Pulmonary artery catheter receipt among cardiac surgery patients from the national inpatient sample (1999-2019): Prevalence, predictors and hospitalization charges.

Despite limited evidence to support its efficacy, use of pulmonary artery catheter (PAC), a relatively expensive medical device, for monitoring clinical status and guiding therapeutic interventions, has become standard of care in many settings, and especially during and after cardiac surgery. We examined the prevalence and predictors of PAC use and its association with hospitalization charges among cardiac surgery patients generally and for each selected subgroup of high-risk or complex surgical procedures. We conducted an analysis on 1,442,528 records from the National Inpatient Sample (1999-2019) that included cardiac surgery patients ≥18 years of age. Subgroups were categorized based on the presence of specific disorders like tricuspid or mitral valve disease, pulmonary hypertension, heart failure, or cardiac surgery combinations. Multivariable regression models were constructed to assess predictors of PAC use as well as PAC use as a predictor of loge hospitalization charges controlling for patient and hospital characteristics. Based on International Classification of Diseases procedure codes, PAC use was prevalent among 7.15 % of cardiac surgery hospitalizations, and hospitalization charges were estimated at $191,345, with no differences according to PAC use. Overall, being female, having Charlson comorbidity index (CCI) > 0, and non-payer (versus Medicare) status were independently associated with PAC use. Among the subgroup with the selected conditions, being female, having CCI>0, and being a Medicaid (versus Medicare) recipient were independently associated with PAC use, whereas elective admission was inversely related to PAC use. Among the subgroup without the selected conditions, having a CCI >0, elective admission, and non-payer (vs. Medicare) status were independently associated with PAC use. PAC use was not independently related to hospitalization charges overall or among subgroups. In conclusion, approximately 7 % of cardiac surgery hospitalizations received a PAC, with no differences in charges according to PAC use and disparities in PAC use driven by sex, elective admission, CCI and health insurance status. Large randomized trials are required to characterize the safety, efficacy, and cost-effectiveness of PAC use among distinct groups of patients undergoing cardiac surgery.

Pathways explaining racial/ethnic and socio-economic disparities in dementia incidence: the UK Biobank study.

BACKGROUND: Pathways explaining racial/ethnic disparities in dementia risk are under-evaluated. METHODS: We examine those disparities and their related pathways among UK Biobank study respondents (50-74 y, N = 323,483; 3.6% non-White minorities) using a series of Cox proportional hazards and generalized structural equations models (GSEM). RESULTS: After ≤15 years, 5,491 all-cause dementia cases were diagnosed. Racial minority status (RACE_ETHN, Non-White vs. White) increased dementia risk by 24% (HR = 1.24, 95% CI: 1.07-1.45, P = 0.005), an association attenuated by socio-economic status (SES), (HR = 1.12, 95% CI: 0.96-1.31). Total race-dementia effect was mediated through both SES and Life's Essential 8 lifestyle sub-score (LE8LIFESTYLE), combining diet, smoking, physical activity, and sleep factors. SES was inversely related to dementia risk (HR = 0.69, 95% CI: 0.67, 0.72, P < 0.001). Pathways explaining excess dementia risk among racial minorities included 'RACE_ETHN(-) → SES(-) → DEMENTIA', 'RACE_ETHN(-) → SES(-) → Poor cognitive performance, COGN(+) → DEMENTIA' and 'RACE_ETHN(-) → SES(+) → LE8LIFESTYLE(-) → DEMENTIA'. CONCLUSIONS: Pending future interventions, lifestyle factors including diet, smoking, physical activity, and sleep are crucial for reducing racial and socio-economic disparities in dementia.

Association of pulmonary artery catheter with in-hospital outcomes after cardiac surgery in the United States: National Inpatient Sample 1999-2019.

