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Race, Ethnicity, and Mortality Following Major Osteoporotic Fracture: Results from the Women\u27s Health Initiative Study.
No full textBACKGROUND: Major osteoporotic fracture (MOF) is associated with increased mortality; however, few studies in postmenopausal women have examined racial and ethnic differences in 1-year and 5-year mortality following MOF.
OBJECTIVE: To assess 1-year and 5-year mortality following MOF by race and ethnicity.
DESIGN: This prospective cohort study included postmenopausal women enrolled in the Women\u27s Health Initiative (WHI), a population-based, multisite US study. Participants were followed from September 1994 to February 2023. Data were analyzed between August 2023 and November 2023.
PARTICIPANTS: Postmenopausal women aged 50 to 79 years old who experienced a MOF (N = 32,675 in 1 year and 29,506 in 5 years following MOF).
MAIN MEASURES: Self-reported race and ethnicity. All-cause mortality was determined by death certificates, reports of surrogates, and the National Death Index Search.
KEY RESULTS: The baseline mean age of participants was 77.0 [SD = 8.5] years with 31,223 [95.6%] White participants in the 1-year mortality analysis, and 76.3 [SD = 8.5] years with 28,212 [95.6%] White participants in the 5-year mortality analysis. In fully adjusted models, compared to White women, Black women had a higher risk of mortality (adjusted odds ratio (aOR) = 1.42, 95% CI [1.06, 1.90], while Asian women had a lower risk of mortality (aOR = 0.48 95% CI [0.27, 0.88]), within 1 year following MOF. Compared to White women, the mortality risk within 5 years after MOF was significantly higher among American Indian/Alaska Native (aOR = 3.30, 95% CI [1.65, 6.60]) and lower among Asian (aOR = 0.58, 95% CI [0.42,0.80]) women. While there were no mortality differences by ethnicity 1 year following MOF, Hispanic/Latina women were less likely to die 5 years following MOF (aOR = 0.74, [95% CI 0.57-0.96]) compared to Non-Hispanic/Latina women.
CONCLUSIONS: In this large prospective study, mortality following MOF differed by race. Future research is needed to delineate the mechanism behind these associations
Evaluation of the Electrocardiographic Tp-e, Tp-e/QT, and Tp-e/QTc Parameters in Patients with Non-Alcoholic Liver Disease.
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Variability in Cost and Procedures in Pediatric Functional GI Disorder Hospitalizations by Patient Socioeconomic Status
Get PDFA study to evaluate anxiety and rates of hospitalization in children with Sickle Cell Disease using GAD-7 anxiety scale.
Get PDFBlack Dads Matter: An Equity-Centered Review of Men’s Health During the Transition to Fatherhood
Get PDFTiming for Assessment of Bleeding Diathesis in Pediatric Blunt Traumatic Brain Injury.
No full textOBJECTIVES: Intracranial hemorrhage may complicate blunt traumatic brain injury (TBI) or result from underlying bleeding disorders, and coagulation studies/factor level assays may be abnormal for both. Current studies do not identify when testing can reliably differentiate between traumatic injuries and bleeding disorders. We sought to evaluate the prevalence of coagulation abnormalities in the initial 36 hours after presentation for blunt TBI and determine a time period for subsequent normalization.
METHODS: Patients under 18 years old with blunt TBI were identified from our institutional trauma registry from 2020 to 2022. Data collected included coagulation studies [prothrombin time (PT), partial thromboplastin time (PTT)], complete blood count, factor levels, final suspected/proven diagnosis, mechanism of injury, patient demographics, radiographic findings, and clinical interventions. Comparisons were made between laboratory values obtained and normal references, and differences were described.
