Browsing by Subject "Sex Distribution"
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Item Open Access Comorbid visual and cognitive impairment: relationship with disability status and self-rated health among older Singaporeans.(Asia-Pacific journal of public health, 2014-05) Whitson, Heather E; Malhotra, Rahul; Chan, Angelique; Matchar, David B; Østbye, TrulsThe objective of this study was to examine the prevalence and consequences of coexisting vision and cognitive impairments in an Asian population. Data were collected from 4508 community-dwelling Singaporeans aged 60 years and older. Cognition was assessed by the Short Portable Mental Status Questionnaire whereas vision, disability, and self-rated health (SRH) were determined by self-report. Vision impairment was present in 902 (18.5%) participants and cognitive impairment in 835 (13.6%), with 232 (3.5%) participants experiencing both impairments. Persons with the comorbidity experienced higher odds of disability than persons with either single impairment. The association of vision impairment with SRH was stronger among women (odds ratio [OR] = 6.79, 95% confidence interval [CI] = 4.64-9.92) than among men (OR = 1.71, 95% CI = 1.21-2.41). Concurrent cognitive and vision impairment is prevalent in older Singaporeans and is associated with high rates of disability. Gender differences in vision-dependent roles may affect the patient-perceived impact of this comorbidity.Item Open Access COVID-19 mortality risk for older men and women.(BMC public health, 2020-11) Yanez, N David; Weiss, Noel S; Romand, Jacques-André; Treggiari, Miriam MBackground
Case-fatality from COVID-19 has been reported to be relatively high in patients age 65 years or older. We sought to determine the age-specific rates of COVID-19 mortality at the population level.Methods
We obtained information regarding the total number of COVID-19 reported deaths for six consecutive weeks beginning at the 50th recorded death, among 16 countries that reported a relatively high number of COVID-19 cases as of April 12, 2020. We performed an ecological study to model COVID-19 mortality rates per week by age group (54 years or younger, 55-64 years, and 65 years or older) and sex using a Poisson mixed effects regression model.Results
Over the six-week period of data, there were 178,568 COVID-19 deaths from a total population of approximately 2.4 billion people. Age and sex were associated with COVID-19 mortality. Compared with individuals ages 54 years or younger, the incident rate ratio (IRR) was 8.1, indicating that the mortality rate of COVID-19 was 8.1 times higher (95%CI = 7.7, 8.5) among those 55 to 64 years, and more than 62 times higher (IRR = 62.1; 95%CI = 59.7, 64.7) among those ages 65 or older. Mortality rates from COVID-19 were 77% higher in men than in women (IRR = 1.77, 95%CI = 1.74, 1.79).Conclusions
In the 16 countries examined, persons age 65 years or older had strikingly higher COVID-19 mortality rates compared to younger individuals, and men had a higher risk of COVID-19 death than women.Item Open Access Cross-national comparison of sex differences in health and mortality in Denmark, Japan and the US.(Eur J Epidemiol, 2010-07) Oksuzyan, Anna; Crimmins, Eileen; Saito, Yasuhiko; O'Rand, Angela; Vaupel, James W; Christensen, KaareThe present study aims to compare the direction and magnitude of sex differences in mortality and major health dimensions across Denmark, Japan and the US. The Human Mortality Database was used to examine sex differences in age-specific mortality rates. The Danish twin surveys, the Danish 1905-Cohort Study, the Health and Retirement Study, and the Nihon University Japanese Longitudinal Study of Aging were used to examine sex differences in health. Men had consistently higher mortality rates at all ages in all three countries, but they also had a substantial advantage in handgrip strength compared with the same-aged women. Sex differences in activities of daily living (ADL) became pronounced among individuals aged 85+ in all three countries. Depression levels tended to be higher in women, particularly, in Denmark and the HRS, and only small sex differences were observed in the immediate recall test and Mini-Mental State Exam. The present study revealed consistent sex differentials in survival and physical health, self-rated health and cognition at older ages, whereas the pattern of sex differences in depressive symptoms was country-specific.Item Open Access Exploring the association between melanoma and glioma risks.