Impact of diabetes control on mortality by race in a national cohort of veterans

PurposeThe association between glycated hemoglobin (HbA1c), medication use/adherence, and mortality stratified by race/ethnicity was examined in a national cohort of veterans with type 2 diabetes.MethodsA total of 892,223 veterans with diabetes in 2002 were followed through 2006. HbA1c category was the main exposure (i.e., HbA1c <7%, HbA1c 7%–8% [reference], HbA1c 8%–9%, and HbA1c >9%). Covariates included age, sex, marital status, rural/urban residence, geographic region, number of comorbidities, and diabetes medication use/adherence (i.e., adherent, medication possession ratio ≥80%; nonadherent; and nonusers). HbA1c and medication use/adherence varied over time, and Cox regression models accounting for time-varying variables were used.ResultsIn nonmedication users, HbA1c greater than 9% predicted higher mortality risk relative to HbA1c of 7%–8% in non-Hispanic whites (hazard ratio [HR], 1.55; 95% confidence interval [95% CI], 1.43–1.69), non-Hispanic blacks (NHB) (HR, 1.58; 95% CI, 1.34–1.87), and Hispanics (HR, 2.22; 95% CI, 1.75–2.82). In contrast, in nonadherent medication users, HbA1c less than 7% predicted higher mortality risk in NHB (HR, 1.12; 95% CI, 1.05–1.20), whereas HbA1c greater than 9% only predicted mortality in non-Hispanic whites (HR, 1.11; 95% CI, 1.06–1.16). In adherent medication users, HbA1c less than 7% predicted higher mortality in NHB (HR, 1.18; 95% CI, 1.07–1.31), whereas HbA1c greater than 9.0% predicted higher mortality risk across all race/ethnic groups.ConclusionWe found evidence for racial/ethnic differences in the association between glycemic control and mortality, which varied by medication use/adherence.     

Is There a Dose–Response Relationship between Tea Consumption and All-Cause,CVD, and Cancer Mortality?

Background: A small change in tea consumption at population level could have large impact on public health. However, the health benefits of tea intake among Americans are inconclusive.

Objective: To evaluate the association between tea consumption and all-causes, cardiovascular disease (CVD) and cancer mortality in the Aerobics Center Longitudinal study (ACLS).

Methods: 11808 participants (20-82 years) initially free of CVD and cancers enrolled in the ACLS and were followed for mortality. Participants provided baseline self-report of tea consumption (cups/day). During a median follow-up of 16 years, 842 participants died. Of others, 250 died from CVD, and 345 died from cancer, respectively. A Cox proportional hazard model was used to produce hazard ratio (HR) and 95% confidence interval (CI).

Results: Compared with participants consuming no tea, tea drinkers had a survival advantage ( Log-2 = 10.2, df = 3, P = 0.017); however, the multivariate hazard ratios (HRs) of all-cause mortality for those drinking 1–7, 8–14, and >14 cups/week were 0.95 (95% CI, 0.81–1.12), 1.00 (95% CI, 0.82–1.22), and 0.98 (95% CI, 0.76–1.25), respectively (P for linear trend = 0.83). The multivariate HR were 1.16 (95% CI, 0.86–1.56), 1.22 (95% CI, 0.85–1.76), and 0.94 (95% CI, 0.56–1.54) for CVD mortality (P for linear trend = 0.47), and 0.97 (95% CI, 0.75–1.25), 0.85 (95% CI, 0.60–1.16), and 0.94 (95% CI, 0.64–1.38) for cancer mortality (P for trend = 0.62).

Conclusions: There were week or null relationships between tea consumption and mortality due to all-cause, CVD disease or cancer were observed in ACLS.     

Disparities in gestational age–specific fetal mortality rates in the United States, 2009–2013

PurposeAlthough studies have examined overall temporal changes in gestational age–specific fetal mortality rates, there is little information on the current status of racial/ethnic differences. We hypothesize that differences exist between racial/ethnic groups across gestational age and that these differences are not equally distributed.MethodsUsing the 2009–2013 data from US fetal death and live birth files for non-Hispanic white (NHW); non-Hispanic black (NHB); Hispanic; and American Indian/Alaska Native (AIAN) women, we conducted analyses to examine fetal mortality rates and estimate adjusted prevalence rate ratios and 95% confidence intervals (CIs).ResultsThere were lower risks of fetal mortality among NHB women (aPRR = 0.76; 95% CI = 0.71–0.81) and Hispanic women (aPRR = 0.89; 95% CI = 0.83–0.96) compared with NHWs at 22–23 weeks’ gestation. For NHB women, the risk was higher starting at 32–33 weeks (aPRR = 1.11; 95% CI = 1.04–1.18) and continued to increase as gestational age increased. Hispanic and AIAN women had lower risks of fetal mortality compared with NHW women until 38–39 weeks.ConclusionsFurther examination is needed to identify causes of fetal death within the later pregnancy period and how those causes and their antecedents might differ by race and ethnicity.     

