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1.
Artigo em Inglês | MEDLINE | ID: mdl-34501529

RESUMO

OBJECTIVE: Smoking status does not indicate the amount or length of tobacco use, and thus, it is an imperfect measure to assess the association between cigarette smoking and severe coronavirus disease 2019 (COVID-19) outcomes. This investigation assessed whether cigarette smoking status, intensity of smoking (i.e., average daily packs of cigarettes smoked), duration of smoking, and pack-years of smoking are associated with severe outcomes among adults diagnosed with COVID-19. METHODS: We conducted a retrospective, cross-sectional study in which we identified consecutive patients diagnosed with COVID-19 at the University of Cincinnati healthcare system between 13 March 2020 and 30 September 2020 who had complete information on smoking status, severe COVID-19 outcomes, and covariates (i.e., demographics and comorbidities). We used logistic regression to evaluate the associations of smoking status and intensity of smoking with COVID-19 severity, defined as hospitalization, admission to intensive care unit (ICU), or death, adjusting for sociodemographics and comorbidities. RESULTS: Among the 4611 COVID-19 patients included in the analysis, 18.2% were current smokers and 20.7% were former smokers. The prevalence of COVID-19 outcomes was 28.9% for hospitalization, 9.8% for ICU admission, and 1.4% for death. In the adjusted analysis, current smoking (AOR: 1.23, 95% CI: 1.02-1.49), former smoking (AOR: 1.28, 95% CI: 1.07-1.54), and pack-years of smoking (AOR: 1.09, 95% CI: 1.02-1.17) were associated with a higher prevalence of hospitalization. Average daily packs of cigarettes smoked was associated with a higher prevalence of hospitalization (AOR: 1.30, 95% CI: 1.10-1.53) and ICU admission (AOR: 1.23, 95% CI: 1.04-1.44). CONCLUSIONS: Smoking status, pack-years, and intensity of smoking were associated with hospitalizations in patients with COVID-19 and intensity of smoking was associated with ICU admission. The findings underscore the need for detailed information beyond smoking status when evaluating smokers with COVID-19 so that the potential for adverse sequelae may be optimally managed in at-risk patients.


Assuntos
COVID-19 , Adulto , Estudos Transversais , Hospitalização , Humanos , Estudos Retrospectivos , SARS-CoV-2 , Fumar/epidemiologia
2.
Respirology ; 2021 Aug 30.
Artigo em Inglês | MEDLINE | ID: mdl-34459069

RESUMO

BACKGROUND AND OBJECTIVE: Ecological studies have suggested an association between exposure to particulate matter ≤2.5 µm (PM2.5 ) and coronavirus disease 2019 (COVID-19) severity. However, these findings are yet to be validated in individual-level studies. We aimed to determine the association of long-term PM2.5 exposure with hospitalization among individual patients infected with severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). METHODS: We estimated the 10-year (2009-2018) PM2.5 exposure at the residential zip code of COVID-19 patients diagnosed at the University of Cincinnati healthcare system between 13 March 2020 and 30 September 2020. Logistic regression was used to determine the odds ratio (OR) and 95% CI for COVID-19 hospitalizations associated with PM2.5 , adjusting for socioeconomic characteristics and comorbidities. RESULTS: Among the 14,783 COVID-19 patients included in our study, 13.6% were hospitalized; the geometric mean (SD) PM2.5 was 10.48 (1.12) µg/m3 . In adjusted analysis, 1 µg/m3 increase in 10-year annual average PM2.5 was associated with 18% higher hospitalization (OR: 1.18, 95% CI: 1.11-1.26). Likewise, 1 µg/m3 increase in PM2.5 estimated for the year 2018 was associated with 14% higher hospitalization (OR: 1.14, 95% CI: 1.08-1.21). CONCLUSION: Long-term PM2.5 exposure is associated with increased hospitalization in COVID-19. Therefore, more stringent COVID-19 prevention measures may be needed in areas with higher PM2.5 exposure to reduce the disease morbidity and healthcare burden.

