Diabetes Minimally Mediated the Association Between PM2.5 Air Pollution and Kidney Outcomes

Bowe, Benjamin; Yan, Yan; Xian, Hong; Al‐Aly, Ziyad

doi:10.1038/s41598-020-61115-x

Cited by 24 publications

(39 citation statements)

References 43 publications

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“…Incident rate was estimated as the number of new LEAs divided by the number of veterans who had at least 1 encounter in that year. 12 , 13 , 14 , 15 , 16 , 26 , 27 , 28 , 29 When multiple LEA procedure codes occurred within a 30-day period, they were treated as a single LEA to reduce influence on counts from repeated coding resulting from the same procedure or a multistage LEA.…”

Section: Methodsmentioning

confidence: 99%

Temporal Trends in Incidence Rates of Lower Extremity Amputation and Associated Risk Factors Among Patients Using Veterans Health Administration Services From 2008 to 2018

et al. 2021

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IMPORTANCE Lower extremity amputation (LEA) is associated with significant morbidity and mortality. However, national temporal trends of LEA incidence rates among US veterans and associated factors have not been well characterized. OBJECTIVE To describe the temporal trends of LEA, characterize associated risk factors, and decompose the associations of these risk factors with changes in temporal trends of LEA among US veterans using Department of Veteran Affairs (VA) services between 2008 and 2018. DESIGN, SETTING, AND PARTICIPANTS This cohort study used VA data from 2008 to 2018 to estimate incidence rates of LEA among veterans using VA services. Cox regression models were used to identify risk factors associated with LEA. Decomposition analyses estimated the associations of changes in prevalence of risk factors with changes in LEA rates. Data were analyzed from October 1, 2007, to September 30, 2018. MAIN OUTCOMES AND MEASURES Toe, transmetatarsal, below-knee, or above-knee LEA. RESULTS A total of 6 493 141 veterans were included (median [interquartile range] age, 64 [54-76] years; 6 060 390 [93.4%] men). Veterans were studied for a median (interquartile range) of 10.9

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Section: Methodsmentioning

confidence: 99%

Temporal Trends in Incidence Rates of Lower Extremity Amputation and Associated Risk Factors Among Patients Using Veterans Health Administration Services From 2008 to 2018

et al. 2021

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“…Characteristics reported include demographics, hospitalization characteristics, comorbidities, laboratory tests and vital signs, and medication history (20)(21)(22)(23)(24)(25). Further details may be found in Supplemental Material and Supplemental Table 1C.…”

Section: Participant Characteristicsmentioning

confidence: 99%

Acute Kidney Injury in a National Cohort of Hospitalized US Veterans with COVID-19

Bowe

Cai

Xie

et al. 2020

CJASN

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Background and objectivesCoronavirus disease 2019 (COVID-19) is associated with higher risk of AKI. We aimed to describe rates and characterize predictors and health outcomes associated with AKI in a national cohort of US veterans hospitalized with COVID-19.Design, setting, participants, & measurementsIn a cohort of 5216 US veterans hospitalized with COVID-19 identified through July 23, 2020, we described changes in serum creatinine and examined predictors of AKI and the associations between AKI, health resource utilization, and death, utilizing logistic regressions. We characterized geographic and temporal variations in AKI rates and estimated variance explained by key variables utilizing Poisson regressions.ResultsIn total, 1655 (32%) participants had AKI; 961 (58%), 223 (13%), and 270 (16%) met Kidney Disease Improving Global Outcomes definitions of stage 1, 2, and 3 AKI, respectively, and 201 (12%) received KRT. Eight percent of participants had AKI within 1 day of hospitalization, and 47% did not recover to baseline serum creatinine by discharge. Older age, Black race, male gender, obesity, diabetes, hypertension, and lower eGFR were significant predictors of AKI during hospitalization with COVID-19. AKI was associated with higher mechanical ventilation use (odds ratio, 6.46; 95% confidence interval, 5.52 to 7.57) and longer hospital stay (5.56 additional days; 95% confidence interval, 4.78 to 6.34). AKI was also associated with higher risk of death (odds ratio, 6.71; 95% confidence interval, 5.62 to 8.04); this association was stronger in Blacks (P value of interaction <0.001). Hospital-level rates of AKI exhibited substantial geographic variability, ranging from 10% to 56%. Between March and July 2020, AKI rates declined from 40% to 27%; proportions of AKI stage 3 and AKI requiring KRT decreased from 44% to 17%. Both geographic and temporal variabilities were predominately explained by percentages of Blacks (31% and 49%, respectively).ConclusionsAKI is common during hospitalization with COVID-19 and associated with higher risk of health care resource utilization and death. Nearly half of patients with AKI did not recover to baseline by discharge. Substantial geographic variation and temporal decline in rates and severity of AKI were observed.PodcastThis article contains a podcast at https://www.asn-online.org/media/podcast/CJASN/2020_11_16_CJN09610620_final.mp3

