76
|
Redelmeier DA, Manzoor F, Thiruchelvam D. Association Between Statin Use and Risk of Dementia After a Concussion. JAMA Neurol 2019; 76:887-896. [PMID: 31107515 DOI: 10.1001/jamaneurol.2019.1148] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
Importance Concussions are an acute injury that may lead to chronic disability, while statin use might improve neurologic recovery. Objective To test whether statin use is associated with an increased or decreased risk of subsequent dementia after a concussion. Design, Setting, and Participants Large extended population-based double cohort study in Ontario, Canada, from April 1, 1993, to April 1, 2013 (enrollment), and continued until March 31, 2016 (follow-up). Dates of analysis were April 28, 2014, through March 21, 2019. Participants were older adults diagnosed as having a concussion, excluding severe cases resulting in hospitalization, individuals with a prior diagnosis of dementia or delirium, and those who died within 90 days. Exposure Statin prescription within 90 days after a concussion. Main Outcome and Measure Long-term incidence of dementia. Results This study identified 28 815 patients diagnosed as having a concussion (median age, 76 years; 61.3% female), of whom 7058 (24.5%) received a statin, and 21 757 (75.5%) did not receive a statin. A total of 4727 patients subsequently developed dementia over a mean follow-up of 3.9 years, equal to an incidence of 1 case per 6 patients. Patients who received a statin had a 13% reduced risk of dementia compared with patients who did not receive a statin (relative risk, 0.87; 95% CI, 0.81-0.93; P < .001). The decreased risk of dementia associated with statin use applied to diverse patient groups, remained independent of other cardiovascular medication use, intensified over time, was distinct from the risk of subsequent depression, and was not observed in patients after an ankle sprain. Conclusions and Relevance In this study, older adults had a substantial long-term risk of dementia after a concussion, which was associated with a modest reduction among patients receiving a statin.
Collapse
|
77
|
|
78
|
Fralick M, Kim SC, Schneeweiss S, Kim D, Redelmeier DA, Patorno E. Fracture Risk After Initiation of Use of Canagliflozin. Ann Intern Med 2019; 171:80. [PMID: 31261403 DOI: 10.7326/l19-0320] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
|
79
|
Schlenker MB, Thiruchelvam D, Redelmeier DA. Association of Cataract Surgery With Driving Safety and Falls-Reply. JAMA Ophthalmol 2019; 137:585-586. [PMID: 30920606 DOI: 10.1001/jamaophthalmol.2019.0396] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
|
80
|
Staples JA, Yip C, Redelmeier DA. Bubble-Wrapping Halloween-Reply. JAMA Pediatr 2019; 173:495. [PMID: 30830142 DOI: 10.1001/jamapediatrics.2019.0088] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
|
81
|
Bhatti JA, Thiruchelvam D, Redelmeier DA. Traumatic brain injury as an independent risk factor for problem gambling: a matched case-control study. Soc Psychiatry Psychiatr Epidemiol 2019; 54:517-523. [PMID: 30232507 DOI: 10.1007/s00127-018-1583-1] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/09/2018] [Accepted: 08/20/2018] [Indexed: 11/26/2022]
Abstract
PURPOSE To assess whether traumatic brain injury (TBI) increases the risks of subsequent problem gambling. METHODS We conducted a matched case-control analysis of adults in Ontario, Canada. The study included those who self-reported their gambling activities in the Canadian Community Health Survey 2007-2008. Using Problem Gambling Severity Index, we defined cases as those who were problem gamblers and controls who were recreational gamblers. Cases were matched to controls 1:2 using propensity scores based on demographics, prior mental health, and self-reported behaviours. The main predictor was prior TBI defined as requiring emergency care and identified using ICD-10 codes from administrative health databases. We estimated the likelihood of prior TBI in problem gamblers compared to controls using conditional logistic regression. RESULTS Of 30,652 survey participants, 16,002 (53%) reported gambling activity of whom 14,910 (49%) were recreational gamblers and 4% (n = 1092) were problem gamblers. A total of 1469 respondents (5%) had a prior TBI. Propensity score matching yielded 2038 matched pairs with 1019 cases matched to 2037 controls. Case-control analysis showed a significant association between prior TBI and subsequent problem gambling (odds ratio 1.27, 95% confidence interval 1.07-1.51, P = 0.007). The increased risk was mostly apparent in men aged 35 to 64 years who reported alcohol use or smoking. The relative risk of problem gambling in those with two or more TBIs equated to an odds ratio of 2.04 (95% confidence interval 1.05-3.99). CONCLUSIONS We found that a prior TBI was associated with an increased subsequent risk of problem gambling. Our findings support more awareness, screening, and treating problem gambling risks among TBI patients.