4.
Respir Med ; 178: 106313, 2021 03.
Artigo em Inglês | MEDLINE | ID: mdl-33550152

RESUMO

BACKGROUND: Ecological evidence suggests that exposure to air pollution affects coronavirus disease 2019 (COVID-19) outcomes. However, no individual-level study has confirmed the association to date. METHODS: We identified COVID-19 patients diagnosed at the University of Cincinnati hospitals and clinics and estimated particulate matter ≤2.5 µm (PM2.5) exposure over a 10-year period (2008-2017) at their residential zip codes. We used logistic regression to evaluate the association between PM2.5 exposure and hospitalizations for COVID-19, adjusting for socioeconomic characteristics and comorbidities. RESULTS: Among the 1128 patients included in our study, the mean (standard deviation) PM2.5 was 11.34 (0.70) µg/m3 for the 10-year average exposure and 13.83 (1.03) µg/m3 for the 10-year maximal exposures. The association between long-term PM2.5 exposure and hospitalization for COVID-19 was contingent upon having pre-existing asthma or chronic obstructive pulmonary (COPD) (Pinteraction = 0.030 for average PM2.5 and Pinteraction = 0.001 for maximal PM2.5). In COVID-19 patients with asthma or COPD, the odds of hospitalization were 62% higher with 1 µg/m3 increment in 10-year average PM2.5 (odds ratio [OR]: 1.62, 95% confidence interval [CI]: 1.00-2.64) and 65% higher with 1 µg/m3 increase in 10-year maximal PM2.5 levels (OR: 1.65, 95% CI: 1.16-2.35). However, among COVID-19 patients without asthma or COPD, PM2.5 exposure was not associated with higher hospitalizations (OR: 0.84, 95% CI: 0.65-1.09 for average PM2.5 and OR: 0.78, 95% CI: 0.65-0.95 for maximal PM2.5). CONCLUSIONS: Long-term exposure to PM2.5 is associated with higher odds of hospitalization in COVID-19 patients with pre-existing asthma or COPD.


Assuntos
Poluentes Atmosféricos/efeitos adversos , Poluição do Ar/efeitos adversos , COVID-19/epidemiologia , Exposição Ambiental/efeitos adversos , Hospitalização/estatística & dados numéricos , Material Particulado/efeitos adversos , Adulto , Asma/epidemiologia , Feminino , Humanos , Modelos Logísticos , Masculino , Pessoa de Meia-Idade , Razão de Chances , Doença Pulmonar Obstrutiva Crônica/epidemiologia , Fatores Socioeconômicos , Fatores de Tempo
5.
medRxiv ; 2020 Aug 14.
Artigo em Inglês | MEDLINE | ID: mdl-32817977

RESUMO

Blood type purportedly influences susceptibility to severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2) infection, but whether it affects severity of coronavirus disease 2019 (COVID-19) is unclear. Therefore, we examined the association of blood type and rhesus with hospitalization and disease severity among 428 COVID-19 patients diagnosed at the University of Cincinnati health system. In the sample, 50.2% of participants had the blood type O, 38.7% had the blood type A, 17.5% had the blood type B, and 3.5% had the blood type AB. In analysis adjusted for sociodemographic characteristics and comorbidities, the blood types A (OR: 0.90, 95% CI: 0.54, 1.50), B (OR: 0.93, 95% CI: 0.51, 1.69), AB (OR: 0.69, 95% CI: 0.20, 2.41), and O (OR: 1.18, 95%: 0.74, 1.98) were not associated with hospitalization for COVID-19. Similarly, the blood types A (OR: 0.93, 95% CI: 0.52, 1.65), B (OR: 0.92, 95% CI: 0.46, 1.84), AB (OR: 0.30, 95% CI: 0.04, 2.44), and O (OR: 1.25, 95%: 0.73, 2.14) were not associated with admission to intensive care unit or death in COVID-19. In conclusion, blood type is not associated with hospitalization or disease severity in COVID-19; therefore, it may not be useful marker for identifying patients at risk for severe COVID-19.

6.
medRxiv ; 2020 Jun 27.
Artigo em Inglês | MEDLINE | ID: mdl-32607513

RESUMO

BACKGROUND: The coronavirus disease (COVID-19) first identified in Wuhan in December 2019 became a pandemic within a few months of its discovery. The impact of COVID-19 is due to both its rapid spread and its severity, but the determinants of severity have not been fully delineated. OBJECTIVE: Identify factors associated with hospitalization and disease severity in a racially and ethnically diverse cohort of COVID-19 patients. METHODS: We analyzed data from COVID-19 patients diagnosed at the University of Cincinnati health system from March 13, 2020 to May 31, 2020. Severe COVID-19 was defined as admission to intensive care unit or death. Logistic regression modeling adjusted for covariates was used to identify the factors associated with hospitalization and severe COVID-19. RESULTS: Among the 689 COVID-19 patients included in our study, 29.2% were non-Hispanic White, 25.5% were non-Hispanic Black, 32.5% were Hispanic, and 12.8% were of other race/ethnicity. About 31.3% of patients were hospitalized and 13.2% had severe disease. In adjusted analyses, the sociodemographic factors associated with hospitalization and/or disease severity included older age, non-Hispanic Black or Hispanic race/ethnicity (compared to non-Hispanic White), and smoking. The following comorbidities: diabetes, hypercholesterolemia, asthma, COPD, chronic kidney disease, cardiovascular diseases, osteoarthritis, and vitamin D deficiency were associated with hospitalization and/or disease severity. Hematological disorders such as anemia, coagulation disorders, and thrombocytopenia were associated with both hospitalization and disease severity. CONCLUSION: This study confirms race and ethnicity as predictors of severe COVID-19. It also finds clinical risk factors for hospitalization and severe COVID-19 not previously identified such a vitamin D deficiency, hypercholesterolemia, osteoarthritis, and anemia.

