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McDowell RD, Hughes CM, Murchie P, Cardwell CR. The effect of medications associated with drug-induced pancreatitis on pancreatic cancer risk: A nested case-control study of routine Scottish data. Cancer Epidemiol 2021; 71:101880. [PMID: 33422975 PMCID: PMC7988460 DOI: 10.1016/j.canep.2020.101880] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2020] [Revised: 12/14/2020] [Accepted: 12/15/2020] [Indexed: 11/25/2022]
Abstract
BACKGROUND Inflammation plays a role in pancreatic cancer. Many medications cause pancreatic inflammation, with some leading to a diagnosis of drug-induced pancreatitis (DIP), but few studies have examined these medications and pancreatic cancer risk. We therefore investigated the associations between pancreatic cancer risk and commonly-prescribed medicines for which there is strongest evidence of DIP. METHODS A nested case-control study was undertaken using the Primary Care Clinical Informatics Unit Research database containing general practice (GP) records from Scotland. Pancreatic cancer cases, diagnosed between 1999 and 2011, were identified and matched with up to five controls (based on age, gender, GP practice and date of registration). Medicines in the highest category of evidence for DIP, based on a recent systematic review, and used by more than 2 % of controls were identified. Odds ratios (OR) and 95 % confidence intervals (CI) for associations with pancreatic cancer were calculated using conditional logistic regression after adjusting for comorbidities. RESULTS There were 1,069 cases and 4,729 controls. Thirteen medicines in the highest category of evidence for DIP were investigated. There was little evidence of an association between any of these medications and pancreatic cancer risk apart from metronidazole (adjusted OR 1.69, 95 % CI 1.18, 2.41) and ranitidine (adjusted OR 1.37, 95 %CI 1.10, 1.70). However, no definitive exposure-response relationships between these medicines and cancer risk were observed. CONCLUSIONS There is little evidence that commonly-prescribed medicines associated with inflammation of the pancreas are also associated with pancreatic cancer. These findings should provide reassurance to patients and prescribing clinicians.
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Affiliation(s)
- R D McDowell
- Centre for Public Health, Queen's University, Grosvenor Rd., Belfast, Co. Antrim, BT12 6 BA, UK.
| | - C M Hughes
- School of Pharmacy, Queen's University, Lisburn Rd., Belfast, Co. Antrim, BT9 7BL, UK
| | - P Murchie
- Division of Applied Health Sciences Section, Academic Primary Care, Foresterhill, Aberdeen, AB24 2ZD, UK
| | - C R Cardwell
- Centre for Public Health, Queen's University, Grosvenor Rd., Belfast, Co. Antrim, BT12 6 BA, UK
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Tran KT, McMenamin ÚC, Hicks B, Murchie P, Thrift AP, Coleman HG, Iversen L, Johnston BT, Lee AJ, Cardwell CR. Proton pump inhibitor and histamine-2 receptor antagonist use and risk of liver cancer in two population-based studies. Aliment Pharmacol Ther 2018; 48:55-64. [PMID: 29741272 DOI: 10.1111/apt.14796] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/22/2018] [Revised: 04/06/2018] [Accepted: 04/18/2018] [Indexed: 02/06/2023]
Abstract
BACKGROUND Proton pump inhibitors (PPIs) and histamine-2 receptor antagonists (H2RAs) are commonly used. PPIs have been shown to promote liver cancer in rats; however, only one study has examined the association in humans. AIMS To investigate PPIs and H2RAs and risk of primary liver cancer in two large independent study populations. METHODS We conducted a nested case-control study within the Primary Care Clinical Informatics Unit (PCCIU) database in which up to five controls were matched to cases with primary liver cancer, recorded by General Practitioners. Odds ratios (ORs) and 95% confidence intervals (95% CIs) for associations with prescribed PPIs and H2RAs were calculated using conditional logistic regression. We also conducted a prospective cohort study within the UK Biobank using self-reported medication use and cancer-registry recorded primary liver cancer. Hazard ratios (HRs) and 95% CIs were calculated using Cox regression. RESULTS In the PCCIU case-control analysis, 434 liver cancer cases were matched to 2103 controls. In the UK Biobank cohort, 182 of 475 768 participants developed liver cancer. In both, ever use of PPIs was associated with increased liver cancer risk (adjusted OR 1.80, 95% CI 1.34, 2.41 and adjusted HR 1.99, 95% CI 1.34, 2.94 respectively). There was little evidence of association with H2RA use (adjusted OR 1.21, 95% CI 0.84, 1.76 and adjusted HR 1.70, 95% CI 0.82, 3.53 respectively). CONCLUSIONS We found some evidence that PPI use was associated with liver cancer. Whether this association is causal or reflects residual confounding or reverse causation requires additional research.
