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Tai CG, Haviland MJ, Kissler SM, Lucia RM, Merson M, Maragakis LL, Ho DD, Anderson DJ, DiFiori J, Grubaugh ND, Grad YH, Mack CD. Low antibody levels associated with significantly increased rate of SARS-CoV-2 infection in a highly vaccinated population from the US National Basketball Association. J Med Virol 2024; 96:e29505. [PMID: 38465748 DOI: 10.1002/jmv.29505] [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: 10/23/2023] [Revised: 02/12/2024] [Accepted: 02/23/2024] [Indexed: 03/12/2024]
Abstract
SARS-CoV-2 antibody levels may serve as a correlate for immunity and could inform optimal booster timing. The relationship between antibody levels and protection from infection was evaluated in vaccinated individuals from the US National Basketball Association who had antibody levels measured at a single time point from September 12, 2021, to December 31, 2021. Cox proportional hazards models were used to estimate the risk of infection within 90 days of serologic testing by antibody level (<250, 250-800, and >800 AU/mL1 ), adjusting for age, time since last vaccine dose, and history of SARS-CoV-2 infection. Individuals were censored on date of booster receipt. The analytic cohort comprised 2323 individuals and was 78.2% male, 68.1% aged ≤40 years, and 56.4% vaccinated (primary series) with the Pfizer-BioNTech mRNA vaccine. Among the 2248 (96.8%) individuals not yet boosted at antibody testing, 77% completed their primary vaccine series 4-6 months before testing and the median (interquartile range) antibody level was 293.5 (interquartile range: 121.0-740.5) AU/mL. Those with levels <250 AU/mL (adj hazard ratio [HR]: 2.4; 95% confidence interval [CI]: 1.5-3.7) and 250-800 AU/mL (adj HR: 1.5; 95% CI: 0.98-2.4) had greater infection risk compared to those with levels >800 AU/mL. Antibody levels could inform individual COVID-19 risk and booster scheduling.
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Affiliation(s)
| | | | - Steven M Kissler
- Harvard University T.H. Chan School of Public Health, Boston, Massachusetts, USA
| | | | - Michael Merson
- Duke University Duke Global Health Institute, Durham, North Carolina, USA
| | - Lisa L Maragakis
- Department of Medicine, Johns Hopkins University, Baltimore, Maryland, USA
| | - David D Ho
- Aaron Diamond AIDS Research Center, Columbia University Vagelos College of Physicians and Surgeons, New York, New York, USA
| | - Deverick J Anderson
- Duke University Center for Antimicrobial Stewardship and Infection Prevention, Durham, North Carolina, USA
| | - John DiFiori
- National Basketball Association, New York, New York, USA
- Hospital for Special Surgery, New York, New York, USA
| | - Nathan D Grubaugh
- Yale University School of Public Health, New Haven, Connecticut, USA
| | - Yonatan H Grad
- Harvard University T.H. Chan School of Public Health, Boston, Massachusetts, USA
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Brinkley E, Mack CD, Albert L, Knuth K, Reynolds MW, Toovey S, Dreyer NA. COVID-19 Vaccinations in Pregnancy: Comparative Evaluation of Acute Side Effects and Self-Reported Impact on Quality of Life between Pregnant and Nonpregnant Women in the United States. Am J Perinatol 2022; 39:1750-1753. [PMID: 35523212 DOI: 10.1055/s-0042-1748158] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [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] [Indexed: 01/28/2023]
Abstract
OBJECTIVE The objective of this study was to describe the acute side effects experienced by pregnant women who received a coronavirus disease 2019 (COVID-19) vaccine in the United States and to compare their experience to nonpregnant women of similar age. STUDY DESIGN Adults who received a COVID-19 vaccine in the United States were invited via social media to enroll in an online, longitudinal, community-based registry ( www.helpstopCOVID19.com ). Participants self-reported pregnancy status, vaccination dates, manufacturer, acute side effects, impact on work and self-care, medical consultation, and hospitalization. This analysis was restricted to women aged 20 to 39 at the time of vaccination. Side effects reported by pregnant women were compared to those reported by nonpregnant women. RESULTS This analysis included 946 pregnant women, with 572 (60%) receiving at least one dose of Pfizer, 321 (34%) Moderna, and 53 (6%) J&J, and 1,178 nonpregnant women. Demographic and medical history were similar across manufacturers for both cohorts.Overall, pregnant women reported similar side effects as nonpregnant women, with the most common being injection site reactions (83 vs. 87%), fatigue (72 vs.78%), and headache (45 vs. 59%). Pregnant women reported fewer side effects (median: 3 vs. 4, respectively). In both cohorts, very few reported seeking medical care (<5%) or being hospitalized (<0.3%) after vaccination. Fewer pregnant women reported working less after vaccination than nonpregnant women (32 vs. 40%) or trouble with self-care (32 vs. 46%), respectively. CONCLUSION Pregnant women reported similar COVID-19 vaccine side effects as nonpregnant women, although fewer total side effects; pregnant women judged these side effects to have less impact on work and self-care. While these results do not address pregnancy outcomes or long-term effects, findings about acute side effects and impact offer reassurance for all three vaccines in terms of tolerability. KEY POINTS · COVID vaccines were well tolerated by pregnant women.. · Pregnant women reported fewer total side effects.. · Pregnant women reported less impact on work and self-care..
