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.

scholarly journals Altered Cortical Brain Structure and Increased Risk for Disease Seen Decades After Perinatal Exposure to Maternal Smoking: A Study of 9000 Adults in the UK Biobank

2019 ◽  
Vol 29 (12) ◽  
pp. 5217-5233 ◽  
Author(s):  
Lauren E Salminen ◽  
Rand R Wilcox ◽  
Alyssa H Zhu ◽  
Brandalyn C Riedel ◽  
Christopher R K Ching ◽  
...  
Keyword(s):  
Brain Structure ◽  
Brain Mri ◽  
Population Based ◽  
Smoke Exposure ◽  
Sensitivity Analyses ◽  
Uk Biobank ◽  
Increased Risk ◽  
Increase Risk ◽  
Sensory Cortices ◽  
The Uk

Abstract Secondhand smoke exposure is a major public health risk that is especially harmful to the developing brain, but it is unclear if early exposure affects brain structure during middle age and older adulthood. Here we analyzed brain MRI data from the UK Biobank in a population-based sample of individuals (ages 44–80) who were exposed (n = 2510) or unexposed (n = 6079) to smoking around birth. We used robust statistical models, including quantile regressions, to test the effect of perinatal smoke exposure (PSE) on cortical surface area (SA), thickness, and subcortical volumes. We hypothesized that PSE would be associated with cortical disruption in primary sensory areas compared to unexposed (PSE−) adults. After adjusting for multiple comparisons, SA was significantly lower in the pericalcarine (PCAL), inferior parietal (IPL), and regions of the temporal and frontal cortex of PSE+ adults; these abnormalities were associated with increased risk for several diseases, including circulatory and endocrine conditions. Sensitivity analyses conducted in a hold-out group of healthy participants (exposed, n = 109, unexposed, n = 315) replicated the effect of PSE on SA in the PCAL and IPL. Collectively our results show a negative, long term effect of PSE on sensory cortices that may increase risk for disease later in life.

scholarly journals The risk of fracture among patients with psoriatic arthritis and psoriasis: a population-based study

2017 ◽  
Vol 76 (5) ◽  
pp. 882-885 ◽  
Author(s):  
Alexis Ogdie ◽  
Lauren Harter ◽  
Daniel Shin ◽  
Joshua Baker ◽  
Junko Takeshita ◽  
...  
Keyword(s):  
Psoriatic Arthritis ◽  
Population Based ◽  
Elevated Risk ◽  
Severe Psoriasis ◽  
Health Improvement ◽  
Risk Of Fracture ◽  
Start Date ◽  
Systemic Medication ◽  
Using Data ◽  
The Uk

ObjectiveTo determine the risk of fracture and osteoporosis among patients with psoriatic arthritis (PsA) and psoriasis, compared with the general population and patients with rheumatoid arthritis (RA).MethodsA population-based cohort study was performed in The Health Improvement Network in the UK using data from 1994 to 2014. Patients aged 18–89 years with PsA or psoriasis and up to five unexposed controls matched by practice and start date within that practice were included. Patients with RA and matched controls were included for comparison. Severe psoriasis was defined by a code for psoriasis and either phototherapy or a systemic medication for psoriasis. Incidence and adjusted HRs (aHR) for fracture (all, hip, vertebral) were calculated.ResultsPatients with PsA (n=9788), psoriasis (n=158 323) and controls (n=821 834) were identified. Patients with PsA had an elevated risk of all fracture aHR 1.26 (1.06 to 1.27). Patients with mild psoriasis had elevated risk of all fractures, vertebral and hip fracture: aHR 1.07 (1.05 to 1.10), 1.17 (1.03 to 1.33) and 1.13 (1.04 to 1.22). Patients with severe psoriasis had significantly elevated risk of all fracture and vertebral fracture: aHR 1.26 (1.15 to 1.39) and 2.23 (1.54 to 3.22).ConclusionsPsA and psoriasis are associated with an elevated risk for fracture.

scholarly journals The risk of COVID-19 in survivors of domestic violence and abuse

BMC Medicine ◽  
2021 ◽  
Vol 19 (1) ◽  
Author(s):  
Joht Singh Chandan ◽  
Anuradhaa Subramanian ◽  
Jaidev Kaur Chandan ◽  
Krishna M. Gokhale ◽  
Alecs Vitoc ◽  
...  
Keyword(s):  
Domestic Violence ◽  
Population Based ◽  
Health Improvement ◽  
Vulnerable Group ◽  
Policy Action ◽  
Network Database ◽  
Health Measures ◽  
Increased Risk ◽  
The Health Improvement Network ◽  
Domestic Violence And Abuse

