A comparison of approaches for estimating combined population attributable risks (PARs) for multiple risk factors

2020 ◽  
Vol 9 (1) ◽  
Author(s):  
Yibing Ruan ◽  
Stephen D. Walter ◽  
Christine M. Friedenreich ◽  
Darren R. Brenner ◽  
_ _
Keyword(s):  
Risk Factors ◽  
Risk Factor ◽  
Population Attributable Risk ◽  
Individual Level ◽  
Joint Distributions ◽  
Multiple Risk Factors ◽  
Relative Risks ◽  
Multiple Risk ◽  
The Individual ◽  
Population Attributable Risks

AbstractObjectivesThe methods to estimate the population attributable risk (PAR) of a single risk factor or the combined PAR of multiple risk factors have been extensively studied and well developed. Ideally, the estimation of combined PAR of multiple risk factors should be based on large cohort studies, which account for both the joint distributions of risk exposures and for their interactions. However, because such individual-level data are often lacking, many studies estimate the combined PAR using a comparative risk assessment framework. It involves estimating PAR of each risk factor based on its prevalence and relative risk, and then combining the individual PARs using an approach that relies on two key assumptions: that the distributions of exposures to the risk factors are independent and that the relative risks are multiplicative. While such assumptions rarely hold true in practice, no studies have investigated the magnitude of bias incurred if the assumptions are violated.MethodsUsing simulation-based models, we compared the combined PARs obtained with this approach to the more accurate estimates of PARs that are available when the joint distributions of exposures and risks can be established.ResultsWe show that the assumptions of exposure independence and risk multiplicativity are sufficient but not necessary for the combined PAR to be unbiased. In the simplest situation of two risk factors, the bias of this approach is a function of the strength of association and the magnitude of risk interaction, for any values of exposure prevalence and their associated risks. In some cases, the combined PAR can be strongly under- or over-estimated, even if the two assumptions are only slightly violated.ConclusionsWe encourage researchers to quantify likely biases in their use of the M–S method, and here, we provided level plots and R code to assist.

ESTIMATING THE POPULATION ATTRIBUTABLE RISK FOR MULTIPLE RISK FACTORS USING CASE-CONTROL DATA

1985 ◽  
Vol 122 (5) ◽  
pp. 904-914 ◽  
Author(s):  
PAOLO BRUZZI ◽  
SYLVAN B. GREEN ◽  
DAVID P. BYAR ◽  
LOUISE A. BRINTON ◽  
CATHERINE SCHAIRER
Keyword(s):  
Risk Factors ◽  
Population Attributable Risk ◽  
Case Control ◽  
Attributable Risk ◽  
Control Data ◽  
Multiple Risk Factors ◽  
Multiple Risk

Number of Risk Factors in Down Syndrome Pregnancies

2018 ◽  
Vol 36 (01) ◽  
pp. 079-085 ◽  
Author(s):  
Deana Hussamy ◽  
Christina Herrera ◽  
Diane Twickler ◽  
Donald Mcintire ◽  
Jodi Dashe
Keyword(s):  
Risk Factors ◽  
Down Syndrome ◽  
Risk Factor ◽  
Population Based ◽  
Femur Length ◽  
Multiple Risk Factors ◽  
Calculated Risk ◽  
Multiple Risk ◽  
Stillborn Infant ◽  
Singleton Pregnancies

Objective The objective of this study was to evaluate risk factor prevalence in pregnancies with fetal Down syndrome, in an effort to characterize efficacy of population-based screening. Study Design Retrospective review of singleton pregnancies with delivery of live born or stillborn infant with Down syndrome from 2009 through 2015. Risk factor categories included maternal age ≥35 years, abnormal serum screening, identification of ≥1 ultrasound marker at 16 to 22 weeks (nuchal thickness ≥6 mm, echogenic intracardiac focus, echogenic bowel, renal pelvis dilatation, femur length <third percentile), and detection of a major fetal anomaly. Statistical analyses included χ2 test and Mantel–Haenszel χ2 test. Results Down syndrome infants represented 1:428 singleton births. All risk categories were assessed in 125 pregnancies and included abnormal serum screen in 110 (88%), ≥1 ultrasound marker in 66 (53%), and ≥1 anomaly in 41 (34%). The calculated risk was at least 1:270 in 93% of Down syndrome pregnancies. More pregnancies had multiple risk factors than had a single risk factor, 90 (72%) versus 30 (24%), p < 0.001. An abnormal ultrasound marker or anomaly was identified in >50% of fetuses in women <35 years and in >75% of those 35 years and older. Conclusion In a population-based cohort, sensitivity of second-trimester Down syndrome screening was 93%, with multiple risk factors present in nearly three-fourths of cases.