8.
Environ Health ; 19(1): 35, 2020 03 16.
Artigo em Inglês | MEDLINE | ID: mdl-32178682

RESUMO

BACKGROUND: Endotoxin is ubiquitous in the environment, but its clustering with indoor allergens is not well characterized. This study examined the clustering patterns of endotoxin with allergens in house dust and their association with asthma outcomes. METHODS: We analyzed data from 6963 participants of the 2005-2006 National Health and Nutrition Examination Survey. House dust sampled from bedroom floor and bedding was evaluated for endotoxin and allergens from fungi, cockroach, dog, cat, mites, and rodents. Two-step cluster analysis and logistic regressions were performed to identify the clustering patterns and their associations with current asthma and wheeze in the past 12 months, adjusting for covariates. RESULTS: Of the homes, 17.8% had low endotoxin and allergen levels in house dust (Cluster 1). High endotoxin level clustered with Alternaria and pet allergens in the homes of participants with a high socioeconomic status who own pets (Cluster 2) (48.9%). High endotoxin clustered with Aspergillus, dust mites, cockroach, and rodent allergens in the homes of participants with low socioeconomic status (Cluster 3) (33.3%). Compared to Cluster 1, Cluster 2 was associated with higher asthma prevalence (OR 1.42, 95% CI: 1.06-1.91) and wheeze (OR 1.32, 95% CI: 1.07-1.63). Cluster 3 was positively associated with wheeze only in participants sensitized to inhalant allergens (OR 1.42, 95% CI: 1.06-1.91) or exposed to tobacco smoke (OR 1.72, 95% CI: 1.15-2.60). CONCLUSIONS: The clustering of endotoxin with allergens in dust from homes with pets or of people with low socioeconomic status is associated with asthma and wheeze.


Assuntos
Poluição do Ar em Ambientes Fechados/efeitos adversos , Alérgenos/efeitos adversos , Asma/epidemiologia , Poeira/análise , Endotoxinas/efeitos adversos , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Asma/etiologia , Criança , Pré-Escolar , Análise por Conglomerados , Exposição Ambiental/análise , Feminino , Humanos , Lactente , Recém-Nascido , Masculino , Pessoa de Meia-Idade , Prevalência , Estados Unidos/epidemiologia , Adulto Jovem
9.
Epidemiology ; 31(3): 459-466, 2020 05.
Artigo em Inglês | MEDLINE | ID: mdl-32028323

RESUMO

BACKGROUND: Various questionnaire-based definitions of chronic obstructive pulmonary disease (COPD) have been applied using the US representative National Health and Nutrition Examination Survey (NHANES), but few have been validated against objective lung function data. We validated two prior definitions that incorporated self-reported physician diagnosis, respiratory symptoms, and/or smoking. We also validated a new definition that we developed empirically using gradient boosting, an ensemble machine learning method. METHODS: Data came from 7,996 individuals 40-79 years who participated in NHANES 2007-2012 and underwent spirometry. We considered participants "true" COPD cases if their ratio of postbronchodilator forced expiratory volume in 1 second to forced vital capacity was below 0.7 or the lower limit of normal. We stratified all analyses by smoking history. We developed a gradient boosting model for smokers only; predictors assessed (25 total) included sociodemographics, inhalant exposures, clinical variables, and respiratory symptoms. RESULTS: The spirometry-based COPD prevalence was 26% for smokers and 8% for never smokers. Among smokers, using questionnaire-based definitions resulted in a COPD prevalence ranging from 11% to 16%, sensitivity ranging from 18% to 35%, and specificity ranging from 88% to 92%. The new definition classified participants based on age, bronchodilator use, body mass index (BMI), smoking pack-years, and occupational organic dust exposure, and resulted in the highest sensitivity (35%) and specificity (92%) among smokers. Among never smokers, the COPD prevalence ranged from 4% to 5%, and we attained good specificity (96%) at the expense of sensitivity (9-10%). CONCLUSION: Our results can be used to parametrize misclassification assumptions for quantitative bias analysis when pulmonary function data are unavailable.


