American Journal of Medicine最新文献

Introduction: Social determinants of health are key factors driving disease progression. In type 2 diabetes there is limited literature on how distal or intermediate factors (e.g., those at the neighborhood level) influence cause-specific mortality or liver disease outcomes.

Methods: This was a single-center retrospective study of patients with type 2 diabetes seen at an integrated healthcare system in the United States. The primary outcomes were overall mortality; death due to cardiovascular disease, cancer, or liver disease; or hepatic decompensation. The primary predictors were neighborhood-level (intermediate) factors measuring neighborhood poverty (Area Deprivation Index [ADI], affluence score, disadvantage score) and rurality (Rural-Urban Commuting Area scores). Associations were modeled using Cox proportional hazards or Fine-Grey competing risk models.

Results: 28,424 participants were included. Higher neighborhood poverty associated with increased overall mortality, with hazard ratio (HR) 1.11 (95% confidence interval 1.10-1.12, p<0.001) per 10 points of ADI and HR 1.32 (95% CI 1.26-1.37, p<0.001) for 10 points of disadvantage. Conversely, higher neighborhood affluence associated with lower overall mortality with HR 0.87 (95% CI 0.86-0.89, p<0.001) per 10 points of affluence. Living in a rural region associated with increased overall mortality: HR 1.08 (95% CI 1.01-1.15, p=0.031). Associations were consistent across cause-specific mortality, though effect sizes were larger for liver-related mortality than for other causes. Living in a more rural neighborhood was associated with increased risk of hepatic decompensation.

Conclusions: Intermediate neighborhood-level socioeconomic status was associated with overall and cause-specific mortality in type 2 diabetes, with larger effects on liver-related mortality than other causes.

Background: Amiodarone is a widely used antiarrhythmic agent with significant toxicities and drug interactions more likely to affect older adults. Nevertheless, data regarding amiodarone safety in this population are limited.

Methods: We conducted a retrospective analysis of FDA Adverse Event Reporting System (FAERS) data from 2003 to 2024 . Reports with amiodarone as the primary suspect were compared to other antiarrhythmics (sotalol, dronedarone, flecainide, propafenone, dofetilide). Disproportionality analysis assessed reporting odds ratios (RORs) for predefined adverse events in adults (<75 years) and older adults (≥75 years). Interaction analysis evaluated differences between age groups.

Results: Among 9,196 amiodarone FAERS reports, 4,129 (44.9%) involved older adults. Hyperthyroidism (ROR 39.1, 95% CI [25-61] and ROR of 23.4 [11-49.8]) and hypothyroidism (ROR 36.9 [15.2-89.8] and ROR 24.5 [11.5-52.1]) were substantially over-reported in amiodarone users among both adults and older adults, respectively. Drug-induced liver injury and peripheral neuropathy were also over-reported without a significant age interaction. Interstitial lung disease was reported more frequently in amiodarone users overall, with significantly higher reporting in older adults (ROR 11.4 [6.9-18.6] vs. 4.9 [3.4-7.0], P_interaction=0.007). Bradycardia was also over-reported in older adults compared to adults (ROR 1.6 [1.3-2] vs. 1.0 [0.8-1.3], P_interaction=0.003). Torsades de Pointes/QT prolongation were less frequently reported in both age groups.

Conclusions: In this global postmarketing study, interstitial lung disease and bradycardia were more frequently reported in older adults treated with amiodarone. These findings support vigilant monitoring for these adverse events, particularly in older patients.

Purpose: To verify whether the trend of AMI mortality throughout the different months of the year may have recently changed in the US due to the coronavirus disease 2019 (COVID-19) pandemic and climate changes.

Methods: We examined monthly mortality trends for acute myocardial infarction (AMI) in the U.S. from 2018 to 2022 by conducting an electronic search of the latest version of the CDC Wonder (Wide-Ranging, Online Data for Epidemiologic Research) online database. We calculated and analyzed the mean and standard deviation (SD) of cumulative AMI deaths each month from 2018 to 2022.

