scholarly journals Do β-adrenoreceptor blocking drugs associate with reduced risk of symptomatic osteoarthritis and total joint replacement in the general population? A primary care-based, prospective cohort study using the Clinical Practice Research Datalink

BMJ Open ◽  
2019 ◽  
Vol 9 (8) ◽  
pp. e032050
Author(s):  
Georgina Nakafero ◽  
Matthew Grainge ◽  
Ana Valdes ◽  
Nick Townsend ◽  
Christian Mallen ◽  
...  
Keyword(s):  
Cohort Study ◽  
Joint Replacement ◽  
Index Date ◽  
Primary Outcome ◽  
Total Joint Replacement ◽  
Hip Osteoarthritis ◽  
Practice Research ◽  
Clinical Practice Research Datalink ◽  
Exclusion Criteria ◽  
Β Blocker

IntroductionTo investigate if β-adrenoreceptor blocking drug (β-blocker) prescription reduces the risk of knee or hip osteoarthritis, total joint replacement and analgesic prescription.SettingPrimary care.Methods and analysisThis is a cohort study using data from the Clinical Practice Research Datalink. Two separate analyses will be performed. Study 1 will be on the association between β-blocker prescription and incident knee/hip osteoarthritis. Inclusion criteria will be age ≥40 years. Exposed participants will be those with ≥2 continuous β-blocker prescriptions, and the index date will be the date of the first prescription of β-blocker. Unexposed participants will include up to four controls matched for age, sex, general practice surgery and propensity score for β-blocker prescription. Exclusion criteria will include contraindications to β-blockers, consultations for osteoarthritis or potent analgesic prescription before the index date. Outcomes will be knee osteoarthritis (primary outcome), hip osteoarthritis, knee pain and hip pain. Study 2 will be on the association between β-blocker prescription and total joint replacement and analgesic prescription in people with osteoarthritis. Inclusion criteria will be age ≥40 years, knee or hip osteoarthritis, and index date will be as in study 1. Unexposed participants will be as in study 1, additionally matched for consultation for knee or hip osteoarthritis prior to the index date. Exclusion criteria will include contraindications to β-blockers and osteoarthritis in other joints prior to the index date. Outcomes will be total knee replacement (primary outcome), total hip replacement and new analgesic prescription.Statistical analysisKaplan-Meier curves will be plotted, and Cox proportional HRs and 95% CIs will be calculated. Stratified analysis will be performed by class of β-blocker, intrinsic sympathomimetic effect and indication(s) for prescription.Ethics and disseminationThis study was ethically approved by the Independent Scientific Advisory Committee of the Medicines and Healthcare Authority (Ref 18_227R). The results of this study will be published in peer-reviewed journals and presented at conferences.SummaryThis prospective cohort study will evaluate the analgesic potential of commonly used drugs for osteoarthritis pain.

scholarly journals Propranolol Reduces Risk of Knee or Hip Replacement Due to Osteoarthritis: a Propensity Score Matched Cohort Study-using Data From the Clinical Practice Research Datalink.

2021 ◽  
Author(s):  
Georgina Nakafero ◽  
Matthew J Grainge ◽  
Ana M Valdes ◽  
Nick Townsend ◽  
Christian Mallen ◽  
...  
Keyword(s):  
Cohort Study ◽  
Clinical Practice ◽  
Propensity Score ◽  
Total Joint Replacement ◽  
Controlled Trial ◽  
Hip Osteoarthritis ◽  
Practice Research ◽  
Clinical Practice Research Datalink ◽  
Number Needed To Treat ◽  
Using Data