Assuntos
Inquéritos Nutricionais , Doença Pulmonar Obstrutiva Crônica , Adulto , Idoso , Feminino , Volume Expiratório Forçado , Humanos , Masculino , Pessoa de Meia-Idade , Prevalência , Doença Pulmonar Obstrutiva Crônica/diagnóstico , Doença Pulmonar Obstrutiva Crônica/epidemiologia , Reprodutibilidade dos Testes , Espirometria , Capacidade Vital
10.
Environ Res ; 183: 108944, 2020 04.
Artigo em Inglês | MEDLINE | ID: mdl-31911000

RESUMO

BACKGROUND: Bisphenols F (BPF) and S (BPS) are bisphenol A (BPA) analogs used as substitutes in consumer products. Despite previous reports of BPA's association with asthma, no studies have examined its structural analogs in relation to asthma and allergy outcomes. OBJECTIVE: To examine the association of urinary BPF, BPS, and BPA with asthma and hay fever in a US representative sample. METHODS: We analyzed data from 3,538 participants aged 12 years or older in the 2013-2016 National Health and Nutrition Examination Survey (NHANES). Children aged 6-11 years (N = 738), who did not have all covariate data available, were analyzed separately. Covariate-adjusted logistic regression was used to assess the association of the exposures with the outcomes. RESULTS: BPF, BPS, and BPA were detected in 57.1%, 88.4%, and 94.8% of the urine samples, respectively. Urinary BPF detection was positively associated with current asthma (odds ratio [OR]: 1.54, 95% confidence interval [CI]: 1.16-2.04) and hay fever (OR: 1.66, 95% CI: 1.12-2.46). Urinary BPS was associated with increased odds of current asthma in men (OR: 1.64, 95% CI: 1.13-2.40) and urinary BPA was associated with increased odds of asthma without hay fever in children aged 6-11 years (OR: 2.65, 95% CI: 1.05-6.68). CONCLUSION: Our nationally-representative findings document that BPF and BPS exposure is common in the US and that exposure to these BPA analogs is associated with asthma and/or hay fever. Our results suggest that BPF and BPS may not be safe alternatives to BPA; however, prospective studies should be conducted to confirm these results.


Assuntos
Asma , Compostos Benzidrílicos , Fenóis , Rinite Alérgica Sazonal , Sulfonas , Asma/epidemiologia , Compostos Benzidrílicos/toxicidade , Compostos Benzidrílicos/urina , Criança , Feminino , Humanos , Masculino , Inquéritos Nutricionais , Fenóis/toxicidade , Fenóis/urina , Estudos Prospectivos , Rinite Alérgica Sazonal/epidemiologia , Sulfonas/toxicidade , Sulfonas/urina
11.
Indoor Air ; 30(1): 88-97, 2020 01.
Artigo em Inglês | MEDLINE | ID: mdl-31605641

RESUMO

Endotoxin exacerbates asthma. We designed the Louisa Environmental Intervention Project (LEIP) and assessed its effectiveness in reducing household endotoxin and improving asthma symptoms in rural Iowa children. Asthmatic school children (N = 104 from 89 homes) of Louisa and Keokuk counties in Iowa (aged 5-14 years) were recruited and block-randomized to receive extensive (education + professional cleaning) or educational interventions. Environmental sampling collection and respiratory survey administration were done at baseline and during three follow-up visits. Mixed-model analyses were used to assess the effect of the intervention on endotoxin levels and asthma symptoms in the main analysis and of endotoxin reduction on asthma symptoms in exploratory analysis. In the extensive intervention group, dust endotoxin load was significantly reduced in post-intervention visits. The extensive compared with the educational intervention was associated with significantly decreased dust endotoxin load in farm homes and less frequent nighttime asthma symptoms. In exploratory analysis, dust endotoxin load reduction from baseline was associated with lower total asthma symptoms score (Odds ratio: 0.52, 95% confidence interval: 0.29-0.92). In conclusion, the LEIP intervention reduced household dust endotoxin and improved asthma symptoms. However, endotoxin reductions were not sustained post-intervention by residents.


Assuntos
Poluição do Ar em Ambientes Fechados/estatística & dados numéricos , Asma/epidemiologia , Endotoxinas/análise , Exposição Ambiental/estatística & dados numéricos , Adolescente , Poluição do Ar em Ambientes Fechados/prevenção & controle , Asma/prevenção & controle , Criança , Pré-Escolar , Descontaminação/métodos , Exposição Ambiental/prevenção & controle , Feminino , Humanos , Iowa/epidemiologia , Masculino , População Rural/estatística & dados numéricos
12.
Viruses ; 11(6)2019 06 01.
Artigo em Inglês | MEDLINE | ID: mdl-31159430

