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Gao L, Roy Robertson J, Bird SM. Scotland's 2009-2015 methadone-prescription cohort: Quintiles for daily dose of prescribed methadone and risk of methadone-specific death. Br J Clin Pharmacol 2021; 87:652-673. [PMID: 32530053 PMCID: PMC7612180 DOI: 10.1111/bcp.14432] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2019] [Revised: 04/16/2020] [Accepted: 04/22/2020] [Indexed: 12/18/2022] Open
Abstract
AIMS As methadone clients age, their drug-related death (DRD) risks increase, more than doubling at 45+ years for methadone-specific DRDs. METHODS Using Community Health Index (CHI) numbers, mortality to 31 December 2015 was ascertained for 36 347 methadone-prescription clients in Scotland during 2009-2015. Cohort entry, quantity of prescribed methadone and daily dose (actual or recovered by effective, simple rules) were defined by clients' first CHI-identified methadone prescription after 30 June 2009 and used in proportional hazards analysis. As custodian of death records, National Records of Scotland identified non-DRDs from DRDs. Methadone-specific DRD means methadone was implicated but neither heroin nor buprenorphine. RESULTS The cohort's 192 928 person-years included 1857 non-DRDs and 1323 DRDs (42%), 546 of which were methadone specific. Actual/recovered daily dose was available for 26 533 (73%) clients who experienced 420 methadone-specific DRDs. Top quintile for daily dose at first CHI-identified methadone prescription was >90 mg. Age 45+ years at cohort-entry (hazard ratio vs 25-34 years: 3.1, 95% confidence interval: 2.4-4.2), top quintile for baseline daily dose of prescribed methadone (vs 50-70 mg: 1.9, 1.1-3.1) and being female (1.3, 1.0-1.6) significantly increased clients' risk of methadone-specific DRD. CONCLUSION Extra care is needed when methadone daily dose exceeds 90 mg. Females' higher risk for methadone-specific DRD is new and needs validation. Further analyses of prescribed daily dose linked to mortality for large cohorts of methadone clients are needed internationally, together with greater pharmacodynamic and pharmacokinetic understanding of methadone by age and sex. Balancing age-related risks is challenging for prescribers who manage chronic opiate dependency against additional uncertainty about the nature, strength and pharmacological characteristics of drugs from illegal markets.
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Affiliation(s)
- Lu Gao
- MRC Biostatistics Unit, University of Cambridge School of Clinical Medicine, Cambridge, UK
| | | | - Sheila M. Bird
- MRC Biostatistics Unit, University of Cambridge School of Clinical Medicine, Cambridge, UK
- University of Edinburgh Centre for Medical Informatics, Edinburgh, UK
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Turnbull AJ, Donaghy E, Salisbury L, Ramsay P, Rattray J, Walsh T, Lone N. Polypharmacy and emergency readmission to hospital after critical illness: a population-level cohort study. Br J Anaesth 2021; 126:415-422. [PMID: 33138965 PMCID: PMC8014911 DOI: 10.1016/j.bja.2020.09.035] [Citation(s) in RCA: 22] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2020] [Revised: 09/08/2020] [Accepted: 09/27/2020] [Indexed: 11/15/2022] Open
Abstract
BACKGROUND Polypharmacy is common and closely linked to drug interactions. The impact of polypharmacy has not been previously quantified in survivors of critical illness who have reduced resilience to stressors. Our aim was to identify factors associated with preadmission polypharmacy and ascertain whether polypharmacy is an independent risk factor for emergency readmission to hospital after discharge from a critical illness. METHODS A population-wide cohort study consisting of patients admitted to all Scottish general ICUs between January 1, 2011 and December 31, 2013, whom survived their ICU stay. Patients were stratified by presence of preadmission polypharmacy, defined as being prescribed five or more regular medications. The primary outcome was emergency hospital readmission within 1 yr of discharge from index hospital stay. RESULTS Of 23 844 ICU patients, 29.9% were identified with polypharmacy (n=7138). Factors associated with polypharmacy included female sex, increasing age, and social deprivation. Emergency 1-yr hospital readmission was significantly higher in the polypharmacy cohort (51.8% vs 35.8%, P<0.001). After confounder adjustment, patients with polypharmacy had a 22% higher hazard of emergency 1-yr readmission (adjusted hazard ratio 1.22, 95% confidence interval 1.16-1.28, P<0.001). On a linear scale of polypharmacy each additional prescription conferred a 3% increase in hazard of emergency readmission by 1 yr (adjusted hazard ratio 1.03, 95% confidence interval 1.02-1.03, P<0.001). CONCLUSIONS This national cohort study of ICU survivors demonstrates that preadmission polypharmacy is an independent risk factor for emergency readmission. In an ever-growing era of polypharmacy, this risk factor may represent a substantial burden in the at-risk post-intensive care population.
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Affiliation(s)
- Angus J Turnbull
- University Department of Anaesthesia, Critical Care and Pain Medicine, Deanery of Clinical Sciences, University of Edinburgh, Edinburgh, UK.
| | - Eddie Donaghy
- University Department of Anaesthesia, Critical Care and Pain Medicine, Deanery of Clinical Sciences, University of Edinburgh, Edinburgh, UK; Usher Institute, University of Edinburgh, Edinburgh, UK
| | - Lisa Salisbury
- School of Health Sciences, Queen Margaret University Edinburgh, Musselburgh, UK
| | - Pamela Ramsay
- School of Health and Social Care, Edinburgh Napier University, Edinburgh, UK
| | - Janice Rattray
- School of Nursing and Health Sciences, University of Dundee, Dundee, UK
| | - Timothy Walsh
- University Department of Anaesthesia, Critical Care and Pain Medicine, Deanery of Clinical Sciences, University of Edinburgh, Edinburgh, UK; Usher Institute, University of Edinburgh, Edinburgh, UK; MRC Centre for Inflammation Research, University of Edinburgh, Edinburgh, UK
| | - Nazir Lone
- University Department of Anaesthesia, Critical Care and Pain Medicine, Deanery of Clinical Sciences, University of Edinburgh, Edinburgh, UK; Usher Institute, University of Edinburgh, Edinburgh, UK
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Morales DR, Macfarlane T, MacDonald TM, Hallas J, Ernst MT, Herings RMC, Smits E, Overbeek JA, Mitchell L, Morant S, Mackenzie I, Doney ASF, Robertson C, Bennie M, Wei L, Nicholson L, Morris C, Flynn RWF. Impact of EMA regulatory label changes on hydroxyzine initiation, discontinuation and switching to other medicines in Denmark, Scotland, England and the Netherlands: An interrupted time series regression analysis. Pharmacoepidemiol Drug Saf 2021; 30:482-491. [PMID: 33386650 DOI: 10.1002/pds.5191] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2020] [Accepted: 12/11/2020] [Indexed: 01/18/2023]
Abstract
BACKGROUND Hydroxyzine is indicated for the management of anxiety, skin and sleep disorders. In 2015, the European Medicines Agency (EMA) concluded that hydroxyzine was pro-arrhythmogenic and changes to the product information were implemented in Europe. This study aimed to evaluate their impact in Denmark, Scotland, England and the Netherlands. METHOD Quarterly time series analyses measuring hydroxyzine initiation, discontinuation, and switching to other antihistamines, benzodiazepines and antidepressants in Denmark, England, Scotland and the Netherlands from 2009 to 2018. Data were analysed using interrupted time series regression. RESULTS Hydroxyzine initiation in quarter one 2010 in Denmark, Scotland, England and the Netherlands per 100 000 was: 23.5, 91.5, 35.9 and 34.4 respectively. Regulatory action was associated with a significant: immediate fall in hydroxyzine initiation per 100 000 in England (-12.05, 95%CI -18.47 to -5.63) and Scotland (-19.01, 95%CI -26.99 to -11.02); change to a negative trend in hydroxyzine initiation per 100 000/quarter in England (-1.72, 95%CI -2.69 to -0.75) and Scotland (-2.38, 95%CI -3.32 to -1.44). Regulatory action was associated with a significant: immediate rise in hydroxyzine discontinuation per 100 000 in England (3850, 95%CI 440-7240). No consistent changes were observed in the Netherlands or Denmark. Regulatory action was associated with no switching to other antihistamines, benzodiazepines or antidepressants following hydroxyzine discontinuation in any country. CONCLUSION The 2015 EMA regulatory action was associated with heterogeneous impact with reductions in hydroxyzine initiation varying by country. There was limited impact on discontinuation with no strong evidence suggesting unintended consequences of major switching to other antihistamines, benzodiazepines or antidepressants.
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Affiliation(s)
- Daniel R Morales
- MEMO Research, University of Dundee, Dundee, UK.,Department of Clinical Pharmacology and Pharmacy, University of Southern Denmark, Odense, Denmark
| | | | | | - Jesper Hallas
- Department of Clinical Pharmacology and Pharmacy, University of Southern Denmark, Odense, Denmark
| | - Martin Thomsen Ernst
- Department of Clinical Pharmacology and Pharmacy, University of Southern Denmark, Odense, Denmark
| | - Ron M C Herings
- PHARMO Institute for Drug Outcomes Research, Utrecht, The Netherlands
| | - Elisabeth Smits
- PHARMO Institute for Drug Outcomes Research, Utrecht, The Netherlands
| | - Jetty A Overbeek
- PHARMO Institute for Drug Outcomes Research, Utrecht, The Netherlands
| | | | | | | | | | - Chris Robertson
- Department of Mathematics and Statistics, University of Strathclyde, Glasgow, UK
| | - Marion Bennie
- Strathclyde Onstitute of Pharmacy and Biomedical Sciences, University of Strathclyde, Glasgow, UK
| | - Li Wei
- School of Pharmacy, University College London, London, UK
| | - Lizzie Nicholson
- Electronic Data Research and Innovation Service, NHS National Services Scotland, Edinburgh, UK
| | - Carole Morris
- Electronic Data Research and Innovation Service, NHS National Services Scotland, Edinburgh, UK
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Henderson DAG, Atherton I, McCowan C, Mercer SW, Bailey N. Linkage of national health and social care data: a cross-sectional study of multimorbidity and social care use in people aged over 65 years in Scotland. Age Ageing 2021; 50:176-182. [PMID: 32687158 DOI: 10.1093/ageing/afaa134] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2020] [Indexed: 12/11/2022] Open
Abstract
BACKGROUND little is known about the relationship between multimorbidity and social care use (also known as long-term care). The aim of this study was to assess the relationship between receipt of formal social care services and multimorbidity. METHODS this retrospective data linkage, observational study included all individuals over the age of 65 in the population of Scotland in financial years 2014-15 and 2015-16 (n = 975,265). The main outcome was receipt of social care measured by presence in the Scottish Social Care Survey. Logistic regression models were used to assess the influence of multimorbidity, age, sex and socioeconomic position on the outcome reporting average marginal effects (AME). FINDINGS 93.3% of those receiving social care had multimorbidity, 16.2% of those with multimorbidity received social care compared with 3.7% of those without. The strongest magnitudes of AME for receiving social care were seen for age and multimorbidity (respectively, 50 and 18% increased probability comparing oldest to youngest and most severe multimorbidity to none). A 5.5% increased probability of receiving social care was observed for the most-deprived compared with the least-deprived. INTERPRETATION higher levels of social care receipt are observed in those with increasing age, severe multimorbidity and living in more deprived areas. Multimorbidity does not fully moderate the relationship between social care receipt and either age or deprivation.
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Affiliation(s)
- David A G Henderson
- School of Health and Social Care, Edinburgh Napier University, Edinburgh, UK
| | - Iain Atherton
- School of Health and Social Care, Edinburgh Napier University, Edinburgh, UK
| | | | | | - Nick Bailey
- Urban Big Data Centre, University of Glasgow, Glasgow, UK
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55
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Cherrie M, Curtis S, Baranyi G, McTaggart S, Cunningham N, Licence K, Dibben C, Bambra C, Pearce J. Use of sequence analysis for classifying individual antidepressant trajectories to monitor population mental health. BMC Psychiatry 2020; 20:551. [PMID: 33228576 PMCID: PMC7684902 DOI: 10.1186/s12888-020-02952-y] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/17/2020] [Accepted: 11/15/2020] [Indexed: 11/15/2022] Open
Abstract
BACKGROUND Over the past decade, antidepressant prescriptions have increased in European countries and the United States, partly due to an increase in the number of new cases of mental illness. This paper demonstrates an innovative approach to the classification of population level change in mental health status, using administrative data for a large sample of the Scottish population. We aimed to identify groups of individuals with similar patterns of change in pattern of prescribing, validate these groups by comparison with other indicators of mental illness, and characterise the population most at risk of increasing mental ill health. METHODS National Health Service (NHS) prescription data were linked to the Scottish Longitudinal Study (SLS), a 5.3% sample of the Scottish population (N = 151,418). Antidepressant prescription status over the previous 6 months was recorded for every month for which data were available (January 2009-December 2014), and sequence dissimilarity was computed by optimal matching. Hierarchical clustering was used to create groups of participants who had similar patterns of change, with multi-level logistic regression used to understand group membership. RESULTS Five distinct prescription pattern groups were observed, indicating: no prescriptions (76%), occasional prescriptions (10%), continuation of prior use of prescriptions (8%), a new course of prescriptions started (4%) or ceased taking prescriptions (3%). Young, white, female participants, of low social grade, residing in socially deprived neighbourhoods, living alone, being separated/divorced or out of the labour force, were more likely to be in the group that started a new course of antidepressant prescriptions. CONCLUSIONS The use of sequence analysis for classifying individual antidepressant trajectories offers a novel approach for capturing population-level changes in mental health risk. By classifying individuals into groups based on their anti-depressant medication use we can better identify how over time, mental health is associated with individual risk factors and contextual factors at the local level and the macro political and economic scale.
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Affiliation(s)
- Mark Cherrie
- School of GeoSciences, The University of Edinburgh, Edinburgh, Scotland, UK. .,Institute of Occupational Medicine, Edinburgh, Scotland, UK.
| | - Sarah Curtis
- grid.4305.20000 0004 1936 7988School of GeoSciences, The University of Edinburgh, Edinburgh, Scotland, UK ,grid.8250.f0000 0000 8700 0572Department of Geography, Durham University, Durham, UK
| | - Gergő Baranyi
- grid.4305.20000 0004 1936 7988School of GeoSciences, The University of Edinburgh, Edinburgh, Scotland, UK
| | | | - Niall Cunningham
- grid.1006.70000 0001 0462 7212School of Geography, Politics & Sociology, Newcastle University, Newcastle upon Tyne, UK
| | - Kirsty Licence
- grid.508718.3Public Health Scotland, Edinburgh, UK ,grid.413893.40000 0001 2232 4338Health Protection Scotland, Glasgow, UK
| | - Chris Dibben
- grid.4305.20000 0004 1936 7988School of GeoSciences, The University of Edinburgh, Edinburgh, Scotland, UK ,grid.4305.20000 0004 1936 7988Scottish Centre for Administrative Data Research, University of Edinburgh, Edinburgh, UK
| | - Clare Bambra
- grid.1006.70000 0001 0462 7212Population Health Sciences Institute, Newcastle University, Newcastle upon Tyne, UK
| | - Jamie Pearce
- grid.4305.20000 0004 1936 7988School of GeoSciences, The University of Edinburgh, Edinburgh, Scotland, UK
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McKeigue PM, Weir A, Bishop J, McGurnaghan SJ, Kennedy S, McAllister D, Robertson C, Wood R, Lone N, Murray J, Caparrotta TM, Smith-Palmer A, Goldberg D, McMenamin J, Ramsay C, Hutchinson S, Colhoun HM. Rapid Epidemiological Analysis of Comorbidities and Treatments as risk factors for COVID-19 in Scotland (REACT-SCOT): A population-based case-control study. PLoS Med 2020; 17:e1003374. [PMID: 33079969 PMCID: PMC7575101 DOI: 10.1371/journal.pmed.1003374] [Citation(s) in RCA: 44] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/02/2020] [Accepted: 09/18/2020] [Indexed: 01/16/2023] Open
Abstract
BACKGROUND The objectives of this study were to identify risk factors for severe coronavirus disease 2019 (COVID-19) and to lay the basis for risk stratification based on demographic data and health records. METHODS AND FINDINGS The design was a matched case-control study. Severe COVID-19 was defined as either a positive nucleic acid test for severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) in the national database followed by entry to a critical care unit or death within 28 days or a death certificate with COVID-19 as underlying cause. Up to 10 controls per case matched for sex, age, and primary care practice were selected from the national population register. For this analysis-based on ascertainment of positive test results up to 6 June 2020, entry to critical care up to 14 June 2020, and deaths registered up to 14 June 2020-there were 36,948 controls and 4,272 cases, of which 1,894 (44%) were care home residents. All diagnostic codes from the past 5 years of hospitalisation records and all drug codes from prescriptions dispensed during the past 240 days were extracted. Rate ratios for severe COVID-19 were estimated by conditional logistic regression. In a logistic regression using the age-sex distribution of the national population, the odds ratios for severe disease were 2.87 for a 10-year increase in age and 1.63 for male sex. In the case-control analysis, the strongest risk factor was residence in a care home, with rate ratio 21.4 (95% CI 19.1-23.9, p = 8 × 10-644). Univariate rate ratios for conditions listed by public health agencies as conferring high risk were 2.75 (95% CI 1.96-3.88, p = 6 × 10-9) for type 1 diabetes, 1.60 (95% CI 1.48-1.74, p = 8 × 10-30) for type 2 diabetes, 1.49 (95% CI 1.37-1.61, p = 3 × 10-21) for ischemic heart disease, 2.23 (95% CI 2.08-2.39, p = 4 × 10-109) for other heart disease, 1.96 (95% CI 1.83-2.10, p = 2 × 10-78) for chronic lower respiratory tract disease, 4.06 (95% CI 3.15-5.23, p = 3 × 10-27) for chronic kidney disease, 5.4 (95% CI 4.9-5.8, p = 1 × 10-354) for neurological disease, 3.61 (95% CI 2.60-5.00, p = 2 × 10-14) for chronic liver disease, and 2.66 (95% CI 1.86-3.79, p = 7 × 10-8) for immune deficiency or suppression. Seventy-eight percent of cases and 52% of controls had at least one listed condition (51% of cases and 11% of controls under age 40). Severe disease was associated with encashment of at least one prescription in the past 9 months and with at least one hospital admission in the past 5 years (rate ratios 3.10 [95% CI 2.59-3.71] and 2.75 [95% CI 2.53-2.99], respectively) even after adjusting for the listed conditions. In those without listed conditions, significant associations with severe disease were seen across many hospital diagnoses and drug categories. Age and sex provided 2.58 bits of information for discrimination. A model based on demographic variables, listed conditions, hospital diagnoses, and prescriptions provided an additional 1.07 bits (C-statistic 0.804). A limitation of this study is that records from primary care were not available. CONCLUSIONS We have shown that, along with older age and male sex, severe COVID-19 is strongly associated with past medical history across all age groups. Many comorbidities beyond the risk conditions designated by public health agencies contribute to this. A risk classifier that uses all the information available in health records, rather than only a limited set of conditions, will more accurately discriminate between low-risk and high-risk individuals who may require shielding until the epidemic is over.
