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Association between Chinese or South Asian ethnicity and end-of-life care in Ontario, Canada.
Yarnell, CJ, Fu, L, Bonares, MJ, Nayfeh, A, Fowler, RA
CMAJ : Canadian Medical Association journal = journal de l'Association medicale canadienne. 2020;(11):E266-E274
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Abstract
BACKGROUND Ethnicity may be associated with important aspects of end-of-life care, such as what treatments are received, access to palliative care and where people die. However, most studies have focused on end-of-life care of white, Hispanic and black patients. We sought to compare end-of-life care delivered to people of Chinese and South Asian ethnicity with that delivered to others from the general population, in Ontario, Canada. METHODS In this population-based cohort study, we included all people who died in Ontario, Canada, between Apr. 1, 2004, and Mar. 31, 2015. People were identified as having Chinese or South Asian ethnicity on the basis of a validated surname algorithm. We used modified Poisson regression analyses to assess location of death and care received in the last 6 months of life. RESULTS We analyzed 967 339 decedents, including 18 959 (2.0%) of Chinese and 11 406 (1.2%) of South Asian ethnicity. Chinese (13.6%) and South Asian (18.5%) decedents were more likely than decedents from the general population (10.1%) to die in the intensive care unit (ICU). The adjusted relative risk of dying in intensive care was 1.21 (95% confidence interval [CI] 1.15 to 1.27) for Chinese and 1.25 (95% CI 1.20 to 1.30) for South Asian decedents. In their last 6 months of life, decedents of Chinese and South Asian ethnicity experienced significantly more ICU admission, hospital admission, mechanical ventilation, dialysis, percutaneous feeding tube placement, tracheostomy and cardiopulmonary resuscitation than the general population. INTERPRETATION Decedents of Chinese and South Asian ethnicity in Ontario were more likely than decedents from the general population to receive aggressive care and to die in an ICU. These findings may be due to communication difficulties between patients and clinicians, differences in preferences about end-of-life care or differences in access to palliative care services.
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Observational and Genetic Associations of Body Mass Index and Hepatobiliary Diseases in a Relatively Lean Chinese Population.
Pang, Y, Kartsonaki, C, Lv, J, Millwood, IY, Yu, C, Guo, Y, Chen, Y, Bian, Z, Yang, L, Chen, J, et al
JAMA network open. 2020;(10):e2018721
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IMPORTANCE There is some support for the existence of genetic associations between adiposity and certain hepatobiliary diseases in Western populations. However, there is little evidence of such genetic associations in China, where the causes of these diseases may differ from those in Western populations and the mean body mass index (BMI) is much lower. OBJECTIVES To compare the observational associations of BMI with hepatobiliary diseases and liver biomarkers with the genetic associations between BMI and these factors and to assess whether the genetic associations of BMI with liver diseases differed by hepatitis B virus infection status. DESIGN, SETTING, AND PARTICIPANTS This cohort study used data from the prospective China Kadoorie Biobank, including 473 938 adults aged 30 to 79 years without hepatobiliary diseases at baseline from 10 diverse areas in China from June 25, 2004, to July 15, 2008. A random sample of 75 736 participants with genotyping data was included in the Mendelian randomization analysis. Follow-up was completed January 1, 2017 (median [interquartile range] length of follow-up, 10.2 [9.2-11.1] years). Data were analyzed from January to October 