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Pescarini JM, Goes E, Scaff P, Schindler B, Rodrigues LC, Brickley EB, Smeeth L, Barreto ML. Mortality among internal and international migrants in the 100 Million Brazilian Cohort. Eur J Public Health 2022. [DOI: 10.1093/eurpub/ckac129.653] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Abstract
Background
There is limited evidence on the health of migrant populations in low and middle-income countries (LMICs). Here, we investigated the patterns of mortality risk in migrants and non-migrants in women and men over the life course.
Methods
We linked socioeconomic and mortality data from 1st Jan 2011 to 31st Dec 2018 in the 100 Million Brazilian Cohort. We calculated all-cause and cause-specific age-standardised mortality rates according to individuals’ migration status. Using Cox regression models, we estimated the age- and sex-adjusted mortality hazard ratios (HR) for internal migrants (i.e., people born in Brazil but living in a different Brazilian state to their state of birth) compared to Brazilian-born non-migrants; and for international migrants (i.e., people born in another country) compared to Brazilian-born individuals.
Results
We followed 45,051,476 individuals, of whom 6,057,814 were internal migrants and 277,230 were international migrants. Internal migrants had a similar overall risk of all-cause mortality compared to Brazilian non-migrants (aHR=0.99, 95%CI=0.98-0.99), with lower mortality from some causes but higher mortality for some non-communicable diseases (NCDs). Compared to Brazilian-born individuals, international migrants had a lower risk of all-cause mortality (aHR=0.82, 95%CI=0.80-0.84), with up to 50% lower risk of death attributed to interpersonal violence among international migrant men (aHR=0.50, 95%CI=0.40-0.64), but a markedly higher risk of death by avoidable causes related to maternal health among young migrant women (aHR=2.17, 95%CI=1.17-4.05).
Conclusions
Overall, internal migration was not associated with excess all-cause mortality, while international migration into Brazil was associated with lower all-cause mortality. Mortality patterns among migrant populations in Brazil show marked variation for specific causes of death, and risks varied by age and sex.
Key messages
• Non-communicable diseases and maternal mortality are disproportionally higher among internal and international migrants, respectively.
• Further investigation of the underlying factors associated with higher maternal mortality among international migrant women is key to informing the targeting of social and health interventions.
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Affiliation(s)
- JM Pescarini
- Centre of Data and Knowledge Integration for Health, Oswaldo Cruz Foundation , Salvador, Brazil
- Faculty of Epidemiology and Population, LSHTM , London, Brazil
| | - E Goes
- Centre of Data and Knowledge Integration for Health, Oswaldo Cruz Foundation , Salvador, Brazil
| | - P Scaff
- Centre of Data and Knowledge Integration for Health, Oswaldo Cruz Foundation , Salvador, Brazil
| | - B Schindler
- Centre of Data and Knowledge Integration for Health, Oswaldo Cruz Foundation , Salvador, Brazil
| | - LC Rodrigues
- Faculty of Epidemiology and Population, LSHTM , London, Brazil
| | - EB Brickley
- Faculty of Epidemiology and Population, LSHTM , London, Brazil
| | - L Smeeth
- Faculty of Epidemiology and Population, LSHTM , London, Brazil
| | - ML Barreto
- Centre of Data and Knowledge Integration for Health, Oswaldo Cruz Foundation , Salvador, Brazil
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Schonmann Y, Mansfield KE, Mulick A, Roberts A, Smeeth L, Langan SM, Nitsch D. Inflammatory skin diseases and the risk of chronic kidney disease: population-based case-control and cohort analyses. Br J Dermatol 2021; 185:772-780. [PMID: 33730366 DOI: 10.1111/bjd.20067] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/12/2021] [Indexed: 12/14/2022]
Abstract
BACKGROUND Emerging evidence suggests an association between common inflammatory skin diseases and chronic kidney disease (CKD). OBJECTIVES To explore the association between CKD stages 3-5 (CKD3-5) and atopic eczema, psoriasis, rosacea and hidradenitis suppurativa. METHODS We undertook two complementary analyses; a prevalent case-control study and a cohort study using routinely collected primary care data [UK Clinical Practice Research Datalink (CPRD)]. We matched individuals with CKD3-5 in CPRD in March 2018 with up to five individuals without CKD for general practitioner practice, age and sex. We compared the prevalence of CKD3-5 among individuals with and without each inflammatory skin disease. We included individuals in CPRD with diabetes mellitus (2004-2018) in a cohort analysis to compare the incidence of CKD3-5 among people with and without atopic eczema and psoriasis. RESULTS Our study included 56 602 cases with CKD3-5 and 268 305 controls. Cases were more likely than controls to have a history of atopic eczema [odds ratio (OR) 1·14, 99% confidence interval (CI) 1·11-1·17], psoriasis (OR 1·13, 99% CI 1·08-1·19) or hidradenitis suppurativa (OR 1·49, 99% CI 1·19-1·85), but were slightly less likely to have been diagnosed with rosacea (OR 0·92, 99% CI 0·87-0·97), after adjusting for age, sex, practice (matching factors), index of multiple deprivation, diabetes, smoking, harmful alcohol use and obesity. Results remained similar after adjusting for hypertension and cardiovascular disease. In the cohort with diabetes (N = 335 827), there was no evidence that CKD3-5 incidence was associated with atopic eczema or psoriasis. CONCLUSIONS Atopic eczema, psoriasis and hidradenitis suppurativa are weakly associated with CKD3-5. Future research is needed to elucidate potential mechanisms and the clinical significance of our findings.
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Affiliation(s)
- Y Schonmann
- Department of Non-communicable Disease Epidemiology, Faculty of Epidemiology and Population Health, London School of Hygiene and Tropical Medicine, London, UK.,Department of Quality Measurements and Research, Clalit Health Services, Tel Aviv, Israel.,Siaal Research Center for Family Medicine and Primary Care, Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer-Sheva, Israel
| | - K E Mansfield
- Department of Non-communicable Disease Epidemiology, Faculty of Epidemiology and Population Health, London School of Hygiene and Tropical Medicine, London, UK
| | - A Mulick
- Department of Non-communicable Disease Epidemiology, Faculty of Epidemiology and Population Health, London School of Hygiene and Tropical Medicine, London, UK
| | - A Roberts
- Nottingham Support Group for Carers of Children with Eczema, Nottingham, UK
| | - L Smeeth
- Department of Non-communicable Disease Epidemiology, Faculty of Epidemiology and Population Health, London School of Hygiene and Tropical Medicine, London, UK
| | - S M Langan
- Department of Non-communicable Disease Epidemiology, Faculty of Epidemiology and Population Health, London School of Hygiene and Tropical Medicine, London, UK.,St John's Institute of Dermatology, Guy's & St Thomas' Hospital NHS Foundation Trust and King's College London, London, UK.,Health Data Research, London, UK
| | - D Nitsch
- Department of Non-communicable Disease Epidemiology, Faculty of Epidemiology and Population Health, London School of Hygiene and Tropical Medicine, London, UK.,Renal Department, Royal Free London NHS Foundation Trust, London, UK.,UK Renal Registry, Bristol, UK
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Matthewman J, Mansfield K, Prieto-Alhambra D, Mulick A, Smeeth L, Lowe K, Silverwood R, Langan S. 059 Atopic-eczema-associated fracture risk and oral corticosteroids: a population-based cohort study. J Invest Dermatol 2021. [DOI: 10.1016/j.jid.2021.08.061] [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: 11/29/2022]
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Mulick AR, Mansfield KE, Silverwood RJ, Budu-Aggrey A, Roberts A, Custovic A, Pearce N, Irvine AD, Smeeth L, Abuabara K, Langan SM. Four childhood atopic dermatitis subtypes identified from trajectory and severity of disease and internally validated in a large UK birth cohort. Br J Dermatol 2021; 185:526-536. [PMID: 33655501 PMCID: PMC8410876 DOI: 10.1111/bjd.19885] [Citation(s) in RCA: 15] [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] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
BACKGROUND Atopic dermatitis (AD) disease activity and severity is highly variable during childhood. Early attempts to identify subtypes based on disease trajectory have assessed AD presence over time without incorporating severity. OBJECTIVES To identify childhood AD subtypes from symptom severity and trajectories, and determine associations with genetic risk factors, comorbidities and demographic and environmental variables. METHODS We split data from children in the Avon Longitudinal Study of Parents and Children birth cohort into development and validation sets. To identify subtypes, we ran latent class analyses in the development set on AD symptom reports up to age 14 years. We regressed identified subtypes on nongenetic variables in mutually adjusted, multiply imputed (genetic: unadjusted, complete case) multinomial regression analyses. We repeated analyses in the validation set and report confirmed results. RESULTS There were 11 866 children who contributed to analyses. We identified one Unaffected/Rare class (66% of children) and four AD subtypes: Severe-Frequent (4%), Moderate-Frequent (7%), Moderate-Declining (11%) and Mild-Intermittent (12%). Symptom patterns within the first two subtypes appeared more homogeneous than the last two. Filaggrin (FLG) null mutations, an AD polygenic risk score (PRS), being female, parental AD and comorbid asthma were associated with higher risk for some or all subtypes; FLG, AD-PRS and asthma associations were stronger along a subtype gradient arranged by increasing severity and frequency; FLG and AD-PRS further differentiated some phenotypes from each other. CONCLUSIONS Considering severity and AD trajectories leads to four well-defined and recognizable subtypes. The differential associations of risk factors among and between subtypes is novel and requires further research.
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Affiliation(s)
- A R Mulick
- Department of Non-Communicable Disease Epidemiology, Faculty of Epidemiology and Population Health, London School of Hygiene and Tropical Medicine, London, UK
| | - K E Mansfield
- Department of Non-Communicable Disease Epidemiology, Faculty of Epidemiology and Population Health, London School of Hygiene and Tropical Medicine, London, UK
| | - R J Silverwood
- Centre for Longitudinal Studies, Department of Social Science, University College London, London, UK
- Department of Medical Statistics, Faculty of Epidemiology and Population Health, London School of Hygiene and Tropical Medicine, London, UK
| | - A Budu-Aggrey
- MRC Integrative Epidemiology Unit, University of Bristol, Bristol, UK
| | - A Roberts
- Nottingham Support Group for Carers of Children with Eczema, Nottingham, UK
| | - A Custovic
- National Heart & Lung Institute, Imperial College London, London, UK
| | - N Pearce
- Department of Non-Communicable Disease Epidemiology, Faculty of Epidemiology and Population Health, London School of Hygiene and Tropical Medicine, London, UK
- Department of Medical Statistics, Faculty of Epidemiology and Population Health, London School of Hygiene and Tropical Medicine, London, UK
| | - A D Irvine
- Clinical Medicine, Trinity College Dublin, Dublin 2, Ireland
| | - L Smeeth
- Department of Non-Communicable Disease Epidemiology, Faculty of Epidemiology and Population Health, London School of Hygiene and Tropical Medicine, London, UK
| | - K Abuabara
- Department of Dermatology, University of California San Francisco, San Francisco, CA, USA
| | - S M Langan
- Department of Non-Communicable Disease Epidemiology, Faculty of Epidemiology and Population Health, London School of Hygiene and Tropical Medicine, London, UK
- Health Data Research UK, London, UK
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Jansen ES, Agyemang C, Boateng D, Danquah I, Beune E, Smeeth L, Klipstein-Grobusch K, Stronks K, Meeks KAC. Rural and urban migration to Europe in relation to cardiovascular disease risk: does it matter where you migrate from? Public Health 2021; 196:172-178. [PMID: 34233244 PMCID: PMC8349844 DOI: 10.1016/j.puhe.2021.06.001] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2020] [Revised: 05/17/2021] [Accepted: 06/01/2021] [Indexed: 10/20/2022]
Abstract
OBJECTIVES To assess whether the environmental context (i.e. rural vs urban) in which individuals in low- and middle-income countries have resided most of their lives is associated with estimated cardiovascular disease (CVD) risk after migration to a high-income country. STUDY DESIGN Data from the Research on Obesity and Diabetes among African Migrants (RODAM) study were used including 1699 Ghanaian participants aged 40-79 years who had migrated to Europe from Ghana (1549 of urban origin, 150 of rural origin). METHODS Ten-year CVD risk was estimated using the Pooled Cohort Equation, with estimates ≥7.5% defining elevated CVD risk. Comparisons between urban and rural origin migrant groups were made using proportions and adjusted odds ratios (ORs). RESULTS The proportion of migrants with an elevated CVD-risk score was substantially higher among rural migrants than among urban migrants (45% vs. 37%, OR = 1.44, 95% confidence interval [CI]:1.03-2.02), which persisted after adjustment for education level, site of residence in Europe (London, Amsterdam or Berlin), length of stay in Europe, physical activity, energy intake and alcohol consumption (OR = 1.67, 95% CI: 1.05-2.67). CONCLUSION Our findings indicate that migrants who spent most of their lives in a rural setting before migration to Europe may have a higher CVD risk than those of urban origins. Further work is needed to confirm these findings in other migrant populations and to unravel the mechanisms driving the differential CVD risk between urban and rural migrants.
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Affiliation(s)
- E S Jansen
- Department of Public Health, Amsterdam Public Health Research Institute, Academic Medical Center, Amsterdam UMC, University of Amsterdam, Meibergdreef 15, 1105AZ, Amsterdam, the Netherlands
| | - C Agyemang
- Department of Public Health, Amsterdam Public Health Research Institute, Academic Medical Center, Amsterdam UMC, University of Amsterdam, Meibergdreef 15, 1105AZ, Amsterdam, the Netherlands
| | - D Boateng
- Julius Global Health, Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht University, Universiteitsweg 100, 3508GA, Utrecht, the Netherlands; School of Public Health, Kwame Nkrumah University of Science and Technology, Accra Rd, Kumasi, Ghana
| | - I Danquah
- Department of Molecular Epidemiology, German Institute of Human Nutrition Potsdam-Rehbruecke, Arthur-Scheunert-Allee 114-116, 14558, Nuthetal, Germany; Institute for Social Medicine, Epidemiology and Health Economics, Charité-Universitaetsmedizin Berlin, Charitépl, 10117, Berlin, Germany
| | - E Beune
- Department of Public Health, Amsterdam Public Health Research Institute, Academic Medical Center, Amsterdam UMC, University of Amsterdam, Meibergdreef 15, 1105AZ, Amsterdam, the Netherlands
| | - L Smeeth
- Department of Non-communicable Disease Epidemiology, London School of Hygiene and Tropical Medicine, Keppel St, Bloomsbury, London, WC1E 7HT, United Kingdom
| | - K Klipstein-Grobusch
- Julius Global Health, Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht University, Universiteitsweg 100, 3508GA, Utrecht, the Netherlands; Division of Epidemiology and Biostatistics, School of Public Health, University of the Witwatersrand, 1 Jan Smuts Ave, Johannesburg, 2000, South Africa
| | - K Stronks
- Department of Public Health, Amsterdam Public Health Research Institute, Academic Medical Center, Amsterdam UMC, University of Amsterdam, Meibergdreef 15, 1105AZ, Amsterdam, the Netherlands
| | - K A C Meeks
- Department of Public Health, Amsterdam Public Health Research Institute, Academic Medical Center, Amsterdam UMC, University of Amsterdam, Meibergdreef 15, 1105AZ, Amsterdam, the Netherlands; Center for Research on Genomics and Global Health, National Human Genome Research Institute, National Institutes of Health, 12 South Dr, Bethesda, MD, 20892-5635, USA.
