Yoona Choi, Bo Kyung Kim, Jung-Hyun Won, Jae Won Yoo, Wona Choi, Surin Jung, Jae Yoon Kim, In Young Choi, Nack-Gyun Chung, Jae Wook Lee, Jung Yoon Choi, Hyoung Jin Kang, Howard Lee
Background: Rapid reduction of leukemic cells in the bone marrow during remission induction chemotherapy (RIC) can lead to significant complications such as tumor lysis syndrome (TLS). We investigated whether prephase steroid treatment before RIC could decrease TLS incidence and improve overall survival in pediatric patients with acute lymphoblastic leukemia (ALL). Methods: Data were extracted from the Common Data Model databases in two tertiary-care hospitals in Seoul, South Korea. Patients were classified into the treated or untreated group if they had received RIC with prephase steroid treatment ≥ 7 days before RIC in 2012– 2021 or not, respectively. Stabilized Inverse Probability of Treatment Weighting (sIPTW) was applied to ensure compatibility between the treated and untreated groups. The incidence of TLS within 14 days of starting RIC, overall survival (OS), and the incidence of adverse events of special interest were the primary endpoints. Multiple sensitivity analyses were performed. Results: Baseline characteristics were effectively balanced between the treated (n=308.4) and untreated (n=246.6) groups after sIPTW. Prephase steroid treatment was associated with a significant 88% reduction in the risk of TLS (OR 0.12, 95% CI: 0.03– 0.41). OS was numerically greater in the treated group than in the untreated group although the difference was not statistically significant (HR 0.64, 95% CI 0.25– 1.64). The treated group experienced significantly elevated risks for hyperbilirubinemia and hyperglycemia. The reduction in TLS risk by prephase steroid treatment was maintained in all of the sensitivity analyses. Conclusion: Prephase steroid treatment for ≥ 7 days before RIC in pediatric patients with ALL reduces the risk of TLS, while careful monitoring for toxicities is necessary. If adequately analyzed, real-world data can provide crucial effectiveness and safety information for proper management of pediatric patients with ALL, for whom prospective randomized studies may be difficult to perform for ethical and practical reasons.
背景：在缓解诱导化疗（RIC）期间，骨髓中白血病细胞的快速减少可导致肿瘤溶解综合征（TLS）等严重并发症。我们研究了RIC前的前期类固醇治疗是否能降低急性淋巴细胞白血病（ALL）儿童患者的TLS发生率并提高总生存率：数据来自韩国首尔两家三级医院的通用数据模型数据库。如果患者在2012-2021年接受RIC前≥7天接受过期前类固醇治疗或未接受过期前类固醇治疗，则分别被分为治疗组和未治疗组。为确保治疗组和未治疗组之间的兼容性，采用了稳定逆治疗概率加权法（sIPTW）。主要终点是开始 RIC 后 14 天内 TLS 的发生率、总生存率（OS）和特殊不良事件的发生率。研究还进行了多重敏感性分析：sIPTW治疗后，治疗组（308.4人）和未治疗组（246.6人）的基线特征有效平衡。前阶段类固醇治疗可使TLS风险显著降低88%（OR 0.12，95% CI：0.03- 0.41）。治疗组的 OS 数值高于未治疗组，但差异无统计学意义（HR 0.64，95% CI 0.25-1.64）。治疗组出现高胆红素血症和高血糖的风险明显升高。在所有的敏感性分析中，前阶段类固醇治疗降低 TLS 风险的效果均得以保持：结论：儿童 ALL 患者在 RIC 前接受≥ 7 天的前阶段类固醇治疗可降低 TLS 风险，但必须仔细监测毒性反应。如果对真实世界的数据进行充分分析，就能为正确管理儿童 ALL 患者提供重要的有效性和安全性信息，由于伦理和实际原因，前瞻性随机研究可能难以开展。
{"title":"A Study to Evaluate the Effectiveness and Safety of Prephase Steroid Treatment before Remission Induction Chemotherapy in Patients with Pediatric Acute Lymphoblastic Leukemia Using Common Data Model-Based Real-World Data: A Retrospective Observational Study","authors":"Yoona Choi, Bo Kyung Kim, Jung-Hyun Won, Jae Won Yoo, Wona Choi, Surin Jung, Jae Yoon Kim, In Young Choi, Nack-Gyun Chung, Jae Wook Lee, Jung Yoon Choi, Hyoung Jin Kang, Howard Lee","doi":"10.2147/clep.s454263","DOIUrl":"https://doi.org/10.2147/clep.s454263","url":null,"abstract":"<strong>Background:</strong> Rapid reduction of leukemic cells in the bone marrow during remission induction chemotherapy (RIC) can lead to significant complications such as tumor lysis syndrome (TLS). We investigated whether prephase steroid treatment before RIC could decrease TLS incidence and improve overall survival in pediatric patients with acute lymphoblastic leukemia (ALL).<br/><strong>Methods:</strong> Data were extracted from the Common Data Model databases in two tertiary-care hospitals in Seoul, South Korea. Patients were classified into the treated or untreated group if they had received RIC with prephase steroid treatment ≥ 7 days before RIC in 2012– 2021 or not, respectively. Stabilized Inverse Probability of Treatment Weighting (sIPTW) was applied to ensure compatibility between the treated and untreated groups. The incidence of TLS within 14 days of starting RIC, overall survival (OS), and the incidence of adverse events of special interest were the primary endpoints. Multiple sensitivity analyses were performed.<br/><strong>Results:</strong> Baseline characteristics were effectively balanced between the treated (n=308.4) and untreated (n=246.6) groups after sIPTW. Prephase steroid treatment was associated with a significant 88% reduction in the risk of TLS (OR 0.12, 95% CI: 0.03– 0.41). OS was numerically greater in the treated group than in the untreated group although the difference was not statistically significant (HR 0.64, 95% CI 0.25– 1.64). The treated group experienced significantly elevated risks for hyperbilirubinemia and hyperglycemia. The reduction in TLS risk by prephase steroid treatment was maintained in all of the sensitivity analyses.<br/><strong>Conclusion:</strong> Prephase steroid treatment for ≥ 7 days before RIC in pediatric patients with ALL reduces the risk of TLS, while careful monitoring for toxicities is necessary. If adequately analyzed, real-world data can provide crucial effectiveness and safety information for proper management of pediatric patients with ALL, for whom prospective randomized studies may be difficult to perform for ethical and practical reasons.<br/><br/>","PeriodicalId":10362,"journal":{"name":"Clinical Epidemiology","volume":"18 1","pages":""},"PeriodicalIF":3.9,"publicationDate":"2024-04-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140636920","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}