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Affiliation(s)
- K T Tran
- Cancer Epidemiology and Health Services Research Group, Centre for Public Health, Queen's University Belfast, Belfast, UK
| | - Ú C McMenamin
- Cancer Epidemiology and Health Services Research Group, Centre for Public Health, Queen's University Belfast, Belfast, UK
| | - B Hicks
- Cancer Epidemiology and Health Services Research Group, Centre for Public Health, Queen's University Belfast, Belfast, UK
| | - P Murchie
- Academic Primary Care, Institute of Applied Health Sciences, University of Aberdeen, Aberdeen, UK
| | - A P Thrift
- Section of Epidemiology and Population Sciences, Department of Medicine, Baylor College of Medicine, Houston, TX, USA
| | - H G Coleman
- Cancer Epidemiology and Health Services Research Group, Centre for Public Health, Queen's University Belfast, Belfast, UK
- Centre for Cancer Research and Cell Biology, Queen's University Belfast, Belfast, UK
| | - L Iversen
- Academic Primary Care, Institute of Applied Health Sciences, University of Aberdeen, Aberdeen, UK
| | - B T Johnston
- Belfast Health and Social Care Trust, Belfast, UK
| | - A J Lee
- Medical Statistics Team, Institute of Applied Health Sciences, University of Aberdeen, Aberdeen, UK
| | - C R Cardwell
- Cancer Epidemiology and Health Services Research Group, Centre for Public Health, Queen's University Belfast, Belfast, UK
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Busby J, McMenamin Ú, Spence A, Johnston BT, Hughes C, Cardwell CR. Angiotensin receptor blocker use and gastro-oesophageal cancer survival: a population-based cohort study. Aliment Pharmacol Ther 2018; 47:279-288. [PMID: 29105106 DOI: 10.1111/apt.14388] [Citation(s) in RCA: 20] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/19/2017] [Revised: 07/04/2017] [Accepted: 09/26/2017] [Indexed: 12/31/2022]
Abstract
BACKGROUND Angiotensin receptor blockers (ARBs; including candesartan, losartan, olmesartan and valsartan) are widely used to treat hypertension, heart failure and diabetic neuropathy. There is considerable pre-clinical evidence that ARBs can reduce cancer progression, particularly for gastric cancer. Despite this, epidemiological studies have yet to assess the impact of ARB use on gastro-oesophageal cancer survival. AIM To investigate the association between post-diagnosis ARB use and gastro-oesophageal cancer survival. METHODS We selected a cohort of patients with newly-diagnosed gastro-oesophageal cancer between 1998 and 2012 from English cancer registries. We linked to prescription and clinical records from the Clinical Practice Research Datalink, and to death records from the Office for National Statistics. We used time-dependant Cox-regression models to calculate hazard ratios (HRs) comparing gastro-oesophageal cancer-specific mortality between post-diagnosis ARB users and non-users, after adjusting for demographics, comorbidities and post-diagnosis aspirin or statin use. RESULTS Our cohort included 5124 gastro-oesophageal cancer patients, of which 360 used ARBs, and 3345 died due to their gastro-oesophageal cancer during follow-up. After adjustment, ARB users had moderately lower risk of gastro-oesophageal cancer mortality than the non-users (HR = 0.83, 95% CI 0.71-0.98). There was evidence of a dose-response relationship with the lowest HRs observed among patients receiving at least 2 years of prescriptions (HR = 0.42, 95% CI 0.25-0.72). CONCLUSIONS In this large population-based gastro-oesophageal cancer cohort, we found moderately reduced cancer-specific mortality among ARB users. However, confirmation in further independent epidemiological studies with sufficient staging information is required.
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Affiliation(s)
- J Busby
- Centre for Public Health, Queen's University Belfast, Belfast, UK
| | - Ú McMenamin
- Centre for Public Health, Queen's University Belfast, Belfast, UK
| | - A Spence
- Centre for Public Health, Queen's University Belfast, Belfast, UK
| | - B T Johnston
- Belfast Health and Social Care Trust, Belfast, UK
| | - C Hughes
- School of Pharmacy, Clinical and Practice Research Group, Queen's University Belfast, Belfast, UK
| | - C R Cardwell
- Centre for Public Health, Queen's University Belfast, Belfast, UK
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McCourt C, Coleman HG, Murray LJ, Cantwell MM, Dolan O, Powe DG, Cardwell CR. Beta-blocker usage after malignant melanoma diagnosis and survival: a population-based nested case-control study. Br J Dermatol 2015; 170:930-8. [PMID: 24593055 DOI: 10.1111/bjd.12894] [Citation(s) in RCA: 48] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/04/2014] [Indexed: 12/18/2022]
Abstract
BACKGROUND Beta-blockers have potential antiangiogenic and antimigratory activity. Studies have demonstrated a survival benefit in patients with malignant melanoma treated with beta-blockers. OBJECTIVES To investigate the association between postdiagnostic beta-blocker usage and risk of melanoma-specific mortality in a population-based cohort of patients with malignant melanoma. METHODS Patients with incident malignant melanoma diagnosed between 1998 and 2010 were identified within the U.K. Clinical Practice Research Datalink and confirmed using cancer registry data. Patients with malignant melanoma with a melanoma-specific death (cases) recorded by the Office of National Statistics were matched on year of diagnosis, age and sex to four malignant melanoma controls (who lived at least as long after diagnosis as their matched case). A nested case-control approach was used to investigate the association between postdiagnostic beta-blocker usage and melanoma-specific death and all-cause mortality. Conditional logistic regression was applied to generate odds ratios (ORs) and 95% confidence intervals (CIs) for beta-blocker use determined from general practitioner prescribing. RESULTS Beta-blocker medications were prescribed after malignant melanoma diagnosis to 20·2% of 242 patients who died from malignant melanoma (cases) and 20·3% of 886 matched controls. Consequently, there was no association between beta-blocker use postdiagnosis and cancer-specific death (OR 0·99, 95% CI 0·68-1·42), which did not markedly alter after adjustment for confounders including stage (OR 0·87, 95% CI 0·56-1·34). No significant associations were detected for individual beta-blocker types, by defined daily doses of use or for all-cause mortality. CONCLUSIONS Contrary to some previous studies, beta-blocker use after malignant melanoma diagnosis was not associated with reduced risk of death from melanoma in this U.K. population-based study.