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Affiliation(s)
- Paul M. McKeigue
- Usher Institute, College of Medicine and Veterinary Medicine, University of Edinburgh, Edinburgh, Scotland
- Public Health Scotland, Glasgow, Scotland
| | | | - Jen Bishop
- Public Health Scotland, Glasgow, Scotland
| | - Stuart J. McGurnaghan
- Institute of Genetics and Molecular Medicine, College of Medicine and Veterinary Medicine, University of Edinburgh, Edinburgh, Scotland
| | - Sharon Kennedy
- NHS Information Services Division (Public Health Scotland), Edinburgh, Scotland
| | - David McAllister
- Public Health Scotland, Glasgow, Scotland
- Institute of Health and Wellbeing, University of Glasgow, Glasgow, Scotland
| | - Chris Robertson
- Department of Mathematics and Statistics, University of Strathclyde, Glasgow, Scotland
| | - Rachael Wood
- NHS Information Services Division (Public Health Scotland), Edinburgh, Scotland
| | - Nazir Lone
- Usher Institute, College of Medicine and Veterinary Medicine, University of Edinburgh, Edinburgh, Scotland
| | | | - Thomas M. Caparrotta
- Institute of Genetics and Molecular Medicine, College of Medicine and Veterinary Medicine, University of Edinburgh, Edinburgh, Scotland
| | | | | | | | | | - Sharon Hutchinson
- Public Health Scotland, Glasgow, Scotland
- School of Health and Life Sciences, Glasgow Caledonian University, Glasgow, Scotland
| | - Helen M. Colhoun
- Public Health Scotland, Glasgow, Scotland
- Institute of Genetics and Molecular Medicine, College of Medicine and Veterinary Medicine, University of Edinburgh, Edinburgh, Scotland
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Sarica SH, Dhaun N, Sznajd J, Harvie J, McLaren J, McGeoch L, Kumar V, Amft N, Erwig L, Marks A, Black C, Basu N. Characterizing infection in anti-neutrophil cytoplasmic antibody-associated vasculitis: results from a longitudinal, matched-cohort data linkage study. Rheumatology (Oxford) 2020; 59:3014-3022. [PMID: 32159801 PMCID: PMC7516107 DOI: 10.1093/rheumatology/keaa070] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2019] [Revised: 01/27/2020] [Indexed: 12/11/2022] Open
Abstract
OBJECTIVES Infection exerts a major burden in ANCA-associated vasculitis (AAV), however, its precise extent and nature remains unclear. In this national study we aimed to longitudinally quantify, characterize and contextualize infection risk in AAV. METHODS We conducted a multicentre matched cohort study of AAV. Complementary data on infections were retrieved via data linkage with the population-based Scottish microbiological laboratory, hospitalization and primary care prescribing registries. RESULTS A total of 379 AAV patients and 1859 controls were followed up for a median of 3.5 years (interquartile range 1.9-5.7). During follow-up, the proportions of AAV patients with at least one laboratory-confirmed infection, severe infection and primary care antibiotic prescription were 55.4%, 35.6% and 74.6%, respectively. The risk of infection was higher in AAV than in matched controls {laboratory-confirmed infections: incidence rate ratio [IRR] 7.3 [95% confidence interval (CI) 5.6, 9.6]; severe infections: IRR 4.4 [95% CI 3.3, 5.7]; antibiotic prescriptions: IRR 2.2 [95% CI 1.9, 2.6]}. Temporal trend analysis showed that AAV patients remained at a higher risk of infections throughout the follow-up period, especially year 1. Although the Escherichia genus was the most commonly identified pathogen (16.6% of AAV, 5.5% of controls; P < 0.0001), AAV patients had the highest risk for Herpes [IRR 12.5 (95% CI 3.7, 42.6)] and Candida [IRR 11.4 (95% CI 2.4, 55.4)]. CONCLUSION AAV patients have up to seven times higher risk of infection than the general population and the overall risk remains significant after 8 years of follow-up. The testing of enhanced short- to medium-term prophylactic antibiotic regimes should be considered.
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Affiliation(s)
- Shifa H Sarica
- Aberdeen Centre for Health Data Science, University of Aberdeen, Aberdeen, UK
| | - Neeraj Dhaun
- Queen’s Medical Research Institute, University/British Heart Foundation Centre of Research Excellence, University of Edinburgh, Edinburgh, UK
| | - Jan Sznajd
- Department of Rheumatology, Raigmore Hospital, Inverness, UK
| | - John Harvie
- Department of Rheumatology, Raigmore Hospital, Inverness, UK
| | - John McLaren
- Fife Rheumatic Diseases Unit, Whyteman’s Brae Hospital, Kirkcaldy, UK
| | - Lucy McGeoch
- Centre for Rheumatic Diseases, Glasgow Royal Infirmary, Glasgow, UK
| | - Vinod Kumar
- Rheumatology Department, Ninewells Hospital, Dundee, UK
| | - Nicole Amft
- GlaxoSmithKline, Medicines Research Centre, Stevenage, UK
| | - Lars Erwig
- GlaxoSmithKline, Medicines Research Centre, Stevenage, UK
| | - Angharad Marks
- Morriston Hospital Renal Unit, Abertawe Bro Morgannwg University Health Board, Swansea, UK
| | - Corri Black
- Aberdeen Centre for Health Data Science, University of Aberdeen, Aberdeen, UK
| | - Neil Basu
- Institute of Infection, Immunity and Inflammation, University of Glasgow, Glasgow, UK
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Henderson A, Mcskimming P, Kinnear D, McCowan C, McIntosh A, Allan L, Cooper SA. Changes over a decade in psychotropic prescribing for people with intellectual disabilities: prospective cohort study. BMJ Open 2020; 10:e036862. [PMID: 32912946 PMCID: PMC7488805 DOI: 10.1136/bmjopen-2020-036862] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/07/2020] [Revised: 07/08/2020] [Accepted: 07/08/2020] [Indexed: 02/06/2023] Open
Abstract
OBJECTIVES To investigate psychotropic prescribing in the intellectual disabilities population over 10 years, and associated mental ill health diagnoses. DESIGN Comparison of cross-sectional data in 2002-2004 (T1) and 2014 (T2). Longitudinal cohort study with detailed health assessments at T1 and record linkage to T2 prescribing data. SETTING General community. PARTICIPANTS 1190 adults with intellectual disabilities in T1 compared with 3906 adults with intellectual disabilities in T2. 545/1190 adults with intellectual disabilities in T1 were alive and their records linked to T2 prescribing data. MAIN OUTCOME MEASURES Encashed regular and as-required psychotropic prescriptions. RESULTS 50.7% (603/1190) of adults in T1 and 48.2% (1881/3906) in T2 were prescribed at least one psychotropic; antipsychotics: 24.5% (292/1190) in T1 and 16.7% (653/3906) in T2; antidepressants: 11.2% (133/1190) in T1 and 19.1% (746/3906) in T2. 21.2% (62/292) prescribed antipsychotics in T1 had psychosis or bipolar disorder, 33.2% (97/292) had no mental ill health or problem behaviours, 20.6% (60/292) had problem behaviours but no psychosis or bipolar disorder. Psychotropics increased from 47.0% (256/545) in T1 to 57.8% (315/545) in T2 (p<0.001): antipsychotics did not change (OR 1.18; 95% CI 0.87 to 1.60; p=0.280), there was an increase for antidepressants (OR 2.80; 95% CI 1.96 to 4.00; p<0.001), hypnotics/anxiolytics (OR 2.19; 95% CI 1.34 to 3.61; p=0.002), and antiepileptics (OR 1.40; 95% CI 1.06 to 1.84; p=0.017). Antipsychotic prescribing increased for people with problem behaviours in T1 (OR 6.45; 95% CI 4.41 to 9.45; p<0.001), more so than for people with other mental ill health in T1 (OR 4.11; 95% CI 2.76 to 6.11; p<0.001). CONCLUSIONS Despite concerns about antipsychotic prescribing and guidelines recommending their withdrawal, it appears that while fewer antipsychotic prescriptions were initiated by T2 than in T1, people were not withdrawn from them once commenced. People with problem behaviours had increased prescribing. There was also a striking increase in antidepressant prescriptions. Adults with intellectual disabilities need frequent and careful medication reviews.
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Affiliation(s)
- Angela Henderson
- Institute of Health and Wellbeing, University of Glasgow, Glasgow, UK
| | - Paula Mcskimming
- Robertson Centre for Biostatistics, University of Glasgow, Glasgow, UK
| | - Deborah Kinnear
- Institute of Health and Wellbeing, University of Glasgow, Glasgow, UK
| | - Colin McCowan
- School of Medicine, University of Saint Andrews, Saint Andrews, Fife, UK
| | - Alasdair McIntosh
- Robertson Centre for Biostatistics, University of Glasgow, Glasgow, UK
| | - Linda Allan
- Institute of Health and Wellbeing, University of Glasgow, Glasgow, UK
| | - Sally-Ann Cooper
- Institute of Health and Wellbeing, University of Glasgow, Glasgow, UK
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59
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Morales DR, Morant SV, MacDonald TM, Hallas J, Ernst MT, Pottegard A, Herings RMC, Smits E, Overbeek JA, Mackenzie IS, Doney ASF, Mitchell L, Bennie M, Robertson C, Wei L, Nicholson L, Morris C, Flynn RWV. Impact of EU regulatory label changes for diclofenac in people with cardiovascular disease in four countries: Interrupted time series regression analysis. Br J Clin Pharmacol 2020; 87:1129-1140. [PMID: 32668021 DOI: 10.1111/bcp.14478] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2020] [Revised: 06/29/2020] [Accepted: 07/05/2020] [Indexed: 12/17/2022] Open
Abstract
OBJECTIVE Due to cardiovascular safety concerns, the European Medicines Agency (EMA) recommended new contraindications and changes to product information for diclofenac across Europe in 2013. This study aims to measure their impact among targeted populations. METHOD Quarterly interrupted time series regression (ITS) analyses of diclofenac initiation among cohorts with contraindications (congestive cardiac failure [CHF], ischaemic heart disease [IHD], peripheral arterial disease [PAD], cerebrovascular disease [CVD]) and cautions (hypertension, hyperlipidaemia, diabetes) from Denmark, the Netherlands, England and Scotland. RESULTS The regulatory action was associated with significant immediate absolute reductions in diclofenac initiation in all countries for IHD (Denmark -0.08%, 95%CI -0.13, -0.03; England -0.09%, 95%CI -0.13 to -0.06%; the Netherlands -1.84%, 95%CI -2.51 to -1.17%; Scotland -0.34%, 95%CI -0.38 to -0.30%), PAD and hyperlipidaemia, the Netherlands, England and Scotland for hypertension and diabetes, and England and Scotland for CHF and CVD. Post-intervention there was a significant negative trend in diclofenac initiation in the Netherlands for IHD (-0.12%, 95%CI -0.19 to -0.04), PAD (-0.13%, 95%CI -0.22 to -0.05), hypertension, hyperlipidaemia and diabetes, and in Scotland for CHF (-0.01%, 95%CI -0.02 to -0.007%), IHD (-0.017, 95%CI -0.02, -0.01%), PAD and hypertension. In England, diclofenac initiation rates fell less steeply. In Denmark changes were more strongly associated with the earlier EMA 2012 regulatory action. CONCLUSION Although significant reductions in diclofenac initiation occurred, patients with contraindications continued to be prescribed diclofenac, the extent of which varied by country and target condition. Understanding reasons for such variation may help to guide the design or dissemination of future safety warnings.
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Affiliation(s)
| | | | | | | | | | | | - Ron M C Herings
- PHARMO Institute for Drug Outcomes Research, The Netherlands.,Department of Epidemiology and Data Science, Amsterdam UMC
| | - Elisabeth Smits
- PHARMO Institute for Drug Outcomes Research, The Netherlands
| | | | | | | | | | - Marion Bennie
- University of Strathclyde, UK.,NHS National Services, Scotland, UK
| | | | - Li Wei
- University College London, UK
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60
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Robertson C, Pan J, Kavanagh K, Ford I, McCowan C, Bennie M, Marwick C, Leanord A. Cost burden of Clostridioides difficile infection to the health service: A retrospective cohort study in Scotland. J Hosp Infect 2020; 106:554-561. [PMID: 32717202 DOI: 10.1016/j.jhin.2020.07.019] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2019] [Accepted: 07/15/2020] [Indexed: 12/19/2022]
Abstract
BACKGROUND Clostridioides difficile infection (CDI) is associated with high healthcare demands and related costs. AIM To evaluate the healthcare and economic burden of CDI in hospitalized patients with community- (HOCA-CDI) or hospital-associated CDI (HOHA-CDI) in the National Health Service in Scotland. METHODS A retrospective cohort study was conducted, examining data between August 2010 and July 2013 from four patient-level Scottish datasets, linked to death data. Data examined included prior antimicrobial prescriptions in the community, hospitalizations, length of stay and mortality. Each CDI case was matched to three hospital-based controls on the basis of age, gender, hospital and date of admission. Descriptive economic evaluations were based on bed-day costs for different types of wards. FINDINGS Overall, 3304 CDI cases were included in the study. CDI was associated with additional median lengths of stay of 7.2 days for HOCA-CDI and 12.0 days for HOHA-CDI compared with their respective, matched controls. The 30-day mortality rate was 6.8% for HOCA-CDI and 12.4% for HOHA-CDI. Overall, recurrence within 90 days of the first CDI episode occurred in 373/2740 (13.6%) survivors. The median additional expenditure for each initial CDI case compared with matched controls was £1713. In the 6 months after the index hospitalization, the cost associated with a CDI case was £5126 higher than for controls. CONCLUSION Using routinely collected national data, we demonstrated the substantial burden of CDI on healthcare services, including lengthy hospital stays and readmissions, which increased the costs of managing patients with CDI compared with matched controls.
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Affiliation(s)
- C Robertson
- Department of Mathematics and Statistics, University of Strathclyde, Glasgow, UK; Health Protection Scotland, NHS National Services Scotland, Glasgow, UK
| | - J Pan
- Department of Mathematics and Statistics, University of Strathclyde, Glasgow, UK
| | - K Kavanagh
- Department of Mathematics and Statistics, University of Strathclyde, Glasgow, UK
| | - I Ford
- Robertson Centre for Biostatistics, University of Glasgow, Glasgow, UK
| | - C McCowan
- School of Medicine, University of St Andrews, St Andrews, UK
| | - M Bennie
- Strathclyde Institute of Pharmacy and Biomedical Sciences, University of Strathclyde, Glasgow, UK; Public Health and Intelligence, NHS National Services Scotland, Edinburgh, UK
| | - C Marwick
- Division of Population Health and Genomics, School of Medicine, University of Dundee, Dundee, UK
| | - A Leanord
- Institute of Infection, Immunity and Inflammation, University of Glasgow, Glasgow, UK; NHS Greater Glasgow and Clyde, Glasgow, UK.
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Torrance N, Veluchamy A, Zhou Y, Fletcher EH, Moir E, Hebert HL, Donnan PT, Watson J, Colvin LA, Smith BH. Trends in gabapentinoid prescribing, co-prescribing of opioids and benzodiazepines, and associated deaths in Scotland. Br J Anaesth 2020; 125:159-167. [PMID: 32571568 DOI: 10.1016/j.bja.2020.05.017] [Citation(s) in RCA: 47] [Impact Index Per Article: 11.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2020] [Revised: 05/01/2020] [Accepted: 05/02/2020] [Indexed: 01/05/2023] Open
Abstract
BACKGROUND Gabapentinoid drugs (gabapentin and pregabalin) are effective in neuropathic pain, which has a prevalence of ∼7%. Concerns about increased prescribing have implications for patient safety, misuse, and diversion. Drug-related deaths (DRDs) have increased and toxicology often implicates gabapentinoids. We studied national and regional prescribing rates (2006-2016) and identified associated sociodemographic factors, co-prescriptions and mortality, including DRDs. METHODS National data from the Information Service Division, NHS Scotland were analysed for prescribing, sociodemographic, and mortality data from the Health Informatics Centre, University of Dundee. DRDs in which gabapentinoids were implicated were identified from National Records of Scotland and Tayside Drug Death Databases. RESULTS From 2006 to 2016, the number of gabapentin prescriptions in Scotland increased 4-fold (164 630 to 694 293), and pregabalin 16-fold (27 094 to 435 490). In 2016 'recurrent users' (three or more prescriptions) had mean age 58.1 yr, were mostly females (62.5%), and were more likely to live in deprived areas. Of these, 60% were co-prescribed an opioid, benzodiazepine, or both (opioid 49.9%, benzodiazepine 26.8%, both 17.1%). The age-standardised death rate in those prescribed gabapentinoids was double that in the Scottish population (relative risk 2.16, 95% confidence interval 2.08-2.25). Increases in gabapentinoids contributing to cause of DRDs were reported regionally and nationally (gabapentin 23% vs 15%; pregabalin 21% vs 7%). In Tayside, gabapentinoids were implicated in 22 (39%) of DRDs, 17 (77%) of whom had not received a prescription. CONCLUSIONS Gabapentinoid prescribing has increased dramatically since 2006, as have dangerous co-prescribing and death (including DRDs). Older people, women, and those living in deprived areas were particularly likely to receive prescriptions. Their contribution to DRDs may be more related to illegal use with diversion of prescribed medication.
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Affiliation(s)
- Nicola Torrance
- School of Nursing & Midwifery, Robert Gordon University, Aberdeen, UK
| | - Abirami Veluchamy
- Division of Population Health and Genomics, School of Medicine, University of Dundee, Dundee, UK
| | - Yiling Zhou
- Division of Population Health and Genomics, School of Medicine, University of Dundee, Dundee, UK
| | - Emma H Fletcher
- NHS Tayside Directorate of Public Health, King's Cross, Dundee, UK
| | - Eilidh Moir
- NHS Tayside Directorate of Public Health, King's Cross, Dundee, UK
| | - Harry L Hebert
- Division of Population Health and Genomics, School of Medicine, University of Dundee, Dundee, UK
| | - Peter T Donnan
- Dundee Epidemiology and Biostatistics Unit, Division of Population Health and Genomics, School of Medicine, University of Dundee, Dundee, UK
| | - Jennifer Watson
- Division of Population Health and Genomics, School of Medicine, University of Dundee, Dundee, UK
| | - Lesley A Colvin
- Division of Population Health and Genomics, School of Medicine, University of Dundee, Dundee, UK.
| | - Blair H Smith
- Division of Population Health and Genomics, School of Medicine, University of Dundee, Dundee, UK
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Baranyi G, Cherrie M, Curtis SE, Dibben C, Pearce J. Changing levels of local crime and mental health: a natural experiment using self-reported and service use data in Scotland. J Epidemiol Community Health 2020; 74:806-814. [PMID: 32503890 PMCID: PMC7577093 DOI: 10.1136/jech-2020-213837] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2020] [Revised: 04/24/2020] [Accepted: 04/28/2020] [Indexed: 11/16/2022]
Abstract
Background This study contributes robust evidence on the association between mental health and local crime rates by showing how changing exposure to small area-level crime relates to self-reported and administrative data on mental health. Methods The study sample comprised 112 251 adults aged 16–60 years, drawn from the Scottish Longitudinal Study, a 5.3% representative sample of Scottish population followed across censuses. Outcomes were individual mental health indicators: self-reported mental illness from the 2011 Census and linked administrative data on antidepressants and antipsychotics prescribed through primary care providers in the National Health Service in 2010/2012. Crime rates at data zone level (500–1000 persons) were matched to the participants’ main place of residence, as defined by general practitioner patient registration duration during 2004/2006, 2007/2009 and 2010/12. Average neighbourhood crime exposure and change in area crime were computed. Covariate-adjusted logistic regressions were conducted, stratified by moving status. Results In addition to average crime exposure during follow-up, recent increases in crime (2007/2009–2010/2012) were associated with a higher risk of self-reported mental illness, among ‘stayers’ aged 16–30 years (OR=1.11; 95% CI 1.00 to 1.22), and among ‘movers’ aged 31–45 years (OR=1.07; 95% CI 1.01 to 1.13). Prescribed medications reinforced these findings; worsening crime rates were linked with antidepressant prescriptions among young stayers (OR=1.09; 95% CI 1.04 to 1.14) and with antipsychotic prescriptions among younger middle-aged movers (OR=1.11; 95% CI 1.01 to 1.23). Conclusion Changing neighbourhood crime exposure is related to individual mental health, but associations differ by psychiatric conditions, age and moving status. Crime reduction and prevention, especially in communities with rising crime rates, may benefit public mental health.