Collapse
|
82
|
Redelmeier DA, Manzoor F. Life-threatening alcohol-related traffic crashes in adverse weather: a double-matched case-control analysis from Canada. BMJ Open 2019; 9:e024415. [PMID: 30872544 PMCID: PMC6429889 DOI: 10.1136/bmjopen-2018-024415] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
IMPORTANCE Drunk driving is a major cause of death in North America, yet physicians rarely counsel patients on the risks of drinking and driving. OBJECTIVE To test whether the risks of a life-threatening alcohol-related traffic crash were further accentuated by adverse weather. DESIGN Double matched case-control analysis of hospitalised patients. SETTING Canada's largest trauma centre between 1 January 1995 and 1 January 2015. PARTICIPANTS Patients hospitalised due to a life-threatening alcohol-related traffic crash. EXPOSURE Relative risk of a crash associated with adverse weather estimated by evaluating the weather at the place and time of the crash (cases) compared with the weather at the same place and time a week earlier and a week later (controls). RESULTS A total of 2088 patients were included, of whom the majority were drivers injured at night. Adverse weather prevailed among 312 alcohol-related crashes and was significantly more frequent compared with control circumstances. The relative risk of a life-threatening alcohol-related traffic crash was 19% higher during adverse weather compared with normal weather (95% CI: 5 to 35, p=0.006). The absolute increase in risk amounted to 43 additional crashes, extended to diverse groups of patients, applied during night-time and daytime, contributed to about 793 additional patient-days in hospital and was distinct from the risks for drivers who were negative for alcohol. CONCLUSIONS Adverse weather was associated with an increased risk of a life-threatening alcohol-related traffic crash. An awareness of this risk might inform warnings to patients about traffic safety and counselling alternatives to drinking and driving.
Collapse
|
83
|
Staples JA, Redelmeier DA. Association Between April 20 Cannabis Celebration and Fatal Crashes. JAMA Intern Med 2019; 179:456. [PMID: 30715145 DOI: 10.1001/jamainternmed.2018.8094] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
|
84
|
Redelmeier DA, Tibshirani RJ. Analyzing excess risk from matched designs with double controls: author's response. J Clin Epidemiol 2019; 107:127-128. [DOI: 10.1016/j.jclinepi.2018.11.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2018] [Accepted: 11/09/2018] [Indexed: 11/29/2022]
|
85
|
Fralick M, Kim SC, Schneeweiss S, Kim D, Redelmeier DA, Patorno E. Fracture Risk After Initiation of Use of Canagliflozin: A Cohort Study. Ann Intern Med 2019; 170:155-163. [PMID: 30597484 PMCID: PMC6602870 DOI: 10.7326/m18-0567] [Citation(s) in RCA: 67] [Impact Index Per Article: 13.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/12/2022] Open
Abstract
BACKGROUND Sodium-glucose cotransporter-2 inhibitors promote glycosuria, resulting in possible effects on calcium, phosphate, and vitamin D homeostasis. Canagliflozin is associated with decreased bone mineral density and a potential increased risk for fracture. OBJECTIVE To estimate risk for nonvertebral fracture among new users of canagliflozin compared with a glucagon-like peptide-1 (GLP-1) agonist. DESIGN Population-based new-user cohort study. SETTING Two U.S. commercial health care databases providing data on more than 70 million patients from March 2013 to October 2015. PATIENTS Persons with type 2 diabetes who initiated use of canagliflozin were propensity score-matched in a 1:1 ratio to those initiating use of a GLP-1 agonist. MEASUREMENTS The primary outcome was a composite end point of humerus, forearm, pelvis, or hip fracture requiring intervention. Secondary outcomes included fractures at other sites. A fixed-effects meta-analysis that pooled results from the 2 databases provided an overall hazard ratio (HR). RESULTS 79 964 patients initiating use of canagliflozin were identified and matched to 79 964 patients initiating use of a GLP-1 agonist. Mean age was 55 years, 48% were female, average baseline hemoglobin A1c level was 8.7%, and 27% were prescribed insulin. The rate of the primary outcome was similar for canagliflozin (2.2 events per 1000 person-years) and GLP-1 agonists (2.3 events per 1000 person-years), with an overall HR of 0.98 (95% CI, 0.75 to 1.26). Risk for pelvic, hip, humerus, radius, ulna, carpal, metacarpal, metatarsal, or ankle fracture was also similar for canagliflozin (14.5 events per 1000 person-years) and GLP-1 agonists (16.1 events per 1000 person-years) (overall HR, 0.92 [CI, 0.83 to 1.02]). LIMITATION Unmeasured confounding, measurement error, and low fracture rate. CONCLUSION In this study of middle-aged patients with type 2 diabetes and relatively low fracture risk, canagliflozin was not associated with increased risk for fracture compared with GLP-1 agonists. PRIMARY FUNDING SOURCE Brigham and Women's Hospital, Division of Pharmacoepidemiology and Pharmacoeconomics.