To examine associations of pulmonary artery catheter (PAC) use with in-hospital death and hospital length of stay (days) overall and within subgroups of hospitalized cardiac surgery patients. Secondary analyses of 1999-2019 National Inpatient Sample data were performed using 969,034 records (68% male, mean age: 65 years) representing adult cardiac surgery patients in the United States. A subgroup of 323,929 records corresponded to patients with congestive heart failure, pulmonary hypertension, mitral/tricuspid valve disease and/or combined surgeries. We evaluated PAC in relation to clinical outcomes using regression and targeted maximum likelihood estimation (TMLE). Hospitalized cardiac surgery patients experienced more in-hospital deaths and longer stays if they had ≥ 1 subgroup characteristics. For risk-adjusted models, in-hospital deaths were similar among recipients and non-recipients of PAC (odds ratio [OR] 1.04, 95% confidence interval [CI] 0.96, 1.12), although PAC was associated with more in-hospital deaths among the subgroup with congestive heart failure (OR 1.14, 95% CI 1.03, 1.26). PAC recipients experienced shorter stays than non-recipients (ß = - 0.40, 95% CI - 0.64, - 0.15), with variations by subgroup. We obtained comparable results using TMLE. In this retrospective cohort study, PAC was associated with shorter stays and similar in-hospital death rates among cardiac surgery patients. Worse clinical outcomes associated with PAC were observed only among patients with congestive heart failure. Prospective cohort studies and randomized controlled trials are needed to confirm and extend these preliminary findings.

Life's simple 7 and its association with trajectories in depressive symptoms among urban middle-aged adults.

BACKGROUND: The American Heart Association Life's Simple 7 (LS7) is a composite metric assessing cardiovascular health on a scale of 0-14 comprised of nutrition, physical activity, cigarette use, body mass index, blood pressure, cholesterol and glucose. METHODS: Using data from the Healthy Aging in Neighborhoods of Diversity across the Life Span study [n = 1465, Age at visit 1 (v1: 2004-2009): 30-66 y, 41.7 % male, 60.6 % African American], we investigated associations of trajectories in depressive symptoms (2004-2017) with Life's simple 7 scores after ∼8.6 years follow-up (2013-2017). Analyses used group-based zero-inflated Poisson trajectory (GBTM) models and multiple linear or ordinal logistic regression. GBTM analyses generated two classes of depressive symptoms trajectories ("low declining" and "high declining"), based on intercept and slope direction and significance. RESULTS: Overall, "high declining depressive symptoms" vs. the "low declining" group was associated with -0.67 ± 0.10 lower scores on LS7 total score (P < 0.001) in analyses adjusted for age, sex, race and the inverse mills ratio. This effect was markedly attenuated to -0.45 ± 0.10 score-points (P < 0.001) upon adjustment for socio-economic factors and to -0.27 ± 0.10 score-points (P < 0.010) in fully adjusted analyses, with a stronger association detected among women (ß ± SE: -0.45 ± 0.14, P = 0.002). An association between elevated depressive symptoms over time ("high declining" vs "low declining") and LS7 total score was detected among African American adults (ß ± SE: -0.281 ± 0.131, p = 0.031, full model). Moreover, the "high declining" vs. "low declining" depressive symptoms group was associated with a lower score on LS7 physical activity (ß ± SE: -0.494 ± 0.130, P < 0.001). CONCLUSIONS: Poorer cardiovascular health was linked to higher depressive symptoms over time.

Pathways explaining racial/ethnic disparities in incident all-cause dementia among middle-aged US adults.

INTRODUCTION: Racial disparities in dementia incidence exist, but less is known about their presence and drivers among middle-aged adults. METHODS: We used time-to-event analysis among a sample of 4378 respondents (age 40-59 years at baseline) drawn from the third National Health and Nutrition Examination Surveys (NHANES III) with administrative linkage-spanning the years 1988-2014-to evaluate potential mediating pathways through socioeconomic status (SES), lifestyle, and health-related characteristics. RESULTS: Compared with Non-Hispanic White (NHW) adults, Non-White adults had a higher incidence of AD-specific (hazard ratio [HR] = 2.05, 95% confidence interval [CI]: 1.21, 3.49) and all-cause dementia (HR = 2.01, 95% CI: 1.36, 2.98). Diet, smoking, and physical activity were among characteristics on the pathway between race/ethnicity, SES, and dementia, with health-mediating effects of smoking and physical activity on dementia risk. DISCUSSION: We identified several pathways that may generate racial disparities in incident all-cause dementia among middle-aged adults. No direct effect of race was observed. More studies are needed to corroborate our findings in comparable populations.

Allostatic Load and Cognitive Function Among Urban Adults in the Healthy Aging in Neighborhoods of Diversity across the Life Span Study.