(Ann Epidemiol, 2014-06) Scarbrough, Peter M; Akushevich, Igor; Wrensch, Margaret; Il'yasova, DoraPURPOSE: Gliomas are one of the most fatal malignancies, with largely unknown etiology. This study examines a possible connection between glioma and melanoma, which might provide insight into gliomas' etiology. METHODS: Using data provided by the Surveillance, Epidemiology, and End Results program from 1992 to 2009, a cohort was constructed to determine the incidence rates of glioma among those who had a prior diagnosis of invasive melanoma. Glioma rates in those with prior melanoma were compared with those in the general population. RESULTS: The incidence rate of all gliomas was greater among melanoma cases than in the general population: 10.46 versus 6.13 cases per 100,000 person-years, standardized incidence ratios = 1.42 (1.22-1.62). The female excess rate was slightly greater (42%) than that among males (29%). Sensitivity analyses did not reveal evidence that radiation treatment of melanoma is responsible for the detected gap in the rates of gliomas. CONCLUSIONS: Our analysis documented increased risk of glioma among melanoma patients. Because no common environmental risk factors are identified for glioma and melanoma, it is hypothesized that a common genetic predisposition may be responsible for the detected association.Item Open Access Fractures in myelomeningocele.(J Orthop Traumatol, 2010-09) Akbar, Michael; Bresch, Bjoern; Raiss, Patric; Fürstenberg, Carl Hans; Bruckner, Thomas; Seyler, Thorsten; Carstens, Claus; Abel, RainerBACKGROUND: In patients with myelomeningocele (MMC), a high number of fractures occur in the paralyzed extremities, affecting mobility and independence. The aims of this retrospective cross-sectional study are to determine the frequency of fractures in our patient cohort and to identify trends and risk factors relevant for such fractures. MATERIALS AND METHODS: Between March 1988 and June 2005, 862 patients with MMC were treated at our hospital. The medical records, surgery reports, and X-rays from these patients were evaluated. RESULTS: During the study period, 11% of the patients (n = 92) suffered one or more fractures. Risk analysis showed that patients with MMC and thoracic-level paralysis had a sixfold higher risk of fracture compared with those with sacral-level paralysis. Femoral-neck z-scores measured by dual-energy X-ray absorptiometry (DEXA) differed significantly according to the level of neurological impairment, with lower z-scores in children with a higher level of lesion. Furthermore, the rate of epiphyseal separation increased noticeably after cast immobilization. Mainly patients who could walk relatively well were affected. CONCLUSIONS: Patients with thoracic-level paralysis represent a group with high fracture risk. According to these results, fracture and epiphyseal injury in patients with MMC should be treated by plaster immobilization. The duration of immobilization should be kept to a minimum (<4 weeks) because of increased risk of secondary fractures. Alternatively, patients with refractures can be treated by surgery, when nonoperative treatment has failed.Item Open Access Global and regional burden of cancer in 2016 arising from occupational exposure to selected carcinogens: a systematic analysis for the Global Burden of Disease Study 2016.(Occupational and environmental medicine, 2020-03) GBD 2016 Occupational Carcinogens CollaboratorsObjectives
This study provides a detailed analysis of the global and regional burden of cancer due to occupational carcinogens from the Global Burden of Disease 2016 study.Methods
The burden of cancer due to 14 International Agency for Research on Cancer Group 1 occupational carcinogens was estimated using the population attributable fraction, based on past population exposure prevalence and relative risks from the literature. The results were used to calculate attributable deaths and disability-adjusted life years (DALYs).Results
There were an estimated 349 000 (95% Uncertainty Interval 269 000 to 427 000) deaths and 7.2 (5.8 to 8.6) million DALYs in 2016 due to exposure to the included occupational carcinogens-3.9% (3.2% to 4.6%) of all cancer deaths and 3.4% (2.7% to 4.0%) of all cancer DALYs; 79% of deaths were of males and 88% were of people aged 55 -79 years. Lung cancer accounted for 86% of the deaths, mesothelioma for 7.9% and laryngeal cancer for 2.1%. Asbestos was responsible for the largest number of deaths due to occupational carcinogens (63%); other important risk factors were secondhand smoke (14%), silica (14%) and diesel engine exhaust (5%). The highest mortality rates were in high-income regions, largely due to asbestos-related cancers, whereas in other regions cancer deaths from secondhand smoke, silica and diesel engine exhaust were more prominent. From 1990 to 2016, there was a decrease in the rate for deaths (-10%) and DALYs (-15%) due to exposure to occupational carcinogens.Conclusions
