Shah, Viraj

Abstract Background Socioeconomic position (SEP) is a fundamental social determinant of health (SDoH) contributing to observed disparities in cancer and cardiovascular (CV) care among individuals with prostate cancer (PC). Understanding the influence of SEP on CV health is essential for addressing outcome inequities within this population. Methods We conducted a retrospective study utilizing Surveillance, Epidemiology, and End Results (SEER)-Medicare to evaluate CV outcomes in patients ≥65 years with PC from 2009 to 2017. We studied the impact of SEP on cardiovascular events (CVEs), cardiovascular mortality (CVm), PC-specific mortality (PCsm), and all-cause mortality. CVE, CVm, and PCsm were analyzed using competing risk models and all-cause mortality with Cox proportional hazards models. A subgroup analysis was performed in Non-Hispanic Black and Non-Hispanic White individuals. Results We included 141 242 patients of whom 76 844 were in high SEP areas (45.6%) and 64 398 in low SEP ones (54.4%). Both groups had a mean age of 72 years; patients in low SEP areas were 67.5% Non-Hispanic White, 34.4% having diabetes, 73.3% hypertension, and 67.7% dyslipidemia versus the high SEP group with 85.6% Non-Hispanic White, 30.4% diabetes, 69.9% hypertension, and 70.7% dyslipidemia. Patients in low SEP areas had higher risks of CVm (subdistribution hazard ratio [sHR] = 1.18, 95% CI = 1.12 to 1.25), PCsm (sHR = 1.12, 95% CI = 1.06 to 1.17), CVE (sHR = 1.07, 95% CI = 1.04 to 1.09), and all-cause mortality (HR 1.16, 95% CI = 1.13 to 1.20). Accentuated results were shown in the Non-Hispanic Black subgroup. Conclusion Adverse SEP plays a significant role in shaping outcomes among older patients with PC, contributing to elevated risks of adverse CV and survival outcomes.

Background: Anemia in Type 2 Myocardial Infarction (T2MI) related hospitalizations has been linked to higher one year mortality along with other causes of hemodynamic stress. We conducted the first ever meta analysis to evaluate the overall global prevalence of Anemia among patients with T2MI with differences by subgroups. Methods: PUBMED, SCOPUS and Google Scholar Databases were systematically reviewed to find studies through January 2023 ascertaining prevalence of Anemia in T2MI. Binary Random Effects models were used to estimate the pooled prevalence and subgroup analysis of anemia in T2MI. Heterogeneity was assessed using I 2 statistics. Leave-One-Out sensitivity analysis was also performed. Results: A total of 16 cohorts with 28,629 patients, hospitalized with T2MI (Mean Age 74; SD13) revealed a 23.3% [95% CI 17.8% - 28.8%, I 2 -98.61%, P<0.001] pooled prevalence of Anemia and a Mean Hb level of 121; SD - 25 in g/L. The prevalence of Anemia was higher among T2MI cohorts with younger Mean Age [Mean <70 vs >70 Years; 24.6% (95% CI 14.1% - 34.1%) vs 21.4% (95% CI 15.6 - 27.2%)]; smaller sample size [ n<500 vs n>500; 26.6% (95% CI 18.4% - 34.8%) vs 18.6% (95%CI 10.4% - 26.8%)]; prospective studies [Prospective vs Retrospective; 26.1% (95%CI 17.4% - 34.7%) vs 18.7% (95%CI 12.7% - 24.7%)] and single center studies [Single Center vs Multi Center; 24.9% (95%CI 17.5% - 32.2%) vs 21.4% (95%CI 12.7% - 30.1%)]. The prevalence of Anemia in T2MI related hospitalizations was also higher in studies from Asia [36.2% (95%CI 24.6% - 47.7%)], Europe [21.9% (95% CI 14.1% - 29.7%)] and Multinational [21.1% (95%CI 11.9%-30.2%)] as compared to North America [16.4% (95%CI 8% - 24.8%)]. Conclusions: The pooled prevalence of Anemia in this worldwide meta analysis of T2MI hospitalized patients was 23.3% with wide variance among subgroups. Further studies should focus on scrutinizing the outcomes and devastating complications of Anemic patients with T2MI among various populations universally.