Predicting cause-specific mortality of older men living in the veterans home by handgrip strength and walking speed: a 3-year, prospective cohort study in Taiwan

ObjectiveTo determine prognostic value of handgrip strength (HGS) and walking speed (WS) in predicting the cause-specific mortality for older men.DesignProspective cohort study.SettingBanciao Veterans Care Home.Participants558 residents aged 75 years and older.MeasurementsAnthropometric data, lifestyle factors, comorbid conditions, biomarkers, HGS, and WS at recruitment; all-cause and cause-specific mortality at 3 years after recruitment.ResultsDuring the study period, 99 participants died and the baseline HGS and WS were significantly lower than survivors (P both <.001). Cox survival analysis showed that subjects with slowest quartile of WS were at significantly higher risk of all-cause mortality and cardiovascular mortality (hazard ratio [HR] 3.55, 95% confidence interval [CI] 1.69–7.43; HR 11.55, 95% CI 2.30–58.04, respectively), whereas the lowest quartile of HGS significantly predicted a higher risk of infection-related death (HR 5.53, 95% CI 1.09–28.09). Participants in the high-risk status with slowest quartile for WS but not those in the high-risk status with weakest quartile for HGS had similar high risk of all-cause mortality with the group with combined high-risk status (HR 2.96, 95% CI 1.68–5.23; HR 2.58, 95% CI 1.45–4.60, respectively) compared with the participants without high-risk status (reference group).ConclusionsSlow WS predicted all-cause and cardiovascular mortality, whereas weak HGS predicted a higher risk of infection-related death among elderly, institutionalized men in Taiwan. Combining HGS with WS simultaneously had no better prognostic value than using WS only in predicting all-cause mortality.     

Chronic Kidney Disease and Its Association With Mortality and Hospitalization in Chinese Nursing Home Older Residents: A 3-Year Prospective Cohort Study

ObjectiveTo investigate chronic kidney disease (CKD) as a predictor of mortality and hospitalization in Chinese nursing homes older residents.DesignA 3-year prospective multicenter cohort study.SettingNine nursing homes in Hong Kong.ParticipantsNursing home older adults (812 total; 271 men and 571 women), mean age 86.0 ± 7.6.MeasurementsGlomerular filtration rate (GFR) was estimated by the Modification of Diet in Renal Disease Study (Chinese-adjusted), and participants were stratified into different severity of renal impairment according to the modified version of Kidney Disease Outcomes Quality Initiative (K/DOQI): stage 1 CKD: GFR > 90 mL/min/1.73 m²; stage 2 CKD: 60–89 mL/min/1.73 m²; stage 3A CKD: 45–59 mL/min/1.73 m²; stage 3B CKD: 30–44 mL/min/1.73m²; stage 4/5: <30 mL/min/1.73 m². The outcome measures were the all-cause, infection-related, and cardiovascular-related mortality and hospitalizations.ResultsOlder adults with stage 3B and stage 4/5 CKD had higher all-cause, infection-related, and cardiovascular-related mortality than those with earlier stages of CKD. After multivariate analysis, stage 3B and stage 4/5 CKD were independent predictors of all-cause mortality (stage 3B, hazard ratio [HR]: 1.62, 95% CI: 1.12–2.33, P = .01; stage 4/5, HR: 2.00, 95% CI: 1.34–3.00, P = .001) and infection-related mortality (stage 3B, HR: 1.41, 95% CI: 1.08–2.30, P = .019; stage 4/5, HR: 1.91, 95% CI: 1.13–3.23, P = .016), but not cardiovascular-related mortalities. The all-cause, infection-related, and cardiovascular-related hospitalizations were significantly higher in older nursing home adults with stage 3B and stage 4/5 CKD.ConclusionIn Chinese nursing home older adults, stage 3B and stage 4/5 CKD are independent predictors of all-cause and infection-related mortality. They also predict increased risks of all-cause, infection-related, and cardiovascular-related hospitalizations.     

