Linking the timing of a mother’s and child’s death: Comparative evidence from two rural South African population-based surveillance studies, 2000–2015

Background The effect of the period before a mother’s death on child survival has been assessed in only a few studies. We conducted a comparative investigation of the effect of the timing of a mother’s death on child survival up to age five years in rural South Africa. Methods We used discrete time survival analysis on data from two HIV-endemic population surveillance sites (2000–2015) to estimate a child’s risk of dying before and after their mother’s death. We tested if this relationship varied between sites and by availability of antiretroviral therapy (ART). We assessed if related adults in the household altered the effect of a mother’s death on child survival. Findings 3,618 children died from 2000–2015. The probability of a child dying began to increase in the 7–11 months prior to the mother’s death and increased markedly in the 3 months before (2000–2003 relative risk = 22.2, 95% CI = 14.2–34.6) and 3 months following her death (2000–2003 RR = 20.1; CI = 10.3–39.4). This increased risk pattern was evident at both sites. The pattern attenuated with ART availability but remained even with availability at both sites. The father and maternal grandmother in the household lowered children’s mortality risk independent of the association between timing of mother and child mortality. Conclusions The persistence of elevated mortality risk both before and after the mother’s death for children of different ages suggests that absence of maternal care and abrupt breastfeeding cessation might be crucial risk factors. Formative research is needed to understand the circumstances for children when a mother is very ill or dies, and behavioral and other risk factors that increase both the mother and child’s risk of dying. Identifying families when a mother is very ill and implementing training and support strategies for other members of the household are urgently needed to reduce preventable child mortality.

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Risk Factors for Child Mortality in the Kassena-Nankana District of Northern Ghana: A Cross-Sectional Study Using Population-Based Data

Scientifica ◽

10.1155/2018/7692379 ◽

2018 ◽

Vol 2018 ◽

pp. 1-7 ◽

Cited By ~ 3

Author(s):

Michael N. K. Babayara ◽

Bright Addo

Keyword(s):

Risk Factors ◽

Child Mortality ◽

Child Survival ◽

Survival Rates ◽

Public Health Problem ◽

Population Based ◽

Survival Strategies ◽

Northern Ghana ◽

Major Public Health Problem ◽

Cross Sectional

Child mortality continues to be a major public health problem in Ghana, especially in northern Ghana where child survival rates are among the lowest. Though strategies are in place to address it, progress made is unsatisfactory and the Sustainable Development Goal 3 risks being missed. This makes the reexamination of the risk factors for child mortality crucial as results will aid in the modification of existing strategies aimed at addressing the problem. This study was a population-based case control study utilizing data (2007–2011) from the Demographic Surveillance System database of the Navrongo Health Research Center. Cases and controls were selected from the database and analysed unmatched. Cases were children who died before age five and controls were live children within the same year group. Univariate and bivariate analyses were performed using STATA (v13). The results revealed the main causes of death in the area to include malaria, diarrhoeal diseases, respiratory infections, and malnutrition. Mother’s age at birth, mother’s educational level, and mother’s household socioeconomic status were significantly related to child mortality. On the basis of these results, we conclude that the known risk factors for child mortality in the Kassena-Nankana district have not changed much over the years. Current child survival strategies therefore need to be evaluated and modified where necessary to yield desired results.

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The incidence of other malignancies before and after sarcoma diagnosis: A population-based study.

Journal of Clinical Oncology ◽

10.1200/jco.2017.35.15_suppl.11076 ◽

2017 ◽

Vol 35 (15_suppl) ◽

pp. 11076-11076

Author(s):

Winette T.A. Van Der Graaf ◽

Husson Olga ◽

Willem J. van Houdt ◽

Ingrid M.E. Desar ◽

Vincent K.Y. Ho

Keyword(s):

