Biostatistics Commons^™

Relationship Between Diet Quality Scores And The Risk Of Frailty And Mortality In Adults Across A Wide Age Spectrum, Kulapong Jayanama, Olga Theou, Judith Godin, Leah Cahill, Nitin Shivappa Mbbs, Mph, Ph.D., James Hébert, Michael David Wirth Msph, Phd, Yong-Moon Park, Teresa T. Fung, Kenneth Rockwood

Faculty Publications

Background

Beyond intakes of total energy and individual nutrient, eating patterns may influence health, and thereby the risk of adverse outcomes. How different diet measures relate to frailty—a general measure of increased vulnerability to unfavorable health outcomes—and mortality risk, and how this might vary across the life course, is not known. We investigated the associations of five dietary indices (Nutrition Index (NI), the energy-density Dietary Inflammatory Index (E-DII™), Healthy Eating Index-2015 (HEI-2015), Mediterranean Diet Score (MDS), and Dietary Approaches to Stop Hypertension (DASH)) with frailty and mortality.

Methods

We included 15,249 participants aged ≥ 20 years from the 2007–2012 cohorts …

Lag Effects Of Ozone, Pm2.5, And Meteorological Factors On Covid-19 New Cases At The Disease Epicenter In Queens, New York, Atin Adhikari, Jingjing Yin

Biostatistics, Epidemiology & Environmental Health Sciences: Faculty Publications

The influences of environmental factors on COVID-19 may not be immediate and could be lagged for days to weeks. This study investigated the choice of lag days for calculating cumulative lag effects of ozone, PM2.5, and five meteorological factors (wind speed, temperature, relative humidity, absolute humidity, and cloud percentages) on COVID-19 new cases at the epicenter of Queens County, New York, before the governor’s executive order on wearing of masks in public places (1 March to 11 April 2020). Daily data for selected air pollutants and meteorological factors were collected from the US EPA Air Quality System, weather observation station …

Validation Of Icd-10-Cm Codes For Injuries Complicating Pregnancy, Childbirth And The Puerperium: A Medical Record Review, Anna Hansen, Dana Quesinberry, Peter Akpunonu, Julia Martin, Svetla Slavova

Kentucky Injury Prevention and Research Center Faculty Publications

INTRODUCTION: The purpose of this study was to estimate the positive predictive value (PPV) of International Classification of Diseases, 10th Revision, Clinical Modification (ICD-10-CM) codes for injury, poisoning, physical or sexual assault complicating pregnancy, childbirth and the puerperium (PCP) to capture injury encounters within both hospital and emergency department claims data.

METHODS: A medical record review was conducted on a sample (n=157) of inpatient and emergency department claims from one Kentucky healthcare system from 2015 to 2017, with any diagnosis in the ICD-10-CM range O9A.2-O9A.4. Study clinicians reviewed medical records for the sampled cases and used an abstraction form to …

Predictive Modeling And Estimation Of The Doubling Time Of Confirmed Cases Of Covid-19 In Niger, Ibrahim Sidi Zakari, Hadiza Galadima

Community & Environmental Health Faculty Publications

Modeling is increasingly used to assess scenarios and make projections on the future course of new coronavirus disease. This allows for better planning of care as well as a relaxation or tightening of the restrictive measures decreed by the government and the health authorities. The data analyzed in this study covers the period from March 19 to June 05, 2020 and allowed predictions of new cases of COVID-19 based on a growth model with a growth rate that changes linearly over time. In addition, we calculated and predicted the doubling time of the number of positive cases in each region …

Exclusive Breastfeeding History Risk Factor Associated With Stunting Of Children Aged 12–23 Months, Nurhalina Sari, Marlida Yuliza Manjorang, Zakiyah Zakiyah, Madeleine Randell

Kesmas

Stunting (low height-for-age) remains a global and national health problem because it increases the risk of disturbances in growth and development and mortality. Banjar Margo District, Tulang Bawang Regency, has the second-highest prevalence in Lampung Province, Indonesia. This study aimed to analyze the association of exclusive breastfeeding history and stunting in children aged 12–23 months in Banjar Margo District. This study used a cross-sectional design on 193 children aged 12–23 months. It was primary data conducted between April and May 2018 with a questionnaire. Data analysis was performed using the chi-square test and multiple logistic regression. The result showed that …

