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Risk of Venous Thromboembolism in Statin Users Compared to Fibrate Users in the United Kingdom Clinical Practice Research Datalink (UK CPRD) GOLD. 英国临床实践研究数据链 (UK CPRD) GOLD 中他汀类药物使用者与非贝特类药物使用者的静脉血栓栓塞风险比较。
IF 3.4 2区 医学 Q1 PUBLIC, ENVIRONMENTAL & OCCUPATIONAL HEALTH Pub Date : 2024-10-05 eCollection Date: 2024-01-01 DOI: 10.2147/CLEP.S481448
Olulade Ayodele, Howard J Cabral, David D McManus, Susan S Jick

Background: A substantial proportion of adults receive statins for treatment of hypercholesterolemia and cardiovascular risk, and statins have been found to improve outcomes in this patient population. However, studies have not consistently demonstrated the potential benefits of statins in preventing venous thromboembolism (VTE). Therefore, we conducted this study to investigate this association.

Methods: We conducted a cohort analysis in a study sample comprised of 40-79-year-old patients with hyperlipidemia who received at least one fibrate or statin prescription between January 1995 and December 2018 in the United Kingdom Clinical Practice Research Datalink (CPRD) GOLD. We evaluated the association between statin use and incident unprovoked VTE, compared to fibrate use, an active comparator, using Kaplan-Meier (KM) analysis, Poisson regression (with and without propensity score matching), and inverse probability of treatment weights (IPTW) marginal structural models (MSM).

Results: In this cohort of 166,292 patients with hyperlipidemia, 0.81% (N=1,353) developed incident unprovoked VTE. In analyses using the KM method, patients who received statins had a slightly lower risk of VTE compared to those who received fibrates (Log rank test: p=0.0524). The adjusted incident rate ratio (95% CI) for VTE, calculated using Poisson regression, controlling for serum cholesterol and other baseline covariates, in patients prescribed statins compared to fibrates was 0.77 (0.45-1.33) in the full cohort, 0.74 (0.38-1.45) in the propensity score matched analysis, and 0.51 (95% conservative CI: 0.34-0.76) in the IPTW MSM analysis.

Conclusion: While the magnitude of effect varied across the different analytic methods, there is consistent evidence for a protective effect of statin use on the occurrence of unprovoked VTE.

背景:相当一部分成年人接受他汀类药物治疗高胆固醇血症和心血管风险,研究发现他汀类药物可改善这类患者的预后。然而,研究并未一致证明他汀类药物在预防静脉血栓栓塞(VTE)方面的潜在益处。因此,我们开展了这项研究来调查这种关联:我们对英国临床实践研究数据链(CPRD)GOLD 中 1995 年 1 月至 2018 年 12 月期间至少接受过一次纤维素类药物或他汀类药物处方的 40-79 岁高脂血症患者样本进行了队列分析。我们采用卡普兰-梅耶(KM)分析、泊松回归(有倾向得分匹配和无倾向得分匹配)和治疗权重反向概率(IPTW)边际结构模型(MSM),评估了他汀类药物的使用与非诱发性 VTE 事件之间的关联:在这组 166292 名高脂血症患者中,0.81%(1353 人)发生了无诱因 VTE。在使用 KM 方法进行的分析中,与服用纤维素类药物的患者相比,服用他汀类药物的患者发生 VTE 的风险略低(对数秩检验:P=0.0524)。在控制血清胆固醇和其他基线协变量的情况下,使用泊松回归计算出的他汀类药物与纤维素类药物处方患者的调整后 VTE 发生率比(95% CI)分别为:全队列为 0.77(0.45-1.33),倾向得分匹配分析为 0.74(0.38-1.45),IPTW MSM 分析为 0.51(95% 保守 CI:0.34-0.76):虽然不同分析方法的影响程度不同,但有一致的证据表明使用他汀类药物对无诱因 VTE 的发生具有保护作用。
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引用次数: 0
Recording of Alcohol Use Disorder in Electronic Health Records: Developing a Recommended Codelist for Research. 在电子健康记录中记录酒精使用障碍:为研究制定推荐目录。
IF 3.4 2区 医学 Q1 PUBLIC, ENVIRONMENTAL & OCCUPATIONAL HEALTH Pub Date : 2024-10-04 eCollection Date: 2024-01-01 DOI: 10.2147/CLEP.S477778
Sarah Cook, David Osborn, Arti Maini, Ravi Parekh, Shamini Gnani, Thomas Beaney, Ana Luisa Neves, Sonia Saxena, Jennifer K Quint

Purpose: Electronic health records (EHR) are valuable resources for health research; however, their use is challenging. A validated alcohol use disorder (AUD) codelist for UK primary care is needed to improve population-based research in this patient group. We aimed to develop an AUD codelist for use in the Clinical Practice Research Datalink (CPRD) Aurum database, a UK EHR primary-care database.

