Adults with an epilepsy history, notably those 45-64 years old or at the lowest income levels, more often report heart disease than adults without an epilepsy history.
Ontology highlight
ABSTRACT:
SUBMITTER: Zack M
PROVIDER: S-EPMC6113097 | biostudies-literature |
REPOSITORIES: biostudies-literature
Similar Datasets
Project description:BackgroundMidlife women have a higher risk of cardiometabolic disease than younger women, but the lifelong biological/lifestyle factors responsible for this increase are unclear.ObjectivesWe investigated whether pregnancy history is a risk factor for midlife overweight/obesity and evaluated potential hormonal mechanisms.MethodsThe Baltimore Midlife Women's Health Study, a prospective cohort, recruited 772 women aged 45-54 y. Women reported pregnancy characteristics via questionnaires, trained staff measured weight/height to calculate midlife BMI, and serum hormones were assessed by ELISA. Logistic regression models assessed associations of pregnancy history with risk of midlife overweight/obesity and BMI gain since age 18. We additionally explored whether associations differed by menopausal status, and whether midlife hormones mediated relationships of pregnancy history and midlife BMI.ResultsThese premenopausal or perimenopausal women were 66% Caucasian/White and 30% African American/Black, with a median of 2 live births (range: 0-11) and median age at first birth of 27 y (range: 12-46 y). Women with 0 and ?2 live births had lower odds of overweight/obesity than those with 1 birth (OR = 0.47; 95% CI: 0.23, 0.96; P = 0.04, and OR = 0.58; 95% CI: 0.35, 0.95; P = 0.03, respectively). Women with ?2 live births also had lower odds of BMI gain than those with 1 birth (OR = 0.66; 95% CI: 0.41, 1.06; P = 0.08). Furthermore, women who were older at their first birth had lower odds of overweight/obesity (OR = 0.96; 95% CI: 0.92, 1.00; P = 0.03) and BMI gain (OR = 0.97; 95% CI: 0.93, 1.00; P = 0.06). Number of pregnancies and age at last pregnancy were not associated with midlife overweight/obesity or BMI gain. Associations did not differ by menopausal status and were not explained by midlife hormones.ConclusionsEarlier childbirth and having 1 child increased women's risk of midlife overweight/obesity and BMI gain since age 18. Additional studies should focus on women's childbearing years as a critical determinant of midlife metabolic health.
| S-EPMC6933615 | biostudies-literature
Project description:To examine mortality and causes of death (CODs) in socioeconomically disadvantaged persons with epilepsy (PWEs) in the United States.We performed a retrospective open cohort analysis using Ohio Medicaid claims data between 1992 and 2008 to assess mortality and COD in 68,785 adult Medicaid beneficiaries with epilepsy. Case fatality (CF), mortality rates (MRs), standardized mortality ratios (SMRs), and years of potential life lost (YPLLs) were calculated. The SMRs were estimated to compare risk of death in PWEs with that in the general Medicaid population with and without disabilities. Proportionate mortality ratios (PMRs), YPLLs, and SMRs for specific COD were also obtained.There were 12,630 deaths in PWEs. CF was 18.4%, the age-race-sex adjusted MR was 18.6/1,000 person-years (95% confidence interval [CI], 18.3-18.9). The SMR was 1.8 (95% CI, 1.8-1.9) when compared to the general Medicaid population, and was 1.4 (95% CI, 1.3-1.6) when compared to those with disabilities. The average YPLL was 16.9 years (range 1-47 years). Both epilepsy and comorbid conditions significantly contributed to premature mortality in PWEs. Cardiovascular diseases, cancer, and unintentional injuries were the most common COD and account for a large proportion of YPLLs. Deaths from epilepsy-related causes occurred in about 10% of the cases.Socioeconomically deprived PWEs, especially young adults, experience high mortality and die 17 years prematurely. The high mortality in Medicaid beneficiaries with epilepsy affirms that comorbid conditions and epilepsy play a crucial role in premature death. Management of comorbid conditions is, at a minimum, as important as epilepsy management, and therefore deserves more attention from physicians, particularly those who care for Medicaid beneficiaries with epilepsy.
