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Wang Y, Zhou X, Guo Z, Fang X, Liu F, Shen L. Consideration of stratification in confirmatory trials with time-to-event endpoint. Contemp Clin Trials 2024; 141:107434. [PMID: 38215875 DOI: 10.1016/j.cct.2024.107434] [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: 07/01/2023] [Revised: 12/11/2023] [Accepted: 01/07/2024] [Indexed: 01/14/2024]
Abstract
Stratification in randomization and analysis are widely employed to balance treatment groups in clinical trials. However, the potential power loss due to under-stratification or over-stratification has not been thoroughly evaluated in the typical setting of confirmatory clinical trials. In cases where there are too many strata and some have small sample sizes or a small number of events, it is common practice to combine these small strata during analysis. However, there is a lack of guidance on how those small strata should be combined. This paper presents extensive simulation studies to evaluate the impact of under-stratification or over-stratification on the power of survival analysis and the estimate of hazard ratio using stratified log-rank test and Cox PH model, respectively. The difference in power between stratified and unstratified log-rank tests is also investigated under different scenarios. Our results suggest that failing to consider prognostic stratification factors with strong effects, and/or accounting for non-prognostic factors such as noise and predictive factors, may reduce the power of the stratified log-rank test. Additionally, methods of combining small strata are explored and compared.
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Affiliation(s)
- Yizhuo Wang
- Department of Biostatistics, University of Michigan, Ann Arbor, MI, USA.
| | - Xuan Zhou
- Merck & Co., Inc., Biostatistics and Research Decision Sciences, North Wales, PA 19454, USA
| | - Zifang Guo
- Merck & Co., Inc., Biostatistics and Research Decision Sciences, North Wales, PA 19454, USA
| | - Xiao Fang
- Merck & Co., Inc., Biostatistics and Research Decision Sciences, North Wales, PA 19454, USA
| | - Fang Liu
- Merck & Co., Inc., Biostatistics and Research Decision Sciences, North Wales, PA 19454, USA
| | - Liji Shen
- Merck & Co., Inc., Biostatistics and Research Decision Sciences, North Wales, PA 19454, USA
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2
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Knikman JE, Wilting TA, Lopez-Yurda M, Henricks LM, Lunenburg CATC, de Man FM, Meulendijks D, Nieboer P, Droogendijk HJ, Creemers GJ, Mandigers CMPW, Imholz ALT, Mathijssen RHJ, Portielje JEA, Valkenburg-van Iersel L, Vulink A, van der Poel MHW, Baars A, Swen JJ, Gelderblom H, Schellens JHM, Beijnen JH, Guchelaar HJ, Cats A. Survival of Patients With Cancer With DPYD Variant Alleles and Dose-Individualized Fluoropyrimidine Therapy-A Matched-Pair Analysis. J Clin Oncol 2023; 41:5411-5421. [PMID: 37639651 DOI: 10.1200/jco.22.02780] [Citation(s) in RCA: 13] [Impact Index Per Article: 13.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2022] [Revised: 04/24/2023] [Accepted: 07/11/2023] [Indexed: 08/31/2023] Open
Abstract
PURPOSE DPYD-guided fluoropyrimidine dosing improves patient safety in carriers of DPYD variant alleles. However, the impact on treatment outcome in these patients is largely unknown. Therefore, progression-free survival (PFS) and overall survival (OS) were compared between DPYD variant carriers treated with a reduced dose and DPYD wild-type controls receiving a full fluoropyrimidine dose in a retrospective matched-pair survival analysis. METHODS Data from a prospective multicenter study (ClinicalTrials.gov identifier: NCT02324452) in which DPYD variant carriers received a 25% (c.1236G>A and c.2846A>T) or 50% (DPYD*2A and c.1679T>G) reduced dose and data from DPYD variant carriers treated with a similarly reduced dose of fluoropyrimidines identified during routine clinical care were obtained. Each DPYD variant carrier was matched to three DPYD wild-type controls treated with a standard dose. Survival analyses were performed using Kaplan-Meier estimates and Cox regression. RESULTS In total, 156 DPYD variant carriers and 775 DPYD wild-type controls were available for analysis. Sixty-one c.1236G>A, 25 DPYD*2A, 13 c.2846A>T, and-when pooled-93 DPYD variant carriers could each be matched to three unique DPYD wild-type controls. For pooled DPYD variant carriers, PFS (hazard ratio [HR], 1.23; 95% CI, 1.00 to 1.51; P = .053) and OS (HR, 0.95; 95% CI, 0.75 to 1.51; P = .698) were not negatively affected by DPYD-guided dose individualization. In the subgroup analyses, a shorter PFS (HR, 1.43; 95% CI, 1.10 to 1.86; P = .007) was found in c.1236G>A variant carriers, whereas no differences were found for DPYD*2A and c.2846A>T carriers. CONCLUSION In this exploratory analysis, DPYD-guided fluoropyrimidine dosing does not negatively affect PFS and OS in pooled DPYD variant carriers. Close monitoring with early dose modifications based on toxicity is recommended, especially for c.1236G>A carriers receiving a reduced starting dose.
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Affiliation(s)
- Jonathan E Knikman
- Division of Pharmacology, The Netherlands Cancer Institute, Amsterdam, the Netherlands
- Department of Pharmacy & Pharmacology, The Netherlands Cancer Institute, Amsterdam, the Netherlands
| | - Tycho A Wilting
- Division of Pharmacology, The Netherlands Cancer Institute, Amsterdam, the Netherlands
| | - Marta Lopez-Yurda
- Biometrics Department, The Netherlands Cancer Institute, Amsterdam, the Netherlands
| | - Linda M Henricks
- Department of Clinical Chemistry and Laboratory Medicine, Leiden University Medical Center, Leiden, the Netherlands
| | - Carin A T C Lunenburg
- Department of Medical Oncology, Leiden University Medical Center, Leiden, the Netherlands
| | - Femke M de Man
- Department of Medical Oncology, Erasmus MC Cancer Institute, Erasmus University Medical Center, Rotterdam, the Netherlands
| | - Didier Meulendijks
- Division of Pharmacology, The Netherlands Cancer Institute, Amsterdam, the Netherlands
- Department of Clinical Pharmacology, Division of Medical Oncology, The Netherlands Cancer Institute, Amsterdam, the Netherlands
- Late Development Oncology, AstraZeneca, Cambridge, UK
| | - Peter Nieboer
- Department of Internal Medicine, Wilhelmina Hospital Assen, Assen, the Netherlands
| | - Helga J Droogendijk
- Department of Internal Medicine, Bravis Hospital, Roosendaal, the Netherlands
| | - Geert-Jan Creemers
- Department of Medical Oncology, Catharina Hospital, Eindhoven, the Netherlands
| | | | | | - Ron H J Mathijssen
- Department of Medical Oncology, Erasmus MC Cancer Institute, Erasmus University Medical Center, Rotterdam, the Netherlands
| | - Johanneke E A Portielje
- Department of Medical Oncology, Leiden University Medical Center, Leiden, the Netherlands
- Department of Medical Oncology, Haga Hospital, The Hague, the Netherlands
| | | | - Annelie Vulink
- Department of Medical Oncology, Reinier de Graaf Gasthuis, Delft, the Netherlands
| | | | - Arnold Baars
- Department of Internal Medicine, Hospital Gelderse Vallei, Ede, the Netherlands
| | - Jesse J Swen
- Department of Clinical Pharmacy and Toxicology, Leiden University Medical Center, Leiden, the Netherlands
| | - Hans Gelderblom
- Department of Medical Oncology, Leiden University Medical Center, Leiden, the Netherlands
| | - Jan H M Schellens
- Department of Pharmaceutical Sciences, Utrecht University, Utrecht, the Netherlands
| | - Jos H Beijnen
- Department of Pharmacy & Pharmacology, The Netherlands Cancer Institute, Amsterdam, the Netherlands
- Division of Pharmacoepidemiology and Clinical Pharmacology, Department of Pharmaceutical Sciences, Utrecht University, Utrecht, the Netherlands
| | - Henk-Jan Guchelaar
