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

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

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

scholarly journals Improved survival with renal transplantation for end-stage renal disease due to granulomatosis with polyangiitis: data from the United States Renal Data System

2018 ◽  
Vol 77 (9) ◽  
pp. 1333-1338 ◽  
Author(s):  
Zachary S Wallace ◽  
Rachel Wallwork ◽  
Yuqing Zhang ◽  
Na Lu ◽  
Frank Cortazar ◽  
...  
Keyword(s):  
United States ◽  
Renal Transplantation ◽  
Renal Transplant ◽  
End Stage Renal Disease ◽  
Granulomatosis With Polyangiitis ◽  
The United States ◽  
Risk Of Death ◽  
All Cause Mortality ◽  
Stage Renal Disease ◽  
End Stage

BackgroundRenal transplantation is the optimal treatment for selected patients with end-stage renal disease (ESRD). However, the survival benefit of renal transplantation among patients with ESRD attributed to granulomatosis with polyangiitis (GPA) is unknown.MethodsWe identified patients from the United States Renal Data System with ESRD due to GPA (ESRD-GPA) between 1995 and 2014. We restricted our analysis to waitlisted subjects to evaluate the impact of transplantation on mortality. We followed patients until death or the end of follow-up. We compared the relative risk (RR) of all-cause and cause-specific mortality in patients who received a transplant versus non-transplanted patients using a pooled logistic regression model with transplantation as a time-varying exposure.ResultsDuring the study period, 1525 patients were waitlisted and 946 received a renal transplant. Receiving a renal transplant was associated with a 70% reduction in the risk of all-cause mortality in multivariable-adjusted analyses (RR=0.30, 95% CI 0.25 to 0.37), largely attributed to a 90% reduction in the risk of death due to cardiovascular disease (CVD) (RR=0.10, 95% 0.06–0.16).DiscussionRenal transplantation is associated with a significant decrease in all-cause mortality among patients with ESRD attributed to GPA, largely due to a decrease in the risk of death to CVD. Prompt referral for transplantation is critical to optimise outcomes for this patient population.

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

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

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

scholarly journals Low serum klotho associated with all-cause mortality among a nationally representative sample of American adults

2021 ◽  
Author(s):  
Jacob K Kresovich ◽  
Catherine M Bulka
Keyword(s):  
Physical Activity ◽  
Mortality Risk ◽  
Representative Sample ◽  
Cox Regression ◽  
The United States ◽  
Risk Of Death ◽  
All Cause Mortality ◽  
Nationally Representative ◽  
Low Serum

Abstract α-Klotho (klotho) is a protein involved in suppressing oxidative stress and inflammation. In animal models, it is reported to underlie numerous aging phenotypes and longevity. Among a nationally representative sample of adults aged 40 to 79 in the United States, we investigated whether circulating concentrations of klotho is a marker of mortality risk. Serum klotho was measured by ELISA on 10,069 individuals enrolled in the National Health and Nutrition Examination Survey between 2007-2014. Mortality follow-up data based on the National Death Index were available through December 31, 2015. After a mean follow-up of 58 months (range: 1-108), 616 incident deaths occurred. Using survey-weighted Cox regression models adjusted for age, sex and survey cycle, low serum klotho concentration (&lt; 666 pg/mL) was associated with a 31% higher risk of death (compared to klotho concentration &gt; 985 pg/mL, HR: 1.31, 95% CI: 1.00, 1.71, P= 0.05). Associations were consistent for mortality caused by heart disease or cancer. Associations of klotho with all-cause mortality did not appear to differ by most participant characteristics. However, we observed effect modification by physical activity, such that low levels of serum klotho were more strongly associated with mortality among individuals who did not meet recommendation-based physical activity guidelines. Our findings suggest that, among the general population of American adults, circulating levels of klotho may serve as a marker of mortality risk.

scholarly journals Changes in Excess Mortality from End Stage Renal Disease in the United States from 1995 to 2013

2017 ◽  
Vol 13 (1) ◽  
pp. 91-99 ◽  
Author(s):  
Bethany J. Foster ◽  
Mark M. Mitsnefes ◽  
Mourad Dahhou ◽  
Xun Zhang ◽  
Benjamin L. Laskin
Keyword(s):  
United States ◽  
General Population ◽  
Excess Mortality ◽  
The United States ◽  
Mortality Rates ◽  
Excess Risk ◽  
Calendar Time ◽  
Risk Of Death ◽  
All Cause Mortality ◽  
Functioning Kidney

