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A risk algorithm for assessing short-term mortality for obese black and white men and women.

ABSTRACT: To develop and validate a mortality risk algorithm for obese black and white men and women to elucidate risk factors prognostic of short-term mortality among obese persons.Prospective cohort study. Reasons for geographic and racial differences in stroke (REGARDS) study, is a cohort of black and white men and women aged ?45 years. Obese (?30 kg m(-2) ) participants in REGARDS (n?=?11 288) were randomly assigned to the derivation data set or an independent validation set.During the mean follow-up period of 4.9 years, 8.9% (n?=?504) in the derivation cohort and 8.7% (n?=?492) in the validation cohort died. The best-fitting model based on data from the derivation cohort included demographic (age, sex), coronary heart disease (CHD) conditions (diabetes, systolic blood pressure, history of CHD), health behaviors (smoking, physical activity, alcohol use), and socioeconomic variables (income, use of physician services). The C-statistic when the model was applied to the validation cohort was 0.80. Observed and predicted rates of mortality were similar across deciles of mortality risk by race.A risk algorithm was established and validated to predict mortality among black and white obese subjects based on CHD risk factors, behavioral risk factors, and socioeconomic status.

SUBMITTER: Lakoski SG

PROVIDER: S-EPMC5036400 | biostudies-other | 2014 Apr

REPOSITORIES: biostudies-other

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A risk algorithm for assessing short-term mortality for obese black and white men and women.

Lakoski Susan G SG Mallick Himel H McClure Leslie A LA Safford Monika M Kissela Brett B Howard George G Cushman Mary M

Obesity (Silver Spring, Md.) 20131017 4

<h4>Objective</h4>To develop and validate a mortality risk algorithm for obese black and white men and women to elucidate risk factors prognostic of short-term mortality among obese persons.<h4>Methods</h4>Prospective cohort study. Reasons for geographic and racial differences in stroke (REGARDS) study, is a cohort of black and white men and women aged ≥45 years. Obese (≥30 kg m(-2) ) participants in REGARDS (n = 11 288) were randomly assigned to the derivation data set or an independent validat ...[more]

PMID: 24115735

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Project description:Study objectives: This study examines the influence of individual and neighbourhood socioeconomic status (SES) on mortality among black, Mexican-American, and white women and men in the US. The authors had three study objectives. Firstly, they examined mortality rates by both individual level SES (measured by income, education, and occupational/employment status) and neighbourhood level SES (index of neighbourhood income/wealth, educational attainment, occupational status, and employment status). Secondly, they examined whether neighbourhood SES was associated with mortality after controlling for individual SES. Thirdly, they calculated the population attributable risk to estimate the reduction in mortality rates if all women and men lived in the highest SES neighbourhoods.DesignNational Health Interview Survey (1987-1994), linked with 1990 census tract (neighbourhood proxy) and mortality data through 1997.Setting/participantsNationally representative sample of 59 935 black, 19 201 Mexican-American, and 344 432 white men and women (six gender and racial/ethnic groups), aged 25-64 at interview.Main resultsMortality rates for all six gender and racial/ethnic groups were two to four times higher for those with the lowest incomes (lowest quartile) who lived in the lowest SES neighbourhoods (lowest tertile) compared with those with the highest incomes who lived in the highest SES neighbourhoods. For the six groups, the age adjusted mortality risk associated with living in the lowest SES neighbourhoods ranged from 1.43 to 1.61. The mortality risk decreased but remained significant (p values <.05) after adjusting for each of the three individual measures of SES, with the exception of Mexican-American women. Furthermore, the mortality risk associated with living in the lowest SES neighbourhoods remained significant after simultaneously adjusting for all three individual measures of SES for white men (p<0.001) and white women (p<0.05). Deaths would hypothetically be reduced by about 20% for each subgroup if everyone had the same death rates as those living in the highest SES neighbourhoods (highest tertile).ConclusionsLiving in a low SES neighbourhood confers additional mortality risk beyond individual SES.

