Mayo Clinic proceedings最新文献

Objective: To examine demographic and regional variations in self-injury mortality (SIM) among individuals aged 15 years or older in the United States with mental and behavioral disorders as contributing causes of death from 1999 to 2023.

Methods: Death certificates from the CDC-WONDER (Centers for Disease Control and Prevention Wide-Ranging Online Data for Epidemiologic Research) database were examined from January 1, 1999, through December 31, 2023, to identify SIM (suicides and drug self-intoxication-related deaths) among individuals with mental and behavioral disorders. Age-adjusted mortality rates (AAMRs) per 100,000 persons were calculated, and temporal trends were described by calculating annual percent change and average annual percentage change (AAPC) using joinpoint regression analysis.

Results: From 1999 to 2023, a total of 639,462 SIM-related deaths were recorded among individuals with mental and behavioral disorders in the United States. The AAMR increased from 2.22 in 1999 to 24.75 in 2023 with an AAPC of 10.17% (95% CI, 9.57% to 11.27%; P<.001). Drug self-intoxication mortality (AAPC, 11.85%) increased at over 5 times the rate of suicide mortality (AAPC, 2.25%) during this period. Around 90% of these deaths were recorded among individuals with substance use disorders. Men had higher mortality rates than women, with AAMRs increasing from 3.50 in 1999 to 35.74 in 2023 among males and from 1.01 to 13.69 in females over the study period. Non-Hispanic Black individuals had the highest AAMR, which increased from 2.70 in 1999 to 41.58 in 2023, followed by non-Hispanic White persons and Hispanic or Latino groups. The Northeast region had the highest SIM-related mortality (32.15 in 2023), and urban areas had higher AAMR than rural areas (21.22 vs 18.51 in 2020).

Conclusion: Self-injury mortality among individuals with mental and behavioral disorders-especially those with substance use disorders-has steadily increased from 1999 to 2023. This rise has been driven primarily by a sharp increase in drug self-intoxication mortality, which has grown at over 5 times the rate of suicide mortality, alongside substantial demographic disparities.

Objective: To determine the clinicoradiologic features and clinical outcomes associated with intrathoracic Erdheim-Chester disease (ECD).

Patients and methods: Electronic medical records of all consecutive patients with ECD encountered at Mayo Clinic from January 2005 to August 2024 were reviewed. Twenty-four patients were included. Treatment response was defined by the Response Evaluation Criteria in Solid Tumors and metabolic response on follow-up positron emission tomography scans. Survival analyses were performed from time of intrathoracic ECD diagnosis.

Results: Median age at diagnostic biopsy was 65 years (range, 43-79 years) and pleuropulmonary/mediastinal biopsy provided the first diagnosis of ECD in 77.8% of patients. Most patients (95.8%) were symptomatic. The BRAF^V600E pathogenic variant or BRAF gene fusions were identified in 58.3% of patients. Common radiographic findings included ground-glass opacities (91.7%), interlobular septal thickening (79.2%), pulmonary nodules (70.8%), and pleural abnormalities (66.7% to 70.8%). Pulmonary function testing revealed predominantly restrictive patterns (40.0%). Diffusion capacity of the lungs for carbon monoxide was almost always reduced (median: 56.5% of predicted; range, 25.0% to 106.0%). Complete response was 10.5%, partial response was 10.5%, and objective response rate was 21.0%. Stable disease and progressive disease were noted in 57.9% and 21.1%, respectively. Median overall survival was 10.9 years (95% CI, 5.5-undefined) and estimated 5-year survival was 85.0%.

Conclusion: Erdheim-Chester disease causes symptomatic pleuropulmonary disease, which may be the initial presenting feature. Erdheim-Chester disease characteristically manifests interlobular septal thickening with ground-glass and/or small nodular opacities, often combined with pleural thickening and/or pleural effusions. Targeted therapy may provide durable therapeutic responses.

Objective: To evaluate cardiovascular benefits associated with sustained intensive and moderate interventions targeting body mass index (BMI), systolic blood pressure (SBP), fasting blood glucose (FBG) level, and total cholesterol (TC) concentration.

Methods: Using longitudinal data (from June 2006-October 2007 to December 2017) of 94,661 cardiovascular disease (CVD)-free participants aged 30 years and older from the Kailuan cohort, we emulated a target trial to assess the long-term effectiveness of intensive (BMI <25 kg/m², SBP <120 mm Hg, FBG <5.6 mmol/L, TC <5.2 mmol/L) and moderate (BMI <30 kg/m², SBP <140 mm Hg, FBG <7.0 mmol/L, TC <6.2 mmol/L) interventions on 10-year risk of incident CVD. The target trial emulation framework with the parametric g-formula was used to simulate counterfactual outcomes under dynamic interventions, accounting for time-varying confounders and competitive events.

Results: Compared with the natural course CVD risk of 6.48%, intensive interventions yielded a 49% decrease in relative risk (risk ratio, 0.51; 95% CI, 0.49 to 0.54), translating to approximately 3 fewer CVD cases per 100 individuals during 10 years (absolute risk reduction, -3.15%; 95% CI, -3.36% to -2.98%), which extended the restricted mean CVD-free time from 9.32 to 9.51 years. Of all the individual risk factors, SBP control yielded the largest benefits. Notably, even moderate interventions produced a 25% relative reduction in CVD risk, with the average proportion intervened on decreasing from 74.8% to 37.6%. Greater absolute risk reductions were observed in male participants and adults aged 60 years and older.