Lily G Bessette, Daniel E Singer, Ajinkya Pawar, Vincent Wong, Dae Hyun Kim, Kueiyu Joshua Lin
Background: High risk of intracranial hemorrhage (ICH) is a leading reason for withholding anticoagulation in patients with atrial fibrillation (AF). We aimed to develop a claims-based ICH risk prediction model in older adults with AF initiating oral anticoagulation (OAC). Methods: We used US Medicare claims data to identify new users of OAC aged ≥ 65 years with AF in 2010– 2017. We used regularized Cox regression to select predictors of ICH. We compared our AF ICH risk score with the HAS-BLED bleed risk and Homer fall risk scores by area under the receiver operating characteristic curve (AUC) and assessed net reclassification improvement (NRI) when predicting 1-year risk of ICH. Results: Our study cohort comprised 840,020 patients (mean [SD] age 77.5 [7.4] years and female 52.2%) split geographically into training (3963 ICH events [0.6%] in 629,804 patients) and validation (1397 ICH events [0.7%] in 210,216 patients) sets. Our AF ICH risk score, including 50 predictors, had superior AUCs of 0.653 and 0.650 in the training and validation sets than the HAS-BLED score of 0.580 and 0.567 (p< 0.001) and the Homer score of 0.624 and 0.623 (p< 0.001). In the validation set, our AF ICH risk score reclassified 57.8%, 42.5%, and 43.9% of low, intermediate, and high-risk patients, respectively, by HAS-BLED score (NRI: 15.3%, p< 0.001). Similarly, it reclassified 0.0, 44.1, and 19.4% of low, intermediate, and high-risk patients, respectively, by the Homer score (NRI: 21.9%, p< 0.001). Conclusion: Our novel claims-based ICH risk prediction model outperformed the standard HAS-BLED score and can inform OAC prescribing decisions.
背景：颅内出血（ICH）的高风险是心房颤动（AF）患者暂停抗凝治疗的主要原因。我们的目标是开发一个基于索赔的 ICH 风险预测模型，用于预测开始口服抗凝药 (OAC) 的老年房颤患者的 ICH 风险：我们使用美国医疗保险理赔数据来识别 2010 年至 2017 年期间年龄≥ 65 岁、患有房颤的 OAC 新用户。我们使用正则化 Cox 回归来选择 ICH 的预测因子。我们通过接收器操作特征曲线下面积（AUC）比较了房颤 ICH 风险评分与 HAS-BLED 出血风险和 Homer 跌倒风险评分，并评估了预测 1 年 ICH 风险时的净再分类改进（NRI）：我们的研究队列包括 840,020 名患者（平均 [SD] 年龄 77.5 [7.4]岁，女性占 52.2%），按地域分为训练集（629,804 名患者中发生 3963 例 ICH 事件 [0.6%]）和验证集（210,216 名患者中发生 1397 例 ICH 事件 [0.7%]）。在训练集和验证集中，我们的房颤 ICH 风险评分（包括 50 个预测因子）的 AUC 分别为 0.653 和 0.650，优于 HAS-BLED 评分的 0.580 和 0.567（p< 0.001）以及 Homer 评分的 0.624 和 0.623（p< 0.001）。在验证组中，我们的房颤 ICH 风险评分按 HAS-BLED 评分分别对 57.8%、42.5% 和 43.9% 的低危、中危和高危患者进行了重新分类（NRI：15.3%，p< 0.001）。同样，根据 Homer 评分，它分别对 0.0、44.1 和 19.4% 的低危、中危和高危患者进行了重新分类（NRI：21.9%，p< 0.001）：我们基于索赔的新型 ICH 风险预测模型优于标准 HAS-BLED 评分，可为 OAC 处方决策提供依据。
{"title":"Development and Validation of an Intracranial Hemorrhage Risk Score in Older Adults with Atrial Fibrillation Treated with Oral Anticoagulant","authors":"Lily G Bessette, Daniel E Singer, Ajinkya Pawar, Vincent Wong, Dae Hyun Kim, Kueiyu Joshua Lin","doi":"10.2147/clep.s438013","DOIUrl":"https://doi.org/10.2147/clep.s438013","url":null,"abstract":"<strong>Background:</strong> High risk of intracranial hemorrhage (ICH) is a leading reason for withholding anticoagulation in patients with atrial fibrillation (AF). We aimed to develop a claims-based ICH risk prediction model in older adults with AF initiating oral anticoagulation (OAC).<br/><strong>Methods:</strong> We used US Medicare claims data to identify new users of OAC aged ≥ 65 years with AF in 2010– 2017. We used regularized Cox regression to select predictors of ICH. We compared our AF ICH risk score with the HAS-BLED bleed risk and Homer fall risk scores by area under the receiver operating characteristic curve (AUC) and assessed net reclassification improvement (NRI) when predicting 1-year risk of ICH.<br/><strong>Results:</strong> Our study cohort comprised 840,020 patients (mean [SD] age 77.5 [7.4] years and female 52.2%) split geographically into training (3963 ICH events [0.6%] in 629,804 patients) and validation (1397 ICH events [0.7%] in 210,216 patients) sets. Our AF ICH risk score, including 50 predictors, had superior AUCs of 0.653 and 0.650 in the training and validation sets than the HAS-BLED score of 0.580 and 0.567 (<em>p</em>< 0.001) and the Homer score of 0.624 and 0.623 (p< 0.001). In the validation set, our AF ICH risk score reclassified 57.8%, 42.5%, and 43.9% of low, intermediate, and high-risk patients, respectively, by HAS-BLED score (NRI: 15.3%, <em>p</em>< 0.001). Similarly, it reclassified 0.0, 44.1, and 19.4% of low, intermediate, and high-risk patients, respectively, by the Homer score (NRI: 21.9%, <em>p</em>< 0.001).<br/><strong>Conclusion:</strong> Our novel claims-based ICH risk prediction model outperformed the standard HAS-BLED score and can inform OAC prescribing decisions.<br/><br/>","PeriodicalId":10362,"journal":{"name":"Clinical Epidemiology","volume":"16 1","pages":""},"PeriodicalIF":3.9,"publicationDate":"2024-04-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140613864","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}
Anne Clausen, Sören Möller, Michael Kriegbaum Skjødt, Rasmus Bank Lynggaard, Pernille Just Vinholt, Martin Lindberg-Larsen, Jens Søndergaard, Bo Abrahamsen, Katrine Hass Rubin
