Predictors of Over-Anticoagulation in Warfarin Users in the UK General Population: A Nested Case–Control Study in a Primary Health Care Database

2018 ◽  
Vol 119 (01) ◽  
pp. 066-076 ◽  
Author(s):  
Mar Martín-Pérez ◽  
David Gaist ◽  
Francisco de Abajo ◽  
Luis García Rodríguez
Keyword(s):  
Index Date ◽  
Case Control ◽  
Adverse Outcomes ◽  
Sensitivity Analyses ◽  
Patient Specific ◽  
Health Improvement ◽  
Chronic Obstructive ◽  
Control Analysis ◽  
Nested Case Control ◽  
Care Database

Background Many patients on warfarin therapy often present with supratherapeutic international normalized ratio (INR) levels, resulting from the influence of several patient-specific factors, which have been associated with adverse outcomes. Objective This article aims to identify risk factors for over-anticoagulation (INR levels ≥4) in a cohort of patients taking warfarin. Methods A cohort of warfarin users aged 18 to 85 years from January 2005 to April 2013 was identified in The Health Improvement Network U.K. primary care database (N = 12,506). A random date was assigned to all patients within their eligible person-time (index date), and a nested case–control analysis was performed with individuals presenting a first episode of INR level ≥4 after the index date used as cases (N = 699) and patients with non-supratherapeutic INR values (≤3) as controls (N = 9,798). Using unconditional logistic regression models, odds ratios with 95% confidence intervals were calculated adjusted for potential confounders. Two sensitivity analyses were performed with alternative definitions of over-anticoagulation (INR levels ≥5 or > 3). Results Among the factors examined, the strongest predictors of over-anticoagulation were warfarin indication (in particular, valvular atrial fibrillation and valve replacement), renal failure (with the risk increasing steeply with decreasing estimated glomerular filtration rate), cancer, anaemia, respiratory infections treated with antibiotics, chronic obstructive pulmonary disease treated with β2-agonists, polypharmacy (≥10 medications), low socio-economic status and residency in rural areas. Similar results were obtained when supratherapeutic levels were defined as INR ≥5 or, alternatively, as INR > 3. Conclusion Predictors of supratherapeutic INR levels found in this study might help physicians identify patients where closer INR monitoring is warranted.

ACE inhibitor use and risk of cataract: a case–control analysis

2019 ◽  
Vol 103 (11) ◽  
pp. 1561-1565 ◽  
Author(s):  
Claudia Becker ◽  
Susan S Jick ◽  
Christoph R Meier
Keyword(s):  
Observational Study ◽  
Index Date ◽  
Antihypertensive Drugs ◽  
Conditional Logistic Regression ◽  
Case Control ◽  
Sensitivity Analyses ◽  
Practice Research ◽  
Clinical Practice Research Datalink ◽  
Control Analysis ◽  
Increased Risk

Background/AimUse of ACE inhibitors (ACEIs) has been associated with an increased risk of cataract in a previous observational study in humans. In contrast, ACEIs were associated with beneficial effects on cataract development in experimental studies. We assessed the risk of cataract in relation to exposure to ACEI and other antihypertensive drugs.MethodsThis is a case-control study based on data from the UK-based Clinical Practice Research Datalink (CPRD). We included first-time cataract patients aged ≥40 years between 1995 and 2015 and an equal number of cataract-free controls. We matched the controls to cases on age, sex, general practice, date of first cataract (ie, index date) and years of history in the CPRD prior to the index date. We assessed the number of prescriptions for ACEI and other antihypertensive drugs in detail and explored the use of single ACEI substances. We performed conditional logistic regression and conducted various sensitivity analyses to test the robustness of our findings. We calculated the risk of cataract associated with previous exposure to ACEI, measured as OR with 95% CIs, and adjusted the multivariable model for body mass index, smoking, diabetes, hypertension, prescriptions of systemic corticosteroids and other antihypertensive drugs.ResultsWe identified 206 931 cataract cases and the same number of matched controls. Use of ACEI was not associated with a materially altered risk of cataract compared with non-use of ACEI, neither in the main analysis (OR 1.06, 95% CI 1.04 to 1.08) nor in any of the sensitivity or stratified analyses.ConclusionIn our large observational study, use of ACEI was not associated with an altered risk of cataract.