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Forbes H, Bhaskaran K, Grint D, Hu V, Langan S, McDonald H, Morton C, Smeeth L, Walker J, Warren‐Gash C. Incidence of acute complications of herpes zoster among immunocompetent adults in England: a matched cohort study using routine health data. Br J Dermatol 2021; 184:1077-1084. [PMID: 33216946 PMCID: PMC8607468 DOI: 10.1111/bjd.19687] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/16/2020] [Indexed: 01/17/2023]
Abstract
BACKGROUND Herpes zoster can cause rare but serious complications; the frequency of these complications has not been well described. OBJECTIVES To quantify the risks of acute non-postherpetic neuralgia (PHN) zoster complications, to inform vaccination policy. METHODS We conducted a cohort study among unvaccinated immunocompetent adults with incident zoster, and age-, sex- and practice-matched control adults without zoster, using routinely collected health data from the UK Clinical Practice Research Datalink (years 2001 to 2018). Crude attributable risks of complications were estimated as the difference between Kaplan-Meier-estimated 3-month cumulative incidences in patients with zoster vs. controls. We used Cox models to obtain hazard ratios for our primary outcomes in patients with and without zoster. Primary outcomes were ocular, neurological, cutaneous, visceral and zoster-specific complications. We also assessed whether antivirals during acute zoster protected against the complications. RESULTS In total 178 964 incident cases of zoster and 1 799 380 controls were included. The absolute risks of zoster-specific complications within 3 months of zoster diagnosis were 0·37% [95% confidence interval (CI) 0·34-0·39] for Ramsay Hunt syndrome, 0·01% (95% CI 0·0-0·01) for disseminated zoster, 0·04% (95% CI 0·03-0·05) for zoster death and 0·97% (95% CI 0·92-1·00) for zoster hospitalization. For other complications, attributable risks were 0·48% (95% CI 0·44-0·51) for neurological complications, 1·33% (95% CI 1·28-1·39) for ocular complications, 0·29% (95% CI 0·26-0·32) for cutaneous complications and 0·78% (95% CI 0·73-0·84) for visceral complications. Attributable risks were higher among patients > 50 years old. Patients with zoster had raised risks of all primary outcomes relative to controls. Antiviral prescription was associated with reduced risk of neurological complications (hazard ratio 0·61, 95% CI 0·53-0·70). CONCLUSIONS Non-PHN complications of zoster were relatively common, which may affect cost-effectiveness calculations for zoster vaccination. Clinicians should be aware that zoster can lead to various complications, besides PHN.
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Affiliation(s)
- H.J. Forbes
- London School of Hygiene & Tropical MedicineLondonUK
| | - K. Bhaskaran
- London School of Hygiene & Tropical MedicineLondonUK
| | - D. Grint
- London School of Hygiene & Tropical MedicineLondonUK
- NIHR Health Protection Research Unit in ImmunisationLondonUK
| | - V.H. Hu
- London School of Hygiene & Tropical MedicineLondonUK
| | - S.M. Langan
- London School of Hygiene & Tropical MedicineLondonUK
| | - H.I. McDonald
- London School of Hygiene & Tropical MedicineLondonUK
- NIHR Health Protection Research Unit in ImmunisationLondonUK
| | - C. Morton
- London School of Hygiene & Tropical MedicineLondonUK
| | - L. Smeeth
- London School of Hygiene & Tropical MedicineLondonUK
| | - J.L. Walker
- London School of Hygiene & Tropical MedicineLondonUK
- NIHR Health Protection Research Unit in ImmunisationLondonUK
- Statistics, Modelling and Economics DepartmentPublic Health EnglandLondonUK
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Mulick A, Mansfield K, Silverwood R, Budu-Aggrey A, Roberts A, Custovic A, Pearce N, Irvine A, Smeeth L, Abuabara K, Langan S. 247 Four childhood atopic dermatitis subtypes identified from trajectory and severity of disease. J Invest Dermatol 2021. [DOI: 10.1016/j.jid.2021.02.269] [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: 11/27/2022]
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Österdahl MF, Wong A, Douglas I, Sinnott SJ, Smeeth L, Williamson E, Tomlinson L. 11 Frailty and the Rate of Fractures in Patients Initiated on Antihypertensive Medication. Age Ageing 2021. [DOI: 10.1093/ageing/afab028.11] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Abstract
Introduction
There is concern regarding adverse effects of antihypertensive treatment, including falls and subsequent fractures, especially hip fractures. As frailty is increasingly recognised as an important risk factor for adverse outcomes, we examined its relationship to fracture rates in older patients after starting antihypertensives.
Methods
Using the Clinical Practice Research Datalink (CPRD), we identified participants over 65-years old starting a first-line antihypertensive medication. Using deficits identified in CPRD we classified patient-level frailty as “Fit”, “Mild”, “Moderate” or “Severe” using the Electronic Frailty Index. We calculated the rate of fractures by frailty level and fracture site, and determined the rate ratio (RR) of first fracture by frailty level, adjusting for confounding, using multivariable poisson regression. We conducted sensitivity analyses to additionally adjust for ethnicity, deprivation, and bisphosphonate use.
Results
44% of participants were classified as mildly frail or greater, but frail participants experienced 58% of all fractures, and 63% of hip fractures. The whole cohort showed a crude rate of 14.1 fractures/1000 person-years, with 4.5 hip fractures/1000 person-years. In severe frailty, this rises to 51.0 fractures/1000 person-years, and 17.7 hip fractures/1000 person-years. After adjustment for confounding, increasing frailty was associated with greater rate of any fracture, reaching RR 2.85 (95% confidence interval 2.43–3.33) for severe frailty versus fit. Results were unchanged in sensitivity analyses.
Conclusions
Frailty and fracture are both common in older participants who start antihypertensive medications. Increasing frailty was positively associated with increased rates of fracture. Clinicians need awareness of this relationship to consider fracture risk assessment and prevention in these patients.
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Affiliation(s)
- M F Österdahl
- London School of Hygiene & Tropical Medicine, Keppel St, London, UK
- Guy’s and St Thomas’ NHS Foundation Trust, Westminster Bridge Rd, London, UK
| | - A Wong
- London School of Hygiene & Tropical Medicine, Keppel St, London, UK
| | - I Douglas
- London School of Hygiene & Tropical Medicine, Keppel St, London, UK
| | - S J Sinnott
- London School of Hygiene & Tropical Medicine, Keppel St, London, UK
| | - L Smeeth
- London School of Hygiene & Tropical Medicine, Keppel St, London, UK
| | - E Williamson
- London School of Hygiene & Tropical Medicine, Keppel St, London, UK
| | - L Tomlinson
- London School of Hygiene & Tropical Medicine, Keppel St, London, UK
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Ascott A, Mansfield KE, Schonmann Y, Mulick A, Abuabara K, Roberts A, Smeeth L, Langan SM. Atopic eczema and obesity: a population-based study. Br J Dermatol 2020; 184:871-879. [PMID: 33090454 DOI: 10.1111/bjd.19597] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/02/2020] [Indexed: 12/28/2022]
Abstract
BACKGROUND Atopic eczema is a common chronic inflammatory skin disease. Research suggests an association between atopic eczema and obesity, with inconsistent evidence from European populations. OBJECTIVES To explore the association between diagnosed atopic eczema and being overweight or obese, and whether increased atopic eczema severity was associated with higher body mass index. METHODS We undertook a cross-sectional analysis within a cohort of adults (matched by age, sex and general practice) with and without a diagnosis of atopic eczema. We used primary care (Clinical Practice Research Datalink Gold) and linked hospital admissions data (1998-2016). We used conditional logistic regression to compare the odds of being overweight or obese (adjusting for confounders and potential mediators) in those with atopic eczema (mild, moderate and severe, and all eczema) vs. those without. RESULTS We identified 441 746 people with atopic eczema, matched to 1 849 722 without. People with atopic eczema had slightly higher odds of being overweight or obese vs. those without [odds ratio (OR) 1·08, 95% confidence interval (CI) 1·07-1·09] after adjusting for age, asthma and socioeconomic deprivation. Adjusting for potential mediators (high-dose glucocorticoids, harmful alcohol use, anxiety, depression, smoking) had a minimal impact on effect estimates (OR 1·07, 95% CI 1·06-1·08). We saw no evidence that odds of being overweight or obese increased with increasing atopic eczema severity, and there was no association in people with severe eczema. CONCLUSIONS We found evidence of a small overall association between atopic eczema and being overweight or obese. However, there was no association with obesity among those with the most severe eczema. Our findings are largely reassuring for this prevalent patient group who may already have an increased risk of cardiovascular disease.
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Affiliation(s)
- A Ascott
- Faculty of Epidemiology and Population Health, London School of Hygiene and Tropical Medicine, Keppel Street, London, WC1E 7HT, UK.,Royal Sussex County Hospital, Brighton and Sussex University Hospitals NHS Trust, Eastern Road, Brighton, UK
| | - K E Mansfield
- Faculty of Epidemiology and Population Health, London School of Hygiene and Tropical Medicine, Keppel Street, London, WC1E 7HT, UK
| | - Y Schonmann
- Faculty of Epidemiology and Population Health, London School of Hygiene and Tropical Medicine, Keppel Street, London, WC1E 7HT, UK.,Department of Quality Measurements and Research, Clalit Health Services, Tel Aviv, Israel.,Siaal Research Center for Family Medicine and Primary Care, Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer-Sheva, Israel
| | - A Mulick
- Faculty of Epidemiology and Population Health, London School of Hygiene and Tropical Medicine, Keppel Street, London, WC1E 7HT, UK
| | - K Abuabara
- Program for Clinical Research, Department of Dermatology, University of California, San Francisco School of Medicine, San Francisco, CA, USA
| | - A Roberts
- Nottingham Support Group for Carers of Children with Eczema, Nottingham, UK
| | - L Smeeth
- Faculty of Epidemiology and Population Health, London School of Hygiene and Tropical Medicine, Keppel Street, London, WC1E 7HT, UK
| | - S M Langan
- Faculty of Epidemiology and Population Health, London School of Hygiene and Tropical Medicine, Keppel Street, London, WC1E 7HT, UK.,St John's Institute of Dermatology, Guy's & St Thomas' Hospital NHS Foundation Trust and King's College London, London, UK.,Health Data Research UK, London, UK
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Wong A, Frøslev T, Dearing L, Forbes H, Mulick A, Mansfield K, Silverwood R, Kjærsgaard A, Sørensen H, Smeeth L, Lewin A, Schmidt S, Langan S. The association between partner bereavement and melanoma: cohort studies in the U.K. and Denmark. Br J Dermatol 2020; 183:673-683. [PMID: 32128788 PMCID: PMC7587014 DOI: 10.1111/bjd.18889] [Citation(s) in RCA: 5] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/18/2020] [Indexed: 12/14/2022]
Abstract
BACKGROUND Psychological stress is commonly cited as a risk factor for melanoma, but clinical evidence is limited. OBJECTIVES This study aimed to evaluate the association between partner bereavement and (i) first-time melanoma diagnosis and (ii) mortality in patients with melanoma. METHODS We conducted two cohort studies using data from the U.K. Clinical Practice Research Datalink (1997-2017) and Danish nationwide registries (1997-2016). In study 1, we compared the risk of first melanoma diagnosis in bereaved vs. matched nonbereaved people using stratified Cox regression. In study 2 we estimated hazard ratios (HRs) for death from melanoma in bereaved compared with nonbereaved individuals with melanoma using Cox regression. We estimated HRs separately for the U.K. and for Denmark, and then pooled the data to perform a random-effects meta-analysis. RESULTS In study 1, the pooled adjusted HR for the association between partner bereavement and melanoma diagnosis was 0·88 [95% confidence interval (CI) 0·84-0·92] across the entire follow-up period. In study 2, we observed increased melanoma-specific mortality in people experiencing partner bereavement across the entire follow-up period (HR 1·17, 95% CI 1·06-1·30), with the peak occurring during the first year of follow-up (HR 1·31, 95% CI 1·07-1·60). CONCLUSIONS We found decreased risk of melanoma diagnosis, but increased mortality associated with partner bereavement. These findings may be partly explained by delayed detection resulting from the loss of a partner who could notice skin changes. Stress may play a role in melanoma progression. Our findings indicate the need for a low threshold for skin examination in individuals whose partners have died. What is already known about this topic? Psychological stress has been proposed as a risk factor for the development and progression of cancer, including melanoma, but evidence is conflicting. Clinical evidence is limited by small sample sizes, potential recall bias associated with self-report, and heterogeneous stress definitions. What does this study add? We found a decreased risk of melanoma diagnosis, but increased mortality associated with partner bereavement. While stress might play a role in the progression of melanoma, an alternative explanation is that bereaved people no longer have a close person to help notice skin changes, leading to delayed melanoma detection. Linked Comment: Talaganis et al. Br J Dermatol 2020; 183:607-608.
