Anbesaw Wolde Selassie

Obesity and diabetes mellitus, or diabetes, are independently associated with post-ischemic stroke outcomes (e.g., functional disability and all-cause mortality). Although obesity and diabetes are also associated with post-ischemic stroke outcomes, the joint effect of obesity and diabetes on these post-ischemic stroke outcomes has not been explored previously. The purpose of the current study was to explore whether the effect of obesity on post-ischemic stroke outcomes differed by diabetes status in a cohort of acute ischemic stroke subjects with at least a moderate stroke severity. Data from the Interventional Management of Stroke (IMS) III clinical trial was analyzed for this post-hoc analysis. A total of 656 subjects were enrolled in IMS III and were followed for one year. The joint effects of obesity and diabetes on functional disability at 3-months and all-cause mortality at 1-year were examined. Of 645 subjects with complete obesity and diabetes information, few were obese (25.74%) or had diabetes (22.64%). Obese subjects with diabetes and non-obese subjects without diabetes had similar odds of functional disability at 3-months following an ischemic stroke (adjusted common odds ratio, 1.038, 95% CI: 0.631, 1.706). For all-cause mortality at 1-year following an ischemic stroke, obese subjects with diabetes had a similar hazard compared with non-obese subjects without diabetes (adjusted hazard ratio, 1.005, 95% CI: 0.559, 1.808). There was insufficient evidence to declare a joint effect between obesity and diabetes on either the multiplicative scale or the additive scale for both outcomes. In this post-hoc analysis of data from the IMS III clinical trial of acute ischemic stroke patients with at least a moderate stroke severity, there was not sufficient evidence to determine that the effect of obesity differed by diabetes status on post-ischemic stroke outcomes. Additionally, there was not sufficient evidence to determine that either factor was independently associated with all-cause mortality. Future studies could differentiate between metabolically healthy and metabolically unhealthy patients within BMI categories to determine if the effect of obesity on post-stroke outcomes differs by diabetes status.

Summary: Objective: Follow‐up studies of children and adolescents with epilepsy (CAW‐E) have revealed higher risk of mortality than children in the general population. The mortality experience of CAW‐E relative to patients with other common neurologic disorders in the pediatric age group is yet undetermined. The objectives of this study are the following: (1) to compare the causes and the adjusted risk of death in CAW‐E with that of children and adolescents with migraine (CAW‐M) in reference to children and adolescents with lower extremity fracture (CAW‐LEF), and children and adolescents in the general population; (2) to evaluate if disparate mortality risks exist by demographic characteristics.Methods: This retrospective cohort study included 56,781 children and adolescents 0–18 years of age hospitalized or treated in an emergency or outpatient department from 2000 to 2011 for epilepsy, migraine, or lower extremity fracture from all nonfederal health care facilities. Data on deaths were acquired from linked multiple causes of death data file using person‐specific unique identifiers. Time of follow‐up was from initial clinical encounter to time of death or censoring date of December 31, 2011. The association of risk characteristics with mortality was examined with Cox proportional hazard model after adjusting for potential confounders.Results: Four hundred forty‐seven CAW‐E and 125 CAW‐M died yielding mortality rates of 8.71 and 1.36 per 1,000 person‐years, respectively. The 5‐year risk of death was 4.38% for CAW‐E, 0.68% for CAW‐M, and 0.71% for CAW‐LEF. Adjusted hazard ratios (HRs) were 3.81 (95% confidence interval [CI] 3.08–3.72) in CAW‐E and 1.14 (95% CI 0.94–1.34) in CAW‐M relative to CAW‐LEF. Risk of death from neurodevelopmental comorbidities was 5.86 (95% CI 4.24–8.08) times greater than those without in the model that compared epilepsy with LEF.Significance: There is an elevated risk of death in CAW‐E with neurodevelopmental comorbidities that remains to be proven.

Background: A gap exists in the current knowledge regarding the epidemiology of traumatic spinal cord injury (TSCI) in a statewide population. Objective: To describe population-based epidemiology and trend of TSCI in persons 22 years and older in South Carolina over a 15-year period from 1998 through 2012. Methods: Data on patients with TSCI were obtained from ongoing statewide TSCI surveillance and follow-up registry. Deaths were ascertained by linking surveillance files and the multiple cause-of-death dataset. Descriptive analyses were completed, and incidence and mortality rates were calculated based on the civilian adult population of the state. Results: Over the 15 years, 3,365 persons with incident TSCI were discharged alive from acute care hospitalization, of whom 555 died during the period of observation. Age-standardized cumulative mortality rate was 14 per million, and the average incidence rate was estimated at 70.8 per million population per year. Age-standardized incidence rate of TSCI increa...

