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Ikesu R, Wu Y, Zimmerman SC, Inoue K, Buto P, Power MC, Schaefer CA, Glymour MM, Mayeda ER. Representativeness of Participants in the ACCORD Trial Compared to Middle-aged and Older Adults Living with Diabetes in the United States. Epidemiology 2024; 35:432-436. [PMID: 38771709 PMCID: PMC11196194 DOI: 10.1097/ede.0000000000001746] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/23/2024]
Abstract
BACKGROUND We evaluated whether participants in the landmark Action to Control Cardiovascular Risk in Diabetes (ACCORD) trial represent US adults aged ≥40 with diabetes. METHODS Using the nationally representative 2017-2020 prepandemic National Health and Nutrition Examination Survey data, we made operational definitions of ACCORD eligibility criteria. We calculated the percentage of individuals aged ≥40 with diabetes and HbA1c ≥ 6.0% or ≥ 7.5% who met operational ACCORD eligibility criteria. RESULTS Applying survey sampling weights to 715 National Health and Nutrition Examination Survey participants aged ≥40 with diabetes and HbA1c ≥ 6.0% (representing 29,717,406 individuals), 12% (95% confidence interval [CI] = 8%, 18%) met the operational ACCORD eligibility criteria. Restricting to HbA1c ≥ 7.5%, 39% (95% CI = 28%, 51%) of respondents met the operational ACCORD eligibility criteria. CONCLUSIONS ACCORD represented a minority of US middle-aged and older adults with diabetes. Given the differential risk profile between ACCORD participants and the general population with diabetes, extrapolating the trial findings may not be appropriate.
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Affiliation(s)
- Ryo Ikesu
- Department of Epidemiology, Fielding School of Public Health, University of California, Los Angeles (UCLA), Los Angeles, CA, USA
- Division of General Internal Medicine and Health Services Research, David Geffen School of Medicine at UCLA, Los Angeles, CA, USA
| | - Yingyan Wu
- Department of Epidemiology, Fielding School of Public Health, University of California, Los Angeles (UCLA), Los Angeles, CA, USA
| | - Scott C. Zimmerman
- Department of Epidemiology and Biostatistics, University of California, San Francisco, CA, USA
| | - Kosuke Inoue
- Department of Social Epidemiology, Graduate School of Medicine, Kyoto University, Kyoto, Japan
| | - Peter Buto
- Department of Epidemiology, Boston University School of Public Health, Boston, MA, USA
| | - Melinda C. Power
- Department of Epidemiology, Milken Institute School of Public Health, George Washington University, Washington, DC., USA
| | | | - M. Maria Glymour
- Department of Epidemiology, Boston University School of Public Health, Boston, MA, USA
| | - Elizabeth Rose Mayeda
- Department of Epidemiology, Fielding School of Public Health, University of California, Los Angeles (UCLA), Los Angeles, CA, USA
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Cao Z, Cho Y, Li F. Transporting randomized trial results to estimate counterfactual survival functions in target populations. Pharm Stat 2024; 23:442-465. [PMID: 38233102 DOI: 10.1002/pst.2354] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2023] [Revised: 08/27/2023] [Accepted: 11/30/2023] [Indexed: 01/19/2024]
Abstract
When the distributions of treatment effect modifiers differ between a randomized trial and an external target population, the sample average treatment effect in the trial may be substantially different from the target population average treatment, and accurate estimation of the latter requires adjusting for the differential distribution of effect modifiers. Despite the increasingly rich literature on transportability, little attention has been devoted to methods for transporting trial results to estimate counterfactual survival functions in target populations, when the primary outcome is time to event and subject to right censoring. In this article, we study inverse probability weighting and doubly robust estimators to estimate counterfactual survival functions and the target average survival treatment effect in the target population, and provide their respective approximate variance estimators. We focus on a common scenario where the target population information is observed only through a complex survey, and elucidate how the survey weights can be incorporated into each estimator we considered. Simulation studies are conducted to examine the finite-sample performances of the proposed estimators in terms of bias, efficiency and coverage, under both correct and incorrect model specifications. Finally, we apply the proposed method to assess transportability of the results in the Action to Control Cardiovascular Risk in Diabetes-Blood Pressure (ACCORD-BP) trial to all adults with Diabetes in the United States.