Optimal Dairy Intake Is Predicated on Total,Cardiovascular, and Stroke Mortalities in a Taiwanese Cohort

Objective: Dairy foods help achieve essential nutrient adequacy. This role may be conflicted where so-called chronic diseases prevail. We have examined associations between dairy intake and mortality where dairy foods have not been traditional.

Methods: A representative Taiwanese cohort of 3810 subjects, aged 19–64 years, derived from the Nutrition and Health Survey in Taiwan (NAHSIT, 1993–1996) was linked to death registration (1993–2008). Participants were categorized by 4 dairy weekly intake frequencies from 0 to >7 times. Mortality hazard ratios (HRs) with 95% confidence intervals (CIs) were calculated using Cox proportional-hazards models.

Results: Nonconsumers of dairy products included 30.7% of the men and 22.1% of the women. Adverse sociodemographic and personal behaviors were generally significantly associated with lower dairy consumption. After adjustment for covariates, together with body mass index (BMI) and supplement use, those with 3–7 times/week intakes had an HR (95% CI) for all-cause mortality of 0.61 (0.39–0.96) with a significant dose–response trend (p = 0.043). Similarly, the HR for cardiovascular disease (CVD) mortality with dairy weekly intake frequency >7 was 0.14 (0.02–0.97) with a significant linear trend (p = 0.007). For stroke, the corresponding HR (95% CI) was 0.03 (0.00–0.28) with a linear trend. By age and with adjustment for dietary quality, food, and calcium or vitamin D intake, significance and dose–response relationships remained. Dairy intake and cancer mortality were not associated.

Conclusion: In a Chinese food culture, a dairy foods intake in adults up to 7 times a week does not increase mortality and may have favorable effects on stroke.     

Anthropometric measures and risk of all-cause and cardiovascular mortality: An 18 years follow-up

BackgroundThe contribution of anthropometric measures to predict mortality in normal-weight subjects is unclear. We aimed to study the association of central obesity measures, e.g., waist circumference (WC), waist-to-hip ratio (WHR), waist-to-height ratio (WHtR), with the risk of all-cause and CVD mortality.MethodsIn a prospective population-based Tehran Lipid and Glucose Study, 8287 participants aged ≥30 y, followed for a median of 18 years. The association of WC, WHR and WHtR with the risk for mortality was estimated using multivariate Cox proportional hazard models in different BMI groups.ResultsWe documented 821 deaths, of which 251 were related to CVD mortality. Normal weight individuals with central obesity were significantly at increased risk of all-cause (HR: 1.5; 95% CI: 1.10, 2.1) and CVD mortality (HR: 1.6; 95% CI: 0.92, 2.9) compared with normal-weight individuals without central obesity; the risk remained significant only in women. Also, normal-weight women (not men) with high WHR were at increased risk of all-cause (HR: 1.7; 95% CI: 1.0, 2.8) and CVD mortality (HR: 5.9; 95% CI: 1.5, 23.2). High WHtR increased the risk of all-cause (HR: 1.5; 95% CI: 1.2, 1.8) and CVD mortality (HR: 1.8; 95% CI: 1.2, 2.7) which remained significant in normal-weight men and women. All central obesity indicators were significantly associated with all-cause and CVD mortality in subjects aged under 65.ConclusionEven in normal-weight individuals, WC and WHR in women and WHtR in both sexes are predictors of all-cause and CVD mortality. WHtR shows a stronger association, especially in the population aged under 65.     

Prospective Analysis of Health and Mortality Risk in Veteran and Non-Veteran Participants in the Women's Health Initiative