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Affiliation(s)
- A.Y.S. Wong
- Faculty of Epidemiology and Population Health, London School of Hygiene and Tropical MedicineLondonU.K
| | - T. Frøslev
- Department of Clinical EpidemiologyAarhus University HospitalAarhusDenmark
| | - L. Dearing
- Faculty of Epidemiology and Population Health, London School of Hygiene and Tropical MedicineLondonU.K
| | - H.J. Forbes
- Faculty of Epidemiology and Population Health, London School of Hygiene and Tropical MedicineLondonU.K
- Health Data Research UKLondonU.K
| | - A. Mulick
- Faculty of Epidemiology and Population Health, London School of Hygiene and Tropical MedicineLondonU.K
| | - K.E. Mansfield
- Faculty of Epidemiology and Population Health, London School of Hygiene and Tropical MedicineLondonU.K
| | - R.J. Silverwood
- Faculty of Epidemiology and Population Health, London School of Hygiene and Tropical MedicineLondonU.K
- Centre for Longitudinal StudiesDepartment of Social ScienceUniversity College LondonLondonU.K
| | - A. Kjærsgaard
- Department of Clinical EpidemiologyAarhus University HospitalAarhusDenmark
| | - H.T. Sørensen
- Department of Clinical EpidemiologyAarhus University HospitalAarhusDenmark
| | - L. Smeeth
- Faculty of Epidemiology and Population Health, London School of Hygiene and Tropical MedicineLondonU.K
- Health Data Research UKLondonU.K
| | - A. Lewin
- Faculty of Epidemiology and Population Health, London School of Hygiene and Tropical MedicineLondonU.K
| | - S.A.J. Schmidt
- Department of Clinical EpidemiologyAarhus University HospitalAarhusDenmark
- Department of DermatologyAarhus University HospitalAarhusDenmark
| | - S.M. Langan
- Faculty of Epidemiology and Population Health, London School of Hygiene and Tropical MedicineLondonU.K
- Health Data Research UKLondonU.K
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11
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Wong AYS, Kjaersgaard A, Frøslev T, Forbes HJ, Mansfield KE, Silverwood RJ, Sørensen HT, Smeeth L, Schmidt SAJ, Langan SM. Partner bereavement and risk of chronic urticaria, alopecia areata and vitiligo: cohort studies in the UK and Denmark. Br J Dermatol 2020; 183:761-763. [PMID: 32282926 DOI: 10.1111/bjd.19122] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Affiliation(s)
- A Y S Wong
- Faculty of Epidemiology and Population Health, London School of Hygiene and Tropical Medicine, London, UK
| | - A Kjaersgaard
- Department of Clinical Epidemiology, Aarhus University Hospital, Aarhus, Denmark
| | - T Frøslev
- Department of Clinical Epidemiology, Aarhus University Hospital, Aarhus, Denmark
| | - H J Forbes
- Faculty of Epidemiology and Population Health, London School of Hygiene and Tropical Medicine, London, UK
- Health Data Research, UK
| | - K E Mansfield
- Faculty of Epidemiology and Population Health, London School of Hygiene and Tropical Medicine, London, UK
| | - R J Silverwood
- Faculty of Epidemiology and Population Health, London School of Hygiene and Tropical Medicine, London, UK
- Centre for Longitudinal Studies, Department of Social Science, University College London, London, UK
| | - H T Sørensen
- Department of Clinical Epidemiology, Aarhus University Hospital, Aarhus, Denmark
| | - L Smeeth
- Faculty of Epidemiology and Population Health, London School of Hygiene and Tropical Medicine, London, UK
- Health Data Research, UK
| | - S A J Schmidt
- Department of Clinical Epidemiology, Aarhus University Hospital, Aarhus, Denmark
- Department of Dermatology, Aarhus University Hospital, Aarhus, Denmark
| | - S M Langan
- Faculty of Epidemiology and Population Health, London School of Hygiene and Tropical Medicine, London, UK
- Health Data Research, UK
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12
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Pescarini JM, Craig P, Allik M, Amorim L, Ali MS, Smeeth L, Barreto ML, Leyland A, Aquino EML, Katikireddi SV. The Brazilian conditional cash transfer program and cardiovascular mortality: a data linkage study. Eur J Public Health 2020. [DOI: 10.1093/eurpub/ckaa165.1418] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Abstract
Background
Conditional cash transfer programmes (CCTs) make monetary transfers to poor families conditional on health check-ups and/or education attendance. CCTs have been key in reducing poverty and improving child and maternal health in low- and middle-income countries (LMICs) but their impact on cardiovascular mortality have not been studied. We aimed to evaluate the effect of the CCT Bolsa Familia Program (BFP) on premature all-cause and cardiovascular mortality in Brazil.
Methods
The 100 Million Brazilian Cohort combined information about individuals applying for social programmes, the BFP and mortality data. We analysed ∼8 million individuals aged 30-69 who applied from 2011 to 2015. We calculated inverse probability weights (IPW) for the probability to receive BFP based on baseline observed characteristics (age, education, race, geographical location, household characteristics and year of application). Individuals were followed until they reached 70 years of age, died by any cause, or until 31st Dec 2015. We used Poisson regression (with person-years as the offset) and IPWs to compare BFP recipients to a comparable control population. Females and males were analysed separately.
Results
By following individuals for up to 4 years, 43,562 deaths by all-causes occurred among 4,197,658 females and 69,209 deaths among 3,672,393 males. Female BFP beneficiaries had approximately 60% lower all-cause mortality (IRR=0.40;95%CI=0.37-0.42) and CVD mortality (IRR=0.42;95%CI=0.37-0.47) than non-beneficiaries. Males who are BFP beneficiaries had ∼50% lower all-cause (IRR=0.53;95%CI=0.52-0.55) and 60% lower cardiovascular mortality (IRR=0.40;95%CI=0.38-0.42) than non-beneficiaries.
Conclusions
BFP, the world's largest CCT, may substantially decrease premature mortality. CCTs might have important implications for the growing burden of non-communicable diseases, with impacts potentially due to improved nutrition, socioeconomic conditions and improved primary care access.
Key messages
The Brazilian CCT, a widely recognized programme for poverty alleviation, have showed to be associated with lower overall and cardiovascular premature mortality in both women and men. Other countries, particularly LMICs, may learn from the health benefits of CCTs and should consider its potential large effect on mortality when planning austerity policies.
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Affiliation(s)
- J M Pescarini
- The Center for Data and Knowledge Integration for Health, Oswaldo Cruz Foundation, Salvador, Brazil
| | - P Craig
- MRC/CSO Social & Public Health Sciences Unit, University of Glasgow, Glasgow, UK
| | - M Allik
- MRC/CSO Social & Public Health Sciences Unit, University of Glasgow, Glasgow, UK
| | - L Amorim
- Institute of Mathematics and Statistics, Federal University of Bahia, Salvador, Brazil
| | - M S Ali
- The Center for Data and Knowledge Integration for Health, Oswaldo Cruz Foundation, Salvador, Brazil
- Department of Non-Communicable Disease Epidemiology, LSHTM, London, UK
| | - L Smeeth
- Department of Non-Communicable Disease Epidemiology, LSHTM, London, UK
- Health Data Research, London, UK
| | - M L Barreto
- The Center for Data and Knowledge Integration for Health, Oswaldo Cruz Foundation, Salvador, Brazil
- Institute of Collective Health, Federal University of Bahia, Salvador, Brazil
| | - A Leyland
- MRC/CSO Social & Public Health Sciences Unit, University of Glasgow, Glasgow, UK
| | - E M L Aquino
- Institute of Collective Health, Federal University of Bahia, Salvador, Brazil
| | - S V Katikireddi
- MRC/CSO Social & Public Health Sciences Unit, University of Glasgow, Glasgow, UK
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13
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Lazo‐Porras M, Ruiz‐Alejos A, Miranda JJ, Carrillo‐Larco RM, Gilman RH, Smeeth L, Bernabé‐Ortiz A. Intermediate hyperglycaemia and 10-year mortality in resource-constrained settings: the PERU MIGRANT Study. Diabet Med 2020; 37:1519-1527. [PMID: 32181918 PMCID: PMC7649719 DOI: 10.1111/dme.14298] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 03/13/2020] [Indexed: 12/13/2022]
Abstract
AIM To determine whether intermediate hyperglycaemia, defined by fasting plasma glucose and HbA1c criteria, is associated with mortality in a 10-year cohort of people in a Latin American country. METHODS Analysis of the PERU MIGRANT Study was conducted in three different population groups (rural, rural-to-urban migrant, and urban). The baseline assessment was conducted in 2007/2008, with follow-up assessment in 2018. The outcome was all-cause mortality, and the exposure was intermediate hyperglycaemia, using three definitions: (1) impaired fasting glucose, defined according to American Diabetes Association criteria [fasting plasma glucose 5.6-6.9 mmol/l (100-125 mg/dl)]; (2) intermediate hyperglycaemia defined according to American Diabetes Association criteria [HbA1c levels 39-46 mmol/mol (5.7-6.4%)]; and (3) intermediate hyperglycaemia defined according to the International Expert Committee criteria [HbA1c levels 42-46 mmol/mol (6.0-6.4%)]. Crude and adjusted hazard ratios and 95% CIs were estimated using Cox proportional hazard models. RESULTS At baseline, the mean (sd) age of the study population was 47.8 (11.9) years and 52.5% of the cohort were women. The study cohort was divided into population groups as follows: 207 people (20.0%) in the rural population group, 583 (59.7%) in the rural-to-urban migrant group and 198 (20.3%) in the urban population group. The prevalence of intermediate hyperglycaemia was: 6%, 12.9% and 38.5% according to the American Diabetes Association impaired fasting glucose definition, the International Expert Committee HbA1c -based definition and the American Diabetes Association HbA1c -based definition, respectively, and the mortality rate after 10 years was 63/976 (7%). Intermediate hyperglycaemia was associated with all-cause mortality using the HbA1c -based definitions in the crude models [hazard ratios 2.82 (95% CI 1.59-4.99) according to the American Diabetes Association and 2.92 (95% CI 1.62-5.28) according to the International Expert Committee], whereas American Diabetes Association-defined impaired fasting glucose was not [hazard ratio 0.84 (95% CI 0.26-2.68)]. In the adjusted model, however, only the American Diabetes Association HbA1c -based definition was associated with all-cause mortality [hazard ratio 1.91 (95% CI 1.03-3.53)], whereas the International Expert Committee HbA1c -based and American Diabetes Association impaired fasting glucose-based definitions were not [hazard ratios 1.42 (95% CI 0.75-2.68) and 1.09 (95% CI 0.33-3.63), respectively]. CONCLUSIONS Intermediate hyperglycaemia defined using the American Diabetes Association HbA1c criteria was associated with an elevated mortality rate after 10 years in a cohort from Peru. HbA1c appears to be a factor associated with mortality in this Peruvian population.
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Affiliation(s)
- M. Lazo‐Porras
- CRONICAS Centre of Excellence in Chronic DiseasesUniversidad Peruana Cayetano HerediaLimaPeru
- Division of Tropical and Humanitarian MedicineGeneva University Hospitals and University of GenevaGenevaSwitzerland
| | - A. Ruiz‐Alejos
- CRONICAS Centre of Excellence in Chronic DiseasesUniversidad Peruana Cayetano HerediaLimaPeru
- Autonomic Dysfunction CentreDepartment of MedicineVanderbilt University Medical CentreTNUSA
| | - J. J. Miranda
- CRONICAS Centre of Excellence in Chronic DiseasesUniversidad Peruana Cayetano HerediaLimaPeru
- School of MedicineUniversidad Peruana Cayetano HerediaLimaPeru
| | - R. M. Carrillo‐Larco
- CRONICAS Centre of Excellence in Chronic DiseasesUniversidad Peruana Cayetano HerediaLimaPeru
- Department of Epidemiology and BiostatisticsSchool of Public HealthImperial College LondonLondonUK
| | - R. H. Gilman
- Department of International HealthBloomberg School of Public HealthJohns Hopkins UniversityBaltimoreMDUSA
| | - L. Smeeth
- Faculty of Epidemiology and Population HealthLondon School of Hygienel and Tropical MedicineLondonUK
| | - A. Bernabé‐Ortiz
- CRONICAS Centre of Excellence in Chronic DiseasesUniversidad Peruana Cayetano HerediaLimaPeru
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14
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Wong A, Frøslev T, Forbes H, Kjærsgaard A, Mulick A, Mansfield K, Silverwood R, Sørensen H, Smeeth L, Schmidt S, Langan S. Partner bereavement and risk of psoriasis and atopic eczema: cohort studies in the U.K. and Denmark. Br J Dermatol 2020; 183:321-331. [PMID: 31782133 PMCID: PMC7496681 DOI: 10.1111/bjd.18740] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/25/2019] [Indexed: 01/02/2023]
Abstract
BACKGROUND Stress is commonly cited as a risk factor for psoriasis and atopic eczema, but such evidence is limited. OBJECTIVES To investigate the association between partner bereavement (an extreme life stressor) and psoriasis or atopic eczema. METHODS We conducted cohort studies using data from the U.K. Clinical Practice Research Datalink (1997-2017) and Danish nationwide registries (1997-2016). The exposed cohort was partners who experienced partner bereavement. The comparison cohort was up to 10 nonbereaved partners, matched to each bereaved partner by age, sex, county of residence (Denmark) and general practice (U.K.). Outcomes were the first recorded diagnosis of psoriasis or atopic eczema. We estimated hazard ratios (HRs) and confidence intervals (CIs) using a stratified Cox proportional hazards model in both settings, which were then pooled in a meta-analysis. RESULTS The pooled adjusted HR for the association between bereavement and psoriasis was 1·01 (95% CI 0·98-1·04) across the entire follow-up. Similar results were found in other shorter follow-up periods. Pooled adjusted HRs for the association between bereavement and atopic eczema were 0·97 (95% CI 0·84-1·12) across the entire follow-up, 1·09 (95% CI 0·86-1·38) within 0-30 days, 1·18 (95% CI 1·04-1·35) within 0-90 days, 1·14 (95% CI 1·06-1·22) within 0-365 days and 1·07 (95% CI 1·02-1·12) within 0-1095 days. CONCLUSIONS We found a modest increase in the risk of atopic eczema within 3 years following bereavement, which peaked in the first 3 months. Acute stress may play a role in triggering onset of new atopic eczema or relapse of atopic eczema previously in remission. We observed no evidence for increased long-term risk of psoriasis and atopic eczema following bereavement.
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Affiliation(s)
- A.Y.S. Wong
- Faculty of Epidemiology and Population HealthLondon School of Hygiene and Tropical MedicineLondonU.K
| | - T. Frøslev
- Department of Clinical EpidemiologyAarhus University HospitalAarhusDenmark
| | - H.J. Forbes
- Faculty of Epidemiology and Population HealthLondon School of Hygiene and Tropical MedicineLondonU.K
- Health Data Research U.K.LondonU.K
| | - A. Kjærsgaard
- Department of Clinical EpidemiologyAarhus University HospitalAarhusDenmark
| | - A. Mulick
- Faculty of Epidemiology and Population HealthLondon School of Hygiene and Tropical MedicineLondonU.K
| | - K. Mansfield
- Faculty of Epidemiology and Population HealthLondon School of Hygiene and Tropical MedicineLondonU.K
| | - R.J. Silverwood
- Faculty of Epidemiology and Population HealthLondon School of Hygiene and Tropical MedicineLondonU.K
- Centre for Longitudinal StudiesDepartment of Social ScienceUniversity College LondonLondonU.K
| | - H.T. Sørensen
- Department of Clinical EpidemiologyAarhus University HospitalAarhusDenmark
| | - L. Smeeth
- Faculty of Epidemiology and Population HealthLondon School of Hygiene and Tropical MedicineLondonU.K
- Health Data Research U.K.LondonU.K
| | - S.A.J. Schmidt
- Department of Clinical EpidemiologyAarhus University HospitalAarhusDenmark
- Department of DermatologyAarhus University HospitalAarhusDenmark
| | - S.M. Langan
- Faculty of Epidemiology and Population HealthLondon School of Hygiene and Tropical MedicineLondonU.K
- Health Data Research U.K.LondonU.K
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15
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Commodore-Mensah Y, Agyemang C, Aboagye JA, Echouffo-Tcheugui JB, Beune E, Smeeth L, Klipstein-Grobusch K, Danquah I, Schulze M, Boateng D, Meeks KAC, Bahendeka S, Ahima RS. Obesity and cardiovascular disease risk among Africans residing in Europe and Africa: the RODAM study. Obes Res Clin Pract 2020; 14:151-157. [PMID: 32061582 DOI: 10.1016/j.orcp.2020.01.007] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [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] [Received: 11/07/2019] [Revised: 12/28/2019] [Accepted: 01/24/2020] [Indexed: 12/25/2022]
Abstract
BACKGROUND The association between anthropometric variables and cardiovascular disease (CVD) risk among Africans is unclear. We examined the discriminative ability of anthropometric variables and estimate cutoffs for predicting CVD risk among Africans. METHODS The Research on Obesity and Diabetes among African Migrants (RODAM) study was a multisite cross-sectional study of Africans in Ghana and Europe. We calculated AHA/ACC Pooled Cohort Equations (PCE) scores for 3661 participants to ascertain CVD risk, and compared a body shape index (ABSI), body mass index (BMI), waist circumference (WC), waist-to-hip ratio (WHR), Relative Fat Mass (RFM), and Waist to Height Ratio (WHtR). Logistic regression and receiver operating curve analyses were performed to derive cutoffs for identifying high predicted CVD risk (PCE score ≥7.5%). RESULTS Among men, WC (adjusted Odds Ratio (aOR): 2.25, 95% CI; 1:50-3:37) was strongly associated with CVD risk. Among women, WC (aOR: 1.69, 95% CI: 1:33-2:14) also displayed the strongest association with CVD risk in the BMI-adjusted model but WHR displayed the strongest fit. All variables were superior discriminators of high CVD risk in men (c-statistic range: 0.887-0.891) than women (c-statistic range: 0.677-0.707). The optimal WC cutoff for identifying participants at high CVD risk was 89 cm among men and identified the most cases (64%). Among women, the recommended WC cutoff of 94 cm or WHR cutoff of 0.90 identified the most cases (92%). CONCLUSIONS Anthropometric variables were stronger discriminators of high CVD risk in African men than women. Greater WC was associated with high CVD risk in men while WHR and WC were associated with high CVD risk in women.