- Department of Clinical Pharmacy and Toxicology, Leiden University Medical Center, Leiden, the Netherlands
| | - Annemieke Cats
- Department of Gastrointestinal Oncology, Division of Medical Oncology, The Netherlands Cancer Institute, Amsterdam, the Netherlands
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3
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Yang Z, Wu Y, Xu L, Zhu Z, Li T, Yu L, Gao K, Zhang X, Shen P, Lin H, Shui L, Tang M, Jin M, Sun Y, Wang J, Chen K. Age at diagnosis modifies associations of type 2 diabetes with cancer incidence and mortality: a retrospective matched-cohort study. Diabetologia 2023; 66:1450-1459. [PMID: 37178138 DOI: 10.1007/s00125-023-05920-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/16/2023] [Accepted: 03/13/2023] [Indexed: 05/15/2023]
Abstract
AIMS/HYPOTHESIS The age-specific associations between type 2 diabetes and cancer risk are not fully understood. The aim of this study was to assess how age at diagnosis modifies the associations between type 2 diabetes and cancer risk. METHODS We used data from the Yinzhou Health Information System, and included 42,279 individuals who were newly diagnosed with type 2 diabetes between 2010 and 2014, as well as 166,010 age- and sex-matched control individuals without diabetes who were selected randomly from the electronic health records of the entire population. Patients were divided into four age groups according to age at diagnosis: <50, 50-59, 60-69 and ≥70 years. Stratified Cox proportional hazards regression models, with age as the time scale, were used to estimate the HRs and 95% CIs for the associations of type 2 diabetes with the risks of overall and site-specific cancers. Population-attributable fractions were also calculated for outcomes associated with type 2 diabetes. RESULTS During median follow-up periods of 9.20 and 9.32 years, we identified 15,729 incident cancer cases and 5383 cancer deaths, respectively. Patients diagnosed with type 2 diabetes before 50 years of age had the highest relative risks of cancer incidence and mortality, with HRs (95% CI) of 1.35 (1.20, 1.52) for overall cancer incidence, 1.39 (1.11, 1.73) for gastrointestinal cancer incidence, 2.02 (1.50, 2.71) for overall cancer mortality, and 2.82 (1.91, 4.18) for gastrointestinal cancer mortality. Risk estimates decreased gradually with each decade increase in diagnostic age. The population-attributable fractions for overall cancer and gastrointestinal cancer mortality also decreased with increasing age. CONCLUSIONS/INTERPRETATION The associations of type 2 diabetes with cancer incidence and mortality varied by age at diagnosis, with a higher relative risk among patients who were diagnosed at a younger age.
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Affiliation(s)
- Zongming Yang
- Department of Public Health, and Department of National Clinical Research Center for Child Health, The Children's Hospital, Zhejiang University School of Medicine, Hangzhou, China
| | - Yonghao Wu
- Department of Public Health, and Department of National Clinical Research Center for Child Health, The Children's Hospital, Zhejiang University School of Medicine, Hangzhou, China
| | - Lisha Xu
- Department of Public Health, and Department of National Clinical Research Center for Child Health, The Children's Hospital, Zhejiang University School of Medicine, Hangzhou, China
| | - Zhanghang Zhu
- Department of Public Health, Second Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, China
| | - Tiezheng Li
- Department of Public Health, and Department of National Clinical Research Center for Child Health, The Children's Hospital, Zhejiang University School of Medicine, Hangzhou, China
| | - Luhua Yu
- Department of Public Health, and Department of National Clinical Research Center for Child Health, The Children's Hospital, Zhejiang University School of Medicine, Hangzhou, China
| | - Kai Gao
- Department of Public Health, Second Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, China
| | - Xinhan Zhang
- Department of Public Health, Second Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, China
| | - Peng Shen
- Department of Chronic Disease and Health Promotion, Yinzhou District Center for Disease Control and Prevention, Ningbo, China
| | - Hongbo Lin
- Department of Chronic Disease and Health Promotion, Yinzhou District Center for Disease Control and Prevention, Ningbo, China
| | - Liming Shui
- Yinzhou District Health Bureau of Ningbo, Ningbo, China
| | - Mengling Tang
- Department of Public Health, Fourth Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, China
| | - Mingjuan Jin
- Department of Public Health, Second Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, China
| | - Yexiang Sun
- Data Center, Yinzhou District Center for Disease Control and Prevention, Ningbo, China.
| | - Jianbing Wang
- Department of Public Health, and Department of National Clinical Research Center for Child Health, The Children's Hospital, Zhejiang University School of Medicine, Hangzhou, China.
| | - Kun Chen
- Department of Public Health, Second Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, China.
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4
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Akyea RK, Iyen B, Georgiopoulos G, Kai J, Qureshi N, Ntaios G. Cardiovascular outcomes and mortality after incident ischaemic stroke in patients with a recent cancer history. Eur J Intern Med 2023; 109:50-57. [PMID: 36549951 DOI: 10.1016/j.ejim.2022.12.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/28/2022] [Revised: 12/07/2022] [Accepted: 12/14/2022] [Indexed: 12/24/2022]
Abstract
BACKGROUND Up to 10% of patients with ischaemic stroke have comorbid cancer and stroke in these patients is thought to have a poor short-term prognosis. There is little known about the long-term cardiovascular morbidity and mortality outcomes after incident ischaemic stroke in patients with recent cancer history. OBJECTIVE To assess the risk of subsequent cardiovascular morbidity and mortality outcomes in patients with an incident ischaemic stroke and recent cancer history. METHODS Patients aged ≥18 years with an incident ischaemic stroke between 1998 and 2017, with any diagnosis of cancer within 12 months before the stroke event, and no prior history of serious vascular event were identified from UK Clinical Practice Research Datalink (CPRD GOLD) linked to Hospital Episode Statistics (HES) data. To minimize selection bias, these patients were propensity-score matched with patients with incident ischaemic stroke and no history of cancer. Propensity-score matching was done using covariates such as demographic data, vascular risk factors, comorbid conditions, and prescribed medication. Multivariable models (Competing risks and Cox regression) were used to determine the risk of subsequent major adverse cardiovascular event (MACE) outcomes and all-cause mortality. RESULTS Our cohort included 22,460 patients with a median age of 75 (IQR 64-83) years and a follow-up of 12.3 (IQR 7.2-16.7) years. Recent cancer was identified in 1,149 patients (5.1%) at the time of incident ischaemic stroke. The patients with recent cancer history had a lower risk of composite MACE (sub-distribution hazard ratio (SHR) 0.83 [95% CI: 0.75-0.92]) and recurrent stroke (SHR 0.85 95% CI:0.75-0.96]) and a higher risk of all-cause mortality (hazard ratio 1.67 [95% CI:1.47-1.91]). The risk of coronary heart disease, peripheral vascular disease, heart failure, and CVD-related death outcomes did not differ significantly between the groups. CONCLUSIONS After incident ischaemic stroke, patients with recent cancer history have a lower risk of composite MACE and recurrent stroke outcomes but a higher risk of all-cause mortality when compared with patients without a prior history of cancer.