Junk Food Consumption And Symptoms Of Mental Health Problems: A Meta-Analysis For Public Health Awareness, Muhammad Hafizurrachman, Risky Kusuma Hartono

Kesmas

Junk food consumption increases the risk of having symptoms of mental health problems. This study aimed to conduct a meta-analysis to assess the association between junk food and symptoms of mental health problems. Six researchers, two primary researchers, and four assistant researchers, from October to December 2020 conducted a systematic literature review. The data sources were selected from Pubmed and Science Direct articles published from 2010 to 2020. Those websites were check-marked for text availability for original articles, using keywords for junk foods and mental health. This study had inclusion criteria for selecting and organizing articles using the Preferred Reporting …

Assessment Of Characteristics And Conditions Before The End Of Lockdown, David San-Martín-Roldán, Francisca Rojo-Lazo, Aracelis Calzadilla-Núñez, Pablo San-Martín-Roldán, Patricia Díaz-Calzadilla, Víctor P. Díaz-Narváez

Kesmas

After months of blockades and restriction, the decision of the best time to end the lockdown after the first wave of the COVID-19 pandemic is the big question for health rectors. This study aimed to evaluate the characteristics and conditions for ending the blockade after the first wave of COVID-19. Data on the variables of interest were subjected to linear and non-linear regression studies to determine the curve that best explains the data. The coefficient of determination, the standard deviation of y in x, and the observed curve of the confidence interval were estimated. Regression which was estimated subsequently revealed …

Analysis Of Measles Vaccination Refusal On Social Media (Facebook) Among Anti-Vaccine Communities In Indonesia, Dwi Meilani, Evi Martha, Hadi Pratomo, Indah Jamiatun Hasanah, Somporn Rungreangkulkij

Kesmas

Measles is one of the main causes of global mortality in the under-fives. The existence of groups that reject immunization caused a decrease in immunization coverage. Anti-vaccine messages are widely delivered on social media. Identification of vaccine rejection behavior can be used as the basis to formulate effective program strategies. The design of this study used rapid assessment procedures (RAP). The informants were from two anti-vaccine communities in the Facebook group. In-depth interviews and observations were done for data collection, and data analysis was performed using the Framework Method. The results found that determinants, such as knowledge, beliefs in health …

Parity And Marital Status As Factors Influencing Contraceptive Use Among Adolescents In Indonesia, Anni Fithriyatul Mas'udah, Terry Yr Pristya, Sulistyo Andarmoyo

Kesmas

Adolescent pregnancy has a higher health risk compared to adult pregnancy. One approach to control pregnancy among adolescents is through contraceptive use. The data on contraceptive use has increased in 2018 and is still controversial among adolescents. Thus, it is necessary to determine the factors encou - rag ing the use of contraceptives among adolescents. This study aimed to determine the relation of parity and marital status on contraceptive use among adolescents. This quantitative study used a cross-sectional design. The population of this study was adolescents aged 15–19 years in Indonesia. The total sample of 936 adolescents was selected from …

Low Knowledge And Unawareness Of The Health Promotion As The Determinant Factors In Non-Compliance To The Mass Drug Administration Program, Nissa Noor Annashr, Icca Stella Amalia, Hoa Thi Phuong Dinh

Kesmas

From the total population of the community in Kuningan District, 78.61% were taking filariasis drugs in the Mass Drug Administration (MDA) program in 2017. Cilimus Subdistrict became a filariasis-endemic area in Kuningan with 72.39% of the MDA program coverage in 2017 (government target >86%). The purpose of this study was to analyze the determinant factors of compliance with the MDA program. The study was an analytical study with a cross-sectional design and conducted from May to June 2018. The sample of 106 people was taken from the population living in Cilimus Subdistrict, Kuningan District, using a simple random sampling technique. …

Patterns And Determinants Of Open Defecation Among Urban People, Vera Yulyani, Christin Angelina Febriani, Shaharuddin Ms, Dessy Hermawan

Kesmas

At the present time, an estimated of 673 million people defecate in the open space, not in private. Indonesia is a densely populated country with a lot of open defecation (OD) both in urban (37%) and rural areas (43%). Tanjung Karang Pusat Subdistrict is an area in Bandar Lampung City with the highest percentage of OD practice (45%). This study aimed to explore and explain the patterns and determinants of OD among urban people in the Tanjung Karang Pusat Subdistrict in- volving 377 respondents for quantitative analysis. Quantitative data were analyzed using the chi square and regression analysis. After controlling …