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Affiliation(s)
- Y Commodore-Mensah
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, United States; Johns Hopkins School of Nursing, MD, United States.
| | - C Agyemang
- Department of Public Health, Amsterdam Public Health Research Institute, Amsterdam UMC, University of Amsterdam, The Netherlands
| | - J A Aboagye
- Department of Surgery, Howard University, Washington, District of Columbia, United States
| | - J B Echouffo-Tcheugui
- Department of Medicine, Johns Hopkins School of Medicine, Baltimore, MD, United States
| | - E Beune
- Department of Public Health, Amsterdam Public Health Research Institute, Amsterdam UMC, University of Amsterdam, The Netherlands
| | - L Smeeth
- Faculty of Epidemiology and Population Health, London School of Hygiene and Tropical Medicine, United Kingdom
| | - K Klipstein-Grobusch
- Julius Global Health, Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht University, Utrecht, The Netherlands; Division of Epidemiology and Biostatistics, School of Public Health, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - I Danquah
- Department of Molecular Epidemiology, German Institute of Human Nutrition Potsdam-Rehbruecke (DIfE), Nuthetal, Germany; Charité - Universitaetsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Institute for Social Medicine, Epidemiology and Health Economics, Berlin, Germany
| | - M Schulze
- Department of Molecular Epidemiology, German Institute of Human Nutrition Potsdam-Rehbruecke (DIfE), Nuthetal, Germany; Institute of Nutritional Sciences, University of Potsdam, Nuthetal, Germany
| | - D Boateng
- Julius Global Health, Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht University, Utrecht, The Netherlands
| | - K A C Meeks
- Department of Public Health, Amsterdam Public Health Research Institute, Amsterdam UMC, University of Amsterdam, The Netherlands; Center for Research on Genomics and Global Health, National Human Genome Research Institute, National Institutes of Health, Bethesda, MD, United States
| | - S Bahendeka
- MKPGMS-Uganda Martyrs University, Kampala, Uganda
| | - R S Ahima
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, United States; Johns Hopkins School of Nursing, MD, United States; Department of Medicine, Johns Hopkins School of Medicine, Baltimore, MD, United States
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16
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Mathur R, Palla L, Farmer RE, Chaturvedi N, Smeeth L. Ethnic differences in the severity and clinical management of type 2 diabetes at time of diagnosis: A cohort study in the UK Clinical Practice Research Datalink. Diabetes Res Clin Pract 2020; 160:108006. [PMID: 31923438 PMCID: PMC7042884 DOI: 10.1016/j.diabres.2020.108006] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/02/2019] [Revised: 12/15/2019] [Accepted: 01/02/2020] [Indexed: 11/21/2022]
Abstract
AIMS To characterize ethnic differences in the severity and clinical management of type 2 diabetes at initial diagnosis. METHODS An observational cohort study of 179,886 people with incident type 2 diabetes between 2004 and 2017 in the Clinical Practice Research Datalink was undertaken; 63.4% of the cohort were of white ethnicity, 3.9% south Asian, and 1.6% black. Ethnic differences in clinical profile at diagnosis, consultation rates, and risk factor recording were derived from linear and logistic regression. Cox-proportional hazards regression was used to determine ethnic differences in time to initiation of therapeutic and non-therapeutic management following diagnosis. All analyses adjusted for age, sex, deprivation, and clustering by practice. RESULTS In the 12 months prior to diagnosis, non-white groups had fewer consultations compared to white groups, but risk factor recording was better than or equivalent to white groups for 9/10 risk factors for south Asian groups and 8/10 risk factors for black groups (p < 0.002). Blood pressure, BMI, cholesterol, eGFR, and CVD risk levels were more favourable in non-white groups, and prevalence of macrovascular disease was significantly lower (p < 0.003). Time to initiation of antidiabetic treatment and first risk assessment was faster in non-white groups relative to white groups, while time to risk factor measurement and diabetes review was slower. CONCLUSIONS We find limited evidence of systematic ethnic inequalities around the time of type 2 diabetes diagnosis. Ethnic disparities in downstream consequences may relate to genetic risk factors, or manifest later in the care pathway, potentially in relation to long-term risk factor control.
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Affiliation(s)
- R Mathur
- London School of Hygiene & Tropical Medicine, Department of Non-Communicable Disease Epidemiology, Keppel Street, London WC1E 7HT, UK.
| | - L Palla
- London School of Hygiene & Tropical Medicine, Department of Non-Communicable Disease Epidemiology, Keppel Street, London WC1E 7HT, UK.
| | - R E Farmer
- London School of Hygiene & Tropical Medicine, Department of Non-Communicable Disease Epidemiology, Keppel Street, London WC1E 7HT, UK.
| | - N Chaturvedi
- University College London, Institute of Cardiovascular Sciences, Gower Street, London WC1E 6BT, UK.
| | - L Smeeth
- London School of Hygiene & Tropical Medicine, Department of Non-Communicable Disease Epidemiology, Keppel Street, London WC1E 7HT, UK.
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17
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Barreto ML, Ichihara MY, Almeida BA, Barreto ME, Cabral L, Fiaccone RL, Carreiro RP, Teles CAS, Pitta R, Penna GO, Barral-Netto M, Ali MS, Barbosa G, Denaxas S, Rodrigues LC, Smeeth L. The Centre for Data and Knowledge Integration for Health (CIDACS): Linking Health and Social Data in Brazil. Int J Popul Data Sci 2019; 4:1140. [PMID: 34095542 PMCID: PMC8142622 DOI: 10.23889/ijpds.v4i2.1140] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/03/2023] Open
Abstract
The Centre for Data and Knowledge Integration for Health (CIDACS) was created in 2016 in Salvador, Bahia-Brazil with the objective of integrating data and knowledge aiming to answer scientific questions related to the health of the Brazilian population. This article details our experiences in the establishment and operations of CIDACS, as well as efforts made to obtain high-quality linked data while adhering to security, ethical use and privacy issues. Every effort has been made to conduct operations while implementing appropriate structures, procedures, processes and controls over the original and integrated databases in order to provide adequate datasets to answer relevant research questions. Looking forward, CIDACS is expected to be an important resource for researchers and policymakers interested in enhancing the evidence base pertaining to different aspects of health, in particular when investigating, from a nation-wide perspective, the role of social determinants of health and the effects of social and environmental policies on different health outcomes.
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Affiliation(s)
- ML Barreto
- Centre for Data and Knowledge Integration for Health (CIDACS), Gonçalo Moniz Institute, Oswaldo Cruz Foundation (FIOCRUZ), Salvador, Brazil.
- Institute of Collective Health, Federal University of Bahia (UFBA), Salvador, Brazil.
| | - MY Ichihara
- Centre for Data and Knowledge Integration for Health (CIDACS), Gonçalo Moniz Institute, Oswaldo Cruz Foundation (FIOCRUZ), Salvador, Brazil.
- Institute of Collective Health, Federal University of Bahia (UFBA), Salvador, Brazil.
| | - BA Almeida
- Centre for Data and Knowledge Integration for Health (CIDACS), Gonçalo Moniz Institute, Oswaldo Cruz Foundation (FIOCRUZ), Salvador, Brazil.
| | - ME Barreto
- Centre for Data and Knowledge Integration for Health (CIDACS), Gonçalo Moniz Institute, Oswaldo Cruz Foundation (FIOCRUZ), Salvador, Brazil.
- Computer Science Department, Federal University of Bahia (UFBA), Salvador, Brazil.
| | - L Cabral
- Centre for Data and Knowledge Integration for Health (CIDACS), Gonçalo Moniz Institute, Oswaldo Cruz Foundation (FIOCRUZ), Salvador, Brazil.
| | - RL Fiaccone
- Centre for Data and Knowledge Integration for Health (CIDACS), Gonçalo Moniz Institute, Oswaldo Cruz Foundation (FIOCRUZ), Salvador, Brazil.
- Statistics Department, Federal University of Bahia (UFBA), Brazil.
| | - RP Carreiro
- Centre for Data and Knowledge Integration for Health (CIDACS), Gonçalo Moniz Institute, Oswaldo Cruz Foundation (FIOCRUZ), Salvador, Brazil.
| | - CAS Teles
- Centre for Data and Knowledge Integration for Health (CIDACS), Gonçalo Moniz Institute, Oswaldo Cruz Foundation (FIOCRUZ), Salvador, Brazil.
| | - R Pitta
- Centre for Data and Knowledge Integration for Health (CIDACS), Gonçalo Moniz Institute, Oswaldo Cruz Foundation (FIOCRUZ), Salvador, Brazil.
| | - GO Penna
- Centre for Data and Knowledge Integration for Health (CIDACS), Gonçalo Moniz Institute, Oswaldo Cruz Foundation (FIOCRUZ), Salvador, Brazil.
- Tropical Medicine Centre, University of Brasília (UnB), Brazil.
- Escola Fiocruz de Governo, FIOCRUZ Brasília, Brazil.
| | - M Barral-Netto
- Centre for Data and Knowledge Integration for Health (CIDACS), Gonçalo Moniz Institute, Oswaldo Cruz Foundation (FIOCRUZ), Salvador, Brazil.
| | - MS Ali
- Centre for Data and Knowledge Integration for Health (CIDACS), Gonçalo Moniz Institute, Oswaldo Cruz Foundation (FIOCRUZ), Salvador, Brazil.
- Center for Statistics in Medicine, Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, University of Oxford, Oxford, UK.
- Faculty of Epidemiology and Population Health, London School of Hygiene and Tropical Medicine, United Kingdom.
| | - G Barbosa
- Centre for Data and Knowledge Integration for Health (CIDACS), Gonçalo Moniz Institute, Oswaldo Cruz Foundation (FIOCRUZ), Salvador, Brazil.
| | - S Denaxas
- Institute of Health Informatics, University College London, United Kingdom.
| | - LC Rodrigues
- Centre for Data and Knowledge Integration for Health (CIDACS), Gonçalo Moniz Institute, Oswaldo Cruz Foundation (FIOCRUZ), Salvador, Brazil.
- Faculty of Epidemiology and Population Health, London School of Hygiene and Tropical Medicine, United Kingdom.
| | - L Smeeth
- Centre for Data and Knowledge Integration for Health (CIDACS), Gonçalo Moniz Institute, Oswaldo Cruz Foundation (FIOCRUZ), Salvador, Brazil.
- Faculty of Epidemiology and Population Health, London School of Hygiene and Tropical Medicine, United Kingdom.
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Bloom CI, Ricciardi F, Smeeth L, Stone P, Quint JK. Predicting COPD 1-year mortality using prognostic predictors routinely measured in primary care. BMC Med 2019; 17:73. [PMID: 30947728 PMCID: PMC6449897 DOI: 10.1186/s12916-019-1310-0] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/19/2018] [Accepted: 03/21/2019] [Indexed: 12/25/2022] Open
Abstract
BACKGROUND Chronic obstructive pulmonary disease (COPD) is a major cause of mortality. Patients with advanced disease often have a poor quality of life, such that guidelines recommend providing palliative care in their last year of life. Uptake and use of palliative care in advanced COPD is low; difficulty in predicting 1-year mortality is thought to be a major contributing factor. METHODS We identified two primary care COPD cohorts using UK electronic healthcare records (Clinical Practice Research Datalink). The first cohort was randomised equally into training and test sets. An external dataset was drawn from a second cohort. A risk model to predict mortality within 12 months was derived from the training set using backwards elimination Cox regression. The model was given the acronym BARC based on putative prognostic factors including body mass index and blood results (B), age (A), respiratory variables (airflow obstruction, exacerbations, smoking) (R) and comorbidities (C). The BARC index predictive performance was validated in the test set and external dataset by assessing calibration and discrimination. The observed and expected probabilities of death were assessed for increasing quartiles of mortality risk (very low risk, low risk, moderate risk, high risk). The BARC index was compared to the established index scores body mass index, obstructive, dyspnoea and exacerbations (BODEx), dyspnoea, obstruction, smoking and exacerbations (DOSE) and age, dyspnoea and obstruction (ADO). RESULTS Fifty-four thousand nine hundred ninety patients were eligible from the first cohort and 4931 from the second cohort. Eighteen variables were included in the BARC, including age, airflow obstruction, body mass index, smoking, exacerbations and comorbidities. The risk model had acceptable predictive performance (test set: C-index = 0.79, 95% CI 0.78-0.81, D-statistic = 1.87, 95% CI 1.77-1.96, calibration slope = 0.95, 95% CI 0.9-0.99; external dataset: C-index = 0.67, 95% CI 0.65-0.7, D-statistic = 0.98, 95% CI 0.8-1.2, calibration slope = 0.54, 95% CI 0.45-0.64) and acceptable accuracy predicting the probability of death (probability of death in 1 year, n high-risk group, test set: expected = 0.31, observed = 0.30; external dataset: expected = 0.22, observed = 0.27). The BARC compared favourably to existing index scores that can also be applied without specialist respiratory variables (area under the curve: BARC = 0.78, 95% CI 0.76-0.79; BODEx = 0.48, 95% CI 0.45-0.51; DOSE = 0.60, 95% CI 0.57-0.61; ADO = 0.68, 95% CI 0.66-0.69, external dataset: BARC = 0.70, 95% CI 0.67-0.72; BODEx = 0.41, 95% CI 0.38-0.45; DOSE = 0.52, 95% CI 0.49-0.55; ADO = 0.57, 95% CI 0.54-0.60). CONCLUSION The BARC index performed better than existing tools in predicting 1-year mortality. Critically, the risk score only requires routinely collected non-specialist information which, therefore, could help identify patients seen in primary care that may benefit from palliative care.