Results: We observed a notable seasonal pattern, with mortality peaking in December and January and dropping from June to September. AMI-related deaths were significantly higher in January compared to other months, except December, with no significant difference between December and January (p = 0.868). The lowest mortality rates were observed in summer, with a marked decline between March and September. Statistically, the monthly variation in mean AMI deaths was significant (ANOVA, f = 13.1, p < 0.001).

Conclusion: Healthcare systems should allocate resources effectively during winter to manage this seasonal burden.

We examined data from 17,498 physicians-in-training who reported on 92,662 months of work over a 20 year study interval that included three major revisions to work hour limits. Extended duration shifts (≥24 hours; EDS) are much less common than they used to be. On average, first-year resident physicians (PGY1s) currently work a total of 4 EDS per year and 3 EDS per month during months in which any EDS are worked. This is in stark contrast to the experience of PGY1s training in the early 2000s when the average was approximately one EDS per week over the year. More senior resident physicians (PGY2+) have observed concurrent reductions despite their exclusion from the ACGME guidelines limiting EDS. Resident physicians across all levels of training in surgical programs continue to work more EDS than those in medical programs. Similarly, resident physicians on Intensive Care Unit (ICU) rotations work these shifts more frequently compared to other rotations.

Objective: Gastrointestinal (GI) cancers account for one-third of global cancer mortality, with nearly half being preventable. This study updates the global burden of GI cancers attributed to major risk factors: smoking, alcohol, and metabolic disturbances.

Methods: We utilized data from the Global Burden of Disease Study 2021 to examine trends in death and age-standardized death rates related to GI cancers caused by smoking, alcohol, high body mass index (BMI), and high fasting blood glucose (FBG) from 2000 to 2021. Trends were analyzed based on countries' developmental status using a sociodemographic index (SDI).

Results: In 2021, there were 1.12 million GI cancer deaths related to smoking, alcohol, high BMI, and high FBG, which was 53.6% higher than in 2000. The largest proportion of GI cancer mortality was attributed to smoking (43.3%), followed by alcohol (20.6%), high FBG (20.5%), and high BMI (15.6%). The increases in GI cancer deaths between 2000 and 2021 were related to high BMI (+102.54%) and FBG (+107.69%), particularly in liver and pancreatic cancer. In 2021, GI cancer mortality in low, low-middle, and middle SDI countries represented 44.3% of the global GI cancer mortality attributed to smoking, 41.9% for alcohol, 34.3% for high BMI, and 31.6% for high FBG. Since 2000, these proportions have increased by +4.5% for smoking, +7.6% for alcohol, +12.3% for high BMI, and +6.4% for high FBG.

Conclusion: From 2000 to 2021, GI cancer mortality increased substantially, driven primarily by obesity and alcohol. Lower SDI countries are increasingly contributing to the global GI cancer mortality burden. Immediate interventions are necessary to mitigate this growing burden.

Background: A wide array of products in the category of complementary or alternative medicine products for cardiovascular disease and prevention are readily available on online retail platforms. However, a critical assessment of these products including their therapeutic claims has not been previously performed.

Methods: "Heart failure supplement" and similar terms were entered into the Amazon.com search engine and all medication products including claims, content and formulations were individually evaluated.

Results: We identified 111 products, most of which lack safety information; include on average 8.2 ingredients; and cost $27.60 per order (median). Most were in capsule form (58.6%) and the most common ingredient was Co-Enzyme Q10. All included a legal disclaimer; physician testimonials were included in only 3 product listings.

Conclusions: Given the popularity of and easy accessibility to online retailing of complementary and alternative medicine and the fact that prior studies suggest a minority of patients discuss use with their providers, further study is needed to evaluate the extent of use and the potential for both undiagnosed drug-drug interactions and/or replacement of guideline-directed medical treatment for heart failure with unapproved products.