Methods: The CPRD code browser was searched using keywords related to alcohol use using a previously developed search strategy. The resulting codes were categorised as AUD if they were: a) diagnostic of AUD, b) indicated alcohol withdrawal, or c) indicated chronic alcohol-related harm (physical or mental). Codes related to alcohol use but not used to define AUD were also classified into relevant categories (alcohol status, acute harm, and alcohol screening). All codes were categorised independently by at least two reviewers (one person reviewed all codes and five reviewers (all practising GPs) each reviewed a subset of codes (100-200 codes each). Disagreements in categorisation were discussed by at least three coders and a consensus was reached. The reliability of categorisation was assessed using kappa statistics.

Results: In total, 556 potential codes related to alcohol use were identified. The Kappa for reliability between coders was moderate for both AUD (0.72) and across all categories (0.62), with substantial variability between coders (AUD: 0.33-0.97; all categories 0.36-0.74). In the final codelist, 138 codes were included as indicating AUD: 38 codes identified which indicated diagnosis of AUD, 14 indicating withdrawal plus 85 codes indicating chronic alcohol-related harm (41 physical health and 44 mental health).

Conclusion: Many codes are used in primary care to record alcohol use and associated harms, and there is substantial variability in how clinicians categorise them. While future work formally validating the codelist against gold standard clinical reviews and qualitative work with General Practitioners is needed for a deeper understanding of coding processes, we have documented here the process used for the development of an AUD codelist within primary care which can be used as a reference for future research.

目的:电子健康记录 (EHR) 是健康研究的宝贵资源,但其使用却具有挑战性。英国基层医疗机构需要一个经过验证的酒精使用障碍(AUD)代码表,以改善对这一患者群体的人群研究。我们的目标是为英国电子病历初级保健数据库临床实践研究数据链(CPRD)Aurum 数据库开发一个酒精使用障碍代码表:方法:利用之前开发的搜索策略,使用与酒精使用相关的关键词搜索 CPRD 代码浏览器。搜索出的代码在以下情况下被归类为 AUD:a) 可诊断为 AUD;b) 表明酒精戒断;或 c) 表明与酒精相关的慢性伤害(身体或精神伤害)。与酒精使用相关但未用于定义 AUD 的代码也被归入相关类别(酒精状态、急性危害和酒精筛查)。所有代码均由至少两名审稿人独立分类(一人审阅所有代码,五名审稿人(均为执业全科医生)每人审阅一组代码(每组 100-200 个代码))。对于分类中出现的分歧,至少由三名编码员进行讨论并达成共识。使用卡帕统计法评估分类的可靠性:结果:总共确定了 556 个与饮酒有关的潜在代码。对于 AUD(0.72)和所有类别(0.62),编码者之间的 Kappa 可信度为中等,编码者之间存在很大差异(AUD:0.33-0.97;所有类别 0.36-0.74)。在最终的代码表中,有 138 个代码表示 AUD:其中 38 个代码表示 AUD 诊断,14 个代码表示戒酒,另外 85 个代码表示与酒精相关的慢性损害(41 个表示身体健康,44 个表示心理健康):结论:初级保健中使用了许多代码来记录酒精使用和相关危害,临床医生对这些代码的分类存在很大差异。为了更深入地了解编码过程,我们需要在今后的工作中根据金标准临床回顾和全科医生的定性工作对编码表进行正式验证,但我们在此记录了在初级医疗中制定 AUD 编码表的过程,可作为今后研究的参考。
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引用次数: 0
Survival in Thyroid Cancer in Sweden From 1999 To 2018. 1999 年至 2018 年瑞典甲状腺癌患者的生存率。
IF 3.4 2区 医学 Q1 PUBLIC, ENVIRONMENTAL & OCCUPATIONAL HEALTH Pub Date : 2024-10-02 eCollection Date: 2024-01-01 DOI: 10.2147/CLEP.S467874
Frantisek Zitricky, Anni Koskinen, Kristina Sundquist, Jan Sundquist, Vaclav Liska, Asta Försti, Akseli Hemminki, Kari Hemminki

Introduction: Thyroid cancer (TC) is diagnosed in several histological types which differ in their clinical characteristics and survival. We aim to describe how they influence TC survival in Sweden.

Methods: Cancer data were obtained from the Swedish cancer registry between years 1999 and 2018, and these were used to analyze relative survival.

Results: Relative survival for all TC improved when analyzed in 10-year periods, and female survival improved more than male survival. Female survival advantage appeared to be present also for specific histological types, although case numbers were low for rare types. Female 5-year relative survival for TC was 100% for follicular, 95.1% for oncocytic, 93.4% for papillary, 89.7% for medullary, and 6.1% for anaplastic cancer. Among the clinical TNM classes, only T4 and M1 stages were associated with decreased survival compared to T1-3 and M0. Anaplastic cancer presented most often at high T and M1 stages, in contrast to other TC. Curiously, the diagnostic age for anaplastic M1 patients was lower than that for M0 patients. Both anaplastic and medullary cancers did not show age-dependent increases in the probability of metastases, in contrast to the main histological types. This could indicate the presence of several types of anaplastic and medullary cancers.