Risk Perception For Developing Erectile Dysfunction Among Malaysian Men With Type 2 Diabetes Mellitus, Anuar Mohamad, Hizlinda Tohid, Saharuddin Ahmad, Seng Fah Tong, Mahadir Ahmad

Kesmas

Risk perception for developing erectile dysfunction (ED) is an appreciation of the susceptibility to having ED and its severity. This study examined this risk perception and its associated factors among 180 men with type 2 diabetes mellitus (T2DM), who claimed not to have ED. This cross sectional study was conducted at a public health clinic using a validated self-administered questionnaire, which assessed participant characteristics, perceived susceptibility to developing ED, perceived severity of ED, and knowledge on risk factors for ED. About 71.1% had an inaccurate perception of susceptibility to developing ED and their perception on its severity was moderate (median …

Determinants Of Exclusive Breastfeeding Practices Of Female Healthcare Workers In Jakarta, Indonesia, Siti Rapingah, Nova Muhani, Besral Besral, Poppy Yuniar

Kesmas

The World Health Organization (WHO) recommended that mothers worldwide exclusively breastfeed their infants for the child's first six months to achieve optimal growth, development, and health. Indonesia had not fulfilled the global standard of breastfeeding rate so that there was low coverage of exclusive breastfeeding in East Jakarta, especially for female healthcare workers. This study aimed to determine the factors associated with exclusive breastfeeding practices of healthcare workers. This was a quantitative study using a cross-sectional design. The recruited sample consisted of 85 female public health center workers with infants aged 6-24 months. Data were collected using self-administered questionnaires. Logistic …

Evaluation Of Added Sugar And Sugar-Sweetened Beverage Consumption By University Students, Çağdaş Salih Meric, Nurcan Yabanci Ayhan, Hacı Ömer Yilmaz

Kesmas

Today, increased intake of sugar and sugar-sweetened beverages is seen today as an important factor in the growing prevalence of chronic diseases, such as obesity, obesity-related diabetes, and coronary heart diseases. This study involved 214 university students from the Department of Nutrition and Dietetics of Ankara University, Faculty of Health Science, which was intended to evaluate the consumption of sugar and sugar-sweetened beverages. The frequency of student consumption of beverages and the quantities and amounts of sugar taken with beverages were questioned. The average total amount of sugar added to drinks by the students was 4.69 ± 6.35 gram, while …

Real World Clinicopathologic Observations Of Patients With Metastatic Solid Tumors Receiving Immune Checkpoint Inhibitor Therapy: Analysis From Kentucky Cancer Registry, Aasems Jacob, Jianrong Wu, Jill M. Kolesar, Eric B. Durbin, Aju Mathew, Susanne Arnold, Aman Chauhan

Biostatistics Faculty Publications

The state of Kentucky has the highest cancer incidence and mortality in the United States. High‐risk populations such as this are often underrepresented in clinical trials. The study aims to do a comprehensive analysis of molecular landscape of metastatic cancers among these patients with detailed evaluation of factors affecting response and outcomes to immune checkpoint inhibitor (ICI) therapy. We performed a retrospective analysis of metastatic solid tumor patients who received ICI and underwent molecular profiling at our institution.

Sixty nine patients with metastatic solid tumors who received ICI were included in the study. Prevalence of smoking and secondhand tobacco exposure …

Maternal Dietary Quality, Inflammatory Potential And Childhood Adiposity: An Individual Participant Data Pooled Analysis Of Seven European Cohorts In The Alphabet Consortium, Ling-Wei Chen, Adrien M. Aubert, Nitin Shivappa, Jonathan Y. Bernard, Sara M. Mensink-Bout, Aisling A. Geraghty, John Mehegan, Matthew Suderman, Kinga Polanska, Wojciech Hanke, Agnieszka Jankowska, Caroline L. Relton, Sarah R. Crozier, Nicholas C. Harvey, Cyrus Cooper, Mark Hanson, Keith M. Godfrey, Romy Gaillard, Liesbeth Duijts, Barbara Heude, James Hébert Scd, Fionnuala M. Mcauliffe, Cecily Kelleher, Catherine M. Phillips

Faculty Publications

Background

Mounting evidence suggests that maternal diet influences pregnancy and birth outcomes, but its contribution to the global epidemic of childhood obesity has not as yet been definitively characterized. We investigated whether maternal whole diet quality and inflammatory potential influence childhood adiposity.