scholarly journals Risk of Dysglycemia in Pregnancy amongst Kenyan Women with HIV Infection: A Nested Case-Control Analysis from the STRiDE Study

2021 ◽  
Vol 2021 ◽  
pp. 1-11
Author(s):  
Sonak D. Pastakia ◽  
Wycliffe K. Kosgei ◽  
Astrid Christoffersen-Deb ◽  
Benson Kiragu ◽  
John N. Hector ◽  
...  
Keyword(s):  
Family History ◽  
Pregnant Women ◽  
Gestational Age ◽  
Fasting Glucose ◽  
Case Control ◽  
Oral Glucose ◽  
Control Analysis ◽  
History Of ◽  
Women With Hiv ◽  
Nested Case Control

Introduction. Gestational diabetes is a common complication, whose incidence is growing globally. There is a pressing need to obtain more data on GDM in low- and middle-income countries, especially amongst high-risk populations, as most of the data on GDM comes from high-income countries. With the growing awareness of the role HIV plays in the progression of noncommunicable diseases and the disproportionate HIV burden African countries like Kenya face, investigating the potential role HIV plays in increasing dysglycemia amongst pregnant women with HIV is an important area of study. Methods. The STRiDE study is one of the largest ever conducted studies of GDM in Kenya. This study enrolled pregnant women aged between 16 and 50 who were receiving care from public and private sector facilities in Eldoret, Kenya. Within this study, women received venous testing for glycosylated hemoglobin (HbA1c) and fasting glucose between 8- and 20-week gestational age. At their 24-32-week visit, they received a venous 75 g oral glucose tolerance test (OGTT). Because of the pressing need to assess the burden of GDM within the population of pregnant women with HIV, a nested case-control study design was used. Pregnant women with HIV within the larger STRiDE cohort were matched to non-HIV-infected women within the STRiDE cohort at a 1 : 3 ratio based on body mass index, parity, family history of GDM, gestational age, and family history of hypertension. The measurements of glucose from the initial visit (fasting glucose and HbA1c) and follow-up visit (OGTT) were compared between the two groups of HIV+ cases and matched HIV- controls. Results. A total of 83 pregnant women with HIV were well matched to 249 non-HIV-infected women from the STRiDE cohort with marital status being the only characteristic that was statistically significantly different between the two groups. Statistically significant differences were not observed in the proportion of women who developed GDM, the fasting glucose values, the HbA1c, or OGTT measurements between the two groups. Discussion. Significant associations were not seen between the different measures of glycemic status between pregnant women with and without HIV. While significant differences were not seen in this cohort, additional investigation is needed to better describe the association of dysglycemia with HIV, especially in Kenyan populations with a higher prevalence of GDM.

scholarly journals Antidepressant use during pregnancy and the risk of gestational diabetes mellitus: a nested case–control study

BMJ Open ◽  
2019 ◽  
Vol 9 (9) ◽  
pp. e025908 ◽  
Author(s):  
Maëlle Dandjinou ◽  
Odile Sheehy ◽  
Anick Bérard
Keyword(s):  
Diabetes Mellitus ◽  
Gestational Diabetes ◽  
Gestational Diabetes Mellitus ◽  
Index Date ◽  
Case Control Study ◽  
Case Control ◽  
Increased Risk ◽  
Antidepressant Use ◽  
Nested Case Control ◽  
Control Study

