Pulmonary embolism: incidence and outcomes in a twelve-year historical series, in Tuscany - Italy (2010-2021).

Background: Pulmonary embolism poses a global health concern. Administrative databases serve as valuable sources for broad epidemiological studies on the prevalence and incidence of major diagnoses or diseases. The primary scope is to provide up-to-date insights into Pulmonary Embolism incidence trends, examining shifts in management and outcomes. Design: This retrospective observational study examines a 12-year dataset from hospitals in the Tuscany Region, covering the first two years of the Covid-19 pandemic. Methods: Administrative data from residents aged 18 and older discharged from hospital between 2010 and 2021 were used for the analysis. Results: Hospitalized pulmonary embolism incidence slightly declined from 2010 to 2019 (64.7 to 60.9 x 100,000; p=0.152). Males under 75 showed a higher incidence rate, while females had higher incidence rates in older age groups. In-hospital and 30-day mortality decreased from 2010 to 2019 (p=0.001 and 0.020 respectively). In 2020, 30-day mortality increased (12.4% vs 10.1%, p=0.029), while in-hospital mortality remained stable. One-year mortality was stable from 2010-2019 but increased in 2020 (32.6% vs 29.4%, p=0.037). Considering the multivariable model, one-year mortality is significantly associated with sex, age, and comorbidities. Conclusions: Our study shows that Pulmonary Embolism persists as a relevant burden in Tuscany region, but with improvements in management over the past decade and a decisive change in pharmacological treatment. Gender-related differences emerge, highlighting the need for a gender-specific healthcare approach.

Individual and Community-level Determinants of Neonatal Mortality in Pakistan: indication from Pakistan Demographic and Health Survey (2017-18).

OBJECTIVE: To evaluate individual and community-level factors influencing neonatal mortality in Pakistan. METHODS: The retrospective, secondary-data, quantitative study was done from July 2021 to January 2022 after approval from the ethics review committee of the International Islamic University, Islamabad, Pakistan, and comprised data of live births from November 22, 2017, to April 30, 2018, which was the period covered by the Pakistan Demographic and Health Survey 2017-18. Significant community-level, maternal and proximate determinants of neonatal mortality were identified. Data was analysed using STATA 13. RESULTS: Among the 12,708 live births covered, the neonatal mortality rate within the first month of birth was 5337(42%), and 3939(31%) neonatal deaths occurred in the first week of life, while 3431(27%) deaths occurred on the first day. Distance to health facility (adjusted hazard ratio: 1.1; 95% confidence interval: 0.8-1.6), unimproved toilet facility (adjusted hazard ratio: 2.0; 95% confidence interval: 0.7-2.1), caesarean section deliveries (adjusted hazard ratio: 1.6; 95% confidence interval: 0.6-1.9) and child's birth size smaller than average (adjusted hazard ratio: 1.7; 95% confidence interval: 1.1-2.7) carried significantly higher risk of neonatal deaths. Compared to women aged 15-19 years, older women's child (adjusted hazard ratio: 0.6; 95% confidence interval: 0.2-1.6) and neonates having birth order 3 compared to birth order 1 (adjusted hazard ratio: 0.5; 95% confidence interval: 0.2-0.9) and female gender of child (adjusted hazard ratio: 0.3; 95% confidence interval: 0.2-0.9) were less likely to die. CONCLUSIONS: There was a markedly high prevalence of neonatal mortality rate in Pakistan. Unimproved toilet facility, distance to health facility, caesarean mode of delivery and small size of the child at birth were found linked with increased risk of neonatal mortality.

The development of the ADO-SQ model to predict 1-year mortality in patients with COPD.

BACKGROUND: Goals of end-of-life care must be adapted to the needs of patients with chronic obstructive pulmonary disease (COPD) who are in the last phase of life. However, identification of those patients is limited by moderate performances of existing prognostic models and by limited validation of the often-recommended surprise question. AIM: To develop a clinical prediction model to predict 1-year mortality in patients with COPD. DESIGN: Prospective study using logistic regression to develop a model in two steps: (1) external validation of the ADO, BODEX, or CODEX models (A = age; B = body mass index; C = comorbidity; D = dyspnea; EX = exacerbations; O = airflow obstruction); (2) updating of best performing model and extending it with the surprise question. Discriminative performance of the new model was assessed using internal-external validation and measured with area under the curve (AUC). A nomogram and web application were developed. SETTINGS/PARTICIPANTS: Patients with COPD from five hospitals (September-November 2017). RESULTS: Of the 358 included patients (median age 69.5 years, 50% male), 63 (17%) died within a year. The ADO index (AUC 0.73) had the best discriminative ability compared to the BODEX (AUC 0.71) or CODEX (AUC 0.68), and was extended with the surprise question. The resulting ADO-surprise question (SQ) model had an AUC of 0.79. CONCLUSION: The ADO-SQ model offers improved discriminative performance for predicting 1-year mortality compared to the surprise question, ADO, BODEX, or CODEX. A user-friendly nomogram and web application (https://dnieboer.shinyapps.io/copd) were developed. Further external validation of the ADO-SQ in patient groups is needed.