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Affiliation(s)
- Zhiqiang Cao
- Department of Mathematics, College of Big Data and Internet, Shenzhen Technology University, Shenzhen, People's Republic of China
| | - Youngjoo Cho
- Department of Applied Statistics, Konkuk University, Seoul, Republic of Korea
| | - Fan Li
- Department of Biostatistics, Yale University School of Public Health, New Haven, Connecticut, USA
- Center for Methods in Implementation and Prevention Science, Yale University School of Public Health, New Haven, Connecticut, USA
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3
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Rysavy MA, Eggleston B, Dahabreh IJ, Tyson JE, Patel RM, Watterberg KL, Greenberg RG, Pedroza C, Trotta M, Stevenson DK, Stoll BJ, Lally KP, Das A, Blakely ML. Generalizability of the Necrotizing Enterocolitis Surgery Trial to the Target Population of Eligible Infants. J Pediatr 2023; 262:113453. [PMID: 37169336 PMCID: PMC10632546 DOI: 10.1016/j.jpeds.2023.113453] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/19/2022] [Revised: 03/25/2023] [Accepted: 04/21/2023] [Indexed: 05/13/2023]
Abstract
OBJECTIVE The objective of this study was to evaluate whether infants randomized in the Eunice Kennedy Shriver National Institute of Child Health and Human Development Neonatal Research Network Necrotizing Enterocolitis Surgery Trial differed from eligible infants and whether differences affected the generalizability of trial results. STUDY DESIGN Secondary analysis of infants enrolled in Necrotizing Enterocolitis Surgery Trial (born 2010-2017, with follow-up through 2019) at 20 US academic medical centers and an observational data set of eligible infants through 2013. Infants born ≤1000 g and diagnosed with necrotizing enterocolitis or spontaneous intestinal perforation requiring surgical intervention at ≤8 weeks were eligible. The target population included trial-eligible infants (randomized and nonrandomized) born during the first half of the study with available detailed preoperative data. Using model-based weighting methods, we estimated the effect of initial laparotomy vs peritoneal drain had the target population been randomized. RESULTS The trial included 308 randomized infants. The target population included 382 (156 randomized and 226 eligible, non-randomized) infants. Compared with the target population, fewer randomized infants had necrotizing enterocolitis (31% vs 47%) or died before discharge (27% vs 41%). However, incidence of the primary composite outcome, death or neurodevelopmental impairment, was similar (69% vs 72%). Effect estimates for initial laparotomy vs drain weighted to the target population were largely unchanged from the original trial after accounting for preoperative diagnosis of necrotizing enterocolitis (adjusted relative risk [95% CI]: 0.85 [0.71-1.03] in target population vs 0.81 [0.64-1.04] in trial) or spontaneous intestinal perforation (1.02 [0.79-1.30] vs 1.11 [0.95-1.31]). CONCLUSION Despite differences between randomized and eligible infants, estimated treatment effects in the trial and target population were similar, supporting the generalizability of trial results. TRIAL REGISTRATION ClinicalTrials.gov ID: NCT01029353.
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Affiliation(s)
- Matthew A Rysavy
- McGovern Medical School at McGovern Medical School at UTHealth Houston, Houston, TX; Children's Memorial Hermann Hospital, Houston, TX.
| | | | - Issa J Dahabreh
- CAUSALab, Department of Epidemiology and Department of Biostatistics, Harvard T.H. Chan School of Public Health, Boston, MA
| | - Jon E Tyson
- McGovern Medical School at McGovern Medical School at UTHealth Houston, Houston, TX
| | - Ravi M Patel
- Emory University School of Medicine, Atlanta, GA
| | | | | | - Claudia Pedroza
- McGovern Medical School at McGovern Medical School at UTHealth Houston, Houston, TX
| | | | | | - Barbara J Stoll
- McGovern Medical School at McGovern Medical School at UTHealth Houston, Houston, TX; Emory University School of Medicine, Atlanta, GA
| | - Kevin P Lally
- McGovern Medical School at McGovern Medical School at UTHealth Houston, Houston, TX; Children's Memorial Hermann Hospital, Houston, TX
| | | | - Martin L Blakely
- McGovern Medical School at McGovern Medical School at UTHealth Houston, Houston, TX; Vanderbilt University Medical Center, Nashville, TN
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Shahim B, Cohen DJ. Transporting Results of TAVR Trials to the Real World: A Long and Winding Road. JACC Cardiovasc Interv 2021; 14:2124-2126. [PMID: 34620390 DOI: 10.1016/j.jcin.2021.08.029] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/10/2021] [Accepted: 08/10/2021] [Indexed: 10/20/2022]
Affiliation(s)
- Bahira Shahim
- Cardiovascular Research Foundation, New York, New York, USA; Division of Cardiology, Department of Medicine, Karolinska University Hospital, Stockholm, Sweden
| | - David J Cohen
- Cardiovascular Research Foundation, New York, New York, USA; Department of Cardiology, St. Francis Hospital, Roslyn, New York, USA.