Collapse
|
86
|
|
87
|
Manzoor F, Redelmeier DA. The perils of teaching medical triads. MEDICAL EDUCATION 2019; 53:110-112. [PMID: 30478908 DOI: 10.1111/medu.13637] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/09/2023]
|
88
|
Ravi B, Pincus D, Choi S, Jenkinson R, Wasserstein DN, Redelmeier DA. Association of Duration of Surgery With Postoperative Delirium Among Patients Receiving Hip Fracture Repair. JAMA Netw Open 2019; 2:e190111. [PMID: 30794305 PMCID: PMC6484601 DOI: 10.1001/jamanetworkopen.2019.0111] [Citation(s) in RCA: 78] [Impact Index Per Article: 15.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/13/2022] Open
Abstract
IMPORTANCE Postoperative delirium in older adults receiving hip fracture surgery is associated with morbidity and increased health care costs, yet little is known of potential modifiable factors that may help limit the risks. OBJECTIVE To use population-wide individual-level data on the duration of hip fracture surgery to determine whether prolonged surgical times and type of anesthesia are associated with an increased risk of postoperative delirium. DESIGN, SETTING, AND PARTICIPANTS This retrospective population-based cohort study analyzed patients aged 65 years and older receiving hip fracture surgery between April 1, 2009, and March 30, 2017, at 80 hospitals in Ontario, Canada. Generalized estimated equations with logistic regression analysis were used to determine the relationship between procedure duration, type of anesthesia, and the occurrence of postoperative delirium. Restricted cubic splines were also generated to visualize this relationship. Data analysis was conducted from July to October 2018, revision in January 2019. EXPOSURE Surgery duration, measured as the total time in the operating room. MAIN OUTCOMES AND MEASURES A diagnosis of postoperative delirium during hospitalization. RESULTS Among 68 131 patients with surgically managed hip fracture (median [interquartile range] age, 84 [78-89] years; 72% women) identified, 7150 patients experienced postoperative delirium. In total, 26 853 patients (39.4%) received general anesthesia. Receiving general anesthesia was associated with a slightly higher rate of postoperative delirium compared with not receiving general anesthesia (2943 [11.0%] vs 4207 [10.2%]; P = .001). The risk for delirium increased with increased surgical duration-every 30-minute increase in the duration of surgery was associated with a 6% increase in the risk for delirium (adjusted odds ratio, 1.06; 95% CI, 1.03-1.08; P < .001). Prolonged surgical duration was associated with a higher incidence of postoperative delirium, and the risk was higher was in patients who had received general anesthesia (adjusted odds ratio, 1.08; 95% CI, 1.04-1.12; P < .001) than in those patients who did not receive GA (adjusted odds ratio, 1.04; 95% CI, 1.01-1.08; P = .01). CONCLUSIONS AND RELEVANCE Among older adults receiving hip fracture surgery, both an increased duration of surgery and receiving a general anesthetic were associated with an increased risk for postoperative delirium.
Collapse
|
89
|
Abstract
This study examines 42 years of National Highway Traffic Safety Administration data to establish whether Halloween is associated with an increased rate of pedestrian fatalities.
