Abdulrahman M. El-Sayed

In-hospital mortality among patients with takotsubo cardiomyopathy: A study of the National Inpatient Sample 2008 to 2009

BACKGROUND Takotsubo cardiomyopathy is characterized by acute, reversible left ventricular apical ballooning. Little is known about the characteristics of patients with takotsubo cardiomyopathy who have in-hospital mortality. We sought to determine in-hospital mortality rate, complication rate, and characteristics of patients with in-hospital mortality related to takotsubo cardiomyopathy. METHODS Patients diagnosed with takotsubo cardiomyopathy in the National Inpatient Database Samples 2008 to 2009 using International Classification of Diseases, Ninth Revision, code 42983 were included in this study. Our primary outcome was in-hospital mortality. In patients with takotsubo cardiomyopathy, we assessed demographic factors, the prevalence and associated mortality of underlying critical illnesses (acute ischemic stroke, sepsis, acute renal failure, respiratory insufficiency, and noncardiac surgery), and acute complications (acute congestive heart failure, respiratory insufficiency with congestive heart failure, cardiogenic shock, ventricular fibrillation/cardiac arrest, and intraaortic balloon pump placement). RESULTS A total of 24,701 patients with takotsubo cardiomyopathy were identified. In-hospital mortality rate was 4.2%. A total of 21,994 patients (89.0%) were female. Male patients had a higher mortality rate than females (8.4% vs 3.6%, P < .0001). Age and race were not associated with mortality. Of patients with in-hospital mortality, 81.4% had underlying critical illnesses. Male patients with takotsubo had higher incidence of underlying critical illnesses than their female counterparts (36.6% vs 26.8%, P < .0001). CONCLUSIONS The presence of underlying critical illness was the main driver of mortality, as these patients comprised >80% of patients with in-hospital mortality. Male patients, who were significantly more likely to have underlying critical illness, had significantly higher mortality rates than female patients. The presence of underlying critical illness likely explains the higher mortality rate among male patients.

Social network analysis and agent-based modeling in social epidemiology

The past five years have seen a growth in the interest in systems approaches in epidemiologic research. These approaches may be particularly appropriate for social epidemiology. Social network analysis and agent-based models (ABMs) are two approaches that have been used in the epidemiologic literature. Social network analysis involves the characterization of social networks to yield inference about how network structures may influence risk exposures among those in the network. ABMs can promote population-level inference from explicitly programmed, micro-level rules in simulated populations over time and space. In this paper, we discuss the implementation of these models in social epidemiologic research, highlighting the strengths and weaknesses of each approach. Network analysis may be ideal for understanding social contagion, as well as the influences of social interaction on population health. However, network analysis requires network data, which may sacrifice generalizability, and causal inference from current network analytic methods is limited. ABMs are uniquely suited for the assessment of health determinants at multiple levels of influence that may couple with social interaction to produce population health. ABMs allow for the exploration of feedback and reciprocity between exposures and outcomes in the etiology of complex diseases. They may also provide the opportunity for counterfactual simulation. However, appropriate implementation of ABMs requires a balance between mechanistic rigor and model parsimony, and the precision of output from complex models is limited. Social network and agent-based approaches are promising in social epidemiology, but continued development of each approach is needed.

The health of Arab-Americans living in the United States: a systematic review of the literature

BackgroundDespite substantial attention paid to Arab-Americans (AAs) in the media and in public discourse, there is limited research about the health of AAs in the United States (US) in the public health literature. This review aims to synthesize the extant peer-reviewed literature concerned with the health of AAs living in the US.MethodsWe summarize existing research on the prevalence, relative burden compared to other ethnic and racial groups, and determinants of diseases within each morbidity cluster among AAs living in the US.ResultsAvailable evidence suggests that the health of AAs may differ from that of other ethnic and racial groups in the US, and that exposures specific to this ethnic group, such as immigration, acculturation, and discrimination may be important in the etiology of several diseases among AAs.ConclusionGiven the growth of this ethnic group and its marginalization in the current sociopolitical climate, more research about the health of AAs in the US seems warranted. We summarize relevant methodological concerns and suggest avenues for future research.