Conclusion: The poor survival for anaplastic TC is an extreme contrast to the excellent survival of differentiated TC. As less than 20% of anaplastic cancer patients survived one year, urgent diagnosis and initiation of treatment are important. Facilitated treatment pathways have been instituted in Denmark resulting in improved survival. Anaplastic cancer should be a target of a major research focus.

简介甲状腺癌(TC)可分为多种组织学类型,这些类型的临床特征和生存率各不相同。我们旨在描述它们如何影响瑞典的甲状腺癌生存率:方法:从瑞典癌症登记处获得1999年至2018年的癌症数据,并利用这些数据分析相对生存率:以10年为周期进行分析,所有TC的相对生存率均有所提高,女性生存率的提高幅度大于男性。在特定组织学类型中,女性生存率似乎也有优势,尽管罕见类型的病例数量较少。滤泡癌的女性5年相对生存率为100%,肿瘤细胞癌为95.1%,乳头状癌为93.4%,髓样癌为89.7%,无细胞癌为6.1%。在临床TNM分期中,与T1-3期和M0期相比,只有T4期和M1期与生存率下降有关。无弹性癌最常出现在T和M1高分期,这与其他TC形成鲜明对比。奇怪的是,无细胞 M1 患者的诊断年龄低于 M0 患者。与主要组织学类型不同的是,无性细胞癌和髓质癌的转移概率并没有出现随年龄而增加的现象。这可能表明存在多种类型的无细胞癌和髓质癌:与分化型肺癌的良好生存率相比,无弹性肺癌的生存率较低。由于只有不到 20% 的无细胞癌患者能存活一年,因此紧急诊断和开始治疗非常重要。丹麦已经建立了便利的治疗途径,从而提高了患者的生存率。无细胞癌应成为重点研究对象。
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引用次数: 0
Using Routinely Collected Electronic Healthcare Record Data to Investigate Fibrotic Multimorbidity in England [Response to Letter]. 利用常规收集的电子医疗记录数据调查英格兰的纤维化多病症[回信]。
IF 3.4 2区 医学 Q1 PUBLIC, ENVIRONMENTAL & OCCUPATIONAL HEALTH Pub Date : 2024-09-27 eCollection Date: 2024-01-01 DOI: 10.2147/CLEP.S494770
Georgie M Massen, Jennifer K Quint
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引用次数: 0
The Danish Centre for Strategic Research in Type 2 Diabetes (DD2) Project Cohort and Biobank from 2010 Through 2023-A Cohort Profile Update. 丹麦 2 型糖尿病战略研究中心 (DD2) 2010 至 2023 年队列和生物库项目--队列概况更新。
IF 3.4 2区 医学 Q1 PUBLIC, ENVIRONMENTAL & OCCUPATIONAL HEALTH Pub Date : 2024-09-25 eCollection Date: 2024-01-01 DOI: 10.2147/CLEP.S469958
Frederik P B Kristensen, Sia K Nicolaisen, Jens S Nielsen, Diana H Christensen, Kurt Højlund, Henning Beck-Nielsen, Jørgen Rungby, Søren G Friborg, Ivan Brandslund, Jens S Christiansen, Peter Vestergaard, Niels Jessen, Michael H Olsen, Mette K Andersen, Torben Hansen, Charlotte Brøns, Allan Vaag, Reimar W Thomsen, Henrik T Sørensen

Purpose: This paper provides an overview of the Danish Centre for Strategic Research in Type 2 Diabetes (DD2) cohort and biobank, including baseline characteristics of participants enrolled up to 2023, and post-enrollment rates of cardiovascular disease outcomes and mortality.

Methods: Since 2010, the DD2 project has enrolled individuals with type 2 diabetes mellitus (T2DM) recently diagnosed by general practitioners and by hospital-based clinicians across Denmark. Data from questionnaires, clinical examinations, and biological samples are collected at enrollment. Additional baseline and longitudinal follow-up data are accessed via linkage to health registries.

Results: Between 2010 and 2023, the DD2 project enrolled 11,369 participants (41.3% women, median age 61.4 years). Median T2DM duration at enrollment was 1.3 years, and median BMI was 31.6 kg/m2 for women and 30.5 kg/m2 for men. 18.3% were smokers, 5.7% consumed more than 14/21 units of alcohol weekly (women/men), and 17.9% reported leisure-time physical inactivity. Original midwife records dating back >80 years revealed that 20.2% of cohort participants had birth weights <3000 g. Based on complete hospital contact history 10 years before enrollment, 20.7% of cohort participants had macrovascular complications, 17.0% had microvascular complications, and 21.7% had kidney disease based on eGFR or urine albumin-creatinine measurements. At enrollment, statins were used by 68.2%, antihypertensive drugs by 69.9%, and glucose-lowering drugs by 86.5% of individuals. Median HbA1c was 48 mmol/mol and median LDL cholesterol 2.2 mmol/L. Genome-wide genotyping and biomarker data have been analyzed for over 9000 individuals. During the current follow-up time from the enrollment date (median 7.9 years), incident cardiovascular disease rate has been 13.8 per 1000 person-years and the mortality rate has been 17.6 per 1000 person-years.