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Affiliation(s)
- Emma Brinkley
- IQVIA Real-World Solutions, 201 Broadway, Cambridge, Massachusetts
| | | | - Lisa Albert
- IQVIA Real-World Solutions, 201 Broadway, Cambridge, Massachusetts
| | - Kendall Knuth
- IQVIA Real-World Solutions, 201 Broadway, Cambridge, Massachusetts
| | | | - Stephen Toovey
- Pegasus Research, Neuschwaendistrasse 6, 6390 Engelberg, Switzerland
| | - Nancy A Dreyer
- IQVIA Real-World Solutions, 201 Broadway, Cambridge, Massachusetts
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Tai CG, Maragakis LL, Connolly S, DiFiori J, Anderson DJ, Grad YH, Mack CD. Association Between COVID-19 Booster Vaccination and Omicron Infection in a Highly Vaccinated Cohort of Players and Staff in the National Basketball Association. JAMA 2022; 328:209-211. [PMID: 35653123 PMCID: PMC9164115 DOI: 10.1001/jama.2022.9479] [Citation(s) in RCA: 15] [Impact Index Per Article: 7.5] [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: 12/13/2022]
Abstract
This study compares the incidence of SARS-CoV-2 infection in players and staff of the National Basketball Association (NBA) who did vs those who did not receive a COVID-19 vaccine booster dose.
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Affiliation(s)
| | - Lisa L. Maragakis
- Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | | | - John DiFiori
- National Basketball Association, New York, New York
| | - Deverick J. Anderson
- Duke Center for Antimicrobial Stewardship and Infection Prevention, Duke University School of Medicine, Durham, North Carolina
| | - Yonatan H. Grad
- Department of Immunology and Infectious Diseases, Harvard T. H. Chan School of Public Health, Boston, Massachusetts
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Mack CD, Osterholm M, Wasserman EB, Petruski-Ivleva N, Anderson DJ, Myers E, Singh N, Walton P, Solomon G, Hostler C, Mancell J, Sills A. Optimizing SARS-CoV-2 Surveillance in the United States: Insights From the National Football League Occupational Health Program. Ann Intern Med 2021; 174:1081-1089. [PMID: 34125571 PMCID: PMC8252091 DOI: 10.7326/m21-0319] [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] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
BACKGROUND Evidence to understand effective strategies for surveillance and early detection of SARS-CoV-2 is limited. OBJECTIVE To describe the results of a rigorous, large-scale COVID-19 testing and monitoring program. DESIGN The U.S. National Football League (NFL) and the NFL Players Association (NFLPA) instituted a large-scale COVID-19 monitoring program involving daily testing using 2 reverse transcription polymerase chain reaction (RT-PCR) platforms (Roche cobas and Thermo Fisher QuantStudio), a transcription-mediated amplification platform (Hologic Panther), and an antigen point-of-care (aPOC) test (Quidel Sofia). SETTING 32 NFL clubs in 24 states during the 2020 NFL season. PARTICIPANTS NFL players and staff. MEASUREMENTS SARS-CoV-2 test results were described in the context of medically adjudicated status. Cycle threshold (Ct) values are reported when available. RESULTS A total of 632 370 tests administered across 11 668 persons identified 270 (2.4%) COVID-19 cases from 1 August to 14 November 2020. Positive predictive values ranged from 73.0% to 82.0% across the RT-PCR platforms. High Ct values (33 to 37) often indicated early infection. For the first positive result, the median Ct value was 32.77 (interquartile range, 30.02 to 34.72) and 22% of Ct values were above 35. Among adjudicated COVID-19 cases tested with aPOC, 42.3% had a negative result. Positive concordance between aPOC test result and adjudicated case status increased as viral load increased. LIMITATIONS Platforms varied by laboratory, and test variability may reflect procedural differences. CONCLUSION Routine RT-PCR testing allowed early detection of infection. Cycle threshold values provided a useful guidepost for understanding results, with high values often indicating early infection. Antigen POC testing was unable to reliably rule out COVID-19 early in infection. PRIMARY FUNDING SOURCE The NFL and the NFLPA.