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Affiliation(s)
- Ralph K Akyea
- Primary Care Stratified Medicine, Centre for Academic Primary Care, School of Medicine, University of Nottingham, Nottingham, United Kingdom.
| | - Barbara Iyen
- Primary Care Stratified Medicine, Centre for Academic Primary Care, School of Medicine, University of Nottingham, Nottingham, United Kingdom
| | - Georgios Georgiopoulos
- School of Biomedical Engineering and Imaging Sciences, St Thomas Hospital, King's College London, London, United Kingdom
| | - Joe Kai
- Primary Care Stratified Medicine, Centre for Academic Primary Care, School of Medicine, University of Nottingham, Nottingham, United Kingdom
| | - Nadeem Qureshi
- Primary Care Stratified Medicine, Centre for Academic Primary Care, School of Medicine, University of Nottingham, Nottingham, United Kingdom
| | - George Ntaios
- Department of Internal Medicine, Faculty of Medicine, School of Health Sciences, University of Thessaly, Larissa, Greece
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Huang JY, Ma KSK, Wang LT, Chiang CH, Yang SF, Wang CH, Wang PH. The Risk of Endometrial Cancer and Uterine Sarcoma Following Endometriosis or Pelvic Inflammatory Disease. Cancers (Basel) 2023; 15:cancers15030833. [PMID: 36765791 PMCID: PMC9913480 DOI: 10.3390/cancers15030833] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2022] [Revised: 01/03/2023] [Accepted: 01/11/2023] [Indexed: 01/31/2023] Open
Abstract
The relationship between uterine corpus cancer and endometriosis was conflicting. We aimed to determine the risk of uterine cancer in patients with endometriosis or pelvic inflammatory disease (PID). In this population-based cohort study, a total of 135,236 females with endometriosis (n = 20,510) or PID (n = 114,726), as well as 135,236 age-matched controls, were included. Cox regression models estimated the risk of uterine cancer in each group. Sub-outcomes of risk for uterine corpus cancer included endometrial cancer and uterine sarcoma were analyzed. An age subgroup analysis was performed to determine the moderator effect of age. A landmark analysis depicted the time varying effect of endometriosis and PID. A propensity score matching analysis was conducted to validate the findings. Patients with endometriosis had significantly higher risk of endometrial cancer (adjusted hazard ratio, aHR = 2.92; 95% CI = 2.12-4.03) and uterine sarcoma (aHR = 5.83; 95% CI = 2.02-16.89), while PID was not associated with the risk of uterine cancer. The increased risk of uterine cancer in patients with endometriosis persisted after propensity score matching (aHR = 2.83, 95%CI = 1.70-4.71). The greatest risk of endometrial cancer occurred in patients who had endometriosis for 37 to 60 months (adjusted relative risk, aRR = 9.15, 95% CI = 4.40-19.02). Females aged 12 to 35 years were at the greatest risk of endometriosis-associated uterine cancer (RR = 6.97, 95% CI = 3.41-14.26). In conclusion, patients with endometriosis were at great risk of uterine cancer, including endometrial cancer and uterine sarcoma, compared with propensity score-matched populations and compared with patients of PID. Younger females with endometriosis and patients who had endometriosis for three to five years were at the greatest risk of endometriosis-associated uterine cancer.
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Affiliation(s)
- Jing-Yang Huang
- Institute of Medicine, Chung Shan Medical University, Taichung 40201, Taiwan
- Department of Medical Research, Chung Shan Medical University Hospital, Taichung 40201, Taiwan
| | - Kevin Sheng-Kai Ma
- Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, MA 02115, USA
- Center for Global Health, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA 19104, USA
- Department of Dermatology, Massachusetts General Hospital, Boston, MA 02114, USA
- Department of Orthodontics and Dentofacial Orthopedics, Henry M. Goldman School of Dental Medicine, Boston University, Boston, MA 02118, USA
| | - Li-Tzu Wang
- Department of Obstetrics & Gynecology, National Taiwan University Hospital & College of Medicine, Taipei 11031, Taiwan
| | - Cho-Han Chiang
- Department of Medicine, Mount Auburn Hospital, Cambridge, MA 02138, USA
- Harvard Medical School, Harvard University, Boston, MA 02115, USA
| | - Shun-Fa Yang
- Institute of Medicine, Chung Shan Medical University, Taichung 40201, Taiwan
- Department of Medical Research, Chung Shan Medical University Hospital, Taichung 40201, Taiwan
| | - Chun-Hao Wang
- Department of Medicine, National Taiwan University, Taipei 10617, Taiwan
| | - Po-Hui Wang
- Institute of Medicine, Chung Shan Medical University, Taichung 40201, Taiwan
- Department of Medical Research, Chung Shan Medical University Hospital, Taichung 40201, Taiwan
- School of Medicine, Chung Shan Medical University, Taichung 40201, Taiwan
- Department of Obstetrics and Gynecology, Chung Shan Medical University Hospital, Taichung 40201, Taiwan
- Correspondence: ; Tel.: +886-4-24739595 (ext. 21721); Fax: +886-4-24738493
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Raisi-Estabragh Z, Cooper J, Salih A, Raman B, Lee AM, Neubauer S, Harvey NC, Petersen SE. Cardiovascular disease and mortality sequelae of COVID-19 in the UK Biobank. Heart 2022; 109:119-126. [PMID: 36280346 PMCID: PMC9811071 DOI: 10.1136/heartjnl-2022-321492] [Citation(s) in RCA: 57] [Impact Index Per Article: 28.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/07/2022] [Accepted: 08/08/2022] [Indexed: 02/04/2023] Open
Abstract
OBJECTIVE To examine association of COVID-19 with incident cardiovascular events in 17 871 UK Biobank cases between March 2020 and 2021. METHODS COVID-19 cases were defined using health record linkage. Each case was propensity score-matched to two uninfected controls on age, sex, deprivation, body mass index, ethnicity, diabetes, prevalent ischaemic heart disease (IHD), smoking, hypertension and high cholesterol. We included the following incident outcomes: myocardial infarction, stroke, heart failure, atrial fibrillation, venous thromboembolism (VTE), pericarditis, all-cause death, cardiovascular death, IHD death. Cox proportional hazards regression was used to estimate associations of COVID-19 with each outcome over an average of 141 days (range 32-395) of prospective follow-up. RESULTS Non-hospitalised cases (n=14 304) had increased risk of incident VTE (HR 2.74 (95% CI 1.38 to 5.45), p=0.004) and death (HR 10.23 (95% CI 7.63 to 13.70), p<0.0001). Individuals with primary COVID-19 hospitalisation (n=2701) had increased risk of all outcomes considered. The largest effect sizes were with VTE (HR 27.6 (95% CI 14.5 to 52.3); p<0.0001), heart failure (HR 21.6 (95% CI 10.9 to 42.9); p<0.0001) and stroke (HR 17.5 (95% CI 5.26 to 57.9); p<0.0001). Those hospitalised with COVID-19 as a secondary diagnosis (n=866) had similarly increased cardiovascular risk. The associated risks were greatest in the first 30 days after infection but remained higher than controls even after this period. CONCLUSIONS Individuals hospitalised with COVID-19 have increased risk of incident cardiovascular events across a range of disease and mortality outcomes. The risk of most events is highest in the early postinfection period. Individuals not requiring hospitalisation have increased risk of VTE, but not of other cardiovascular-specific outcomes.
