scholarly journals 773. Statins Decrease the Risk of Active Tuberculosis: A Propensity Score-Matched Analysis

2018 ◽  
Vol 5 (suppl_1) ◽  
pp. S277-S277
Author(s):  
Min-Chul Kim ◽  
Sung-Cheol Yun ◽  
Sung-Han Kim
Keyword(s):  
Propensity Score ◽  
South Korea ◽  
Propensity Score Matching ◽  
Health Technology ◽  
Active Tuberculosis ◽  
Lipid Lowering ◽  
Matched Pairs ◽  
Lipid Lowering Agents ◽  
Insurance Database ◽  
Statin Use

Abstract Background Statins, which are lipid-lowering agents, have anti-inflammatory and immunomodulatory properties that may affect the development of tuberculosis (TB). We assessed the association between statins and the risk of active TB with propensity score-matching. Methods The study was based on the National Health Insurance database and its subset database of the “medical check-up” population of South Korea. These cohorts consist of about one million and 570,000 people, respectively, representative of the entire population of South Korea. We identified 107,689 statin users and 433,067 nonstatin users. After propensity score matching, 26,036 statin users and the same number of nonstatin users were finally analyzed. The development of active TB was monitored in these matched pairs over the 11 years from 2003 to 2013. Results The number of active TB cases was 150 in 31,645 person-years (4.74 per 1,000 person-years; 95% CI, 3.98 to 5.50) in the statin users, and 902 in 153,401 person-years (5.88 per 1,000 person-years; 95% CI, 5.50 to 6.26) in the nonstatin users. Statin users had a significantly lower risk of TB than nonstatin users: hazard ratio (HR) 0.78 (95% CI, 0.65 to 0.93) (P = 0.006). A subgroup analysis showed that statin use reduced the risk of TB significantly in subjects without diabetes but not in subjects with diabetes: HRs were, respectively, 0.73 (95% CI, 0.56 to 0.95) (P = 0.018) and 0.83 (95% CI, 0.54 to 1.28) (P = 0.40). Conclusion These epidemiologic findings provide strong evidence that statin use decreases the risk of active TB. The protective effect of statins against TB was attenuated by diabetes. Further studies about the effect of statins on TB incorporating experimental and clinical researches are required. Disclosures S. H. Kim, the Korea Health Technology R&D Project through the Korea Health Industry Development Institute (KHIDI): Investigator, Grant recipient.

scholarly journals Effects of Recent Use of Renin-Angiotensin System Inhibitors on Mortality of Patients With Coronavirus Disease 2019

2020 ◽  
Vol 7 (11) ◽  
Author(s):  
Seongman Bae ◽  
Ju Hyeon Kim ◽  
Ye-Jee Kim ◽  
Joon Seo Lim ◽  
Sung-Cheol Yun ◽  
...  
Keyword(s):  
Propensity Score ◽  
South Korea ◽  
Hospital Mortality ◽  
Propensity Score Matching ◽  
Renin Angiotensin System ◽  
Angiotensin Converting Enzyme Inhibitors ◽  
Diagnostic Code ◽  
Angiotensin Ii Receptor ◽  
Converting Enzyme Inhibitors ◽  
Risk Of Death

Abstract Background There is growing concern about the potential harmful effects of angiotensin-converting enzyme inhibitors (ACEIs) and angiotensin II receptor blockers (ARBs) in patients with coronavirus disease 2019 (COVID-19) and cardiovascular diseases (CVDs). The aim of this study was to evaluate the association between recent exposure to ACEIs/ARBs and in-hospital mortality in patients with COVID-19. Methods We used data from a nationwide cohort of patients with COVID-19 from the health insurance claims data of South Korea, which were released for research purposes for public health by the Ministry of Health and Welfare of South Korea. Patients with COVID-19 were identified using the relevant diagnostic code. Propensity score matching (1:1) was carried out among patients with CVD according to the type of medication (ACEIs/ARBs vs other), and the risk of death was assessed. Results A total of 4936 patients with COVID-19 were analyzed, of whom 1048 (21.2%) had CVD. Of the 1048 patients with CVD, 864 (82.4%) received at least 1 antihypertensive medication before the diagnosis of COVID-19, including 359 (41.6%) who received ACEIs/ARBs and 505 (58.4%) who received drugs other than ACEIs/ARBs. Using the propensity scores for ACEI/ARB use, we matched 305 pairs of patients receiving ACEIs/ARBs and patients receiving other drugs. Recent use of ACEIs/ARBs was not significantly associated with in-hospital mortality in unadjusted analysis (odds ratio [OR], 0.62; 95% CI, 0.33–1.14) or propensity score matching analysis (OR, 1.00; 95% CI, 0.46–2.16). Conclusions In patients with COVID-19 and underlying CVDs, the recent use of ACEIs/ARBs was not significantly associated with in-hospital mortality. These findings do not support stopping or modifying ACEIs/ARBs in patients during the current COVID-19 pandemic.

