Shaker M Eid

Sex and age differences in the associations between sleep behaviors and all-cause mortality in older adults: results from the National Health and Nutrition Examination Surveys

OBJECTIVEnOur aim was to examine sex- and age-specific relationships of sleep behaviors with all-cause mortality rates.nnnMETHODSnA retrospective cohort study was conducted among 5288 adults (≥50 years) from the 2005-2008 National Health and Nutrition Examination Surveys who were followed-up for 54.9xa0±xa01.2 months. Sleep duration was categorized as < 7xa0h, 7-8xa0h and >8xa0h. Two sleep quality indices were generated through factor analyses. Help-seeking behavior for sleep problems and diagnosis with sleep disorders were defined as yes/no questions. Sociodemographic covariates-adjusted Cox regression models were applied to estimate hazard ratios (HRs) and 95% confidence intervals (CIs).nnnRESULTSnA positive relationship was observed between long sleep and all-cause mortality rate in the overall sample (HRxa0=xa01.90, 95% CI: 1.38, 2.60), among males (HRxa0=xa01.48, 95% CI: 1.05, 2.09), females (HRxa0=xa02.32, 95% CI: 1.48, 3.61) and elderly (≥65 years) people (HRxa0=xa01.80, 95% CI: 1.30, 2.50). Sleepiness/sleep disturbance (Factor I) and all-cause mortality rate were positively associated among males (HRxa0=xa01.22, 95% CI: 1.03, 1.45), whereas poor sleep-related daytime dysfunction (Factor II) and all-cause mortality (HRxa0=xa00.75, 95% CI: 0.62, 0.91) were negatively associated among elderly people.nnnCONCLUSIONSnSex- and age-specific relationships were observed between all-cause mortality rate and specific sleep behaviors among older adults.

Racial and Ethnic Disparities in Treatment Outcomes of Patients with Ruptured or Unruptured Intracranial Aneurysms

ObjectiveThe aim of this study is to examine how health outcomes varied by treatment selection and race/ethnicity among hospitalized US patients with ruptured or unruptured IAs.MethodsA retrospective cohort study was conducted using a sample of 62,224 hospital discharges from the 2002–2012 Nationwide Inpatient Sample. Logistic regression models evaluated treatment selection as predictor of in-hospital survival (IHS: “yes,” “no”) and length of stay (LOS ≤u20097xa0days, >u20097xa0days), overall and across racial/ethnic groups, taking hospital- and patient-level confounders into account, while stratifying by IA rupture status.ResultsCompared to surgical clipping, endovascular coiling was associated with better IHS, after controlling for confounders. Compared to surgical clipping, LOS ≤u20097xa0days was less likely in patients with combination of treatments and more likely among patients with endovascular coiling as well as balloon- or stent-assisted coiling. Observed relationships varied significantly by race and ethnicity for IHS, but not for LOS ≤u20097xa0days. Whereas combination of treatments were associated with worse IHS than surgical clipping among Blacks alone, endovascular coiling was associated with better IHS than surgical clipping among White and Other racial/ethnic subgroups. These relationships were for the most part consistent among patients with and without IA rupture.ConclusionsRacial and ethnic subgroups of IA patients experienced differential IHS by treatment selection, irrespective of IA rupture status. Prospective cohort studies are needed to further elucidate these racial and ethnic disparities, while collecting data on IA size, location, and morphology as well as Hunt and Hess grade for ruptured IA.