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Johnston A, Smith GN, Tanuseputro P, Coutinho T, Edwards JD. Assessing cardiovascular disease risk in women with a history of hypertensive disorders of pregnancy: A guidance paper for studies using administrative data. Paediatr Perinat Epidemiol 2024; 38:254-267. [PMID: 38220144 DOI: 10.1111/ppe.13043] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/15/2023] [Revised: 12/29/2023] [Accepted: 01/03/2024] [Indexed: 01/16/2024]
Abstract
BACKGROUND Hypertensive disorders of pregnancy (HDP) are a major cause of maternal morbidity and mortality, and their association with increased cardiovascular disease (CVD) risk represents a major public health concern. However, assessing CVD risk in women with a history of these conditions presents unique challenges, especially when studies are carried out using routinely collected data. OBJECTIVES To summarise and describe key challenges related to the design and conduct of administrative studies assessing CVD risk in women with a history of HDP and provide concrete recommendations for addressing them in future research. METHODS This is a methodological guidance paper. RESULTS Several conceptual and methodological factors related to the data-generating mechanism and study conceptualisation, design/data management and analysis, as well as the interpretation and reporting of study findings should be considered and addressed when designing and carrying out administrative studies on this topic. Researchers should develop an a priori conceptual framework within which the research question is articulated, important study variables are identified and their interrelationships are carefully considered. CONCLUSIONS To advance our understanding of CVD risk in women with a history of HDP, future studies should carefully consider and address the conceptual and methodological considerations outlined in this guidance paper. In highlighting these challenges, and providing specific recommendations for how to address them, our goal is to improve the quality of research carried out on this topic.
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Affiliation(s)
- Amy Johnston
- School of Epidemiology and Public Health, University of Ottawa, Ottawa, Ontario, Canada
- Brain and Heart Nexus Research Program, University of Ottawa Heart Institute, Ottawa, Ontario, Canada
| | - Graeme N Smith
- Department of Obstetrics and Gynecology, Division of Maternal-Fetal Medicine, Kingston Health Sciences Centre, Queens University, Kingston, Ontario, Canada
| | - Peter Tanuseputro
- ICES, Ottawa, Ontario, Canada
- Ottawa Hospital Research Institute, Ottawa, Ontario, Canada
- Division of Palliative Care, Department of Medicine, University of Ottawa, Ottawa, Ontario, Canada
| | - Thais Coutinho
- Department of Cardiovascular Medicine, Mayo Clinic, Rochester, Minnesota, USA
| | - Jodi D Edwards
- School of Epidemiology and Public Health, University of Ottawa, Ottawa, Ontario, Canada
- Brain and Heart Nexus Research Program, University of Ottawa Heart Institute, Ottawa, Ontario, Canada
- ICES, Ottawa, Ontario, Canada
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Wu TT, Smith LH, Vernooij LM, Patel E, Devlin JW. Data Missingness Reporting and Use of Methods to Address It in Critical Care Cohort Studies. Crit Care Explor 2023; 5:e1005. [PMID: 37954900 PMCID: PMC10637400 DOI: 10.1097/cce.0000000000001005] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2023] Open
Abstract
IMPORTANCE Failure to recognize and address data missingness in cohort studies may lead to biased results. Although Strengthening the Reporting of Observational Studies in Epidemiology reporting guidelines advocate data missingness reporting, the degree to which missingness is reported and addressed in the critical care literature remains unclear. OBJECTIVES To review published ICU cohort studies to characterize data missingness reporting and the use of methods to address it. DESIGN SETTING AND PARTICIPANTS We searched the 2022 table of contents of 29 critical care/critical care subspecialty journals having a 2021 impact factor greater than or equal to 3 to identify published prospective clinical or retrospective database cohort studies enrolling greater than or equal to 100 patients. MAIN OUTCOMES AND MEASURES In duplicate, two