BackgroundThe health of postmenopausal women veterans is a neglected area of study. A stronger empirical evidence base is needed, and would inform the provision of health care for the nearly 1 million U.S. women veterans currently 50 years of age or older. To this end, the present work compares salient health outcomes and risk of all-cause mortality among veteran and non-veteran participants of the Women's Health Initiative (WHI).MethodsThis study features prospective analysis of long-term health outcomes and mortality risk (average follow-up, 8 years) among the 3,706 women veterans and 141,009 non-veterans who participated in the WHI Observational Study or Clinical Trials. Outcome measurements included confirmed incident cases of cardiovascular disease (CVD), cancer, diabetes, hip fractures, and all-cause mortality.ResultsWe identified 17,968 cases of CVD, 19,152 cases of cancer, 18,718 cases of diabetes, 2,817 cases of hip fracture, and 13,747 deaths. In Cox regression models adjusted for age, sociodemographic variables, and health risk factors, veteran status was associated with significantly increased risk of all-cause mortality (hazard ratio [HR], 1.13; 95% CI, 1.03–1.23), but not with risk of CVD (HR, 1.00; 95% CI, 0.90–1.11), cancer (HR, 1.04; 95% CI, 0.95–1.14), hip fracture (HR, 1.16; 95% CI, 0.94–1.43), or diabetes (HR, 1.00; 95% CI, 0.89–1.1).ConclusionsWomen veterans' postmenopausal health, particularly risk for all-cause mortality, warrants further consideration. In particular, efforts to identify and address modifiable risk factors associated with all-cause mortality are needed.     

Neighborhood context and mortality among older Mexican Americans: is there a barrio advantage?

OBJECTIVES: We examined whether Mexican Americans living in high-density Mexican American neighborhoods experience increased morbidity and mortality compared with the rates observed among Mexican Americans living in low-density areas. METHODS: We conducted a prospective analysis of a cohort of 3050 Mexican Americans aged 65 years or older. We examined prevalence of 6 medical conditions and survival over 7 years of follow-up in relation to percentage of Mexican Americans in the census tract. RESULTS: With adjustment for covariates, odds for disease prevalence among older Mexican Americans as a function of percentage of Mexican Americans in the census tract were 0.33 (95% confidence interval [CI]=0.16, 0.71) for stroke, 0.28 (95% CI= 0.11, 0.70) for cancer, and 0.31 (95% CI=0.10, 0.98) for hip fracture. The hazard ratio for all-cause mortality over 7 years' follow-up was 0.64 (95% CI=0.42, 0.96). CONCLUSIONS: Sociocultural advantages conferred on Mexican Americans by living in high-density Mexican American neighborhoods outweigh the disadvantages conferred by the high poverty of those neighborhoods.     

Frailty Status Predicts All-Cause and Cause-Specific Mortality in Community Dwelling Older Adults

ObjectivesTo examine the relationship between frailty status and risk of all-cause and cause-specific mortality.DesignLongitudinal cohort study with an 11-year follow up.Setting and participantsData from the Survey on Health, Aging and Retirement in Europe (SHARE) were used. In the analysis, we included data from 11 European countries. We included men and women older than 50 years residing in Europe. Overall, 24,634 participants were analyzed with a mean age of 64.2 (9.8), 53.6% female, where 14.7% and 6.9% were found to be prefrail or frail, respectively, at the baseline.MethodsFrailty status was calculated using the SHARE–Frailty Instrument, categorizing the participants as robust, prefrail, and frail. Multivariate Cox regression models were used to estimate the risk of all-cause and cause-specific (stroke, heart attack, other cardiovascular disease, cancer, respiratory illness, infectious, and digestive and other) mortality.ResultsDuring the follow-up, and after adjusting for sex, age, education, body mass index, smoking, alcohol consumption, and number of comorbidities, frailty was associated with a higher risk of all-cause (HR 2.17, 95% CI 1.90-2.48) and mortality due to stroke (HR 2.06, 95% CI 1.37-3.10), heart attack (HR 1.67, 95% CI 1.19-2.34), other cardiovascular disease (HR 2.77, 95% CI 1.87-4.12), cancer (HR 2.11, 95% CI 1.63-2.73), respiratory disease (HR 2.76, 95% CI 1.66-4.60), infectious diseases (HR 1.79, 95% CI 1.03-3.11), and digestive and other causes (HR 2.02, 95% CI 1.51-2.71). Prefrailty was associated with a higher risk of all-cause (HR 1.47, 95% CI 1.31-1.63), heart attack (HR 1.31, 95% CI 1.01-1.72), other cardiovascular disease (HR 2.03, 95% CI 1.46-2.81), respiratory disease (HR 1.70, 95% CI 1.09-2.65), and digestive and other causes (HR 1.50, 95% CI 1.18-1.91) mortality.Conclusions and implicationsBaseline prefrailty and frailty are associated with increased all-cause and cause-specific mortality over an 11-year follow up. Public health policy should include preventive programs aimed at older adults to prevent frailty and reduce mortality.     

