1
|
Ide J, Shoaibi A, Wagner K, Weinstein R, Boyle KE, Myers A. Patterns of Comorbidities and Prescribing and Dispensing of Non-steroidal Anti-inflammatory Drugs (NSAIDs) Among Patients with Osteoarthritis in the USA: Real-World Study. Drugs Aging 2024; 41:357-366. [PMID: 38520626 PMCID: PMC11021340 DOI: 10.1007/s40266-024-01108-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/07/2024] [Indexed: 03/25/2024]
Abstract
BACKGROUND Osteoarthritis (OA) is a major cause of chronic pain. Non-steroidal anti-inflammatory drugs (NSAIDs) are analgesics commonly used for musculoskeletal pain; however, NSAIDs can increase the risk of certain adverse events, such as gastrointestinal bleeding, edema, heart failure, and hypertension. OBJECTIVE The objective of this study was to characterize existing comorbidities among patients with OA. For patients with OA with and without a coexisting medical condition of interest (CMCOI), we estimated the prevalence of prescribing and dispensing NSAIDs pre-OA and post-OA diagnosis. METHODS Data from three large administrative claims databases were used to construct an OA retrospective cohort. Databases leveraged were IBM MarketScan Medicare Supplemental Database (MDCR), IBM MarketScan Commercial Database (CCAE), and Optum's de-identified Clinformatics® Data Mart Database (Optum CDM). The OA study population was defined to be those patients who had an OA diagnosis from an inpatient or outpatient visit with at least 365 days of prior observation time in the database during January 2000 through May 2021. Asthma, cardiovascular disorders, renal impairment, and gastrointestinal bleeding risks were the CMCOI of interest. Patients with OA were then classified as having or not having evidence of a CMCOI. For both groups, NSAID dispensing patterns pre-OA and post-OA diagnosis were identified. Descriptive analysis was performed within the Observational Health Data Sciences and Informatics framework. RESULTS In each database, the proportion of the OA population with at least one CMCOI was nearly 50% or more (48.0% CCAE; 74.4% MDCR; 68.6% Optum CDM). Cardiovascular disease was the most commonly observed CMCOI in each database, and in two databases, nearly one in four patients with OA had two or more CMCOI (23.2% MDCR; 22.6% Optum CDM). Among the OA population with CMCOI, NSAID utilization post-OA diagnosis ranged from 33.0 to 46.2%. Following diagnosis of OA, an increase in the prescribing and dispensing of NSAIDs was observed in all databases, regardless of patient CMCOI presence. CONCLUSIONS This study provides real-world evidence of the pattern of prescribing and dispensing of NSAIDs among patients with OA with and without CMCOI, which indicates that at least half of patients with OA in the USA have a coexisting condition. These conditions may increase the risk of side effects commonly associated with NSAIDs. Yet, at least 32% of these patients were prescribed and dispensed NSAIDs. These data support the importance of shared decision making between healthcare professionals and patients when considering NSAIDs for the treatment of OA in patients with NSAID-relevant coexisting medical conditions.
Collapse
Affiliation(s)
- Joshua Ide
- Johnson & Johnson Consumer Inc., Skillman, NJ, 08558, USA.
| | | | - Kerstin Wagner
- Johnson & Johnson Consumer Inc., Skillman, NJ, 08558, USA
| | | | | | - Andrew Myers
- Johnson & Johnson Consumer Inc., Fort Washington, PA, USA
| |
Collapse
|
2
|
Kern DM, Shoaibi A, Shearer D, Richarz U, Killion L, Knight RK. Association between prolactin increasing antipsychotic use and the risk of breast cancer: a retrospective observational cohort study in a United States Medicaid population. Front Oncol 2024; 14:1356640. [PMID: 38595824 PMCID: PMC11003262 DOI: 10.3389/fonc.2024.1356640] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2023] [Accepted: 02/19/2024] [Indexed: 04/11/2024] Open
Abstract
Introduction Results of retrospective studies examining the relationship between prolactin increasing antipsychotics and incident breast cancer have been inconsistent. This study assessed the association between use of high prolactin increasing antipsychotics (HPD) and the incidence of breast cancer using best practices in pharmacoepidemiology. Methods Using administrative claims data from the MarketScan Medicaid database, schizophrenia patients initiating antipsychotics were identified. Those initiating HPD were compared with new users of non/low prolactin increasing drugs (NPD). Two definitions of breast cancer, two at-risk periods, and two large-scale propensity score (PS) adjustment methods were used in separate analyses. PS models included all previously diagnosed conditions, medication use, demographics, and other available medical history. Negative control outcomes were used for empirical calibration. Results Five analysis variants passed all diagnostics for sufficient statistical power and balance across all covariates. Four of the five variants used an intent-to-treat (ITT) approach. Between 4,256 and 6,341 patients were included in each group for the ITT analyses, and patients contributed approximately four years of follow-up time on average. There was no statistically significant association between exposure to HPD and risk of incident breast cancer in any analysis, and hazard ratios remained close to 1.0, ranging from 0.96 (95% confidence interval 0.62 - 1.48) to 1.28 (0.40 - 4.07). Discussion Using multiple PS methods, outcome definitions and at-risk periods provided robust and consistent results which found no evidence of an association between use of HPD and risk of breast cancer.
Collapse
Affiliation(s)
- David M Kern
- Janssen Research & Development, LLC, Horsham, PA, United States
| | - Azza Shoaibi
- Janssen Research & Development, LLC, Titusville, NJ, United States
| | - David Shearer
- Janssen Research & Development, LLC, Horsham, PA, United States
| | - Ute Richarz
- Janssen Research & Development, LLC, Zug, Switzerland
| | - Leslie Killion
- Janssen Research & Development, LLC, Horsham, PA, United States
| | - R Karl Knight
- Janssen Research & Development, LLC, Titusville, NJ, United States
| |
Collapse
|
3
|
Cai CX, Nishimura A, Bowring MG, Westlund E, Tran D, Ng JH, Nagy P, Cook M, McLeggon JA, DuVall SL, Matheny ME, Golozar A, Ostropolets A, Minty E, Desai P, Bu F, Toy B, Hribar M, Falconer T, Zhang L, Lawrence-Archer L, Boland MV, Goetz K, Hall N, Shoaibi A, Reps J, Sena AG, Blacketer C, Swerdel J, Jhaveri KD, Lee E, Gilbert Z, Zeger SL, Crews DC, Suchard MA, Hripcsak G, Ryan PB. Similar Risk of Kidney Failure among Patients with Blinding Diseases Who Receive Ranibizumab, Aflibercept, and Bevacizumab: An Observational Health Data Sciences and Informatics Network Study. Ophthalmol Retina 2024:S2468-6530(24)00118-0. [PMID: 38519026 DOI: 10.1016/j.oret.2024.03.014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2024] [Revised: 03/08/2024] [Accepted: 03/12/2024] [Indexed: 03/24/2024]
Abstract
PURPOSE To characterize the incidence of kidney failure associated with intravitreal anti-VEGF exposure; and compare the risk of kidney failure in patients treated with ranibizumab, aflibercept, or bevacizumab. DESIGN Retrospective cohort study across 12 databases in the Observational Health Data Sciences and Informatics (OHDSI) network. SUBJECTS Subjects aged ≥ 18 years with ≥ 3 monthly intravitreal anti-VEGF medications for a blinding disease (diabetic retinopathy, diabetic macular edema, exudative age-related macular degeneration, or retinal vein occlusion). METHODS The standardized incidence proportions and rates of kidney failure while on treatment with anti-VEGF were calculated. For each comparison (e.g., aflibercept versus ranibizumab), patients from each group were matched 1:1 using propensity scores. Cox proportional hazards models were used to estimate the risk of kidney failure while on treatment. A random effects meta-analysis was performed to combine each database's hazard ratio (HR) estimate into a single network-wide estimate. MAIN OUTCOME MEASURES Incidence of kidney failure while on anti-VEGF treatment, and time from cohort entry to kidney failure. RESULTS Of the 6.1 million patients with blinding diseases, 37 189 who received ranibizumab, 39 447 aflibercept, and 163 611 bevacizumab were included; the total treatment exposure time was 161 724 person-years. The average standardized incidence proportion of kidney failure was 678 per 100 000 persons (range, 0-2389), and incidence rate 742 per 100 000 person-years (range, 0-2661). The meta-analysis HR of kidney failure comparing aflibercept with ranibizumab was 1.01 (95% confidence interval [CI], 0.70-1.47; P = 0.45), ranibizumab with bevacizumab 0.95 (95% CI, 0.68-1.32; P = 0.62), and aflibercept with bevacizumab 0.95 (95% CI, 0.65-1.39; P = 0.60). CONCLUSIONS There was no substantially different relative risk of kidney failure between those who received ranibizumab, bevacizumab, or aflibercept. Practicing ophthalmologists and nephrologists should be aware of the risk of kidney failure among patients receiving intravitreal anti-VEGF medications and that there is little empirical evidence to preferentially choose among the specific intravitreal anti-VEGF agents. FINANCIAL DISCLOSURES Proprietary or commercial disclosure may be found in the Footnotes and Disclosures at the end of this article.
Collapse
Affiliation(s)
- Cindy X Cai
- Wilmer Eye Institute, Johns Hopkins School of Medicine, Baltimore, Maryland.
| | - Akihiko Nishimura
- Department of Biostatistics, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland
| | - Mary G Bowring
- Department of Biomedical Engineering, Johns Hopkins School of Medicine, Baltimore, Maryland
| | - Erik Westlund
- Department of Biostatistics, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland
| | - Diep Tran
- Wilmer Eye Institute, Johns Hopkins School of Medicine, Baltimore, Maryland
| | - Jia H Ng
- Division of Kidney Diseases and Hypertension, Donald and Barbara School of Medicine at Hofstra/Northwell, New York
| | - Paul Nagy
- Department of Biomedical Informatics and Data Science, Johns Hopkins School of Medicine, Johns Hopkins University, Baltimore, Maryland
| | | | - Jody-Ann McLeggon
- Department of Biomedical Informatics, Columbia University, New York, New York
| | - Scott L DuVall
- VA Informatics and Computing Infrastructure, US Department of Veterans Affairs, Salt Lake City, Utah; Department of Internal Medicine Division of Epidemiology, University of Utah School of Medicine, Salt Lake City, Utah
| | - Michael E Matheny
- VA Informatics and Computing Infrastructure, Tennessee Valley Healthcare System, Nashville, Tennessee; Department of Biomedical Informatics, Vanderbilt University, Nashville, Tennessee
| | - Asieh Golozar
- Odysseus Data Services, Inc., Cambridge, Massachusetts; OHDSI Center at the Roux Institute, Northeastern University, Boston, Massachusetts
| | | | - Evan Minty
- O'Brien Center for Public Health, Department of Medicine, University of Calgary, Canada
| | - Priya Desai
- Technology / Digital Solutions, Stanford Health Care and Stanford University School of Medicine, Palo Alto, California
| | - Fan Bu
- Department of Biostatistics, University of California - Los Angeles, Los Angeles, California
| | - Brian Toy
- Roski Eye Institute, Keck School of Medicine, University of Southern California; Los Angeles, California
| | - Michelle Hribar
- National Eye Institute, National Institutes of Health, Bethesda, Maryland; Casey Eye Institute, Oregon Health & Science University, Portland, Oregon
| | - Thomas Falconer
- Department of Biomedical Informatics, Columbia University, New York, New York
| | - Linying Zhang
- Department of Biomedical Informatics, Columbia University, New York, New York
| | - Laurence Lawrence-Archer
- Odysseus Data Services, Inc., Cambridge, Massachusetts; OHDSI Center at the Roux Institute, Northeastern University, Boston, Massachusetts
| | - Michael V Boland
- Mass Eye and Ear, and Harvard Medical School, Boston, Massachusetts
| | - Kerry Goetz
- National Eye Institute, National Institutes of Health, Bethesda, Maryland
| | - Nathan Hall
- Janssen Research and Development, Titusville, New Jersey
| | - Azza Shoaibi
- Janssen Research and Development, Titusville, New Jersey
| | - Jenna Reps
- Janssen Research and Development, Titusville, New Jersey
| | - Anthony G Sena
- Janssen Research and Development, Titusville, New Jersey; Department of Medical Informatics, Erasmus University Medical Center, Rotterdam, the Netherlands
| | | | - Joel Swerdel
- Janssen Research and Development, Titusville, New Jersey
| | - Kenar D Jhaveri
- Glomerular Center at Northwell Health, Division of Kidney Diseases and Hypertension, Donald and Barbara School of Medicine at Hofstra/Northwell, New York
| | - Edward Lee
- Roski Eye Institute, Keck School of Medicine, University of Southern California; Los Angeles, California
| | - Zachary Gilbert
- Roski Eye Institute, Keck School of Medicine, University of Southern California; Los Angeles, California
| | - Scott L Zeger
- Department of Biostatistics, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland
| | - Deidra C Crews
- Division of Nephrology, Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Marc A Suchard
- VA Informatics and Computing Infrastructure, US Department of Veterans Affairs, Salt Lake City, Utah; Department of Biostatistics, University of California - Los Angeles, Los Angeles, California
| | - George Hripcsak
- Department of Biomedical Informatics, Columbia University, New York, New York
| | - Patrick B Ryan
- Janssen Research and Development, Titusville, New Jersey
| |
Collapse
|
4
|
Makadia R, Shoaibi A, Rao GA, Ostropolets A, Rijnbeek PR, Voss EA, Duarte-Salles T, Ramírez-Anguita JM, Mayer MA, Maljković F, Denaxas S, Nyberg F, Papez V, Sena AG, Alshammari TM, Lai LYH, Haynes K, Suchard MA, Hripcsak G, Ryan PB. Evaluating the impact of alternative phenotype definitions on incidence rates across a global data network. JAMIA Open 2023; 6:ooad096. [PMID: 38028730 PMCID: PMC10662662 DOI: 10.1093/jamiaopen/ooad096] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2023] [Revised: 07/25/2023] [Accepted: 10/31/2023] [Indexed: 12/01/2023] Open
Abstract
Objective Developing accurate phenotype definitions is critical in obtaining reliable and reproducible background rates in safety research. This study aims to illustrate the differences in background incidence rates by comparing definitions for a given outcome. Materials and Methods We used 16 data sources to systematically generate and evaluate outcomes for 13 adverse events and their overall background rates. We examined the effect of different modifications (inpatient setting, standardization of code set, and code set changes) to the computable phenotype on background incidence rates. Results Rate ratios (RRs) of the incidence rates from each computable phenotype definition varied across outcomes, with inpatient restriction showing the highest variation from 1 to 11.93. Standardization of code set RRs ranges from 1 to 1.64, and code set changes range from 1 to 2.52. Discussion The modification that has the highest impact is requiring inpatient place of service, leading to at least a 2-fold higher incidence rate in the base definition. Standardization showed almost no change when using source code variations. The strength of the effect in the inpatient restriction is highly dependent on the outcome. Changing definitions from broad to narrow showed the most variability by age/gender/database across phenotypes and less than a 2-fold increase in rate compared to the base definition. Conclusion Characterization of outcomes across a network of databases yields insights into sensitivity and specificity trade-offs when definitions are altered. Outcomes should be thoroughly evaluated prior to use for background rates for their plausibility for use across a global network.
Collapse
Affiliation(s)
- Rupa Makadia
- OHDSI Collaborators, Observational Health Data Sciences and Informatics (OHDSI), New York, NY 10027, United States
- Global Epidemiology, Janssen Pharmaceutical Research and Development, LLC, Titusville, NJ 08560, United States
| | - Azza Shoaibi
- OHDSI Collaborators, Observational Health Data Sciences and Informatics (OHDSI), New York, NY 10027, United States
- Global Epidemiology, Janssen Pharmaceutical Research and Development, LLC, Titusville, NJ 08560, United States
| | - Gowtham A Rao
- OHDSI Collaborators, Observational Health Data Sciences and Informatics (OHDSI), New York, NY 10027, United States
- Global Epidemiology, Janssen Pharmaceutical Research and Development, LLC, Titusville, NJ 08560, United States
| | - Anna Ostropolets
- OHDSI Collaborators, Observational Health Data Sciences and Informatics (OHDSI), New York, NY 10027, United States
- Department of Biomedical Informatics, Columbia University Irving Medical Center, New York, NY 10027, United States
| | - Peter R Rijnbeek
- OHDSI Collaborators, Observational Health Data Sciences and Informatics (OHDSI), New York, NY 10027, United States
- Department of Medical Informatics, Erasmus University Medical Center, Rotterdam, 3000 CA, The Netherlands
| | - Erica A Voss
- OHDSI Collaborators, Observational Health Data Sciences and Informatics (OHDSI), New York, NY 10027, United States
- Global Epidemiology, Janssen Pharmaceutical Research and Development, LLC, Titusville, NJ 08560, United States
| | - Talita Duarte-Salles
- OHDSI Collaborators, Observational Health Data Sciences and Informatics (OHDSI), New York, NY 10027, United States
- Fundació Institut Universitari per a la recerca a l'Atenció Primària de Salut Jordi Gol i Gurina (IDIAPJGol), Barcelona, 08007, Spain
| | - Juan Manuel Ramírez-Anguita
- Research Programme on Biomedical Informatics (GRIB), Hospital del Mar Medical Research Institute (IMIM), Barcelona, 08003, Spain
| | - Miguel A Mayer
- Management Control Department, Parc de Salut Mar (PSMAR), Barcelona, 08007, Spain
| | - Filip Maljković
- Research and Development, Heliant d.o.o, Belgrade, 11000, Serbia
| | - Spiros Denaxas
- Institute of Health Informatics, University College London, London, NW1 2DA, United Kingdom
- British Heart Foundation Data Science Centre, HDR, London, NW1 2DA, United Kingdom
| | - Fredrik Nyberg
- School of Public Health and Community Medicine, Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, 40530, Sweden
| | - Vaclav Papez
- Institute of Health Informatics, University College London, London, NW1 2DA, United Kingdom
| | - Anthony G Sena
- OHDSI Collaborators, Observational Health Data Sciences and Informatics (OHDSI), New York, NY 10027, United States
- Global Epidemiology, Janssen Pharmaceutical Research and Development, LLC, Titusville, NJ 08560, United States
- Department of Medical Informatics, Erasmus University Medical Center, Rotterdam, 3000 CA, The Netherlands
| | - Thamir M Alshammari
- OHDSI Collaborators, Observational Health Data Sciences and Informatics (OHDSI), New York, NY 10027, United States
- College of Pharmacy, Prince Sattam Bin Abdulaziz University, Riyadh, 11942, Saudi Arabia
| | - Lana Y H Lai
- OHDSI Collaborators, Observational Health Data Sciences and Informatics (OHDSI), New York, NY 10027, United States
- Division of Informatics, Imaging and Data Sciences, University of Manchester, Manchester, M13 9PL, United Kingdom
| | - Kevin Haynes
- Global Epidemiology, Janssen Pharmaceutical Research and Development, LLC, Titusville, NJ 08560, United States
| | - Marc A Suchard
- OHDSI Collaborators, Observational Health Data Sciences and Informatics (OHDSI), New York, NY 10027, United States
- Department of Biostatistics, University of California, Los Angeles, Los Angeles, CA 90025, United States
| | - George Hripcsak
- OHDSI Collaborators, Observational Health Data Sciences and Informatics (OHDSI), New York, NY 10027, United States
- Department of Biomedical Informatics, Columbia University Irving Medical Center, New York, NY 10027, United States
| | - Patrick B Ryan
- OHDSI Collaborators, Observational Health Data Sciences and Informatics (OHDSI), New York, NY 10027, United States
- Global Epidemiology, Janssen Pharmaceutical Research and Development, LLC, Titusville, NJ 08560, United States
- Department of Biomedical Informatics, Columbia University Irving Medical Center, New York, NY 10027, United States
| |
Collapse
|
5
|
Ostropolets A, Albogami Y, Conover M, Banda JM, Baumgartner WA, Blacketer C, Desai P, DuVall SL, Fortin S, Gilbert JP, Golozar A, Ide J, Kanter AS, Kern DM, Kim C, Lai LYH, Li C, Liu F, Lynch KE, Minty E, Neves MI, Ng DQ, Obene T, Pera V, Pratt N, Rao G, Rappoport N, Reinecke I, Saroufim P, Shoaibi A, Simon K, Suchard MA, Swerdel JN, Voss EA, Weaver J, Zhang L, Hripcsak G, Ryan PB. Reproducible variability: assessing investigator discordance across 9 research teams attempting to reproduce the same observational study. J Am Med Inform Assoc 2023; 30:859-868. [PMID: 36826399 PMCID: PMC10114120 DOI: 10.1093/jamia/ocad009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2022] [Revised: 01/04/2023] [Accepted: 01/23/2023] [Indexed: 02/25/2023] Open
Abstract
OBJECTIVE Observational studies can impact patient care but must be robust and reproducible. Nonreproducibility is primarily caused by unclear reporting of design choices and analytic procedures. This study aimed to: (1) assess how the study logic described in an observational study could be interpreted by independent researchers and (2) quantify the impact of interpretations' variability on patient characteristics. MATERIALS AND METHODS Nine teams of highly qualified researchers reproduced a cohort from a study by Albogami et al. The teams were provided the clinical codes and access to the tools to create cohort definitions such that the only variable part was their logic choices. We executed teams' cohort definitions against the database and compared the number of subjects, patient overlap, and patient characteristics. RESULTS On average, the teams' interpretations fully aligned with the master implementation in 4 out of 10 inclusion criteria with at least 4 deviations per team. Cohorts' size varied from one-third of the master cohort size to 10 times the cohort size (2159-63 619 subjects compared to 6196 subjects). Median agreement was 9.4% (interquartile range 15.3-16.2%). The teams' cohorts significantly differed from the master implementation by at least 2 baseline characteristics, and most of the teams differed by at least 5. CONCLUSIONS Independent research teams attempting to reproduce the study based on its free-text description alone produce different implementations that vary in the population size and composition. Sharing analytical code supported by a common data model and open-source tools allows reproducing a study unambiguously thereby preserving initial design choices.