Risk Factors ◽

Unknown Origin ◽

Population Based ◽

Population Based Study ◽

Netherlands Cancer Registry ◽

Increased Risk ◽

Hematological Cancers ◽

Before And After ◽

Second Tumors ◽

Associated Risk Factors

11076 Background: Sarcomas encompass a group of rare and heterogeneous mesenchymal malignancies with mostly unknown origin. Both exogenous risk factors, in particular radiotherapy, as well as genetic risk factors have been described. Second tumors next to sarcomas suggest associated risk factors. In the current study, we investigate the incidence of sarcomas and other malignancies by using population-based data from the Netherlands Cancer Registry. Methods: In 29,638 patients diagnosed with sarcoma between 1989 and 2015, with a median age of 59 years, we quantified the risk of other malignancies after sarcoma diagnosis using standardized incidence ratios (SIRs). In assessing associations with malignancies before sarcoma diagnosis, we focussed on previous radiotherapy. Skin carcinomas, with the exception of melanomas, were excluded. Results: In total, 3,381 (11.4%) sarcoma patients, median age 71years, had a previous malignancy (at a median age of 66 years). The most frequent sarcomas associated with prior tumors were angiosarcoma (34.5%) and gastrointestinal stromal tumours (20.6%). In the angiosarcoma group, 78.6% of patients had received prior radiotherapy for their previous tumors. Subsequent tumors (diagnosed in patients with median age of 69.5 years) after sarcoma diagnoses were detected in 2,523 patients with median age of 63 years (SIR 1.13; 95%CI: 1.09–1.18). Risks appear notably elevated for breast cancer (SIR 1.19; 95%CI: 1.06–1.34), lung cancer (SIR 1.15; 95%CI: 1.04–1.27), cancers of the urinary tract system (SIR 1.33; 95%CI: 1.14–1.53) and hematological cancers (SIR 1.31; 95%CI: 1.13–1.51). Median time until diagnosis of subsequent cancer was 52.7 months. Conclusions: Sarcoma patients have a markedly increased risk on another malignancy, either before or after the sarcoma diagnosis. Further research into genetic and exogenous risk factors may help to explain the associations.

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Systemic sclerosis portends increased risk of conduction and rhythm abnormalities at diagnosis and during disease course: A US population-based cohort

Journal of Scleroderma and Related Disorders ◽

10.1177/23971983211034074 ◽

2021 ◽

pp. 239719832110340

Author(s):

Yasser A Radwan ◽

Reto D Kurmann ◽

Avneek S Sandhu ◽

Edward A El-Am ◽

Cynthia S Crowson ◽

...

Keyword(s):

Risk Factors ◽

Pulmonary Hypertension ◽

Systemic Sclerosis ◽

Confidence Interval ◽

Cumulative Incidence ◽

Disease Onset ◽

Population Based ◽

Hazard Ratio ◽

Conduction Disorders ◽

Increased Risk

Objectives: To study the incidence, risk factors, and outcomes of conduction and rhythm disorders in a population-based cohort of patients with systemic sclerosis versus nonsystemic sclerosis comparators. Methods: An incident cohort of patients with systemic sclerosis (1980–2016) from Olmsted County, MN, was compared to age- and sex-matched nonsystemic sclerosis subjects (1:2). Electrocardiograms, Holter electrocardiograms, and a need for cardiac interventions were reviewed to determine the occurrence of any conduction or rhythm abnormalities. Results: Seventy-eight incident systemic sclerosis cases and 156 comparators were identified (mean age 56 years, 91% female). The prevalence of any conduction disorder before systemic sclerosis diagnosis compared to nonsystemic sclerosis subjects was 15% versus 7% ( p = 0.06), and any rhythm disorder was 18% versus 13% ( p = 0.33). During a median follow-up of 10.5 years in patients with systemic sclerosis and 13.0 years in nonsystemic sclerosis comparators, conduction disorders developed in 25 patients with systemic sclerosis with cumulative incidence of 20.5% (95% confidence interval: 12.4%–34.1%) versus 28 nonsystemic sclerosis patients with cumulative incidence of 10.4% (95% confidence interval: 6.2%–17.4%) (hazard ratio: 2.57; 95% confidence interval: 1.48–4.45), while rhythm disorders developed in 27 patients with systemic sclerosis with cumulative incidence of 27.3% (95% confidence interval: 17.9%–41.6%) versus 43 nonsystemic sclerosis patients with cumulative incidence of 18.0% (95% confidence interval: 12.3%–26.4%) (hazard ratio: 1.62; 95% confidence interval: 1.00–2.64). Age, pulmonary hypertension, and smoking were identified as risk factors. Conclusion: Patients with systemic sclerosis have an increased risk of conduction and rhythm disorders both at disease onset and over time, compared to nonsystemic sclerosis patients. These findings warrant increased vigilance and screening for electrocardiogram abnormalities in systemic sclerosis patients with pulmonary hypertension.

