Objective: To quantify the proportion of the association between comorbidity and fall risk mediated by the uric acid-to-lymphocyte ratio (UALR) in older adults, and to assess its invariance across sex. Design: Observational retrospective longitudinal cohort study, with 5-year follow-up. Setting: Primary care. Participants: 310 community-dwelling adults aged 70-85 years (52.6% women) under active follow-up. Main measurements: Charlson Comorbidity Index (CCI); baseline uric acid/lymphocytes (UALR) and its change; incident high fall risk (Downton fall risk index >= 3). Mediation was estimated using structural equation modeling (SEM-WLSMV) with bias-corrected and accelerated (BCa) bootstrap and replicated using the PROCESS macro for SPSS; sex invariance with the Satorra-Bentler Delta chi(2) test. Results: The indirect effect of UALR was significant (a & times;b= 0,040;95%CI 0,007-0,072; p = 0,016), with a proportion mediated of 33.8% (p = 0,054). The UALR -> fall-risk association (B = 0,402; P<0,001; OR = 1.49) was about 4 times larger than CCI -> UALR (B = 0.099; p = 0.003). The direct effect was borderline (c' = 0,078; p = 0,060). No sex differences were detected (Delta chi(2) = 1.133; p = 0,769), with limited power. Conclusions: UALR mediates a substantial part of the comorbidity-incident high fall-risk association and is more strongly associated with falls than comorbidity itself. Obtainable from routine blood tests, it could be useful for risk stratification in primary care, pending validation in independent prospective cohorts.
Objective: To analyze clinical and therapeutic determinants associated with clinically relevant bleeding in anticoagulated patients followed in primary care. Design: Population-based retrospective observational study. Site: Primary care centers of Badalona Serveis Assistencials, from January 1 to December 31, 2024. Participants: Adult patients prescribed vitamin K antagonists or direct oral anticoagulants. Interventions: No interventions were performed; routinely recorded clinical data were analyzed. Main measurements: The primary outcome was clinically relevant bleeding according to International Society on Thrombosis and Haemostasis criteria. Descriptive and comparative analyses and exploratory logistic regression adjusted for age, estimated glomerular filtration rate (eGFR), and extreme polypharmacy were performed in patients with available eGFR. Chronic kidney disease was defined as eGFR <60ml/min/1.73 m(2) persisting for at least 3 months. Results: A total of 1,377 patients were included; 1,189 (86.8%) had atrial fibrillation. Twentynine bleeding events were recorded (2.1%; 95% CI: 1.5-3.0). Patients with bleeding were older (83.9 vs 76.3 years; p < 0.001), had lower eGFR (57.6 vs 68.1 ml/min/1.73 m2; p = 0.006), more chronic kidney disease (56.0 vs 32.6%; p = 0.014), and more hospital admissions (0.91 vs 0.25; p < 0.001). In 986 complete cases, only age remained independently associated (adjusted OR 1.08 per year; 95% CI: 1.02-1.14; p = 0.006). Conclusions: Age was the only factor independently associated with bleeding. The findings are exploratory because of the low number of events and incomplete renal function data.