| S-EPMC4232978 | biostudies-literature
Project description:Hospitals play an important role in caring for patients in the current opioid crisis, but data on the outcomes and composition of opioid-driven hospitalizations in the United States have been lacking. Nationally representative all-payer data for the period 1993-2014 from the National Inpatient Sample were used to compare the mortality rates and composition of hospitalizations with opioid-related primary diagnoses and those of hospitalizations for other drugs and for all other causes. Mortality among opioid-driven hospitalizations increased from 0.43 percent before 2000 to 2.02 percent in 2014, an average increase of 0.12 percentage points per year relative to the mortality of hospitalizations due to other drugs-which was unchanged. While the total volume of opioid-driven hospitalizations remained relatively stable, it shifted from diagnoses mostly involving opioid dependence or abuse to those centered on opioid or heroin poisoning (the latter have higher case fatality rates). After 2000, hospitalizations for opioid/heroin poisoning grew by 0.01 per 1,000 people per year, while hospitalizations for opioid dependence or abuse declined by 0.01 per 1,000 people per year. Patients admitted for opioid/heroin poisoning were more likely to be white, ages 50-64, Medicare beneficiaries with disabilities, and residents of lower-income areas. As the United States combats the opioid epidemic, efforts to help hospitals respond to the increasing severity of opioid intoxication are needed, especially in vulnerable populations.
| S-EPMC5814297 | biostudies-literature
Project description:BackgroundCOVID-19 has been associated with a broad range of thromboembolic, ischemic, and hemorrhagic complications (coagulopathy complications). Most studies have focused on patients with severe disease from high-income countries (HICs).ObjectivesThe main aims were to compare the frequency of coagulopathy complications in developing countries (low- and middle-income countries [LMICs]) with those in HICs, delineate the frequency across a range of treatment levels, and determine associations with in-hospital mortality.MethodsAdult patients enrolled in an observational, multinational registry, the International Severe Acute Respiratory and Emerging Infections COVID-19 study, between January 1, 2020, and September 15, 2021, met inclusion criteria, including admission to a hospital for laboratory-confirmed, acute COVID-19 and data on complications and survival. The advanced-treatment cohort received care, such as admission to the intensive care unit, mechanical ventilation, or inotropes or vasopressors; the basic-treatment cohort did not receive any of these interventions.ResultsThe study population included 495,682 patients from 52 countries, with 63% from LMICs and 85% in the basic treatment cohort. The frequency of coagulopathy complications was higher in HICs (0.76%-3.4%) than in LMICs (0.09%-1.22%). Complications were more frequent in the advanced-treatment cohort than in the basic-treatment cohort. Coagulopathy complications were associated with increased in-hospital mortality (odds ratio, 1.58; 95% CI, 1.52-1.64). The increased mortality associated with these complications was higher in LMICs (58.5%) than in HICs (35.4%). After controlling for coagulopathy complications, treatment intensity, and multiple other factors, the mortality was higher among patients in LMICs than among patients in HICs (odds ratio, 1.45; 95% CI, 1.39-1.51).ConclusionIn a large, international registry of patients hospitalized for COVID-19, coagulopathy complications were more frequent in HICs than in LMICs (developing countries). Increased mortality associated with coagulopathy complications was of a greater magnitude among patients in LMICs. Additional research is needed regarding timely diagnosis of and intervention for coagulation derangements associated with COVID-19, particularly for limited-resource settings.
| S-EPMC10439444 | biostudies-literature
Project description:IntroductionEmergency physicians are trained to treat a variety of ailments in the emergency department (ED), some of which are emergent, while others are not. A common complaint seen in the ED is a sore throat. While most sore throats are easily diagnosed and treated, less common causes are often not considered in the differential diagnoses. Therefore, the purpose of this case study was to present an atypical case of sore throat and discuss differential diagnoses.Case presentationThe patient was a 45-year-old female who presented to the ED with a three-day history of sore throat that was exacerbated by eating and drinking. The patient was not on any prescription medications, but tried over-the-counter medications for the sore throat without any improvement in symptoms. Review of systems was positive for sore throat, fevers, and chills. Physical examination of her oropharynx revealed mildly dry mucous membranes with confluent plaques and white patchy ulcerative appearance involving the tongue, tonsils, hard palate, and soft palate. Rapid streptococcal antigen, mononucleosis spot test, and KOH test were performed and found to be negative.DiscussionAfter initial testing was negative, a follow-up complete blood count with differential and complete metabolic profile were ordered. The patient was found to have decreased lymphocytes and platelets. Based upon those results, a diagnosis was made in the ED, the patient was started on medication, and further laboratory workup was ordered to confirm the diagnosis. ED providers should consider non-infectious as well as infectious causes for a sore throat, as this might lead to a diagnosis of an underlying condition.
