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Dissanayake AS, Burrows E, Ho KM, Phillips TJ, Honeybul S, Hankey GJ. Rebleeding following aneurysmal subarachnoid hemorrhage before 'endovascular first' treatment: a retrospective case-control study of published scoring systems. J Neurointerv Surg 2024; 16:498-505. [PMID: 37316197 DOI: 10.1136/jnis-2023-020390] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2023] [Accepted: 05/31/2023] [Indexed: 06/16/2023]
Abstract
BACKGROUND Pre-treatment re-bleeding following aneurysmal subarachnoid hemorrhage (aSAH) affects up to 7.2% of patients even with ultra-early treatment within 24 hours. We retrospectively compared the utility of three published re-bleed prediction models and individual predictors between cases who re-bled matched to controls using size and parent vessel location from a cohort of patients treated in an ultra-early, 'endovascular first' manner. METHODS On retrospective analysis of our 9-year cohort of 707 patients suffering 710 episodes of aSAH, there were 53 episodes of pre-treatment re-bleeding (7.5%). Forty-seven cases who had a single culprit aneurysm were matched to 141 controls. Demographic, clinical and radiological data were extracted and predictive scores calculated. Univariate, multivariate, area under the receiver operator characteristic curve (AUROCC) and Kaplan-Meier (KM) survival curve analyses were performed. RESULTS The majority of patients (84%) were treated using endovascular techniques at a median 14.5 hours post-diagnosis. On AUROCC analysis the score of Liu et al. had minimal utility (C-statistic 0.553, 95% confidence interval (CI) 0.463 to 0.643) while the risk score of Oppong et al. (C-statistic 0.645 95% CI 0.558 to 0.732) and the ARISE-extended score of van Lieshout et al. (C-statistic 0.53 95% CI 0.562 to 0.744) had moderate utility. On multivariate modeling, the World Federation of Neurosurgical Societies (WFNS) grade was the most parsimonious predictor of re-bleeding (C-statistic 0.740, 95% CI 0.664 to 0.816). CONCLUSIONS For aSAH patients treated in an ultra-early timeframe matched on size and parent vessel location, WFNS grade was superior to three published models for re-bleed prediction. Future re-bleed prediction models should incorporate the WFNS grade.
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Affiliation(s)
- Arosha S Dissanayake
- Department of Neurosurgery, Sir Charles Gairdner Hospital, Nedlands, Perth, Western Australia, Australia
| | - Emalee Burrows
- Department of Neurosurgery, Sir Charles Gairdner Hospital, Nedlands, Perth, Western Australia, Australia
| | - Kwok M Ho
- Department of Intensive Care Medicine, Royal Perth Hospital, Perth, Western Australia, Australia
| | - Timothy J Phillips
- Neurological Intervention and Imaging Service of Western Australia, Sir Charles Gairdner Hospital, Nedlands, Western Australia, Australia
| | - Stephen Honeybul
- Department of Neurosurgery, Sir Charles Gairdner Hospital, Nedlands, Perth, Western Australia, Australia
| | - Graeme J Hankey
- School of Medicine, The University of Western Australia, Perth, Western Australia, Australia
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2
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Takeuchi Y, Hagiwawa Y, Komukai S, Matsuyama Y. Estimation of the causal effects of time-varying treatments in nested case-control studies using marginal structural Cox models. Biometrics 2024; 80:ujae005. [PMID: 38465985 DOI: 10.1093/biomtc/ujae005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2022] [Revised: 10/30/2023] [Accepted: 01/22/2024] [Indexed: 03/12/2024]
Abstract
When estimating the causal effects of time-varying treatments on survival in nested case-control (NCC) studies, marginal structural Cox models (Cox-MSMs) with inverse probability weights (IPWs) are a natural approach. However, calculating IPWs from the cases and controls is difficult because they are not random samples from the full cohort, and the number of subjects may be insufficient for calculation. To overcome these difficulties, we propose a method for calculating IPWs to fit Cox-MSMs to NCC sampling data. We estimate the IPWs using a pseudo-likelihood estimation method with an inverse probability of sampling weight using NCC samples, and additional samples of subjects who experience treatment changes and subjects whose follow-up is censored are required to calculate the weights. Our method only requires covariate histories for the samples. The confidence intervals are calculated from the robust variance estimator for the NCC sampling data. We also derive the asymptotic properties of the estimator of Cox-MSM under NCC sampling. The proposed methods will allow researchers to apply several case-control matching methods to improve statistical efficiency. A simulation study was conducted to evaluate the finite sample performance of the proposed method. We also applied our method to a motivating pharmacoepidemiological study examining the effect of statins on the incidence of coronary heart disease. The proposed method may be useful for estimating the causal effects of time-varying treatments in NCC studies.