Conclusion: Long-term interventions addressing cardiometabolic risk factors have considerable public health implications for primary prevention of CVD in China and other Western Pacific countries, where suboptimal cardiometabolic risk profiles remain prevalent.

Objectives: To compare the clinical profile and outcomes after heart failure (HF) hospitalization in adults with and without congenital heart disease.

Methods: Leveraging a national database of commercially insured and Medicare Advantage patients in the United States, this study included patients hospitalized for HF with adult congenital heart disease (ACHD+) and without adult congenital heart disease (ACHD-) between January 1, 2010, and December 31, 2021. The association of baseline characteristics with mortality, major adverse cardiac and cerebrovascular events (MACCE), and health resource utilization was examined using cox proportional hazard regressions.

Results: Of 287,616 unique HF admissions, 5805 (2%) were ACHD+ and 281,811 (98%) were ACHD-. Over a mean follow-up period of 1.98±2.04 years, ACHD+ patients had a lower risk of mortality (HR, 0.74; 95% CI, 0.69 to 0.80; P<.001), MACCE (HR, 0.93; 95% CI, 0.89 to 0.97; P=.002), and rehospitalization (HR, 0.91; 95% CI, 0.88 to 0.95; P<.001). One-third (32.6%) of ACHD+ patients experienced a MACCE during follow-up, most commonly due to atrial fibrillation (n=939; 16.1%), recurrent HF (n=696; 12.0%), stroke (n=398; 6.8%) or intracranial bleed (n=102; 1.8%), myocardial infarction (n=276; 4.8%), and cardiac arrest (n=176; 3.0%).

Conclusion: Compared with the general HF population, ACHD patients had substantially lower mortality risk after HF hospitalization. Despite this, the risk of complications following HF hospitalization was high, reinforcing the importance of discharge planning and post-acute care for improving outcomes in ACHD HF patients.

Objective: To describe the establishment and initial experience of a multidisciplinary Alzheimer disease treatment clinic (ADTC), focusing on the evaluation of eligibility for novel disease-modifying therapies, as well as the treatment and monitoring of qualifying patients.

Patients and methods: We completed a retrospective review of cases seen through the Mayo Clinic ADTC between October 2, 2023, and December 31, 2024. Typical evaluations occurred over 4 to 5 days and included multimodal testing, office visits, and a weekly case conference modeled on tumor board meetings.

Results: Patients evaluated in the ADTC (N=232) ranged from 52 to 85 years of age (mean age, 71.2 years). Most patients had mild cognitive impairment (128 of 232 [55%]) or mild dementia (72 of 232 [31%]) syndromes. Overall, 121 patients (52%) were judged eligible for antiamyloid therapy. Eligibility rates were higher among internal (from our institution) referrals compared with external referrals (63% [146 of 232] vs 37% [86 of 232). Reasons for treatment ineligibility were typically multiple but commonly included magnetic resonance imaging features, too severe cognitive/functional impairment, and general health conditions believed likely to increase therapeutic risks. In some cases, the ADTC evaluation uniquely identified treatment risk factors, such as cerebral amyloid angiopathy, that had not been previously discussed with patients. Through shared decision making, approximately 30% of eligible patients (25 of 81) ultimately deferred antiamyloid therapy. In addition, approximately 10% of patients evaluated in the ADTC were amyloid-negative by positron emission tomography, suggesting non-Alzheimer disease diagnoses for their presentations.

Conclusion: The ADTC facilitated systematic implementation of antiamyloid therapies for early Alzheimer disease and provided a scalable foundation for integrating future approved treatment options.

Objective: To identify factors associated with complementary and alternative medicine (CAM) use, investigate regional patterns, and examine whether CAM usage is associated with decreased expenditures in conventional medicine (CM).

Participants and methods: We conducted a retrospective analysis of Swiss health insurance claims data from January 1, 2017, to December 31, 2021, including mandatory health insurance (MHI) and supplementary insurance (SI) schemes. We analyzed 816,080 person-years from 205,423 Swiss residents with dual coverage using 2-part multilevel models and geographic clustering analyses.

Results: CAM utilization differed markedly between schemes: 59% (481,176 of 816,080) used CAM (SI) while 2.2% (18,023) used CAM (MHI). Women had nearly double the odds of CAM (MHI) usage (adjusted odds ratio, 1.97; P<.001) and 56% higher odds of CAM (SI) usage (adjusted odds ratio, 1.56; P<.001). Higher socioeconomic status was associated with dose-response relationships, with increased usage across both schemes. Substantial geographic variations emerged, with French-speaking regions having 33% lower odds of CAM (MHI) usage (adjusted odds ratio, 0.67; P<.001) yet 26.6% higher expenditures (P<.001) among users. CAM users initially incurred 49.1% higher CM expenditures, but this gap narrowed to 34.2% by year 5, representing a 14.9 percentage point convergence. This pattern was most pronounced among individuals without chronic conditions based on medication patterns (CAM MHI: 139.7% to 20.1% difference) and patients with cancer (CAM SI: expenditure differences shifted from +13.9% to -5.9%).

Conclusion: CAM serves distinct populations through different insurance schemes, with initial higher CM costs but slower expenditure growth over time. These findings suggest expenditure patterns that warrant further mechanistic investigation to optimize integrative health care delivery.