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Wan EYF, Yu EYT, Chin WY, Fong DYT, Choi EPH, Tang EHM, Lam CLK. Burden of CKD and Cardiovascular Disease on Life Expectancy and Health Service Utilization: a Cohort Study of Hong Kong Chinese Hypertensive Patients. J Am Soc Nephrol 2019; 30:1991-1999. [PMID: 31492808 DOI: 10.1681/asn.2018101037] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2018] [Accepted: 06/17/2019] [Indexed: 12/21/2022] Open
Abstract
BACKGROUND The relative effects of combinations of CKD, heart disease, and stroke on risk of mortality, direct medical costs, and life expectancy are unknown. METHODS In a retrospective cohort study of 506,849 Chinese adults in Hong Kong with hypertension, we used Cox regressions to examine associations between all-cause mortality and combinations of moderate CKD (eGFR of 30-59 ml/min per 1.73 m2), severe CKD (eGFR of 15-29 ml/min per 1.73 m2), heart disease (coronary heart disease or heart failure), and stroke, and modeling to estimate annual public direct medical costs and life expectancy. RESULTS Over a median follow-up of 5.8 years (2.73 million person-years), 55,666 deaths occurred. Having an increasing number of comorbidities was associated with incremental increases in mortality risk and medical costs and reductions in life expectancy. Compared with patients who had neither CKD nor cardiovascular disease, patients with one, two, or three conditions (heart disease, stroke, and moderate CKD) had relative risk of mortality increased by about 70%, 160%, and 290%, respectively; direct medical costs increased by about 70%, 160%, and 280%, respectively; and life expectancy at age 60 years decreased by about 5, 10, and 15 years, respectively. Burdens were higher with severe CKD. CONCLUSIONS This study demonstrated extremely high mortality risk and medical cost increases for severe CKD, exceeding the combined effects from heart disease and stroke. Mortality risks and costs for moderate CKD, heart disease, and stroke were similar individually and roughly multiplicative for any combination. These findings suggest that to reduce mortality and health care costs in patients with hypertension, CKD prevention and intervention merits priority equal to that of cardiovascular disease.
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Affiliation(s)
- Eric Yuk Fai Wan
- Departments of Family Medicine and Primary Care and .,Pharmacology and Pharmacy, and
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Minagawa YS. Changing Life Expectancy and Health Expectancy Among Russian Adults: Results from the Past 20 Years. POPULATION RESEARCH AND POLICY REVIEW 2018. [DOI: 10.1007/s11113-018-9478-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
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Steensma C, Choi BC, Loukine L, Schanzer D. Period Life Tables for Calculating Life Expectancy: Options to Assess and Minimize the Potential for Bias. Am J Public Health 2018; 108:e14. [DOI: 10.2105/ajph.2017.304268] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Affiliation(s)
- Colin Steensma
- Colin Steensma and Lidia Loukine are with Health Canada, Ottawa, Ontario. Bernard C. K. Choi and Dena Schanzer are with the Public Health Agency of Canada, Ottawa
| | - Bernard C. K. Choi
- Colin Steensma and Lidia Loukine are with Health Canada, Ottawa, Ontario. Bernard C. K. Choi and Dena Schanzer are with the Public Health Agency of Canada, Ottawa
| | - Lidia Loukine
- Colin Steensma and Lidia Loukine are with Health Canada, Ottawa, Ontario. Bernard C. K. Choi and Dena Schanzer are with the Public Health Agency of Canada, Ottawa
| | - Dena Schanzer
- Colin Steensma and Lidia Loukine are with Health Canada, Ottawa, Ontario. Bernard C. K. Choi and Dena Schanzer are with the Public Health Agency of Canada, Ottawa
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Perron L, Simard M, Brisson J, Hamel D, Lo E. Standard Period Life Table Used to Compute the Life Expectancy of Diseased Subpopulations: More Confusing Than Helpful. Am J Public Health 2017; 107:1615-1620. [PMID: 28817326 DOI: 10.2105/ajph.2017.303932] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/14/2023]
Abstract
Life expectancy (LE) based on a period life table (PLT) traditionally serves as a general population summary metric. It is, however, becoming more frequently reported for chronically afflicted subpopulations. In general populations, there is always an obvious real cohort sharing the hypothetical PLT cohort characteristics, and the LE estimate is intuitively understood as that real cohort mean survival time, assuming constancy of death risks. In diseased subpopulations, the correspondence between the hypothetical cohort and a real cohort is not straightforward. Furthermore, the excess mortality of chronic diseases usually changes according to age at onset and time since onset. The standard PLT method does not allow for proper control of these issues, so the LE estimate can only be deemed valid under specific assumptions. Without clear statements about the real cohort to whom the estimate is intended and the assumptions allowing disregard of the effect of age at onset and time since onset, LEs of afflicted subpopulations computed with the PLT are only abstract numbers summarizing mortality rates. If called "life expectancy," they can be seriously misleading. The same applies to health-adjusted LE.
