Women and chronic obstructive pulmonary disease: does sex influence survival?
Explore the source record for details and available documents.
Female↗
Biomedical subjects
David M Mannino
Publications and source records attributed to David M Mannino.
Asthma prevalence among US adults, 1998-2000: role of Puerto Rican ethnicity and behavioral and geographic factors.
OBJECTIVES: We analyzed asthma prevalence among US adults by age, gender, race, Puerto Rican ethnicity, and other demographic, behavioral, health, and geographic variables. We hypothesized that high prevalences would be observed among Puerto Ricans and in the Northeast census region. METHODS: We used data from the 1998 through 2000 US National Health Interview Surveys. Information on lifetime history of asthma and asthma in the past year was collected from 95615 adults. We calculated weighted prevalence estimates and odds ratios from logistic regression. RESULTS: Of US adults, 8.9% had ever been diagnosed with asthma, and 3.4% had experienced an episode in the past 12 months. Asthma diagnosis rates were highest among Puerto Ricans (17.0%) and lowest among Mexican Americans (3.9%); rates were 9.6% and 9.2% among non-Hispanic Blacks and non-Hispanic Whites, respectively. Geographically, asthma prevalence was highest in the West (10.5%) and lowest in the Northeast (8.6%). Puerto Ricans in all regions had high asthma rates. CONCLUSIONS: final logistic regression model included race/ethnicity, obesity, poverty, female gender, and cigarette smoking. Higher asthma rates were confirmed among Puerto Ricans but not in the Northeast region.
Adolescent↗
Lung function decline and outcomes in an adult population.
RATIONALE: Chronic obstructive pulmonary disease (COPD) is an important cause of morbidity and mortality. OBJECTIVES: To determine risk factors for and outcomes of rapid lung function decline in a cohort of adults in the United States. METHODS: We analyzed data from 15,536 adults aged 44-66 yr in the Atherosclerosis Risk in Communities study. We used Cox proportional hazard models to determine the risk of rapid lung function decline at 3 yr on mortality and COPD hospitalizations over the subsequent 8 yr. MEASUREMENTS AND MAIN RESULTS: Of those in the baseline cohort, 13,756 (88.5%) had spirometry at the Year 3 visit. The strongest risk factors for not having a follow-up spirometry were as follows: having Global Initiative for Chronic Obstructive Lung Disease (GOLD) stage 3 or 4 disease at baseline (adjusted odds ratio [OR] 2.8; 95% confidence interval [CI], 2.1-3.8), being black (adjusted OR, 2.4; 95% CI, 2.1-2.7), and being a current smoker (adjusted OR, 1.8; 95% CI, 1.5-2.0). Participants with GOLD stage 3 or 4 disease were also more likely to be in the most rapidly declining lung function quartile (adjusted OR, 3.7; 95% CI, 2.7-5.0). Overall, participants with the most rapidly declining lung function had a modestly increased risk of death (adjusted hazard ratio, 1.4; 95% CI, 1.2-1.7) and time to a COPD-related hospitalization (adjusted hazard ratio, 1.4; 95% CI, 1.2-1.8). CONCLUSION: Rapid lung function decline was independently associated with a modest increased risk of COPD hospitalizations and deaths.
Adult↗
Tobacco and other drug use among high school students with asthma.
The 2003 national Youth Risk Behavior Survey data were analyzed to compare drug use among high school students with and without asthma. High school students with current asthma used cigarettes, cigars, marijuana, and inhalants (huffing) at rates equal to or greater than high school students without current asthma.
Adolescent↗
Global Initiative on Obstructive Lung Disease (GOLD) classification of lung disease and mortality: findings from the Atherosclerosis Risk in Communities (ARIC) study.
