Biomedical subjects

C S Crowson

Publications and source records attributed to C S Crowson.

At least 19 recordsLinked to original sources

PubMed2006

Immunophenotyping of chimeric cells in localized scleroderma.

OBJECTIVE: Localized scleroderma causes thickening of the skin due to excessive collagen deposition. This condition has clinical and histopathological similarities to chronic graft-vs-host disease. We wanted to identify whether chimeric cells are present in the affected tissue in localized scleroderma and to further investigate the role of chimerism by immunophenotyping the chimeric cells. We hypothesize that the presence of chimerism and immunotypic chimeric cells will lend to an understanding of the pathogenesis of localized scleroderma and possible mechanisms by which chimeric cells participate in autoimmunity. METHODS: We studied skin biopsies from 18 localized scleroderma patients and compared them with concurrent biopsies from unaffected skin in a subset of patients. Skin biopsies from morphoea and linear scleroderma patients were analysed for the presence of chimeric cells using male-female (X, Y) differences. Cell surface markers (CD4, CD8, CD19/20, CD68, S100, CD14 and CD56) were determined for cell phenotyping of chimeric cells. RESULTS: Overall, the affected tissue contained a greater number of lymphocytic inflammatory cells. In the affected tissue, 38% of the total chimeric cells were CD68+ (dendritic cell, monocyte and macrophage marker), 29% Langerin/S100+ (dendritic cell marker), 26% CD8+ (cytotoxic T-lymphocyte marker), 20% CD19/20+ (B-lymphocyte marker), 14% CD4+ (T-helper lymphocyte) and 0% CD56+ (natural killer cell marker). CONCLUSIONS: We report that not only are chimeric cells present in affected localized scleroderma lesions but they also are more likely to be dendritic cells and B lymphocytes suggesting a role in the pathogenesis of localized scleroderma.

Adolescent↗

PubMed2006

Raised erythrocyte sedimentation rate signals heart failure in patients with rheumatoid arthritis.

BACKGROUND: Inflammatory markers are associated with heart failure. Patients with rheumatoid arthritis have twice the risk of heart failure compared with people without rheumatoid arthritis. OBJECTIVE: To assess whether heart failure in patients with rheumatoid arthritis is preceded by an inflammatory activation as shown by erythrocyte sedimentation rate (ESR), a systemic marker of inflammation. METHODS: A population-based inception cohort of 575 patients with rheumatoid arthritis, free of heart failure at their rheumatoid arthritis incidence date, was followed up longitudinally until death or 2001. During 15 years of follow-up, they had a median of 15 ESR tests, and 172 patients had new-onset heart failure (Framingham Heart Study criteria). The follow-up period, beginning with the rheumatoid arthritis incidence date and ending with date of the last follow-up, was divided into 6-month intervals. The proportions of patients with at least one ESR value >/=40 mm/h and with anaemia (haemoglobin <11 g/dl) within each 6-month interval were plotted against time from fulfilment of heart failure criteria. A binomial test was used to compare proportions. RESULTS: In patients with rheumatoid arthritis who developed heart failure, the proportion with ESR >/=40 mm/h was highest (23%) during the 6-month period immediately preceding the new-onset heart failure, as compared with the average ESR during the entire remaining follow-up period, both before and after heart failure (10.6%; p<0.01). The proportion of patients with anaemia peaked (54%) during the 6-month period after heart failure. CONCLUSIONS: Inflammatory stimuli may be involved in the initiation of heart failure among patients with rheumatoid arthritis.

Acute-Phase Reaction↗

PubMed2003

Cost-equivalence of different osteoporotic fractures.

