Objective
To determine mortality and causes of death in a multinational inception cohort of subjects with systemic sclerosis (SSc).
Methods
We quantified mortality as standardized mortality ratio ...(SMR), years of life lost, and percentage mortality in the first decade of disease. The inception cohort comprised subjects recruited within 4 years of disease onset. For comparison, we used a prevalent cohort, which included all subjects irrespective of disease duration at recruitment. We determined a single primary cause of death (SSc related or non–SSc related) using a standardized case report form, and we evaluated predictors of mortality using multivariable Cox regression.
Results
In the inception cohort of 1,070 subjects, there were 140 deaths (13%) over a median follow‐up of 3.0 years (interquartile range 1.0–5.1 years), with a pooled SMR of 4.06 (95% confidence interval 95% CI 3.39–4.85), up to 22.4 years of life lost in women and up to 26.0 years of life lost in men, and mortality in the diffuse disease subtype of 24.2% at 8 years. In the prevalent cohort of 3,218 subjects, the pooled SMR was lower at 3.39 (95% CI 3.06–3.71). In the inception cohort, 62.1% of the primary causes of death were SSc related. Malignancy, sepsis, cerebrovascular disease, and ischemic heart disease were the most common non–SSc‐related causes of death. Predictors of early mortality included male sex, older age at disease onset, diffuse disease subtype, pulmonary arterial hypertension, and renal crisis.
Conclusion
Early mortality in SSc is substantial, and prevalent cohorts underestimate mortality in SSc by failing to capture early deaths, particularly in men and those with diffuse disease.
The impact of chronic exposure to fine particulate matter (particulate matter with an aerodynamic diameter less than or equal to 2.5 μm (PM2.5)) on respiratory disease and lung cancer mortality is ...poorly understood. In a cohort of 18.9 million Medicare beneficiaries (4.2 million deaths) living across the conterminous United States between 2000 and 2008, we examined the association between chronic PM2.5 exposure and cause-specific mortality. We evaluated confounding through adjustment for neighborhood behavioral covariates and decomposition of PM2.5 into 2 spatiotemporal scales. We found significantly positive associations of 12-month moving average PM2.5 exposures (per 10-μg/m3 increase) with respiratory, chronic obstructive pulmonary disease, and pneumonia mortality, with risk ratios ranging from 1.10 to 1.24. We also found significant PM2.5-associated elevated risks for cardiovascular and lung cancer mortality. Risk ratios generally increased with longer moving averages; for example, an elevation in 60-month moving average PM2.5 exposures was linked to 1.33 times the lung cancer mortality risk (95% confidence interval: 1.24, 1.40), as compared with 1.13 (95% confidence interval: 1.11, 1.15) for 12-month moving average exposures. Observed associations were robust in multivariable models, although evidence of unmeasured confounding remained. In this large cohort of US elderly, we provide important new evidence that long-term PM2.5 exposure is significantly related to increased mortality from respiratory disease, lung cancer, and cardiovascular disease.
Introduction and ObjectivesProgressive pleuroparenchymal fibroelastosis (PPFE) is associated with a high symptom burden and frequently co-exists with a separate interstitial lung disease. The ...prognostic impact of such combinations is unclear and the clinical and computed tomographic (CT) determinants of mortality remain poorly characterised.MethodsPatients with a diagnosis of PPFE (2004–19) were retrieved from the Royal Brompton Hospital ILD databases. CTs were evaluated for radiologic features, including: 1) the cranio-caudal extent and the severity of PPFE; 2) the hilar position (ratio of the lung apex to the ‘hilar point’ distance/lung apex to the diaphragmatic dome distance); 3) upper lobe volume loss, and 4) presence of co-existent ILD.Results139 patients (75 54% female; median age 63.5, IQR 52–71.5) were evaluated, including 51 (36.7%) with idiopathic PPFE, 41 (29.5%) with concomitant idiopathic UIP, 17 (12.2%) with hypersensitivity pneumonitis and 8 (5.8%) with autoimmunity. Histopathological information was available in 50 (36%) patients, including from 39 surgical biopsies. 51 deaths were recorded among 130 patients with longitudinal data, yielding a median survival of 3 years. The mean severity of PPFE was negatively correlated with hilar position (r = -0.38, P<0.0005). Unadjusted hazard ratio (HR) analysis for mortality showed: age (HR 1.03 95% CI: 1.01–1.05; P <0.01), DLco (HR 0.97 95% CI: 0.95–0.99; P=0.01), composite physiologic index/CPI (HR 1.04 95% CI: 1.01–1.07; P<0.005), right and left upper lobe volume loss (HR 0.97 95% CI: 0.95–0.99; P <0.01 and HR 0.95 95% CI: 0.92–0.99; P<0.005, respectively) and the average of the right and left hilar position (HR 1.08 95% CI: 1.04–1.13; P<0.0005). Although PPFE severity (P<0.001) and co-existent ILD (P<0.0005) were revealed as determinants of the hilar position (R2=0.26), multivariable adjustment confirmed that only CPI (HR, 1.04 95% CI: 1.00–1.07; P <0.05), increased age (HR, 1.03 95% CI: 1.01–1.06; P =0.01) and mean hilar position (HR, 1.06 95% CI, 1.01–1.12; P =0.02) independently predicted mortality.ConclusionsPatients with progressive PPFE have a poor outcome, with a median survival that is comparable to IPF. Identifiable and measurable changes in specific clinical, physiologic and radiologic parameters appear to characterise the adverse prognostic profile of these individuals.
Aim
To estimate the prevalence of both cardiometabolic and other co‐morbidities in patients with COVID‐19, and to estimate the increased risk of severity of disease and mortality in people with ...co‐morbidities.
Materials and Methods
Medline, Scopus and the World Health Organization website were searched for global research on COVID‐19 conducted from January 2019 up to 23 April 2020. Study inclusion was restricted to English language publications, original articles that reported the prevalence of co‐morbidities in individuals with COVID‐19, and case series including more than 10 patients. Eighteen studies were selected for inclusion. Data were analysed using random effects meta‐analysis models.
Results
Eighteen studies with a total of 14 558 individuals were identified. The pooled prevalence for co‐morbidities in patients with COVID‐19 disease was 22.9% (95% CI: 15.8 to 29.9) for hypertension, 11.5% (9.7 to 13.4) for diabetes, and 9.7% (6.8 to 12.6) for cardiovascular disease (CVD). For chronic obstructive pulmonary disease (COPD), chronic kidney disease (CKD), cerebrovascular disease and cancer, the pooled prevalences were all less than 4%. With the exception of cerebrovascular disease, all the other co‐morbidities presented a significantly increased risk for having severe COVID‐19. In addition, the risk of mortality was significantly increased in individuals with CVD, COPD, CKD, cerebrovascular disease and cancer.
Conclusions
In individuals with COVID‐19, the presence of co‐morbidities (both cardiometabolic and other) is associated with a higher risk of severe COVID‐19 and mortality. These findings have important implications for public health with regard to risk stratification and future planning.
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