Collapse
Affiliation(s)
- Anna Ostropolets
- Department of Biomedical Informatics, Columbia University Irving Medical Center, New York, New York, USA
| | - Yasser Albogami
- Department of Clinical Pharmacy, College of Pharmacy, King Saud University, Riyadh, Saudi Arabia
| | - Mitchell Conover
- Observational Health Data Analytics, Janssen Research & Development, Titusville, New Jersey, USA
| | - Juan M Banda
- Department of Computer Science, Georgia State University, Atlanta, Georgia, USA
| | - William A Baumgartner
- Division of General Internal Medicine, Department of Medicine, University of Colorado Anschutz Medical Campus, Aurora, Colorado, USA
| | - Clair Blacketer
- Observational Health Data Analytics, Janssen Research & Development, Titusville, New Jersey, USA
| | - Priyamvada Desai
- Research IT, Technology and Digital Solutions, Stanford Medicine, Stanford, California, USA
| | - Scott L DuVall
- VA Salt Lake City Health Care System, Salt Lake City, Utah, USA
- Department of Internal Medicine, University of Utah School of Medicine, Salt Lake City, Utah, USA
| | - Stephen Fortin
- Observational Health Data Analytics, Janssen Research & Development, Titusville, New Jersey, USA
| | - James P Gilbert
- Observational Health Data Analytics, Janssen Research & Development, Titusville, New Jersey, USA
| | | | - Joshua Ide
- Johnson & Johnson, Titusville, New Jersey, USA
| | - Andrew S Kanter
- Department of Biomedical Informatics, Columbia University Irving Medical Center, New York, New York, USA
| | - David M Kern
- Observational Health Data Analytics, Janssen Research & Development, Titusville, New Jersey, USA
| | - Chungsoo Kim
- Department of Biomedical Sciences, Ajou University Graduate School of Medicine, Suwon, South Korea
| | - Lana Y H Lai
- Department of Informatics, Imaging & Data Sciences, University of Manchester, Manchester, UK
| | - Chenyu Li
- Department of Biomedical Informatics, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
| | - Feifan Liu
- Department of Population and Quantitative Health Sciences, University of Massachusetts Chan Medical School, Worcester, Massachusetts, USA
| | - Kristine E Lynch
- VA Salt Lake City Health Care System, Salt Lake City, Utah, USA
- Department of Internal Medicine, University of Utah School of Medicine, Salt Lake City, Utah, USA
| | - Evan Minty
- O’Brien Institute for Public Health, Faculty of Medicine, University of Calgary, Calgary, Canada
| | | | - Ding Quan Ng
- Department of Pharmaceutical Sciences, School of Pharmacy & Pharmaceutical Sciences, University of California, Irvine, California, USA
| | - Tontel Obene
- Mississippi Urban Research Center, Jackson State University, Jackson, Mississippi, USA
| | - Victor Pera
- Department of Medical Informatics, Erasmus University Medical Center, Rotterdam, The Netherlands
| | - Nicole Pratt
- Quality Use of Medicines and Pharmacy Research Centre, University of South Australia, Adelaide, Australia
| | - Gowtham Rao
- Observational Health Data Analytics, Janssen Research & Development, Titusville, New Jersey, USA
| | - Nadav Rappoport
- Department of Software and Information Systems Engineering, Ben-Gurion University of the Negev, Israel
| | - Ines Reinecke
- Institute for Medical Informatics and Biometry, Carl Gustav Carus Faculty of Medicine, Technische Universität Dresden, Dresden, Germany
| | - Paola Saroufim
- Cleveland Institute for Computational Biology, Case Western Reserve University, Cleveland, Ohio, USA
| | - Azza Shoaibi
- Observational Health Data Analytics, Janssen Research & Development, Titusville, New Jersey, USA
| | - Katherine Simon
- VA Tennessee Valley Health Care System, Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Marc A Suchard
- Department of Biostatistics, University of California, Los Angeles, California, USA
- Department of Human Genetics, University of California, Los Angeles, California, USA
| | - Joel N Swerdel
- Observational Health Data Analytics, Janssen Research & Development, Titusville, New Jersey, USA
| | - Erica A Voss
- Observational Health Data Analytics, Janssen Research & Development, Titusville, New Jersey, USA
| | - James Weaver
- Observational Health Data Analytics, Janssen Research & Development, Titusville, New Jersey, USA
| | - Linying Zhang
- Department of Biomedical Informatics, Columbia University Irving Medical Center, New York, New York, USA
| | - George Hripcsak
- Department of Biomedical Informatics, Columbia University Irving Medical Center, New York, New York, USA
- Medical Informatics Services, New York-Presbyterian Hospital, New York, New York, USA
| | - Patrick B Ryan
- Department of Biomedical Informatics, Columbia University Irving Medical Center, New York, New York, USA
- Observational Health Data Analytics, Janssen Research & Development, Titusville, New Jersey, USA
| |
Collapse
|
6
|
Nishimura A, Xie J, Kostka K, Duarte-Salles T, Fernández Bertolín S, Aragón M, Blacketer C, Shoaibi A, DuVall SL, Lynch K, Matheny ME, Falconer T, Morales DR, Conover MM, Chan You S, Pratt N, Weaver J, Sena AG, Schuemie MJ, Reps J, Reich C, Rijnbeek PR, Ryan PB, Hripcsak G, Prieto-Alhambra D, Suchard MA. International cohort study indicates no association between alpha-1 blockers and susceptibility to COVID-19 in benign prostatic hyperplasia patients. Front Pharmacol 2022; 13:945592. [PMID: 36188566 PMCID: PMC9518954 DOI: 10.3389/fphar.2022.945592] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2022] [Accepted: 07/25/2022] [Indexed: 12/02/2022] Open
Abstract
Purpose: Alpha-1 blockers, often used to treat benign prostatic hyperplasia (BPH), have been hypothesized to prevent COVID-19 complications by minimising cytokine storm release. The proposed treatment based on this hypothesis currently lacks support from reliable real-world evidence, however. We leverage an international network of large-scale healthcare databases to generate comprehensive evidence in a transparent and reproducible manner. Methods: In this international cohort study, we deployed electronic health records from Spain (SIDIAP) and the United States (Department of Veterans Affairs, Columbia University Irving Medical Center, IQVIA OpenClaims, Optum DOD, Optum EHR). We assessed association between alpha-1 blocker use and risks of three COVID-19 outcomes—diagnosis, hospitalization, and hospitalization requiring intensive services—using a prevalent-user active-comparator design. We estimated hazard ratios using state-of-the-art techniques to minimize potential confounding, including large-scale propensity score matching/stratification and negative control calibration. We pooled database-specific estimates through random effects meta-analysis. Results: Our study overall included 2.6 and 0.46 million users of alpha-1 blockers and of alternative BPH medications. We observed no significant difference in their risks for any of the COVID-19 outcomes, with our meta-analytic HR estimates being 1.02 (95% CI: 0.92–1.13) for diagnosis, 1.00 (95% CI: 0.89–1.13) for hospitalization, and 1.15 (95% CI: 0.71–1.88) for hospitalization requiring intensive services. Conclusion: We found no evidence of the hypothesized reduction in risks of the COVID-19 outcomes from the prevalent-use of alpha-1 blockers—further research is needed to identify effective therapies for this novel disease.
Collapse
Affiliation(s)
- Akihiko Nishimura
- Department of Biostatistics, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD, United States
| | - Junqing Xie
- Centre for Statistics in Medicine, Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, Oxford University, Oxford, United Kingdom
| | - Kristin Kostka
- Real World Solutions, IQVIA, Cambridge, MA, United States
- The OHDSI Center at The Roux Institute, Northeastern University, Portland, ME, United States
| | - Talita Duarte-Salles
- Fundació Institut Universitari Per a la Recerca a l'Atenció Primària de Salut Jordi Gol i Gurina (IDIAPJGol), Barcelona, Spain
| | - Sergio Fernández Bertolín
- Fundació Institut Universitari Per a la Recerca a l'Atenció Primària de Salut Jordi Gol i Gurina (IDIAPJGol), Barcelona, Spain
| | - María Aragón
- Fundació Institut Universitari Per a la Recerca a l'Atenció Primària de Salut Jordi Gol i Gurina (IDIAPJGol), Barcelona, Spain
| | - Clair Blacketer
- Observational Health Data Analytics, Janssen Research and Development, Titusville, NJ, United States
| | - Azza Shoaibi
- Observational Health Data Analytics, Janssen Research and Development, Titusville, NJ, United States
| | - Scott L. DuVall
- VA Informatics and Computing Infrastructure, VA Salt Lake City Health Care System, Salt Lake City, UT, United States
- Department of Internal Medicine, University of Utah School of Medicine, Salt Lake City, UT, United States
| | - Kristine Lynch
- VA Informatics and Computing Infrastructure, VA Salt Lake City Health Care System, Salt Lake City, UT, United States
- Department of Internal Medicine, University of Utah School of Medicine, Salt Lake City, UT, United States
| | - Michael E. Matheny
- Tennessee Valley Healthcare System, Veterans Affairs Medical Center, Nashville, TN, United States
- Department of Biomedical Informatics, Vanderbilt University Medical Center, Nashville, TN, United States
| | - Thomas Falconer
- Department of Biomedical Informatics, Columbia University, New York, NY, United States
| | - Daniel R. Morales
- Division of Population Health and Genomics, University of Dundee, Dundee, United Kingdom
- Department of Public Health, University of Southern Denmark, Southern Denmark, Denmark
| | - Mitchell M. Conover
- Observational Health Data Analytics, Janssen Research and Development, Titusville, NJ, United States
| | - Seng Chan You
- Department of Preventive Medicine and Public Health, Yonsei University College of Medicine, Seoul, South Korea
| | - Nicole Pratt
- Quality Use of Medicines and Pharmacy Research Centre, Clinical and Health Sciences, University of South Australia, Adelaide, Australia
| | - James Weaver
- Observational Health Data Analytics, Janssen Research and Development, Titusville, NJ, United States
| | - Anthony G. Sena
- Observational Health Data Analytics, Janssen Research and Development, Titusville, NJ, United States
- Department of Medical Informatics, Erasmus University Medical Center, Rotterdam, Netherlands
| | - Martijn J. Schuemie
- Observational Health Data Analytics, Janssen Research and Development, Titusville, NJ, United States
- Department of Biostatistics, UCLA Fielding School of Public Health, University of California, Los Angeles, Los Angeles, CA, United States
| | - Jenna Reps
- Observational Health Data Analytics, Janssen Research and Development, Titusville, NJ, United States
| | | | - Peter R. Rijnbeek
- Department of Medical Informatics, Erasmus University Medical Center, Rotterdam, Netherlands
| | - Patrick B. Ryan
- Observational Health Data Analytics, Janssen Research and Development, Titusville, NJ, United States
| | - George Hripcsak
- Department of Biomedical Informatics, Columbia University, New York, NY, United States
| | - Daniel Prieto-Alhambra
- Centre for Statistics in Medicine, Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, Oxford University, Oxford, United Kingdom
- *Correspondence: Daniel Prieto-Alhambra,
| | - Marc A. Suchard
- Department of Biostatistics, UCLA Fielding School of Public Health, University of California, Los Angeles, Los Angeles, CA, United States
- Department of Computational Medicine, David Geffen School of Medicine at UCLA, University of California, Los Angeles, Los Angeles, CA, United States
- Department of Human Genetics, David Geffen School of Medicine at UCLA, University of California, Los Angeles, Los Angeles, CA, United States
| |
Collapse
|
7
|
Williams RD, Markus AF, Yang C, Duarte-Salles T, DuVall SL, Falconer T, Jonnagaddala J, Kim C, Rho Y, Williams AE, Machado AA, An MH, Aragón M, Areia C, Burn E, Choi YH, Drakos I, Abrahão MTF, Fernández-Bertolín S, Hripcsak G, Kaas-Hansen BS, Kandukuri PL, Kors JA, Kostka K, Liaw ST, Lynch KE, Machnicki G, Matheny ME, Morales D, Nyberg F, Park RW, Prats-Uribe A, Pratt N, Rao G, Reich CG, Rivera M, Seinen T, Shoaibi A, Spotnitz ME, Steyerberg EW, Suchard MA, You SC, Zhang L, Zhou L, Ryan PB, Prieto-Alhambra D, Reps JM, Rijnbeek PR. Seek COVER: using a disease proxy to rapidly develop and validate a personalized risk calculator for COVID-19 outcomes in an international network. BMC Med Res Methodol 2022; 22:35. [PMID: 35094685 PMCID: PMC8801189 DOI: 10.1186/s12874-022-01505-z] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2021] [Accepted: 01/03/2022] [Indexed: 12/23/2022] Open
Abstract
Background We investigated whether we could use influenza data to develop prediction models for COVID-19 to increase the speed at which prediction models can reliably be developed and validated early in a pandemic. We developed COVID-19 Estimated Risk (COVER) scores that quantify a patient’s risk of hospital admission with pneumonia (COVER-H), hospitalization with pneumonia requiring intensive services or death (COVER-I), or fatality (COVER-F) in the 30-days following COVID-19 diagnosis using historical data from patients with influenza or flu-like symptoms and tested this in COVID-19 patients. Methods We analyzed a federated network of electronic medical records and administrative claims data from 14 data sources and 6 countries containing data collected on or before 4/27/2020. We used a 2-step process to develop 3 scores using historical data from patients with influenza or flu-like symptoms any time prior to 2020. The first step was to create a data-driven model using LASSO regularized logistic regression, the covariates of which were used to develop aggregate covariates for the second step where the COVER scores were developed using a smaller set of features. These 3 COVER scores were then externally validated on patients with 1) influenza or flu-like symptoms and 2) confirmed or suspected COVID-19 diagnosis across 5 databases from South Korea, Spain, and the United States. Outcomes included i) hospitalization with pneumonia, ii) hospitalization with pneumonia requiring intensive services or death, and iii) death in the 30 days after index date. Results Overall, 44,507 COVID-19 patients were included for model validation. We identified 7 predictors (history of cancer, chronic obstructive pulmonary disease, diabetes, heart disease, hypertension, hyperlipidemia, kidney disease) which combined with age and sex discriminated which patients would experience any of our three outcomes. The models achieved good performance in influenza and COVID-19 cohorts. For COVID-19 the AUC ranges were, COVER-H: 0.69–0.81, COVER-I: 0.73–0.91, and COVER-F: 0.72–0.90. Calibration varied across the validations with some of the COVID-19 validations being less well calibrated than the influenza validations. Conclusions This research demonstrated the utility of using a proxy disease to develop a prediction model. The 3 COVER models with 9-predictors that were developed using influenza data perform well for COVID-19 patients for predicting hospitalization, intensive services, and fatality. The scores showed good discriminatory performance which transferred well to the COVID-19 population. There was some miscalibration in the COVID-19 validations, which is potentially due to the difference in symptom severity between the two diseases. A possible solution for this is to recalibrate the models in each location before use. Supplementary Information The online version contains supplementary material available at 10.1186/s12874-022-01505-z.