Collapse
|
90
|
Yu AYX, Kapral MK, Fang J, Redelmeier DA. Increased Risk of Traffic Injury After a Cerebrovascular Event. Stroke 2018; 49:3006-3011. [PMID: 30571416 DOI: 10.1161/strokeaha.118.022657] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Background and Purpose- We aimed to determine the long-term risks of a motor vehicle collision after a cerebrovascular event and whether the risks were similar after left- or right-hemispheric events. Methods- We used a population-based registry to identify patients diagnosed with a transient ischemic attack or stroke (hemorrhagic or ischemic) between 2003 and 2013 in Ontario, Canada. Hemispheric laterality was determined using radiological and clinical findings. We identified subsequent serious injuries involving the patient as a driver using linked administrative data. Secondary outcomes included serious injuries involving the patient as a pedestrian, as a passenger, or other traumatic events (fall, fracture, ankle sprain). We used proportional hazard models accounting for death as a competing risk to test the association of hemispheric laterality and outcomes with and without adjustment for age, sex, discharge modified Rankin Scale score, home location, and prior driving record. Patients were followed through to 2017. Results- Among 26 144 patients with hemispheric cerebrovascular events, 377 subsequent serious traffic injuries as a driver (2.2 per 1000 person-year) were identified over a median follow-up of 6.4 person-years. The rate did not differ by laterality (adjusted hazard ratio, 1.00; 95% CI, 0.82-1.23). The risk of a serious traffic injury as a pedestrian was significantly higher after a right-sided than left-sided event (adjusted hazard ratio, 1.27; 95% CI, 1.02-1.58). Subsequent risks for other traumatic injuries did not differ by laterality of cerebrovascular event. Conclusions- The risk of a serious traffic injury as a pedestrian is substantially higher after a right-hemispheric cerebrovascular event compared with a left-sided event. Walking should be promoted for exercise in survivors of a stroke or transient ischemic attack, but these vulnerable road users may benefit from additional poststroke rehabilitation to optimize safety.
Collapse
|
91
|
Lapointe-Shaw L, Austin PC, Ivers NM, Luo J, Redelmeier DA, Bell CM. Death and readmissions after hospital discharge during the December holiday period: cohort study. BMJ 2018; 363:k4481. [PMID: 30530782 PMCID: PMC6287120 DOI: 10.1136/bmj.k4481] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/09/2023]
Abstract
OBJECTIVE To determine whether patients discharged from hospital during the December holiday period have fewer outpatient follow-ups and higher rates of death or readmission than patients discharged at other times. DESIGN Population based retrospective cohort study. SETTING Acute care hospitals in Ontario, Canada, 1 April 2002 to 31 January 2016. PARTICIPANTS 217 305 children and adults discharged home after an urgent admission, during the two week December holiday period, compared with 453 641 children and adults discharged during two control periods in late November and January. MAIN OUTCOME MEASURES The primary outcome was death or readmission, defined as a visit to an emergency department or urgent rehospitalisation, within 30 days. Secondary outcomes were death or readmission and outpatient follow-up with a physician within seven and 14 days after discharge. Multivariable logistic regression with generalised estimating equations was used to adjust for characteristics of patients, admissions, and hospital. RESULTS 217 305 (32.4%) patients discharged during the holiday period and 453 641 (67.6%) discharged during control periods had similar baseline characteristics and previous healthcare utilisation. Patients who were discharged during the holiday period were less likely to have follow-up with a physician within seven days (36.3% v 47.8%, adjusted odds ratio 0.61, 95% confidence interval 0.60 to 0.62) and 14 days (59.5% v 68.7%, 0.65, 0.64 to 0.66) after discharge. Patients discharged during the holiday period were also at higher risk of 30 day death or readmission (25.9% v 24.7%, 1.09, 1.07 to 1.10). This relative increase was also seen at seven days (13.2% v 11.7%, 1.16, 1.14 to 1.18) and 14 days (18.6% v 17.0%, 1.14, 1.12 to 1.15). Per 100 000 patients, there were 2999 fewer follow-up appointments within 14 days, 26 excess deaths, 188 excess hospital admissions, and 483 excess emergency department visits attributable to hospital discharge during the holiday period. CONCLUSIONS Patients discharged from hospital during the December holiday period are less likely to have prompt outpatient follow-up and are at higher risk of death or readmission within 30 days.