Abstract Objectives To examine the association between β-blocker prescription and knee or hip total joint replacement (TJR) in a UK primary-care population with incident knee or hip osteoarthritis (OA).Methods Cohort study using data from the Clinical Practice Research Datalink. Participants aged ≥40 years with incident knee or hip OA, exposed to β-blockers after OA diagnosis (new-user design), were matched to one control for age, sex, OA location and propensity score (PS) for β-blocker prescription. Cox-proportional hazard ratios (HRs) and 95% confidence intervals (CI) were calculated. The analyses were adjusted for factors that influence health-seeking behaviour, progression of OA, and stratified according to β-blocker classification. Data analysis was conducted using Stata.Results Data for 6,970 PS-matched β-blocker exposed and unexposed participants were included. Any β-blocker prescription was not associated with knee or hip TJR (aHR 1.11; 95% CI 0.98 – 1.25). However, prescription of lipophilic non-selective β-blockers having membrane stabilising effects associated with reduced risk of knee or hip TJR (aHR 0.69; 95% CI 0.52 – 0.93). Of these, there was a protective effect for propranolol (aHR 0.71; 95% CI 0.53 – 0.95), the commonest prescribed drug in this class. The number needed to treat (95% CI) with propranolol for two years in order to prevent one TJR was 32 (23-52).Conclusion Propranolol, a non-selective β-blocker, reduces the risk of knee and hip TJR. This is consistent with its analgesic effects in other conditions and a randomised controlled trial is required to further evaluate its analgesic potential and safety in OA.

scholarly journals Statin use and risk of joint replacement due to osteoarthritis and rheumatoid arthritis: a propensity-score matched longitudinal cohort study

Rheumatology ◽  
2020 ◽  
Vol 59 (10) ◽  
pp. 2898-2907 ◽  
Author(s):  
Aliya Sarmanova ◽  
Michael Doherty ◽  
Changfu Kuo ◽  
Jie Wei ◽  
Abhishek Abhishek ◽  
...  
Keyword(s):  
Cohort Study ◽  
Propensity Score ◽  
Joint Replacement ◽  
Density Lipoprotein ◽  
Practice Research ◽  
Statin User ◽  
Clinical Practice Research Datalink ◽  
Hip Joint Replacement ◽  
The Impact ◽  
Reduced Risk

Abstract Objective Statins are reported to have a potential benefit on progression of OA and on disease activity in RA, but existing evidence is conflicting. Our objective was to examine whether statins associate with reduction in the risk for joint replacement due to OA and RA. Methods This was a propensity score-matched cohort study. Electronic health records from the UK Clinical Practice Research Datalink were used. We selected people prescribed statins and people never prescribed statins. Each statin user was matched to a non-user by age, gender, practice and propensity score for statin prescription. The main outcome measures were knee or hip joint replacement overall, and specifically because of OA or RA. The association between statins and risk of joint replacement was assessed using Cox proportional hazard regression. Statin exposure was categorized according to the potency of reducing low-density lipoprotein as low (21–28%), medium (32–38%) or high (42–55%) intensity. Results A total of 178 467 statin users were matched with 178 467 non-users by age, gender, practice and propensity score. Overall, statin was not associated with reduced risk of knee or hip replacement (hazard ratio 0.99, 95% CI: 0.97, 1.03), unless prescribed at high strength (0.86, 0.75–0.98). The reduced risk was only observed for joint replacement due to RA (0.77, 0.63–0.94) but not OA (0.97, 0.94–1.01). Conclusion Statins at high intensity may reduce the risk of hip or knee replacement. This effect may be RA specific. Further studies to investigate mechanisms of risk reduction and the impact in people with RA are warranted.

scholarly journals Prognostic value of first-recorded breathlessness for future chronic respiratory and heart disease: a cohort study using a UK national primary care database

2020 ◽  
Vol 70 (693) ◽  
pp. e264-e273 ◽  
Author(s):  
Ying Chen ◽  
Richard Hayward ◽  
Carolyn A Chew-Graham ◽  
Richard Hubbard ◽  
Peter Croft ◽  
...  
Keyword(s):  
Primary Care ◽  
Cohort Study ◽  
Heart Disease ◽  
Index Date ◽  
Early Mortality ◽  
Practice Research ◽  
Chronic Obstructive ◽  
Clinical Practice Research Datalink ◽  
Obstructive Pulmonary Disease