Association Between Muscular Strength and Mortality in Clinical Populations: A Systematic Review and Meta-Analysis

ObjectivesTo assess the relationship between muscular strength measures and mortality in outpatient populations with chronic diseases such as cancer, chronic obstructive pulmonary disease, renal disease, and metabolic and vascular diseases, and in critically ill hospitalized patients.DesignA systematic review and random-effects meta-analysis of prospective cohort studies was performed.Setting and participantsThe databases Medline, Embase, Clinical Trial Register, and Cochrane Trial Register were searched from inception until September 30, 2018. The systematic literature review yielded 39 studies with a total of 39,852 participants.ResultsLowest vs highest category of muscular strength revealed a statistically significant increased risk of all-cause mortality with a hazard ratio (HR) and 95% confidence intervals (CI) of 1.80 (95% CI 1.54–2.10). Lower muscular strength was associated with enhanced mortality in patients with cancer (HR 2.40; 95% CI 1.57–3.69), critical illness (HR 2.06; 95% CI 1.33–3.21), renal disease (HR 1.84; 95% CI 1.37–2.47), metabolic and vascular diseases (HR 1.64; 95% CI 1.26–2.14), and chronic obstructive pulmonary disease (HR 1.36; 95% CI 1.16–1.61). Conversely, a 5-kg higher level of muscular strength conferred a reduced risk of overall mortality (HR 0.72; 95% CI 0.59–0.89) and was accompanied by a reduction in mortality in patients with metabolic and vascular diseases (HR 0.52; 95% CI 0.29–0.91), critical illness (HR 0.78; 95% CI 0.61–0.99), and renal disease (HR 0.82; 95% CI 0.73–0.91).Conclusions and implicationsMuscular strength is inversely associated with mortality risk in various acute and chronic conditions. Future trials should focus on developing validated cut-points for diagnosing low muscular strength and their predictive value for hard end-points.     

Initial BMI and Weight Loss over Time Predict Mortality in Parkinson Disease

ObjectivesAlthough weight loss is a frequent symptom in Parkinson disease (PD), there have been few studies on the association between body mass index (BMI) and mortality. The objective of this study was to investigate the association between BMI and change in BMI at diagnosis in patients with PD and all-cause mortality.DesignCohort study using Korean National Health Insurance Service–Elderly Cohort data.Setting and ParticipantsPatients with new-onset PD were selected using the International Classification of Diseases 10th edition code (G20). Then, patients who were diagnosed more than 3 times with PD and had been prescribed anti-parkinsonian medication for ≥30 days were included. Those with a combined diagnosis of atypical parkinsonism and secondary parkinsonism were excluded.MethodsThe primary outcome was all-cause mortality. Anthropometric data, including height and weight, were obtained from the health screening data to calculate BMI. The Cox proportional hazards model was used to assess mortality risk by BMI.ResultsAmong the 2703 patients with PD, 492 (18.20%) died during the 11-year follow-up period. There was a significant inverse dose-response relationship between baseline BMI and mortality [<18.5 kg/m²: hazard ratio (HR), 1.872, 95% CI, 1.338–2.494; 23–25 kg/m²: HR, 0.695, 95% CI, 0.546–0.886; 25–30 kg/m²: HR, 0.644, 95% CI, 0.476–0.869; ≥30 kg/m²: HR, 0.396, 95% CI, 0.165–0.950]. Change in BMI of 10% revealed a significant association with mortality. Subgroup analyses by sex showed a significant inverse dose-response relationship between BMI and all-cause mortality only in women.Conclusions and ImplicationsWe demonstrated an inverse dose-response association between BMI at diagnosis and mortality in patients with PD, especially in women. Early detection of PD before weight loss progression and proper management might improve mortality. The small number of obese PD participants in our study should be considered when interpreting and generalizing results.     