Collapse
|
8
|
Lane JCE, Weaver J, Kostka K, Duarte-Salles T, Abrahao MTF, Alghoul H, Alser O, Alshammari TM, Areia C, Biedermann P, Banda JM, Burn E, Casajust P, Fister K, Hardin J, Hester L, Hripcsak G, Kaas-Hansen BS, Khosla S, Kolovos S, Lynch KE, Makadia R, Mehta PP, Morales DR, Morgan-Stewart H, Mosseveld M, Newby D, Nyberg F, Ostropolets A, Woong Park R, Prats-Uribe A, Rao GA, Reich C, Rijnbeek P, Sena AG, Shoaibi A, Spotnitz M, Subbian V, Suchard MA, Vizcaya D, Wen H, de Wilde M, Xie J, You SC, Zhang L, Lovestone S, Ryan P, Prieto-Alhambra D. Risk of depression, suicide and psychosis with hydroxychloroquine treatment for rheumatoid arthritis: a multinational network cohort study. Rheumatology (Oxford) 2021; 60:3222-3234. [PMID: 33367863 PMCID: PMC7798671 DOI: 10.1093/rheumatology/keaa771] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2020] [Revised: 10/19/2020] [Indexed: 12/16/2022] Open
Abstract
OBJECTIVES Concern has been raised in the rheumatology community regarding recent regulatory warnings that HCQ used in the coronavirus disease 2019 pandemic could cause acute psychiatric events. We aimed to study whether there is risk of incident depression, suicidal ideation or psychosis associated with HCQ as used for RA. METHODS We performed a new-user cohort study using claims and electronic medical records from 10 sources and 3 countries (Germany, UK and USA). RA patients ≥18 years of age and initiating HCQ were compared with those initiating SSZ (active comparator) and followed up in the short (30 days) and long term (on treatment). Study outcomes included depression, suicide/suicidal ideation and hospitalization for psychosis. Propensity score stratification and calibration using negative control outcomes were used to address confounding. Cox models were fitted to estimate database-specific calibrated hazard ratios (HRs), with estimates pooled where I2 <40%. RESULTS A total of 918 144 and 290 383 users of HCQ and SSZ, respectively, were included. No consistent risk of psychiatric events was observed with short-term HCQ (compared with SSZ) use, with meta-analytic HRs of 0.96 (95% CI 0.79, 1.16) for depression, 0.94 (95% CI 0.49, 1.77) for suicide/suicidal ideation and 1.03 (95% CI 0.66, 1.60) for psychosis. No consistent long-term risk was seen, with meta-analytic HRs of 0.94 (95% CI 0.71, 1.26) for depression, 0.77 (95% CI 0.56, 1.07) for suicide/suicidal ideation and 0.99 (95% CI 0.72, 1.35) for psychosis. CONCLUSION HCQ as used to treat RA does not appear to increase the risk of depression, suicide/suicidal ideation or psychosis compared with SSZ. No effects were seen in the short or long term. Use at a higher dose or for different indications needs further investigation. TRIAL REGISTRATION Registered with EU PAS (reference no. EUPAS34497; http://www.encepp.eu/encepp/viewResource.htm? id=34498). The full study protocol and analysis source code can be found at https://github.com/ohdsi-studies/Covid19EstimationHydroxychloroquine2.
Collapse
Affiliation(s)
- Jennifer C E Lane
- Centre for Statistics in Medicine, Nuffield Department of Orthopaedics, Rheumatology, and Musculoskeletal Sciences (NDORMS), University of Oxford, Oxford, UK
| | - James Weaver
- Janssen Research and Development, Titusville, NJ, USA
| | | | - Talita Duarte-Salles
- Fundació Institut Universitari per a la recerca a l’Atenció Primària de Salut Jordi Gol i Gurina (IDIAPJGol), Barcelona, Spain
| | | | - Heba Alghoul
- Faculty of Medicine, Islamic University of Gaza, Gaza, Palestine
| | - Osaid Alser
- Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
| | - Thamir M Alshammari
- Medication Safety Research Chair, King Saud University, Riyadh, Saudi Arabia
| | - Carlos Areia
- Nuffield Department of Clinical Neurosciences, University of Oxford, Oxford, UK
| | | | | | - Edward Burn
- Centre for Statistics in Medicine, Nuffield Department of Orthopaedics, Rheumatology, and Musculoskeletal Sciences (NDORMS), University of Oxford, Oxford, UK
- Fundació Institut Universitari per a la recerca a l’Atenció Primària de Salut Jordi Gol i Gurina (IDIAPJGol), Barcelona, Spain
| | - Paula Casajust
- Real-World Evidence, Trial Form Support, Barcelona,Spain
| | - Kristina Fister
- School of Medicine, Andrija Štampar School of Public Health, University of Zagreb, Zagreb, Croatia
| | - Jill Hardin
- Janssen Research and Development, Titusville, NJ, USA
| | - Laura Hester
- Janssen Research and Development, Titusville, NJ, USA
| | - George Hripcsak
- Department of Biomedical Informatics, Columbia University Irving Medical Center, New York, NY, USA
- New York-Presbyterian Hospital, New York, NY, USA
| | - Benjamin Skov Kaas-Hansen
- Clinical Pharmacology Unit, Zealand University Hospital, Roskilde, Denmark
- NNF Centre for Protein Research, University of Copenhagen, Copenhagen, Denmark
| | - Sajan Khosla
- Real World Science & Digital, AstraZeneca, Cambridge, UK
| | - Spyros Kolovos
- Centre for Statistics in Medicine, Nuffield Department of Orthopaedics, Rheumatology, and Musculoskeletal Sciences (NDORMS), University of Oxford, Oxford, UK
| | - Kristine E Lynch
- Department of Veterans Affairs, Salt Lake City, UT, USA
- University of Utah School of Medicine, Salt Lake City, UT, USA
| | - Rupa Makadia
- Janssen Research and Development, Titusville, NJ, USA
| | - Paras P Mehta
- College of Medicine, University of Arizona, Tucson, AZ, USA
| | - Daniel R Morales
- Division of Population Health and Genomics, University of Dundee, Dundee, UK
| | | | - Mees Mosseveld
- Department of Medical Informatics, Erasmus University Medical Center, Rotterdam, The Netherlands
| | - Danielle Newby
- Department of Psychiatry, University of Oxford, Oxford, UK
| | - Fredrik Nyberg
- School of Public Health and Community Medicine, Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - Anna Ostropolets
- Department of Biomedical Informatics, Columbia University Irving Medical Center, New York, NY, USA
| | - Rae Woong Park
- Department of Biomedical Informatics, Ajou University School of Medicine, Suwon-si, Gyeonggi-do, South Korea
| | - Albert Prats-Uribe
- Centre for Statistics in Medicine, Nuffield Department of Orthopaedics, Rheumatology, and Musculoskeletal Sciences (NDORMS), University of Oxford, Oxford, UK
| | - Gowtham A Rao
- Janssen Research and Development, Titusville, NJ, USA
| | | | - Peter Rijnbeek
- Department of Medical Informatics, Erasmus University Medical Center, Rotterdam, The Netherlands
| | - Anthony G Sena
- Janssen Research and Development, Titusville, NJ, USA
- Department of Medical Informatics, Erasmus University Medical Center, Rotterdam, The Netherlands
| | - Azza Shoaibi
- Janssen Research and Development, Titusville, NJ, USA
| | - Matthew Spotnitz
- Department of Biomedical Informatics, Columbia University Irving Medical Center, New York, NY, USA
| | - Vignesh Subbian
- College of Engineering, University of Arizona, Tucson, AZ, USA
| | - Marc A Suchard
- Departments of Biomathematics and Human Genetics David Geffen School of Medicine at UCLA, and Department of Biostatistics, UCLA School of Public Health, South Los Angeles, CA, USA
| | - David Vizcaya
- Bayer Pharmaceuticals, Sant Joan Despi, Barcelona, Spain
| | - Haini Wen
- Department of Pharmacy, Shanghai Chest Hospital, Shanghai Jiao Tong University, Shanghai, P.R. China
| | - Marcel de Wilde
- Department of Medical Informatics, Erasmus University Medical Center, Rotterdam, The Netherlands
| | - Junqing Xie
- Centre for Statistics in Medicine, Nuffield Department of Orthopaedics, Rheumatology, and Musculoskeletal Sciences (NDORMS), University of Oxford, Oxford, UK
| | - Seng Chan You
- Department of Biomedical Informatics, Ajou University School of Medicine, Suwon-si, Gyeonggi-do, South Korea
| | - Lin Zhang
- School of Public Health, Peking Union Medical College, Chinese Academy of Medical Sciences, Beijing, P.R. China
- Melbourne School of Population and Global Health, University of Melbourne, Melbourne, Australia
| | - Simon Lovestone
- Janssen-Cilag, 50-100 Holmers Farm Way, High Wycombe HP12 4EG, UK
| | - Patrick Ryan
- Janssen Research and Development, Titusville, NJ, USA
- Department of Biomedical Informatics, Columbia University Irving Medical Center, New York, NY, USA
| | - Daniel Prieto-Alhambra
- Centre for Statistics in Medicine, Nuffield Department of Orthopaedics, Rheumatology, and Musculoskeletal Sciences (NDORMS), University of Oxford, Oxford, UK
| | | |
Collapse
|
9
|
Li X, Ostropolets A, Makadia R, Shoaibi A, Rao G, Sena AG, Martinez-Hernandez E, Delmestri A, Verhamme K, Rijnbeek PR, Duarte-Salles T, Suchard MA, Ryan PB, Hripcsak G, Prieto-Alhambra D. Characterising the background incidence rates of adverse events of special interest for covid-19 vaccines in eight countries: multinational network cohort study. BMJ 2021; 373:n1435. [PMID: 35727911 PMCID: PMC8193077 DOI: 10.1136/bmj.n1435] [Citation(s) in RCA: 78] [Impact Index Per Article: 26.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 06/03/2021] [Indexed: 12/12/2022]
Abstract
OBJECTIVE To quantify the background incidence rates of 15 prespecified adverse events of special interest (AESIs) associated with covid-19 vaccines. DESIGN Multinational network cohort study. SETTING Electronic health records and health claims data from eight countries: Australia, France, Germany, Japan, the Netherlands, Spain, the United Kingdom, and the United States, mapped to a common data model. PARTICIPANTS 126 661 070 people observed for at least 365 days before 1 January 2017, 2018, or 2019 from 13 databases. MAIN OUTCOME MEASURES Events of interests were 15 prespecified AESIs (non-haemorrhagic and haemorrhagic stroke, acute myocardial infarction, deep vein thrombosis, pulmonary embolism, anaphylaxis, Bell's palsy, myocarditis or pericarditis, narcolepsy, appendicitis, immune thrombocytopenia, disseminated intravascular coagulation, encephalomyelitis (including acute disseminated encephalomyelitis), Guillain-Barré syndrome, and transverse myelitis). Incidence rates of AESIs were stratified by age, sex, and database. Rates were pooled across databases using random effects meta-analyses and classified according to the frequency categories of the Council for International Organizations of Medical Sciences. RESULTS Background rates varied greatly between databases. Deep vein thrombosis ranged from 387 (95% confidence interval 370 to 404) per 100 000 person years in UK CPRD GOLD data to 1443 (1416 to 1470) per 100 000 person years in US IBM MarketScan Multi-State Medicaid data among women aged 65 to 74 years. Some AESIs increased with age. For example, myocardial infarction rates in men increased from 28 (27 to 29) per 100 000 person years among those aged 18-34 years to 1400 (1374 to 1427) per 100 000 person years in those older than 85 years in US Optum electronic health record data. Other AESIs were more common in young people. For example, rates of anaphylaxis among boys and men were 78 (75 to 80) per 100 000 person years in those aged 6-17 years and 8 (6 to 10) per 100 000 person years in those older than 85 years in Optum electronic health record data. Meta-analytic estimates of AESI rates were classified according to age and sex. CONCLUSION This study found large variations in the observed rates of AESIs by age group and sex, showing the need for stratification or standardisation before using background rates for safety surveillance. Considerable population level heterogeneity in AESI rates was found between databases.
Collapse
Affiliation(s)
- Xintong Li
- Centre for Statistics in Medicine, NDORMS, University of Oxford, Oxford, UK
| | - Anna Ostropolets
- Department of Biomedical Informatics, Columbia University Irving Medical Center, New York, NY, USA
| | - Rupa Makadia
- Janssen Research and Development, Titusville, NJ, USA
| | - Azza Shoaibi
- Janssen Research and Development, Titusville, NJ, USA
| | - Gowtham Rao
- Janssen Research and Development, Titusville, NJ, USA
| | - Anthony G Sena
- Janssen Research and Development, Titusville, NJ, USA
- Department of Medical Informatics, Erasmus University Medical Center, Rotterdam, Netherlands
| | | | | | - Katia Verhamme
- Department of Medical Informatics, Erasmus University Medical Center, Rotterdam, Netherlands
- Department of Bio-Analysis, Faculty of Pharmaceutical Sciences, Ghent University, Ottergemsesteenweg, Gent, Belgium
| | - Peter R Rijnbeek
- Department of Medical Informatics, Erasmus University Medical Center, Rotterdam, Netherlands
| | - Talita Duarte-Salles
- Fundacio Institut Universitari per a la recerca a l'Atencio Primaria de Salut Jordi Gol i Gurina (IDIAPJGol), Barcelona, Spain
| | - Marc A Suchard
- Department of Biostatistics, Fielding School of Public Health, University of California, Los Angeles, Los Angeles, CA, USA
- Department of Human Genetics, David Geffen School of Medicine at UCLA, University of California, Los Angeles, Los Angeles, CA, USA
| | - Patrick B Ryan
- Department of Biomedical Informatics, Columbia University Irving Medical Center, New York, NY, USA
- Janssen Research and Development, Titusville, NJ, USA
| | - George Hripcsak
- Department of Biomedical Informatics, Columbia University Irving Medical Center, New York, NY, USA
| | - Daniel Prieto-Alhambra
- Centre for Statistics in Medicine, NDORMS, University of Oxford, Oxford, UK
- Department of Medical Informatics, Erasmus University Medical Center, Rotterdam, Netherlands
| |
Collapse
|
10
|
Reps JM, Kim C, Williams RD, Markus AF, Yang C, Duarte-Salles T, Falconer T, Jonnagaddala J, Williams A, Fernández-Bertolín S, DuVall SL, Kostka K, Rao G, Shoaibi A, Ostropolets A, Spotnitz ME, Zhang L, Casajust P, Steyerberg EW, Nyberg F, Kaas-Hansen BS, Choi YH, Morales D, Liaw ST, Abrahão MTF, Areia C, Matheny ME, Lynch KE, Aragón M, Park RW, Hripcsak G, Reich CG, Suchard MA, You SC, Ryan PB, Prieto-Alhambra D, Rijnbeek PR. Implementation of the COVID-19 Vulnerability Index Across an International Network of Health Care Data Sets: Collaborative External Validation Study. JMIR Med Inform 2021; 9:e21547. [PMID: 33661754 PMCID: PMC8023380 DOI: 10.2196/21547] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2020] [Revised: 11/12/2020] [Accepted: 02/27/2021] [Indexed: 11/18/2022] Open
Abstract
Background SARS-CoV-2 is straining health care systems globally. The burden on hospitals during the pandemic could be reduced by implementing prediction models that can discriminate patients who require hospitalization from those who do not. The COVID-19 vulnerability (C-19) index, a model that predicts which patients will be admitted to hospital for treatment of pneumonia or pneumonia proxies, has been developed and proposed as a valuable tool for decision-making during the pandemic. However, the model is at high risk of bias according to the “prediction model risk of bias assessment” criteria, and it has not been externally validated. Objective The aim of this study was to externally validate the C-19 index across a range of health care settings to determine how well it broadly predicts hospitalization due to pneumonia in COVID-19 cases. Methods We followed the Observational Health Data Sciences and Informatics (OHDSI) framework for external validation to assess the reliability of the C-19 index. We evaluated the model on two different target populations, 41,381 patients who presented with SARS-CoV-2 at an outpatient or emergency department visit and 9,429,285 patients who presented with influenza or related symptoms during an outpatient or emergency department visit, to predict their risk of hospitalization with pneumonia during the following 0-30 days. In total, we validated the model across a network of 14 databases spanning the United States, Europe, Australia, and Asia. Results The internal validation performance of the C-19 index had a C statistic of 0.73, and the calibration was not reported by the authors. When we externally validated it by transporting it to SARS-CoV-2 data, the model obtained C statistics of 0.36, 0.53 (0.473-0.584) and 0.56 (0.488-0.636) on Spanish, US, and South Korean data sets, respectively. The calibration was poor, with the model underestimating risk. When validated on 12 data sets containing influenza patients across the OHDSI network, the C statistics ranged between 0.40 and 0.68. Conclusions Our results show that the discriminative performance of the C-19 index model is low for influenza cohorts and even worse among patients with COVID-19 in the United States, Spain, and South Korea. These results suggest that C-19 should not be used to aid decision-making during the COVID-19 pandemic. Our findings highlight the importance of performing external validation across a range of settings, especially when a prediction model is being extrapolated to a different population. In the field of prediction, extensive validation is required to create appropriate trust in a model.
Collapse
Affiliation(s)
- Jenna M Reps
- Janssen Research & Development, Titusville, NJ, United States
| | - Chungsoo Kim
- Department of Biomedical Sciences, Ajou University Graduate School of Medicine, Suwon, Republic of Korea
| | - Ross D Williams
- Department of Medical Informatics, Erasmus University Medical Center, Rotterdam, Netherlands
| | - Aniek F Markus
- Department of Medical Informatics, Erasmus University Medical Center, Rotterdam, Netherlands
| | - Cynthia Yang
- Department of Medical Informatics, Erasmus University Medical Center, Rotterdam, Netherlands
| | - Talita Duarte-Salles
- Fundacio Institut Universitari per a la recerca a l'Atencio Primaria de Salut Jordi Gol i Gurina, Barcelona, Spain
| | - Thomas Falconer
- Department of Biomedical Informatics, Columbia University, New York, NY, United States
| | - Jitendra Jonnagaddala
- School of Public Health and Community Medicine, University of New South Wales, Sydney, Australia
| | - Andrew Williams
- Tufts Institute for Clinical Research and Health Policy Studies, Boston, MA, United States
| | - Sergio Fernández-Bertolín
- Fundacio Institut Universitari per a la recerca a l'Atencio Primaria de Salut Jordi Gol i Gurina, Barcelona, Spain
| | - Scott L DuVall
- Department of Veterans Affairs, University of Utah, Salt Lake City, UT, United States
| | - Kristin Kostka
- Real World Solutions, IQVIA, Cambridge, MA, United States
| | - Gowtham Rao
- Janssen Research & Development, Titusville, NJ, United States
| | - Azza Shoaibi
- Janssen Research & Development, Titusville, NJ, United States
| | - Anna Ostropolets
- Department of Biomedical Informatics, Columbia University, New York, NY, United States
| | - Matthew E Spotnitz
- Department of Biomedical Informatics, Columbia University, New York, NY, United States
| | - Lin Zhang
- Melbourne School of Public Health, The University of Melbourne, Victoria, Australia.,School of Public Health, Peking Union Medical College, Beijing, China
| | - Paula Casajust
- Department of Real-World Evidence, Trial Form Support, Barcelona, Spain
| | - Ewout W Steyerberg
- Department of Public Health, Erasmus University Medical Center, Rotterdam, Netherlands.,Department of Biomedical Data Sciences, Leiden University Medical Center, Leiden, Netherlands
| | - Fredrik Nyberg
- School of Public Health and Community Medicine, Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - Benjamin Skov Kaas-Hansen
- Clinical Pharmacology Unit, Zealand University Hospital, Roskilde, Denmark.,NNF Centre for Protein Research, University of Copenhagen, Copenhagen, Denmark
| | - Young Hwa Choi
- Department of Infectious Diseases, Ajou University School of Medicine, Suwon, Republic of Korea
| | - Daniel Morales
- Division of Population Health and Genomics, University of Dundee, Dundee, United Kingdom
| | - Siaw-Teng Liaw
- School of Public Health and Community Medicine, University of New South Wales, Sydney, Australia
| | | | - Carlos Areia
- Nuffield Department of Clinical Neurosciences, University of Oxford, Oxford, United Kingdom
| | - Michael E Matheny
- Department of Veterans Affairs, Vanderbilt University, Nashville, TN, United States
| | - Kristine E Lynch
- Department of Veterans Affairs, University of Utah, Salt Lake City, UT, United States
| | - María Aragón
- Fundacio Institut Universitari per a la recerca a l'Atencio Primaria de Salut Jordi Gol i Gurina, Barcelona, Spain
| | - Rae Woong Park
- Department of Biomedical Informatics, Ajou University School of Medicine, Suwon, Republic of Korea
| | - George Hripcsak
- Department of Biomedical Informatics, Columbia University, New York, NY, United States
| | | | - Marc A Suchard
- Department of Biostatistics, UCLA Fielding School of Public Health, University of California, Los Angeles, CA, United States
| | - Seng Chan You
- Department of Biomedical Informatics, Ajou University School of Medicine, Suwon, Republic of Korea
| | - Patrick B Ryan
- Janssen Research & Development, Titusville, NJ, United States
| | - Daniel Prieto-Alhambra
- Centre for Statistics in Medicine, Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, University of Oxford, Oxford, United Kingdom
| | - Peter R Rijnbeek
- Department of Medical Informatics, Erasmus University Medical Center, Rotterdam, Netherlands
| |
Collapse
|
11
|
Nishimura A, Xie J, Kostka K, Duarte-Salles T, Bertolín SF, Aragón M, Blacketer C, Shoaibi A, DuVall SL, Lynch K, Matheny ME, Falconer T, Morales DR, Conover MM, You SC, Pratt N, Weaver J, Sena AG, Schuemie MJ, Reps J, Reich C, Rijnbeek PR, Ryan PB, Hripcsak G, Prieto-Alhambra D, Suchard MA. Alpha-1 blockers and susceptibility to COVID-19 in benign prostate hyperplasia patients : an international cohort study. medRxiv 2021:2021.03.18.21253778. [PMID: 33791740 PMCID: PMC8010772 DOI: 10.1101/2021.03.18.21253778] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 12/03/2022]
Abstract
Alpha-1 blockers, often used to treat benign prostate hyperplasia (BPH), have been hypothesized to prevent COVID-19 complications by minimising cytokine storms release. We conducted a prevalent-user active-comparator cohort study to assess association between alpha-1 blocker use and risks of three COVID-19 outcomes: diagnosis, hospitalization, and hospitalization requiring intensive services. Our study included 2.6 and 0.46 million users of alpha-1 blockers and of alternative BPH therapy during the period between November 2019 and January 2020, found in electronic health records from Spain (SIDIAP) and the United States (Department of Veterans Affairs, Columbia University Irving Medical Center, IQVIA OpenClaims, Optum DOD, Optum EHR). We estimated hazard ratios using state-of-the-art techniques to minimize potential confounding, including large-scale propensity score matching/stratification and negative control calibration. We found no differential risk for any of COVID-19 outcome, pointing to the need for further research on potential COVID-19 therapies.