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Affiliation(s)
| | | | | | | | - Deverick J Anderson
- Duke University School of Medicine, Durham, North Carolina, and Infection Control Education for Major Sports, Chapel Hill, North Carolina (D.J.A.)
| | - Emily Myers
- National Football League, New York, New York (E.M., G.S., A.S.)
| | - Navdeep Singh
- Eden Medical Center, Castro Valley, California (N.S.)
| | - Patti Walton
- Williamson Medical Center, Franklin, Tennessee (P.W.)
| | - Gary Solomon
- National Football League, New York, New York (E.M., G.S., A.S.)
| | - Christopher Hostler
- Duke University School of Medicine and Durham VA Health Care System, Durham, North Carolina, and Infection Control Education for Major Sports, Chapel Hill, North Carolina (C.H.)
| | - Jimmie Mancell
- University of Tennessee Health Science Center, Memphis, Tennessee (J.M.)
| | - Allen Sills
- National Football League, New York, New York (E.M., G.S., A.S.)
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Dreyer NA, Reynolds M, DeFilippo Mack C, Brinkley E, Petruski-Ivleva N, Hawaldar K, Toovey S, Morris J. Self-reported symptoms from exposure to Covid-19 provide support to clinical diagnosis, triage and prognosis: An exploratory analysis. Travel Med Infect Dis 2020; 38:101909. [PMID: 33152512 PMCID: PMC7606076 DOI: 10.1016/j.tmaid.2020.101909] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2020] [Revised: 10/29/2020] [Accepted: 10/30/2020] [Indexed: 01/03/2023]
Abstract
Background Symptomatic COVID-19 is prevalent in the community. We identify factors indicating COVID-19 positivity in non-hospitalized patients and prognosticators of moderate-to-severe disease. Methods Appeals conducted in April–June 2020 in social media, collaborating medical societies and patient advocacy groups recruited 20,476 participants ≥18 years who believed they had COVID-19 exposure. Volunteers consented on-line and reported height, weight, concomitant illnesses, medication and supplement use, residential, occupational or community COVID-19 exposure, symptoms and symptom severity on a 4-point scale. Of the 12,117 curated analytic population 2279 reported a COVID-19 viral test result: 865 positive (COVID+) and 1414 negative (COVID-). Results The triad of anosmia, ageusia and fever best distinguished COVID+ from COVID-participants (OR 6.07, 95% CI: 4.39 to 8.47). COVID + subjects with BMI≥30, concomitant respiratory disorders or an organ transplant had increased risk of moderate-to- severe dyspnoea. Race and anti-autoimmunity medication did not affect moderate-to-severe dyspnea risk. Conclusions The triad of anosmia, ageusia and fever differentiates COVID-19. Elevated risks of severe symptoms outside the hospital were most evident among the obese and those with pulmonary comorbidity. Race and use of medication for autoimmune disease did not predict severe disease. These findings should facilitate rapid COVID-19 diagnosis and triage in settings without testing. The triad of anosmia, ageusia and fever best distinguished those who tested positive from those who tested negative. Race nor use of medications for autoimmune disorders showed meaningful increase in risk of moderate or severe dyspnea. Moderate-to-severe dyspnea in the community was increased in those with obesity or underlying respiratory disorders.
