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Medscape
10 hours ago
- Health
- Medscape
Tiotropium Use in COPD Linked to Minimal Risk for Dementia
The initiation of tiotropium monotherapy was associated with, at most, a modest increase in dementia risk among older adults with chronic obstructive pulmonary disease (COPD) compared with long-acting beta 2-agonist combined with inhaled corticosteroid (LABA-ICS) over a long-term follow-up, although the clinical significance of this finding remains uncertain. METHODOLOGY: Researchers conducted a population-based cohort study using administrative data from Ontario, Canada, to examine whether the initiation of tiotropium monotherapy affects the risk for dementia in older adults with COPD. They included 30,960 new users of tiotropium monotherapy and compared them with 19,530 new users of LABA-ICS (mean age, 75.1 years; 46.7% women), all of whom had COPD without dementia and had started the medication from September 2004 through February 2012. The participants were followed up for a median of 7.59 years from the time of cohort entry. The study endpoint was incident dementia or censoring (death, insurance termination, or 10-year follow-up), whichever happened first. TAKEAWAY: Compared with the initiation of LABA-ICS, tiotropium monotherapy was associated with a 9% higher risk for dementia (hazard ratio [HR], 1.09; 95% CI, 1.04-1.14). However, in the secondary as-treated analysis, the initiation of tiotropium was not associated with an increased risk for dementia compared with LABA-ICS (HR, 1.11; 95% CI, 0.93-1.32). Subgroup analysis revealed an 18% higher risk for dementia with tiotropium monotherapy vs LABA-ICS in adults younger than 75 years and a 12% higher risk in men. IN PRACTICE: 'On balance, this evidence does not provide a compelling argument that patients with COPD should avoid tiotropium due to concerns about cognitive decline,' the authors of the study wrote. SOURCE: This study was led by Che-Yuan Wu, University of Toronto, Toronto, Ontario, Canada. It was published online on May 19, 2025, in JAMA Internal Medicine. LIMITATIONS: This study was potentially confounded by unmeasured factors such as smoking, dyspnea, peripheral biomarkers, spirometry measures, and other anticholinergic drugs. The assumption that the LABA-ICS comparator had no effect on the risk for dementia might not be true. The data for midlife medication dispensing and dementia biomarkers were unavailable. DISCLOSURES: This study was supported by the Heart-Brain Connection Brain-Heart Research Integrative Innovation Team Endeavor IMPACT Award from the Heart and Stroke Foundation of Canada, Brain Canada, and other sources. Few authors reported receiving financial support and grants from study funders and other sources.
Medscape
16-05-2025
- Health
- Medscape
Maternal Disability Linked to Higher Infant ED Use
Infants born to mothers with disabilities had higher rates of emergency department (ED) visits in their first year of life than those born to mothers without disabilities. METHODOLOGY: Researchers conducted a population-based study of 1,596,932 live-born infants from April 1, 2008, to March 31, 2021, in Canada. A total of 139,698 infants (8.7%) were born to women with a physical disability; among them, 48,112 infants were born to women with a sensory disability, 2547 were born to women with an intellectual or developmental disability, and 10,312 were born to women with multiple disabilities. The primary outcome was any ED visit within the first year of life. TAKEAWAY: ED visits were more common among infants born to mothers with physical (46.9%), sensory (45.2%), intellectual or developmental (55.4%), or multiple (51.0%) disabilities than among those born to mothers without disabilities (40.0%). These differences corresponded to 12%, 7%, 17%, and 14% higher odds of ED use, respectively. Infants of mothers with disabilities had more ED visits both before 28 days of life and between 28 and 365 days, with the highest risks seen among infants of mothers with intellectual or developmental disabilities (adjusted hazard ratios of 1.58 and 1.41 for the respective time periods). Similar patterns were observed for ED visits for high-acuity, moderate-acuity, and low-acuity cases. ED visit characteristics (timing, diagnosis, discharge destination, and rates of follow-up with the primary care physician) were similar regardless of maternal disability status. IN PRACTICE: "This cohort study found that infants of women with a disability were more likely than infants of women without disabilities to have an ED visit and repeat ED visits, although the timing, diagnosis, discharge disposition, and rates of follow-up with the primary care physician within 7 days were similar," the authors wrote. "These findings suggest that more could be done for infants of women with a disability to prevent nonurgent ED visits, reduce risk factors for urgent ED visits, and support families when ED visits occur," they added. SOURCE: The study was led by Hilary K. Brown, PhD, University of Toronto Scarborough, Toronto, Ontario, Canada, and was published online on May 5, 2025, in JAMA Network Open . LIMITATIONS: Misclassification of disability status was a limitation. Additionally, the study lacked information on the severity of disability, the preventability of ED visits in outpatient settings, and the circumstances surrounding the decision to seek ED care, such as the quality of the relationship with the primary care physician, transportation issues, or distance to care. DISCLOSURES: The study was supported by the Institute for Clinical Evaluative Sciences. The authors reported receiving grants from various sources, including the Canadian Institutes of Health Research.
