TY - JOUR T1 - Cardiovascular disease risk prediction for people with type 2 diabetes in a population-based cohort and in electronic health record data JF - Jamia Open Y1 - 2020 A1 - Szymonifka, Jackie A1 - Conderino, Sarah A1 - Christine T Cigolle A1 - Ha, Jinkyung A1 - Mohammed U Kabeto A1 - Yu, Jaehong A1 - John A. Dodson A1 - Thorpe, Lorna A1 - Caroline S Blaum A1 - Zhong, Judy KW - Cardiovascular disease KW - type 2 diabetes AB - Electronic health records (EHRs) have become a common data source for clinical risk prediction, offering large sample sizes and frequently sampled metrics. There may be notable differences between hospital-based EHR and traditional cohort samples: EHR data often are not population-representative random samples, even for particular diseases, as they tend to be sicker with higher healthcare utilization, while cohort studies often sample healthier subjects who typically are more likely to participate. We investigate heterogeneities between EHR- and cohort-based inferences including incidence rates, risk factor identifications/quantifications, and absolute risks.This is a retrospective cohort study of older patients with type 2 diabetes using EHR from New York University Langone Health ambulatory care (NYULH-EHR, years 2009–2017) and from the Health and Retirement Survey (HRS, 1995–2014) to study subsequent cardiovascular disease (CVD) risks. We used the same eligibility criteria, outcome definitions, and demographic covariates/biomarkers in both datasets. We compared subsequent CVD incidence rates, hazard ratios (HRs) of risk factors, and discrimination/calibration performances of CVD risk scores.The estimated subsequent total CVD incidence rate was 37.5 and 90.6 per 1000 person-years since T2DM onset in HRS and NYULH-EHR respectively. HR estimates were comparable between the datasets for most demographic covariates/biomarkers. Common CVD risk scores underestimated observed total CVD risks in NYULH-EHR.EHR-estimated HRs of demographic and major clinical risk factors for CVD were mostly consistent with the estimates from a national cohort, despite high incidences and absolute risks of total CVD outcome in the EHR samples. SN - 2574-2531 ER - TY - JOUR T1 - Chronic obstructive pulmonary disease, cognitive impairment, and development of disability: the health and retirement study JF - Annals of the American Thoracic Society Y1 - 2014 A1 - Martinez, Carlos H. A1 - Richardson, Caroline R. A1 - Han, MeiLan K. A1 - Christine T Cigolle KW - Disabilities KW - Health Conditions and Status KW - Healthcare AB - RATIONALE: The relationship between chronic obstructive pulmonary disease (COPD) and cognitive impairment in leading to disability has not been characterized. OBJECTIVES: We aimed to investigate the prevalence and cumulative incidence of disability among adults with and without COPD and the association of COPD and cognitive impairment with disability. METHODS: We analyzed 2006-2008 waves of the Health and Retirement Study, a nationally representative longitudinal health survey. COPD was self-reported. Prevalent disability was defined as baseline dependency in one or more activities of daily living (ADLs) and incident disability as one or more additional ADL dependencies. We used a validated performance-based measure of cognition to identify dementia and mild cognitive impairment. Covariates included seven chronic diseases, four geriatric syndromes, and sociodemographics. We used logistic regression to test associations between COPD, cognitive status, and prevalent/incident disability. MEASUREMENTS AND MAIN RESULTS: Of 17,535 participants at least 53 years of age in wave 2006 (representing 77.7 million Americans), 9.5 reported COPD and 13.5 mild cognitive impairment; 17.5 of those with COPD had mild cognitive impairment. Prevalent disability for COPD was 12.8 (5.2 for no-COPD, P 0.001). An additional 9.2 with COPD developed incident disability at 2 years (4.0 for no-COPD, P 0.001). In adjusted models, COPD was associated with baseline (odds ratio, 2.0) and incident disability (odds ratio, 2.1; adjusted for baseline disability). Cognitive impairment had an additive effect to COPD. The COPD-disability association, prevalent/incident, was of similar or greater magnitude than that of other chronic diseases (e.g., stroke, diabetes). The associations were maintained in sensitivity analyses using alternative definitions of disability (dependency in two or more ADLs, dependency in instrumental ADLs), and in analysis excluding respondents with dementia. CONCLUSIONS: Both COPD and mild cognitive impairment increase the risk of disability. The risk conferred by COPD is significant and similar or higher than other chronic diseases. PB - 11 VL - 11 IS - 9 N1 - Times Cited: 0 0 U4 - chronic obstructive pulmonary disease/cognitive impairment/multimorbidity/disability/disability/geriatrics ER - TY - JOUR T1 - Physical Function Limitations Among Middle-Aged and Older Adults With Prediabetes One exercise prescription may not fit all JF - Diabetes Care Y1 - 2013 A1 - Pearl G. Lee A1 - Christine T Cigolle A1 - Ha, Jinkyung A1 - Lillian C. Min A1 - Susan L Murphy A1 - Caroline S Blaum A1 - Herman, William H. KW - Demographics KW - Disabilities KW - Event History/Life Cycle KW - Health Conditions and Status KW - Other KW - Risk Taking AB - OBJECTIVETo describe the prevalence of physical function limitations among a nationally representative sample of adults with prediabetes.RESEARCH DESIGN AND METHODSWe performed a cross-sectional analysis of 5,991 respondents 53 years of age from the 2006 wave of the Health and Retirement Study. All respondents self-reported physical function limitations and comorbidities (chronic diseases and geriatric conditions). Respondents with prediabetes reported no diabetes and had a measured glycosylated hemoglobin (HbA(1c)) of 5.7-6.4 . Descriptive analyses and logistic regressions were used to compare respondents with prediabetes versus diabetes (diabetes history or HbA(1c) 6.5 ) or normoglycemia (no diabetes history and HbA(1c) 5.7 ).RESULTSTwenty-eight percent of respondents 53 years of age had prediabetes; 32 had mobility limitations (walking several blocks and/or climbing a flight of stairs); 56 had lower-extremity limitations (getting up from a chair and/or stooping, kneeling, or crouching); and 33 had upper-extremity limitations (pushing or pulling heavy objects and/or lifting 10 lb). Respondents with diabetes had the highest prevalence of comorbidities and physical function limitations, followed by those with prediabetes, and then normoglycemia (P 0.05). Compared with respondents with normoglycemia, respondents with prediabetes had a higher odds of having functional limitations that affected mobility (odds ratio OR 1.48), the lower extremities (OR 1.35), and the upper extremities (OR 1.37) (all P 0.01). The higher odds of having lower-extremity limitations remained after adjusting for age, sex, and body mass index (OR 1.21, P 0.05).CONCLUSIONSComorbidities and physical function limitations are prevalent among middle-aged and older adults with prediabetes. Effective lifestyle interventions to prevent diabetes must accommodate physical function limitations. PB - 36 VL - 36 IS - 10 N1 - Times Cited: 1 U4 - Impaired Glucose Tolerance/Geriatric Conditions/United-States/Life Style/Disability/Disability/Health/Prevalence/Reduction/Risk Factor ER -