Conclusion: The DD2 cohort, with its detailed information and long-term follow up, can improve our understanding of the progression and prevention of complications among individuals with newly diagnosed T2DM.

目的:本文概述了丹麦2型糖尿病战略研究中心(DD2)的队列和生物库,包括截至2023年入组参与者的基线特征以及入组后的心血管疾病预后和死亡率:自2010年以来,DD2项目在丹麦各地招募了最近由全科医生和医院临床医生诊断出的2型糖尿病(T2DM)患者。项目在入组时收集了来自问卷、临床检查和生物样本的数据。其他基线和纵向随访数据通过与健康登记处的链接获取:从 2010 年到 2023 年,DD2 项目共招募了 11,369 名参与者(41.3% 为女性,中位年龄为 61.4 岁)。中位 T2DM 病程为 1.3 年,中位体重指数(BMI)为女性 31.6 kg/m2,男性 30.5 kg/m2。18.3%的人吸烟,5.7%的人每周饮酒超过14/21单位(女性/男性),17.9%的人称闲暇时间缺乏运动。助产士的原始记录可追溯到 80 多年前,其中 20.2% 的队列参与者有出生体重结论:DD2 队列的详细信息和长期随访,可以提高我们对新诊断 T2DM 患者并发症进展和预防的认识。
{"title":"The Danish Centre for Strategic Research in Type 2 Diabetes (DD2) Project Cohort and Biobank from 2010 Through 2023-A Cohort Profile Update.","authors":"Frederik P B Kristensen, Sia K Nicolaisen, Jens S Nielsen, Diana H Christensen, Kurt Højlund, Henning Beck-Nielsen, Jørgen Rungby, Søren G Friborg, Ivan Brandslund, Jens S Christiansen, Peter Vestergaard, Niels Jessen, Michael H Olsen, Mette K Andersen, Torben Hansen, Charlotte Brøns, Allan Vaag, Reimar W Thomsen, Henrik T Sørensen","doi":"10.2147/CLEP.S469958","DOIUrl":"https://doi.org/10.2147/CLEP.S469958","url":null,"abstract":"<p><strong>Purpose: </strong>This paper provides an overview of the Danish Centre for Strategic Research in Type 2 Diabetes (DD2) cohort and biobank, including baseline characteristics of participants enrolled up to 2023, and post-enrollment rates of cardiovascular disease outcomes and mortality.</p><p><strong>Methods: </strong>Since 2010, the DD2 project has enrolled individuals with type 2 diabetes mellitus (T2DM) recently diagnosed by general practitioners and by hospital-based clinicians across Denmark. Data from questionnaires, clinical examinations, and biological samples are collected at enrollment. Additional baseline and longitudinal follow-up data are accessed via linkage to health registries.</p><p><strong>Results: </strong>Between 2010 and 2023, the DD2 project enrolled 11,369 participants (41.3% women, median age 61.4 years). Median T2DM duration at enrollment was 1.3 years, and median BMI was 31.6 kg/m<sup>2</sup> for women and 30.5 kg/m<sup>2</sup> for men. 18.3% were smokers, 5.7% consumed more than 14/21 units of alcohol weekly (women/men), and 17.9% reported leisure-time physical inactivity. Original midwife records dating back >80 years revealed that 20.2% of cohort participants had birth weights <3000 g. Based on complete hospital contact history 10 years before enrollment, 20.7% of cohort participants had macrovascular complications, 17.0% had microvascular complications, and 21.7% had kidney disease based on eGFR or urine albumin-creatinine measurements. At enrollment, statins were used by 68.2%, antihypertensive drugs by 69.9%, and glucose-lowering drugs by 86.5% of individuals. Median HbA1c was 48 mmol/mol and median LDL cholesterol 2.2 mmol/L. Genome-wide genotyping and biomarker data have been analyzed for over 9000 individuals. During the current follow-up time from the enrollment date (median 7.9 years), incident cardiovascular disease rate has been 13.8 per 1000 person-years and the mortality rate has been 17.6 per 1000 person-years.</p><p><strong>Conclusion: </strong>The DD2 cohort, with its detailed information and long-term follow up, can improve our understanding of the progression and prevention of complications among individuals with newly diagnosed T2DM.</p>","PeriodicalId":10362,"journal":{"name":"Clinical Epidemiology","volume":"16 ","pages":"641-656"},"PeriodicalIF":3.4,"publicationDate":"2024-09-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11439366/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142342835","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
Excess Risk of Mortality and Hospitalization in Patients with Heart Failure According to Age and Comorbidity - A Nationwide Register Study. 根据年龄和并发症划分的心力衰竭患者死亡和住院的过高风险--一项全国范围的登记研究。
IF 3.4 2区 医学 Q1 PUBLIC, ENVIRONMENTAL & OCCUPATIONAL HEALTH Pub Date : 2024-09-25 eCollection Date: 2024-01-01 DOI: 10.2147/CLEP.S469816
Christian Madelaire, Thomas Gerds, Lars Køber, Finn Gustafsson, Charlotte Andersson, Søren Lund Kristensen, Jawad Haider Butt, Deewa Zahir Anjum, Ann Banke, Emil Loldrup Fosbøl, Gunnar Gislason, Christian Torp-Pedersen, Morten Schou