BACKGROUND: Cross-sectional studies have linked cognition to allostatic load (AL) which reflects multisystem dysregulation from life course exposure to stressors. OBJECTIVE: To examine baseline and changes in AL and their relationships with 11 cognitive function test scores, while exploring health disparities according to sex and race. METHODS: Longitudinal [Visit 1 (2004-2009) and Visit 2 (2009-2013)] data were analyzed from 2,223 Healthy Aging in Neighborhoods of Diversity across the Life Span participants. We calculated AL total score using cardiovascular, metabolic, and inflammatory risk indicators, and applied group-based trajectory modeling to define AL change. RESULTS: Overall and stratum-specific relationships were evaluated using mixed-effects linear regression models that controlled for socio-demographic, lifestyle, and health characteristics. Baseline AL was significantly associated with higher log-transformed Part A Trail Making Test score [Loge (TRAILS A)] (ß= 0.020, p = 0.004) and increasing AL was associated with higher Benton Visual Retention Test score [BVRT] (ß= 0.35, p = 0.002) at baseline, in models that controlled for age, sex, race, poverty status, education, literacy, smoking, drug use, the 2010 healthy eating index and body mass index. Baseline AL and AL change were not related to change in cognitive function between visits. There were no statistically significant interaction effects by sex or race in fully-adjusted models. CONCLUSION: At baseline, AL was associated with worse attention or executive functioning. Increasing AL was associated with worse non-verbal memory or visuo-constructional abilities at baseline. AL was not related to change in cognitive function over time, and relationships did not vary by sex or race.

Association of Serum Antioxidant Vitamins and Carotenoids With Incident Alzheimer Disease and All-Cause Dementia Among US Adults.

BACKGROUND AND OBJECTIVES: Serum antioxidant vitamins and carotenoids may protect against neurodegeneration with age. We examined associations of these nutritional biomarkers with incident all-cause and Alzheimer disease (AD) dementia among US middle-aged and older adults. METHODS: Using data from the third National Health and Nutrition Examination Surveys (1988-1994), linked with Centers for Medicare & Medicaid follow-up data, we tested associations and interactions of serum vitamins A, C, and E and total and individual serum carotenoids and interactions with incident AD and all-cause dementia. Cox proportional hazards regression models were conducted. RESULTS: After ≤26 years follow-up (mean 16-17 years, 7,283 participants aged 45-90 years at baseline), serum lutein+zeaxanthin was associated with reduced risk of all-cause dementia (65+ age group), even in the lifestyle-adjusted model (per SD: hazard ratio [HR] 0.93, 95% CI 0.87-0.99; p = 0.037), but attenuated in comparison with a socioeconomic status (SES)-adjusted model (HR 0.92, 95% CI 0.86-0.93; p = 0.013). An inverse relationship was detected between serum ß-cryptoxanthin (per SD increase) and all-cause dementia (45+ and 65+) for age- and sex-adjusted models (HR 0.86, 95% CI 0.80-0.93; p < 0.001 for 45+; HR 0.86, 95% CI 0.80-0.93; p = 0.001 for 65+), a relationship remaining strong in SES-adjusted models (HR 0.89, 95% CI 0.82-0.96; p = 0.006 for 45+; HR 0.88, 95% CI 0.81-0.96; p = 0.007 for 65+), but attenuated in subsequent models. Antagonistic interactions indicate putative protective effects of 1 carotenoid may be observed at lower levels other carotenoids or antioxidant vitamin. DISCUSSION: Incident all-cause dementia was inversely associated with serum lutein+zeaxanthin and ß-cryptoxanthin levels. Further studies with time-dependent exposures and randomized trials are needed to test neuroprotective effects of supplementing the diet with select carotenoids. CLASSIFICATION OF EVIDENCE: This study provides Class II evidence that incident all-cause dementia was inversely associated with serum lutein+zeaxanthin and ß-cryptoxanthin levels.

Interrupted Time-Series Analysis of Stereotactic Radiosurgery for Brain Metastases Before and After the Affordable Care Act.