trained researchers conducted a manuscript/supplemental material PDF word search for "missing*" and extracted study type, patient age, ICU type, sample size, missingness reporting, and the use of methods to address it. RESULTS A total of 656 studies were reviewed. Of the 334 of 656 (50.9%) studies mentioning missingness, missingness was reported for greater than or equal to 1 variable in 234 (70.1%) and it exceeded 5% for at least one variable in 160 (47.9%). Among the 334 studies mentioning missingness, 88 (26.3%) used exclusion criteria, 36 (10.8%) used complete-case analysis, and 164 (49.1%) used a formal method to avoid missingness. In these 164 studies, imputation only was used in 100 (61.0%), an analytic strategy only in 24 (14.6%), and both in 40 (24.4%). Only missingness greater than 5% (in ≥ 1 variable) was independently associated with greater use of a missingness method (adjusted odds ratio 2.91; 95% CI, 1.85-4.60). Among 140 studies using imputation, multiple imputation was used in 87 studies (62.1%) and simple imputation in 49 studies (35.0%). For the 64 studies using an analytic method, 12 studies (18.8%) assigned missingness as an unknown category, whereas sensitivity analysis was used in 47 studies (73.4%). CONCLUSIONS AND RELEVANCE Among published critical care cohort studies, only half mentioned result missingness, one-third reported actual missingness and only one-quarter used a method to manage missingness. Educational strategies to promote missingness reporting and resolution methods are required.
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Affiliation(s)
- Ting Ting Wu
- Department of Health Sciences, Bouve College of Health Sciences, Northeastern University, Boston, MA
- Division of Pulmonary and Critical Care Medicine, Brigham and Women's Hospital, Boston, MA
| | - Louisa H Smith
- Department of Health Sciences, Bouve College of Health Sciences, Northeastern University, Boston, MA
- The Roux Institute, Northeastern University, Portland, ME
| | - Lisette M Vernooij
- Department of Health Sciences, Bouve College of Health Sciences, Northeastern University, Boston, MA
- Department of Intensive Care Medicine and Anesthesiology, University Medical Center Utrecht, Utrecht University, Utrecht, the Netherlands
- Department of Anesthesiology, Intensive Care and Pain Medicine, St. Antonius Hospital, Nieuwegein, the Netherlands
| | - Emi Patel
- Department of Pharmacy and Health Systems Sciences, Bouve College of Health Sciences, Northeastern, University, Boston, MA
| | - John W Devlin
- Division of Pulmonary and Critical Care Medicine, Brigham and Women's Hospital, Boston, MA
- Department of Pharmacy and Health Systems Sciences, Bouve College of Health Sciences, Northeastern, University, Boston, MA
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Sandhu MRS, Tickoo M, Bardia A. Data Science and Geriatric Anesthesia Research: Opportunity and Challenges. Anesthesiol Clin 2023; 41:631-646. [PMID: 37516499 DOI: 10.1016/j.anclin.2023.03.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/31/2023]
Abstract
With an increase in geriatric population undergoing surgical procedures, research focused on enhancing their perioperative outcomes is of paramount importance. Currently, most of the evidence-based medicine protocols are driven by studies concentrating on adults encompassing all adult age groups. Given the alterations in physiology with aging, geriatric patients respond differently to anesthetics and, therefore, require specific research initiatives to further expound on the same. Large databases and the development of sophisticated analytic tools can provide meaningful insights into this. Here, we discuss a few research opportunities and challenges that data scientists face when focusing on geriatric perioperative research.
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Affiliation(s)
- Mani Ratnesh S Sandhu
- Department of Neurosurgery, University of Iowa Hospitals and Clinics, Iowa City, IA, USA
| | - Mayanka Tickoo
- Division of Pulmonary, Department of Medicine, Critical Care and Sleep Medicine, Tufts Medical Center, Biewend Building, 3Road Floor, 260 Tremont Street, Boston, MA 02118, USA
| | - Amit Bardia
- Department of Anesthesiology, Critical Care and Pain Medicine, Massachusetts General Hospital, Boston, MA 06520, USA.