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Affiliation(s)
- Zahra Raisi-Estabragh
- William Harvey Research Institute, NIHR Barts Biomedical Research Centre, Queen Mary University of London, London, UK
- Barts Heart Centre, St Bartholomew's Hospital, Barts Health NHS Trust, London, UK
| | - Jackie Cooper
- William Harvey Research Institute, NIHR Barts Biomedical Research Centre, Queen Mary University of London, London, UK
| | - Ahmed Salih
- William Harvey Research Institute, NIHR Barts Biomedical Research Centre, Queen Mary University of London, London, UK
| | - Betty Raman
- Division of Cardiovascular Medicine, Radcliffe Department of Medicine, National Institute for Health Research Oxford Biomedical Research Centre, University of Oxford, Oxford, UK
| | - Aaron Mark Lee
- William Harvey Research Institute, NIHR Barts Biomedical Research Centre, Queen Mary University of London, London, UK
| | - Stefan Neubauer
- Division of Cardiovascular Medicine, Radcliffe Department of Medicine, National Institute for Health Research Oxford Biomedical Research Centre, University of Oxford, Oxford, UK
| | - Nicholas C Harvey
- MRC Lifecourse Epidemiology Centre, University of Southampton, Southampton, UK
- NIHR Southampton Biomedical Research Centre, University of Southampton and University Hospital Southampton NHS Foundation Trust, Southampton, UK
| | - Steffen E Petersen
- William Harvey Research Institute, NIHR Barts Biomedical Research Centre, Queen Mary University of London, London, UK
- Barts Heart Centre, St Bartholomew's Hospital, Barts Health NHS Trust, London, UK
- Health Data Research UK, London, UK
- Alan Turing Institute, London, UK
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Hsu MH, Hsu CA, Lai SC, Yen JC. Gout as a Risk Factor for Age-Related Macular Degeneration in Taiwanese Adults-A Population-Based Study in Taiwan. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:10142. [PMID: 36011777 PMCID: PMC9408113 DOI: 10.3390/ijerph191610142] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 06/23/2022] [Revised: 08/10/2022] [Accepted: 08/14/2022] [Indexed: 06/15/2023]
Abstract
The relationship between gout and age-related macular degeneration (AMD) was suggested in previous literature but has yet to be accepted fully among physicians. This study aimed to explore the effect of gout on the development of age-related macular degeneration in Taiwan. A retrospective cohort study was conducted using Taiwan's National Health Insurance Database that includes a 2-million-persons dataset. The crude hazard ratio, Kaplan-Meier plot, and separate cox proportional hazard ratio were utilized to demonstrate the effect of gout on the development of age-related macular degeneration. The crude hazard ratio for gout patients developing AMD was 1.55 and the adjusted hazard ratio 1.20. In conclusion, gout is a risk factor for developing AMD, and achieving good disease management is therefore essential for preventing AMD from occurring.
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Affiliation(s)
- Min-Huei Hsu
- Graduate Institute of Data Science, College of Management, Taipei Medical University, Taipei 11042, Taiwan
- Department of Neurosurgery, Shuang Ho Hospital, Taipei Medical University, Taipei 23561, Taiwan
| | - Chia-An Hsu
- Department of Ophthalmology, Taipei Veterans General Hospital, Taipei 11217, Taiwan
| | - Shih-Chung Lai
- Department of Ophthalmology, Shuang Ho Hospital, Taipei Medical University, Taipei 23561, Taiwan
| | - Ju-Chuan Yen
- Graduate Institute of Biomedical Informatics, College of Medical Science and Technology, Taipei Medical University, Taipei 11042, Taiwan
- Department of Ophthalmology, Ren-Ai Branch, Taipei City Hospital, Taipei 10341, Taiwan
- Department of Education and Research, Taipei City Hospital, Taipei 10341, Taiwan
- University of Taipei, Taipei 10048, Taiwan
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8
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Akyea RK, Georgiopoulos G, Iyen B, Kai J, Qureshi N, Ntaios G. Comparison of risk of serious cardiovascular events after haemorrhagic versus ischaemic stroke: a population-based study. Thromb Haemost 2022; 122:1921-1931. [PMID: 35688459 DOI: 10.1055/a-1873-9092] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
BACKGROUND Patients with ischaemic stroke are considered a very-high risk population for subsequent cardiovascular events and guidelines recommend intensive preventive strategies. In contrast, there is no clear recommendation that patients with haemorrhagic stroke should also be regarded as a very-high cardiovascular risk population. OBJECTIVE To compare the risk of subsequent cardiovascular morbidity/mortality between patients with incident haemorrhagic versus ischaemic stroke. METHODS Patients aged >18 years with incident haemorrhagic or ischaemic stroke between 1998-2017, and no prior history of serious vascular event were identified from UK Clinical Practice Research Datalink (CPRD-GOLD) linked to Hospital Episode Statistics (HES) data. RESULTS The cohort included 32,091 patients with an overall follow-up of 381,237 person-years (median: 11.8 years). After adjusting for potential confounders, patients with incident haemorrhagic stroke had no significantly different risk of subsequent cardiovascular morbidity compared with patients with incident ischaemic stroke - CHD [HR:0.86, 95%CI:0.56-1.32], recurrent stroke [HR:0.92, 95%CI:0.83-1.02], PVD [HR:1.15, 95%CI:0.56-2.38], or heart failure [HR:1.03, 95%CI:0.61-1.74]. Patients with incident haemorrhagic stroke had significantly higher risk of subsequent CVD-related mortality [HR:2.35, 95%CI:2.04-2.72] and all-cause mortality [HR:2.16, 95%CI: 1.94-2.41]. Propensity-score matched analysis of 1,039 patients with haemorrhagic stroke and 1,039 with ischaemic stroke showed similar risk in subsequent cardiovascular morbidity - CHD [stratified hazard ratio (sHR):0.92, 95%CI:0.55-1.54], recurrent stroke [sHR:0.93, 95%CI:0.82-1.02)], PVD [sHR:1.04 95%CI:0.45-2.41], or heart failure [HR:0.71, 95%CI:0.39-1.27]. CONCLUSIONS The risk of subsequent cardiovascular events is similar between patients with incident haemorrhagic or ischaemic stroke. Patients with previous haemorrhagic stroke should be regarded as a population at very-high risk of subsequent CVD.