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“…Bhaskar et al, 2008 , Bowe et al, 2018b , Bowe et al, 2019 , Bowe et al, 2019 , Bowe et al, 2020;10:4586.c , Cai et al, 2021 , Chan et al, 2018 , Cohen et al, 2017 , Department of Veterans Affairs, 2020 , Huang et al, 2019 , Mateus et al, 2020:eabd3871. , NAAQS, 2012 , Strobl, xxxx , CDW, 2014 , Travaglio et al, 2004 , University of Wisconsin School of Medicine Public Health, 2013 , VA Information Resource Center.…”

Section: Uncited Referencesmentioning

confidence: 99%

Ambient fine particulate matter air pollution and the risk of hospitalization among COVID-19 positive individuals: Cohort study

Bowe

Xie

Gibson

et al. 2021

Environment International

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Background Ecologic analyses suggest that living in areas with higher levels of ambient fine particulate matter air pollution (PM 2.5 ) is associated with higher risk of adverse COVID-19 outcomes. Studies accounting for individual-level health characteristics are lacking. Methods We leveraged the breadth and depth of the US Department of Veterans Affairs national healthcare databases and built a national cohort of 169,102 COVID-19 positive United States Veterans, enrolled between March 2, 2020 and January 31, 2021, and followed them through February 15, 2021. Annual average 2018 PM 2.5 exposure, at an approximately 1 km 2 resolution, was linked with residential street address at the year prior to COVID-19 positive test. COVID-19 hospitalization was defined as first hospital admission between 7 days prior to, and 15 days after, the first COVID-19 positive date. Adjusted Poisson regression assessed the association of PM 2.5 with risk of hospitalization. Results There were 25,422 (15.0%) hospitalizations; 5,448 (11.9%), 5,056 (13.0%), 7,159 (16.1%), and 7,759 (19.4%) were in the lowest to highest PM 2.5 quartile, respectively. In models adjusted for State, demographic and behavioral factors, contextual characteristics, and characteristics of the pandemic a one interquartile range increase in PM 2.5 (1.9 µg/m 3 ) was associated with a 10% (95% CI: 8%-12%) increase in risk of hospitalization. The association of PM 2.5 and risk of hospitalization among COVID-19 individuals was present in each wave of the pandemic. Models of non-linear exposure-response suggested increased risk at PM 2.5 concentrations below the national standard 12 µg/m 3 . Formal effect modification analyses suggested higher risk of hospitalization associated with PM 2.5 in Black people compared to White people (p=0.045), and in those living in socioeconomically disadvantaged neighborhoods (p<0.001). Conclusions Exposure to higher levels of PM 2.5 was associated with increased risk of hospitalization among COVID-19 infected individuals. The risk was evident at PM 2.5 levels below the regulatory standards. The analysis identified those of Black race and those living in disadvantaged neighborhoods as population groups that may be more susceptible to the untoward effect of PM 2.5 on risk of hospitalization in the setting of COVID-19.

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Diabetes Minimally Mediated the Association Between PM2.5 Air Pollution and Kidney Outcomes

Cited by 24 publications

References 43 publications

Temporal Trends in Incidence Rates of Lower Extremity Amputation and Associated Risk Factors Among Patients Using Veterans Health Administration Services From 2008 to 2018

Temporal Trends in Incidence Rates of Lower Extremity Amputation and Associated Risk Factors Among Patients Using Veterans Health Administration Services From 2008 to 2018

Acute Kidney Injury in a National Cohort of Hospitalized US Veterans with COVID-19

Ambient fine particulate matter air pollution and the risk of hospitalization among COVID-19 positive individuals: Cohort study

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