Faculty of Medicine

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Sex differences and disparities in cardiovascular outcomes of COVID-19
(Oxford University Press (OUP), 2023-01-18)
Bugiardini, Raffaele
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Nava, Stefano
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Caramori, Gaetano
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Yoon, Jinsung
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Badimon, Lina
Background Previous analyses on sex differences in case fatality rates at population-level data had limited adjustment for key patient clinical characteristics thought to be associated with COVID-19 outcomes. We aimed to estimate the risk of specific organ dysfunctions and mortality in women and men. Methods and Results This retrospective cross-sectional study included 17 hospitals within 5 European countries participating in the International Survey of Acute Coronavirus Syndromes (ISACS) COVID-19(NCT05188612). Participants were individuals hospitalized with positive SARS-CoV-2 from March 2020 to February 2022. Risk-adjusted ratios(RR) of in-hospital mortality, acute respiratory failure(ARF), acute heart failure(AHF), and acute kidney injury(AKI) were calculated for women versus men. Estimates were evaluated by inverse probability of weighting and logistic regression models. The overall care cohort included 4,499 patients with COVID-19 associated hospitalizations. Of these, 1,524(33.9%) were admitted to ICU, and 1,117(24.8%) died during hospitalization. Compared with men, women were less likely to be admitted to ICU (RR:0.80; 95%CI: 0.71–0.91). In general wards (GW) and ICU cohorts, the adjusted women-to-men RRs for in-hospital mortality were of 1.13(95%CI: 0.90–1.42) and 0.86(95%CI: 0.70–1.05; pinteraction=0.04). Development of AHF, AKI and ARF was associated with increased mortality risk (ORs: 2.27; 95%CI; 1.73–2.98,3.85; 95%CI:3.21–4.63 and 3.95; 95%CI:3.04–5.14, respectively). The adjusted RRs for AKI and ARF were comparable among women and men regardless of intensity of care. By contrast, female sex was associated with higher odds for AHF in GW, but not in ICU (RRs:1.25; 95%CI0.94–1.67 versus 0.83; 95%CI:0.59–1.16, pinteraction=0.04). Conclusions Women in GW were at increased risk of AHF and in-hospital mortality for COVID-19 compared with men. For patients receiving ICU care, fatal complications including AHF and mortality appeared to be independent of sex. Equitable access to COVID-19 ICU care is needed to minimize the unfavourable outcome of women presenting with COVID-19 related complications.
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Relation between sex and mortality after myocardial infarction in high-income and middle-income European countries
(Oxford University Press (OUP), 2022-10-01)
Cenko, E
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Bergami, M
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Yoon, J
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Van Der Schaar, M
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Manfrini, O
Background: The relationship between female sex and cardiovascular mortality in myocardial infarction (MI) is controversial. Most available data are from high-income countries (HIC) where baseline risk is lower and revascularization procedures are more likely, so the generalizability to other populations is unclear. Purpose: The main goal of this study was to unravel the relation between patient-specific revascularization through percutaneous coronary intervention (PCI) and mortality among women and men. Methods: Data were drawn from the ISACS-Archives (NCT04008173) which includes a large cohort of patients enrolled in 6 European HIC (Croatia, Italy, Lithuania, Hungary, Romania, and United Kingdom) and 7 middle-income countries (MIC; Bosnia & Herzegovina, Kosovo, Macedonia, Moldova, Montenegro, and Serbia). Participants were stratified by MI subtypes: STEMI and NSTEMI. The primary outcome was 30-day mortality. To yield unbiased sex estimates of the effects of MI on mortality we modeled covariates and outcomes by propensity score-based analytic methods. We calculated the women to men risk ratios (RRs) using weighting with estimates compared by test of interaction on the log scale. Results: The cohort consisted of 22,087 patients with MI (30.2% women). Patient outcomes varied according to the subtype of MI. Females was associated with a greater excess risk of 30-day mortality in STEMI (RR: 1.94; 95% CI: 1.71–2.21) compared with NSTEMI (RR: 1.12; 95% CI: 0.95–1.50; P interaction <0.001). Coronary revascularization reduced the incidence of death among women and men in the overall population. Despite this, the primary outcome of 30-day mortality remained higher in women than men with STEMI (RR: 2.38; 95% CI: 2.00–2.82) whereas it was comparable across sexes in patients with NSTEMI (RR: 1.21; 95% CI: 0.79–1.83; P interaction=0.002). Sex differences in mortality from STEMI were more significant in MIC compared with HIC (RRs: 2.30; 95% CI: 1.98–2.68 vs. 1.36; 95% CI: 1.05–1.75; P interaction <0.001). The sex gap in mortality was mitigated by the use of revascularization therapy (RRs: 2.05; 95% CI: 1.68–2.50 in MIC vs. 2.17; 95% CI: 1.48–3.18 in HIC; P interaction=0.40) Conclusion: Women presenting with STEMI have worse early mortality rates than their male counterparts in both HIC and MIC even in patients undergoing revascularization. By contrast, sex differences are attenuated or no longer apparent in NSTEMI. With no information on the type of MI on admission, sex differences in early outcomes are difficult to be fully understood.
