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  • 11
    Online Resource
    Online Resource
    Ethnic Differences in Dementia Risk: A Systematic Review and Meta-Analysis
    IOS Press ; 2021
    In:  Journal of Alzheimer's Disease Vol. 80, No. 1 ( 2021-03-09), p. 337-355
    Details
    In: Journal of Alzheimer's Disease, IOS Press, Vol. 80, No. 1 ( 2021-03-09), p. 337-355
    Abstract: Background: Globally around 50 million people have dementia. Risk factors for dementia such as hypertension and diabetes are more common in Black, Asian, and other ethnic minorities. There are also marked ethnic inequalities in care seeking, likelihood of diagnosis, and uptake of treatments for dementia. Nevertheless, ethnic differences in dementia incidence and prevalence remain under-explored. Objective: To examine published peer-reviewed observational studies comparing age-specific or age-adjusted incidence or prevalence rates of dementia between at least two ethnic groups. Methods: We searched seven databases on 1 September 2019 using search terms for ethnicity, dementia, and incidence or prevalence. We included population-based studies comparing incidence or prevalence of dementia after accounting for age of at least two ethnic groups in adults aged 18 or more. Meta-analysis was conducted for eligible ethnic comparisons. Results: We included 12 cohort studies and seven cross-sectional studies. Thirteen were from the US, and two studies each from the UK, Singapore, and Xinjiang Uyghur Autonomous Region in China. The pooled risk ratio for dementia incidence obtained from four studies comparing Black and White ethnic groups was 1.33 (95% CI 1.07–1.65; I-squared = 58.0%). The pooled risk ratio for dementia incidence comparing the Asian and White ethnic groups was 0.86 (95% CI 0.728–1.01; I-squared = 43.9%). There was no difference in the incidence of dementia for Latino ethnic group compared to the White ethnic group. Conclusion: Evidence to date suggest there are ethnic differences in risk of dementia. Better understanding of the drivers of these differences may inform efforts to prevent or treat dementia.
    Type of Medium: Online Resource
    ISSN: 1387-2877 , 1875-8908
    URL: Article
    DOI: 10.3233/JAD-201209
    Language: Unknown
    Publisher: IOS Press
    Publication Date: 2021
    detail.hit.zdb_id: 2070772-1
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  • 12
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    Risk of herpes zoster after exposure to varicella to explore the exogenous boosting hypothesis: self controlled case series study using UK electronic healthcare data
    BMJ ; 2020
    In:  BMJ
    Details
    In: BMJ, BMJ
    Abstract: To assess the magnitude and duration of any hypothesised protective effect of household exposure to a child with varicella on the relative incidence of herpes zoster in adults. Design Self controlled case series. Setting UK general practices contributing to Clinical Practice Research Datalink. Participants 9604 adults (≥18 years) with a diagnosis of herpes zoster (in primary care or hospital records) between 1997 and 2018, who during their observation period lived with a child ( 〈 18 years) with a diagnosis of varicella. Main outcome measures Relative incidence of herpes zoster in the 20 years after exposure to a child with varicella in the household compared with baseline time (all other time, excluding the 60 days before exposure). Results 6584 of the 9604 adults with herpes zoster (68.6%) were women. Median age of exposure to a child with varicella was 38.3 years (interquartile range 32.3-48.8 years) and median observation period was 14.7 (11.1-17.7) years. 4116 adults developed zoster in the baseline period, 433 in the 60 days before exposure and 5055 in the risk period. After adjustment for age, calendar time, and season, strong evidence suggested that in the two years after household exposure to a child with varicella, adults were 33% less likely to develop zoster (incidence ratio 0.67, 95% confidence interval 0.62 to 0.73) compared with baseline time. In the 10-20 years after exposure, adults were 27% less likely to develop herpes zoster (0.73, 0.62 to 0.87) compared with baseline time. A stronger boosting effect was observed among men than among women after exposure to varicella. Conclusions The relative incidence of zoster was lower in the periods after exposure to a household contact with varicella, with modest but long lasting protective effects observed. This study suggests that exogenous boosting provides some protection from the risk of herpes zoster, but not complete immunity, as assumed by previous cost effectiveness estimates of varicella immunisation.