OBJECTIVE: To determine whether a modified Global Initiative on Obstructive Lung Diseases (GOLD) classification of chronic obstructive pulmonary disease (COPD) predicts mortality in a cohort of subjects followed for up to 11 years. METHODS: We analyzed data from 15,759 adult participants, aged 43-66 years at baseline, in the Atherosclerosis Risk in Communities (ARIC) study. All baseline and follow-up data were available for 15,440 (97.9%) of the initial participants. We classified subjects using a modification of the GOLD criteria for COPD (prebronchodilator forced expiratory volume in 1s (FEV(1)) stratification of disease severity), and added a "restricted" category (FEV(1)/FVC>70% and FVC<80% predicted). We used Cox proportional hazard models to determine the risk of impaired lung function on subsequent mortality, after adjusting for age, race, sex and smoking status. RESULTS: 1242 (8.0%) subjects died by the end of 1997. The overall rate of death was 8.9 per 1000 person years, but varied from 5.4/1000 among normal subjects to 42.9/1000 among subjects with GOLD Stage 3 or 4 COPD. After adjusting for covariates, all GOLD categories, along with the restricted category, predicted a higher risk of death: GOLD Stage 3 or 4, hazard ratio (HR) 5.7, 95% confidence interval (CI) 4.4, 7.3; GOLD Stage 2 HR 2.4, 95% CI 2.0, 2.9; GOLD Stage 1 HR 1.4, 95% CI 1.1, 1.6; GOLD Stage 0 HR 1.5, 95% CI 1.3, 1.8; and restricted HR 2.3, 95% CI 1.9, 2.8. CONCLUSION: The modified GOLD classification system of COPD predicts mortality in this cohort of middle-aged Americans followed for up to 11 years.
Adult↗
The effect of age on the development and outcome of adult sepsis.
OBJECTIVE: Sepsis is an increasingly common and lethal medical condition that occurs in people of all ages. The influence of age on sepsis risk and outcome is incompletely understood. We sought to determine the independent effect of age on the incidence, severity, and outcome of adult sepsis. DESIGN: Longitudinal observational study using national hospital discharge data. SETTING: Approximately 500 geographically separated nonfederal acute care hospitals in the United States. PATIENTS: Patients were 10,422,301 adult sepsis patients hospitalized over 24 yrs, from 1979 to 2002. INTERVENTIONS: None. MEASUREMENTS AND MAIN RESULTS: Incident sepsis cases were age adjusted and characterized by demographics, sources and types of infection, comorbid medical conditions, and hospital discharge status. Elderly patients (> or = 65 yrs of age) accounted for 12% of the U.S. population and 64.9% of sepsis cases, yielding a relative risk of 13.1 compared with younger patients (95% confidence interval, 12.6-13.6). Elderly patients were more likely to have Gram-negative infections, particularly in association with pneumonia (relative risk, 1.66; 95% confidence interval, 1.63-1.69) and to have comorbid medical conditions (relative risk, 1.99; 95% confidence interval, 1.92-2.06). Case-fatality rates increased linearly by age; age was an independent predictor of mortality in an adjusted multivariable regression (odds ratio, 2.26; 95% confidence interval, 2.17-2.36). Elderly sepsis patients died earlier during hospitalization, and elderly survivors were more likely to be discharged to a nonacute health care facility. CONCLUSIONS: The incidence of sepsis is disproportionately increased in elderly adults, and age is an independent predictor of mortality. Compared with younger sepsis patients, elderly nonsurvivors of sepsis die earlier during hospitalization and elderly survivors more frequently require skilled nursing or rehabilitative care after hospitalization. These findings have implications for patient care and health care resource prioritization and provide insights for expanded scientific investigations and potential patient interventions.
Adult↗
The role of infection and comorbidity: Factors that influence disparities in sepsis.
OBJECTIVE: Large healthcare disparities exist in the incidence of sepsis based on both race and gender. We sought to determine factors that may influence the occurrence of these healthcare disparities, with respect to the source of infection, causal organisms, and chronic comorbid medical conditions. DESIGN: Historical cohort study. SETTING: U.S. acute care hospitals from 1979 to 2003. PATIENTS: Hospitalized patients with a diagnosis of sepsis were identified from the National Hospital Discharge Survey per codes of the International Statistical Classification of Diseases, Ninth Revision (ICD-9CM). Chronic comorbid medical conditions and the source and type of infection were characterized by corresponding ICD-9CM diagnoses. INTERVENTIONS: None. MEASUREMENTS AND MAIN RESULTS: Sepsis incidence rates are mean cases per 100,000 after age adjustment to the 2000 U.S. Census. Males and nonwhite races were confirmed at increased risk for sepsis. Both proportional source distribution and incidence rates favored respiratory sources of sepsis in males (36% vs. 29%, p < .01) and genitourinary sources in females (35% vs. 27%, p < .01). Incidence rates for all common sources of sepsis were greater in nonwhite races, but proportional source distribution was approximately equal. After stratification by the source of infection, males (proportionate ratio 1.16, 95% confidence interval 1.04-1.29) and black persons (proportionate ratio 1.25, 95% confidence interval 1.18-1.32) remained more likely to have Gram-positive infections. Chronic comorbid conditions that alter immune function (chronic renal failure, diabetes mellitus, HIV, alcohol abuse) were more common in nonwhite sepsis patients, and cumulative comorbidities were associated with greater acute organ dysfunction. Compared with white sepsis patients, nonwhite sepsis patients had longer hospital length of stay (2.0 days, 95% confidence interval 1.9-2.1) and were less likely to be discharged to another medical facility (30% whites, 25% blacks, 18% other races). Case-fatality rates were not significantly different across racial and gender groups. CONCLUSIONS: Healthcare disparities exist in the incidence of sepsis within all major sources of infection, and males and blacks have greater frequency of Gram-positive infections independent of the infection source. The differential distribution of specific chronic comorbid medical conditions may contribute to these disparities. Large cohort and administrative studies are required to confirm discrete root causes of sepsis disparities.