Project description:BackgroundObesity and insulin resistance (IR) are common features of polycystic ovary syndrome (PCOS). Metformin (MET) increases insulin sensitivity, but it is associated with unsatisfactory weight loss. The glucagon-like peptide-1 receptor agonist exenatide has been shown to reduce weight and IR in patients with diabetes. This study aimed to explore the therapeutic effects of exenatide once-weekly (QW) combined with MET on body weight, as well as metabolic and endocrinological parameters in overweight/obese women with PCOS.MethodsFifty overweight/obese women with PCOS diagnosed via the Rotterdam criteria were randomized to one of two treatment groups: MET (500 mg three times a day [TID]) or combination treatment (COM) (MET 500 mg TID, exenatide 2 mg QW) for 12 weeks. The primary outcomes were anthropometric changes associated with obesity, and the secondary outcomes included changes in reproductive hormone levels, glucose and lipid metabolism, and C-reactive protein.ResultsForty (80%) patients completed the study. COM therapy was superior to MET monotherapy in reducing weight (P = 0.045), body mass index (BMI) (P = 0.041), and waist circumference (P = 0.023). Patients in the COM group on an average lost 3.8 ± 2.4 kg compared with 2.1 ± 3.0 kg in the MET group. In the COM group, BMI and waist circumference decreased by 1.4 ± 0.87 kg/m2 and 4.63 ± 4.42 cm compared with 0.77 ± 1.17 kg/m2 and 1.72 ± 3.07 cm in the MET group, respectively. Moreover, levels of fasting glucose, oral glucose tolerance test (OGTT) 2-h glucose, and OGTT 2-h insulin were significantly lower with COM therapy than with MET (P < 0.050). Mild and moderate gastrointestinal reactions were the most common adverse events in both groups.ConclusionsCOM therapy was more effective than MET alone in reducing body weight, BMI, and waist circumference, and improving insulin sensitivity in overweight/obese women with PCOS, with acceptable short-term side effects.Trial registrationClinicalTrials.gov, NCT04029272. https://clinicaltrials.gov/ct2/show/NCT04029272.

Project description:BackgroundReducing disparities in men with prostate cancer (PCa) that may be caused by racial and socioeconomic differences is a major public health priority. Few reports have studied whether these disparities have changed over time.MethodsMen diagnosed with PCa from January 1, 2000 to December 31, 2015 were identified from the Massachusetts and Pennsylvania cancer registries. All-cause mortality and PCa and cardiovascular cause-specific mortality were assessed. To estimate neighborhood socioeconomic position (nSEP), a summary score was generated using census tract-level measures of income, wealth, educational attainment, and racial and income segregation. Participants were grouped by diagnosis year (2000-2003, 2004-2007, 2008-2011, or 2012-2015), and changing trends in the mortality rate ratio by race and nSEP were estimated using covariate-adjusted Cox models with follow-up for up to 10 years, until death, or until censoring on January 1, 2018.ResultsThere were 193,883 patients with PCa and 43,661 deaths over 1,404,131 person-years of follow-up. The Black-White adjusted hazard ratio (aHR) from 2000 to 2003 through 2012 to 2015 was stable for all-cause mortality (aHR, 1.14 to 0.97; P for heterogeneity = .42), decreased for PCa-specific mortality (aHR, 1.38 to 0.93; P for heterogeneity = .005), and increased for cardiovascular mortality (aHR, 1.09 to 1.28; P for heterogeneity = .034). The aHR comparing those in the lowest versus the highest nSEP quintile increased significantly for all-cause mortality (aHR, 1.54 to 1.79; P for heterogeneity = .008), but not for PCa-specific mortality (aHR, 1.60 to 1.72; P for heterogeneity = .40) or cardiovascular mortality (aHR, 1.72 to 1.89; P for heterogeneity = .085).ConclusionsAlthough Black-White disparities in prostate mortality declined in Massachusetts and Pennsylvania over the study period, nSEP mortality disparity trends were stagnant or increased, warranting further attention.Lay summaryFew reports have examined whether racial and socioeconomic disparities in prostate cancer mortality have widened or narrowed in recent years. Using data from 2 state registries (Massachusetts and Pennsylvania) with differing intensities of government-mandated health insurance, trends in racial and neighborhood socioeconomic disparities were studied among Black and White men diagnosed from 2000 to 2015. Overall, trends in racial disparities were stagnant for all-cause mortality, shrank for prostate mortality, and widened for cardiovascular mortality. Disparities associated with neighborhood socioeconomic status either were stagnant or widened across all mortality end points. In general, disparities were more pronounced in Pennsylvania than in Massachusetts.

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A risk algorithm for assessing short-term mortality for obese black and white men and women.

Publications

A risk algorithm for assessing short-term mortality for obese black and white men and women.

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