Collapse
Affiliation(s)
| | - Junqing Xie
- Centre for Statistics in Medicine, Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, Oxford University, Oxford, UK
| | - Kristin Kostka
- Real World Solutions, IQVIA, Cambridge, MA, USA
- The OHDSI Center at The Roux Institute, Northeastern University, Portland, ME, USA
| | - Talita Duarte-Salles
- Fundació Institut Universitari per a la recerca a l’Atenció Primària de Salut Jordi Gol i Gurina (IDIAPJGol), Barcelona, Spain
| | - Sergio Fernández Bertolín
- Fundació Institut Universitari per a la recerca a l’Atenció Primària de Salut Jordi Gol i Gurina (IDIAPJGol), Barcelona, Spain
| | - María Aragón
- Fundació Institut Universitari per a la recerca a l’Atenció Primària de Salut Jordi Gol i Gurina (IDIAPJGol), Barcelona, Spain
| | - Clair Blacketer
- Observational Health Data Analytics, Janssen Research and Development, Titusville, NJ, USA
| | - Azza Shoaibi
- Observational Health Data Analytics, Janssen Research and Development, Titusville, NJ, USA
| | - Scott L DuVall
- VA Informatics and Computing Infrastructure, VA Salt Lake City Health Care System, Salt Lake City, UT, USA
- Department of Internal Medicine, University of Utah School of Medicine, Salt Lake City, UT, USA
| | - Kristine Lynch
- VA Informatics and Computing Infrastructure, VA Salt Lake City Health Care System, Salt Lake City, UT, USA
- Department of Internal Medicine, University of Utah School of Medicine, Salt Lake City, UT, USA
| | - Michael E Matheny
- Tennessee Valley Healthcare System, Veterans Affairs Medical Center, Nashville, TN, USA
- Department of Biomedical Informatics, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Thomas Falconer
- Department of Biomedical Informatics, Columbia University, New York, USA
| | - Daniel R Morales
- Division of Population Health and Genomics, University of Dundee, UK
- Department of Public Health, University of Southern Denmark, Denmark
| | - Mitchell M Conover
- Observational Health Data Analytics, Janssen Research and Development, Titusville, NJ, USA
| | - Seng Chan You
- Department of Preventive Medicine and Public Health, Yonsei University College of Medicine, Seoul, Korea
| | - Nicole Pratt
- Quality Use of Medicines and Pharmacy Research Centre, Clinical and Health Sciences, University of South Australia, Adelaide, Australia
| | - James Weaver
- Observational Health Data Analytics, Janssen Research and Development, Titusville, NJ, USA
| | - Anthony G Sena
- Observational Health Data Analytics, Janssen Research and Development, Titusville, NJ, USA
- Department of Medical Informatics, Erasmus University Medical Center, Rotterdam, The Netherlands
| | - Martijn J Schuemie
- Observational Health Data Analytics, Janssen Research and Development, Titusville, NJ, USA
- Department of Biostatistics, UCLA Fielding School of Public Health, University of California, Los Angeles, Los Angeles, CA, USA
| | - Jenna Reps
- Observational Health Data Analytics, Janssen Research and Development, Titusville, NJ, USA
| | | | - Peter R Rijnbeek
- Department of Medical Informatics, Erasmus University Medical Center, Rotterdam, The Netherlands
| | - Patrick B Ryan
- Observational Health Data Analytics, Janssen Research and Development, Titusville, NJ, USA
| | - George Hripcsak
- Department of Biomedical Informatics, Columbia University, New York, USA
| | - Daniel Prieto-Alhambra
- Centre for Statistics in Medicine, Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, Oxford University, Oxford, UK
| | - Marc A Suchard
- Department of Biostatistics, UCLA Fielding School of Public Health, University of California, Los Angeles, Los Angeles, CA, USA
- Department of Computational Medicine, David Geffen School of Medicine at UCLA, University of California, Los Angeles, Los Angeles, CA, USA
- Department of Human Genetics, David Geffen School of Medicine at UCLA, University of California, Los Angeles, Los Angeles, CA, USA
| |
Collapse
|
12
|
Weaver J, Shoaibi A, Truong HQ, Larbi L, Wu S, Wildgoose P, Rao G, Freedman A, Wang L, Yuan Z, Barnathan E. Comparative Risk Assessment of Severe Uterine Bleeding Following Exposure to Direct Oral Anticoagulants: A Network Study Across Four Observational Databases in the USA. Drug Saf 2021; 44:479-497. [PMID: 33651368 PMCID: PMC7994226 DOI: 10.1007/s40264-021-01060-4] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/16/2021] [Indexed: 10/26/2022]
Abstract
BACKGROUND Antithrombotic therapies are associated with an increased bleeding risk. Abnormal uterine bleeding data have been reported in clinical trials of patients with venous thromboembolism (VTE), but data are limited for patients with atrial fibrillation (AF). OBJECTIVE Using real-world data from four US healthcare databases (October 2010 to December 2018), we compared the occurrence of severe uterine bleeding among women newly exposed to rivaroxaban, apixaban, dabigatran, and warfarin stratified by indication. METHODS To reduce potential confounding, patients in comparative cohorts were matched on propensity scores. Treatment effect estimates were generated using Cox proportional hazard models for each indication, in each database, and only for pairwise comparisons that met a priori study diagnostics. If estimates were homogeneous (I2 < 40%), a meta-analysis across databases was performed and pooled hazard ratios reported. RESULTS Data from 363,919 women newly exposed to a direct oral anticoagulant or warfarin with a prior diagnosis of AF (60.8%) or VTE (39.2%) were analyzed. Overall incidence of severe uterine bleeding was low in the populations exposed to direct oral anticoagulants, although relatively higher in the younger VTE population vs the AF population (unadjusted incidence rates: 2.8-33.7 vs 1.9-10.0 events/1000 person-years). In the propensity score-matched AF population, a suggestive, moderately increased risk of severe uterine bleeding was observed for rivaroxaban relative to warfarin [hazard ratios and 95% confidence intervals from 0.83 (0.27-2.48) to 2.84 (1.32-6.23) across databases with significant heterogeneity], apixaban [pooled hazard ratio 1.45 (0.91-2.28)], and dabigatran [2.12 (1.01-4.43)], which were sensitive to the time-at-risk period. In the propensity score-matched VTE population, a consistent increased risk of severe uterine bleeding was observed for rivaroxaban relative to warfarin [2.03 (1.19-3.27)] and apixaban [2.25 (1.45-3.41)], which were insensitive to the time-at-risk period. CONCLUSIONS For women who need antithrombotic therapy, personalized management strategies with careful evaluation of benefits and risks are required. CLINICALTRIALS. GOV REGISTRATION NCT04394234; registered in May 2020.
Collapse
Affiliation(s)
- James Weaver
- Janssen Research & Development, LLC, 1125 Trenton-Harbourton Road, Titusville, NJ, 08560, USA
| | - Azza Shoaibi
- Janssen Research & Development, LLC, 1125 Trenton-Harbourton Road, Titusville, NJ, 08560, USA
| | - Huy Q Truong
- Janssen Research & Development, LLC, Raritan, NJ, USA
| | - Leila Larbi
- Janssen Research & Development, LLC, Raritan, NJ, USA
| | - Shujian Wu
- Janssen Research & Development, LLC, Horsham, PA, USA
| | - Peter Wildgoose
- Janssen Research & Development, LLC, 1125 Trenton-Harbourton Road, Titusville, NJ, 08560, USA
| | - Gowtham Rao
- Janssen Research & Development, LLC, 1125 Trenton-Harbourton Road, Titusville, NJ, 08560, USA
| | - Amy Freedman
- Janssen Research & Development, LLC, 1125 Trenton-Harbourton Road, Titusville, NJ, 08560, USA
| | - Lu Wang
- Janssen Research & Development, LLC, 1125 Trenton-Harbourton Road, Titusville, NJ, 08560, USA
| | - Zhong Yuan
- Janssen Research & Development, LLC, 1125 Trenton-Harbourton Road, Titusville, NJ, 08560, USA.
| | | |
Collapse
|
13
|
Burn E, You SC, Sena AG, Kostka K, Abedtash H, Abrahão MTF, Alberga A, Alghoul H, Alser O, Alshammari TM, Aragon M, Areia C, Banda JM, Cho J, Culhane AC, Davydov A, DeFalco FJ, Duarte-Salles T, DuVall S, Falconer T, Fernandez-Bertolin S, Gao W, Golozar A, Hardin J, Hripcsak G, Huser V, Jeon H, Jing Y, Jung CY, Kaas-Hansen BS, Kaduk D, Kent S, Kim Y, Kolovos S, Lane JCE, Lee H, Lynch KE, Makadia R, Matheny ME, Mehta PP, Morales DR, Natarajan K, Nyberg F, Ostropolets A, Park RW, Park J, Posada JD, Prats-Uribe A, Rao G, Reich C, Rho Y, Rijnbeek P, Schilling LM, Schuemie M, Shah NH, Shoaibi A, Song S, Spotnitz M, Suchard MA, Swerdel JN, Vizcaya D, Volpe S, Wen H, Williams AE, Yimer BB, Zhang L, Zhuk O, Prieto-Alhambra D, Ryan P. Deep phenotyping of 34,128 adult patients hospitalised with COVID-19 in an international network study. Nat Commun 2020; 11:5009. [PMID: 33024121 PMCID: PMC7538555 DOI: 10.1038/s41467-020-18849-z] [Citation(s) in RCA: 66] [Impact Index Per Article: 16.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2020] [Accepted: 09/10/2020] [Indexed: 01/08/2023] Open
Abstract
Comorbid conditions appear to be common among individuals hospitalised with coronavirus disease 2019 (COVID-19) but estimates of prevalence vary and little is known about the prior medication use of patients. Here, we describe the characteristics of adults hospitalised with COVID-19 and compare them with influenza patients. We include 34,128 (US: 8362, South Korea: 7341, Spain: 18,425) COVID-19 patients, summarising between 4811 and 11,643 unique aggregate characteristics. COVID-19 patients have been majority male in the US and Spain, but predominantly female in South Korea. Age profiles vary across data sources. Compared to 84,585 individuals hospitalised with influenza in 2014-19, COVID-19 patients have more typically been male, younger, and with fewer comorbidities and lower medication use. While protecting groups vulnerable to influenza is likely a useful starting point in the response to COVID-19, strategies will likely need to be broadened to reflect the particular characteristics of individuals being hospitalised with COVID-19.
Collapse
Affiliation(s)
- Edward Burn
- Fundació Institut Universitari per a la recerca a l'Atenció Primària de Salut Jordi Gol i Gurina (IDIAPJGol), Barcelona, Spain
- Centre for Statistics in Medicine (CSM), Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences (NDROMS), University of Oxford, Oxford, UK
| | - Seng Chan You
- Department of Biomedical Informatics, Ajou University School of Medicine, Suwon, Korea
| | - Anthony G Sena
- Janssen Research and Development, Titusville, NJ, USA
- Department of Medical Informatics, Erasmus University Medical Center, Rotterdam, The Netherlands
| | | | | | | | - Amanda Alberga
- Observational Health Data Sciences and Informatics Network, Alberta, Canada
| | - Heba Alghoul
- Faculty of Medicine, Islamic University of Gaza, Gaza, Palestine
| | - Osaid Alser
- Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
| | - Thamir M Alshammari
- Medication Safety Research Chair, King Saud University, Riyadh, Saudi Arabia
| | - Maria Aragon
- Fundació Institut Universitari per a la recerca a l'Atenció Primària de Salut Jordi Gol i Gurina (IDIAPJGol), Barcelona, Spain
| | - Carlos Areia
- Nuffield Department of Clinical Neurosciences, University of Oxford, Oxford, UK
| | - Juan M Banda
- Department of Computer Science, Georgia State University, Atlanta, GA, USA
| | - Jaehyeong Cho
- Department of Biomedical Informatics, Ajou University School of Medicine, Suwon, Korea
| | - Aedin C Culhane
- Data Science, Dana-Farber Cancer Institute. Biostatistics, Harvard TH Chan School of Public Health, Boston, MA, USA
| | - Alexander Davydov
- Odysseus Data Services, Inc., Cambridge, MA, USA
- Department for Microbiology, Virology and Immunology, Belarusian State Medical University, Minsk, Belarus
| | | | - Talita Duarte-Salles
- Fundació Institut Universitari per a la recerca a l'Atenció Primària de Salut Jordi Gol i Gurina (IDIAPJGol), Barcelona, Spain
| | - Scott DuVall
- Department of Veterans Affairs, Salt Lake City, UT, USA
- University of Utah School of Medicine, Salt Lake City, UT, USA
| | - Thomas Falconer
- Department of Biomedical Informatics, Columbia University, New York, NY, USA
| | - Sergio Fernandez-Bertolin
- Fundació Institut Universitari per a la recerca a l'Atenció Primària de Salut Jordi Gol i Gurina (IDIAPJGol), Barcelona, Spain
| | - Weihua Gao
- Health Economics and Outcomes Research, AbbVie, North Chicago, IL, USA
| | - Asieh Golozar
- Pharmacoepidemiology, Regeneron, NY, USA
- Department of Epidemiology, Johns Hopkins School of Public, Baltimore, MD, USA
| | - Jill Hardin
- Janssen Research and Development, Titusville, NJ, USA
| | - George Hripcsak
- Department of Biomedical Informatics, Columbia University, New York, NY, USA
- New York-Presbyterian Hospital, New York, NY, USA
| | - Vojtech Huser
- National Library of Medicine, National Institutes of Health, Bethesda, MD, USA
| | - Hokyun Jeon
- Department of Biomedical Sciences, Ajou University Graduate School of Medicine, Suwon, Korea
| | - Yonghua Jing
- Health Economics and Outcomes Research, AbbVie, North Chicago, IL, USA
| | - Chi Young Jung
- Division of Respiratory and Critical Care Medicine, Department of Internal Medicine, Daegu Catholic University Medical Center, Daegu, Korea
| | - Benjamin Skov Kaas-Hansen
- Clinical Pharmacology Unit, Zealand University Hospital, Køge, Denmark
- NNF Centre for Protein Research, University of Copenhagen, København, Denmark
| | - Denys Kaduk
- Odysseus Data Services, Inc., Cambridge, MA, USA
- Department of Pediatrics № 2, V. N. Karazin Kharkiv National University, Kharkiv, Ukraine
| | - Seamus Kent
- Science Policy and Research, National Institute for Health and Care Excellence, London, UK
| | - Yeesuk Kim
- Department of Orthopaedic Surgery, College of Medicine, Hanyang University, Seoul, Korea
| | - Spyros Kolovos
- Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences (NDROMS), University of Oxford, Oxford, UK
| | - Jennifer C E Lane
- Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences (NDROMS), University of Oxford, Oxford, UK
| | - Hyejin Lee
- Bigdata Department, Health Insurance Review & Assessment Service, Wonju, Korea
| | - Kristine E Lynch
- Department of Veterans Affairs, Salt Lake City, UT, USA
- University of Utah School of Medicine, Salt Lake City, UT, USA
| | - Rupa Makadia
- Janssen Research and Development, Titusville, NJ, USA
| | - Michael E Matheny
- GRECC, Tennessee Valley Healthcare System VA, Nashville, TN, USA
- Department of Biomedical Informatics, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Paras P Mehta
- College of Medicine-Tucson, University of Arizona, Tucson, AZ, USA
| | - Daniel R Morales
- Division of Population Health and Genomics, University of Dundee, Dundee, UK
| | - Karthik Natarajan
- Department of Biomedical Informatics, Columbia University, New York, NY, USA
- New York-Presbyterian Hospital, New York, NY, USA
| | - Fredrik Nyberg
- School of Public Health and Community Medicine, Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - Anna Ostropolets
- Department of Biomedical Informatics, Columbia University, New York, NY, USA
| | - 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
| | - Jimyung Park
- Department of Biomedical Sciences, Ajou University Graduate School of Medicine, Suwon, Korea
| | - Jose D Posada
- Department of Medicine, School of Medicine, Stanford University, Stanford, CA, USA
| | - Albert Prats-Uribe
- Centre for Statistics in Medicine (CSM), Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences (NDROMS), University of Oxford, Oxford, UK
| | - Gowtham Rao
- Janssen Research and Development, Titusville, NJ, USA
| | | | - Yeunsook Rho
- Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences (NDROMS), University of Oxford, Oxford, UK
| | - Peter Rijnbeek
- Department of Medical Informatics, Erasmus University Medical Center, Rotterdam, The Netherlands
| | - Lisa M Schilling
- Data Science to Patient Value Program, Department of Medicine, University of Colorado Anschutz Medical Campus, Aurora, CO, USA
| | - Martijn Schuemie
- Janssen Research and Development, Titusville, NJ, USA
- Department of Biostatistics, UCLA Fielding School of Public Health, University of California, Los Angeles, CA, USA
| | - Nigam H Shah
- Department of Medicine, School of Medicine, Stanford University, Stanford, CA, USA
| | - Azza Shoaibi
- Janssen Research and Development, Titusville, NJ, USA
| | - Seokyoung Song
- Department of Anesthesiology and Pain Medicine, Catholic University of Daegu, School of Medicine, Gyeongsan, Korea
| | - Matthew Spotnitz
- Department of Biomedical Informatics, Columbia University, New York, NY, USA
| | - Marc A Suchard
- Department of Biostatistics, UCLA Fielding School of Public Health, University of California, Los Angeles, CA, USA
| | | | | | - Salvatore Volpe
- Department of Biomedical Informatics, Columbia University, New York, NY, USA
| | - Haini Wen
- Shuguang Hospital affiliated to Shanghai University of Traditional Chinese Medicine, Shanghai, China
| | - Andrew E Williams
- Tufts Institute for Clinical Research and Health Policy Studies, Boston, MA, USA
| | - Belay B Yimer
- Centre for Epidemiology Versus Arthritis, Manchester Academic Health Science Centre, The University of Manchester, Manchester, UK
| | - Lin Zhang
- School of Public Health, Peking Union Medical College, Chinese Academy of Medical Sciences, Beijing, China
- Melbourne School of Population and Global Health, The University of Melbourne, Melbourne, Australia
| | - Oleg Zhuk
- Odysseus Data Services, Inc., Cambridge, MA, USA
| | - Daniel Prieto-Alhambra
- Centre for Statistics in Medicine (CSM), Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences (NDROMS), University of Oxford, Oxford, UK.