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Affiliation(s)
- C. I. Bloom
- National Heart Lung Institute, Imperial College London, Emmanuel Kaye Building, 1b Manresa Road, London, SW3 6LR UK
| | - F. Ricciardi
- Department of Statistical Science, University College London, London, UK
| | - L. Smeeth
- Epidemiology and Population Health, London School of Hygiene and Tropical Medicine, LSHTM, Keppel Street, London, WC1E 7HT UK
| | - P. Stone
- Marie Curie Palliative Care Research Department, University College London, London, UK
| | - J. K. Quint
- Department of Respiratory Epidemiology, Occupational Medicine and Public Health, NHLI, Imperial College London, London, UK
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Jain A, van Hoek A, Walker J, Forbes H, Langan S, Root A, Smeeth L, Thomass S. 带状疱疹疾病负担的不均衡:基于人群的队列研究. Br J Dermatol 2018. [DOI: 10.1111/bjd.16763] [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: 11/29/2022]
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Jain A, van Hoek A, Walker J, Forbes H, Langan S, Root A, Smeeth L, Thomas S. Inequalities in zoster disease burden: a population-based cohort study to identify social determinants using linked data from the U.K. Clinical Practice Research Datalink. Br J Dermatol 2018; 178:1324-1330. [PMID: 29388189 PMCID: PMC6033149 DOI: 10.1111/bjd.16399] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/22/2018] [Indexed: 01/14/2023]
Abstract
BACKGROUND Zoster vaccination was introduced in England in 2013, where tackling health inequalities is a statutory requirement. However, specific population groups with higher zoster burden remain largely unidentified. OBJECTIVES To evaluate health inequalities in zoster disease burden prior to zoster vaccine introduction in England. METHODS This population-based cohort study used anonymized U.K. primary care data linked to hospitalization and deprivation data. Individuals aged ≥ 65 years without prior zoster history (N = 862 470) were followed from 1 September 2003 to 31 August 2013. Poisson regression was used to obtain adjusted rate ratios (ARRs) for the association of sociodemographic factors (ethnicity, immigration status, individuals' area-level deprivation, care home residence, living arrangements) with first zoster episode. Possible mediation by comorbidities and immunosuppressive medications was also assessed. RESULTS There were 37 014 first zoster episodes, with an incidence of 8·79 [95% confidence interval (CI) 8·70-8·88] per 1000 person-years at risk. In multivariable analyses, factors associated with higher zoster rates included care home residence (10% higher vs. those not in care homes), being a woman (16% higher vs. men), nonimmigrants (~30% higher than immigrants) and white ethnicity (for example, twice the rate compared with those of black ethnicity). Zoster incidence decreased slightly with increasing deprivation (ARR most vs. least deprived 0·96 (95% CI 0·92-0·99) and among those living alone (ARR 0·96, 95% CI 0·94-0·98). Mediating variables made little difference to the ARR of social factors but were themselves associated with increased zoster burden (ARR varied from 1·11 to 3·84). CONCLUSIONS The burden of zoster was higher in specific sociodemographic groups. Further study is needed to ascertain whether these individuals are attending for zoster vaccination.
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Affiliation(s)
- A. Jain
- Faculty of Epidemiology and Population HealthLondon School of Hygiene and Tropical MedicineKeppel StreetLondonWC1E 7HTU.K.
| | - A.J. van Hoek
- Faculty of Epidemiology and Population HealthLondon School of Hygiene and Tropical MedicineKeppel StreetLondonWC1E 7HTU.K.
| | - J.L. Walker
- Faculty of Epidemiology and Population HealthLondon School of Hygiene and Tropical MedicineKeppel StreetLondonWC1E 7HTU.K.
- Statistics, Modelling and Economics DepartmentPublic Health England61 Colindale AvenueLondonNW9 5EQU.K.
| | - H.J. Forbes
- Faculty of Epidemiology and Population HealthLondon School of Hygiene and Tropical MedicineKeppel StreetLondonWC1E 7HTU.K.
| | - S.M. Langan
- Faculty of Epidemiology and Population HealthLondon School of Hygiene and Tropical MedicineKeppel StreetLondonWC1E 7HTU.K.
| | - A. Root
- Faculty of Epidemiology and Population HealthLondon School of Hygiene and Tropical MedicineKeppel StreetLondonWC1E 7HTU.K.
| | - L. Smeeth
- Faculty of Epidemiology and Population HealthLondon School of Hygiene and Tropical MedicineKeppel StreetLondonWC1E 7HTU.K.
| | - S.L. Thomas
- Faculty of Epidemiology and Population HealthLondon School of Hygiene and Tropical MedicineKeppel StreetLondonWC1E 7HTU.K.
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21
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Jain A, van Hoek A, Walker J, Forbes H, Langan S, Root A, Smeeth L, Thomas S. Inequalities in zoster disease burden: a population-based cohort study to identify social determinants using linked data from the U.K. Clinical Practice Research Datalink. Br J Dermatol 2018. [DOI: 10.1111/bjd.16751] [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: 11/30/2022]
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22
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Ekoru K, Young EH, Dillon DG, Gurdasani D, Stehouwer N, Faurholt-Jepsen D, Levitt NS, Crowther NJ, Nyirenda M, Njelekela MA, Ramaiya K, Nyan O, Adewole OO, Anastos K, Compostella C, Dave JA, Fourie CM, Friis H, Kruger IM, Longenecker CT, Maher DP, Mutimura E, Ndhlovu CE, Praygod G, Pefura Yone EW, Pujades-Rodriguez M, Range N, Sani MU, Sanusi M, Schutte AE, Sliwa K, Tien PC, Vorster EH, Walsh C, Gareta D, Mashili F, Sobngwi E, Adebamowo C, Kamali A, Seeley J, Smeeth L, Pillay D, Motala AA, Kaleebu P, Sandhu MS. HIV treatment is associated with a two-fold higher probability of raised triglycerides: Pooled Analyses in 21 023 individuals in sub-Saharan Africa. Glob Health Epidemiol Genom 2018; 3:e7. [PMID: 29881632 PMCID: PMC5985947 DOI: 10.1017/gheg.2018.7] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2017] [Revised: 04/08/2018] [Accepted: 04/10/2018] [Indexed: 12/14/2022] Open
Abstract
BACKGROUND Anti-retroviral therapy (ART) regimes for HIV are associated with raised levels of circulating triglycerides (TG) in western populations. However, there are limited data on the impact of ART on cardiometabolic risk in sub-Saharan African (SSA) populations. METHODS Pooled analyses of 14 studies comprising 21 023 individuals, on whom relevant cardiometabolic risk factors (including TG), HIV and ART status were assessed between 2003 and 2014, in SSA. The association between ART and raised TG (>2.3 mmol/L) was analysed using regression models. FINDINGS Among 10 615 individuals, ART was associated with a two-fold higher probability of raised TG (RR 2.05, 95% CI 1.51-2.77, I2=45.2%). The associations between ART and raised blood pressure, glucose, HbA1c, and other lipids were inconsistent across studies. INTERPRETATION Evidence from this study confirms the association of ART with raised TG in SSA populations. Given the possible causal effect of raised TG on cardiovascular disease (CVD), the evidence highlights the need for prospective studies to clarify the impact of long term ART on CVD outcomes in SSA.
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Affiliation(s)
- K. Ekoru
- Department of Medicine, University of Cambridge, Cambridge, UK
- Global Health and Populations Group, Wellcome Trust Sanger Institute, Hinxton, Cambridge, UK
| | - E. H. Young
- Department of Medicine, University of Cambridge, Cambridge, UK
- Global Health and Populations Group, Wellcome Trust Sanger Institute, Hinxton, Cambridge, UK
| | - D. G. Dillon
- Weill Cornell Medical College, New York City, New York, USA
| | - D. Gurdasani
- Department of Medicine, University of Cambridge, Cambridge, UK
- Global Health and Populations Group, Wellcome Trust Sanger Institute, Hinxton, Cambridge, UK
| | - N. Stehouwer
- University Hospitals Case Medical Center, Cleveland, Ohio, USA
| | - D. Faurholt-Jepsen
- Department of Infectious Diseases, University of Copenhagen (Rigshospitalet), Copenhagen, Denmark
| | - N. S. Levitt
- Division of Diabetic Medicine and Endocrinology, Department of Medicine, University of Cape Town, Cape Town, South Africa
| | - N. J. Crowther
- Department of Chemical Pathology, National Health Laboratory Service, University of the Witwatersrand Medical School, Johannesburg, South Africa
| | - M. Nyirenda
- Malawi Epidemiology and Intervention Research Unit, Malawi, Lilongwe
| | - M. A. Njelekela
- Department of Physiology, Muhimbili University of Health and Allied Sciences, Dar es Salaam, Tanzania
| | - K. Ramaiya
- Shree Hindu Mandal Hospital, Dar es Salaam, Tanzania
| | - O. Nyan
- Royal Victoria Teaching Hospital, School of Medicine, University of The Gambia, Banjul, The Gambia
| | - O. O. Adewole
- Department of Medicine, Obafemi Awolowo University, Ile Ife, Nigeria
| | - K. Anastos
- Albert Einstein College of Medicine, Bronx NY, USA
| | - C. Compostella
- Department of Medicine, University of Padua, Padua, Italy
| | - J. A. Dave
- Division of Diabetic Medicine and Endocrinology, Department of Medicine, University of Cape Town, Cape Town, South Africa
| | - C. M. Fourie
- HART (Hypertension in Africa Research Team), North-West University, Potchefstroom, South Africa
| | - H. Friis
- Department of Nutrition, Exercise and Sports, Faculty of Science, University of Copenhagen, Denmark
| | - I. M. Kruger
- Africa Unit for Transdisciplinary Health Research (AUTHeR), North-West University, Potchefstroom, South Africa
| | | | - D. P. Maher
- Special Programme for Research & Training in Tropical Diseases (TDR), World Health Organization, Geneva, Switzerland
| | - E. Mutimura
- Albert Einstein College of Medicine, Bronx NY, USA
| | - C. E. Ndhlovu
- Clinical Epidemiology Resource Training Centre, University of Zimbabwe College of Health Sciences, Harare, Zimbabwe
| | - G. Praygod
- National Institute for Medical Research, Tanzania, Dar es Salaam
| | | | - M. Pujades-Rodriguez
- Epicentre, Médecins Sans Frontières, Paris, France
- Department of Epidemiology and Public Health, University College of London, Clinical Epidemiology Group, London, UK
| | - N. Range
- National Institute for Medical Research, Tanzania, Dar es Salaam
| | - M. U. Sani
- Cardiology Unit, Department of Medicine, Aminu Kano Teaching Hospital, Kano, Nigeria
| | - M. Sanusi
- Cardiology Unit, Department of Medicine, Aminu Kano Teaching Hospital, Kano, Nigeria
| | - A. E. Schutte
- HART (Hypertension in Africa Research Team), North-West University, Potchefstroom, South Africa
- MRC Unit for Hypertension and Cardiovascular Disease, North-West University, Potchefstroom, South Africa
| | - K. Sliwa
- Soweto Cardiovascular Research Unit, Chris Hani Baragwanath Hospital, University of the Witwatersrand, Johannesburg, South Africa
| | - P. C. Tien
- Department of Medicine, University of California, San Francisco, USA
| | - E. H. Vorster
- Faculty of Health Sciences, North-West University, Potchefstroom, South Africa
| | - C. Walsh
- Department of Nutrition and Dietetics, University of the Free State, Bloemfontein, South Africa
| | - D. Gareta
- Africa Health Research Institute, University of KwaZulu-Natal, Durban, South Africa
| | - F. Mashili
- National Institute for Medical Research, Tanzania, Dar es Salaam
| | - E. Sobngwi
- Faculty of Medicine and Biomedical Sciences, University of Yaoundé 1, Cameroon, Yaoundé
| | - C. Adebamowo
- Institute of Human Virology, Abuja, Nigeria
- Department of Epidemiology and Public Health, Institute of Human Virology and Greenebaum Cancer Center, University of Maryland School of Medicine, Baltimore, USA
| | - A. Kamali
- MRC/UVRI Uganda Research Unit on AIDS, Entebbe, Uganda
| | - J. Seeley
- MRC/UVRI Uganda Research Unit on AIDS, Entebbe, Uganda
| | - L. Smeeth
- Faculty of Epidemiology and Population Health, London School of Hygiene and Tropical Medicine, London, UK
| | - D. Pillay
- Africa Health Research Institute, University of KwaZulu-Natal, Durban, South Africa
| | - A. A. Motala
- Department of Diabetes and Endocrinology, Nelson R. Mandela School of Medicine, University of KwaZulu-Natal, Durban, South Africa
| | - P. Kaleebu
- MRC/UVRI Uganda Research Unit on AIDS, Entebbe, Uganda
| | - M. S. Sandhu
- Department of Medicine, University of Cambridge, Cambridge, UK
- Global Health and Populations Group, Wellcome Trust Sanger Institute, Hinxton, Cambridge, UK
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Boateng D, Agyemang C, Beune E, Meeks K, Smeeth L, Schulze M, Addo J, Galbete C, Danquah I, Agyei-Baffour P, Owusu Dabo E, Pascal Kengne A, Grobbee D, Klipstein-Grobusch K. 2.1-O7Cardiovascular disease risk prediction in sub-Saharan African migrant and home populations – comparative analysis of risk algorithms in the RODAM study. Eur J Public Health 2018. [DOI: 10.1093/eurpub/cky047.045] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Affiliation(s)
- D Boateng
- School of Public Health, Kwame Nkrumah University of Science and Technology, Kumasi, Ghana
| | - C Agyemang
- Academic Medical Center, University of Amsterdam, The Netherlands
| | - E Beune
- Academic Medical Center, University of Amsterdam, The Netherlands
| | - K Meeks
- Academic Medical Center, University of Amsterdam, The Netherlands
| | - L Smeeth
- Department of Non-communicable Disease Epidemiology, London School of Hygiene and Tropical Medicine, United Kingdom
| | - M Schulze
- Department of Molecular Epidemiology, German Institute of Human Nutrition, Potsdam-Rehbruecke, Germany
| | - J Addo
- Department of Non-communicable Disease Epidemiology, London School of Hygiene and Tropical Medicine, United Kingdom
| | - C Galbete
- Department of Molecular Epidemiology, German Institute of Human Nutrition, Potsdam-Rehbruecke, Germany
| | - I Danquah
- Department of Molecular Epidemiology, German Institute of Human Nutrition, Potsdam-Rehbruecke, Germany
| | - P Agyei-Baffour
- School of Public Health, Kwame Nkrumah University of Science and Technology, Kumasi, Ghana
| | - E Owusu Dabo
- Kumasi Centre for collaborative Research, KNUST, Ghana
| | - A Pascal Kengne
- Non-communicable Disease Research Unit, South African Medical Research Council, Non-communicable Disease Research Unit, South African Medical Research Council, South Africa
| | - D Grobbee
- Julius Global Health, Julius Center for Health Sciences and Primary Care, University Medical Centre, Utrecht University, The Netherlands
| | - K Klipstein-Grobusch
- Julius Global Health, Julius Center for Health Sciences and Primary Care, University Medical Centre, Utrecht University, The Netherlands
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von Kobyletzki LB, Beckman L, Smirnova J, Smeeth L, Williams HC, McKee M, Abuabara K, Langan SM. Eczema and educational attainment: a systematic review. Br J Dermatol 2017; 177:e47-e49. [PMID: 27995605 DOI: 10.1111/bjd.15242] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Affiliation(s)
- L B von Kobyletzki
- Department of Public Health Sciences, Karlstad University, Karlstad, Sweden.,Lund University, Skåne University Hospital, Department of Dermatology, Malmö, Sweden
| | - L Beckman
- Department of Public Health Sciences, Karlstad University, Karlstad, Sweden
| | - J Smirnova
- Department of Public Health Sciences, Karlstad University, Karlstad, Sweden
| | - L Smeeth
- London School of Hygiene and Tropical Medicine, London, U.K
| | - H C Williams
- Centre of Evidence Based Dermatology, University of Nottingham, Nottingham, U.K
| | - M McKee
- London School of Hygiene and Tropical Medicine, London, U.K.,European Observatory on Health Systems and Policies, London, U.K
| | - K Abuabara
- University of California, San Francisco, CA, U.S.A
| | - S M Langan
- London School of Hygiene and Tropical Medicine, London, U.K.,St John's Institute of Dermatology, London, U.K
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25
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Bazo‐Alvarez JC, Quispe R, Pillay TD, Bernabé‐Ortiz A, Smeeth L, Checkley W, Gilman RH, Málaga G, Miranda JJ. Glycated haemoglobin (HbA 1c ) and fasting plasma glucose relationships in sea-level and high-altitude settings. Diabet Med 2017; 34:804-812. [PMID: 28196274 PMCID: PMC5432378 DOI: 10.1111/dme.13335] [Citation(s) in RCA: 11] [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] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 02/09/2017] [Indexed: 12/28/2022]
Abstract
AIM Higher haemoglobin levels and differences in glucose metabolism have been reported among high-altitude residents, which may influence the diagnostic performance of HbA1c . This study explores the relationship between HbA1c and fasting plasma glucose (FPG) in populations living at sea level and at an altitude of > 3000 m. METHODS Data from 3613 Peruvian adults without a known diagnosis of diabetes from sea-level and high-altitude settings were evaluated. Linear, quadratic and cubic regression models were performed adjusting for potential confounders. Receiver operating characteristic (ROC) curves were constructed and concordance between HbA1c and FPG was assessed using a Kappa index. RESULTS At sea level and high altitude, means were 13.5 and 16.7 g/dl (P > 0.05) for haemoglobin level; 41 and 40 mmol/mol (5.9% and 5.8%; P < 0.01) for HbA1c ; and 5.8 and 5.1 mmol/l (105 and 91.3 mg/dl; P < 0.001) for FPG, respectively. The adjusted relationship between HbA1c and FPG was quadratic at sea level and linear at high altitude. Adjusted models showed that, to predict an HbA1c value of 48 mmol/mol (6.5%), the corresponding mean FPG values at sea level and high altitude were 6.6 and 14.8 mmol/l (120 and 266 mg/dl), respectively. An HbA1c cut-off of 48 mmol/mol (6.5%) had a sensitivity for high FPG of 87.3% (95% confidence interval (95% CI) 76.5 to 94.4) at sea level and 40.9% (95% CI 20.7 to 63.6) at high altitude. CONCLUSION The relationship between HbA1c and FPG is less clear at high altitude than at sea level. Caution is warranted when using HbA1c to diagnose diabetes mellitus in this setting.