Black or African American↗
The role of body mass index and diabetes in the development of acute organ failure and subsequent mortality in an observational cohort.
INTRODUCTION: Several studies have shown a correlation between body mass index (BMI) and both the development of critical illness and adverse outcomes in critically ill patients. The goal of our study was to examine this relationship prospectively with particular attention to the influence of concomitant diabetes mellitus (DM). METHODS: We analyzed data from 15,408 participants in the Atherosclerosis Risk in Communities (ARIC) study for this analysis. BMI and the presence of DM were defined at baseline. We defined 'acute organ failure' as those subjects who met a standard definition with diagnostic codes abstracted from hospitalization records. Outcomes assessed included the following: risk of the development of acute organ failure within three years of the baseline examination; in-hospital death while ill with acute organ failure; and death at three years among all subjects and among those with acute organ failure. RESULTS: At baseline, participants with a BMI of at least 30 were more likely than those in lower BMI categories to have DM (22.4% versus 7.9%, p < 0.01). Overall, BMI was not a significant predictor of developing acute organ failure. The risk for developing acute organ failure was increased among subjects with DM in comparison with those without DM (2.4% versus 0.7%, p < 0.01). Among subjects with organ failure, both in-hospital mortality (46.5% versus 12.2%, p < 0.01) and 3-year mortality (51.2% versus 21.1%, p < 0.01) was higher in subjects with DM. CONCLUSION: Our findings suggest that obesity by itself is not a significant predictor of either acute organ failure or death during or after acute organ failure in this cohort. However, the presence of DM, which is related to obesity, is a strong predictor of both acute organ failure and death after acute organ failure.
Acute Disease↗
The epidemiology of sepsis in patients with malignancy.
STUDY OBJECTIVES: To evaluate the longitudinal epidemiology of sepsis in patients with a history of cancer and to specifically examine sepsis-related disparities in risk or outcome. DESIGN: Sepsis cases from 1979 through 2001 using a nationally representative sample of nonfederal acute-care hospitalizations in the United States (the National Hospital Discharge Survey) integrated with cancer prevalence from the Surveillance, Epidemiology, and End Results database. SETTING: Eight hundred fifty-four million acute-care hospitalizations and 8.9 million patients with cancer. PATIENTS OR PARTICIPANTS: Patients with a history of cancer hospitalized with a diagnosis of sepsis. MEASUREMENTS AND RESULTS: From 1979 to 2001, there were a total of 1,781,445 cases of sepsis in patients with cancer, yielding a mean annual incidence rate of 1,465 cases per 100,000 cancer patients and a relative risk [RR] of 9.77 compared to noncancer patients (95% confidence interval [95% CI], 9.67 to 9.88). In contrast to the absolute number of cases, the incidence rate of sepsis decreased over time, from a peak of 1,959 cases per 100,000 cancer patients in 1987 to 995 cases per 100,000 in 2001. The distribution of infectious sources causing sepsis was associated with the type of malignancy. White cancer patients had a lower risk for sepsis compared to nonwhites (African-American RR, 1.28; 95% CI, 1.16 to 1.40) and other races (RR, 1.47; 95% CI, 1.22 to 1.72); and male cancer patients had a higher risk for sepsis compared to female cancer patients (male RR, 1.17; 95% CI, 1.10 to 1.23). Cancer was an independent predictor of death among sepsis patients by multivariable analysis (adjusted odds ratio for death, 1.98; 95% CI, 1.97 to 1.99). CONCLUSIONS: Patients with a history of cancer are at increased risk for acquiring and subsequently dying from sepsis, compared to the general population, although incidence and fatality rates are decreasing over time. There are significant racial and gender disparities in the incidence and outcome of sepsis among cancer patients that require explanation.