Methods

We harmonized and pooled individual participant data from 16,295 mother-child pairs in seven European birth cohorts. Maternal pre-, early-, late-, and whole-pregnancy (any time during pregnancy) dietary quality and inflammatory potential assessed with the Dietary Approaches to Stop Hypertension (DASH) score and the energy-adjusted Dietary Inflammatory Index (E-DII™) score, respectively. Primary outcome was childhood overweight and obesity …

Whole-Exome Sequencing And Hipsc Cardiomyocyte Models Identify Myrip, Trappc11, And Slc27a6 Of Potential Importance To Left Ventricular Hypertrophy In An African Ancestry Population, Marguerite R. Irvin, Praful Aggarwal, Steven A. Claas, Lisa De Las Fuentes, Anh N. Do, C. Charles Gu, Andrea Matter, Benjamin S. Olson, Amit Patki, Karen Schwander, Joshua D. Smith, Vinodh Srinivasasainagendra, Hemant K. Tiwari, Amy J. Turner, Deborah A. Nickerson, Dabeeru C. Rao, Ulrich Broeckel, Donna K. Arnett

Epidemiology and Environmental Health Faculty Publications

Background: Indices of left ventricular (LV) structure and geometry represent useful intermediate phenotypes related to LV hypertrophy (LVH), a predictor of cardiovascular (CV) disease (CVD) outcomes.

Methods and Results: We conducted an exome-wide association study of LV mass (LVM) adjusted to height^2.7, LV internal diastolic dimension (LVIDD), and relative wall thickness (RWT) among 1,364 participants of African ancestry (AAs) in the Hypertension Genetic Epidemiology Network (HyperGEN). Both single-variant and gene-based sequence kernel association tests were performed to examine whether common and rare coding variants contribute to variation in echocardiographic traits in AAs. We then used a data-driven …

Dietary Quality And Dietary Inflammatory Potential During Pregnancy And Offspring Emotional And Behavioral Symptoms In Childhood: An Individual Participant Data Meta-Analysis Of Four European Cohorts, Kinga Polanska, Pawel Kaluzny, Adrien M. Aubert, Liesbeth Duijts, Hanan El Marroun, Wojciech Hanke, James R. Hébert, Barbara Heude, Agnieszka Jankowska, Giulia Mancano, Sara M. Mensink-Bout, Caroline Relton, Nitin Shivappa Mbbs, Mph, Ph.D., Matthew Suderman, Elzbieta Trafalska, Ewelina Wesolowska, Raquel Garcia-Esteban, Mònica Guxens, Maribel Casas, Catherine M. Phillips

Faculty Publications

Background

The impact of maternal diet during pregnancy on child neurodevelopment is of public health and clinical relevance. We evaluated the associations of dietary quality based on the Dietary Approaches to Stop Hypertension (DASH) score and dietary inflammatory potential based on the energy-adjusted Dietary Inflammatory Index (E-DII) score during pregnancy with emotional and behavioral symptoms of offspring at 7 to 10 years of age.

Methods

Individual participant data for 11,870 mother–child pairs from four European cohorts participating in the ALPHABET project were analyzed. Maternal antenatal DASH and E-DII scores were generated from self-completed food frequency questionnaires. Symptoms of depression …

Measurement Matters: Changing Penalty Calculations Under The Hospital Acquired Condition Reduction Program (Hacrp) Cost Hospitals Millions, Olga A. Vsevolozhskaya, Karina C. Manz, Pierre M. Zephyr, Teresa M. Waters

Biostatistics Faculty Publications

BACKGROUND: Since October 2014, the Centers for Medicare and Medicaid Services has penalized 25% of U.S. hospitals with the highest rates of hospital-acquired conditions under the Hospital Acquired Conditions Reduction Program (HACRP). While early evaluations of the HACRP program reported cumulative reductions in hospital-acquired conditions, more recent studies have not found a clear association between receipt of the HACRP penalty and hospital quality of care. We posit that some of this disconnect may be driven by frequent scoring updates. The sensitivity of the HACRP penalties to updates in the program's scoring methodology has not been independently evaluated.

