We aimed to analyze baseline socio-demographic and clinical factors associated with an increased likelihood of mortality in men and women with coronavirus disease (COVID-19). We conducted a ...retrospective cohort study (PRECOVID Study) on all 4412 individuals with laboratory-confirmed COVID-19 in Aragon, Spain, and followed them for at least 30 days from cohort entry. We described the socio-demographic and clinical characteristics of all patients of the cohort. Age-adjusted logistic regressions models were performed to analyze the likelihood of mortality based on demographic and clinical variables. All analyses were stratified by sex. Old age, specific diseases such as diabetes, acute myocardial infarction, or congestive heart failure, and dispensation of drugs like vasodilators, antipsychotics, and potassium-sparing agents were associated with an increased likelihood of mortality. Our findings suggest that specific comorbidities, mainly of cardiovascular nature, and medications at the time of infection could explain around one quarter of the mortality in COVID-19 disease, and that women and men probably share similar but not identical risk factors. Nonetheless, the great part of mortality seems to be explained by other patient- and/or health-system-related factors. More research is needed in this field to provide the necessary evidence for the development of early identification strategies for patients at higher risk of adverse outcomes.
Background Clinical outcomes among COVID-19 patients vary greatly with age and underlying comorbidities. We aimed to determine the demographic and clinical factors, particularly baseline chronic ...conditions, associated with an increased risk of severity in COVID-19 patients from a population-based perspective and using data from electronic health records (EHR). Methods Retrospective, observational study in an open cohort analyzing all 68,913 individuals (mean age 44.4 years, 53.2% women) with SARS-CoV-2 infection between 15 June and 19 December 2020 using exhaustive electronic health registries. Patients were followed for 30 days from inclusion or until the date of death within that period. We performed multivariate logistic regression to analyze the association between each chronic disease and severe infection, based on hospitalization and all-cause mortality. Results 5885 (8.5%) individuals showed severe infection and old age was the most influencing factor. Congestive heart failure (odds ratio -OR- men: 1.28, OR women: 1.39), diabetes (1.37, 1.24), chronic renal failure (1.31, 1.22) and obesity (1.21, 1.26) increased the likelihood of severe infection in both sexes. Chronic skin ulcers (1.32), acute cerebrovascular disease (1.34), chronic obstructive pulmonary disease (1.21), urinary incontinence (1.17) and neoplasms (1.26) in men, and infertility (1.87), obstructive sleep apnea (1.43), hepatic steatosis (1.43), rheumatoid arthritis (1.39) and menstrual disorders (1.18) in women were also associated with more severe outcomes. Conclusions Age and specific cardiovascular and metabolic diseases increased the risk of severe SARS-CoV-2 infections in men and women, whereas the effects of certain comorbidities are sex specific. Future studies in different settings are encouraged to analyze which profiles of chronic patients are at higher risk of poor prognosis and should therefore be the targets of prevention and shielding strategies.
Abstract
One of the most robust signals of climate change is the relentless rise in global mean surface temperature, which is linked closely with the water-holding capacity of the atmosphere. A more ...humid atmosphere will lead to enhanced moisture transport due to, among other factors, an intensification of atmospheric rivers (ARs) activity, which are an important mechanism of moisture advection from subtropical to extra-tropical regions. Here we show an enhanced evapotranspiration rates in association with landfalling atmospheric river events. These anomalous moisture uptake (AMU) locations are identified on a global scale. The interannual variability of AMU displays a significant increase over the period 1980-2017, close to the Clausius-Clapeyron (CC) scaling, at 7 % per degree of surface temperature rise. These findings are consistent with an intensification of AR predicted by future projections. Our results also reveal generalized significant increases in AMU at the regional scale and an asymmetric supply of oceanic moisture, in which the maximum values are located over the region known as the Western Hemisphere Warm Pool (WHWP) centred on the Gulf of Mexico and the Caribbean Sea.