The 2010 Patient Protection and Affordable Care Act was aimed at reducing healthcare costs, improving healthcare quality, and expanding health insurance coverage among uninsured individuals in the United States. We examined trends in the utilization of radiation therapies and stereotactic radiosurgery before and after its implementation among U.S. adults hospitalized with brain metastasis. Interrupted time-series analyses of data on 383,934 Nationwide Inpatient Sample hospitalizations (2005-2010 and 2011-2013) were performed, whereby yearly and quarterly cross-sectional data were evaluated and Affordable Care Act implementation was considered the main exposure variable, stratifying by patient and hospital characteristics. Overall, we observed a declining trend in radiation therapy over time, with an upward shift post-Affordable Care Act. A downward shift in radiation therapy post-Affordable Care Act was observed among Northeastern and rural hospitals, whereas an upward shift was noted among specific patient (females, 18-39 or ≥ 65 years of age, Charlson Comorbidity Index (CCI) ≥10, non-elective admissions, Medicare, self-pay, no pay or other insurance) and hospital (Midwestern, Western, non-teaching urban) subgroups. Stereotactic radiosurgery utilization among recipients of radiation therapy increased over time among Hispanics, elective admissions, and rural hospitals, whereas post-Affordable Care Act was associated with increased stereotactic radiosurgery among African-Americans and non-elective admissions and decreased stereotactic radiosurgery among elective admissions, and rural hospitals. Whereas hospitalized adults in the United States utilized less radiation therapy over the nine-year period, utilization of radiation therapy, in general, and stereotactic radiosurgery, in particular, were not consistent among distinct subgroups defined by patient and hospital characteristics, with some traditionally underserved populations more likely to receive healthcare services post-Affordable Care Act. The Affordable Care Act may be helpful at closing the gap in access to technological advances such as stereotactic radiosurgery for treating brain metastases.

Hospitalization outcomes among brain metastasis patients receiving radiation therapy with or without stereotactic radiosurgery from the 2005-2014 Nationwide Inpatient Sample.

The purpose of this study was to compare hospitalization outcomes among US inpatients with brain metastases who received stereotactic radiosurgery (SRS) and/or non-SRS radiation therapies without neurosurgical intervention. A cross-sectional study was conducted whereby existing data on 35,199 hospitalization records (non-SRS alone: 32,981; SRS alone: 1035; SRS + non-SRS: 1183) from 2005 to 2014 Nationwide Inpatient Sample were analyzed. Targeted maximum likelihood estimation and Super Learner algorithms were applied to estimate average treatment effects (ATE), marginal odds ratios (MOR) and causal risk ratio (CRR) for three distinct types of radiation therapy in relation to hospitalization outcomes, including length of stay (' ≥ 7 days' vs. ' < 7 days') and discharge destination ('non-routine' vs. 'routine'), controlling for patient and hospital characteristics. Recipients of SRS alone (ATE = - 0.071, CRR = 0.88, MOR = 0.75) or SRS + non-SRS (ATE = - 0.17, CRR = 0.70, MOR = 0.50) had shorter hospitalizations as compared to recipients of non-SRS alone. Recipients of SRS alone (ATE = - 0.13, CRR = 0.78, MOR = 0.59) or SRS + non-SRS (ATE = - 0.17, CRR = 0.72, MOR = 0.51) had reduced risks of non-routine discharge as compared to recipients of non-SRS alone. Similar analyses suggested recipients of SRS alone had shorter hospitalizations and similar risk of non-routine discharge when compared to recipients of SRS + non-SRS radiation therapies. SRS alone or in combination with non-SRS therapies may reduce the risks of prolonged hospitalization and non-routine discharge among hospitalized US patients with brain metastases who underwent radiation therapy without neurosurgical intervention.

Association of Antioxidant Vitamins A, C, E and Carotenoids with Cognitive Performance over Time: A Cohort Study of Middle-Aged Adults.

Carotenoids may strengthen the association of antioxidant vitamins A, C, and E with favorable cognitive outcomes over time, though a few prospective studies have examined this hypothesis. We evaluated the longitudinal data from 1251 participants in the Healthy Aging in Neighborhoods of Diversity across the Life Span (HANDLS) study (Age at visit 1 in 2004-2009 (v1): 30-65 years). Vitamins A, C, and E dietary intakes and total and individual dietary carotenoids were computed using two 24-h recalls at v1. Cognitive tests, covering global mental status and domains of memory/learning, attention, psychomotor speed, visuo-spatial, language/verbal, and executive function were conducted at v1 and/or v2 (2009-2013); mean ± SD follow-up: 4.66 ± 0.93 years. Mixed-effects linear regression models detected an interaction between vitamin E and total (and individual) carotenoids for three of 11 cognitive tests at v1, with only one meeting the statistical significance upon multiple testing correction whereby vitamin E was linked with greater verbal memory performance in the uppermost total carotenoid tertile (γ0a = +0.26 ± 0.08, p = 0.002), a synergism largely driven by carotenoid lycopene. Vitamins A and C showed no consistent interactions with carotenoids. In conclusion, we provide partial evidence for synergism between vitamin E and carotenoids in relation to better baseline cognitive performance, pending further studies with time-dependent exposures and randomized trials directly examining this synergism.