Black or African American↗
GOLD stage 0 COPD: is it real? Does it matter?
Explore the source record for details and available documents.
Disease Progression↗
Respiratory symptoms: a reason to obtain spirometry.
Explore the source record for details and available documents.
Humans↗
"Haeso cheonsik" and chronic obstructive pulmonary disease in Korea.
Explore the source record for details and available documents.
Humans↗
Does insomnia kill?
STUDY OBJECTIVES: We investigated the prevalence and hazard ratios for insomnia complaints in a large cohort of middle-aged men and women. DESIGN: The Atherosclerosis Risk in Communities Study is a prospective study of cardiovascular disease. Using multivariate regression analysis, we predicted the likelihood of endorsing the insomnia complaints by age, sex, alcohol intake, smoking, diabetes, heart disease, menopausal status, use of hypnotics, hypertension, depressive symptoms, education level, body mass index, respiratory symptoms, and pulmonary function status. We predicted the hazard ratios (HR) of death at 6.3 +/- 1.1 year by endorsement of insomnia complaints and by hypnotic use controlling for covariates. SETTING: North American communities. PARTICIPANTS: 13563 participants aged 45 to 69 years at baseline INTERVENTIONS: None. MEASUREMENTS AND RESULTS: The prevalence of insomnia complaints in this cohort was 23%. Predictors of insomnia complaints were female sex (odds ratio [OR] 0.56, 95% confidence interval [CI] 0.45-0.70 for men), annual family income below 50,000 dollars (OR 1.23, CI 1.09-1.40), age 40 to 49 years (OR 1.29, CI 1.11-1.50), depressive symptoms (OR 5.05, CI 4.60-5.55), heart disease (OR 1.89, CI 1.67-2.14), severe airflow obstruction (OR 1.61, CI 1.17-2.22), pulmonary symptoms (OR 1.71, CI 1.5-1.95), and restrictive lung disease (OR 1.27, CI 1.10-1.47). After controlling for covariates, insomnia complaints were not associated with an increased risk for death (OR 1.01, CI 0.85-1.21), nor was the use of hypnotics (OR 1.38, CI 0.90-2.13). CONCLUSIONS: In this cohort, the prevalence of insomnia complaints was 23%. After controlling for confounders, neither insomnia complaints nor hypnotic use predicted increased mortality over 6.3 years.
Aged↗
Impact factor, impact, and smoke and mirrors.
Explore the source record for details and available documents.
Bibliometrics↗
Alcohol intake is associated with altered pulmonary function.
Little is known about the effect of moderate alcohol intake on lung function in the general population. Because moderate alcohol intake appears to reduce cardiovascular disease risk, we hypothesized that moderate alcohol intake is associated with better pulmonary function. To test this hypothesis, we examined the association between alcohol intake and pulmonary function, measured by spirometry, in a representative sample of U.S. adults who participated in the Third National Health and Nutrition Examination Survey. A stratified multistage clustered probability design was used to select a population-based sample. Data analyzed included alcohol intake, smoking status, education, body mass, sex, age, race, diabetes status, and CHF status. The Third National Health and Nutrition Examination Survey was conducted from 1988 to 1994 by the National Center for Health Statistics of the Centers for Disease Control and Prevention, Atlanta, GA. We analyzed data from 15,294 study participants who completed extensive questionnaires in the household and a comprehensive physical examination, including pulmonary function testing, either in the household or at a specially equipped mobile examination center. Low-to-moderate alcohol intake was not associated with reduced odds of obstructive lung function. In fact, increased odds for obstructive lung pattern were observed only in former heavy drinkers. In contrast, low-to-moderate alcohol intake was associated with better forced vital capacity and forced exhaled volume in 1s in the absence of obstruction, consistent with reduced odds for lung restriction. Using a logistic regression model, we found that individuals reporting alcohol consumption had a lower risk of lung restriction both before and after adjusting for confounding factors including smoking (P< or =.001). Alcohol intake-related reduced risk for restriction was associated with lower risk of CHF, diabetes, obesity, and lower markers of inflammation (white blood cell, fibrinogen, and C-reactive protein) consistent with less lung congestion, external restriction, and/or lung inflammation. Our analyses indicate that alcohol consumption, even at very modest intake levels, is associated with less lung restriction.
