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Reich C, Ostropolets A, Ryan P, Rijnbeek P, Schuemie M, Davydov A, Dymshyts D, Hripcsak G. OHDSI Standardized Vocabularies-a large-scale centralized reference ontology for international data harmonization. J Am Med Inform Assoc 2024; 31:583-590. [PMID: 38175665 PMCID: PMC10873827 DOI: 10.1093/jamia/ocad247] [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: 05/12/2023] [Revised: 11/30/2023] [Accepted: 12/23/2023] [Indexed: 01/05/2024] Open
Abstract
IMPORTANCE The Observational Health Data Sciences and Informatics (OHDSI) is the largest distributed data network in the world encompassing more than 331 data sources with 2.1 billion patient records across 34 countries. It enables large-scale observational research through standardizing the data into a common data model (CDM) (Observational Medical Outcomes Partnership [OMOP] CDM) and requires a comprehensive, efficient, and reliable ontology system to support data harmonization. MATERIALS AND METHODS We created the OHDSI Standardized Vocabularies-a common reference ontology mandatory to all data sites in the network. It comprises imported and de novo-generated ontologies containing concepts and relationships between them, and the praxis of converting the source data to the OMOP CDM based on these. It enables harmonization through assigned domains according to clinical categories, comprehensive coverage of entities within each domain, support for commonly used international coding schemes, and standardization of semantically equivalent concepts. RESULTS The OHDSI Standardized Vocabularies comprise over 10 million concepts from 136 vocabularies. They are used by hundreds of groups and several large data networks. More than 8600 users have performed 50 000 downloads of the system. This open-source resource has proven to address an impediment of large-scale observational research-the dependence on the context of source data representation. With that, it has enabled efficient phenotyping, covariate construction, patient-level prediction, population-level estimation, and standard reporting. DISCUSSION AND CONCLUSION OHDSI has made available a comprehensive, open vocabulary system that is unmatched in its ability to support global observational research. We encourage researchers to exploit it and contribute their use cases to this dynamic resource.
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Affiliation(s)
- Christian Reich
- Coordinating Center, Observational Health Data Sciences and Informatics, New York City NY 10032, United States
- OHDSI Center at the Roux Institute, Northeastern University, Portland ME 04101, United States
- Department of Medical Informatics, Erasmus University Medical Center, 3015 GD Rotterdam, The Netherlands
| | - Anna Ostropolets
- Coordinating Center, Observational Health Data Sciences and Informatics, New York City NY 10032, United States
- Department of Biomedical Informatics, Columbia University Medical Center, New York City NY 10032, United States
- Odysseus Data Services, Cambridge MA 02142, United States
| | - Patrick Ryan
- Coordinating Center, Observational Health Data Sciences and Informatics, New York City NY 10032, United States
- Department of Biomedical Informatics, Columbia University Medical Center, New York City NY 10032, United States
- Observational Health Data Analytics, Janssen Research & Development, Titusville NJ 08560, United States
| | - Peter Rijnbeek
- Coordinating Center, Observational Health Data Sciences and Informatics, New York City NY 10032, United States
- Department of Medical Informatics, Erasmus University Medical Center, 3015 GD Rotterdam, The Netherlands
| | - Martijn Schuemie
- Coordinating Center, Observational Health Data Sciences and Informatics, New York City NY 10032, United States
- Observational Health Data Analytics, Janssen Research & Development, Titusville NJ 08560, United States
| | - Alexander Davydov
- Coordinating Center, Observational Health Data Sciences and Informatics, New York City NY 10032, United States
- Odysseus Data Services, Cambridge MA 02142, United States
| | - Dmitry Dymshyts
- Coordinating Center, Observational Health Data Sciences and Informatics, New York City NY 10032, United States
- Observational Health Data Analytics, Janssen Research & Development, Titusville NJ 08560, United States
| | - George Hripcsak
- Coordinating Center, Observational Health Data Sciences and Informatics, New York City NY 10032, United States
- Department of Biomedical Informatics, Columbia University Medical Center, New York City NY 10032, United States
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Zafari Z, Park JE, Shah CH, dosReis S, Gorman EF, Hua W, Ma Y, Tian F. The State of Use and Utility of Negative Controls in Pharmacoepidemiologic Studies. Am J Epidemiol 2024; 193:426-453. [PMID: 37851862 DOI: 10.1093/aje/kwad201] [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: 12/16/2022] [Revised: 07/27/2023] [Accepted: 10/06/2023] [Indexed: 10/20/2023] Open
Abstract
Uses of real-world data in drug safety and effectiveness studies are often challenged by various sources of bias. We undertook a systematic search of the published literature through September 2020 to evaluate the state of use and utility of negative controls to address bias in pharmacoepidemiologic studies. Two reviewers independently evaluated study eligibility and abstracted data. Our search identified 184 eligible studies for inclusion. Cohort studies (115, 63%) and administrative data (114, 62%) were, respectively, the most common study design and data type used. Most studies used negative control outcomes (91, 50%), and for most studies the target source of bias was unmeasured confounding (93, 51%). We identified 4 utility domains of negative controls: 1) bias detection (149, 81%), 2) bias correction (16, 9%), 3) P-value calibration (8, 4%), and 4) performance assessment of different methods used in drug safety studies (31, 17%). The most popular methodologies used were the 95% confidence interval and P-value calibration. In addition, we identified 2 reference sets with structured steps to check the causality assumption of the negative control. While negative controls are powerful tools in bias detection, we found many studies lacked checking the underlying assumptions. This article is part of a Special Collection on Pharmacoepidemiology.