RESUMO

Influenza virus is among the most common causes of respiratory illness worldwide and can be complicated by secondary bacterial pneumonia, a frequent cause of mortality. When influenza virus infects the lung, the innate immune response is activated, and interferons and inflammatory mediators are released. This "cytokine storm" is thought to play a role in influenza-induced lung pathogenesis. Peroxisome proliferator-activated receptor gamma (PPARγ) is a member of the nuclear hormone receptor super-family. PPARγ has numerous functions including enhancing lipid and glucose metabolism and cellular differentiation and suppressing inflammation. Synthetic PPARγagonists (thiazolidinediones or glitazones) have been used clinically in the treatment of type II diabetes. Using data from the National Health and Nutrition Examination Survey (NHANES), diabetic participants taking rosiglitazone had an increased risk of mortality from influenza/pneumonia compared to those not taking the drug. We examined the effect of rosiglitazone treatment during influenza and secondary bacterial (Methicillin resistant Staphylococcus aureus) pneumonia in mice. We found decreased influenza viral burden, decreased numbers of neutrophils and macrophages in bronchoalveolar lavage, and decreased production of cytokines and chemokines in influenza infected, rosiglitazone-treated mice when compared to controls. However, rosiglitazone treatment compromised bacterial clearance during influenza-bacterial super-infection. Both human and mouse data suggest that rosiglitazone treatment worsens the outcome of influenza-associated pneumonia.


Assuntos
Infecções Bacterianas , Coinfecção/tratamento farmacológico , Inflamação/patologia , Influenza Humana , Rosiglitazona/efeitos adversos , Animais , Infecções Bacterianas/complicações , Infecções Bacterianas/tratamento farmacológico , Infecções Bacterianas/imunologia , Coinfecção/imunologia , Coinfecção/microbiologia , Coinfecção/virologia , Citocinas/efeitos dos fármacos , Citocinas/metabolismo , Diabetes Mellitus Tipo 2/complicações , Diabetes Mellitus Tipo 2/tratamento farmacológico , Diabetes Mellitus Tipo 2/microbiologia , Diabetes Mellitus Tipo 2/virologia , Feminino , Regulação da Expressão Gênica/efeitos dos fármacos , Humanos , Inflamação/genética , Inflamação/microbiologia , Inflamação/virologia , Vírus da Influenza A Subtipo H1N1/efeitos dos fármacos , Vírus da Influenza A Subtipo H1N1/crescimento & desenvolvimento , Vírus da Influenza A Subtipo H1N1/imunologia , Influenza Humana/complicações , Influenza Humana/tratamento farmacológico , Influenza Humana/imunologia , Interferons/efeitos dos fármacos , Interferons/metabolismo , Pulmão/imunologia , Pulmão/microbiologia , Pulmão/patologia , Pulmão/virologia , Masculino , Staphylococcus aureus Resistente à Meticilina/efeitos dos fármacos , Staphylococcus aureus Resistente à Meticilina/crescimento & desenvolvimento , Staphylococcus aureus Resistente à Meticilina/imunologia , Camundongos , PPAR gama/agonistas , Rosiglitazona/farmacologia , Transdução de Sinais/efeitos dos fármacos , Carga Viral/efeitos dos fármacos
13.
Am J Respir Crit Care Med ; 200(6): 712-720, 2019 09 15.
Artigo em Inglês | MEDLINE | ID: mdl-30965018

RESUMO

Rationale: House endotoxin and ambient air pollution are risk factors for asthma; however, the effects of their coexposure on asthma are not well characterized.Objectives: To examine potential synergistic associations of coexposure to house dust endotoxin and ambient air pollutants with asthma outcomes.Methods: We analyzed data of 6,488 participants in the National Health and Nutrition Examination Survey 2005-2006. Dust from bedding and bedroom floor was analyzed for endotoxin content. The Community Multiscale Air Quality Modeling System (CMAQ) and Downscaler Model data were used to determine annual average particulate matter ≤2.5 µm in aerodynamic diameter (PM2.5), ozone (O3), and nitrogen dioxide (NO2) exposures at participants' residential locations. The associations of the coexposures with asthma outcomes were assessed and tested for synergistic interaction.Measurements and Main Results: In adjusted analysis, PM2.5 (CMAQ) (odds ratio [OR], 1.12; 95% confidence interval [CI], 1.07-1.18), O3 (Downscaler Model) (OR, 1.07; 95% CI, 1.02-1.13), and log10 NO2 (CMAQ) (OR, 3.15; 95% CI, 1.33-7.45) were positively associated with emergency room visits for asthma in the past 12 months. Coexposure to elevated concentrations of house dust endotoxin and PM2.5 (CMAQ) was synergistically associated with the outcome, increasing the odds by fivefold (OR, 5.01; 95% CI, 2.54-9.87). A synergistic association was also found for coexposure to higher concentrations of endotoxin and NO2 in children (OR, 3.45; 95% CI, 1.65-7.18).Conclusions: Coexposure to elevated concentrations of residential endotoxin and ambient PM2.5 in all participants and NO2 in children is synergistically associated with increased emergency room visits for asthma. Therefore, decreasing exposure to both endotoxin and air pollution may help reduce asthma morbidity.