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Affiliation(s)
- C McCourt
- Department of Dermatology, Belfast Health and Social Care Trust, Belfast, Northern Ireland; Cancer Epidemiology and Health Services Research Group, Centre for Public Health, Institute of Clinical Sciences-B, Royal Victoria Hospital Site, Queen's University Belfast, Grosvenor Road, Belfast, BT12 6BJ, Northern Ireland
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Hill CJ, Cardwell CR, Patterson CC, Maxwell AP, Magee GM, Young RJ, Matthews B, O'Donoghue DJ, Fogarty DG. Chronic kidney disease and diabetes in the national health service: a cross-sectional survey of the U.K. national diabetes audit. Diabet Med 2014; 31:448-54. [PMID: 24102856 DOI: 10.1111/dme.12312] [Citation(s) in RCA: 50] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/09/2013] [Revised: 08/02/2013] [Accepted: 09/04/2013] [Indexed: 12/16/2022]
Abstract
AIMS We investigated the prevalence of chronic kidney disease and attainment of therapeutic targets for HbA1c and blood pressure in a large U.K.-based diabetes population. METHODS The U.K. National Diabetes Audit provided data from 1 January 2007 to 31 March 2008. Inclusion criteria were a documented urinary albumin:creatinine ratio and serum creatinine. Patients were stratified according to chronic kidney disease stage and albuminuria status. Chronic kidney disease was defined as an estimated glomerular filtration rate < 60 ml min(-1) 1.73 m(-2) , albuminuria or both. The proportions of patients achieving nationally defined glycaemic and systolic blood pressure targets were determined. RESULTS The cohort comprised 1,423,669 patients, of whom 868,616 (61%) met inclusion criteria. Of the patients analysed, 92.2% had Type 2 diabetes. A higher proportion of people with Type 2 diabetes (42.3%) had renal dysfunction compared with those with Type 1 diabetes (32.4%). Achievement of systolic blood pressure and HbA1c targets was poor. Among people with Type 1 diabetes, 67.8% failed to achieve an HbA1c < 58 mmol/mol (7.5%). Of all people with diabetes, 37.8% failed to achieve a systolic blood pressure < 140 mmHg. Blood pressure control was poor in advanced chronic kidney disease. For example, mean (standard deviation) systolic blood pressure rose from 128.6 (15.4) mmHg among people with Type 1 diabetes and normal renal function to 141.0 (23.6) mmHg in those with chronic kidney disease stage 5 and macroalbuminuria. CONCLUSIONS The high prevalence of chronic kidney disease and poor attainment of treatment targets highlights a large subset of the diabetes population at increased risk of cardiovascular mortality or progressive kidney disease.
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Affiliation(s)
- C J Hill
- Centre for Public Health, Queen's University Belfast, Belfast, UK; Regional Nephrology Unit, Belfast City Hospital, Belfast, UK
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Morgan E, Patterson CC, Cardwell CR. General practice-recorded depression and antidepressant use in young people with newly diagnosed Type 1 diabetes: a cohort study using the Clinical Practice Research Datalink. Diabet Med 2014; 31:241-5. [PMID: 24111949 DOI: 10.1111/dme.12330] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/03/2013] [Revised: 08/20/2013] [Accepted: 09/19/2013] [Indexed: 01/23/2023]
Abstract
AIMS To investigate whether young people with Type 1 diabetes have an increased rate of depression and antidepressant use and whether their risk varies by age group, time from diabetes diagnosis, calendar period of diagnosis or complications status. METHODS A cohort of incident cases of patients with Type 1 diabetes diagnosed before 35 years of age (n = 5548) was identified within the Clinical Practice Research Datalink and individually age and sex matched with up to two control subjects without diabetes (n = 10 657). Patients with depression were identified through general practice-recorded depression codes and antidepressant prescriptions. Cox regression models gave hazard ratios for depression in people with Type 1 diabetes compared with control subjects. RESULTS People with Type 1 diabetes were twice as likely to have a record of antidepressant use and general practice-diagnosed depression as their matched control subjects (hazard ratio 2.08, 95% CI 1.73-2.50, P < 0.001). These associations varied by time from diagnosis, with marked increases observed within the first 5 years of diagnosis (hazard ratio 2.14, 95% CI 1.51-3.03, P < 0.001), and by age at diabetes diagnosis, with excesses noted even in the 10- to 19-year age group (hazard ratio 1.45, 95% CI 1.06-1.98, P = 0.02). CONCLUSIONS This population-based study shows that people with Type 1 diabetes have higher rates of general practice-recorded depression and antidepressant use. The excess is present within 5 years of diabetes diagnosis, suggesting psychological input for patients is warranted in the early years of their condition.
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Affiliation(s)
- E Morgan
- UKCRC Centre of Excellence for Public Health NI; Centre for Public Health, Queen's University Belfast, Belfast, UK
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Hill CJ, Cardwell CR, Maxwell AP, Young RJ, Matthews B, O'Donoghue DJ, Fogarty DG. Obesity and kidney disease in type 1 and 2 diabetes: an analysis of the National Diabetes Audit. QJM 2013; 106:933-42. [PMID: 23696677 DOI: 10.1093/qjmed/hct123] [Citation(s) in RCA: 30] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/01/2023] Open
Abstract
BACKGROUND Obesity is increasingly prevalent in many countries. Obesity is a major risk factor for the development of type 2 diabetes but its relationship with diabetic kidney disease (DKD) remains unclear. Some studies have suggested that the metabolic syndrome (including obesity) may be associated with DKD in type 1 diabetes. AIM To investigate the association between obesity and DKD. DESIGN Retrospective cross-sectional study. METHODS National Diabetes Audit data were available for the 2007-08 cycle. Type 1 and 2 diabetes patients with both a valid serum creatinine and urinary albumin:creatinine ratio were included. DKD was defined as an estimated glomerular filtration rate (eGFR) <60 ml/min/1.73 m(2), albuminuria or both. Logistic regression was used to analyse associations of obesity (body mass index ≥30 kg/m(2)) and other variables including year of birth, year of diagnosis, ethnicity and stage of kidney disease. RESULTS A total of 58 791 type 1 and 733 769 type 2 diabetes patients were included in the analysis. After adjustment, when compared with type 1 diabetes patients with normal renal function those with DKD were up to twice as likely to be obese. Type 2 DKD patients were also more likely to be obese. For example, type 2 diabetes patients with an eGFR <15 ml/min/1.73 m(2) and normoalbuminuria, microalbuminuria or macroalbuminuria were all more likely to be obese; odds ratios (95% CI) 1.65 (1.3-2.1), 1.56 (1.28-1.92) and 1.27 (1.05-1.54), respectively. CONCLUSION This study has highlighted a strong association between obesity and kidney disease in type 1 diabetes and confirmed their association in type 2 diabetes.
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Affiliation(s)
- C J Hill
- Centre for Public Health, Institute of Clinical Sciences Block B, Queen's University Belfast, Royal Victoria Hospital, Grosvenor Road, Belfast BT12 6BA, UK.