METHODS: We used …

The Intersection Of Rural Residence And Minority Race/Ethnicity In Cancer Disparities In The United States, Whitney Zahnd, Cathryn Murphy, Marie Knoll, Gabriel A. Benavidez, Kelsey R. Day, Radhika Ranganathan, Parthenia Luke, Anja Zgodic, Kewei Shi, Melinda A. Merrell, Elizabeth L. Crouch, Heather M. Brandt, Jan Eberth

Faculty Publications

One in every twenty-five persons in America is a racial/ethnic minority who lives in a rural area. Our objective was to summarize how racism and, subsequently, the social determinants of health disproportionately affect rural racial/ethnic minority populations, provide a review of the cancer disparities experienced by rural racial/ethnic minority groups, and recommend policy, research, and intervention approaches to reduce these disparities. We found that rural Black and American Indian/Alaska Native populations experience greater poverty and lack of access to care, which expose them to greater risk of developing cancer and experiencing poorer cancer outcomes in treatment and ultimately survival. There …

A Cluster-Based Approach For Identifying Prognostic Microrna Signatures In Digestive System Cancers, Jun Zhou, Xiang Cui, Feifei Xiao, Guoshuai Cai

Faculty Publications

Cancer remains the second leading cause of death all over the world. Aberrant expression of miRNA has shown diagnostic and prognostic value in many kinds of cancer. This study aims to provide a novel strategy to identify reliable miRNA signatures and develop improved cancer prognostic models from reported cancer-associated miRNAs. We proposed a new cluster-based approach to identify distinct cluster(s) of cancers and corresponding miRNAs. Further, with samples from TCGA and other independent studies, we identified prognostic markers and validated their prognostic value in prediction models. We also performed KEGG pathway analysis to investigate the functions of miRNAs associated with …

Regression Analyses Assessing The Impact Of Environmental Factors On Covid-19 Transmission And Mortality, El Hussain Shamsa, Kezhong Zhang

Medical Student Research Symposium

No abstract provided.

Identification And Robust Estimation Of Swapped Direct And Indirect Effects: Mediation Analysis With Unmeasured Mediator–Outcome Confounding And Intermediate Confounding, An-Shun Tai, Sheng-Hsuan Lin

Harvard University Biostatistics Working Paper Series

Counterfactual-model-based mediation analysis can yield substantial insight into the causal mechanism through the assessment of natural direct effects (NDEs) and natural indirect effects (NIEs). However, the assumptions regarding unmeasured mediator–outcome confounding and intermediate mediator–outcome confounding that are required for the determination of NDEs and NIEs present practical challenges. To address this problem, we introduce an instrumental blocker, a novel quasi-instrumental variable, to relax both of these assumptions, and we define a swapped direct effect (SDE) and a swapped indirect effect (SIE) to assess the mediation. We show that the SDE and SIE are identical to the NDE and NIE, respectively, …

Optimal Two-Stage Designs Based On Restricted Mean Survival Time For A Single-Arm Study, Guogen Shan

School of Public Health Faculty Research

© 2021 The Author(s) Restricted mean survival time is an alternative measure of treatment effect to hazard ratio in clinical trials with time-to-event outcome. The current methods have been focused on one-stage designs. In this article, we propose optimal two-stage designs for a single-arm study with the smallest expected sample size. We compare the performance of the new optimal two-stage designs with the existing one-stage design with regards to the expected sample size and the expected total study length. The simulation results indicate that the new two-stage designs can save the expected sample size substantially as compared to the one-stage …

Mental Health And Psychosocial Functioning In Recently Separated U.S. Women Veterans: Trajectories And Bi-Directional Relationships, Karen A. Lawrence, Dawne Vogt, Adam Dugan, Shawn R. Nigam, Emily Slade, Brian N. Smith

Social Work Faculty Publications

Prior research on the relationship between veterans’ mental health and psychosocial functioning has primarily relied on male samples. Here, we investigated prospective longitudinal relationships between mental health and psychosocial functioning in 554 female Iraq and Afghanistan War veterans who were surveyed three times between two- and seven-years following separation from service. Mixed effects modeling revealed that increasing depression and posttraumatic stress disorder (PTSD) severity predicted declines in work functioning. Increasing PTSD severity predicted declining parental functioning and worsening depression predicted a decline in relationship functioning. In turn, decreased work and intimate relationship functioning predicted increased PTSD and depression symptom severity …

Neighborhood Characteristics And The Mental Health Of Caregivers Cohabiting With Care Recipients Diagnosed With Alzheimer’S Disease, Dana M. Alhasan, Jana A. Hirsch, Chandra L. Jackson, Margaret Chandlee Miller, Bo Cai Ph.D., Matthew C. Lohman Ph.D.