Epilepsy is a common childhood neurologic disorder. In 2007, epilepsy affected an estimated 450,000 children aged 0-17 years in the United States. Approximately 53% of children with epilepsy and special health care needs have co-occurring conditions, and only about one third have access to comprehensive care. The few studies of mortality risk among children with epilepsy as compared with the general population generally find a higher risk for death among children with epilepsy with co-occurring conditions but a similar risk for death among children with epilepsy with no co-occurring conditions. However, samples from these mortality studies are often small, limiting comparisons, and are not representative. This highlights the need for expanded mortality surveillance among children with epilepsy to better understand their excess mortality. This report describes mortality among children with epilepsy in South Carolina during 2000-2011 by demographic characteristics and underlying causes of death. The overall mortality rate among children with epilepsy was 8.8 deaths per 1,000 person-years, and the annual risk for death was 0.84%. Developmental conditions, cardiovascular disorders, and injuries were the most common causes of death among children with epilepsy. Team-based care coordination across medical and nonmedical systems can improve outcomes and reduce health care costs for children with special health care needs, but they require more study among children with epilepsy. Ensuring appropriate and timely health care and social services for children with epilepsy, especially those with complications, might reduce the risk for premature death. Health care providers, social service providers, advocacy groups and others can work together to assess whether coordinated care can improve outcomes for children with epilepsy.

Objectives: To determine the influence of preexisting heart, liver, kidney, cancer, stroke, and mental health problems and examine the influence of low socioeconomic status on mortality after discharge from acute care facilities for individuals with traumatic brain injury. Participants: Population-based retrospective cohort study of 33695 persons discharged from acute care hospital with traumatic brain injury in South Carolina, 1999-2010. Main Measures: Days elapsing from the dates of injury to death established the survival time (T). Data were censored at the 145th month. Multivariable Cox regression was used to examine the independent effect of the variables on death. Age-adjusted cumulative probability of death for each chronic disease of interest was plotted. Results: By the 70th month of follow-up, rate of death was accelerated from 10-fold for heart diseases to 2.5-fold for mental health problems. Adjusted hazard ratios for diseases of the heart (2.13), liver-renal (3.25), cancer (2.64), neurological diseases and stroke (2.07), diabetes (1.89), hypertension (1.43), and mental health problems (1.59) were highly significant (each with P < .001). Compared with persons with private insurance, the hazard ratio was significantly elevated with Medicaid (1.67), Medicare (1.54), and uninsured (1.27) (each with P < .001). Conclusion: Specific chronic diseases strongly influenced postdischarge mortality after traumatic brain injury. Low socioeconomic status as measured by the type of insurance elevated the risk of death.

Objectives: First, to evaluate the influence of comorbid diseases and concomitant injuries on the risk of in-hospital death after traumatic spinal cord injury (TSCI). Second, to identify the risk characteristics of TSCI patients with likelihood of death. Study design: Population-based retrospective cohort study. Setting: Sixty-two acute care hospitals in South Carolina, USA. Methods: Records of 3389 TSCI patients hospitalized with acute TSCI were evaluated. Days elapsing from the date of injury to date of death established the survival time (T). Cox regression examined risk of in-hospital death as a function of counts of comorbid conditions and injuries along with their joint effects controlling for other covariates. Results: Counts of comorbid conditions and injuries showed dose-dependent risk of death while in-hospital independent of demographical and clinical covariates. Hazard ratios (HR) for counts 3+, 2 and 1 comorbid conditions were 2.19 (PP=0.005) and 1.20 (P=0.322), respectively. For counts of 4+, 3 and 2 other injuries were 1.85 (PPP=0.022), respectively. The joint effect of the two was transadditive with statistically significant HR ranging from 1.72–3.14. Conclusion: Counts of comorbid conditions and injured body regions strongly indicate risk of in-hospital death after TSCI and their joint effects elicited dose-dependent gradient independent of demographical and clinical covariates. Assessing risk of in-hospital death based on joint use of counts of comorbid diseases and injuries is highly informative to target TSCI patients at high risk of dying.