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Affiliation(s)
- Linda Perron
- Linda Perron, Marc Simard, Denis Hamel, and Ernest Lo are with the Institut national de santé publique du Québec, Quebec City, QC. Linda Perron and Jacques Brisson are with the Département de médecine sociale et préventive, Faculté de médecine, Université Laval, Quebec City. Jacques Brisson is also with the Centre de recherche du chu de Québec-Université Laval, Centre hospitalier universitaire de Québec, Quebec City. Ernest Lo is also with the Department of Epidemiology, Biostatistics, and Occupational Health, McGill University, Montreal, QC
| | - Marc Simard
- Linda Perron, Marc Simard, Denis Hamel, and Ernest Lo are with the Institut national de santé publique du Québec, Quebec City, QC. Linda Perron and Jacques Brisson are with the Département de médecine sociale et préventive, Faculté de médecine, Université Laval, Quebec City. Jacques Brisson is also with the Centre de recherche du chu de Québec-Université Laval, Centre hospitalier universitaire de Québec, Quebec City. Ernest Lo is also with the Department of Epidemiology, Biostatistics, and Occupational Health, McGill University, Montreal, QC
| | - Jacques Brisson
- Linda Perron, Marc Simard, Denis Hamel, and Ernest Lo are with the Institut national de santé publique du Québec, Quebec City, QC. Linda Perron and Jacques Brisson are with the Département de médecine sociale et préventive, Faculté de médecine, Université Laval, Quebec City. Jacques Brisson is also with the Centre de recherche du chu de Québec-Université Laval, Centre hospitalier universitaire de Québec, Quebec City. Ernest Lo is also with the Department of Epidemiology, Biostatistics, and Occupational Health, McGill University, Montreal, QC
| | - Denis Hamel
- Linda Perron, Marc Simard, Denis Hamel, and Ernest Lo are with the Institut national de santé publique du Québec, Quebec City, QC. Linda Perron and Jacques Brisson are with the Département de médecine sociale et préventive, Faculté de médecine, Université Laval, Quebec City. Jacques Brisson is also with the Centre de recherche du chu de Québec-Université Laval, Centre hospitalier universitaire de Québec, Quebec City. Ernest Lo is also with the Department of Epidemiology, Biostatistics, and Occupational Health, McGill University, Montreal, QC
| | - Ernest Lo
- Linda Perron, Marc Simard, Denis Hamel, and Ernest Lo are with the Institut national de santé publique du Québec, Quebec City, QC. Linda Perron and Jacques Brisson are with the Département de médecine sociale et préventive, Faculté de médecine, Université Laval, Quebec City. Jacques Brisson is also with the Centre de recherche du chu de Québec-Université Laval, Centre hospitalier universitaire de Québec, Quebec City. Ernest Lo is also with the Department of Epidemiology, Biostatistics, and Occupational Health, McGill University, Montreal, QC
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Krittayaphong R, Rangsin R, Thinkhamrop B, Hurst C, Rattanamongkolgul S, Sripaiboonkij N, Wangworatrakul W. Prevalence of chronic kidney disease associated with cardiac and vascular complications in hypertensive patients: a multicenter, nation-wide study in Thailand. BMC Nephrol 2017; 18:115. [PMID: 28372539 PMCID: PMC5376688 DOI: 10.1186/s12882-017-0528-3] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2016] [Accepted: 03/23/2017] [Indexed: 01/19/2023] Open
Abstract
BACKGROUND Hypertension and chronic kidney disease (CKD) are common conditions and both are major risk factors for cardiovascular events. The objectives were 1) to study the prevalence of CKD in hypertensive patients and 2) to study the association of CKD with cardiac and vascular complications in a multicenter, nation-wide fashion. METHODS This cross-sectional study evaluated patients aged 20 years or older who were diagnosed with hypertension and who had been treated for at least 12 months at 831 public hospitals in Thailand during the 2012 study period. Outcome measurements included calculated glomerular filtration rate (GFR) and cardiac and vascular complications that included coronary artery disease, stroke, peripheral arterial disease, heart failure, and atrial fibrillation. Multivariable modeling was conducted to determine independent factors associated with increased risk of cardiac and vascular complications. RESULTS A total of 28770 patients were enrolled. Average age was 62.8 years and 37% were male. Prevalence of CKD stage 3 and 4-5 was 33.2 and 4.3%, respectively. Prevalence of cardiac and vascular complications was 10.5% (5% having coronary artery disease, 3.9% stroke, 1.7% heart failure, and 1.2% atrial fibrillation). CKD was an independent risk factor associated with each of the complications and overall cardiac and vascular complications with an adjusted Odds ratio of 1.4 for CKD stage 3 and 1.9 for CKD stage 4-5. CONCLUSION Prevalence of CKD stage 3-5 in hypertensive population was 37.5%. CKD is an independent risk factor for adverse cardiac and vascular outcome.