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Affiliation(s)
- Nancy A Dreyer
- Real World Solutions, IQVIA Cambridge, Massachusetts, USA.
| | | | | | - Emma Brinkley
- Real World Solutions, IQVIA Cambridge, Massachusetts, USA
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Herzog MM, Mack CD, Dreyer NA, Wikstrom EA, Padua DA, Kocher MS, DiFiori JP, Marshall SW. Ankle Sprains in the National Basketball Association, 2013-2014 Through 2016-2017. Am J Sports Med 2019; 47:2651-2658. [PMID: 31389712 DOI: 10.1177/0363546519864678] [Citation(s) in RCA: 30] [Impact Index Per Article: 6.0] [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: 01/31/2023]
Abstract
BACKGROUND Ankle sprains are one of the most common injuries in basketball. Despite this, the incidence and setting of ankle sprains among elite basketball players are not well described. PURPOSE To describe the epidemiology of ankle sprains among National Basketball Association (NBA) players. STUDY DESIGN Cohort study; Level of evidence, 3. METHODS All players on an NBA roster for ≥1 NBA game (preseason, regular season, or playoffs) during the 2013-14 through 2016-17 seasons were included. Data were collected with the NBA electronic medical record system. All NBA teams used the electronic medical record continuously throughout the study period to record comprehensive injury data, including onset, mechanism, setting, type, and time lost. Game incidence rates were calculated per 1000 player-games and per 10,000 player-minutes of participation, stratified by demographic and playing characteristics. RESULTS There were 796 ankle sprains among 389 players and 2341 unique NBA player-seasons reported in the league from 2013-14 through 2016-17. The overall single-season risk of ankle sprain was 25.8% (95% CI, 23.9%-28.0%). The majority of ankle sprains occurred in games (n = 565, 71.0%) and involved a contact mechanism of injury (n = 567, 71.2%). Most ankle sprains were lateral (n = 638, 80.2%). The incidence of ankle sprain among players with a history of prior ankle sprain in the past year was 1.41 times (95% CI, 1.13-1.74) the incidence of those without a history of ankle sprain in the past year (P = .002). Fifty-six percent of ankle sprains did not result in any NBA games missed (n = 443); among those that did, players missed a median of 2 games (interquartile range, 1-4) resulting in a cumulative total of 1467 missed player-games over the 4-season study period. CONCLUSION Ankle sprains affect approximately 26% of NBA players on average each season and account for a large number of missed NBA games in aggregate. Younger players and players with a history of ankle sprain have elevated rates of incident ankle sprains in games, highlighting the potential benefit for integrating injury prevention programs into the management of initial sprains. Research on basketball- and ankle-specific injury prevention strategies could provide benefits.
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Affiliation(s)
- Mackenzie M Herzog
- Department of Epidemiology, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA.,University of North Carolina Injury Prevention Research Center, Chapel Hill, North Carolina, USA.,Injury Surveillance and Analytics, Real-World Analytics Solutions, IQVIA Durham, North Carolina, USA
| | - Christina DeFilippo Mack
- Department of Epidemiology, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA.,Injury Surveillance and Analytics, Real-World Analytics Solutions, IQVIA Durham, North Carolina, USA
| | - Nancy A Dreyer
- Department of Epidemiology, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA.,Injury Surveillance and Analytics, Real-World Analytics Solutions, IQVIA Durham, North Carolina, USA
| | - Erik A Wikstrom
- Department of Exercise and Sport Science, College of Arts and Sciences, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
| | - Darin A Padua
- Department of Exercise and Sport Science, College of Arts and Sciences, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
| | - Mininder S Kocher
- The Micheli Center for Sports Injury Prevention, Boston Children's Hospital Boston, Massachusetts, USA.,Division of Sports Medicine, Department of Orthopedics, Boston Children's Hospital Boston, Massachusetts, USA.,Department of Orthopaedic Surgery, Harvard Medical School Boston, Massachusetts, USA
| | - John P DiFiori
- National Basketball Association New York, New York, USA.,Primary Care Sports Medicine, Hospital for Special Surgery New York, New York, USA
| | - Stephen W Marshall
- Department of Epidemiology, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA.,University of North Carolina Injury Prevention Research Center, Chapel Hill, North Carolina, USA.,Department of Exercise and Sport Science, College of Arts and Sciences, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