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Zalla LC, Yang JY, Edwards JK, Cole SR. Leveraging auxiliary data to improve precision in inverse probability-weighted analyses. Ann Epidemiol 2022; 74:75-83. [PMID: 35940394 PMCID: PMC10734400 DOI: 10.1016/j.annepidem.2022.07.011] [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: 07/21/2021] [Revised: 07/14/2022] [Accepted: 07/30/2022] [Indexed: 11/01/2022]
Abstract
PURPOSE To demonstrate improvements in the precision of inverse probability-weighted estimators by use of auxiliary variables, i.e., determinants of the outcome that are independent of treatment, missingness or selection. METHODS First with simulated data, and then with public data from the National Health and Nutrition Examination Survey (NHANES), we estimated the mean of a continuous outcome using inverse probability weights to account for informative missingness. We assessed gains in precision resulting from the inclusion of auxiliary variables in the model for the weights. We compared the performance of robust and nonparametric bootstrap variance estimators in this setting. RESULTS We found that the inclusion of auxiliary variables reduced the empirical variance of inverse probability-weighted estimators. However, that reduction was not captured in standard errors computed using the robust variance estimator, which is widely used in weighted analyses due to the non-independence of weighted observations. In contrast, a nonparametric bootstrap estimator properly captured the precision gain. CONCLUSIONS Epidemiologists can leverage auxiliary data to improve the precision of weighted estimators by using bootstrap variance estimation, or a closed-form variance estimator that properly accounts for the estimation of the weights, in place of the standard robust variance estimator.
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Affiliation(s)
- Lauren C Zalla
- Department of Epidemiology, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, NC.
| | - Jeff Y Yang
- Department of Epidemiology, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, NC
| | - Jessie K Edwards
- Department of Epidemiology, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, NC
| | - Stephen R Cole
- Department of Epidemiology, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, NC
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Tran NK, Lash TL, Goldstein ND. Practical data considerations for the modern epidemiology student. GLOBAL EPIDEMIOLOGY 2021; 3. [PMID: 35844206 PMCID: PMC9286486 DOI: 10.1016/j.gloepi.2021.100066] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
As an inherent part of epidemiologic research, practical decisions made during data collection and analysis have the potential to impact the measurement of disease occurrence as well as statistical and causal inference from the results. However, the computational skills needed to collect, manipulate, and evaluate data have not always been a focus of educational programs, and the increasing interest in “data science” suggest that data literacy has become paramount to ensure valid estimation. In this article, we first motivate such practical concerns for the modern epidemiology student, particularly as it relates to challenges in causal inference; second, we discuss how such concerns may be manifested in typical epidemiological analyses and identify the potential for bias; third, we present a case study that exemplifies the entire process; and finally, we draw attention to resources that can help epidemiology students connect the theoretical underpinning of the science to the practical considerations as described herein.
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Lash TL, Ahern TP, Collin LJ, Fox MP, MacLehose RF. Bias Analysis Gone Bad. Am J Epidemiol 2021; 190:1604-1612. [PMID: 33778845 DOI: 10.1093/aje/kwab072] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2020] [Accepted: 12/15/2020] [Indexed: 11/12/2022] Open
Abstract
Quantitative bias analysis comprises the tools used to estimate the direction, magnitude, and uncertainty from systematic errors affecting epidemiologic research. Despite the availability of methods and tools, and guidance for good practices, few reports of epidemiologic research incorporate quantitative estimates of bias impacts. The lack of familiarity with bias analysis allows for the possibility of misuse, which is likely most often unintentional but could occasionally include intentional efforts to mislead. We identified 3 examples of suboptimal bias analysis, one for each common bias. For each, we describe the original research and its bias analysis, compare the bias analysis with good practices, and describe how the bias analysis and research findings might have been improved. We assert no motive to the suboptimal bias analysis by the original authors. Common shortcomings in the examples were lack of a clear bias model, computed example, and computing code; poor selection of the values assigned to the bias model's parameters; and little effort to understand the range of uncertainty associated with the bias. Until bias analysis becomes more common, community expectations for the presentation, explanation, and interpretation of bias analyses will remain unstable. Attention to good practices should improve quality, avoid errors, and discourage manipulation.