Collapse
|
92
|
Zipursky JS, Redelmeier DA. Medical Principles in Obstetrical Consults. Am J Med 2018; 131:1405-1407. [PMID: 30012358 DOI: 10.1016/j.amjmed.2018.06.015] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/07/2018] [Revised: 06/11/2018] [Accepted: 06/11/2018] [Indexed: 10/28/2022]
|
93
|
Abstract
OBJECTIVE To assess the association of eczema with a patient's subsequent risk of death from suicide. We hypothesised that persistent eczema would be associated with an increased risk for death from suicide. DESIGN Double matched case-control study. SETTING General population of Ontario, Canada. PARTICIPANTS Patients 15-55 years old. We identified cases of suicide from coroners' reports between 1 January 1994 and 31 December 2014 and matched 1:2 with alive controls based on age, sex and socioeconomic status. EXPOSURE The primary predictor was a history of persistent eczema, defined as five or more physician visits for the diagnosis over the preceding 5 years. MAIN OUTCOME AND MEASURE Logistic regression to estimate the association between eczema and death from suicide. RESULTS We identified 18 441 cases of suicide matched to 36 882 controls over the 21-year accrual period. Persistent eczema occurred in 174 (0.94%) suicide cases and 285 (0.77%) controls yielding a 22% increased risk of suicide associated with persistent eczema (OR 1.22, 95% CI 1.01 to 1.48, p=0.037). In mediation analyses, this association was largely explained through major suicide risk factors. Two-thirds of patients with eczema who died from suicide had visited a physician in the month before their death and one in eight had visited for eczema in the month before their death. Among patients who died by suicide, jumping and poisoning were relatively more frequent mechanisms among patients with eczema. CONCLUSIONS Patients with persistent eczema have a modestly increased subsequent risk of death from suicide, but this is not independent of overall mental health and the absolute risk is low. Physicians caring for these patients have opportunities to intervene for suicide prevention.
Collapse
|
94
|
Abstract
BACKGROUND Agricultural work involves hazards that may harm long-term well-being. We evaluated the risk of long-term disability and death for agricultural workers compared to construction workers with similar demographics. We hypothesized that delays to emergency care and subsequent long-term disability following injury might be worse for agricultural workers compared to those injured in construction. METHODS We evaluated all adults severely injured on farms or on construction sites in Ontario, Canada, between April 1, 2009, and March 31, 2012, according to the Ontario Trauma Registry. We excluded individuals living outside of the province, those missing a valid health card number, or youth less than 17 years old. Our primary outcome was death or the subsequent application for disability support. RESULTS In total, 353 patients were injured on a farm or construction site during the study period. Delays to emergency care exceeding 12 hours were more frequent for agricultural workers compared to construction workers (43% vs 23%, P <.001). After a 5-year follow-up, agricultural workers had a death or disability rate marginally higher than construction workers (23% vs 14%, P = .068), equivalent to a hazard ratio of 1.62 that was marginally statistically significant (95% confidence interval 0.96-2.75, P = .072). The risk of death and disability was greatest for patients who had the longest delays to emergency care. INTERPRETATION Agricultural workers experience a substantial delay in receiving emergency care and a marginally higher risk of death or disability in the years following injury compared to construction workers.
Collapse
|
95
|
Lapointe-Shaw L, Bouck Z, Howell NA, Lange T, Orchanian-Cheff A, Austin PC, Ivers NM, Redelmeier DA, Bell CM. Mediation analysis with a time-to-event outcome: a review of use and reporting in healthcare research. BMC Med Res Methodol 2018; 18:118. [PMID: 30373524 PMCID: PMC6206666 DOI: 10.1186/s12874-018-0578-7] [Citation(s) in RCA: 50] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2018] [Accepted: 10/16/2018] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Mediation analysis tests whether the relationship between two variables is explained by a third intermediate variable. We sought to describe the usage and reporting of mediation analysis with time-to-event outcomes in published healthcare research. METHODS A systematic search of Medline, Embase, and Web of Science was executed in December 2016 to identify applications of mediation analysis to healthcare research involving a clinically relevant time-to-event outcome. We summarized usage over time and reporting of important methodological characteristics. RESULTS We included 149 primary studies, published from 1997 to 2016. Most studies were published after 2011 (n = 110, 74%), and the annual number of studies nearly doubled in the last year (from n = 21 to n = 40). A traditional approach (causal steps or change in coefficient) was most commonly taken (n = 87, 58%), and the majority of studies (n = 114, 77%) used a Cox Proportional Hazards regression for the outcome. Few studies (n = 52, 35%) mentioned any of the assumptions or limitations fundamental to a causal interpretation of mediation analysis. CONCLUSION There is increasing use of mediation analysis with time-to-event outcomes. Current usage is limited by reliance on traditional methods and the Cox Proportional Hazards model, as well as low rates of reporting of underlying assumptions. There is a need for formal criteria to aid authors, reviewers, and readers reporting or appraising such studies.