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Affiliation(s)
- J. C. Bazo‐Alvarez
- CRONICAS Centre of Excellence in Chronic DiseasesUniversidad Peruana Cayetano HerediaLimaPeru
| | - R. Quispe
- CRONICAS Centre of Excellence in Chronic DiseasesUniversidad Peruana Cayetano HerediaLimaPeru
| | - T. D. Pillay
- CRONICAS Centre of Excellence in Chronic DiseasesUniversidad Peruana Cayetano HerediaLimaPeru
- University College London Medical SchoolLondon School of Hygiene and Tropical MedicineLondonUK
| | - A. Bernabé‐Ortiz
- CRONICAS Centre of Excellence in Chronic DiseasesUniversidad Peruana Cayetano HerediaLimaPeru
| | - L. Smeeth
- CRONICAS Centre of Excellence in Chronic DiseasesUniversidad Peruana Cayetano HerediaLimaPeru
- Faculty of Epidemiology and Population HealthLondon School of Hygiene and Tropical MedicineLondonUK
| | - W. Checkley
- CRONICAS Centre of Excellence in Chronic DiseasesUniversidad Peruana Cayetano HerediaLimaPeru
- Division of Pulmonary and Critical CareJohns Hopkins UniversityBaltimoreMDUSA
| | - R. H. Gilman
- CRONICAS Centre of Excellence in Chronic DiseasesUniversidad Peruana Cayetano HerediaLimaPeru
- Área de Investigación y DesarrolloA.B. PRISMALimaPeru
- Department of International HealthJohns Hopkins Bloomberg School of Public HealthJohns Hopkins UniversityBaltimoreMDUSA
| | - G. Málaga
- CRONICAS Centre of Excellence in Chronic DiseasesUniversidad Peruana Cayetano HerediaLimaPeru
- Department of MedicineUniversidad Peruana Cayetano HerediaLimaPeru
| | - J. J. Miranda
- CRONICAS Centre of Excellence in Chronic DiseasesUniversidad Peruana Cayetano HerediaLimaPeru
- Department of MedicineUniversidad Peruana Cayetano HerediaLimaPeru
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Bernabe-Ortiz A, Sanchez JF, Carrillo-Larco RM, Gilman RH, Poterico JA, Quispe R, Smeeth L, Miranda JJ. Rural-to-urban migration and risk of hypertension: longitudinal results of the PERU MIGRANT study. J Hum Hypertens 2017; 31:22-28. [PMID: 26865219 PMCID: PMC4981561 DOI: 10.1038/jhh.2015.124] [Citation(s) in RCA: 19] [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] [Subscribe] [Scholar Register] [Received: 08/31/2015] [Revised: 11/10/2015] [Accepted: 11/23/2015] [Indexed: 11/09/2022]
Abstract
Urbanization can be detrimental to health in populations due to changes in dietary and physical activity patterns. The aim of this study was to determine the effect of migration on the incidence of hypertension. Participants of the PERU MIGRANT study, that is, rural, urban and rural-to-urban migrants, were re-evaluated after 5 years after baseline assessment. The outcome was incidence of hypertension; and the exposures were study group and other well-known risk factors. Incidence rates, relative risks (RRs) and population attributable fractions (PAFs) were calculated. At baseline, 201 (20.4%), 589 (59.5%) and 199 (20.1%) participants were rural, rural-to-urban migrant and urban subjects, respectively. Overall mean age was 47.9 (s.d.±12.0) years, and 522 (52.9%) were female. Hypertension prevalence at baseline was 16.0% (95% confidence interval (CI) 13.7-18.3), being more common in urban group; whereas pre-hypertension was more prevalent in rural participants (P<0.001). Follow-up rate at 5 years was 94%, 895 participants were re-assessed and 33 (3.3%) deaths were recorded. Overall incidence of hypertension was 1.73 (95%CI 1.36-2.20) per 100 person-years. In multivariable model and compared with the urban group, rural group had a greater risk of developing hypertension (RR 3.58; 95%CI 1.42-9.06). PAFs showed high waist circumference as the leading risk factor for the hypertension development in rural (19.1%), migrant (27.9%) and urban (45.8%) participants. Subjects from rural areas are at higher risk of developing hypertension relative to rural-urban migrant or urban groups. Central obesity was the leading risk factor for hypertension incidence in the three population groups.
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Affiliation(s)
- A Bernabe-Ortiz
- CRONICAS Center of Excellence in Chronic Diseases, Universidad Peruana Cayetano Heredia, Lima, Peru,Faculty of Epidemiology and Population Health, London School of Hygiene and Tropical Medicine, London, UK
| | - J F Sanchez
- US Naval Medical Research Unit No. 6 (NAMRU-6), Lima, Peru
| | - R M Carrillo-Larco
- CRONICAS Center of Excellence in Chronic Diseases, Universidad Peruana Cayetano Heredia, Lima, Peru
| | - R H Gilman
- CRONICAS Center of Excellence in Chronic Diseases, Universidad Peruana Cayetano Heredia, Lima, Peru,Department of International Health, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD, USA
| | - J A Poterico
- CRONICAS Center of Excellence in Chronic Diseases, Universidad Peruana Cayetano Heredia, Lima, Peru
| | - R Quispe
- CRONICAS Center of Excellence in Chronic Diseases, Universidad Peruana Cayetano Heredia, Lima, Peru
| | - L Smeeth
- Faculty of Epidemiology and Population Health, London School of Hygiene and Tropical Medicine, London, UK
| | - J J Miranda
- CRONICAS Center of Excellence in Chronic Diseases, Universidad Peruana Cayetano Heredia, Lima, Peru,Department of Medicine, School of Medicine, Universidad Peruana Cayetano Heredia, Lima, Peru,CRONICAS Center of Excellence in Chronic Diseases, Universidad Peruana Cayetano Heredia, Av. Armendariz 497, Miraflores, Lima 18, Peru. E-mail:
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Moore E, Hashmi M, Sultana K, Chatzidiakou L, Jones RL, Beevers S, Kelly FJ, Smeeth L, Barratt B, Wright M, Quint JK. P211 Using the clinical practice research datalink (CPRD) to recruit participants from primary care to investigate chronic obstructive pulmonary disease (COPD) exacerbations. Thorax 2016. [DOI: 10.1136/thoraxjnl-2016-209333.354] [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: 11/03/2022]
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Barr AL, Young EH, Smeeth L, Newton R, Seeley J, Ripullone K, Hird TR, Thornton JRM, Nyirenda MJ, Kapiga S, Adebamowo CA, Amoah AG, Wareham N, Rotimi CN, Levitt NS, Ramaiya K, Hennig BJ, Mbanya JC, Tollman S, Motala AA, Kaleebu P, Sandhu MS. The need for an integrated approach for chronic disease research and care in Africa. Glob Health Epidemiol Genom 2016; 1:e19. [PMID: 29868211 PMCID: PMC5870416 DOI: 10.1017/gheg.2016.16] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2016] [Revised: 08/09/2016] [Accepted: 09/11/2016] [Indexed: 02/06/2023] Open
Abstract
With the changing distribution of infectious diseases, and an increase in the burden of non-communicable diseases, low- and middle-income countries, including those in Africa, will need to expand their health care capacities to effectively respond to these epidemiological transitions. The interrelated risk factors for chronic infectious and non-communicable diseases and the need for long-term disease management, argue for combined strategies to understand their underlying causes and to design strategies for effective prevention and long-term care. Through multidisciplinary research and implementation partnerships, we advocate an integrated approach for research and healthcare for chronic diseases in Africa.
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Affiliation(s)
- A. L. Barr
- Department of Medicine, University of Cambridge, Cambridge, UK
- Wellcome Trust Sanger Institute, Genome Campus, Hinxton, UK
| | - E. H. Young
- Department of Medicine, University of Cambridge, Cambridge, UK
- Wellcome Trust Sanger Institute, Genome Campus, Hinxton, UK
| | - L. Smeeth
- Epidemiology and Population Health, London School of Hygiene & Tropical Medicine, London, UK
| | - R. Newton
- Medical Research Council/Uganda Virus Research Institute (MRC/UVRI), Uganda Research Unit on AIDS, Entebbe, Uganda
| | - J. Seeley
- Medical Research Council/Uganda Virus Research Institute (MRC/UVRI), Uganda Research Unit on AIDS, Entebbe, Uganda
- Global Health and Development, London School of Hygiene & Tropical Medicine, London, UK
| | - K. Ripullone
- Department of Medicine, University of Cambridge, Cambridge, UK
- Wellcome Trust Sanger Institute, Genome Campus, Hinxton, UK
| | - T. R. Hird
- Department of Medicine, University of Cambridge, Cambridge, UK
- Wellcome Trust Sanger Institute, Genome Campus, Hinxton, UK
| | - J. R. M. Thornton
- Department of Medicine, University of Cambridge, Cambridge, UK
- Wellcome Trust Sanger Institute, Genome Campus, Hinxton, UK
| | - M. J. Nyirenda
- Epidemiology and Population Health, London School of Hygiene & Tropical Medicine, London, UK
- Malawi Epidemiology and Intervention Research Unit, Lilongwe, Malawi
| | - S. Kapiga
- Epidemiology and Population Health, London School of Hygiene & Tropical Medicine, London, UK
- Mwanza Intervention Trials Unit, National Institute for Medical Research, Mwanza, Tanzania
| | - C. A. Adebamowo
- Department of Epidemiology and Public Health, Greenebaum Comprehensive Cancer Center and Institute of Human Virology, University of Maryland School of Medicine, Baltimore MD 21201 USA
- Institute of Human Virology, Nigeria
| | - A. G. Amoah
- Department of Medicine, University of Ghana Medical School, Korlebu, Ghana
| | - N. Wareham
- MRC Epidemiology Unit, University of Cambridge, Cambridge, UK
| | - C. N. Rotimi
- Center for Research on Genomics and Global Health, National Human Genome Research Institute, National Institutes of Health, Bethesda, USA
| | - N. S. Levitt
- Division of Diabetic Medicine and Endocrinology, Department of Medicine, University of Cape Town, Cape Town, South Africa
| | - K. Ramaiya
- Shree Hindu Mandal Hospital, Dar es Salaam, Tanzania
| | - B. J. Hennig
- MRC Unit, The Gambia, Fajara, The Gambia
- MRC International Nutrition Group, London School of Hygiene & Tropical Medicine, London, UK
| | - J. C. Mbanya
- Department of Internal Medicine and Specialties, Faculty of Medicine and Biomedical Sciences, University of Yaoundé I, Yaoundé, Cameroon
| | - S. Tollman
- MRC/Wits Rural Public Health and Health Transitions Research Unit, School of Public Health, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
- INDEPTH Network, Accra, Ghana
| | - A. A. Motala
- Department of Diabetes and Endocrinology, Nelson R Mandela School of Medicine, University of KwaZulu-Natal, Durban, South Africa
| | - P. Kaleebu
- Medical Research Council/Uganda Virus Research Institute (MRC/UVRI), Uganda Research Unit on AIDS, Entebbe, Uganda
| | - M. S. Sandhu
- Department of Medicine, University of Cambridge, Cambridge, UK
- Wellcome Trust Sanger Institute, Genome Campus, Hinxton, UK
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Angkurawaranon C, Nitsch D, Larke N, Rehman AM, Smeeth L, Addo J. Ecological Study of HIV Infection and Hypertension in Sub-Saharan Africa: Is There a Double Burden of Disease? PLoS One 2016; 11:e0166375. [PMID: 27855194 PMCID: PMC5113946 DOI: 10.1371/journal.pone.0166375] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2016] [Accepted: 10/27/2016] [Indexed: 12/01/2022] Open
Abstract
METHODS Data on prevalence of hypertension were derived from a systematic search of literature published between 1975 and 2014 with corresponding national estimates on HIV prevalence and antiretroviral therapy (ART) coverage from the Demographic and Health Surveys and the joint United Nations Programme on HIV/AIDS databases. National estimates on gross national income (GNI) and under-five mortality were obtained from the World Bank database. Linear regression analyses using robust standard errors (allowing for clustering at country level) were carried out for associations of age-standardised hypertension prevalence ratios (standardized to rural Uganda's hypertension prevalence data) with HIV prevalence, adjusted for national indicators, year of study and sex of the study population. RESULTS In total, 140 estimates of prevalence of hypertension representing 25 nations were sex-and area-matched with corresponding HIV prevalence. A two-fold increase in HIV prevalence was associated with a 9.29% increase in age, sex and study year-adjusted prevalence ratio for hypertension (95% CI 2.0 to 16.5, p = 0.01), which increased to 16.3% (95% CI 9.3 to 21.1) after adjusting for under-five mortality, GNI per capita and ART coverage. CONCLUSIONS Countries with a pronounced burden of HIV may also have an increased burden of non-communicable diseases such as hypertension with potential economic and health systems implications.