ObjectivesThe aim of this study was to determine the association between antidepressant (AD) classes, types and duration of use during pregnancy and the risk of gestational diabetes mellitus (GDM).Design and settingA nested case–control study was conducted within the Quebec Pregnancy Cohort (QPC), a Canadian provincial database which includes data on all pregnancies and children in Quebec from January 1998 to December 2015.Primary outcome measuresGestational diabetes mellitus.ParticipantsCases of GDM were identified after week 20 of pregnancy and randomly matched 1:10 to controls on gestational age at index date (ie, calendar date of GDM) and year of pregnancy. AD exposure was assessed by filled prescriptions between the beginning of pregnancy (first day of last menstrual period) and index date. Conditional logistic regression models were used to estimate crude and adjusted odds ratios (aOR).ResultsAmong 20 905 cases and 209 050 matched controls, 9741 (4.2%) women were exposed to ADs. When adjusting for potential confounders, AD use was associated with an increased risk of GDM (aOR 1.19, 95% CI 1.08 to 1.30); venlafaxine (aOR 1.27, 95% CI 1.09 to 1.49) and amitriptyline (aOR 1.52, 95% CI 1.25 to 1.84) were also associated with an increased risk of GDM. Moreover, the risk of GDM was increased with longer duration of AD use, specifically for serotonin norepinephrine reuptake inhibitors, tricyclic ADs and combined use of two AD classes. No statistically significant association was observed for selective serotonin reuptake inhibitors.ConclusionThe findings suggest that ADs—and specifically venlafaxine and amitriptyline—were associated with an increased risk of GDM.

scholarly journals Risk of hand osteoarthritis in new users of hormone replacement therapy: A nested case-control analysis

Maturitas ◽  
2020 ◽  
Vol 132 ◽  
pp. 17-23
Author(s):  
Theresa Burkard ◽  
Marlene Rauch ◽  
Julia Spoendlin ◽  
Daniel Prieto-Alhambra ◽  
Susan S. Jick ◽  
...  
Keyword(s):  
Hormone Replacement Therapy ◽  
Replacement Therapy ◽  
Hormone Replacement ◽  
Case Control ◽  
Hand Osteoarthritis ◽  
Control Analysis ◽  
Case Control Analysis ◽  
Nested Case Control

Damage accrual related to pregnancies before and after diagnosis of systemic lupus erythematosus: a cross-sectional and nested case-control analysis from a lupus registry

Lupus ◽  
2020 ◽  
Vol 29 (2) ◽  
pp. 176-181
Author(s):  
M Morishita ◽  
K-E Sada ◽  
K Ohashi ◽  
Y Miyawaki ◽  
Y Asano ◽  
...  
Keyword(s):  
Systemic Lupus Erythematosus ◽  
Confidence Interval ◽  
Lupus Erythematosus ◽  
Odds Ratio ◽  
Case Control ◽  
Control Analysis ◽  
Systemic Lupus ◽  
Before And After ◽  
Case Control Analysis ◽  
Nested Case Control

Objective The objective of this study was to evaluate the chronic damage associated with pregnancies before and after the diagnosis of systemic lupus erythematosus (SLE). Methods Using childbearing-aged female SLE patient data registered at the Okayama and Showa University Hospitals, a nested case-control analysis was performed to investigate the relationship between pregnancy and chronic damage using the Systemic Lupus International Collaborating Clinics/American College of Rheumatology Damage Index (SDI). Results Pregnancy occurred in 22 patients before and 13 patients after the diagnosis of SLE in 104 eligible patients. Live births occurred in 82% (33/40) and 50% (9/18) of the pregnancies before and after the diagnosis of SLE, respectively. After matching age and disease duration, 33 case patients with chronic damage (SDI ≥ 1) and 33 control patients without chronic damage (SDI = 0) were selected. Hypertension was more frequent in cases than in controls (48% vs. 24%, p = 0.041). Pregnancies before and after the diagnosis of SLE were comparable between cases and controls (before the diagnosis: nine case patients and eight control patients; after the diagnosis: three case patients and five control patients; p = 1.00). Even after adjusting for hypertension using multivariate analysis, the pregnancies before and after the diagnosis were not significant predictors for chronic damage (odds ratio = 1.48 (95% confidence interval 0.33–6.65)), p = 0.60 of the pregnancy before the diagnosis; odds ratio = 0.78 (95% confidence interval 0.13–4.74), p = 0.78 of the pregnancy after the diagnosis). Conclusion Pregnancies, either before or after the diagnosis of SLE, did not show any differences in chronic damage. Our results help alleviate fears regarding childbearing in female patients with SLE and their families.