2019. EXPOSURES Measured BMI obtained during the baseline survey and genetically instrumented BMI derived using 92 single-nucleotide variations. MAIN OUTCOMES AND MEASURES Incident cases of hepatobiliary diseases, liver enzymes, fatty liver index, and fibrosis score. RESULTS Among 473 938 individuals (276 041 [58.2%] women), the mean (SD) age was 52 (10.9) years and mean (SD) BMI was 23.8 (3.4). Baseline BMI was associated with higher risks of chronic liver disease (adjusted risk ratio per 1-SD increase, 1.14; 95% CI, 1.11 to 1.17) and gallbladder disease (adjusted risk ratio per 1-SD increase, 1.29; 95% CI, 1.27 to 1.31), with heterogeneity by disease subtype (P < .001). Genetically instrumented BMI was associated with higher risks of chronic liver disease (risk ratio per 1-SD increase, 1.55; 95% CI, 1.08 to 2.24) and gallbladder disease (risk ratio per 1-SD increase, 1.40; 95% CI, 1.11 to 1.76), with no heterogeneity between subtypes. A meta-analysis of the genetic associations in China Kadoorie Biobank and those calculated in UK Biobank gave a risk ratio of 1.55 (95% CI, 1.30 to 1.84) for chronic liver disease and 1.42 (95% CI, 1.22 to 1.64) for gallbladder disease. In the China Kadoorie Biobank study, there were positive genetic associations of BMI with liver enzymes, steatosis, and fibrosis scores, consistent with observational associations. The genetic associations of BMI with liver diseases and biomarkers did not differ by hepatitis B virus infection status. CONCLUSIONS AND RELEVANCE In this cohort study of a relatively lean Chinese population, there were positive genetic associations of BMI with hepatobiliary diseases. These results suggest that maintaining a healthy weight through diet and physical activity may help prevent hepatobiliary diseases.
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The risk of herpes zoster virus infection in patients with depression: A longitudinal follow-up study using a national sample cohort.
Choi, HG, Kim, EJ, Lee, YK, Kim, M
Medicine. 2019;(40):e17430
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The features of herpes zoster share some commonalities with depression, including decreased cellular immunity, a close correlation with nutritional status, and a higher prevalence in the elderly population. We aimed to assess the association between herpes zoster infection and depression in the Korean population.We performed a longitudinal follow-up study of a nationwide sample cohort derived from the Korean National Health Insurance Service database. Individuals diagnosed with depression between 2002 and 2013 (n = 58,278) as well as matched controls (n = 233,112), with both groups comprising 34.3% male and 65.7% female subjects, were extracted and analyzed for the presence of herpes zoster infection. Depression was diagnosed based on the International Classification of Diseases tenth revision (ICD-10) codes F31-F39, while herpes zoster was diagnosed as ICD-10 B02.The rate of herpes zoster infection was higher in the depressed group (6.8% [3967/58,278]) than in the control group (6.3% [14,689/233,122], P < .001). The adjusted hazard ratio (HR) for herpes zoster infection was 1.09 (95% CI: 1.05-1.13) in the depressed group (P < .001). Subgroup analyses revealed that the adjusted HRs for herpes zoster infection were higher only in women younger than 60 years among participants with depression. These HRs were 1.13 (95% CI: 1.02-1.25; P = .016) in women younger than 40 years and 1.11 (95% CI: 1.04-1.17; P < .001) in women aged 40-59 years.Depression is a predictor of herpes zoster infection in Korean women younger than 60 years.
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Clinical characteristics and long-term prognosis of contemporary patients with vasospastic angina: Ethnic differences detected in an international comparative study.