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Hicks BM, Murray LJ, Powe DG, Hughes CM, Cardwell CR. β-Blocker usage and colorectal cancer mortality: a nested case-control study in the UK Clinical Practice Research Datalink cohort. Ann Oncol 2013; 24:3100-6. [PMID: 24050955 DOI: 10.1093/annonc/mdt381] [Citation(s) in RCA: 40] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022] Open
Abstract
BACKGROUND Epidemiological and laboratory studies suggest that β-blockers may reduce cancer progression in various cancer sites. The aim of this study was to conduct the first epidemiological investigation of the effect of post-diagnostic β-blocker usage on colorectal cancer-specific mortality in a large population-based colorectal cancer patient cohort. PATIENTS AND METHODS A nested case-control analysis was conducted within a cohort of 4794 colorectal cancer patients diagnosed between 1998 and 2007. Patients were identified from the UK Clinical Practice Research Datalink and confirmed using cancer registry data. Patients with a colorectal cancer- specific death (data from the Office of National Statistics death registration system) were matched to five controls. Conditional logistic regression was applied to calculate odds ratios (OR) and 95% confidence intervals (95% CIs) according to β-blocker usage (data from GP-prescribing records). RESULTS Post-diagnostic β-blocker use was identified in 21.4% of 1559 colorectal cancer-specific deaths and 23.7% of their 7531 matched controls, with little evidence of an association (OR = 0.89 95% CI 0.78-1.02). Similar associations were found when analysing drug frequency, β-blocker type or specific drugs such as propranolol. There was some evidence of a weak reduction in all-cause mortality in β-blocker users (adjusted OR = 0.88; 95% CI 0.77-1.00; P = 0.04) which was in part due to the marked effect of atenolol on cardiovascular mortality (adjusted OR = 0.62; 95% CI 0.40-0.97; P = 0.04). CONCLUSIONS In this novel, large UK population-based cohort of colorectal cancer patients, there was no evidence of an association between post-diagnostic β-blocker use and colorectal cancer-specific mortality. CLINICAL TRIALS NUMBER NCT00888797.
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Affiliation(s)
- B M Hicks
- Centre for Public Health, Queen's University Belfast, Belfast, Northern, Ireland
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Scott-Pillai R, Spence D, Cardwell CR, Hunter A, Holmes VA. The impact of body mass index on maternal and neonatal outcomes: a retrospective study in a UK obstetric population, 2004-2011. BJOG 2013; 120:932-9. [DOI: 10.1111/1471-0528.12193] [Citation(s) in RCA: 200] [Impact Index Per Article: 18.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/28/2013] [Indexed: 11/27/2022]
Affiliation(s)
- R Scott-Pillai
- School of Nursing and Midwifery; Queen's University; Belfast; UK
| | - D Spence
- School of Nursing and Midwifery; Queen's University; Belfast; UK
| | - CR Cardwell
- Centre for Public Health; School of Medicine; Dentistry and Biomedical Sciences; Queen's University; Belfast; UK
| | - A Hunter
- Royal Jubilee Maternity Service; Belfast Health and Social Care Trust; Belfast; UK
| | - VA Holmes
- Centre for Public Health; School of Medicine; Dentistry and Biomedical Sciences; Queen's University; Belfast; UK
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McCourt HJ, Hunter SJ, Cardwell CR, Young IS, Murray LJ, Boreham CA, McEneny J, Woodside JV, McKinley MC. Adiponectin multimers, body weight and markers of cardiovascular risk in adolescence: Northern Ireland Young Hearts Project. Int J Obes (Lond) 2013; 37:1247-53. [PMID: 23318722 DOI: 10.1038/ijo.2012.214] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/13/2012] [Revised: 10/23/2012] [Accepted: 11/28/2012] [Indexed: 12/29/2022]
Abstract
BACKGROUND Research examining the relationship between adiponectin (AN) isoforms, body weight and cardiovascular (CV) risk factors is limited, particularly in younger populations. OBJECTIVES To investigate the inter-relationships between AN isoforms and CV risk factors, and their dependence on body weight status, in adolescents. DESIGN Blood samples from 92 obese, 92 overweight and 92 normal weight age- and sex-matched adolescents were analysed for traditional cardiovascular disease (CVD) risk biomarkers and also total, high molecular weight (HMW), medium and low molecular weight (LMW) AN. RESULTS A significant inverse association was observed between total and HMW AN and waist-hip ratio (P=0.015, P=0.006, respectively), triglycerides (P=0.003, P=0.003, respectively) and systolic blood pressure (P=0.012, P=0.024, respectively) and a significant positive association with high-density lipoprotein (P<0.001, P<0.001, respectively) in multi-adjusted analyses. There was no evidence of a relationship between multimeric AN and high-sensitivity C-reactive protein. There was also little evidence of a relationship between LMW AN and CVD risk factors. There was a strong, body mass index (BMI)-independent, association between AN, CVD biomarkers and the hypertriglyceridemic waist phenotype. CONCLUSION Prominent, BMI-independent associations between total and HMW AN, but not LMW AN, and CVD risk factors were already evident in this young population. This research in adolescents supports the contention that AN subfractions may have different biological actions. These associations in apparently healthy adolescents suggest an important role for AN and its subfractions in the pathogenesis of metabolic syndrome traits and indicate that the potential for total or HMW AN to act as early universal biomarkers of CV risk warrants further study.
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Affiliation(s)
- H J McCourt
- Centre for Public Health, School of Medicine, Dentistry and Biomedical Science, Queen's University Belfast, Belfast, UK
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Hynds S, Mcgarry CK, Mitchell DM, Early S, Shum L, Stewart DP, Harney JA, Cardwell CR, O'Sullivan JM. Assessing the consistency of bladder filling using an ultrasonic Bladderscan® device: Author response. Br J Radiol 2012. [DOI: 10.1259/bjr/74975356] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
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Abstract
AIMS To review and synthesize the evidence for an increased risk of childhood Type 1 diabetes mellitus in children born to mothers diagnosed with pre-eclampsia during pregnancy. METHODS A comprehensive search of the published literature was performed in MEDLINE, Web of Science and EMBASE limited to studies published before August 2010. Crude odds ratios and 95% confidence intervals were calculated from the data reported in each study. Meta-analysis techniques were then used to derive a combined odds ratio and investigate heterogeneity. Sensitivity analyses were conducted by study design, ascertainment of pre-eclampsia and study quality. RESULTS Data were available from 16 studies including 8315 children with Type 1 diabetes. Overall, there was little evidence of an increase in the risk of Type 1 diabetes in children born to mothers who had pre-eclampsia during pregnancy (OR = 1.10, 95% CI 0.96-1.27; P = 0.17). This association did not vary much between studies (I(2) = 28%, P for heterogeneity =0.14). The association was similar in three cohort studies (OR = 1.05, 95% CI 0.77-1.44; P = 0.75) and in seven studies with a low risk of bias (OR = 1.13, 95% CI 0.91-1.40; P = 0.27), but was more marked in 13 studies which ascertained pre-eclampsia from obstetrical records or birth registry data (OR = 1.18, 95% CI 1.03-1.36; P = 0.02). CONCLUSIONS This analysis demonstrates little evidence of any substantial increase in childhood Type 1 diabetes risk after pregnancy complicated by pre-eclampsia.