scholarly journals Statins and clinical outcomes in hospitalized COVID-19 patients with and without Diabetes Mellitus: a retrospective cohort study with propensity score matching

2021 ◽  
Vol 20 (1) ◽  
Author(s):  
Prateek Lohia ◽  
Shweta Kapur ◽  
Sindhuri Benjaram ◽  
Zachary Cantor ◽  
Navid Mahabadi ◽  
...  
Keyword(s):  
Diabetes Mellitus ◽  
Cohort Study ◽  
Propensity Score ◽  
Propensity Score Matching ◽  
Retrospective Cohort Study ◽  
Retrospective Cohort ◽  
Randomized Clinical Trials ◽  
Multivariable Analysis ◽  
Statin Group ◽  
Statin Use

Abstract Background The pleiotropic effects of statins may reduce the severity of COVID-19 disease. This study aims to determine the association between inpatient statin use and severe disease outcomes among hospitalized COVID-19 patients, especially those with Diabetes Mellitus (DM). Research design and methods A retrospective cohort study on hospitalized patients with confirmed COVID-19 diagnosis. The primary outcome was mortality during hospitalization. Patients were classified into statin and non-statin groups based on the administration of statins during hospitalization. Analysis included multivariable regression analysis adjusting for confounders and propensity score matching to achieve a 1:1 balanced cohort. Subgroup analyses based on presence of DM were conducted. Results In the cohort of 922 patients, 413 had a history of DM. About 27.1% patients (n = 250) in the total cohort (TC) and 32.9% patients (n = 136) in DM cohort received inpatient statins. Atorvastatin (n = 205, 82%) was the most commonly prescribed statin medication in TC. On multivariable analysis in TC, inpatient statin group had reduced mortality compared to the non-statin group (OR, 0.61; 95% CI, 0.42–0.90; p = 0.01). DM modified this association between inpatient statins and mortality. Patients with DM who received inpatient statins had reduced mortality (OR, 0.35; 95% CI, 0.21–0.61; p < 0.001). However, no such association was noted among patients without DM (OR, 1.21; 95% CI, 0.67–2.17; p = 0.52). These results were further validated using propensity score matching. Conclusions Inpatient statin use was associated with significant reduction in mortality among COVID-19 patients especially those with DM. These findings support the pursuit of randomized clinical trials and inpatient statin use appears safe among COVID-19 patients.

Doctoral Education, Job Mismatch, and Wage Consequences in South Korea: A Propensity Score Matching Approach

2021 ◽  
pp. 002190962110529
Author(s):  
Kihong Park
Keyword(s):  
Propensity Score ◽  
South Korea ◽  
Propensity Score Matching ◽  
Negative Influence ◽  
Rapid Expansion ◽  
Wage Penalty ◽  
Omitted Variable Bias ◽  
Wage Effects ◽  
Variable Bias ◽  
Job Mismatch

This study extends the previous literature on the wage effects of over-education, focusing on young doctorate holders (DHs). It also contributes to the conventional over-education literature on a causal relationship between over-education and wages by implementing techniques of propensity score matching (PSM). By tackling potential bias as a consequence of omitted variable bias via the PSM strategy, this study provides evidence of the negative influence of over-education on wages (i.e., the over-education wage penalty) once potential sources of bias are adequately considered. While the current analysis is focused on one country, South Korea, its results might be relevant for many other countries that have experienced a rapid expansion in the supply of DHs over recent years.