Work-related carcinogens are responsible for considerable disease burden worldwide. The results provide guidance for prevention and control initiatives.Item Open Access Global and regional burden of disease and injury in 2016 arising from occupational exposures: a systematic analysis for the Global Burden of Disease Study 2016.(Occupational and environmental medicine, 2020-03) GBD 2016 Occupational Risk Factors CollaboratorsOBJECTIVES:This study provides an overview of the influence of occupational risk factors on the global burden of disease as estimated by the occupational component of the Global Burden of Disease (GBD) 2016 study. METHODS:The GBD 2016 study estimated the burden in terms of deaths and disability-adjusted life years (DALYs) arising from the effects of occupational risk factors (carcinogens; asthmagens; particulate matter, gases and fumes (PMGF); secondhand smoke (SHS); noise; ergonomic risk factors for low back pain; risk factors for injury). A population attributable fraction (PAF) approach was used for most risk factors. RESULTS:In 2016, globally, an estimated 1.53 (95% uncertainty interval 1.39-1.68) million deaths and 76.1 (66.3-86.3) million DALYs were attributable to the included occupational risk factors, accounting for 2.8% of deaths and 3.2% of DALYs from all causes. Most deaths were attributable to PMGF, carcinogens (particularly asbestos), injury risk factors and SHS. Most DALYs were attributable to injury risk factors and ergonomic exposures. Men and persons 55 years or older were most affected. PAFs ranged from 26.8% for low back pain from ergonomic risk factors and 19.6% for hearing loss from noise to 3.4% for carcinogens. DALYs per capita were highest in Oceania, Southeast Asia and Central sub-Saharan Africa. On a per capita basis, between 1990 and 2016 there was an overall decrease of about 31% in deaths and 25% in DALYs. CONCLUSIONS:Occupational exposures continue to cause an important health burden worldwide, justifying the need for ongoing prevention and control initiatives.Item Open Access Heterogeneity of stimulant dependence: a national drug abuse treatment clinical trials network study.(The American journal on addictions, 2009-05) Wu, Li-Tzy; Blazer, Dan G; Patkar, Ashwin A; Stitzer, Maxine L; Wakim, Paul G; Brooner, Robert KWe investigated the presence of DSM-IV subtyping for dependence on cocaine and amphetamines (with versus without physical dependence) among outpatient stimulant users enrolled in a multisite study of the Clinical Trials Network (CTN). Three mutually exclusive groups were identified: primary cocaine users (n = 287), primary amphetamine users (n = 99), and dual users (cocaine and amphetamines; n = 29). Distinct subtypes were examined with latent class and logistic regression procedures. Cocaine users were distinct from amphetamine users in age and race/ethnicity. There were four distinct classes of primary cocaine users: non-dependence (15%), compulsive use (14%), tolerance and compulsive use (15%), and physiological dependence (tolerance, withdrawal, and compulsive use; 56%). Three distinct classes of primary amphetamine users were identified: non-dependence (11%), intermediate physiological dependence (31%), and physiological dependence (58%). Regardless of stimulants used, most female users were in the most severe or the physiological dependence group. These results lend support for subtyping dependence in the emerging DSM-V.Item Open Access Inhalant use and disorders among adults in the United States.(Drug and alcohol dependence, 2006-10) Wu, Li-Tzy; Ringwalt, Christopher LTo examine the patterns of adult inhalant use and correlates of inhalant use disorder.We drew study data from the 2002 and 2003 National Surveys on Drug Use and Health (NSDUH). We used logistic regression to identify the characteristics associated both with inhalant use and inhalant use disorder.One in 10 of all adults had used an inhalant at least once in their lives, and 0.5% used one in the past year. Among all past year inhalant users, 8% met the criteria for an inhalant use disorder (i.e., 6.6% for abuse and 1.1% for dependence) within that period. We found an increased prevalence of past year inhalant use among young adults aged 18-25 years, Asians, past year alcohol abusers and dependents, lifetime drug users, white women, and men reporting symptoms of serious mental illness. Inhalant-using adults who met the criteria for an inhalant use disorder were predominantly adults aged 35-49 years and were less educated, had received recent professional treatment for emotional or psychological problems, used inhalants weekly, and had a coexisting alcohol use disorder.The patterns and consequences of adult inhalant use differ from those of adolescents. Compared with adolescent inhalant users, adult users tend not to initiate inhalant use until adulthood, use inhalants less frequently, use fewer inhalants, and are less likely to engage in criminal activities.Item Open Access Non-prescribed use of pain relievers among adolescents in the United States.