METHODS: Among 985 Olmsted County, Minnesota, residents who experienced an osteoporotic fracture (distal forearm, humerus, clavicle/scapula/sternum, ribs, vertebrae, pelvis, hip, other femur or tibia/fibula [the latter in women only]), we estimated the incremental cost of direct medical care in the following year compared with age- and sex-matched controls without a fracture randomly sampled from the same community. RESULTS: The overall median incremental (case minus control) cost in the succeeding year was $2,390, with a particularly high incremental cost for hip fractures ($11,241). There was fair concordance between the incremental cost of the different fractures, relative to hip fracture alone, and the previously published disutility associated with each fracture type relative to hip fracture. Overall, the incremental cost for all osteoporotic fractures combined was 46% greater than that for hip fractures alone in women and 47% greater in men. This is consistent with the earlier report that overall morbidity from all osteoporotic fractures combined is 47% and 39% greater in women and men, respectively, than the morbidity attributable solely to hip fractures. CONCLUSION: These data lend support to the notion that other osteoporotic fractures can be quantified relative to hip fracture on the basis of their cost, as well as their morbidity and mortality. This may simplify health economic analyses by allowing all fracture outcomes to be modeled relative to hip fractures (i.e., hip fracture 'equivalents') and will provide a more comprehensive assessment of osteoporosis outcomes than is possible by focusing only on hip fractures.

Aged↗

PubMed2003

Extra-articular disease manifestations in rheumatoid arthritis: incidence trends and risk factors over 46 years.

OBJECTIVE: To investigate the trends in incidence of extra-articular rheumatoid arthritis (ExRA) in a well defined community based cohort of patients with rheumatoid arthritis (RA), and to examine possible predictors of ExRA occurrence. METHODS: Using the resources of the Rochester Epidemiology Project, a retrospective medical record review was conducted of a cohort of 609 cases of RA in Olmsted County, MN, diagnosed during 1955-94. These cases had been previously classified using the ACR 1987 criteria for RA. Patients were followed up from 1955 to 2000 (median follow up 11.8 years; range 0.1-42.8), and incident ExRA manifestations were recorded according to predefined criteria. Time to first presentation of ExRA was compared in patients with RA by decade of diagnosis. Possible ExRA risk factors were identified in case record reviews. RESULTS: ExRA occurred in 247 patients (40.6%). A subgroup of 78 patients (12.8%) had ExRA manifestations considered to be severe in a previous study from Malmö, Sweden. The incidence of severe ExRA did not change significantly over the decades (p=0.165). In a multivariate analysis the main predictors of severe ExRA were smoking at RA diagnosis (risk ratio (RR)=2.94; 95% confidence interval (95% CI) 1.68 to 5.13) and early disability (Steinbrocker class III-IV at diagnosis) (RR=2.45; 95% CI 1.51 to 4.00). The effect of smoking overwhelmed the weaker effect of rheumatoid factor seropositivity. CONCLUSION: There was no decrease in the incidence of extra-articular manifestations in patients with RA diagnosed up to 1995. Smoking and early disability are independent risk factors for extra-articular RA.

Adult↗

PubMed2002

Direct medical costs attributable to osteoporotic fractures.

Osteoporotic fractures are a major cause of morbidity in the elderly, the most rapidly growing segment of our population. We characterized the incremental direct medical costs following such fractures in a population-based cohort of men and women in Olmsted County, Minnesota. Cases included all County residents 50 years of age and older with an incident fracture due to minimal or moderate trauma between January 1, 1989 and January 1, 1992. For each case, a control of the same age (+/- 1 year) and sex who was attended in the local medical system in the same year was identified. Total incremental costs (cases - controls) in the year after fracture were estimated. Unit costs for each health service/procedure were obtained through the Mayo Cost Data Warehouse, which provides a standardized, inflation-adjusted estimate reflecting the national average cost of providing the service. Regression analysis was used to identify factors associated with incremental costs. There were 1263 case/control pairs; their average age was 73.8 years and 78% were female. Median total direct medical costs were $761 and $625, respectively, for cases and nonfracture controls in the year prior to fracture, and $3884 and $712, respectively, in the year following fracture. The highest median incremental costs were for distal femur ($11756) and hip fractures ($11241), whereas the lowest were for rib fractures ($213). Although hip fractures resulted in more incremental cost than any other fracture type, this amounted to only 37% of the total incremental cost of all moderate-trauma fractures combined. Regression analyses revealed that age, prior year costs and type of fracture were significant predictors of incremental costs (p<0.03 for all comparisons). The incremental costs of osteoporotic fractures are therefore substantial. Whereas hip fractures contributed disproportionately, they accounted for only one-third of the total incremental cost of fractures in our cohort. The use of incremental costs in economic analyses will provide a more accurate reflection of the true cost-effectiveness of osteoporosis prevention.