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Affiliation(s)
- Yoshinori Takeuchi
- Department of Biostatistics, School of Public Health, Graduate School of Medicine, The University of Tokyo, Bunkyo-ku, Tokyo 113-0033, Japan
- Division of Medical Statistics, Department of Social Medicine, Faculty of Medicine, Toho University, Ota-ku, Tokyo 143-8540, Japan
| | - Yasuhiro Hagiwawa
- Department of Biostatistics, School of Public Health, Graduate School of Medicine, The University of Tokyo, Bunkyo-ku, Tokyo 113-0033, Japan
| | - Sho Komukai
- Department of Biomedical Statistics, Graduate School of Medicine, Osaka University, Suita-shi, Osaka 565-0871, Japan
| | - Yutaka Matsuyama
- Department of Biostatistics, School of Public Health, Graduate School of Medicine, The University of Tokyo, Bunkyo-ku, Tokyo 113-0033, Japan
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3
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Manitchoko L, Abrahamowicz M, Tubert-Bitter P, Benichou J, Thiébaut ACM. Comparison of cohort and nested case-control designs for estimating the effect of time-varying drug exposure on the risk of adverse event in the presence of ties. Biom J 2023:e2100384. [PMID: 36846937 DOI: 10.1002/bimj.202100384] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2021] [Revised: 08/12/2022] [Accepted: 10/20/2022] [Indexed: 03/01/2023]
Abstract
Cohort and nested case-control (NCC) designs are frequently used in pharmacoepidemiology to assess the associations of drug exposure that can vary over time with the risk of an adverse event. Although it is typically expected that estimates from NCC analyses are similar to those from the full cohort analysis, with moderate loss of precision, only few studies have actually compared their respective performance for estimating the effects of time-varying exposures (TVE). We used simulations to compare the properties of the resulting estimators of these designs for both time-invariant exposure and TVE. We varied exposure prevalence, proportion of subjects experiencing the event, hazard ratio, and control-to-case ratio and considered matching on confounders. Using both designs, we also estimated the real-world associations of time-invariant ever use of menopausal hormone therapy (MHT) at baseline and updated, time-varying MHT use with breast cancer incidence. In all simulated scenarios, the cohort-based estimates had small relative bias and greater precision than the NCC design. NCC estimates displayed bias to the null that decreased with a greater number of controls per case. This bias markedly increased with higher proportion of events. Bias was seen with Breslow's and Efron's approximations for handling tied event times but was greatly reduced with the exact method or when NCC analyses were matched on confounders. When analyzing the MHT-breast cancer association, differences between the two designs were consistent with simulated data. Once ties were taken correctly into account, NCC estimates were very similar to those of the full cohort analysis.
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Affiliation(s)
- Liliane Manitchoko
- Université Paris-Saclay, UVSQ, Inserm, CESP, High Dimensional Biostatistics for Drug Safety and Genomics, Villejuif, France
| | - Michal Abrahamowicz
- Department of Epidemiology, Biostatistics and Occupational Health, McGill University, Montreal, Canada
| | - Pascale Tubert-Bitter
- Université Paris-Saclay, UVSQ, Inserm, CESP, High Dimensional Biostatistics for Drug Safety and Genomics, Villejuif, France
| | - Jacques Benichou
- Université Paris-Saclay, UVSQ, Inserm, CESP, High Dimensional Biostatistics for Drug Safety and Genomics, Villejuif, France.,Department of Biostatistics, Rouen University Hospital, Rouen, France
| | - Anne C M Thiébaut
- Université Paris-Saclay, UVSQ, Inserm, CESP, High Dimensional Biostatistics for Drug Safety and Genomics, Villejuif, France
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4
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Peters BA, Moon JY, Hanna DB, Kutsch O, Fischl M, Moran CA, Adimora AA, Gange S, Roan NR, Michel KG, Augenbraun M, Sharma A, Landay A, Desai S, Kaplan RC. T-Cell Immune Dysregulation and Mortality in Women With Human Immunodeficiency Virus. J Infect Dis 2022; 225:675-685. [PMID: 34448873 PMCID: PMC8844590 DOI: 10.1093/infdis/jiab433] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2021] [Accepted: 08/25/2021] [Indexed: 01/25/2023] Open
Abstract
SUMMARY In women with HIV, higher activation and exhaustion of CD4+ T cells were associated with risk of non-HIV-related mortality during a median of 13.3 years of follow-up, independent of baseline demographic, behavioral, HIV-related, and cardiometabolic factors and longitudinal HIV disease progression. BACKGROUND Dysregulation of adaptive immunity is a hallmark of human immunodeficiency virus (HIV) infection that persists on antiretroviral therapy (ART). Few long-term prospective studies have related adaptive immunity impairments to mortality in HIV, particularly in women. METHODS Among 606 women with HIV in the Women's Interagency HIV Study, peripheral blood mononuclear cells collected from 2002 to 2005 underwent multiparameter flow cytometry. Underlying cause of death was ascertained from the National Death Index up to 2018. We examined associations of CD4+ and CD8+ T-cell activation (%CD38+HLA-DR+), senescence (%CD57+CD28-), exhaustion (%PD-1+), and nonactivation/normal function (%CD57-CD28+) with natural-cause, HIV-related, and non-HIV-related mortality. RESULTS At baseline, median participant age was 41, and 67% were on ART. Among 100 deaths during a median of 13.3 years follow-up, 90 were natural-cause (53 non-HIV-related, 37 HIV-related). Higher activation and exhaustion of CD4+ T cells were associated with risk of natural-cause and non-HIV-related mortality, adjusting for age, demographic, behavioral, HIV-related, and cardiometabolic factors at baseline. Additional adjustment for time-varying viral load and CD4+ T-cell count did not attenuate these associations. CD8+ T-cell markers were not associated with any outcomes adjusting for baseline factors. CONCLUSIONS Persistent CD4+ T-cell activation and exhaustion may contribute to excess long-term mortality risk in women with HIV, independent of HIV disease progression.