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COPD IN A SAMPLE OF GENERAL ADULT POPULATION FROM THE SKOPJE REGION
(University Ss. Cyril and Methodius in Skopje, 2022)
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Atanasovska, Aneta
Introduction. Chronic obstructive pulmonary disease (COPD) is one of the leading causes of morbidity, disability and mortality in the last decades worldwide. Aim of the study. To determine the COPD prevalence in a sample of general adult population from the Skopje region and its distribution by sex, age, smoking status, working status, family history of chronic bronchitis/asthma, and mode of household heating and cooking. Methods. A cross-sectional study (prevalence study) including 2,348 participants (1,239 males and 1,109 females, aged 18 to 86 years) from the Skopje region was performed at the Institute for Occupational Health of RN Macedonia, Skopje, in the period 2018-2021. The study protocol included completion of a questionnaire and spirometric measurements (pre and post-bronchodilator spirometry). COPD was defined by spirometric finding of persistent airflow limitation in symptomatic study subjects. Results. COPD prevalence in the whole study sample was 4.6%, being non-significantly higher in men (5.1%) than in women (4.1%). Fourfold higher prevalence of COPD was registered in the study subjects aged over 45 years as compared to the younger ones (6.7% vs. 1.6%; P = 0.000). COPD prevalence was significantly higher in active smokers as compared to non-smoking study subjects (9.4% vs. 1.9%; P = 0.000). In regard to working status, COPD prevalence among active workers was 3.9%, in the group of retired persons 8.7%, while in the group of students there was not a single subject with COPD. In addition, COPD prevalence in the workers occupationally exposed to noxious particles or gases was significantly higher than in unexposed workers (4.7% vs. 2.4%; P = 0.021). There was no statistically significant difference in the COPD prevalence between study subjects with positive and negative family history of asthma/chronic bronchitis (4.8% vs. 4.5%), as well as between study subjects who used biomass fuels for heating and cooking (6.2%) and those who did not use traditional fuels for household needs (4.0%). Conclusion. Our findings have indicated the age, active smoking and occupational exposures to noxious particles or gases as the factors significantly related to COPD prevalence in the examined sample of general adult population from the Skopje region.
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Global variations in prevalence of eczema symptoms in children from ISAAC Phase Three
(Elsevier BV, 2009-12)
Odhiambo, Joseph A
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Williams, Hywel C
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Clayton, Tadd O
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Robertson, Colin F
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Asher, M Innes
Background: In 1999, The International Study of Asthma and Allergies in Childhood (ISAAC) Phase One reported the prevalence of eczema symptoms in 715,033 children from 154 centers in 56 countries by using standardized epidemiologic tools. Objective: To update the world map of eczema prevalence after 5 to 10 years (ISAAC Phase Three) and include additional data from over 100 new centers. Methods: Cross-sectional surveys using the ISAAC questionnaire on eczema symptoms were completed by adolescents 13 to 14 years old and by parents of children 6 to 7 years old. Current eczema was defined as an itchy flexural rash in the past 12 months and was considered severe eczema if associated with 1 or more nights per week of sleep disturbance. Results: For the age group 6 to 7 years, data on 385,853 participants from 143 centers in 60 countries showed that the prevalence of current eczema ranged from 0.9% in India to 22.5% in Ecuador, with new data showing high values in Asia and Latin America. For the age group 13 to 14 years, data on 663,256 participants from 230 centers in 96 countries showed prevalence values ranging from 0.2% in China to 24.6% in Columbia with the highest values in Africa and Latin America. Current eczema was lower for boys than girls (odds ratio, 0.94 and 0.72 at ages 6 to 7 years and 13 to 14 years, respectively). Conclusion:ISAAC Phase Three provides comprehensive global data on the prevalence of eczema symptoms that is essential for public health planning. New data reveal that eczema is a disease of developing as well as developed countries.

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