Browsing by Subject "morbidity"
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Item Open Access An Economic Assessment of Extreme Heat Events on Labor Productivity in the U.S.(2018-04-27) Parks, Devyn; Xu, MinchaoExtreme Heat Events (EHE) across the U.S. have become more common as climate change continues to progress. There have been numerous studies on the mortality effects of EHEs but relatively little has been done to study the morbidity effects, especially the economic consequences at a national level. We looked at the economic effect of heat on labor in each U.S. state. From previous studies, labor lost was found to be significant in four high risk occupational sectors: farming, construction, installation, and transportation. Looking at 3 representative years (1983, 2014, and 2016) we found that labor lost per state increased, with California, Texas and Arizona taking the majority of the losses. California was especially prevalent in the farming sector, accounting for >80% of the losses in the occupational category. For the other 3 sectors, California and Texas accounted for >40% individually, and Arizona >6%Item Open Access Association Between Comorbidities and Outcomes in Heart Failure Patients With and Without an Implantable Cardioverter-Defibrillator for Primary Prevention.(J Am Heart Assoc, 2015-08-06) Khazanie, Prateeti; Hellkamp, Anne S; Fonarow, Gregg C; Bhatt, Deepak L; Masoudi, Frederick A; Anstrom, Kevin J; Heidenreich, Paul A; Yancy, Clyde W; Curtis, Lesley H; Hernandez, Adrian F; Peterson, Eric D; Al-Khatib, Sana MBACKGROUND: Implantable cardioverter-defibrillator (ICD) therapy is associated with improved outcomes in patients with heart failure (HF), but whether this association holds among older patients with multiple comorbid illnesses and worse HF burden remains unclear. METHODS AND RESULTS: Using the National Cardiovascular Data Registry's ICD Registry and the Get With The Guidelines-Heart Failure (GWTG-HF) registry linked with Medicare claims, we examined outcomes associated with primary-prevention ICD versus no ICD among HF patients aged ≥65 years in clinical practice. We included patients with an ejection fraction ≤35% who received (ICD Registry) and who did not receive (GWTG-HF) an ICD. Compared with patients with an ICD, patients in the non-ICD group were older and more likely to be female and white. In matched cohorts, the 3-year adjusted mortality rate was lower in the ICD group versus the non-ICD group (46.7% versus 55.8%; adjusted hazard ratio [HR] 0.76; 95% CI 0.69 to 0.83). There was no associated difference in all-cause readmission (HR 0.99; 95% CI 0.92 to 1.08) but a lower risk of HF readmission (HR 0.88; 95% CI 0.80 to 0.97). When compared with no ICD, ICDs were also associated with better survival in patients with ≤3 comorbidities (HR 0.77; 95% CI 0.69 to 0.87) and >3 comorbidities (HR 0.77; 95% CI 0.64 to 0.93) and in patients with no hospitalization for HF (HR 0.75; 95% CI 0.65 to 0.86) and at least 1 prior HF hospitalization (HR 0.69; 95% CI 0.58 to 0.82). In subgroup analyses, there were no interactions between ICD and mortality risk for comorbidity burden (P=0.95) and for prior HF hospitalization (P=0.46). CONCLUSION: Among older HF patients, ICDs for primary prevention were associated with lower risk of mortality even among those with high comorbid illness burden and prior HF hospitalization.Item Open Access Catheter Ablation of Atrial Fibrillation in U.S. Community Practice--Results From Outcomes Registry for Better Informed Treatment of Atrial Fibrillation (ORBIT-AF).(J Am Heart Assoc, 2015-05-21) Holmqvist, Fredrik; Simon, DaJuanicia; Steinberg, Benjamin A; Hong, Seok Jae; Kowey, Peter R; Reiffel, James A; Naccarelli, Gerald V; Chang, Paul; Gersh, Bernard J; Peterson, Eric D; Piccini, Jonathan P; ORBIT‐AF InvestigatorsBACKGROUND: The characteristics of patients undergoing atrial fibrillation (AF) ablation and subsequent outcomes in community practice are not well described. METHODS AND RESULTS: Using the Outcomes Registry for Better Informed Treatment of Atrial Fibrillation (ORBIT-AF), we investigated the prevalence and impact of catheter ablation of AF. Among 9935 patients enrolled, 5.3% had previous AF ablation. Patients with AF ablation were significantly younger, more frequently male, and had less anemia, chronic obstructive pulmonary disease, and previous myocardial infarction (P<0.05 for all analyses) than