Risk of Cataracts among Idiopathic Thrombocytopenic Purpura (ITP) Patients in the UK General Practice Research Database (GPRD).

Blood ◽  
2007 ◽  
Vol 110 (11) ◽  
pp. 3922-3922
Author(s):  
Maurille A. Feudjo-Tepie ◽  
Susan A. Hall ◽  
John W. Logie ◽  
Noah J. Robinson ◽  
Dimitri Bennett
Keyword(s):  
Rate Ratio ◽  
General Practice Research Database ◽  
Oral Steroid ◽  
Practice Research ◽  
Research Database ◽  
Steroid Use ◽  
Increased Risk ◽  
Oral Steroids ◽  
Adjusted Rate ◽  
Adjusted Rate Ratio

Abstract ITP is a disease caused by inadequate platelet production as well as increased platelet destruction. Oral systemic steroids are recommended as first-line treatment. Prolonged use of oral steroids in other disease populations has been associated with an approximately two-fold increase in the risk of developing a cataract. This study aimed to quantify the underlying risk of cataracts among ITP patients compared with non-ITP patients. Using the GPRD, a retrospective matched cohort study was conducted in which each ITP patient newly diagnosed between 1992 and 2005 and age 18 years or older was matched to 5 non-ITP patients on gender, age, practice and duration of follow-up. ITP patients and cataract events were identified using specific Read/Oxmis disease codes and validated by a clinical epidemiologist. The exposure of interest was oral steroid use and the primary outcome was cataracts (recorded as cataracts or cataract surgery). Patients with a history of cataracts were not excluded from the study. Potential covariates of interest were diabetes, schizophrenia, glaucoma, splenectomy and hypertension. The risk of cataracts was quantified using incidence rates and 95% confidence intervals (CI) and, the difference between groups was estimated using a rate ratio and 95% CI. All analyses were further stratified by age and gender. Adjusted rate ratios were estimated using the Cox proportional hazard model. Seven hundred sixty ITP patients were identified, 745 (98%) of whom had 5 matched controls. The entire sample had a mean age of 56.4 years and 60.1% were female. Among ITP patients, users of oral steroids had a cataract incidence rate of 14.0 per 1000 person-years (PY) (95% CI: 8.7 – 21.4) and non steroid users 6.1 per 1000 PY (95% CI: 2.7 – 11.4). In the non-ITP population, these figures were 16.9 per 1000 PY (95% CI: 11.9 – 23.3) and 9.2 per 1000 PY (95% CI: 7.6 – 11.0), respectively. The incidence of cataracts was observed to increase with age. Adjusting for steroid use and other factors, the risk of cataracts was similar in the ITP and non-ITP populations (adjusted rate ratio 0.8, 95% CI: 0.5 – 1.2) whereas, oral steroid use was associated with an increased risk of cataracts in both ITP and non ITP populations (adjusted rate ratio 1.6, 95% CI: 1.2 – 2.2). There was no evidence of increased risk with either inhaled steroids, or intranasal steroids. As expected, our study shows that the use of oral steroids is associated with an increased risk of cataracts in both ITP and non-ITP populations. However, we found no evidence of a difference in the risk of cataracts between an ITP and a matched non-ITP population.

scholarly journals Association between maternal and paternal mental illness and risk of injuries in children and adolescents: nationwide register based cohort study in Sweden

BMJ ◽  
2020 ◽  
pp. m853 ◽  
Author(s):  
Alicia Nevriana ◽  
Matthias Pierce ◽  
Christina Dalman ◽  
Susanne Wicks ◽  
Marie Hasselberg ◽  
...  
Keyword(s):  
Mental Illness ◽  
Cohort Study ◽  
Rate Ratio ◽  
Parental Mental Illness ◽  
Affective Psychosis ◽  
Fall Injuries ◽  
Increased Risk ◽  
Adjusted Rate ◽  
Adjusted Rate Ratio ◽  
Parents With Mental Illness

Abstract Objective To determine the association between parental mental illness and the risk of injuries among offspring. Design Retrospective cohort study. Setting Swedish population based registers. Participants 1 542 000 children born in 1996-2011 linked to 893 334 mothers and 873 935 fathers. Exposures Maternal or paternal mental illness (non-affective psychosis, affective psychosis, alcohol or drug misuse, mood disorders, anxiety and stress related disorders, eating disorders, personality disorders) identified through linkage to inpatient or outpatient healthcare registers. Main outcome measures Risk of injuries (transport injury, fall, burn, drowning and suffocation, poisoning, violence) at ages 0-1, 2-5, 6-9, 10-12, and 13-17 years, comparing children of parents with mental illness and children of parents without mental illness, calculated as the rate difference and rate ratio adjusted for confounders. Results Children with parental mental illness contributed to 201 670.5 person years of follow-up, while children without parental mental illness contributed to 2 434 161.5 person years. Children of parents with mental illness had higher rates of injuries than children of parents without mental illness (for any injury at age 0-1, these children had an additional 2088 injuries per 100 000 person years; number of injuries for children with and without parental mental illness was 10 235 and 72 723, respectively). At age 0-1, the rate differences ranged from 18 additional transport injuries to 1716 additional fall injuries per 100 000 person years among children with parental mental illness compared with children without parental mental illness. A higher adjusted rate ratio for injuries was observed from birth through adolescence and the risk was highest during the first year of life (adjusted rate ratio at age 0-1 for the overall association between any parental mental illness that has been recorded in the registers and injuries 1.30, 95% confidence interval 1.26 to 1.33). Adjusted rate ratios at age 0-1 ranged from 1.28 (1.24 to 1.32) for fall injuries to 3.54 (2.28 to 5.48) for violence related injuries. Common and serious maternal and paternal mental illness was associated with increased risk of injuries in children, and estimates were slightly higher for common mental disorders. Conclusions Parental mental illness is associated with increased risk of injuries among offspring, particularly during the first years of the child’s life. Efforts to increase access to parental support for parents with mental illness, and to recognise and treat perinatal mental morbidity in parents in secondary care might prevent child injury.

