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Korsgaard S, Munch T, Horváth-Puhó E, Adelborg K, Christiansen CF, Pedersen L, Schmidt M, Sørensen HT. Preadmission Opioid Use and 1-Year Mortality Following Incident Myocardial Infarction: A Danish Population-Based Cohort Study (1997-2016). J Am Heart Assoc 2023; 12:e026251. [PMID: 36892067 PMCID: PMC10111518 DOI: 10.1161/jaha.122.026251] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 03/10/2023]
Abstract
Background Opioid use has been linked to an increased risk of myocardial infarction and cardiovascular mortality, but the prognostic impact of opioid use before an incident myocardial infarction is largely unknown. Methods and Results We conducted a nationwide population-based cohort study including all patients hospitalized for an incident myocardial infarction in Denmark (1997-2016). Based on their last redeemed opioid prescription before admission, patients were categorized as current users (0-30 days), recent users (31-365 days), former users (>365 days), and nonusers. One-year all-cause mortality was calculated using the Kaplan-Meier method. Hazard ratios (HRs) were computed using Cox proportional hazards regression analyses, adjusting for age, sex, comorbidity, any preceding surgery within 6 months before the myocardial infarction admission, and medication use before the myocardial infarction admission. We identified 162 861 patients with an incident myocardial infarction. Of these, 8% were current opioid users, 10% were recent opioid users, 24% were former opioid users, and 58% were nonusers of opioids. One-year mortality was highest among current users (42.5% [95% CI, 41.7%-43.3%]) and lowest among nonusers (20.5% [95% CI, 20.2%-20.7%]). Compared with nonusers, current users had an elevated 1-year all-cause mortality risk (adjusted HR, 1.26 [95% CI, 1.22-1.30]). Following adjustment, neither recent users nor former users of opioids were at elevated risk. Conclusions Preadmission opioid use was associated with an increased 1-year all-cause mortality risk following an incident myocardial infarction. Opioid users thus represent a high-risk subgroup of patients with myocardial infarction.
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Affiliation(s)
- Søren Korsgaard
- Department of Clinical Epidemiology Aarhus University Hospital Aarhus Denmark
- Department of Clinical Medicine Aarhus University Aarhus Denmark
| | - Troels Munch
- Department of Clinical Epidemiology Aarhus University Hospital Aarhus Denmark
- Department of Clinical Medicine Aarhus University Aarhus Denmark
| | - Erzsébet Horváth-Puhó
- Department of Clinical Epidemiology Aarhus University Hospital Aarhus Denmark
- Department of Clinical Medicine Aarhus University Aarhus Denmark
| | - Kasper Adelborg
- Department of Clinical Epidemiology Aarhus University Hospital Aarhus Denmark
- Department of Clinical Medicine Aarhus University Aarhus Denmark
- Department of Clinical Biochemistry, Thrombosis and Hemostasis Research Unit Aarhus University Hospital Aarhus Denmark
| | - Christian Fynbo Christiansen
- Department of Clinical Epidemiology Aarhus University Hospital Aarhus Denmark
- Department of Clinical Medicine Aarhus University Aarhus Denmark
| | - Lars Pedersen
- Department of Clinical Epidemiology Aarhus University Hospital Aarhus Denmark
- Department of Clinical Medicine Aarhus University Aarhus Denmark
| | - Morten Schmidt
- Department of Clinical Epidemiology Aarhus University Hospital Aarhus Denmark
- Department of Clinical Medicine Aarhus University Aarhus Denmark
