Faculty Opinions recommendation of Bias in relative odds estimation owing to imprecise measurement of correlated exposures.

Introduction: Previous meta-analyses have reported reduced cardiovascular mortality and myocardial infarction in intravascular ultrasound-guided (IVUS) stent implantation in comparison to angiography-only approach. However, these studies have unanimously excluded patients with unprotected left-main coronary artery (LMCA) disease, questioning its widespread applicability. We performed a systematic review and meta-analysis to investigate the prognostic significance of IVUS-guided LMCA intervention. Methods: Studies comparing clinical outcomes between IVUS-guided and angiography-only percutaneous LMCA intervention were identified through PubMed, Cochrane and EMBASE databases until June, 2020. Data was analyzed using a random effect model to calculate the relative odds of all-cause death, cardiac death, left-main revascularization, myocardial infarction, stent thrombosis and stroke. Results: A total of 13 studies comprising 7680 patients were included. The odds of all-cause death (OR 0.6, 95%CI 0.47-0.78; p<0.0001), cardiac death (OR 0.37, 95%CI 0.26-0.54; p<0.00001), left-main revascularization (OR 0.63, 95%CI 0.45-0.89; p=0.009) and myocardial infarction (OR 0.77 [95%CI 0.60-0.98; p=0.04]) were significantly lower in patients who underwent IVUS-guided LMCA stent implantation compared to angiography-only approach. There was no significant difference observed in the relative odds of stent thrombosis (OR 0.57, 95%CI 0.31-1.05; p=0.07) and stroke (OR 1.7, 95%CI 0.56-5.14; p=0.35) between the two arms at least 1-year of the index procedure. A subgroup analysis based on study design and sensitivity analysis based on the characteristics of the included studies mirrored the pooled results. Conclusion: IVUS-guided LMCA intervention is associated with overall improved cardiovascular outcomes than angiography-only approach. Large scale randomized controlled trials are needed to validate our findings.

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Plasma homocyst(e)ine as a risk factor for early familial coronary artery disease

Clinical Chemistry ◽

10.1093/clinchem/40.4.552 ◽

1994 ◽

Vol 40 (4) ◽

pp. 552-561 ◽

Cited By ~ 103

Author(s):

L L Wu ◽

J Wu ◽

S C Hunt ◽

B C James ◽

G M Vincent ◽

...

Keyword(s):

Coronary Artery Disease ◽

Coronary Artery ◽

Low Density Lipoprotein ◽

Density Lipoprotein ◽

Coronary Risk Factors ◽

Low Density Lipoprotein Cholesterol ◽

Relative Odds ◽

The Mean ◽

High Concentrations ◽

Artery Disease

Abstract We measured plasma homocyst(e)ine [H(e)] and other coronary risk factors in 266 patients with early coronary artery disease from 170 families in which two or more siblings were affected and in 168 unmatched controls. The mean H(e) concentration adjusted for significant correlates (serum creatinine, uric acid, and low-density lipoprotein cholesterol) was 12.0 mumol/L in proband cases compared with 10.1 mumol/L in controls (P = 0.0001). Many (17.6%) of the proband cases had H(e) concentrations exceeding the 95th percentile for the controls (relative odds = 4.9, P < 0.001). H(e) among cases was bimodally distributed even after adjustment for concentrations of plasma vitamins. Concordant high H(e) was seen in at least 10 (12%) of 85 families with two or more affected siblings. We conclude that a substantial proportion of early familial coronary artery disease is probably related to production of high concentrations of H(e) by one or more major genes.

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How Independent Are “Independent” Effects? Relative Risk Estimation When Correlated Exposures Are Measured Imprecisely

International Journal of Epidemiology ◽

10.1093/ije/dyz011 ◽

2019 ◽

Vol 48 (5) ◽

pp. 1398-1406

Author(s):

Andrew N Phillips ◽

George Davey Smith

Keyword(s):

Relative Risk ◽

Risk Estimation ◽

Independent Effects ◽

Correlated Exposures

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The Role of Individual and Small-Area Social and Environmental Factors on Heat Vulnerability to Mortality Within and Outside of the Home in Boston, MA

Climate ◽

10.3390/cli8020029 ◽

2020 ◽

Vol 8 (2) ◽

pp. 29 ◽

Cited By ~ 1

Author(s):

Augusta Williams ◽

Joseph Allen ◽

Paul Catalano ◽

John Spengler

Keyword(s):

Climate Change ◽

Environmental Factors ◽

Limited English Proficiency ◽

Small Area ◽

Warm Season ◽

Heat Index ◽

Relative Odds ◽

Mitigation And Adaptation ◽

Hot Days ◽

At Home

Climate change is resulting in heatwaves that are more frequent, severe, and longer lasting, which is projected to double-to-triple the heat-related mortality in Boston, MA if adequate climate change mitigation and adaptation strategies are not implemented. A case-only analysis was used to examine subject and small-area neighborhood characteristics that modified the association between hot days and mortality. Deaths of Boston, Massachusetts residents that occurred from 2000–2015 were analyzed in relation to the daily temperature and heat index during the warm season as part of the case-only analysis. The modification by small-area (census tract, CT) social, and environmental (natural and built) factors was assessed. At-home mortality on hot days was driven by both social and environmental factors, differentially across the City of Boston census tracts, with a greater proportion of low-to-no income individuals or those with limited English proficiency being more highly represented among those who died during the study period; but small-area built environment features, like street trees and enhanced energy efficiency, were able to reduce the relative odds of death within and outside the home. At temperatures below current local thresholds used for heat warnings and advisories, there was increased relative odds of death from substance abuse and assault-related altercations. Geographic weighted regression analyses were used to examine these relationships spatially within a subset of at-home deaths with high-resolution temperature and humidity data. This revealed spatially heterogeneous associations between at-home mortality and social and environmental vulnerability factors.