Adolescent↗
Cardiorespiratory hospitalizations associated with smoke exposure during the 1997, Southeast Asian forest fires.
We investigated the cardiorespiratory health effects of smoke exposure from the 1997 Southeast Asian Forest Fires among persons who were hospitalized in the region of Kuching, Malaysia. We selected admissions to seven hospitals in the Kuching region from a database of all hospital admissions in the state of Sarawak during January 1, 1995 and December 31, 1998. For several cardiorespiratory disease classifications we used Holt-Winters time-series analyses to determine whether the total number of monthly hospitalizations during the forest fire period (August 1 to October 31, 1997), or post-fire period (November 1, 1997 to December 31, 1997) exceeded forecasted estimates established from a historical baseline period of January 1, 1995 to July 31, 1997. We also identified age-specific cohorts of persons whose members were admitted for specific cardiorespiratory problems during January 1 to July 31 of each year (1995--1997). We compared Kaplan-Meier survival curves of time to first readmission for the 1997 cohorts (exposed to the forest fire smoke) with the survival curves for the 1995 and 1996 cohorts (not exposed, pre-fire cohorts). The time-series analyses indicated that statistically significant fire-related increases were observed in respiratory hospitalizations, specifically those for chronic obstructive pulmonary disease (COPD) and asthma. The survival analyses indicated that persons over age 65 years with previous hospital admissions for any cause (chi2(1df) = 5.98, p = 0.015), any cardiorespiratory disease (chi2(1df) = 5.3, p = 0.02), any respiratory disease (chi2(1df) = 7.8, p = 0.005), or COPD (chi2(1df) = 3.9, p = 0.047), were significantly more likely to be rehospitalized during the follow-up period in 1997 than during the follow-up periods in the pre-fire years of 1995 or 1996. The survival functions of the exposed cohorts resumed similar trajectories to unexposed cohorts during the post-fire period of November 1, 1997 to December 31, 1998. Communities exposed to forest fire smoke during the Southeast Asian forest fires of 1997 experienced short-term increases in cardiorespiratory hospitalizations. When an air quality emergency is anticipated, persons over age 65 with histories of respiratory hospitalizations should be preidentified from existing hospitalization records and given priority access to interventions.
Adolescent↗
Epidemiology and global impact of chronic obstructive pulmonary disease.
Chronic obstructive pulmonary disease (COPD) is a preventable and treatable disease that causes a heavy health and increasing economic burden both in the United States and around the world. Most of the risk factors for COPD are well known and include smoking, occupational exposures, air pollution, airway hyperresponsiveness, asthma, and certain genetic variations, although many questions, such as why a minority of smokers develop significant airway obstruction, remain. Major medical organizations have agreed on a common definition of COPD, although newer measures, such as functional status or exercise capability, have emerged as important in determining the prognosis of COPD patients. In most of the world, COPD prevalence and mortality are still increasing and will likely continue to rise in response to increases in smoking, particularly by women and adolescents. Resources aimed at smoking cessation and prevention, COPD education and early detection, and better treatment will be of the most benefit in our continuing efforts against this important cause of morbidity and mortality.
Bronchitis, Chronic↗
Active and passive smoking and blood lead levels in U.S. adults: data from the Third National Health and Nutrition Examination Survey.
Lead is a component of tobacco and tobacco smoke. We examined the relationship between current, former, and passive smoking and blood lead levels in a nationally representative sample of 16,458 U.S. adults, aged 17 years or older, who participated in the Third National Health and Nutrition Examination Survey (1988-1994). We used linear and logistic regression modeling, adjusting for known covariates, to determine the relationship between smoking and blood lead levels. Geometric mean blood lead levels were 1.8 microg/dl, 2.1 microg/dl, and 2.3 microg/dl in never-smokers with no, low, and high cotinine levels, respectively. Levels were 2.9 microg/dl in former smokers and 3.5 microg/dl in current smokers. The adjusted linear regression model showed that geometric mean blood lead levels were 30% higher (95% CI = 24%-36%) in adults with high cotinine levels than they were in those with no detectable cotinine. Active and passive smoking is associated with increased blood lead levels in U.S. adults.
Adolescent↗