Age Factors↗

PubMed2001

Circadian and seasonal occurrence of subarachnoid and intracerebral hemorrhage.

OBJECTIVE: To determine whether the time of onset of subarachnoid hemorrhage (SAH) or intracerebral hemorrhage (ICH) is associated with a time of day or season of year. BACKGROUND: Prior studies have suggested that there may be a circadian and seasonal pattern of ischemic stroke occurrence, but this is less certain for hemorrhagic stroke. Population-based data have been unavailable. METHODS: All incident ICH and SAH among residents of Rochester, MN, were ascertained. The medical records of patients were reviewed to determine the time of onset and date of occurrence. The day was divided into 8-hour periods, and the year into seasonal quartiles. Each patient was assigned a period based on the time of onset of symptoms. The data were analyzed by chi(2) analysis to determine whether there was a trend toward increased occurrence based on time period or seasonal quartile of onset. RESULTS: From 1960 to 1989, there were 155 cases (48 men, 107 women) of incident SAH. From 1975 to 1989, there were 137 cases (57 men, 80 women) of incident ICH. There was a significant increase in the time of onset for ICH and SAH in the 8 AM to 4 PM period (p = 0.005 and p = 0.03, respectively). The concomitant occurrence of hypertension, gender, and age did not affect the time of day of occurrence. In the analysis of seasonal variation, there was a significant increase in events during December, January, and February in the combined SAH and ICH group (p = 0.032) and a trend for SAH alone (p = 0.07) but not for ICH (p = 0.34). Hypertension and age had no impact on the association between season and the occurrence of SAH and ICH. CONCLUSION: The occurrence of SAH and ICH is increased from 8 AM to 4 PM. The occurrence of hemorrhage is increased during the winter months, but this is likely limited only to SAH.

Cerebral Hemorrhage↗

PubMed2001

Bone density in an immigrant population from Southeast Asia.

The epidemiology of bone loss in populations of Asian heritage is still poorly known. This study compared the skeletal status of a convenience sample of 396 Southeast Asian immigrants (172 Vietnamese, 171 Cambodians and 53 Laotians) residing in Rochester, Minnesota in 1997 with 684 white subjects previously recruited from an age-stratified random sample of community residents. Areal bone mineral density (BMD, g/cm2) and volumetric bone mineral apparent density (BMAD, g/cm3) were determined for lumbar spine and proximal femur using the Hologic QDR 2000 instrument for the white population and the QDR 4500 for Southeast Asian subjects; the machines were cross-calibrated from data on 20 volunteers. Lumbar spine BMD was 7% higher in white than Southeast Asian women (p < 0.001), and similar results were observed for the femoral neck; lumbar spine BMD was 12% higher in white than nonwhite men (p < 0.001). Race-specific discrepancies were reduced by calculating BMAD: for premenopausal women, lumbar spine and femoral neck differences between whites and Southeast Asians were eliminated; for postmenopausal women the lumbar spine differences persisted (p < 0.0001), while femoral neck BMAD was actually higher for Southeast Asians. There were no race-specific differences in femoral neck BMAD among men of any age (p = 0.312), but lumbar spine BMAD was less for younger (p = 0.042) but not older (p = 0.693) Southeast Asian men. There were differences among the Southeast Asian subgroups, but no clear pattern emerged. Predictors of lumbar spine BMAD in Southeast Asian women were age (p < 0.001), weight (p = 0.015) and gravidity (p = 0.037). Even after adjusting for bone size using BMAD, 32% and 9% of Southeast Asian women and men, respectively, would be considered to have osteoporosis at the femoral neck and 25% and 4%, respectively, at the lumbar spine. These findings indicate a need for culturally sensitive educational interventions for Southeast Asians and for physicians to pursue diagnosis and treatment to prevent osteoporosis-related disabilities in this population.

Adult↗

PubMed2001

Value of immunological markers in predicting responsiveness to influenza vaccination in elderly individuals.