Aspects of Dietary Diversity Changes across Adulthood in Racially Diverse Adults.

Knowledge of various aspects of dietary diversity (DD)-an essential healthful dietary component-across adulthood is limited. This study examined three DD aspects over time in racially diverse adults. Participants were from the National Institute on Aging, Healthy Aging in Neighborhoods of Diversity across the Life Span study. DD measures were calculated at baseline (N = 2177), and first and second examination follow-ups (N = 2140 and N = 2066, respectively) using two 24-h recalls. The count was based on the consumption of ≥50% of an equivalent from 21 food groups. Evenness was derived using the Berry-Index adjusted by the food's health value; dissimilarity, by Mahalanobis Distance. Mixed-effects linear regression models were conducted to test changes in DD across adulthood, adjusting for sex, race, poverty status and education as fixed effects, and adjusting for smoking, age and energy as time-dependent variables. Only dissimilarity showed significant interactions of time × race (p = 0.0005), and time × poverty status (p = 0.0325), indicating a slower rate of increase over time in dissimilarity scores among Whites compared with African-Americans and those with income >125% poverty versus <125% poverty. A significant interaction between time×energy (p < 0.0001) was noted for both evenness and dissimilarity scores. To our knowledge, this is the first study to document the differential change in dissimilarity scores by race and income over time.

Two latent classes of diagnostic and treatment procedures among traumatic brain injury inpatients.

To characterize latent classes of diagnostic and/or treatment procedures among hospitalized U.S. adults, 18-64 years, with primary diagnosis of TBI from 2004-2014 Nationwide Inpatient Samples, latent class analysis (LCA) was applied to 10 procedure groups and differences between latent classes on injury, patient, hospital and healthcare utilization outcome characteristics were modeled using multivariable regression. Using 266,586 eligible records, LCA resulted in two classes of hospitalizations, namely, class I (n = 217,988) (mostly non-surgical) and class II (n = 48,598) (mostly surgical). Whereas orthopedic procedures were equally likely among latent classes, skin-related, physical medicine and rehabilitation procedures as well as behavioral health procedures were more likely among class I, and other types of procedures were more likely among class II. Class II patients were more likely to have moderate-to-severe TBI, to be admitted on weekends, to urban, medium-to-large hospitals in Midwestern, Southern or Western regions, and less likely to be > 30 years, female or non-White. Class II patients were also less likely to be discharged home and necessitated longer hospital stays and greater hospitalization charges. Surgery appears to distinguish two classes of hospitalized patients with TBI with divergent healthcare needs, informing the planning of healthcare services in this target population.

Patterns of Bariatric Surgeries Among U.S. Women Diagnosed with Polycystic Ovarian Syndrome.

Background: To examine patterns and outcomes of bariatric surgeries, including Roux-en-Y gastric bypass (RYGB), laparoscopic sleeve gastrectomy (LSG) and laparoscopic adjustable gastric banding (LAGB), among women diagnosed with polycystic ovarian syndrome (PCOS). Materials and Methods: Retrospective cohort study using 1998-2011 Nationwide Inpatient Sample data. A total of 52,668 hospital discharge records met eligibility criteria among PCOS women, 18-49 years. Of those, 17,759 had an obesity/overweight diagnosis and 4310 underwent bariatric surgery. Furthermore, 3086 underwent RYGB (n = 2411), LSG (n = 126), or LAGB (n = 549), and were compared to 78,931 non-PCOS controls. Multiple regression models were constructed to examine patient- and hospital-level predictors of obesity/overweight and bariatric surgery, as well as type of bariatric surgery (RYGB, LSG, or LAGB) as a predictor of in-hospital outcomes and PCOS status. Results: The prevalence of obesity/overweight (≈34%) among women diagnosed with PCOS, and of bariatric surgery (≈24%) among women diagnosed with PCOS and obese/overweight varied by patient- and hospital-level characteristics. Women having PCOS and overweight/obesity, who underwent LSG or LAGB, had shorter hospital stay, reduced hospital charges, and better disposition at discharge compared to those who underwent RYGB. PCOS cases and non-PCOS controls experienced similar treatment selection and in-hospital outcomes after bariatric surgery. Also, PCOS cases and non-PCOS controls experienced similar in-hospital outcomes after undergoing RYGB, LSG, or LAGB. Conclusions: Compared to RYGB, LSG and LAGB resulted in improved in-hospital outcomes among obese/overweight PCOS and non-PCOS patients. Further research is needed to examine health care disparities in the context of PCOS, obesity/overweight, and bariatric surgery.