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Gokhale M, Buse JB, DeFilippo Mack C, Jonsson Funk M, Lund J, Simpson RJ, Stürmer T. Calendar time as an instrumental variable in assessing the risk of heart failure with antihyperglycemic drugs. Pharmacoepidemiol Drug Saf 2018; 27:857-866. [PMID: 29943442 DOI: 10.1002/pds.4578] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [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: 09/22/2017] [Revised: 05/15/2018] [Accepted: 05/16/2018] [Indexed: 01/23/2023]
Abstract
OBJECTIVE In recent years, second-line diabetes treatment with dipeptidyl peptidase-4 inhibitors (DPP-4i) increased with a corresponding decrease in thiazolidinediones (TZDs). Using hospitalization for heart failure (HF) as a positive control outcome, we explored the use of calendar time as an instrumental variable (IV) and compared this approach to an active comparator new-user study. METHODS We identified DPP-4i or TZD initiators after a 6-month washout using Medicare claims 2006-2013. The IV was defined as a binary variable comparing initiators during October 2010 to December 2013 (postperiod) versus January 2008 to May 2010 (preperiod). We examined IV strength and estimated risk differences (RDs) for HF using Kaplan-Meier curves, which were compared with propensity score (PS)-weighted RD for DPP-4i versus TZD. RESULTS The IV compared 22 696 initiators (78% DPP-4i) in the postperiod versus 20 283 initiators (38% DPP-4i) in the preperiod, resulting in 40% compliance. The active-comparator (PS-weighted) approach compared 26 198 DPP-4i and 18 842 TZD initiators. Covariate balance across IV levels was slightly better than across treatments (standardized difference, 3% vs 4.5%). The 1- and 2-year local average treatment effects of RD of HF per 100 patients in the "compliers" (95% confidence intervals) were -0.62 (-0.99 to -0.25) and -0.88 (-1.46 to -0.25). Corresponding PS-weighted results were -0.20 (-0.33 to -0.05) and -0.18 (-0.30 to 0.03). CONCLUSION Both approaches indicated lesser risk of HF hospitalizations among DPP-4i vs TZD initiators. The magnitude of the estimated effects may differ due to differences in the target populations and assumptions. Calendar time can be leveraged as an IV when market dynamics lead to profound changes in treatments.
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Affiliation(s)
- Mugdha Gokhale
- Department of Epidemiology, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapell Hill, NC, USA
- Real World Evidence & Epidemiology, GlaxoSmithKline, Collegeville, PA, USA
| | - John B Buse
- Department of Medicine, University of North Carolina School of Medicine, Chapell Hill, NC, USA
| | - Christina DeFilippo Mack
- Department of Epidemiology, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapell Hill, NC, USA
- Real-World and Late Phase Research, Quintiles, Research Triangle Park, NC, USA
| | - Michele Jonsson Funk
- Department of Epidemiology, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapell Hill, NC, USA
| | - Jennifer Lund
- Department of Epidemiology, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapell Hill, NC, USA
| | - Ross J Simpson
- Department of Medicine, University of North Carolina School of Medicine, Chapell Hill, NC, USA
| | - Til Stürmer
- Department of Epidemiology, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapell Hill, NC, USA
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Mack CD, Gokhale M. Toward an Understanding of the Challenges and Opportunities when Studying Emerging Therapies. CURR EPIDEMIOL REP 2016. [DOI: 10.1007/s40471-016-0090-8] [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: 11/24/2022]
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Mack CD, Brookhart MA, Glynn RJ, Meyer AM, Carpenter WR, Sandler RS, Stürmer T. Comparative Effectiveness of Oxaliplatin Versus 5-flourouricil in Older Adults: An Instrumental Variable Analysis. Epidemiology 2015; 26:690-9. [PMID: 26196683 PMCID: PMC4906444 DOI: 10.1097/ede.0000000000000355] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.6] [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: 12/27/2022]
Abstract