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Affiliation(s)
- C. Angkurawaranon
- Department of Family Medicine, Faculty of Medicine, Chiang Mai University, Chiang Mai, Thailand
| | - D Nitsch
- Department of Non-Communicable Disease Epidemiology, Faculty of Epidemiology and Population Health, London School of Hygiene and Tropical Medicine, London, United Kingdom
| | - N Larke
- Medical Research Council Tropical Epidemiology Group, Department of Infectious Disease Epidemiology, Faculty of Epidemiology and Population Health, London School of Hygiene and Tropical Medicine, London, United Kingdom
| | - A. M. Rehman
- Medical Research Council Tropical Epidemiology Group, Department of Infectious Disease Epidemiology, Faculty of Epidemiology and Population Health, London School of Hygiene and Tropical Medicine, London, United Kingdom
| | - L. Smeeth
- Department of Non-Communicable Disease Epidemiology, Faculty of Epidemiology and Population Health, London School of Hygiene and Tropical Medicine, London, United Kingdom
| | - J. Addo
- Department of Non-Communicable Disease Epidemiology, Faculty of Epidemiology and Population Health, London School of Hygiene and Tropical Medicine, London, United Kingdom
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Matthews A, Turkson M, Forbes H, Langan SM, Smeeth L, Bhaskaran K. Statin use and the risk of herpes zoster: a nested case-control study using primary care data from the U.K. Clinical Research Practice Datalink. Br J Dermatol 2016; 175:1183-1194. [PMID: 27292233 PMCID: PMC5215701 DOI: 10.1111/bjd.14815] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/01/2016] [Indexed: 02/06/2023]
Abstract
Background Statins are commonly prescribed worldwide and recent evidence suggests that they may increase the risk of herpes zoster (HZ). Objectives To quantify the effect of statin exposure on the risk of HZ in the U.K. Methods A matched case–control study was conducted using data from U.K. primary care and hospital records. Patients > 18 years with an incident diagnosis of HZ were matched to up to four controls for age, sex and general practice. Patients were included in the statin exposure group if they had ever used a statin, and the daily dosage of the most recent statin prescription and the time since the most recent statin prescription were also recorded. The primary outcome was an incident diagnosis of HZ. Odds ratios (ORs) were estimated from conditional logistic regression and adjusted for potential confounders. Results A total of 144 959 incident cases of HZ were matched to 549 336 controls. Adjusted analysis suggested strong evidence for an increase in the risk of HZ related to statin exposure (OR 1·13, 95% confidence interval 1·11–1·15). There was also an increased risk when dosages were increased for patients who were currently or had recently been receiving statin treatment (Ptrend < 0·001), and we found an attenuation of the increased risk of HZ in previous statin users as the time since last statin exposure increased (Ptrend < 0·001). Conclusions These findings are consistent with the hypothesis that statin therapy leads to an increase in the risk of HZ. What's already known about this topic? Studies in both Canada and Taiwan have recently reported a small but significantly increased risk of herpes zoster (HZ) in patients receiving statin treatment. As statins are one of the most widely prescribed drugs in the U.K., with around 45 million prescriptions every year, any adverse effects will have substantial public health implications.
What does this study add? In this large matched case–control study, statin exposure was associated with a modest increase in the risk of HZ. A dose–response relationship was observed, and there was an attenuation of the increased risk over time among people who stopped statin therapy, indicating that the increased risk is consistent with a causal effect. There may be extra motivation to maximize HZ vaccine uptake among eligible patients receiving a statin.
Linked Comment:Shalom and Cohen. Br J Dermatol 2016; 175:1137–1138.
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Affiliation(s)
- A Matthews
- Department of Noncommunicable Diseases Epidemiology, London School of Hygiene and Tropical Medicine, London, U.K
| | - M Turkson
- Department of Noncommunicable Diseases Epidemiology, London School of Hygiene and Tropical Medicine, London, U.K
| | - H Forbes
- Department of Noncommunicable Diseases Epidemiology, London School of Hygiene and Tropical Medicine, London, U.K
| | - S M Langan
- Department of Noncommunicable Diseases Epidemiology, London School of Hygiene and Tropical Medicine, London, U.K
| | - L Smeeth
- Department of Noncommunicable Diseases Epidemiology, London School of Hygiene and Tropical Medicine, London, U.K
| | - K Bhaskaran
- Department of Noncommunicable Diseases Epidemiology, London School of Hygiene and Tropical Medicine, London, U.K
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Boateng D, Agyemang C, Beune EJAJ, Smeeth L, Schulze M, Addo J, Aikins A, Galbete C, Agyei-Baffour P, Kengne AP, Grobbee DE, Stronks K, Klipstein-Grobusch K. Migration and cardiovascular disease risk among Ghanaian populations in Europe: The RODAM study. Eur J Public Health 2016. [DOI: 10.1093/eurpub/ckw170.028] [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: 11/13/2022] Open
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Ekoru K, Young EH, Adebamowo C, Balde N, Hennig BJ, Kaleebu P, Kapiga S, Levitt NS, Mayige M, Mbanya JC, McCarthy MI, Nyan O, Nyirenda M, Oli J, Ramaiya K, Smeeth L, Sobngwi E, Rotimi CN, Sandhu MS, Motala AA. H3Africa multi-centre study of the prevalence and environmental and genetic determinants of type 2 diabetes in sub-Saharan Africa: study protocol. Glob Health Epidemiol Genom 2016; 1:e5. [PMID: 29276615 PMCID: PMC5732581 DOI: 10.1017/gheg.2015.6] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2015] [Revised: 11/20/2015] [Accepted: 12/25/2015] [Indexed: 12/30/2022] Open
Abstract
The burden and aetiology of type 2 diabetes (T2D) and its microvascular complications may be influenced by varying behavioural and lifestyle environments as well as by genetic susceptibility. These aspects of the epidemiology of T2D have not been reliably clarified in sub-Saharan Africa (SSA), highlighting the need for context-specific epidemiological studies with the statistical resolution to inform potential preventative and therapeutic strategies. Therefore, as part of the Human Heredity and Health in Africa (H3Africa) initiative, we designed a multi-site study comprising case collections and population-based surveys at 11 sites in eight countries across SSA. The goal is to recruit up to 6000 T2D participants and 6000 control participants. We will collect questionnaire data, biophysical measurements and biological samples for chronic disease traits, risk factors and genetic data on all study participants. Through integrating epidemiological and genomic techniques, the study provides a framework for assessing the burden, spectrum and environmental and genetic risk factors for T2D and its complications across SSA. With established mechanisms for fieldwork, data and sample collection and management, data-sharing and consent for re-approaching participants, the study will be a resource for future research studies, including longitudinal studies, prospective case ascertainment of incident disease and interventional studies.
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Affiliation(s)
- K. Ekoru
- Department of Medicine, University of Cambridge, Cambridge, UK
- Genetic Epidemiology Group, Wellcome Trust Sanger Institute, Hinxton, Cambridge, UK
| | - E. H. Young
- Department of Medicine, University of Cambridge, Cambridge, UK
- Genetic Epidemiology Group, Wellcome Trust Sanger Institute, Hinxton, Cambridge, UK
| | - C. Adebamowo
- Institute of Human Virology, Abuja, Nigeria
- Department of Epidemiology and Public Health, Institute of Human Virology and Greenebaum Cancer Center, University of Maryland Baltimore School of Medicine, MD, USA
| | - N. Balde
- CHU Donka, University of Conakry, Non Communicable Disease Unit, Ministry of Health, Conackry, Guinea
| | - B. J. Hennig
- MRC International Nutrition Group at MRC Keneba, MRC Unit, The Gambia
- MRC International Nutrition Group, London School of Hygiene and Tropical Medicine, UK
| | - P. Kaleebu
- MRC/UVRI Uganda Research Unit on AIDS, Entebbe, Uganda
| | - S. Kapiga
- Mwanza Intervention Trials Unit/NIMR, Mwanza, Tanzania
- University of Nigeria Teaching Hospital, Enugu, Nigeria
| | - N. S. Levitt
- Division of Diabetic Medicine and Endocrinology, Department of Medicine, University of Cape Town, Cape Town, Chronic Diseases Initiative in Africa, South Africa
| | - M. Mayige
- National Institute for Medical Research, Dar es Salaam, Tanzania
| | - J. C. Mbanya
- Faculty of Medicine and Biomedical Sciences, University of Yaounde 1, Yaounde, Cameroon
| | - M. I. McCarthy
- Oxford Centre for Diabetes, Endocrinology and Metabolism, University of Oxford, Churchill Hospital, Old Road, Headington, Oxford, UK
- Wellcome Trust Centre for Human Genetics, University of Oxford, Roosevelt Drive, Oxford, UK
- Oxford NIHR Biomedical Research Centre, Churchill Hospital, Old Road, Headington, Oxford, UK
| | - O. Nyan
- Edward Francis Small Teaching Hospital, School of Medicine, University of The Gambia, Banjul, The Gambia
| | - M. Nyirenda
- Malawi Epidemiology and Intervention Research Unit, Lilongwe, Malawi
| | - J. Oli
- University of Nigeria Teaching Hospital, Enugu, Nigeria
| | - K. Ramaiya
- Department of Medicine, Muhimbili University of Health and Allied Sciences, Dar es Salaam, Tanzania
| | - L. Smeeth
- Faculty of Epidemiology and Population Health, London School of Hygiene and Tropical Medicine, London, UK
| | - E. Sobngwi
- Faculty of Medicine and Biomedical Sciences, University of Yaounde 1, Yaounde, Cameroon
| | - C. N. Rotimi
- Center for Research on Genomics and Global Health, National Human Genome Research Institute, NIH, Bethesda, MD, USA
| | - M. S. Sandhu
- Department of Medicine, University of Cambridge, Cambridge, UK
- Genetic Epidemiology Group, Wellcome Trust Sanger Institute, Hinxton, Cambridge, UK
| | - A. A. Motala
- Department of Diabetes and Endocrinology, Nelson R. Mandela School of Medicine, University of KwaZulu-Natal, Durban, South Africa
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Langan S, Smeeth L, West J. Reply to: Validation of database search strategies for the epidemiological study of pemphigus and pemphigoid. Br J Dermatol 2016; 174:696-7. [DOI: 10.1111/bjd.14397] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Affiliation(s)
- S.M. Langan
- Faculty of Epidemiology and Population Health; London School of Hygiene and Tropical Medicine; London U.K
| | - L. Smeeth
- Faculty of Epidemiology and Population Health; London School of Hygiene and Tropical Medicine; London U.K
| | - J. West
- Department of Epidemiology; University of Nottingham; Nottingham U.K
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Rothnie KJ, Mullerova H, Hurst JR, Smeeth L, Chandan J, Davis K, Thomas S, Quint JK. P47 Recording of hospitalisations for acute exacerbations of COPD in UK electronic healthcare records databases. Thorax 2015. [DOI: 10.1136/thoraxjnl-2015-207770.184] [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: 11/04/2022]
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Abstract
BACKGROUND While acute kidney injury (AKI) alone is associated with increased mortality, the incidence of hospital admission with AKI among stable and exacerbating COPD patients and the effect of concurrent AKI at COPD exacerbation on mortality is not known. METHODS A total of 189,561 individuals with COPD were identified from the Clinical Practice Research Datalink. Using Poisson and logistic regressions, we explored which factors predicted admission for AKI (identified in Hospital Episode Statistics) in this COPD cohort and concomitant AKI at a hospitalization for COPD exacerbation. Using survival analysis, we investigated the effect of concurrent AKI at exacerbation on mortality (n=36,107) and identified confounding factors. RESULTS The incidence of AKI in the total COPD cohort was 128/100,000 person-years. The prevalence of concomitant AKI at exacerbation was 1.9%, and the mortality rate in patients with AKI at exacerbation was 521/1,000 person-years. Male sex, older age, and lower glomerular filtration rate predicted higher risk of AKI or death. There was a 1.80 fold (95% confidence interval: 1.61, 2.03) increase in adjusted mortality within the first 6 months post COPD exacerbation in patients suffering from AKI and COPD exacerbation compared to those who were AKI free. CONCLUSION In comparison to previous studies on general populations and hospitalizations, the incidence and prevalence of AKI is relatively high in COPD patients. Coexisting AKI at exacerbation is prognostic of poor outcome.
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Affiliation(s)
- MF Barakat
- Faculty of Epidemiology and Population Health, London School of Hygiene and Tropical Medicine, London, UK
| | - HI McDonald
- Faculty of Epidemiology and Population Health, London School of Hygiene and Tropical Medicine, London, UK
| | - TJ Collier
- Faculty of Epidemiology and Population Health, London School of Hygiene and Tropical Medicine, London, UK
| | - L Smeeth
- Faculty of Epidemiology and Population Health, London School of Hygiene and Tropical Medicine, London, UK
| | - D Nitsch
- Faculty of Epidemiology and Population Health, London School of Hygiene and Tropical Medicine, London, UK
| | - JK Quint
- Faculty of Epidemiology and Population Health, London School of Hygiene and Tropical Medicine, London, UK
- Department of Respiratory Epidemiology, Occupational Medicine and Public Health, National Heart and Lung Institute, Imperial College London, London, UK
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Hayes JF, Bhaskaran K, Batterham R, Smeeth L, Douglas I. The effect of sibutramine prescribing in routine clinical practice on cardiovascular outcomes: a cohort study in the United Kingdom. Int J Obes (Lond) 2015; 39:1359-64. [PMID: 25971925 PMCID: PMC4551415 DOI: 10.1038/ijo.2015.86] [Citation(s) in RCA: 12] [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] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/18/2015] [Revised: 04/24/2015] [Accepted: 05/06/2015] [Indexed: 02/02/2023]
Abstract
BACKGROUND/OBJECTIVES The marketing authorization for the weight loss drug sibutramine was suspended in 2010 following a major trial that showed increased rates of non-fatal myocardial infarction and cerebrovascular events in patients with pre-existing cardiovascular disease. In routine clinical practice, sibutramine was already contraindicated in patients with cardiovascular disease and so the relevance of these influential clinical trial findings to the 'real World' population of patients receiving or eligible for the drug is questionable. We assessed rates of myocardial infarction and cerebrovascular events in a cohort of patients prescribed sibutramine or orlistat in the United Kingdom. SUBJECTS/METHODS A cohort of patients prescribed weight loss medication was identified within the Clinical Practice Research Datalink. Rates of myocardial infarction or cerebrovascular event, and all-cause mortality were compared between patients prescribed sibutramine and similar patients prescribed orlistat, using both a multivariable Cox proportional hazard model, and propensity score-adjusted model. Possible effect modification by pre-existing cardiovascular disease and cardiovascular risk factors was assessed. RESULTS Patients prescribed sibutramine (N=23,927) appeared to have an elevated rate of myocardial infarction or cerebrovascular events compared with those taking orlistat (N=77,047; hazard ratio 1.69, 95% confidence interval 1.12-2.56). However, subgroup analysis showed the elevated rate was larger in those with pre-existing cardiovascular disease (hazard ratio 4.37, 95% confidence interval 2.21-8.64), compared with those with no cardiovascular disease (hazard ratio 1.52, 95% confidence interval 0.92-2.48, P-interaction=0.0076). All-cause mortality was not increased in those prescribed sibutramine (hazard ratio 0.67, 95% confidence interval 0.34-1.32). CONCLUSIONS Sibutramine was associated with increased rates of acute cardiovascular events in people with pre-existing cardiovascular disease, but there was a low absolute risk in those without. Sibutramine's marketing authorization may have, therefore, been inappropriately withdrawn for people without cardiovascular disease.