those without previous catheter ablation of AF. Ablated patients were more likely to have a family history of AF, obstructive sleep apnea, paroxysmal AF, and moderate-to-severe symptoms (P<0.0001 for all analyses). Patients with previous ablation were more often in sinus rhythm on entry into the registry (52% vs. 32%; P<0.0001). Despite previous ablation, 46% in the ablation group were still on antiarrhythmic therapy. Oral anticoagulation was prescribed in 75% of those with previous ablation versus 76% in those without previous ablation (P=0.5). The adjusted risk of death (hazard ratio [HR], 0.78; 95% confidence interval [CI], 0.52 to 1.18; P=0.2) and cardiovascular (CV) hospitalization (HR, 1.06; 95% CI, 0.90 to 1.26; P=0.5) were similar in both groups. Patients with incident AF ablation had higher risk of subsequent CV hospitalization than matched patients without incident ablation (HR, 1.67; 95% CI, 1.24 to 2.26; P=0.0008). CONCLUSIONS: In U.S. clinical practice, a minority of patients with AF are managed with catheter ablation. Subsequent to ablation, there were no significant differences in oral anticoagulation use or outcomes, including stroke/non-central nervous system embolism/transient ischemic attack or death. CLINICAL TRIAL REGISTRATION: URL: http://www.clinicaltrials.gov. Unique identifier: NCT01165710.Item Open Access How Costly Are Smokers to Other People? Longitudinal Evidence on the Near Elderly(2001) Picone, Gabriel A; Sloan, Frank AMany studies have estimated the cost of smoking. In recent years, such estimates have been widely used in litigation against the tobacco companies. Both longitudinal and cross-sectional methods have been used. On balance, the longitudinal approach, the one used in this study, is much preferable since one can account for the effects of smoking on the pool of eligibles rather than just conditioning expenditures on being eligible. We used data from four waves of the Health and Retirement Study to assess the impact of smoking on use of hospital and physicians’ services and nursing home care. The analysis was limited to utilization among persons aged 51 to 67 (“near elderly” ). During this phase of the life cycle, many adverse effects of smoking, measured in terms of mortality and morbidity,Item Open Access The Omic Modifiers of Morbidity and Mortality in Sickle Cell Disease(2023) Lê, Brandon MinhSickle cell disease (SCD) is a human genetic disorder caused by a mutation in the hemoglobin beta gene, causing sickling of red blood cells (RBCs) under hypoxic conditions, vaso-occlusion and adherence to other cells and endothelium, and downstream cellular and organ damage, ultimately resulting in higher morbidity and mortality relative to healthy people. While SCD is a Mendelian disorder defined by mutation in a single gene, the clinical presentation of people with SCD is highly heterogeneous. Typical SCD complications like acute chest syndrome (ACS), pain crises, and strokes are common but not universal, the range of severity of these outcomes is highly variable (higher morbidity, but not in all people with SCD), and life expectancy is lower on average (United States: 54 years). While the hemoglobin beta locus has been comprehensively studied as the origin of SCD, study on the other genetic and “-omic” factors that modify the disease presentation are less understood. Investigation into these omic modifiers of SCD may provide insight into many potential therapeutic targets that can greatly increase the quality of life and lifespan of people with SCD.
To advance knowledge of omic modifiers of SCD, multiple approaches combining large-scale biological datasets with new methodologies and toolkits have been used to assess SCD progression across multiple facets. Whereas prior research on SCD modifiers has been performed on smaller datasets with limited genomic data, we have performed genome-wide analyses with whole-genome sequences across much larger cohorts of people with SCD. In addition, other omic datasets are addressed. Variability in methylation at CpG sites are utilized to provide measurements of biological aging in SCD that differs from normal, healthy biological aging.
Across these analyses, a more comprehensive assessment of the omic modifiers of morbidity and mortality in SCD is achieved. Further work will serve to validate the results of these analyses and recommend omic variants for investigation in therapeutic interventions.