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Abstract 12385: Past Alcohol Consumption and Incident Atrial Fibrillation

Circulation ◽

10.1161/circ.132.suppl_3.12385 ◽

2015 ◽

Vol 132 (suppl_3) ◽

Author(s):

Shalini Dixit ◽

Alvaro Alonso ◽

Elsayed Z Soliman ◽

Lin Y Chen ◽

Gregory M Marcus

Keyword(s):

Atrial Fibrillation ◽

Alcohol Consumption ◽

Alcohol Use ◽

Population Based ◽

Self Report ◽

Atherosclerosis Risk In Communities ◽

Increased Risk ◽

Before And After ◽

Dietary Intake Assessment ◽

Aric Study

Introduction: Although current alcohol consumption appears to be a risk factor for incident atrial fibrillation (AF), limitations related to self-reported alcohol use and confounding in observational studies limit the certainty of conclusions regarding causality. Whether cessation of alcohol consumption can protect against incident AF remains unknown. Methods: We examined all participants in the Atherosclerosis Risk in Communities (ARIC) study, a population-based cohort of 15,792 men and women aged 45-65, without prevalent AF. Past alcohol consumption was assessed via self-report during the baseline dietary intake assessment. Cases of incident AF were ascertained via study ECGs, hospital discharge ICD-9 codes, and death certificates. Results: Among 15,262 participants with complete survey data, 2,898 (19.0%) were former drinkers. During an average follow-up of 17.4 years, there were 380 cases of incident AF in former consumers. Both before and after adjustment for potential confounders, a longer duration of alcohol abstinence was associated with a lower risk of developing AF; previously consuming alcohol for a longer duration and consuming a greater quantity of alcohol were each associated with a higher risk of developing AF (Table). Conclusions: Among former drinkers, the number of years of drinking and the amount of alcohol consumed may each confer an increased risk of AF. Given that a longer duration of abstinence was associated with a decreased risk of AF, modification of alcohol use could potentially play a role in AF prevention.

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701. Blood Stream Infection And Risk Of Endocarditis Following Cardiac Valve Repair: A Population-Based Study

Open Forum Infectious Diseases ◽

10.1093/ofid/ofaa439.893 ◽

2020 ◽

Vol 7 (Supplement_1) ◽

pp. S401-S401

Author(s):

Jack McHugh ◽

Talha Khawaja ◽

Larry M Baddour ◽

Juan Crestanello ◽

...

Keyword(s):

Risk Factors ◽

Blood Stream Infection ◽

Subsequent Development ◽

Bloodstream Infections ◽

Population Based ◽

Cardiac Valve ◽

Valve Repair ◽

Population Based Study ◽

Increased Risk ◽

One Year

Abstract Background Bloodstream infections (BSIs) confer an increased risk of infective endocarditis (IE) in patients with a prosthetic cardiac valve. This relationship is less well established in patients undergoing valve repair. We conducted a retrospective population-based study to determine the incidence of BSIs following valve repair and identify risk factors associated with the development of IE. Methods The Rochester Epidemiology Project (REP) data linkage system was used to identify all persons who underwent valve repair in a 7-county region in Southeastern Minnesota between January 1, 2010 and December 31, 2018. Medical records were screened for the development of a BSI from time of procedure until May 15, 2020. Patients were classified as having BSI only, BSI with IE at outset, or BSI with subsequent development of new IE. IE at outset was defined as cases where IE was diagnosed at the time of initial positive blood culture. Results A total of 387 patients underwent valve repair surgery. A total of 31 (8%) patients subsequently developed a BSI, 4% within one year of surgery. Seventeen patients underwent mitral repair with annuloplasty, 9 underwent tricuspid annuloplasty, and 5 had concurrent repairs. Median time to the development of BSI was 338 days. Of the 31 patients with BSI, 4 (13%) had BSI with IE at outset. No patients developed IE subsequent to BSI, Enterococcus spp. was responsible for 3 cases of IE, and MSSA for 1. All cases occurred within one year of surgery. Given the low incidence, statistical analysis of associated risk factors for IE was not feasible. All patients with BSI and IE at outset, however, died by the end of the study period, versus 11/27 in the BSI only group. Conclusion Incidence of BSIs was higher in patients undergoing cardiac valve repair than in the general population. The incidence of IE with a BSI was 13%, which is lower than what has been previously published. It is notable that all cases of IE occurred within one year of surgery. Recognizing that endothelialization of device surfaces occurs, it is tempting to speculate that the risk of IE may be time dependent and may decline over time. Subsequent investigation of this theory is underway. Disclosures Larry M. Baddour, MD, Boston Scientific (Consultant)