RESULTS: Two hundred sixty-eight patients were identified. The majority were male, and the median age was 8.5 months (interquartile range 4-45.3 mo). The coagulation studies and factor level assays were more often completed for patients who suffered child physical abuse, whereas testing was obtained in \u3c 10% of patients following unintentional trauma. The mechanism of injury was unintentional blunt injury in 70.1%, abusive TBI in 27.2%, and a medical cause in 3%. Intracranial hemorrhage was identified in 49.2% of patients. Within 36 hours after presentation, the most common laboratory abnormality was significantly elevated PT [median 13.65 s (interquartile range 13.1-14.8 s)] as compared with the normal range (P\u3c 0.001). This did not differ significantly based on the mechanism of trauma. Significant elevations were also seen for von Willebrand factor antigen and d-dimer. There were no patients with significant factor level deficiencies. Although 64% of patients had follow-up, only 11.8% had repeat laboratory testing, with persistent abnormalities observed in up to 7%.
CONCLUSIONS: Coagulation studies and factor level assays were not routinely obtained following blunt head trauma in pediatric patients. Coagulation abnormalities were, however, observed in \u3e50% of patients who underwent testing. These patients may have coagulation abnormalities that persist for 2 weeks after injury without an underlying bleeding disorder. Further delineating the time frame of these abnormalities may inform practice guidelines for the diagnostic evaluation of underlying bleeding disorders and follow-up
Global, Regional, and National Burden of Nontraumatic Subarachnoid Hemorrhage: The Global Burden of Disease Study 2021.
No full textIMPORTANCE: Nontraumatic subarachnoid hemorrhage (SAH) represents the third most common stroke type with unique etiologies, risk factors, diagnostics, and treatments. Nevertheless, epidemiological studies often cluster SAH with other stroke types leaving its distinct burden estimates obscure.
OBJECTIVE: To estimate the worldwide burden of SAH.
DESIGN, SETTING, AND PARTICIPANTS: Based on the repeated cross-sectional Global Burden of Disease (GBD) 2021 study, the global burden of SAH in 1990 to 2021 was estimated. Moreover, the SAH burden was compared with other diseases, and its associations with 14 individual risk factors were investigated with available data in the GBD 2021 study. The GBD study included the burden estimates of nontraumatic SAH among all ages in 204 countries and territories between 1990 and 2021.
EXPOSURES: SAH and 14 modifiable risk factors.
MAIN OUTCOMES AND MEASURES: Absolute numbers and age-standardized rates with 95% uncertainty intervals (UIs) of SAH incidence, prevalence, mortality, and disability-adjusted life-years (DALYs) as well as risk factor-specific population attributable fractions (PAFs).
RESULTS: In 2021, the global age-standardized SAH incidence was 8.3 (95% UI, 7.3-9.5), prevalence was 92.2 (95% UI, 84.1-100.6), mortality was 4.2 (95% UI, 3.7-4.8), and DALY rate was 125.2 (95% UI, 110.5-142.6) per 100 000 people. The highest burden estimates were found in Latin America, the Caribbean, Oceania, and high-income Asia Pacific. Although the absolute number of SAH cases increased, especially in regions with a low sociodemographic index, all age-standardized burden rates decreased between 1990 and 2021: the incidence by 28.8% (95% UI, 25.7%-31.6%), prevalence by 16.1% (95% UI, 14.8%-17.7%), mortality by 56.1% (95% UI, 40.7%-64.3%), and DALY rate by 54.6% (95% UI, 42.8%-61.9%). Of 300 diseases, SAH ranked as the 36th most common cause of death and 59th most common cause of DALY in the world. Of all worldwide SAH-related DALYs, 71.6% (95% UI, 63.8%-78.6%) were associated with the 14 modeled risk factors of which high systolic blood pressure (population attributable fraction [PAF] = 51.6%; 95% UI, 38.0%-62.6%) and smoking (PAF = 14.4%; 95% UI, 12.4%-16.5%) had the highest attribution.
CONCLUSIONS AND RELEVANCE: Although the global age-standardized burden rates of SAH more than halved over the last 3 decades, SAH remained one of the most common cardiovascular and neurological causes of death and disabilities in the world, with increasing absolute case numbers. These findings suggest evidence for the potential health benefits of proactive public health planning and resource allocation toward the prevention of SAH