Physical trauma recorded in primary care is associated with the onset of psoriatic arthritis among patients with psoriasis

2016 ◽  
Vol 76 (3) ◽  
pp. 521-525 ◽  
Author(s):  
Stefán Már Thorarensen ◽  
Na Lu ◽  
Alexis Ogdie ◽  
Joel M Gelfand ◽  
Hyon K Choi ◽  
...  
Keyword(s):  
Psoriatic Arthritis ◽  
Health Improvement ◽  
Proportional Hazard ◽  
Physical Trauma ◽  
Cox Proportional Hazard ◽  
Increased Risk ◽  
Cox Proportional Hazard Models ◽  
The Health Improvement Network ◽  
Using Data ◽  
Joint Trauma

ObjectivesTo evaluate the risk of psoriatic arthritis (PsA) among patients with psoriasis exposed to physical trauma.MethodsA matched cohort study was performed using data from The Health Improvement Network (THIN). Patients with psoriasis exposed to trauma were randomly matched to up to five unexposed psoriasis controls based on gender, age, duration of psoriasis and the date of entry into THIN. Trauma exposure was stratified into subgroups of joint, bone, nerve and skin trauma. Cox proportional hazard models were used to estimate the HRs for developing PsA. For comparison, an identical analysis was performed in the entire THIN population evaluating rheumatoid arthritis (RA) risk following physical trauma.ResultsPatients with psoriasis exposed to trauma (N=15 416) and matched unexposed patients (N=55 230) were followed for a total of 425 120 person-years during which 1010 incident PsA cases were recorded. Adjusting for potential confounders, patients with psoriasis exposed to trauma had an increased risk of PsA compared with controls, with a multivariate HR of 1.32 (95% CI 1.13 to 1.54). In our subset analysis, bone and joint trauma were associated with multivariate HRs of 1.46 (95% CI 1.04 to 2.04) and 1.50 (95% CI 1.19 to 1.90), respectively; while nerve and skin trauma were not associated with a statistically significant increase in risk compared with controls. Patients exposed to trauma in the entire THIN population did not have an increased risk of developing RA: HR 1.04 (95% CI 0.99 to 1.10).ConclusionsPatients with psoriasis exposed to physical trauma are at an increased risk of developing PsA.

Expanding Research on the School-to-Prison Pipeline: Examining the Relationships between Suspension, Expulsion, and Recidivism among Justice-Involved Youth

2021 ◽  
pp. 001112872199933
Author(s):  
Abigail Novak ◽  
Abigail Fagan
Keyword(s):  
Juvenile Justice ◽  
Hazard Models ◽  
Educational Systems ◽  
Proportional Hazard ◽  
Proportional Hazard Models ◽  
Cox Proportional Hazard ◽  
Increased Risk ◽  
Cox Proportional Hazard Models ◽  
Using Data ◽  
Pathways To Desistance

Limited research has examined the associations between different forms of school exclusion and offending, and variation in these associations according to age of first exclusionary event, among justice-involved youth. Using data from the Pathways to Desistance Study, the current study examined the associations between suspension, expulsion, and recidivism and the association between age at first suspension/expulsion and recidivism. According to Cox proportional hazard models, both expulsion and frequency of suspension increased risk of recidivism; age at first suspension was not associated with recidivism, and youth who were first expelled in childhood were significantly less likely to recidivate than youth first expelled in adolescence. Results suggest juvenile justice and educational systems should provide collaborative services to better support justice-involved youth.

Prediction of Cardiovascular Events in Patients with Ankylosing Spondylitis and Psoriatic Arthritis: Role of Lipoproteins in a High-risk Population

2012 ◽  
Vol 39 (7) ◽  
pp. 1433-1440 ◽  
Author(s):  
ANNE GRETE SEMB ◽  
TORE K. KVIEN ◽  
DAVID A. DeMICCO ◽  
RANA FAYYAD ◽  
CHUAN-CHUAN WUN ◽  
...  
Keyword(s):  
Psoriatic Arthritis ◽  
Ankylosing Spondylitis ◽  
Density Lipoprotein ◽  
High Risk Population ◽  
Proportional Hazard ◽  
Mortality And Morbidity ◽  
Cox Proportional Hazard ◽  
Hazard Ratios ◽  
Increased Risk