Lactate-dehydrogenase associated with mortality in hospitalized patients with COVID-19 in Mexico: a multi-centre retrospective cohort study.

INTRODUCTION AND OBJECTIVES: As of January 2021, over 88 million people have been infected with COVID-19. Almost two million people have died of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). A high SOFA score and a D-Dimer >1 µg/mL identifies patients with high risk of mortality. High lactate dehydrogenase (LDH) levels on admission are associated with severity and mortality. Different degrees of alanine aminotransferase (ALT) and/or aspartate aminotransferase (AST) abnormalities have been reported in these patients, its association with a mortality risk remains controversial. The aim of this study was to explore the correlation between LDH and in-hospital mortality in Mexican patients admitted with COVID-19. MATERIALS & METHODS: We performed a retrospective multi-centre cohort study with 377 hospitalized patients with confirmed SARS-CoV-2 in three centres in Mexico City, Mexico, who were ≥18 years old and died or were discharged between April 1 and May 31, 2020. RESULTS: A total of 377 patients were evaluated, 298 (79.1%) patients were discharged, and 79 (20.9%) patients died during hospitalization. Non-survivors were older, with a median age of 46.7 ± 25.7 years old, most patients were male. An ALT > 61 U/l (OR 3.45, 95% CI 1.27-9.37; p = 0.015), C-reactive protein (CRP) > 231 mg/l (OR 4.71, 95% CI 2.35-9.46; p = 0.000), LDH > 561 U/l (OR 3.03, 95% CI 1.40-6.55; p = 0.005) were associated with higher odds for in-hospital death. CONCLUSIONS: Our results indicate that higher levels of LDH, CRP, and ALT are associated with higher in-hospital mortality risk in Mexican patients admitted with COVID-19.

Shrunken Pore Syndrome is associated with a sharp rise in mortality in patients undergoing elective coronary artery bypass grafting.

Shrunken Pore Syndrome was recently suggested for the pathophysiologic state in patients characterized by an estimation of their glomerular filtration rate (GFR) based upon cystatin C, which is lower or equal to 60% of their estimated GFR based upon creatinine, i.e. when eGFR cystatin C ≤ 60% of eGFR creatinine. Not only the cystatin C level, but also the levels of other low molecular mass proteins are increased in this condition. The preoperative plasma levels of cystatin C and creatinine were measured in 1638 patients undergoing elective coronary artery bypass grafting. eGFR cystatin C and eGFR creatinine were calculated using two pairs of estimating equations, CAPA and LMrev, and CKD-EPI cystatin C and CKD-EPI creatinine, respectively. The Shrunken Pore Syndrome was present in 2.1% of the patients as defined by the CAPA and LMrev equations and in 5.7% of the patients as defined by the CKD-EPI cystatin C and CKD-EPI creatinine equations. The patients were studied over a median follow-up time of 3.5 years (2.0-5.0 years) and the mortality determined. Shrunken Pore Syndrome defined by both pairs of equations was a strong, independent, predictor of long-term mortality as evaluated by Cox analysis and as illustrated by Kaplan-Meier curves. Increased mortality was observed also for the subgroups of patients with GFR above or below 60 mL/min/1.73 m(2). Changing the cut-off level from 60 to 70% for the CAPA and LMrev equations increased the number of patients with Shrunken Pore Syndrome to 6.5%, still displaying increased mortality.

Predictors of Mortality in Patients with COPD and Chronic Respiratory Failure: The Quality-of-Life Evaluation and Survival Study (QuESS): A Three-Year Study.