Sato, K, Takahashi, J, Odaka, Y, Suda, A, Sueda, S, Teragawa, H, Ishii, K, Kiyooka, T, Hirayama, A, Sumiyoshi, T, et al
International journal of cardiology. 2019;:13-18
Abstract
BACKGROUND Possible ethnic differences in clinical characteristics and long-term prognosis of contemporary patients with vasospastic angina (VSA) remain to be elucidated. METHODS AND RESULTS The Japanese Coronary Spasm Association (JCSA) conducted an international, prospective, and multicenter registry study for VSA patients. A total of 1457 VSA patients (Japanese/Caucasians, 1339/118) were enrolled based on the same diagnostic criteria. Compared with Caucasian patients, Japanese patients were characterized by higher proportions of males (68 vs. 51%) and smoking history (60 vs. 49%). Japanese patients more often had angina especially during the night and early morning hours, compared with Caucasians. Ninety-five percent of Japanese and 84% of Caucasian patients underwent pharmacological provocation test. Importantly, no significant differences in the patterns of coronary spasm were apparent, with diffuse spasm most frequently noted in both ethnicities. The prescription rate of calcium-channel blockers was higher in Japanese (96 vs. 86%), whereas the uses of nitrates (46 vs. 59%), statins (43 vs. 65%), renin-angiotensin-system inhibitors (27 vs. 51%), and β-blockers (10 vs. 24%) were more common in Caucasian patients. Survival rate free from major adverse cardiac events (MACE) was slightly but significantly higher in Japanese than in Caucasians (86.7 vs. 76.6% at 5 years, P < 0.001). Notably, multivariable analysis revealed that the JCSA risk score correlated with MACE rates not only in Japanese but also in Caucasian patients. CONCLUSION These results indicate that there are ethnic differences in clinical profiles and long-term prognosis of contemporary VSA patients.
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The major causes and risk factors of total and cause-specific mortality during 5.4-year follow-up: the Shanghai Changfeng Study.
Wu, L, Lin, H, Hu, Y, Zhu, C, Ma, H, Gao, J, Wu, J, Shen, H, Jiang, W, Zhao, N, et al
European journal of epidemiology. 2019;(10):939-949
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To investigate the major causes and predictive factors of death in a middle-aged and elderly Chinese population. A total of 6591 residents aged ≥ 45 years from Shanghai Changfeng community were followed up for an average of 5.4 years. The causes of death were coded according to the 10th Revision of International Classification of Diseases. The mortality rate was calculated by person-years of follow up and age-standardized according to the 2010 Chinese census data. Multivariable-adjusted Cox proportional hazards model was performed to investigate the predictors of all-cause and cause-specific mortality. During the total follow-up of 35,739 person-years, 370 deaths were documented (157 from malignant neoplasms, 70 from heart diseases, 68 from cerebrovascular diseases, 75 from other causes). The age-standardized all-cause mortality rate was 798.2 per 100,000 person-years (927.9 among men and 716.7 among women). Results from multivariable analyses showed that aging, diabetes, and osteoporosis at baseline were independent predictors of all-cause mortality, with hazard ratios (HR) of 1.11 (95% CI 1.10-1.13), 1.91 (1.51-2.42), and 1.71 (1.24-2.35), respectively. The population attributable risk percent of diabetes and osteoporosis was 19.7% and 11.7%, respectively. Cigarette smoking was associated with a higher risk of all-cause mortality in men (HR and 95%CI 1.44, 1.01-2.06). In women, diabetes and osteoporosis were related to a higher risk of cardiovascular mortality (3.27, 1.82-5.88 and 1.89, 1.04-3.46, respectively). While in men, osteoporosis was related to a higher risk of malignant neoplasms mortality (2.39, 1.07-5.33). Malignant neoplasms, heart diseases, and cerebrovascular diseases are the leading causes of death. Aging, smoking, underweight, diabetes, and osteoporosis are independent predictors of premature death among middle-aged and elderly Chinese community population. Moreover, there may have been some differences in the causes and predictors of premature death between men and women.
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Spectrum of Inherited Metabolic Disorders in Pakistani Children Presenting at a Tertiary Care Centre.