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Smith LH. Selection Mechanisms and Their Consequences: Understanding and Addressing Selection Bias. CURR EPIDEMIOL REP 2020. [DOI: 10.1007/s40471-020-00241-6] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
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Richards M, Ferber J, Li DK, Darrow LA. Cesarean delivery and the risk of allergic rhinitis in children. Ann Allergy Asthma Immunol 2020; 125:280-286.e5. [PMID: 32387533 DOI: 10.1016/j.anai.2020.04.028] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2020] [Revised: 04/24/2020] [Accepted: 04/27/2020] [Indexed: 01/09/2023]
Abstract
BACKGROUND Cesarean delivery (C-section) may influence the infant microbiome and affect immune system development and subsequent risk for allergic rhinitis (AR). OBJECTIVE To investigate the association between C-section and AR at ages 6, 8, and 10 years. METHODS Data were collected prospectively through Kaiser Permanente Northern Californias (KPNC) integrated healthcare system. Children were eligible if they were born in a KPNC hospital and remained in the KPNC system for minimum 6 years (n = 117,768 age 6; n = 75,115 age 8; n = 40,332 age 10). Risk ratios (RR) for C-section and AR were estimated at each follow-up age and adjusted for important covariates, including intrapartum antibiotics, pre-pregnancy body mass index, maternal allergic morbidities, and breastfeeding. Subanalyses considered information on C-section indication, labor, and membrane rupture. RESULTS After adjusting for confounders, we did not observe an association between C-section and AR at follow-up ages 6, 8, or 10 years (RR [CI]: 6 years, 0.98 [0.91, 1.04]; 8 years, 1.00 [0.95, 1.07]; 10 years, 1.03 [0.96, 1.10]). In stratified analyses, there was limited evidence that C-section increases the risk of AR in certain subgroups (eg, children of non-atopic mothers, second or higher birth order children), but most estimated risk ratios were consistent with no association. Estimated associations were unaffected by participant attrition, missing data, or intrapartum antibiotics. CONCLUSION C-section delivery was not associated with AR at follow-up ages of 6, 8, or 10 years in a large contemporary US cohort.
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Affiliation(s)
- Megan Richards
- School of Community Health Sciences, University of Nevada, Reno, Nevada.