BACKGROUND Oxaliplatin was rapidly adopted for treatment of stage III colon cancer after FDA approval in November 2004, thus providing an opportunity to use calendar time as an instrumental variable in nonexperimental comparative effectiveness research. Assuming instrument validity, instrumental variable analyses account for unmeasured confounding and are particularly valuable in sub-populations of unresolved effectiveness, such as older individuals. METHODS We examined stage III colon cancer patients ages 65+ years initiating chemotherapy between 2003 and 2008 using US population-based cancer registry data linked with Medicare claims (N = 3,660). Risk differences for all-cause mortality were derived from Kaplan-Meier survival curves. We examined instrumental variable strength and compared risk differences with propensity score estimates. RESULTS Calendar time greatly affected oxaliplatin receipt. The calendar time instrument compared patients treated from January 2003 through September 2004 (N = 1,449) with those treated from March 2005 through May 2007 (N = 1,432), resulting in 54% compliance. The 1-, 2-, and 3-year local average treatment effect of the risk differences per 100 patients in the "compliers" (95% confidence intervals) were -4.6 (-8.2, -0.44), -6.3 (-12, -0.16), and -9.2 (-15, -2.5), respectively. Corresponding propensity score-matched results were -1.9 (-4.0, 0.2), -3.4 (-6.2, -0.05), and -4.3 (-7.5, -0.96). CONCLUSIONS Instrumental variable and propensity score analyses both indicate better survival among patients treated with oxaliplatin. As these results are based on different populations and assumptions, the instrumental variable analysis adds to evidence of oxaliplatin's effectiveness in older adults, who bear the greatest burden of colon cancer yet were underrepresented in clinical trials. In nonexperimental comparative effectiveness research of rapidly emerging therapies, the potential to use calendar time as an instrumental variable is worth consideration.
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Affiliation(s)
- Christina DeFilippo Mack
- From the aDepartment of Epidemiology, UNC Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, NC; bQuintiles, Research Triangle Park, NC; cDivision of Pharmacoepidemiology and Pharmacoeconomics, Department of Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, MA; dLineberger Comprehensive Cancer Center and Cecil G. Sheps Center for Health Services Research, University of North Carolina, Chapel Hill, NC; eDepartment of Health Policy and Management, Gillings School of Global Public Health UNC, Chapel Hill, NC; and fDivision of Gastroenterology and Hepatology, University of North Carolina, Chapel Hill, NC
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Penn DC, Chang Y, Meyer AM, DeFilippo Mack C, Sanoff HK, Stitzenberg KB, Carpenter WR. Provider-based research networks may improve early access to innovative colon cancer treatment for African Americans treated in the community. Cancer 2014; 121:93-101. [PMID: 25209056 DOI: 10.1002/cncr.29028] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [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: 05/27/2014] [Revised: 07/16/2014] [Accepted: 07/30/2014] [Indexed: 01/21/2023]
Abstract
BACKGROUND African American (AA) patients with colon cancer (CC) experience worse outcomes than whites partly due to differential treatment. The National Cancer Institute's Community Clinical Oncology Program (CCOP), a provider-based research network, adopts and diffuses innovative CC treatments quickly. The authors hypothesized that CCOP participation would lessen racial differences in the receipt of oxaliplatin, an innovative treatment for CC, among patients with stage III CC in the community. METHODS Using Surveillance, Epidemiology, and End Results (SEER)-Medicare data, the authors performed a population-based retrospective cohort study of AA and white individuals aged ≥66 years who were diagnosed with AJCC stage III CC from 2003 through 2005. Generalized estimating equations were used to calculate the odds of receiving an oxaliplatin-containing regimen. Predicted probabilities of oxaliplatin receipt for race-CCOP combinations were calculated. The absolute difference in oxaliplatin receipt between races was estimated using the interaction contrast ratio. RESULTS Of 2971 included individuals, 36% received oxaliplatin, 29.5% were CCOP-affiliated, and 7.6% were AA. On multivariate analysis, early diffusion of oxaliplatin was not found to be associated with race or CCOP participation. The probability of receiving oxaliplatin for AAs participating in a CCOP (0.46) was nearly double that of AAs who were not participating in a CCOP (0.25; P <.05). For white individuals, the probabilities of receiving oxaliplatin did not differ by CCOP participation. For oxaliplatin receipt, the joint effects assessment suggested a greater benefit of CCOP participation among AAs (interaction contrast ratio, 1.7). CONCLUSIONS Among older patients with stage III CC, there is a differential impact of race on oxaliplatin receipt depending on CCOP participation. AAs treated by CCOPs were more likely to receive oxaliplatin than AAs treated elsewhere. Provider-based research networks may facilitate early access to innovative treatment for AAs with stage III CC.