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Butala NM, Secemsky E, Kazi DS, Song Y, Strom JB, Faridi KF, Brennan JM, Elmariah S, Shen C, Yeh RW. Applicability of Transcatheter Aortic Valve Replacement Trials to Real-World Clinical Practice: Findings From EXTEND-CoreValve. JACC Cardiovasc Interv 2021; 14:2112-2123. [PMID: 34620389 DOI: 10.1016/j.jcin.2021.08.006] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/21/2020] [Revised: 07/28/2021] [Accepted: 08/03/2021] [Indexed: 01/15/2023]
Abstract
OBJECTIVES The aim of this study was to examine the applicability of pivotal transcatheter aortic valve replacement (TAVR) trials to the real-world population of Medicare patients undergoing TAVR. BACKGROUND It is unclear whether randomized controlled trial results of novel cardiovascular devices apply to patients encountered in clinical practice. METHODS Characteristics of patients enrolled in the U.S. CoreValve pivotal trials were compared with those of the population of Medicare beneficiaries who underwent TAVR in U.S. clinical practice between November 2, 2011, and December 31, 2017. Inverse probability weighting was used to reweight the trial cohort on the basis of Medicare patient characteristics, and a "real-world" treatment effect was estimated. RESULTS A total of 2,026 patients underwent TAVR in the U.S. CoreValve pivotal trials, and 135,112 patients underwent TAVR in the Medicare cohort. Trial patients were mostly similar to real-world patients at baseline, though trial patients were more likely to have hypertension (50% vs 39%) and coagulopathy (25% vs 17%), whereas real-world patients were more likely to have congestive heart failure (75% vs 68%) and frailty. The estimated real-world treatment effect of TAVR was an 11.4% absolute reduction in death or stroke (95% CI: 7.50%-14.92%) and an 8.7% absolute reduction in death (95% CI: 5.20%-12.32%) at 1 year with TAVR compared with conventional therapy (surgical aortic valve replacement for intermediate- and high-risk patients and medical therapy for extreme-risk patients). CONCLUSIONS The trial and real-world populations were mostly similar, with some notable differences. Nevertheless, the extrapolated real-world treatment effect was at least as high as the observed trial treatment effect, suggesting that the absolute benefit of TAVR in clinical trials is similar to the benefit of TAVR in the U.S. real-world setting.
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Affiliation(s)
- Neel M Butala
- Richard A. and Susan F. Smith Center for Outcomes Research in Cardiology, Division of Cardiovascular Medicine, Beth Israel Deaconess Medical Center, Boston, Massachusetts, USA; Cardiology Division, Department of Medicine, Massachusetts General Hospital, Boston, Massachusetts, USA
| | - Eric Secemsky
- Richard A. and Susan F. Smith Center for Outcomes Research in Cardiology, Division of Cardiovascular Medicine, Beth Israel Deaconess Medical Center, Boston, Massachusetts, USA
| | - Dhruv S Kazi
- Richard A. and Susan F. Smith Center for Outcomes Research in Cardiology, Division of Cardiovascular Medicine, Beth Israel Deaconess Medical Center, Boston, Massachusetts, USA
| | - Yang Song
- Baim Institute for Clinical Research, Boston, Massachusetts, USA
| | - Jordan B Strom
- Richard A. and Susan F. Smith Center for Outcomes Research in Cardiology, Division of Cardiovascular Medicine, Beth Israel Deaconess Medical Center, Boston, Massachusetts, USA
| | - Kamil F Faridi
- Section of Cardiology, Department of Medicine, Yale School of Medicine, New Haven, Connecticut, USA
| | - J Matthew Brennan
- Duke Clinical Research Institute, Duke University School of Medicine, Durham, North Carolina, USA
| | - Sammy Elmariah
- Cardiology Division, Department of Medicine, Massachusetts General Hospital, Boston, Massachusetts, USA
| | - Changyu Shen
- Richard A. and Susan F. Smith Center for Outcomes Research in Cardiology, Division of Cardiovascular Medicine, Beth Israel Deaconess Medical Center, Boston, Massachusetts, USA
| | - Robert W Yeh
- Richard A. and Susan F. Smith Center for Outcomes Research in Cardiology, Division of Cardiovascular Medicine, Beth Israel Deaconess Medical Center, Boston, Massachusetts, USA.