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Affiliation(s)
- Brandilyn A Peters
- Department of Epidemiology and Population Health, Albert Einstein College of Medicine, Bronx, New York, USA
| | - Jee-Young Moon
- Department of Epidemiology and Population Health, Albert Einstein College of Medicine, Bronx, New York, USA
| | - David B Hanna
- Department of Epidemiology and Population Health, Albert Einstein College of Medicine, Bronx, New York, USA
| | - Olaf Kutsch
- Department of Medicine, University of Alabama at Birmingham, Birmingham, Alabama, USA
| | - Margaret Fischl
- Department of Medicine, University of Miami Miller School of Medicine, Miami, Florida, USA
| | - Caitlin A Moran
- Department of Medicine, Emory University School of Medicine, Atlanta, Georgia, USA
| | - Adaora A Adimora
- Department of Medicine, School of Medicine, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
| | - Stephen Gange
- Department of Epidemiology, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, Maryland, USA
| | - Nadia R Roan
- Department of Urology, University of California, San Francisco, California, USA
| | - Katherine G Michel
- Department of Medicine, Georgetown University, Washington, District of Columbia, USA
| | - Michael Augenbraun
- Department of Medicine, State University of New York Downstate Medical Center, Brooklyn, New York, USA
| | - Anjali Sharma
- Department of Medicine, Albert Einstein College of Medicine, Bronx, New York, USA
| | - Alan Landay
- Rush University Medical Center, Chicago, Illinois, USA
| | - Seema Desai
- Rush University Medical Center, Chicago, Illinois, USA
| | - Robert C Kaplan
- Department of Epidemiology and Population Health, Albert Einstein College of Medicine, Bronx, New York, USA.,Public Health Sciences Division, Fred Hutchinson Cancer Research Center, Seattle, Washington, USA
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5
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Liao KM, Huang YB, Chen CY, Kuo CC. Risk of ischemic stroke in patients with prostate cancer receiving androgen deprivation therapy in Taiwan. BMC Cancer 2019; 19:1263. [PMID: 31888558 PMCID: PMC6937911 DOI: 10.1186/s12885-019-6487-2] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2019] [Accepted: 12/20/2019] [Indexed: 11/11/2022] Open
Abstract
Background Androgen deprivation therapy (ADT) in the treatment of prostate cancer may be associated with an increased risk of thromboembolic disease. The aim of our study was to investigate the association of ADT in the treatment of prostate cancer with ischemic stroke risk. Methods We identified individuals older than 20 years of age who were newly diagnosed with prostate cancer between January 1, 2005, and December 31, 2012. Patients who experienced ischemic stroke or transient ischemic stroke before the index date were excluded. Patients who received at least one prescription for ADT within 6 months were defined as the ADT user group. Patients who did not receive at least one prescription for ADT within 6 months were defined as the ADT nonuser group. The patients were followed until the first occurrence of one of the primary outcome measures (ischemic stroke or death) or until December 31, 2013. The primary composite outcome was the time to any cause of death or ischemic stroke. Results There was no significant difference in the primary composite outcomes in the prostate cancer patients between the ADT user and nonuser groups. Prostate cancer patients who received ADT had a higher mortality rate than those who were not treated with ADT, and the adjusted hazard ratio was 1.907 (95% confidence interval: 1.278–2.844; P = 0.0016) after adjusting for age, comorbidities and comedication use. Conclusion ADT in the treatment of prostate cancer may not be associated with an increased risk of ischemic stroke. The differences in thromboembolic effects in cardiovascular disease and ischemic stroke secondary to ADT should be further discussed and evaluated prospectively.
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Affiliation(s)
- Kuang-Ming Liao
- Department of Internal Medicine, Chi Mei Medical Center, Chiali, Taiwan
| | - Yaw-Bin Huang
- School of Pharmacy, Master Program in Clinical Pharmacy, Kaohsiung Medical University, No. 100, Shihcyuan 1st Rd., Sanmin District, Kaohsiung City, 80708, Taiwan, Republic of China.,Department of Pharmacy, Kaohsiung Medical University Hospital, Kaohsiung, Taiwan
| | - Chung-Yu Chen
- School of Pharmacy, Master Program in Clinical Pharmacy, Kaohsiung Medical University, No. 100, Shihcyuan 1st Rd., Sanmin District, Kaohsiung City, 80708, Taiwan, Republic of China. .,Department of Pharmacy, Kaohsiung Medical University Hospital, Kaohsiung, Taiwan. .,Department of Medical Research, Kaohsiung Medical University Hospital, Kaohsiung, Taiwan.