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Affiliation(s)
- Ralph Kwame Akyea
- Centre for Academic Primary Care, University of Nottingham, Nottingham, United Kingdom of Great Britain and Northern Ireland
| | - Georgios Georgiopoulos
- National and Kapodistrian University of Athens School of Medicine Therapeutic Clinic, Athens, Greece.,School of Biomedical Engineering and Imaging Sciences,, King's College London, London, United Kingdom of Great Britain and Northern Ireland
| | - Barbara Iyen
- Centre for Academic Primary Care, University of Nottingham, Nottingham, United Kingdom of Great Britain and Northern Ireland
| | - Joe Kai
- Centre for Academic Primary Care, University of Nottingham, Nottingham, United Kingdom of Great Britain and Northern Ireland
| | - Nadeem Qureshi
- Centre for Academic Primary Care, University of Nottingham, Nottingham, United Kingdom of Great Britain and Northern Ireland
| | - George Ntaios
- Department of Medicine, University of Thessaly, Larissa, Greece
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Iwagami M, Shinozaki T. Introduction to Matching in Case-Control and Cohort Studies. ANNALS OF CLINICAL EPIDEMIOLOGY 2022; 4:33-40. [PMID: 38504854 PMCID: PMC10760465 DOI: 10.37737/ace.22005] [Citation(s) in RCA: 18] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 03/21/2024]
Abstract
Matching is a technique through which patients with and without an outcome of interest (in case-control studies) or patients with and without an exposure of interest (in cohort studies) are sampled from an underlying cohort to have the same or similar distributions of some characteristics. This technique is used to increase the statistical efficiency and cost efficiency of studies. In case-control studies, besides time in risk set sampling, controls are often matched for each case with respect to important confounding factors, such as age and sex, and covariates with a large number of values or levels, such as area of residence (e.g., post code) and clinics/hospitals. In the statistical analysis of matched case-control studies, fixed-effect models such as the Mantel-Haenszel odds ratio estimator and conditional logistic regression model are needed to stratify matched case-control sets and remove selection bias artificially introduced by sampling controls. In cohort studies, exact matching is used to increase study efficiency and remove or reduce confounding effects of matching factors. Propensity score matching is another matching method whereby patients with and without exposure are matched based on estimated propensity scores to receive exposure. If appropriately used, matching can improve study efficiency without introducing bias and could also present results that are more intuitive for clinicians.
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Affiliation(s)
- Masao Iwagami
- Department of Health Services Research, Faculty of Medicine, University of Tsukuba
- Faculty of Epidemiology and Population Health, London School of Hygiene and Tropical Medicine
| | - Tomohiro Shinozaki
- Tokyo University of Science, Department of Information and Computer Technology
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10
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Badurdeen S, Santomartino GA, Thio M, Heng A, Woodward A, Polglase GR, Hooper SB, Blank DA, Davis PG. Respiratory support after delayed cord clamping: a prospective cohort study of at-risk births at ≥35 +0 weeks gestation. Arch Dis Child Fetal Neonatal Ed 2021; 106:627-634. [PMID: 34112723 PMCID: PMC8543210 DOI: 10.1136/archdischild-2020-321503] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/24/2020] [Revised: 03/30/2021] [Accepted: 04/12/2021] [Indexed: 01/14/2023]
Abstract
OBJECTIVE To identify risk factors associated with delivery room respiratory support in at-risk infants who are initially vigorous and received delayed cord clamping (DCC). DESIGN Prospective cohort study. SETTING Two perinatal centres in Melbourne, Australia. PATIENTS At-risk infants born at ≥35+0 weeks gestation with a paediatric doctor in attendance who were initially vigorous and received DCC for >60 s. MAIN OUTCOME MEASURES Delivery room respiratory support defined as facemask positive pressure ventilation, continuous positive airway pressure and/or supplemental oxygen within 10 min of birth. RESULTS Two hundred and ninety-eight infants born at a median (IQR) gestational age of 39+3 (38+2-40+2) weeks were included. Cord clamping occurred at a median (IQR) of 128 (123-145) s. Forty-four (15%) infants received respiratory support at a median of 214 (IQR 156-326) s after birth. Neonatal unit admission for respiratory distress occurred in 32% of infants receiving delivery room respiratory support vs 1% of infants who did not receive delivery room respiratory support (p<0.001). Risk factors independently associated with delivery room respiratory support were average heart rate (HR) at 90-120 s after birth (determined using three-lead ECG), mode of birth and time to establish regular cries. Decision tree analysis identified that infants at highest risk had an average HR of <165 beats per minute at 90-120 s after birth following caesarean section (risk of 39%). Infants with an average HR of ≥165 beats per minute at 90-120 s after birth were at low risk (5%). CONCLUSIONS We present a clinical decision pathway for at-risk infants who may benefit from close observation following DCC. Our findings provide a novel perspective of HR beyond the traditional threshold of 100 beats per minute.
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Affiliation(s)
- Shiraz Badurdeen
- Newborn Research Centre, Royal Women's Hospital, Parkville, Victoria, Australia .,The Ritchie Centre, Hudson Institute of Medical Research, Clayton, Victoria, Australia
| | | | - Marta Thio
- Newborn Research Centre, Royal Women's Hospital, Parkville, Victoria, Australia
| | - Alissa Heng
- Monash University Faculty of Medicine, Nursing and Health Sciences, Clayton, Victoria, Australia
| | - Anthony Woodward
- Department of Obstetrics, Royal Women's Hospital Department of Obstetrics and Gynaecology, Melbourne, Victoria, Australia
| | - Graeme R Polglase
- The Ritchie Centre, Hudson Institute of Medical Research, Clayton, Victoria, Australia,Obstetrics and Gynaecology, Monash University Faculty of Medicine, Nursing and Health Sciences, Clayton, Victoria, Australia
| | - Stuart B Hooper
- The Ritchie Centre, Hudson Institute of Medical Research, Clayton, Victoria, Australia,Obstetrics and Gynaecology, Monash University Faculty of Medicine, Nursing and Health Sciences, Clayton, Victoria, Australia
| | - Douglas A Blank
- The Ritchie Centre, Hudson Institute of Medical Research, Clayton, Victoria, Australia,Monash Newborn, Monash Health, Clayton, Victoria, Australia
| | - Peter G Davis
- Newborn Research Centre, Royal Women's Hospital, Parkville, Victoria, Australia
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11
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King N, Davison CM, Pickett W. Development of a dual-factor measure of adolescent mental health: an analysis of cross-sectional data from the 2014 Canadian Health Behaviour in School-aged Children (HBSC) study. BMJ Open 2021; 11:e041489. [PMID: 34593480 PMCID: PMC8487193 DOI: 10.1136/bmjopen-2020-041489] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/09/2022] Open
Abstract
INTRODUCTION Studies of adolescent mental health require valid measures that are supported by evidence-based theories. An established theory is the dual-factor model, which argues that mental health status is only fully understood by incorporating information on both subjective well-being and psychopathology. OBJECTIVES To develop a novel measure of adolescent mental health based on the dual-factor model and test its construct validity. DESIGN Cross-sectional analysis of national health survey data. SETTING AND PARTICIPANTS Nationally weighted sample of 21 993 grade 6-10 students; average age: 14.0 (SD 1.4) years from the 2014 Canadian Health Behaviour in School-aged Children study. MEASURES Self-report indicators of subjective well-being (life satisfaction, positive and negative affect), and psychopathology (psychological symptoms and overt risk-taking behaviour) were incorporated into the dual-factor measure. Characteristics of adolescents families, specific mental health indicators and measures of academic and social functioning were used in the assessment of construct validity. RESULTS Proportions of students categorised to the four mental health groups indicated by the dual-factor measure were 67.6% 'mentally healthy', 17.5% 'symptomatic yet content', 5.5% 'asymptomatic yet discontent' and 9.4% 'mentally unhealthy'. Being mentally healthy was associated with the highest functioning (greater social support and academic functioning) and being mentally unhealthy was associated with the worst. A one-unit increase (ranges=0-10) in peer support (OR 1.19; 95% CI 1.15 to 1.22), family support (OR 1.32; 95% CI 1.28 to 1.36), student support (OR 1.20; 95% CI 1.17 to 1.24) and average school marks (OR 1.18; 95% CI 1.10 to 1.27) increased the odds of being symptomatic yet content versus mentally unhealthy. Mentally healthy youth were the most likely to live with both parents (77% vs ≤65%) and report their family as well-off (62% vs ≤53%). CONCLUSIONS We developed a novel, construct valid dual-factor measure of adolescent mental health. This potentially provides a nuanced and comprehensive approach to the assessment of adolescent mental health that is direly needed.
