is that older Mexicans who participate once or more per week in religious activities tend to exhibit a 19% reduction in the risk of all-cause mortality than those who never participate. This estimate persisted with adjustments for health selection (chronic disease burden, activities of daily living, instrumental activities of daily living, cognitive functioning, and depressive symptoms), several potential mediators (social support, smoking, and drinking), and a range of sociodemographic characteristics. Although we observed considerable health selection due to physical health and cognitive functioning, we found no evidence of mediation. Discussion Our results confirm that religious participation is associated with lower all-cause mortality risk among older adults in Mexico. Our analyses contribute to previous research by replicating and extending the external validity of studies conducted in the United States, Israel, Denmark, Finland, and Taiwan.

scholarly journals Association of Happiness and Life Satisfaction with Cancer Mortality in the United States: A Longitudinal Analysis

2020 ◽  
Vol 4 (2) ◽  
pp. 162-169
Author(s):  
Hyunjung Lee ◽  
Gopal K. Singh
Keyword(s):  
United States ◽  
Life Satisfaction ◽  
Mortality Risk ◽  
Cancer Mortality ◽  
Proportional Hazards ◽  
The United States ◽  
Cox Proportional Hazards ◽  
Cox Models ◽  
Creative Commons ◽  
Cancer Mortality Risk

Background: Theimpact of happiness and life satisfaction on cancer mortality is not well studied. Using a longitudinal dataset, we examined the association between levels of happiness/life satisfaction and cancer mortality in the United States. Methods: We analyzed the 2001 National Health Interview Survey (NHIS) prospectively linked to 2001-2014 mortality records in the National Death Index (NDI) (N=30,933). Cox proportional hazards regression was used to model survival time as a function of happiness, life satisfaction, and sociodemographic and behavioral characteristics. Results: In Cox models with 14 years of mortality follow-up, cancer mortality risk was 78% higher (hazard ratio [HR]=1.78; 95% CI=1.42,2.23) in adults with little or no happiness, controlling for age, and 53% higher (HR=1.53; 95% CI=1.19,1.97) in adults with little/no happiness, controlling for sociodemographic, behavioral and health characteristics, when compared with adults reporting happiness most or all of the time. Age-adjusted cancer mortality risk increased by 41% (HR=1.41; 95% CI=1.21,1.77) in adults who were very dissatisfied with their life. Cancer mortality did not vary by life satisfaction after adjusting for all covariates. Conclusions and Implications for Translation: Adults with lower happiness levels had significantly higher cancer mortality risks than those with higher happiness levels. Excess mortality was substantially accounted for by sociodemographic, behavioral, and health risk factors. Key words: • Happiness • Life satisfaction • Cancer • Mortality • Longitudinal • Social determinants   Copyright © 2020 Lee and Singh. Published by Global Health and Education Projects, Inc. This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY 4.0) which permits unrestricted use, distribution, and reproduction in any medium, provided the original work, first published in this journal, is properly cited.

scholarly journals Inequalities in Life Expectancy and All-Cause Mortality in the United States by Levels of Happiness and Life Satisfaction: A Longitudinal Study

2020 ◽  
Vol 9 (3) ◽  
pp. 305-315
Author(s):  
Hyunjung Lee ◽  
Gopal K. Singh
Keyword(s):  
United States ◽  
Life Satisfaction ◽  
Life Expectancy ◽  
Global Health ◽  
Mortality Risk ◽  
Well Being ◽  
The United States ◽  
Subjective Well Being ◽  
All Cause Mortality ◽  
The Impact