Background: Heart failure (HF) is associated with increased risk of death and a hospitalization, but for patients initiating guideline directed medical therapy, it is unknown how high these risks are compared to the general population - and how this may vary depending on age and comorbidity.

Methods: In this retrospective cohort study, we identified patients diagnosed with HF in the period 2011-2017, surviving the initial 120 days after diagnosis. Patients who were on angiotensin converting enzyme inhibitor (ACEi)/ angiotensin receptor blocker (ARB) and beta-blocker were included and matched to 5 non-HF individuals from the background population each based on age and sex. We assessed the 5-year risk of all-cause death, HF and non-HF hospitalization according to sex and age and baseline comorbidity.

Results: We included 35,367 patients with HF and 176,835 matched non-HF individuals. Patients with HF had a five-year excess risk (absolute risk difference) of death of 13% (31% [for HF] - 18% [for non-HF]), of HF hospitalization of 17% and of non-HF hospitalization of 24%. Excess risk of death increased with increasing age, whereas the relative risk decreased - for women in their twenties, the excess risk was 7%, risk ratio 7.2, while the excess risk was 18%, risk ratio 1.5 for women in their eighties. Having HF as a 60-year old man was associated with a five-year risk of death similar to a 75-year old man without HF. Further, HF was associated with an excess risk of non-HF hospitalization, ranging from 8% for patients >85 years to 30% for patients <30 years.

Conclusion: Regardless of age, sex and comorbidity, HF was associated with excess risk of mortality and non-HF hospitalizations, but the relative risk ratio diminishes sharply with advancing age, which may influence allocation of resources for medical care across populations.

背景:心力衰竭(HF)与死亡和住院风险增加有关,但对于开始接受指南指导的药物治疗的患者来说,这些风险与普通人群相比有多高,以及根据年龄和合并症的不同会有怎样的变化,目前还不得而知:在这项回顾性队列研究中,我们确定了 2011-2017 年期间确诊为高血压的患者,这些患者在确诊后最初 120 天内存活。研究纳入了正在服用血管紧张素转换酶抑制剂(ACEi)/血管紧张素受体阻滞剂(ARB)和β-受体阻滞剂的患者,并根据年龄和性别分别与背景人群中的5名非高血压患者进行配对。我们根据性别、年龄和基线合并症评估了全因死亡、高血压和非高血压住院的 5 年风险:我们纳入了 35,367 名高血压患者和 176,835 名匹配的非高血压患者。心房颤动患者五年内的超额死亡风险(绝对风险差)为 13%(31% [心房颤动] - 18% [非心房颤动]),心房颤动住院风险为 17%,非心房颤动住院风险为 24%。死亡的超额风险随着年龄的增长而增加,而相对风险却在下降--20 多岁女性的超额风险为 7%,风险比为 7.2,而 80 多岁女性的超额风险为 18%,风险比为 1.5。60 岁男性患心房颤动的五年死亡风险与 75 岁无心房颤动的男性相似。此外,心房颤动还与非心房颤动的超额住院风险有关,年龄大于 85 岁的患者的风险率为 8%,而年龄小于 85 岁的患者的风险率为 30%:无论年龄、性别和合并症如何,心房颤动都与死亡率和非心房颤动住院风险过高有关,但随着年龄的增长,相对风险比会急剧下降,这可能会影响医疗资源在不同人群中的分配。
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引用次数: 0
Drug-Induced Gynecomastia: Data Mining and Analysis of the FDA Adverse Event Reporting System Database 药物诱发的妇科肿瘤:FDA 不良事件报告系统数据库的数据挖掘和分析
IF 3.9 2区 医学 Q1 PUBLIC, ENVIRONMENTAL & OCCUPATIONAL HEALTH Pub Date : 2024-09-11 DOI: 10.2147/clep.s470959
Xiuli Yang, Xiaochun Zheng, Miaomiao Zhang, Jinlong Huang, Ping Huang, Jiangfeng Wang
Purpose: Drug-induced gynecomastia significantly affects patient health and quality of life. This study aimed to perform an exploratory analysis of gynecomastia reports and the most commonly associated medications within the FAERS database.
Patients and Methods: A comprehensive analysis of the FAERS from January 2004 to December 2023 was conducted. Disproportionality analysis and subsequent sensitivity analysis were performed to identify drugs potentially associated with gynecomastia, utilizing the reported odds ratio (ROR). Logistic regression analysis was employed to assess potential risk factors. The Weibull shape parameter (WSP) test was used to assess the time-to-onset characteristics of the top drugs associated with gynecomastia.
Results: The study identified 30,265 cases of gynecomastia, primarily associated with nervous system drugs, accounting for 85.50% of cases. Notably, risperidone accounted for 80.81% of the total cases. Among the 165 agents with ≥ 5 cases of gynecomastia, the strongest signals were exhibited by risperidone (ROR 602.38, 95% CI 585.07– 620.20), dutasteride (ROR 17.18, 95% CI 15.55– 18.89), spironolactone (ROR 15.8, 95% CI 13.99– 17.83), and paliperidone (ROR 7.16, 95% CI 6.55– 7.84). In the sensitivity analysis of disproportionality, unexpected associations were observed, such as montelukast (n = 21, ROR 1.94, 95% CI 1.26– 2.98). The logistic regression analysis indicated that the risk of risperidone-induced gynecomastia was significantly lower in adults compared to pediatric patients (OR 0.12, 95% CI 0.09– 0.15) and in patients with higher body weight than in those with lower body weight (OR 5.24, 95% CI 3.62– 7.76). The WSP test showed that gynecomastia induced by most of the top 10 common agents tends to occur in an early failure mode.
Conclusion: The rankings and signal strengths of drugs associated with gynecomastia were extracted from the FAERS. The age distribution and time-to-onset distribution of the top 10 drugs linked to gynecomastia were investigated, which can facilitate accurate clinical recognition of drug-induced gynecomastia.