- Department of Cardiology Aarhus University Hospital Aarhus Denmark
| | - Henrik Toft Sørensen
- Department of Clinical Epidemiology Aarhus University Hospital Aarhus Denmark
- Department of Clinical Medicine Aarhus University Aarhus Denmark
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Munch T, Christensen LB, Adelborg K, Tell GS, Apalset EM, Westerlund A, Lagerros YT, Kahlert J, Xue F, Ehrenstein V. Positive predictive values of ICD-10 codes to identify incident acute pancreatitis and incident primary malignancy in the Scandinavian national patient registries among women with postmenopausal osteoporosis. Clin Epidemiol 2017; 9:411-419. [PMID: 28860860 PMCID: PMC5566398 DOI: 10.2147/clep.s139895] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022] Open
Abstract
Background Validation of definitions used to identify conditions of interest is imperative to epidemiologic studies based on routinely collected data. The objective of the study was thus to estimate positive predictive values (PPVs) of International Classification of Diseases, 10th Revision (ICD-10) codes to identify cases of incident acute pancreatitis leading to hospitalization and incident primary malignancy in the Scandinavian (Denmark, Norway, and Sweden) national patient registries in women with postmenopausal osteoporosis (PMO). Methods This validation study included postmenopausal (defined as 55 years or older) women with osteoporosis, identified between 2005–2014. Potential cases were sampled based on ICD-10 codes from the three national patient registries. Cases were adjudicated by physicians, using medical record review as gold standard. PPVs with corresponding 95% CIs were computed. Results Medical records of 286 of 325 (retrieval rate 88%) women with PMO were available for adjudication. Acute pancreatitis leading to hospitalization had a PPV of 87.6% (95% CI: 80.8%–90.2%). Incident primary malignancy had a PPV of 88.1% (95% CI: 81.3%–92.7%). The PPVs did not vary substantially across the three countries. Conclusion ICD-10 codes to identify acute pancreatitis leading to hospitalization, and incident primary malignancy in the Scandinavian national patient registries had high PPVs among women with PMO. This allows identification of cases of acute pancreatitis and incident primary malignancy with reasonable validity and to use these as outcomes in comparative analyses.
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Affiliation(s)
- Troels Munch
- Department of Clinical Epidemiology, Aarhus University Hospital, Aarhus, Denmark
| | - Lotte B Christensen
- Department of Clinical Epidemiology, Aarhus University Hospital, Aarhus, Denmark
| | - Kasper Adelborg
- Department of Clinical Epidemiology, Aarhus University Hospital, Aarhus, Denmark
| | - Grethe S Tell
- Department of Global Public Health and Primary Care, University of Bergen, Bergen, Norway
| | - Ellen M Apalset
- Department of Global Public Health and Primary Care, University of Bergen, Bergen, Norway.,Department of Rheumatology, Bergen Group of Epidemiology and Biomarkers in Rheumatic Disease, Haukeland University Hospital, Bergen, Norway
| | - Anna Westerlund
- Department of Rheumatology, Bergen Group of Epidemiology and Biomarkers in Rheumatic Disease, Haukeland University Hospital, Bergen, Norway.,Department of Medicine Solna, Centre for Pharmacoepidemiology, Karolinska Institutet, Stockholm, Sweden
| | - Ylva T Lagerros
- Department of Medicine Solna, Clinical Epidemiology Unit, Karolinska Institutet, Stockholm, Sweden.,Department of Medicine, Clinic of Endocrinology, Metabolism and Diabetes, Karolinska University Hospital, Sweden