| | - Jeannette Ferber
- Division of Research, Kaiser Permanente Northern California, Oakland, California
| | - De-Kun Li
- Division of Research, Kaiser Permanente Northern California, Oakland, California
| | - Lyndsey A Darrow
- School of Community Health Sciences, University of Nevada, Reno, Nevada
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Ma Q, Chung H, Shambhu S, Roe M, Cziraky M, Jones WS, Haynes K. Administrative claims data to support pragmatic clinical trial outcome ascertainment on cardiovascular health. Clin Trials 2019; 16:419-430. [PMID: 31081367 DOI: 10.1177/1740774519846853] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/20/2023]
Abstract
BACKGROUND/AIMS Health plan administrative claims data present a cost-effective complement to traditional trial-specific ascertainment of clinical events typically conducted through patient report or a single health system electronic health record. We aim to demonstrate the value of health plan claims data in improving the capture of endpoints in longitudinal pragmatic clinical trials. METHODS This retrospective cohort study paralleled the design of the ADAPTABLE (Aspirin Dosing: A Patient-centric Trial Assessing Benefits and Long-Term Effectiveness) trial designed to compare the effectiveness of two doses of aspirin. We applied the ADAPTABLE identification query in claims data from Anthem, an American health insurance company, and identified health plan members who met the ADAPTABLE trial criteria. Among the ADAPTABLE eligible members, we selected overlapping members with PCORnet Clinical Data Research Networks in the 2 years prior to the index date (1 April 2014). PCORnet Clinical Data Research Networks consist of network partners (or healthcare systems) that store their electronic health record data in the same format to support multi-institutional research. ADAPTABLE outcome events-cardiovascular hospitalizations including admissions for myocardial infarction, stroke, or cardiac procedures; hospitalizations for major bleeding; and in-hospital deaths-were evaluated for a 2-year follow-up period. Events were classified as within or outside PCORnet Clinical Data Research Networks using facility identifiers affiliated with each hospital stay. Patient characteristics were examined with descriptive statistics, and incidence rates were reported for available Clinical Data Research Networks and claims data. RESULTS Among 884,311 ADAPTABLE eligible health plan members, 11,101 patients overlapped with PCORnet Clinical Data Research Networks. Average age was 70 years, 71% were male, and average follow-up was 20.7 months. Patients had 1521 cardiovascular hospitalizations (571 (37.5%) occurred outside PCORnet Clinical Data Research Networks), 710 for major bleeding (296 (41.7%) outside PCORnet Clinical Data Research Networks), and 196 in-hospital deaths (67 (34.2%) outside PCORnet Clinical Data Research Networks). Incidence rates (events per1000 patient-months) differed between available network partners and claims data: cardiovascular hospitalizations, 4.1 (95% confidence interval: 3.9, 4.4) versus 6.6 (95% confidence interval: 6.3, 7.0), major bleeding, 1.8 (95% confidence interval: 1.6, 2.0) versus 3.1 (95% confidence interval: 2.9, 3.3), and in-hospital death, 0.56 (95% confidence interval: 0.47, 0.67) versus 0.85 (95% confidence interval: 0.74, 0.98), respectively. CONCLUSION This study demonstrated the value of supplementing longitudinal site-based clinical studies with administrative claims data. Our results suggest that claims data together with network partner electronic health record data constitute an effective vehicle to capture patient outcomes since >30% of patients have non-fatal and fatal events outside of enrolling sites.
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Affiliation(s)
- Qinli Ma
- 1 HealthCore, Inc., Wilmington, DE, USA
| | | | | | - Matthew Roe
- 2 Duke Heart Center, Duke Clinical Research Institute, Duke University Medical Center, Durham, NC, USA
| | | | - W Schuyler Jones
- 2 Duke Heart Center, Duke Clinical Research Institute, Duke University Medical Center, Durham, NC, USA
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Strongman H, Williams R, Meeraus W, Murray‐Thomas T, Campbell J, Carty L, Dedman D, Gallagher AM, Oyinlola J, Kousoulis A, Valentine J. Limitations for health research with restricted data collection from UK primary care. Pharmacoepidemiol Drug Saf 2019; 28:777-787. [PMID: 30993808 PMCID: PMC6618795 DOI: 10.1002/pds.4765] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2018] [Revised: 11/30/2018] [Accepted: 02/14/2019] [Indexed: 11/12/2022]
Abstract
Purpose UK primary care provides a rich data source for research. The impact of proposed data collection restrictions is unknown. This study aimed to assess the impact of restricting the scope of electronic health record (EHR) data collection on the ability to conduct research. The study estimated the consequences of restricted data collection on published Clinical Practice Research Datalink studies from high impact journals or referenced in clinical guidelines. Methods A structured form was used to systematically analyse the extent to which individual studies would have been possible using a database with data collection restrictions in place: (1) retrospective collection of specified diseases only; (2) retrospective collection restricted to a 6‐ or 12‐year period; (3) prospective and retrospective collection restricted to non‐sensitive data. Outcomes were categorised as unfeasible (not reproducible without major bias); compromised (feasible with design modification); or unaffected. Results Overall, 91% studies were compromised with all restrictions in place; 56% studies were unfeasible even with design modification. With restrictions on diseases alone, 74% studies were compromised; 51% were unfeasible. Restricting collection to 6/12 years had a major impact, with 67 and 22% of studies compromised, respectively. Restricting collection of sensitive data had a lesser but marked impact with 10% studies compromised. Conclusion EHR data collection restrictions can profoundly reduce the capacity for public health research that underpins evidence‐based medicine and clinical guidance. National initiatives seeking to collect EHRs should consider the implications of restricting data collection on the ability to address vital public health questions.