UNLABELLED: Previous studies sought to identify survival or outcome predictors in patients with COPD and chronic respiratory failure, but their findings are inconsistent. We identified mortality-associated factors in a prospective study in 21 centers in 7 countries. Follow-up data were available in 221 patients on home mechanical ventilation and/or long-term oxygen therapy. MEASUREMENTS: diagnosis, co-morbidities, medication, oxygen therapy, mechanical ventilation, pulmonary function, arterial blood gases, exercise performance were recorded. Health status was assessed using the COPD-specific SGRQ and the respiratory-failure-specific MRF26 questionnaires. Date and cause of death were recorded in those who died. Overall mortality was 19.5%. The commonest causes of death were related to the underlying respiratory diseases. At baseline, patients who subsequently died were older than survivors (p = 0.03), had a lower forced vital capacity (p = 0.03), a higher use of oxygen at rest (p = 0.003) and a worse health status (SGRQ and MRF26, both p = 0.02). Longitudinal analyses over a follow-up period of 3 years showed higher median survival times in patients with use of oxygen at rest less than 1.75 l/min and with a better health status. In contrast, an increase from baseline levels of 1 liter in O2 flow at rest, 1 unit in SGRQ or MRF26, or 1 year increase in age resulted in an increase of mortality of 68%, 2.4%, 1.3%, and 6%, respectively. In conclusion, the need for oxygen at rest, and health status assessment seems to be the strongest predictors of mortality in COPD patients with chronic respiratory failure.

Improving the estimation of the burden of risk factors: an illustrative comparison of methods to measure smoking-attributable mortality.

BACKGROUND: Prevention efforts are informed by the numbers of deaths or cases of disease caused by specific risk factors, but these are challenging to estimate in a population. Fortunately, an increasing number of jurisdictions have increasingly rich individual-level, population-based data linking exposures and outcomes. These linkages enable multivariable approaches to risk assessment. We demonstrate how this approach can estimate the population burden of risk factors and illustrate its advantages over often-used population-attributable fraction methods. METHODS: We obtained risk factor information for 78,597 individuals from a series of population-based health surveys. Each respondent was linked to death registry (568,997 person-years of follow-up, 6,399 deaths).Two methods were used to obtain population-attributable fractions. First, the mortality rate difference between the entire population and the population of non-smokers was divided by the total mortality rate. Second, often-used attributable fraction formulas were used to combine summary measures of smoking prevalence with relative risks of death for select diseases. The respective fractions were then multiplied to summary measures of mortality to obtain smoking-attributable mortality. Alternatively, for our multivariable approach, we created algorithms for risk of death, predicted by health behaviors and various covariates (age, sex, socioeconomic position, etc.). The burden of smoking was determined by comparing the predicted mortality of the current population with that of a counterfactual population where smoking is eliminated. RESULTS: Our multivariable algorithms accurately predicted an individual's risk of death based on their health behaviors and other variables in the models. These algorithms estimated that 23.7% of all deaths can be attributed to smoking in Ontario. This is higher than the 20.0% estimated using population-attributable risk methods that considered only select diseases and lower than the 35.4% estimated from population-attributable risk methods that examine the excess burden of all deaths due to smoking. CONCLUSIONS: The multivariable algorithms presented have several advantages, including: controlling for confounders, accounting for complexities in the relationship between multiple exposures and covariates, using consistent definitions of exposure, and using specific measures of risk derived internally from the study population. We propose the wider use of multivariable risk assessment approach as an alternative to population-attributable fraction methods.

Mortality of a cohort of workers in Great Britain with blood lead measurements.

OBJECTIVES: We examined the mortality of a historic cohort of workers in Great Britain with measured blood lead levels (BLLs). METHODS: SMRs were calculated with the population of Great Britain as the external comparator. Trends in mortality with mean and maximum BLLs and assessed lead exposure were examined using Cox regression. RESULTS: Mean follow-up length among the 9122 study participants was 29.2 years and 3466 deaths occurred. For all causes and all malignant neoplasms, the SMRs were statistically significantly raised. For disease groups of a priori interest, the SMR was significantly raised for lung cancer but not for stomach, brain, kidney, bladder or oesophageal cancers. The SMR was not increased for non-malignant kidney disease but was borderline significantly increased for circulatory diseases, for ischaemic heart disease (IHD) and cerebrovascular disease (CVD). No significant trends with exposure were observed for the cancers of interest, but for circulatory diseases and IHD, there was a statistically significant trend for increasing HR with mean and maximum BLLs. CONCLUSIONS: This study found an excess of lung cancer, although the risk was not clearly associated with increasing BLLs. It also found marginally significant excesses of IHD and CVD, the former being related to mean and maximum BLLs. The finding for IHD may have been due to lead, but could also have been due to other dust exposure associated with lead exposure and possibly tobacco smoking. Further work is required to clarify this and the carcinogenicity of lead.