Cheema, HA, Malik, HS, Parkash, A, Fayyaz, Z
Journal of the College of Physicians and Surgeons--Pakistan : JCPSP. 2016;(6):498-502
Abstract
OBJECTIVE To determine the frequency, presentation and outcome of various inherited metabolic diseases in children presenting in a tertiary care hospital, Lahore, Pakistan. STUDY DESIGN An observational study. PLACE AND DURATION OF STUDY Gastroenterology, Hepatology and Nutrition Department of The Children Hospital and Institute of Child Health, Lahore, from January 2011 to October 2014. METHODOLOGY All children aged < 14 years with high suspicion of a metabolic disorder were inducted. Routine and radiological investigation were carried out at the study place. Comprehensive diagnostic testing of particular metabolic disorder was sent abroad. Those with a specific metabolic disorder were included in the study while those with normal metabolic work-up were excluded. All data was collected on preformed proforma. RESULTS Atotal of 239 patients were enrolled. Nineteen different types of inherited metabolic disorders were diagnosed in 180 patients; age ranged from 8 days to 14 years. Consanguinity was positive in 175 (97%) among the parents of the affected children, with previously affected siblings in 64 (35.5%). The most frequent disorders were inherited disorders of carbohydrate metabolism (92, 51%), lipid storage disease (59, 32.7%), organic acidemia and energy defects (18, 10%), amino acid disorder (6, 3.3%), and miscellaneous (4, 2.2%). Fifty-eight (32.2%) presented with acute metabolic crisis, 28 (15.5%) patients presented with early onset liver failure, and 24 (13.3%) with mental retardation. Out of these, 16 (8.8%) expired. CONCLUSION Glycogen storage disorders being the commonest followed by Gaucher disease and Galactosemia. The associated complications resulted in high morbidity and mortality.
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Changes in characteristics and management of Asian and Anglo-Celts with type 2 diabetes over a 15-year period in an urban Australian community: The Fremantle Diabetes Study.
Tan, ED, Davis, WA, Davis, TM
Journal of diabetes. 2016;(1):139-47
Abstract
BACKGROUND The aim of the present study was to determine temporal changes in characteristics and management of Asians with type 2 diabetes (T2D) compared with those of the majority Anglo-Celt (AC) patients in an urban Australian community. METHODS Cross-sectional data from the observational Fremantle Diabetes Study (FDS) collected in 1993-96 (Phase I; FDS1) and 2008-11 (Phase II; FDS2) were analyzed for patients classified as Asian (n = 44 and 65 in FDS1 and FDS2, respectively) or AC (n = 796 and 793, respectively). Between-group differences in changes in key variables between FDS phases were analyzed by generalized linear modeling with adjustment for age and gender. RESULTS Asians patients were significantly younger at diagnosis and recruitment and had a lower body mass index and smaller waist circumference than the AC participants in both FDS phases. They were also less likely to be treated for hypertension. Cardiovascular risk factors and their management and macrovascular complications were similar in the two groups over time. A greater propensity to retinopathy with Asian ethnicity in FDS1 (27.3% vs 13.5%; P = 0.23) was attenuated in FDS2 (23.7% vs 19.0%; P = 0.39). Asians had a significantly lower prevalence of peripheral sensory neuropathy in FDS2 (33.8% vs 63.3%; P < 0.001; adjusted P = 0.011 for between-group temporal change). CONCLUSIONS There were persistent differences between the phenotypic features of Asian migrants with T2D versus AC patients in an Australian urban community over 15 years of follow-up, but management of diabetes and non-glycemic risk factors remained comparable. Ethnicity-specific differences in susceptibility to microvascular complications should be considered in clinical management.
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Gene and dietary calcium interaction effects on brachial-ankle pulse wave velocity.