Objective: To evaluate the validity of diagnosis codes for Major Osteoporotic Fracture (MOF) in the Danish National Patient Registry (NPR) and secondly to evaluate whether the fracture was incident/acute using register-based definitions including date criteria and procedural codes. Methods: We identified a random sample of 2400 records with a diagnosis code for a MOF in the NPR with dates in the year of 2018. Diagnoses were coded with the 10th revision of the International Classification of Diseases (ICD-10). The sample included 2375 unique fracture patients from the Region of Southern Denmark. Medical records were retrieved for the study population and reviewed by an algorithmic search function and medical doctors to verify the MOF diagnoses. Register-based definitions of incident/acute MOF was evaluated in NPR data by applying date criteria and procedural codes. Results: The PPV for MOF diagnoses overall was 0.99 (95% CI: 0.98;0.99) and PPV=0.99 for the four individual fracture sites, respectively. Further, analyses of incident/acute fractures applying date criteria, procedural codes and using patients’ first contact in the NPR resulted in PPV=0.88 (95% CI: 0.84;0.91) for hip fractures, PPV=0.78 (95% CI: 0.74;0.83) for humerus fractures, PPV=0.78 (95% CI: 0.73;0.83) for clinical vertebral fractures and PPV=0.87 (95% CI: 0.83;0.90) for wrist fractures. Conclusion: ICD-10 coded MOF diagnoses are valid in the NPR. Furthermore, a set of register-based criteria can be applied to qualify if the MOF fracture was incident/acute. Thus, the NPR is a valuable and reliable data source for epidemiological research on osteoporotic fractures.
Keywords: major osteoporotic fractures, validity, positive predictive value, the Danish National Patient Register, algorithmic search function, epidemiology
{"title":"Validity of Major Osteoporotic Fracture Diagnoses in the Danish National Patient Registry","authors":"Anne Clausen, Sören Möller, Michael Kriegbaum Skjødt, Rasmus Bank Lynggaard, Pernille Just Vinholt, Martin Lindberg-Larsen, Jens Søndergaard, Bo Abrahamsen, Katrine Hass Rubin","doi":"10.2147/clep.s444447","DOIUrl":"https://doi.org/10.2147/clep.s444447","url":null,"abstract":"<strong>Objective:</strong> To evaluate the validity of diagnosis codes for Major Osteoporotic Fracture (MOF) in the Danish National Patient Registry (NPR) and secondly to evaluate whether the fracture was incident/acute using register-based definitions including date criteria and procedural codes.<br/><strong>Methods:</strong> We identified a random sample of 2400 records with a diagnosis code for a MOF in the NPR with dates in the year of 2018. Diagnoses were coded with the 10th revision of the International Classification of Diseases (ICD-10). The sample included 2375 unique fracture patients from the Region of Southern Denmark. Medical records were retrieved for the study population and reviewed by an algorithmic search function and medical doctors to verify the MOF diagnoses. Register-based definitions of incident/acute MOF was evaluated in NPR data by applying date criteria and procedural codes.<br/><strong>Results:</strong> The PPV for MOF diagnoses overall was 0.99 (95% CI: 0.98;0.99) and PPV=0.99 for the four individual fracture sites, respectively. Further, analyses of incident/acute fractures applying date criteria, procedural codes and using patients’ first contact in the NPR resulted in PPV=0.88 (95% CI: 0.84;0.91) for hip fractures, PPV=0.78 (95% CI: 0.74;0.83) for humerus fractures, PPV=0.78 (95% CI: 0.73;0.83) for clinical vertebral fractures and PPV=0.87 (95% CI: 0.83;0.90) for wrist fractures.<br/><strong>Conclusion:</strong> ICD-10 coded MOF diagnoses are valid in the NPR. Furthermore, a set of register-based criteria can be applied to qualify if the MOF fracture was incident/acute. Thus, the NPR is a valuable and reliable data source for epidemiological research on osteoporotic fractures.<br/><br/><strong>Keywords:</strong> major osteoporotic fractures, validity, positive predictive value, the Danish National Patient Register, algorithmic search function, epidemiology<br/>","PeriodicalId":10362,"journal":{"name":"Clinical Epidemiology","volume":"298 1","pages":""},"PeriodicalIF":3.9,"publicationDate":"2024-04-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140593720","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}
Purpose: Hypertension is an important risk factor in cardio-epidemiological research, but data quality remains a concern. We validated different registry-based definitions of hypertension. Patients and Methods: The cohort included all first-time responders of the Danish National Health Surveys (2010, 2013, or 2017). Prescription-defined hypertension was defined as ≥ 1 or ≥ 2 filled prescriptions of antihypertensive specific drugs in ≥ 1 or ≥ 2 different antihypertensive drug classes within 90, 180, or 365 days before survey response. Hospital-diagnosed hypertension was defined from hypertension diagnoses within five years before the survey response. Considering self-reported hypertension as the reference, we calculated the positive predictive value (PPV), the negative predictive value (NVP), the sensitivity, and the specificity of prescription-defined and hospital-diagnosed hypertension. Results: Among 442,490 survey responders, 127,247 (29%) had self-reported hypertension. For prescription-defined hypertension with 365-day lookback, the PPV was highest for ≥ 2 prescriptions in ≥ 2 drug classes (94%) and lowest for ≥ 1 prescription in ≥ 1 drug class (85%). The NPV was highest for ≥ 1 prescription in ≥ 2 drug classes (94%) and lowest for ≥ 1 prescription in ≥ 2 drug classes (80%). The sensitivity was highest for ≥ 1 prescription in ≥ 1 drug class (79%) and lowest for ≥ 2 prescriptions in ≥ 2 drug classes (30%). The specificity was ≥ 94% for all algorithms. The PPV and specificity did not change noteworthy with length of lookback period, whereas the NPV and the sensitivity generally were higher for longer lookback. The algorithm ≥ 1 prescription in ≥ 2 drug classes with 365-day lookback was among the best balanced across all measures of validity (PPV=88%, NPV=94%, sensitivity=75%, specificity=96%). For hospital-diagnosed hypertension, the PPV was 90%, the NPV was 76%, the sensitivity was 22%, and the specificity was 99%. Conclusion: Compared with self-reported hypertension, the algorithms for prescription-defined and hospital-diagnosed hypertension had high predictive values and specificity, but low sensitivity.