    Type of Medium: Online Resource
    ISSN: 1756-1833
    URL: Article
    DOI: 10.1136/bmj.l6987
    Language: English
    Publisher: BMJ
    Publication Date: 2020
    detail.hit.zdb_id: 1479799-9
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  • 13
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    Human herpesvirus infections and dementia or mild cognitive impairment: a systematic review and meta-analysis
    Springer Science and Business Media LLC ; 2019
    In:  Scientific Reports Vol. 9, No. 1 ( 2019-03-18)
    Details
    In: Scientific Reports, Springer Science and Business Media LLC, Vol. 9, No. 1 ( 2019-03-18)
    Abstract: Interest is growing in the role of infectious agents in the pathogenesis of dementia, but current evidence is limited. We conducted a systematic review and meta-analysis to investigate the effect of any of eight human herpesviruses on development of dementia or mild cognitive impairment (MCI). We searched the Cochrane Library, Embase, Global Health, Medline, PsycINFO, Scopus, Web of Science, clinical trials registers and grey literature sources from inception to December 2017 for observational studies with cohort, case control or self-controlled designs, or randomised controlled trials of interventions against herpesviruses. Pooled effect estimates and 95% confidence intervals (CIs) were generated through random effects meta-analyses across studies with the same design, outcome, and virus type, method and site of measurement. We included 57 studies across various geographic settings. Past infection with herpesviruses, measured by IgG seropositivity, was generally not associated with dementia risk. A single cohort study rated moderate quality showed an association between varicella zoster virus reactivation (ophthalmic zoster) and incident dementia (HR 2.97; 95%CI, 1.89 to 4.66). Recent infection with, or reactivation of, herpes simplex virus type 1 or type 1/2 unspecified, cytomegalovirus and human herpes virus-6 measured by serum IgM, high titre IgG or clinical disease may be associated with dementia or MCI, though results were inconsistent across studies and overall evidence rated very low quality. Longitudinal population studies with robust repeated virus measurements taken sufficiently proximal to dementia onset are needed to establish whether, when and among whom herpesviruses affect dementia risk.
    Type of Medium: Online Resource
    ISSN: 2045-2322
    URL: Article
    DOI: 10.1038/s41598-019-41218-w
    Language: English
    Publisher: Springer Science and Business Media LLC
    Publication Date: 2019
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  • 14
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    Antibodies to Human Herpesviruses and Rate of Incident Cardiovascular Events and All-Cause Mortality in the UK Biobank Infectious Disease Pilot Study
    Oxford University Press (OUP) ; 2022
    In:  Open Forum Infectious Diseases Vol. 9, No. 7 ( 2022-07-04)
    Details
    In: Open Forum Infectious Diseases, Oxford University Press (OUP), Vol. 9, No. 7 ( 2022-07-04)
    Abstract: Associations between human herpesviruses (HHVs) and cardiovascular disease/mortality have been reported, but evidence is inconsistent. We investigated associations between 3 common herpesviruses and (1) incident stroke or myocardial infarction (MI) and (2) all-cause mortality. Methods We included participants from the UK Biobank Infectious Disease pilot study with valid serum antibody (IgG) measurements taken at cohort entry (2006–2010) for herpes simplex virus type 1 (HSV1), varicella zoster virus (VZV), and cytomegalovirus (CMV). Linked hospital and mortality records up to December 30 2019 provided information on rates of (1) incident first stroke or MI and (2) all-cause mortality. Hazard ratios (HRs) from Cox proportional hazards regression models were used to assess relationships between (1) HHV seropositivity, (2) HHV titer and incident stroke/MI, and death outcomes. Fully adjusted models accounted for sociodemographic information (age, sex, ethnicity, education, deprivation quintile, birthplace, population density), baseline comorbidities (including diabetes and hypertension), smoking status, body mass index, and serum cholesterol. Results Of 9429 study participants (56% female, 95% White, median age 58 years), 41% were seropositive for all 3 HHVs. Human herpesvirus seropositivity was not associated with stroke/MI (fully adjusted HRs and 95% confidence intervals [CIs]: HSV1 = 0.93 [CI, 0.72–1.22] , VZV = 0.78 [CI, 0.51–1.20], CMV = 0.91 [CI, 0.71–1.16] ) or all-cause mortality (HSV1 = 1.21 [CI, 1.00–1.47], VZV = 0.79 [CI, 0.58–1.07] , CMV = 0.90 [CI, 0.76–1.06]). Human herpesvirus titers were not associated with outcomes. Conclusions In this mostly White UK Biobank subset, neither HHV seropositivity nor titers were associated with stroke/MI or all-cause mortality.