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Affiliation(s)
- E B Henry
- Centre for Public Health, School of Medicine, Dentistry and Biomedical Science, The Queen's University of Belfast, Belfast, UK
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Quinn MP, Cardwell CR, Rainey A, McNamee PT, Kee F, Maxwell AP, Fogarty DG, Courtney AE. Patterns of hospitalisation before and following initiation of haemodialysis: a 5 year single centre study. Postgrad Med J 2011; 87:389-93. [DOI: 10.1136/pgmj.2010.099028] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
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Hynds S, McGarry CK, Mitchell DM, Early S, Shum L, Stewart DP, Harney JA, Cardwell CR, O'Sullivan JM. Assessing the daily consistency of bladder filling using an ultrasonic Bladderscan device in men receiving radical conformal radiotherapy for prostate cancer. Br J Radiol 2010; 84:813-8. [PMID: 21159811 DOI: 10.1259/bjr/50048151] [Citation(s) in RCA: 36] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
OBJECTIVE Consistency in target organ and organ at risk position from planning to treatment is an important basic principle of radiotherapy. This study evaluates the effectiveness of bladder-filling instructions in achieving a consistent and reproducible bladder volume at the time of planning CT and daily during the course of radical radiotherapy for prostate cancer. It also assessed the rate of bladder filling before and at the end of radiotherapy. METHODS 30 men attending for radiation therapy planning for prostate cancer received written and verbal bladder-filling instructions. They had their bladder volume assessed using a bladder ultrasound scanner post-void, immediately prior to planning CT scan and then daily immediately prior to treatment while in the therapy position. The inflow was calculated using the void and full bladder volumes and the time for the bladder to fill. RESULTS The mean bladder volume at the time of planning was 282 ml (range 89-608 ml, standard deviation (SD) = 144.5 ml). This fell during treatment, with a mean value for all treatments of 189 ml (range 11-781 ml, SD = 134 ml). During radiotherapy, 76% (828/1090), 53% (579/1090) and 36% (393/1090) of bladder volumes had >50 ml, >100 ml and >150 ml difference, respectively when compared with their volume at the time of planning. Inflow reduced from 4.6 ml min(-1), SD = 2.9 min(-1) at planning to 2.5 min(-1), SD = 1.8 min(-1) after radiotherapy. CONCLUSION The Bladderscan device (BVI 6400 Bladderscan, Verathon Medical UK, Sandford, UK) provides an effective means of assessing bladder volume prior to radiotherapy for prostate cancer. The evaluated bladder-filling protocol does not produce consistent, reproducible bladder volumes for radiotherapy.
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Affiliation(s)
- S Hynds
- Radiotherapy Department, Northern Ireland Cancer Centre Belfast City Hospital, Belfast, UK
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Cardwell CR, Stene LC, Joner G, Bulsara MK, Cinek O, Rosenbauer J, Ludvigsson J, Svensson J, Goldacre MJ, Waldhoer T, Jarosz-Chobot P, Gimeno SG, Chuang LM, Roberts CL, Parslow RC, Wadsworth EJ, Chetwynd A, Brigis G, Urbonaite B, Sipetic S, Schober E, Devoti G, Ionescu-Tirgoviste C, de Beaufort CE, Stoyanov D, Buschard K, Radon K, Glatthaar C, Patterson CC. Birth order and childhood type 1 diabetes risk: a pooled analysis of 31 observational studies. Int J Epidemiol 2010; 40:363-74. [DOI: 10.1093/ije/dyq207] [Citation(s) in RCA: 43] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022] Open
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Abstract
AIMS The aim of this study was to use general practice data to estimate the prevalence of diabetic nephropathy within the registered diabetes patients and examine variation in practice prevalence and management performance since introduction of this initiative. METHODS Reported quality indicators from the Northern Ireland General Practice Quality and Outcomes Framework were analysed for diabetes and diabetic nephropathy prevalence and management in the period 2004-2008. Variation in prevalence at practice level was assessed using multiple linear regression adjusting for age, practice size, deprivation and glycaemic control. RESULTS In 2006-2007, 57,454 (4.1%) adult diabetic patients were registered in the denominator population of 1.4 million compared with 51,923 (3.8%) in 2004-2005 (mean practice range 0.5-7.7%). Diabetic nephropathy prevalence was 15.1 and 11.5%, respectively (8688 and 5955 patients). Documented diabetic nephropathy prevalence showed marked variation across practices (range 0-100%) and was significantly negatively correlated with diabetes list size, albumin creatinine ratio testing rates and renin-angiotensin-aldosterone system blockade use and positively correlated with exception reporting rates. Specifically, for every increase in 100 diabetic patients to a register, documented diabetic nephropathy prevalence reduced by 40% (P=0.003). On the positive side, median albumin-creatinine ratio testing rates doubled to 82% compared with figures in the pre-Framework era. CONCLUSIONS Implementation of the Northern Ireland General Practice Quality and Outcomes Framework has positively benefitted testing for diabetic nephropathy and increased numbers of detected patients in a short space of time. Large variation in diabetic nephropathy prevalence remains and is associated with diabetes registry size, screening and treatment practices, suggesting that understanding this variation may help detect and better manage diabetic nephropathy.
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Affiliation(s)
- G M Magee
- Regional Centre for Diabetes and Endocrinology, Royal Victoria Hospital, Belfast, Co Antrim, UK.