Keywords: epidemiologic studies, epidemiology, hypertension, predictive value of tests, sensitivity and specificity, validation study
{"title":"Validity of Prescription-Defined and Hospital-Diagnosed Hypertension Compared with Self-Reported Hypertension in Denmark","authors":"Kasper Bonnesen, Morten Schmidt","doi":"10.2147/clep.s448347","DOIUrl":"https://doi.org/10.2147/clep.s448347","url":null,"abstract":"<strong>Purpose:</strong> Hypertension is an important risk factor in cardio-epidemiological research, but data quality remains a concern. We validated different registry-based definitions of hypertension.<br/><strong>Patients and Methods:</strong> The cohort included all first-time responders of the Danish National Health Surveys (2010, 2013, or 2017). Prescription-defined hypertension was defined as ≥ 1 or ≥ 2 filled prescriptions of antihypertensive specific drugs in ≥ 1 or ≥ 2 different antihypertensive drug classes within 90, 180, or 365 days before survey response. Hospital-diagnosed hypertension was defined from hypertension diagnoses within five years before the survey response. Considering self-reported hypertension as the reference, we calculated the positive predictive value (PPV), the negative predictive value (NVP), the sensitivity, and the specificity of prescription-defined and hospital-diagnosed hypertension.<br/><strong>Results:</strong> Among 442,490 survey responders, 127,247 (29%) had self-reported hypertension. For prescription-defined hypertension with 365-day lookback, the PPV was highest for ≥ 2 prescriptions in ≥ 2 drug classes (94%) and lowest for ≥ 1 prescription in ≥ 1 drug class (85%). The NPV was highest for ≥ 1 prescription in ≥ 2 drug classes (94%) and lowest for ≥ 1 prescription in ≥ 2 drug classes (80%). The sensitivity was highest for ≥ 1 prescription in ≥ 1 drug class (79%) and lowest for ≥ 2 prescriptions in ≥ 2 drug classes (30%). The specificity was ≥ 94% for all algorithms. The PPV and specificity did not change noteworthy with length of lookback period, whereas the NPV and the sensitivity generally were higher for longer lookback. The algorithm ≥ 1 prescription in ≥ 2 drug classes with 365-day lookback was among the best balanced across all measures of validity (PPV=88%, NPV=94%, sensitivity=75%, specificity=96%). For hospital-diagnosed hypertension, the PPV was 90%, the NPV was 76%, the sensitivity was 22%, and the specificity was 99%.<br/><strong>Conclusion:</strong> Compared with self-reported hypertension, the algorithms for prescription-defined and hospital-diagnosed hypertension had high predictive values and specificity, but low sensitivity.<br/><br/><strong>Keywords:</strong> epidemiologic studies, epidemiology, hypertension, predictive value of tests, sensitivity and specificity, validation study<br/>","PeriodicalId":10362,"journal":{"name":"Clinical Epidemiology","volume":"49 1","pages":""},"PeriodicalIF":3.9,"publicationDate":"2024-04-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140593727","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}
Sara Hatam, Sean Timothy Scully, Sarah Cook, Hywel T Evans, Alastair Hume, Constantinos Kallis, Ian Farr, Chris Orton, Aziz Sheikh, Jennifer K Quint
Background: Electronic healthcare records (EHRs) are an important resource for health research that can be used to improve patient outcomes in chronic respiratory diseases. However, consistent approaches in the analysis of these datasets are needed for coherent messaging, and when undertaking comparative studies across different populations. Methods and Results: We developed a harmonised curation approach to generate comparable patient cohorts for asthma, chronic obstructive pulmonary disease (COPD) and interstitial lung disease (ILD) using datasets from within Clinical Practice Research Datalink (CPRD; for England), Secure Anonymised Information Linkage (SAIL; for Wales) and DataLoch (for Scotland) by defining commonly derived variables consistently between the datasets. By working in parallel on the curation methodology used for CPRD, SAIL and DataLoch for asthma, COPD and ILD, we were able to highlight key differences in coding and recording between the databases and identify solutions to enable valid comparisons. Conclusion: Codelists and metadata generated have been made available to help re-create the asthma, COPD and ILD cohorts in CPRD, SAIL and DataLoch for different time periods, and provide a starting point for the curation of respiratory datasets in other EHR databases, expediting further comparable respiratory research.