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Affiliation(s)
- Gergő Baranyi
- Center for Research on Environment, Society and Health, School of GeoSciences, University of Edinburgh, Edinburgh, UK
| | - Mark Cherrie
- Center for Research on Environment, Society and Health, School of GeoSciences, University of Edinburgh, Edinburgh, UK
| | - Sarah E Curtis
- Center for Research on Environment, Society and Health, School of GeoSciences, University of Edinburgh, Edinburgh, UK.,Geography Department, Durham University, Durham, UK
| | - Chris Dibben
- Center for Research on Environment, Society and Health, School of GeoSciences, University of Edinburgh, Edinburgh, UK
| | - Jamie Pearce
- Center for Research on Environment, Society and Health, School of GeoSciences, University of Edinburgh, Edinburgh, UK
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Rezende Macedo do Nascimento RC, Mueller T, Godman B, MacBride Stewart S, Hurding S, de Assis Acurcio F, Guerra Junior AA, Alvares Teodoro J, Morton A, Bennie M, Kurdi A. Real-world evaluation of the impact of statin intensity on adherence and persistence to therapy: A Scottish population-based study. Br J Clin Pharmacol 2020; 86:2349-2361. [PMID: 32353163 PMCID: PMC7688536 DOI: 10.1111/bcp.14333] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2019] [Revised: 03/31/2020] [Accepted: 04/20/2020] [Indexed: 12/11/2022] Open
Abstract
Aim To assess associations between statin intensity and adherence, persistence and discontinuation of statin therapy in Scotland. Method Retrospective cohort study, using linked electronic health records covering a period from January 2009 to December 2016. The study cohort included adult patients (≥18 years) newly initiating statins within Greater Glasgow and Clyde, Scotland. Study outcomes comprised adherence, discontinuation and persistence to treatment, stratified by three exposure groups (high, moderate and low intensity). Discontinuation and persistence were calculated using the refill‐gap and anniversary methods, respectively. Proportion of days covered (PDC) was used as a proxy for adherence. Kaplan‐Meier survival curves and Cox proportional hazard models were used to evaluate discontinuation, and associations between adherence/persistence and statin intensity were assessed using logistic regression. Results A total of 73 716 patients with a mean age of 61.4 ± 12.6 years were included; the majority (88.3%) received moderate intensity statins. Discontinuation rates differed between intensity levels, with high‐intensity patients less likely to discontinue treatment compared to those on moderate intensity (prior cardiovascular disease [CVD]: HR 0.43 [95% CI 0.34‐0.55]; no prior CVD: 0.80 [0.74‐0.86]). Persistence declined over time, and high‐intensity patients had the highest persistence rates. Overall, 52.6% of patients were adherent to treatment (PDC ≥ 80%), but adherence was considerably higher among high‐intensity patients (63.7%). Conclusion High‐intensity statins were associated with better persistence and adherence to treatment, but overall long‐term persistence and adherence remain a challenge, particularly among patients without prior CVD. This needs addressing.
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Affiliation(s)
| | - Tanja Mueller
- Strathclyde Institute of Pharmacy and Biomedical Sciences, University of Strathclyde, Glasgow, UK
| | - Brian Godman
- Strathclyde Institute of Pharmacy and Biomedical Sciences, University of Strathclyde, Glasgow, UK.,Division of Clinical Pharmacology, Karolinska Institutet, Stockholm, Sweden.,Division of Public Health Pharmacy and Management, School of Pharmacy, Sefako Makgatho Health Sciences University, Pretoria, South Africa
| | | | - Simon Hurding
- Directorate for Health Finance, The Scottish Government, Edinburgh, UK
| | - Francisco de Assis Acurcio
- SUS Collaborating Centre for Technology Assessment and Excellence in Health, School of Pharmacy, Federal University of Minas Gerais, Belo Horizonte, Minas Gerais, Brazil
| | - Augusto Afonso Guerra Junior
- SUS Collaborating Centre for Technology Assessment and Excellence in Health, School of Pharmacy, Federal University of Minas Gerais, Belo Horizonte, Minas Gerais, Brazil
| | - Juliana Alvares Teodoro
- SUS Collaborating Centre for Technology Assessment and Excellence in Health, School of Pharmacy, Federal University of Minas Gerais, Belo Horizonte, Minas Gerais, Brazil
| | - Alec Morton
- Strathclyde Business School, University of Strathclyde, Glasgow, UK
| | - Marion Bennie
- Strathclyde Institute of Pharmacy and Biomedical Sciences, University of Strathclyde, Glasgow, UK.,Public Health and Intelligence Strategic Business Unit, NHS National Services Scotland, Edinburgh, UK
| | - Amanj Kurdi
- Strathclyde Institute of Pharmacy and Biomedical Sciences, University of Strathclyde, Glasgow, UK.,Department of Pharmacology and Toxicology, College of Pharmacy, Hawler Medical University, Erbil, Iraq
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Cardwell CR, O'Sullivan JM, Jain S, Harbinson MT, Cook MB, Hicks BM, McMenamin ÚC. The Risk of Cardiovascular Disease in Prostate Cancer Patients Receiving Androgen Deprivation Therapies. Epidemiology 2020; 31:432-440. [PMID: 31651660 PMCID: PMC7138701 DOI: 10.1097/ede.0000000000001132] [Citation(s) in RCA: 22] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
BACKGROUND Androgen deprivation therapy (ADT), with a proven role in prostate cancer management, has been associated with various cardiovascular diseases. However, few studies have investigated these associations by type of ADT, particularly for newer ADTs such as the gonadotropin-releasing hormone (GnRH) antagonist degarelix. We investigated the risk of cardiovascular disease by type of ADT in a real-world setting. METHODS We identified men newly diagnosed with prostate cancer, from 2009 to 2015, from the Scottish Cancer Registry and ADTs from the nationwide Prescribing Information System. Cardiovascular events were based upon hospitalization (from hospital records) or death from cardiovascular disease (from death records). We used Cox regression to calculate hazard ratios (HRs) and 95% confidence intervals (CIs) for cardiovascular events with time-varying ADT exposure, comparing ADT users with untreated patients, after adjusting for potential confounders, including prior cardiovascular disease. RESULTS The cohort contained 20,216 prostate cancer patients, followed for 73,570 person-years, during which there were 3,853 cardiovascular events. ADT was associated with a 30% increase in cardiovascular events (adjusted HR = 1.3; 95% CI = 1.2, 1.4). This reflected increases in cardiovascular events associated with GnRH agonists (adjusted HR = 1.3; 95% CI = 1.2, 1.4), degarelix (adjusted HR = 1.5; 95% CI = 1.2, 1.9), but not bicalutamide monotherapy (adjusted HR = 1.0; 95% CI = 0.82, 1.3). CONCLUSIONS There were increased risks of cardiovascular disease with the use of GnRH agonists and degarelix, but not with bicalutamide monotherapy. This is the first study to observe increased cardiovascular risks with degarelix, but the cause of this association is unclear and merits further investigation.
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Affiliation(s)
- Chris R Cardwell
- From the Centre for Public Health, Queen's University Belfast, Belfast, Northern Ireland, United Kingdom
| | - Joe M O'Sullivan
- Centre for Cancer Research and Cell Biology, Queen's University Belfast, Belfast, Northern Ireland, United Kingdom
- Radiotherapy Department, Cancer Centre, Belfast City Hospital, Belfast, Northern Ireland, United Kingdom
| | - Suneil Jain
- Centre for Cancer Research and Cell Biology, Queen's University Belfast, Belfast, Northern Ireland, United Kingdom
- Radiotherapy Department, Cancer Centre, Belfast City Hospital, Belfast, Northern Ireland, United Kingdom
| | - Mark T Harbinson
- Centre for Experimental Medicine, Queen's University Belfast, Belfast, Northern Ireland, United Kingdom
| | - Michael B Cook
- Division of Cancer Epidemiology and Genetics, National Cancer Institute, Bethesda, MD
| | - Blánaid M Hicks
- From the Centre for Public Health, Queen's University Belfast, Belfast, Northern Ireland, United Kingdom
| | - Úna C McMenamin
- From the Centre for Public Health, Queen's University Belfast, Belfast, Northern Ireland, United Kingdom
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65
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Coutts J, Fullarton J, Morris C, Grubb E, Buchan S, Rodgers-Gray B, Thwaites R. Association between respiratory syncytial virus hospitalization in infancy and childhood asthma. Pediatr Pulmonol 2020; 55:1104-1110. [PMID: 32040885 PMCID: PMC7187471 DOI: 10.1002/ppul.24676] [Citation(s) in RCA: 34] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/13/2019] [Accepted: 01/25/2020] [Indexed: 11/17/2022]
Abstract
INTRODUCTION Respiratory syncytial virus infection in early childhood has been linked to longer-term respiratory morbidity; however, debate persists around its impact on asthma. The objective was to assess the association between respiratory syncytial virus hospitalization and childhood asthma. METHODS Asthma hospital admissions and medication use through 18 years were compared in children with (cases) and without (controls) respiratory syncytial virus hospitalization in the first 2 years of life. All children born in National Health Service Scotland between 1996 and 2011 were included. RESULTS Of 740 418 children (median follow-up: 10.6 years), 15 795 (2.1%) had a respiratory syncytial virus hospitalization at ≤2 years (median age: 143 days). Asthma hospitalizations were three-fold higher in cases than controls (8.4% vs 2.4%; relative risk: 3.3, 95% confidence interval [CI]: 3.1-3.5; P < .0001) and admission rates were four-fold higher (193.2 vs 46.0/1000). Cases had two-fold higher asthma medication usage (25.5% vs 14.7%; relative risk: 1.7, 95% CI: 1.7-1.8; P < .0001) and a three-fold higher rate of having both an asthma admission and medication (4.8% vs 1.5%; relative risk 3.1, 95% CI: 2.9-3.3; P < .0001). Admission rates and medication use remained significantly (P < .001) higher for cases than controls throughout childhood (admissions: ≥2-fold higher; medication: ≥1.5-fold higher). Respiratory syncytial virus hospitalization was the most significant risk factor for asthma hospitalizations±medication use (odds ratio: 1.9-2.8; P < .001). CONCLUSIONS Respiratory syncytial virus hospitalization was associated with significantly increased rates and severity of asthma throughout childhood, which has important implications for preventive strategies.
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Affiliation(s)
| | - John Fullarton
- Health Economics & Outcomes Research, Strategen Limited, Basingstoke, UK
| | - Carole Morris
- Information Services Division Scotland, Farr Institute Scotland, Edinburgh, UK
| | - ElizaBeth Grubb
- Health Economics & Outcomes Research, AbbVie Inc, North Chicago, Illinois
| | - Scot Buchan
- Health Economics & Outcomes Research, Strategen Limited, Basingstoke, UK
| | - Barry Rodgers-Gray
- Health Economics & Outcomes Research, Strategen Limited, Basingstoke, UK
| | - Richard Thwaites
- Portsmouth Hospitals NHS Trust, Queen Alexandra Hospital, Portsmouth, UK
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66
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Baranyi G, Cherrie M, Curtis S, Dibben C, Pearce JR. Neighborhood Crime and Psychotropic Medications: A Longitudinal Data Linkage Study of 130,000 Scottish Adults. Am J Prev Med 2020; 58:638-647. [PMID: 32173163 DOI: 10.1016/j.amepre.2019.12.022] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/31/2019] [Revised: 12/01/2019] [Accepted: 12/02/2019] [Indexed: 01/14/2023]
Abstract
INTRODUCTION Although neighborhood crime has been associated with mental health problems, longitudinal research utilizing objective measures of small-area crime and mental health service use is lacking. This study examines how local crime is associated with newly prescribed psychotropic medications in a large longitudinal sample of Scottish adults and explores whether the relationships vary between sociodemographic groups. METHODS Data from the Scottish Longitudinal Study, a 5.3% representative sample of the population, were linked with police-recorded crime in 2011 for residential locality and with psychotropic medications from 2009 to 2014, extracted from the prescription data set of National Health Service Scotland. Individuals receiving medication during the first 6 months of observation were excluded; the remaining sample was followed for 5.5 years. Covariate-adjusted, multilevel mixed-effects logistic models estimated associations between area crime and prescriptions for antidepressants, antipsychotics, and anxiolytics (analyzed in 2018-2019). RESULTS After adjustment for individual and neighborhood covariates, findings on 129,945 adults indicated elevated risk of antidepressant (OR=1.05, 95% CI=1.00, 1.10) and antipsychotic (OR=1.20, 95% CI=1.03, 1.39), but not anxiolytic (OR=0.99, 95% CI=0.93, 1.05) medication in high-crime areas. Crime showed stronger positive association with antidepressants among individuals (especially women) aged 24-53 years in 2009 and with antipsychotics among men aged 44-53 years in 2009. Skilled workers and people from lower nonmanual occupations had increased risk of medications in high-crime areas. CONCLUSIONS Local crime is an important predictor of mental health, independent of individual and other contextual risk factors. Place-based crime prevention and targeting vulnerable groups may have benefits for population mental health.
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Affiliation(s)
- Gergő Baranyi
- Center for Research on Environment Society and Health, School of GeoSciences, University of Edinburgh, Edinburgh, United Kingdom.
| | - Mark Cherrie
- Center for Research on Environment Society and Health, School of GeoSciences, University of Edinburgh, Edinburgh, United Kingdom
| | - Sarah Curtis
- Center for Research on Environment Society and Health, School of GeoSciences, University of Edinburgh, Edinburgh, United Kingdom; Geography Department, Durham University, Durham, United Kingdom
| | - Chris Dibben
- Center for Research on Environment Society and Health, School of GeoSciences, University of Edinburgh, Edinburgh, United Kingdom
| | - Jamie R Pearce
- Center for Research on Environment Society and Health, School of GeoSciences, University of Edinburgh, Edinburgh, United Kingdom
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Baillie K, Mueller T, Pan J, Laskey J, Bennie M, Crearie C, Kavanagh K, Alvarez-Madrazo S, Morrison D, Clarke J, Keel A, Cameron D, Wu O, Kurdi A, Jones RJ. Use of record linkage to evaluate treatment outcomes and trial eligibility in a real-world metastatic prostate cancer population in Scotland. Pharmacoepidemiol Drug Saf 2020; 29:653-663. [PMID: 32316077 PMCID: PMC8246935 DOI: 10.1002/pds.4998] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2019] [Revised: 01/31/2020] [Accepted: 03/18/2020] [Indexed: 12/19/2022]
Abstract
Purpose New treatments are introduced into standard care based on clinical trial results. However, it is not clear if these benefits are reflected in the broader population. This study analysed the clinical outcomes of patients with metastatic castration‐resistant prostate cancer, treated with abiraterone and enzalutamide, within the Scottish National Health Service. Methods Retrospective cohort study using record linkage of routinely collected healthcare data (study period: February 2012 to February 2017). Overall survival (OS) was analysed using Kaplan‐Meier methods and Cox Proportional Hazard models; a subgroup analysis comprised potentially trial‐eligible patients. Results Overall, 271 patients were included and 73.8% died during the study period. Median OS was poorer than in the pivotal trials, regardless of medication and indication: 10.8 months (95% confidence interval [CI] 8.6‐15.1) and 20.9 months (95% CI 14.9‐29.0) for abiraterone, and 12.6 months (95% CI 10.5‐18.2) and 16.0 months (95% CI 9.8—not reached) for enzalutamide, post and pre chemotherapy, respectively. Only 46% of patients were potentially “trial eligible” and in this subgroup OS improved. Factors influencing survival included baseline performance status, and baseline prostate‐specific antigen, alkaline phosphatase, and albumin levels. Conclusions Poorer prognostic features of non‐trial eligible patients impact real‐world outcomes of cancer medicines. Electronic record linkage of routinely collected healthcare data offers an opportunity to report outcomes on cancer medicines at scale and describe population demographics. The availability of such observational data to supplement clinical trial results enables patients and clinicians to make more informed treatment decisions, and policymakers to contextualise trial findings.
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Affiliation(s)
- Kelly Baillie
- Beatson West of Scotland Cancer Centre, NHS Greater Glasgow & Clyde, Glasgow, UK
| | - Tanja Mueller
- Strathclyde Institute of Pharmacy and Biomedical Sciences, University of Strathclyde, Glasgow, UK
| | - Jiafeng Pan
- Department of Mathematics and Statistics, University of Strathclyde, Glasgow, UK
| | - Jennifer Laskey
- Beatson West of Scotland Cancer Centre, NHS Greater Glasgow & Clyde, Glasgow, UK
| | - Marion Bennie
- Strathclyde Institute of Pharmacy and Biomedical Sciences, University of Strathclyde, Glasgow, UK.,Public Health Intelligence, NHS National Services Scotland, Edinburgh, UK
| | - Christine Crearie
- Beatson West of Scotland Cancer Centre, NHS Greater Glasgow & Clyde, Glasgow, UK
| | - Kimberley Kavanagh
- Department of Mathematics and Statistics, University of Strathclyde, Glasgow, UK
| | - Samantha Alvarez-Madrazo
- Strathclyde Institute of Pharmacy and Biomedical Sciences, University of Strathclyde, Glasgow, UK
| | - David Morrison
- Institute of Health and Wellbeing, University of Glasgow, Glasgow, UK
| | - Julie Clarke
- Beatson West of Scotland Cancer Centre, NHS Greater Glasgow & Clyde, Glasgow, UK
| | - Aileen Keel
- Innovative Healthcare Delivery Programme (IHDP), University of Edinburgh, Edinburgh, UK
| | - David Cameron
- Cancer Research UK Edinburgh Centre, University of Edinburgh, Edinburgh, UK
| | - Olivia Wu
- Institute of Health and Wellbeing, University of Glasgow, Glasgow, UK
| | - Amanj Kurdi
- Strathclyde Institute of Pharmacy and Biomedical Sciences, University of Strathclyde, Glasgow, UK
| | - Robert J Jones
- Beatson West of Scotland Cancer Centre, NHS Greater Glasgow & Clyde, Glasgow, UK.,Institute of Cancer Sciences, University of Glasgow, Glasgow, UK
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Hemingway H, Lyons R, Li Q, Buchan I, Ainsworth J, Pell J, Morris A. A national initiative in data science for health: an evaluation of the UK Farr Institute. Int J Popul Data Sci 2020; 5:1128. [PMID: 32935051 PMCID: PMC7480324 DOI: 10.23889/ijpds.v5i1.1128] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023] Open
Abstract
OBJECTIVE To evaluate the extent to which the inter-institutional, inter-disciplinary mobilisation of data and skills in the Farr Institute contributed to establishing the emerging field of data science for health in the UK. DESIGN AND OUTCOME MEASURES We evaluated evidence of six domains characterising a new field of science:defining central scientific challenges,demonstrating how the central challenges might be solved,creating novel interactions among groups of scientists,training new types of experts,re-organising universities,demonstrating impacts in society.We carried out citation, network and time trend analyses of publications, and a narrative review of infrastructure, methods and tools. SETTING Four UK centres in London, North England, Scotland and Wales (23 university partners), 2013-2018. RESULTS 1. The Farr Institute helped define a central scientific challenge publishing a research corpus, demonstrating insights from electronic health record (EHR) and administrative data at each stage of the translational cycle in 593 papers with at least one Farr Institute author affiliation on PubMed. 2. The Farr Institute offered some demonstrations of how these scientific challenges might be solved: it established the first four ISO27001 certified trusted research environments in the UK, and approved more than 1000 research users, published on 102 unique EHR and administrative data sources, although there was no clear evidence of an increase in novel, sustained record linkages. The Farr Institute established open platforms for the EHR phenotyping algorithms and validations (>70 diseases, CALIBER). Sample sizes showed some evidence of increase but remained less than 10% of the UK population in primary care-hospital care linked studies. 3.The Farr Institute created novel interactions among researchers: the co-author publication network expanded from 944 unique co-authors (based on 67 publications in the first 30 months) to 3839 unique co-authors (545 papers in the final 30 months). 4. Training expanded substantially with 3 new masters courses, training >400 people at masters, short-course and leadership level and 48 PhD students. 5. Universities reorganised with 4/5 Centres established 27 new faculty (tenured) positions, 3 new university institutes. 6. Emerging evidence of impacts included: > 3200 citations for the 10 most cited papers and Farr research informed eight practice-changing clinical guidelines and policies relevant to the health of millions of UK citizens. CONCLUSION The Farr Institute played a major role in establishing and growing the field of data science for health in the UK, with some initial evidence of benefits for health and healthcare. The Farr Institute has now expanded into Health Data Research (HDR) UK but key challenges remain including, how to network such activities internationally.