scholarly journals Outcomes of Pregnancy after Breast Cancer in Korean Women: A Large Cohort Study

2020 ◽  
Vol 52 (2) ◽  
pp. 426-437
Author(s):  
Moo Hyun Lee ◽  
Young Ae Kim ◽  
Jin Hyuk Hong ◽  
So-Youn Jung ◽  
Sunmi Lee ◽  
...  
Keyword(s):  
Breast Cancer ◽  
Propensity Score ◽  
Propensity Score Matching ◽  
Survival Outcome ◽  
Study Cohort ◽  
Korean Women ◽  
Large Cohort Study ◽  
Using Data ◽  
Insurance Database

Purpose The purpose of this study was to determine the rate and outcomes of pregnancies subsequent to breast cancer in Korea, and the effect of such pregnancies on the prognosis of women who survived breast cancer and subsequently conceived. Materials and Methods We followed a total of 31,761 Korean women 45 years of age or younger who were treated for primary breast cancer from 2002 to 2010. We also included follow-up surveys that were conducted through December 2011. We identified recurrence and mortality from breast cancer using data linked to the Korea National Health Insurance database. We used propensity score matching of the study cohort to analyze the risks of recurrence and mortality from breast cancer depending on pregnancy. Results Within our sample, 992 women (3.1%) became pregnant after receiving treatment for breast cancer. Of those, 622 (67.5%) successfully delivered; the remaining 370 (32.5%) failed to deliver. After propensity score matching, we found that the women who became pregnant after breast cancer did not have a different risk of recurrence (hazard ratio [HR], 0.503; 95% confidence interval [CI], 0.434 to 0.584) and death (HR, 0.520; 95% CI, 0.397 to 0.681), compared with those who did not conceive after breast cancer treatment. Conclusion Our study is the first to report outcomes for Korean women who survived breast cancer and subsequently conceived. Women who survived breast cancer and subsequently became pregnant did not show a poorer survival outcome, compared with those who did not become pregnant.

Statin Therapy Improves Multiple Myeloma (MM) Specific Surviva

Blood ◽  
2015 ◽  
Vol 126 (23) ◽  
pp. 879-879
Author(s):  
Kristen M. Sanfilippo ◽  
Jesse Keller ◽  
Suhong Luo ◽  
Brian F. Gage ◽  
Gerald Moskowitz ◽  
...  
Keyword(s):  
Heart Disease ◽  
Propensity Score ◽  
Statin Therapy ◽  
Propensity Score Analysis ◽  
Lipid Lowering ◽  
Defined Daily Dose ◽  
Immortal Time Bias ◽  
All Cause Mortality ◽  
Specific Mortality ◽  
Statin Use