Assuntos
Poluição do Ar em Ambientes Fechados/efeitos adversos , Asma/induzido quimicamente , Endotoxinas/efeitos adversos , Monitoramento Ambiental/métodos , Material Particulado/efeitos adversos , Asma/epidemiologia , Feminino , Humanos , Masculino , Razão de Chances , Fatores de Risco , Estados Unidos/epidemiologia
14.
Respirology ; 24(7): 646-651, 2019 07.
Artigo em Inglês | MEDLINE | ID: mdl-30761687

RESUMO

BACKGROUND AND OBJECTIVE: Chronic lower respiratory diseases (CLRD) increase the risk of type 2 diabetes, which in turn may worsen lung function. Metformin, a common antidiabetic with anti-inflammatory and antioxidant properties, may improve respiratory outcomes. Therefore, we examined the association of metformin use with the risk of mortality from CLRD. METHODS: We analysed data from the National Health and Nutrition Examination Survey during 1988-1994 and 1999-2010 for participants aged 40 years or older who had diabetes and were followed up for mortality through 2011. Information on prescription medicine was collected at baseline and CLRD-related mortality during follow-up was defined using the 10th Revision of the International Classification of Diseases (ICD-10). Cox proportional hazards modelling was used to determine the mortality hazard ratio (HR) associated with metformin use, adjusting for relevant covariates. RESULTS: A total of 5266 participants with a median follow-up of 6.1 years were included. The prevalence of metformin use was 31.9% and 1869 participants died during follow-up, including 72 of CLRD. In the adjusted Cox proportional regression analysis, metformin was associated with a decreased risk of CLRD mortality in the overall population (HR: 0.39, 95% CI: 0.15-0.99) and among participants with baseline CLRD (HR: 0.30, 95% CI: 0.10-0.93), after adjusting for age, gender, race/ethnicity, cigarette smoking, body mass index, current asthma and chronic obstructive pulmonary disease (COPD), insulin and other diabetic medications, and glycohaemoglobin level. We found no association between other antidiabetic medications and CLRD mortality. CONCLUSION: In this sample representative of the U.S. population, metformin was associated with lower CLRD mortality in adults with diabetes.


Assuntos
Diabetes Mellitus Tipo 2/tratamento farmacológico , Metformina/uso terapêutico , Inquéritos Nutricionais , Doenças Respiratórias/mortalidade , Adulto , Idoso , Estudos Transversais , Diabetes Mellitus Tipo 2/etiologia , Feminino , Seguimentos , Humanos , Hipoglicemiantes/uso terapêutico , Masculino , Pessoa de Meia-Idade , Doenças Respiratórias/complicações , Taxa de Sobrevida/tendências , Fatores de Tempo , Estados Unidos/epidemiologia
15.
Int J Epidemiol ; 47(6): 1821-1829, 2018 12 01.
Artigo em Inglês | MEDLINE | ID: mdl-30169829

RESUMO

Background: Osteoarthritis (OA) is the most common joint disease, but its association with mortality is unclear. Methods: We analysed data on adult participants in the 1988-94 and 1999-2010 National Health and Nutrition Examination Surveys, followed for mortality through 2011. OA was defined by self-report, and in a subset of participants 60 years or older with knee X-rays, radiographic knee OA (RKOA) was defined as Kellgren-Lawrence score ≥2. Cox proportional hazards were used to determine the mortality hazard ratio (HR) associated with self-reported OA and RKOA, adjusting for covariates. Results: The sample included 51 938 participants followed for a median 8.9 years; 2589 of them had knee X-rays and were followed for a median of 13.6 years. Self-reported OA and RKOA prevalences were 6.6% and 40.6%, respectively. Self-reported OA was not associated with mortality. RKOA was associated with an increased risk of mortality from cardiovascular diseases (CVD) {HR 1.43 [95% confidence interval (CI): 1.32, 1.64]}, diabetes [HR 2.04 (1.87, 2.23)] and renal diseases [HR 1.14 (1.04, 1.25)], but with a reduced risk of cancer mortality [HR 0.88 (0.80, 0.96)]. Participants with early RKOA onset (diagnosed before age 40) had a higher risk of mortality from all causes [HR 1.53 (1.43, 1.65)] and from diabetes [HR 7.18 (5.45, 9.45)]. Obese participants with RKOA were at increased risk of mortality from CVD [HR 1.89 (1.56, 2.29)] and from diabetes [HR: 3.42 (3.01, 3.88)]. Conclusions: Self-reported OA was not associated with mortality. RKOA was associated with higher CVD, diabetes and renal mortality, especially in people with early onset of the disease or with obesity.


