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Aims/hypothesisThe aim of the study was to describe trends in all-cause and cause-specific mortality rates in Hong Kong Chinese people with diabetes from 2001 to 2016.MethodsThe Hong Kong Diabetes Surveillance Database (HKDSD) is a territory-wide diabetes cohort identified from the Hong Kong Hospital Authority electronic medical record system. Deaths between 2001 and 2016 were identified from linkage to the Hong Kong Death Registry. We used Joinpoint regression analysis to describe mortality patterns among people with diabetes by age and sex, and standardised mortality ratios (SMRs) to compare all-cause mortality rates in people with and without diabetes.ResultsBetween 2001 and 2016, a total of 390,071 men and 380,007 women aged 20 years or older with diabetes were included in the HKDSD. There were 96,645 deaths among men and 88,437 deaths among women. Mortality rates for all-cause, cardiovascular disease and cancer among people with diabetes declined by 52.3%, 72.2% and 65.1% in men, respectively, and by 53.5%, 78.5% and 59.6% in women, respectively. Pneumonia mortality rates remained stable. The leading cause of death in people with diabetes has shifted from cardiovascular disease to pneumonia in the oldest age group, with cancer remaining the most common cause of death in people aged 45–74 years. The all-cause SMRs for men declined from 2.82 (95% CI 2.72, 2.94) to 1.50 (95% CI 1.46, 1.54), and for women, they declined from 3.28 (95% CI 3.15, 3.41) to 1.67 (95% CI 1.62, 1.72). However, among people aged 20–44 years, the declines in all-cause mortality rates over the study period were not statistically significant for both men (average annual per cent change [AAPC]: −3.2% [95% CI −7.3%, 1.0%]) and women (AAPC: −1.2% [95% CI −6.5%, 4.4%]). The SMRs in people aged 20−44 years fluctuated over time, between 7.86 (95% CI 5.74, 10.5) in men and 6.10 (95% CI 3.68, 9.45) in women in 2001, and 4.95 (95% CI 3.72, 6.45) in men and 4.92 (95% CI 3.25, 7.12) in women in 2016.Conclusions/interpretationAbsolute and relative mortality has declined overall in people with diabetes in Hong Kong, with less marked improvements in people under 45 years of age, calling for urgent action to improve care in young people with diabetes.

Background Glycemic control is crucial in peritoneal dialysis (PD) patients with diabetes. Although fasting blood glucose (FBG) is the most commonly used index to measure blood glucose levels, there is currently no evidence supporting the association between FBG level and mortality risk in PD patients. Methods A total of 3548 diabetic PD patients between 2002 and 2018 were enrolled from the National Health Insurance Service database of Korea. We investigated the association between FBG levels and the risk of all‐cause and cause‐specific mortality. Results Patients with FBG levels 80–99 mg/dL exhibited the highest survival rates, whereas those with FBG levels ≥180 mg/dL had the lowest survival rates. Compared with FBG levels 80–99 mg/dL, the adjusted hazard ratios and 95% confidence interval for all‐cause mortality significantly increased as follows: 1.02 (0.87–1.21), 1.41 (1.17–1.70), 1.44 (1.18–2.75), and 2.05 (1.73–2.42) for patients with FBG 100–124 mg/dL, FBG 125–149 mg/dL, FBG 150–179 mg/dL, and FBG ≥180 mg/dL, respectively. The risk for all‐cause mortality also showed an increasing pattern in patients with FBG levels <80 mg/L. The risk of cardiovascular death significantly increased as FBG levels exceeded 125 mg/dL. However, the risk of infection‐related and malignancy‐related deaths did not show a significant increase with increasing FBG levels. Conclusion There was an increase in the risk of all‐cause mortality as FBG levels exceeded 125 mg/dL in PD patients with diabetes, and the risk of cardiovascular death showed a strong correlation with FBG levels compared with other causes of death. Highlights A clear association was observed between FBG levels and the risk of all‐cause mortality in PD patients, indicating that FBG is a significant indicator for quantifying the risk of all‐cause mortality in these patients. Although a higher FBG level was significantly associated with an increased risk of cardiovascular‐related death, there was no notable increase in the risk of death from cancer or infections as the FBG levels increased.

