Modelling recurrent events: comparison of statistical models with continuous and discontinuous risk intervals on recurrent malaria episodes data

Abstract Background Inadequate prevention and treatment of malaria can lead to reinfections and recurrent episodes, and for vivax malaria, further recurrences from the dormant liver stage. This study quantified the impact of recurrent malaria episodes on morbidity and mortality. Methods Routinely collected data were available from 68,381 malaria patients presenting to the primary referral hospital in Papua, Indonesia. A multi-state modelling framework, with Cox regression for transition rates, was employed to determine the risks of re-presentation to hospital, receiving in-patient treatment, and early (≤14 days post treatment)/late death following multiple malaria episodes. Results The risk of re-presentation to hospital increased from 34.7% (95%CI: 34.4%–35.1%) at first episode to 58.6% (57.5%–59.6%) following the third episode. Infection with vivax malaria increased the rate of re-presentation to hospital by 1.48-fold (Hazard Ratio 1.48; 95%CI 1.44–1.51) and late hospital in-patient admission by 1.17-fold (1.11–1.22), compared to falciparum. Falciparum malaria caused a higher overall rate of early death (1.54 (1.25–1.92)), however, after multiple episodes, there was a trend towards a greater rate of early death for vivax infection (1.91 (0.73–4.97)). Conclusions Recurrent episodes of malaria can cause substantial morbidity and mortality, highlighting the importance of prevention and effective treatments for both falciparum and vivax malaria. Key messages To achieve elimination of malaria in South-East Asia, where prevalence of vivax malaria is high, we must prioritise the radical cure of vivax to eliminate the liver-stage of this species that causes relapses of infection.

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Statistical models for recurrent events and death: Application to cancer events

Mathematical and Computer Modelling ◽

10.1016/j.mcm.2010.02.002 ◽

2010 ◽

Vol 52 (7-8) ◽

pp. 949-955 ◽

Cited By ~ 14

Author(s):

V. Rondeau

Keyword(s):

Statistical Models ◽

Recurrent Events

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Longitudinal analysis of naturally acquired antibodies to PfEMP1 CIDR domain variants and their association with malaria protection

10.1101/2020.02.11.944330 ◽

2020 ◽

Cited By ~ 1

Author(s):

Nyamekye Obeng-Adjei ◽

Daniel B. Larremore ◽

Louise Turner ◽

Aissata Ongoiba ◽

Shanping Li ◽

...

Keyword(s):

Plasmodium Falciparum ◽

Cohort Study ◽

Specific Interactions ◽

Specific Antibodies ◽

Future Studies ◽

Recurrent Malaria ◽

Clinical Protection ◽

Prospective Risk ◽

Malaria Episodes ◽

Malaria Protection

ABSTRACTMalaria pathogenicity is determined, in part, by the adherence of Plasmodium falciparum infected erythrocytes to the microvasculature mediated via specific interactions between PfEMP1 variant domains to host endothelial receptors. Naturally acquired antibodies against specific PfEMP1 variants can play an important role in clinical protection against malaria. We evaluated IgG responses against a repertoire of PfEMP1 CIDR domain variants to determine the rate and order of variant-specific antibody acquisition and their association with protection against febrile malaria in a prospective cohort study conducted in an area of intense, seasonal malaria transmission. Using longitudinal data, we found that IgG to the pathogenic domain variants CIDRα1.7 and CIDRα1.8 were acquired the earliest. Furthermore, IgG to CIDRγ3 was associated with reduced prospective risk of febrile malaria and recurrent malaria episodes. Future studies will need to validate these findings in other transmission settings and determine the functional activity of these naturally acquired CIDR variant-specific antibodies.

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Statistical Models: Theory and Practice

10.1017/cbo9781139165495 ◽

2005 ◽

Cited By ~ 204

Author(s):

David Freedman

Keyword(s):

Statistical Models ◽

Theory And Practice

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Current MCSS Study: Statistical models for cancer control and epidemiology

PsycEXTRA Dataset ◽

10.1037/e409002008-004 ◽

2005 ◽

Keyword(s):

Statistical Models ◽

Cancer Control

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The Prediction of Adolescents At-Risk for Attempting Suicide Using Tree-Based Statistical Models

PsycEXTRA Dataset ◽

10.1037/e698392011-001 ◽

2011 ◽

Author(s):

Eric E. Pierson ◽

Holmes W. Finch

Keyword(s):

At Risk ◽

Statistical Models

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Generation of Reduced Statistical Models for NLP and MINLP Optimization

Computers & Chemical Engineering ◽

10.1016/s0098-1354(97)00099-9 ◽

1997 ◽

Vol 21 (1-2) ◽

pp. S505-S510 ◽

Cited By ~ 2

Author(s):

S Noronha

Keyword(s):

Statistical Models

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Recurrent Stroke Risk in Pilots with Atrial Fibrillation

Aerospace Medicine and Human Performance ◽

10.3357/amhp.5326.2020 ◽

2020 ◽

Vol 91 (4) ◽

pp. 352-357

Author(s):

Jessica Tedford ◽

Valerie Skaggs ◽

Ann Norris ◽

Farhad Sahiar ◽

Charles Mathers

Keyword(s):

Atrial Fibrillation ◽

General Population ◽

Recurrent Events ◽

Stroke Risk ◽

Event Rate ◽

Recurrent Stroke ◽

Previous History ◽

Recurrent Event ◽

Recurrence Rates ◽

Medical Certification

INTRODUCTION: Atrial fibrillation (AF) is one of the most common cardiac arrhythmias in the general population and is considered disqualifying aeromedically. This study is a unique examination of significant outcomes in aviators with previous history of both AF and stroke.METHODS: Pilots examined by the FAA between 2002 and 2012 who had had AF at some point during his or her medical history were reviewed, and those with an initial stroke or transient ischemic attack (TIA) during that time period were included in this study. All records were individually reviewed to determine stroke and AF history, medical certification history, and recurrent events. Variables collected included medical and behavior history, stroke type, gender, BMI, medication use, and any cardiovascular or neurological outcomes of interest. Major recurrent events included stroke, TIA, cerebrovascular accident, death, or other major events. These factors were used to calculate CHA2DS2-VASc scores.RESULTS: Of the 141 pilots selected for the study, 17.7% experienced a recurrent event. At 6 mo, the recurrent event rate was 5.0%; at 1 yr, 5.8%; at 3 yr 6.9%; and at 5 yr the recurrent event rate was 17.3%. No statistical difference between CHA2DS2-VASc scores was found as it pertained to number of recurrent events.DISCUSSION: We found no significant factors predicting risk of recurrent event and lower recurrence rates in pilots than the general population. This suggests CHA2DS2-VASc scores are not appropriate risk stratification tools in an aviation population and more research is necessary to determine risk of recurrent events in aviators with atrial fibrillation.Tedford J, Skaggs V, Norris A, Sahiar F, Mathers C. Recurrent stroke risk in pilots with atrial fibrillation. Aerosp Med Hum Perform. 2020; 91(4):352–357.

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