Background: Despite having one of the highest Gross Domestic Product (GDP) per capita levels, United States (US) ranks lower in subjective well-being, including happiness and life satisfaction, compared with European countries. Studies of the impact of happiness and life satisfaction on life expectancy and mortality in the US are limited or non-existent. Using a national longitudinal dataset, we examined the association between levels of happiness/life satisfaction and US life expectancy and all-cause mortality. Methods: We analyzed the 2001 National Health Interview Survey (NHIS) prospectively linked to 2001-2014 mortality records in the National Death Index (NDI) (N=30,377). Cox proportional hazards regression was used to model survival time as a function of happiness, life satisfaction, and sociodemographic and behavioral covariates. Results: Life expectancies at age 18 among adults with high levels of happiness and life satisfaction were, respectively, 7.5 and 8.9 years higher compared to those with low levels of happiness and life satisfaction. In Cox models with 14 years of mortality follow-up, all-cause mortality risk was 82% higher (hazard ratio [HR]=1.82; 95% CI=1.59,2.08) in adults with little or no happiness, controlling for age, and 36% higher (HR=1.36; 95% CI=1.17,1.57) in adults with little/no happiness, controlling for sociodemographic, behavioral and health characteristics, when compared with adults reporting happiness all of the time. Mortality risk was 107% higher (HR=2.07; 95% CI=1.80,2.38) in adults who were very dissatisfied with their life, controlling for age, and 39% higher (HR=1.39; 95% CI=1.20,1.60) in adults who were very dissatisfied, controlling for all covariates, when compared with adults who were very satisfied. Conclusions and Global Health Implications: Adults with higher happiness and life satisfaction levels had significantly higher life expectancy and lower all-cause mortality risks than those with lower happiness and satisfaction levels. These findings underscore the significance of addressing subjective well-being in the population as a strategy for reducing all-cause mortality. Key words: • Inequalities • Disparities • Happiness • Life satisfaction • Life expectancy • Mortality • Longitudinal • Social determinants   Copyright © 2020 Lee and Singh. Published by Global Health and Education Projects, Inc. This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY 4.0) which permits unrestricted use, distribution, and reproduction in any medium, provided the original work, first published in this journal, is properly cited.

scholarly journals Marked Disparities in Cardiovascular Disease Mortality by Levels of Happiness and Life Satisfaction in the United States

2020 ◽  
Vol 4 (2) ◽  
pp. 170-177
Author(s):  
Hyunjung Lee ◽  
Gopal K. Singh
Keyword(s):  
United States ◽  
Cardiovascular Disease ◽  
Life Satisfaction ◽  
Mortality Risk ◽  
Proportional Hazards ◽  
Well Being ◽  
The United States ◽  
Cox Proportional Hazards ◽  
Subjective Well Being ◽  
Cvd Mortality

Background: Theimpact of happiness and life satisfaction on cardiovascular disease (CVD) mortality is not well-studied. Using a longitudinal dataset, we examined the association between levels of happiness/life satisfaction and CVD mortality in the United States. Methods: We analyzed the 2001 National Health Interview Survey (NHIS) prospectively linked to 2001-2014 mortality records in the National Death Index (NDI) (N=30,933). Cox proportional hazards regression was used to model survival time as a function of happiness, life satisfaction, and sociodemographic and behavioral characteristics. Results: In Cox models with 14 years of mortality follow-up, CVD mortality risk was 59% higher (hazard ratio [HR]=1.59; 95% CI=1.26,2.02) in adults with little or no happiness, controlling for age, and 30% higher (HR=1.30; 95% CI=1.01,1.67) in adults with little/no happiness, controlling for sociodemographic, behavioral and health characteristics, when compared with adults reporting happiness most or all of the time. Mortality risk was 81% higher (HR=1.81; 95% CI=1.40,2.34) in adults who were very dissatisfied with their life, controlling for age, and 39% higher (HR=1.39; 95% CI=1.05,1.82) in adults who were very dissatisfied, controlling for all covariates, when compared with adults who were very satisfied. Conclusions and Implications for Translation: Adults with lower happiness and life satisfaction levels had significantly higher CVD mortality risks than those with higher happiness and life satisfaction levels. Subjective well-being is an important determinant of CVD mortality. Key words: • Happiness • Life satisfaction • Cardiovascular • Mortality • Longitudinal • Social determinants   Copyright © 2020 Lee and Singh. Published by Global Health and Education Projects, Inc. This is an open-access arti-cle distributed under the terms of the Creative Commons Attribution License (CC BY 4.0) which permits unrestricted use, distribution, and reproduction in any medium, provided the original work, first published in this journal, is properly cited.

scholarly journals OP0015 SEX-SPECIFIC U-SHAPED RELATIONSHIP BETWEEN SERUM URATE AND MORTALITY IN THE UNITED STATES GENERAL POPULATION

2020 ◽  
Vol 79 (Suppl 1) ◽  
pp. 10-11 ◽  
Author(s):  
K. D’silva ◽  
C. Yokose ◽  
L. Lu ◽  
Y. Zhang ◽  
H. Choi
Keyword(s):  
United States ◽  
Alzheimer’S Disease ◽  
Alzheimer's Disease ◽  
Mortality Risk ◽  
The United States ◽  
Serum Urate ◽  
Nhanes Iii ◽  
All Cause Mortality ◽  
Specific Mortality ◽  
The Relationship