| | - Chen-Chun Kuo
- Department of Pharmacy, Kaohsiung Medical University Hospital, Kaohsiung, Taiwan
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6
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Wang J, Su K, Sang W, Li L, Ma S. Thiazide Diuretics and the Incidence of Osteoporotic Fracture: A Systematic Review and Meta-Analysis of Cohort Studies. Front Pharmacol 2019; 10:1364. [PMID: 31824314 PMCID: PMC6881387 DOI: 10.3389/fphar.2019.01364] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2019] [Accepted: 10/28/2019] [Indexed: 01/29/2023] Open
Abstract
Background: Thiazide diuretics may improve bone mineral density. However, results are inconsistent for studies evaluating the association between thiazides and risk of osteoporotic fracture. We performed an updated meta-analysis of cohort studies to determine the association between thiazides use and fracture risk. Methods: Relevant studies were identified via systematic search of PubMed and Embase. A random-effect model was used for meta-analysis. Subgroup analyses were performed to explore the potential influences of study characteristics on the outcome. Results: Seventeen cohort studies with 3,537,504 participants were included. The pooled results showed that use of thiazide diuretics at baseline did not significantly affect the risk of overall osteoporotic fracture incidence as compared with controls (risk ratio [RR]: 0.96, 95% confidence interval [CI]: 0.83 to 1.09, p = 0.51) with significant heterogeneity (p for Cochrane’s Q test < 0.001, I2 = 90%). Results of subgroup analyses indicated that general status of the participants may be an important determinant for the association between thiazide diuretics and subsequent risk of osteoporotic fracture. Use of thiazide diuretics was associated with significantly reduced risk of fracture in patients with acute status including new-onset stroke or spinal cord injury (RR: 0.70, 95% CI: 0.57 to 0.86, p < 0.001), but not in those with good conditions such as community-dwelling population or hypertensive patients (p for subgroup difference = 0.02). Conclusions: Use of thiazide diuretics is not associated with significantly affected risk of overall osteoporotic fracture. However, the association may be different according to the general status of the participants.
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Affiliation(s)
- Jun Wang
- The Second Department of Orthopedics, Cangzhou Central Hospital, Cangzhou, China
| | - Ke Su
- The Second Department of Orthopedics, Cangzhou Central Hospital, Cangzhou, China
| | - Weihua Sang
- The Second Department of Orthopedics, Cangzhou Central Hospital, Cangzhou, China
| | - Longjie Li
- The Second Department of Orthopedics, Cangzhou Central Hospital, Cangzhou, China
| | - Shiyun Ma
- The Second Department of Orthopedics, Cangzhou Central Hospital, Cangzhou, China
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7
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Smischney NJ. Predictors of hemodynamic derangement during intubation in the critically ill: A nested case-control study of hemodynamic management – Part II. J Crit Care 2017; 42:374. [DOI: 10.1016/j.jcrc.2017.10.030] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2017] [Accepted: 10/22/2017] [Indexed: 11/17/2022]
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8
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Horton DB, Scott FI, Haynes K, Putt ME, Rose CD, Lewis JD, Strom BL. Antibiotic Exposure, Infection, and the Development of Pediatric Psoriasis: A Nested Case-Control Study. JAMA Dermatol 2016; 152:191-9. [PMID: 26560335 DOI: 10.1001/jamadermatol.2015.3650] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/28/2023]
Abstract
IMPORTANCE Antibiotics disrupt human microbiota and have been associated with several pediatric autoimmune diseases. Psoriasis activity has been linked to group A streptococcal and viral infections. OBJECTIVE To determine whether antibiotic exposure and infections are independently associated with incident psoriasis in children. DESIGN, SETTING, AND PARTICIPANTS This nested case-control study used data from the Health Improvement Network database, a population-representative electronic health records database from the United Kingdom, from June 27, 1994, through January 15, 2013. Data were analyzed from September 17, 2014, through August 12, 2015. Children aged 1 to 15 years with newly diagnosed psoriasis (n = 845) were compared with age- and sex-matched controls (n = 8450) randomly chosen at the time of psoriasis diagnosis from general practices with at least one case, excluding children with immunodeficiency, inflammatory bowel disease, and juvenile arthritis. EXPOSURES Systemic antibacterial prescriptions and infections of the skin and other sites within 2 years before psoriasis diagnosis. MAIN OUTCOMES AND MEASURES Incident psoriasis as determined by validated diagnostic codes. The association of antibiotic exposure and infections with incident psoriasis was determined by conditional logistic regression, adjusting for confounders. RESULTS After adjusting for matching, country, socioeconomic deprivation, outpatient visits, and infections within the past 2 years, antibiotic exposure in the last 2 years was weakly associated with incident psoriasis (adjusted odds ratio [aOR], 1.2; 95% CI, 1.0-1.5). The associations for infections of skin (aOR, 1.5; 95% CI, 1.2-1.7) and other sites (aOR, 1.3; 95% CI, 1.1-1.6) were similar. Untreated nonskin infections (aOR, 1.5; 95% CI, 1.3-1.8) but not antibiotic-treated nonskin infections (aOR, 1.1; 95% CI, 0.9-1.4) were associated with psoriasis. Results were similar when using a lifetime exposure window. Different classes of antibiotics and age of first antibiotic exposure were also not associated with psoriasis. The findings did not substantively change when excluding periods of varying length before diagnosis. CONCLUSIONS AND RELEVANCE Infections are associated with the development of pediatric psoriasis, but antibiotics do not appear to contribute substantially to that risk.