scholarly journals Drug interactions and risk of acute bleeding leading to hospitalisation or death in patients with chronic atrial fibrillation treated with warfarin

2005 ◽  
Vol 94 (09) ◽  
pp. 537-543 ◽  
Author(s):  
Jennifer Hollowell ◽  
Christoph R. Meier ◽  
Walter E. Haefeli ◽  
Christiane Gasse
Keyword(s):  
Atrial Fibrillation ◽  
Drug Interactions ◽  
Conditional Logistic Regression ◽  
General Practice Research Database ◽  
Practice Research ◽  
Control Analysis ◽  
Research Database ◽  
Nonvalvular Atrial Fibrillation ◽  
Increased Risk

SummaryAlthough drug interactions with warfarin are an important cause of excessive anticoagulation, their impact on the risk of serious bleeding is unknown. We therefore performed a cohort study and a nested case-control analysis to determine the risk of serious bleeding in 4152 patients (aged 40–84 years) with nonvalvular atrial fibrillation (AF) taking long-term warfarin (>3 months). The study population was drawn from the UK General Practice Research Database. More than half (58%) of eligible patients used potentially interacting drugs during continuous warfarin treatment. Among 45 identified cases of incident idiopathic bleeds (resulting in hospitalisation within 30 days or death within 7 days) and 143 matched controls, more cases than controls took ≥1 potentially interacting drug within the preceding 30 days (62.2% vs. 35.7%) and used >4 drugs (polypharmacy) within the preceding 90 days (80.0% vs. 66.4%). Conditional logistic regression analysis yielded an odds ratio (OR) of 3.4 (95% confidence interval [CI]: 1.4–8.5) for the risk of serious bleeding in patients treated with warfarin and ≥1 drugs potentially increasing the effect of warfarin vs. warfarin alone adjusted for polypharmacy, diabetes, hypertension, heart failure, and thyroid disease; the adjusted OR for the combined use of warfarin and aspirin vs. warfarin alone was 4.5 (95% CI: 1.1–18.1). We conclude that concurrent use of potentially interacting drugs with warfarin is associated with a 3 to 4.5-fold increased risk of serious bleeding in long-term warfarin users.

Risks of stroke and mortality associated with suboptimal anticoagulation in atrial fibrillation patients

2011 ◽  
Vol 106 (11) ◽  
pp. 968-977 ◽  
Author(s):  
Arlene Gallagher ◽  
Efrosini Setakis ◽  
Jonathan Plumb ◽  
Andreas Clemens ◽  
Tjeerd-Pieter van Staa
Keyword(s):  
Atrial Fibrillation ◽  
Therapeutic Range ◽  
Cox Regression ◽  
Relative Rate ◽  
General Practice Research Database ◽  
Practice Research ◽  
Study Cohort ◽  
Research Database ◽  
Increased Risk ◽  
The Uk

SummaryAtrial fibrillation (AF) carries an increased risk of ischaemic stroke, and oral anticoagulation with warfarin can reduce this risk. The objective of this study was to evaluate the association between time in therapeutic International Normalised Ratio (INR) range when receiving warfarin and the risk of stroke and mortality. The study cohort included AF patients aged 40 years and older included in the UK General Practice Research Database. For patients treated with warfarin we computed the percentage of follow-up time spent within therapeutic range. Cox regression was used to assess the association between INR and outcomes while controlling for patient demographics, health status and concomitant medication. The study population included 27,458 warfarintreated (with at least 3 INR measurements) and 10,449 patients not treated with antithrombotic therapy. Overall the warfarin users spent 63% of their time within therapeutic range (TTR). This percentage did not vary substantially by age, sex and CHA2DS2-VASc score. Patients who spent at least 70% of time within therapeutic range had a 79% reduced risk of stroke compared to patients with ≤30% of time in range (adjusted relative rate of 0.21; 95% confidence interval 0.18–0.25). Mortality rates were also significantly lower with at least 70% of time spent within therapeutic range. In conclusion, good anticoagulation control was associated with a reduction in the risk of stroke.