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Affiliation(s)
- H Hemingway
- HDR UK London
- UCL Institute of Health Informatics, 222 Euston Road, London NW1 2DA
| | - R Lyons
- HDRUK Wales/Northern Ireland
- Swansea University Medical School, Fourth Floor, Data Science Building, Singleton Campus, Swansea, SA2 8PP
| | - Q Li
- UCL Institute of Health Informatics, 222 Euston Road, London NW1 2DA
- West China Hospital, Chengdu, China
| | - I Buchan
- University of Liverpool, Liverpool L69 3BX
| | - J Ainsworth
- Division of Informatics, Imaging & Data Sciences, The University of Manchester, Oxford Rd, Manchester M13 9PL
| | - J Pell
- Institute of Health and Wellbeing, University of Glasgow, 1 Lilybank Gardens, Glasgow G12 8RZ
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Ciminata G, Geue C, Langhorne P, Wu O. A two-part model to estimate inpatient, outpatient, prescribing and care home costs associated with atrial fibrillation in Scotland. BMJ Open 2020; 10:e028575. [PMID: 32193256 PMCID: PMC7150597 DOI: 10.1136/bmjopen-2018-028575] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [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
OBJECTIVE This study aimed to estimate global inpatient, outpatient, prescribing and care home costs for patients with atrial fibrillation using population-based, individual-level linked data. DESIGN A two-part model was employed to estimate the probability of resource utilisation and costs conditional on positive utilisation using individual-level linked data. SETTINGS Scotland, 5 years following first hospitalisation for AF between 1997 and 2015. PARTICIPANTS Patients hospitalised with a known diagnosis of AF or atrial flutter. PRIMARY AND SECONDARY OUTCOME MEASURES Inpatient, outpatient, prescribing and care home costs. RESULTS The mean annual cost for a patient with AF was estimated at £3785 (95% CI £3767 to £3804). Inpatient admissions and outpatient visits accounted for 79% and 8% of total costs, respectively; prescriptions and care home stay accounted for 7% and 6% of total costs. Inpatient cost was the main driver across all age groups. While inpatient cost contributions (~80%) were constant between 0 and 84 years, they decreased for patients over 85 years. This is offset by increasing care home cost contributions. Mean annual costs associated with AF increased significantly with increasing number of comorbidities. CONCLUSION This study used a contemporary and representative cohort, and a comprehensive approach to estimate global costs associated with AF, taking into account resource utilisation beyond hospital care. While overall costs, considerably affected by comorbidity, did not increase with increasing age, care home costs increased proportionally with age. Inpatient admission was the main contributor to the overall financial burden of AF, highlighting the need for improved mechanisms of early diagnosis to prevent hospitalisations.
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Affiliation(s)
- Giorgio Ciminata
- Health Economics and Health Technology Assessment (HEHTA), University of Glasgow, Glasgow, UK
| | - Claudia Geue
- Health Economics and Health Technology Assessment (HEHTA), University of Glasgow, Glasgow, UK
| | - Peter Langhorne
- Institute of Cardiovascular and Medical Sciences, University of Glasgow, Glasgow, UK
| | - Olivia Wu
- Health Economics and Health Technology Assessment (HEHTA), University of Glasgow, Glasgow, UK
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Bennie M, Malcolm W, McTaggart S, Mueller T. Improving prescribing through big data approaches-Ten years of the Scottish Prescribing Information System. Br J Clin Pharmacol 2020; 86:250-257. [PMID: 31758595 PMCID: PMC7015743 DOI: 10.1111/bcp.14184] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2019] [Revised: 11/07/2019] [Accepted: 11/11/2019] [Indexed: 12/16/2022] Open
Abstract
Medicines are a major component of modern healthcare delivery, both in resource consumption and as drivers of innovation. The ever-increasing application of digitalisation within day-to-day living and as part of our healthcare systems-with the resultant data generation-presents the opportunity to better define the populations exposed to medicines, and their benefits and harm in real world settings. This article outlines the development of the Scottish National Prescribing Information System (PIS) and describes how this capability is being used to support the safe and effective use of medicines, both nationally and internationally. Since 2009, PIS has included e-prescribed/e-dispensed and reimbursed medicines data, now totalling 976 million prescriptions, with codified structured data on dose instructions. A literature review, covering the period from January 2009 to March 2019, identified 40 full publications using PIS, the first occurring in 2014. The majority involved pharmacoepidemiology/drug-use studies (50%) in cancer and cardiovascular disease. Measuring the value and impact of PIS was extended beyond publication quantification by illustrating the translation of PIS outputs into the learning health system at scale. The developing Scottish capabilities add breadth and depth to the wider evolving international environment, and offer the potential to contribute collegiately to the global effort on medicine safety and effectiveness, including support for the World Health Organisation Global Patient Safety Challenge: Medication Without Harm.
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Affiliation(s)
- Marion Bennie
- Strathclyde Institute of Pharmacy and Biomedical SciencesUniversity of StrathclydeGlasgowUK
- Public Health and Intelligence Strategic Business UnitNHS National Services ScotlandEdinburghUK
| | - William Malcolm
- Public Health and Intelligence Strategic Business UnitNHS National Services ScotlandEdinburghUK
| | - Stuart McTaggart
- Public Health and Intelligence Strategic Business UnitNHS National Services ScotlandEdinburghUK
| | - Tanja Mueller
- Strathclyde Institute of Pharmacy and Biomedical SciencesUniversity of StrathclydeGlasgowUK
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71
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Morales DR, Morant SV, MacDonald TM, Mackenzie IS, Doney ASF, Mitchell L, Bennie M, Robertson C, Hallas J, Pottegard A, Ernst MT, Wei L, Nicholson L, Morris C, Herings RMC, Overbeek JA, Smits E, Flynn RWV. Impact of EMA regulatory label changes on systemic diclofenac initiation, discontinuation, and switching to other pain medicines in Scotland, England, Denmark, and The Netherlands. Pharmacoepidemiol Drug Saf 2020; 29:296-305. [PMID: 31899936 PMCID: PMC7079064 DOI: 10.1002/pds.4955] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2019] [Revised: 11/25/2019] [Accepted: 12/13/2019] [Indexed: 01/29/2023]
Abstract
Purpose In June 2013 a European Medicines Agency referral procedure concluded that diclofenac was associated with an elevated risk of acute cardiovascular events and contraindications, warnings, and changes to the product information were implemented across the European Union. This study measured the impact of the regulatory action on the prescribing of systemic diclofenac in Denmark, The Netherlands, England, and Scotland. Methods Quarterly time series analyses measuring diclofenac prescription initiation, discontinuation and switching to other systemic nonsteroidal anti‐inflammatory (NSAIDs), topical NSAIDs, paracetamol, opioids, and other chronic pain medication in those who discontinued diclofenac. Absolute effects were estimated using interrupted time series regression. Results Overall, diclofenac prescription initiations fell during the observation periods of all countries. Compared with Denmark where there appeared to be a more limited effect, the regulatory action was associated with significant immediate reductions in diclofenac initiation in The Netherlands (−0.42%, 95% CI, −0.66% to −0.18%), England (−0.09%, 95% CI, −0.11% to −0.08%), and Scotland (−0.67%, 95% CI, −0.79% to −0.55%); and falling trends in diclofenac initiation in the Netherlands (−0.03%, 95% CI, −0.06% to −0.01% per quarter) and Scotland (−0.04%, 95% CI, −0.05% to −0.02% per quarter). There was no significant impact on diclofenac discontinuation in any country. The regulatory action was associated with modest differences in switching to other pain medicines following diclofenac discontinuation. Conclusions The regulatory action was associated with significant reductions in overall diclofenac initiation which varied by country and type of exposure. There was no impact on discontinuation and variable impact on switching.
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Affiliation(s)
| | | | | | | | | | | | - Marion Bennie
- Strathclyde Onstitute of Pharmacy and Biomedical Sciences, University of Strathclyde, Glasgow, UK
| | - Chris Robertson
- Dept of Mathematics and Statistics, University of Strathclyde, Glasgow, UK
| | - Jesper Hallas
- Dept of Clinical Pharmacology and Pharmacy, University of Southern Denmark, Odense, Denmark
| | - Anton Pottegard
- Dept of Clinical Pharmacology and Pharmacy, University of Southern Denmark, Odense, Denmark
| | - Martin Thomsen Ernst
- Dept of Clinical Pharmacology and Pharmacy, University of Southern Denmark, Odense, Denmark
| | - Li Wei
- School of Pharmacy, University College London, London, UK
| | - Lizzie Nicholson
- Electronic Data Research and Innovation Service, NHS National Services Scotland, Edinburgh, UK
| | - Carole Morris
- Electronic Data Research and Innovation Service, NHS National Services Scotland, Edinburgh, UK
| | - Ron M C Herings
- PHARMO Institute for Drug Outcomes Research, Utrecht, The Netherlands
| | - Jetty A Overbeek
- PHARMO Institute for Drug Outcomes Research, Utrecht, The Netherlands
| | - Elisabeth Smits
- PHARMO Institute for Drug Outcomes Research, Utrecht, The Netherlands
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Sanchez-Duque JA, Gaviria-Mendoza A, Moreno-Gutierrez PA, Machado-Alba JE. Big data, farmacoepidemiología y farmacovigilancia. REVISTA DE LA FACULTAD DE MEDICINA 2020. [DOI: 10.15446/revfacmed.v68n1.73456] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022] Open
Abstract
Big data es un término que comprende un grupo de herramientas tecnológicas capaces de procesar conjuntos de datos heterogéneos extremadamente grandes, los cuales se recolectan de manera continua, están disponibles para ser usados y constituyen una fuente de evidencia científica.En el área de la farmacoepidemiología, los análisis generados a partir de estos conjuntos de datos pueden resultar en la obtención de terapias médicas más eficientes, con menor número de reacciones adversas y menos costosas. Asimismo, el uso de herramientas como el Text Mining o el Machine Learning también ha llevado a grandes avances en las áreas de farmacoepidemiología y farmacovigilancia, por lo que es probable que su empleo sea cada vez mayor.
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Mark PB, Papworth R, Ramparsad N, Tomlinson LA, Sawhney S, Black C, McConnachie A, McCowan C. Risk factors associated with biochemically detected and hospitalised acute kidney injury in patients prescribed renin angiotensin system inhibitors. Br J Clin Pharmacol 2020; 86:121-131. [PMID: 31663151 PMCID: PMC6983520 DOI: 10.1111/bcp.14141] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2019] [Revised: 09/18/2019] [Accepted: 09/25/2019] [Indexed: 12/15/2022] Open
Abstract
AIMS Therapy with angiotensin-converting enzyme inhibitors (ACEi) and angiotensin receptor blockers (ARB) is a mainstay of treatment for heart failure (HF), diabetes mellitus (DM) and chronic kidney disease (CKD). These agents have been associated with development of acute kidney injury (AKI) during intercurrent illness. Risk factors for AKI in patients prescribed ACEi/ARB therapy are not well described. METHODS We captured the incidence of AKI in patients commencing ACEi/ARB during 2009-2015 using anonymised patient records. Hospital-coded AKI was defined from hospital episode statistics; biochemical AKI was ascertained from laboratory data. Risk factors for biochemically detected and hospitalised AKI were investigated. RESULTS Of 61,318 patients prescribed ACEi/ARB, with 132 885 person years (py) follow-up, there were 1070 hospitalisations with AKI as a diagnosis recorded and a total of 4645 AKI events, including AKI episodes indicated by biochemical KDIGO-based creatinine change criteria. Incidence of any AKI event was 35.0 per 1000-py, hospital-coded AKI was 7.8 per 1000-py and biochemical AKI was 33.7 per 1000-py. Independent risk factors in a multivariable model for hospital-coded AKI events were age, male gender, HF, diabetes, cerebrovascular disease, lower estimated glomerular filtration rate, socioeconomic deprivation, diuretic or non-steroidal anti-inflammatory use (all P < 0.001). CONCLUSION In patients prescribed ACEi/ARB, the highest risk of AKI is associated with conditions which are considered strong evidence-based indications for their prescription. Socio-economic status is an under-reported risk factor for AKI with these agents. Strategies targeted at prevention of AKI may be of benefit, such as enhanced awareness based on higher risk comorbidities.
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Affiliation(s)
- Patrick B. Mark
- Institute of Cardiovascular and Medical SciencesUniversity of GlasgowGlasgowUK
- Glasgow Renal and Transplant UnitQueen Elizabeth University HospitalGlasgowUK
| | - Richard Papworth
- Robertson Centre for Biostatistics, Institute of Health and WellbeingUniversity of GlasgowGlasgowUK
| | - Nitish Ramparsad
- Robertson Centre for Biostatistics, Institute of Health and WellbeingUniversity of GlasgowGlasgowUK
| | | | - Simon Sawhney
- Aberdeen Centre for Health Data Science, School of Medicine, Medical Science and NutritionUniversity of AberdeenAberdeenUK
| | - Corri Black
- Aberdeen Centre for Health Data Science, School of Medicine, Medical Science and NutritionUniversity of AberdeenAberdeenUK
- Department of Public HealthNHS GrampianAberdeenUK
| | - Alex McConnachie
- Robertson Centre for Biostatistics, Institute of Health and WellbeingUniversity of GlasgowGlasgowUK
| | - Colin McCowan
- Robertson Centre for Biostatistics, Institute of Health and WellbeingUniversity of GlasgowGlasgowUK
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74
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McCowan C, McSkimming P, Papworth R, Kotzur M, McConnachie A, Macdonald S, Wyke S, Crighton E, Campbell C, Weller D, Steele RJC, Robb KA. Comparing uptake across breast, cervical and bowel screening at an individual level: a retrospective cohort study. Br J Cancer 2019; 121:710-714. [PMID: 31481732 PMCID: PMC6889480 DOI: 10.1038/s41416-019-0564-9] [Citation(s) in RCA: 23] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2019] [Accepted: 08/16/2019] [Indexed: 11/23/2022] Open
Abstract
BACKGROUND We investigated demographic and clinical predictors of lower participation in bowel screening relative to breast and cervical screening. METHODS Data linkage study of routinely collected clinical data from 430,591 women registered with general practices in the Greater Glasgow & Clyde Health Board. Participation in the screening programmes was measured by attendance at breast or cervical screening or the return of a bowel screening kit. RESULTS 72.6% of 159,993 women invited attended breast screening, 80.7% of 309,899 women invited attended cervical screening and 61.7% of 180,408 women invited completed bowel screening. Of the 68,324 women invited to participate in all three screening programmes during the study period, 52.1% participated in all three while 7.2% participated in none. Women who participated in breast (OR = 3.34 (3.21, 3.47), p < 0.001) or cervical (OR = 3.48 (3.32, 3.65), p < 0.001) were more likely to participate in bowel screening. CONCLUSION Participation in bowel screening was lower than breast or cervical for this population although the same demographic factors were associated with uptake, namely lower social deprivation, increasing age, low levels of comorbidity and prior non-malignant neoplasms. As women who complete breast and cervical are more likely to also complete bowel screening, interventions at these procedures to encourage bowel screening participation should be explored.
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Affiliation(s)
- Colin McCowan
- School of Medicine, University of St Andrews, St Andrews, KY16 9TF, UK.
| | - Paula McSkimming
- Robertson Centre for Biostatistics, Institute of Health & Wellbeing, University of Glasgow, Glasgow, G12 8QQ, UK
| | - Richard Papworth
- Robertson Centre for Biostatistics, Institute of Health & Wellbeing, University of Glasgow, Glasgow, G12 8QQ, UK
| | - Marie Kotzur
- Institute of Health & Wellbeing, University of Glasgow, Glasgow, G120XH, UK
| | - Alex McConnachie
- Robertson Centre for Biostatistics, Institute of Health & Wellbeing, University of Glasgow, Glasgow, G12 8QQ, UK
| | - Sara Macdonald
- Institute of Health & Wellbeing, University of Glasgow, Glasgow, G129LX, UK
| | - Sally Wyke
- Institute of Health & Wellbeing, University of Glasgow, Glasgow, G128RS, UK
| | - Emilia Crighton
- NHS Greater Glasgow and Clyde, Gartnavel Royal Hospital, Glasgow, G120XH, UK
| | | | - David Weller
- Usher Institute, University of Edinburgh, Edinburgh, EH8 9AG, UK
| | | | - Kathryn A Robb
- Institute of Health & Wellbeing, University of Glasgow, Glasgow, G120XH, UK
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75
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Hickman M, Dillon JF, Elliott L, De Angelis D, Vickerman P, Foster G, Donnan P, Eriksen A, Flowers P, Goldberg D, Hollingworth W, Ijaz S, Liddell D, Mandal S, Martin N, Beer LJZ, Drysdale K, Fraser H, Glass R, Graham L, Gunson RN, Hamilton E, Harris H, Harris M, Harris R, Heinsbroek E, Hope V, Horwood J, Inglis SK, Innes H, Lane A, Meadows J, McAuley A, Metcalfe C, Migchelsen S, Murray A, Myring G, Palmateer NE, Presanis A, Radley A, Ramsay M, Samartsidis P, Simmons R, Sinka K, Vojt G, Ward Z, Whiteley D, Yeung A, Hutchinson SJ. Evaluating the population impact of hepatitis C direct acting antiviral treatment as prevention for people who inject drugs (EPIToPe) - a natural experiment (protocol). BMJ Open 2019; 9:e029538. [PMID: 31551376 PMCID: PMC6773339 DOI: 10.1136/bmjopen-2019-029538] [Citation(s) in RCA: 21] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/14/2019] [Revised: 07/25/2019] [Accepted: 07/29/2019] [Indexed: 01/15/2023] Open
Abstract
INTRODUCTION Hepatitis C virus (HCV) is the second largest contributor to liver disease in the UK, with injecting drug use as the main risk factor among the estimated 200 000 people currently infected. Despite effective prevention interventions, chronic HCV prevalence remains around 40% among people who inject drugs (PWID). New direct-acting antiviral (DAA) HCV therapies combine high cure rates (>90%) and short treatment duration (8 to 12 weeks). Theoretical mathematical modelling evidence suggests HCV treatment scale-up can prevent transmission and substantially reduce HCV prevalence/incidence among PWID. Our primary aim is to generate empirical evidence on the effectiveness of HCV 'Treatment as Prevention' (TasP) in PWID. METHODS AND ANALYSIS We plan to establish a natural experiment with Tayside, Scotland, as a single intervention site where HCV care pathways are being expanded (including specialist drug treatment clinics, needle and syringe programmes (NSPs), pharmacies and prison) and HCV treatment for PWID is being rapidly scaled-up. Other sites in Scotland and England will act as potential controls. Over 2 years from 2017/2018, at least 500 PWID will be treated in Tayside, which simulation studies project will reduce chronic HCV prevalence among PWID by 62% (from 26% to 10%) and HCV incidence will fall by approximately 2/3 (from 4.2 per 100 person-years (p100py) to 1.4 p100py). Treatment response and re-infection rates will be monitored. We will conduct focus groups and interviews with service providers and patients that accept and decline treatment to identify barriers and facilitators in implementing TasP. We will conduct longitudinal interviews with up to 40 PWID to assess whether successful HCV treatment alters their perspectives on and engagement with drug treatment and recovery. Trained peer researchers will be involved in data collection and dissemination. The primary outcome - chronic HCV prevalence in PWID - is measured using information from the Needle Exchange Surveillance Initiative survey in Scotland and the Unlinked Anonymous Monitoring Programme in England, conducted at least four times before and three times during and after the intervention. We will adapt Bayesian synthetic control methods (specifically the Causal Impact Method) to generate the cumulative impact of the intervention on chronic HCV prevalence and incidence. We will use a dynamic HCV transmission and economic model to evaluate the cost-effectiveness of the HCV TasP intervention, and to estimate the contribution of the scale-up in HCV treatment to observe changes in HCV prevalence. Through the qualitative data we will systematically explore key mechanisms of TasP real world implementation from provider and patient perspectives to develop a manual for scaling up HCV treatment in other settings. We will compare qualitative accounts of drug treatment and recovery with a 'virtual cohort' of PWID linking information on HCV treatment with Scottish Drug treatment databases to test whether DAA treatment improves drug treatment outcomes. ETHICS AND DISSEMINATION Extending HCV community care pathways is covered by ethics (ERADICATE C, ISRCTN27564683, Super DOT C Trial clinicaltrials.gov: NCT02706223). Ethical approval for extra data collection from patients including health utilities and qualitative interviews has been granted (REC ref: 18/ES/0128) and ISCRCTN registration has been completed (ISRCTN72038467). Our findings will have direct National Health Service and patient relevance; informing prioritisation given to early HCV treatment for PWID. We will present findings to practitioners and policymakers, and support design of an evaluation of HCV TasP in England.