    Type of Medium: Online Resource
    ISSN: 2328-8957
    URL: Article
    DOI: 10.1093/ofid/ofac294
    Language: English
    Publisher: Oxford University Press (OUP)
    Publication Date: 2022
    detail.hit.zdb_id: 2757767-3
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  • 15
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    Vitamin D Deficiency or Supplementation and the Risk of Human Herpesvirus Infections or Reactivation: A Systematic Review and Meta-analysis
    Oxford University Press (OUP) ; 2021
    In:  Open Forum Infectious Diseases Vol. 8, No. 1 ( 2021-01-01)
    Details
    In: Open Forum Infectious Diseases, Oxford University Press (OUP), Vol. 8, No. 1 ( 2021-01-01)
    Abstract: Vitamin D may protect against respiratory virus infections, but any association with herpesviruses is unclear. Methods We undertook a systematic review of vitamin D deficiency or supplementation and the risk of 8 human herpesviruses. Six databases and 4 gray literature databases were searched for relevant cohort studies, case–control studies, and clinical trials. Results Ten studies were included, all conducted among immunosuppressed patients. There was no evidence that vitamin D deficiency is associated with cytomegalovirus (CMV) disease (pooled risk ratio, 1.06; 95% CI, 0.66–1.7), herpes zoster after transplantation (1 study), or HHV-8 among HIV patients (1 study). Vitamin D supplementation may decrease herpes zoster among hemodialysis patients (1 study) or CMV disease after renal transplantation (1 study), but supplementation was not associated with reduced EBV viral load among multiple sclerosis patients (1 study). Conclusions Any association between vitamin D and herpesviruses remains inconclusive. Further studies in the general population are needed.
    Type of Medium: Online Resource
    ISSN: 2328-8957
    URL: Article
    DOI: 10.1093/ofid/ofaa570
    Language: English
    Publisher: Oxford University Press (OUP)
    Publication Date: 2021
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  • 16
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    Influenza and ischaemic heart disease: research challenges and future directions
    BMJ ; 2013
    In:  Heart Vol. 99, No. 24 ( 2013-12-15), p. 1795-1796
    Details
    In: Heart, BMJ, Vol. 99, No. 24 ( 2013-12-15), p. 1795-1796
    Type of Medium: Online Resource
    ISSN: 1355-6037 , 1468-201X
    URL: Article
    DOI: 10.1136/heartjnl-2013-304748
    Language: English
    Publisher: BMJ
    Publication Date: 2013
    detail.hit.zdb_id: 2378689-9
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  • 17
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    Exploring the impact of mental health conditions on vaccine uptake in high-income countries: a systematic review
    Springer Science and Business Media LLC ; 2023
    In:  BMC Psychiatry Vol. 23, No. 1 ( 2023-01-07)
    Details
    In: BMC Psychiatry, Springer Science and Business Media LLC, Vol. 23, No. 1 ( 2023-01-07)
    Abstract: Vaccination is an essential public health intervention to reduce morbidity and mortality from infectious diseases. Despite being at higher at risk of infectious diseases, health inequalities towards vaccine uptake in people with mental health issues have not been systematically appraised. Methods We searched 7 databases from 1994 to 26/03/2021. We included all studies with a relative measure of effect comparing a group with a mental health issue to a control group. All studies covering any mental health issue were eligible with no constraints to study population, vaccine type or region, provided in a high-income country for comparability of health care systems. The study outcomes were synthesised by study population, mental health issue and type of vaccine. Results From 4,069 titles, 23 eligible studies from 12 different countries were identified, focusing on adults ( n  = 13) or children ( n  = 4) with mental health issues, siblings of children with mental health issues ( n  = 2), and mothers with mental health issue and vaccine uptake in their children ( n  = 6). Most studies focused on depression ( n  = 12), autism, anxiety, or alcoholism ( n  = 4 respectively). Many studies were at high risk of selection bias. Discussion Mental health issues were associated with considerably lower vaccine uptake in some contexts such as substance use disorder, but findings were heterogeneous overall and by age, mental health issue or types of vaccine. Only individuals with mental health issues and physical comorbidities had consistently higher uptake in comparison to other adults. Mental health should be considered as a health inequality for vaccine uptake but more context specific research is needed focusing more on specific mental health issues and subgroups of the population to understand who misses vaccination and why.