Elderly individuals are at high risk for morbidity and mortality when infected with influenza virus. Vaccinations with inactivated virus are less effective in the elderly due to the declining competency of the aging immune system. We have explored whether immunological parameters predict poor anti-influenza virus vaccine responses and can be used as biological markers of immunosenescence. One hundred fifty-three residents of community-based retirement facilities aged 65 to 98 years received a trivalent influenza vaccine. Vaccine-induced antibody responses were determined by comparing hemagglutination inhibition titers before and 28 days after immunization. The composition of the T-cell compartment was analyzed by flow cytometry and the sizes of three T-cell subsets, CD4(+) CD45RO(+) cells, CD4(+) CD28(null) cells, and CD8(+) CD28(null) cells, were determined. Only 17% of the vaccine recipients were able to generate an increase in titers of antibody to all three vaccine components, and 46% of the immunized individuals failed to respond to any of the three hemagglutinins. The likelihood of successful vaccination declined with age and was independently correlated with the expansion of a particular T-cell subset, CD8(+) CD28(null) T cells. The sizes of the CD4(+) CD45RO(+) memory T-cell and CD4(+) CD28(null) T-cell subsets had no effect on the ability to mount anti-influenza virus antibody responses. Frequencies of CD8(+) CD28(null) T cells are useful biological markers of compromised immunocompetence, identifying individuals at risk for insufficient antibody responses.

Age Factors↗

PubMed2000

Relative influence of physical activity, muscle mass and strength on bone density.

In a population-based sample of 348 men (age 22-90 years) and 351 women (age 21-93 years), we evaluated the relationship of bone density assessed at a variety of skeletal sites by dual-energy X-ray absorptiometry (DXA) with various muscle mass estimates obtained also from the DXA scan and with physical activity by interview and strength assessed both subjectively and objectively. All these parameters declined with age as judged from these cross-sectional data. All estimates of total skeletal muscle mass were strongly correlated with bone density at different skeletal sites. Muscle mass, in turn, was correlated with physical activity and hand strength. In multivariate models including these variables, muscle mass was the strongest determinant of bone density, accounting for 6-53% (mean 27%) of the variance at the different skeletal sites. Physical activity (and/or a physical activity x age interaction) was an independent predictor of bone mass in 48% of the site-specific models and accounted for 0.03-39% (mean 10%) of the variance, while hand strength (and/or a hand strength x age interaction) accounted for up to 4% (mean 1%) of the variance as an independent predictor of bone density in a third of the models. Although these variables together accounted for a large proportion of the variance in bone density, other potential predictors were not assessed in these analyses. The dramatic decline in physical activity over life seemed unable to completely explain the age-related loss of bone mass, and additional research is needed to determine whether the relationship of muscle mass with bone density is a direct one or due instead to other factors such as circulating hormone levels.

Absorptiometry, Photon↗

PubMed2000

Endometrial cancer in Olmsted County, MN: trends in incidence, risk factors and survival.

PURPOSE: We updated an earlier study in this community from 1945-1974 in order to assess trends in the incidence of, risk factors for, and survival from endometrial cancer in 1975-1991. METHODS: Incidence rates were based on all new cases of endometrial cancer diagnosed among Olmsted County, Minnesota, women during the years 1975-1991, with the population denominator from decennial census data. Risk factors were assessed with conditional logistic regression comparing the incidence cases to age- and gender-matched controls with intact uteri seen the same year the case was diagnosed. Survival was assessed using the Kaplan-Meier method. RESULTS: The incidence of endometrial cancer (age-adjusted to 1970 United States total) in 1975-1991 was 14.3 per 100,000 person-years, which is slightly increased from 1965-74. The rate was 21.7 per 100,000 person-years after adjustment for hysterectomy prevalence. As in the previous study, conjugated estrogen use for six months or more (odds ratio [OR] 2.71; 95% confidence interval [CI] 1.14-6.46) and body mass index (OR 1.06; 95% CI 1.01-1.11) increased the risk of endometrial cancer. The five-year relative survival rate (82%) was not improved over the earlier study. CONCLUSIONS: A small increase in endometrial cancer incidence was linked to the same risk factors identified in an earlier study in this community. No improvement in survival was seen.

Case-Control Studies↗

PubMed2000

Fractures following thyroidectomy in women: a population-based cohort study.