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Tie H, Li Z, Welp H, Guha A, Caraballo C, Deschka H, Shi R, Zheng X, Martens S, Sindermann J, Chen D, Wu Q, Martens S. Calcium channel blockers and clinical outcomes in patients with continuous-flow left ventricular assist devices. ESC Heart Fail 2024; 11:271-281. [PMID: 37967837 PMCID: PMC10804166 DOI: 10.1002/ehf2.14576] [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: 05/14/2023] [Revised: 10/15/2023] [Accepted: 10/19/2023] [Indexed: 11/17/2023] Open
Abstract
AIMS Current guidelines suggest calcium channel blockers (CCBs) as the second or third option for blood pressure management in patients with left ventricular assist device (LVAD). However, the clinical outcomes of patients with LVAD who receive CCBs remain unclear. Our study aims to analyse the association of CCBs with clinical outcomes in patients after LVAD implantation. METHODS AND RESULTS This is a retrospective analysis based on the Interagency Registry for Mechanically Assisted Circulatory Support (INTERMACS) from 2006 to 2017, and adult patients who were alive with LVAD and CCB treatment information at 6 months after implantation were included. Among 10 717 patients, 1369 received CCBs 6 months after implantation, and there was an increasing trend of CCB use after LVAD. Patients receiving CCB therapy at 6 months had a similar 5 year survival rate to those not receiving CCB [49.6%, 95% confidence interval (CI): 47.5-51.7% vs. 51.1%, 95% CI: 45.3-56.7%]. In both Cox and competing risk regressions after adjusting for confounding factors, CCB treatment at 6 months after implantation was not associated with long-term mortality [hazard ratio (HR): 1.03, 95% CI: 0.91-1.17, P = 0.624 and subdistribution HR (SHR): 1.07, 95% CI: 0.95-1.22, P = 0.260]. Consistently, in time-varying models, CCB treatment was not linked to long-term mortality (HR: 0.97, 95% CI: 0.87-1.09, P = 0.682 and SHR: 1.05, 95% CI: 0.94-1.18, P = 0.359). This null association remained in subgroup analysis according to device strategy and propensity-matching analyses. Neurological dysfunction, stroke, bleeding, rehospitalization, and renal dysfunction were more likely to occur among those with CCB when compared with those without CCB treatment. CONCLUSIONS In patients with LVAD, CCB therapy fails to show benefits in long-term survival and is associated with increased incidences of neurological dysfunction, bleeding, renal dysfunction, and rehospitalization.
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Affiliation(s)
- Hongtao Tie
- Department of Cardiothoracic SurgeryUniversity Hospital MuensterMuensterGermany
- Department of Cardiothoracic SurgeryThe First Affiliated Hospital of Chongqing Medical UniversityChongqingChina
| | - Zhenhan Li
- Department of EndocrinologyChongqing Traditional Chinese Medicine HospitalChongqingChina
- Department of Anaesthesiology, Intensive Care Medicine and Pain MedicineUniversity Hospital MuensterMuensterGermany
| | - Henryk Welp
- Department of Cardiothoracic SurgeryUniversity Hospital MuensterMuensterGermany
| | - Avirup Guha
- Division of Cardiology, Department of Internal MedicineMedical College of Georgia at Augusta UniversityAugustaGAUSA
- Cardio‐Oncology Program, Division of CardiologyThe Ohio State University Medical CenterColumbusOHUSA
| | - César Caraballo
- Section of Cardiovascular MedicineYale School of MedicineNew HavenCTUSA
- Center for Outcomes Research and EvaluationNew HavenCTUSA
| | - Heinz Deschka
- Department of Cardiothoracic SurgeryUniversity Hospital MuensterMuensterGermany
| | - Rui Shi
- Department of Critical Care MedicineThe First Affiliated Hospital of Sun Yat‐sen UniversityGuangzhouChina
| | | | - Sven Martens
- Department of Cardiothoracic SurgeryUniversity Hospital MuensterMuensterGermany
| | - Jürgen Sindermann
- Department of Cardiothoracic SurgeryUniversity Hospital MuensterMuensterGermany
| | - Dan Chen
- Department of Cardiothoracic SurgeryThe First Affiliated Hospital of Chongqing Medical UniversityChongqingChina
| | - Qingchen Wu
- Department of Cardiothoracic SurgeryThe First Affiliated Hospital of Chongqing Medical UniversityChongqingChina
| | - Sabrina Martens
- Department of Cardiothoracic SurgeryUniversity Hospital MuensterMuensterGermany
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Kweon T, Kim Y, Lee KJ, Seo WW, Seo SI, Shin WG, Shin DH. Proton pump inhibitors and chronic kidney disease risk: a comparative study with histamine-2 receptor antagonists. Sci Rep 2023; 13:21169. [PMID: 38036592 PMCID: PMC10689439 DOI: 10.1038/s41598-023-48430-9] [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: 07/10/2023] [Accepted: 11/27/2023] [Indexed: 12/02/2023] Open
Abstract
This observational study explored the association between proton pump inhibitor (PPI) and histamine-2 receptor antagonist (H2RA) use and the risk of chronic kidney disease (CKD). Using the National Health Insurance Service-National Sample Cohort (NHIS-NSC) and six-hospital electronic health record (EHR) databases, CKD incidence was analyzed among PPI and H2RA users. Propensity score matching was used to balance baseline characteristics, with 1,869 subjects each in the PPI and H2RA groups from the NHIS-NSC, and 5,967 in EHR databases. CKD incidence was similar for both groups (5.72/1000 person-years vs. 7.57/1000 person-years; HR = 0.68; 95% CI, 0.35-1.30). A meta-analysis of the EHR databases showed no significant increased CKD risk associated with PPI use (HR = 1.03, 95% CI: 0.87-1.23). These results suggest PPI use may not increase CKD risk compared to H2RA use, but the potential role of PPI-induced CKD needs further research. Clinicians should consider this when prescribing long-term PPI therapy.