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Affiliation(s)
- Nathan King
- Public Health Sciences, Queen's University, Kingston, Ontario, Canada
| | - Colleen M Davison
- Public Health Sciences, Queen's University, Kingston, Ontario, Canada
| | - William Pickett
- Health Sciences, Brock University, Saint Catharines, Ontario, Canada
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12
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Martinez-Hernaez A, Bekele D, Sabariego C, Rodríguez-Laso Á, Vorstenbosch E, Rico-Uribe LA, Ayuso-Mateos JL, Sánchez-Niubò A, Rodríguez-Mañas L, Haro JM. The Structural and Intercultural Competence for Epidemiological Studies (SICES) guidelines: a 22-item checklist. BMJ Glob Health 2021; 6:e005237. [PMID: 33853845 PMCID: PMC8728389 DOI: 10.1136/bmjgh-2021-005237] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2021] [Revised: 03/22/2021] [Accepted: 03/23/2021] [Indexed: 11/15/2022] Open
Abstract
Structural and intercultural competence approaches have been widely applied to fields such as medical training, healthcare practice, healthcare policies and health promotion. Nevertheless, their systematic implementation in epidemiological research is absent. Based on a scoping review and a qualitative analysis, in this article we propose a checklist to assess cultural and structural competence in epidemiological research: the Structural and Intercultural Competence for Epidemiological Studies guidelines. These guidelines are organised as a checklist of 22 items and consider four dimensions of competence (awareness and reflexivity, cultural and structural validation, cultural and structural sensitivity, and cultural and structural representativeness), which are applied to the different stages of epidemiological research: (1) research team building and research questions; (2) study design, participant recruitment, data collection and data analysis; and (3) dissemination. These are the first guidelines addressing structural and cultural competence in epidemiological inquiry.
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Affiliation(s)
| | - Deborah Bekele
- Medical Anthropology Research Center, Rovira i Virgili University, Tarragona, Spain
| | - Carla Sabariego
- Center for Rehabilitation in Global Health Systems, WHO Collaborating Center, University of Lucerne, Lucerne, Switzerland
- Swiss Paraplegic Research, Swiss Paraplegics Foundation, Nottwil, Switzerland
| | | | - Ellen Vorstenbosch
- Teaching, Research and Innovation Unit, Sant Joan de Deu Health Park, Sant Boi de Llobregat, Spain
- CIBERSAM, CIBER Institute of Health Carlos III, Madrid, Spain
| | - Laura Alejandra Rico-Uribe
- CIBERSAM, CIBER Institute of Health Carlos III, Madrid, Spain
- Department of Psychiatry, Autonomous University of Madrid, Madrid, Spain
| | - José Luis Ayuso-Mateos
- CIBERSAM, CIBER Institute of Health Carlos III, Madrid, Spain
- Department of Psychiatry, Autonomous University of Madrid, Madrid, Spain
| | - Albert Sánchez-Niubò
- Teaching, Research and Innovation Unit, Sant Joan de Deu Health Park, Sant Boi de Llobregat, Spain
- CIBERSAM, CIBER Institute of Health Carlos III, Madrid, Spain
| | - Leocadio Rodríguez-Mañas
- CIBERFES, CIBER Institute of Health Carlos III, Madrid, Spain
- Geriatrics Department, Getafe University Hospital, Getafe, Spain
| | - Josep Maria Haro
- Teaching, Research and Innovation Unit, Sant Joan de Deu Health Park, Sant Boi de Llobregat, Spain
- CIBERSAM, CIBER Institute of Health Carlos III, Madrid, Spain
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13
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Sarmanova A, Doherty M, Kuo C, Wei J, Abhishek A, Mallen C, Zeng C, Wang Y, Lei G, Zhang W. Statin use and risk of joint replacement due to osteoarthritis and rheumatoid arthritis: a propensity-score matched longitudinal cohort study. Rheumatology (Oxford) 2021; 59:2898-2907. [PMID: 32097491 DOI: 10.1093/rheumatology/keaa044] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2019] [Revised: 12/20/2019] [Indexed: 01/13/2023] Open
Abstract
OBJECTIVE Statins are reported to have a potential benefit on progression of OA and on disease activity in RA, but existing evidence is conflicting. Our objective was to examine whether statins associate with reduction in the risk for joint replacement due to OA and RA. METHODS This was a propensity score-matched cohort study. Electronic health records from the UK Clinical Practice Research Datalink were used. We selected people prescribed statins and people never prescribed statins. Each statin user was matched to a non-user by age, gender, practice and propensity score for statin prescription. The main outcome measures were knee or hip joint replacement overall, and specifically because of OA or RA. The association between statins and risk of joint replacement was assessed using Cox proportional hazard regression. Statin exposure was categorized according to the potency of reducing low-density lipoprotein as low (21-28%), medium (32-38%) or high (42-55%) intensity. RESULTS A total of 178 467 statin users were matched with 178 467 non-users by age, gender, practice and propensity score. Overall, statin was not associated with reduced risk of knee or hip replacement (hazard ratio 0.99, 95% CI: 0.97, 1.03), unless prescribed at high strength (0.86, 0.75-0.98). The reduced risk was only observed for joint replacement due to RA (0.77, 0.63-0.94) but not OA (0.97, 0.94-1.01). CONCLUSION Statins at high intensity may reduce the risk of hip or knee replacement. This effect may be RA specific. Further studies to investigate mechanisms of risk reduction and the impact in people with RA are warranted.