Collapse
|
96
|
Schlenker MB, Thiruchelvam D, Redelmeier DA. Association of Cataract Surgery With Traffic Crashes. JAMA Ophthalmol 2018; 136:998-1007. [PMID: 29955857 PMCID: PMC6142973 DOI: 10.1001/jamaophthalmol.2018.2510] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/01/2018] [Accepted: 05/04/2018] [Indexed: 01/19/2023]
Abstract
Importance Cataracts are the most common cause of impaired vision worldwide and may increase a driver's risk of a serious traffic crash. The potential benefits of cataract surgery for reducing a patient's subsequent risk of traffic crash are uncertain. Objective To conduct a comprehensive longitudinal analysis testing whether cataract surgery is associated with a reduction in serious traffic crashes where the patient was the driver. Design, Setting, and Participants Population-based individual-patient self-matching exposure-crossover design in Ontario, Canada, between April 1, 2006, and March 31, 2016. Consecutive patients 65 years and older undergoing cataract surgery (n = 559 546). Interventions First eye cataract extraction surgery (most patients received second eye soon after). Main Outcomes and Measures Emergency department visit for a traffic crash as a driver. Results Of the 559 546 patients, mean (SD) age was 76 (6) years, 58% were women (n = 326 065), and 86% lived in a city (n = 481 847). A total of 4680 traffic crashes (2.36 per 1000 patient-years) accrued during the 3.5-year baseline interval and 1200 traffic crashes (2.14 per 1000 patient-years) during the 1-year subsequent interval, representing 0.22 fewer crashes per 1000 patient-years following cataract surgery (odds ratio [OR], 0.91; 95% CI, 0.84-0.97; P = .004). The relative reduction included patients with diverse characteristics. No significant reduction was observed in other outcomes, such as traffic crashes where the patient was a passenger (OR, 1.03; 95% CI, 0.96-1.12) or pedestrian (OR, 1.02; 95% CI, 0.88-1.17), nor in other unrelated serious medical emergencies. Patients with younger age (OR, 1.27; 95% CI, 1.13-1.14), male sex (OR, 1.64; 95% CI, 1.46-1.85), a history of crash (baseline OR, 2.79; 95% CI, 1.94-4.02; induction OR, 4.26; 95% CI, 2.01-9.03), more emergency visits (OR, 1.34; 95% CI, 1.19-1.52), and frequent outpatient physician visits (OR, 1.17; 95% CI, 1.01-1.36) had higher risk of subsequent traffic crashes (multivariable model). Conclusions and Relevance This study suggests that cataract surgery is associated with a modest decrease in a patient's subsequent risk of a serious traffic crash as a driver, which has potential implications for mortality, morbidity, and costs to society.
Collapse
|
97
|
Staples JA, Redelmeier DA. The April 20 Cannabis Celebration and Fatal Traffic Crashes in the United States. JAMA Intern Med 2018; 178:569-572. [PMID: 29435568 PMCID: PMC5876802 DOI: 10.1001/jamainternmed.2017.8298] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
This data analysis examines the association between the April 20 cannabis celebrations in the United States and a population-level increase in the risk of fatal traffic crash involvement.