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Josey KP, Berkowitz SA, Ghosh D, Raghavan S. Transporting experimental results with entropy balancing. Stat Med 2021; 40:4310-4326. [PMID: 34018204 PMCID: PMC8487904 DOI: 10.1002/sim.9031] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2020] [Revised: 04/02/2021] [Accepted: 04/25/2021] [Indexed: 11/11/2022]
Abstract
We show how entropy balancing can be used for transporting experimental treatment effects from a trial population onto a target population. This method is doubly robust in the sense that if either the outcome model or the probability of trial participation is correctly specified, then the estimate of the target population average treatment effect is consistent. Furthermore, we only require the sample moments of the effect modifiers drawn from the target population to consistently estimate the target population average treatment effect. We compared the finite-sample performance of entropy balancing with several alternative methods for transporting treatment effects between populations. Entropy balancing techniques are efficient and robust to violations of model misspecification. We also examine the results of our proposed method in an applied analysis of the Action to Control Cardiovascular Risk in Diabetes Blood Pressure trial transported to a sample of US adults with diabetes taken from the National Health and Nutrition Examination Survey cohort.
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Affiliation(s)
- Kevin P. Josey
- Department of Biostatistics and Informatics, Colorado School of Public Health, University of Colorado Anschutz Medical Campus, Colorado, USA
| | - Seth A. Berkowitz
- Division of General Medicine and Clinical Epidemiology, University of North Carolina at Chapel Hill School of Medicine, North Carolina, USA
| | - Debashis Ghosh
- Department of Biostatistics and Informatics, Colorado School of Public Health, University of Colorado Anschutz Medical Campus, Colorado, USA
| | - Sridharan Raghavan
- Rocky Mountain Regional VA Medical Center, Colorado, USA
- Division of Hospital Medicine, University of Colorado School of Medicine, Colorado, USA
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Richards M, Weigel M, Li M, Rosenberg M, Ludema C. Household food insecurity and antepartum depression in the National Children's Study. Ann Epidemiol 2020; 44:38-44.e1. [PMID: 32220512 DOI: 10.1016/j.annepidem.2020.01.010] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2019] [Revised: 01/06/2020] [Accepted: 01/20/2020] [Indexed: 12/15/2022]
Abstract
PURPOSE The purpose of this study was to determine the association between household food insecurity (HFI) and elevated antepartum depressive symptoms (EADS) in the National Children's Study, 2009-2014, as well as standardize our results to the U.S. pregnant population. METHODS HFI was collected at participants' baseline visits using the U.S. Household Food Security Survey Module; antepartum depression symptoms were collected twice during pregnancy using the Center for Epidemiologic Study Depression scale. Generalized estimating equations for binary outcomes were used to estimate the association between HFI and EADS. Inverse probability weighting was used to generalize the effect to the U.S. population using the National Health and Nutrition Examination Survey. RESULTS Among 746 participants, 20.6% were food insecure. Women who were food insecure were 3.39 times (95% confidence interval: 1.73, 6.62) as likely to report EADS compared with women who were food secure. This estimate was marginally strengthened in a weighted analysis (odds ratio: 3.68; 95% confidence interval: 1.43, 9.43). CONCLUSIONS This study suggests that women who are food insecure are at a greater risk of EADS, and HFI should be evaluated when assessing antepartum depression.
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Affiliation(s)
- Megan Richards
- Department of Epidemiology and Biostatistics, School of Public Health, Indiana University, Bloomington.
| | - Margaret Weigel
- Department of Environmental Health, School of Public Health, Indiana University, Bloomington
| | - Ming Li
- Department of Epidemiology and Biostatistics, School of Public Health, Indiana University, Bloomington
| | - Molly Rosenberg
- Department of Epidemiology and Biostatistics, School of Public Health, Indiana University, Bloomington
| | - Christina Ludema
- Department of Epidemiology and Biostatistics, School of Public Health, Indiana University, Bloomington
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Bakris GL, Polonsky TS. Presence of Diabetes Does Not Mandate Lower Blood Pressure to Reduce Cardiovascular Events. J Am Coll Cardiol 2018; 72:1224-1226. [PMID: 30189999 DOI: 10.1016/j.jacc.2018.07.016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/10/2018] [Accepted: 07/16/2018] [Indexed: 11/29/2022]
Affiliation(s)
- George L Bakris
- Comprehensive Hypertension Center, Section of Endocrinology, Diabetes and Metabolism, Department of Medicine, University of Chicago Medicine, Chicago, Illinois.
| | - Tamar S Polonsky
- Section of Cardiology, Department of Medicine, University of Chicago Medicine, Chicago, Illinois
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