(Drug and alcohol dependence, 2008-04) Wu, Li-Tzy; Pilowsky, Daniel J; Patkar, Ashwin AWe examined gender-specific prevalences, patterns, and correlates of non-prescribed use of pain relievers - mainly opioids - in a representative sample of American adolescents (N=18,678).Data were drawn from the public use data file of the 2005 U.S. National Survey on Drug Use and Health, a survey of non-institutionalized American household residents. The patterns of non-prescribed use of prescription pain relievers were examined, and logistic regression procedures were conducted to identify correlates of non-prescribed use.Approximately one in 10 adolescents aged 12-17 years reported non-prescribed use of pain relievers in their lifetime (9.3% in males and 10.3% in females). The mean age of first non-prescribed use was 13.3 years, which was similar to the mean age of first use of alcohol and marijuana but older than the age of first inhalant use. Among all non-prescribed users, 52% reported having used hydrocodone products (Vicodin, Lortab, Lorcet, and Lorcet Plus, and hydrocodone), 50% had used propoxyphene (Darvocet or Darvon) or codeine (Tylenol with codeine), and 24% had used oxycodone products (OxyContin, Percocet, Percodan, and Tylox). Approximately one quarter (26%) of all non-prescribed users had never used other non-prescribed or illicit drugs. There were gender variations in correlates of non-prescribed use.Use of non-prescribed pain relievers occurs early in adolescence. Research is needed to understand whether early use of non-prescribed pain relievers is related to later drug use.Item Open Access Nonmedical Opioid Pain Relievers and All-Cause Mortality: A 27-Year Follow-Up From the Epidemiologic Catchment Area Study.(American journal of public health, 2016-03) Cottler, Linda B; Hu, Hui; Smallwood, Bryan A; Anthony, James C; Wu, Li-Tzy; Eaton, William WWe investigated whether nonmedical opioid pain reliever use is associated with higher mortality in the general US population.We assessed the history of nonmedical opioid pain reliever use among 9985 people interviewed at baseline of the Epidemiologic Catchment Area Program initiated in 1981 to 1983 in Baltimore, Maryland; St. Louis, Missouri; and Durham, North Carolina. We linked the data with the National Death Index through 2007.Nonmedical opioid pain reliever use was 1.4%. Compared with no nonmedical drug use, mortality was increased for nonmedical opioid pain reliever use (hazard ratio [HR] = 1.60; 95% confidence interval [CI] = 1.01, 2.53) or nonmedical use of other drugs (HR = 1.31; 95% CI = 1.07, 1.62). Mortality was also higher for males and for those beginning nonmedical opioid pain reliever use before aged 15 years.A history of nonmedical opioid pain reliever use was associated with increased mortality, in particular for males and early onset users.Item Open Access Sex differences in health and mortality in Moscow and Denmark.(Eur J Epidemiol, 2014-04) Oksuzyan, A; Shkolnikova, M; Vaupel, JW; Christensen, K; Shkolnikov, VMIn high income countries females outlive men, although they generally report worse health, the so-called male-female health-survival paradox. Russia has one of the world's largest sex difference in life expectancy with a male disadvantage of more than 10 years. We compare components of the paradox between Denmark and Moscow by examining sex differences in mortality and several health measures. The Human Mortality Database and the Russian Fertility and Mortality Database were used to examine sex differences in all-cause death rates in Denmark, Russia, and Moscow in 2007-2008. Self-reported health data were obtained from the Study of Middle-Aged Danish Twins (n = 4,314), the Longitudinal Study of Aging Danish Twins (n = 4,731), and the study of Stress, Aging, and Health in Russia (n = 1,800). In both Moscow and Denmark there was a consistent female advantage at ages 55-89 years in survival and a male advantage in self-rated health, physical functioning, and depression symptomatology. Only on cognitive tests males performed similarly to or worse than women. Nevertheless, Muscovite males had more than twice higher mortality at ages 55-69 years compared to Muscovite women, almost double the ratio in Denmark. The present study showed that despite similar directions of sex differences in health and mortality in Moscow and Denmark, the male-female health-survival paradox is very pronounced in Moscow suggesting a stronger sex-specific disconnect between health indicators and mortality among middle-aged and young-old Muscovites.Item Open Access Time trends of incidence of age-associated diseases in the US elderly population: Medicare-based analysis.