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Affiliation(s)
| | | | | | | | | | - Lucy Carty
- Clinical Practice Research Datalink (CPRD)MHRALondonUK
| | - Daniel Dedman
- Clinical Practice Research Datalink (CPRD)MHRALondonUK
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Rozani V, Giladi N, Gurevich T, El-Ad B, Tsamir J, Hemo B, Peretz C. Anemia in men and increased Parkinson's disease risk: A population-based large scale cohort study. Parkinsonism Relat Disord 2019; 64:90-96. [PMID: 30922776 DOI: 10.1016/j.parkreldis.2019.03.010] [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] [Received: 08/05/2018] [Revised: 03/12/2019] [Accepted: 03/16/2019] [Indexed: 12/01/2022]
Abstract
OBJECTIVE To evaluate the association between anemia and Parkinson's disease risk (PD) in men and women. METHODS A population-based cohort of 474,129 individuals (aged 40-79 years at date of first Hb test, 47.4% men) with repeated Hb levels was derived from a large Healthcare Maintenance Organization that serves 2 million citizens in Israel (study-period 1.1.1999-31.12.2012). An annual anemia indicator [Hb levels (g/dL) for men <13; for women <12.0] was assessed for each individual and they were followed from first Hb test until the date of PD incidence, death or end of the study. Cox-proportional hazards models, stratified by sex and age, with time-dependent anemia covariate were used to estimate adjusted Hazard Ratio with 95% of confidence intervals (HR, 95%CI) for PD. RESULTS During a mean follow up of 8.8 ± 3.9 years (7.0 ± 3.6 for men and 7.9 ± 4.1 for women), 2427 incident PD cases were detected. Cumulative PD incidence at ages over 65 years was 3.3%. The mean levels of Hb at baseline was 14.8 ± 1.1 g/dL among men; 12.8 ± 1.1 g/dL among women. Anemia was associated with significant PD risk among men, age-pooled HR = 1.19 (95%CI: 1.04-1.37), with the highest risk between ages 60-64 years [HR = 1.41 (95%CI: 1.03-1.93)]. Anemia was not associated with PD risk among women across all age-groups. The age-pooled HR for women was 1.02 (95%CI 0.95-1.09). CONCLUSIONS The finding that anemia was associated with PD risk in men, especially in middle age, warrants further investigations on common pathophysiologic processes between Hb abnormalities and brain dysfunction.
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Affiliation(s)
- Violetta Rozani
- Department of Epidemiology, School of Public Health, Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Nir Giladi
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel; Neurological Institute, Tel Aviv Medical Center, Tel Aviv, Israel; Sagol School of Neuroscience, Tel Aviv University, Tel Aviv, Israel.