| | - Johnny Kahlert
- Department of Clinical Epidemiology, Aarhus University Hospital, Aarhus, Denmark
| | - Fei Xue
- Center for Observational Research, Amgen Inc., Thousand Oaks, CA, USA
| | - Vera Ehrenstein
- Department of Clinical Epidemiology, Aarhus University Hospital, Aarhus, Denmark
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Adelborg K, Horváth-Puhó E, Schmidt M, Munch T, Pedersen L, Nielsen PH, Bøtker HE, Sørensen HT. Thirty-Year Mortality After Coronary Artery Bypass Graft Surgery: A Danish Nationwide Population-Based Cohort Study. Circ Cardiovasc Qual Outcomes 2017; 10:e002708. [PMID: 28500223 DOI: 10.1161/circoutcomes.116.002708] [Citation(s) in RCA: 54] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/19/2016] [Accepted: 03/29/2017] [Indexed: 11/16/2022]
Abstract
BACKGROUND Data are sparse on long-term mortality after coronary artery bypass graft (CABG) surgery. We examined short-term and long-term mortality of patients undergoing CABG surgery and a general population comparison cohort. METHODS AND RESULTS Linking data from Danish registries, we conducted a nationwide, population-based cohort study on 51 307 CABG patients and 513 070 individuals from the general population matched on age, sex, and calendar year (1980-2009). The mortality risk was higher in patients having isolated CABG surgery than in the general population, particularly during 0 to 30 days (3.2% versus 0.2%), 11 to 20 years (51.1% versus 35.6%), and 21 to 30 years (62.4% versus 44.8%), but not substantially higher during 31 to 364 days (2.9% versus 2.4%) or 1 to 10 years (30.7% versus 25.8%). The 30-day adjusted mortality rate ratio for isolated CABG surgery was 13.51 (95% confidence interval [CI], 12.59-14.49). Between 31 to 364 days and 1 to 10 years, the isolated CABG surgery cohort had a slightly higher mortality rate than the general population comparison cohort, adjusted mortality rate ratios of 1.15 (95% CI, 1.09-1.21) and 1.09 (95% CI, 1.08-1.11), respectively. Between 11 to 20 years and 21 to 30 years, the adjusted mortality rate ratios were 1.62 (95% CI, 1.58-1.66) and 1.76 (95% CI, 1.62-1.91). Within 30 days, CABG patients had a 25-fold, a 26-fold, and a 18-fold higher risk of dying from myocardial infarction, heart failure, or stroke, respectively, than members of the general population comparison cohort. We found substantial heterogeneity in absolute mortality rates according to baseline risk groups. CONCLUSIONS The isolated CABG cohort had a higher mortality rate than the general population comparison cohort, especially within 30 days of and 10 years after surgery.
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Affiliation(s)
- Kasper Adelborg
- From the Department of Clinical Epidemiology (K.A., E.H.-P., M.S., T.M., L.P., H.T.S.), Department of Cardiology (K.A., H.E.B.), and Department of Cardiothoracic Surgery (P.H.N.), Aarhus University Hospital, Skejby, Denmark.
| | - Erzsébet Horváth-Puhó
- From the Department of Clinical Epidemiology (K.A., E.H.-P., M.S., T.M., L.P., H.T.S.), Department of Cardiology (K.A., H.E.B.), and Department of Cardiothoracic Surgery (P.H.N.), Aarhus University Hospital, Skejby, Denmark
| | - Morten Schmidt
- From the Department of Clinical Epidemiology (K.A., E.H.-P., M.S., T.M., L.P., H.T.S.), Department of Cardiology (K.A., H.E.B.), and Department of Cardiothoracic Surgery (P.H.N.), Aarhus University Hospital, Skejby, Denmark
| | - Troels Munch