Keywords: drug-induced, gynecomastia, FAERS, risperidone, time-to-onset
目的:药物引起的妇科炎症严重影响患者的健康和生活质量。本研究旨在对 FAERS 数据库中的妇科炎症报告和最常见的相关药物进行探索性分析:对 2004 年 1 月至 2023 年 12 月的 FAERS 进行了全面分析。利用报告的几率比(ROR)进行了比例失调分析和随后的敏感性分析,以确定可能与妇科乳腺增生有关的药物。采用逻辑回归分析评估潜在的风险因素。采用Weibull形状参数(WSP)检验来评估与妇科乳腺增生相关的主要药物的发病时间特征:研究发现了30265例妇科乳腺增生病例,其中85.50%的病例主要与神经系统药物有关。值得注意的是,利培酮占总病例数的 80.81%。在妇科肿瘤病例数≥5 例的 165 种药物中,利培酮(ROR 602.38,95% CI 585.07-620.20)、度他雄胺(ROR 17.18,95% CI 15.55-18.89)、螺内酯(ROR 15.8,95% CI 13.99-17.83)和帕利培酮(ROR 7.16,95% CI 6.55-7.84)的信号最强。在比例失调的敏感性分析中,观察到了意想不到的关联,如孟鲁司特(n = 21,ROR 1.94,95% CI 1.26-2.98)。逻辑回归分析表明,利培酮诱发妇科肿瘤的风险在成人患者中显著低于儿童患者(OR 0.12,95% CI 0.09-0.15),在体重较高的患者中显著低于体重较低的患者(OR 5.24,95% CI 3.62-7.76)。WSP测试表明,在前10种常见药物中,大多数药物诱发的妇科炎症往往发生在早期失效模式:结论:从 FAERS 中提取了与妇科乳腺增生有关的药物的排名和信号强度。结论:从 FAERS 中提取了与妇科肿瘤相关药物的排名和信号强度,研究了与妇科肿瘤相关的前 10 种药物的年龄分布和发病时间分布,有助于临床准确识别药物诱发的妇科肿瘤。
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引用次数: 0
Impact of Smoking Reduction Scenarios on the Burden of Myocardial Infarction in the French Population Until 2035 2035 年前减少吸烟方案对法国人口心肌梗死负担的影响
IF 3.9 2区 医学 Q1 PUBLIC, ENVIRONMENTAL & OCCUPATIONAL HEALTH Pub Date : 2024-09-07 DOI: 10.2147/clep.s440815
Johann Kuhn, Valérie Olié, Clémence Grave, Yann Le Strat, Christophe Bonaldi, Pierre Joly
Aim: Myocardial infarction (MI) is a cardiovascular disease caused by necrosis of the myocardium, which places a heavy burden on patients. In France, the proportion of daily smokers remains high, reaching at 25.5% in 2020. We evaluated the impact of smoking reduction scenarios on the projection of MI prevalence, mean age of incident cases and number of MI prevented cases until 2035.
Methods and Results: The French government has introduced smoking cessation policies that have led to an annual decrease in smoking prevalence. Based on this annual decline, we implemented three scenarios (SC) simulating an annual decrease in the proportion of smokers aged over 35 (SC1: 1%, ie, natural evolution without intervention, SC2: 2%, SC3: 9.87%) and a fourth scenario (SC4) in which there is a complete discontinuation of smoking from 2024 onwards using MI hospitalization and demographic data, estimations for the proportion of daily smokers between 35 and 95 years and multi-state models. Between 2023 and 2035, MI prevalence increased from 3.18% to 4.23% in males and from 1.00% to 1.46% in females under SC1. MI prevalence was equal to 4.21%, 4.06%, and 3.82% in males and 1.45%, 1.40%, and 1.34% in females in 2035 according to SC2, SC3, and SC4, respectively. Compared with SC1, 0.68% MI cases would be prevented with SC2, 4.52% with SC3 and 10.34% with SC4, with almost half of cases being prevented before 65 years of age. The increase in the mean age of MI incident cases ranged from 3 to 4 years among males and from 1 to 2 years among females.
Conclusion: While reducing tobacco use could substantially reduce the number of MI cases prevented, its prevalence would continue to increase due to the ageing population. An integrated prevention strategy that includes the leading cardiovascular risk factors should more efficiently reduce the future burden of MI.