{"title":"A Harmonised Approach to Curating Research-Ready Datasets for Asthma, Chronic Obstructive Pulmonary Disease (COPD) and Interstitial Lung Disease (ILD) in England, Wales and Scotland Using Clinical Practice Research Datalink (CPRD), Secure Anonymised Information Linkage (SAIL) Databank and DataLoch","authors":"Sara Hatam, Sean Timothy Scully, Sarah Cook, Hywel T Evans, Alastair Hume, Constantinos Kallis, Ian Farr, Chris Orton, Aziz Sheikh, Jennifer K Quint","doi":"10.2147/clep.s437937","DOIUrl":"https://doi.org/10.2147/clep.s437937","url":null,"abstract":"<strong>Background:</strong> Electronic healthcare records (EHRs) are an important resource for health research that can be used to improve patient outcomes in chronic respiratory diseases. However, consistent approaches in the analysis of these datasets are needed for coherent messaging, and when undertaking comparative studies across different populations.<br/><strong>Methods and Results:</strong> We developed a harmonised curation approach to generate comparable patient cohorts for asthma, chronic obstructive pulmonary disease (COPD) and interstitial lung disease (ILD) using datasets from within Clinical Practice Research Datalink (CPRD; for England), Secure Anonymised Information Linkage (SAIL; for Wales) and DataLoch (for Scotland) by defining commonly derived variables consistently between the datasets. By working in parallel on the curation methodology used for CPRD, SAIL and DataLoch for asthma, COPD and ILD, we were able to highlight key differences in coding and recording between the databases and identify solutions to enable valid comparisons.<br/><strong>Conclusion:</strong> Codelists and metadata generated have been made available to help re-create the asthma, COPD and ILD cohorts in CPRD, SAIL and DataLoch for different time periods, and provide a starting point for the curation of respiratory datasets in other EHR databases, expediting further comparable respiratory research.<br/><br/>","PeriodicalId":10362,"journal":{"name":"Clinical Epidemiology","volume":"298 1","pages":""},"PeriodicalIF":3.9,"publicationDate":"2024-04-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140593539","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}
Background: Healthcare databases play a crucial role in improving our understanding of glaucoma epidemiology, which is the leading cause of irreversible blindness globally. However, the accuracy of diagnostic codes used in these databases to detect glaucoma is still uncertain. Aim: To assess the accuracy of ICD-9-CM and ICD-10-CM codes in identifying patients with glaucoma, including two distinct subtypes, primary open-angle glaucoma (POAG) and primary angle-closure glaucoma (PACG). Methods: We analyzed electronic medical records data from a 2% random sample of patients who newly underwent visual field examination in Taiwan’s largest multi-institutional healthcare system from 2011 to 2020. The diagnosis of glaucoma was confirmed by two ophthalmologists, based on the glaucoma diagnostic criteria. The positive predictive value (PPV), negative predictive value (NPV), sensitivity and specificity for ICD-9-CM codes 365.1X and 365.2X, and ICD-10-CM codes H4010X, H4011X, H4012X, H4020X, H4021X, H4022X, H4023X and H4024X for glaucoma were calculated. Results: We randomly selected 821 patients (mean age: 56.9 years old; female: 50.5%) from the original cohort of 41,050 newly receiving visual field examination in the study. Among 464 cases with an ICD-9-CM glaucoma code, the sensitivity, specificity, PPV and NPV for glaucoma were 86.5, 96.5, 91.9, and 90.9%, respectively. Among 357 cases with an ICD-10-CM glaucoma code, the sensitivity, specificity, PPV and NPV for glaucoma were 87.0, 92.8, 92.2 and 87.9%, respectively. The accuracy of diagnostic codes to identify POAG and PACG remained consistent. Conclusion: The diagnostic codes were highly reliable for identifying cases of glaucoma in Taiwan’s routine healthcare practice. These results provide confidence when using ICD-9-CM and ICD-10-CM codes to define glaucoma cases in healthcare database research in Taiwan.
{"title":"Validation of Diagnostic Codes to Identify Glaucoma in Taiwan’s Claims Data: A Multi-Institutional Study","authors":"Pei-Ting Lu, Tsung-Hsien Tsai, Chi-Chun Lai, Lan-Hsin Chuang, Shih-Chieh Shao","doi":"10.2147/clep.s443872","DOIUrl":"https://doi.org/10.2147/clep.s443872","url":null,"abstract":"<strong>Background:</strong> Healthcare databases play a crucial role in improving our understanding of glaucoma epidemiology, which is the leading cause of irreversible blindness globally. However, the accuracy of diagnostic codes used in these databases to detect glaucoma is still uncertain.<br/><strong>Aim:</strong> To assess the accuracy of ICD-9-CM and ICD-10-CM codes in identifying patients with glaucoma, including two distinct subtypes, primary open-angle glaucoma (POAG) and primary angle-closure glaucoma (PACG).<br/><strong>Methods:</strong> We analyzed electronic medical records data from a 2% random sample of patients who newly underwent visual field examination in Taiwan’s largest multi-institutional healthcare system from 2011 to 2020. The diagnosis of glaucoma was confirmed by two ophthalmologists, based on the glaucoma diagnostic criteria. The positive predictive value (PPV), negative predictive value (NPV), sensitivity and specificity for ICD-9-CM codes 365.1X and 365.2X, and ICD-10-CM codes H4010X, H4011X, H4012X, H4020X, H4021X, H4022X, H4023X and H4024X for glaucoma were calculated.<br/><strong>Results:</strong> We randomly selected 821 patients (mean age: 56.9 years old; female: 50.5%) from the original cohort of 41,050 newly receiving visual field examination in the study. Among 464 cases with an ICD-9-CM glaucoma code, the sensitivity, specificity, PPV and NPV for glaucoma were 86.5, 96.5, 91.9, and 90.9%, respectively. Among 357 cases with an ICD-10-CM glaucoma code, the sensitivity, specificity, PPV and NPV for glaucoma were 87.0, 92.8, 92.2 and 87.9%, respectively. The accuracy of diagnostic codes to identify POAG and PACG remained consistent.<br/><strong>Conclusion:</strong> The diagnostic codes were highly reliable for identifying cases of glaucoma in Taiwan’s routine healthcare practice. These results provide confidence when using ICD-9-CM and ICD-10-CM codes to define glaucoma cases in healthcare database research in Taiwan. <br/><br/>","PeriodicalId":10362,"journal":{"name":"Clinical Epidemiology","volume":"10 1","pages":""},"PeriodicalIF":3.9,"publicationDate":"2024-04-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140593652","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}
David Bergman, Bjorn Roelstraete, Jiangwei Sun, Fahim Ebrahimi, Rickard Lidström, Axel Svedbom, Mona Ståhle, Jonas F Ludvigsson
Background: Microscopic colitis (MC) has been associated with several immune-mediated diseases including psoriasis, but earlier research has been limited to psoriasis occurring before MC. Data from large-scale cohort studies investigating MC and risk of future psoriasis are lacking. Objective: To examine the association between MC and psoriasis. Methods: In a nationwide, population-based, matched cohort study in Sweden from 2007 to 2021, we identified 8404 patients with biopsy-verified MC (diagnosed in 2007– 2017), 37,033 matched reference individuals, and 8381 siblings without MC. Information on MC was obtained through the ESPRESSO cohort (a Swedish histopathology database with nationwide coverage). Using Cox regression, we calculated hazard ratios (HRs) and 95% confidence intervals (CIs) for psoriasis up until 2021. Results: During a median follow-up of 9.2 years (interquartile range = 6.7– 11.7), 179 MC patients and 440 reference individuals were diagnosed with psoriasis (241.1 vs 131.8 events per 100,000 person-years), corresponding to one extra case of psoriasis in 91 patients with MC over 10 years. After adjustment for the matching variables (birth year, sex, county of residence, and calendar period) and level of education, we computed an adjusted hazard ratio (aHR) of 1.82 (95% CI = 1.53– 2.17). Stratified by sex, estimates were similar and when examining the aHR across different lengths of follow-up, we found significantly elevated estimates up to 10 years after MC diagnosis. Compared to MC-free siblings, the aHR was 1.85 (95% CI = 1.36– 2.51). Conclusion: Patients with MC are at an almost doubled risk of psoriasis compared to the general population. Clinicians need to consider psoriasis in MC patients with skin lesions.