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Affiliation(s)
- Daniel B Horton
- Center for Clinical Epidemiology and Biostatistics, Perelman School of Medicine, University of Pennsylvania, Philadelphia2Division of Rheumatology, Nemours A.I. duPont Hospital for Children, Thomas Jefferson University, Wilmington, Delaware3Rutgers Biomed
| | - Frank I Scott
- Center for Clinical Epidemiology and Biostatistics, Perelman School of Medicine, University of Pennsylvania, Philadelphia4Division of Gastroenterology, Hospital of the University of Pennsylvania, Philadelphia
| | - Kevin Haynes
- Center for Clinical Epidemiology and Biostatistics, Perelman School of Medicine, University of Pennsylvania, Philadelphia5Clinical Epidemiology, HealthCore, Wilmington, Delaware
| | - Mary E Putt
- Center for Clinical Epidemiology and Biostatistics, Perelman School of Medicine, University of Pennsylvania, Philadelphia
| | - Carlos D Rose
- Division of Rheumatology, Nemours A.I. duPont Hospital for Children, Thomas Jefferson University, Wilmington, Delaware
| | - James D Lewis
- Center for Clinical Epidemiology and Biostatistics, Perelman School of Medicine, University of Pennsylvania, Philadelphia4Division of Gastroenterology, Hospital of the University of Pennsylvania, Philadelphia
| | - Brian L Strom
- Center for Clinical Epidemiology and Biostatistics, Perelman School of Medicine, University of Pennsylvania, Philadelphia3Rutgers Biomedical and Health Sciences, Child Health Institute of New Jersey, New Brunswick
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9
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Laurens KR, Luo L, Matheson SL, Carr VJ, Raudino A, Harris F, Green MJ. Common or distinct pathways to psychosis? A systematic review of evidence from prospective studies for developmental risk factors and antecedents of the schizophrenia spectrum disorders and affective psychoses. BMC Psychiatry 2015; 15:205. [PMID: 26302744 PMCID: PMC4548447 DOI: 10.1186/s12888-015-0562-2] [Citation(s) in RCA: 80] [Impact Index Per Article: 8.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/21/2015] [Accepted: 07/14/2015] [Indexed: 01/28/2023] Open
Abstract
BACKGROUND Identifying the unique and shared premorbid indicators of risk for the schizophrenia spectrum disorders (SSD) and affective psychoses (AP) may refine aetiological hypotheses and inform the delivery of universal versus targeted preventive interventions. This systematic review synthesises the available evidence concerning developmental risk factors and antecedents of SSD and AP to identify those with the most robust support, and to highlight remaining evidence gaps. METHODS A systematic search of prospective birth, population, high-risk, and case-control cohorts was conducted in Medline and supplemented by hand searching, incorporating published studies in English with full text available. Inclusion/exclusion decisions and data extraction were completed in duplicate. Exposures included three categories of risk factors and four categories of antecedents, with case and comparison groups defined by adult psychiatric diagnosis. Effect sizes and prevalence rates were extracted, where available, and the strength of evidence synthesised and evaluated qualitatively across the study designs. RESULTS Of 1775 studies identified by the search, 127 provided data to the review. Individuals who develop SSD experience a diversity of subtle premorbid developmental deficits and risk exposures, spanning the prenatal period through early adolescence. Those of greatest magnitude (or observed most consistently) included obstetric complications, maternal illness during pregnancy (especially infections), other maternal physical factors, negative family emotional environment, psychopathology and psychotic symptoms, and cognitive and motor dysfunctions. Relatively less evidence has accumulated to implicate this diversity of exposures in AP, and many yet remain unexamined, with the most consistent or strongest evidence to date being for obstetric complications, psychopathology, cognitive indicators and motor dysfunction. Among the few investigations affording direct comparison between SSD and AP, larger effect sizes and a greater number of significant associations are commonly reported for SSD relative to AP. CONCLUSIONS Shared risk factors for SSD and AP may include obstetric complications, childhood psychopathology, cognitive markers and motor dysfunction, but the capacity to distinguish common versus distinct risk factors/antecedents for SSD and AP is limited by the scant availability of prospective data for AP, and inconsistency in replication. Further studies considering both diagnoses concurrently are needed. Nonetheless, the prevalence of the risk factors/antecedents observed in cases and controls helps demarcate potential targets for preventative interventions for these disorders.
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Affiliation(s)
- Kristin R. Laurens
- Research Unit for Schizophrenia Epidemiology, School of Psychiatry, University of New South Wales, Sydney, Australia ,Schizophrenia Research Institute, Sydney, Australia ,Department of Forensic and Neurodevelopmental Sciences, Institute of Psychiatry, Psychology & Neuroscience, King’s College London, London, UK ,Black Dog Institute, Prince of Wales Hospital, Sydney, Australia
| | - Luming Luo
- Research Unit for Schizophrenia Epidemiology, School of Psychiatry, University of New South Wales, Sydney, Australia. .,Schizophrenia Research Institute, Sydney, Australia.
| | - Sandra L. Matheson
- Research Unit for Schizophrenia Epidemiology, School of Psychiatry, University of New South Wales, Sydney, Australia ,Schizophrenia Research Institute, Sydney, Australia
| | - Vaughan J. Carr
- Research Unit for Schizophrenia Epidemiology, School of Psychiatry, University of New South Wales, Sydney, Australia ,Schizophrenia Research Institute, Sydney, Australia ,Department of Psychiatry, Monash University, Melbourne, Australia
| | - Alessandra Raudino
- Research Unit for Schizophrenia Epidemiology, School of Psychiatry, University of New South Wales, Sydney, Australia. .,Schizophrenia Research Institute, Sydney, Australia.