Abstract WP229: Young African Americans With Stroke Have a Greater Burden of Multiple Risk Factors Than Their White Counterparts

Stroke ◽  
2020 ◽  
Vol 51 (Suppl_1) ◽  
Author(s):  
Prachi Mehndiratta ◽  
Kathleen Ryan ◽  
John W Cole ◽  
Marcella Wozniak ◽  
Seemant Chaturvedi ◽  
...  
Keyword(s):  
Risk Factors ◽  
Young Adults ◽  
Logistic Regression ◽  
Risk Factor ◽  
Vascular Risk Factors ◽  
Factor Group ◽  
Vascular Risk ◽  
Multiple Risk Factors ◽  
Multiple Risk ◽  
Group D

Background: Stroke in young adults accounts for 15-18% of all ischemic stroke (IS) cases and disproportionately affects African Americans (AfrAm). While it is well known that a higher prevalence of vascular risk factors, particularly HTN and DM, contributes to this excess risk, few studies have examined the potential contribution of the synergistic risk from multiple vascular risk factors. Methods: A population-based case-control study with 582 cases and 727 controls ages 15-49 was used to investigate the relationship of multiple risk factors and IS in young adults and compare AfrAM and White cases for the prevalence of multiple risk factors. Logistic regression analysis with adjustment for age, sex, and race was used to evaluate the association between the following mutually exclusive risk factor groups and IS: (a) Smoking alone, (b) Smoking+ HTN only, (c) Smoking + HTN +Obesity only (d) Smoking + HTN + Obesity +DM. The reference group for these analyses was those with no risk factors. Logistic regression with adjustment for age only was also used to compare AfrAM vs White cases for their prevalence in each risk factor group. Results: There were a total 218 cases with no risk factors. The odds of having an IS increased exponentially as the number of risk factors increased (OR 2.3, 95% CI 1.8 - 3.0, p <0.0001 for group a versus OR 16.5, 95% CI 4.8-56.1, p<0.0001 for group d). Young AfrAM cases were approximately 6 times more likely (25.3% vs. 4.3% p<0.0001) than White cases to be in the multiple risk factor group d. Conclusion: The risk of IS increases in an exponential manner in young adults with an increasing number of traditional risk factors. Compared to their White counterparts, young AfrAm IS cases are approximately 6 times more likely to have all 4 risk factors: smoking, HTN, DM and obesity. Risk factor synergy could contribute to the excess risk of IS among young AfrAm and our study emphasizes early screening for vascular risk factors in this subgroup.

scholarly journals Patterns and co-occurrence of risk factors for hepatocellular carcinoma in four Asian American communities: a cross-sectional study

BMJ Open ◽  
2019 ◽  
Vol 9 (6) ◽  
pp. e026409 ◽  
Author(s):  
Susan L Stewart ◽  
Julie HT Dang ◽  
Natalie J Török ◽  
Moon S Chen
Keyword(s):  
Risk Factors ◽  
Hepatocellular Carcinoma ◽  
Chronic Hepatitis ◽  
Risk Factor ◽  
Secondary Outcome ◽  
Simultaneous Occurrence ◽  
Multiple Risk Factors ◽  
Chronic Hepatitis B Virus ◽  
Multiple Risk ◽  
Hmong Women