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Affiliation(s)
- Rungroj Krittayaphong
- Division of Cardiology, Department of Medicine, Siriraj Hospital, Mahidol University, 2 Wanglang Road, Bangkoknoi, Bangkok, 10700, Thailand.
| | - Ram Rangsin
- Department of Military and Community Medicine, Phramongkutklao College of Medicine, Bangkok, Thailand
| | | | - Cameron Hurst
- Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand
| | | | | | - Wipaporn Wangworatrakul
- Division of Cardiology, Department of Medicine, Siriraj Hospital, Mahidol University, 2 Wanglang Road, Bangkoknoi, Bangkok, 10700, Thailand
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Turin TC, Ahmed SB, Tonelli M, Manns B, Ravani P, James M, Quinn RR, Jun M, Gansevoort R, Hemmelgarn B. Kidney function, albuminuria and life expectancy. Can J Kidney Health Dis 2014; 1:33. [PMID: 25780622 PMCID: PMC4349777 DOI: 10.1186/s40697-014-0033-6] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2014] [Accepted: 12/05/2014] [Indexed: 01/13/2023] Open
Abstract
BACKGROUND Lower estimated glomerular filtration rate is associated with reduced life expectancy. Whether this association is modified by the presence or absence of albuminuria, another cardinal finding of chronic kidney disease, is unknown. OBJECTIVE Our objective was to estimate the life expectancy of middle-aged men and women with varying levels of eGFR and concomitant albuminuria. DESIGN A retrospective cohort study. SETTING A large population-based cohort identified from the provincial laboratory registry in Alberta, Canada. PARTICIPANTS Adults aged ≥30 years who had outpatient measures of serum creatinine and albuminuria between May 1, 2002 and March 31, 2008. MEASUREMENTS PREDICTOR Baseline levels of kidney function identified from serum creatinine and albuminuria measurements. OUTCOMES all cause mortality during the follow-up. METHODS Patients were categorized based on their estimated glomerular filtration rate (eGFR) (≥60, 45-59, 30-44, and 15-29 mL/min/1 · 73 m(2)) as well as albuminuria (normal, mild, and heavy) measured by albumin-to-creatinine ratio or urine dipstick. The abridged life table method was applied to calculate the life expectancies of men and women from age 40 to 80 years across combined eGFR and albuminuria categories. We also categorized participants by severity of kidney disease (low risk, moderately increased risk, high risk, and very high risk) using the combination of eGFR and albuminuria levels. RESULTS Among men aged 50 years and with eGFR ≥60 mL/min/1.73 m(2), estimated life expectancy was 24.8 (95% CI: 24.6-25.0), 17.5 (95% CI: 17.1-17.9), and 13.5 (95% CI: 12.6-14.3) years for participants with normal, mild and heavy albuminuria respectively. Life expectancy for men with mild and heavy albuminuria was 7.3 (95% CI: 6.9-7.8) and 11.3 (95% CI: 10.5-12.2) years shorter than men with normal proteinuria, respectively. A reduction in life expectancy was associated with an increasing severity of kidney disease; 24.8 years for low risk (95% CI: 24.6-25.0), 19.1 years for moderately increased risk (95% CI: 18.7-19.5), 14.2 years for high risk (95% CI: 13.5-15.0), and 9.6 years for very high risk (95% CI: 8.4-10.8). Among women of similar age and kidney function, estimated life expectancy was 28.9 (95% CI: 28.7-29.1), 19.8 (95% CI: 19.2-20.3), and 14.8 (95% CI: 13.5-16.0) years for participants with normal, mild and heavy albuminuria respectively. Life expectancy for women with mild and heavy albuminuria was 9.1 (95% CI: 8.5-9.7) and 14.2 (95% CI: 12.9-15.4) years shorter than the women with normal proteinuria, respectively. For women also a graded reduction in life expectancy was observed across the increasing severity of kidney disease; 28.9 years for low risk (95% CI: 28.7-29.1), 22.5 years for moderately increased risk (95% CI: 22.0-22.9), 16.5 years for high risk (95% CI: 15.4-17.5), and 9.2 years for very high risk (95% CI: 7.8-10.7). LIMITATIONS Possible misclassification of long-term kidney function categories cannot be eliminated. Possibility of confounding due to concomitant comorbidities cannot be ruled out. CONCLUSION The presence and degree of albuminuria was associated with lower estimated life expectancy for both gender and was especially notable in those with eGFR ≥30 mL/min/1.73 m(2). Life expectancy associated with a given level of eGFR differs substantially based on the presence and severity of albuminuria.