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Cardwell CR, Stene LC, Joner G, Davis EA, Cinek O, Rosenbauer J, Ludvigsson J, Castell C, Svensson J, Goldacre MJ, Waldhoer T, Polanska J, Gimeno SGA, Chuang LM, Parslow RC, Wadsworth EJK, Chetwynd A, Pozzilli P, Brigis G, Urbonaite B, Sipetić S, Schober E, Ionescu-Tirgoviste C, de Beaufort CE, Stoyanov D, Buschard K, Patterson CC. Birthweight and the risk of childhood-onset type 1 diabetes: a meta-analysis of observational studies using individual patient data. Diabetologia 2010; 53:641-51. [PMID: 20063147 DOI: 10.1007/s00125-009-1648-5] [Citation(s) in RCA: 74] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/11/2009] [Accepted: 12/10/2009] [Indexed: 10/20/2022]
Abstract
AIMS/HYPOTHESIS We investigated whether children who are heavier at birth have an increased risk of type 1 diabetes. METHODS Relevant studies published before February 2009 were identified from literature searches using MEDLINE, Web of Science and EMBASE. Authors of all studies containing relevant data were contacted and asked to provide individual patient data or conduct pre-specified analyses. Risk estimates of type 1 diabetes by category of birthweight were calculated for each study, before and after adjustment for potential confounders.Meta-analysis techniques were then used to derive combined ORs and investigate heterogeneity between studies. RESULTS Data were available for 29 predominantly European studies (five cohort, 24 case-control studies), including 12,807 cases of type 1 diabetes. Overall, studies consistently demonstrated that children with birthweight from 3.5 to 4 kg had an increased risk of diabetes of 6% (OR 1.06 [95% CI 1.01-1.11]; p=0.02) and children with birthweight over 4 kg had an increased risk of 10% (OR 1.10 [95% CI 1.04-1.19]; p=0.003), compared with children weighing 3.0 to 3.5 kg at birth. This corresponded to a linear increase in diabetes risk of 3% per 500 g increase in birthweight (OR 1.03 [95% CI 1.00-1.06]; p=0.03). Adjustments for potential confounders such as gestational age, maternal age, birth order, Caesarean section, breastfeeding and maternal diabetes had little effect on these findings. CONCLUSIONS/INTERPRETATION Children who are heavier at birth have a significant and consistent, but relatively small increase in risk of type 1 diabetes.
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Affiliation(s)
- C R Cardwell
- Centre for Public Health, School of Medicine, Dentistry and Biomedical Sciences, Queen's University Belfast, Grosvenor Road, Belfast BT12 6BJ, UK,
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Cardwell CR, Patterson CC. Re: "birth weight, early weight gain, and subsequent risk of type 1 diabetes: systematic review and meta-analysis". Am J Epidemiol 2009; 170:529-30; author reply 530-1. [PMID: 19571060 DOI: 10.1093/aje/kwp189] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022] Open
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Magee GM, Bilous RW, Cardwell CR, Hunter SJ, Kee F, Fogarty DG. Is hyperfiltration associated with the future risk of developing diabetic nephropathy? A meta-analysis. Diabetologia 2009; 52:691-7. [PMID: 19198800 DOI: 10.1007/s00125-009-1268-0] [Citation(s) in RCA: 245] [Impact Index Per Article: 16.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/20/2008] [Accepted: 12/21/2008] [Indexed: 01/03/2023]
Abstract
AIMS/HYPOTHESIS Glomerular hyperfiltration is a well-established phenomenon occurring early in some patients with type 1 diabetes. However, there is no consistent answer regarding whether hyperfiltration predicts later development of nephropathy. We performed a systematic review and meta-analysis of observational studies that compared the risk of developing diabetic nephropathy in patients with and without glomerular hyperfiltration and also explored the impact of baseline GFR. METHODS A systematic review and meta-analysis was carried out. Cohort studies in type 1 diabetic participants were included if they contained data on the development of incipient or overt nephropathy with baseline measurement of GFR and presence or absence of hyperfiltration. RESULTS We included ten cohort studies following 780 patients. After a study median follow-up of 11.2 years, 130 patients had developed nephropathy. Using a random effects model, the pooled odds of progression to a minimum of microalbuminuria in patients with hyperfiltration was 2.71 (95% CI 1.20-6.11) times that of patients with normofiltration. There was moderate heterogeneity (heterogeneity test p = 0.05, measure of degree of inconsistency = 48%) and some evidence of funnel plot asymmetry, possibly due to publication bias. The pooled weighted mean difference in baseline GFR was 13.8 ml min(-1) 1.73 m(-2) (95% CI 5.0-22.7) greater in the group progressing to nephropathy than in those not progressing (heterogeneity test p < 0.01). CONCLUSIONS/INTERPRETATION In published studies, individuals with glomerular hyperfiltration were at increased risk of progression to diabetic nephropathy using study level data. Further larger studies are required to explore this relationship and the role of potential confounding variables.
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Affiliation(s)
- G M Magee
- Regional Centre for Diabetes and Endocrinology, Level 1, Royal Victoria Hospital, Grosvenor Road, Belfast, BT12 6BA, UK.
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Thavagnanam S, Fleming J, Bromley A, Shields MD, Cardwell CR. A meta-analysis of the association between Caesarean section and childhood asthma. Clin Exp Allergy 2008; 38:629-33. [PMID: 18352976 DOI: 10.1111/j.1365-2222.2007.02780.x] [Citation(s) in RCA: 438] [Impact Index Per Article: 27.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
BACKGROUND Children born by Caesarean section have modified intestinal bacterial colonization and consequently may have an increased risk of developing asthma under the hygiene hypothesis. The results of previous studies that have investigated the association between Caesarean section and asthma have been conflicting. OBJECTIVE To review published literature and perform a meta-analysis summarizing the evidence in support of an association between children born by Caesarean section and asthma. METHODS MEDLINE, Web Science, Google Scholar and PubMed were searched to identify relevant studies. Odds ratio (OR) and 95% confidence interval (CI) were calculated for each study from the reported prevalence of asthma in children born by Caesarean section and in control children. Meta-analysis was then used to derive a combined OR and test for heterogeneity in the findings between studies. RESULTS Twenty-three studies were identified. The overall meta-analysis revealed an increase in the risk of asthma in children delivered by Caesarean section (OR=1.22, 95% CI 1.14, 1.29). However, in this analysis, there was evidence of heterogeneity (I(2)=46%) that was statistically significant (P<0.001). Restricting the analysis to childhood studies, this heterogeneity was markedly decreased (I(2)=32%) and no longer attained statistical significance (P=0.08). In these studies, there was also evidence of an increase (P<0.001) in the risk of asthma after Caesarean section (OR=1.20, 95% CI 1.14, 12.6). CONCLUSION In this meta-analysis, we found a 20% increase in the subsequent risk of asthma in children who had been delivered by Caesarean section.