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Affiliation(s)
- Dolly C Penn
- Department of Social Medicine, Preventive Medicine Residency, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina
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Mack CD, Glynn RJ, Brookhart MA, Carpenter WR, Meyer AM, Sandler RS, Stürmer T. Calendar time-specific propensity scores and comparative effectiveness research for stage III colon cancer chemotherapy. Pharmacoepidemiol Drug Saf 2013; 22:810-8. [PMID: 23296544 PMCID: PMC3659185 DOI: 10.1002/pds.3386] [Citation(s) in RCA: 44] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2012] [Revised: 11/06/2012] [Accepted: 11/09/2012] [Indexed: 11/09/2022]
Abstract
PURPOSE Nonexperimental studies of treatment effectiveness provide an important complement to randomized trials by including heterogeneous populations. Propensity scores (PSs) are common in these studies but may not adequately capture changes in channeling experienced by innovative treatments. We use calendar time-specific (CTS) PSs to examine the effect of oxaliplatin during dissemination from off-label to widespread use. METHODS Stage III colon cancer patients aged 65+ years initiating chemotherapy between 2003 and 2006 were examined using cancer registry data linked with Medicare claims. Two PS approaches for receipt of oxaliplatin versus 5-flourouricil were constructed using logistic models with key components of age, sex, substage, grade, census-level income, and comorbidities: (i) a conventional, year-adjusted PS and (ii) a CTS PS constructed and matched separately within 1-year intervals, then combined. We compared PS-matched hazard ratios (HRs) for mortality using Cox models. RESULTS Oxaliplatin use increased significantly; 8% (n = 86) of patients received it in the first time period versus 52% (n = 386) in the last. Channeling by comorbidities, income, and age appeared to change over time. The CTS PS improved covariate balance within calendar time strata and yielded an attenuated estimated benefit of oxaliplatin (HR = 0.75) compared with the conventional PS (HR = 0.69). CONCLUSION In settings where prescribing patterns have changed and calendar time acts as a confounder, a CTS PS can characterize changes in treatment choices and estimating separate PSs within specific calendar time periods may result in enhanced confounding control. To increase validity of comparative effectiveness research, researchers should carefully consider drug lifecycles and effects of innovative treatment dissemination over time.
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Affiliation(s)
- Christina DeFilippo Mack
- Department of Epidemiology, UNC Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, NC 27599, USA.
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Jones L, Akugizibwe P, Clayton M, Amon JJ, Sabin ML, Bennett R, Stegling C, Baggaley R, Kahn JG, Holmes CB, Garg N, Obermeyer CM, Mack CD, Williams P, Smyth C, Vitoria M, Crowley S, Williams B, McClure C, Granich R, Hirnschall G. Costing human rights and community support interventions as a part of universal access to HIV treatment and care in a Southern African setting. Curr HIV Res 2012; 9:416-28. [PMID: 21999777 PMCID: PMC3531822 DOI: 10.2174/157016211798038614] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [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] [Received: 07/12/2010] [Revised: 07/28/2011] [Accepted: 07/29/2011] [Indexed: 12/04/2022]
Abstract
Expanding access to antiretroviral therapy (ART) has both individual health benefits and potential to decrease HIV incidence. Ensuring access to HIV services is a significant human rights issue and successful programmes require adequate human rights protections and community support. However, the cost of specific human rights and community support interventions for equitable, sustainable and non-discriminatory access to ART are not well described. Human rights and community support interventions were identified using the literature and through consultations with experts. Specific costs were then determined for these health sector interventions. Population and epidemic data were provided through the Statistics South Africa 2009 national mid-year estimates. Costs of scale up of HIV prevention and treatment were taken from recently published estimates. Interventions addressed access to services, minimising stigma and discrimination against people living with HIV, confidentiality, informed consent and counselling quality. Integrated HIV programme interventions included training for counsellors, ‘Know Your Rights’ information desks, outreach campaigns for most at risk populations, and adherence support. Complementary measures included post-service interviews, human rights abuse monitoring, transportation costs, legal assistance, and funding for human rights and community support organisations. Other essential non-health sector interventions were identified but not included in the costing framework. The annual costs for the human rights and community support interventions are United States (US) $63.8 million (US $1.22 per capita), representing 1.5% of total health sector HIV programme costs. Respect for human rights and community engagement can be understood both as an obligation of expanded ART programmes and as a critically important factor in their success. Basic rights-based and community support interventions constitute only a small percentage of overall programmes costs. ART programs should consider measuring the cost and impact of human rights and community support interventions as key aspects of successful programme expansion.