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Affiliation(s)
- Takhyeon Kweon
- Department of Internal Medicine, College of Medicine, Kangdong Sacred Heart Hospital, Hallym University, 150, Seongan-to, Guangdong-Gu, Seoul, 05355, Korea
| | - Yerim Kim
- Department of Internal Medicine, College of Medicine, Kangdong Sacred Heart Hospital, Hallym University, 150, Seongan-to, Guangdong-Gu, Seoul, 05355, Korea
| | - Kyung Joo Lee
- Department of Internal Medicine, College of Medicine, Kangdong Sacred Heart Hospital, Hallym University, 150, Seongan-to, Guangdong-Gu, Seoul, 05355, Korea
| | - Won-Woo Seo
- Department of Internal Medicine, College of Medicine, Kangdong Sacred Heart Hospital, Hallym University, 150, Seongan-to, Guangdong-Gu, Seoul, 05355, Korea
| | - Seung In Seo
- Department of Internal Medicine, College of Medicine, Kangdong Sacred Heart Hospital, Hallym University, 150, Seongan-to, Guangdong-Gu, Seoul, 05355, Korea
| | - Woon Geon Shin
- Department of Internal Medicine, College of Medicine, Kangdong Sacred Heart Hospital, Hallym University, 150, Seongan-to, Guangdong-Gu, Seoul, 05355, Korea
| | - Dong Ho Shin
- Department of Internal Medicine, College of Medicine, Kangdong Sacred Heart Hospital, Hallym University, 150, Seongan-to, Guangdong-Gu, Seoul, 05355, Korea.
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You SC, Lee S, Choi B, Park RW. Establishment of an International Evidence Sharing Network Through Common Data Model for Cardiovascular Research. Korean Circ J 2022; 52:853-864. [PMID: 36478647 PMCID: PMC9742390 DOI: 10.4070/kcj.2022.0294] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2022] [Accepted: 11/10/2022] [Indexed: 08/21/2023] Open
Abstract
A retrospective observational study is one of the most widely used research methods in medicine. However, evidence postulated from a single data source likely contains biases such as selection bias, information bias, and confounding bias. Acquiring enough data from multiple institutions is one of the most effective methods to overcome the limitations. However, acquiring data from multiple institutions from many countries requires enormous effort because of financial, technical, ethical, and legal issues as well as standardization of data structure and semantics. The Observational Health Data Sciences and Informatics (OHDSI) research network standardized 928 million unique records or 12% of the world's population into a common structure and meaning and established a research network of 453 data partners from 41 countries around the world. OHDSI is a distributed research network wherein researchers do not own or directly share data but only analyzed results. However, sharing evidence without sharing data is difficult to understand. In this review, we will look at the basic principles of OHDSI, common data model, distributed research networks, and some representative studies in the cardiovascular field using the network. This paper also briefly introduces a Korean distributed research network named FeederNet.
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Affiliation(s)
- Seng Chan You
- Department of Biomedical Systems Informatics, Yonsei University College of Medicine, Seoul, Korea
- Institute for Innovation in Digital Healthcare, Yonsei University, Seoul, Korea
| | - Seongwon Lee
- Department of Biomedical Informatics, Ajou University School of Medicine, Suwon, Korea
| | - Byungjin Choi
- Department of Biomedical Informatics, Ajou University School of Medicine, Suwon, Korea
- Department of Biomedical Sciences, Ajou University Graduate School of Medicine, Suwon, Korea
| | - Rae Woong Park
- Department of Biomedical Informatics, Ajou University School of Medicine, Suwon, Korea
- Department of Biomedical Sciences, Ajou University Graduate School of Medicine, Suwon, Korea.
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Zhang L, Wang Y, Schuemie MJ, Blei DM, Hripcsak G. Adjusting for indirectly measured confounding using large-scale propensity score. J Biomed Inform 2022; 134:104204. [PMID: 36108816 DOI: 10.1016/j.jbi.2022.104204] [Citation(s) in RCA: 12] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2022] [Revised: 08/16/2022] [Accepted: 09/06/2022] [Indexed: 11/15/2022]
Abstract
Confounding remains one of the major challenges to causal inference with observational data. This problem is paramount in medicine, where we would like to answer causal questions from large observational datasets like electronic health records (EHRs) and administrative claims. Modern medical data typically contain tens of thousands of covariates. Such a large set carries hope that many of the confounders are directly measured, and further hope that others are indirectly measured through their correlation with measured covariates. How can we exploit these large sets of covariates for causal inference? To help answer this question, this paper examines the performance of the large-scale propensity score (LSPS) approach on causal analysis of medical data. We demonstrate that LSPS may adjust for indirectly measured confounders by including tens of thousands of covariates that may be correlated with them. We present conditions under which LSPS removes bias due to indirectly measured confounders, and we show that LSPS may avoid bias when inadvertently adjusting for variables (like colliders) that otherwise can induce bias. We demonstrate the performance of LSPS with both simulated medical data and real medical data.
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Affiliation(s)
- Linying Zhang
- Department of Biomedical Informatics, Columbia University Irving Medical Center, 622 W. 168th Street, PH20, New York, 10032, NY, USA
| | - Yixin Wang
- Department of Statistics, University of Michigan, 1085 S University Ave, Ann Arbor, 48109, MI, USA
| | - Martijn J Schuemie
- Janssen Research and Development, 1125 Trenton-Harbourton Road, Titusville, 08560, NJ, USA
| | - David M Blei
- Department of Statistics, Columbia University, 1255 Amsterdam Ave, New York, 10027, NY, USA; Department of Computer Science, Columbia University, 500 West 120 Street, Room 450 MC0401, New York, 10027, NY, USA
| | - George Hripcsak
- Department of Biomedical Informatics, Columbia University Irving Medical Center, 622 W. 168th Street, PH20, New York, 10032, NY, USA; Medical Informatics Services, New York-Presbyterian Hospital, 622 W. 168th Street, PH20, New York, 10032, NY, USA.