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Affiliation(s)
- S Thavagnanam
- Royal Belfast Hospital for Sick Children, Belfast, Northern Ireland
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Cardwell CR, Stene LC, Joner G, Cinek O, Svensson J, Goldacre MJ, Parslow RC, Pozzilli P, Brigis G, Stoyanov D, Urbonaite B, Sipetić S, Schober E, Ionescu-Tirgoviste C, Devoti G, de Beaufort CE, Buschard K, Patterson CC. Caesarean section is associated with an increased risk of childhood-onset type 1 diabetes mellitus: a meta-analysis of observational studies. Diabetologia 2008; 51:726-35. [PMID: 18292986 DOI: 10.1007/s00125-008-0941-z] [Citation(s) in RCA: 377] [Impact Index Per Article: 23.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/05/2007] [Accepted: 01/14/2008] [Indexed: 01/15/2023]
Abstract
AIMS/HYPOTHESIS The aim of this study was to investigate the evidence of an increased risk of childhood-onset type 1 diabetes in children born by Caesarean section by systematically reviewing the published literature and performing a meta-analysis with adjustment for recognised confounders. METHODS After MEDLINE, Web of Science and EMBASE searches, crude ORs and 95% CIs for type 1 diabetes in children born by Caesarean section were calculated from the data reported in each study. Authors were contacted to facilitate adjustments for potential confounders, either by supplying raw data or calculating adjusted estimates. Meta-analysis techniques were then used to derive combined ORs and to investigate heterogeneity between studies. RESULTS Twenty studies were identified. Overall, there was a significant increase in the risk of type 1 diabetes in children born by Caesarean section (OR 1.23, 95% CI 1.15-1.32, p < 0.001). There was little evidence of heterogeneity between studies (p = 0.54). Seventeen authors provided raw data or adjusted estimates to facilitate adjustments for potential confounders. In these studies, there was evidence of an increase in diabetes risk with greater birthweight, shorter gestation and greater maternal age. The increased risk of type 1 diabetes after Caesarean section was little altered after adjustment for gestational age, birth weight, maternal age, birth order, breast-feeding and maternal diabetes (adjusted OR 1.19, 95% CI 1.04-1.36, p = 0.01). CONCLUSIONS/INTERPRETATION This analysis demonstrates a 20% increase in the risk of childhood-onset type 1 diabetes after Caesarean section delivery that cannot be explained by known confounders.
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Affiliation(s)
- C R Cardwell
- Department of Epidemiology and Public Health, School of Medicine and Dentistry, Queen's University Belfast, Grosvenor Road, Belfast, BT12 6BJ, UK.
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Cardwell CR, Carson DJ, Patterson CC. No association between routinely recorded infections in early life and subsequent risk of childhood-onset Type 1 diabetes: a matched case-control study using the UK General Practice Research Database. Diabet Med 2008; 25:261-7. [PMID: 18201209 DOI: 10.1111/j.1464-5491.2007.02351.x] [Citation(s) in RCA: 36] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
AIMS To determine whether children with infections in early life (recorded routinely in general practice) have a reduced risk of Type 1 diabetes, as would be expected from the hygiene hypothesis. METHODS Children with Type 1 diabetes and up to 20 matched (on year of birth, sex and region) control subjects were selected from a cohort of children born in the UK at General Practice Research Database practices. For each child, the frequency of general practitioner consultations for infections and prescriptions for antibiotics in the first year of life were determined. Odds ratios (ORs) and 95% confidence intervals (95%CIs) were calculated using conditional logistic regression. RESULTS The main analysis included 367 case and 4579 matched control subjects. There was no evidence of any reduction in the subsequent risk of Type 1 diabetes in children with at least one infection in the first year of life (OR = 1.03, 95%CI 0.79, 1.34) or in children prescribed antibiotics in the first year of life (OR = 1.03, 95%CI 0.82, 1.29). Further analyses also revealed little evidence of a difference in subsequent risk of Type 1 diabetes after different types of infection in the first year of life (including gastrointestinal, conjunctivitis, otitis media and upper and lower respiratory tract). Analyses of infections in the first 2 years of life reached similar conclusions. CONCLUSIONS This study provides no evidence of an association between infections in early life and subsequent risk of childhood-onset Type 1 diabetes and therefore does not support the hygiene hypothesis.
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Affiliation(s)
- C R Cardwell
- School of Medicine and Dentistry, The Queen's University of Belfast, Belfast, UK
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Cardwell CR, Carson DJ, Patterson CC. Secular trends, disease maps and ecological analyses of the incidence of childhood onset Type 1 diabetes in Northern Ireland, 1989-2003. Diabet Med 2007; 24:289-95. [PMID: 17305789 DOI: 10.1111/j.1464-5491.2007.02080.x] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/30/2023]
Abstract
AIMS To investigate secular trends in the incidence of Type 1 diabetes in Northern Ireland over the period 1989-2003. To highlight geographical variations in the incidence of Type 1 diabetes by producing disease maps and to compare incidence rates by relevant area characteristics. METHODS New cases of Type 1 diabetes in children aged 0-14 years in Northern Ireland were prospectively registered from 1989 to 2003. Standardized incidence rates were calculated and secular trends investigated. Bayesian methodology was used to produce maps of disease incidence using small geographical areas (582 electoral wards). Ecological analyses were conducted using Poisson regression to investigate incidence rates by area characteristics at a finer geographical subdivision (5022 census output areas). RESULTS In Northern Ireland during 1989-2003, there were 1433 new cases, giving a directly standardized incidence rate of 24.7 per 100,000 person-years. This incidence rate increased by a mean of 4.2% per annum. Disease maps highlighted higher incidence rates in the predominately rural north-east of the province and lower incidence rates in the urban areas around Belfast in the east and Derry in the north-west of the province. Ecological analysis identified higher incidence in rural areas (P < 0.001), areas with low migration rates (P = 0.002), affluent areas (P < 0.0001), sparsely populated areas (P = 0.0001) and remote areas (P = 0.005). CONCLUSIONS In Northern Ireland the incidence of Type 1 diabetes is increasing. The observed higher incidence in rural, affluent, sparsely populated and remote areas may reflect a reduced or delayed exposure to infections in these areas.