背景：显微镜下结肠炎（MC）与包括银屑病在内的多种免疫介导疾病相关，但早期研究仅限于 MC 之前发生的银屑病。目前还缺乏大规模队列研究的数据，这些研究调查了 MC 与未来患银屑病的风险：目的：研究 MC 与银屑病之间的关系：2007年至2021年，我们在瑞典进行了一项全国性、基于人群的匹配队列研究，确定了8404名经活检证实的MC患者（2007年至2017年确诊）、37033名匹配参照个体和8381名无MC的兄弟姐妹。有关 MC 的信息通过 ESPRESSO 队列（瑞典覆盖全国的组织病理学数据库）获得。我们使用考克斯回归法计算了2021年前银屑病的危险比（HRs）和95%置信区间（CIs）：在中位随访 9.2 年（四分位间范围 = 6.7-11.7）期间，179 名 MC 患者和 440 名参照个体被诊断为银屑病（每 10 万人年 241.1 例 vs 131.8 例），相当于 10 年间 91 名 MC 患者中多了一个银屑病病例。在对匹配变量（出生年份、性别、居住县和日历期）和教育水平进行调整后，我们计算出调整后的危险比（aHR）为 1.82（95% CI = 1.53-2.17）。按性别进行分层后，估计值相似，而在检查不同随访期的 aHR 时，我们发现 MC 诊断后 10 年内的估计值明显升高。与无 MC 的兄弟姐妹相比，aHR 为 1.85（95% CI = 1.36-2.51）：结论：与普通人群相比，MC 患者患银屑病的风险几乎翻倍。临床医生需要考虑有皮损的 MC 患者是否患有银屑病。
{"title":"Microscopic Colitis and Risk of Incident Psoriasis: A Nationwide Population-Based Matched Cohort Study","authors":"David Bergman, Bjorn Roelstraete, Jiangwei Sun, Fahim Ebrahimi, Rickard Lidström, Axel Svedbom, Mona Ståhle, Jonas F Ludvigsson","doi":"10.2147/clep.s454677","DOIUrl":"https://doi.org/10.2147/clep.s454677","url":null,"abstract":"<strong>Background:</strong> Microscopic colitis (MC) has been associated with several immune-mediated diseases including psoriasis, but earlier research has been limited to psoriasis occurring before MC. Data from large-scale cohort studies investigating MC and risk of future psoriasis are lacking.<br/><strong>Objective:</strong> To examine the association between MC and psoriasis.<br/><strong>Methods:</strong> In a nationwide, population-based, matched cohort study in Sweden from 2007 to 2021, we identified 8404 patients with biopsy-verified MC (diagnosed in 2007– 2017), 37,033 matched reference individuals, and 8381 siblings without MC. Information on MC was obtained through the ESPRESSO cohort (a Swedish histopathology database with nationwide coverage). Using Cox regression, we calculated hazard ratios (HRs) and 95% confidence intervals (CIs) for psoriasis up until 2021.<br/><strong>Results:</strong> During a median follow-up of 9.2 years (interquartile range = 6.7– 11.7), 179 MC patients and 440 reference individuals were diagnosed with psoriasis (241.1 vs 131.8 events per 100,000 person-years), corresponding to one extra case of psoriasis in 91 patients with MC over 10 years. After adjustment for the matching variables (birth year, sex, county of residence, and calendar period) and level of education, we computed an adjusted hazard ratio (aHR) of 1.82 (95% CI = 1.53– 2.17). Stratified by sex, estimates were similar and when examining the aHR across different lengths of follow-up, we found significantly elevated estimates up to 10 years after MC diagnosis. Compared to MC-free siblings, the aHR was 1.85 (95% CI = 1.36– 2.51).<br/><strong>Conclusion:</strong> Patients with MC are at an almost doubled risk of psoriasis compared to the general population. Clinicians need to consider psoriasis in MC patients with skin lesions.<br/><br/>","PeriodicalId":10362,"journal":{"name":"Clinical Epidemiology","volume":"34 1","pages":""},"PeriodicalIF":3.9,"publicationDate":"2024-03-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140324042","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}
Zhiting Wang, Piia Lavikainen, Katja Wikström, Tiina Laatikainen
Objective: We aimed to assess how longitudinal body mass index (BMI) trajectories are associated with diabetes complications and all-cause mortality in Finnish patients with type 2 diabetes (T2D). Methods: In this cohort study, electronic health records from public primary and specialized healthcare services in all 13 municipalities of North Karelia, Finland, were utilized. This study included a total of 889 adults with newly diagnosed T2D in 2011 or 2012 (mean age at baseline 62.0 years). Individual BMI trajectories from the T2D diagnosis until 2014 were estimated and grouped by growth mixture modeling (GMM). Hazard ratios (HRs) with 95% confidence intervals (CIs) for microvascular complications, macrovascular complications, any diabetes complications, and all-cause mortality from 2015 to 2022 across BMI trajectory groups were estimated using Cox regression models. Results: Three distinct BMI trajectory groups were identified using GMM and labeled as follows: “stable” (n = 774, 87.1%), “decreasing” (n = 87, 9.8%), and “increasing” (n = 28, 3.1%). During a median follow-up of 8 years, there were 119 (13.3%) patients with microvascular complications, 187 (21.0%) with macrovascular complications, 258 (29.0%) with any diabetes complications, and 180 (20.2%) deaths. Compared with the “stable” BMI, the “increasing” BMI was associated with an increased risk of microvascular complications (HR = 2.88, 95% CI: 1.32 to 6.28), macrovascular complications (HR = 2.52, 95% CI: 1.17 to 5.43), and any diabetes complications (HR = 2.21, 95% CI: 1.16 to 4.20). The “decreasing” BMI was associated with an increased risk of all-cause mortality (HR = 1.90, 95% CI: 1.14 to 3.15), compared to the “stable” BMI. Conclusion: Our findings underscore the significance of continuous BMI monitoring and weight management in patients with T2D. Tailored treatments are crucial for efficiently preventing weight gain and reducing the risk of diabetes complications.