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Metabolome-defined obesity and the risk of future diabetes and mortality

10.1101/2021.11.03.21265744 ◽

2021 ◽

Author(s):

Filip Ottosson ◽

Einar Smith ◽

Ulrika Ericson ◽

Salvatore Di Somma ◽

Paola Antonini ◽

...

Keyword(s):

Risk Factors ◽

High Risk ◽

Population Based ◽

Normal Weight ◽

Plasma Metabolites ◽

Italian Population ◽

Related Risk ◽

Increased Risk ◽

All Cause Mortality ◽

Future Diabetes

Background Obesity is a key risk factor for type 2 diabetes, however, up to 20% of patients are normal weight. Our aim was to identify metabolite patterns reproducibly predictive of BMI, and subsequently to test if lean individuals who carry an obese metabolome are at hidden high risk of obesity related diseases, such as diabetes. Methods We measured 109 metabolites in fasted plasma samples of 7663 individuals from two Swedish and one Italian population-based cohort. Ridge regression models were used to predict BMI using the plasma metabolites. Individuals with a predicted BMI either more than 5 kg/m2 higher (overestimated) or lower (underestimated) than their actual BMI were characterized as outliers and further investigated for obesity related risk factors and future risk of diabetes and mortality. Results The plasma metabolome could predict BMI in all cohorts (r2 = 0.48, 0.26 and 0.19). The overestimated group had a BMI similar to individuals correctly predicted as normal weight, similar waist circumference, were not more likely to change weight over time but had a 2 times higher risk of future diabetes and an 80 % increased risk of all-cause mortality. These associations remained after adjustments for obesity-related risk factors and lifestyle parameters. Conclusions We found that lean individuals with an obese metabolome, have an increased risk for diabetes and all-cause mortality compared to lean individuals with a healthy metabolome. Metabolomics may be used to identify hidden high-risk individuals, in order to initiate lifestyle and pharmacological interventions.

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Genetic and Environmental Risk Factors for Intracerebral Hemorrhage

Stroke ◽

10.1161/str.32.suppl_1.321 ◽

2001 ◽

Vol 32 (suppl_1) ◽

pp. 321-321

Author(s):

Daniel Woo ◽

Laura Sauerbeck ◽

Brett M Kissela ◽

Jane C Khoury ◽

Rakesh Shukla ◽

...

Keyword(s):

Risk Factors ◽

Intracerebral Hemorrhage ◽

Environmental Risk ◽

Multivariable Analysis ◽

Population Based ◽

Environmental Risk Factors ◽

Degree Relative ◽

Increased Risk ◽

Apo E ◽

Apo E Genotype

27 Introduction: We report a planned midpoint analysis of a prospective, population-based, case-control study of the genetic and environmental risk factors of spontaneous, non-traumatic, intracerebral hemorrhage (ICH). Methods: Cases were matched to two controls by age, race and gender. Data was obtained by direct interview and review of all available medical and neuroimaging data. Apolipoprotein E (Apo E)genotype was determined by polymerase chain reaction. Multivariable analyses were performed using logistic regression modeling. Results: Between 6/97 and 2/00, 189 cases of ICH (150 white/39 black; 68 lobar/121 non-lobar) and 368 controls were enrolled into the study. Independent risk factors for multivariable analysis are listed in the table. Only prior stroke was an independent risk factor for both lobar and non-lobar ICH. Conclusions: The importance of individual genetic and environmental risk factors for ICH vary substantially by location of ICH. A history of a first-degree relative with ICH was associated with an increased risk of lobar ICH, independent of Apo E genotype. This finding indicates that other genetic risk factors may be important in the development of ICH.