scholarly journals Outcomes of undernutrition in patients in the community with cancer or cardiovascular disease

1999 ◽  
Vol 58 (3) ◽  
pp. 655-661 ◽  
Author(s):  
Jackie Edington ◽  
Paul D. Winter ◽  
Steve J. Coles ◽  
Catharine R. Gale ◽  
Christopher N. Martyn
Keyword(s):  
Cardiovascular Disease ◽  
Nutritional Status ◽  
General Practice Research Database ◽  
Well Being ◽  
Health Concern ◽  
Practice Research ◽  
Research Database ◽  
Men And Women ◽  
Risk Of Death ◽  
Increased Risk

Public health concern has tended to focus on the dangers of obesity, but there is evidence that undernutrition may also pose a risk to physical and mental well-being, particularly in those who are already ill. Using the General Practice Research Database (see office for Population Censuses and Surveys, 1995), we followed up 10 128 men and women aged 18 years and over who had been diagnosed with cancer or cardiovascular disease to examine whether nutritional status, as indicated by BMI, affected rates of use of health care resources and mortality. In both diagnostic groups, patients with a BMI below 20 kg/m 2 had higher rates of consultation with GP, higher rates of prescription and higher death rates during the follow-up period compared with those with a BMI of 20 – < 25 kg/m 2. In men and women with cardiovascular disease, poor nutritional status was associated with a sharply increased risk of hospital admission. Patients whose BMI was 30 – <40 kg/m 2 also tended to have increased rates of GP consultation and prescription, and if they were under the age of 65 years, they had an increased risk of death. The results of the present study suggest that in men and women with cancer or cardiovascular disease, even minor degrees of undernutrition are associated with a marked increase in morbidity and mortality.

scholarly journals Medical outcome of pregnancy in women with psychotic disorders and their infants in the first year after birth

2003 ◽  
Vol 182 (1) ◽  
pp. 63-67 ◽  
Author(s):  
Louise M. Howard ◽  
Claudia Goss ◽  
Morven Leese ◽  
Graham Thornicroft
Keyword(s):  
General Practice ◽  
Psychotic Disorder ◽  
Psychotic Disorders ◽  
General Practice Research Database ◽  
Practice Research ◽  
Obstetric Outcomes ◽  
Research Database ◽  
Increased Risk ◽  
Significant Difference ◽  
History Of

BackgroundThere has been little research into the health of infants of women with psychotic disorders.AimsTo investigate the antenatal care of mothers with a history of psychotic disorders, obstetric outcomes and the subsequent health of their babies.MethodA matched, controlled cohort study was carried out using the General Practice Research Database. Women with a history of a psychotic disorder, who gave birth in 1996–1998, were compared with women matched for age and general practice (199 cases and 787 controls) and their infants.ResultsCases had a higher proportion of stillbirths (OR=4.03, 95% CI 1.14–4.25, P=0.03) and neonatal deaths (P<0.001). There was no difference in gestational age at antenatal booking. Mothers with psychotic disorders were less likely than controls to attend for infant immunisations 90–270 days after birth (RR=0.94, 95% CI 0.88–0.99, P=0.03). There was no significant difference in the rates of accidents and hospital contacts for infants.ConclusionsThere is an increased risk of stillbirth and neonatal death in women with a history of psychotic disorder, and it is therefore important for health care professionals to focus on optimal obstetric care. The physical health of babies who live with mothers with psychotic disorders is not significantly different from that of matched baby controls.

scholarly journals Risk of hip fracture in patients with a history of schizophrenia

2007 ◽  
Vol 190 (2) ◽  
pp. 129-134 ◽  
Author(s):  
Louise Howard ◽  
Graham Kirkwood ◽  
Morven Leese
Keyword(s):  
Hip Fracture ◽  
Antipsychotic Medication ◽  
Univariate Analysis ◽  
General Practice Research Database ◽  
Practice Research ◽  
Research Database ◽  
Mineral Density ◽  
Increased Risk ◽  
History Of ◽  
Clinically Significant

BackgroundThere is evidence of an association between decreased bone mineral density schizophrenia, and prolactin-raising antipsychotic medication. However, it is not known whether this is clinically significant.AimsTo investigate whether patients with a history of schizophrenia are at increased risk of hip fracture.MethodIn a case-control study, we compared cases of ‘hip fracture’ on the General Practice Research Database (n=16 341) with matched controls (n=29 889).ResultsHip fracture was associated with schizophrenia (OR=1.73; 95% CI 1.32-2.28), and prolactin-raising antipsychotics (OR=2.6; 95% CI 2.432.78), in the univariate analysis. In the multivariate analysis, prolactin-raising antipsychotics were independently associated with hip fracture but schizophrenia was not. A significant interaction between gender and antipsychotics was found in the association with hip fracture (P=0.042); OR=2.12 (95% C11.73-2.59)for men, OR=l.93 (95% C11.78-2.10) for women.ConclusionsThe association between prolactin-raising antipsychotic medication and hip fracture may have serious implications for public health. Mental health service patients may require preventive measures including dietary and lifestyle advice.

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