| | - Patrick Ryan
- Janssen Research and Development, Titusville, NJ, USA
- Columbia University, New York, NY, USA
| |
Collapse
|
14
|
Lane JCE, Weaver J, Kostka K, Duarte-Salles T, Abrahao MTF, Alghoul H, Alser O, Alshammari TM, Biedermann P, Banda JM, Burn E, Casajust P, Conover MM, Culhane AC, Davydov A, DuVall SL, Dymshyts D, Fernandez-Bertolin S, Fišter K, Hardin J, Hester L, Hripcsak G, Kaas-Hansen BS, Kent S, Khosla S, Kolovos S, Lambert CG, van der Lei J, Lynch KE, Makadia R, Margulis AV, Matheny ME, Mehta P, Morales DR, Morgan-Stewart H, Mosseveld M, Newby D, Nyberg F, Ostropolets A, Park RW, Prats-Uribe A, Rao GA, Reich C, Reps J, Rijnbeek P, Sathappan SMK, Schuemie M, Seager S, Sena AG, Shoaibi A, Spotnitz M, Suchard MA, Torre CO, Vizcaya D, Wen H, de Wilde M, Xie J, You SC, Zhang L, Zhuk O, Ryan P, Prieto-Alhambra D. Risk of hydroxychloroquine alone and in combination with azithromycin in the treatment of rheumatoid arthritis: a multinational, retrospective study. Lancet Rheumatol 2020; 2:e698-e711. [PMID: 32864627 PMCID: PMC7442425 DOI: 10.1016/s2665-9913(20)30276-9] [Citation(s) in RCA: 89] [Impact Index Per Article: 22.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
Background Hydroxychloroquine, a drug commonly used in the treatment of rheumatoid arthritis, has received much negative publicity for adverse events associated with its authorisation for emergency use to treat patients with COVID-19 pneumonia. We studied the safety of hydroxychloroquine, alone and in combination with azithromycin, to determine the risk associated with its use in routine care in patients with rheumatoid arthritis. Methods In this multinational, retrospective study, new user cohort studies in patients with rheumatoid arthritis aged 18 years or older and initiating hydroxychloroquine were compared with those initiating sulfasalazine and followed up over 30 days, with 16 severe adverse events studied. Self-controlled case series were done to further establish safety in wider populations, and included all users of hydroxychloroquine regardless of rheumatoid arthritis status or indication. Separately, severe adverse events associated with hydroxychloroquine plus azithromycin (compared with hydroxychloroquine plus amoxicillin) were studied. Data comprised 14 sources of claims data or electronic medical records from Germany, Japan, the Netherlands, Spain, the UK, and the USA. Propensity score stratification and calibration using negative control outcomes were used to address confounding. Cox models were fitted to estimate calibrated hazard ratios (HRs) according to drug use. Estimates were pooled where the I 2 value was less than 0·4. Findings The study included 956 374 users of hydroxychloroquine, 310 350 users of sulfasalazine, 323 122 users of hydroxychloroquine plus azithromycin, and 351 956 users of hydroxychloroquine plus amoxicillin. No excess risk of severe adverse events was identified when 30-day hydroxychloroquine and sulfasalazine use were compared. Self-controlled case series confirmed these findings. However, long-term use of hydroxychloroquine appeared to be associated with increased cardiovascular mortality (calibrated HR 1·65 [95% CI 1·12-2·44]). Addition of azithromycin appeared to be associated with an increased risk of 30-day cardiovascular mortality (calibrated HR 2·19 [95% CI 1·22-3·95]), chest pain or angina (1·15 [1·05-1·26]), and heart failure (1·22 [1·02-1·45]). Interpretation Hydroxychloroquine treatment appears to have no increased risk in the short term among patients with rheumatoid arthritis, but in the long term it appears to be associated with excess cardiovascular mortality. The addition of azithromycin increases the risk of heart failure and cardiovascular mortality even in the short term. We call for careful consideration of the benefit-risk trade-off when counselling those on hydroxychloroquine treatment. Funding National Institute for Health Research (NIHR) Oxford Biomedical Research Centre, NIHR Senior Research Fellowship programme, US National Institutes of Health, US Department of Veterans Affairs, Janssen Research and Development, IQVIA, Korea Health Industry Development Institute through the Ministry of Health and Welfare Republic of Korea, Versus Arthritis, UK Medical Research Council Doctoral Training Partnership, Foundation Alfonso Martin Escudero, Innovation Fund Denmark, Novo Nordisk Foundation, Singapore Ministry of Health's National Medical Research Council Open Fund Large Collaborative Grant, VINCI, Innovative Medicines Initiative 2 Joint Undertaking, EU's Horizon 2020 research and innovation programme, and European Federation of Pharmaceutical Industries and Associations.
Collapse
Affiliation(s)
- Jennifer C E Lane
- Centre for Statistics in Medicine, Nuffield Department of Orthopaedics, Rheumatology, and Musculoskeletal Sciences, University of Oxford, Oxford, UK
| | - James Weaver
- Janssen Research and Development, Titusville, NJ, USA
| | | | - Talita Duarte-Salles
- Fundació Institut Universitari per a la Recerca a l'Atenció Primària de Salut Jordi Gol i Gurina (IDIAPJGol), Barcelona, Spain
| | | | - Heba Alghoul
- Faculty of Medicine, Islamic University of Gaza, Palestine
| | - Osaid Alser
- Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
| | - Thamir M Alshammari
- Medication Safety Research Chair, King Saud University, Riyadh, Saudi Arabia
| | | | - Juan M Banda
- Department of Computer Science, Georgia State University, Atlanta, GA, USA
| | - Edward Burn
- Centre for Statistics in Medicine, Nuffield Department of Orthopaedics, Rheumatology, and Musculoskeletal Sciences, University of Oxford, Oxford, UK.,Fundació Institut Universitari per a la Recerca a l'Atenció Primària de Salut Jordi Gol i Gurina (IDIAPJGol), Barcelona, Spain
| | - Paula Casajust
- Real-World Evidence, Trial Form Support, Barcelona, Spain
| | | | - Aedin C Culhane
- Department of Data Sciences, Dana-Farber Cancer Institute, Department of Biostatistics, Harvard T H Chan School of Public Health, Boston, MA, USA
| | - Alexander Davydov
- Medical Ontology Solutions, Odysseus Data Services, Cambridge MA, USA
| | - Scott L DuVall
- Western Institute for Biomedical Research, Department of Veterans Affairs, Salt Lake City, UT, USA.,Department of Internal Medicine, Division of Epidemiology, University of Utah School of Medicine, Salt Lake City, UT, USA
| | - Dmitry Dymshyts
- Medical Ontology Solutions, Odysseus Data Services, Cambridge MA, USA
| | - Sergio Fernandez-Bertolin
- Fundació Institut Universitari per a la Recerca a l'Atenció Primària de Salut Jordi Gol i Gurina (IDIAPJGol), Barcelona, Spain
| | - Kristina Fišter
- School of Medicine, Andrija Štampar School of Public Health, University of Zagreb, Zagreb, Croatia
| | - Jill Hardin
- Janssen Research and Development, Titusville, NJ, USA
| | - Laura Hester
- Janssen Research and Development, Titusville, NJ, USA
| | - George Hripcsak
- Department of Biomedical Informatics, Columbia University Irving Medical Center, New York, NY, USA.,New York-Presbyterian Hospital, New York, NY, USA
| | - Benjamin Skov Kaas-Hansen
- Clinical Pharmacology Unit, Zealand University Hospital, Roskilde, Denmark.,NNF Centre for Protein Research, University of Copenhagen, Copenhagen, Denmark
| | - Seamus Kent
- National Institute for Health and Care Excellence, London, UK
| | - Sajan Khosla
- Real World Science and Digital, AstraZeneca, Cambridge, UK
| | - Spyros Kolovos
- Centre for Statistics in Medicine, Nuffield Department of Orthopaedics, Rheumatology, and Musculoskeletal Sciences, University of Oxford, Oxford, UK
| | - Christophe G Lambert
- Department of Internal Medicine, Center for Global Health and Division of Translational Informatics, Albuquerque, NM, USA
| | - Johan van der Lei
- Department of Medical Informatics, Erasmus University Medical Center, Rotterdam, Netherlands
| | - Kristine E Lynch
- Western Institute for Biomedical Research, Department of Veterans Affairs, Salt Lake City, UT, USA.,Department of Internal Medicine, Division of Epidemiology, University of Utah School of Medicine, Salt Lake City, UT, USA
| | - Rupa Makadia
- Janssen Research and Development, Titusville, NJ, USA
| | | | - Michael E Matheny
- Geriatrics Research Education and Clinical Care Center, Tennessee Valley Healthcare System VA, Nashville, TN, USA.,Department of Biomedical Informatics, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Paras Mehta
- College of Medicine, University of Arizona, Tucson, AZ, USA
| | - Daniel R Morales
- Division of Population Health and Genomics, University of Dundee, UK
| | | | - Mees Mosseveld
- Department of Medical Informatics, Erasmus University Medical Center, Rotterdam, Netherlands
| | - Danielle Newby
- Department of Psychiatry, University of Oxford, Warneford Hospital, Oxford, UK
| | - Fredrik Nyberg
- School of Public Health and Community Medicine, Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - Anna Ostropolets
- Department of Biomedical Informatics, Columbia University Irving Medical Center, New York, NY, USA
| | - Rae Woong Park
- Department of Biomedical Informatics, Ajou University School of Medicine, Suwon-si Gyeonggi-do, South Korea
| | - Albert Prats-Uribe
- Centre for Statistics in Medicine, Nuffield Department of Orthopaedics, Rheumatology, and Musculoskeletal Sciences, University of Oxford, Oxford, UK
| | - Gowtham A Rao
- Janssen Research and Development, Titusville, NJ, USA
| | | | - Jenna Reps
- Janssen Research and Development, Titusville, NJ, USA
| | - Peter Rijnbeek
- Department of Medical Informatics, Erasmus University Medical Center, Rotterdam, Netherlands
| | | | | | | | - Anthony G Sena
- Janssen Research and Development, Titusville, NJ, USA.,Department of Medical Informatics, Erasmus University Medical Center, Rotterdam, Netherlands
| | - Azza Shoaibi
- Janssen Research and Development, Titusville, NJ, USA
| | - Matthew Spotnitz
- Department of Biomedical Informatics, Columbia University Irving Medical Center, New York, NY, USA
| | - Marc A Suchard
- Department of Biomathematics and Department of Human Genetics, David Geffen School of Medicine at UCLA, and Department of Biostatistics, UCLA Fielding School of Public Health, University of California, Los Angeles, CA, USA
| | | | | | - Haini Wen
- Department of Pharmacy, Shanghai Chest Hospital, Shanghai Jiao Tong University, Shanghai, China
| | - Marcel de Wilde
- Department of Medical Informatics, Erasmus University Medical Center, Rotterdam, Netherlands
| | - Junqing Xie
- Centre for Statistics in Medicine, Nuffield Department of Orthopaedics, Rheumatology, and Musculoskeletal Sciences, University of Oxford, Oxford, UK
| | - Seng Chan You
- Department of Biomedical Informatics, Ajou University School of Medicine, Suwon-si Gyeonggi-do, South Korea
| | - Lin Zhang
- School of Population Medicine and Public Health, Peking Union Medical College/Chinese Academy of Medical Sciences, Beijing, China.,Melbourne School of Population and Global Health, University of Melbourne, VIC, Australia
| | - Oleg Zhuk
- Medical Ontology Solutions, Odysseus Data Services, Cambridge MA, USA
| | - Patrick Ryan
- Janssen Research and Development, Titusville, NJ, USA.,Department of Biomedical Informatics, Columbia University Irving Medical Center, New York, NY, USA
| | - Daniel Prieto-Alhambra
- Centre for Statistics in Medicine, Nuffield Department of Orthopaedics, Rheumatology, and Musculoskeletal Sciences, University of Oxford, Oxford, UK.,Fundació Institut Universitari per a la Recerca a l'Atenció Primària de Salut Jordi Gol i Gurina (IDIAPJGol), Barcelona, Spain
| | | |
Collapse
|
15
|
Burn E, You SC, Sena A, Kostka K, Abedtash H, Abrahao MTF, Alberga A, Alghoul H, Alser O, Alshammari TM, Aragon M, Areia C, Banda JM, Cho J, Culhane AC, Davydov A, DeFalco FJ, Duarte-Salles T, DuVall SL, Falconer T, Fernandez-Bertolin S, Gao W, Golozar A, Hardin J, Hripcsak G, Huser V, Jeon H, Jing Y, Jung CY, Kaas-Hansen BS, Kaduk D, Kent S, Kim Y, Kolovos S, Lane J, Lee H, Lynch KE, Makadia R, Matheny ME, Mehta P, Morales DR, Natarajan K, Nyberg F, Ostropolets A, Park RW, Park J, Posada JD, Prats-Uribe A, Rao GA, Reich C, Rho Y, Rijnbeek P, Schilling LM, Schuemie M, Shah NH, Shoaibi A, Song S, Spotnitz M, Suchard MA, Swerdel J, Vizcaya D, Volpe S, Wen H, Williams AE, Yimer BB, Zhang L, Zhuk O, Prieto-Alhambra D, Ryan P. Deep phenotyping of 34,128 patients hospitalised with COVID-19 and a comparison with 81,596 influenza patients in America, Europe and Asia: an international network study. medRxiv 2020. [PMID: 32511443 DOI: 10.1101/2020.04.22.20074336] [Citation(s) in RCA: 22] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Abstract
Background In this study we phenotyped individuals hospitalised with coronavirus disease 2019 (COVID-19) in depth, summarising entire medical histories, including medications, as captured in routinely collected data drawn from databases across three continents. We then compared individuals hospitalised with COVID-19 to those previously hospitalised with influenza. Methods We report demographics, previously recorded conditions and medication use of patients hospitalised with COVID-19 in the US (Columbia University Irving Medical Center [CUIMC], Premier Healthcare Database [PHD], UCHealth System Health Data Compass Database [UC HDC], and the Department of Veterans Affairs [VA OMOP]), in South Korea (Health Insurance Review & Assessment [HIRA]), and Spain (The Information System for Research in Primary Care [SIDIAP] and HM Hospitales [HM]). These patients were then compared with patients hospitalised with influenza in 2014-19. Results 34,128 (US: 8,362, South Korea: 7,341, Spain: 18,425) individuals hospitalised with COVID-19 were included. Between 4,811 (HM) and 11,643 (CUIMC) unique aggregate characteristics were extracted per patient, with all summarised in an accompanying interactive website (http://evidence.ohdsi.org/Covid19CharacterizationHospitalization/). Patients were majority male in the US (CUIMC: 52%, PHD: 52%, UC HDC: 54%, VA OMOP: 94%,) and Spain (SIDIAP: 54%, HM: 60%), but were predominantly female in South Korea (HIRA: 60%). Age profiles varied across data sources. Prevalence of asthma ranged from 4% to 15%, diabetes from 13% to 43%, and hypertensive disorder from 24% to 70% across data sources. Between 14% and 33% were taking drugs acting on the renin-angiotensin system in the 30 days prior to hospitalisation. Compared to 81,596 individuals hospitalised with influenza in 2014-19, patients admitted with COVID-19 were more typically male, younger, and healthier, with fewer comorbidities and lower medication use. Conclusions We provide a detailed characterisation of patients hospitalised with COVID-19. Protecting groups known to be vulnerable to influenza is a useful starting point to minimize the number of hospital admissions needed for COVID-19. However, such strategies will also likely need to be broadened so as to reflect the particular characteristics of individuals hospitalised with COVID-19.
Collapse
|
16
|
Neelon B, Shoaibi A, Benjamin-Neelon SE. A multivariate discrete failure time model for the analysis of infant motor development. Stat Med 2019; 38:1543-1557. [PMID: 30484904 DOI: 10.1002/sim.8055] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2018] [Revised: 09/12/2018] [Accepted: 11/08/2018] [Indexed: 11/07/2022]
Abstract
We develop a multivariate discrete failure time model for the analysis of infant motor development. We use the model to jointly evaluate the time (in months) to achievement of three well-established motor milestones: sitting up, crawling, and walking. The model includes a subject-specific latent factor that reflects underlying heterogeneity in the population and accounts for within-subject dependence across the milestones. The factor loadings and covariate effects are allowed to vary flexibly across milestones, and the milestones are permitted to have unique at-risk intervals corresponding to different developmental windows. We adopt a Bayesian inferential approach and develop a convenient data-augmented Gibbs sampler for posterior computation. We conduct simulation studies to illustrate key features of the model and use the model to analyze data from the Nurture study, a birth cohort examining infant health and development during the first year of life.