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Affiliation(s)
- Aliya Sarmanova
- Academic Rheumatology Department, Division of Rheumatology, Orthopaedics and Dermatology, School of Medicine, University of Nottingham, Nottingham, UK.,MRC Integrative Epidemiology Unit, Bristol Medical School (PHS), University of Bristol, Bristol, UK
| | - Michael Doherty
- Academic Rheumatology Department, Division of Rheumatology, Orthopaedics and Dermatology, School of Medicine, University of Nottingham, Nottingham, UK
| | - Changfu Kuo
- Academic Rheumatology Department, Division of Rheumatology, Orthopaedics and Dermatology, School of Medicine, University of Nottingham, Nottingham, UK.,Division of Rheumatology, Allergy and Immunology, Chang Gung Memorial Hospital, Taoyuan, Taiwan
| | - Jie Wei
- Division of Rheumatology, Allergy, and Immunology, Department of Medicine, Massachusetts General Hospital, Harvard Medical School, MA, USA.,Health Management Center, Xiangya Hospital, Central South University, Changsha, Hunan, China
| | - Abhishek Abhishek
- Academic Rheumatology Department, Division of Rheumatology, Orthopaedics and Dermatology, School of Medicine, University of Nottingham, Nottingham, UK
| | - Christian Mallen
- Arthritis Research UK Primary Care Centre, Research Institute for Primary Care and Health Sciences, Keele University, Keele, UK
| | - Chao Zeng
- Division of Rheumatology, Allergy, and Immunology, Department of Medicine, Massachusetts General Hospital, Harvard Medical School, MA, USA.,Department of Orthopaedics, Xiangya Hospital, Central South University, Changsha, Hunan
| | - Yilun Wang
- Department of Orthopaedics, Xiangya Hospital, Central South University, Changsha, Hunan
| | - Guanghua Lei
- Department of Orthopaedics, Xiangya Hospital, Central South University, Changsha, Hunan.,Hunan Key Laboratory of Joint Degeneration and Injury, Changsha, Hunan.,National Clinical Research Center of Geriatric Disorders, Xiangya Hospital, Central South University, Changsha, Hunan, China
| | - Weiya Zhang
- Academic Rheumatology Department, Division of Rheumatology, Orthopaedics and Dermatology, School of Medicine, University of Nottingham, Nottingham, UK
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14
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Xu J, Jiang F, Wang A, Zhi H, Gao Y, Tian J, Mo J, Chen Z, Xu AD, Luo B, Hu B, Zhang Y, Zhao X, Wang Y, Li H, Shen H, Wang Y. Ambulatory blood pressure profile and stroke recurrence. Stroke Vasc Neurol 2021; 6:352-358. [PMID: 33468639 PMCID: PMC8485247 DOI: 10.1136/svn-2020-000526] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2020] [Revised: 10/06/2020] [Accepted: 10/23/2020] [Indexed: 11/03/2022] Open
Abstract
OBJECTIVES To establish a new ambulatory blood pressure (ABP) parameter (24-hour ABP profile) and evaluated its performance on stroke outcome in ischaemic stroke (IS) or transient ischaemic attack (TIA) patients. METHODS The prospective cohort consisted of 1996 IS/TIA patients enrolled for ABP monitoring and a 3-month follow-up for stroke recurrence as outcome. Profile groups of systolic blood pressure (SBP) were identified via an advanced functional clustering method, and the associations of the profile groups and conventional ABP parameters with stroke recurrence were examined in a Cox proportional hazards model. RESULTS Three discrete profile groups (n=604, 781 and 611 in profiles 1, 2 and 3, respectively) in 24-hour ambulatory SBP were identified. Profile 1 resembled most to the normal diurnal blood pressure pattern; profile 2 also dropped at night, but climbed earlier and with higher morning surge; while profile 3 had sustained higher nocturnal SBP without significant nocturnal SBP decline. The incidence of stroke recurrence was 2.9%, 3.9% and 5.5% in profiles 1, 2 and 3, respectively. After adjustment for covariates, profile 3 was significantly associated with higher risk of stroke recurrence with profile 1 as reference (HR 1.76, 95% CI: 1.00 to 3.09), while no significant difference was observed between profiles 2 and 1 (HR 1.22, 95% CI: 0.66 to 2.25). None of conventional ABP parameters showed significant associations with the outcome. CONCLUSIONS Ambulatory 24-hour SBP profile is associated with short-term stroke recurrence. Profiles of ABP may help improve identification of stroke recurrence by capturing the additive effects of individual ABP parameters.
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Affiliation(s)
- Jie Xu
- Department of Neurology, Beijing Tiantan Hospital, Capital Medical University, Beijing, China.,China National Clinical Research Center for Neurological Diseases (NCRCND), Beijing Tiantan Hospital, Capital Medical University, Beijing, China
| | - Fei Jiang
- Department of Statistics and Actuarial Sciences, University of Hong Kong, Hong Kong, China
| | - Anxin Wang
- Department of Neurology, Beijing Tiantan Hospital, Capital Medical University, Beijing, China.,China National Clinical Research Center for Neurological Diseases (NCRCND), Beijing Tiantan Hospital, Capital Medical University, Beijing, China
| | - Hui Zhi
- Biostatistics and Clinical Research Methodology Unit, Faculty of Medicine, University of Hong Kong, Hong Kong, China
| | - Yuan Gao
- Department of Neurology, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, Henan, China
| | - Junping Tian
- Department of Cardiology, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
| | - Jinglin Mo
- Department of Neurology, Beijing Tiantan Hospital, Capital Medical University, Beijing, China.,China National Clinical Research Center for Neurological Diseases (NCRCND), Beijing Tiantan Hospital, Capital Medical University, Beijing, China
| | - Zimo Chen
- Department of Neurology, Beijing Tiantan Hospital, Capital Medical University, Beijing, China.,China National Clinical Research Center for Neurological Diseases (NCRCND), Beijing Tiantan Hospital, Capital Medical University, Beijing, China
| | - An-Ding Xu
- Department of Neurology and Stroke Center, The First Affiliated Hospital of Jinan University, Guangzhou, Guangdong, China
| | - Benyan Luo
- Department of Neurology and Brain Medical Centre, The First Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou, Zhejiang, China
| | - Bo Hu
- Department of Neurology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, China
| | - Yuqing Zhang
- Division of Hypertension, National Center for Cardiovascular Disease China, Fuwai Hospital, Beijing, China
| | - Xingquan Zhao
- Department of Neurology, Beijing Tiantan Hospital, Capital Medical University, Beijing, China.,China National Clinical Research Center for Neurological Diseases (NCRCND), Beijing Tiantan Hospital, Capital Medical University, Beijing, China
| | - Yilong Wang
- Department of Neurology, Beijing Tiantan Hospital, Capital Medical University, Beijing, China.,China National Clinical Research Center for Neurological Diseases (NCRCND), Beijing Tiantan Hospital, Capital Medical University, Beijing, China
| | - Hao Li
- China National Clinical Research Center for Neurological Diseases (NCRCND), Beijing Tiantan Hospital, Capital Medical University, Beijing, China
| | - Haipeng Shen
- Faculty of Business and Economics, University of Hong Kong, Hong Kong, China
| | - Yongjun Wang
- Department of Neurology, Beijing Tiantan Hospital, Capital Medical University, Beijing, China .,China National Clinical Research Center for Neurological Diseases (NCRCND), Beijing Tiantan Hospital, Capital Medical University, Beijing, China
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15
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Jan RL, Tai MC, Ho CH, Chu CC, Wang JJ, Tseng SH, Chang YS. Risk of recurrent corneal erosion in patients with diabetes mellitus in Taiwan: a population-based cohort study. BMJ Open 2020; 10:e035933. [PMID: 32565466 PMCID: PMC7311018 DOI: 10.1136/bmjopen-2019-035933] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/29/2022] Open
Abstract
OBJECTIVE To investigate the risk of recurrent corneal erosion (RCE) in patients with diabetes mellitus (DM). DESIGN, SETTING AND PARTICIPANTS This retrospective, nationwide, matched cohort study included 239 854 patients with DM recruited between 2003 and 2005 from the Longitudinal Cohort of Diabetes Patients database. The control group included the same number of age-matched and sex-matched patients without DM selected from the Taiwan Longitudinal Health Insurance Database, 2000. Data for each patient were collected from the index date until December 2013. MAIN OUTCOMES AND MEASURES The incidence and risk of RCE were compared between the two groups. Cox proportional hazards regression was used to calculate the HR for RCE after adjustment for potential confounders. The cumulative RCE incidence rate was calculated using Kaplan-Meier analysis. RESULTS In total, 1236 patients with DM and 884 controls developed RCE during the follow-up period, resulting in an incidence rate of RCE in patients with DM (5.87/10 000 person-years (PY)) higher than that in the controls (4.23/10 000 PY). After adjustment for potential confounders, including hypertension, hyperlipidaemia, chronic renal disease and keratoconjunctivitis sicca, patients with DM were 1.35 times (95% CI, 1.24 to 1.48) more likely to develop RCE than the total sample cohort. CONCLUSIONS DM increases the risk of RCE, which is an interdisciplinary issue. Therefore, close collaboration between endocrinologists and ophthalmologists is important in managing RCE following DM.