Hip fracture risk has been associated with hyperthyroidism and thyroidectomy in men and with hyperthyroidism in women, but the influence of thyroidectomy on fracture risk in women has not been adequately addressed. The 630 Rochester, MN women who underwent thyroidectomy in 1950-1974 were followed subsequently for 12,804 person-years (retrospective cohort study) during which 601 fractures were observed. Relative to incidence rates in the community, there was no increase in overall fracture risk (standardized incidence ratio [SIR] 0.9; 95% confidence interval [CI] 0.8-1.00). No increase was seen in limb fractures generally or in distal forearm fractures specifically (SIR 1.1, 95% CI 0.8-1.4). There was a modest but statistically significant increase in the risk of hip fractures following thyroidectomy (SIR 1.3, 95% CI 1.01-1.8), but much greater increases were apparent in the risk of subsequent fractures of the ribs, spine, and pelvis. There was almost a threefold increase in vertebral fractures (SIR 2.8, 95% CI 2.3-3.3), but the excess was mostly observed long after the original operation and may be attributable to ascertainment bias. Fracture risk was associated with advancing age and with the presence of one or more of the diseases that have been associated with secondary osteoporosis but not with a history of hyperthyroidism, extent of thyroid surgery, or subsequent use of thyroid replacement therapy. Thus, with the exception of some fractures of the axial skeleton, which might have been more completely diagnosed among affected women, there was no increase in fracture risk among women following thyroidectomy performed mainly for adenoma or goiter.

Adolescent↗

PubMed2000

Epidemiology of sarcopenia.

OBJECTIVES: To examine patterns of muscle mass change with aging and to estimate the prevalence of sarcopenia. DESIGN: Cross-sectional survey. SETTING: Population-based study in Rochester, Minnesota. PARTICIPANTS: Age-stratified sample of men and women from the community. MEASUREMENTS: Muscle mass estimated from total body scans by dual-energy X-ray absorptiometry. Sarcopenia was defined as muscle mass more than 2 standard deviations below the sex-specific young-normal mean. RESULTS: Total lean body mass (exclusive of bone) and total skeletal muscle mass both were greater in men than women and declined linearly with age as judged from these cross-sectional data. Adjustment for height reduced the gender difference. The age- and sex-adjusted prevalence of sarcopenia varied from 6 to 15% among subjects 65 years of age or over, depending on the muscle mass parameter that was evaluated, but prevalence rates were quite sensitive to the normal values used to define cutoff levels. Subjects with sarcopenia appeared to have more physical limitations than the others. CONCLUSIONS: Late in life, a substantial portion of the population reaches low levels of muscle mass that are associated with increased physical disability. However, additional efforts are needed to validate an operational definition of sarcopenia.

Absorptiometry, Photon↗

PubMed1999

The ups and downs of anorexia nervosa.

OBJECTIVE: We updated our incidence study by identifying Rochester, Minnesota, residents diagnosed with anorexia nervosa during 1985 through 1989. METHOD: From a community-based epidemiologic resource, 2,806 medical records with diagnoses including anorexia nervosa, eating disorder, bulimia, amenorrhea and other conditions were screened to identify new cases of anorexia nervosa. RESULTS: Two hundred eight (193 females and 15 males) residents fulfilled standard diagnostic criteria for anorexia nervosa. The overall age-sex-adjusted incidence rate was 8.3 per 100,000 person-years. The age-adjusted incidence among females was 15.0 per 100,000 person-years compared to 1.5 per 100,000 among males. The long-term linear increase for 15 to 24-year-old females noted during the first 50 years of the study continued. The disorder remained less frequent among older females. DISCUSSION: Anorexia nervosa remains a relatively common disorder among young females. While there are short-term fluctuations in incidence, the long-term increasing trend for 15 to 24-year-old females has continued.

Adolescent↗

PubMed1999

The epidemiology of rheumatoid arthritis in Rochester, Minnesota, 1955-1985.