Collapse
Affiliation(s)
- Brian Neelon
- Department of Public Health Sciences, Medical University of South Carolina, Charleston, South Carolina
| | - Azza Shoaibi
- Department of Public Health Sciences, Medical University of South Carolina, Charleston, South Carolina
| | - Sara E Benjamin-Neelon
- Department of Public Health Sciences, Medical University of South Carolina, Charleston, South Carolina.,Department of Health, Behavior and Society, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland
| |
Collapse
|
17
|
Shoaibi A, Neelon B, Østbye T, Benjamin-Neelon SE. Longitudinal associations of gross motor development, motor milestone achievement and weight-for-length z score in a racially diverse cohort of US infants. BMJ Open 2019; 9:e024440. [PMID: 30782735 PMCID: PMC6340444 DOI: 10.1136/bmjopen-2018-024440] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/28/2022] Open
Abstract
OBJECTIVES To investigate longitudinal associations between gross motor development, motor milestone achievement and weight-for-length z scores in a sample of infants. In a secondary aim, we explored potential bidirectional relationships, as higher weight-for-length z scores may impede motor development, and poor motor development may lead to obesity. DESIGN The design was an observational birth cohort. SETTING We used data from the Nurture study, a birth cohort of predominately black women and their infants residing in the Southeastern USA. PARTICIPANTS 666 women enrolled their infants in Nurture. We excluded infants with missing data on exposure, outcome or main covariates, leaving a total analytic sample of 425 infants. PRIMARY OUTCOME The outcome was weight-for-length z score, measured when infants were 3, 6, 9 12 months. RESULTS Among infants, 64.7% were black, 18.8% were white and 16.9% were other/multiple race. Mean (SD) breastfeeding duration was 17.6 (19.7) weeks. Just over one-third (38.5%) had an annual household income of < $20 000. After adjusting for potential confounders, higher motor development score was associated with lower weight-for-length z score (-0.004; 95% CI -0.001 to -0.007; p=0.01), mainly driven by associations among boys (-0.007; 95% CI -0.014 to -0.001; p=0.03) and not girls (0.001; 95% CI -0.005 to 0.008; p=0.62). Earlier crawling was the only milestone associated with a lower weight-for-length z score at 12 months (-0.328; 95% CI -0.585 to 0.072; p=0.012). However, this association appeared to be driven by male infants only (-0.461; 95% CI -0.825 to -0.096; p=0.01). Weight-for-length z score was unrelated to subsequent motor development score and was thus not bidirectional in our sample. CONCLUSIONS Higher motor development score and earlier crawling were associated with lower subsequent weight-for-length z score. However, this was primary true for male infants only. These findings contribute to the growing body of evidence suggesting that delayed motor development may be associated with later obesity.
Collapse
Affiliation(s)
- Azza Shoaibi
- Department of Public Health Sciences, Medical University of South Carolina, Charleston, South Carolina, USA
| | - Brian Neelon
- Department of Public Health Sciences, Medical University of South Carolina, Charleston, South Carolina, USA
| | - Truls Østbye
- Department of Community and Family Medicine, Duke University Medical Center, Charleston, South Carolina, UK
| | - Sara E Benjamin-Neelon
- Department of Health, Behavior and Society, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
| |
Collapse
|
18
|
Khatiwada A, Shoaibi A, Neelon B, Emond JA, Benjamin Neelon SE. Household chaos during infancy and infant weight status at 12 months. Pediatr Obes 2018; 13:607-613. [PMID: 30019385 PMCID: PMC6300983 DOI: 10.1111/ijpo.12395] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/01/2017] [Accepted: 04/09/2018] [Indexed: 12/24/2022]
Abstract
BACKGROUND Infancy is a critical period for obesity prevention. Emerging evidence links household chaos to poor health outcomes, yet its impact on obesity in infancy is unknown. OBJECTIVES We examined associations between household chaos when infants were 6 and 12 months and weight-for-length (WFL) z-score at 12 months, exploring potential mediation by infant sleep and screen time. METHODS We examined 401 predominately Black women and infants in the southeastern United States. We conducted multivariable linear regressions examining household chaos and infant WFL z-score, assessing breastfeeding, sleep, screen time as potential mediators. RESULTS Among infants, 69.7% were Black and 49.0% were female. Mean breasting duration was 3.7 months. Over half (50.4%) of families had annual household incomes <$20 000. After adjustment for potential confounders, household chaos was associated with infant WFL z-score (0.02; 95% CI 0.001, 0.04; p = 0.04) at 12 months. We did not observe associations between chaos and infant breastfeeding, sleep or screen time. CONCLUSIONS Higher household chaos was associated with greater infant weight at 12 months, but there was no evidence of mediation by breastfeeding, sleep or screen time.
Collapse
Affiliation(s)
- Aastha Khatiwada
- Department of Public Health Sciences, Medical University of South Carolina, Charleston, South Carolina 29425
| | - Azza Shoaibi
- Department of Public Health Sciences, Medical University of South Carolina, Charleston, South Carolina 29425
| | - Brian Neelon
- Department of Public Health Sciences, Medical University of South Carolina, Charleston, South Carolina 29425
| | - Jennifer A Emond
- Department of Biomedical Data Science, Dartmouth Geisel School of Medicine, Hanover, New Hampshire 03755
| | - Sara E Benjamin Neelon
- Department of Health, Behavior and Society, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland 21205
| |
Collapse
|
19
|
Shoaibi A, Obeid JS, Oates JC, Habrat ML, Lenert LA. The association between method of solicitation and patient permissions for use of surplus tissues and contact for future research. JAMIA Open 2018; 1:195-201. [PMID: 30474075 PMCID: PMC6241503 DOI: 10.1093/jamiaopen/ooy038] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2018] [Revised: 08/10/2018] [Accepted: 09/17/2018] [Indexed: 11/14/2022] Open
Abstract
Objective Obtaining patient permissions for research contact and for surplus tissue use as part of routine clinical practice can improve research participation. This study aims to investigate the difference in patient permissions for use of surplus tissues, and for direct contact for research, using 2 different methods of solicitation. Methods An opt-in, population-based approach for gathering research permissions was implemented in 2 methods. The first method, applied a 2-item patient questionnaire delivered through the electronic health record patient portal. The questionnaire composed of 2 questions (1) whether de-identified surplus specimens may be used for research and (2) whether patients could be contacted about research. In the second method, the same questionnaire was physically presented in clinic within the clinical workflow. We used 1 to 1 propensity score matching and multivariate logistic regression to estimate the odds of obtaining permission and the difference between the 2 methods of solicitation. Results The propensity score model matched 8044 observations (4114 submissions in each group). Among the in-clinic submission group, 70.13% provided permission for surplus tissue compared with 66.65% in the patient portal submission group (odds ratio [OR] = 1.20; 95% confidence interval [CI] 1.09–1.32; P < 0.001). Permission for future research contact was similar among in-clinic (65.07%) and patient portal submission (66.65%) groups (OR = 0.94; 95% CI 0.85–1.03; P = 0.175). These trends were consistent among European Americans and African American patients. However, among patients of other race, higher permission for both future contact (OR = 0.58; 95% CI 0.39–0.86; P < 0.007) and surplus tissue use (OR = 0.65; 95% CI 0.43–0.97; P = 0.036) was observed among patient portal submission. Discussion Our findings suggest that in-clinic solicitation of patient permissions may provide the same opportunity to patients who do not use patient portals and may be associated with higher permission rate for surplus tissue. However, this was primary true for European American and African Americans patients. Patients of other race minorities might respond better to online approaches. Conclusion Adopting a patient-centric approach that combines in-clinic and portal-based administration may be feasible and promising. Further research is required in this area.
Collapse
Affiliation(s)
- Azza Shoaibi
- Biomedical Informatics Center, Medical University of South Carolina, Charleston, South Carolina, USA
| | - Jihad S Obeid
- Biomedical Informatics Center, Medical University of South Carolina, Charleston, South Carolina, USA
| | - Jim C Oates
- Department of Medicine, Medical University of South Carolina, Charleston, South Carolina, USA
| | - Melissa L Habrat
- Biomedical Informatics Center, Medical University of South Carolina, Charleston, South Carolina, USA
| | - Leslie A Lenert
- Biomedical Informatics Center, Medical University of South Carolina, Charleston, South Carolina, USA
| |
Collapse
|
20
|
Obeid JS, Shoaibi A, Oates JC, Habrat ML, Hughes-Halbert C, Lenert LA. Research participation preferences as expressed through a patient portal: implications of demographic characteristics. JAMIA Open 2018; 1:202-209. [PMID: 30474076 PMCID: PMC6241507 DOI: 10.1093/jamiaopen/ooy034] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2018] [Revised: 06/27/2018] [Accepted: 07/31/2018] [Indexed: 11/13/2022] Open
Abstract
Objective As patient portals are increasingly used for research recruitment, it is important to examine the demographic makeup of research registries that are populated via portals and the factors that influence participation in these registries. Methods We examined the response to a routine research preference questionnaire among patients who were enrolled in a patient portal at an academic health center and characterized the sub-population that responded and was tracked in a research preferences registry. We examined the factors that influence choices in two research preferences: future contact for research opportunities and biobanking of de-identified specimens. Results Out of 79 834 patients to whom the questionnaire was sent, 32% responded. Of those 74% agreed to future contact and 77% to the biobank preference. We found significantly lower odds of agreement in both preferences in minority populations, especially in the population >65 years of age when stratified by race. Individuals with higher comorbidity indexes had significantly higher odds for agreement. Discussion The disparities in volunteerism as expressed by agreement to future contact and willingness to participate in biobanking are exacerbated by lower levels of enrollment in the patient portal by minorities, especially in the oldest age group. Future work should examine other socioeconomic factors and the differences across age groups, sicker individuals, and payer categories. Conclusion Although patient portals can be more efficient for recruitment, researchers have to be cognizant of, and proactively address, potential biases when recruiting participants from these registries.
Collapse
Affiliation(s)
- Jihad S Obeid
- Biomedical Informatics Center, Medical University of South Carolina, Charleston, South Carolina, USA
| | - Azza Shoaibi
- Biomedical Informatics Center, Medical University of South Carolina, Charleston, South Carolina, USA
| | - Jim C Oates
- Department of Medicine, Medical University of South Carolina, Charleston, SC, USA.,Medical Service, Rheumatology Section, Ralph H. Johnson VA Medical Center, Charleston, SC, USA
| | - Melissa L Habrat
- Biomedical Informatics Center, Medical University of South Carolina, Charleston, South Carolina, USA
| | - Chanita Hughes-Halbert
- Department of Psychiatry and Behavioral Sciences, Medical University of South Carolina, Charleston, SC, USA
| | - Leslie A Lenert
- Biomedical Informatics Center, Medical University of South Carolina, Charleston, South Carolina, USA
| |
Collapse
|
21
|
Zheng J, Merchant AT, Wirth MD, Zhang J, Antwi SO, Shoaibi A, Shivappa N, Stolzenberg-Solomon RZ, Hebert JR, Steck SE. Inflammatory potential of diet and risk of pancreatic cancer in the Prostate, Lung, Colorectal and Ovarian (PLCO) Cancer Screening Trial. Int J Cancer 2018; 142:2461-2470. [PMID: 29355939 DOI: 10.1002/ijc.31271] [Citation(s) in RCA: 25] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2017] [Revised: 12/30/2017] [Accepted: 01/09/2018] [Indexed: 01/28/2023]
Abstract
Inflammation plays a central role in pancreatic cancer etiology and can be modulated by diet. We aimed to examine the association between the inflammatory potential of diet, assessed with the Dietary Inflammatory Index (DII®), and pancreatic cancer risk in the Prostate, Lung, Colorectal and Ovarian Cancer Screening Trial prospective cohort. Our study included 101,449 participants aged 52-78 years at baseline who completed both baseline questionnaire and a diet history questionnaire. Energy-adjusted DII (E-DII) scores were computed based on food and supplement intake. Cox proportional hazards models and time dependent Cox models were used to estimate hazard ratios (HRs) and 95% confidence intervals (CIs) with participants in the lowest E-DII quintile (most anti-inflammatory scores) as referent. After a median 8.5 years of follow-up, 328 pancreatic cancer cases were identified. E-DII scores were not associated with pancreatic cancer risk in the multivariable model (HRQ5vsQ1 = 0.94; 95% CI = 0.66-1.35; p-trend = 0.43). Time significantly modified the association (p-interaction = 0.01). During follow up <4 years, there was suggestive evidence of an inverse association between E-DII and pancreatic cancer (HRQ5vsQ1 = 0.60; 95% CI = 0.35-1.02; p-trend = 0.20) while there was a significant positive trend in the follow up ≥4 years (HRQ5vsQ1 = 1.31; 95% CI = 0.83-2.08; p-trend = 0.03). Similar results were observed for E-DII from food only. Our study does not support an association between inflammatory potential of diet and pancreatic cancer risk; however, heterogeneous results were obtained with different follow-up times. These divergent associations may result from the influences of undetected disease in the short-term.
Collapse
Affiliation(s)
- Jiali Zheng
- Department of Epidemiology and Biostatistics, Arnold School of Public Health, University of South Carolina, Columbia, SC.,Cancer Prevention and Control Program, University of South Carolina, Columbia, SC.,Department of Epidemiology, Division of Cancer Prevention and Population Sciences, The University of Texas MD Anderson Cancer Center, Houston, TX
| | - Anwar T Merchant
- Department of Epidemiology and Biostatistics, Arnold School of Public Health, University of South Carolina, Columbia, SC
| | - Michael D Wirth
- Department of Epidemiology and Biostatistics, Arnold School of Public Health, University of South Carolina, Columbia, SC.,Cancer Prevention and Control Program, University of South Carolina, Columbia, SC.,Connecting Health Innovations, LLC, Columbia, SC
| | - Jiajia Zhang
- Department of Epidemiology and Biostatistics, Arnold School of Public Health, University of South Carolina, Columbia, SC
| | - Samuel O Antwi
- Department of Health Sciences Research, Division of Epidemiology, Mayo Clinic, Jacksonville, FL
| | - Azza Shoaibi
- Biomedical Informatics Center, Medical University of South Carolina, Charleston, SC
| | - Nitin Shivappa
- Department of Epidemiology and Biostatistics, Arnold School of Public Health, University of South Carolina, Columbia, SC.,Cancer Prevention and Control Program, University of South Carolina, Columbia, SC.,Connecting Health Innovations, LLC, Columbia, SC
| | - Rachael Z Stolzenberg-Solomon
- Division of Cancer Epidemiology and Genetics, Metabolic Epidemiology Branch, National Cancer Institute (NCI/DCEG), Rockville, MD
| | - James R Hebert
- Department of Epidemiology and Biostatistics, Arnold School of Public Health, University of South Carolina, Columbia, SC.,Cancer Prevention and Control Program, University of South Carolina, Columbia, SC.,Connecting Health Innovations, LLC, Columbia, SC
| | - Susan E Steck
- Department of Epidemiology and Biostatistics, Arnold School of Public Health, University of South Carolina, Columbia, SC.,Cancer Prevention and Control Program, University of South Carolina, Columbia, SC
| |
Collapse
|
22
|
Marshall EA, Oates JC, Shoaibi A, Obeid JS, Habrat ML, Warren RW, Brady KT, Lenert LA. A population-based approach for implementing change from opt-out to opt-in research permissions. PLoS One 2017; 12:e0168223. [PMID: 28441388 PMCID: PMC5404843 DOI: 10.1371/journal.pone.0168223] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2016] [Accepted: 11/28/2016] [Indexed: 01/23/2023] Open
Abstract
Due to recently proposed changes in the Common Rule regarding the collection of research preferences, there is an increased need for efficient methods to document opt-in research preferences at a population level. Previously, our institution developed an opt-out paper-based workflow that could not be utilized for research in a scalable fashion. This project was designed to demonstrate the feasibility of implementing an electronic health record (EHR)-based active opt-in research preferences program. The first phase of implementation required creating and disseminating a patient questionnaire through the EHR portal to populate discreet fields within the EHR indicating patients’ preferences for future research study contact (contact) and their willingness to allow anonymised use of excess tissue and fluid specimens (biobank). In the second phase, the questionnaire was presented within a clinic nurse intake workflow in an obstetrical clinic. These permissions were tabulated in registries for use by investigators for feasibility studies and recruitment. The registry was also used for research patient contact management using a new EHR encounter type to differentiate research from clinical encounters. The research permissions questionnaire was sent to 59,670 patients via the EHR portal. Within four months, 21,814 responses (75% willing to participate in biobanking, and 72% willing to be contacted for future research) were received. Each response was recorded within a patient portal encounter to enable longitudinal analysis of responses. We obtained a significantly lower positive response from the 264 females who completed the questionnaire in the obstetrical clinic (55% volunteers for biobank and 52% for contact). We demonstrate that it is possible to establish a research permissions registry using the EHR portal and clinic-based workflows. This patient-centric, population-based, opt-in approach documents preferences in the EHR, allowing linkage of these preferences to health record information.
Collapse
Affiliation(s)
- Elizabeth A. Marshall
- Biomedical Informatics Center, Medical University of South Carolina, Charleston, South Carolina, United States of America
- Department of Public Health Sciences, Medical University of South Carolina, Charleston, South Carolina, United States of America
- * E-mail:
| | - Jim C. Oates
- Department of Medicine, Division of Rheumatology and Immunology, Medical University of South Carolina, Charleston, South Carolina, United States of America
- Medical Service, Rheumatology Section, Ralph H. Johnson VA Medical Center, Charleston, South Carolina, United States of America
| | - Azza Shoaibi
- Biomedical Informatics Center, Medical University of South Carolina, Charleston, South Carolina, United States of America
- Department of Public Health Sciences, Medical University of South Carolina, Charleston, South Carolina, United States of America
| | - Jihad S. Obeid
- Department of Public Health Sciences, Medical University of South Carolina, Charleston, South Carolina, United States of America
| | - Melissa L. Habrat
- Biomedical Informatics Center, Medical University of South Carolina, Charleston, South Carolina, United States of America
| | - Robert W. Warren
- Department of Pediatrics, Division of Pediatric Rheumatology and Immunology, Medical University of South Carolina, Charleston, South Carolina, United States of America
| | - Kathleen T. Brady
- Department of Psychiatry and Behavioral Sciences, Medical University of South Carolina, Charleston, South Carolina, United States of America
| | - Leslie A. Lenert
- Biomedical Informatics Center, Medical University of South Carolina, Charleston, South Carolina, United States of America
- Department of Medicine, Division of General Internal Medicine, Medical University of South Carolina, Charleston, South Carolina, United States of America
| |
Collapse
|
23
|
Hebert JR, Turner A, Payne J, Shoaibi A. Abstract C66: Screening via multiple PSA measures to detect virulent prostate cancer could provide a way to address fundamental issues in African-American men's health. Cancer Epidemiol Biomarkers Prev 2017. [DOI: 10.1158/1538-7755.disp16-c66] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Abstract
The dilemma facing individuals wishing to make decisions regarding prostate cancer (PrCA) screening pivots on two opposing outcomes: over-diagnosing indolent cancer and under-diagnosing virulent cancer. In conjunction with limited data on which to draw conclusions, this dilemma formed the basis on which the US Preventive Services Task Force made its decision to not recommend PSA screening. Data driving that decision-making process was derived nearly entirely from European and European-American men, even though African Americans are much more likely to be diagnosed with later-stage, more aggressive disease at younger ages. The discrepancy that we see between the US' highest-world-quintile incidence rates and second-lowest-world-quintile mortality rates may be explained entirely by the presence of high-virulence disease among African Americans.