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Abstract 1158: Sudden Death in Children with Cardiomyopathy: Long Term Follow-Up from a National Population-Based Study of Childhood Cardiomyopathy

Circulation ◽

10.1161/circ.118.suppl_18.s_651-b ◽

2008 ◽

Vol 118 (suppl_18) ◽

Author(s):

Tara Bharucha ◽

Andrew M Davis ◽

Christian Turner ◽

Robert Justo ◽

Terry Robertson ◽

...

Keyword(s):

Risk Factors ◽

Primary Prevention ◽

Sudden Death ◽

Systolic Dysfunction ◽

Population Based ◽

Z Score ◽

Icd Implantation ◽

Population Based Study ◽

Increased Risk

Introduction Better data regarding the incidence and risk factors for sudden cardiac death (SCD) in children with cardiomyopathy (CM) is critical in defining appropriate primary prevention strategies. Methods The National Australian Childhood Cardiomyopathy Study is a prospective cohort study, including all children in Australia with primary CM diagnosed at 0 – 10 years of age, between 1987–1997. SCD was defined as sudden and unexpected death in children who were not hospitalized and not in congestive heart failure at the time of death. Nine subjects with sudden death as presenting symptom were excluded. Indexed echocardiographic measurements at latest follow-up were compared between subjects with SCD and survivors. Results Study criteria were met by 291 children. Mean duration of follow-up was 9.2 years. The incidence of sudden death relative to each CM type, for all cases and as a proportion of deaths, is shown in the Table : Incidence of SCD by CM type. SCD incidence was significantly associated with CM type, for all cases ( p = 0.006) and when only those subjects who died were considered ( p = 0.005), with LVNC and RCM having up to 4 times the risk of other CM types. Children with familial DCM had a significantly higher rate of SCD than subjects with non-familial CM (12% vs 3%; p = 0.028), however, familial CM was not a risk factor in other CM types. DCM SCD subjects had larger LVEDd Z score than survivors (median 5.53 vs 1.16; p <0.0001) and lower FS Z score (median −9.23 vs −0.51; p = 0.0025). HCM SCD subjects had thicker LVPW dimension Z scores than survivors (median 4.63 vs 1.18; p = 0.007). Twelve subjects (2 DCM, 8 HCM and 2 LVNC) underwent ICD implantation (8/12 for primary prevention). Conclusions: This population based study defines new risk factors for sudden death in children with CM. RCM is well known to have a high incidence of SCD. In addition, children with LVNC and those with DCM who have severe dilatation, systolic dysfunction or familial DCM are at increased risk of sudden death.

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Genetic and treatment risks for diabetes mellitus (DM) in survivors of childhood cancer: A report from the Childhood Cancer Survivor Study (CCSS) and St. Jude Lifetime (SJLIFE) cohorts.

Journal of Clinical Oncology ◽

10.1200/jco.2021.39.15_suppl.10014 ◽

2021 ◽

Vol 39 (15_suppl) ◽

pp. 10014-10014

Author(s):

Melissa A. Richard ◽

Sogol Mostoufi-Moab ◽

Nisha Rathore ◽

Austin L. Brown ◽

Stephen J. Chanock ◽

...

Keyword(s):