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Affiliation(s)
- Ren-Long Jan
- Department of Pediatrics, Chi Mei Medical Center, Liouying, Tainan, Taiwan
- Graduate Institute of Medical Science, College of Health Science, Chang Jung Christian University, Tainan, Taiwan
| | - Ming-Cheng Tai
- Department of Ophthalmology, Tri-Service General Hospital, National Defense Medical Center, Taipei, Taiwan
| | - Chung-Han Ho
- Department of Medical Research, Chi Mei Medical Center, Tainan, Taiwan
- Department of Hospital and Health Care Administration, Chia Nan University of Pharmacy and Science, Tainan, Taiwan
| | - Chin-Chen Chu
- Department of Anesthesiology, Chi Mei Medical Center, Tainan, Taiwan
- Department of Recreation and Health-Care Management, Chia-Nan University of Pharmacy and Science, Tainan, Taiwan
| | - Jhi-Joung Wang
- Department of Medical Research, Chi Mei Medical Center, Tainan, Taiwan
- Department of Anesthesiology, Chi Mei Medical Center, Tainan, Taiwan
| | - Sung-Huei Tseng
- Department of Ophthalmology, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan, Taiwan
- Department of Ophthalmology, Chi Mei Medical Center, Tainan, Taiwan
| | - Yuh-Shin Chang
- Graduate Institute of Medical Science, College of Health Science, Chang Jung Christian University, Tainan, Taiwan
- Department of Ophthalmology, Chi Mei Medical Center, Tainan, Taiwan
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16
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Goodwin JS, Li S, Kuo YF. Association of the Work Schedules of Hospitalists With Patient Outcomes of Hospitalization. JAMA Intern Med 2020; 180:215-222. [PMID: 31764937 PMCID: PMC6902197 DOI: 10.1001/jamainternmed.2019.5193] [Citation(s) in RCA: 20] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
IMPORTANCE The working schedules of hospitalists vary widely. Discontinuous schedules, such as 24 hours on and 48 hours off, result in several hospitalists providing care during a patient's hospital stay. Poor continuity of care during hospitalization may be associated with poor patient outcomes. OBJECTIVE To determine whether admitted patients receiving care from hospitalists with more discontinuous schedules experience worse outcomes. DESIGN, SETTING, AND PARTICIPANTS This retrospective cohort study used conditional models to assess Medicare claims data for 114 777 medical admissions of patients with a 3-day to 6-day length of stay from January 1, 2014, through November 30, 2016, who received all general medical care from hospitalists in 229 hospitals in Texas. Data were analyzed from November 2018 to June 2019. EXPOSURES For each admission, the weighted mean of schedule continuity for the treating hospitalists, assessed as the percentage of all their working days in that year that were part of a block of 7 or more consecutive working days, was calculated. MAIN OUTCOMES AND MEASURES The primary outcome was patient mortality in the 30 days after discharge. Secondary outcomes were readmission rates and Medicare costs in the 30 days after discharge, and discharge destination. RESULTS Of the 114 777 patient admissions, the mean (SD) age was 79.9 (8.3) years, and 70 047 (61.0%) were women. For admissions in the lowest quartile for continuity of hospitalist schedules, the hospitalists providing care worked 0% to 30% of their total working days as part of a block of 7 or more consecutive days vs 67% to 100% for hospitalists providing care for patients in the highest quartile for continuity. Patient characteristics were not associated with the continuity of working schedules for the hospitalist(s) providing care. In conditional logistic regression models, admitted patients cared for by hospitalists in the highest quartile of schedule continuity (vs the lowest quartile) had lower 30-day mortality after discharge (adjusted odds ratio [aOR], 0.88; 95% CI, 0.81-0.95), lower readmission rates (aOR, 0.94; 95% CI, 0.90-0.99), higher rates of discharge to the home (aOR, 1.08; 95% CI, 1.03-1.13), and lower 30-day postdischarge costs (-$223; 95% CI, -$441 to -$7). The results were similar across a range of different methods for defining continuity of hospitalist schedules and selecting the cohort. CONCLUSIONS AND RELEVANCE Hospitalist schedules vary widely. Admitted patients receiving care from hospitalists with schedules that promote inpatient continuity of care may experience better outcomes of hospitalization.
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Affiliation(s)
- James S Goodwin
- Department of Preventive Medicine and Community Health, The University of Texas Medical Branch at Galveston.,Sealy Center on Aging, The University of Texas Medical Branch at Galveston.,Department of Internal Medicine, The University of Texas Medical Branch at Galveston
| | - Shuang Li
- Department of Preventive Medicine and Community Health, The University of Texas Medical Branch at Galveston.,Sealy Center on Aging, The University of Texas Medical Branch at Galveston
| | - Yong-Fang Kuo
- Department of Preventive Medicine and Community Health, The University of Texas Medical Branch at Galveston.,Sealy Center on Aging, The University of Texas Medical Branch at Galveston
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17
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Shinozaki T, Mansournia MA. Hazard Ratio Estimators after Terminating Observation within Matched Pairs in Sibling and Propensity Score Matched Designs. Int J Biostat 2019; 15:/j/ijb.ahead-of-print/ijb-2017-0103/ijb-2017-0103.xml. [PMID: 30648668 DOI: 10.1515/ijb-2017-0103] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2017] [Accepted: 12/21/2018] [Indexed: 11/15/2022]
Abstract
Similar to unmatched cohort studies, matched cohort studies may suffer from the censoring of events prior to the end of follow-up. Moreover, in some matched-pair cohort studies, observation time is prematurely terminated immediately after the follow-up of his/her matched member is completed by an event or censoring. Although the follow-up termination within matched pairs may or may not change the hazard ratio estimators, when and how the change occurs has not been clarified. We study the change in the estimates of the hazard ratio conditional on matched pairs and/or covariates by considering two types of matched-pair designs in cohort studies-sibling pair matching and propensity score matching-in which termination can be naturally considered. If all possible confounders are shared within the matched pairs, after termination, a wide range of hazard ratio estimators coincides with that obtained from a stratified Cox model. If unshared confounders should be adjusted for in the analysis, however, such coincidence is not observed. Simulation studies on sibling designs with unshared confounders suggested that the pair-stratified covariate-adjusted Cox model for the hazard ratio conditional on matched pairs and covariates is generally preferred, for which termination does not deteriorate the estimation. Conversely, the comparison between stratifying or not stratifying on pair is a more subtle issue in propensity score matching which targets a marginal or covariate-conditional hazard ratio. Based on simulation studies considering Cox models after matching based on estimated propensity scores, we discourage pair-stratified analysis and termination, particularly after data collection.
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Affiliation(s)
- Tomohiro Shinozaki
- Department of Biostatistics, School of Public Health, The University of Tokyo, 7-3-1 Hongo, Bunkyo, Tokyo 1130033, Japan
| | - Mohammad Ali Mansournia
- Department of Epidemiology and Biostatistics, School of Public Health, Tehran University of Medical Sciences, Tehran, Iran
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