Clearly, detecting aggressive disease represents a significant public health issue and unmet clinical need. Development and discovery of biomarkers to predict PrCA that is likely to kill if left untreated is the major challenge in PrCA prevention and control. With this background in mind we sought to interrogate a large data set with multiple PSAs measured at regular (i.e., annual) intervals to see if we could predict high-virulence PrCA. Using the PLCO data we showed that with ≥three measures we were able to improve sensitivity and specificity of the PSA test to >97% overall and >99% among African-American men for detecting virulent, clinically relevant high-risk prostate cancer (PSA level ≥ 20ng/ml, cancer that invades prostate capsule, PrCA that involves more than one lobe, or Gleason score >7).
At this juncture, we have begun to address the question of what can be done to distinguish aggressive PrCA in African-American men. We propose creating a cohort of 48,000 individuals who are willing to undergo annual PSA screening with the intention of validating/refining the algorithm that the University of South Carolina team developed using PLCO trial data that combines three or more PSA measures to detect virulent, high-risk PrCA. This cohort also would serve another important purpose. There currently exists no other cohort with a sufficient number of African-American men to address other important cancer-related health issues. So, if designed correctly, this cohort could serve numerous other purposes.
This would be a simple follow-up study design with extensive baseline data collection and follow-up data collected at regular (i.e., annual) intervals. This would require strong community buy-in, commitment to providing information needed for informed decision-making, formulating rules for referring men out for diagnostic workup, and putting procedures in place for data linkage (e.g., to the cancer registries). Twelve institutions in 10 states across the US have expressed interest in being involved.
Currently, there are two, non-mutually exclusive, options for recruitment.
The Veterans Administration (VA) system could be ideal setting for this because: 1. They already have the screening infrastructure in place; 2. There isn't the financial incentive to over-diagnose and over-treat; 3. There is an excellent system of medical records; 4. There are many African-American veterans in the VA system; and 5. The medical home (for subsequent care) already is in place.
The NCI's community oncology research program (NCORP) appears to understand the CBPR imperative. As such, they have good access to local, interested communities and in some regions of the country this includes large AA populations. They have excellent community relations and local “connectivity” that could help to ensure a competent, caring ‘medical home' that would be essential for program viability (i.e., recruitment and follow-up). Depending on geographical particulars, there could be good overlap with the VA. NCORPS could add an important element of academic medicine/ NCI imprimatur to the mix.
Citation Format: James R. Hebert, Abraham Turner, Johnny Payne, Azza Shoaibi. Screening via multiple PSA measures to detect virulent prostate cancer could provide a way to address fundamental issues in African-American men's health. [abstract]. In: Proceedings of the Ninth AACR Conference on the Science of Cancer Health Disparities in Racial/Ethnic Minorities and the Medically Underserved; 2016 Sep 25-28; Fort Lauderdale, FL. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2017;26(2 Suppl):Abstract nr C66.
Collapse
Affiliation(s)
| | | | - Johnny Payne
- 3UsTOO Prostate Cancer Education and Support Group, Greenville, SC,
| | - Azza Shoaibi
- 4Medical University of South Carolina, Charleston, SC
| |
Collapse
|
24
|
Shoaibi A, Rao GA, Cai B, Rawl J, Haddock KS, Hébert JR. Prostate Specific Antigen-Growth Curve Model to Predict High-Risk Prostate Cancer. Prostate 2017; 77:173-184. [PMID: 27699819 DOI: 10.1002/pros.23258] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/23/2016] [Accepted: 09/07/2016] [Indexed: 11/06/2022]
Abstract
PURPOSE To investigate if a prostate specific antigen (PSA)-derived growth curve can predict the occurrence of high-risk prostate cancer (PrCA). METHODS Data from 38,340 men randomized to the PrCA screening arm in the prostate, lung, colorectal, and ovarian cancer screening trial (PLCO) were used to develop a PSA growth curve model to estimate PSA rate of change. The model was then used to predict high-risk PrCA in clinical data available from 680,390 veterans seeking routine care. The PSA growth curve was modeled using non-linear mixed regression and the PSA rate was estimated by taking the 1st derivative of the growth curve equation at 1 year prior to diagnosis/exit. RESULTS In the PLCO, PrCA incidence was 8.1%; ≈19% of whom had high-risk PrCA. Overall, a PSA rate threshold of 0.37 ng/ml/year had the best combination of sensitivity (97.2%) and specificity (97.3%) for detecting high-risk PrCA. In the VA data; 7,347 men were diagnosed with PrCA; of these 4,315 (58.7%) were diagnosed with high-risk PrCA. The PLCO optimal threshold of 0.37 ng/ml/year produced sensitivity = 95.5% and specificity = 85.2%. An optimal threshold of 0.99 ng/ml/year in AA produced sensitivity = 89.1% and specificity = 80.0%. PSA rate was a better predictor than the single last PSA value. CONCLUSIONS PSA growth curves predicted high-risk PrCA in the PLCO data. Fitting the same algorithm in the VA data produced lower specificity. Although encouraging, this finding underlines the need for further research to prospectively test the algorithm, especially for African-American men, the population group at highest risk of aggressive PrCA. Prostate 77:173-184, 2017. © 2016 Wiley Periodicals, Inc.
Collapse
Affiliation(s)
- Azza Shoaibi
- Department of Health Sciences, Medical University of South Carolina, Columbia, South Carolina
- South Carolina Statewide Cancer Prevention and Control Program, University of South Carolina, Columbia, South Carolina
| | - Gowtham A Rao
- Department of Epidemiology and Biostatistics, Arnold School of Public Health, University of South Carolina, Columbia, South Carolina
- Department of Family and Preventive Medicine, School of Medicine, University of South Carolina, Columbia, South Carolina
| | - Bo Cai
- Department of Epidemiology and Biostatistics, Arnold School of Public Health, University of South Carolina, Columbia, South Carolina
| | - John Rawl
- Columbia Urological Associates, P.A., Columbia, South Carolina
| | - Kathlyn Sue Haddock
- Research Department, Veterans Affairs Medical Center, WJB Dorn VA Hospital, Columbia, South Carolina
| | - James R Hébert
- South Carolina Statewide Cancer Prevention and Control Program, University of South Carolina, Columbia, South Carolina
- Department of Epidemiology and Biostatistics, Arnold School of Public Health, University of South Carolina, Columbia, South Carolina
- Department of Family and Preventive Medicine, School of Medicine, University of South Carolina, Columbia, South Carolina
| |
Collapse
|
25
|
Critchley J, Capewell S, O'Flaherty M, Abu-Rmeileh N, Rastam S, Saidi O, Sözmen K, Shoaibi A, Husseini A, Fouad F, Ben Mansour N, Aissi W, Ben Romdhane H, Unal B, Bandosz P, Bennett K, Dherani M, Al Ali R, Maziak W, Arık H, Gerçeklioğlu G, Altun DU, Şimşek H, Doganay S, Demiral Y, Aslan Ö, Unwin N, Phillimore P, Achour N, Aissi W, Allani R, Arfa C, Abu-Kteish H, Abu-Rmeileh N, Al Ali R, Altun D, Ahmad B, Arık H, Aslan Ö, Beltaifa L, Ben Mansour N, Bennett K, Ben Romdhane H, Ben Salah N, Collins M, Critchley J, Capewell S, Dherani M, Demiral Y, Doganay S, Elias M, Ergör G, Fadhil I, Fouad F, Gerçeklioğlu G, Ghandour R, Göğen S, Husseini A, Jaber S, Kalaca S, Khatib R, Khatib R, Koudsie S, Kilic B, Lassoued O, Mason H, Maziak W, Mayaleh MA, Mikki N, Moukeh G, Flaherty MO, Phillimore P, Rastam S, Roglic G, Saidi O, Saatli G, Satman I, Shoaibi A, Şimşek H, Soulaiman N, Sözmen K, Tlili F, Unal B, Unwin N, Yardim N, Zaman S. Contrasting cardiovascular mortality trends in Eastern Mediterranean populations: Contributions from risk factor changes and treatments. Int J Cardiol 2016; 208:150-61. [PMID: 26878275 DOI: 10.1016/j.ijcard.2016.01.031] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/11/2015] [Revised: 11/05/2015] [Accepted: 01/01/2016] [Indexed: 11/29/2022]
Abstract
BACKGROUND Middle income countries are facing an epidemic of non-communicable diseases, especially coronary heart disease (CHD). We used a validated CHD mortality model (IMPACT) to explain recent trends in Tunisia, Syria, the occupied Palestinian territory (oPt) and Turkey. METHODS Data on populations, mortality, patient numbers, treatments and risk factor trends from national and local surveys in each country were collated over two time points (1995-97; 2006-09); integrated and analysed using the IMPACT model. RESULTS Risk factor trends: Smoking prevalence was high in men, persisting in Syria but decreasing in Tunisia, oPt and Turkey. BMI rose by 1-2 kg/m(2) and diabetes prevalence increased by 40%-50%. Mean systolic blood pressure and cholesterol levels increased in Tunisia and Syria. Mortality trends: Age-standardised CHD mortality rates rose by 20% in Tunisia and 62% in Syria. Much of this increase (79% and 72% respectively) was attributed to adverse trends in major risk factors, occurring despite some improvements in treatment uptake. CHD mortality rates fell by 17% in oPt and by 25% in Turkey, with risk factor changes accounting for around 46% and 30% of this reduction respectively. Increased uptake of community treatments (drug treatments for chronic angina, heart failure, hypertension and secondary prevention after a cardiac event) accounted for most of the remainder. DISCUSSION CHD death rates are rising in Tunisia and Syria, whilst oPt and Turkey demonstrate clear falls, reflecting improvements in major risk factors with contributions from medical treatments. However, smoking prevalence remains very high in men; obesity and diabetes levels are rising dramatically.
Collapse
Affiliation(s)
- Julia Critchley
- Population Health Research Institute, St. George's, University of London, Cranmer Terrace, London SW17 0RE, UK.
| | - Simon Capewell
- Department of Public Health and Policy, University of Liverpool, UK
| | | | - Niveen Abu-Rmeileh
- Institute of Community and Public Health, Birzeit University, State of Palestine
| | - Samer Rastam
- Syrian Center For Tobacco Studies, Aleppo, Syria
| | - Olfa Saidi
- Cardiovascular Epidemiology and Prevention Research Laboratory, Tunisia
| | - Kaan Sözmen
- Dept. of Public Health, Faculty of Medicine, Dokuz Eylul University, Turkey
| | - Azza Shoaibi
- Institute of Community and Public Health, Birzeit University, State of Palestine
| | - Abdullatif Husseini
- Public Health Program, Department of Health Sciences, Qatar University, Doha, Qatar
| | - Fouad Fouad
- Syrian Center For Tobacco Studies, Aleppo, Syria; Department of Epidemiology and Public Health, American University of Beirut, Lebanon
| | - Nadia Ben Mansour
- Cardiovascular Epidemiology and Prevention Research Laboratory, Tunisia
| | - Wafa Aissi
- Cardiovascular Epidemiology and Prevention Research Laboratory, Tunisia
| | | | - Belgin Unal
- Dept. of Public Health, Faculty of Medicine, Dokuz Eylul University, Turkey
| | - Piotr Bandosz
- Department of Public Health and Policy, University of Liverpool, UK
| | - Kathleen Bennett
- Department of Pharmacology & Therapeutics, Trinity College, Dublin, Ireland
| | - Mukesh Dherani
- Department of Public Health and Policy, University of Liverpool, UK
| | | | - Wasim Maziak
- Syrian Center For Tobacco Studies, Aleppo, Syria; Robert Stempel College of Public Health And Social Work, Florida International University, Miami, FL, USA
| | - Hale Arık
- Dept. of Public Health, Faculty of Medicine, Dokuz Eylul University, Turkey
| | - Gül Gerçeklioğlu
- Dept. of Public Health, Faculty of Medicine, Dokuz Eylul University, Turkey
| | - Deniz Utku Altun
- Dept. of Public Health, Faculty of Medicine, Dokuz Eylul University, Turkey
| | - Hatice Şimşek
- Dept. of Public Health, Faculty of Medicine, Dokuz Eylul University, Turkey
| | - Sinem Doganay
- Dept. of Public Health, Faculty of Medicine, Dokuz Eylul University, Turkey
| | - Yücel Demiral
- Dept. of Public Health, Faculty of Medicine, Dokuz Eylul University, Turkey
| | - Özgür Aslan
- Dept. of Public Health, Faculty of Medicine, Dokuz Eylul University, Turkey
| | - Nigel Unwin
- The Faculty of Medical Sciences, University of the West Indies, Barbados
| | | | | | | | | | - Waffa Aissi
- Cardiovascular Epidemiology and Prevention Research Laboratory, Tunis, Tunisia
| | - Riadh Allani
- Cardiovascular Epidemiology and Prevention Research Laboratory, Tunis, Tunisia
| | - Chokra Arfa
- Cardiovascular Epidemiology and Prevention Research Laboratory, Tunis, Tunisia
| | | | - Niveen Abu-Rmeileh
- Institute of Community and Public Health, Birzeit University, Birzeit, State of Palestine
| | | | - Deniz Altun
- Dept of Public Health, Faculty of Medicine, Dokuz Eylul University, Turkey
| | - Balsam Ahmad
- Institute of Health and Society, Newcastle University, Newcastle upon Tyne, UK
| | - Hale Arık
- Dept of Public Health, Faculty of Medicine, Dokuz Eylul University, Turkey
| | - Özgür Aslan
- Dept of Public Health, Faculty of Medicine, Dokuz Eylul University, Turkey
| | - Latifa Beltaifa
- Cardiovascular Epidemiology and Prevention Research Laboratory, Tunis, Tunisia
| | - Nadia Ben Mansour
- Cardiovascular Epidemiology and Prevention Research Laboratory, Tunis, Tunisia
| | - Kathleen Bennett
- Department of Pharmacology & Therapeutics, Trinity College, Dublin, Ireland
| | - Habiba Ben Romdhane
- Cardiovascular Epidemiology and Prevention Research Laboratory, Tunis, Tunisia
| | | | | | - Julia Critchley
- Division of Population Health Sciences and Education, St. George's, University of London, Cranmer Terrace, London SW17 0RE, UK
| | - Simon Capewell
- Department of Public Health and Policy, University of Liverpool, Liverpool, UK
| | - Mukesh Dherani
- Department of Public Health and Policy, University of Liverpool, Liverpool, UK
| | - Yücel Demiral
- Dept of Public Health, Faculty of Medicine, Dokuz Eylul University, Turkey
| | - Sinem Doganay
- Dept of Public Health, Faculty of Medicine, Dokuz Eylul University, Turkey
| | | | - Gül Ergör
- Dept of Public Health, Faculty of Medicine, Dokuz Eylul University, Turkey
| | | | - Fouad Fouad
- Syrian Center for Tobacco Studies, Aleppo, Syria
| | - Gül Gerçeklioğlu
- Dept of Public Health, Faculty of Medicine, Dokuz Eylul University, Turkey
| | - Rula Ghandour
- Institute of Community and Public Health, Birzeit University, Birzeit, State of Palestine
| | - Sibel Göğen
- Primary Health Care General Directorate, Turkish Ministry of Health, Turkey
| | - Abdullatif Husseini
- Institute of Community and Public Health, Birzeit University, Birzeit, State of Palestine
| | - Samer Jaber
- Institute of Community and Public Health, Birzeit University, Birzeit, State of Palestine
| | | | - Rana Khatib
- Institute of Community and Public Health, Birzeit University, Birzeit, State of Palestine
| | - Rasha Khatib
- Institute of Community and Public Health, Birzeit University, Birzeit, State of Palestine
| | | | - Bülent Kilic
- Dept of Public Health, Faculty of Medicine, Dokuz Eylul University, Turkey
| | - Olfa Lassoued
- Cardiovascular Epidemiology and Prevention Research Laboratory, Tunis, Tunisia
| | | | - Wasim Maziak
- Syrian Center for Tobacco Studies, Aleppo, Syria; Robert Stempel College of Public Health and Social Work, Florida International University, Miami, USA
| | | | - Nahed Mikki
- Institute of Community and Public Health, Birzeit University, Birzeit, State of Palestine
| | | | - Martin O Flaherty
- Department of Public Health and Policy, University of Liverpool, Liverpool, UK
| | - Peter Phillimore
- Institute of Health and Society, Newcastle University, Newcastle upon Tyne, UK
| | - Samer Rastam
- Syrian Center for Tobacco Studies, Aleppo, Syria
| | | | - Olfa Saidi
- Cardiovascular Epidemiology and Prevention Research Laboratory, Tunis, Tunisia
| | - Gül Saatli
- Dept of Public Health, Faculty of Medicine, Dokuz Eylul University, Turkey
| | | | - Azza Shoaibi
- Institute of Community and Public Health, Birzeit University, Birzeit, State of Palestine
| | - Hatice Şimşek
- Dept of Public Health, Faculty of Medicine, Dokuz Eylul University, Turkey
| | | | - Kaan Sözmen
- Dept of Public Health, Faculty of Medicine, Dokuz Eylul University, Turkey
| | - Faten Tlili
- Cardiovascular Epidemiology and Prevention Research Laboratory, Tunis, Tunisia
| | - Belgin Unal
- Dept of Public Health, Faculty of Medicine, Dokuz Eylul University, Turkey
| | - Nigel Unwin
- University of the West Indies, Georgetown, Barbados
| | - Nazan Yardim
- Primary Health Care General Directorate, Turkish Ministry of Health, Turkey
| | - Shahaduz Zaman
- Institute of Health and Society, Newcastle University, Newcastle upon Tyne, UK
| |
Collapse
|
26
|
Shoaibi A, Rao GA, Cai B, Rawl J, Hébert JR. The use of multiphase nonlinear mixed models to define and quantify long-term changes in serum prostate-specific antigen: data from the Prostate, Lung, Colorectal, and Ovarian Cancer Screening Trial. Ann Epidemiol 2015; 26:36-42.e1-2. [PMID: 26611771 DOI: 10.1016/j.annepidem.2015.10.003] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2015] [Revised: 09/15/2015] [Accepted: 10/04/2015] [Indexed: 10/22/2022]
Abstract
PURPOSE To test the hypothesis that the pattern of prostate-specific antigen (PSA) change in men diagnosed with high-risk prostate cancer (PrCA) differs from the pattern evident in men diagnosed with low-risk PrCA or those with no evidence of PrCA. METHODS A retrospective cohort study from which PSA measures were taken before PrCA diagnosis from the Prostate, Lung, Colorectal and Ovarian Cancer Screening Trial. Data were fitted using a nonlinear regression model to estimate the adjusted absolute and relative (%) change of PSA. RESULTS Data on 20,888 men with an average age of 61.61 years were included in the analysis. Of these, the 324 (1.55%) diagnosed with high-risk PrCA had a steeper and earlier transition into an exponential pattern of PSA change than the 1368 men diagnosed with low-risk cancer. At 1 year before diagnosis and/or exit, the average absolute PSA rates were 0.05 ng/mL/year (0.05-0.05), 0.59 (0.52-0.66), and 2.60 (2.11-3.09) for men with no evidence of PrCA, men with low-risk PrCA and those with high-risk PrCA, respectively. CONCLUSIONS The pattern of PSA change with time was significantly different for men who develop high-risk PrCA from those diagnosed with low-risk PrCA. Further research is required to validate this method and its utilization in PrCA screening.