Determinants of mortality in a combined cohort of 501 patients with HIV-associated Cryptococcal meningitis: implications for improving outcomes.

BACKGROUND: Cryptococcal meningitis (CM) is a leading cause of death in individuals infected with human immunodeficiency virus (HIV). Identifying factors associated with mortality informs strategies to improve outcomes. METHODS: Five hundred one patients with HIV-associated CM were followed prospectively for 10 weeks during trials in Thailand, Uganda, Malawi, and South Africa. South African patients (n = 266) were followed for 1 year. Similar inclusion/exclusion criteria were applied at all sites. Logistic regression identified baseline variables independently associated with mortality. RESULTS: Mortality was 17% at 2 weeks and 34% at 10 weeks. Altered mental status (odds ratio [OR], 3.1; 95% confidence interval [CI], 1.7-5.9), high cerebrospinal fluid (CSF) fungal burden (OR, 1.4 per log10 colony-forming units/mL increase; 95% CI, 1.0-1.8), older age (>50 years; OR, 3.9; 95% CI, 1.4-11.1), high peripheral white blood cell count (>10 × 10(9) cells/L; OR, 8.7; 95% CI, 2.5-30.2), fluconazole-based induction treatment, and slow clearance of CSF infection were independently associated with 2-week mortality. Low body weight, anemia (hemoglobin <7.5 g/dL), and low CSF opening pressure were independently associated with mortality at 10 weeks in addition to altered mental status, high fungal burden, high peripheral white cell count, and older age. In those followed for 1 year, overall mortality was 41%. Immune reconstitution inflammatory syndrome occurred in 13% of patients and was associated with 2-week CSF fungal burden (P = .007), but not with time to initiation of antiretroviral therapy (ART). CONCLUSIONS: CSF fungal burden, altered mental status, and rate of clearance of infection predict acute mortality in HIV-associated CM. The results suggest that earlier diagnosis, more rapidly fungicidal amphotericin-based regimens, and prompt immune reconstitution with ART are priorities for improving outcomes.

Socioeconomic inequalities in premature mortality in Colombia, 1998-2007: the double burden of non-communicable diseases and injuries.

OBJECTIVES: Non-communicable diseases have become the leading cause of death in middle-income countries, but mortality from injuries and infections remains high. We examined the contribution of specific causes to disparities in adult premature mortality (ages 25-64) by educational level from 1998 to 2007 in Colombia. METHODS: Data from mortality registries were linked to population censuses to obtain mortality rates by educational attainment. We used Poisson regression to model trends in mortality by educational attainment and estimated the contribution of specific causes to the Slope Index of Inequality. RESULTS: Men and women with only primary education had higher premature mortality than men and women with post-secondary education (RRmen=2.60, 95% confidence interval [CI]: 2.56, 2.64; RRwomen=2.36, CI: 2.31, 2.42). Mortality declined in all educational groups, but declines were significantly larger for higher-educated men and women. Homicide explained 55.1% of male inequalities while non-communicable diseases explained 62.5% of female inequalities and 27.1% of male inequalities. Infections explained a small proportion of inequalities in mortality. CONCLUSION: Injuries and non-communicable diseases contribute considerably to disparities in premature mortality in Colombia. Multi-sector policies to reduce both interpersonal violence and non-communicable disease risk factors are required to curb mortality disparities.

Preoperative anaemia is associated with poor clinical outcome in non-cardiac surgery patients.

BACKGROUND: Retrospective studies suggest that preoperative anaemia is associated with poor outcomes after surgery. The objective of this study was to describe mortality rates and patterns of intensive care resource use for patients with anaemia undergoing non-cardiac and non-neurological in-patient surgery. METHODS: We performed a secondary analysis of a large prospective study describing perioperative care and survival in 28 European nations. Patients at least 16 yr old undergoing in-patient surgery during a 7 day period were included in the study. Data were collected for in-hospital mortality, duration of hospital stay, admission to intensive care, and intensive care resource use. Multivariable logistic regression analysis was performed to understand the effects of preoperative haemoglobin (Hb) levels on in-hospital mortality. RESULTS: We included 39 309 patients in the analysis. Preoperative anaemia had a high prevalence in both men and women (31.1% and 26.5%, respectively). Multivariate analysis showed that patients with severe [odds ratio 2.82 (95% confidence interval 2.06-3.85)] or moderate [1.99 (1.67-2.37)] anaemia had higher in-hospital mortality than those with normal preoperative Hb concentrations. Furthermore, hospital length of stay (P<0.001) and postoperative admission to intensive care (P<0.001) were greater in patients with anaemia than in those with normal Hb concentrations. CONCLUSIONS: Anaemia is common among non-cardiac and non-neurological surgical patients, and is associated with poor clinical outcome and increased healthcare resource use. CLINICAL TRIAL REGISTRATION: NCT01203605 (ClinicalTrials.gov).