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Affiliation(s)
- Matthew Hickman
- Population Health Sciences, Bristol Medical School, Bristol, Bristol, UK
| | - John F Dillon
- Hepatology & Gastroenterology, Clinical & Molecular Medicine, School of Medicine, University of Dundee, Dundee, UK
| | | | - Daniela De Angelis
- MRC Biostatistics Unit, School of Clinical Medicine, University of Cambridge, Cambridge, UK
| | - Peter Vickerman
- Population Health Sciences, Bristol Medical School, Bristol, Bristol, UK
| | - Graham Foster
- Blizard Institute, Queen Mary University of London, London, UK
- Barts Health NHS Trust, London, UK
| | - Peter Donnan
- Dundee Epidemiology and Biostatistics Unit, University of Dundee, Dundee, UK
| | | | | | - David Goldberg
- Glasgow Caledonian University, Glasgow, UK
- Health Protection Scotland, Glasgow, UK
| | | | - Samreen Ijaz
- National Infection Service, Public Health England, London, UK
| | | | - Sema Mandal
- National Infection Service, Public Health England, London, UK
| | - Natasha Martin
- Division of Infectious Diseases and Global Public Health, University of California San Diego, San Diego, UK
| | - Lewis J Z Beer
- Tayside Clinical Trials Unit, Tayside Medical Science Centre, University of Dundee, Dundee, UK
| | - Kate Drysdale
- Blizard Institute, Queen Mary University of London, London, UK
- Barts Health NHS Trust, London, UK
| | - Hannah Fraser
- Population Health Sciences, Bristol Medical School, Bristol, Bristol, UK
| | - Rachel Glass
- National Infection Service, Public Health England, London, UK
| | | | - Rory N Gunson
- West Of Scotland Specialist Virology Centre, NHS Greater Glasgow & Clyde Board, Glasgow, UK
| | | | - Helen Harris
- National Infection Service, Public Health England, London, UK
| | | | - Ross Harris
- National Infection Service, Public Health England, London, UK
| | | | - Vivian Hope
- Liverpool John Moores University, Liverpool, UK
| | - Jeremy Horwood
- Population Health Sciences, Bristol Medical School, Bristol, Bristol, UK
| | - Sarah Karen Inglis
- Tayside Clinical Trials Unit, Tayside Medical Science Centre, University of Dundee, Dundee, UK
| | - Hamish Innes
- Glasgow Caledonian University, Glasgow, UK
- Health Protection Scotland, Glasgow, UK
| | - Athene Lane
- Population Health Sciences, Bristol Medical School, Bristol, Bristol, UK
| | - Jade Meadows
- Population Health Sciences, Bristol Medical School, Bristol, Bristol, UK
| | - Andrew McAuley
- Glasgow Caledonian University, Glasgow, UK
- Health Protection Scotland, Glasgow, UK
| | - Chris Metcalfe
- Population Health Sciences, Bristol Medical School, Bristol, Bristol, UK
| | | | | | - Gareth Myring
- Population Health Sciences, Bristol Medical School, Bristol, Bristol, UK
| | - Norah E Palmateer
- Glasgow Caledonian University, Glasgow, UK
- Health Protection Scotland, Glasgow, UK
| | - Anne Presanis
- MRC Biostatistics Unit, School of Clinical Medicine, University of Cambridge, Cambridge, UK
| | - Andrew Radley
- Hepatology & Gastroenterology, Clinical & Molecular Medicine, School of Medicine, University of Dundee, Dundee, UK
- Directorate of Public Health, NHS Tayside, Dundee, UK
| | - Mary Ramsay
- National Infection Service, Public Health England, London, UK
| | - Pantelis Samartsidis
- MRC Biostatistics Unit, School of Clinical Medicine, University of Cambridge, Cambridge, UK
| | - Ruth Simmons
- National Infection Service, Public Health England, London, UK
| | - Katy Sinka
- National Infection Service, Public Health England, London, UK
| | | | - Zoe Ward
- Population Health Sciences, Bristol Medical School, Bristol, Bristol, UK
| | | | - Alan Yeung
- Glasgow Caledonian University, Glasgow, UK
- Health Protection Scotland, Glasgow, UK
| | - Sharon J Hutchinson
- Glasgow Caledonian University, Glasgow, UK
- Health Protection Scotland, Glasgow, UK
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Alvarez-Madrazo S, Kavanagh K, Siebert S, Semple Y, Godman B, Maciel Almeida A, Acurcio FDA, Bennie M. Discontinuation, persistence and adherence to subcutaneous biologics delivered via a homecare route to Scottish adults with rheumatic diseases: a retrospective study. BMJ Open 2019; 9:e027059. [PMID: 31488467 PMCID: PMC6731860 DOI: 10.1136/bmjopen-2018-027059] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/17/2022] Open
Abstract
OBJECTIVES To understand patterns of subcutaneous (SC) biologics use over time in adults with inflammatory rheumatic musculoskeletal diseases receiving a homecare delivery service. DESIGN Retrospective cohort. SETTING Patients in secondary care receiving SC biologics in the largest Scottish Health Board. PARTICIPANTS A new bespoke cohort was created from routine data gathered as part of a health board Homecare Service Database. Patients over 18 years who received a supply of SC biologic from January 2012 to May 2015 with a diagnosis for rheumatoid arthritis (RA), psoriatic arthritis (PsA) or ankylosing spondylitis (AS) were included. OUTCOMES MEASURED A standardised framework was applied by measuring discontinuation rates, persistence using Kaplan-Meier analysis and Cox regression and adherence using medication refill adherence (MRA) and compliance rate (CR). RESULTS 751 patients were identified (AS: 105, PsA: 227, RA: 419) of whom 89.3% had more than one biologic delivery (median days' follow-up: AS: 494; PsA: 544; RA: 529) and 83.2% did not switch biologic. For all conditions, approximately half were persistent on their index biologic (52% AS, 54% PsA, 48%RA). Of patients who discontinued treatment, the majority reinitiated with the same biologic (19% AS, 18% PsA and 21% RA). Overall adherence during the period of treatment was over 80% when calculated using MRA (median %MRA: AS: 84.0%, PsA: 85.0%, RA: 82.4%) or CR (median %CR: AS: 96.6%, PsA: 97%, RA: 96.6%). CONCLUSION Use of linked routine data is a sustainable pathway to enable ongoing evaluation of biologics use. A more consistent approach to studying use (discontinuation, persistence and adherence metrics) should be adopted to enable comparability of studies.
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Affiliation(s)
- Samantha Alvarez-Madrazo
- Health Data Research Scotland, Strathclyde Institute of Pharmacy and Biomedical Sciences, University of Strathclyde, Glasgow, UK
- School of Public Health, Imperial College London, London, United Kingdom
| | - Kimberley Kavanagh
- Department of Mathematics and Statistics, University of Strathclyde, Glasgow, UK
| | - Stefan Siebert
- Institute of Infection Immunity and Inflammation, University of Glasgow, Glasgow, UK
| | - Yvonne Semple
- Strathclyde Institute of Pharmacy and Biomedical Sciences, University of Strathclyde, Glasgow, UK
- Medicines Information, Pharmacy Department, Glasgow Royal Infirmary, Glasgow, UK
| | - Brian Godman
- Division of Clinical Pharmacology, Karolinska Institutet, Karolinska University Hospital, Stockholm, Sweden
- Division of Public Health Pharmacy and Management, School of Pharmacy, Sefako Makgatho Health Sciences University, Ga-Rankuwa, Pretoria, South Africa
| | | | | | - Marion Bennie
- Health Data Research Scotland, Strathclyde Institute of Pharmacy and Biomedical Sciences, University of Strathclyde, Glasgow, UK
- Information Services Division, NHS National Services Scotland, Edinburgh, UK
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77
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George G, Scailteux L, Garmo H, Balusson F, Cardwell C, Coster GD, Schutter HD, Kuiper JG, McMenamin Ú, Verbeeck J, Van Hemelrijck M. Real-world insights into risk of developing cardiovascular disease following GnRH agonists versus antagonists for prostate cancer: a methodological protocol to a study using five European databases. Fundam Clin Pharmacol 2019; 33:479-499. [PMID: 30776136 PMCID: PMC6850363 DOI: 10.1111/fcp.12454] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2018] [Revised: 01/23/2019] [Accepted: 02/15/2019] [Indexed: 12/13/2022]
Abstract
One of the more recently investigated adverse long-term side effects of gonadotropin-releasing hormone (GnRH) agonists for prostate cancer (PCa) is cardiovascular disease (CVD). Studies suggest lower risk of CVD following GnRH antagonists (degarelix) than GnRH agonists. This protocol describes precise codes used to extract variables from five European databases for a study that compares risk of CVD following GnRH agonists and antagonists for PCa. PCa men on primary GnRH agonists or antagonists were identified from the UK THIN (The Health Improvement Network) database, National Health Service (NHS) Scotland, Belgian Cancer Registry (BCR), Dutch PHARMO Database Network and French National Database (SNIIRAM). Cohort entry was defined as date of treatment initiation. CVD event was defined as any first incident or fatal CVD after cohort entry. Readcodes in THIN and ICD codes in NHS Scotland, BCR, PHARMO and SNIIRAM were used to extract variables. Risk of Bias in Non-randomised studies of Interventions (ROBINS-I) tool was used to assess the potential risk of biases in this study. 51 572 men with a median follow-up time of 2 years started on GnRH agonists and 2 417 men with a median follow-up time of 1 year started on GnRH antagonists between 2010 and 2017 in the UK, Scotland, Belgium, the Netherlands and France. Data from five countries improved the study power and internal validity required to compare risk of CVD between GnRH agonists and antagonists, the latter being a fairly new drug with limited data in individual countries.
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Affiliation(s)
- Gincy George
- Translational Oncology and Urology ResearchKing's College LondonLondonUK
| | - Lucie‐Marie Scailteux
- Pharmacovigilance, Pharmacoepidemiology and Drug Information CenterRennes Hospital UniversityRennesFrance
- REPERES (Pharmacoepidemiology and Heath Services Research)Rennes UniversityEA 7449, F‐35000RennesFrance
| | - Hans Garmo
- Translational Oncology and Urology ResearchKing's College LondonLondonUK
| | - Frédéric Balusson
- REPERES (Pharmacoepidemiology and Heath Services Research)Rennes UniversityEA 7449, F‐35000RennesFrance
| | - Christopher Cardwell
- Centre for Public HealthInstitute for Health SciencesQueen's University BelfastBelfastNorthern Ireland
| | | | | | | | - Úna McMenamin
- Centre for Public HealthInstitute for Health SciencesQueen's University BelfastBelfastNorthern Ireland
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78
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Wotton CJ, Green J, Brown A, Armstrong MEG, Floud S, Beral V, Reeves GK. Use of oral bisphosphonates and risk of hospital admission with osteonecrosis of the jaw: Large prospective cohort study in UK women. Bone 2019; 124:69-74. [PMID: 30959190 DOI: 10.1016/j.bone.2019.04.003] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/14/2018] [Revised: 03/19/2019] [Accepted: 04/04/2019] [Indexed: 11/21/2022]
Abstract
About 1 in 10 postmenopausal UK women are currently prescribed oral bisphosphonates, but there are concerns about their adverse effects. Osteonecrosis of the jaw is a recognised uncommon but important side effect of intravenous bisphosphonates, but epidemiological evidence on risk of osteonecrosis of the jaw associated with oral bisphosphonate use is less conclusive. The incidence of hospital admission with osteonecrosis of the jaw was examined among 521,695 Million Women Study participants, aged 64.7 years at baseline. Cox proportional hazards regression was used to estimate adjusted relative risks (RRs) and 95% confidence intervals (CIs) associated with use of oral bisphosphonates in postmenopausal women followed-up by record-linkage to National Health Service hospital admission databases. During mean follow-up of 8.2 years per woman, 100 women were admitted to hospital with first recorded osteonecrosis of the jaw, at mean age 72.4 years. Almost a third (29/100) of the cases had ever-used oral bisphosphonates. Ever-users had a six-fold increased risk of hospital admission for osteonecrosis of the jaw, when compared with never-users (adjusted RR = 6.09, 95% CI 3.83-9.66; p < 0.0001). The relative risk for osteonecrosis of the jaw in never-users of oral bisphosphonates was increased in women with prior cancer (RR = 3.40, 2.22-5.22, p < 0.0001). The estimated absolute risk of hospital admission for osteonecrosis of the jaw over a 5-year period from age 70 to 74 in women without prior cancer was 0.09 per 1000 in never-users and 0.69 per 1000 in ever-users of oral bisphosphonates. In this UK population of postmenopausal women, use of oral bisphosphonates was associated with a 6-fold increased risk of hospital admission with osteonecrosis of the jaw, accounting for around one-third of cases, with an excess risk of about 0.6/1000 users over 5 years.
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Affiliation(s)
- Clare J Wotton
- Cancer Epidemiology Unit, University of Oxford, Richard Doll Building, Old Road Campus, Oxford OX3 7LF, UK.
| | - Jane Green
- Cancer Epidemiology Unit, University of Oxford, Richard Doll Building, Old Road Campus, Oxford OX3 7LF, UK
| | - Anna Brown
- Cancer Epidemiology Unit, University of Oxford, Richard Doll Building, Old Road Campus, Oxford OX3 7LF, UK
| | | | - Sarah Floud
- Cancer Epidemiology Unit, University of Oxford, Richard Doll Building, Old Road Campus, Oxford OX3 7LF, UK
| | - Valerie Beral
- Cancer Epidemiology Unit, University of Oxford, Richard Doll Building, Old Road Campus, Oxford OX3 7LF, UK
| | - Gillian K Reeves
- Cancer Epidemiology Unit, University of Oxford, Richard Doll Building, Old Road Campus, Oxford OX3 7LF, UK
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79
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Lyall LM, Penades N, Smith DJ. Changes in prescribing for bipolar disorder between 2009 and 2016: national-level data linkage study in Scotland. Br J Psychiatry 2019; 215:415-421. [PMID: 30816839 PMCID: PMC6581537 DOI: 10.1192/bjp.2019.16] [Citation(s) in RCA: 45] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
BACKGROUND People with bipolar disorder typically require long-term pharmacological treatment to prevent episodes of depression or mania. However, evidence-based guidelines are often not followed by prescribers and, in some countries, prescribing of lithium is in decline. Polypharmacy is also common in bipolar disorder.AimsTo employ a data linkage approach to describe and evaluate prescribing patterns in bipolar disorder in Scotland between 2009 and 2016. METHOD By linking prescribing data to the electronic Scottish Morbidity Records, we identified a cohort of 23 135 patients with bipolar disorder who were prescribed psychotropic medication between 2009 and 2016. We examined trends in proportions of patients prescribed each of six drug categories. Random effects logistic models examined change in prescribing over years of interest. RESULTS The most common form of treatment was antidepressant monotherapy (24.96%), with only 5.90% of patients receiving lithium monotherapy. Prescribing of antipsychotics and anti-epileptics increased from 2009 to 2016 (antipsychotics: odds ratio 1.16, 95% CI 1.15-1.18; anti-epileptics: odds ratio 1.34, 95% CI 1.32-1.36), whereas prescribing of lithium decreased (odds ratio 0.83, 95% CI 0.82-0.85). Prescribing of valproate decreased from 2009-2016 in women, but increased in men (women: odds ratio 0.93, 95% CI 0.90-0.97; men: odds ratio 1.11, 95% CI 1.04-1.18). CONCLUSIONS Antidepressant monotherapy was the most common form of treatment for bipolar disorder in Scotland and prescribing of lithium has declined between 2009 and 2016. The findings are concerning and represent a gap between treatment guidelines and clinical practice.Declaration of interestNone.
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Affiliation(s)
- Laura M. Lyall
- Institute of Health and Wellbeing, University of Glasgow, Glasgow,
UK
| | | | - Daniel J. Smith
- Institute of Health and Wellbeing, University of Glasgow, Glasgow,
UK,Corresponding author:
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80
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Pan J, Kavanagh K, Marwick C, Davey P, Wuiff C, Bryson S, Robertson C, Bennie M. Residual effect of community antimicrobial exposure on risk of hospital onset healthcare-associated Clostridioides difficile infection: a case-control study using national linked data. J Hosp Infect 2019; 103:259-267. [PMID: 31173780 DOI: 10.1016/j.jhin.2019.05.016] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2019] [Accepted: 05/29/2019] [Indexed: 11/28/2022]
Abstract
BACKGROUND Associations between antimicrobial exposure in the community and community-associated Clostridioides difficile infection (CA-CDI) are well documented but associations with healthcare-associated CDI (HA-CDI) are less clear. This study estimates the association between antimicrobial prescribing in the community and HA-CDI. METHODS A matched case-control study was conducted by linking three national patient level datasets covering CDI cases, community prescriptions and hospitalizations. All validated cases of HA-CDI (August 2010 to July 2013) were extracted and up to three hospital-based controls were matched to each case on the basis of gender, age, hospital and date of admission. Conditional logistic regression was applied to estimate the association between antimicrobial prescribing in the community and HA-CDI. A sensitivity analysis was conducted to consider the impact of unmeasured hospital antimicrobial prescribing. RESULTS Nine-hundred and thirty unique cases of HA-CDI with onset in hospital and no hospital discharge in the 12 weeks prior to index admission were linked with 1810 matched controls. Individuals with prior prescription of any antimicrobial in the community had an odds ratio (OR) = 1.41 (95% confidence interval (CI) 1.13-1.75) for HA-CDI compared with those without. Individuals exposed to high-risk antimicrobials (cephalosporins, clindamycin, co-amoxiclav or fluoroquinolones) had an OR = 1.86 (95% CI: 1.33-2.59). After accounting for the likely impact of unmeasured hospital prescribing, the community exposure, particulary to high-risk antimicrobials, was still associated with elevated HA-CDI risk. CONCLUSIONS Community antimicrobial exposure is an independent risk factor for HA-CDI and should be considered as part of the risk assessment of patients developing diarrhoea in hospital.