The most important sources of atmospheric moisture at the global scale are herein identified, both oceanic and terrestrial, and a characterization is made of how continental regions are influenced by ...water from different moisture source regions. The methods used to establish source‐sink relationships of atmospheric water vapor are reviewed, and the advantages and caveats associated with each technique are discussed. The methods described include analytical and box models, numerical water vapor tracers, and physical water vapor tracers (isotopes). In particular, consideration is given to the wide range of recently developed Lagrangian techniques suitable both for evaluating the origin of water that falls during extreme precipitation events and for establishing climatologies of moisture source‐sink relationships. As far as oceanic sources are concerned, the important role of the subtropical northern Atlantic Ocean provides moisture for precipitation to the largest continental area, extending from Mexico to parts of Eurasia, and even to the South American continent during the Northern Hemisphere winter. In contrast, the influence of the southern Indian Ocean and North Pacific Ocean sources extends only over smaller continental areas. The South Pacific and the Indian Ocean represent the principal source of moisture for both Australia and Indonesia. Some landmasses only receive moisture from the evaporation that occurs in the same hemisphere (e.g., northern Europe and eastern North America), while others receive moisture from both hemispheres with large seasonal variations (e.g., northern South America). The monsoonal regimes in India, tropical Africa, and North America are provided with moisture from a large number of regions, highlighting the complexities of the global patterns of precipitation. Some very important contributions are also seen from relatively small areas of ocean, such as the Mediterranean Basin (important for Europe and North Africa) and the Red Sea, which provides water for a large area between the Gulf of Guinea and Indochina (summer) and between the African Great Lakes and Asia (winter). The geographical regions of Eurasia, North and South America, and Africa, and also the internationally important basins of the Mississippi, Amazon, Congo, and Yangtze Rivers, are also considered, as is the importance of terrestrial sources in monsoonal regimes. The role of atmospheric rivers, and particularly their relationship with extreme events, is discussed. Droughts can be caused by the reduced supply of water vapor from oceanic moisture source regions. Some of the implications of climate change for the hydrological cycle are also reviewed, including changes in water vapor concentrations, precipitation, soil moisture, and aridity. It is important to achieve a combined diagnosis of moisture sources using all available information, including stable water isotope measurements. A summary is given of the major research questions that remain unanswered, including (1) the lack of a full understanding of how moisture sources influence precipitation isotopes; (2) the stationarity of moisture sources over long periods; (3) the way in which possible changes in intensity (where evaporation exceeds precipitation to a greater of lesser degree), and the locations of the sources, (could) affect the distribution of continental precipitation in a changing climate; and (4) the role played by the main modes of climate variability, such as the North Atlantic Oscillation or the El Niño–Southern Oscillation, in the variability of the moisture source regions, as well as a full evaluation of the moisture transported by low‐level jets and atmospheric rivers.
Key Points
Review of the most important sources of atmospheric moisture at the global scale
Review the methods to establish source‐sink relationships of atmospheric vapor
Discussion of the role of climate change in changes in the moisture transport
Type 2 diabetes mellitus (T2D) is often accompanied by chronic diseases, including mental health problems. We aimed at studying mental health comorbidity prevalence in T2D patients and its ...association with T2D outcomes through a retrospective, observational study of individuals of the EpiChron Cohort (Aragón, Spain) with prevalent T2D in 2011 (n = 63,365). Participants were categorized as having or not mental health comorbidity (i.e., depression, anxiety, schizophrenia, and/or substance use disorder). We performed logistic regression models, controlled for age, sex and comorbidities, to analyse the likelihood of 4-year mortality, 1-year all-cause hospitalization, T2D-hospitalization, and emergency room visit. Mental health comorbidity was observed in 19% of patients. Depression was the most frequent condition, especially in women (20.7% vs. 7.57%). Mortality risk was higher in patients with mental health comorbidity (odds ratio 1.24; 95% confidence interval 1.16-1.31), especially in those with substance use disorder (2.18; 1.84-2.57) and schizophrenia (1.82; 1.50-2.21). Mental health comorbidity also increased the likelihood of all-cause hospitalization (1.16; 1.10-1.23), T2D-hospitalization (1.51; 1.18-1.93) and emergency room visit (1.26; 1.21-1.32). These results suggest that T2D healthcare management should include specific strategies for the early detection and treatment of mental health problems to reduce its impact on health outcomes.