scholarly journals Associations between schistosomiasis and HIV‐1 acquisition risk in four prospective cohorts: a nested case‐control analysis

2020 ◽  
Vol 23 (6) ◽  
Author(s):  
Aaron F Bochner ◽  
Jared M Baeten ◽  
W Evan Secor ◽  
Govert J Dam ◽  
Adam A Szpiro ◽  
...  
Keyword(s):  
Case Control ◽  
Control Analysis ◽  
Prospective Cohorts ◽  
Case Control Analysis ◽  
Nested Case Control ◽  
Hiv 1

scholarly journals Chronic Obstructive Pulmonary Disease and Incidence of Hip Fracture: A Nested Case–Control Study in the EpiChron Cohort

2020 ◽  
Vol Volume 15 ◽  
pp. 2799-2806
Author(s):  
Jesús Díez-Manglano ◽  
María Berges Vidal ◽  
Lucía Martínez Barredo ◽  
Beatriz Poblador-Plou ◽  
Antonio Gimeno-Miguel ◽  
...  
Keyword(s):  
Chronic Obstructive Pulmonary Disease ◽  
Hip Fracture ◽  
Pulmonary Disease ◽  
Case Control Study ◽  
Case Control ◽  
Chronic Obstructive ◽  
Obstructive Pulmonary Disease ◽  
Nested Case Control ◽  
Control Study

The association between proton pump inhibitors (PPI) use for gastro-esophageal reflux disease (GERD) and lung cancer (LC): A nested case-control study.

2017 ◽  
Vol 35 (15_suppl) ◽  
pp. 1562-1562
Author(s):  
Hadas Dresler ◽  
Daniel Keizman ◽  
Ronac Mamtani ◽  
Maya Gottfried ◽  
Natalie Maimon ◽  
...  
Keyword(s):  
Lung Cancer ◽  
Cancer Risk ◽  
Cancer Diagnosis ◽  
Case Control Study ◽  
Lung Cancer Risk ◽  
Case Control ◽  
Sensitivity Analyses ◽  
Diagnostic Code ◽  
Nested Case Control ◽  
Control Study

1562 Background: Data suggests that GERD with recurrent reflux and microaspiration of stomach contents, may be associated with lung injury, inflammation, activation of proliferative signals, and eventually DNA damage and malignant transformation. Recently, a large population based cohort study found that GERD may increase the risk of lung cancer in Asians. In the present nested case control study, we aimed to evaluate the association between PPI use as a surrogate for GERD and lung cancer in a large western population. Methods: We conducted a matched case-control study within a population-representative database from the United Kingdom. Study cases were defined as individuals with any diagnostic code of lung cancer. For every case, four eligible controls were matched on age, gender, practice site, time and duration of follow-up. Exposure of interest was PPI use prior to cancer diagnosis. Adjusted odds ratios (ORs) and 95% confidence intervals (CIs) for lung cancer were estimated using conditional logistic regression. Adjustment was performed for smoking. Results: The study population included 19143 lung cancer cases and 74473 matched controls. PPI use was associated with a significantly increased lung cancer risk (adjusted OR 1.70, 95%CI 1.64-1.77, p < 0.001). In a sensitivity analyses we observed similar associations when PPI use was initiated more than one year prior to cancer diagnosis (adjusted OR 1.18, 95%CI 1.13-1.23, p < 0.001) and more than two years prior to cancer diagnosis (adjusted OR 1.15, 95%CI 1.10-1.20, p < 0.001) Conclusions: ChronicPPI use, as a surrogate for symptomatic GERD, may be associated with a higher lung cancer risk.

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