The patient-centered oncology care on health care utilization and cost: A systematic review and meta-analysis.

BACKGROUND: Optimal cancer care entails coordination among multiple providers and continued follow-up and surveillance over time. The patient-centered care brings opportunities to improve the delivery of cancer care. The adoption of patient-centered oncology care (PCOC) is in its infancy. Evidence synthesis on the model's effectiveness is scant. PURPOSES: This is the first systemic review and meta-analysis on associations of PCOC with cancer patients' adverse health care utilization, cost, patient satisfaction, and quality of care. METHODS: Our study was guided by the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-analyses) framework. Quality appraisal was performed using Downs and Black's quality checklist. Study-level effect sizes of adverse health care utilization were computed using Cohen's d and summarized using forest plots. Funnel plots were constructed to examine publication bias. RESULTS: Of 334 studies that were reviewed, 10 met eligibility criteria and were included into the final analysis. Many included studies implemented almost all six of patient-centered care core attributes, plus three additional attributes that specifically addressed cancer patients' needs, including triage pathways, standardized and evidence-based symptom management, as well as support patient navigation. PCOC patients had lower utilization of inpatient care (standardized means difference [SMD] = -0.027, p = .049). Overall positive effect of PCOC on emergency department use was small and not significant (SMD = -0.023, p = .103). With regard to cost and quality of care, our narrative summaries showed an overall positive direction, though we found limitations in individual study quality that precluded a meta-analysis. PUBLIC IMPLICATION: The results showed that it is possible to utilize patient-centered model to support best practice of cancer care. Early evidence shows that the PCOC model has potential to improve health care utilization, cost, and quality of care, but limited numbers of included articles and heterogeneity of those studies implied that more rigorous research is expected to further investigate the model's effects.

Mediating-Moderating Effect of Allostatic Load on the Association between Dietary Approaches to Stop Hypertension Diet and All-Cause and Cause-Specific Mortality: 2001-2010 National Health and Nutrition Examination Surveys.

This secondary analysis of survey data examined mediating-moderating effects of allostatic load score (calculated using the Rodriquez method) on the association between nutrient-based Dietary Approaches to Stop Hypertension (DASH) diet score (Mellen Index) and the all-cause and cause-specific mortality risks among 11,630 adults ≥ 30 years of age from the 2001-2010 National Health and Nutrition Examination Surveys with no history of cardiovascular disease or cancer at baseline, and who were followed-up for ~9.35 years. Multivariable models were adjusted for demographic, socioeconomic, lifestyle, and health characteristics. All-cause, cardiovascular disease, and cancer-specific mortality rates were estimated at 6.5%, 1.1%, and 1.9%, respectively. The median DASH total score was 3.0 (range: 1-8) (with 78.3% scoring < 4.5), whereas the median allostatic load score was 3 (range: 0-9). The DASH diet, fiber, and magnesium were negatively correlated with allostatic load, whereas allostatic load predicted higher all-cause mortality, irrespective of the DASH diet. Whereas protein was protective, potassium increased all-cause mortality risk, irrespective of allostatic load. Potassium was protective against cardiovascular disease-specific mortality but was a risk factor for cancer-specific mortality. Although no moderating effects were observed, mediation by the allostatic load on cardiovascular disease-specific mortality was observed for DASH total score and selected component scores. Direct (but not indirect) effects of DASH through the allostatic load were observed for all-cause mortality, and no direct or indirect effects were observed for cancer-specific mortality. From a public health standpoint, the allostatic load may be a surrogate for the preventive effects of the DASH diet and its components on cardiovascular disease-specific mortality risk.

Cytokines are associated with longitudinal changes in cognitive performance among urban adults.