BackgroundBreathlessness is a common presentation in primary care.AimTo assess the long-term risk of diagnosed chronic obstructive pulmonary disease (COPD), asthma, ischaemic heart disease (IHD), and early mortality in patients with undiagnosed breathlessness.Design and settingMatched cohort study using data from the UK Clinical Practice Research Datalink.MethodAdults with first-recorded breathlessness between 1997 and 2010 and no prior diagnostic or prescription record for IHD or a respiratory disease (‘exposed’ cohort) were matched to individuals with no record of breathlessness (‘unexposed’ cohort). Analyses were adjusted for sociodemographic and comorbidity characteristics.ResultsIn total, 75 698 patients (the exposed cohort) were followed for a median of 6.1 years, and more than one-third subsequently received a diagnosis of COPD, asthma, or IHD. In those who remained undiagnosed after 6 months, there were increased long-term risks of all three diagnoses compared with those in the unexposed cohort. Adjusted hazard ratios for COPD ranged from 8.6 (95% confidence interval [CI] = 6.8 to 11.0) for >6–12 months after the index date to 2.8 (95% CI = 2.6 to 3.0) for >36 months after the index date; asthma, 11.7 (CI = 9.4 to 14.6) to 4.3 (CI = 3.9 to 4.6); and IHD, 3.0 (CI = 2.7 to 3.4) to 1.6 (CI = 1.5 to 1.7). Risk of a longer time to diagnosis remained higher in members of the exposed cohort who had no relevant prescription in the first 6 months; approximately half of all future diagnoses were made for such patients. Risk of early mortality (all cause and disease specific) was higher in members of the exposed cohort.ConclusionBreathlessness can be an indicator of developing COPD, asthma, and IHD, and is associated with early mortality. With careful assessment, appropriate intervention, and proactive follow-up and monitoring, there is the potential to improve identification at first presentation in primary care in those at high risk of future disease who present with this symptom.

scholarly journals OP0074 MULTIMORBIDITY CLUSTERS, DETERMINANTS AND TRAJECTORIES IN OSTEOARTHRITIS IN THE UK: FINDINGS FROM THE CLINICAL PRACTICE RESEARCH DATALINK

2020 ◽  
Vol 79 (Suppl 1) ◽  
pp. 49.1-50
Author(s):  
S. Swain ◽  
C. Coupland ◽  
V. Strauss ◽  
C. Mallen ◽  
C. F. Kuo ◽  
...  
Keyword(s):  
Chronic Conditions ◽  
Index Date ◽  
Latent Class ◽  
Rapid Onset ◽  
Practice Research ◽  
Clinical Practice Research Datalink ◽  
Research Support ◽  
Gradual Onset ◽  
The Uk ◽  
Slow Onset