| | - Felicity Harris
- Research Unit for Schizophrenia Epidemiology, School of Psychiatry, University of New South Wales, Sydney, Australia. .,Schizophrenia Research Institute, Sydney, Australia.
| | - Melissa J. Green
- Research Unit for Schizophrenia Epidemiology, School of Psychiatry, University of New South Wales, Sydney, Australia ,Schizophrenia Research Institute, Sydney, Australia ,Black Dog Institute, Prince of Wales Hospital, Sydney, Australia ,Neuroscience Research Australia, Sydney, Australia
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10
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Sutradhar R, Baxter NN, Austin PC. Terminating observation within matched pairs of subjects in a matched cohort analysis: a Monte Carlo simulation study. Stat Med 2015; 35:294-304. [PMID: 26278725 DOI: 10.1002/sim.6621] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2014] [Revised: 06/15/2015] [Accepted: 07/23/2015] [Indexed: 01/06/2023]
Abstract
Matched cohort analyses are becoming increasingly popular for estimating treatment effects in observational studies. However, in the applied biomedical literature, analysts and authors are inconsistent regarding whether to terminate follow-up among members of a matched set once one member is no longer under observation. This paper focused on time-to-event outcomes and used Monte Carlo simulation methods to determine the optimal approach. We found that the bias of the estimated treatment effect estimate was negligible under both approaches and that the percentage of censoring had no discernible effect on the magnitude of bias. The mean model-based standard error of the treatment estimate was consistently higher when we terminated observation within matched pairs. Furthermore, the type 1 error rate was consistently lower when we did not terminate follow-up within matched pairs. In conclusion, when the focus was on time-to-event outcomes, we demonstrated that there was no advantage to terminating follow-up within matched pairs. Continuing follow-up on each subject until their observation was naturally complete was superior compared with terminating a subject's observation time once its matched pair had ceased to be under observation. Given the frequency with which these analyses are conducted in the applied literature, our results provide important guidance to analysts and applied researchers as to the preferred analytic approach.
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Affiliation(s)
- Rinku Sutradhar
- Institute for Clinical Evaluative Sciences, Toronto, Canada.,Institute of Health Policy, Management, and Evaluation, University of Toronto, Toronto, Canada.,Department of Biostatistics, Dalla Lana School of Public Health, University of Toronto, Toronto, Canada
| | - Nancy N Baxter
- Institute for Clinical Evaluative Sciences, Toronto, Canada.,Institute of Health Policy, Management, and Evaluation, University of Toronto, Toronto, Canada.,Department of Surgery and Keenan Research Centre, Li Ka Shing Knowledge Institute, St. Michael's Hospital, University of Toronto, Toronto, Canada
| | - Peter C Austin
- Institute for Clinical Evaluative Sciences, Toronto, Canada.,Institute of Health Policy, Management, and Evaluation, University of Toronto, Toronto, Canada
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11
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Horton DB, Scott FI, Haynes K, Putt ME, Rose CD, Lewis JD, Strom BL. Antibiotic Exposure and Juvenile Idiopathic Arthritis: A Case-Control Study. Pediatrics 2015; 136. [PMID: 26195533 PMCID: PMC4516942 DOI: 10.1542/peds.2015-0036] [Citation(s) in RCA: 95] [Impact Index Per Article: 10.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
BACKGROUND AND OBJECTIVE Recent evidence has linked childhood antibiotic use and microbiome disturbance to autoimmune conditions. This study tested the hypothesis that antibiotic exposure was associated with newly diagnosed juvenile idiopathic arthritis (JIA). METHODS We performed a nested case-control study in a population-representative medical records database from the United Kingdom. Children with newly diagnosed JIA were compared with age- and gender-matched control subjects randomly selected from general practices containing at least 1 case, excluding those with inflammatory bowel disease, immunodeficiency, or other systemic rheumatic diseases. Conditional logistic regression was used to examine the association between antibacterial antibiotics (including number of antibiotic courses and timing) and JIA after adjusting for significant confounders. RESULTS Any antibiotic exposure was associated with an increased rate of developing JIA (adjusted odds ratio: 2.1 [95% confidence interval: 1.2-3.5]). This relationship was dose dependent (adjusted odds ratio over 5 antibiotic courses: 3.0 [95% confidence interval: 1.6-5.6]), strongest for exposures within 1 year of diagnosis, and did not substantively change when adjusting for number or type of infections. In contrast, nonbacterial antimicrobial agents (eg, antifungal, antiviral) were not associated with JIA. In addition, antibiotic-treated upper respiratory tract infections were more strongly associated with JIA than untreated upper respiratory tract infections. CONCLUSIONS Antibiotics were associated with newly diagnosed JIA in a dose- and time-dependent fashion in a large pediatric population. Antibiotic exposure may play a role in JIA pathogenesis, perhaps mediated through alterations in the microbiome.