[Effect of gender equality on mortality from non-communicable diseases]. / Efecto de la igualdad de género en la mortalidad por enfermedades no transmisibles.

OBJECTIVE: Relate gender inequalities with the probability of mortality from non-communicable diseases (NCD), in the countries of the world from the year 2000 to 2019, to detect the progress of Target 3.4 of the Sustainable Development Goal 3, to reduce NCD by one third between the ages of 30 and 70 by 2030. METHOD: Exploratory ecological study on the association between the probability of death from NCD and the gender inequality index (GII) at the global level in 2000, 2015 and 2019. Logistic regression estimation of the risk of not being on track to meet Target 3.4 by 2019 by gender inequality. RESULTS: The mean probability of death from NCD decreased progressively in all countries. Median 2000/2015/2019: women 20.20/16.58/16; men 26.59/22.45/21.88; total 23.14/20.10/19.23. The risk of not achieving the goal in 2019 is greater in countries with a lower GII than in countries with a higher GII (OR: 2.13; 95% CI: 1.14-3.99; p=0.018), being the higher risk in women (OR: 2.64; 95% CI: 1.40-5.06; p=0.003) than in men (OR: 2.12; 95% CI: 1.44-3.98; p=0.017). CONCLUSIONS: The risk of deaths from NCD has decreased in both sexes in all countries of the world since the year 2000; but progress is slow, so the greater gender inequality in the countries, there is a greater risk of not achieving the reduction needed to comply with the agreement to reduce mortality from NCD by one third in 2030; this risk being greater in women than in men.

Social integration, social support and mortality in the US National Health Interview Survey.

BACKGROUND: Social relationship quantity and quality are associated with mortality, but it is unclear whether each relationship dimension is equally important for longevity and whether these associations are sensitive to baseline health status. METHODS: This study examined the individual and joint associations of relationship quantity (measured using a social integration score) and quality (measured by perceived social support) with mortality in a representative US sample (n = 30,574). The study also evaluated whether these associations were consistent across individuals with and without diagnosed chronic illness and whether they were independent of socioeconomic status (SES; education, income, employment, and wealth). Baseline data were collected in 2001 and were linked to vital status records 5 years later (1836 deaths). RESULTS: Both social integration and social support were individually related to mortality (hazard ratios [HRs] = 0.83 [95% confidence interval {CI} = 0.80-0.85] and HR = 0.94 [95% CI = 0.89-0.98], respectively). However, in multivariate models including demographic and SES variables, social integration (HR = 0.86, 95% CI = 0.83-0.89) but not social support (HR = 1.03, 95% CI = 0.98-1.08) was associated with mortality. The social integration association was linear and consistent across baseline health status and men and women. CONCLUSIONS: Social integration but not social support was independently associated with mortality in the US sample. This association was consistent across baseline health status and not accounted for by SES.

Mortality in depressed and non-depressed primary care Swedish patients: a 12-year follow-up cohort study.

BACKGROUND: Data regarding mortality among depressed patients in Swedish primary care is limited. OBJECTIVES: We compared mortality in a cohort of depressed and non-depressed patients at long-term follow-up and compared these values with standardized mortality rates (SMRs) in the Swedish population. Hazards ratios (HRs) for the relationship between death and depression, psychosocial factors and lifestyle were analysed, and we explored the proportion of unnatural causes of deaths. METHODS: Mortality was studied in a cohort of 124 depressed and 280 non-depressed patients 12 years after being diagnosed with depression in primary care. Mortality and the mortality rates and SMRs in depressed and non-depressed patients were compared by gender. Cox regression was applied to calculate HRs for the risk of dying for explanatory variables, including depression, psychosocial factors and lifestyle. RESULTS: A larger number of depressed patients, 11% (n = 14), compared with non-depressed patients, 4% (n = 12), died (P = 0.008), with significantly higher values among depressed men (P = 0.014). SMRs did not differ from those of the Swedish population. Depression was the only variable associated with a significantly elevated risk of death (HR, 3.34; 95% CI, 1.38-8.08). Nearly one-third of deaths had unnatural causes when alcohol-related deaths were included. CONCLUSION: This study underlines the importance of careful follow-up of all depressed patients' mental and physical health and the intervention on unhealthy lifestyles. Large primary care database studies are needed to explore the association between depression, co-morbid somatic diseases, lifestyle and mortality.

