BMJ medicine最新文献

Objective: To determine how often meta-analyses of effects of interventions are reproducible.

Design: Meta-research study.

Setting: Systematic reviews with meta-analyses of the effects of health, social, behavioural, or educational interventions indexed in five databases (PubMed, Science Citation Index, Social Sciences Citation Index, Scopus, and Education Collection), 2 November to 2 December 2020.

Population: 296 reviews meeting the inclusion criteria formed the overall sample of the study. 175/296 (59%) reviews included a forest plot from Review Manager and were considered inherently reproducible. The remaining 121/296 (41%) reviews constituted the reproduction sample.

Main outcome measures: Original review authors were contacted to obtain meta-analysis data files, and analytic code used to generate the first reported (index) meta-analysis; if not provided, the necessary data and statistical details of the meta-analysis methods were extracted from the review. Two investigators independently reproduced each review's first reported meta-analysis using the original computational steps and analytic code. Meta-analyses were classified as fully reproducible if the difference between the original and reproduced summary estimates and 95% confidence interval (CI) widths was less than 10%. Differences in meta-analysis results were classified as meaningful if there was a change in direction of the summary effect estimate or if the 95% CI included the null, which may alter the interpretation of the results.

Results: 22 authors provided data files or analytic code, or both. 104 meta-analyses (86%) were fully reproducible, seven (6%) were not fully reproducible, and 10 (8%) had insufficient data available to attempt reproduction. No meaningful differences were found in the reproduced meta-analytic results that might alter their interpretation (eg, changes in the direction of summary effect estimate or if the 95% CI included the null).

Conclusions: The findings of the study suggested that the results of meta-analyses could be reliably replicated if the original data or analytic code, or both, could be obtained, or if the necessary data were accessible in the review. Few systematic reviewers responded to requests to share data or code. Making data files and analytic code publicly available will facilitate future investigations of reproducibility.

Objective: To determine the annual trends over two decades in hypertension diagnosis, true hypertension prevalence, and control and use of antihypertensive drugs in England.

Design: Annual, representative, nationwide Health Surveys for England from 2003 to 2021.

Setting: Nationally representative sample consisting of participants from private households, identified through stratified, national, multistage sampling.

Participants: 67 242 people older than 16 years surveyed between 2003 and 2021.

Results: Between 2003 and 2021, the prevalence of measured hypertension decreased significantly from 37.8% in 2003 to 33.2% in 2018 (average annual percentage change (AAPC) -0.9%, 95% confidence interval -1.6% to -0.6%). Mean population systolic and diastolic blood pressure decreased significantly between 2003 to 2019 (systolic blood pressure from 128.7 to 124.0 mm Hg, AAPC -0.15%, -0.21% to -0.11%; diastolic blood pressure from 73.7 to 71.8 mm Hg, AAPC -0.12%, -0.20% to -0.04%). The prevalence of those with undiagnosed hypertension in the community decreased from 32.6% in 2003 to 23.7% in 2011, gradually worsening thereafter, with a steep increase in 2021 when 32.4% of those with hypertension were undiagnosed (AAPC -1.04%, -1.92% to -0.22%). Among people diagnosed (known) with hypertension, the proportion of those with blood pressure controlled to target increased across the study period (AAPC 1.66%, 0.04% to 2.27%), but this was mainly driven by the significant increase from 47.3% in 2003 to 56.5% in 2009 (AAPC 3.62%, 1.52% to 5.74%). A plateau was observed from 2011 onwards when there was no further significant improvement in the proportion of people with diagnosed (known) hypertension and blood pressure controlled to target. People with diagnosed (known) but uncontrolled hypertension showed a small but significant decrease in the mean number (standard deviation) of antihypertensive drugs used during the study period from 2.17 (0.86) in 2003 to 2.14 (0.96) in 2021 (AAPC -0.18%, -0.68% to -0.03%). Those with diagnosed (known) and controlled hypertension had no significant change in the mean number of drugs used.

Conclusions: These findings indicate that there was a significant improvement in hypertension prevalence and control in the 2000s, with a plateau after 2011. The prevalence of undiagnosed hypertension in the community reduced in the early 2000s and 2010s, but has since returned to the same level as two decades ago.