Keywords: body mass index trajectory, type 2 diabetes, diabetes complications, all-cause mortality
{"title":"Trajectories of Body Mass Index and Risk for Diabetes Complications and All-Cause Mortality in Finnish Type 2 Diabetes Patients","authors":"Zhiting Wang, Piia Lavikainen, Katja Wikström, Tiina Laatikainen","doi":"10.2147/clep.s450455","DOIUrl":"https://doi.org/10.2147/clep.s450455","url":null,"abstract":"<strong>Objective:</strong> We aimed to assess how longitudinal body mass index (BMI) trajectories are associated with diabetes complications and all-cause mortality in Finnish patients with type 2 diabetes (T2D).<br/><strong>Methods:</strong> In this cohort study, electronic health records from public primary and specialized healthcare services in all 13 municipalities of North Karelia, Finland, were utilized. This study included a total of 889 adults with newly diagnosed T2D in 2011 or 2012 (mean age at baseline 62.0 years). Individual BMI trajectories from the T2D diagnosis until 2014 were estimated and grouped by growth mixture modeling (GMM). Hazard ratios (HRs) with 95% confidence intervals (CIs) for microvascular complications, macrovascular complications, any diabetes complications, and all-cause mortality from 2015 to 2022 across BMI trajectory groups were estimated using Cox regression models.<br/><strong>Results:</strong> Three distinct BMI trajectory groups were identified using GMM and labeled as follows: “stable” (n = 774, 87.1%), “decreasing” (n = 87, 9.8%), and “increasing” (n = 28, 3.1%). During a median follow-up of 8 years, there were 119 (13.3%) patients with microvascular complications, 187 (21.0%) with macrovascular complications, 258 (29.0%) with any diabetes complications, and 180 (20.2%) deaths. Compared with the “stable” BMI, the “increasing” BMI was associated with an increased risk of microvascular complications (HR = 2.88, 95% CI: 1.32 to 6.28), macrovascular complications (HR = 2.52, 95% CI: 1.17 to 5.43), and any diabetes complications (HR = 2.21, 95% CI: 1.16 to 4.20). The “decreasing” BMI was associated with an increased risk of all-cause mortality (HR = 1.90, 95% CI: 1.14 to 3.15), compared to the “stable” BMI.<br/><strong>Conclusion:</strong> Our findings underscore the significance of continuous BMI monitoring and weight management in patients with T2D. Tailored treatments are crucial for efficiently preventing weight gain and reducing the risk of diabetes complications.<br/><br/><strong>Keywords:</strong> body mass index trajectory, type 2 diabetes, diabetes complications, all-cause mortality<br/>","PeriodicalId":10362,"journal":{"name":"Clinical Epidemiology","volume":"53 1","pages":""},"PeriodicalIF":3.9,"publicationDate":"2024-03-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140324033","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}
Eva Futtrup Maksten, Rasmus Rask Kragh Jørgensen, Mathilde Selmar Pedersen, Kirsten Fonager, Rie Sander Bech, Ingolf Mølle, Andreas Due Ørskov, Claudia Schöllkopf, Ulrik Malthe Overgaard, Gunhild Nynke Thomsen, Tarec C El-Galaly, Marianne Tang Severinsen
Purpose: Most adult patients diagnosed with acute lymphoblastic leukemia (ALL) are below retirement age. The overall survival of patients with ALL has improved with implementation of high intensity pediatric-inspired treatment protocols. However, this treatment comes with a risk of long-term complications, which could affect the ability to work. The aim of this study was to investigate the risk of disability pension (DP) and return to work (RTW) for patients with ALL. Patients and Methods: Patients aged 18– 60 years diagnosed with ALL between 2005 and 2019 were identified in the Danish National Acute Leukemia Registry. Each patient was matched with five comparators from the general population on birth year, sex, and Charlson Comorbidity Index. The Aalen-Johansen estimator was used to calculate the cumulative risk of DP for patients and comparators from index date (defined as 1 year after diagnosis) with competing events (transplantation or relapse, death, retirement pension, or early retirement pension). Differences in cumulative incidences were calculated using Gray’s test. RTW was calculated as proportions one, three, and five years after the index date for patients holding a job before diagnosis. Results: A total of 154 patients with ALL and 770 matched comparators were included. The 5-year cumulative risk of DP was increased fivefold for patients with ALL compared with the general population. RTW was 41.7%, 65.7%, and 60.7% one, three, and five years after the index date, respectively. Conclusion: The risk of DP in patients with ALL increased significantly compared with the general population. Five years after the index date, RTW was 60.7% for patients with ALL.