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Kim T, Seo SI, Lee KJ, Park CH, Kim TJ, Kim J, Shin WG. Decreasing Incidence of Gastric Cancer with Increasing Time after Helicobacter pylori Treatment: A Nationwide Population-Based Cohort Study. Antibiotics (Basel) 2022; 11:antibiotics11081052. [PMID: 36009921 PMCID: PMC9405442 DOI: 10.3390/antibiotics11081052] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2022] [Revised: 07/31/2022] [Accepted: 08/01/2022] [Indexed: 02/04/2023] Open
Abstract
Background: Treatment of Helicobacter pylori (HP) has been shown to reduce the risk of gastric cancer (GC) development. However, previous studies have focused on patients at high risk of GC. This study aimed to assess the effect of HP treatment on the incidence of GC in the general population. Materials and Methods: Medical records were obtained from the Common Data Model-converted sample Cohort of the National Health Insurance Service of Korea (NHIS-CDM). The target cohort included those who had been prescribed HP treatment and the comparator cohort included those who had not. The association between HP treatment and the risk of GC development was assessed using the Cox proportional hazard model. The incidences of GC according to the period after HP treatment in different age groups were analyzed using proportional trend tests. Results: After large-scale 1:4 propensity score matching, 2735 and 5328 individuals were included in the target and comparator cohorts, respectively. During the median follow-up of 6.5 years, the GC incidence was lower in the HP treatment cohort than in the comparator cohort, but this was statistically insignificant (hazard ratio [HR]: 0.76; 95% confidence interval [CI]: 0.50−1.13; p-value = 0.19). This trend was also observed among the older age (≥65 years, HR: 0.87; 95% CI: 0.44−1.68; p-value = 0.69) and male cohorts (HR: 0.82; 95% CI: 0.51−1.27; p-value = 0.38). Among 58,684 individuals who were treated for HP from the whole NHIS-CDM cohort, the incidence of GC consistently decreased over time and showed a marked decrease with increasing age (p for trend < 0.05). Conclusions: In all age groups of the general population, HP treatment could be recommended to reduce the risk of GC.
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Affiliation(s)
- Taewan Kim
- Department of Internal Medicine, Kangdong Sacred Heart Hospital, Hallym University College of Medicine, Seoul 05355, Korea;
- Institute for Liver and Digestive Diseases, Hallym University, Chuncheon 24252, Korea
| | - Seung In Seo
- Department of Internal Medicine, Kangdong Sacred Heart Hospital, Hallym University College of Medicine, Seoul 05355, Korea;
- Institute for Liver and Digestive Diseases, Hallym University, Chuncheon 24252, Korea
- Correspondence: (S.I.S.); (W.G.S.)
| | - Kyung Joo Lee
- University Industry Foundation, Hallym University, Chuncheon 24252, Korea;
| | - Chan Hyuk Park
- Department of Internal Medicine, Hanyang University Guri Hospital, College of Medicine, Hanyang University, Guri 11923, Korea;
| | - Tae Jun Kim
- Department of Medicine, Samsung Medical Center, School of Medicine, Sungkyunkwan University, Seoul 06351, Korea;
| | - Jinseob Kim
- Department of Epidemiology, School of Public Health, Seoul National University, Seoul 03080, Korea;
| | - Woon Geon Shin
- Department of Internal Medicine, Kangdong Sacred Heart Hospital, Hallym University College of Medicine, Seoul 05355, Korea;
- Institute for Liver and Digestive Diseases, Hallym University, Chuncheon 24252, Korea
- Correspondence: (S.I.S.); (W.G.S.)
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Park DH, Seo SI, Lee KJ, Kim J, Kim Y, Seo WW, Lee HS, Shin WG, Yoo JJ. Long-term proton pump inhibitor use and risk of osteoporosis and hip fractures: A nationwide population-based and multicenter cohort study using a common data model. J Gastroenterol Hepatol 2022; 37:1534-1543. [PMID: 35501296 DOI: 10.1111/jgh.15879] [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: 01/05/2022] [Revised: 04/14/2022] [Accepted: 04/30/2022] [Indexed: 12/09/2022]
Abstract
BACKGROUND AND AIM Association between protonpump inhibitors (PPIs) and osteoporosis, hip fractures has not been fully elucidated. We aimed to evaluate the relationship between PPIs use and the risk of osteoporosis and hip fractures in the databases converted to a common data model (CDM) and to compare the results across the databases. METHODS This was a population-based, propensity-matched, retrospective cohort study that included patients aged ≥ 50 years who were prescribed with PPIs for over 180 days. We compared the incidence of osteoporosis and hip fractures between new PPI user and new user of other drugs using the Cox proportional hazards model and performed meta-analysis in the electronic health record (EHR) databases. RESULTS In the Korean National Health Insurance Service (NHIS)-CDM database, long-term PPI users had greater risk of osteoporosis [PPIs vs non-PPIs groups, 28.42/1000 person-years vs 19.29/1000 person-years; hazard ratio (HR), 1.62; 95% confidence interval (CI), 1.22-2.15; P = 0.001]. The meta-analytic results of six EHR databases also showed similar result (pooled HR, 1.57; 95% CI, 1.28-1.92). In the analysis of hip fracture, PPI use was not significantly associated with a hip fracture in the NHIS-CDM database (PPI vs non-PPI groups, 3.09/1000 person-years vs 2.26/1000 person-years; HR, 1.45; 95% CI, 0.74-2.80; P = 0.27). However, in the meta-analysis of four EHR databases, the risk of hip fractures was higher in PPI users (pooled HR, 1.82; 95% CI, 1.04-3.19). CONCLUSIONS Long-term PPI was significantly associated with osteoporosis; however, the results of hip fractures were inconsistent. Further study based on better data quality may be needed.
