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PubMed2026

Age-stratified associations of glycemia, blood pressure, and cholesterol with mortality in diabetes: A prospective cohort study.

BACKGROUND: Optimization of HbA1c, blood pressure and cholesterol, referred to as the "ABCs", is central to the management of diabetes. However, the age-specific associations of these factors with mortality in patients with diabetes remains unclear. METHODS: In this prospective cohort study, 43,732 Chinese adults aged&#x2009;&#x2265;&#x2009;40 years with diabetes were included from the China Cardiometabolic Disease and Cancer Cohort (4C) Study. Participants were stratified by age (<&#x2009;55, 55-<65, 65-<75, &#x2265;&#x2009;75 years). Cox proportional hazards regression and Fine-Gray competing risk models were employed to estimate the associations of HbA1c, systolic blood pressure (SBP), and low-density lipoprotein cholesterol (LDL-C) with all-cause, cardiovascular, and non-cardiovascular mortality across age groups. Relative importance and population attributable fractions (PAFs) were computed for each metabolic factor. RESULTS: During a median follow-up of 10.1 years, 3,975 deaths were documented. Age significantly modified the associations of HbA1c, SBP, and LDL-C with all mortality outcomes (all P for interaction&#x2009;<&#x2009;0.05). Among participants aged&#x2009;<&#x2009;75 years, HbA1c showed graded positive associations with all-cause, cardiovascular, and non-cardiovascular mortality. The SBP thresholds associated with increased mortality risk were 140 mmHg in those aged&#x2009;<&#x2009;65 years and 160 mmHg in those aged 65-<75 years. Among those aged&#x2009;&#x2265;&#x2009;75 years, however, the patterns of these associations differed markedly. Elevated mortality risk was observed only at HbA1c&#x2009;&#x2265;&#x2009;9%, with a hazard ratio (HR) of 1.51 (95% confidence interval [CI]: 1.19-1.91) for all-cause mortality and a subdistribution hazard ratio (SHR) of 1.70 (95% CI: 1.23-2.36) for cardiovascular mortality, while SBP showed no significant association with any mortality outcome in this age group. Moreover, LDL-C emerged as a significant risk factor for cardiovascular mortality. Compared with participants with LDL-C&#x2009;<&#x2009;1.8 mmol/L, those with LDL-C of 1.8-<2.6 mmol/L exhibited a significantly higher risk (SHR: 1.86; 95% CI: 1.11-3.11). Additionally, LDL-C had the largest PAF for cardiovascular mortality (9.6%) within this age group. CONCLUSIONS: The impacts of ABC factors on mortality risk vary substantially by age among adults with diabetes. In patients aged&#x2009;&#x2265;&#x2009;75 years, less stringent glycemic and blood pressure targets may be appropriate, whereas lipid management remains critically important for reducing cardiovascular mortality.

Humans↗
PubMedDate not supplied

[Perinatal mortality in the Hospital Juarez, S.S.A].

A retrospective analysis on perinatal mortality was carried out at "Hospital Juárez" in México City, between June 1975 and May 1976. The collected data shows a gross perinatal mortality rate of 89.7 per one thousand live borns with a late fetal mortality rate of 33.1 and early mortality rate of 56.6. A prospective study was planned in order to record the perinatal mortality rate between June the first 1976, to May 31, 1977 showing a perinatal mortality rate of 60.8, with a late fetal mortality rate of 25.4 and early neonatal mortality rate of 35.4. The significant decrease in the rate of perinatal mortality could be the result of an accurate perinatal clinical history, specifically designed for such purpose, allowing a better supervision of the pregnant mother, the fetus and the newborn, which permitted to disclose many diagnoses that otherwise would not be obtained and this also contributted to the establishment of better opportunities for treatment. Besides the establishment of routine practices in the handling of newborns, the better relationships between pediatrician and obstetrician and the redistribution of medical and nursing personnel in critical areas, allowed a better perinatal attention. The relationships between perinatal mortality with maternal age and number of pregnancies and the relationships between neonatal mortality with birth weight and gestational age are presented. The factors that have favored the high rates of perinatal mortality in this hospital are also reviewed and corrective measures are proposed.