Risk Factors ◽

Cancer Survivors ◽

Cancer Treatment ◽

Childhood Cancer ◽

Regulatory Region ◽

Childhood Cancer Survivors ◽

Population Based ◽

European Ancestry ◽

Radiation Group ◽

Increased Risk

10014 Background: Childhood cancer survivors face increased risk for DM, a polygenic trait also attributable to cancer treatment exposures, particularly abdominal radiation. We aimed to characterize the role of genetic and treatment risk factors for DM among two large cohorts of childhood cancer survivors. Methods: We performed a nested case-control genome-wide association study for DM managed with oral medications in the original CCSS cohort (diagnosed 1970-1986). Logistic regression was conducted in the total sample (N = 5083) and stratified by 1) European ancestry (EA) and 2) abdominal radiation. Replication of suggestive variants (P < 1×10-7) using Fisher’s exact test was performed in independent cohorts: i) CCSS expansion diagnosed 1987-1999 (N = 2588) and ii) SJLIFE diagnosed 1962-2012 (N = 2182). To evaluate the effect of cancer treatment on the background genetic predisposition to DM, we estimated standardized effect sizes (Z’) among EA survivors in each abdominal radiation group for 398 index variants from the largest population-based EA DM study. Radiation group Z’ estimates were compared using linear regression. Results: In the original CCSS cohort we identified nine variants associated with DM and provide further support for four linked variants in the ERCC6L2 locus. Among all survivors, the rs55849673-A allele was associated with increased odds for DM among survivors in the original CCSS cohort (minor allele frequency [MAF]-cases = 0.055; MAF-controls = 0.024; adjusted odds ratio [aOR] = 2.9, 95% CI: 2.0-4.2, P = 3.7×10-8). Allele frequencies were consistent in the CCSS expansion (MAF-cases = 0.075; MAF-controls = 0.028; P = 0.07) and SJLIFE (MAF-cases = 0.036; MAF-controls = 0.027; P = 0.5). Additionally, rs55849673-A estimates were consistent among EA survivors and stronger among survivors not treated with abdominal radiation (MAF-cases = 0.052; MAF-controls = 0.021; aOR = 3.6, P = 1.6×10-6). Notably, in the CCSS expansion all rs55849673-A EA carriers who developed DM did not receive abdominal radiation (MAF-cases = 0.1; MAF-controls = 0.026; P = 0.04). More broadly, the Z’ of population-based DM index variants were 78% lower in survivors treated with abdominal radiation than survivors not treated with abdominal radiation (beta = 0.22; P = 0.01), indicating the background genetic risk for DM may be altered by treatment. Conclusions: We provide evidence for a novel locus of DM in childhood cancer survivors. This locus is a regulatory region associated with expression of ERCC6L2, a gene implicated in an East Asian population-based DM study. Taken together, our findings support the overwhelming effect of abdominal radiation on DM risk in childhood cancer survivors, relative to other risk factors, and provide insight on a genetic locus that may be useful for DM risk prediction in the context of cancer treatment.

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Risks of suicide attempts after prescription of zolpidem in people with depression: a nationwide population study in South Korea

SLEEP ◽

10.1093/sleep/zsz235 ◽

2019 ◽

Vol 43 (3) ◽

Author(s):

Hyewon Kim ◽

Yuwon Kim ◽

Woojae Myung ◽

Maurizio Fava ◽

David Mischoulon ◽

...

Keyword(s):

Suicide Attempt ◽

Medical Records ◽

Suicide Attempts ◽

Case Series ◽

Population Based ◽

Additional Increase ◽

Series Design ◽

Increased Risk ◽

Before And After ◽

Rate Ratios

Abstract Objectives To investigate the association between zolpidem prescription and suicide attempts in people with depression Methods A nationwide, population-based electronic medical records database from the Health Insurance Review & Assessment Service of South was used to investigate the incidence rate ratios (IRRs) of suicide attempts and probable suicide attempts in people with depression before and after zolpidem prescription using self-controlled case series design. Results In a total of 445 people who attempted suicide and 23 141 people who attempted probable suicide attempt, the IRRs of suicidal behavior during the risk periods before and after zolpidem prescription increased compared with those at the baseline. The IRRs gradually increased and peaked immediately before the prescription of zolpidem. The IRR was 70.06 (95% CI: 25.58–191.90) on day 2 before zolpidem prescription and 63.35 (95% CI: 22.99–174.59) on day 1 after zolpidem prescription in the suicide attempt group. The IRR was 24.07 (95% CI: 20.50–28.26) on the day before zolpidem prescription and 14.96 (95% CI: 12.21–18.34) on the day after zolpidem prescription in the probable suicide attempt group. The ratios declined eventually after zolpidem was prescribed. Conclusions Although zolpidem prescription was associated with an increased risk of suicide attempts in people with depression, the risk increased and peaked immediately before zolpidem prescription. The risk declined gradually thereafter. This result indicates that the risk of suicide attempts increases at the time of zolpidem prescription. However, zolpidem prescription does not contribute to additional increase in the risk of suicide attempts.

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