Unevenly distributed: a systematic review of the health literature about socioeconomic inequalities in adult obesity in the United Kingdom

BackgroundThere is a growing literature documenting socioeconomic inequalities in obesity risk among adults in the UK, with poorer groups suffering higher risk.MethodsIn this systematic review, we summarize and appraise the extant peer-reviewed literature about socioeconomic inequalities in adult obesity risk in the UK published between 1980 and 2010. Only studies featuring empirical assessments of relations between socioeconomic indicators and measures of obesity among adults in the UK were included.ResultsA total of 35 articles met inclusion criteria, and were reviewed here.ConclusionSocioeconomic indicators of low socioeconomic position (SEP), including occupational social class of the head-of-household at birth and during childhood, earlier adulthood occupational social class, contemporaneous occupational social class, educational attainment, and area-level deprivation were generally inversely associated with adult obesity risk in the UK. Measures of SEP were more predictive of obesity among women than among men. We outline important methodological limitations to the literature and recommend avenues for future research.

Demographic and Co-Morbid Predictors of Stress (Takotsubo) Cardiomyopathy

Little is known about the epidemiology of stress (takotsubo) cardiomyopathy (SC). We used a 3-arm case-control study to assess differences in demographic and co-morbid predictors of SC compared to orthopedic controls and myocardial infarction (MI) controls to characterize (1) population-level predictors of SC generally and (2) differences and similarities in determinants of SC compared to MI. We included data on all discharges of patients diagnosed with SC from the 2008 to 2009 National Inpatient Samples and randomly selected 1-to-1 age-matched controls from patients hospitalized with MI and patients hospitalized with joint injuries after trauma. We used McNemar tests to assess differences in demographic characteristics and co-morbidities between patients with SC and controls. There were 24,701 patients with SC in our study. Of patients with SC, 89.0% were women compared to 38.9% of patients with MI and 55.7% of orthopedic controls. Patients with SC were more likely to be white and to reside in wealthier ZIP codes compared to MI and orthopedic controls. Patients with SC were less likely to have cardiovascular risk factors compared to MI and orthopedic controls but were more likely to have had histories of cerebrovascular accidents, drug abuse, anxiety disorders, mood disorders, malignancy, chronic liver disease, and sepsis. In conclusion, demographic and co-morbid predictors of SC differ substantially from those of MI and may be of interest to providers when diagnosing SC. Several co-morbid risk factors predictive of SC may operate by increased catecholamines.

Ethnic inequalities in obesity among children and adults in the UK: a systematic review of the literature

Ethnic minority groups are growing as a proportion of the British population. Although disparate, literature suggests inequalities in obesity risk within and among ethnic minority groups relative to Caucasians in the UK. We summarize and appraise the existing peer‐reviewed literature about the prevalence and determinants of obesity among ethnic minority groups relative to Caucasians among children and adults in the UK. There was no consensus about obesity prevalence relative to Caucasians among South Asian or Black children or among South Asian adults relative to Caucasians. Black adults generally had higher risk for obesity than Caucasians. Both Chinese children and adults had lower risk for obesity than Caucasians. Few studies have considered differences in the aetiology of obesity by ethnicity. The lack of consensus regarding obesity risk among large ethnic minority groups relative to Caucasians in the UK, and the paucity of studies concerned with differences in obesity aetiology by ethnicity warrant further research in this area. Certain obesity metrics may bias obesity prevalence among particular ethnic groups relative to Caucasians. We summarize key methodological limitations to the current literature and suggest avenues for future research.

Epidemiology in the Era of Big Data

Big Data has increasingly been promoted as a revolutionary development in the future of science, including epidemiology. However, the definition and implications of Big Data for epidemiology remain unclear. We here provide a working definition of Big Data predicated on the so-called “three V’s”: variety, volume, and velocity. From this definition, we argue that Big Data has evolutionary and revolutionary implications for identifying and intervening on the determinants of population health. We suggest that as more sources of diverse data become publicly available, the ability to combine and refine these data to yield valid answers to epidemiologic questions will be invaluable. We conclude that while epidemiology as practiced today will continue to be practiced in the Big Data future, a component of our field’s future value lies in integrating subject matter knowledge with increased technical savvy. Our training programs and our visions for future public health interventions should reflect this future.