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Affiliation(s)
- Da Hee Park
- Division of Gastroenterology, Department of Internal Medicine, Kangdong Sacred Heart Hospital, Hallym University College of Medicine, Seoul, South Korea
| | - Seung In Seo
- Division of Gastroenterology, Department of Internal Medicine, Kangdong Sacred Heart Hospital, Hallym University College of Medicine, Seoul, South Korea.,Institute for Liver and Digestive Diseases, Hallym University, Chuncheon, South Korea
| | - Kyung Joo Lee
- University Industry Foundation, Hallym University, Chuncheon, South Korea
| | - Jinseob Kim
- Department of Epidemiology, School of Public Health, Seoul National University, Seoul, South Korea
| | - Yerim Kim
- Department of Neurology, Kangdong Sacred Heart Hospital, Hallym University College of Medicine, Seoul, South Korea
| | - Won-Woo Seo
- Division of Cardiology, Department of Internal Medicine, Kangdong Sacred Heart Hospital, Hallym University College of Medicine, Seoul, South Korea
| | - Hyung Seok Lee
- Division of Nephrology, Department of Internal Medicine, Hallym University Sacred Heart Hospital, Hallym University College of Medicine, Anyang, South Korea
| | - Woon Geon Shin
- Division of Gastroenterology, Department of Internal Medicine, Kangdong Sacred Heart Hospital, Hallym University College of Medicine, Seoul, South Korea.,Institute for Liver and Digestive Diseases, Hallym University, Chuncheon, South Korea
| | - Jong Jin Yoo
- Division of Rheumatology, Department of Internal Medicine, Kangdong Sacred Heart Hospital, Hallym University College of Medicine, Seoul, South Korea
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Incidence and Survival Outcomes of Colorectal Cancer in Long-Term Metformin Users with Diabetes: A Population-Based Cohort Study Using a Common Data Model. J Pers Med 2022; 12:jpm12040584. [PMID: 35455700 PMCID: PMC9031185 DOI: 10.3390/jpm12040584] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2022] [Revised: 03/30/2022] [Accepted: 04/03/2022] [Indexed: 11/24/2022] Open
Abstract
Background and aims: Previous studies have reported that metformin use in patients with diabetes mellitus may reduce the risk of colorectal cancer (CRC) incidence and prognosis; however, the evidence is not definite. This population-based cohort study aimed to investigate whether metformin reduces the risk of CRC incidence and prognosis in patients with diabetes mellitus using a common data model of the Korean National Health Insurance Service database from 2002 to 2013. Methods: Patients who used metformin for at least 6 months were defined as metformin users. The primary outcome was CRC incidence, and the secondary outcomes were the all-cause and CRC-specific mortality. Cox proportional hazard model was performed and large-scaled propensity score matching was used to control for potential confounding factors. Results: During the follow-up period of 81,738 person-years, the incidence rates (per 1000 person-years) of CRC were 5.18 and 8.12 in metformin users and non-users, respectively (p = 0.001). In the propensity score matched cohort, the risk of CRC incidence in metformin users was significantly lower than in non-users (hazard ratio (HR), 0.58; 95% CI (confidence interval), 0.47–0.71). In the sensitivity analysis, the lag period extending to 1 year showed similar results (HR: 0.63, 95% CI: 0.51–0.79). The all-cause mortality was significantly lower in metformin users than in non-users (HR: 0.71, 95% CI: 0.64–0.78); CRC-related mortality was also lower among metformin users. However, there was no significant difference (HR: 0.55, 95% CI: 0.26–1.08). Conclusions: Metformin use was associated with a reduced risk of CRC incidence and improved overall survival.
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Lee CJ, Choi B, Pak H, Park JM, Lee JH, Lee SH. Genetic Variants Associated with Adverse Events after Angiotensin-Converting Enzyme Inhibitor Use: Replication after GWAS-Based Discovery. Yonsei Med J 2022; 63:342-348. [PMID: 35352885 PMCID: PMC8965428 DOI: 10.3349/ymj.2022.63.4.342] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/15/2021] [Revised: 12/13/2021] [Accepted: 01/11/2022] [Indexed: 11/27/2022] Open
Abstract
PURPOSE Angiotensin-converting enzyme inhibitors (ACEIs) are medications generally prescribed for patients with high cardiovascular risk; however, they are suboptimally used due to frequent adverse events (AEs). The present study aimed to identify and replicate the genetic variants associated with ACEI-related AEs in the Korean population. MATERIALS AND METHODS A two-stage approach employing genome-wide association study (GWAS)-based discovery and replication through target sequencing was used. In total, 1300 individuals received ACEIs from 2001 to 2007; among these, 228 were selected for GWAS. An additional 336 patients were selected for replication after screening 1186 subjects treated from 2008 to 2018. Candidate genes for target sequencing were selected based on the present GWAS, previous GWASs, and data from the PharmGKB database. Furthermore, association analyses were performed between no AE and AE or cough groups after target sequencing. RESULTS Five genes, namely CRIM1, NELL1, CACNA1D, VOPP1, and MYBPC1, were identified near variants associated with ACEI-related AEs. During target sequencing of 34 candidate genes, six single-nucleotide polymorphisms (SNPs; rs5224, rs8176786, rs10766756, rs561868018, rs4974539, and rs10946364) were replicated for association with all ACEI-related AEs. Four of these SNPs and rs147912715 exhibited associations with ACEI-related cough, whereas four SNPs (rs5224, rs81767786, rs10766756, and rs4974539 near BDKRB2, NELL1, NELL1 intron, and CPN2, respectively) were significantly associated with both categories of AEs. CONCLUSION Several variants, including novel and known variants, were successfully replicated and found to have associations with ACEI-related AEs. These results provide rare and clinically relevant information for safer use of ACEIs.
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Affiliation(s)
- Chan Joo Lee
- Division of Cardiology, Department of Internal Medicine, Severance Hospital, Yonsei University College of Medicine, Seoul, Korea
| | - Bogeum Choi
- Kyung Hee University College of Medicine, Seoul, Korea
| | - Hayeon Pak
- Department of Life and Nanopharmaceutical Sciences, Graduate School, Kyung Hee University, Seoul, Korea
| | - Jung Mi Park
- Department of Biostatistics and Computing, Graduate School, Yonsei University, Seoul, Korea
| | - Ji Hyun Lee
- Department of Clinical Pharmacology and Therapeutics, Kyung Hee University College of Medicine, Seoul, Korea
- Department of Biomedical Science and Technology, Kyung Hee University, Seoul, Korea.
| | - Sang-Hak Lee
- Division of Cardiology, Department of Internal Medicine, Severance Hospital, Yonsei University College of Medicine, Seoul, Korea.