Background:Multimorbidity (≥2 chronic conditions) escalates the risk of adverse health outcomes. However, its burden in people with osteoarthritis (OA) remains largely unknown.Objectives:To identify the clusters of patients with multimorbidity and associated factors in OA and non-OA populations and to estimate the risk of developing multimorbidity clusters after the index date (after diagnosis).Methods:The study used the Clinical Practice Research Datalink – a primary care database from the UK. Firstly, age, sex and practice matched OA and non-OA people aged 20+ were identified to explore patterns and associations of clusters of multimorbidity within each group. Non-OA controls were assigned with same index date as that of matched OA cases. Secondly, multimorbidity trajectories for 20 years after the index date were examined in people without any comorbidities at baseline in both OA and non-OA groups. Latent class analysis was used to identify clusters and latent class growth modelling was used for cluster trajectories. The associations between clusters and age, sex, body mass index (BMI), alcohol use, smoking habits at baseline were quantified through multinomial logistic regression.Results:In total, 47 long-term conditions were studied in 443,822 people (OA- 221922; non-OA- 221900), with a mean age of 62 years (standard deviation ± 13 years), and 58% being women. The prevalence of multimorbidity was 76.6% and 68.9% in the OA and non-OA groups, respectively. In the OA group five clusters were identified including relatively healthy (18%), ‘cardiovascular (CVD) and musculoskeletal (MSK)’ (12.3%), metabolic syndrome (28.2%), ‘pain and psychological (9.1%), and ‘musculoskeletal’ (32.4%). The non-OA group had similar patterns except that the ‘pain+ psychological’ cluster was replaced by ‘thyroid and psychological’. (Figure 1) Among people with OA, ‘CVD+MSK’ and metabolic syndrome clusters were strongly associated with obesity with a relative risk ratio (RRR) of 2.04 (95% CI 1.95-2.13) and 2.10 (95% CI 2.03-2.17), respectively. Women had four times higher risk of being in the ‘pain+ psychological’ cluster than men when compared to the gender ratio in the healthy cluster, (RRR 4.28; 95% CI 4.09-4.48). In the non-OA group, obesity was significantly associated with all the clusters.Figure 1: Posterior probability distribution of chronic conditions across the clusters in Osteoarthritis (OA, n=221922) and Non-Osteoarthritis (Non-OA, n=221900) group. COPD- Chronic Obstructive Pulmonary Disease; CVD- Cardiovascular; MSK- MusculoskeletalOA (n=24139) and non-OA (n=24144) groups had five and four multimorbidity trajectory clusters, respectively. Among the OA population, 2.7% had rapid onset of multimorbidity, 9.5% had gradual onset and 11.6% had slow onset, whereas among the non-OA population, there was no rapid onset cluster, 4.6% had gradual onset and 14.3% had slow onset of multimorbidity. (Figure 2)Figure 2: Clusters of multimorbidity trajectories after index date in OA (n=24139) and Non-OA (n=24144)Conclusion:Distinct identified groups in OA and non-OA suggests further research for possible biological linkage within each cluster. The rapid onset of multimorbidity in OA should be considered for chronic disease management.Supported by:Acknowledgments:We would like to thank the University of Nottingham, UK, Beijing Joint Care Foundation, China and Foundation for Research in Rheumatology (FOREUM) for supporting the study.Disclosure of Interests:Subhashisa Swain: None declared, Carol Coupland: None declared, Victoria Strauss: None declared, Christian Mallen Grant/research support from: My department has received financial grants from BMS for a cardiology trial., Chang-Fu Kuo: None declared, Aliya Sarmanova: None declared, Michael Doherty Grant/research support from: AstraZeneca funded the Nottingham Sons of Gout study, Consultant of: Advisory borads on gout for Grunenthal and Mallinckrodt, Weiya Zhang Consultant of: Grunenthal for advice on gout management, Speakers bureau: Bioiberica as an invited speaker for EULAR 2016 satellite symposium

scholarly journals Paediatric rotavirus vaccination, coeliac disease and type 1 diabetes in children: a population-based cohort study

BMC Medicine ◽  
2021 ◽  
Vol 19 (1) ◽  
Author(s):  
Thomas Inns ◽  
Kate M. Fleming ◽  
Miren Iturriza-Gomara ◽  
Daniel Hungerford
Keyword(s):  
Type 1 Diabetes ◽  
Cohort Study ◽  
Coeliac Disease ◽  
Practice Research ◽  
Clinical Practice Research Datalink ◽  
Rotavirus Vaccine ◽  
Rotavirus Vaccination ◽  
Increased Risk ◽  
The Uk

Abstract Background Rotavirus infection has been proposed as a risk factor for coeliac disease (CD) and type 1 diabetes (T1D). The UK introduced infant rotavirus vaccination in 2013. We have previously shown that rotavirus vaccination can have beneficial off-target effects on syndromes, such as hospitalised seizures. We therefore investigated whether rotavirus vaccination prevents CD and T1D in the UK. Methods A cohort study of children born between 2010 and 2015 was conducted using primary care records from the Clinical Practice Research Datalink. Children were followed up from 6 months to 7 years old, with censoring for outcome, death or leaving the practice. CD was defined as diagnosis of CD or the prescription of gluten-free goods. T1D was defined as a T1D diagnosis. The exposure was rotavirus vaccination, defined as one or more doses. Mixed-effects Cox regression was used to estimate hazard ratios (HR) and 95% confidence intervals (CIs). Models were adjusted for potential confounders and included random intercepts for general practices. Results There were 880,629 children in the cohort (48.8% female). A total of 343,113 (39.0%) participants received rotavirus vaccine; among those born after the introduction of rotavirus vaccination, 93.4% were vaccinated. Study participants contributed 4,388,355 person-years, with median follow-up 5.66 person-years. There were 1657 CD cases, an incidence of 38.0 cases per 100,000 person-years. Compared with unvaccinated children, the adjusted HR for a CD was 1.05 (95% CI 0.86–1.28) for vaccinated children. Females had a 40% higher hazard than males. T1D was recorded for 733 participants, an incidence of 17.1 cases per 100,000 person-years. In adjusted analysis, rotavirus vaccination was not associated with risk of T1D (HR = 0.89, 95% CI 0.68–1.19). Conclusions Rotavirus vaccination has reduced diarrhoeal disease morbidity and mortality substantial since licencing in 2006. Our finding from this large cohort study did not provide evidence that rotavirus vaccination prevents CD or T1D, nor is it associated with increased risk, delivering further evidence of rotavirus vaccine safety.