Transitions in Frailty and 4-Year Mortality Risk in Taiwan Longitudinal Study on Aging

ObjectivesTo explore the associations of (1) the frailty phenotype or frailty index transition with cause-specific mortality, and (2) different combinations of transition in frailty phenotype and frailty index with all-cause mortality.DesignRetrospective cohort study.Setting and ParticipantsData from 3529 respondents aged >50 years who completed the 1999 and 2003 surveys of the Taiwan Longitudinal Study on Aging were analyzed.MethodsCox regression and subdistribution hazard models were constructed to investigate frailty phenotype or frailty index transitions (by categories of frailty phenotype, absolute and percentage changes in frailty index, and combined categories of the 2 measurements) and subsequent 4-year all-cause and cause-specific mortality, respectively.ResultsAmong the frailty phenotype transition groups, the improved frailty group had overall mortality risk comparable to that of the maintained robustness/prefrailty group [hazard ratio (HR): 0.9; 95% CI: 0.7–1.2] and lower risk of mortality due to organ failure (HR: 0.4; 95% CI: 0.2–0.8; P = .015), whereas the worsened frailty group had the highest risk of all-cause mortality and death from infection, malignancy, cardiometabolic/cerebrovascular diseases, and other causes (HR: 1.8–3.7; all P < .03). The rapidly increased frailty index group had significantly higher all-cause and every cause-specific mortality than the decreased frailty index group (HR: 1.8–7.7; all P < .05). When frailty phenotype and frailty index transition groups were combined, participants with worsened frailty/rapidly increased frailty index had increased risk under the same frailty index/frailty phenotype transition condition, particularly for large changes in each factor (HR: 1.5–2.2; P < .01 for worsened frailty; 1.7–4.5, P < .03 for rapidly increased frailty index).Conclusions and ImplicationsWe found that considering both frailty phenotype and frailty index provided best mortality prediction. These associations were independent of baseline frailty status and comorbidities. Nevertheless, even capturing transitions in frailty phenotype or frailty index only can provide good mortality prediction, which supported adopting these approaches in different clinical settings.     

Maternal Pre-Pregnancy Weight and Gestational Weight Gain and Their Association with Birthweight with a Focus on Racial Differences

Our objectives were to examine the interaction between maternal pre-pregnancy body mass index (BMI) and gestational weight gain (GWG) and their association with birthweight, with a focus on racial differences. We used birth certificate data from live singleton births of South Carolina resident mothers, who self-reported their race as non-Hispanic white (NHW, n = 140, 128) or non-Hispanic black (NHB, n = 82,492) and who delivered at 34–44 weeks of gestation between 2004 and 2008 to conduct a cross-sectional study. Linear regression was used to examine the relationship between our exposures (i.e., race, BMI and GWG) and our outcome birthweight. Based on 2009 Institute of Medicine guidelines, the prevalence of adequate, inadequate and excessive GWG was 27.1, 24.2 and 48.7%, respectively, in NHW women and 24.2, 34.8 and 41.0%, respectively, in NHB women. Adjusting for infant sex, gestational age, maternal age, tobacco use, education, prenatal care, and Medicaid, the difference in birthweight between excessive and adequate GWG at a maternal BMI of 30 kg/m² was 118 g (95% CI: 109, 127) in NHW women and 101 g (95% CI: 91, 111) in NHB women. Moreover, excessive versus adequate GWG conveyed similar protection from having a small for gestational age infant in NHW [OR = 0.64 (95% CI 0.61, 0.67)] and NHB women [OR = 0.68 (95% CI: 0.65, 0.72)]. In conclusion, we report a strong association between excessive GWG and higher infant birthweight across maternal BMI classes in NHW and NHB women. Given the high prevalence of excessive GWG even a small increase in birthweight may have considerable implications at the population level.     

Impact of obesity on influenza compared to pneumonia hospitalization outcomes

ObjectivesPrevious literature has suggested that obesity impacts mortality risk differently in bacterial versus viral infections. This study sought to further elucidate this association in pneumonia versus influenza.DesignRetrospective cohort study.Setting and participantsData were collected from the US Nationwide Readmission Database from 2013 to 2014.MethodsPatients were categorized into three weight groups: normal weight (BMI 18.5–25.0 kg/m²), obese (BMI 30–40.0 kg/m²), and morbidly obese (BMI ≥ 40 kg/m²). To minimize confounding, we excluded patients with a history of smoking, alcoholism, or chronic wasting conditions, as suggested by the Global BMI Mortality Collaboration. To further isolate obesity from baseline differences across cohorts, we performed a three-way propensity matching analysis. The association between body weight and in-hospital all-cause 30-day mortality was assessed using Cox proportional hazard regression analysis.Results132,965 influenza and 34,177 pneumonia hospitalizations were identified. For patients with influenza, obesity (hazard ratio [HR]: 1.51; 95% CI: 1.01–2.26) and morbid obesity (HR: 1.64; 95% CI: 1.10–2.44) were associated with higher in-hospital 30-day mortality compared to normal weight. For pneumonia, obesity (HR, 0.41; 95% CI, 0.20–0.84) and morbid obesity (HR, 0.49; 95% CI, 0.25–0.96) were associated with reduced 30-day mortality compared to normal weight.Conclusions and implicationsObesity may increase 30-day mortality risk during influenza hospitalization but provide mortality benefit in pneumonia, a divergent effect not adequately explained by lower admission threshold.     