AbstractA ‘shadow pandemic’ of domestic violence and abuse (DVA) has emerged secondary to strict public health measures containing the spread of SARS-CoV-2. Many countries have implemented policies to allow the free movement of DVA survivors in attempts to minimise their exposure to abusive environments. Although these policies are well received, as a result there is a possibility of increased COVID-19 transmission within this vulnerable group who are not currently prioritised for vaccination. Therefore, we aimed to compare the risk of developing suspected or confirmed COVID-19 in women (aged over 16 years) exposed to DVA against age-sex-matched unexposed controls, following adjustment for known COVID-19 risk factors. A population-based retrospective open cohort study was undertaken between the 31 January 2020 and 28 February 2021 using ‘The Health Improvement Network’ database. We identified 10,462 eligible women exposed to DVA who were matched to 41,467 similarly aged unexposed women. Following adjustment for key covariates, women exposed to DVA were at an increased risk (aHR 1.57; 95% CI 1.29–1.90) of suspected/confirmed COVID-19 compared to unexposed women. These findings support previous calls for positive policy action improving DVA surveillance and prioritising survivors for COVID-19 vaccination.

scholarly journals Mortality in Eosinophilic Esophagitis – a nationwide, population-based matched cohort study from 2005 to 2017

2021 ◽  
Vol 126 (1) ◽  
Author(s):  
Lovisa Röjler ◽  
John J. Garber ◽  
Bjorn Roelstraete ◽  
Marjorie M. Walker ◽  
Jonas F. Ludvigsson
Keyword(s):  
Cohort Study ◽  
General Population ◽  
Eosinophilic Esophagitis ◽  
Population Based ◽  
Sensitivity Analyses ◽  
Matched Cohort ◽  
Matched Cohort Study ◽  
Risk Of Death ◽  
Gastrointestinal Pathology ◽  
Increased Risk

Background: There is a lack of knowledge about mortality in eosinophilic esophagitis (EoE). Therefore, this study aimed to examine the mortality in EoE. Methods: A nationwide, population-based matched cohort study was conducted of all EoE patients in Sweden diagnosed between July 2005 and December 2017. Individuals with EoE (n = 1,625) were identified through prospectively recorded histopathology codes from all gastrointestinal pathology reports in Sweden, representing 28 pathology departments (the ESPRESSO study). Each individual with EoE was then matched with up to five reference individuals from the general population (n = 8,003) for age, sex, year of birth, and place of residence. We used the Cox proportional hazard modeling to estimate the adjusted hazard ratio (aHR) and 95% confidence interval (95% CI) while adjusting for other potential confounders. In sensitivity analyses, mortality in EoE patients was compared with mortality in their siblings. Results: Through December 2017, 34 deaths were confirmed in EoE patients (4.60 per 1,000 person-years) compared with 165 in reference individuals (4.57 per 1,000 person-years). This rate corresponds to an aHR of 0.97 (95% CI = 0.67–1.40). HRs were similar in males (aHR = 1.00 [0.66–1.51]) and females (aHR = 0.92 [0.38–2.18]). We observed no increased risk in mortality due to esophageal or other gastrointestinal cancers in patients with EoE (aHR = 1.02 [0.51–2.02]). Mortality was similar in EoE patients and their siblings (aHR = 0.91 [0.44–1.85]). Conclusion: In this nationwide, population-based matched cohort study in Sweden, there was no increased risk of death in patients with EoE compared with their siblings and the general population.

Risk of osteoarthritis in an incident cohort of people with psoriatic arthritis: a population-based cohort study

2020 ◽  
pp. jrheum.200564
Author(s):  
Rachel Charlton ◽  
Amelia Green ◽  
Gavin Shaddick ◽  
Julia Snowball ◽  
Alison Nightingale ◽  
...  
Keyword(s):  
Psoriatic Arthritis ◽  
General Population ◽  
Population Based ◽  
Practice Research ◽  
Clinical Practice Research Datalink ◽  
Study Cohort ◽  
Relative Risks ◽  
Population Cohort ◽  
Increased Risk ◽  
General Population Cohort