| | - Tanya Gurevich
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel; Neurological Institute, Tel Aviv Medical Center, Tel Aviv, Israel; Sagol School of Neuroscience, Tel Aviv University, Tel Aviv, Israel
| | | | | | | | - Chava Peretz
- Department of Epidemiology, School of Public Health, Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
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Rozani V, Gurevich T, Giladi N, El-Ad B, Tsamir J, Hemo B, Peretz C. Higher serum cholesterol and decreased Parkinson's disease risk: A statin-free cohort study. Mov Disord 2018; 33:1298-1305. [DOI: 10.1002/mds.27413] [Citation(s) in RCA: 52] [Impact Index Per Article: 8.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2017] [Revised: 03/04/2018] [Accepted: 03/08/2018] [Indexed: 01/22/2023] Open
Affiliation(s)
- Violetta Rozani
- Department of Epidemiology, School of Public Health, Sackler Faculty of Medicine; Tel Aviv University; Tel Aviv Israel
| | - Tanya Gurevich
- Neurological Institute; Tel Aviv Medical Center; Tel Aviv Israel
- Sagol School of Neuroscience, Sackler Faculty of Medicine; Tel Aviv University; Tel Aviv Israel
| | - Nir Giladi
- Neurological Institute; Tel Aviv Medical Center; Tel Aviv Israel
- Sagol School of Neuroscience, Sackler Faculty of Medicine; Tel Aviv University; Tel Aviv Israel
| | | | | | | | - Chava Peretz
- Department of Epidemiology, School of Public Health, Sackler Faculty of Medicine; Tel Aviv University; Tel Aviv Israel
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Howe CJ, Dulin-Keita A, Cole SR, Hogan JW, Lau B, Moore RD, Mathews WC, Crane HM, Drozd DR, Geng E, Boswell SL, Napravnik S, Eron JJ, Mugavero MJ. Evaluating the Population Impact on Racial/Ethnic Disparities in HIV in Adulthood of Intervening on Specific Targets: A Conceptual and Methodological Framework. Am J Epidemiol 2018; 187:316-325. [PMID: 28992096 DOI: 10.1093/aje/kwx247] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2016] [Accepted: 06/08/2017] [Indexed: 01/10/2023] Open
Abstract
Reducing racial/ethnic disparities in human immunodeficiency virus (HIV) disease is a high priority. Reductions in HIV racial/ethnic disparities can potentially be achieved by intervening on important intermediate factors. The potential population impact of intervening on intermediates can be evaluated using observational data when certain conditions are met. However, using standard stratification-based approaches commonly employed in the observational HIV literature to estimate the potential population impact in this setting may yield results that do not accurately estimate quantities of interest. Here we describe a useful conceptual and methodological framework for using observational data to appropriately evaluate the impact on HIV racial/ethnic disparities of interventions. This framework reframes relevant scientific questions in terms of a controlled direct effect and estimates a corresponding proportion eliminated. We review methods and conditions sufficient for accurate estimation within the proposed framework. We use the framework to analyze data on 2,329 participants in the CFAR [Centers for AIDS Research] Network of Integrated Clinical Systems (2008-2014) to evaluate the potential impact of universal prescription of and ≥95% adherence to antiretroviral therapy on racial disparities in HIV virological suppression. We encourage the use of the described framework to appropriately evaluate the potential impact of targeted interventions in addressing HIV racial/ethnic disparities using observational data.