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Cystic fibrosis carriers are at increased risk for a wide range of cystic fibrosis-related conditions

Proceedings of the National Academy of Sciences ◽

10.1073/pnas.1914912117 ◽

2019 ◽

Vol 117 (3) ◽

pp. 1621-1627 ◽

Cited By ~ 13

Author(s):

Aaron C. Miller ◽

Alejandro P. Comellas ◽

Douglas B. Hornick ◽

David A. Stoltz ◽

Joseph E. Cavanaugh ◽

...

Keyword(s):

Cystic Fibrosis ◽

Failure To Thrive ◽

Population Level ◽

Population Based ◽

Carrier State ◽

Individual Level ◽

Relative Odds ◽

Increased Risk ◽

Wide Range ◽

Autosomal Recessive Diseases

Autosomal recessive diseases, such as cystic fibrosis (CF), require inheritance of 2 mutated genes. However, some studies indicate that CF carriers are at increased risk for some conditions associated with CF. These investigations focused on single conditions and included small numbers of subjects. Our goal was to determine whether CF carriers are at increased risk for a range of CF-related conditions. Using the Truven Health MarketScan Commercial Claims database (2001–2017), we performed a population-based retrospective matched-cohort study. We identified 19,802 CF carriers and matched each carrier with 5 controls. The prevalence of 59 CF-related diagnostic conditions was evaluated in each cohort. Odds ratios for each condition were computed for CF carriers relative to controls. All 59 CF-related conditions were more prevalent among carriers compared with controls, with significantly increased risk (P < 0.05) for 57 conditions. Risk was increased for some conditions previously linked to CF carriers (e.g., pancreatitis, male infertility, bronchiectasis), as well as some conditions not previously reported (e.g., diabetes, constipation, cholelithiasis, short stature, failure to thrive). We compared our results with 23,557 subjects with CF, who were also matched with controls; as the relative odds of a given condition increased among subjects with CF, so did the corresponding relative odds for carriers (P < 0.001). Although individual-level risk remained low for most conditions, because there are more than 10 million carriers in the US, population-level morbidity attributable to the CF carrier state is likely substantial. Genetic testing may inform prevention, diagnosis, and treatment for a broad range of CF carrier-related conditions.

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A Latent Variable Approach to Study Gene-Environment Interactions in the Presence of Multiple Correlated Exposures

Biometrics ◽

10.1111/j.1541-0420.2011.01677.x ◽

2011 ◽

Vol 68 (2) ◽

pp. 466-476 ◽

Cited By ~ 5

Author(s):

Brisa N. Sánchez ◽

Shan Kang ◽

Bhramar Mukherjee

Keyword(s):

Latent Variable ◽

Variable Approach ◽

Gene Environment ◽

Correlated Exposures ◽

Latent Variable Approach

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Filters on the pathway to mental health care, II. Sociodemographic factors

Psychological Medicine ◽

10.1017/s0033291700033122 ◽

1995 ◽

Vol 25 (6) ◽

pp. 1149-1160 ◽

Cited By ~ 119

Author(s):

J. J. Gallo ◽

S. Marino ◽

D. Ford ◽

J. C. Anthony

Keyword(s):

Mental Health ◽

Health Care ◽

Mental Health Services ◽

Health Services ◽

Psychiatric Disorder ◽

The United States ◽

Sociodemographic Characteristics ◽

Health Services Use ◽

Relative Odds ◽

Services Use

SynopsisThis study uses the prospectively gathered data of the Epidemiologic Catchment Area Program, a multi-site interview survey of mental disturbances among adult household residents in the United States, to compare health services use by individuals with different sociodemographic characteristics, accounting for the first-time occurrence of psychiatric disorder, over the course of a 1-year follow-up interval. Case ascertainment was by means of a standardized interview method, the Diagnostic Interview Schedule. In the present investigation, 13400 continuing participants in the household sample who reported no contact with mental health services in the 6 months prior to the initial interview were studied with regard to health services use and sociodemographic characteristics. Separately, and before the mental health assessments were made, respondents were asked about their use of health and mental health services. African-Americans were significantly less likely than whites to have consulted with a specialist in mental health (estimated relative odds, 0·22, 95% confidence interval 0·10 to 0·52), even accounting for coincident psychiatric disorder, gender, and other covariates known to be associated with differential use of health care services. Hispanics and other minorities were also less likely to have consulted a specialist in mental health (estimated relative odds, 0·37 and 0·26, respectively). This large community study extends previous work on mental health services and ethnicity.

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