Objective.To evaluate lipids and apolipoproteins as predictors of cardiovascular mortality and morbidity (CVD) in patients with spondyloarthritis (SpA).Methods.In the pooled cohort of participants in the IDEAL, TNT, and CARDS trials, 50 had ankylosing spondylitis (AS), 36 had psoriatic arthritis (PsA), and 21,641 did not have AS or PsA (non-SpA). We compared lipid levels at baseline between AS or PsA and non-SpA, and hazard ratios (HR) for CVD were calculated in a Cox proportional hazard model.Results.Atherogenic lipids were lower in samples from AS, but not in PsA, compared to non-SpA. The HR for 1 SD increase in baseline lipids for future CVD was for total cholesterol 1.39 (95% CI 0.82, 2.36) in AS, 1.01 (95% CI 0.44, 2.31) in PsA, and 1.10 (95% CI 1.07, 1.14) in non-SpA. Both high-density lipoprotein (HDL) and apolipoprotein (ApoA-1) were significantly associated with CVD in AS (HR 3.67, 95% CI 1.47, 9.06, and HR 1.89, 95% CI 1.02, 3.54, respectively), in contrast to PsA (HDL: HR 1.03, 95% CI 0.49, 2.15; ApoA-1: HR 0.79, 95% CI 0.34, 1.89) and non-SpA (HDL: HR 0.86, 95% CI 0.84, 0.89; ApoA-1: HR 0.88, 95% CI 0.85, 0.91).Conclusion.HDL and ApoA-1 were surprisingly associated with increased risk of future CVD in patients with AS, whereas these lipids were protective in non-SpA.

scholarly journals Risk of acute arterial events associated with treatment of inflammatory bowel diseases: nationwide French cohort study

Gut ◽  
2019 ◽  
Vol 69 (5) ◽  
pp. 852-858 ◽  
Author(s):  
Julien Kirchgesner ◽  
Nynne Nyboe Andersen ◽  
Fabrice Carrat ◽  
Tine Jess ◽  
Laurent Beaugerie
Keyword(s):  
Incidence Rates ◽  
Proportional Hazard ◽  
Cox Proportional Hazard ◽  
Increased Risk ◽  
Bowel Diseases ◽  
Cox Proportional Hazard Models ◽  
Inflammatory Bowel ◽  
Artery Disease ◽  
The Impact ◽  
Necrosis Factor

ObjectivePatients with IBD are at increased risk of acute arterial events. Antitumour necrosis factor (TNF) agents and thiopurines may, via their anti-inflammatory properties, lower the risk of acute arterial events. The aim of this study was to assess the impact of thiopurines and anti-TNFs on the risk of acute arterial events in patients with IBD.DesignPatients aged 18 years or older and affiliated to the French national health insurance with a diagnosis of IBD were followed up from 1 April 2010 until 31 December 2014. The risks of acute arterial events (including ischaemic heart disease, cerebrovascular disease and peripheral artery disease) were compared between thiopurines and anti-TNFs exposed and unexposed patients with marginal structural Cox proportional hazard models adjusting for baseline and time-varying demographics, medications, traditional cardiovascular risk factors, comorbidities and IBD disease activity.ResultsAmong 177 827 patients with IBD (96 111 (54%) women, mean age at cohort entry 46.2 years (SD 16.3), 90 205 (50.7%) with Crohn’s disease (CD)), 4145 incident acute arterial events occurred (incidence rates: 5.4 per 1000 person-years). Compared with unexposed patients, exposure to anti-TNFs (HR 0.79, 95% CI 0.66 to 0.95), but not to thiopurines (HR 0.93, 95% CI 0.82 to 1.05), was associated with a decreased risk of acute arterial events. The magnitude in risk reduction was highest in men with CD exposed to anti-TNFs (HR 0.54, 95% CI 0.40 to 0.72).ConclusionExposure to anti-TNFs is associated with a decreased risk of acute arterial events in patients with IBD, particularly in men with CD.

scholarly journals Age and product dependent vaccine effectiveness against SARS-CoV-2 infection and hospitalisation among adults in Norway: a national cohort study, January to September 2021.