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11
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Lu Y, Van Zandt M, Liu Y, Li J, Wang X, Chen Y, Chen Z, Cho J, Dorajoo SR, Feng M, Hsu MH, Hsu JC, Iqbal U, Jonnagaddala J, Li YC, Liaw ST, Lim HS, Ngiam KY, Nguyen PA, Park RW, Pratt N, Reich C, Rhee SY, Sathappan SMK, Shin SJ, Tan HX, You SC, Zhang X, Krumholz HM, Suchard MA, Xu H. Analysis of Dual Combination Therapies Used in Treatment of Hypertension in a Multinational Cohort. JAMA Netw Open 2022; 5:e223877. [PMID: 35323951 PMCID: PMC8948532 DOI: 10.1001/jamanetworkopen.2022.3877] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/21/2022] Open
Abstract
IMPORTANCE More than 1 billion adults have hypertension globally, of whom 70% cannot achieve their hypertension control goal with monotherapy alone. Data are lacking on clinical use patterns of dual combination therapies prescribed to patients who escalate from monotherapy. OBJECTIVE To investigate the most common dual combinations prescribed for treatment escalation in different countries and how treatment use varies by age, sex, and history of cardiovascular disease. DESIGN, SETTING, AND PARTICIPANTS This cohort study used data from 11 electronic health record databases that cover 118 million patients across 8 countries and regions between January 2000 and December 2019. Included participants were adult patients (ages ≥18 years) who newly initiated antihypertensive dual combination therapy after escalating from monotherapy. There were 2 databases included for 3 countries: the Iqvia Longitudinal Patient Database (LPD) Australia and Electronic Practice-based Research Network 2019 linked data set from South Western Sydney Local Health District (ePBRN SWSLHD) from Australia, Ajou University School of Medicine (AUSOM) and Kyung Hee University Hospital (KHMC) databases from South Korea, and Khoo Teck Puat Hospital (KTPH) and National University Hospital (NUH) databases from Singapore. Data were analyzed from June 2020 through August 2021. EXPOSURES Treatment with dual combinations of the 4 most commonly used antihypertensive drug classes (angiotensin-converting enzyme inhibitor [ACEI] or angiotensin receptor blocker [ARB]; calcium channel blocker [CCB]; β-blocker; and thiazide or thiazide-like diuretic). MAIN OUTCOMES AND MEASURES The proportion of patients receiving each dual combination regimen, overall and by country and demographic subgroup. RESULTS Among 970 335 patients with hypertension who newly initiated dual combination therapy included in the final analysis, there were 11 494 patients from Australia (including 9291 patients in Australia LPD and 2203 patients in ePBRN SWSLHD), 6980 patients from South Korea (including 6029 patients in Ajou University and 951 patients in KHMC), 2096 patients from Singapore (including 842 patients in KTPH and 1254 patients in NUH), 7008 patients from China, 8544 patients from Taiwan, 103 994 patients from France, 76 082 patients from Italy, and 754 137 patients from the US. The mean (SD) age ranged from 57.6 (14.8) years in China to 67.7 (15.9) years in the Singapore KTPH database, and the proportion of patients by sex ranged from 24 358 (36.9%) women in Italy to 408 964 (54.3%) women in the US. Among 12 dual combinations of antihypertensive drug classes commonly used, there were significant variations in use across country and patient subgroup. For example starting an ACEI or ARB monotherapy followed by a CCB (ie, ACEI or ARB + CCB) was the most commonly prescribed combination in Australia (698 patients in ePBRN SWSLHD [31.7%] and 3842 patients in Australia LPD [41.4%]) and Singapore (216 patients in KTPH [25.7%] and 439 patients in NUH [35.0%]), while in South Korea, CCB + ACEI or ARB (191 patients in KHMC [20.1%] and 1487 patients in Ajou University [24.7%]), CCB + β-blocker (814 patients in Ajou University [13.5%] and 217 patients in KHMC [22.8%]), and ACEI or ARB + CCB (147 patients in KHMC [15.5%] and 1216 patients in Ajou University [20.2%]) were the 3 most commonly prescribed combinations. The distribution of 12 dual combination therapies were significantly different by age and sex in almost all databases. For example, use of ACEI or ARB + CCB varied from 873 of 3737 patients ages 18 to 64 years (23.4%) to 343 of 2292 patients ages 65 years or older (15.0%) in South Korea's Ajou University database (P for database distribution by age < .001), while use of ACEI or ARB + CCB varied from 2121 of 4718 (44.8%) men to 1721 of 4549 (37.7%) women in Australian LPD (P for drug combination distributions by sex < .001). CONCLUSIONS AND RELEVANCE In this study, large variation in the transition between monotherapy and dual combination therapy for hypertension was observed across countries and by demographic group. These findings suggest that future research may be needed to investigate what dual combinations are associated with best outcomes for which patients.