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Affiliation(s)
- C R Cardwell
- School of Medicine and Dentistry, The Queen's University of Belfast, Belfast, UK.
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Cardwell CR, Carson DJ, Patterson CC. Higher incidence of childhood-onset type 1 diabetes mellitus in remote areas: a UK regional small-area analysis. Diabetologia 2006; 49:2074-7. [PMID: 16868747 DOI: 10.1007/s00125-006-0342-0] [Citation(s) in RCA: 34] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/29/2006] [Accepted: 05/04/2006] [Indexed: 11/24/2022]
Abstract
AIMS/HYPOTHESIS We investigated the association between the incidence of type 1 diabetes mellitus and remoteness (a proxy measure for exposure to infections) using recently developed techniques for statistical analysis of small-area data. SUBJECTS, MATERIALS AND METHODS New cases in children aged 0 to 14 years in Northern Ireland were prospectively registered from 1989 to 2003. Ecological analysis was conducted using small geographical units (582 electoral wards) and area characteristics including remoteness, deprivation and child population density. Analysis was conducted using Poisson regression models and Bayesian hierarchical models to allow for spatially correlated risks that were potentially caused by unmeasured explanatory variables. RESULTS In Northern Ireland between 1989 and 2003, there were 1,433 new cases of type 1 diabetes, giving a directly standardised incidence rate of 24.7 per 100,000 person-years. Areas in the most remote fifth of all areas had a significantly (p=0.0006) higher incidence of type 1 diabetes mellitus (incidence rate ratio=1.27 [95% CI 1.07, 1.50]) than those in the most accessible fifth of all areas. There was also a higher incidence rate in areas that were less deprived (p<0.0001) and less densely populated (p=0.002). After adjustment for deprivation and additional adjustment for child population density the association between diabetes and remoteness remained significant (p=0.01 and p=0.03, respectively). CONCLUSIONS/INTERPRETATION In Northern Ireland, there is evidence that remote areas experience higher rates of type 1 diabetes mellitus. This could reflect a reduced or delayed exposure to infections, particularly early in life, in these areas.
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Affiliation(s)
- C R Cardwell
- School of Medicine and Dentistry, The Queen's University of Belfast, Belfast, UK.
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Abstract
AIMS To assess the care received, compared to national guidelines, and to investigate factors associated with glycaemic control in children and adolescents with type 1 diabetes attending clinics in Northern Ireland. METHODS An audit of the care provided to all patients attending 11 paediatric diabetes clinics commenced in 2002. A research nurse interviewed 914 patients completing a questionnaire recording characteristics, social circumstances, and aspects of diabetes management, including the monitoring of complications and access to members of the diabetes team. Glycaemic control was measured by glycosylated haemoglobin (HbA1c), determined at a DCCT aligned central laboratory. RESULTS The average HbA1c concentration was 8.8% (SD 1.5%), with 20% of patients achieving recommended HbA1c levels of less than 7.5%. In the year prior to the audit, 76% of patients were reviewed by a diabetes specialist nurse and 42% were tested for microalbuminuria. After adjustment for confounding factors, better glycaemic control was identified, particularly in patients who had attended exactly four diabetes clinics in the previous year, were members of the patient association Diabetes UK, and lived with both natural parents. CONCLUSIONS In Northern Ireland only a minority of patients achieved recommended HbA1c levels. Furthermore, children and adolescents with diabetes were reviewed by fewer specialists and were less intensively monitored for microvascular complications than recommended. There was evidence of better control in children who were members of Diabetes UK, suggesting that parental attitude and involvement could lead to benefits.
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Affiliation(s)
- C R Cardwell
- Department of Epidemiology & Public Health, The Queen's University of Belfast, UK.
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Cardwell CR, Carson DJ, Patterson CC. Parental age at delivery, birth order, birth weight and gestational age are associated with the risk of childhood Type 1 diabetes: a UK regional retrospective cohort study. Diabet Med 2005; 22:200-6. [PMID: 15660739 DOI: 10.1111/j.1464-5491.2005.01369.x] [Citation(s) in RCA: 81] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
AIMS To investigate perinatal risk factors for childhood Type 1 diabetes in a UK population cohort. METHODS Perinatal data have been routinely recorded in Northern Ireland for all births in the period 1971-86 (n = 447 663). Diabetes status at the age of 15 years was ascertained in this cohort by identifying 991 children from 1079 registered with Type 1 diabetes diagnosed from 1971 to 2001 and date of birth in the period 1971-86. RESULTS Increased Type 1 diabetes risk was associated with higher maternal age, paternal age, birth weight and birth weight for gestational and lower gestational age. After adjustment for maternal age, the association between Type 1 diabetes and paternal age remained significant [relative risk (RR) = 1.52 (1.10, 2.09) comparing father's age 35 years or more to less than 25 years] but not vice versa [RR = 1.11 (0.80, 1.54) comparing mother's age 35 years or more to less than 25 years]. Increased birth order was associated with a significant decrease in the risk of Type 1 diabetes [adjusted RR = 0.75 (0.62, 0.90) comparing birth order three or more with firstborn], but this only became apparent when adjustment was made for maternal age. Furthermore this association with birth order was significant only for diabetes diagnosed under the age of 5 years. CONCLUSIONS Our analysis demonstrates, for the first time in a UK regional cohort setting, that maternal age and paternal age at delivery, birth order, birth weight and gestational age are significantly associated with Type 1 diabetes risk.
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Affiliation(s)
- C R Cardwell
- Department of Epidemiology & Public Health, The Queen's University of Belfast, Belfast, UK.
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