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Affiliation(s)
- J Pan
- Department of Mathematics and Statistics, University of Strathclyde, Glasgow, Scotland, UK.
| | - K Kavanagh
- Department of Mathematics and Statistics, University of Strathclyde, Glasgow, Scotland, UK; Information Services Division, NHS National Services Scotland, Edinburgh, Scotland, UK
| | - C Marwick
- Population Health Sciences, School of Medicine, University of Dundee, Dundee, Scotland, UK
| | - P Davey
- Population Health Sciences, School of Medicine, University of Dundee, Dundee, Scotland, UK
| | - C Wuiff
- Health Protection Scotland, NHS National Services Scotland, Glasgow, Scotland, UK
| | - S Bryson
- Strathclyde Institute of Pharmacy and Biomedical Sciences, University of Strathclyde, Glasgow, Scotland, UK
| | - C Robertson
- Department of Mathematics and Statistics, University of Strathclyde, Glasgow, Scotland, UK; Health Protection Scotland, NHS National Services Scotland, Glasgow, Scotland, UK; International Prevention Research Institute, Lyon, France
| | - M Bennie
- Strathclyde Institute of Pharmacy and Biomedical Sciences, University of Strathclyde, Glasgow, Scotland, UK; Information Services Division, NHS National Services Scotland, Edinburgh, Scotland, UK
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81
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Gao L, Robertson JR, Bird SM. Non drug-related and opioid-specific causes of 3262 deaths in Scotland's methadone-prescription clients, 2009-2015. Drug Alcohol Depend 2019; 197:262-270. [PMID: 30875647 PMCID: PMC6445802 DOI: 10.1016/j.drugalcdep.2019.01.019] [Citation(s) in RCA: 27] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/14/2018] [Revised: 01/07/2019] [Accepted: 01/23/2019] [Indexed: 02/06/2023]
Abstract
BACKGROUND Opioid drug use is a major cause of premature mortality, with opioid substitution therapy the leading intervention. As methadone-clients age, non-drug-related deaths (non-DRDs) predominate and DRD-risks increase differentially, quadrupling at 45+ years for methadone-specific DRDs. METHODS 36,606 methadone-prescription-clients in Scotland during 2009-2015 were linked to mortality records to end-2015 by their Community Health Index (CHI). Cohort-entry, also baseline quantity of prescribed methadone, were defined by clients' first CHI-identified methadone-prescription during 2009-2015. National Records of Scotland identified non-DRDs from DRDs; and provided ICD10 codes for underlying and co-present causes of death. Methadone-specific DRD means methadone was implicated in DRD but neither heroin nor buprenorphine. RESULTS During 193,800 person-years of follow-up, 1939 non-DRDs (59%) and 1323 DRDs occurred, of which 546 were methadone-specific. Predominant underlying ICD10 chapters for non-DRDs were: neoplasm (377); external causes (341); diseases of digestive (303), circulatory (286) or respiratory (212) system. As methadone-clients aged, the non-DRD proportion of their deaths increased from 54% (717/1318) at 35-44 years to 89% (372/417) at 55+ years. After allowing for DRDs' opioid-specificity, age-group and quintile for last-prescribed methadone, there was a significant, positive interaction for co-present circulatory disease between top-quintile for prescribed methadone and 45+ years at death (p = 0.033 after Bonferroni); not for digestive or respiratory co-presence. CONCLUSIONS Circulatory disease is the co-morbidity most likely implicated in the quadrupling of methadone-specific DRD-risk at 45+ years; followed by digestive disease. Cultural shift is needed in treatment-services because degenerative non-DRDs predominate as methadone-clients age. Future linkage-studies should access hospitalizations and methadone-daily-dose.
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Affiliation(s)
- Lu Gao
- MRC Biostatistics Unit, University of Cambridge School of Clinical Medicine, Cambridge CB2 0SR, United Kingdom
| | - J Roy Robertson
- University of Edinburgh Usher Institute, Edinburgh EH8 9AG, United Kingdom
| | - Sheila M Bird
- MRC Biostatistics Unit, University of Cambridge School of Clinical Medicine, Cambridge CB2 0SR, United Kingdom; University of Edinburgh Centre for Medical Informatics, Edinburgh EH16 4UX, United Kingdom.
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82
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Hafferty JD, Wigmore EM, Howard DM, Adams MJ, Clarke TK, Campbell AI, MacIntyre DJ, Nicodemus KK, Lawrie SM, Porteous DJ, McIntosh AM. Pharmaco-epidemiology of antidepressant exposure in a UK cohort record-linkage study. J Psychopharmacol 2019; 33:482-493. [PMID: 30808242 DOI: 10.1177/0269881119827888] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
OBJECTIVES Antidepressants are the most commonly prescribed psychiatric medication but concern has been raised about significant increases in their usage in high income countries. We aimed to quantify antidepressant prevalence, incidence, adherence and predictors of use in the adult population. METHODS The study record-linked administrative prescribing and morbidity data to the Generation Scotland cohort ( N = 11,052), between 2009 and 2016. Prevalence and incidence of any antidepressant use was determined. Antidepressant adherence was measured using Proportion of Days Covered and Medication Possession Ratio. Time-to-event analysis for incident antidepressant use within 5 years of Generation Scotland: Scottish Family Health Study (GS:SFHS) recruitment was performed to reveal patient-level predictors of use. RESULTS Almost one-third (28.0%, 95%CI 26.9-29.1) of the adults in our sample were prescribed at least one antidepressant in the 5-year period 2012-2016. There was a 36.2% increase in annual prevalence between 2010 and 2016. Incidence was 2.4(2.1-2.7)% per year. The majority of antidepressant episodes (57.6%) were greater than 9 months duration and adherence was generally high (69.0% with Proportion of Days Covered >80%). Predictors of new antidepressant use included history of affective disorder, being female, physical comorbidities, higher neuroticism scores, and lower cognitive function scores. CONCLUSIONS Antidepressant prevalence is greater than previously reported but incidence remains relatively stable. We found the majority of antidepressant episodes to be of relatively long duration with good estimated adherence. Our study supports the hypothesis that increased long-term use among existing (and returning) users, along with wider ranges of indications for antidepressants, has significantly increased the prevalence of these medications.
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Affiliation(s)
- Jonathan D Hafferty
- 1 Division of Psychiatry, Royal Edinburgh Hospital, University of Edinburgh, Edinburgh, UK
| | - Eleanor M Wigmore
- 1 Division of Psychiatry, Royal Edinburgh Hospital, University of Edinburgh, Edinburgh, UK
| | - David M Howard
- 1 Division of Psychiatry, Royal Edinburgh Hospital, University of Edinburgh, Edinburgh, UK
| | - Mark J Adams
- 1 Division of Psychiatry, Royal Edinburgh Hospital, University of Edinburgh, Edinburgh, UK
| | - Toni-Kim Clarke
- 1 Division of Psychiatry, Royal Edinburgh Hospital, University of Edinburgh, Edinburgh, UK
| | - Archie I Campbell
- 2 Centre for Genomic and Experimental Medicine, Institute of Genetics and Molecular Medicine, Western General Hospital, University of Edinburgh, Edinburgh, UK
| | - Donald J MacIntyre
- 1 Division of Psychiatry, Royal Edinburgh Hospital, University of Edinburgh, Edinburgh, UK
| | - Kristin K Nicodemus
- 2 Centre for Genomic and Experimental Medicine, Institute of Genetics and Molecular Medicine, Western General Hospital, University of Edinburgh, Edinburgh, UK.,3 Centre for Cognitive Ageing and Cognitive Epidemiology, University of Edinburgh, Edinburgh, UK
| | - Stephen M Lawrie
- 1 Division of Psychiatry, Royal Edinburgh Hospital, University of Edinburgh, Edinburgh, UK
| | - David J Porteous
- 2 Centre for Genomic and Experimental Medicine, Institute of Genetics and Molecular Medicine, Western General Hospital, University of Edinburgh, Edinburgh, UK.,3 Centre for Cognitive Ageing and Cognitive Epidemiology, University of Edinburgh, Edinburgh, UK
| | - Andrew M McIntosh
- 1 Division of Psychiatry, Royal Edinburgh Hospital, University of Edinburgh, Edinburgh, UK.,3 Centre for Cognitive Ageing and Cognitive Epidemiology, University of Edinburgh, Edinburgh, UK
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83
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McTaggart S, Nangle C, Caldwell J, Alvarez-Madrazo S, Colhoun H, Bennie M. Use of text-mining methods to improve efficiency in the calculation of drug exposure to support pharmacoepidemiology studies. Int J Epidemiol 2019; 47:617-624. [PMID: 29420741 PMCID: PMC5913611 DOI: 10.1093/ije/dyx264] [Citation(s) in RCA: 21] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/11/2017] [Indexed: 01/01/2023] Open
Abstract
Background Efficient generation of structured dose instructions that enable researchers to calculate drug exposure is central to pharmacoepidemiology studies. Our aim was to design and test an algorithm to codify dose instructions, applied to the NHS Scotland Prescribing Information System (PIS) that records about 100 million prescriptions per annum. Methods A natural language processing (NLP) algorithm was developed that enabled free-text dose instructions to be represented by three attributes - quantity, frequency and qualifier - specified by three, three and two variables, respectively. A sample of 15 593 distinct dose instructions was used to test, validate and refine the algorithm. The final algorithm used a zero-assumption approach and was then applied to the full dataset. Results The initial algorithm generated structured output for 13 152 (84.34%) of the 15 593 sample dose instructions, and reviewers identified 767 (5.83%) incorrect translations, giving an accuracy of 94.17%. Following subsequent refinement of the algorithm rules, application to the full dataset of 458 227 687 prescriptions (99.67% had dose instructions represented by 4 964 083 distinct instructions) generated a structured output for 92.3% of dose instruction texts. This varied by therapeutic area (from 86.7% for the central nervous system to 96.8% for the cardiovascular system). Conclusions We created an NLP algorithm, operational at scale, to produce structured output that gives data users maximum flexibility to formulate, test and apply their own assumptions according to the medicines under investigation. Text mining approaches can provide a solution to the safe and efficient management and provisioning of large volumes of data generated through our health systems.
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Affiliation(s)
- Stuart McTaggart
- Public Health and Intelligence Strategic Business Unit, NHS National Services Scotland, Edinburgh, UK
| | - Clifford Nangle
- Public Health and Intelligence Strategic Business Unit, NHS National Services Scotland, Edinburgh, UK.,Farr Institute of Health Informatics Research, Edinburgh, UK
| | - Jacqueline Caldwell
- Public Health and Intelligence Strategic Business Unit, NHS National Services Scotland, Edinburgh, UK.,Farr Institute of Health Informatics Research, Edinburgh, UK
| | - Samantha Alvarez-Madrazo
- Strathclyde Institute of Pharmacy and Biomedical Sciences, University of Strathclyde, Glasgow, UK.,Farr Institute of Health Informatics Research, Edinburgh, UK
| | - Helen Colhoun
- Institute of Genetics and Molecular Medicine, University of Edinburgh, Edinburgh, UK.,Farr Institute of Health Informatics Research, Edinburgh, UK
| | - Marion Bennie
- Public Health and Intelligence Strategic Business Unit, NHS National Services Scotland, Edinburgh, UK.,Strathclyde Institute of Pharmacy and Biomedical Sciences, University of Strathclyde, Glasgow, UK.,Farr Institute of Health Informatics Research, Edinburgh, UK
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84
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Mueller T, Alvarez‐Madrazo S, Robertson C, Wu O, Bennie M. Comparative safety and effectiveness of direct oral anticoagulants in patients with atrial fibrillation in clinical practice in Scotland. Br J Clin Pharmacol 2019; 85:422-431. [PMID: 30423191 PMCID: PMC6339970 DOI: 10.1111/bcp.13814] [Citation(s) in RCA: 39] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2018] [Revised: 11/06/2018] [Accepted: 11/08/2018] [Indexed: 12/23/2022] Open
Abstract
AIMS The aim of this study was to compare the clinical effectiveness and safety of direct oral anticoagulants (DOACs) in patients with atrial fibrillation (AF) in routine clinical practice. METHODS This retrospective cohort study used linked administrative data. The study population (n = 14 577) included patients with a diagnosis of AF (confirmed in hospital) who initiated DOAC treatment in Scotland between August 2011 and December 2015. Multivariate Cox proportional hazard models were used to estimate hazard ratios of thromboembolic events, mortality and bleeding events. RESULTS No differences between the DOACs were observed with regard to the risk of stroke, systemic embolism or cardiovascular death. In contrast, the risk of myocardial infarction was higher among patients prescribed apixaban in comparison to those on rivaroxaban (HR 1.67, 95% CI 1.02-2.71), and all-cause mortality was higher among rivaroxaban patients in contrast to both apixaban (1.22 [1.01-1.47]) and dabigatran (1.55 [1.16-2.05]) patients; rivaroxaban patients also had a higher risk of pulmonary embolism than apixaban patients (5.27 [1.79-15.53]). The risk of other major bleeds was higher among rivaroxaban patients compared to apixaban (1.50 [1.10-2.03]) and dabigatran (1.58 [1.01-2.48]) patients; the risks of gastrointestinal bleeds and overall bleeding were higher among rivaroxaban patients than among apixaban patients (1.48 [1.01-2.16] and 1.52 [1.21-1.92], respectively). CONCLUSIONS All DOACs were similarly effective in preventing strokes and systemic embolisms, while patients being treated with rivaroxaban exhibited the highest bleeding risks. Observed differences in the risks of all-cause mortality, myocardial infarction and pulmonary embolism warrant further research.
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Affiliation(s)
- Tanja Mueller
- The Farr Institute of Health Informatics Research, Strathclyde Institute of Pharmacy and Biomedical SciencesUniversity of StrathclydeGlasgowUK
| | - Samantha Alvarez‐Madrazo
- The Farr Institute of Health Informatics Research, Strathclyde Institute of Pharmacy and Biomedical SciencesUniversity of StrathclydeGlasgowUK
| | - Chris Robertson
- Department of Mathematics and StatisticsUniversity of StrathclydeGlasgowUK
- Health Protection ScotlandNHS National Services ScotlandGlasgowUK
| | - Olivia Wu
- Institute of Health and WellbeingUniversity of GlasgowGlasgowUK
| | - Marion Bennie
- The Farr Institute of Health Informatics Research, Strathclyde Institute of Pharmacy and Biomedical SciencesUniversity of StrathclydeGlasgowUK
- Public Health and Intelligence Strategic Business UnitNHS National Services ScotlandEdinburghUK
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85
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Devereux G, Craig L, Seaton A, Turner S. Maternal vitamin D and E intakes in pregnancy and asthma to age 15 years: A cohort study. Pediatr Pulmonol 2019; 54:11-19. [PMID: 30426718 DOI: 10.1002/ppul.24184] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/18/2018] [Accepted: 10/07/2018] [Indexed: 01/17/2023]
Abstract
This study investigated whether the previously reported associations in this birth cohort between maternal vitamin D and E intakes during pregnancy and childhood wheeze/asthma outcomes at age 5 and 10 years are still evident at age 15 years. In a prospective study of 1924 children recruited in utero, maternal vitamin D and E intakes during pregnancy were assessed by food frequency questionnaire and the children completed raespiratory questionnaire at age 15 years. Treatment for asthma at age 15 was also ascertained using healthcare data. Maternal vitamin D and E intakes were also related to combined childhood asthma data collected at 1, 2, 5, 10, and 15 years of age. Symptom data were available for 747 (39%) 15-year olds and healthcare data for 1689 (88%). There were no associations between maternal vitamin D and E intakes and childhood wheeze and asthma at age 15. Analysis of combined data collected between 1 and 15 years of age demonstrated that higher maternal vitamin D and E intakes during pregnancy were associated with a reduced likelihood of being diagnosed with asthma in the first 15 years: hazard ratio (95%CI) per quartile increase in vitamin intake of 0.87 (0.78,0.98) and 0.88 (0.78,0.98), respectively. Lower maternal vitamin D and E intakes during pregnancy are associated with increased risk of children wheezing and being diagnosed with asthma in the first 10 years but not after puberty, suggesting that post-natal exposures predominate in the etiology of incident asthma as children transition through puberty into adulthood.
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Affiliation(s)
- Graham Devereux
- Child Health, Royal Aberdeen Children's Hospital, University of Aberdeen, Aberdeen, UK
- Environmental and Occupational Medicine, University of Aberdeen, Aberdeen, UK
| | - Leone Craig
- Applied Health Sciences, Rowett Institute, University of Aberdeen, Aberdeen, UK
| | - Anthony Seaton
- Environmental and Occupational Medicine, University of Aberdeen, Aberdeen, UK
| | - Steve Turner
- Child Health, Royal Aberdeen Children's Hospital, University of Aberdeen, Aberdeen, UK
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86
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Jakupi A, Godman B, Martin A, Haycox A, Baholli I. Utilization and Expenditure of Anti-cancer Medicines in Kosovo: Findings and Implications. PHARMACOECONOMICS - OPEN 2018; 2:423-432. [PMID: 29396661 PMCID: PMC6249196 DOI: 10.1007/s41669-017-0066-8] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 06/07/2023]
Abstract
BACKGROUND AND OBJECTIVE The Ministry of Health (MoH) leads and organizes health policy in Kosovo, which includes procurement and provision of medicines, including anti-cancer medicines, which compose a special group of medicines. However, there has been limited analysis of the utilization and expenditure on anti-cancer medicines in Kosovo; consequently, the objective of this study is to undertake research to provide future guidance on the use of anti-cancer medicines. METHOD National drug utilization data is available in Kosovo. Utilization and expenditure on anti-cancer medicines [Anatomical Therapeutic Chemical (ATC) code L], initially from 2011 to 2013, especially for anti-cancer medicines on the essential medicines list was analysed from national data. In addition, current systems for procuring and managing anti-cancer medicines in Kosovo was documented. RESULTS There was appreciable variability in the utilization of anti-cancer medicines over the years, with low or limited use of some anti-cancer medicines on the Essential Medicine List. This is a concern in view of their essential medicine status. From 2011 to 2013, €16.49 million was spent on anti-cancer medicines (ATC L). The process of selection of new medicines begins with suggestions from doctors at the University Clinical Centre in Kosovo. CONCLUSION The analysis has shown appreciable variation with current utilization patterns for anti-cancer medicines in Kosovo. This needs to be addressed as part of improving the drug management process to optimize patient care within available resources. Future years and reforms need to be assessed to improve current utilization and expenditure patterns.
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Affiliation(s)
- Arianit Jakupi
- Faculty of Pharmacy, UBT Higher Education Institution, Prishtina, Kosovo
- Pharmaceutical Consulting, Prishtina, Kosovo
| | - Brian Godman
- Strathclyde Institute of Pharmacy and Biomedical Sciences, University of Strathclyde, Glasgow, UK
- Department of Laboratory Medicine, Division of Clinical Pharmacology, Karolinska Institute, Karolinska University Hospital Huddinge, Stockholm, Sweden
- Health Economics Centre, University of Liverpool Management School, Liverpool, UK
| | - Antony Martin
- Health Economics Centre, University of Liverpool Management School, Liverpool, UK
| | - Alan Haycox
- Health Economics Centre, University of Liverpool Management School, Liverpool, UK
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87
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Abstract
PURPOSE OF REVIEW The purpose of this review is to provide an overview of the published studies that have been used to generate evidence on the safety of medicine use when only medication dispensing data are available. RECENT FINDINGS Medication dispensing databases are increasingly available for research on large populations, particularly in countries that provide universal coverage for medicines. These data are often used for drug utilisation studies to identify inappropriate medicine use at the population level that may be associated with known safety issues. Lack of coded diagnoses, to identify outcomes, and lack of data on confounders can limit use of these data in practice for medication safety assessment. To overcome these issues, studies have exploited the fact that symptoms of adverse effects of medications can be treated with other medications, for example antidepressants to treat depression or oxybutynin to treat urinary incontinence. The challenge of unmeasured confounding has been addressed by implementing self-controlled study designs that use within-person comparisons and provide inherent control for confounding. Prescription sequence symmetry analysis (SSA) is a within-person study design that has been demonstrated as a useful tool for safety signal generation in dispensing data. SUMMARY Using medicine initiation as a proxy for the development of adverse events can help to generate evidence of the safety of medicines when only medication dispensing data are available. Careful consideration, however, should be given to the sensitivity and specificity of the proxy medicine for the adverse event and potential for time-varying confounding due to trends in medicine utilisation. Data-mining approaches using dispensing data have the potential to improve safety assessments; however, the challenge of unmeasured confounding with these methods remains to be investigated.