Background Numerous studies support the association of exercise training, physical activity (PA) and sedentary behaviour (SB) with both mortality and morbidity outcomes. The results across studies have been inconsistent, and no umbrella reviews have yet been conducted on this topic. Methods We conducted an umbrella review of meta‐analyses of observational studies by screening articles in PubMed/MEDLINE, EMBASE and Web of Science databases from inception to 30 April 2024. Quality appraisal of each included meta‐analysis was done using the AMSTAR 2 tool, with evidence certainty evaluated based on statistical significance, study size, heterogeneity, small‐study effects, prediction intervals (PI) and potential biases. Results Frothy‐eight meta‐analyses were included (AMSTAR 2 ratings: high 25, moderate 10, low 2 and critically low 11). No evidence was highly suggestive or convincing. Suggestive evidence linked any PA and SB to lower and higher risks of all‐cause, cardiovascular and cancer mortality. Suggestive evidence indicated a significant association between self‐reported and device‐measured total PA (equivalent odds ratio [eOR] 0.78 [0.70–0.86] and eHR = 0.50 [0.38–0.65], respectively), self‐reported leisure time PA (eHR = 0.73 [0.66–0.80]), device‐measured daily steps (eHR = 0.44 [0.35–0.56]) and aerobic plus resistance training (eHR = 0.60 [0.56–0.64]) with lower all‐cause mortality. Weak evidence supported links between self‐reported and device‐measured SB and higher mortality (eHR = 1.3 [1.22–1.38] and eHR = 2.16 [1.09–4.28], respectively). Suggestive evidence was noted for the association between self‐reported leisure time PA (eHR = 0.74 [0.69–0.80]) and resistance training (eHR = 0.82 [0.81–0.84]) with cardiovascular mortality. Suggestive evidence was also found for the association between self‐reported leisure time PA (eHR = 0.87 [0.83–0.91]) with cancer mortality. Associations between self‐reported running time and mortality from all causes, cardiovascular diseases (CVD) and cancer did not reach statistical significance nor did the association between low skeletal muscle mass and all‐cause mortality. Meta‐regression analyses showed that physical activity reduces mortality risk, with age reducing the protective effects against all‐cause, CVD and cancer mortality. We also found that combined exercise training (aerobic plus resistance) most effectively reduces all‐cause and CVD mortality. Conclusions Converging evidence supports that physical activity and sedentary behaviour are associated with lower and higher rates of all‐cause, cardiovascular and cancer mortality. More high‐quality prospective studies are needed for a better understanding of the associations between running time and also TV‐viewing time and health‐related outcomes.

Although most drugs currently approved are meant to treat specific diseases or symptoms, it has been hypothesized that some might bear a beneficial effect on lifespan in healthy older individuals, outside of their specific disease indication. Such drugs include, among others, metformin, SGLT2 inhibitors and rapamycin. Since 2006, the UK biobank has recorded prescription medication and mortality data for over 500′000 participants, aged between 40 and 70 years old. In this work, we examined the impact of the top 406 prescribed medications on overall mortality rates within the general population of the UK. As expected, most drugs were linked to a shorter lifespan, likely due to the life‐limiting nature of the diseases they are prescribed to treat. Importantly, a few drugs were associated with increased lifespans, including notably Sildenafil, Atorvastatin, Naproxen and Estradiol. These retrospective results warrant further investigation in randomized controlled trials. The UK Biobank has collected data on prescription medications and mortality for over 500,000 participants aged 40–70 years. We analyzed the effects of the top 406 prescribed medications on overall mortality rates in the general population. Most drugs were linked to a shortened lifespan, likely due to the life‐limiting nature of the diseases they are prescribed to treat. However, a few medications, notably Sildenafil, Atorvastatin, Naproxen, and Estradiol, were associated with increased lifespans.