2021 ◽  
Author(s):  
Jostein Starrfelt ◽  
Eirik Alnes Buanes ◽  
Lene Kristine Juvet ◽  
Trude Marie Lyngstad ◽  
Gunnar Oyvind Isaksson Ro ◽  
...  
Keyword(s):  
Severe Disease ◽  
Population Level ◽  
Vaccine Effectiveness ◽  
Proportional Hazard ◽  
Icu Admission ◽  
Cox Proportional Hazard ◽  
National Cohort ◽  
Cox Proportional Hazard Models ◽  
Using Data ◽  
Protection Against Infection

Background: SARS-CoV-2 vaccines show high effectiveness against infection and (severe) disease. However, few studies estimate population level vaccine effectiveness against multiple COVID-19 outcomes, by age and including homologous and heterologous vaccine regimens. Methods: Using Cox proportional hazard models on data from 4 293 544 individuals (99% of Norwegian adults), we estimated overall, age-, and product-specific vaccine effectiveness against SARS-CoV-2 infection, hospitalisation, ICU admission and death in Norway, using data from national registries. Vaccine status was included as time-dependent variable and we adjusted for sex, pre-existing medical conditions, country of birth, county of residence, and crowded living conditions. Results: Adjusted vaccine effectiveness among fully vaccinated is 72.1% (71.2-73.0) against SARS-CoV-2 infection, 92.9% (91.2-94.2) against hospitalisation, 95.5% (92.6-97.2) against ICU admission, and 88.0% (82.5-91.8) against death. Among partially vaccinated, the effectiveness is 24.3% (22.3-26-2) against infection and 82.7% (77.7-86.6) against hospitalisation. Vaccine effectiveness against infection is 84.7% (83.1-86.1) for heterologous mRNA vaccine regimens, 78.3% (76.8-79.7) for Spikevax (Moderna; mRNA-1273), 69.7% (68.6-70.8) for Comirnaty (Pfizer/BioNTech; BNT162b2), and 60.7% (57.5-63.6) for Vaxzevria (AstraZeneca; ChAdOx nCoV-19; AZD1222) with a mRNA dose among fully vaccinated. Conclusion: We demonstrate good protection against SARS-CoV-2 infection and severe disease in fully vaccinated, including heterologous vaccine regimens, which could facilitate rapid immunization. Partially vaccinated were less likely to get severe disease than unvaccinated, though protection against infection was not as high, which could be essential in making vaccine prioritisation policies especially when availability is limited.

scholarly journals The Influence of Early Menopause on Cardiovascular Risk in Women with Rheumatoid Arthritis

2014 ◽  
Vol 41 (7) ◽  
pp. 1270-1275 ◽  
Author(s):  
Emily C. Pfeifer ◽  
Cynthia S. Crowson ◽  
Shreyasee Amin ◽  
Sherine E. Gabriel ◽  
Eric L. Matteson
Keyword(s):  
Rheumatoid Arthritis ◽  
Hormone Replacement ◽  
Population Based ◽  
Proportional Hazard ◽  
Inception Cohort ◽  
Early Menopause ◽  
American College Of Rheumatology ◽  
Cox Proportional Hazard ◽  
Increased Risk ◽  
Cox Proportional Hazard Models

Objective.Early menopause is associated with an increased risk for developing rheumatoid arthritis (RA). The risk for cardiovascular disease (CVD) in women increases following menopause. Because RA is associated with an increased risk of CVD, this study was undertaken to determine whether early menopause affects the risk of developing CVD in women with RA.Methods.A population-based inception cohort of 600 women with RA who fulfilled 1987 American College of Rheumatology criteria for RA between 1955 and 2007 and were age ≥ 45 years at diagnosis was assembled and followed. Age at menopause and duration of hormone replacement therapy, along with occurrence of CVD, was ascertained by review of medical records. Cox proportional hazard models compared women who underwent early menopause (natural or artificial menopause at age ≤ 45 yrs) to those within the cohort who did not undergo early menopause.Results.Of 600 women, 79 experienced early menopause. Women who underwent early menopause were at significantly higher risk for developing CVD when compared to women who did not (HR 1.56; 95% CI 1.08–2.26).Conclusion.The risk of CVD in women with RA was higher in those who experienced early menopause, and like other known risk factors should increase clinician concern for development of CVD in these patients.