Collapse
|
98
|
Redelmeier DA, Raza S. Optical illusions and life-threatening traffic crashes: A perspective on aerial perspective. Med Hypotheses 2018; 114:23-27. [PMID: 29602457 DOI: 10.1016/j.mehy.2018.02.008] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2017] [Accepted: 02/10/2018] [Indexed: 11/28/2022]
Abstract
Aerial perspective illusion is a feature of visual perception where landscapes appear relatively close in clear light and distant in dim light. We hypothesized that bright sunlight might cause drivers to perceive distant terrain as relatively close and misinterpret the approach speed of surrounding landscape as unduly slow. This hypothesis would mean, in turn, that drivers in bright sunlight may underestimate their progress on the road, compensate by traveling at a faster baseline speed, and ultimately increase the prevailing risk of a life-threatening traffic crash. We conducted three pilot studies to illustrate how the illusion might contribute to a life- threatening traffic crash. The first illustration used a questionnaire to demonstrate that most respondents were mistaken when judging the distance between simple balls in different positions. The second illustration involved an experimental manipulation to assess whether aerial perspective influenced judgments about the relative positions of vehicles in traffic. The third illustration analyzed a segment of high-volume fast-speed traffic and found an increased frequency of speeding under bright sunlight. Together with past work based on the visual arts, these examples illustrate how an aerial perspective illusion can affect distance perception, may appear in realistic traffic situations, and could potentially contribute to the risk of a life-threatening traffic crash. An awareness of this hypothesis might lead to applications on how optical illusions could extend to everyday traffic and might potentially inform safety warnings to prevent life- threatening crashes.
Collapse
|
99
|
Redelmeier DA, Tibshirani RJ. Methods for analyzing matched designs with double controls: excess risk is easily estimated and misinterpreted when evaluating traffic deaths. J Clin Epidemiol 2018; 98:117-122. [PMID: 29452220 DOI: 10.1016/j.jclinepi.2018.02.005] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2017] [Revised: 02/01/2018] [Accepted: 02/04/2018] [Indexed: 10/18/2022]
Abstract
OBJECTIVES To demonstrate analytic approaches for matched studies where two controls are linked to each case and events are accumulating counts rather than binary outcomes. A secondary intent is to clarify the distinction between total risk and excess risk (unmatched vs. matched perspectives). STUDY DESIGN AND SETTING We review past research testing whether elections can lead to increased traffic risks. The results are reinterpreted by analyzing both the total count of individuals in fatal crashes and the excess count of individuals in fatal crashes, each time accounting for the matched double controls. RESULTS Overall, 1,546 individuals were in fatal crashes on the 10 election days (average = 155/d), and 2,593 individuals were in fatal crashes on the 20 control days (average = 130/d). Poisson regression of total counts yielded a relative risk of 1.19 (95% confidence interval: 1.12-1.27). Poisson regression of excess counts yielded a relative risk of 3.22 (95% confidence interval: 2.72-3.80). The discrepancy between analyses of total counts and excess counts replicated with alternative statistical models and was visualized in graphical displays. CONCLUSION Available approaches provide methods for analyzing count data in matched designs with double controls and help clarify the distinction between increases in total risk and increases in excess risk.
Collapse
|
100
|
Redelmeier DA, Kraus NC. Patterns in Patient Access and Utilization of Online Medical Records: Analysis of MyChart. J Med Internet Res 2018; 20:e43. [PMID: 29410386 PMCID: PMC5820458 DOI: 10.2196/jmir.8372] [Citation(s) in RCA: 29] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2017] [Revised: 12/12/2017] [Accepted: 12/16/2017] [Indexed: 02/01/2023] Open
Abstract
BACKGROUND Electronic patient portals provide a new method for sharing personal medical information with individual patients. OBJECTIVE Our aim was to review utilization patterns of the largest online patient portal in Canada's largest city. METHODS We conducted a 4-year time-trend analysis of aggregated anonymous utilization data of the MyChart patient portal at Sunnybrook Health Sciences Centre in Ontario, Canada, from January 1, 2012, through December 31, 2015. Prespecified analyses examined trends related to day (weekend vs weekday), season (July vs January), year (2012 vs 2015), and an extreme adverse weather event (ice storm of December 20-26, 2013). Primary endpoints included three measures of patient portal activity: registrations, logins, and pageviews. RESULTS We identified 32,325 patients who registered for a MyChart account during the study interval. Time-trend analysis showed no sign of attenuating registrations over time. Logins were frequent, averaged 734 total per day, and showed an increasing trend over time. Pageviews mirrored logins, averaged about 3029 total per day, and equated to about 5 pageviews during the average login. The most popular pageviews were clinical notes, followed by laboratory results and medical imaging reports. All measures of patient activity were lower on weekends compared to weekdays (P<.001) yet showed no significant changes related to seasons or extreme weather. No major security breach, malware attack, or software failure occurred during the study. CONCLUSIONS Online patient portals can provide a popular and reliable system for distributing personal medical information to active patients and may merit consideration for hospitals.
Collapse
|