| S-EPMC7219994 | biostudies-literature
Project description:BackgroundSeveral states have opted to expand Medicaid under the Patient Protection and Affordable Care Act (ACA), which offers insurance coverage to low-income individuals up to 138% of the federal poverty level. This expansion of Medicaid to a medically vulnerable population potentially can reduce cancer outcome disparities, especially among patients with screening-amenable cancers. The objective of the current study was to estimate the effect of Medicaid expansion on the percentage of adults from low-income communities with screening-amenable cancers who present with metastatic disease.MethodsUsing state cancer registry data linked with block group-level income data, a total of 12,760 individuals aged 30 to 64 years who were diagnosed with incident invasive breast (female), cervical, colorectal, or lung cancer from 2011 through 2016 and who were uninsured or had Medicaid insurance at the time of diagnosis were identified. This sample was probability weighted based on income to reflect potential Medicaid eligibility under the ACA's Medicaid expansion. A multivariable logistic model then was fitted to examine the independent association between the exposure (pre-expansion [years 2011-2013] vs postexpansion [years 2014-2016]) and the outcome (metastatic vs nonmetastatic disease at the time of diagnosis).ResultsAfter adjusting for potential confounders, individuals who were diagnosed postexpansion were found to have 15% lower odds of having metastatic disease compared with those who were diagnosed pre-expansion (adjusted odds ratio, 0.85; 95% confidence interval, 0.77-0.93). As a control, a separate analysis that focused on individuals with private insurance who resided in high-income communities found nonsignificant postexpansion (vs pre-expansion) changes in the outcome (adjusted odds ratio, 1.02; 95% confidence interval, 0.96-1.09).ConclusionsMedicaid expansion is associated with a narrowing of a critical cancer outcome disparity in adults from low-income communities.
| S-EPMC8571714 | biostudies-literature
Project description: Not available
| S-EPMC5641985 | biostudies-literature
Project description:Numerous recent studies have found that overweight adults experience lower overall mortality than those who are underweight, normal-weight, or obese. These highly publicized findings imply that overweight may be the optimal weight category for overall health via its association with longevity-a conclusion with important public health implications. In this study, the authors examined the association between body mass index (BMI; (weight (kg)/height (m)(2))) and 3 markers of health risks using a nationally representative sample of US adults aged 20-80 years (n = 9,255) from the National Health and Nutrition Examination Survey (2005-2008). Generalized additive models, a type of semiparametric regression model, were used to examine the relations between BMI and biomarkers of inflammation, metabolic function, and cardiovascular function (C-reactive protein, hemoglobin A(1c), and high density lipoprotein cholesterol, respectively). The association between BMI and each biomarker was monotonic, with higher BMI being consistently associated with worse health risk profiles at all ages, in contrast to the U-shaped relation between BMI and mortality. Prior results suggesting that the overweight BMI category corresponds to the lowest risk of mortality may not be generalizable to indicators of health risk.
| S-EPMC3900866 | biostudies-literature
Project description:OBJECTIVE:To identify food choices allowing the fulfillment of nutritionally adequate diets resembling actual food patterns at the lowest cost achievable for the Brazilian population, stratified by income level. METHODS:Food consumption and prices were obtained from the Household Budget Survey (n = 55,970 households) and National Dietary Survey (n = 32,749 individuals). The sample was stratified into capitals of the states and further by income levels according to the official minimum wage (totaling 108 geographic-economic strata, or GES). Linear programming models were performed for each GES in order to find the lowest cost of diets that meet a set of nutritional constraints. In order to find realistic diets, constraints referring to preferences were introduced in the models allowing optimized food quantities to depart progressively from the current intake for each food and food group. The impact of meeting each target nutrient was assessed by performing models removing each nutrient at the time. RESULTS:The observed and optimized diet costs were US$2.16 and US$2.58 per capita/day. The highest cost increment and the greatest food shifts were observed in the lowest income level. The nutrient adequacy was reached by mainly increasing fruits and vegetables, beans, fish and seafood, dairy, nuts, and eggs; and reducing red and processed meat, chicken, margarine and butter, cookies, cakes, sugar-sweetened beverages, and sauces. As the departure from the current intakes increase, the optimized healthy diet cost reduced. In the lowest income, the lowest cost increment was about US$ 0.10; in the higher income levels, it tended to be cheaper than the observed cost. Calcium was the most expensive nutrient to meet adequacy. CONCLUSION:Nutritionally adequate diets are possible but costlier than the observed.
| S-EPMC7065914 | biostudies-literature
Project description: Not available
| S-EPMC5706354 | biostudies-literature