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Affiliation(s)
- J F Hayes
- Division of Psychiatry, University College London, London, UK
| | - K Bhaskaran
- Department of Non-Communicable Disease Epidemiology, London School of Hygiene and Tropical Medicine, London, UK
| | - R Batterham
- Department of Medicine, University College London, London, UK
| | - L Smeeth
- Department of Non-Communicable Disease Epidemiology, London School of Hygiene and Tropical Medicine, London, UK
| | - I Douglas
- Department of Non-Communicable Disease Epidemiology, London School of Hygiene and Tropical Medicine, London, UK
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Rothnie K, Smeeth L, Herrett E, Pearce N, Hemingway H, Timmis A, Wedzicha J, Quint J. S107 Explaining The Mortality Gap In Copd Patients After Myocardial Infarction: Data From The Uk Myocardial Ischaemia National Audit Project (minap). Thorax 2014. [DOI: 10.1136/thoraxjnl-2014-206260.113] [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: 11/04/2022]
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Windsor C, Herrett E, Smeeth L, Quint J. M142 The Association Between Exacerbation Frequency And Stroke Risk, In Patients With Copd: A Matched Case-control Study. Thorax 2014. [DOI: 10.1136/thoraxjnl-2014-206260.437] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
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Millett E, De Stavola B, Quint J, Smeeth L, Thomas S. S14 Time Trends And Risk Factors For Hospitalisation After Community-acquired Pneumonia In Older Adults In England. Thorax 2014. [DOI: 10.1136/thoraxjnl-2014-206260.20] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
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Navaratnam V, Millett E, Hurst J, Thomas S, Smeeth L, Hubbard R, Brown J, Quint J. P81 The Increasing Secondary Care Burden Of Bronchiectasis In England. Thorax 2014. [DOI: 10.1136/thoraxjnl-2014-206260.222] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [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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Navaratnam V, Millett E, Hurst J, Thomas S, Smeeth L, Hubbard R, Brown J, Quint J. S17 Cardiovascular Risk Factors In People With Bronchiectasis: A Cross Sectional Study. Thorax 2014. [DOI: 10.1136/thoraxjnl-2014-206260.23] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
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van Staa TP, Klungel O, Smeeth L. Use of electronic healthcare records in large-scale simple randomized trials at the point of care for the documentation of value-based medicine. J Intern Med 2014; 275:562-9. [PMID: 24635449 DOI: 10.1111/joim.12211] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
A solid foundation of evidence of the effects of an intervention is a prerequisite of evidence-based medicine. The best source of such evidence is considered to be randomized trials, which are able to avoid confounding. However, they may not always estimate effectiveness in clinical practice. Databases that collate anonymized electronic health records (EHRs) from different clinical centres have been widely used for many years in observational studies. Randomized point-of-care trials have been initiated recently to recruit and follow patients using the data from EHR databases. In this review, we describe how EHR databases can be used for conducting large-scale simple trials and discuss the advantages and disadvantages of their use.
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Affiliation(s)
- T-P van Staa
- Utrecht Institute for Pharmaceutical Sciences, Utrecht University, Utrecht, the Netherlands; London School of Hygiene and Tropical Medicine, London, UK
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Ban L, Gibson JE, West J, Fiaschi L, Sokal R, Smeeth L, Doyle P, Hubbard RB, Tata LJ. Maternal depression, antidepressant prescriptions, and congenital anomaly risk in offspring: a population-based cohort study. BJOG 2014; 121:1471-81. [PMID: 24612301 PMCID: PMC4232879 DOI: 10.1111/1471-0528.12682] [Citation(s) in RCA: 68] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/22/2013] [Indexed: 11/29/2022]
Abstract
Objective To estimate risks of major congenital anomaly (MCA) among children of mothers prescribed antidepressants during early pregnancy or diagnosed with depression but without antidepressant prescriptions. Design Population-based cohort study. Setting Linked UK maternal–child primary care records. Population A total of 349 127 singletons liveborn between 1990 and 2009. Methods Odds ratios adjusted for maternal sociodemographics and comorbidities (aORs) were calculated for MCAs, comparing women with first-trimester selective serotonin reuptake inhibitors (SSRIs) or tricyclic antidepressants (TCAs) and women with diagnosed but unmedicated depression, or women without diagnosed depression. Main outcome measures Fourteen system-specific MCA groups classified according to the European Surveillance of Congenital Anomalies and five specific heart anomaly groups. Results Absolute risks of MCA were 2.7% (95% confidence interval, 95% CI, 2.6–2.8%) in children of mothers without diagnosed depression, 2.8% (95% CI 2.5–3.2%) in children of mothers with unmedicated depression, and 2.7% (95% CI 2.2–3.2%) and 3.1% (95% CI 2.2–4.1%) in children of mothers with SSRIs or TCAs, respectively. Compared with women without depression, MCA overall was not associated with unmedicated depression (aOR 1.07, 95% CI 0.96–1.18), SSRIs (aOR 1.01, 95% CI 0.88–1.17), or TCAs (aOR 1.09, 95% CI 0.87–1.38). Paroxetine was associated with increased heart anomalies (absolute risk 1.4% in the exposed group compared with 0.8% in women without depression; aOR 1.78, 95% CI 1.09–2.88), which decreased marginally when compared with women with diagnosed but unmedicated depression (aOR 1.67, 95% CI 1.00–2.80). Conclusions Overall MCA risk did not increase with maternal depression or with antidepressant prescriptions. Paroxetine was associated with increases of heart anomalies, although this could represent a chance finding from a large number of comparisons undertaken.
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Affiliation(s)
- L Ban
- Division of Epidemiology & Public Health, University of Nottingham, Nottingham, UK
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Quint JK, Herrett E, Bhaskaran K, Timmis A, Hemingway H, Wedzicha JA, Smeeth L. Effect of β blockers on mortality after myocardial infarction in adults with COPD: population based cohort study of UK electronic healthcare records. BMJ 2013; 347:f6650. [PMID: 24270505 PMCID: PMC3898388 DOI: 10.1136/bmj.f6650] [Citation(s) in RCA: 94] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 10/25/2013] [Indexed: 01/25/2023]
Abstract
OBJECTIVES To investigate whether the use and timing of prescription of β blockers in patients with chronic obstructive pulmonary disease (COPD) having a first myocardial infarction was associated with survival and to identify factors related to their use. DESIGN Population based cohort study in England. SETTING UK national registry of myocardial infarction (Myocardial Ischaemia National Audit Project (MINAP)) linked to the General Practice Research Database (GPRD), 2003-11. PARTICIPANTS Patients with COPD with a first myocardial infarction in 1 January 2003 to 31 December 2008 as recorded in MINAP, who had no previous evidence of myocardial infarction in their GPRD or MINAP record. Data were provided by the Cardiovascular Disease Research using Linked Bespoke studies and Electronic Health Records (CALIBER) group at University College London. MAIN OUTCOME MEASURE Cox proportional hazards ratio for mortality after myocardial infarction in patients with COPD in those prescribed β blockers or not, corrected for covariates including age, sex, smoking status, drugs, comorbidities, type of myocardial infarction, and severity of infarct. RESULTS Among 1063 patients with COPD, treatment with β blockers started during the hospital admission for myocardial infarction was associated with substantial survival benefits (fully adjusted hazard ratio 0.50, 95% confidence interval 0.36 to 0.69; P<0.001; median follow-up time 2.9 years). Patients already taking a β blocker before their myocardial infarction also had a survival benefit (0.59, 0.44 to 0.79; P<0.001). Similar results were obtained with propensity scores as an alternative method to adjust for differences between those prescribed and not prescribed β blockers. With follow-up started from date of discharge from hospital, the effect size was slightly attenuated but there was a similar protective effect of treatment with β blockers started during hospital admission for myocardial infarction (0.64, 0.44 to 0.94; P=0.02). CONCLUSIONS The use of β blockers started either at the time of hospital admission for myocardial infarction or before a myocardial infarction is associated with improved survival after myocardial infarction in patients with COPD. REGISTRATION NCT01335672.
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Affiliation(s)
- J K Quint
- Department of Non-Communicable Disease Epidemiology, London School of Hygiene and Tropical Medicine, London WC1E 7HT, UK
| | - E Herrett
- Department of Non-Communicable Disease Epidemiology, London School of Hygiene and Tropical Medicine, London WC1E 7HT, UK
| | - K Bhaskaran
- Department of Non-Communicable Disease Epidemiology, London School of Hygiene and Tropical Medicine, London WC1E 7HT, UK
| | - A Timmis
- NIHR Biomedical Research Unit, Barts and the London School of Medicine and Dentistry, London Chest Hospital, London E2 9JX, UK
| | - H Hemingway
- Department of Epidemiology and Public Health, and Farr Institute of Health Informatics Research at UCL Partners, University College London, London WC1E 6BT, UK
| | - J A Wedzicha
- Centre for Respiratory Medicine, University College London, Royal Free Campus, London NW3 2PF, UK
| | - L Smeeth
- Department of Non-Communicable Disease Epidemiology, London School of Hygiene and Tropical Medicine, London WC1E 7HT, UK
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Etyang A, Warne B, Kapesa S, Cruickshank J, Smeeth L, Scott J. P3.30 DIFFERENCE IN THE PREVALENCE OF HYPERTENSION USING STANDARD BLOOD PRESSURE MEASUREMENT COMPARED TO AMBULATORY BLOOD PRESSURE MONITORING IN KILIFI, KENYA. Artery Res 2013. [DOI: 10.1016/j.artres.2013.10.117] [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: 10/26/2022] Open
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Quint JK, Millett E, Hurst JR, Smeeth L, Brown J. P172 Time Trends in Incidence and Prevalence of Bronchiectasis in the UK: Abstract P169 Table 1. Thorax 2012. [DOI: 10.1136/thoraxjnl-2012-202678.233] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
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Langham J, Smeeth L, Brauer R, Bhaskaran K, Douglas I. OP93 Orlistat and the Risk of Acute Liver Injury: A Self-Controlled Case-Series Study in United Kingdom General Practice Research Database. Br J Soc Med 2012. [DOI: 10.1136/jech-2012-201753.093] [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: 11/04/2022]
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George J, Herrett E, Denaxas S, Rapsomaniki E, Timmis A, Smeeth L, Hemingway H. OP88 The Hazard of Smoking for Specific Coronary Disease Phenotypes: An Electronic Health Records Study with Linked Data in 915,000 Patients. Br J Soc Med 2012. [DOI: 10.1136/jech-2012-201753.088] [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: 11/04/2022]
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Abstract
BACKGROUND Data on the association between acute infections and venous thromboembolism (VTE) are sparse. We examined whether various hospital-diagnosed infections or infections treated in the community increase the risk of VTE. METHODS We conducted this population-based case-control study in Northern Denmark (population 1.8 million) using medical databases. We identified all patients with a first hospital-diagnosed VTE during the period 1999-2009 (n = 15 009). For each case, we selected 10 controls from the general population matched for age, gender and county of residence (n = 150 074). We identified all hospital-diagnosed infections and community prescriptions for antibiotics 1 year predating VTE. We used odds ratios from a conditional logistic regression model to estimate incidence rate ratios (IRRs) of VTE within different time intervals of the first year after infection, controlling for confounding. RESULTS Respiratory tract, urinary tract, skin, intra-abdominal and bacteraemic infections diagnosed in hospital or treated in the community were associated with a greater than equal to twofold increased VTE risk. The association was strongest within the first 2 weeks after infection onset, gradually declining thereafter. Compared with individuals without infection during the year before VTE, the IRR for VTE within the first 3 months after infection was 12.5 (95% confidence interval (CI): 11.3-13.9) for patients with hospital-diagnosed infection and 4.0 (95% CI: 3.8-4.1) for patients treated with antibiotics in the community. Adjustment for VTE risk factors reduced these IRRs to 3.3 (95% CI: 2.9-3.8) and 2.6 (95% CI: 2.5-2.8), respectively. Similar associations were found for unprovoked VTE and for deep venous thrombosis and pulmonary embolism individually. CONCLUSIONS Infections are a risk factor for VTE.
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Affiliation(s)
- M Schmidt
- Department of Clinical Epidemiology, Institute of Clinical Medicine, Aarhus University Hospital, Aarhus, Denmark.
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Addo J, Agyemang C, Smeeth L, de-Graft Aikins A, Edusei AK, Ogedegbe O. A review of population-based studies on hypertension in Ghana. Ghana Med J 2012; 46:4-11. [PMID: 23661811 PMCID: PMC3645150] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/02/2023] Open
Abstract
BACKGROUND Hypertension is becoming a common health problem worldwide with increasing life expectancy and increasing prevalence of risk factors. Epidemiological data on hypertension in Ghana is necessary to guide policy and develop effective interventions. METHODS A review of population-based studies on hypertension in Ghana was conducted by a search of the PUBMED database, supplemented by a manual search of bibliographies of the identified articles and through the Ghana Medical Journal. A single reviewer extracted data using standard data collection forms. RESULTS Eleven studies published on hypertension with surveys conducted between 1973 and 2009 were identified. The prevalence of hypertension was higher in urban than rural areas in studies that covered both types of area and increased with increasing age (prevalence ranging from 19.3% in rural to 54.6% in urban areas). Factors associated with high blood pressure included increasing body mass index, increased salt consumption, family history of hypertension and excessive alcohol intake. The levels of hypertension detection, treatment and control were generally low (control rates ranged from 1.7% to 12.7%). CONCLUSION An increased burden of hypertension should be expected in Ghana as life expectancy increases and with rapid urbanisation. Without adequate detection and control, this will translate into a higher incidence of stroke and other adverse health outcomes for which hypertension is an established risk factor. Prevention and control of hypertension in Ghana is thus imperative and any delays in instituting preventive measures would most likely pose a greater challenge on the already overburdened health system.
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Affiliation(s)
- J Addo
- Department of Epidemiology and Population Health, London School of Hygiene and Tropical Medicine, Keppel Street, London, UK.
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