Prevalence and burden of diseases presenting to a general pediatrics ward in Gondar, Ethiopia.

BACKGROUND: Little is known about pediatric hospital admissions in Ethiopia. METHODS: This cross-sectional study analyzed all data entered into the Gondar University Hospital pediatric ward's admission registration books over 1 year. Patient age, sex, origin, length of stay, diagnosis and discharge condition were transcribed into an electronic database for all observations. Missing data were retrieved by chart and death certificate review. Primary outcome measures included death and death in the first 24 h of admission. RESULTS: In all, 1927 patients were admitted to our facility during the year of study. Of these, 64.5% improved, 4.6% were discharged unchanged, 6.5% disappeared and 7.5% died; the remaining 17.0% of outcome data were registered as 'non-death' but could not be specified further. The median age of admission was 2.2 years (interquartile range 1-7 years), with more admissions for children younger than 5 years (70.3%) and more male subjects admitted than female subjects (59.6% male). The median length of stay was 4.0 days (interquartile range 2-10 days). Eighty-one percent of admissions originated from Gondar or its neighboring districts. Most admissions carried a respiratory, nutritional or infectious diagnosis (47.5, 46.8 and 36.5%, respectively). Conditions diagnosed most commonly (>200 cases) included community-acquired pneumonia (812 cases), severe acute malnutrition (381), anemia (274) and acute gastroenteritis (219). Seven diagnoses were associated with mortality after adjusting for demographic covariates: severe acute malnutrition (odds ratio (OR) 2.5, P < 0.001), coma (OR 4.2, P < 0.001), meningitis (OR 2.3, P = 0.018), congestive heart failure (OR 2.4, P = 0.001), severe dehydration (OR 2.5, P = 0.004), aspiration pneumonia (OR 5.4, P < 0.001) and sepsis (OR 3.2, P < 0.001). Thirty-three percent of deaths occurred in the first 24 h of admission, with four diagnoses associated with first-24-h mortality after adjusting for demographic covariates: coma (OR 7.0, P < 0.001), meningitis (OR 3.2, P = 0.008), congestive heart failure (OR 3.1, P = 0.008) and aspiration pneumonia (OR 12.1, P < 0.001). CONCLUSIONS: This study demonstrates a mortality pattern at our hospital that differs considerably from Ethiopia as a whole, and may differ from other hospitals in sub-Saharan Africa. Hospitals must look beyond national and regional agenda when identifying mortality reduction targets.

Validation of a Multivariate Prediction Model of the Clinical Progression of Alzheimer's Disease in a Community-Dwelling Multiethnic Cohort.

BACKGROUND: The major aims of the three Predictors Studies have been to further our understanding of Alzheimer's disease (AD) progression sufficiently to predict the length of time from disease onset to major disease outcomes in individual patients with AD. OBJECTIVES: To validate a longitudinal Grade of Membership (L-GoM) prediction algorithm developed using clinic-based, mainly white patients from the Predictors 2 Study in a statistically representative community-based sample of Hispanic (N = 211) and non-Hispanic (N = 62) older adults (with 60 males and 213 females) from the Predictors 3 Study and extend the algorithm to mild cognitive impairment (MCI). METHODS: The L-GoM model was applied to data collected at the initial Predictors 3 visit for 150 subjects with AD and 123 with MCI. Participants were followed annually for up to seven years. Observed rates of survival and need for full-time care (FTC) were compared to those predicted by the algorithm. RESULTS: Initial MCI/AD severity in Predictors 3 was substantially higher than among clinic-based AD patients enrolled at the specialized Alzheimer's centers in Predictors 2. The observed survival and need for FTC followed the L-GoM model trajectories in individuals with MCI or AD, except for N = 32 subjects who were initially diagnosed with AD but reverted to a non-AD diagnosis on follow-up. CONCLUSION: These findings indicate that the L-GoM model is applicable to community-dwelling, multiethnic older adults with AD. They extend the use of the model to the prediction of outcomes for MCI. They also justify release of our L-GoM calculator at this time.