scholarly journals Non-O Blood Group is Associated With a Higher Risk of Dyslipidaemia Amongst French Women

2020 ◽  
Author(s):  
Conor MacDonald ◽  
Anne-Laure Madika ◽  
Gianluca Severi ◽  
Agnes Fournier ◽  
Marie-Christine Boutron-Ruault
Keyword(s):  
Cardiovascular Disease ◽  
Blood Group ◽  
Blood Groups ◽  
Proportional Hazard ◽  
Abo Blood Groups ◽  
Cross Sectional ◽  
Cox Proportional Hazard ◽  
Increased Risk ◽  
Cox Proportional Hazard Models ◽  
Incident Cases

Abstract IntroductionThe non-O blood groups have previously been associated with higher risk of cardiovascular disease in prospective cohort studies. While cross-sectional studies have identified higher serum cholesterol amongst A-group individuals, there is no evidence from prospective studies whether this translates into a higher risk of dyslipidaemia that requires treatment. This study aimed to prospectively determine potential associations between ABO blood groups and risk of incident dyslipidaemia requiring treatment.MethodsWe assessed associations between blood ABO group and dyslipidaemia in women participating in the E3N cohort. We included women who did not have cardiovascular disease at baseline. We used logistic regression to determine associations between ABO group and prevalent dyslipidaemia at baseline. Cox proportional hazard models were used to determine if blood ABO group was associated with an increased risk of incident dyslipidaemia, controlling for potential confounding.ResultsAt baseline, 55,512 women were included, and 10,058 incident cases of dyslipidaemia were identified at a rate of 17.6/1,000 PY. Of these participants, 24,510 reported being of the O-group, and 31,002 of non-O. Non-O blood groups were associated with prevalent dyslipidaemia (OR = 1.17 [1.13: 1.21]). The non-O blood groups were associated with an increased risk of dyslipidaemia (HR non-O = 1.14 [1.10: 1.19]), specifically the A group (HRA = 1.18 [1.13: 1.23]). Interactions with smoking were considered possible (p-interaction = 0.06), with AB smokers showing the highest risk of dyslipidaemia (HRAB smokers = 1.54 [1.12: 2.11]).ConclusionNon-O blood group, specifically the A group were associated with a moderately increased risk of dyslipidaemia.

scholarly journals Biologics-associated Risks for Incident Skin and Soft Tissue Infections in Psoriasis Patients: Results from Propensity Score-Stratified Survival Analysis

2017 ◽  
Author(s):  
Su-Hsun Liu ◽  
Tsung-Han Hsieh ◽  
Leslie Y Chen ◽  
Yhu-Chering Huang ◽  
Yu-Huei Huang
Keyword(s):  
Propensity Score ◽  
Univariate Analysis ◽  
Proportional Hazard ◽  
Dermatology Clinic ◽  
Cox Proportional Hazard ◽  
Increased Risk ◽  
Cox Proportional Hazard Models ◽  
Time Periods ◽  
Propensity Score Stratification

ABSTRACTBackgroundHow biologics affect psoriasis patients’ risks for SSTIs in a pragmatic clinical setting remains unclear.MethodsIn a cohort of adult psoriasis outpatients (aged 20 years or older) who visited the Dermatology Clinic in 2010-2015, we compared incident SSTI risks between patients using biologics (users) versus nonbiologics (nonusers). We also estimated SSTI risks in biologics-associated time-periods relative to nonbiologics only in users. We applied random effects Cox proportional hazard models with propensity score-stratification to account for differential baseline hazards.ResultsOver a median follow-up of 2.8 years (interquartile range: 1.5, 4.3), 172 of 922 patients ever received biologics (18.7%); 233 SSTI incidents occurred during 2518.3 person-years, with an overall incidence of 9.3/100 person-years (95% confidence interval [CI]: 8.1, 10.6). In univariate analysis, users showed an 89% lower risk for SSTIs than nonusers (hazard ratio [HR]: 0.11, 95%CI: 0.05, 0.26); the association persisted in a multivariable model (adjusted HR: 0.26, 95%CI: 0.12, 0.58). Among biologics users, biologics-exposed time-periods were associated with a nonsignificant 21% increased risk (adjusted HR: 1.21, 95%CI: 0.41, 3.59).ConclusionsDespite of adjusting for the underlying risk profiles, risk comparisons between biologics users and nonusers remained confounded by treatment selection. By comparing time-periods being exposed versus unexposed to biologics among users, the current analysis did not find evidence for an increased SSTI risk that was associated with biologics use in psoriasis patients.