    Type of Medium: Online Resource
    ISSN: 1471-244X
    URL: Article
    DOI: 10.1186/s12888-022-04512-y
    Language: English
    Publisher: Springer Science and Business Media LLC
    Publication Date: 2023
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  • 18
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    Anticoagulant prescribing in atrial fibrillation and risk of incident dementia: A UK population‐based cohort study : Developing topics
    Wiley ; 2020
    In:  Alzheimer's & Dementia Vol. 16, No. S10 ( 2020-12)
    Details
    In: Alzheimer's & Dementia, Wiley, Vol. 16, No. S10 ( 2020-12)
    Abstract: Dementia risk is approximately doubled among patients with atrial fibrillation (AF) 1‐3 , who are often recommended to take blood‐thinning drugs (anticoagulants) to prevent stroke. Recent evidence has also shown that taking anticoagulant drugs may help to delay the onset of dementia among individuals with AF 4 , however, we do not know which types of anticoagulants drugs are most beneficial and for which groups of patients. Hence, the aim of this study was to compare the effect of direct oral anticoagulants (DOACs) versus vitamin K antagonists (VKAs) on risks of incident dementia and mild cognitive impairment (MCI) among patients with newly diagnosed atrial fibrillation (AF). Method Using linked electronic health records data from the Clinical Practice Research Datalink (CPRD) in the United Kingdom, we conducted a historical cohort study among first‐time oral anticoagulant users with patients with incident non‐valvular AF diagnosed from 2012 to 2018. Crude incidence rates of dementia and MCI were calculated overall and separately for DOACs and VKAs. Cox proportional hazards regression models were then used to compare the incidence of clinically coded dementia and MCI between patients prescribed VKAs and DOACs, adjusting for sociodemographic and lifestyle factors, clinical comorbidities and medications. Result Of 39,200 first time oral anticoagulant users (44.6% female, median age 76 years, IQR 68‐83), 20,687 (53%) were prescribed a VKA and 18,513 (47%) a DOAC at baseline. Overall, 1,258 patients (3.2%) had GP‐recorded incident dementia, incidence rate 14.9 per 1,000 person‐years and 1,483 patients (3.9%) received a diagnosis of MCI, incidence rate 19.29 per 1,000‐person years. DOAC treatment for AF was associated with a 15% reduction in dementia risk compared to VKA treatment in the whole cohort (HR 0.85, 95% CI: 0.73, 0.98) and with a 20% reduction in MCI risk (HR 0.80, 95% CI: 0.71‐0.91). Conclusion The risks of incident EHR‐recorded dementia and MCI were lower among patients prescribed DOACs for new AF compared to those prescribed VKAs. The cognitive risk profile of a patient should help to inform choice of oral anticoagulant treatment for AF among older individuals.
    Type of Medium: Online Resource
    ISSN: 1552-5260 , 1552-5279
    URL: Issue
    URL: Article
    DOI: 10.1002/alz.v16.S10
    DOI: 10.1002/alz.047554
    Language: English
    Publisher: Wiley
    Publication Date: 2020
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  • 19
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    Overall and cause-specific hospitalisation and death after COVID-19 hospitalisation in England: A cohort study using linked primary care, secondary care, and death registration data in the OpenSAFELY platform
    Public Library of Science (PLoS) ; 2022
    In:  PLOS Medicine Vol. 19, No. 1 ( 2022-1-25), p. e1003871-
    Details
    In: PLOS Medicine, Public Library of Science (PLoS), Vol. 19, No. 1 ( 2022-1-25), p. e1003871-
    Abstract: There is concern about medium to long-term adverse outcomes following acute Coronavirus Disease 2019 (COVID-19), but little relevant evidence exists. We aimed to investigate whether risks of hospital admission and death, overall and by specific cause, are raised following discharge from a COVID-19 hospitalisation. Methods and findings With the approval of NHS-England, we conducted a cohort study, using linked primary care and hospital data in OpenSAFELY to compare risks of hospital admission and death, overall and by specific cause, between people discharged from COVID-19 hospitalisation (February to December 2020) and surviving at least 1 week, and (i) demographically matched controls from the 2019 general population; and (ii) people discharged from influenza hospitalisation in 2017 to 2019. We used Cox regression adjusted for age, sex, ethnicity, obesity, smoking status, deprivation, and comorbidities considered potential risk factors for severe COVID-19 outcomes. We included 24,673 postdischarge COVID-19 patients, 123,362 general population controls, and 16,058 influenza controls, followed for ≤315 days. COVID-19 patients had median age of 66 years, 13,733 (56%) were male, and 19,061 (77%) were of white