Background:A U-shaped relationship may exist between serum urate (SU) and cardiovascular events, although the relationship between SU and mortality is unclear. The most recent EULAR recommendations for gout advise against maintaining SU <3 mg/dl for prolonged periods.Objectives:To examine the relationship between SU and all-cause and cause-specific mortality in large cohorts in the United States (US).Methods:We examined National Health and Nutrition Examination Survey (NHANES) data from 1988-1994 (NHANES III) and 1999-2007 including subjects aged ≥18 with an enrollment SU measurement. We used Cox proportional hazards regression models to estimate sex-specific mortality risk relative to a referent SU 5-6 mg/dL, adjusting for NHANES cycle, age, race, body mass index (BMI), education, alcohol use, smoking, hypertension, total cholesterol, estimated glomerular filtration rate (GFR), and competing risks, using age as a time scale for survival analysis.Results:Among 19,954 men and 21,853 women, there were 5,714 male deaths and 4,901 female deaths (median follow-up 14.2 ± 6.9 years). Among men, there was a 33% increased all-cause mortality risk at SU <4 mg/dL (HR 1.33, 95% CI 1.17-1.51) and 52% increased all-cause mortality risk at SU >8 mg/dL (HR 1.52, 95% CI 1.37-1.69) compared to subjects with SU 5-6 mg/dL, driven by cause-specific mortality from diabetes at low SU and chronic lower respiratory diseases and cardiovascular disease at high SU (Table). In women, there was no increased mortality risk at low SU and a 45% increased all-cause mortality risk at SU >7 mg/dL (HR 1.45, CI 1.31-1.61) compared to subjects with SU 5-6 mg/dL, driven by cause-specific mortality from diabetes. Mortality from Alzheimer’s disease was lower at high SU among men (HR 0.23, 95% CI 0.05-0.99) and women (HR 0.54, 95% CI 0.25-1.15).Table.Multivariable hazard ratios for all-cause and cause-specific mortality in NHANES III and 1999-2007.Conclusion:In large cohorts representative of the US population, there was a U-shaped relationship between SU and all-cause mortality in men but not women. In men with low SU, mortality was driven primarily by diabetes, which may be explained by the uricosuric effect of uncontrolled hyperglycemia in diabetes patients. The lower mortality from Alzheimer’s disease at high SU agrees with previously shown inverse associations between gout and Alzheimer’s disease. Further studies are needed to determine the presence of causality underlying these associations.Disclosure of Interests:Kristin D’Silva: None declared, Chio Yokose: None declared, Leo Lu: None declared, Yuqing Zhang: None declared, Hyon Choi Grant/research support from: Ironwood, Horizon, Consultant of: Takeda, Selecta, Horizon, Kowa, Vaxart, Ironwood

scholarly journals Sex disparity in long-term stroke recurrence and mortality in a rural population in the United States

2020 ◽  
Vol 13 ◽  
pp. 175628642097189
Author(s):  
Clare Lambert ◽  
Durgesh Chaudhary ◽  
Oluwaseyi Olulana ◽  
Shima Shahjouei ◽  
Venkatesh Avula ◽  
...  
Keyword(s):  
United States ◽  
Ischemic Stroke ◽  
Rural Population ◽  
The United States ◽  
Competing Risk ◽  
Stroke Recurrence ◽  
Composite Outcome ◽  
Stroke Patients ◽  
Central Pennsylvania ◽  
All Cause Mortality

Background: Several studies suggest women may be disproportionately affected by poorer stroke outcomes than men. This study aims to investigate whether women have a higher risk of all-cause mortality and recurrence after an ischemic stroke than men in a rural population in central Pennsylvania, United States. Methods: We analyzed consecutive ischemic stroke patients captured in the Geisinger NeuroScience Ischemic Stroke research database from 2004 to 2019. Kaplan–Meier (KM) estimator curves stratified by gender and age were used to plot survival probabilities and Cox Proportional Hazards Ratios were used to analyze outcomes of all-cause mortality and the composite outcome of ischemic stroke recurrence or death. Fine–Gray Competing Risk models were used for the outcome of recurrent ischemic stroke, with death as the competing risk. Two models were generated; Model 1 was adjusted by data-driven associated health factors, and Model 2 was adjusted by traditional vascular risk factors. Results: Among 8900 adult ischemic stroke patients [median age of 71.6 (interquartile range: 61.1–81.2) years and 48% women], women had a higher crude all-cause mortality. The KM curves demonstrated a 63.3% survival in women compared with a 65.7% survival in men ( p = 0.003) at 5 years; however, the survival difference was not present after controlling for covariates, including age, atrial fibrillation or flutter, myocardial infarction, diabetes mellitus, dyslipidemia, heart failure, chronic lung diseases, rheumatic disease, chronic kidney disease, neoplasm, peripheral vascular disease, past ischemic stroke, past hemorrhagic stroke, and depression. There was no adjusted or unadjusted sex difference in terms of recurrent ischemic stroke or composite outcome. Conclusion: Sex was not an independent risk factor for all-cause mortality and ischemic stroke recurrence in the rural population in central Pennsylvania.