Keywords: acute lymphoblastic leukemia, disability pension, return to work
{"title":"Work Disability and Return to Work After Treatment for Acute Lymphoblastic Leukemia: A Danish Nationwide Cohort Study","authors":"Eva Futtrup Maksten, Rasmus Rask Kragh Jørgensen, Mathilde Selmar Pedersen, Kirsten Fonager, Rie Sander Bech, Ingolf Mølle, Andreas Due Ørskov, Claudia Schöllkopf, Ulrik Malthe Overgaard, Gunhild Nynke Thomsen, Tarec C El-Galaly, Marianne Tang Severinsen","doi":"10.2147/clep.s444270","DOIUrl":"https://doi.org/10.2147/clep.s444270","url":null,"abstract":"<strong>Purpose:</strong> Most adult patients diagnosed with acute lymphoblastic leukemia (ALL) are below retirement age. The overall survival of patients with ALL has improved with implementation of high intensity pediatric-inspired treatment protocols. However, this treatment comes with a risk of long-term complications, which could affect the ability to work. The aim of this study was to investigate the risk of disability pension (DP) and return to work (RTW) for patients with ALL.<br/><strong>Patients and Methods:</strong> Patients aged 18– 60 years diagnosed with ALL between 2005 and 2019 were identified in the Danish National Acute Leukemia Registry. Each patient was matched with five comparators from the general population on birth year, sex, and Charlson Comorbidity Index. The Aalen-Johansen estimator was used to calculate the cumulative risk of DP for patients and comparators from index date (defined as 1 year after diagnosis) with competing events (transplantation or relapse, death, retirement pension, or early retirement pension). Differences in cumulative incidences were calculated using Gray’s test. RTW was calculated as proportions one, three, and five years after the index date for patients holding a job before diagnosis.<br/><strong>Results:</strong> A total of 154 patients with ALL and 770 matched comparators were included. The 5-year cumulative risk of DP was increased fivefold for patients with ALL compared with the general population. RTW was 41.7%, 65.7%, and 60.7% one, three, and five years after the index date, respectively.<br/><strong>Conclusion:</strong> The risk of DP in patients with ALL increased significantly compared with the general population. Five years after the index date, RTW was 60.7% for patients with ALL.<br/><br/><strong>Keywords:</strong> acute lymphoblastic leukemia, disability pension, return to work<br/>","PeriodicalId":10362,"journal":{"name":"Clinical Epidemiology","volume":"110 1","pages":""},"PeriodicalIF":3.9,"publicationDate":"2024-03-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140126615","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}
Anders Møller, Nikolaj Eldrup, Jørn Wetterslev, Dorthe Hellemann, Henning Bay Nielsen, Klaus Rostgaard, Henrik Hjalgrim, Ole Birger Pedersen
Background: Significant changes in Western populations’ abdominal aortic aneurysm (AAA) epidemiology have been reported following the introduction of screening, endovascular AAA repair, and reduced tobacco consumption. We report incidence and mortality of AAA repair in Denmark from 1996 to 2018, where AAA screening was not implemented. Methods: Nationwide cohort study of prospective data from population-based Danish registries covering 1996 to 2018. We identified 15,395 patients undergoing first-time AAA repair using the Danish Vascular Registry. Comorbidity was assessed by Charlson’s Comorbidity Index (CCI). Incidence rate (IR) ratios and mortality rate ratios (MRR) were estimated by multivariable Poisson and Cox regression, respectively. Results: Overall AAA repair IR decreased by 24% from 1996 through 2018, mainly reflecting a 53% IR reduction in ruptured AAA repairs in men. Overall, the IR decreased 52– 63% in age groups below 70 years and increased 81% among octogenarians. The proportion of intact AAAs repaired endovascularly increased from 2% in 1996– 1999 to 42% in 2015– 2018. For both ruptured and intact AAAs the CCI score increased by 0.9% annually independently of age and sex. The adjusted five-year MRR in 2016– 2018 vs.1996– 2000 was 0.46 (95% confidence interval (CI): 0.39– 0.54) following ruptured and 0.51 (95% CI: 0.44– 0.59) following intact AAA repair. Conclusion: In Denmark, overall AAA repair incidence decreased between 1996 and 2018, primarily reflecting a reduction among males and a shift to an older population requiring intervention. These trends mirror changes in tobacco consumption in Denmark. Regardless of age and comorbidity, AAA repair mortality decreased markedly during the study period.
{"title":"Trends in Abdominal Aortic Aneurysm Repair Incidence, Comorbidity, Treatment, and Mortality: A Danish Nationwide Cohort Study, 1996–2018","authors":"Anders Møller, Nikolaj Eldrup, Jørn Wetterslev, Dorthe Hellemann, Henning Bay Nielsen, Klaus Rostgaard, Henrik Hjalgrim, Ole Birger Pedersen","doi":"10.2147/clep.s427348","DOIUrl":"https://doi.org/10.2147/clep.s427348","url":null,"abstract":"<strong>Background:</strong> Significant changes in Western populations’ abdominal aortic aneurysm (AAA) epidemiology have been reported following the introduction of screening, endovascular AAA repair, and reduced tobacco consumption. We report incidence and mortality of AAA repair in Denmark from 1996 to 2018, where AAA screening was not implemented.<br/><strong>Methods:</strong> Nationwide cohort study of prospective data from population-based Danish registries covering 1996 to 2018. We identified 15,395 patients undergoing first-time AAA repair using the Danish Vascular Registry. Comorbidity was assessed by Charlson’s Comorbidity Index (CCI). Incidence rate (IR) ratios and mortality rate ratios (MRR) were estimated by multivariable Poisson and Cox regression, respectively.<br/><strong>Results:</strong> Overall AAA repair IR decreased by 24% from 1996 through 2018, mainly reflecting a 53% IR reduction in ruptured AAA repairs in men. Overall, the IR decreased 52– 63% in age groups below 70 years and increased 81% among octogenarians. The proportion of intact AAAs repaired endovascularly increased from 2% in 1996– 1999 to 42% in 2015– 2018. For both ruptured and intact AAAs the CCI score increased by 0.9% annually independently of age and sex. The adjusted five-year MRR in 2016– 2018 vs.1996– 2000 was 0.46 (95% confidence interval (CI): 0.39– 0.54) following ruptured and 0.51 (95% CI: 0.44– 0.59) following intact AAA repair.<br/><strong>Conclusion:</strong> In Denmark, overall AAA repair incidence decreased between 1996 and 2018, primarily reflecting a reduction among males and a shift to an older population requiring intervention. These trends mirror changes in tobacco consumption in Denmark. Regardless of age and comorbidity, AAA repair mortality decreased markedly during the study period.<br/><br/>","PeriodicalId":10362,"journal":{"name":"Clinical Epidemiology","volume":"79 1","pages":""},"PeriodicalIF":3.9,"publicationDate":"2024-03-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140114905","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}
扫码关注我们
求助内容：
应助结果提醒方式：
京公网安备 11010802042870号