ethnicity. Overall risk of hospitalisation or death (30,968 events) was higher in the COVID-19 group than general population controls (fully adjusted hazard ratio [aHR] 2.22, 2.14 to 2.30, p 〈 0.001) but slightly lower than the influenza group (aHR 0.95, 0.91 to 0.98, p = 0.004). All-cause mortality (7,439 events) was highest in the COVID-19 group (aHR 4.82, 4.48 to 5.19 versus general population controls [ p 〈 0.001] and 1.74, 1.61 to 1.88 versus influenza controls [ p 〈 0.001]). Risks for cause-specific outcomes were higher in COVID-19 survivors than in general population controls and largely similar or lower in COVID-19 compared with influenza patients. However, COVID-19 patients were more likely than influenza patients to be readmitted or die due to their initial infection or other lower respiratory tract infection (aHR 1.37, 1.22 to 1.54, p 〈 0.001) and to experience mental health or cognitive-related admission or death (aHR 1.37, 1.02 to 1.84, p = 0.039); in particular, COVID-19 survivors with preexisting dementia had higher risk of dementia hospitalisation or death (age- and sex-adjusted HR 2.47, 1.37 to 4.44, p = 0.002). Limitations of our study were that reasons for hospitalisation or death may have been misclassified in some cases due to inconsistent use of codes, and we did not have data to distinguish COVID-19 variants. Conclusions In this study, we observed that people discharged from a COVID-19 hospital admission had markedly higher risks for rehospitalisation and death than the general population, suggesting a substantial extra burden on healthcare. Most risks were similar to those observed after influenza hospitalisations, but COVID-19 patients had higher risks of all-cause mortality, readmission or death due to the initial infection, and dementia death, highlighting the importance of postdischarge monitoring.
    Type of Medium: Online Resource
    ISSN: 1549-1676
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    DOI: 10.1371/journal.pmed.1003871
    DOI: 10.1371/journal.pmed.1003871.g001
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    Language: English
    Publisher: Public Library of Science (PLoS)
    Publication Date: 2022
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  • 20
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    Distribution of vitamin D status in the UK: a cross-sectional analysis of UK Biobank
    BMJ ; 2021
    In:  BMJ Open Vol. 11, No. 1 ( 2021-01), p. e038503-
    Details
    In: BMJ Open, BMJ, Vol. 11, No. 1 ( 2021-01), p. e038503-
    Abstract: No recent large studies have described the distribution of vitamin D status in the UK. Understanding the epidemiology of vitamin D deficiency is important to inform targeted public health recommendations. This study aimed to investigate the distribution of factors associated with serum vitamin D status in a large national cohort. Design A cross-sectional study. Setting The UK Biobank, a prospective cohort study following the health and well-being of middle-aged and older adults recruited between 2006 and 2010. Participants A total of 449 943 participants aged 40–69 years with measured serum vitamin D status were eligible for the analysis. Participants completed a questionnaire about sex, age, ethnic background, vitamin D supplementation, smoking, drinking and socioeconomic status. Primary and secondary outcome measures We investigated the distribution of serum vitamin D status and the association between demographic factors and vitamin D deficiency or insufficiency. Vitamin D deficiency was defined as a serum 25-hydroxyvitamin D level 〈 25 nmol/L. Multivariable logistic regression was used to assess the association between demographic factors and vitamin D status. Results Asian (n=4297/8000, 53.7%) and black (n=2459/7046, 34.9%) participants had a higher proportion of vitamin D deficiency than white participants (n=50 920/422 907, 12%). During spring and winter, the proportion of vitamin D deficiency was higher across the UK and higher in the north than in the south. Male sex, abnormal body mass index, non-white ethnic backgrounds, smoking and being more socioeconomically deprived were associated with higher odds of vitamin D deficiency. Increasing age, taking vitamin D supplements and drinking alcohol were associated with lower odds of deficiency. Conclusions Vitamin D status varied among different ethnic groups and by season and geographical area within the UK. Taking supplements was associated with a lower risk of vitamin D deficiency. These findings support the vitamin D supplementation recommendations of Public Health England.
    Type of Medium: Online Resource
    ISSN: 2044-6055 , 2044-6055
    URL: Article
    DOI: 10.1136/bmjopen-2020-038503
    Language: English
    Publisher: BMJ
    Publication Date: 2021
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