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Affiliation(s)
- Chanelle J Howe
- Centers for Epidemiology and Environmental Health, Department of Epidemiology, School of Public Health, Brown University, Providence, Rhode Island
| | - Akilah Dulin-Keita
- Center for Health Equity Research, Department of Behavioral and Social Sciences, School of Public Health, Brown University, Providence, Rhode Island
| | - Stephen R Cole
- Department of Epidemiology, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina
| | - Joseph W Hogan
- Center for Statistical Sciences, Department of Biostatistics, School of Public Health, Brown University, Providence, Rhode Island
| | - Bryan Lau
- Department of Epidemiology, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, Maryland
| | - Richard D Moore
- Department of Epidemiology, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, Maryland
| | | | - Heidi M Crane
- Department of Medicine, School of Medicine, University of Washington, Seattle, Washington
| | - Daniel R Drozd
- Department of Medicine, School of Medicine, University of Washington, Seattle, Washington
| | - Elvin Geng
- Department of Medicine, School of Medicine, University of Washington, Seattle, Washington
| | | | - Sonia Napravnik
- Department of Epidemiology, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina
- Division of Infectious Diseases, Department of Medicine, School of Medicine, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina
| | - Joseph J Eron
- Division of Infectious Diseases, Department of Medicine, School of Medicine, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina
| | - Michael J Mugavero
- Division of Infectious Diseases, Department of Medicine, School of Medicine, University of Alabama at Birmingham, Birmingham, Alabama
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Rozani V, Giladi N, El-Ad B, Gurevich T, Tsamir J, Hemo B, Peretz C. Statin adherence and the risk of Parkinson's disease: A population-based cohort study. PLoS One 2017; 12:e0175054. [PMID: 28388626 PMCID: PMC5384675 DOI: 10.1371/journal.pone.0175054] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2016] [Accepted: 03/20/2017] [Indexed: 01/30/2023] Open
Abstract
BACKGROUND While experimental data provided some compelling evidence on the benefits of statins on dopaminergic neurons, observational studies reported conflicting results regarding the potential of statins to effect the risk of Parkinson's disease (PD). OBJECTIVES To evaluate the association between changes in statin adherence over time and PD risk. METHODS A population-based cohort of new statin users (ages 40-79, years 1999-2012) was derived from a large Israeli healthcare services organization. Data included history of statin purchases and low density lipoprotein cholesterol (LDL-C) levels. Personal statin adherence was measured annually by the proportion of days covered (PDC). PD was detected employing a drug-tracer approach. Stratified (by sex, LDL-C levels at baseline and age) Cox proportional hazards models with time-dependent covariates were used to compute adjusted Hazard Ratio (HR) with 95%CI. RESULTS The cohort included 232,877 individuals, 49.3% men. Mean age at first statin purchase was 56.5 (±9.8) years for men and 58.7 (±9.2) years for women. PDC distribution for the whole follow up period differed between men and women: medians 58.3% and 54.1% respectively. During a mean follow up of 7.6 (±3.4) years, 2,550 (1.1%) PD cases were identified. In a 1-year lagged analysis, we found no association between annual statin adherence and PD risk in all age-groups regardless of statin type and potency. Age-pooled HR (95%CI) for men and women with LDL-C levels at baseline ≤160mg/dL were: 0.99 (0.99-1.01), 1.01 (1.00-1.02); and for men and women with LDL-C >160mg/dL levels: 0.99 (0.98-1.01), 0.97 (0.98-1.01). CONCLUSIONS Our findings suggest that statin adherence over time does not affect PD risk. Future studies should use large-scale cohorts and refining assessments of long-term profiles in statin adherence.
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Affiliation(s)
- Violetta Rozani
- Department of Epidemiology, School of Public Health, Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Nir Giladi
- Neurological Institute, Tel Aviv Medical Center, Tel Aviv, Israel
- Sagol School of Neuroscience, Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | | | - Tanya Gurevich
- Neurological Institute, Tel Aviv Medical Center, Tel Aviv, Israel
- Sagol School of Neuroscience, Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | | | | | - Chava Peretz
- Department of Epidemiology, School of Public Health, Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
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Gran JM, Hoff R, Røysland K, Ledergerber B, Young J, Aalen OO. Estimating the treatment effect on the treated under time‐dependent confounding in an application to the Swiss HIV Cohort Study. J R Stat Soc Ser C Appl Stat 2017. [DOI: 10.1111/rssc.12221] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
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17
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Suzuki E, Tsuda T, Mitsuhashi T, Mansournia MA, Yamamoto E. Errors in causal inference: an organizational schema for systematic error and random error. Ann Epidemiol 2016; 26:788-793.e1. [DOI: 10.1016/j.annepidem.2016.09.008] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2016] [Revised: 09/17/2016] [Accepted: 09/18/2016] [Indexed: 01/17/2023]
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