The correct management of patients with multimorbidity remains one of the main challenges for healthcare systems worldwide. In this study, we analyze the existence of multimorbidity patterns in the ...general population based on gender and age. We conducted a cross-sectional study of individuals of all ages from the EpiChron Cohort, Spain (1,253,292 subjects), and analyzed the presence of systematic associations among chronic disease diagnoses using exploratory factor analysis. We identified and clinically described a total of 14 different multimorbidity patterns (12 in women and 12 in men), with some relevant differences in the functions of age and gender. The number and complexity of the patterns was shown to increase with age in both genders. We identified associations of circulatory diseases with respiratory disorders, chronic musculoskeletal diseases with depression and anxiety, and a very consistent pattern of conditions whose co-occurrence is known as metabolic syndrome (hypertension, diabetes, obesity, and dyslipidaemia), among others. Our results demonstrate the potential of using real-world data to conduct large-scale epidemiological studies to assess the complex interactions among chronic conditions. This could be useful in designing clinical interventions for patients with multimorbidity, as well as recommendations for healthcare professionals on how to handle these types of patients in clinical practice.
Aging is an important risk factor for most chronic diseases. Patients with COPD develop more comorbidities than non-COPD subjects. We hypothesized that the development of comorbidities ...characteristically affecting the elderly occur at an earlier age in subjects with the diagnosis of COPD.
We included all subjects carrying the diagnosis of COPD (n = 27,617), and a similar number of age and sex matched individuals without the diagnosis, extracted from the 727,241 records of individuals 40 years and older included in the EpiChron Cohort (Aragon, Spain). We compared the cumulative number of comorbidities, their prevalence and the mortality risk between both groups. Using network analysis, we explored the connectivity between comorbidities and the most influential comorbidities in both groups. We divided the groups into 5 incremental age categories and compared their comorbidity networks. We then selected those comorbidities known to affect primarily the elderly and compared their prevalence across the 5 age groups. In addition, we replicated the analysis in the smokers' subgroup to correct for the confounding effect of cigarette smoking. Subjects with COPD had more comorbidities and died at a younger age compared to controls. Comparison of both cohorts across 5 incremental age groups showed that the number of comorbidities, the prevalence of diseases characteristic of aging and network's density for the COPD group aged 56-65 were similar to those of non-COPD 15 to 20 years older. The findings persisted after adjusting for smoking.
Multimorbidity increases with age but in patients carrying the diagnosis of COPD, these comorbidities are seen at an earlier age.
This study provides a global analysis of the relationship between drought metrics obtained from several climatic, hydrologic and ecological variables in a climate change framework using CMIP6 model ...data. A comprehensive analysis of the evolution of drought severity on a global scale is carried out for the historical experiment (1850–2014) and for future simulations under a high emissions scenario (SSP5‐8.5). This study focuses on comparing trends in the magnitude and duration of drought events according to different standardized indices over the world land‐surface area. The spatial and temporal relationship between the different drought indices on a global scale was also evaluated. Overall, there is a fairly large consensus among models and drought metrics in pointing to drought increase in southern North America, Central America, the Amazon region, the Mediterranean, southern Africa and southern Australia. Our results show important spatial differences in drought projections, which are highly dependent on the drought metric employed. While a strong relationship between climatic indices was evident, climatic and ecological drought metrics showed less dependency over both space and time. Importantly, our study demonstrates uncertainties in future projections of drought trends and their interannual variability related to the relationship among indices, stressing the importance of coherent climatic, hydrological and plant physiological patterns when analyzing CMIP6 model simulations of droughts under a warming climate scenario.