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Affiliation(s)
- Daniel B. Horton
- Center for Clinical Epidemiology and Biostatistics, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pennsylvania;,Division of Rheumatology, Nemours/Alfred I. duPont Hospital for Children, Wilmington, Delaware
| | - Frank I. Scott
- Center for Clinical Epidemiology and Biostatistics, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pennsylvania;,Division of Gastroenterology, Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania
| | - Kevin Haynes
- Center for Clinical Epidemiology and Biostatistics, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pennsylvania;,Clinical Epidemiology, HealthCore, Wilmington, Delaware; and
| | - Mary E. Putt
- Center for Clinical Epidemiology and Biostatistics, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pennsylvania
| | - Carlos D. Rose
- Division of Rheumatology, Nemours/Alfred I. duPont Hospital for Children, Wilmington, Delaware
| | - James D. Lewis
- Center for Clinical Epidemiology and Biostatistics, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pennsylvania;,Division of Gastroenterology, Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania
| | - Brian L. Strom
- Center for Clinical Epidemiology and Biostatistics, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pennsylvania;,Rutgers Biomedical and Health Sciences, New Brunswick, New Jersey
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Carter MW, Zhu M, Xiang J, Porell FW. Investigating the long-term consequences of adverse medical events among older adults. Inj Prev 2014; 20:408-15. [DOI: 10.1136/injuryprev-2013-041043] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
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13
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Austin PC, Park-Wyllie LY, Juurlink DN. Using fractional polynomials to model the effect of cumulative duration of exposure on outcomes: applications to cohort and nested case-control designs. Pharmacoepidemiol Drug Saf 2014; 23:819-29. [PMID: 24664670 PMCID: PMC4230473 DOI: 10.1002/pds.3607] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2013] [Revised: 01/27/2014] [Accepted: 02/09/2014] [Indexed: 12/17/2022]
Abstract
Purpose Determining the nature of the relationship between cumulative duration of exposure to an agent and the hazard of an adverse outcome is an important issue in environmental and occupational epidemiology, public health and clinical medicine. The Cox proportional hazards regression model can incorporate time-dependent covariates. An important class of continuous time-dependent covariates is that denoting cumulative duration of exposure. Methods We used fractional polynomial methods to describe the association between cumulative duration of exposure and adverse outcomes. We applied these methods in a cohort study to examine the relationship between cumulative duration of use of the antiarrhythmic drug amiodarone and the risk of thyroid dysfunction. We also used these methods with a conditional logistic regression model in a nested case-control study to examine the relationship between cumulative duration of use of bisphosphonate medication and the risk of atypical femur fracture. Results Using a cohort design and a Cox proportional hazards model, we found a non-linear relationship between cumulative duration of use of the antiarrhythmic drug amiodarone and the risk of thyroid dysfunction. The risk initially increased rapidly with increasing cumulative use. However, as cumulative duration of use increased, the rate of increase in risk attenuated and eventually levelled off. Using a nested case-control design and a conditional logistic regression model, we found evidence of a linear relationship between duration of use of bisphosphonate medication and risk of atypical femur fractures. Conclusions Fractional polynomials allow one to model the relationship between cumulative duration of medication use and adverse outcomes.
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Affiliation(s)
- Peter C Austin
- Institute for Clinical Evaluative Sciences, Toronto, Ontario, Canada; Institute of Health Management, Policy and Evaluation, University of Toronto, Toronto, Ontario, Canada; Schulich Heart Research Program, Sunnybrook Research Institute, Toronto, Canada
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Zhou T, Li X, Tang Z, Xie C, Tao L, Pan L, Huo D, Sun F, Luo Y, Wang W, Yan A, Guo X. Risk factors of CVD mortality among the elderly in Beijing, 1992 - 2009: an 18-year cohort study. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2014; 11:2193-208. [PMID: 24566047 PMCID: PMC3945592 DOI: 10.3390/ijerph110202193] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/11/2013] [Revised: 01/14/2014] [Accepted: 01/21/2014] [Indexed: 01/01/2023]
Abstract
Few researchers have examined the effects of multiple risk factors of cardiovascular disease (CVD) mortality simultaneously. This study was to determine the associations of combined lifestyle and other factors with CVD mortality among the elderly (n = 3,257), in Beijing, China, through data mining of the Beijing Longitudinal Study of Aging (BLSA). BLSA is a representative cohort study from 1992 to 2009, hosted by Xuan Wu Hospital. Competing risk survival analysis was conducted to explore the association between risk factors and CVD mortality. The factors focused mainly on lifestyle, physical condition, and the model was adjusted for age and gender. There were 273 of the 1,068 recorded deaths caused by CVD among the 2010 participants. Living in a suburban area (HR = 0.614, 95% CI: 0.410-0.921) was associated with lower CVD mortality. Increasing age (66-75: HR = 1.511, 95% CI: 1.111-2.055; ≥ 76: HR = 1.847, 95% CI: 1.256-2.717), high blood pressure (HR = 1.407, 95% CI: 1.031-1.920), frequent consumption of meat (HR = 1.559, 95% CI: 1.079-2.254) and physical inactivity (p = 0.046) were associated with higher CVD mortality. The study provides an instructional foundation for the control and prevention of CVD in Beijing, China.
