geoffrey modest medical blogs

  a recent Scottish study found that patients with diabetes who develop stage 4 chronic kidney disease (CKD) and continue metformin had improved survival (see dm metformin with lower GFR AmJKidnDis2025  in dropbox, or doi: 10.1053/ j.ajkd.2024.08.012) Details : -- 371,742 Scottish residents with type 2 diabetes were evaluated from the Scottish Diabetes Research Network-National Diabetes Study, from 2010-2019 -- 4,287 prevalent metformin users were identified who had incident stage 4 CKD (ie, eGFR <30); 1,713 of them (40.1%) discontinued the metformin     -- patients who stopped the metformin did so within 6 months of reaching CKD stage 4; those who continued metformin did so for at least 6 months     --55% of those who continued the metformin did stop it in the follow-up period (about 60 patients/year from years 7-12, about 25/year from year 13 to end of study): 44% continued throughout the follow-up -- median age 77, 51% women...

  A recent analysis found that wealth redistribution to decrease inequities in the United States would be predicted to lead to both substantial reductions in social inequities together with population longevity, similar to other high income countries in the world (see  income inequality dec life expectancy JAMAIntMed2024  in dropbox or d oi:10.1001/jamainternmed.2023.7975)   Details : -- 35,164 participants were evaluated with data on wealth and longevity from the Health and Retirement Study (1992-2018), a study of community-dwelling individuals >50yo, assessing the difference between personal wealth and their death rates. Death rates were adjudicated through the National Death Index     -- the HRS involved interviews in 14 biennial waves     -- the researchers chose to assess deciles of wealth given the nonlinear pattern of wealth differences in the US (see below for details of the dramatic inequities within the US)   ...

smoking cessation: 20-30yrs to normalize mortality rates MG Modest, Geoffrey (HMFP - Medicine)       To: ​ Modest, Geoffrey (HMFP - Medicine) ​ Wed 1/24/2024 8:46 AM A study based on the National Health Interview Survey (NHIS) from 1997-2018 assessed the association of smoking cessation and mortality from cardiovascular, cancer, and respiratory diseases (see  smoking cessation 30 yrs til dec mortality JAMAIntMed2023  in dropbox or  . doi:10.1001/jamainternmed.2023.6419.     Details :  -- 438,015 adults were included in NHIS, a cross-sectional household interview study, which included regular annual assessments of smoking rates (a questionnaire-based health survey with lots of questions about demographics, living situation, and health issues; very few questions about diet, a bit more about exercise, one question about stress but in the context of whether one participated in mindfulness-based stress reduction); this information was linked with...