Keywords: myocardial infarction, prevalence, burden, projection, tobacco control, smoking prevalence
目的:心肌梗塞(MI)是一种由心肌坏死引起的心血管疾病,给患者带来沉重负担。在法国,每日吸烟者的比例仍然很高,2020 年将达到 25.5%。我们评估了减烟方案对 2035 年前心肌梗死发病率、发病病例平均年龄和心肌梗死预防病例数预测的影响:法国政府推出的戒烟政策导致吸烟率逐年下降。根据这一逐年下降的趋势,我们使用心肌梗死住院和人口数据、35岁至95岁每日吸烟者比例估算值以及多状态模型,模拟了35岁以上吸烟者比例逐年下降的三种情景(SC1:1%,即无干预的自然演变;SC2:2%;SC3:9.87%)和第四种情景(SC4),即从2024年起完全停止吸烟。在 2023 年至 2035 年期间,SC1 的男性心肌梗死患病率从 3.18% 上升至 4.23%,女性从 1.00% 上升至 1.46%。根据 SC2、SC3 和 SC4,2035 年男性心肌梗死发病率分别为 4.21%、4.06% 和 3.82%,女性分别为 1.45%、1.40% 和 1.34%。与 SC1 相比,SC2 可预防 0.68% 的心肌梗死病例,SC3 可预防 4.52% 的心肌梗死病例,SC4 可预防 10.34% 的心肌梗死病例,其中近一半的病例可在 65 岁之前预防。男性心肌梗死病例的平均年龄增加了 3 至 4 岁,女性增加了 1 至 2 岁:结论:虽然减少烟草使用可大幅减少心肌梗死的发病率,但由于人口老龄化,心肌梗死的发病率仍将继续上升。包括主要心血管风险因素在内的综合预防策略应能更有效地降低心肌梗死的未来负担。关键词:心肌梗死;流行率;负担;预测;烟草控制;吸烟率
{"title":"Impact of Smoking Reduction Scenarios on the Burden of Myocardial Infarction in the French Population Until 2035","authors":"Johann Kuhn, Valérie Olié, Clémence Grave, Yann Le Strat, Christophe Bonaldi, Pierre Joly","doi":"10.2147/clep.s440815","DOIUrl":"https://doi.org/10.2147/clep.s440815","url":null,"abstract":"<strong>Aim:</strong> Myocardial infarction (MI) is a cardiovascular disease caused by necrosis of the myocardium, which places a heavy burden on patients. In France, the proportion of daily smokers remains high, reaching at 25.5% in 2020. We evaluated the impact of smoking reduction scenarios on the projection of MI prevalence, mean age of incident cases and number of MI prevented cases until 2035.<br/><strong>Methods and Results:</strong> The French government has introduced smoking cessation policies that have led to an annual decrease in smoking prevalence. Based on this annual decline, we implemented three scenarios (SC) simulating an annual decrease in the proportion of smokers aged over 35 (SC1: 1%, ie, natural evolution without intervention, SC2: 2%, SC3: 9.87%) and a fourth scenario (SC4) in which there is a complete discontinuation of smoking from 2024 onwards using MI hospitalization and demographic data, estimations for the proportion of daily smokers between 35 and 95 years and multi-state models. Between 2023 and 2035, MI prevalence increased from 3.18% to 4.23% in males and from 1.00% to 1.46% in females under SC1. MI prevalence was equal to 4.21%, 4.06%, and 3.82% in males and 1.45%, 1.40%, and 1.34% in females in 2035 according to SC2, SC3, and SC4, respectively. Compared with SC1, 0.68% MI cases would be prevented with SC2, 4.52% with SC3 and 10.34% with SC4, with almost half of cases being prevented before 65 years of age. The increase in the mean age of MI incident cases ranged from 3 to 4 years among males and from 1 to 2 years among females.<br/><strong>Conclusion:</strong> While reducing tobacco use could substantially reduce the number of MI cases prevented, its prevalence would continue to increase due to the ageing population. An integrated prevention strategy that includes the leading cardiovascular risk factors should more efficiently reduce the future burden of MI.<br/><br/><strong>Keywords:</strong> myocardial infarction, prevalence, burden, projection, tobacco control, smoking prevalence<br/>","PeriodicalId":10362,"journal":{"name":"Clinical Epidemiology","volume":"3 1","pages":""},"PeriodicalIF":3.9,"publicationDate":"2024-09-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142203747","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
Using Routinely Collected Electronic Healthcare Record Data to Investigate Fibrotic Multimorbidity in England [Letter]. 利用常规收集的电子医疗记录数据调查英格兰的纤维化多发病 [信函]。
IF 3.4 2区 医学 Q1 PUBLIC, ENVIRONMENTAL & OCCUPATIONAL HEALTH Pub Date : 2024-09-04 eCollection Date: 2024-01-01 DOI: 10.2147/CLEP.S493274
Avid Wijaya, Endang Sri Dewi Hastuti Suryandari, Dea Allan Karunia Sakti, Tsalits Maulidah Hariez, Harinto Nur Seha
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引用次数: 0
Burden of Gastrointestinal Tumors in Asian Countries, 1990–2021: An Analysis for the Global Burden of Disease Study 2021 1990-2021 年亚洲国家的胃肠道肿瘤负担:2021 年全球疾病负担研究分析
IF 3.9 2区 医学 Q1 PUBLIC, ENVIRONMENTAL & OCCUPATIONAL HEALTH Pub Date : 2024-09-04 DOI: 10.2147/clep.s472553
Donglin Jiang, Yangxue Wu, Ling Liu, Yajing Shen, Tiandong Li, Yin Lu, Peng Wang, Changqing Sun, Kaijuan Wang, Keyan Wang, Hua Ye
Background: Gastrointestinal tumors represent a significant component of the cancer burden in Asia. This study aims to evaluate the burden of gastrointestinal tumors in Asia from 1990 to 2021 using data from the Global Burden of Disease Study 2021 (GBD 2021).
Methods: The absolute incidence, mortality, and disability adjusted life years (DALYs) number and rate of six gastrointestinal tumors(colon and rectum cancer (CRC), stomach cancer (SC), pancreatic cancer (PC), esophageal cancer (EC), liver cancer (LC) and gallbladder and biliary tract cancer (GBTC)) in 48 Asian countries were extracted from GBD 2021. Differences were analyzed based on gender, age, year, location and socio-demographic index (SDI).
Results: In 2021, SC accounted for the highest disease burden in Asia (DALYs=16.41million [95% UI: 13.70, 19.62]). From 1990 to 2021, the age-standardized incidence rates of EC, LC, and SC in Asia declined, while the incidence rates of CRC and PC increased significantly, with CRC showing the largest rise (AAPC=1.08 [95% CI: 1.02 to 1.12]). Gastrointestinal tumors DALY rates peaked at age 70 and above, with males generally exhibiting higher rates than females. Furthermore, East Asia bears a higher burden compared to other Asian subregions. A higher SDI correlates with increased DALY rates for PC, but no linear relationship was observed for other gastrointestinal tumors.
Conclusion: The burden of gastrointestinal tumors in Asia remains high and may continue to increase. Therefore, effective prevention and treatment measures are essential to address the challenge posed by gastrointestinal tumors.