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Affiliation(s)
- Nicole Pratt
- Quality Use of Medicines and Pharmacy Research Centre, School of Pharmacy and Medical Science, University of South Australia, Adelaide, Australia
| | - Elizabeth Roughead
- Quality Use of Medicines and Pharmacy Research Centre, School of Pharmacy and Medical Science, University of South Australia, Adelaide, Australia
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88
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Scott D, Fletcher E, Kane H, Malcolm W, Kavanagh K, Banks AL, Rankin A. Risk of infection following semi-invasive ultrasound procedures in Scotland, 2010 to 2016: A retrospective cohort study using linked national datasets. ULTRASOUND (LEEDS, ENGLAND) 2018; 26:168-177. [PMID: 30147741 PMCID: PMC6099767 DOI: 10.1177/1742271x18774594] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/31/2018] [Accepted: 04/09/2018] [Indexed: 11/16/2022]
Abstract
INTRODUCTION Outbreak reports indicate a risk of cross-infection following medical procedures using semi-invasive ultrasound probes. This study aimed to evaluate the risk of infection, using microbiological reports and antibiotic prescriptions as proxy measures, associated with semi-invasive ultrasound probe procedures, including transoesophageal echocardiography, transvaginal and transrectal ultrasound. METHODS Patient records from the Electronic Communication of Surveillance in Scotland and the Prescribing Information System were linked with the Scottish Morbidity Records for cases in Scotland between 2010 and 2016. Three retrospective cohorts were created to include inpatients/day-cases and outpatients in the following specialties: Cardiology, Gynaecology and Urology. Cox regression was used to quantify the association between semi-invasive ultrasound probe procedures and the risk of positive microbiological reports and community antibiotic prescriptions in the 30-day period following the procedure. RESULTS There was a greater hazard ratio of microbiological reports for patients who had undergone transoesophageal echocardiography (HR: 4.92; 95% CI: 3.17-7.63), transvaginal (HR: 1.41; 95% CI: 1.21-1.64) and transrectal ultrasound (HR: 3.40; 95% CI: 2.90-3.99), compared with unexposed cohort members after adjustment for age, co-morbidities, previous hospital admissions and past care home residence. Similarly, there was a greater hazard ratio of antibiotic prescribing for those who had received transvaginal (HR: 1.26; 95% CI: 1.20-1.32) and transrectal (HR: 1.75; 95% CI: 1.66-1.84) ultrasound, compared with unexposed patients. CONCLUSION Analysis of linked national datasets demonstrated a greater risk of infection within 30 days of undergoing semi-invasive ultrasound probe procedures, using microbiological reports and antibiotic prescriptions as proxy measures of infection.
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Affiliation(s)
- David Scott
- Bristol Dental School, University of Bristol, Bristol, UK
| | - Eilidh Fletcher
- Information Services Division, NHS National Services Scotland, Edinburgh, UK
| | - Hayley Kane
- Health Protection Scotland, NHS National Services Scotland, Glasgow, UK
| | - William Malcolm
- Health Protection Scotland, NHS National Services Scotland, Glasgow, UK
| | - Kimberley Kavanagh
- Department of Mathematics and Statistics, University of Strathclyde, Glasgow, UK
| | - A-Lan Banks
- Health Protection Scotland, NHS National Services Scotland, Glasgow, UK
| | - Annette Rankin
- Health Protection Scotland, NHS National Services Scotland, Glasgow, UK
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89
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Mazlan-Kepli W, Dawson J, Berry C, Walters M. Cessation of dual antiplatelet therapy and cardiovascular events following acute coronary syndrome. Heart 2018; 105:67-74. [PMID: 30030335 DOI: 10.1136/heartjnl-2018-313148] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/10/2018] [Revised: 06/13/2018] [Accepted: 07/02/2018] [Indexed: 11/03/2022] Open
Abstract
OBJECTIVE To assess whether cardiovascular events are increased after cessation of dual antiplatelet therapy (DAPT) following acute coronary syndrome (ACS) and to explore predictors for recurrent events after DAPT cessation during long-term follow-up. METHODS We did a retrospective observational cohort study. We included consecutive people with ACS who were discharged from Scottish hospitals between January 2008 and December 2013 and who received DAPT after discharge followed by antiplatelet monotherapy. The rates of cardiovascular events were assessed during each 90-day period of DAPT treatment and 90-day period after stopping DAPT. Cardiovascular events were defined as a composite of death, ACS, transient ischaemic attack or stroke. Cox regression was used to identify predictors of cardiovascular events following DAPT cessation. RESULTS 1340 patients were included (62% male, mean age 64.9 (13.0) years). Cardiovascular events occurred in 15.7% (n=211) during the DAPT period (mean DAPT duration 175.1 (155.3) days) and in 16.7% (n=188) following DAPT cessation (mean of 2.7 years follow-up). Independent predictors for a cardiovascular event following DAPT cessation were age (HR 1.07; 95% CI 1.05 to 1.08; p<0.001), DAPT duration (HR 0.997; 95% CI 0.995 to 0.998; p<0.001) and having revascularisation therapy during the index admission (HR 0.58; 95% CI 0.39 to 0.85; p=0.005). CONCLUSIONS The rate of cardiovascular events was not significantly increased in the early period post-DAPT cessation compared with later periods in this ACS population. Increasing age, DAPT duration and lack of revascularisation therapy were associated with increased risk of cardiovascular events during long-term follow-up after DAPT cessation.
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Affiliation(s)
| | - Jesse Dawson
- Institute of Cardiovascular and Medical Sciences, University of Glasgow, Glasgow, UK
| | - Colin Berry
- Institute of Cardiovascular and Medical Sciences, University of Glasgow, Glasgow, UK
| | - Matthew Walters
- Institute of Cardiovascular and Medical Sciences, University of Glasgow, Glasgow, UK
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90
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Henson KE, Brock R, Shand B, Coupland VH, Elliss-Brookes L, Lyratzopoulos G, Godfrey P, Haigh A, Hunter K, McCabe MG, Mitchell G, Monckton N, Robson R, Round T, Wong K, Rashbass J. Cohort profile: prescriptions dispensed in the community linked to the national cancer registry in England. BMJ Open 2018; 8:e020980. [PMID: 29991628 PMCID: PMC6082455 DOI: 10.1136/bmjopen-2017-020980] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/11/2017] [Revised: 03/09/2018] [Accepted: 06/01/2018] [Indexed: 11/25/2022] Open
Abstract
PURPOSE The linked prescriptions cancer registry data resource was set up to extend our understanding of the pathway for patients with cancer past secondary care into the community, to ultimately improve patient outcomes. PARTICIPANTS The linked prescriptions cancer registry data resource is currently available for April to July 2015, for all patients diagnosed with cancer in England with a dispensed prescription in that time frame.The dispensed prescriptions data are collected by National Health Service (NHS) Prescription Services, and the cancer registry data are processed by Public Health England. All data are routine healthcare data, used for secondary purposes, linked using a pseudonymised version of the patient's NHS number and date of birth.Detailed demographic and clinical information on the type of cancer diagnosed and treatment is collected by the cancer registry. The dispensed prescriptions data contain basic demographic information, geography measures of the dispensed prescription, drug information (quantity, strength and presentation), cost of the drug and the date that the dispensed prescription was submitted to NHS Business Services Authority. FINDINGS TO DATE Findings include a study of end of life prescribing in the community among patients with cancer, an investigation of repeat prescriptions to derive measures of prior morbidity status in patients with cancer and studies of prescription activity surrounding the date of cancer diagnosis. FUTURE PLANS This English linked resource could be used for cancer epidemiological studies of diagnostic pathways, health outcomes and inequalities; to establish primary care comorbidity indices and for guideline concordance studies of treatment, particularly hormonal therapy, as a major treatment modality for breast and prostate cancer which has been largely delivered in the community setting for a number of years.
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Affiliation(s)
- Katherine E Henson
- National Cancer Registration and Analysis Service, Public Health England, London, UK
| | - Rachael Brock
- National Cancer Registration and Analysis Service, Public Health England, London, UK
| | - Brian Shand
- National Cancer Registration and Analysis Service, Public Health England, London, UK
| | - Victoria H Coupland
- National Cancer Registration and Analysis Service, Public Health England, London, UK
| | - Lucy Elliss-Brookes
- National Cancer Registration and Analysis Service, Public Health England, London, UK
| | - Georgios Lyratzopoulos
- National Cancer Registration and Analysis Service, Public Health England, London, UK
- Department of Behavioural Science and Health, ECHO (Epidemiology of Cancer Healthcare and Outcomes) Group, University College London, London, UK
| | - Philip Godfrey
- NHS Prescription Services, NHS Business Services Authority, Newcastle upon Tyne, UK
| | - Abigail Haigh
- NHS Prescription Services, NHS Business Services Authority, Newcastle upon Tyne, UK
| | - Kelvin Hunter
- Department of Medicine (Cambridge University), Addenbrooke's Hospital, Cambridge, UK
| | - Martin G McCabe
- National Cancer Registration and Analysis Service, Public Health England, London, UK
- Institute of Cancer Sciences, Manchester Academic Health Science Centre, Core Technology Facility, University of Manchester, Manchester, UK
| | - Graham Mitchell
- NHS Prescription Services, NHS Business Services Authority, Newcastle upon Tyne, UK
| | - Nina Monckton
- NHS Prescription Services, NHS Business Services Authority, Newcastle upon Tyne, UK
| | - Robert Robson
- NHS Prescription Services, NHS Business Services Authority, Newcastle upon Tyne, UK
| | - Thomas Round
- Department of Primary Care and Public Health Sciences, King's College London, London, UK
| | - Kwok Wong
- National Cancer Registration and Analysis Service, Public Health England, London, UK
| | - Jem Rashbass
- National Cancer Registration and Analysis Service, Public Health England, London, UK
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91
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Association of opioid prescribing practices with chronic pain and benzodiazepine co-prescription: a primary care data linkage study. Br J Anaesth 2018; 120:1345-1355. [DOI: 10.1016/j.bja.2018.02.022] [Citation(s) in RCA: 43] [Impact Index Per Article: 7.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2017] [Revised: 01/29/2018] [Accepted: 02/19/2018] [Indexed: 02/07/2023] Open
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92
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Gray RT, Coleman HG, Hughes C, Murray LJ, Cardwell CR. Low-dose aspirin use and survival in colorectal cancer: results from a population-based cohort study. BMC Cancer 2018; 18:228. [PMID: 29486728 PMCID: PMC6389196 DOI: 10.1186/s12885-018-4142-y] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2016] [Accepted: 02/19/2018] [Indexed: 12/21/2022] Open
Abstract
BACKGROUND Aspirin has been proposed as a novel adjuvant agent in colorectal cancer (CRC). Six observational studies have reported CRC-specific survival outcomes in patients using aspirin after CRC diagnosis but the results from these studies have been conflicting. Using a population-based cohort design this study aimed to assess if low-dose aspirin use after diagnosis reduced CRC-specific mortality. METHODS A cohort of 8391 patients with Dukes' A-C CRC (2009-2012) was identified from the Scottish Cancer Registry and linked to national prescribing and death records. Adjusted hazard ratios (HRs) and 95% confidence intervals (CIs) for CRC-specific mortality were calculated using time-dependent Cox regression. RESULTS There were 1064 CRC-specific deaths after a median follow-up of 3.6 years. Post-diagnostic low-dose aspirin use was not associated with a reduction in CRC-specific mortality either before or after adjustment for confounders (adjusted HR = 1.17, 95% CI 1.00-1.36). In sensitivity analysis pre-diagnostic low-dose aspirin was also not associated with reduced CRC-specific mortality (adjusted HR = 0.96, 95% CI 0.88-1.05). CONCLUSION Low-dose aspirin use, either before or after diagnosis, did not prolong survival in this population-based CRC cohort.
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Affiliation(s)
- Ronan T. Gray
- Cancer Epidemiology and Health Services Research Group, Centre for Public Health, Queen’s University Belfast, Royal Victoria Hospital, Belfast, Northern Ireland BT12 6BA UK
| | - Helen G. Coleman
- Cancer Epidemiology and Health Services Research Group, Centre for Public Health, Queen’s University Belfast, Royal Victoria Hospital, Belfast, Northern Ireland BT12 6BA UK
| | - Carmel Hughes
- School of Pharmacy, Queen’s University Belfast, 97 Lisburn Road, Belfast, Northern Ireland BT9 7BL UK
| | - Liam J. Murray
- Cancer Epidemiology and Health Services Research Group, Centre for Public Health, Queen’s University Belfast, Royal Victoria Hospital, Belfast, Northern Ireland BT12 6BA UK
| | - Chris R. Cardwell
- Cancer Epidemiology and Health Services Research Group, Centre for Public Health, Queen’s University Belfast, Royal Victoria Hospital, Belfast, Northern Ireland BT12 6BA UK
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93
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Hafferty JD, Campbell AI, Navrady LB, Adams MJ, MacIntyre D, Lawrie SM, Nicodemus K, Porteous DJ, McIntosh AM. Self-reported medication use validated through record linkage to national prescribing data. J Clin Epidemiol 2018; 94:132-142. [PMID: 29097340 PMCID: PMC5808931 DOI: 10.1016/j.jclinepi.2017.10.013] [Citation(s) in RCA: 64] [Impact Index Per Article: 10.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2017] [Revised: 10/10/2017] [Accepted: 10/23/2017] [Indexed: 12/20/2022]
Abstract
OBJECTIVES Researchers need to be confident about the reliability of epidemiologic studies that quantify medication use through self-report. Some evidence suggests that psychiatric medications are systemically under-reported. Modern record linkage enables validation of self-report with national prescribing data as gold standard. Here, we investigated the validity of medication self-report for multiple medication types. STUDY DESIGN AND SETTING Participants in the Generation Scotland population-based cohort (N = 10,244) recruited 2009-2011 self-reported regular usage of several commonly prescribed medication classes. This was matched against Scottish NHS prescriptions data using 3- and 6-month fixed time windows. Potential predictors of discordant self-report, including general intelligence and psychological distress, were studied via multivariable logistic regression. RESULTS Antidepressants self-report showed very good agreement (κ = 0.85, [95% confidence interval (CI) 0.84-0.87]), comparable to antihypertensives (κ = 0.90 [CI 0.89-0.91]). Self-report of mood stabilizers showed moderate-poor agreement (κ = 0.42 [CI 0.33-0.50]). Relevant past medical history was the strongest predictor of self-report sensitivity, whereas general intelligence was not predictive. CONCLUSION In this large population-based study, we found self-report validity varied among medication classes, with no simple relationship between psychiatric medication and under-reporting. History of indicated illness predicted more accurate self-report, for both psychiatric and nonpsychiatric medications. Although other patient-level factors influenced self-report for some medications, none predicted greater accuracy across all medications studied.
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Affiliation(s)
- Jonathan D Hafferty
- Division of Psychiatry, Royal Edinburgh Hospital, University of Edinburgh, Edinburgh EH10 5HF, UK.
| | - Archie I Campbell
- Generation Scotland, Centre for Genomics and Experimental Medicine, Institute for Genetics and Molecular Medicine, Western General Hospital, University of Edinburgh, Edinburgh EH4 2XU, UK
| | - Lauren B Navrady
- Division of Psychiatry, Royal Edinburgh Hospital, University of Edinburgh, Edinburgh EH10 5HF, UK
| | - Mark J Adams
- Division of Psychiatry, Royal Edinburgh Hospital, University of Edinburgh, Edinburgh EH10 5HF, UK
| | - Donald MacIntyre
- Division of Psychiatry, Royal Edinburgh Hospital, University of Edinburgh, Edinburgh EH10 5HF, UK
| | - Stephen M Lawrie
- Division of Psychiatry, Royal Edinburgh Hospital, University of Edinburgh, Edinburgh EH10 5HF, UK
| | - Kristin Nicodemus
- Generation Scotland, Centre for Genomics and Experimental Medicine, Institute for Genetics and Molecular Medicine, Western General Hospital, University of Edinburgh, Edinburgh EH4 2XU, UK; Institute for Genetics and Molecular Medicine, Western General Hospital, University of Edinburgh1, Edinburgh EH4 2XU, UK
| | - David J Porteous
- Generation Scotland, Centre for Genomics and Experimental Medicine, Institute for Genetics and Molecular Medicine, Western General Hospital, University of Edinburgh, Edinburgh EH4 2XU, UK; Institute for Genetics and Molecular Medicine, Western General Hospital, University of Edinburgh1, Edinburgh EH4 2XU, UK; Centre for Cognitive Ageing and Cognitive Epidemiology, University of Edinburgh, 7 George Square, EH8 9JZ, UK
| | - Andrew M McIntosh
- Division of Psychiatry, Royal Edinburgh Hospital, University of Edinburgh, Edinburgh EH10 5HF, UK; Centre for Cognitive Ageing and Cognitive Epidemiology, University of Edinburgh, 7 George Square, EH8 9JZ, UK
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94
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Turner S, Fielding S, Devereux G. First trimester fetal size and prescribed asthma medication at 15 years of age. Eur Respir J 2018; 51:51/2/1701509. [PMID: 29386348 DOI: 10.1183/13993003.01509-2017] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2017] [Accepted: 11/10/2017] [Indexed: 11/05/2022]
Abstract
There is increasing evidence that antenatal factors predispose to childhood asthma. We tested the hypothesis that reduced first trimester fetal size is associated with increased risk for asthma at 15 years of age.Fetal size in the first and second trimester was ascertained by ultrasound scan. The primary outcome of being dispensed one or more asthma medications by the family doctor in the year before the 15th birthday was determined from routinely acquired dispensing data.Dispensing data were available for 1699 (88% of the original cohort) participants at 15 years of age and questionnaire data for 750 (39%). Each reduction in z-score for first trimester size was associated with increased odds for dispensed asthma medication at 15 years of age (OR 1.26, 95% CI 1.03-1.54) and self-reported use of asthma medications (OR 1.55, 95% CI 1.16-2.08). Overall, first and second trimester size and forced expiratory volume in 1 s at ages 5, 10 and 15 years were reduced for those dispensed asthma medications compared with those not dispensed asthma medications (p=0.003).Antenatal factors that are active by the first trimester may contribute to respiratory well-being throughout childhood. Dropout from a birth cohort study can overestimate of the magnitude of any true association.