scholarly journals High School Quality and 56-Year All-Cause Mortality Risk Across Race and Ethnicity

2020 ◽  
Vol 4 (Supplement_1) ◽  
pp. 505-506
Author(s):  
Dominika Seblova ◽  
Kelly Peters ◽  
Susan Lapham ◽  
Laura Zahodne ◽  
Tara Gruenewald ◽  
...  
Keyword(s):  
High School ◽  
Mortality Risk ◽  
Race And Ethnicity ◽  
Proportional Hazards ◽  
School Quality ◽  
Cox Proportional Hazards ◽  
School Level ◽  
Lower Mortality ◽  
All Cause Mortality ◽  
Race Ethnicity

Abstract Having more years of education is independently associated with lower mortality, but it is unclear whether other attributes of schooling matter. We examined the association of high school quality and all-cause mortality across race/ethnicity. In 1960, about 5% of US high schools participated in Project Talent (PT), which collected information about students and their schools. Over 21,000 PT respondents were followed for mortality into their eighth decade of life using the National Death Index. A school quality factor, capturing term length, class size, and teacher qualifications, was used as the main predictor. First, we estimated overall and sex-stratified Cox proportional hazards models with standard errors clustered at the school level, adjusting for age, sex, composite measure of parental socioeconomic status, and 1960 cognitive ability. Second, we added an interaction between school quality and race/ethnicity. Among this diverse cohort (60% non-Hispanic Whites, 23% non-Hispanic Blacks, 7% Hispanics, 10% classified as another race/s) there were 3,476 deaths (16.5%). School quality was highest for Hispanic respondents and lowest for non-Hispanic Blacks. Non-Hispanic Blacks also had the highest mortality risk. In the whole sample, school quality was not associated with mortality risk. However, higher school quality was associated with lower mortality among those classified as another race/s (HR 0.75, 95% CI: 0.56-0.99). For non-Hispanic Blacks and Whites, the HR point estimates were unreliable, but suggest that higher school quality is associated with increased mortality. Future work will disentangle these differences in association of school quality across race/ethnicity and examine cause-specific mortality.

Impact of Baseline Neutrophil-to-Lymphocyte Ratio on Long-Term Prognosis in Patients With Atrial Fibrillation

Angiology ◽  
2021 ◽  
pp. 000331972110004
Author(s):  
Shuang Wu ◽  
Yan-min Yang ◽  
Jun Zhu ◽  
Jia-meng Ren ◽  
Juan Wang ◽  
...  
Keyword(s):  
Atrial Fibrillation ◽  
Continuous Variable ◽  
Cox Proportional Hazards ◽  
Neutrophil To Lymphocyte Ratio ◽  
Long Term Outcomes ◽  
Lymphocyte Ratio ◽  
Net Reclassification Improvement ◽  
Increased Risk ◽  
All Cause Mortality

We performed a retrospective analysis involving 1269 patients with atrial fibrillation (AF) to evaluate the predictive value of the neutrophil-to-lymphocyte ratio (NLR) on long-term outcomes. The primary outcomes were all-cause mortality and combined end point events (CEEs). Cox proportional hazards regression analysis and net reclassification improvement (NRI) analysis were performed. During a median follow-up of 3.32 years, 285 deaths and 376 CEEs occurred. With the elevation of the NLR, the incidence of all-cause mortality (2.77, 4.14, 6.12, and 12.18/100 person-years) and CEEs (4.19, 7.40, 8.03, and 15.22/100 person-years) significantly increased. Multivariate Cox analysis indicated that the highest NLR quartile was independently associated with the incidence of all-cause mortality (hazard ratio [HR] = 1.77, 95% CI: 1.19-2.65) and CEEs (HR = 1.66, 95% CI: 1.18-2.33). When the NLR was analyzed as a continuous variable, a 1-unit increment in log NLR was related to 134% increased risk of all-cause mortality and 119% increased risk of CEEs. Net reclassification improvement analysis revealed that NLR significantly improved risk stratification for all-cause death and CEEs by 15.0% and 9.6%, respectively. Neutrophil-to-lymphocyte ratio could be an independent predictor of long-term outcomes in patients with AF.

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