Physical activity and all-cause and cause-specific mortality: assessing the impact of reverse causation and measurement error in two large prospective cohorts

Most cohort studies have only a single physical activity (PA) measure and are thus susceptible to reverse causation and measurement error. Few studies have examined the impact of these potential biases on the association between PA and mortality. A total of 133,819 participants from Nurses’ Health Study and Health Professionals Follow-up Study (1986–2014) reported PA through biennial questionnaires. Cox regression was used to estimate hazard ratios (HRs) and 95% confidence intervals (CIs) for PA and mortality using different analytic approaches comparing single (baseline, simple update?=?most recent) versus repeated (cumulative average) measures of PA and applying various lag times separating PA measurement and time at risk. Over 3.2 million person-years, we documented 47,273 deaths. The pooled multivariable-adjusted HR (95% CI) of all-cause mortality per 10 MET-hour/week was 0.95 (0.94–0.96) for baseline PA, 0.78 (0.77–0.79) for simple updated PA and 0.87 (0.86–0.88) for cumulative average PA in the range of 0–50 MET-hour/week. Simple updated PA showed the strongest inverse association, suggesting larger impact of reverse causation. Application of 2-year lag substantially reduced the apparent reverse causation (0.85 (0.84–0.86) for simple updated PA and 0.90 (0.89–0.91) for cumulative average PA), and 4–12-year lags had minimal additional effects. In the dose–response analysis, baseline or simple updated PA showed a J or U-shaped association with all-cause mortality while cumulative average PA showed an inverse association across a wide range of PA (0–150 MET-hour/week). Similar findings were observed for different specific mortality causes. In conclusion, PA measured at baseline or with short lag time was prone to bias. Cumulative average PA showed robust evidence that PA is inversely associated with mortality in a dose-response manner.

     

Disparities in human papillomavirus vaccination coverage in the United States,National Health and Nutrition Examination Survey,January 2017–March 2020

BackgroundWe assessed disparities in HPV vaccination coverage by sociodemographic characteristics in the United States.MethodsUsing 2017-March 2020 National Health and Nutrition Examination Survey data, we estimated vaccination coverage of ≥ 1 dose of HPV vaccine by race/ethnicity and poverty, insurance, and nativity status for females and males aged 9–14, 15–19, and 20–29 years.ResultsAmong those aged 9–14 years, coverage among non-Hispanic Black (NHB), Hispanic, and non-Hispanic Asian (NHA) females (40.0%, 33.6%, 34.0%) and males (27.1%, 35.3%, 30.9%) was higher than non-Hispanic White (NHW) females (26.5%) and males (25.2%). Among those aged 15–19 and 20–29 years, coverage varied among NHB, Hispanic, and NHA compared to NHW females and was lower among NHB, Hispanic, and NHA than NHW males. Coverage was lower among uninsured than insured in most comparisons.ConclusionsHPV vaccination coverage varied by race/ethnicity and other characteristics. Efforts are needed to increase HPV vaccination coverage in all populations.     