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Affiliation(s)
- Yuan Lu
- Center for Outcomes Research and Evaluation, Yale New Haven Hospital, New Haven, Connecticut
- Section of Cardiovascular Medicine, Department of Internal Medicine, Yale School of Medicine, New Haven, Connecticut
| | | | - Yun Liu
- School of Biomedical Engineering and Informatics, Department of Medical Informatics, Nanjing Medical University, Jiangsu, China
| | - Jing Li
- Real World Solutions, Iqvia, Durham, North Carolina
| | - Xialin Wang
- Real World Solutions, Iqvia, Durham, North Carolina
| | - Yong Chen
- Perelman School of Medicine, Department of Biostatistics, Epidemiology and Informatics, University of Pennsylvania
| | - Zhengfeng Chen
- National University Heart Center, Yong Loo Lin School of Medicine, National University of Singapore, Singapore
| | - Jaehyeong Cho
- Department of Biomedical Sciences, Ajou University Graduate School of Medicine, Suwon, Republic of Korea
| | | | - Mengling Feng
- Saw Swee Hock School of Public Health, National University of Singapore, Singapore
- Institute of Data Science, National University of Singapore, Singapore
| | | | - Jason C. Hsu
- International PhD Program in Biotech and Healthcare Management, College of Management, Taipei Medical University, Taipei, Taiwan
| | - Usman Iqbal
- International Center for Health Information Technology, Taipei Medical University, Taipei City, Taiwan
| | - Jitendra Jonnagaddala
- World Health Organization Collaborating Center on eHealth, School of Population Health, University of New South Wales Sydney, Australia
| | - Yu-Chuan Li
- Graduate Institute of Biomedical Informatics, College of Medical Science and Technology, Taipei Medical University, Taipei City, Taiwan
| | - Siaw-Teng Liaw
- World Health Organization Collaborating Center on eHealth, School of Population Health, University of New South Wales Sydney, Australia
| | - Hong-Seok Lim
- Department of Cardiology, Ajou University School of Medicine, Suwon, Republic of Korea
| | - Kee Yuan Ngiam
- Group Chief Technology Office, National University Health System, Singapore
| | - Phung-Anh Nguyen
- International Center for Health Information Technology, Taipei Medical University, Taipei, Taiwan
- School of Health Technology, Taiwan Department of Healthcare Information and Management, Ming Chuan University, Taipei, Taiwan
| | - Rae Woong Park
- Department of Biomedical Informatics, Ajou University School of Medicine, Suwon, Republic of Korea
- Department of Biomedical Sciences, Ajou University Graduate School of Medicine, Suwon, Republic of Korea
| | - Nicole Pratt
- Quality Use of Medicines and Pharmacy Research Center, Clinical and Health Sciences, University of South Australia, Adelaide, Australia
| | | | - Sang Youl Rhee
- Kyung Hee University Medical Center, Seoul, Republic of Korea
| | - Selva Muthu Kumaran Sathappan
- Saw Swee Hock School of Public Health, National University of Singapore, Singapore
- National University of Singapore, Singapore
| | - Seo Jeong Shin
- Department of Biomedical Sciences, Ajou University Graduate School of Medicine, Suwon, Republic of Korea
| | | | - Seng Chan You
- Department of Preventive Medicine, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Xin Zhang
- School of Biomedical Engineering and Informatics, Department of Medical Informatics, Nanjing Medical University, Jiangsu, China
| | - Harlan M. Krumholz
- Center for Outcomes Research and Evaluation, Yale New Haven Hospital, New Haven, Connecticut
- Section of Cardiovascular Medicine, Department of Internal Medicine, Yale School of Medicine, New Haven, Connecticut
- Department of Health Policy and Management, Yale School of Public Health, New Haven, Connecticut
| | - Marc A. Suchard
- Department of Biostatistics, Fielding School of Public Health, University of California, Los Angeles
| | - Hua Xu
- University of Texas Health Science Center at Houston, Houston
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12
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Seo SI, Park CH, Kim TJ, Bang CS, Kim JY, Lee KJ, Kim J, Kim HH, You SC, Shin WG. Aspirin, metformin, and statin use on the risk of gastric cancer: A nationwide population-based cohort study in Korea with systematic review and meta-analysis. Cancer Med 2021; 11:1217-1231. [PMID: 34970858 PMCID: PMC8855895 DOI: 10.1002/cam4.4514] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2021] [Revised: 12/01/2021] [Accepted: 12/03/2021] [Indexed: 01/04/2023] Open
Abstract
BACKGROUND/AIMS Although several chemopreventive drugs against gastric cancer have been proposed, their effects have not been fully evaluated. We examined the impacts of aspirin, metformin, and statin use on gastric cancer development in a population-based cohort in Korea. METHODS We analyzed the association between potential chemopreventive drugs-aspirin, metformin, and statin-and gastric cancer through the Observational Medical Outcomes Partnership Common Data Model-based Korean nationwide cohort. Use of aspirin, metformin, and statin was defined by ≥365 days of prescriptions for each drug in the general population. To summarize the current evidence, we further performed a systematic review and meta-analysis of the impact of aspirin, metformin, and statin on gastric cancer development. RESULTS After propensity score matching, 31,839, 6764, and 10,251 subjects were observed for medians of 4.7, 4.2, and 4.2 years for aspirin, metformin, and statin analysis, respectively. Use of aspirin or statin was associated with lower risks of gastric cancer compared to their non-use, respectively (hazard ratio [HR] [95% confidence interval [CI]]: aspirin, 0.72 [0.60-0.85], p < 0.01; statin, 0.67 [0.49-0.92], p = 0.01). However, no association was observed between metformin use and gastric cancer development (HR [95% CI]: 0.85 [0.59-1.23], p = 0.40). A subgroup of subjects with diabetes mellitus showed a lower risk of gastric cancer development with statin use. The meta-analysis showed the highest effect size of gastric cancer development for statin, followed by aspirin and metformin. CONCLUSIONS Statin and aspirin use were associated with significantly reduced risks of gastric cancer development, while the use of metformin was not associated with the gastric cancer risk. The protective effect of statin against gastric cancer was also significant in patients with diabetes mellitus.
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Affiliation(s)
- Seung In Seo
- Department of Internal Medicine, Kangdong Sacred Heart Hospital, Hallym University College of Medicine, Seoul, Korea.,Institute for Liver and Digestive Diseases, Hallym University, Chuncheon, Korea
| | - Chan Hyuk Park
- Department of Internal Medicine, Hanyang University Guri Hospital, Hanyang University College of Medicine, Guri, Korea
| | - Tae Jun Kim
- Department of Internal Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Chang Seok Bang
- Institute for Liver and Digestive Diseases, Hallym University, Chuncheon, Korea.,Department of Internal Medicine, Chuncheon Sacred Heart Hospital, Hallym University College of Medicine, Chuncheon, Korea
| | - Jae Young Kim
- University Industry Foundation, Hallym University, Chuncheon, Korea
| | - Kyung Joo Lee
- University Industry Foundation, Hallym University, Chuncheon, Korea
| | - Jinseob Kim
- Department of Epidemiology, School of Public Health, Seoul National University, Seoul, Korea
| | - Hyon Hee Kim
- Department of Statistics and Information Science, Dongduk Women's University, Seoul, Korea
| | - Seng Chan You
- Department of Preventive Medicine, Yonsei University College of Medicine, Seoul, Korea
| | - Woon Geon Shin
- Department of Internal Medicine, Kangdong Sacred Heart Hospital, Hallym University College of Medicine, Seoul, Korea.,Institute for Liver and Digestive Diseases, Hallym University, Chuncheon, Korea
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13
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Shin J, Lee CH. The roles of sodium and volume overload on hypertension in chronic kidney disease. Kidney Res Clin Pract 2021; 40:542-554. [PMID: 34922428 PMCID: PMC8685361 DOI: 10.23876/j.krcp.21.800] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2021] [Accepted: 10/18/2021] [Indexed: 11/24/2022] Open
Abstract
Chronic kidney disease (CKD) is associated with increased risk of cardiovascular (CV) events, and the disease burden is rising rapidly. An important contributor to CV events and CKD progression is high blood pressure (BP). The main mechanisms of hypertension in early and advanced CKD are renin-angiotensin system activation and volume overload, respectively. Sodium retention is well known as a factor for high BP in CKD. However, a BP increase in response to total body sodium or volume overload can be limited by neurohormonal modulation. Recent clinical trial data favoring intensive BP lowering in CKD imply that the balance between volume and neurohormonal control could be revisited with respect to the safety and efficacy of strict volume control when using antihypertensive medications. In hemodialysis patients, the role of more liberal use of antihypertensive medications with the concept of functional dry weight for intensive BP control must be studied.