Socioeconomic Inequalities in Childhood Obesity in the United Kingdom: A Systematic Review of the Literature

Childhood obesity is a major public health challenge worldwide. There is a growing literature documenting socioeconomic inequalities in childhood obesity risk. Here we draw inference from the literature about inequalities in childhood obesity risk in the UK. We summarize and appraise the extant peer-reviewed literature about socioeconomic inequalities in childhood obesity in the UK. Common area-level indices of socioeconomic position, including the Carstairs Deprivation Index, the Index of Multiple Deprivation and the Townsend Deprivation Index, as well as common household and individual-level metrics of childhood socioeconomic position, including head-of-household social class and maternal education, were generally inversely associated with childhood obesity in the UK. We summarize key methodological limitations to the extant literature and suggest avenues for future research.

Postoperative outcomes following closed head injury and craniotomy for evacuation of hematoma in patients older than 80 years

OBJECT Advances in the management of trauma-induced intracranial hematomas and hemorrhage (epidural, subdural, and intraparenchymal hemorrhage) have improved survival in these conditions over the last several decades. However, there is a paucity of research investigating the relation between patient age and outcomes of surgical treatment for these conditions. In this study, the authors examined the relation between patient age over 80 years and postoperative outcomes following closed head injury and craniotomy for intracranial hemorrhage. METHODS A consecutive population of patients undergoing emergent craniotomy for evacuation of intracranial hematoma following closed head trauma between 2006 and 2009 was identified. Using multivariable logistic regression models, the authors assessed the relation between age (> 80 vs ≤ 80 years) and postoperative complications, intensive care unit stay, hospital stay, morbidity, and mortality. RESULTS Of 103 patients, 27 were older than 80 years and 76 patients were 80 years of age or younger. Older age was associated with longer length of hospital stay (p = 0.014), a higher rate of complications (OR 5.74, 95% CI 1.29-25.34), and a higher likelihood of requiring rehabilitation (OR 3.28, 95% CI 1.13-9.74). However, there were no statistically significant differences between the age groups in 30-day mortality or ability to recover to functional baseline status. CONCLUSIONS The findings suggest that in comparison with younger patients, patients over 80 years of age may be similarly able to return to preinjury functional baselines but may require increased postoperative medical attention in the forms of rehabilitation and longer hospital stays. Prospective studies concerned with the relation between older age, perioperative parameters, and postoperative outcomes following craniotomy for intracranial hemorrhage are needed. Nonetheless, the findings of this study may allow for more informed decisions with respect to the care of elderly patients with intracranial hemorrhage.

Insurance Status and Inequalities in Outcomes After Neurosurgery

OBJECTIVE Little is known about socioeconomic differences in postoperative outcomes after neurosurgery. We assessed the relation between insurance status and postoperative complication risk, neurosurgical intensive care unit stay, and hospital stay after neurosurgery. METHODS We collected data on 918 consecutive craniotomy or spine-related neurosurgical cases in patients at least 18 years of age at the University of Michigan Hospitals after April 2006. Bivariate χ(2) tests and analysis of variance were used to assess bivariate relations, and multivariable logistic regression models and analysis of covariance were used to adjust for potential confounders. RESULTS A total of 11.2% of privately insured patients, 23.6% of Medicare patients, 25.8% of Medicaid patients, and 27.3% of uninsured patients suffered complications within 30 days of surgery (P < 0.001). In adjusted models, odds of postoperative complications among Medicare (odds ratio [OR] = 2.1, 95% confidence interval [CI] 1.3-3.3), Medicaid (OR = 3.1, 95% CI 1.5-6.1), and uninsured patients (OR = 3.6. 95% CI 1.3-10.3) were higher than among privately insured patients. By analysis of covariance, only Medicaid patients had significantly longer intensive care unit (P = 0.040) and hospital stays (P = 0.028) than privately insured patients. CONCLUSIONS Our findings suggest important socioeconomic disparities in outcomes after neurosurgical intervention. Access to postoperative outpatient care may mediate our findings.