Female↗
PubMed1979

Mortality among Finnish doctors, 1953-1972.

The mortality with respect to the total population of Finnish physicians during the period 1953 to 1972 has been analysed and compared with the corresponding statistics for the general Finnish population, for Finnish foundry workers, and for American physicians. It was found that the overall mortality was lower for male physicians than that for the general population or for foundry workers, but was clearly higher than that for American physicians. Male physicians did not exhibit any major differences from the general population with regard to cardiovascular diseases and suicide, but had a lower mortality from malignant neoplasms, accidents and "other diseases" (including infectious diseases). The explanation of cancer mortality being lower than expected among male physicians was mainly to be found in a deficit in lung cancer. Although female physicians had higher life expectancy than male physicians and the female general Finnish population, they did not show any clear deficit for cancer. In respect of all specialists, surgical specialists had the lowest mortality; general practitioners had the highest mortality. Most of these variations were attributable to differences in coronary mortality, but mortality from lung cancer was also remarkably low among surgeons. Differences of a similar type were also found between occupational sub-categories; private practitioners had the highest, and research workers and central hospital physicians the lowest mortality figures. The lower cancer mortality among male physicians, as contrasted with the general population, is probably attributable to differences in smoking habits; about 22% of male physicians smoked in 1973, whereas earlier studies by others have indicated that the corresponding proportion was about 50% in the general population. In contrast, the differences in mortality between different specialist categories probably arises from other factors, since Finnish physicians reportedly display a relatively homogeneous smoking pattern.

Adult↗
PubMed2025

Mediating effects of waist circumference and BMI on the association between meal frequency and mortality.

OBJECTIVE: To examine the potential indirect effect of meal frequency on mortality via obesity indices. DESIGN: Prospective cohort study. SETTING: Korean Genome and Epidemiology Study. PARTICIPANTS: This cohort study involved 148 438 South Korean adults aged 40 years and older. RESULTS: Meal frequency at the baseline survey was assessed using a validated FFQ. Outcomes included all-cause mortality, cancer mortality and CVD mortality. Cox proportional hazards regression models were employed to examine the relationship between meal frequency and the risk of mortality. Mediation analyses were performed with changes in obesity indices (BMI and weight circumference (WC)) as mediators. In comparison to the three-time group, the once-per-day and four-times-per-day groups had a higher risk for all-cause mortality. The irregular frequency group had a higher risk for CVD mortality. Both once-per-day and four-times-per-day groups exhibited higher risks for cancer mortality. The effect of meal frequency on all-cause mortality was partially mediated by WC. For specific-cause mortality, similar mediation effects were found. CONCLUSIONS: The data suggests that three meals per day have a lower mortality and longer life expectancy compared with other meal frequencies. Increased waist circumference partially mediates this effect. These findings support the implementation of a strategy that addresses meal frequency and weight reduction together.

Humans↗
PubMed1978

Improvement in infant and perinatal mortality in the United States, 1965--1973: I. Priorities for intervention.

Changes in United States infant and perinatal mortality in the period 1965--1973 were examined by race, age at death or length of gestation, and degree of urbanization. The decline of postneonatal mortality rates was greater than the declines of fetal and neonatal mortality rates. Other-than white infant and fetal mortality rates improved more than the white rates, except in the first day of life. Postneonatal mortality rates improved more in rural than in urban areas, while neonatal and perinatal mortality rates improved more in urban areas than in rural. These improvements in mortality rates have occurred at the same time as changes in medical techniques and the organization and availability of health services, improvements in economic conditions and standards of living, and changes in the demographic characteristics of the child-bearing population of the United States. Each of these changes was in a direction expected to have a favorable effect on infant and perinatal mortality. Nevertheless, the improvement of infant mortality rates has not changed the relative position of the United States in comparison with other countries. Programs to improve infant and perinatal mortality can use the data in this study to define high priority target groups using a method based on the size of the problem in the target group, the severity of the problem, and the amount and direction of change.

Age Factors↗