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Affiliation(s)
- Tao Zhou
- School of Public Health, Capital Medical University, 10 Xitoutiao, Youanmen, Beijing 100069, China.
| | - Xia Li
- School of Public Health, Capital Medical University, 10 Xitoutiao, Youanmen, Beijing 100069, China.
| | - Zhe Tang
- Xuan Wu Hospital, Capital Medical University, 45 Changchun Street, Beijing 100069, China.
| | - Changchun Xie
- Division of Epidemiology and Biostatistics, Department of Environmental Health, University of Cincinnati, Ohio, OH 45267, USA.
| | - Lixin Tao
- School of Public Health, Capital Medical University, 10 Xitoutiao, Youanmen, Beijing 100069, China.
| | - Lei Pan
- School of Public Health, Capital Medical University, 10 Xitoutiao, Youanmen, Beijing 100069, China.
| | - Da Huo
- Institute for Infectious Disease and Endemic Disease Control, Beijing Center for Disease Prevention and Control, No. 16 Hepingli Middle Street, Dongcheng District, Beijing 100013, China.
| | - Fei Sun
- Xuan Wu Hospital, Capital Medical University, 45 Changchun Street, Beijing 100069, China.
| | - Yanxia Luo
- School of Public Health, Capital Medical University, 10 Xitoutiao, Youanmen, Beijing 100069, China.
| | - Wei Wang
- School of Medical Science, Edith Cowan University, 2 Bradford Street, Mount Lawley, Massachusetts, WA 6050, Australia.
| | - Aoshuang Yan
- Beijing Municipal Science and Technology Commission, Sijiqing Street, Beijing 100195, China.
| | - Xiuhua Guo
- School of Public Health, Capital Medical University, 10 Xitoutiao, Youanmen, Beijing 100069, China.
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Risk factors for cerebrovascular disease mortality among the elderly in Beijing: a competing risk analysis. PLoS One 2014; 9:e87884. [PMID: 24504327 PMCID: PMC3913670 DOI: 10.1371/journal.pone.0087884] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2013] [Accepted: 01/04/2014] [Indexed: 11/29/2022] Open
Abstract
Objective To examine the associations of combined lifestyle factors and physical conditions with cerebrovascular diseases (CBVD) mortality, after accounting for competing risk events, including death from cardiovascular diseases, cancers and other diseases. Methods Data on 2010 subjects aged over 55 years were finally analyzed using competing risk models. All the subjects were interviewed by the Beijing Longitudinal Study of Aging (BLSA), in China, between 1 January 1992 and 30 August 2009. Results Elderly females were at a lower risk of death from CBVD than elderly males (HR = 0.639, 95% CI = 0.457–0.895). Increasing age (HR = 1.543, 95% CI = 1.013–2.349), poor self-rated health (HR = 1.652, 95% CI = 1.198–2.277), hypertension (HR = 2.201, 95% CI = 1.524–3.178) and overweight (HR = 1.473, 95% CI = 1.013–2.142) or obesity (HR = 1.711, 95% CI = 1.1754–2.490) was associated with higher CBVD mortality risk. Normal cognition function (HR = 0.650, 95% CI = 0.434–0.973) and living in urban (HR = 0.456, 95% CI = 0.286–0.727) was associated with lower CBVD mortality risk. Gray’s test also confirmed the cumulative incidence (CIF) of CBVD was lower in the ‘married’ group than those without spouse, and the mortality was lowest in the ‘nutrition sufficient’ group among the ‘frequent consumption of meat group’ and the ‘medial type group’ (P value<0.001). Conclusions CBVD mortality was associated with gender, age, blood pressure, residence, BMI, cognitive function, nutrition and the result of self-rated health assessment in the elderly in Beijing, China.
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Nielsen AG, Nielsen RB, Riis AH, Johnsen SP, Sørensen HT, Thomsen RW. The impact of statin use on pneumonia risk and outcome: a combined population-based case-control and cohort study. CRITICAL CARE : THE OFFICIAL JOURNAL OF THE CRITICAL CARE FORUM 2012; 16:R122. [PMID: 22789037 PMCID: PMC3580701 DOI: 10.1186/cc11418] [Citation(s) in RCA: 42] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/02/2012] [Accepted: 07/12/2012] [Indexed: 01/03/2023]
Abstract
Introduction The impact of statin use on pneumonia risk and outcome remains unclear. We therefore examined this risk in a population-based case-control study and did a 5-year update of our previous 30-day mortality analyses. Methods We identified 70,953 adults with a first-time hospitalization for pneumonia between 1997 and 2009 in Northern Denmark. Ten age- and sex-matched population controls were selected for each pneumonia patient. To control for potential confounders, we retrieved individual-level data on other medications, comorbidities, recent surgery, socioeconomic indicators, influenza vaccination, and other markers of frailty or health awareness from medical databases. We followed all pneumonia patients for 30 days after hospital admission. Results A total of 7,223 pneumonia cases (10.2%) and 64 523 controls (9.1%) were statin users before admission, corresponding to an age- and sex-matched odds ratio (OR) of 1.17 (95% confidence interval [CI]: 1.14-1.21). After controlling for higher comorbidity and a wide range of other potential confounders, the adjusted OR for pneumonia associated with current statin use dropped to 0.80 (95% CI: 0.77-0.83). Previous statin use was not associated with decreased pneumonia risk (adjusted OR = 0.97, 95% CI: 0.91-1.02). Decreased risk remained significant after further adjustment for frailty and health awareness markers. The prevalence of statin use among Danish pneumonia patients increased from 1% in 1997 to 24% in 2009. Thirty-day mortality following pneumonia hospitalization was 11.3% among statin users versus 15.1% among nonusers. This corresponded to a 27% reduced mortality rate (adjusted hazard ratio = 0.73, 95% CI: 0.67-0.79), corroborating our earlier findings. Conclusions Current statin use was associated with both a decreased risk of hospitalization for pneumonia and lower 30-day mortality following pneumonia.
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