Abstract Background: Statins (3-hydroxy-3-methylglutaryl coenzyme A reductase inhibitors) are widely used for treatment of dyslipidemia and prevention of coronary heart disease. Recently, a multicenter clinical trial found discontinuation of statin therapy in patients with estimated survival of < 1 year had no significant impact on mortality or cardiovascular outcomes [Kutner JAMA Int Med 2015]. In this trial, approximately 50% of patients had cancer as their primary diagnosis. However, statin use has been associated with improved cancer-specific survival in several malignancies. Preclinical evidence suggests that this effect may be independent of the lipid lowering properties. In addition, in the case of MM, statins influence similar pathways as the bisphosphonates. To understand the putative benefit of statins in MM, we evaluated the association between statin use and mortality in a large cohort of MM patients. Methods: We identified patients diagnosed with MM in the Veterans Administration Cancer Registry from September 1, 1999 to December 31, 2009 and followed them through October 2014. We excluded patients who did not receive MM directed therapy within 6 months of diagnosis or who died within 6 months of diagnosis. We defined statin use as the presence of any prescription for a statin on or after the date of MM diagnosis. To standardize statin utilization, we calculated the defined daily dose (DDD), which allows normalization of dose and potency amongst differing statins. The DDD is the assumed average maintenance dose per day for a drug used for its main indication. To reduce immortal time bias, we assessed statin use as a time varying covariate. Cox proportional hazards regression modeling assessed the association between statin use, overall mortality, and cause-specific mortality, while controlling for known MM prognostic factors. Propensity score analyses balanced baseline differences between statin users and non-users. Results: The cohort included a total of 3,069 patients, of whom 1,334 received statin therapy. Statin use was associated with a significant decrease in all-cause mortality (adjusted HR (aHR) 0.81, 95% CI: 0.73-0.90). Stratifying statin use by DDD, MM patients receiving <365 days of statins had a 14% reduction in all-cause mortality (aHR 0.86, 95%: CI 0.76-0.97), while patients receiving ≥365 days of statin therapy had a 24% reduction in mortality (aHR 0.76; 95% CI: 0.66-0.87). When looking at MM-specific mortality, statin use was associated with a 19% reduction in death from MM (aHR 0.81, 95% CI: 0.71-0.93). Stratifying statin use by DDD, we found that patients receiving <365 days of statin use had a 15% reduction in MM-specific mortality (aHR 0.85, 95%: CI 0.72-0.99), while patients receiving ≥365 days of statin therapy had a 25% reduction in mortality (aHR 0.75; 95% CI: 0.62-0.91). At baseline, statin users were more likely to be older, obese, Caucasian, and have more medical comorbidities (diabetes, chronic kidney disease, ischemic heart disease, cerebrovascular disease, peripheral vascular disease, and dyslipidemia). These differences were well balanced in the propensity score analysis, in which statin use remained significantly associated with a reduction in mortality (aHR 0.60; 95% CI: 0.52-0.70). Conclusion: In this cohort of patients with MM, statin therapy was significantly associated with a reduction in both all-cause and MM-specific mortality. These findings argue against discontinuing statin therapy in patients with MM, including those with a prognosis of < 1 year. Disclosures Sanfilippo: Amgen: Speakers Bureau.

scholarly journals Statin Use and In‐Hospital Mortality in Patients With Diabetes Mellitus and COVID‐19

2020 ◽  
Vol 9 (24) ◽  
Author(s):  
Omar Saeed ◽  
Francesco Castagna ◽  
Ilir Agalliu ◽  
Xiaonan Xue ◽  
Snehal R. Patel ◽  
...  
Keyword(s):  
Diabetes Mellitus ◽  
Propensity Score ◽  
Hospital Mortality ◽  
Propensity Score Matching ◽  
Interquartile Range ◽  
Survival Models ◽  
Inverse Probability ◽  
Risk Of Death ◽  
Patients With Diabetes ◽  
Statin Use

Background Severe coronavirus disease 2019 (COVID‐19) is characterized by a proinflammatory state with high mortality. Statins have anti‐inflammatory effects and may attenuate the severity of COVID‐19. Methods and Results An observational study of all consecutive adult patients with COVID‐19 admitted to a single center located in Bronx, New York, was conducted from March 1, 2020, to May 2, 2020. Patients were grouped as those who did and those who did not receive a statin, and in‐hospital mortality was compared by competing events regression. In addition, propensity score matching and inverse probability treatment weighting were used in survival models to examine the association between statin use and death during hospitalization. A total of 4252 patients were admitted with COVID‐19. Diabetes mellitus modified the association between statin use and in‐hospital mortality. Patients with diabetes mellitus on a statin (n=983) were older (69±11 versus 67±14 years; P <0.01), had lower inflammatory markers (C‐reactive protein, 10.2; interquartile range, 4.5–18.4 versus 12.9; interquartile range, 5.9–21.4 mg/dL; P <0.01) and reduced cumulative in‐hospital mortality (24% versus 39%; P <0.01) than those not on a statin (n=1283). No difference in hospital mortality was noted in patients without diabetes mellitus on or off statin (20% versus 21%; P =0.82). Propensity score matching (hazard ratio, 0.88; 95% CI, 0.83–0.94; P <0.01) and inverse probability treatment weighting (HR, 0.88; 95% CI, 0.84–0.92; P <0.01) showed a 12% lower risk of death during hospitalization for statin users than for nonusers. Conclusions Statin use was associated with reduced in‐hospital mortality from COVID‐19 in patients with diabetes mellitus. These findings, if validated, may further reemphasize administration of statins to patients with diabetes mellitus during the COVID‐19 era.

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