BACKGROUND: Chronic systemic inflammation has been positively associated with structural and functional brain changes representing early markers of Alzheimer's Disease (AD) and cognitive decline. The current study examined associations between systemic inflammation and cognitive performance among African-Americans and Whites urban adults. METHODS: Participants were selected from the Healthy Aging in Neighborhoods of Diversity across the Life Span (HANDLS) study (2004-2013, baseline age: 30-64 y, mean ±â€¯SD follow-up time of 4.64 ±â€¯0.93 y, N = 189-222, k = 1.5-1.7 observations/participant). Cytokines known to be positively linked to AD incidence among others were tested against cross-sectional and longitudinal cognitive function, stratifying by age group (≤50 y vs. >50 y), sex and race. A series of mixed-effects regression models were conducted, adjusting for key confounders. RESULTS: Among key findings, IL1ß was positively associated with a faster rate of decline on a test of executive functioning, among older adults (age >50 y, γ11 = +2.49 ±â€¯0.89, p = 0.005), while in the total population, IL-6 was linked to a faster decline on a test of verbal memory (γ11 = -0.011 ±â€¯0.004, p = 0.009). Among younger participants, IL-18 was linked to a poorer performance on a test of attention at baseline (age ≤50 y, γ01 = -0.007 ±â€¯0.0025, p = 0.004) though a slower rate of decline with higher IL-18 was detected for a test of psychomotor speed in older adults (age >50 y, γ11 = +0.0010 ±â€¯0.0004, p = 0.008). Finally, among Whites, unlike among African-Americans, IL-6 was associated with a better baseline performance on two tests of verbal and working memory. CONCLUSIONS: Cytokines were shown to be associated with age-related cognitive decline among middle-aged and older urban adults in an age group and race-specific manner. Further longitudinal studies are needed to replicate our findings and mediation through relevant biological and psychosocial factors need to be studied as well.

Vitamin D and breast cancer: A systematic review and meta-analysis of observational studies.

CONTEXT: Breast cancer (BC) is the most common malignancy among women in the US. Vitamin D status and intakes are thought to be inversely associated with BC occurrence. OBJECTIVES: In our systematic review and meta-analysis, we evaluated evidence linking serum 25(OH)D (both in serum and diet) with breast cancer (BC) occurrence. DATA SOURCES AND EXTRACTION: Only observational studies from databases such as PubMed and Cochrane (January 1st 2000 through March 15th, 2018) were included using PRISMA guidelines. Publication bias and consistency upon replication were assessed, while harmonizing risk ratios (RR, 95% CI) of BC, per fixed increment of 5 exposures [10 ng/mL of 25(OH)D; 100 IU/d for total/dietary vitamin D intakes; vitamin D deficiency; supplement use). RRs were pooled using random effect models. DATA ANALYSIS: Pooled findings from 22 studies suggested a net direct association between 25(OH)D deficiency and BC, with RRpooled = 1.91, 95% CI: 1.51-2.41, P < 0.001). Total vitamin D intake (RRpooled = 0.99, 95% CI: 0.97-1.00, P = 0.022, per 100 IU/d) and supplemental vitamin D (RRpooled = 0.97, 95% CI:0.95-1.00, P = 0.026) were inversely associated with BC. No evidence of publication bias was found; all 5 exposures of interest were consistent upon replication. CONCLUSIONS: 25(OH)D deficiency was directly related to BC while total vitamin D and supplemental vitamin D intakes had an inverse relationship with this outcome. Randomized clinical trials are warranted pending further evidence from primary meta-analyses of observational studies.

Omega-3 Fatty Acids and Genome-Wide Interaction Analyses Reveal DPP10-Pulmonary Function Association.