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Affiliation(s)
- Steve Turner
- Child Health, University of Aberdeen, Aberdeen, UK
| | - Shona Fielding
- Medical Statistics Team, Institute of Applied Health Sciences, University of Aberdeen, Aberdeen, UK
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95
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Kerr SM, Campbell A, Marten J, Vitart V, McIntosh AM, Porteous DJ, Hayward C. Electronic health record and genome-wide genetic data in Generation Scotland participants. Wellcome Open Res 2017; 2:85. [PMID: 29062915 PMCID: PMC5645708 DOI: 10.12688/wellcomeopenres.12600.1] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/17/2017] [Indexed: 12/26/2022] Open
Abstract
This article provides the first detailed demonstration of the research value of the Electronic Health Record (EHR) linked to research data in Generation Scotland Scottish Family Health Study (GS:SFHS) participants, together with how to access this data. The structured, coded variables in the routine biochemistry, prescribing and morbidity records, in particular, represent highly valuable phenotypic data for a genomics research resource. Access to a wealth of other specialized datasets, including cancer, mental health and maternity inpatient information, is also possible through the same straightforward and transparent application process. The EHR linked dataset is a key component of GS:SFHS, a biobank conceived in 1999 for the purpose of studying the genetics of health areas of current and projected public health importance. Over 24,000 adults were recruited from 2006 to 2011, with broad and enduring written informed consent for biomedical research. Consent was obtained from 23,603 participants for GS:SFHS study data to be linked to their Scottish National Health Service (NHS) records, using their Community Health Index number. This identifying number is used for NHS Scotland procedures (registrations, attendances, samples, prescribing and investigations) and allows healthcare records for individuals to be linked across time and location. Here, we describe the NHS EHR dataset on the sub-cohort of 20,032 GS:SFHS participants with consent and mechanism for record linkage plus extensive genetic data. Together with existing study phenotypes, including family history and environmental exposures, such as smoking, the EHR is a rich resource of real world data that can be used in research to characterise the health trajectory of participants, available at low cost and a high degree of timeliness, matched to DNA, urine and serum samples and genome-wide genetic information.
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Affiliation(s)
- Shona M Kerr
- MRC Human Genetics Unit, University of Edinburgh, Institute of Genetics and Molecular Medicine, Western General Hospital, Edinburgh, EH4 2XU, UK
| | - Archie Campbell
- Generation Scotland, Centre for Genomic and Experimental Medicine, University of Edinburgh, Institute of Genetics and Molecular Medicine, Western General Hospital, Edinburgh, EH4 2XU, UK
| | - Jonathan Marten
- MRC Human Genetics Unit, University of Edinburgh, Institute of Genetics and Molecular Medicine, Western General Hospital, Edinburgh, EH4 2XU, UK
| | - Veronique Vitart
- MRC Human Genetics Unit, University of Edinburgh, Institute of Genetics and Molecular Medicine, Western General Hospital, Edinburgh, EH4 2XU, UK
| | - Andrew M McIntosh
- Centre for Cognitive Ageing and Cognitive Epidemiology, Department of Psychology, University of Edinburgh, Edinburgh, EH8 9JZ, UK.,Division of Psychiatry, University of Edinburgh, Royal Edinburgh Hospital, Edinburgh, EH10 5HF, UK
| | - David J Porteous
- Generation Scotland, Centre for Genomic and Experimental Medicine, University of Edinburgh, Institute of Genetics and Molecular Medicine, Western General Hospital, Edinburgh, EH4 2XU, UK.,Medical Genetics Section, Centre for Genomic and Experimental Medicine, Institute of Genetics and Molecular Medicine, University of Edinburgh, Edinburgh, EH4 2XU, UK
| | - Caroline Hayward
- MRC Human Genetics Unit, University of Edinburgh, Institute of Genetics and Molecular Medicine, Western General Hospital, Edinburgh, EH4 2XU, UK
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96
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Mueller T, Alvarez-Madrazo S, Robertson C, Bennie M. Use of direct oral anticoagulants in patients with atrial fibrillation in Scotland: Applying a coherent framework to drug utilisation studies. Pharmacoepidemiol Drug Saf 2017; 26:1378-1386. [PMID: 28752670 PMCID: PMC5697642 DOI: 10.1002/pds.4272] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2016] [Revised: 05/12/2017] [Accepted: 06/15/2017] [Indexed: 12/22/2022]
Abstract
PURPOSE To report the use of direct oral anticoagulants (DOACs) for stroke prevention in patients with atrial fibrillation in Scotland and advocate the standardisation of drug utilisation research methods. METHODS Retrospective cohort study using linked administrative data. Patients included those with a diagnosis of atrial fibrillation (confirmed in hospital) who received a first prescription for a DOAC (dabigatran, rivaroxaban, or apixaban) from September 2011 to June 2014. Drug utilisation measures included discontinuation, persistence, and adherence. RESULTS A total of 5398 patients (mean CHA2 DS2 -VASc score 2.98 [SD 1.71], 89.7% with ≥5 concomitant medicines) were treated with DOACs for a median of 228 days (interquartile range 105-425). Of 35.6% who discontinued DOAC treatment, 11.0% switched to warfarin, and 48.3% reinitiated DOACs. Persistence after 12 and 18 months was 75.9% and 69.8%, respectively. Differences between individual DOACs were observed: Discontinuation rates ranged from 20.4% (apixaban) to 60.6% (dabigatran) and 12 months persistence from 60.1% (dabigatran) to 85.5% (apixaban). Adherence to treatment with all DOACs was good: Overall DOAC median medication refill adherence was 102.9% (interquartile range 88.9%-115.5%), and 82.3% of patients had a medication refill adherence > 80%. CONCLUSIONS In Scotland, adherence to DOAC treatment was good, and switching from DOAC to warfarin was low. However, discontinuation and persistence rates were variable-although treatment interruptions were often temporary. To decrease the inconsistencies in drug utilisation methods and facilitate meaningful study comparison, the use of a coherent framework-using a combination of discontinuation, persistence, and adherence-and the standardisation of measurements is advocated.
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Affiliation(s)
- Tanja Mueller
- Strathclyde Institute of Pharmacy and Biomedical Sciences, University of Strathclyde, Glasgow, UK
| | - Samantha Alvarez-Madrazo
- Strathclyde Institute of Pharmacy and Biomedical Sciences, University of Strathclyde, Glasgow, UK
| | - Chris Robertson
- Department of Mathematics and Statistics, University of Strathclyde, Glasgow, UK
| | - Marion Bennie
- Strathclyde Institute of Pharmacy and Biomedical Sciences, University of Strathclyde, Glasgow, UK.,Public Health and Intelligence Strategic Business Unit, NHS National Services Scotland, Edinburgh, UK
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97
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Kavanagh K, Pan J, Marwick C, Davey P, Wiuff C, Bryson S, Robertson C, Bennie M. Cumulative and temporal associations between antimicrobial prescribing and community-associated Clostridium difficile infection: population-based case-control study using administrative data. J Antimicrob Chemother 2017; 72:1193-1201. [PMID: 27999064 DOI: 10.1093/jac/dkw528] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2016] [Accepted: 11/10/2016] [Indexed: 12/11/2022] Open
Abstract
Background Community-associated Clostridium difficile infection (CA-CDI; defined as cases without prior hospitalization in the previous 12 weeks who were either tested outside of hospital or tested within 2 days of admission to hospital) is a major public health problem. This study estimates the magnitude of the association between temporal and cumulative prescribing of antimicrobials in primary care and CA-CDI. Methods Three national patient-level datasets, covering CDI cases, community prescriptions and hospitalizations, were linked by the NHS Scotland unique patient identifier, the Community Health Index (CHI). All validated cases of CDI from August 2010 to July 2013 were extracted and up to six population-based controls were matched to each case from the CHI register for Scotland. Statistical analysis used conditional logistic regression. Results The 1446 unique cases of CA-CDI were linked with 7964 age-, sex- and location-matched controls. Cumulative exposure to any antimicrobial in the previous 6 months has a monotonic dose-response association with CA-CDI. Individuals with more than 28 DDDs to any antimicrobial (19.9% of cases) had an OR of 4.4 (95% CI 3.4-5.6) compared with those unexposed. Individuals exposed to 29+ DDDs of high-risk antimicrobials (cephalosporins, clindamycin, co-amoxiclav or fluoroquinolones) had an OR of 17.9 (95% CI 7.6-42.2). Elevated CA-CDI risk following high-risk antimicrobial exposure was greatest in the first month (OR = 12.5, 95% CI 8.9-17.4), but was still present 4-6 months later (OR = 2.6, 95% CI 1.7-3.9). Cases exposed to 29+ DDDs had prescription patterns more consistent with repeated therapeutic courses, using different antimicrobials, than long-term prophylactic use. Conclusions This analysis demonstrated temporal and dose-response associations between CA-CDI risk and antimicrobials, with an impact of exposure to high-risk antimicrobials remaining 4-6 months later.
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Affiliation(s)
- Kimberley Kavanagh
- Department of Mathematics and Statistics, University of Strathclyde, Glasgow, UK
- Information Services Division, NHS National Services Scotland, Edinburgh, UK
| | - Jiafeng Pan
- Department of Mathematics and Statistics, University of Strathclyde, Glasgow, UK
| | - Charis Marwick
- Population Health Sciences, School of Medicine, University of Dundee, Dundee, UK
| | - Peter Davey
- Population Health Sciences, School of Medicine, University of Dundee, Dundee, UK
| | - Camilla Wiuff
- Health Protection Scotland, NHS National Services Scotland, Glasgow, UK
| | - Scott Bryson
- Strathclyde Institute of Pharmacy and Biomedical Sciences, University of Strathclyde, Glasgow, UK
| | - Chris Robertson
- Department of Mathematics and Statistics, University of Strathclyde, Glasgow, UK
- Health Protection Scotland, NHS National Services Scotland, Glasgow, UK
- International Prevention Research Institute, Lyon, France
| | - Marion Bennie
- Information Services Division, NHS National Services Scotland, Edinburgh, UK
- Strathclyde Institute of Pharmacy and Biomedical Sciences, University of Strathclyde, Glasgow, UK
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98
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Mc Menamin ÚC, Cardwell CR, Hughes CM, Murray LJ. Low-dose aspirin use and survival in breast cancer patients: A nationwide cohort study. Cancer Epidemiol 2017; 47:20-27. [PMID: 28088656 DOI: 10.1016/j.canep.2016.12.008] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2016] [Revised: 10/10/2016] [Accepted: 12/20/2016] [Indexed: 11/16/2022]
Abstract
BACKGROUND Preclinical evidence from breast cancer cell lines and animal models suggest that aspirin could have anti-cancer properties. In a large breast cancer patient cohort, we investigated whether post-diagnostic low-dose aspirin use was associated with a reduction in the risk of breast cancer-specific mortality. METHODS We identified 15,140 newly diagnosed breast cancer patients within the Scottish Cancer Registry. Linkages to the Scottish Prescribing Information System provided data on dispensed medications and breast cancer-specific deaths were identified from National Records of Scotland Death Records. Time-dependent Cox regression models were used to calculate hazard ratios (HR) and 95% CIs for breast cancer-specific and all-cause mortality by post-diagnostic low-dose aspirin use. HRs were adjusted for a range of potential confounders including age at diagnosis, year of diagnosis, cancer stage, grade, cancer treatments received, comorbidities, socioeconomic status and use of statins. Secondary analysis investigated the association between pre-diagnostic low-dose aspirin use and breast cancer-specific and all-cause mortality. RESULTS Post-diagnostic users of low-dose aspirin appeared to have increased breast cancer-specific mortality compared with non-users (HR 1.44, 95% CI 1.26, 1.65) but this association was entirely attenuated after adjustment for potential confounders (adjusted HR 0.92, 95% CI 0.75, 1.14). Findings were similar in analysis by increasing duration of use and in analysis of pre-diagnostic low-dose aspirin use. CONCLUSION In this large nationwide study of breast cancer patients, we found little evidence of an association between post-diagnostic low-dose aspirin use and cancer-specific mortality.
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Affiliation(s)
- Úna C Mc Menamin
- Cancer Epidemiology and Health Services Research Group, Centre for Public Health, Queen's University Belfast, Belfast, Northern Ireland, United Kingdom.
| | - Chris R Cardwell
- Cancer Epidemiology and Health Services Research Group, Centre for Public Health, Queen's University Belfast, Belfast, Northern Ireland, United Kingdom
| | - Carmel M Hughes
- School of Pharmacy, Queen's University Belfast, Northern Ireland, United Kingdom
| | - Liam J Murray
- Cancer Epidemiology and Health Services Research Group, Centre for Public Health, Queen's University Belfast, Belfast, Northern Ireland, United Kingdom; Centre of Excellence for Public Health (NI), Centre for Public Health, Queen's University Belfast, Belfast, Northern Ireland, United Kingdom
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99
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Gray RT, Coleman HG, Hughes C, Murray LJ, Cardwell CR. Statin use and survival in colorectal cancer: Results from a population-based cohort study and an updated systematic review and meta-analysis. Cancer Epidemiol 2016; 45:71-81. [PMID: 27750068 DOI: 10.1016/j.canep.2016.10.004] [Citation(s) in RCA: 53] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2016] [Revised: 09/19/2016] [Accepted: 10/03/2016] [Indexed: 12/13/2022]
Abstract
BACKGROUND The aim of this study was to investigate the association between statin use and survival in a population-based colorectal cancer (CRC) cohort and perform an updated meta-analysis to quantify the magnitude of any association. METHODS A cohort of 8391 patients with newly diagnosed Dukes' A-C CRC (2009-2012) was identified from the Scottish Cancer Registry. This cohort was linked to the Prescribing Information System and the National Records of Scotland Death Records (until January 2015) to identify 1064 colorectal cancer-specific deaths. Adjusted hazard ratios (HRs) and 95% confidence intervals (CIs) for cancer-specific mortality by statin use were calculated using time dependent Cox regression models. The systematic review included relevant studies published before January 2016. Meta-analysis techniques were used to derive combined HRs for associations between statin use and cancer-specific and overall mortality. RESULTS In the Scottish cohort, statin use before diagnosis (HR=0.84, 95% CI 0.75-0.94), but not after (HR=0.90, 95% CI 0.77-1.05), was associated with significantly improved cancer-specific mortality. The systematic review identified 15 relevant studies. In the meta-analysis, there was consistent (I2=0%,heterogeneity P=0.57) evidence of a reduction in cancer-specific mortality with statin use before diagnosis in 6 studies (n=86,622, pooled HR=0.82, 95% CI 0.79-0.86) but this association was less apparent and more heterogeneous (I2=67%,heterogeneity P=0.03) with statin use after diagnosis in 4 studies (n=19,152, pooled HR=0.84, 95% CI 0.68-1.04). CONCLUSION In a Scottish CRC cohort and updated meta-analysis there was some evidence that statin use was associated with improved survival. However, these associations were weak in magnitude and, particularly for post-diagnosis use, varied markedly between studies.
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Affiliation(s)
- Ronan T Gray
- Cancer Epidemiology and Health Services Research Group, Centre for Public Health, Queen's University Belfast, Royal Victoria Hospital, Belfast BT12 6BA, Northern Ireland, UK.
| | - Helen G Coleman
- Cancer Epidemiology and Health Services Research Group, Centre for Public Health, Queen's University Belfast, Royal Victoria Hospital, Belfast BT12 6BA, Northern Ireland, UK
| | - Carmel Hughes
- School of Pharmacy, Queen's University Belfast, 97 Lisburn Road, Belfast BT9 7BL, Northern Ireland, UK
| | - Liam J Murray
- Cancer Epidemiology and Health Services Research Group, Centre for Public Health, Queen's University Belfast, Royal Victoria Hospital, Belfast BT12 6BA, Northern Ireland, UK
| | - Chris R Cardwell
- Cancer Epidemiology and Health Services Research Group, Centre for Public Health, Queen's University Belfast, Royal Victoria Hospital, Belfast BT12 6BA, Northern Ireland, UK
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100
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Cardwell CR, Pottegård A, Vaes E, Garmo H, Murray LJ, Brown C, Vissers PAJ, O’Rorke M, Visvanathan K, Cronin-Fenton D, De Schutter H, Lambe M, Powe DG, van Herk-Sukel MPP, Gavin A, Friis S, Sharp L, Bennett K. Propranolol and survival from breast cancer: a pooled analysis of European breast cancer cohorts. Breast Cancer Res 2016; 18:119. [PMID: 27906047 PMCID: PMC5133766 DOI: 10.1186/s13058-016-0782-5] [Citation(s) in RCA: 33] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2016] [Accepted: 11/17/2016] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Preclinical studies have demonstrated that propranolol inhibits several pathways involved in breast cancer progression and metastasis. We investigated whether breast cancer patients who used propranolol, or other non-selective beta-blockers, had reduced breast cancer-specific or all-cause mortality in eight European cohorts. METHODS Incident breast cancer patients were identified from eight cancer registries and compiled through the European Cancer Pharmacoepidemiology Network. Propranolol and non-selective beta-blocker use was ascertained for each patient. Breast cancer-specific and all-cause mortality were available for five and eight cohorts, respectively. Cox regression models were used to calculate hazard ratios (HR) and 95% confidence intervals (CIs) for cancer-specific and all-cause mortality by propranolol and non-selective beta-blocker use. HRs were pooled across cohorts using meta-analysis techniques. Dose-response analyses by number of prescriptions were also performed. Analyses were repeated investigating propranolol use before cancer diagnosis. RESULTS The combined study population included 55,252 and 133,251 breast cancer patients in the analysis of breast cancer-specific and all-cause mortality respectively. Overall, there was no association between propranolol use after diagnosis of breast cancer and breast cancer-specific or all-cause mortality (fully adjusted HR = 0.94, 95% CI, 0.77, 1.16 and HR = 1.09, 95% CI, 0.93, 1.28, respectively). There was little evidence of a dose-response relationship. There was also no association between propranolol use before breast cancer diagnosis and breast cancer-specific or all-cause mortality (fully adjusted HR = 1.03, 95% CI, 0.86, 1.22 and HR = 1.02, 95% CI, 0.94, 1.10, respectively). Similar null associations were observed for non-selective beta-blockers. CONCLUSIONS In this large pooled analysis of breast cancer patients, use of propranolol or non-selective beta-blockers was not associated with improved survival.
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Affiliation(s)
- Chris R. Cardwell
- Institute of Clinical Sciences Block B, Centre for Public Health, Queen’s University Belfast, Royal Victoria Hospital, Belfast, BT12 6BA UK
| | - Anton Pottegård
- Department of Public Health, University of South Denmark, Odense, Denmark
| | - Evelien Vaes
- Research Department, Belgian Cancer Registry, Brussels, Belgium
| | - Hans Garmo
- Division of Cancer Studies, Cancer Epidemiology Unit, King’s College London, London, UK
- Regional Cancer Centre Uppsala-Örebro, Uppsala, Sweden
| | - Liam J. Murray
- Institute of Clinical Sciences Block B, Centre for Public Health, Queen’s University Belfast, Royal Victoria Hospital, Belfast, BT12 6BA UK
| | - Chris Brown
- National Cancer Registry Ireland, Cork, Ireland
| | | | - Michael O’Rorke
- Institute of Clinical Sciences Block B, Centre for Public Health, Queen’s University Belfast, Royal Victoria Hospital, Belfast, BT12 6BA UK
| | - Kala Visvanathan
- Johns Hopkins University Bloomberg School of Public Health and School of Medicine, Baltimore, USA
| | | | | | - Mats Lambe
- Regional Cancer Centre Uppsala-Örebro, Uppsala, Sweden
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden
| | - Des G. Powe
- Department of Cellular Pathology, Queens Medical Centre, NUH, Nottingham, UK
| | | | - Anna Gavin
- Institute of Clinical Sciences Block B, Centre for Public Health, Queen’s University Belfast, Royal Victoria Hospital, Belfast, BT12 6BA UK
- Northern Ireland Cancer Registry, Queen’s University Belfast, Belfast, UK
| | - Søren Friis
- Danish Cancer Society Research Center, Danish Cancer Society, Copenhagen, Denmark
| | - Linda Sharp
- Institute of Health and Society, Newcastle University, Newcastle upon Tyne, UK
| | - Kathleen Bennett
- Department of Pharmacology & Therapeutics, Trinity College Dublin, Dublin, Ireland
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