OBJECTIVE: To describe trends in the epidemiology of rheumatoid arthritis (RA) over a period of 30 years in a population-based cohort. METHODS: An inception cohort of Rochester, Minnesota residents who were > or =35 years of age and had RA (as defined by the 1987 American College of Rheumatology criteria for RA) first diagnosed between January 1, 1955 and January 1, 1985 was assembled and followed up until January 1, 1995. Incidence rates were age- and sex-adjusted to the 1970 US white population. Prevalence of RA in this cohort was estimated on January 1, 1985. A birth-cohort analysis was performed by calculating and comparing incidence rates in each of 16 birth cohorts. RESULTS: Of the 425 Rochester residents who fulfilled the inclusion criteria, there were 113 men (26.6%) and 312 women (73.4%), with a mean age at diagnosis of 60.2 years. The mean followup time was 15.1 years. The overall age- and sex-adjusted annual incidence of RA among Rochester, Minnesota residents > or =35 years of age (1955-1985) was 75.3 per 100,000 population (95% confidence interval 68.0-82.5). This incidence was approximately double in women compared with that in men and increased steadily with age, until age 85, after which the incidence of RA decreased. Secular trends in the incidence of RA over the entire study period were demonstrated. The overall prevalence of RA on January 1, 1985 was approximately 1%. The birth-cohort analysis showed peak incidence rates in the 1880-1895 birth cohorts. CONCLUSION: The epidemiology of RA is dynamic. The findings in this study lend further support to the hypothesis of a host-environment interaction in the pathogenesis of RA.

Adult↗

PubMed1999

Fracture incidence in Olmsted County, Minnesota: comparison of urban with rural rates and changes in urban rates over time.

Using the data resources of the Rochester Epidemiology Project, we carried out a descriptive study of fracture incidence among the residents of Olmsted County, Minnesota. During the 3-year period 1989-91, 2901 County residents > or = 35 years of age experienced 3665 separate fractures. The age- and sex-adjusted (to 1990 United States whites) incidence of any fracture was 2205 per 100,000 person-years (95% CI, 2123 to 2286) and that of all fractures was 2797 per 100,000 (95% CI, 2705 to 2889). Age-adjusted fracture rates were 40% greater among women. Incidence rates increased with age in both sexes. One-third of the fractures involved the hip, spine or distal forearm - the skeletal sites traditionally associated with osteoporosis. The age- and sex-adjusted incidence of fractures due to moderate trauma (2205 per 100,000 person-years; 95% CI, 2106 to 2303) was twice that of fractures due to more severe trauma (1164 per 100,000; 95% CI, 1106 to 1223) and 12 times that of pathological fractures (178 per 100,000; 95% CI, 133 to 222). Overall fracture rates were 15% greater among residents of the central city of Rochester compared with the rural portion of Olmsted County. The incidence of limb fractures among Rochester residents was 14% higher than comparable rates documented for this community 20 years earlier in 1969-71, due mainly to a substantial increase in the incidence of leg fractures.

Adult↗

PubMed1999

Forearm fractures as predictors of subsequent osteoporotic fractures.

To assess the ability of distal forearm fractures to predict future fractures, we conducted a population-based retrospective cohort study among the 1288 residents (243 men, 1045 women) of Rochester, Minnesota age 35 years or older who experienced their first distal forearm fracture in 1975-94. During 9664 person-years of follow-up, 548 patients experienced 1109 subsequent fractures, excluding 195 that occurred on the same day as the index forearm fracture. The cumulative incidence of any subsequent fracture was 55% by 10 years and 80% by 20 years following the initial distal forearm fracture. Compared to expected fracture rates in the community, the risk of a hip fracture following the index forearm fracture was increased 1.4-fold in women (95% CI, 1.1-1.8) and 2.7-fold in men (95% CI, 0.98-5.8). In women, the risk of hip fracture differed by age, as we had found in a previous study. Women over age 70 had a 1.6-fold increase (95% CI, 1.2-2.0) in subsequent hip fracture risk whereas women who sustained their first forearm fracture before age 70 years did not have significantly increase risk. By contrast, vertebral fractures were significantly increased at all ages, with a 5.2-fold increase (95% CI, 4.5-5.9) in risk among women and a 10.7-fold increase (95% CI, 6.7-16.3) among men following a first distal forearm fracture. The increased risk in men suggests that a sentinel forearm fracture should not be ignored. Among the women, we also found a missed opportunity for intervention as hormone replacement therapy was underutilized.