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Affiliation(s)
- Jinho Shin
- Division of Cardiology, Department of Internal Medicine, Hanyang University Medical Center, Seoul, Republic of Korea
| | - Chang Hwa Lee
- Division of Nephrology, Department of Internal Medicine, Hanyang University Medical Center, Seoul, Republic of Korea
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14
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Seo SI, Park CH, You SC, Kim JY, Lee KJ, Kim J, Kim Y, Yoo JJ, Seo WW, Lee HS, Shin WG. Association between proton pump inhibitor use and gastric cancer: a population-based cohort study using two different types of nationwide databases in Korea. Gut 2021; 70:2066-2075. [PMID: 33975868 DOI: 10.1136/gutjnl-2020-323845] [Citation(s) in RCA: 57] [Impact Index Per Article: 19.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/10/2020] [Revised: 04/23/2021] [Accepted: 04/24/2021] [Indexed: 12/24/2022]
Abstract
OBJECTIVE The association between proton pump inhibitor (PPI) use and gastric cancer related to Helicobacter pylori eradication has not been fully investigated in geographical regions with high risk of gastric cancer. We aimed to evaluate the association between PPIs and gastric cancer in Korea. DESIGN This study analysed the original and common data model versions of the Korean National Health Insurance Service database from 2002 to 2013. We compared the incidence rates of gastric cancer after 1-year drug exposure, between new users of PPIs and other drugs excluding PPIs, by Cox proportional hazards model. We also analysed the incidence of gastric cancer among PPI users after H. pylori eradication. RESULTS The analysis included 11 741 patients in matched PPI and non-PPI cohorts after large-scale propensity score matching. During a median follow-up of 4.3 years, PPI use was associated with a 2.37-fold increased incidence of gastric cancer (PPI≥30 days vs non-PPI; 118/51 813 person-years vs 40/49 729 person-years; HR 2.37, 95% CI 1.56 to 3.68, p=0.001). The incidence rates of gastric cancer showed an increasing trend parallel to the duration of PPI use. In H. pylori-eradicated subjects, the incidence of gastric cancer was significantly associated with PPI use over 180 days compared with the non-PPI group (PPI≥180 days vs non-PPI; 30/12 470 person-years vs 9/7814 person-years; HR 2.22, 95% CI 1.05 to 4.67, p=0.036). CONCLUSION PPI use was associated with gastric cancer, regardless of H. pylori eradication status. Long-term PPIs should be used with caution in high-risk regions for gastric cancer.
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Affiliation(s)
- Seung In Seo
- Department of Internal Medicine, Kangdong Sacred Heart Hospital, Hallym University College of Medicine, Seoul, South Korea
- Institute for Liver and Digestive Diseases, Hallym University, Chuncheon, South Korea
| | - Chan Hyuk Park
- Department of Internal Medicine, Hanyang University Guri Hospital, Hanyang University College of Medicine, Guri, South Korea
| | - Seng Chan You
- Department of Preventive Medicine, Yonsei University College of Medicine, Seoul, South Korea
| | - Jae Young Kim
- University Industry Foundation, Hallym University, Chuncheon, South Korea
| | - Kyung Joo Lee
- University Industry Foundation, Hallym University, Chuncheon, South Korea
| | - Jinseob Kim
- Department of Epidemiology, School of Public Health, Seoul National University, Seoul, South Korea
| | - Yerim Kim
- Department of Neurology, Kangdong Sacred Heart Hospital, Hallym University College of Medicine, Seoul, South Korea
| | - Jong Jin Yoo
- Department of Internal Medicine, Kangdong Sacred Heart Hospital, Hallym University College of Medicine, Seoul, South Korea
| | - Won-Woo Seo
- Department of Internal Medicine, Kangdong Sacred Heart Hospital, Hallym University College of Medicine, Seoul, South Korea
| | - Hyung Seok Lee
- Department of Internal Medicine, Hallym University Sacred Heart Hospital, Hallym University College of Medicine, Anyang, South Korea
| | - Woon Geon Shin
- Department of Internal Medicine, Kangdong Sacred Heart Hospital, Hallym University College of Medicine, Seoul, South Korea
- Institute for Liver and Digestive Diseases, Hallym University, Chuncheon, South Korea
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15
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La recherche clinique à partir d’entrepôts de données. L’expérience de l’Assistance Publique – Hôpitaux de Paris (AP–HP) à l’épreuve de la pandémie de Covid-19. Rev Med Interne 2020; 41:303-307. [PMID: 32334860 PMCID: PMC7164890 DOI: 10.1016/j.revmed.2020.04.005] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2020] [Accepted: 04/14/2020] [Indexed: 12/25/2022]
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16
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Lee HY. Big Challenge in Big Data Research: Continual Dispute on Big Data Analysis. Korean Circ J 2019; 50:69-71. [PMID: 31854157 PMCID: PMC6923239 DOI: 10.4070/kcj.2019.0349] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2019] [Accepted: 11/20/2019] [Indexed: 02/03/2023] Open
Affiliation(s)
- Hae Young Lee
- Department of Internal Medicine, Seoul National University College of Medicine, Seoul, Korea.
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