Quantifying function before and after total joint replacement surgery in patients with hip osteoarthritis

2015 ◽  
Vol 42 ◽  
pp. S32
Author(s):  
J.E. Naili ◽  
A.C. Esbjörnsson ◽  
M.D. Iversen ◽  
M.H. Schwartz ◽  
C. Häger ◽  
...  
Keyword(s):  
Joint Replacement ◽  
Total Joint Replacement ◽  
Hip Osteoarthritis ◽  
Joint Replacement Surgery ◽  
Replacement Surgery ◽  
Before And After

scholarly journals Validity of an algorithm to identify cardiovascular deaths from administrative health records: a multi-database population-based cohort study

2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Lisa M. Lix ◽  
Shamsia Sobhan ◽  
Audray St-Jean ◽  
Jean-Marc Daigle ◽  
Anat Fisher ◽  
...  
Keyword(s):  
Cohort Study ◽  
Cardiovascular Mortality ◽  
Population Based ◽  
Vital Statistics ◽  
Practice Research ◽  
Clinical Practice Research Datalink ◽  
Health Records ◽  
Predictive Values ◽  
Site Specific ◽  
Hospital Deaths

Abstract Background Cardiovascular death is a common outcome in population-based studies about new healthcare interventions or treatments, such as new prescription medications. Vital statistics registration systems are often the preferred source of information about cause-specific mortality because they capture verified information about the deceased, but they may not always be accessible for linkage with other sources of population-based data. We assessed the validity of an algorithm applied to administrative health records for identifying cardiovascular deaths in population-based data. Methods Administrative health records were from an existing multi-database cohort study about sodium-glucose cotransporter-2 (SGLT2) inhibitors, a new class of antidiabetic medications. Data were from 2013 to 2018 for five Canadian provinces (Alberta, British Columbia, Manitoba, Ontario, Quebec) and the United Kingdom (UK) Clinical Practice Research Datalink (CPRD). The cardiovascular mortality algorithm was based on in-hospital cardiovascular deaths identified from diagnosis codes and select out-of-hospital deaths. Sensitivity, specificity, and positive and negative predictive values (PPV, NPV) were calculated for the cardiovascular mortality algorithm using vital statistics registrations as the reference standard. Overall and stratified estimates and 95% confidence intervals (CIs) were computed; the latter were produced by site, location of death, sex, and age. Results The cohort included 20,607 individuals (58.3% male; 77.2% ≥70 years). When compared to vital statistics registrations, the cardiovascular mortality algorithm had overall sensitivity of 64.8% (95% CI 63.6, 66.0); site-specific estimates ranged from 54.8 to 87.3%. Overall specificity was 74.9% (95% CI 74.1, 75.6) and overall PPV was 54.5% (95% CI 53.7, 55.3), while site-specific PPV ranged from 33.9 to 72.8%. The cardiovascular mortality algorithm had sensitivity of 57.1% (95% CI 55.4, 58.8) for in-hospital deaths and 72.3% (95% CI 70.8, 73.9) for out-of-hospital deaths; specificity was 88.8% (95% CI 88.1, 89.5) for in-hospital deaths and 58.5% (95% CI 57.3, 59.7) for out-of-hospital deaths. Conclusions A cardiovascular mortality algorithm applied to administrative health records had moderate validity when compared to vital statistics data. Substantial variation existed across study sites representing different geographic locations and two healthcare systems. These variations may reflect different diagnostic coding practices and healthcare utilization patterns.

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