Background and objectivesIndividuals with ESRD have a very high risk of death. Although mortality rates have decreased over time in ESRD, it is unknown if improvements merely reflect parallel increases in general population survival. We, therefore, examined changes in the excess risk of all-cause mortality—over and above the risk in the general population—among people treated for ESRD in the United States from 1995 to 2013. We hypothesized that the magnitude of change in the excess risk of death would differ by age and RRT modality.Design, setting, participants, & measurementsWe used time-dependent relative survival models including data from persons with incident ESRD as recorded in the US Renal Data System and age-, sex-, race-, and calendar year–specific general population mortality rates from the Centers for Disease Control and Prevention. We calculated relative excess risks (analogous to hazard ratios) to examine the association between advancing calendar time and the primary outcome of all-cause mortality.ResultsWe included 1,938,148 children and adults with incident ESRD from 1995 to 2013. Adjusted relative excess risk per 5-year increment in calendar time ranged from 0.73 (95% confidence interval, 0.69 to 0.77) for 0–14 year olds to 0.88 (95% confidence interval, 0.88 to 0.88) for ≥65 year olds, meaning that the excess risk of ESRD-related death decreased by 12%–27% over any 5-year interval between 1995 and 2013. Decreases in excess mortality over time were observed for all ages and both during treatment with dialysis and during time with a functioning kidney transplant (year by age and year by renal replacement modality interactions were both P<0.001), with the largest relative improvements observed for the youngest persons with a functioning kidney transplant. Absolute decreases in excess ESRD-related mortality were greatest for the oldest persons.ConclusionsThe excess risk of all-cause mortality among people with ESRD, over and above the risk in the general population, decreased significantly between 1995 and 2013 in the United States.

scholarly journals Religious Participation and Mortality Risk in Mexico

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

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

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

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

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

scholarly journals Severity of the COVID-19 pandemic assessed with all-cause mortality in the United States during 2020.

2021 ◽  
Author(s):  
Fredrick Dahlgren ◽  
Lauren Rossen ◽  
Alicia Fry ◽  
Carrie Reed
Keyword(s):  
United States ◽  
New York ◽  
Age Groups ◽  
The United States ◽  
Mortality Data ◽  
Demographic Groups ◽  
High Severity ◽  
All Cause Mortality ◽  
The Impact ◽  
Very High

Background. In the United States, infection with SARS-CoV-2 caused 380,000 reported deaths from March to December 2020. Methods. We adapted the Moving Epidemic Method to all-cause mortality data from the United States to assess the severity of the COVID-19 pandemic across age groups and all 50 states. By comparing all-cause mortality during the pandemic with intensity thresholds derived from recent, historical all-cause mortality, we categorized each week from March to December 2020 as either low severity, moderate severity, high severity, or very high severity. Results. Nationally for all ages combined, all-cause mortality was in the very high severity category for 9 weeks. Among people 18 to 49 years of age, there were 29 weeks of consecutive very high severity mortality. Forty-seven states, the District of Columbia, and New York City each experienced at least one week of very high severity mortality for all ages combined. Conclusions. These periods of very high severity of mortality during March through December 2020 are likely directly or indirectly attributable to the COVID-19 pandemic. This method for standardized comparison of severity over time across different geographies and demographic groups provides valuable information to understand the impact of the COVID-19 pandemic and to identify specific locations or subgroups for deeper investigations into differences in severity.

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

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

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

scholarly journals Geographically-targeted COVID-19 vaccination is more equitable than age-based thresholds alone

2021 ◽  
Author(s):  
Elizabeth Wrigley-Field ◽  
Mathew V Kiang ◽  
Alicia R Riley ◽  
Magali Barbieri ◽  
Yea-Hung Chen ◽  
...  
Keyword(s):  
United States ◽  
High Risk ◽  
Mortality Risk ◽  
The United States ◽  
People Of Color ◽  
White People ◽  
Risk Of Death ◽  
Geographic Prioritization ◽  
Geographically Targeted ◽  
Racial Ethnic

AbstractCOVID-19 mortality increases dramatically with age and is also substantially higher among Black, Indigenous, and People of Color (BIPOC) populations in the United States. These two facts introduce tradeoffs because BIPOC populations are younger than white populations. In analyses of California and Minnesota--demographically divergent states--we show that COVID vaccination schedules based solely on age benefit the older white populations at the expense of younger BIPOC populations with higher risk of death from COVID-19. We find that strategies that prioritize high-risk geographic areas for vaccination at all ages better target mortality risk than age-based strategies alone, although they do not always perform as well as direct prioritization of high-risk racial/ethnic groups.One-sentence summaryAge-based COVID-19 vaccination prioritizes white people above higher-risk others; geographic prioritization improves equity.

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

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

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

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