Plain Language Summary
Using climate change models, we perform a drought analysis in terms of climatic, hydrologic and ecological variables on a global scale, studying the projections under a high emission scenario. We analyze how drought events will evolve in the future with respect to their magnitude and duration, and if the different drought metrics agree in space and time. In general, models and metrics agree that there will be drought increase in southern North America, Central America, the Amazon region, the Mediterranean, southern Africa and southern Australia. However, results differ across the world and really depend on the metric used. We show that climatic indices are strongly connected with each other, but no so related to ecological ones. We also find that there are uncertainties in future projections of drought trends, highlighting that we should always take into account the spatial and temporal agreement between climatic, hydrological and plant physiological patterns when studying drought projections.
Key Points
Important differences in drought projections as a function of drought metrics
The temporal relationship between the precipitation‐based climatic metrics is high worldwide
A weak relationship is found between climatic and ecological drought indices
The consequences of multimorbidity include polypharmacy and repeated referrals for specialised care, which may increase the risk of adverse drug events (ADEs).
The objective of this study was to ...analyse the influence of multimorbidity, polypharmacy, and multiple referrals on the frequency of ADEs, as an indicator of therapeutic safety, in the context of a national healthcare system.
This was a multicentre, retrospective, observational study of 79 089 adult patients treated during 2008 in primary care centres.
The explanatory patient variables sex, age, level of multimorbidity, polypharmacy, number of primary care physician visits, and number of different specialties attended were analysed. The response variable was the occurrence of ADEs. Logistic regression models were used to identify associations among the analysed variables.
The prevalence of individuals with at least one ADE was 0.88%. Multivariate analysis identified the following variables as risk factors for the occurrence of ADE in descending order of effect size: multimorbidity level (odds ratio ORVeryhigh/Low = 45.26; ORHigh/Low = 17.58; ORModerate/Low = 4.25), polypharmacy (OR = 1.34), female sex (OR = 1.31), number of different specialties (OR = 1.20), and number of primary care physician visits (OR = 1.01). Age, however, did not show statistical significance (OR = 1.00; 95% confidence interval = 0.996 to 1.005).
The results of this study demonstrate that multimorbidity is strongly related to the occurrence of ADEs, insofar as it requires the intervention of multiple specialties and the prescription of multiple medications. Further research should shed light on the causal pathway between multimorbidity and increased risk of adverse events.
Chronic obstructive airway diseases such as chronic obstructive pulmonary disease (COPD), asthma, rhinitis, and obstructive sleep apnea (OSA) are amongst the most common treatable and preventable ...chronic conditions with high morbidity burden and mortality risk. We aimed to explore the existence of multimorbidity clusters in patients with such diseases and to estimate their prevalence and impact on mortality. We conducted an observational retrospective study in the EpiChron Cohort (Aragon, Spain), selecting all patients with a diagnosis of allergic rhinitis, asthma, COPD, and/or OSA. The study population was stratified by age (i.e., 15-44, 45-64, and ≥ 65 years) and gender. We performed cluster analysis, including all chronic conditions recorded in primary care electronic health records and hospital discharge reports. More than 75% of the patients had multimorbidity (co-existence of two or more chronic conditions). We identified associations of dermatologic diseases with musculoskeletal disorders and anxiety, cardiometabolic diseases with mental health problems, and substance use disorders with neurologic diseases and neoplasms, amongst others. The number and complexity of the multimorbidity clusters increased with age in both genders. The cluster with the highest likelihood of mortality was identified in men aged 45 to 64 years and included associations between substance use disorder, neurologic conditions, and cancer. Large-scale epidemiological studies like ours could be useful when planning healthcare interventions targeting patients with chronic obstructive airway diseases and multimorbidity.
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