Objective: To compare routine high risk human papillomavirus (hrHPV) screening with cytological screening in two screening rounds in a well established, routine screening programme for cervical cancer.

Design: Population based cohort study.

Setting: Finland's Mass Screening Registry, 2012-22, with diagnostic follow-up examinations until October 2024.

Participants: 1 180 491 women participating at least once in cytological test (PAP smear) or hrHPV based cervical cancer screening between 2012 and 2022.

Main outcome measures: Numbers and proportions of attendees, positive routine test results, follow-up screening referrals, colposcopy referrals, and incidence of cervical intraepithelial neoplasia ≥grade 2 (CIN2+) in the first and second hrHPV and cytological screening rounds. Results adjusted for age, year, region, and education.

Results: Data for 1 574 688 full screening rounds were analysed. The overall referral rate for colposcopy was 3.37% (n=12 273) in the hrHPV group and 0.98% (n=11 895) in the cytology group, with an adjusted risk ratio of 2.97 (95% confidence interval (CI) 2.87 to 3.07). The overall rate for detection of CIN2+ was 0.92% in the hrHPV group and 0.35% in the cytology group, with an adjusted risk ratio of 2.17 (2.04 to 2.31). For the second hrHPV screening round compared with the first screening round, the adjusted risk ratio was 0.77 (0.71 to 0.84) for referral for colposcopy and 0.57 (0.46 to 0.72) for detection of CIN2+. Actual rates for referral for colposcopy were 3.54% (n=11 709) in the first hrHPV screening round and 2.42% (n=564) in the second screening round. The rate for detection of CIN2+ for hrHPV screening was 0.98% (n=3 248) in the first hrHPV screening round and 0.38% (n=88) in the second screening round. In cytological screening, no observed reduction was seen in either the referral rate or CIN2+ findings. After a negative hrHPV test in the first screening round, CIN2+ was detected in only 0.2% of women (n=44/314 286) in the second screening round.

Conclusions: Within a well established, population based national screening programme, the results of the study indicated that hrHPV screening with a five year interval was effective and safe. hrHPV screening identified precancerous lesions earlier than cytological screening. The incidence of CIN2+ was low in the second screening round in women with a negative hrHPV test result in the initial round and in those aged ≥50 years, and hence a longer screening interval for specific subgroups should be considered.

Objective: To quantify prescribing of hormone replacement therapy (HRT) in women aged 40-60 years by type of HRT and length of use, and to determine sociodemographic factors associated with receiving a HRT prescription.

Design: Population based cohort study.

Setting: QResearch database of primary care practices in England, 1 January 2013 to 13 July 2023, and patient electronic health records for prescribing information .

Participants: 1 978 348 women aged 40-60 years at any time over a 10 year period.

Main outcome measures: Overall uptake of two or more prescriptions of the same type of HRT in women of menopausal age, length of use, and association between ethnic group, deprivation, and geographical region and receiving a HRT prescription before and during the eight years since implementation of National Institute for Health and Care Excellence (NICE) guidance on the menopause in 2015 in the UK.

Results: The cohort comprised 1 978 348 women with a mean age of 49.4 years, and 76.2% were white women. Overall, 379 911 (19.2%) women received two or more HRT prescriptions. Combination HRT formulations in one prescription were the most frequently prescribed (62.4% of those prescribed HRT), with 43.3% receiving oral and 26.3% transdermal formulations. Mean age at first prescription was 49.8 years. Rates for two or more prescriptions of HRT were higher in white women (22.6%) than in other ethnic groups, ranging from 8.9% in Caribbean women to 3.9% in black African women. Prescription rates decreased with increasing social deprivation, from 24.2% in the most affluent to 10.9% in the most deprived groups. London had lower prescription rates (11.7%) than other regions (all >19%). Multivariable Cox regression showed that non-white ethnic groups had significantly lower HRT prescription rates (hazard ratios 0.85-0.92, P<0.001), and each increase in social deprivation group was associated with lower HRT prescription rates (hazard ratio for the most deprived group 0.92, 95% confidence interval 0.92 to 0.93, P<0.001).

Conclusions: This study identified differences in HRT prescribing in England based on ethnic group, socioeconomic status, and geographical location. White women and those in more affluent neighbourhoods were more likely to receive HRT than non-white women and those in more deprived areas. These findings suggest potential inequities that require further exploration.