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Affiliation(s)
- Tanvir Chowdhury Turin
- />Department of Family Medicine, University of Calgary, Room G012F, 3330 Hospital Drive Northwest, Calgary, Alberta T2N 4N1 Canada
- />Department of Community Health Sciences, University of Calgary, Calgary, Alberta Canada
- />Libin Cardiovascular Institute, University of Calgary, Calgary, Alberta Canada
- />Institute of Public Health, University of Calgary, Calgary, Alberta Canada
| | - Sofia B Ahmed
- />Libin Cardiovascular Institute, University of Calgary, Calgary, Alberta Canada
- />Department of Medicine, University of Calgary, Calgary, Alberta Canada
| | - Marcello Tonelli
- />Department of Medicine, University of Alberta, Edmonton, Alberta Canada
| | - Braden Manns
- />Department of Community Health Sciences, University of Calgary, Calgary, Alberta Canada
- />Libin Cardiovascular Institute, University of Calgary, Calgary, Alberta Canada
- />Institute of Public Health, University of Calgary, Calgary, Alberta Canada
- />Department of Medicine, University of Calgary, Calgary, Alberta Canada
| | - Pietro Ravani
- />Department of Community Health Sciences, University of Calgary, Calgary, Alberta Canada
- />Libin Cardiovascular Institute, University of Calgary, Calgary, Alberta Canada
- />Institute of Public Health, University of Calgary, Calgary, Alberta Canada
- />Department of Medicine, University of Calgary, Calgary, Alberta Canada
| | - Matthew James
- />Department of Community Health Sciences, University of Calgary, Calgary, Alberta Canada
- />Libin Cardiovascular Institute, University of Calgary, Calgary, Alberta Canada
- />Institute of Public Health, University of Calgary, Calgary, Alberta Canada
- />Department of Medicine, University of Calgary, Calgary, Alberta Canada
| | - Robert R Quinn
- />Department of Community Health Sciences, University of Calgary, Calgary, Alberta Canada
- />Libin Cardiovascular Institute, University of Calgary, Calgary, Alberta Canada
- />Institute of Public Health, University of Calgary, Calgary, Alberta Canada
- />Department of Medicine, University of Calgary, Calgary, Alberta Canada
| | - Min Jun
- />Department of Medicine, University of Calgary, Calgary, Alberta Canada
| | - Ron Gansevoort
- />Department of Nephrology, University Medical Center Groningen, Groningen, The Netherlands
| | - Brenda Hemmelgarn
- />Department of Community Health Sciences, University of Calgary, Calgary, Alberta Canada
- />Libin Cardiovascular Institute, University of Calgary, Calgary, Alberta Canada
- />Institute of Public Health, University of Calgary, Calgary, Alberta Canada
- />Department of Medicine, University of Calgary, Calgary, Alberta Canada
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Gansevoort RT, Correa-Rotter R, Hemmelgarn BR, Jafar TH, Heerspink HJL, Mann JF, Matsushita K, Wen CP. Chronic kidney disease and cardiovascular risk: epidemiology, mechanisms, and prevention. Lancet 2013; 382:339-52. [PMID: 23727170 DOI: 10.1016/s0140-6736(13)60595-4] [Citation(s) in RCA: 1431] [Impact Index Per Article: 130.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
Since the first description of the association between chronic kidney disease and heart disease, many epidemiological studies have confirmed and extended this finding. As chronic kidney disease progresses, kidney-specific risk factors for cardiovascular events and disease come into play. As a result, the risk for cardiovascular disease is notably increased in individuals with chronic kidney disease. When adjusted for traditional cardiovascular risk factors, impaired kidney function and raised concentrations of albumin in urine increase the risk of cardiovascular disease by two to four times. Yet, cardiovascular disease is frequently underdiagnosed and undertreated in patients with chronic kidney disease. This group of patients should, therefore, be acknowledged as having high cardiovascular risk that needs particular medical attention at an individual level. This view should be incorporated in the development of guidelines and when defining research priorities. Here, we discuss the epidemiology and pathophysiological mechanisms of cardiovascular risk in patients with chronic kidney disease, and discuss methods of prevention.