Prognostic predictors for mortality of patients with COVID-19 in an intensive care unit.

INTRODUCTION: Fatality due to COVID-19 continues to be a challenge. Timely identification of critical COVID-19 patients is crucial for their close clinical follow-up and treatment. We aimed to identify the mortality predictors of critical COVID-19 patients. METHODOLOGY: We analyzed medical records of 232 out of 300 patients with COVID-19 hospitalized in the intensive care unit (ICU) whose medical records were available in the hospital database. Non-survivors and survivors were compared for parameters. Medical records of demographics, comorbidities, radiological signs, respiratory support, and laboratory tests on the first day of ICU admission were included. The durations of ICU stay and hospitalization were also evaluated. RESULTS: The patients with Acute Physiology and Chronic Health Evaluation II (APACHE-II) score above 28.5 and the patients with blood urea nitrogen (BUN) above 45.5 mg/dL were significantly more mortal (95% CI: 0.701, p = 0.0001; 95% CI: 0.599, p = 0.022; respectively). Partial oxygen pressure/fraction of inspired oxygen (P/F) ratio below 110.5 mmHg was a predictor for mortality (95% CI: 0.397, p = 0.018). Older age, smoking, crazy paving pattern on computed tomography (CT), and short duration of hospitalization were also predictors of mortality. The patients requiring invasive mechanical ventilation were significantly more mortal whereas the patients requiring high flow oxygen and non-invasive ventilation were significantly more likely to survive. CONCLUSIONS: We recommend evaluating APACHE-II score, BUN value, P/F ratio, age, smoking status, radiological signs on CT, length of hospitalization and modality of respiratory support upon ICU admission to identify critical patients with poor prognoses.

Predictors of respiratory cancer-related mortality for Jews and Arabs in Israel.

BACKGROUND: Respiratory cancers, including lung, tracheal and bronchus cancers, are a leading cause of cancer-related mortality in Israel; however, incidence can differ among demographic groups. Despite the importance of sociodemographic characteristics and the interactions between them to incidence and mortality, this topic is understudied. This study analyzes sociodemographic disparities by sex and ethnicity among Jews and Arabs to understand cancer outcome differences stratified by SES, marital status, and number of children as potential contextual factors. METHODS: This retrospective cohort study analyzed respiratory cancer-related mortality rates among Israelis born between 1940 and 1960 over 21-years. The follow up period was between January 1, 1996 and 12.31.2016. Mortality rates for Jews and Arabs were calculated. Using a Cox Regression, a multivariate model was constructed to determine the association between ethnicity and respiratory cancer mortality. The study population was then divided into four groups, by sex and ethnicity, to determine the association between marital status, number of children, and SES with respiratory cancer mortality for each subgroup. RESULTS: The overall mortality rate was 0.6%. Arabs had higher mortality rates compared to Jews, even after adjusting for demographic factors including age, sex and SES (Adjusted Hazard Ratio (AHR) = 1.442, 99% confidence intervals (CI) = 1.354,1.546). Among men, a higher mortality rate was found among Arabs (AHR = 1.383, 99%CI = 1.295,1.477), while among women, Arabs had lower mortality rates (AHR = 0.469, 99%CI = 0.398,0.552). Significant mortality rate differences were observed by ethnicity and sex for each sociodemographic variable. CONCLUSIONS: This study highlights the importance and implications of understanding differences in respiratory cancer mortality between Jews and Arabs, a minority group in Israel, and is relevant for minority groups in general. There is a need to tailor interventions for these groups, based on differing underlying causes and contextual factors for these cancers. Cancer outcomes among these groups should also be studied separately, by sex, to better understand them.

Prognosis and outcome determinants after heart failure diagnosis in patients who underwent aortic valvular intervention.