Background Although nut consumption has been associated with a reduced risk of cardiovascular disease and all-cause mortality, data on less common causes of death has not been systematically assessed. Previous reviews missed several studies and additional studies have since been published. We therefore conducted a systematic review and meta-analysis of nut consumption and risk of cardiovascular disease, total cancer, and all-cause and cause-specific mortality. Methods PubMed and Embase were searched for prospective studies of nut consumption and risk of cardiovascular disease, total cancer, and all-cause and cause-specific mortality in adult populations published up to July 19, 2016. Summary relative risks (RRs) and 95% confidence intervals (CIs) were calculated using random-effects models. The burden of mortality attributable to low nut consumption was calculated for selected regions. Results Twenty studies (29 publications) were included in the meta-analysis. The summary RRs per 28 grams/day increase in nut intake was for coronary heart disease, 0.71 (95% CI: 0.63–0.80, I 2  = 47%, n  = 11), stroke, 0.93 (95% CI: 0.83–1.05, I 2  = 14%, n  = 11), cardiovascular disease, 0.79 (95% CI: 0.70–0.88, I 2  = 60%, n  = 12), total cancer, 0.85 (95% CI: 0.76–0.94, I 2  = 42%, n  = 8), all-cause mortality, 0.78 (95% CI: 0.72–0.84, I 2  = 66%, n  = 15), and for mortality from respiratory disease, 0.48 (95% CI: 0.26–0.89, I 2  = 61%, n  = 3), diabetes, 0.61 (95% CI: 0.43–0.88, I 2  = 0%, n  = 4), neurodegenerative disease, 0.65 (95% CI: 0.40–1.08, I 2  = 5.9%, n  = 3), infectious disease, 0.25 (95% CI: 0.07–0.85, I 2  = 54%, n  = 2), and kidney disease, 0.27 (95% CI: 0.04–1.91, I 2  = 61%, n  = 2). The results were similar for tree nuts and peanuts. If the associations are causal, an estimated 4.4 million premature deaths in the America, Europe, Southeast Asia, and Western Pacific would be attributable to a nut intake below 20 grams per day in 2013. Conclusions Higher nut intake is associated with reduced risk of cardiovascular disease, total cancer and all-cause mortality, and mortality from respiratory disease, diabetes, and infections.

INTRODUCTION The association between cognitive function, healthy lifestyle, and mortality remains understudied in large Chinese cohorts. METHODS In this nationwide 10‐year prospective study of 24,657 older adults, we assessed Mini‐Mental State Examination (MMSE) categories (<18, 18 to 23, 24 to 27, 28 to 30) and a seven‐component lifestyle score (0 to 7) for their relationships with all‐cause, cardiovascular, and cerebrovascular mortality. RESULTS Compared with individuals scoring 28 to 30 on the MMSE, lower scores were linked to elevated all‐cause and cerebrovascular mortality but not cardiovascular mortality. Participants with lifestyle scores of 4 or 5 had a higher risk of all‐cause mortality. Even optimal lifestyle practices did not fully mitigate the heightened mortality risk associated with declining cognitive performance. DISCUSSION A healthy lifestyle is beneficial but cannot fully offset the impact of cognitive impairment. Therefore, integrating routine cognitive assessments and targeted interventions with healthy lifestyle practices is crucial for effectively reducing mortality risk. Highlights A nationally representative, 10‐year prospective cohort in China was employed to investigate the combined effects of lifestyle behaviors and cognitive function on all‐cause, cardiovascular, and cerebrovascular mortality. Both healthy lifestyle and better cognitive function were associated with a reduced risk of all‐cause mortality. Even among individuals practicing optimal lifestyle behaviors, cognitive impairment significantly elevated the risk of all‐cause and cerebrovascular mortality. These findings underscore the necessity of incorporating routine cognitive assessments and targeted interventions with healthy lifestyle practices aimed at reducing mortality risk in aging populations.