Collapse
Affiliation(s)
- Azza Shoaibi
- South Carolina Statewide Cancer Prevention and Control Program, Arnold School of Public Health, University of South Carolina, Columbia; Department of Epidemiology and Biostatistics, Arnold School of Public Health, University of South Carolina, Columbia.
| | - Gowtham A Rao
- Department of Epidemiology and Biostatistics, Arnold School of Public Health, University of South Carolina, Columbia; Department of Family and Preventive Medicine, School of Medicine, University of South Carolina, Columbia
| | - Bo Cai
- Department of Epidemiology and Biostatistics, Arnold School of Public Health, University of South Carolina, Columbia
| | - John Rawl
- Columbia Urological Associates, P.A., Columbia, SC
| | - James R Hébert
- South Carolina Statewide Cancer Prevention and Control Program, Arnold School of Public Health, University of South Carolina, Columbia; Department of Epidemiology and Biostatistics, Arnold School of Public Health, University of South Carolina, Columbia.
| |
Collapse
|
27
|
Ghandour R, Shoaibi A, Khatib R, Abu Rmeileh N, Unal B, Sözmen K, Kılıç B, Fouad F, Al Ali R, Ben Romdhane H, Aissi W, Ahmad B, Capewell S, Critchley J, Husseini A. Priority setting for the prevention and control of cardiovascular diseases: multi-criteria decision analysis in four eastern Mediterranean countries. Int J Public Health 2014; 60 Suppl 1:S73-81. [PMID: 24879318 DOI: 10.1007/s00038-014-0569-3] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2013] [Revised: 05/07/2014] [Accepted: 05/12/2014] [Indexed: 10/25/2022] Open
Abstract
OBJECTIVES To explore the feasibility of using a simple multi-criteria decision analysis method with policy makers/key stakeholders to prioritize cardiovascular disease (CVD) policies in four Mediterranean countries: Palestine, Syria, Tunisia and Turkey. METHODS A simple multi-criteria decision analysis (MCDA) method was piloted. A mixed methods study was used to identify a preliminary list of policy options in each country. These policies were rated by different policymakers/stakeholders against pre-identified criteria to generate a priority score for each policy and then rank the policies. RESULTS Twenty-five different policies were rated in the four countries to create a country-specific list of CVD prevention and control policies. The response rate was 100% in each country. The top policies were mostly population level interventions and health systems' level policies. CONCLUSIONS Successful collaboration between policy makers/stakeholders and researchers was established in this small pilot study. MCDA appeared to be feasible and effective. Future applications should aim to engage a larger, representative sample of policy makers, especially from outside the health sector. Weighting the selected criteria might also be assessed.
Collapse
Affiliation(s)
- Rula Ghandour
- Institute of Community and Public Health, Birzeit University, Birzeit, Palestine,
| | | | | | | | | | | | | | | | | | | | | | | | | | | | | |
Collapse
|
28
|
Rao GA, Mann JR, Shoaibi A, Bennett CL, Nahhas G, Sutton SS, Jacob S, Strayer SM. Azithromycin and levofloxacin use and increased risk of cardiac arrhythmia and death. Ann Fam Med 2014; 12:121-7. [PMID: 24615307 PMCID: PMC3948758 DOI: 10.1370/afm.1601] [Citation(s) in RCA: 94] [Impact Index Per Article: 9.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023] Open
Abstract
PURPOSE Azithromycin use has been associated with increased risk of death among patients at high baseline risk, but not for younger and middle-aged adults. The Food and Drug Administration issued a public warning on azithromycin, including a statement that the risks were similar for levofloxacin. We conducted a retrospective cohort study among US veterans to test the hypothesis that taking azithromycin or levofloxacin would increase the risk of cardiovascular death and cardiac arrhythmia compared with persons taking amoxicillin. METHODS We studied a cohort of US veterans (mean age, 56.8 years) who received an exclusive outpatient dispensation of either amoxicillin (n = 979,380), azithromycin (n = 594,792), or levofloxacin (n = 201,798) at the Department of Veterans Affairs between September 1999 and April 2012. Azithromycin was dispensed mostly for 5 days, whereas amoxicillin and levofloxacin were dispensed mostly for at least 10 days. RESULTS During treatment days 1 to 5, patients receiving azithromycin had significantly increased risk of death (hazard ratio [HR] = 1.48; 95% CI, 1.05-2.09) and serious arrhythmia (HR = 1.77; 95% CI, 1.20-2.62) compared with patients receiving amoxicillin. On treatment days 6 to 10, risks were not statistically different. Compared with patients receiving amoxicillin, patients receiving levofloxacin for days 1 to 5 had a greater risk of death (HR = 2.49, 95% CI, 1.7-3.64) and serious cardiac arrhythmia (HR = 2.43, 95% CI, 1.56-3.79); this risk remained significantly different for days 6 to 10 for both death (HR = 1.95, 95% CI, 1.32-2.88) and arrhythmia (HR = 1.75; 95% CI, 1.09-2.82). CONCLUSIONS Compared with amoxicillin, azithromycin resulted in a statistically significant increase in mortality and arrhythmia risks on days 1 to 5, but not 6 to 10. Levofloxacin, which was predominantly dispensed for a minimum of 10 days, resulted in an increased risk throughout the 10-day period.
Collapse
Affiliation(s)
- Gowtham A Rao
- Department of Family and Preventive Medicine, School of Medicine, University of South Carolina, Columbia, South Carolina
| | | | | | | | | | | | | | | |
Collapse
|
29
|
Mason H, Shoaibi A, Ghandour R, O'Flaherty M, Capewell S, Khatib R, Jabr S, Unal B, Sözmen K, Arfa C, Aissi W, Romdhane HB, Fouad F, Al-Ali R, Husseini A. A cost effectiveness analysis of salt reduction policies to reduce coronary heart disease in four Eastern Mediterranean countries. PLoS One 2014; 9:e84445. [PMID: 24409297 PMCID: PMC3883693 DOI: 10.1371/journal.pone.0084445] [Citation(s) in RCA: 60] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2013] [Accepted: 11/15/2013] [Indexed: 11/22/2022] Open
Abstract
Background Coronary Heart Disease (CHD) is rising in middle income countries. Population based strategies to reduce specific CHD risk factors have an important role to play in reducing overall CHD mortality. Reducing dietary salt consumption is a potentially cost-effective way to reduce CHD events. This paper presents an economic evaluation of population based salt reduction policies in Tunisia, Syria, Palestine and Turkey. Methods and Findings Three policies to reduce dietary salt intake were evaluated: a health promotion campaign, labelling of food packaging and mandatory reformulation of salt content in processed food. These were evaluated separately and in combination. Estimates of the effectiveness of salt reduction on blood pressure were based on a literature review. The reduction in mortality was estimated using the IMPACT CHD model specific to that country. Cumulative population health effects were quantified as life years gained (LYG) over a 10 year time frame. The costs of each policy were estimated using evidence from comparable policies and expert opinion including public sector costs and costs to the food industry. Health care costs associated with CHDs were estimated using standardized unit costs. The total cost of implementing each policy was compared against the current baseline (no policy). All costs were calculated using 2010 PPP exchange rates. In all four countries most policies were cost saving compared with the baseline. The combination of all three policies (reducing salt consumption by 30%) resulted in estimated cost savings of $235,000,000 and 6455 LYG in Tunisia; $39,000,000 and 31674 LYG in Syria; $6,000,000 and 2682 LYG in Palestine and $1,3000,000,000 and 378439 LYG in Turkey. Conclusion Decreasing dietary salt intake will reduce coronary heart disease deaths in the four countries. A comprehensive strategy of health education and food industry actions to label and reduce salt content would save both money and lives.
Collapse
Affiliation(s)
- Helen Mason
- Yunus Centre for Social Business and Health, Glasgow Caledonian University, Glasgow, United Kingdom
- * E-mail:
| | - Azza Shoaibi
- Institute of Community and Public Health, Birzeit University, Birzeit, Palestine, Occupied Palestinian territory
| | - Rula Ghandour
- Institute of Community and Public Health, Birzeit University, Birzeit, Palestine, Occupied Palestinian territory
| | - Martin O'Flaherty
- Department of Public Health and Policy, Institute of Psychology, Health and Society, University of Liverpool, Liverpool, United Kingdom
| | - Simon Capewell
- Department of Public Health and Policy, Institute of Psychology, Health and Society, University of Liverpool, Liverpool, United Kingdom
| | - Rana Khatib
- Institute of Community and Public Health, Birzeit University, Birzeit, Palestine, Occupied Palestinian territory
| | - Samer Jabr
- Department of Health Economics, Ministry of Health, Nablus, Palestine, Occupied Palestinian territory
| | - Belgin Unal
- Dokuz Eylül University Faculty of Medicine, Department of Public Health, İnciraltı- İzmir, Turkiye
| | - Kaan Sözmen
- Narlidere Community Health Center, Provincial Health Directorate of Izmir, Izmir, Turkey
| | - Chokri Arfa
- INTES/University of Carthage, Tunis, Tunisia
| | - Wafa Aissi
- Cardiovascular Disease Epidemiology and Prevention Research Laboratory, Faculty of Medicine, University Tunis El Manar, Tunis, Tunisia
| | - Habiba Ben Romdhane
- Cardiovascular Disease Epidemiology and Prevention Research Laboratory, Faculty of Medicine, University Tunis El Manar, Tunis, Tunisia
| | - Fouad Fouad
- Syrian Center for Tobacco Studies, Aleppo, Syria
| | | | - Abdullatif Husseini
- Institute of Community and Public Health, Birzeit University, Birzeit, Palestine, Occupied Palestinian territory
- Public Health Program, Department of Health Sciences, Qatar University, Doha, Qatar
| | | |
Collapse
|
30
|
Phillimore P, Zaman S, Ahmad B, Shoaibi A, Khatib R, Khatib R, Husseini A, Fouad F, Elias M, Maziak W, Tlili F, Tinsa F, Ben Romdhane H, Kılıç B, Kalaça S, Ünal B, Critchley J. Health system challenges of cardiovascular disease and diabetes in four Eastern Mediterranean countries. Glob Public Health 2013; 8:875-89. [DOI: 10.1080/17441692.2013.830756] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
|
31
|
Bowman S, Unwin N, Critchley J, Capewell S, Husseini A, Maziak W, Zaman S, Ben Romdhane H, Fouad F, Phillimore P, Unal B, Khatib R, Shoaibi A, Ahmad B. Use of evidence to support healthy public policy: a policy effectiveness-feasibility loop. Bull World Health Organ 2012; 90:847-53. [PMID: 23226897 DOI: 10.2471/blt.12.104968] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2012] [Revised: 08/12/2012] [Accepted: 08/20/2012] [Indexed: 12/22/2022] Open
Abstract
Public policy plays a key role in improving population health and in the control of diseases, including non-communicable diseases. However, an evidence-based approach to formulating healthy public policy has been difficult to implement, partly on account of barriers that hinder integrated work between researchers and policy-makers. This paper describes a "policy effectiveness-feasibility loop" (PEFL) that brings together epidemiological modelling, local situation analysis and option appraisal to foster collaboration between researchers and policy-makers. Epidemiological modelling explores the determinants of trends in disease and the potential health benefits of modifying them. Situation analysis investigates the current conceptualization of policy, the level of policy awareness and commitment among key stakeholders, and what actually happens in practice, thereby helping to identify policy gaps. Option appraisal integrates epidemiological modelling and situation analysis to investigate the feasibility, costs and likely health benefits of various policy options. The authors illustrate how PEFL was used in a project to inform public policy for the prevention of cardiovascular diseases and diabetes in four parts of the eastern Mediterranean. They conclude that PEFL may offer a useful framework for researchers and policy-makers to successfully work together to generate evidence-based policy, and they encourage further evaluation of this approach.
Collapse
Affiliation(s)
- Sarah Bowman
- Institute of Health and Society, Newcastle University, Newcastle, England
| | | | | | | | | | | | | | | | | | | | | | | | | | | |
Collapse
|
32
|
Abu-Rmeileh NME, Shoaibi A, O'Flaherty M, Capewell S, Husseini A. Analysing falls in coronary heart disease mortality in the West Bank between 1998 and 2009. BMJ Open 2012; 2:e001061. [PMID: 22923626 PMCID: PMC3432845 DOI: 10.1136/bmjopen-2012-001061] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/28/2012] [Accepted: 07/20/2012] [Indexed: 01/07/2023] Open
Abstract
OBJECTIVES To analyse coronary heart disease (CHD) mortality and risk factor trends in the West Bank, occupied Palestinian territory between 1998 and 2009. DESIGN Modelling study using CHD IMPACT model. SETTING The West Bank, occupied Palestinian territory. PARTICIPANTS Data on populations, mortality, patient groups and numbers, treatments and cardiovascular risk factor trends were obtained from national and local surveys, routine national and WHO statistics, and critically appraised. Data were then integrated and analysed using a previously validated CHD model. PRIMARY AND SECONDARY OUTCOME MEASURES CHD deaths prevented or postponed are the main outcome. RESULTS CHD death rates fell by 20% in the West Bank, between 1998 and 2009. Smoking prevalence was initially high in men, 51%, but decreased to 42%. Population blood pressure levels and total cholesterol levels also decreased. Conversely, body mass index rose by 1-2 kg/m(2) and diabetes increased by 2-8%. Population modelling suggested that more than two-thirds of the mortality fall was attributable to decreases in major risk factors, mainly total cholesterol, blood pressure and smoking. Approximately one-third of the CHD mortality decreases were attributable to treatments, particularly for secondary prevention and heart failure. However, the contributions from statins, surgery and angioplasty were consistently small. CONCLUSIONS CHD mortality fell by 20% between 1998 and 2009 in the West Bank. More than two-third of this fall was due to decreases in major risk factors, particularly total cholesterol and blood pressure. Our results clearly indicate that risk factor reductions in the general population compared save substantially more lives to specific treatments for individual patients. This emphasizes the importance of population-wide primary prevention strategies.
Collapse
Affiliation(s)
- Niveen M E Abu-Rmeileh
- Institute of Community and Public Health, Birzeit University, Ramallah, Occupied Palestinian Territory
| | | | | | | | | |
Collapse
|
33
|
Ayesh A, Yahya A, Qara' AAA, Dababat A, Hadeed AA, Shoaibi A, Mahmoud DA, Issa F, Qaisi F, Hasan F, Saadeh H, Alami H, El Hadi H, Hamda HA, Al Kawazba L, Ya'qoub M, Hannoon M, Ibrahim M, Bsiso M, Jarar M, Daraghmeh M, Fahmawi N, Saeed NH, Harhash N, Darwish N, Omar O, Shu'ibi R, E Hazineh R, Safat RA, Shraim R, Shamasna S, Odeh SB, Shamasneh S, Al Haj Ali S, Mitwali S. Making the future ours in the occupied Palestinian territory. Lancet 2010; 376:8-10. [PMID: 20609978 DOI: 10.1016/s0140-6736(10)60968-3] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
Affiliation(s)
- Abeer Ayesh
- Birzeit University, West Bank, occupied Palestinian territory
| | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | |
Collapse
|
34
|
Patankar S, Munasinghe A, Shoaibi A, Cummings LM, Wirth DF. Serial analysis of gene expression in Plasmodium falciparum reveals the global expression profile of erythrocytic stages and the presence of anti-sense transcripts in the malarial parasite. Mol Biol Cell 2001; 12:3114-25. [PMID: 11598196 PMCID: PMC60160 DOI: 10.1091/mbc.12.10.3114] [Citation(s) in RCA: 121] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023] Open
Abstract
Serial analysis of gene expression (SAGE) was applied to the malarial parasite Plasmodium falciparum to characterize the comprehensive transcriptional profile of erythrocytic stages. A SAGE library of approximately 8335 tags representing 4866 different genes was generated from 3D7 strain parasites. Basic local alignment search tool analysis of high abundance SAGE tags revealed that a majority (88%) corresponded to 3D7 sequence, and despite the low complexity of the genome, 70% of these highly abundant tags matched unique loci. Characterization of these suggested the major metabolic pathways that are used by the organism under normal culture conditions. Furthermore several tags expressed at high abundance (30% of tags matching to unique loci of the 3D7 genome) were derived from previously uncharacterized open reading frames, demonstrating the use of SAGE in genome annotation. The open platform "profiling" nature of SAGE also lead to the important discovery of a novel transcriptional phenomenon in the malarial pathogen: a significant number of highly abundant tags that were derived from annotated genes (17%) corresponded to antisense transcripts. These SAGE data were validated by two independent means, strand specific reverse transcription-polymerase chain reaction and Northern analysis, where antisense messages were detected in both asexual and sexual stages. This finding has implications for transcriptional regulation of Plasmodium gene expression.
Collapse
Affiliation(s)
- S Patankar
- Department of Immunology and Infectious Diseases, Harvard School of Public Health, Harvard University, Boston, MA 02115, USA
| | | | | | | | | |
Collapse
|
35
|
Munasinghe A, Patankar S, Cook BP, Madden SL, Martin RK, Kyle DE, Shoaibi A, Cummings LM, Wirth DF. Serial analysis of gene expression (SAGE) in Plasmodium falciparum: application of the technique to A-T rich genomes. Mol Biochem Parasitol 2001; 113:23-34. [PMID: 11254951 DOI: 10.1016/s0166-6851(00)00378-9] [Citation(s) in RCA: 36] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
The advent of high-throughput methods for the analysis of global gene expression, together with the Malaria Genome Project open up new opportunities for furthering our understanding of the fundamental biology and virulence of the malaria parasite. Serial analysis of gene expression (SAGE) is particularly well suited for malarial systems, as the genomes of Plasmodium species remain to be fully annotated. By simultaneously and quantitatively analyzing mRNA transcript profiles from a given cell population, SAGE allows for the discovery of new genes. In this study, one reports the successful application of SAGE in Plasmodium falciparum, 3D7 strain parasites, from which a preliminary library of 6880 tags corresponding to 4146 different genes was generated. It was demonstrated that P. falciparum is amenable to this technique, despite the remarkably high A-T content of its genome. SAGE tags as short as 10 nucleotides were sufficient to uniquely identify parasite transcripts from both nuclear and mitochondrial genomes. Moreover, the skewed A-T content of parasite sequence did not preclude the use of enzymes that are crucial for generating representative SAGE libraries. Finally, a few modifications to DNA extraction and cloning steps of the SAGE protocol proved useful for circumventing specific problems presented by A-T rich genomes.
Collapse
Affiliation(s)
- A Munasinghe
- Department of Immunology and Infectious Diseases, Harvard School of Public Health, Harvard University, Building 1, Room 704, 665 Huntington Ave, Boston MA 02115, USA
| | | | | | | | | | | | | | | | | |
Collapse
|
36
|
Abstract
The 9p- syndrome is a chromosomal disorder which is easily recognized by its characteristic craniofacial features. Neurologic abnormalities are evident in all reported cases, the most common of which is severe mental retardation. We add another case with unusual features including glaucoma, seizures, and polydactyly, and review the somatic and neurologic features from 41 previously reported cases.
Collapse
|