ObjectivesTo investigate risk factor patterns and the simultaneous occurrence of multiple risk factors in the viral, metabolic and lifestyle domains among Asian Americans, who have had the highest mortality rates from hepatocellular carcinoma (HCC).SettingSacramento County, California, USA.ParticipantsEligible participants were county residents ages 18 and older who had not been screened for chronic hepatitis B virus (HBV) and were born in a CDC-defined endemic area or whose parent was born in that area. Of 1004 enrolled, 917 were foreign-born Chinese (130 women, 94 men), Hmong (133 women, 75 men), Korean (178 women, 90 men) or Vietnamese (136 women, 81 men) with complete risk factor data.Primary and secondary outcome measuresWe tested participants for HBV and chronic hepatitis C virus (HCV); measured haemoglobin A1c and waist circumference; and recorded self-reported history of diabetes, hypertension, alcohol use and smoking status. We identified risk factor patterns using cluster analysis and estimated gender-specific age-standardised prevalence rates.ResultsWe identified four patterns: (1) viral (chronic HBV or HCV); (2) lifestyle (current smoker or alcohol user, no viral); (3) metabolic (≥2 metabolic, no lifestyle or viral); and (4) lower risk (≤1 metabolic, no lifestyle or viral). Vietnamese men (16.3%, 95% CI 7.4% to 25.3%) and Hmong women (15.1%, 95% CI 7.8% to 22.5%) had the highest viral pattern prevalence. Hmong women had the highest metabolic (37.8%, 95% CI 29.8% to 45.9%), and Vietnamese men the highest lifestyle (70.4%, 95% CI 59.1% to 81.7%) pattern prevalence. In multiple domains, Hmong men and women were most likely to have viral+metabolic risk factors (men: 14.4%, 95% CI 6.0% to 22.7%; women: 11.9%, 95% CI 5.6% to 18.3%); Vietnamese men were most likely to have lifestyle+viral (10.7%, 95% CI 2.7% to 18.8%), and lifestyle+metabolic but not viral (46.4%, 95% CI 34.4% to 58.5%) risk factors.ConclusionsEfforts to reduce HCC must comprehensively address multiple risk factors.Trial registration numberNCT02596438.

scholarly journals Increasing prevalence of vascular risk factors in patients with stroke

Neurology ◽  
2017 ◽  
Vol 89 (19) ◽  
pp. 1985-1994 ◽  
Author(s):  
Fadar Oliver Otite ◽  
Nicholas Liaw ◽  
Priyank Khandelwal ◽  
Amer M. Malik ◽  
Jose G. Romano ◽  
...  
Keyword(s):  
Risk Factors ◽  
Risk Factor ◽  
Drug Abuse ◽  
Carotid Stenosis ◽  
The United States ◽  
Joinpoint Regression ◽  
Risk Factor Modification ◽  
Multiple Risk Factors ◽  
Multiple Risk ◽  
Over Time

Objective:To evaluate trends in prevalence of cardiovascular risk factors (hypertension, diabetes, dyslipidemia, smoking, and drug abuse) and cardiovascular diseases (carotid stenosis, chronic renal failure [CRF], and coronary artery disease [CAD]) in acute ischemic stroke (AIS) in the United States.Methods:We used the 2004–2014 National Inpatient Sample to compute weighted prevalence of each risk factor in hospitalized patients with AIS and used joinpoint regression to evaluate change in prevalence over time.Results:Across the 2004–2014 period, 92.5% of patients with AIS had ≥1 risk factor. Overall age- and sex-adjusted prevalence of hypertension, diabetes, dyslipidemia, smoking, and drug abuse were 79%, 34%, 47%, 15%, and 2%, respectively, while those of carotid stenosis, CRF, and CAD were 13%, 12%, and 27%, respectively. Risk factor prevalence varied by age (hypertension: 44% in 18–39 years vs 82% in 60–79 years), race (diabetes: Hispanic 49% vs white 30%), and sex (drug abuse: men 3% vs women 1.4%). Using joinpoint regression, prevalence of hypertension increased annually by 1.4%, diabetes by 2%, dyslipidemia by 7%, smoking by 5%, and drug abuse by 7%. Prevalence of CRF, carotid stenosis, and CAD increased annually by 13%, 6%, and 1%, respectively. Proportion of patients with multiple risk factors also increased over time.Conclusions:Despite numerous guidelines and prevention initiatives, prevalence of hypertension, diabetes, dyslipidemia, smoking, and drug abuse in AIS increased across the 2004–2014 period. Proportion of patients with carotid stenosis, CRF, and multiple risk factors also increased. Enhanced risk factor modification strategies and implementation of evidence-based recommendations are needed for optimal stroke prevention.