scholarly journals The risk of metachronous cancers in patients with small-intestinal carcinoid tumors: a US population-based study

2012 ◽  
Vol 19 (3) ◽  
pp. 381-387 ◽  
Author(s):  
Sunil Amin ◽  
Richard R P Warner ◽  
Steven H Itzkowitz ◽  
Michelle Kang Kim
Keyword(s):  
Small Bowel ◽  
Population Based ◽  
Proportional Hazard ◽  
Population Based Study ◽  
Cox Proportional Hazard ◽  
Kaplan Meier ◽  
Increased Risk ◽  
Before And After ◽  
Cox Proportional Hazard Models ◽  
Small Intestinal

Small-intestinal carcinoids (SIC) are the most common small-bowel malignancies. We sought to determine the risk of developing SIC before and after other primary malignancies (PM) and the prognosis of patients with SIC, with and without another PM. We used the Surveillance, Epidemiology, and End Results database to identify patients diagnosed with SICs between 1973 and 2007. Multiple primary-standardized incidence ratios were calculated as an approximation of relative risk (RR) to explore the association of SICs with metachronous malignancies. Survival analysis was performed using Kaplan–Meier methods and Cox proportional-hazard models. Among 8331 patients with SICs, 2424 (29%) had another PM at some time. The most common sites were prostate (26.2%), breast (14.3%), colon (9.1%), lung/bronchus (6.3%), and bladder (5.3%). Overall, 67% of patients had a PM diagnosed before SIC (pre-SIC), 33% after SIC (post-SIC), and 8% had a PM both before and after SIC. Among the pre-SIC group, the risk of future SIC was increased after cancers of the small bowel (RR 11.86 (95% CI: 6.13–20.72)), esophagus (4.05 (1.10–10.36)), colon (1.39 (1.05–1.81)), kidney (1.93 (1.12–3.09)), prostate (1.38 (1.17–1.62)), and leukemia (2.15 (1.18–3.61)). Among the post-SIC group, there was an increased risk of future PM of the small bowel (8.78 (4.54–15.34)), liver (2.49 (1.08–4.91)), prostate (1.25 (1.0–1.53)), and thyroid (2.73 (1.10–5.62)). Compared to patients with only SIC, those with a PM pre-SIC had worse mean survival (57.9 vs 40.9 months, HR 1.55 (1.42–1.69), P<0.001). In conclusion, almost one-third of patients with SICs have an associated metachronous primary tumor. When these primaries occur prior to (but not after) the SIC diagnosis, the prognosis is worse than with an initial SIC. The type of malignancies associated with SICs may guide future screening efforts.

Abstract 3114: Antiplatelet Therapy Use and the Risk of Venous Thromboembolic Events in the Double-Blind Raloxifene Use in The Heart (RUTH) Trial

Circulation ◽  
2007 ◽  
Vol 116 (suppl_16) ◽  
Author(s):  
Claire S Duvernoy ◽  
Adeline A Yeo ◽  
Mayme Wong ◽  
David A Cox ◽  
Hyungin M Kim
Keyword(s):  
Clinical Symptoms ◽  
Proportional Hazard ◽  
Thromboembolic Events ◽  
Double Blind ◽  
Cox Proportional Hazard ◽  
Hazard Ratios ◽  
Increased Risk ◽  
Venous Thromboembolic Events ◽  
Venous Thromboembolic ◽  
Cox Proportional Hazard Models