Depression is associated with increased mortality, however, little is known about its variation by ethnicity. We conducted a cohort study of individuals with ICD-10 unipolar depression from secondary mental healthcare, from an ethnically diverse location in southeast London, followed for 8 years (2007-2014) linked to death certificates. Age- and sex- standardised mortality ratios (SMRs), with the population of England and Wales as a standard population were derived. Hazard ratios (HRs) for mortality were derived through multivariable regression procedures. Data from 20 320 individuals contributing 91 635 person-years at risk with 2366 deaths were used for analyses. SMR for all-cause mortality in depression was 2.55(95% CI 2.45-2.65), with similar trends by ethnicity. Within the cohort with unipolar depression, adjusted HR (aHRs) for all-cause mortality in ethnic minority groups relative to the White British group were 0.62(95% CI 0.53-0.74) (Black Caribbean), 0.53(95% CI 0.39-0.72) (Black African) and 0.69(95% CI 0.52-0.90) (South Asian). Male sex and alcohol/substance misuse were associated with an increased all-cause mortality risk [aHR:1.94 (95% CI 1.68-2.24) and aHR:1.18 (95% CI 1.01-1.37) respectively], whereas comorbid anxiety was associated with a decreased risk [aHR: 0.72(95% CI 0.58-0.89)]. Similar associations were noted for natural-cause mortality. Alcohol/substance misuse and male sex were associated with a near-doubling in unnatural-cause mortality risk, whereas Black Caribbean individuals with depression had a reduced unnatural-cause mortality risk, relative to White British people with depression. Although individuals with depression experience an increased mortality risk, marked heterogeneity exists by ethnicity. Research and practice should focus on addressing tractable causes underlying increased mortality in depression.

Anemia and acute heart failure (AHF) frequently coexist. Several published studies have investigated the association of anemia with all‐cause mortality and all‐cause heart failure events in AHF patients, but their findings remain controversial. This study is intended to evaluate the relationship between anemia and AHF. We systematically searched PubMed, Medline, the Cochrane Library, Embase, and Elsevier's ScienceDirect databases until July 30, 2023, and selected prospective or retrospective cohort studies to evaluate anemia for AHF. A total of nine trials involving 29 587 AHF patients were eventually included. Pooled analyses demonstrated anemia is associated with a higher risk of all‐cause heart failure event rate (OR: 1.82, 95% CI: 1.58−2.10, p < .01) and all‐cause mortality, both for short‐term (30 days) all‐cause mortality (OR: 1.91, 95% CI: 1.31−2.79, p < .01) and long‐term (1 year) all‐cause mortality (OR: 1.72, 95% CI: 1.27−2.32, p < .01). The evidence from this meta‐analysis suggested that anemia may be an independent risk factor for all‐cause mortality and all‐cause heart failure events in patients with AHF and might emphasize the importance of anemia correction before discharge. A total of nine trials involving 29 587 acute heart failure patients were eventually included. Pooled analyses demonstrated anemia is associated with a higher risk of all‐cause heart failure event rate (OR: 1.82, 95% CI: 1.58−2.10, p < .01) and all‐cause mortality, both for short‐term (30 days) all‐cause mortality (OR: 1.91, 95% CI: 1.31−2.79, p < .01) and long‐term (1 year) all‐cause mortality (OR: 1.72, 95% CI: 1.27−2.32, p < .01).

ImportanceStudies have reported an association among systemic immune inflammation index (SII), all-cause and cause-specific mortality, but the results are inconsistent.ObjectiveTo comprehensively explore the association between Systemic Immune Inflammation (SII) and the risk of all-cause mortality, cardiovascular disease (CVD), and cancer mortality.Evidence reviewA meta-analysis was conducted by reviewing existing literature. The search encompassed prominent databases including PubMed, Embase, Cochrane, and the Web of Science, with the cutoff date set at March 1, 2024. Furthermore, subgroup analyses and dose-response assessments were undertaken to provide a nuanced exploration of mortality risk factors.FindingsA total of 33 articles were included (427,819 participants). In the study, SII was associated with an increased risk of all-cause mortality (HR = 1.45, 95%CI [1.36,1.54], P < 0.05). SII increased the risk of CVD mortality (HR = 1.44, 95%CI [1.29,1.60], P < 0.05). The Linear independence shows that for every 100 units increase in SII, the risk of all-cause and CVD death increases by 5% and 6%. SII was not associated with a statistically significant risk of cancer death (HR = 1.09, 95%CI [0.96,1.23], P < 0.05).Conclusions and relevanceMeta-analysis showed that SII was associated with all-cause mortality and CVD mortality. More data and basic research are needed to confirm the association.