Choi, S, Jung, S, Kim, MK, Shin, J, Shin, MH, Shin, DH, Lee, YH, Chun, BY, Hong, KW, Hwang, JY
Clinical nutrition (Edinburgh, Scotland). 2016;(5):1127-34
Abstract
BACKGROUND & AIM: Understanding the lifestyle and genetic factors that affect pulse wave velocity (PWV) may provide clues to preventing atherosclerotic cardiovascular events. The aim of this study is to investigate genome-wide genetic and dietary calcium (Ca) intake interaction effects on brachial-ankle pulse wave velocity (baPWV). METHODS The baPWV was measured, and Ca intake was quantified by administering a food frequency questionnaire (FFQ) to 3198 participants, which included men and women (≥40 years) from the Korean Multi-Rural communities Cohort study (MRCohort). The interaction effects of dietary Ca intake and 19 single-nucleotide polymorphisms (SNPs) on baPWV were assessed using the general linear models. RESULTS Dietary Ca intake was not significantly associated with baPWV or any type of SNP among the subjects herein. In men, however, the adducin1 (ADD1) rs4961_C SNP had a significant dietary Ca intake-dependent effect on mean baPWV (pinteraction = 0.002). In women, the interaction of zinc finger proteins 618 (ZNF618) rs10817542_A with dietary Ca intake played a significant and key role in mean baPWV (pinteraction = 0.001). In the results of ADD1 rs4961_C in men and ZNF618 rs10817542_A in women, the minor allele-lowest Ca intake tertile (T1) group had significantly higher mean baPWV value than other subgroups of Ca intake tertile-genotype cross-classification whereas genotype was not a significant effector on mean baPWV values among highest Ca intake subgroups (T3). CONCLUSIONS The baPWV, a phenotype of arterial stiffness, can be modulated in subjects through regulation of dietary Ca intake, particularly in subjects with more vulnerable genotypes.
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A comparison of bone mineral densities and body composition between Southeast Asia college students and Chinese college students.
Liu, P, Ye, Z, Lu, J, Lu, H, Guan, L, Teng, Z, Gao, S, Li, M
Medicine. 2016;(37):e4724
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The aim of this study was to compare bone mineral densities (BMDs) and body composition between Southeast Asia college students and Chinese college students, in order to provide a certain reference enhancing college students' physical fitness.A total of 1694 Chinese college students (294 men and 1400 women, aged 18-22 years) and 250 Southeast Asia college students (148 men and 102 women, aged 19-22 years) were included in the study. Weight, height, and body mass index were measured anthropometrically. BMD values were determined by ultrasound bone densitometer and body composition was determined by body composition analyzer.Southeast Asia college students were overweight than Chinese college students (250 vs 1694) (P < 0.05). Chinese college students had a significantly lower body weight, fat mass, lean tissue mass, lean body weight, estimation of bone mass, protein, and metabolic rate but higher BMD at the calcaneus compared with Southeast Asia college students (P < 0.05 for all parameters). However, body water, intracellular fluid, and extracellular fluid were not significantly different between Chinese college students and Southeast Asia college students (P > 0.01 for all parameters).The results of this cross-sectional study suggest that Chinese college students had a higher BMD but lower body composition than Southeast Asia college students, which may be associated with genes, diet, exercise, and other factors.
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Stressful life events preceding the onset of depression in Asian patients with major depressive disorder.
Park, S, Hatim, A, Si, TM, Jeon, HJ, Srisurapanont, M, Bautista, D, Liu, SI, Chua, HC, Hong, JP
The International journal of social psychiatry. 2015;(8):735-42
Abstract
BACKGROUND Previous studies have identified the significant role of stressful life events in the onset of depressive episodes. However, there is a paucity of cross-national studies on stressful life events that precede depression. AIMS We aimed to compare types of stressful life events associated with the onset of depressive episodes in patients with major depressive disorder (MDD) in five Asian countries. METHOD A total of 507 outpatients with MDD were recruited in China (n = 114), South Korea (n = 101), Malaysia (n = 90), Thailand (n = 103) and Taiwan (n = 99). All patients were assessed with the Mini-International Neuropsychiatric Interview and the List of Threatening Experiences. The prevalence of each type of stressful life events was calculated and compared between each country. RESULTS The type of stressful life event that preceded the onset of a depressive episode differed between patients in China and Taiwan and those in South Korea, Malaysia and Thailand. Patients in China and Taiwan were less likely to report interpersonal relationship problems and occupational/financial problems than patients in South Korea, Malaysia and Thailand. CONCLUSION Understanding the nature and basis of culturally determined susceptibilities to specific stressful life events is critical for establishing a policy of depression prevention and providing effective counseling services for depressed patients.