Assuntos
Doenças Cardiovasculares/mortalidade , Diabetes Mellitus/mortalidade , Nefropatias/mortalidade , Obesidade/complicações , Osteoartrite do Joelho/complicações , Adulto , Idoso , Estudos de Coortes , Feminino , Humanos , Estimativa de Kaplan-Meier , Masculino , Pessoa de Meia-Idade , Neoplasias/mortalidade , Inquéritos Nutricionais , Prevalência , Modelos de Riscos Proporcionais , Fatores de Risco , Estados Unidos/epidemiologia
16.
Clin Respir J ; 12(8): 2369-2377, 2018 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-29873189

RESUMO

BACKGROUND: Perceived to be distinct, asthma and chronic obstructive pulmonary disease (COPD) can co-exist and potentially have a worse prognosis than the separate diseases. Yet, little is known about the exact prevalence and the characteristics of the Asthma-COPD overlap (ACO) in the US population. AIMS: To determine ACO prevalence in the United States, identify ACO predictors, examine ACO association with asthma and COPD severity, and describe distinctive spirometry and laboratory features of ACO. METHODS: Data on adult participants to the National Health and Nutrition Examination Surveys conducted from 2007 to 2012 was analyzed. ACO was defined as current asthma and post-bronchodilator forced expiratory volume in 1 second/forced vital capacity (FEV1/FVC) <0.7. RESULTS: Overall, 7,570 participants representing 98.58 million Americans were included in our study. From 2007 to 2012, the crude and age-standardized ACO prevalence were, respectively, 0.96% (95% CI: 0.65%-1.26%) and 1.05% (0.74%-1.37%). In asthma, ACO predictors included older age, male gender, and smoking. In COPD, ACO predictors were non-Hispanic Black race/ethnicity and obesity. ACO was associated with increased ER visits for asthma (OR = 3.46, 95% CI: 1.48-8.06]) and oxygen therapy in COPD (OR = 11.17, 95% CI: 5.17-24.12]). In spirometry, FEV1 and peak expiratory flow were lower in ACO than in asthma or COPD alone. CONCLUSION: Age-adjusted prevalence of ACO in the United States was 1.05% in 2007-2012, representing 0.94 (95% CI: 0.62-1.26) million Americans. It is much lower than previously reported. The overlap was associated with higher asthma and COPD severity as well as decreased lung function compared with COPD or asthma alone.


Assuntos
Asma/epidemiologia , Asma/fisiopatologia , Doença Pulmonar Obstrutiva Crônica/epidemiologia , Doença Pulmonar Obstrutiva Crônica/fisiopatologia , Adulto , Idoso , Asma/metabolismo , Estudos Transversais/métodos , Feminino , Volume Expiratório Forçado/efeitos dos fármacos , Humanos , Masculino , Pessoa de Meia-Idade , Prevalência , Doença Pulmonar Obstrutiva Crônica/metabolismo , Índice de Gravidade de Doença , Espirometria/estatística & dados numéricos , Estados Unidos/epidemiologia , Capacidade Vital/efeitos dos fármacos
18.
J Allergy Clin Immunol Pract ; 6(6): 2006-2013.e4, 2018.
Artigo em Inglês | MEDLINE | ID: mdl-29684578

RESUMO

BACKGROUND: Pets are major contributors of endotoxin in homes, but whether they influence endotoxin association with respiratory outcomes is unclear. OBJECTIVE: To examine whether exposure and sensitization to dog and cat modify the relationship between endotoxin exposure and asthma and wheeze. METHODS: We analyzed data from 6051 participants in the 2005-2006 cycle of the National Health and Nutrition Examination Survey (NHANES). House dust from bedroom floor and bedding was evaluated for endotoxin and for dog (Canis familiaris 1) and cat (Feline domesticus 1) allergens. The NHANES also collected data on respiratory outcomes and measured IgE specific to allergens. Associations of log-endotoxin and pet exposure with respiratory outcomes were examined, adjusting for covariates including pet avoidance. RESULTS: Dog and cat ownership among participants was 48.3% and 37.5%, respectively. Endotoxin geometric mean (SE) was 15.49 (0.50) EU/mg. Endotoxin and pet allergen levels were significantly higher in households with a dog or cat. Overall, endotoxin was positively associated with wheeze (odds ratio [OR], 1.30; 95% CI, 1.04-1.62), but not with asthma. However, in participants nonsensitized to dog, the odds of endotoxin association with wheeze were higher with exposure to dog allergen (OR, 1.80; 95% CI, 1.27-2.53; Pinteraction = .048). In participants sensitized to cat and exposed to cat allergen, endotoxin became positively associated with asthma (OR, 1.92; 95% CI, 1.21-3.0; Pinteraction = .040). With coexposure to dog and cat allergens, endotoxin association with asthma and wheeze was exacerbated (OR, 2.00; 95% CI, 1.04-3.83; Pinteraction = .012 and OR, 1.88; 95% CI, 1.32-2.66; Pinteraction = .016, respectively). CONCLUSIONS: Exposure to dog and cat allergens enhances the association of endotoxin with asthma and wheeze.