Objective To determine the risk of a diagnosis of osteoarthritis (OA) in psoriatic arthritis (PsA) patients compared to patients with psoriasis and a general population cohort. Methods Incident PsA patients aged 18-89 years at diagnosis were identified from the UK Clinical Practice Research Datalink between 1998 and 2014. All PsA patients were matched to two cohorts of patients both at a 1:4 ratio. The first cohort included patients with psoriasis (and no PsA) and the second was a general population cohort (with no psoriasis or PsA). The baseline prevalence of OA was calculated for each study cohort. The incidence of OA was calculated and adjusted relative risks (RRadj) were calculated using conditional Poisson regression. Results We identified 6,783 incident PsA patients. The baseline prevalence of OA ranged from 22.1% (CI9521.1-23.1) in the PsA cohort to 12.6% (CI9512.2-13.0) and 11.0% (CI9510.6- 11.3) in the psoriasis and general population cohorts respectively. The incidence of OA was significantly higher in the PsA cohort compared to the psoriasis and general population cohorts after adjusting for BMI (RRadj 1.68 CI951.46-1.93 and RRadj 1.86 CI951.62-2.14 respectively). Conclusion An increased risk of OA was observed in patients with PsA compared to patients with psoriasis alone and those in the general population. Further work is needed to determine whether this reflects a true increase in OA risk or misdiagnosed PsA and the extent to which it can be explained by differences in the opportunity for OA diagnosis between cohorts.

An excessive risk of suicide may no longer be a reality for multiple sclerosis patients

2017 ◽  
Vol 23 (6) ◽  
pp. 864-871 ◽  
Author(s):  
Shoshannah Kalson-Ray ◽  
Gilles Edan ◽  
Emmanuelle Leray ◽  
Keyword(s):  
Multiple Sclerosis ◽  
General Population ◽  
Population Based ◽  
Sensitivity Analyses ◽  
Clinical Onset ◽  
Increased Risk ◽  
Multiple Sclerosis Patients ◽  
Mean Time ◽  
Long Term Mortality

Background: Few recent studies have shown that there is no longer an increased risk of suicide in patients affected with multiple sclerosis (MS). Objectives: To describe suicide cases within a large French MS cohort and assess whether MS patients are at a higher risk of suicide compared with the general population. Methods: Data derives from a study on long-term mortality of 27,603 prevalent cases from 15 MS specialist centres. Of 1,569 deceased MS patients (5.7%) on 1 January 2010, 47 were suicides. Results: The mean time between MS clinical onset and death was 13.5 years (standard deviation (SD): 9.3 years; none within the first 3 years) and was significantly shorter than for MS patients who had died from other causes (mean = 21.4 (SD = 11.6), p < 0.0001). Age at death was also lower (46.3 vs 56.7). The standardized mortality rates were around 1 in several sensitivity analyses, reflecting no excess mortality in MS compared with general population. Conclusion: Our findings indicate that an excess suicide risk may no longer be true for MS patients and highlight the changing profile of cases, occurring later in the disease course. Further studies in population-based registries are needed to confirm and explain these potential changes (e.g. treatments’ impact?).

scholarly journals Impact of Genetically Predicted Red Blood Cell Traits on Venous Thromboembolism: Multivariable Mendelian Randomization Study Using UK Biobank

2020 ◽  
Vol 9 (14) ◽  
Author(s):  
Shan Luo ◽  
Shiu Lun Au Yeung ◽  
Verena Zuber ◽  
Stephen Burgess ◽  
Catherine Mary Schooling
Keyword(s):  
Venous Thromboembolism ◽  
General Population ◽  
Blood Cell ◽  
Red Blood Cell ◽  
Mendelian Randomization ◽  
Sensitivity Analyses ◽  
European Ancestry ◽  
Uk Biobank ◽  
Increased Risk ◽  
The Uk

Background Red blood cell (RBC) transfusion and erythropoiesis‐stimulating agent administration are cornerstones of clinical practice, yet concerns exist as to potential increased risk of thrombotic events. This study aims to identify RBC traits most relevant to venous thromboembolism (VTE) and assess their genetically predicted effects on VTE in the general population. Methods and Results We used multivariable mendelian randomization with bayesian model averaging for exposure selection. We obtained genetic variants predicting any of 12 RBC traits from the largest genome‐wide association study of hematological traits (173 480 participants of European ancestry) and applied them to the UK Biobank (265 424 white British participants). We used univariable mendelian randomization methods as sensitivity analyses for validation. Among 265 424 unrelated participants in the UK Biobank, there were 9752 cases of VTE (4490 men and 5262 women). Hemoglobin was selected as the plausible important RBC trait for VTE (marginal inclusion probability=0.91). The best‐fitting model across all RBC traits contained hemoglobin only (posterior probability=0.46). Using the inverse variance–weighted method, genetically predicted hemoglobin was positively associated (odds ratio, 1.21 per g/dL unit of hemoglobin; 95% CI, 1.05–1.41) with VTE. Sensitivity analyses (mendelian randomization–Egger, weighted median, and mendelian randomization pleiotropy residual sum and outlier test) gave consistent estimates. Conclusions Endogenous hemoglobin is the key RBC trait causing VTE, with a detrimental effect in the general population on VTE. Given men have higher hemoglobin than women, this finding may help explain the sexual disparity in VTE rates. The benefits of therapies and other factors that raise hemoglobin need to be weighed against their risks.

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