(Age Ageing, 2013-07) Akushevich, Igor; Kravchenko, Julia; Ukraintseva, Svetlana; Arbeev, Konstantin; Yashin, Anatoly IOBJECTIVES: time trends of age-adjusted incidence rates of 19 ageing-related diseases were evaluated for 1992-2005 period with the National Long Term Care Survey and the Surveillance, Epidemiology and End RESULTS Registry data both linked to Medicare data (NLTCS-Medicare and SEER-Medicare, respectively). METHODS: the rates were calculated using individual medical histories (34,077 individuals from NLTCS-Medicare and 199,418 from SEER-Medicare) reconstructed using information on diagnoses coded in Medicare data, dates of medical services/procedures and Medicare enrolment/disenrolment. RESULTS: increases of incidence rates were dramatic for renal disease [the average annual percent change (APC) is 8.56%, 95% CI = 7.62, 9.50%], goiter (APC = 6.67%, 95% CI = 5, 90, 7, 44%), melanoma (APC = 6.15%, 95% CI = 4.31, 8.02%) and Alzheimer's disease (APC = 3.96%, 95% CI = 2.67, 5.26%), and less prominent for diabetes and lung cancer. Decreases of incidence rates were remarkable for angina pectoris (APC = -6.17%, 95% CI = -6.96, -5.38%); chronic obstructive pulmonary disease (APC = -5.14%, 95% CI = -6.78,-3.47%), and ulcer (APC = -5.82%, 95% CI = -6.77,-4.86%) and less dramatic for carcinomas of colon and prostate, stroke, hip fracture and asthma. Incidence rates of female breast carcinoma, myocardial infarction, Parkinson's disease and rheumatoid arthritis were almost stable. For most diseases, an excellent agreement was observed for incidence rates between NLTCS-Medicare and SEER-Medicare. A sensitivity analysis proved the stability of the evaluated time trends. CONCLUSION: time trends of the incidence of diseases common in the US elderly population were evaluated. The results show dramatic increase in incidence rates of melanoma, goiter, chronic renal and Alzheimer's disease in 1992-2005. Besides specifying widely recognised time trends on age-associated diseases, new information was obtained for trends of asthma, ulcer and goiter among the older adults in the USA.Item Open Access Using electronic health records data to assess comorbidities of substance use and psychiatric diagnoses and treatment settings among adults.(Journal of psychiatric research, 2013-04) Wu, Li-Tzy; Gersing, Kenneth R; Swartz, Marvin S; Burchett, Bruce; Li, Ting-Kai; Blazer, Dan GTo examine prevalences of substance use disorders (SUD) and comprehensive patterns of comorbidities among psychiatric patients ages 18-64 years (N = 40,099) in an electronic health records (EHR) database.DSM-IV diagnoses among psychiatric patients in a large university system were systematically captured: SUD, anxiety (AD), mood (MD), personality (PD), adjustment, childhood-onset, cognitive/dementia, dissociative, eating, factitious, impulse-control, psychotic (schizophrenic), sexual/gender identity, sleep, and somatoform diagnoses. Comorbidities and treatment types among patients with a SUD were examined.Among all patients, 24.9% (n = 9984) had a SUD, with blacks (35.2%) and Hispanics (32.9%) showing the highest prevalence. Among patients with a SUD, MD was prevalent across all age groups (50.2-56.6%). Patients aged 18-24 years had elevated odds of comorbid PD, adjustment, childhood-onset, impulse-control, psychotic, and eating diagnoses. Females had more PD, AD, MD, eating, and somatoform diagnoses, while males had more childhood-onset, impulse-control, and psychotic diagnoses. Blacks had greater odds than whites of psychotic and cognitive/dementia diagnoses, while whites exhibited elevated odds of PA, AD, MD, childhood-onset, eating, somatoform, and sleep diagnoses. Women, blacks, and Native American/multiple-race adults had elevated odds of using inpatient treatment; men, blacks, and Hispanics had increased odds of using psychiatric emergency care. Comorbid MD, PD, adjustment, somatoform, psychotic, or cognitive/dementia diagnoses increased inpatient treatment.Patients with a SUD, especially minority members, use more inpatient or psychiatric emergency care than those without. Findings provide evidence for research on understudied diagnoses and underserved populations in the real-world clinical settings.