Assuntos
Alérgenos/imunologia , Asma/epidemiologia , Poeira/imunologia , Endotoxinas/imunologia , Exposição Ambiental/efeitos adversos , Adolescente , Adulto , Poluição do Ar em Ambientes Fechados , Alérgenos/química , Animais , Asma/imunologia , Gatos , Criança , Cães , Poeira/análise , Endotoxinas/química , Feminino , Humanos , Imunização , Masculino , Animais de Estimação , Sons Respiratórios , Estados Unidos/epidemiologia , Adulto Jovem
19.
Environ Health Perspect ; 126(3): 037007, 2018 03 23.
Artigo em Inglês | MEDLINE | ID: mdl-29578323

RESUMO

BACKGROUND: Endotoxin has been reported to be associated with chronic bronchitis or emphysema (CBE) at high occupational exposures. However, whether levels found in domestic environments have similar effects is unknown. OBJECTIVES: We aimed to study the association between house dust endotoxin and CBE in a sample representative of the U.S. population. METHODS: We analyzed data from 3,393 participants ≥20 y old from the National Health and Nutrition Examination Survey (NHANES) 2005-2006. House dust from bedding and from bedroom floors was analyzed for endotoxin content. NHANES participants received questionnaires and underwent examination as well as extensive laboratory testing. Logistic regression was used to examine the association of endotoxin levels with CBE diagnosis and symptoms, adjusting for covariates. The survey design and weights were applied so that estimates were nationally representative and so that statistical inferences were made appropriately. RESULTS: The median endotoxin concentration in house dust was 14.61 EU/mg dust, and CBE was reported by 8.2% of participants. In the adjusted analysis, one unit (EU/mg) increase in log10-transformed endotoxin concentrations was associated with a 27% increase in the odds of CBE diagnosis [OR=1.27 (95% CI: 1.00, 1.61)] and a 78% increase in the odds of chronic bronchitis symptoms (defined as cough and phlegm for ≥3 mo in a year for ≥2 y) [OR=1.78 (95% CI: 1.01, 3.12)]. Sensitization to inhalant allergens (p=0.001) modified the relationship between endotoxin and CBE diagnosis, with stronger associations observed in sensitized participants [OR=2.46 (95% CI: 1.72, 3.50) for a unit increase in log10-endotoxin]. CONCLUSIONS: In a population-based sample of U.S. adults, endotoxin levels in homes were associated with a self-reported history of CBE diagnosis and chronic bronchitis symptoms, with stronger associations among people sensitized to inhalant allergens. https://doi.org/10.1289/EHP2452.


Assuntos
Bronquite Crônica/epidemiologia , Poeira , Enfisema/epidemiologia , Endotoxinas/toxicidade , Bronquite Crônica/etiologia , Enfisema/etiologia , Feminino , Humanos , Modelos Logísticos , Masculino , Pessoa de Meia-Idade , Inquéritos e Questionários
20.
Am J Public Health ; 108(2): 256-258, 2018 02.
Artigo em Inglês | MEDLINE | ID: mdl-29267054

RESUMO

OBJECTIVES: To determine the prevalence trends of osteoarthritis (OA), rheumatoid arthritis (RA), and other types of arthritis in the United States from 1999 to 2014. METHODS: We analyzed data on 43 706 community-dwelling adults aged 20 years and older who participated in the 1999-2014 National Health and Nutrition Examination Surveys. We accounted for survey design and sampling weights so that estimates were nationally representative. We assessed temporal trends in age-standardized arthritis prevalence by using joinpoint regression. RESULTS: Age-adjusted prevalence of arthritis was 24.7% (OA = 9.7%; RA = 4.2%; other arthritis = 2.8%; "don't know" type = 8.0%). Prevalence of OA increased from 6.6% to 14.3%, whereas RA prevalence decreased from 5.9% to 3.8%. Increase in OA prevalence was significant in both genders; in non-Hispanic Whites, non-Hispanic Blacks, and Hispanics; and in people with high socioeconomic status. Decrease in RA prevalence was more pronounced in men, non-Hispanic Blacks, and participants with low income or obesity. CONCLUSIONS: Between 1999 and 2014, nearly one quarter of American adults reported arthritis. The prevalence of OA has more than doubled over time, whereas RA prevalence has declined.


Assuntos
Artrite/epidemiologia , Adulto , Fatores Etários , Idoso , Artrite/diagnóstico , Artrite/etnologia , Feminino , Humanos , Vida Independente , Masculino , Pessoa de Meia-Idade , Inquéritos Nutricionais/tendências , Prevalência , Fatores Sexuais , Estados Unidos/epidemiologia , Adulto Jovem
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