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Abstract
OBJECTIVE To determine the number and characteristics of motor vehicle crash deaths related to police pursuits in the United States. METHODS Analysis of the Fatality Analysis Reporting System and the Crashworthiness Data System of the National Highway Traffic Safety Administration for the years 1994-2002. RESULTS There were 2654 fatal crashes involving 3965 vehicles and 3146 fatalities during the nine year study period. Of these, 1088 were to people not in the fleeing vehicle. These crashes often occurred at high speed, in the night, on local roads. Most of the pursued drivers had prior motor vehicle related convictions. CONCLUSIONS Many deaths related to police pursuits are to innocent victims. Given that most of the pursued drivers had prior convictions, alternative means of detaining them should be explored.
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Affiliation(s)
- F P Rivara
- Harborview Injury Prevention and Research Center, Department of Epidemiology, University of Washington, Seattle 98104, USA.
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Brundage SI, Jurkovich GJ, Grossman DC, Tong WC, Mack CD, Maier RV. Stapled versus sutured gastrointestinal anastomoses in the trauma patient. J Trauma 1999; 47:500-7; discussion 507-8. [PMID: 10498304 DOI: 10.1097/00005373-199909000-00011] [Citation(s) in RCA: 32] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
BACKGROUND Construction of gastrointestinal anastomoses by using stapling devices has become a familiar procedure. Most studies have shown no significant differences in complication rates between stapled and sutured anastomoses performed during elective surgery. To date, no study has evaluated the incidence of complications of stapled anastomoses in the trauma patient. The purpose of our study was to determine whether the incidence of postoperative complications differs between stapled and sutured anastomoses after the emergent repair of traumatic bowel injuries. METHODS A retrospective analysis of the medical and institutional trauma registry records of patients identified to have undergone a gastrointestinal anastomosis in a regional Level I trauma center over a 4-year period. RESULTS A total of 84 patients with 118 gastrointestinal anastomoses were identified. A surgical stapling device was used to create 58 separate anastomoses, whereas a hand-sutured method was used in 60 anastomoses. A complication was defined as an anastomotic leak verified at reoperation. The ratio of blunt versus penetrating injuries, mean abdominal Abbreviated Injury Scale score, and Injury Severity Score were similar in the two groups. Stapling and suturing techniques were evenly distributed between small and large bowel repairs. Mean intensive care unit length of stay was comparable in both cohorts. However, inpatient length of stay was longer in patients with solely a stapled anastomosis compared with sutured anastomoses. Four of the 58 stapled anastomoses and none of the 60 hand-sewn anastomoses resulted in a clinically significant leak requiring reoperation (relative risk = undefined; 95% confidence interval, 1.14-infinity; p = 0.037). Each anastomotic leak occurred in a separate individual. The only death occurred in the stapled cohort secondary to peritonitis and subsequent sepsis. CONCLUSION Anastomotic leaks seem to be associated with stapled bowel repairs compared with sutured anastomoses in the traumatically injured patient.
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Affiliation(s)
- S I Brundage
- Department of Surgery, The University of Washington, Seattle, USA
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