AIMS: To study clinical phenotype, prognosis for all-cause and cardiovascular (CV) mortality and predictive factors in patients with incident heart failure (HF) after aortic valvular intervention (AVI) for aortic stenosis (AS). METHODS AND RESULTS: In this retrospective, observational study we included patients from the Swedish Heart Failure Registry (SwedeHF) recorded 2003-2016, with AS diagnosis and AVI before HF diagnosis. The AS diagnosis was established according to International Classification of Diseases 10th revision (ICD-10) codes, thus without information concerning clinical or echocardiographical data on the aortic valve disease. The patients were divided into two subgroups: left ventricular ejection fraction (LVEF) ≥ 50% (AS-HFpEF) and <50% (AS-HFrEF). We individually matched three controls with HF from the SwedeHF without AS (control group) for each patient. Baseline characteristics, co-morbidities, survival status and outcomes were obtained by linking the SwedeHF with two other Swedish registries. We used Kaplan-Meier curves to present time to all-cause mortality, cumulative incidence function for time to CV mortality and Cox proportional hazards model to evaluate the relative difference between AS-HFrEF and AS-HFpEF and AS-HF and controls. The crude all-cause mortality was 49.0%, CV mortality 27.9% in AS-HF patients, respectively 44.7% and 26.6% in matched controls. The adjusted risk for all-cause mortality and CV mortality was similar in HF, regardless of LVEF vs. controls. No significant difference in factors predicting higher all-cause mortality was observed in AS-HFrEF vs. AS-HFpEF, except for diabetes (only in AS-HFrEF), with statistically significant interaction predicting death between the two groups. CONCLUSIONS: In this nationwide SwedeHF study, we characterized incident HF population after AVI. We found no significant differences in all-cause and CV mortality compared with general HF population. They had virtually the same predictors for mortality, regardless of LVEF.

Efecto de la igualdad de género en la mortalidad por enfermedades no transmisibles / Effect of gender equality on mortality from non-communicable diseases

Objetivo: Relacionar las desigualdades de género con la probabilidad de mortalidad por enfermedades no transmisibles (ENT) en los países del mundo desde 2000 hasta 2019, para detectar el progreso de la Meta 3.4 del Objetivo de Desarrollo Sostenible 3, de reducir en un tercio las ENT entre los 30 y los 70 años para 2030. Método: Estudio ecológico exploratorio sobre la asociación entre la probabilidad de fallecimiento por ENT y el índice de desigualdad de género (IDG) en el mundo en 2000, 2015 y 2019. Estimación mediante regresión logística del riesgo de no estar en proceso de cumplir la Meta 3.4 en 2019 según desigualdad de género. Resultados: La probabilidad media de fallecimiento por ENT descendió progresivamente en todos los países. Medianas 2000/2015/2019: mujeres 20,20/16,58/16; hombres 26,59/22,45/21,88; total 23,14/20,10/19,23. El riesgo de no estar logrando la meta en 2019 es mayor en los países con menor IDG que en los países con mayor IDG (OR: 2,13; IC95%: 1,14-3,99; p = 0,018), siendo el riesgo mayor en las mujeres (OR: 2,64; IC95%: 1,40-5,06; p = 0,003) que en los hombres (OR: 2,12; IC95%: 1,44-3,98; p = 0,017). Conclusiones: El riesgo de fallecimiento por ENT descendió en ambos sexos en todos los países del mundo desde el año 2000, pero el progreso es lento y, a mayor desigualdad de género en los países, mayor riesgo de no estar logrando el descenso necesitado para cumplir con el acuerdo de reducir un tercio la mortalidad por ENT en 2030, siendo este riesgo mayor en las mujeres que en los hombres.(AU)

Objective: Relate gender inequalities with the probability of mortality from non-communicable diseases (NCD), in the countries of the world from the year 2000 to 2019, to detect the progress of Target 3.4 of the Sustainable Development Goal 3, to reduce NCD by one third between the ages of 30 and 70 by 2030. Method: Exploratory ecological study on the association between the probability of death from NCD and the gender inequality index (GII) at the global level in 2000, 2015 and 2019. Logistic regression estimation of the risk of not being on track to meet Target 3.4 by 2019 by gender inequality. Results: The mean probability of death from NCD decreased progressively in all countries. Median 2000/2015/2019: women 20.20/16.58/16; men 26.59/22.45/21.88; total 23.14/20.10/19.23. The risk of not achieving the goal in 2019 is greater in countries with a lower GII than in countries with a higher GII (OR: 2.13; 95% CI: 1.14–3.99; p = 0.018), being the higher risk in women (OR: 2.64; 95% CI: 1.40–5.06; p = 0.003) than in men (OR: 2.12; 95% CI: 1.44–3.98; p = 0.017). Conclusions: The risk of deaths from NCD has decreased in both sexes in all countries of the world since the year 2000; but progress is slow, so the greater gender inequality in the countries, there is a greater risk of not achieving the reduction needed to comply with the agreement to reduce mortality from NCD by one third in 2030; this risk being greater in women than in men.(AU)