scholarly journals Effect of various cardiovascular risk factors on oxidative stress markers in post menopausal women

2017 ◽  
Vol 6 (7) ◽  
pp. 1768
Author(s):  
Subrat Kumar Tripathy ◽  
Pramila Kumari Mishra
Keyword(s):  
Oxidative Stress ◽  
Risk Factors ◽  
Risk Factor ◽  
Cardiovascular Risk ◽  
Vitamin E ◽  
Cardiovascular Risk Factors ◽  
Multiple Risk Factors ◽  
Single Risk Factor ◽  
Multiple Risk ◽  
Post Menopausal

Background: The objectives was to study the association between oxidative stress and various cardiovascular risk factors individually and also there cumulative effect in post-menopausal women.Methods: 50 postmenopausal women with cardiovascular risk factors like hyperglycemia, hypertension, high Body Mass Index and Hyperlipidaemia were selected and burden of various cardiovascular risk factors in them is noted and also compared with 50 age matched apparently healthy post menopausal controls. Malon-di-aldehyde (MDA), vitaminE and vitamin C were taken to assess oxidative stress status. ANOVA was applied to find the effect of individual risk factor on oxidative stress and Student’s t-test was applied to compare between cases with single risk factors and multiple risk factors.Results: It was found that though all cardiovascular risk factors increase oxidative stress significantly but none of them has significant association in comparison to others (F value 0.37, 0.88 and 0.62 for MDA, vitamin E and C respectively). However, MDA value found in cases with multiple risk factors when compared with that of cases with single risk factor was found to be statistically significant (P <0.001). Similarly, the decrease in vitamin E in cases with multiple risk factors when compared with single risk factor cases was found to be significant. (P <0.01) and vitamin C in women with multiple risk factors was decreased in comparison to women with a single risk factor and was significant (P <0.001).Conclusions: The study shows that all the risk factors are equally responsible for increase in oxidative stress and multiple risk factors increase the oxidative stress significantly in comparison to any single risk factor.

scholarly journals Treatment Challenges in Pediatric Stroke Patients

2011 ◽  
Vol 2011 ◽  
pp. 1-9
Author(s):  
A. Yılmaz ◽  
S. Teber ◽  
Ö. Bektaş ◽  
N. Akar ◽  
L. Z. Uysal ◽  
...  
Keyword(s):  
Risk Factors ◽  
Risk Factor ◽  
Prophylactic Treatment ◽  
Statistical Correlation ◽  
Arterial Ischemic Stroke ◽  
Multiple Risk Factors ◽  
Sinovenous Thrombosis ◽  
Effect Of Treatment ◽  
Multiple Risk ◽  
The Right

Aim. In this study we presented our experience of 18 years on the etiology, risk factors, prophylactic and acute treatment, the effect of treatment to recurrence rate of patients with stroke.Methods. The population included 108 patients who had been treated for stroke at Pediatric Neurology Department of Ankara University with the diagnosis of arterial ischemic stroke and sinovenous thrombosis between January 1992 and August 2010. Forty-one girls (38%) and 67 boys (62%) with mean symptom age years, (0–18 years old) were followed up with a mean period of years (0–17 years).Results. 30 patients had no risk factors, 34 patients had only one risk factor and 44 patients had multiple risk factors. Recurrence was seen in three patients. There was no any statistical correlation between the recurrence of stroke and the existence of risk factors (). Seventeen patients received prophylactic treatment; 2 of them without any risk factors, 3 had one risk factor, 12 patients, who constituted the majority of our patients, had multiple risk factors ().Conclusion. With this study we showed that the right prophylaxis for right patients reduces the rate of recurrence.

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