Faculty Publications

While studies have documented the influence of caregiver and care recipient factors on caregiver health, it is important to address the potential impact of neighborhood contexts. This study estimated the cross-sectional associations between neighborhood characteristics and mental health among caregivers cohabiting with Alzheimer’s disease care recipients that were experiencing severe or non-severe neuropsychiatric symptoms (NPSs) (e.g., aggression/anxiety). We obtained data collected in 2010 on caregivers and care recipients (n

While studies have documented the influence of caregiver and care recipient factors on caregiver health, it is important to address the potential impact of neighborhood contexts. This study estimated the cross-sectional …

Emergency Department Use Following Incentives To Provide After-Hours Primary Care: A Retrospective Cohort Study., Michael Hong, Amardeep Thind, Gregory S Zaric, Sisira Sarma

Epidemiology and Biostatistics Publications

BACKGROUND: Access to primary care outside of regular working hours is limited in many countries. This study investigates the relation between the after-hours premium, an incentive for primary care physicians to provide services after hours, and less-urgent visits to the emergency department in Ontario, Canada.

METHODS: We analyzed a retrospective cohort of a random sample of Ontario residents from April 2002 to March 2006, and a subcohort of patients followed from April 2005 to March 2016. We linked patient and primary care physician data with emergency department visit data. We used fixed-effects regression models to analyze the association between the …

Integrated Profiling Identifies Itgb3bp As Prognostic Biomarker For Hepatocellular Carcinoma, Qiuli Liang, Chao Tan, Feifei Xiao, Fuqiang Yin, Meiliang Liu, Lei Lei, Liuyu Wu, Yu Yang, Jennifer Hui Juan Tan, Shun Liu, Xiaoyun Zeng

Faculty Publications

Hepatocellular carcinoma (HCC) is a highly malignant tumor. In this study, we sought to identify a novel biomarker for HCC by analyzing transcriptome and clinical data. The R software was used to analyze the differentially expressed genes (DEGs) in the datasets GSE74656 and GSE84598 downloaded from the Gene Expression Omnibus database, followed by a functional annotation. A total of 138 shared DEGs were screened from two datasets. They were mainly enriched in the “Metabolic pathways” pathway (Padj = 8.21E-08) and involved in the carboxylic acid metabolic process (Padj = 0.0004). The top 10 hub genes were found by protein-protein interaction …

Sars-Cov-2 Pandemic Analytical Overview With Machine Learning Predictability, Anthony Tanaydin, Jingchen Liang, Daniel W. Engels

SMU Data Science Review

Understanding diagnostic tests and examining important features of novel coronavirus (COVID-19) infection are essential steps for controlling the current pandemic of 2020. In this paper, we study the relationship between clinical diagnosis and analytical features of patient blood panels from the US, Mexico, and Brazil. Our analysis confirms that among adults, the risk of severe illness from COVID-19 increases with pre-existing conditions such as diabetes and immunosuppression. Although more than eight months into pandemic, more data have become available to indicate that more young adults were getting infected. In addition, we expand on the definition of COVID-19 test and discuss …

Covid-19 Pandemic In Brazil: Clinical Manifestation And Effect Of Comorbidities On Outcomes Of Hospitalized Sari Cases, Mario Keko, Karl E. Peace

Biostatistics, Epidemiology & Environmental Health Sciences: Faculty Publications

Hospitalized SARI cases of 2020 reported to the Ministry of Health of Brazil through the SIVEP Gripe system are subject to our analysis. They are classified as COVID-19 and non-COVID-19 and clinical manifestations and comorbidities are reported for each group. The time trend in the number of cases reported in 2020 is compared to the previous year and the performance of the PCR test is explored in each group. The proportion of death is reported among different subgroups of the patients by epidemiological week. Logistic and Poisson regression models are used to check the effect of comorbidities on clinical outcomes.