Coffee Consumption and the Risk of All-Cause and Cause-Specific Mortality in the Korean Population

BackgroundThere is a dearth of information regarding the association between coffee consumption and its health effects with respect to mortality among Korean people.ObjectiveThe aim of this study was to examine the association between coffee consumption and all-cause mortality and cause-specific mortality risks in the Korean population.DesignThis prospective cohort study had a median follow-up period of 9.1 years.Participants/settingIn total, 173,209 participants aged 40 years and older from the Health Examinees study were enrolled between 2004 and 2013. The analytic sample included 110,920 participants without diabetes, cardiovascular disease (CVD), or cancer at baseline who could be linked with their death information.Main outcome measuresDeaths of participants until December 31, 2018 were ascertained using the death certificate database of the National Statistical Office. Cause of death was classified according to the International Classification of Diseases, 10th Revision.Statistical analyses performedParticipants were categorized according to the amount and type of coffee consumed. Cox proportional hazards regression analysis was performed to estimate the hazard ratio (HR) and 95%CI of all-cause mortality and cause-specific mortality, such as CVD and cancer mortality.ResultsCompared with nonconsumers of coffee, participants who consumed > 3 cups/day had a reduced risk of all-cause mortality (HR 0.79, 95% CI 0.66 to 0.95). Participants who consumed ≤1 cup/day and 1 to 3 cups/day had a reduced risk of CVD mortality (≤1 cup/day: HR 0.58, 95% CI 0.69 to 0.94; 1 to 3 cups/day: HR 0.62, 95% CI 0.41 to 0.96).ConclusionsThis study provides evidence that greater coffee consumption is associated with a decreased risk of all-cause mortality and moderate coffee consumption (approximately 3 cups/day) is associated with a decreased risk of CVD mortality, regardless of the type of coffee, in a Korean population.     

All-cause and cardiovascular mortality among Mexican-American and non-Hispanic White older participants in the San Antonio Heart Study- evidence against the "Hispanic paradox"

The observation that Hispanics have lower all-cause and cardiovascular mortality rates despite increased rates of diabetes and obesity and lower socioeconomic status has been termed the "Hispanic paradox." The authors therefore examined the relation between ethnicity and mortality in 1,438 Mexican-American and 921 non-Hispanic White San Antonio Heart Study participants, aged 45-64 years when they enrolled between 1979 and 1988. Over an average of 14.5 years, 466 deaths occurred: 238 attributed to cardiovascular disease (death certificate International Classification of Diseases, Ninth Revision, codes 401-414 or codes 420-447 with the exception of code 427.5) and 117 attributed to coronary heart disease (codes 410-414). Age- and gender-adjusted hazard ratios for all-cause, cardiovascular, and coronary heart disease mortality comparing Mexican Americans with non-Hispanic Whites were 1.50 (95% confidence interval (CI): 1.23, 1.81), 1.70 (95% CI: 1.30, 2.24), and 1.60 (95% CI: 1.09, 2.36), respectively. After adjusting for possible confounders, among diabetic individuals not using insulin, the authors found excess risk of all-cause, cardiovascular, and coronary heart disease mortality associated with being Mexican American; however, in nondiabetic individuals and insulin-using diabetic individuals, Mexican Americans and non-Hispanic Whites appeared to be at similar risk of mortality. Contrary to the prediction of the "Hispanic paradox," in the San Antonio Heart Study, Mexican Americans were at greater risk of all-cause, cardiovascular, and coronary heart disease mortality than were non-Hispanic Whites.     

Successful Aging and Mortality Risk: The Korean Longitudinal Study of Aging (2006-2014)

ObjectivesThe aim of this study is to examine the association of successful aging with mortality and further find gender differences in the effect of components of successful aging on mortality risks.DesignRetrospective cohort study.Setting and participantsA total of 3848 adults aged 65 and older from the Korean Longitudinal Study of Aging (2006-2014) data.MeasuresSuccessful aging was defined as success in the following 7 components: absence of major disease, no depression, no freedom from disability, high cognitive and physical function, active social engagement, and satisfaction with life. All-cause mortality was measured by death certificate and family interview.ResultsIn both genders, the mortality rate was higher in the older adults who did not achieve successful aging than in their counterparts (men: hazard ratio [HR] = 1.69, 95% confidence interval [CI] 1.18-2.43; and women: HR = 2.37, 95% CI 1.21-4.63). All components of no successful aging were associated with an increased risk of mortality except for no satisfaction with life in females. Mortality rates were predominant in major disease (HR = 1.86, 95% CI 1.54-2.25) and depressive symptoms (HR = 1.62, 95% CI 1.26-2.10) in males, and disability (HR = 2.08, 95% CI 1.68-2.57) and low physical functioning (HR = 2.31, 95% CI 1.79-2.98) were predominant in females.Conclusion/ImplicationWe found that older Koreans who did not achieve successful aging had a higher risk of all-cause mortality than successful agers. There were gender differences in mortality risks across all components of successful aging.