- From the Department of Clinical Epidemiology (K.A., E.H.-P., M.S., T.M., L.P., H.T.S.), Department of Cardiology (K.A., H.E.B.), and Department of Cardiothoracic Surgery (P.H.N.), Aarhus University Hospital, Skejby, Denmark
| | - Lars Pedersen
- From the Department of Clinical Epidemiology (K.A., E.H.-P., M.S., T.M., L.P., H.T.S.), Department of Cardiology (K.A., H.E.B.), and Department of Cardiothoracic Surgery (P.H.N.), Aarhus University Hospital, Skejby, Denmark
| | - Per Hostrup Nielsen
- From the Department of Clinical Epidemiology (K.A., E.H.-P., M.S., T.M., L.P., H.T.S.), Department of Cardiology (K.A., H.E.B.), and Department of Cardiothoracic Surgery (P.H.N.), Aarhus University Hospital, Skejby, Denmark
| | - Hans Erik Bøtker
- From the Department of Clinical Epidemiology (K.A., E.H.-P., M.S., T.M., L.P., H.T.S.), Department of Cardiology (K.A., H.E.B.), and Department of Cardiothoracic Surgery (P.H.N.), Aarhus University Hospital, Skejby, Denmark
| | - Henrik Toft Sørensen
- From the Department of Clinical Epidemiology (K.A., E.H.-P., M.S., T.M., L.P., H.T.S.), Department of Cardiology (K.A., H.E.B.), and Department of Cardiothoracic Surgery (P.H.N.), Aarhus University Hospital, Skejby, Denmark
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Adelborg K, Christensen LB, Munch T, Kahlert J, Trolle Lagerros Y, Tell GS, Apalset EM, Xue F, Ehrenstein V. Positive predictive values of International Classification of Diseases, 10th revision codes for dermatologic events and hypersensitivity leading to hospitalization or emergency room visit among women with postmenopausal osteoporosis in the Danish and Swedish national patient registries. Clin Epidemiol 2017; 9:179-184. [PMID: 28392715 PMCID: PMC5373846 DOI: 10.2147/clep.s126370] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
BACKGROUND Clinical epidemiology research studies, including pharmacoepidemiology and pharmacovigilance studies, use routinely collected health data, such as diagnoses recorded in national health and administrative registries, to assess clinical effectiveness and safety of treatments. We estimated positive predictive values (PPVs) of International Classification of Diseases, 10th revision (ICD-10) codes for primary diagnoses of dermatologic events and hypersensitivity recorded at hospitalization or emergency room visit in the national patient registries of Denmark and Sweden among women with postmenopausal osteoporosis (PMO). METHODS This validation study included women with PMO identified from the Danish and Swedish national patient registries (2005-2014). Medical charts of the potential cases served as the gold standard for the diagnosis confirmation and were reviewed and adjudicated by physicians. RESULTS We obtained and reviewed 189 of 221 sampled medical records (86%). The overall PPV was 92.4% (95% confidence interval [CI], 85.1%-96.3%) for dermatologic events, while the PPVs for bullous events and erythematous dermatologic events were 52.5% (95% CI, 37.5%-67.1%) and 12.5% (95% CI, 2.2%-47.1%), respectively. The PPV was 59.0% (95% CI, 48.3%-69.0%) for hypersensitivity; however, the PPV of hypersensitivity increased to 100.0% (95% CI, 67.6%-100.0%) when restricting to diagnostic codes for anaphylaxis. The overall results did not vary by country. CONCLUSION Among women with PMO, the PPV for any dermatologic event recorded as the primary diagnosis at hospitalization or at an emergency room visit was high and acceptable for epidemiologic research in the Danish and Swedish national patient registries. The PPV was substantially lower for hypersensitivity leading to hospitalization or emergency room visit.