RATIONALE: Omega-3 polyunsaturated fatty acids (n-3 PUFAs) have anti-inflammatory properties that could benefit adults with comprised pulmonary health. OBJECTIVE: To investigate n-3 PUFA associations with spirometric measures of pulmonary function tests (PFTs) and determine underlying genetic susceptibility. METHODS: Associations of n-3 PUFA biomarkers (α-linolenic acid, eicosapentaenoic acid, docosapentaenoic acid [DPA], and docosahexaenoic acid [DHA]) were evaluated with PFTs (FEV1, FVC, and FEV1/FVC) in meta-analyses across seven cohorts from the Cohorts for Heart and Aging Research in Genomic Epidemiology Consortium (N = 16,134 of European or African ancestry). PFT-associated n-3 PUFAs were carried forward to genome-wide interaction analyses in the four largest cohorts (N = 11,962) and replicated in one cohort (N = 1,687). Cohort-specific results were combined using joint 2 degree-of-freedom (2df) meta-analyses of SNP associations and their interactions with n-3 PUFAs. RESULTS: DPA and DHA were positively associated with FEV1 and FVC (P < 0.025), with evidence for effect modification by smoking and by sex. Genome-wide analyses identified a novel association of rs11693320-an intronic DPP10 SNP-with FVC when incorporating an interaction with DHA, and the finding was replicated (P2df = 9.4 × 10-9 across discovery and replication cohorts). The rs11693320-A allele (frequency, ∼80%) was associated with lower FVC (PSNP = 2.1 × 10-9; ßSNP = -161.0 ml), and the association was attenuated by higher DHA levels (PSNP×DHA interaction = 2.1 × 10-7; ßSNP×DHA interaction = 36.2 ml). CONCLUSIONS: We corroborated beneficial effects of n-3 PUFAs on pulmonary function. By modeling genome-wide n-3 PUFA interactions, we identified a novel DPP10 SNP association with FVC that was not detectable in much larger studies ignoring this interaction.

Modifiable health risk factors, related counselling, and treatment among patients in health centres.

Chronic disease burden and its related health risk factors are especially concentrated among the poor. Community health centres reach the nation's most vulnerable population. This study explored the prevalence, racial/ethnic, and gender disparities of five modifiable health risk factors and the receipt of related counselling and treatment among patients in U.S. federally qualified health centres. The 2014 Health Center Patient Survey was used for this study. We performed a cross-sectional study. Measures included tobacco use, excessive alcohol consumption, obese/overweight, high blood pressure, high blood cholesterol, and five related counselling/treatment measures. Logistic regression models were conducted to examine the multivariable-adjusted putative associations of several sociodemographic and health-related factors with modifiable health risk and counselling/treatment measures. Preliminary findings revealed differences in modifiable health risk factors across different racial/ethnic groups, while few racial/ethnic differences existed in related counselling/treatment measures. In the multivariable-adjusted logistic regression models, these differences in health risk factors were still apparent, while associations between race/ethnicity status and counselling/treatment measures were not detected. Gender was also a predictor for four types of health risk measures and two types of counselling/treatment measures. Health centre patients had high rates of modifiable health risk factors. The rates were different across race/ethnicity groups, and the differences found did not always favour non-Hispanic Whites. However, the findings reveal equitable access to related counselling/treatment service among patients across race/ethnicity groups.

Complications associated with surgical treatment of sleep-disordered breathing among hospitalized U.S. adults.

The purpose of this cross-sectional study is to examine the relationship between surgical treatments for sleep-disordered breathing (SDB) and composite measure of surgical complications in a nationally representative sample of hospital discharges among U.S. adults. We performed secondary analyses of 33,679 hospital discharges from the 2002-2012 Nationwide Inpatient Sample that corresponded to U.S. adults (≥18 years) who were free of head-and-neck neoplasms, were diagnosed with SDB and had undergone at least one of seven procedures. Multivariate logistic regression models were constructed to estimate adjusted odds ratios (aOR) and 95% confidence intervals (CI), controlling for age, sex, race/ethnicity, obstructive sleep apnea (OSA) and obesity diagnoses. Positive associations were found between composite measure of surgical complications and specific procedures: palatal procedure (aOR = 12.69, 95% CI: 11.91,13.53), nasal surgery (aOR = 6.47, 95% CI: 5.99,6.99), transoral robotic assist (aOR = 5.06, 95% CI: 4.34-5.88), tongue base/hypopharynx (aOR = 4.24, 95% CI: 3.88,4.62), maxillomandibular advancement (MMA) (aOR = 3.24, 95% CI: 2.74,3.84), supraglottoplasty (aOR = 2.75, 95% CI: 1.81,4.19). By contrast, a negative association was found between composite measures of surgical complications and tracheostomy (aOR = 0.033, 95% CI: 0.031,0.035). In conclusion, most procedures for SDB, except tracheostomy, were positively associated with complications, whereby palatal procedures exhibited the strongest and supraglottoplasty exhibited the weakest association.