Adult↗

PubMed1999

A comparison of two comorbidity instruments in arthritis.

Comorbidity (CM) is a powerful predictor of health outcome and cost, as well as an important confounder in many epidemiologic studies. However, choosing the most appropriate CM measurement instrument is difficult because comparative data on how the available instruments perform in various disease settings are limited. We collected CM data (from the complete medical records) for two population-based prevalence cohorts with rheumatoid arthritis (RA) and osteoarthritis (OA) and a comparison cohort without arthritis (NA), using two different CM instruments: the Charlson CM index (Charl), which is based on 17 diagnoses each weighted by mortality risk, and the Index of Coexistent Diseases (ICED), which estimates the severity and frequency of 14 comorbid conditions and provides an assessment of the impairment or disability caused by each. Cox proportional hazards modeling was used to assess the impact of the two types of comorbidity scores (Charl and ICED) on survival after prevalence (index) date, adjusting for the age, sex, and disease status. There were 450, 441, and 889 individuals in the RA, OA, and NA groups, respectively, with a mean follow-up period of 10.6 years. During the follow-up, 293, 307, and 546 deaths occurred in the RA, OA, and NA groups, respectively. The mean age and percent females were: 63.3 years, 74%; 70.7 years, 74%; and 67.5 years, 75% for the RA, OA, and NA groups, respectively. Comorbidity was highest in RA, intermediate in OA, and lowest in NA by both Charl and ICED. Cox proportional hazards modeling demonstrated that both Charl and ICED were highly statistically significant predictors of mortality (P<0.0001) after adjusting for age, sex, and disease state (RA, OA, or NA) and that ICED remained highly significant as a predictor of mortality, even after adjusting for Charl. We conclude that estimating CM from medical records using ICED, an instrument that incorporates an assessment of impairment and disability, is feasible and that such as assessment provides information that independently predicts mortality, even after adjusting for the results of traditional diagnosis-based CM measures, such as Charl.

Age Distribution↗

PubMed1999

Fracture risk after surgery for peptic ulcer disease: a population-based cohort study.

In the 30-year period from 1956 to 1985, 471 Rochester, MN residents had an initial operation for peptic ulcer disease, 438 of whom were followed for at least 30 days (median 14.8 years per subject). In this population-based cohort, risk was elevated for all of the fracture sites traditionally associated with osteoporosis, including the proximal femur (standardized incidence ratio [SIR] 2.5, 95% CI 1.9-3.3), vertebra (SIR 4.7, 95% CI 3.8-5.7), and distal forearm (SIR 2.2, 95% CI 1.5-3.1). Fracture risk rose with age and was greater among women than men, but there was no influence on overall fracture risk of ulcer type or nature of the operation. In multivariate analyses, the independent predictors of vertebral fractures were age (hazard ratio [HR] per 10-year increase 1.8, 95% CI 1.6-2.0), use of corticosteroids (HR 2.3, 95% CI 1.01-5.2), thyroid replacement (HR 2.5, 95% CI 1.4-4.6), chronic anticoagulation (HR 2.3, 95% CI 1.1-4.6), and the presence of one or more conditions associated with secondary osteoporosis (HR 1.6, 95% CI 1.2-2.1). Gastrectomy with Billroth II reconstruction appeared to be relatively protective (HR 0.5, 95% CI 0.3-0.9), but such patients still had an increased risk of vertebral fractures compared with community residents generally (SIR 3.6, 95% CI 2.4-5.4). The independent predictors of hip fracture risk in this cohort were age (HR 2.7, 95% CI 2.1-3.5) and use of corticosteroids (HR 5.8, 95% CI 2.2-15.3) or anticonvulsants (HR 4.6, 95% CI 1.8-12.0), while higher body mass index was protective (HR 0.9, 95% CI 0.8-0.96). The independent predictors of distal forearm fractures were female gender (HR 4.7, 95% CI 2.2-10.1) and chronic anticoagulant use (HR 2.8, 95% CI 1.1-7.3). Thus, while the risk of osteoporotic fractures was significantly increased among patients operated for peptic ulcers, this appeared to be due more to specific characteristics of the cohort than to adverse effects of particular surgical procedures.

Adolescent↗