Background: Raloxifene (RLX) use in postmenopausal women (PMW) with osteoporosis increases risk of venous thromboembolic events (VTE) 2-fold, compared to placebo (PL). Platelet activation is involved in the pathophysiology of arterial thromboses more than venous thromboses, but some data suggest that aspirin may reduce VTE risk associated with estrogen use. This analysis examines the effects of concomitant antiplatelet (AP) therapy on VTE risk in RLX-treated women. Methods: In RUTH, 10,101 PMW with coronary heart disease (CHD) or increased risk of CHD were randomized to either PL or RLX 60 mg/d and followed for a median 5.6 yr. Reports of clinical symptoms of VTE were supported by relevant diagnostic data and adjudicated. Concomitant use of AP agents (aspirin, clopidogrel, ticlopidine, dipyridamole) was allowed. Cox proportional hazard models, with use of warfarin, presence of fracture, and/or hospitalization as covariates, were used to estimate hazard ratios (HR) with 95% confidence intervals (CI). Results: Overall, RLX 60 mg/d use was associated with an increased VTE risk [HR 1.44 (95% CI 1.06 –1.95)] from PL. Most women (71%) reported using aspirin, and 14.2% reported using non-aspirin AP agents. VTE risk was similar (HR = 1.04, Table ) for women who used RLX alone versus those who used RLX with AP agents. The increase in VTE risk with RLX compared to PL was similar between women who used any AP prior to VTE and those who did not (interaction P=0.29). Women who used aspirin prior to VTE had a similar increased VTE risk with RLX from PL [HR 1.57(95% CI 1.00 –2.47)], compared to women who did not use aspirin [HR 1.34 (95% CI 0.89 –2.01)] (interaction P=0.62). Conclusion: In RUTH, PMW with CHD or at high risk of CHD treated with RLX had an increased risk of VTE compared to PL. Concomitant use of aspirin or non-aspirin AP agents with RLX therapy did not lower VTE risk from RLX alone.

scholarly journals Smoking paradox in the development of psoriatic arthritis among patients with psoriasis: a population-based study

2017 ◽  
Vol 77 (1) ◽  
pp. 119-123 ◽  
Author(s):  
Uyen-Sa D T Nguyen ◽  
Yuqing Zhang ◽  
Na Lu ◽  
Qiong Louie-Gao ◽  
Jingbo Niu ◽  
...  
Keyword(s):  
Psoriatic Arthritis ◽  
General Population ◽  
Mediation Analysis ◽  
Population Based ◽  
Sensitivity Analyses ◽  
Health Improvement ◽  
Intermediate Variable ◽  
Increased Risk ◽  
The Health Improvement Network ◽  
The Uk

ObjectivesSmoking is associated with an increased risk of psoriatic arthritis (PsA) in the general population, but not among patients with psoriasis. We sought to clarify the possible methodological mechanisms behind this paradox.MethodsUsing 1995–2015 data from The Health Improvement Network, we performed survival analysis to examine the association between smoking and incident PsA in the general population and among patients with psoriasis. We clarified the paradox using mediation analysis and conducted bias sensitivity analyses to evaluate the potential impact of index event bias and quantify its magnitude from uncontrolled/unmeasured confounders.ResultsOf 6.65 million subjects without PsA at baseline, 225 213 participants had psoriasis and 7057 developed incident PsA. Smoking was associated with an increased risk of PsA in the general population (HR 1.27; 95% CI 1.19 to 1.36), but with a decreased risk among patients with psoriasis (HR 0.91; 95% CI 0.84 to 0.99). Mediation analysis showed that the effect of smoking on the risk of PsA was mediated almost entirely through its effect on psoriasis. Bias-sensitivity analyses indicated that even when the relation of uncontrolled confounders to either smoking or PsA was modest (both HRs=~1.5), it could reverse the biased effect of smoking among patients with psoriasis (HR=0.9).ConclusionsIn this large cohort representative of the UK general population, smoking was positively associated with PsA risk in the general population, but negatively associated among patients with psoriasis. Conditioning on a causal intermediate variable (psoriasis) may even reverse the association between smoking and PsA, potentially explaining the smoking paradox for the risk of PsA among patients with psoriasis.

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