背景:胃肠道肿瘤是亚洲癌症负担的重要组成部分。本研究旨在利用《2021 年全球疾病负担研究》(GBD 2021)的数据,评估 1990 年至 2021 年亚洲胃肠道肿瘤的负担:方法:从《2021年全球疾病负担研究》(GBD 2021)中提取了48个亚洲国家6种消化道肿瘤(结肠癌和直肠癌(CRC)、胃癌(SC)、胰腺癌(PC)、食管癌(EC)、肝癌(LC)以及胆囊癌和胆道癌(GBTC))的绝对发病率、死亡率、残疾调整生命年(DALYs)数量和比率。根据性别、年龄、年份、地点和社会人口指数(SDI)对差异进行了分析:结果:2021 年,体弱多病是亚洲疾病负担最重的疾病(残疾调整寿命年数=1641 万 [95% UI: 13.70, 19.62])。从1990年到2021年,亚洲EC、LC和SC的年龄标准化发病率有所下降,而CRC和PC的发病率显著上升,其中CRC的上升幅度最大(AAPC=1.08 [95% CI:1.02至1.12])。消化道肿瘤的残疾调整寿命年数发病率在 70 岁及以上达到高峰,男性发病率普遍高于女性。此外,与其他亚洲次区域相比,东亚的负担较重。SDI越高,PC的残疾调整寿命率就越高,但其他胃肠道肿瘤的残疾调整寿命率则没有线性关系:结论:亚洲胃肠道肿瘤的负担仍然很重,并可能继续增加。因此,有效的预防和治疗措施对于应对胃肠道肿瘤带来的挑战至关重要。
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引用次数: 0
期刊
Clinical Epidemiology
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