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Affiliation(s)
- Ron T Gansevoort
- Department of Nephrology, University Medical Centre Groningen, University Hospital Groningen, Groningen, Netherlands.
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Turin TC, Murakami Y, Miura K, Rumana N, Kita Y, Hayakawa T, Okamura T, Okayama A, Ueshima H. Hypertension and life expectancy among Japanese: NIPPON DATA80. Hypertens Res 2012; 35:954-8. [DOI: 10.1038/hr.2012.86] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
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Loukine L, Waters C, Choi BCK, Ellison J. Impact of diabetes mellitus on life expectancy and health-adjusted life expectancy in Canada. Popul Health Metr 2012; 10:7. [PMID: 22531113 PMCID: PMC3787852 DOI: 10.1186/1478-7954-10-7] [Citation(s) in RCA: 42] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2011] [Accepted: 04/11/2012] [Indexed: 01/14/2023] Open
Abstract
The objectives of this study were to estimate life expectancy (LE) and health-adjusted life expectancy (HALE) for Canadians with and without diabetes and to evaluate the impact of diabetes on population health using administrative and survey data.Mortality data from the Canadian Chronic Disease Surveillance System (2004 to 2006) and Health Utilities Index data from the Canadian Community Health Survey (2000 to 2005) were used. Life table analysis was applied to calculate LE, HALE, and their confidence intervals using the Chiang and the adapted Sullivan methods.LE and HALE were significantly lower among people with diabetes than for people without the disease. LE and HALE for females without diabetes were 85.0 and 73.3 years, respectively (males: 80.2 and 70.9 years). Diabetes was associated with a loss of LE and HALE of 6.0 years and 5.8 years, respectively, for females, and 5.0 years and 5.3 years, respectively, for males, living with diabetes at 55 years of age. The overall gains in LE and HALE after the hypothetical elimination of prevalent diagnosed diabetes cases in the population were 1.4 years and 1.2 years, respectively, for females, and 1.3 years for both LE and HALE for males.The results of the study confirm that diabetes is an important disease burden in Canada impacting the female and male populations differently. The methods can be used to calculate LE and HALE for other chronic conditions, providing useful information for public health researchers and policymakers.
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Affiliation(s)
- Lidia Loukine
- Centre for Chronic Disease Prevention and Control, Public Health Agency of Canada (PHAC), Government of Canada, Ottawa, ON, Canada
- Centre for Chronic Disease Prevention and Control, Public Health Agency of Canada, Government of Canada, A.L.6806A, 785 Carling Avenue, Ottawa, ON, K1A 0 K9, Canada
| | - Chris Waters
- Centre for Chronic Disease Prevention and Control, Public Health Agency of Canada (PHAC), Government of Canada, Ottawa, ON, Canada
| | - Bernard CK Choi
- Centre for Chronic Disease Prevention and Control, Public Health Agency of Canada (PHAC), Government of Canada, Ottawa, ON, Canada
- Department of Epidemiology and Community Medicine, University of Ottawa, Ottawa, ON, Canada
- Shantou University Medical College, Shantou, China
| | - Joellyn Ellison
- Centre for Chronic Disease Prevention and Control, Public Health Agency of Canada (PHAC), Government of Canada, Ottawa, ON, Canada
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