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Affiliation(s)
- Kasper Adelborg
- Department of Clinical Epidemiology, Aarhus University Hospital, Aarhus N, Denmark
| | | | - Troels Munch
- Department of Clinical Epidemiology, Aarhus University Hospital, Aarhus N, Denmark
| | - Johnny Kahlert
- Department of Clinical Epidemiology, Aarhus University Hospital, Aarhus N, Denmark
| | - Ylva Trolle Lagerros
- Department of Medicine, Clinical Epidemiology Unit, Karolinska Institutet; Department of Medicine, Clinic of Endocrinology, Metabolism and Diabetes, Karolinska University Hospital, Stockholm, Sweden
| | - Grethe S Tell
- Department of Global Public Health and Primary Care, University of Bergen
| | - Ellen M Apalset
- Department of Global Public Health and Primary Care, University of Bergen; Department of Rheumatology, Haukeland University Hospital, Bergen, Norway
| | - Fei Xue
- Center for Observational Research, Amgen Inc. Thousand Oaks, CA, USA
| | - Vera Ehrenstein
- Department of Clinical Epidemiology, Aarhus University Hospital, Aarhus N, Denmark
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Adelborg K, Sundbøll J, Munch T, Frøslev T, Sørensen HT, Bøtker HE, Schmidt M. Positive predictive value of cardiac examination, procedure and surgery codes in the Danish National Patient Registry: a population-based validation study. BMJ Open 2016; 6:e012817. [PMID: 27940630 PMCID: PMC5168662 DOI: 10.1136/bmjopen-2016-012817] [Citation(s) in RCA: 104] [Impact Index Per Article: 13.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/04/2022] Open
Abstract
OBJECTIVE Danish medical registries are widely used for cardiovascular research, but little is known about the data quality of cardiac interventions. We computed positive predictive values (PPVs) of codes for cardiac examinations, procedures and surgeries registered in the Danish National Patient Registry during 2010-2012. DESIGN Population-based validation study. SETTING We randomly sampled patients from 1 university hospital and 2 regional hospitals in the Central Denmark Region. PARTICIPANTS 1239 patients undergoing different cardiac interventions. MAIN OUTCOME MEASURE PPVs with medical record review as reference standard. RESULTS A total of 1233 medical records (99% of the total sample) were available for review. PPVs ranged from 83% to 100%. For examinations, the PPV was overall 98%, reflecting PPVs of 97% for echocardiography, 97% for right heart catheterisation and 100% for coronary angiogram. For procedures, the PPV was 98% overall, with PPVs of 98% for thrombolysis, 92% for cardioversion, 100% for radiofrequency ablation, 98% for percutaneous coronary intervention, and 100% for both cardiac pacemakers and implantable cardiac defibrillators. For cardiac surgery, the overall PPVs was 99%, encompassing PPVs of 100% for mitral valve surgery, 99% for aortic valve surgery, 98% for coronary artery bypass graft surgery, and 100% for heart transplantation. The accuracy of coding was consistent within age, sex, and calendar year categories, and the agreement between independent reviewers was high (99%). CONCLUSIONS Cardiac examinations, procedures and surgeries have high PPVs in the Danish National Patient Registry.
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Affiliation(s)
- Kasper Adelborg
- Department of Clinical Epidemiology, Aarhus University Hospital, Aarhus, Denmark
- Department of Cardiology, Aarhus University Hospital, Aarhus, Denmark
| | - Jens Sundbøll
- Department of Clinical Epidemiology, Aarhus University Hospital, Aarhus, Denmark
- Department of Cardiology, Aarhus University Hospital, Aarhus, Denmark
| | - Troels Munch
- Department of Clinical Epidemiology, Aarhus University Hospital, Aarhus, Denmark
| | - Trine Frøslev
- Department of Clinical Epidemiology, Aarhus University Hospital, Aarhus, Denmark
| | - Henrik Toft Sørensen
- Department of Clinical Epidemiology, Aarhus University Hospital, Aarhus, Denmark
| | - Hans Erik Bøtker
- Department of Cardiology, Aarhus University Hospital, Aarhus, Denmark
| | - Morten Schmidt
- Department of Clinical Epidemiology, Aarhus University Hospital, Aarhus, Denmark
- Department of Internal Medicine, Randers Regional Hospital, Randers, Denmark
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Sundbøll J, Adelborg K, Munch T, Frøslev T, Sørensen HT, Bøtker HE, Schmidt M. Positive predictive value of cardiovascular diagnoses in the Danish National Patient Registry: a validation study. BMJ Open 2016; 6:e012832. [PMID: 27864249 PMCID: PMC5129042 DOI: 10.1136/bmjopen-2016-012832] [Citation(s) in RCA: 547] [Impact Index Per Article: 68.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/20/2022] Open
Abstract
OBJECTIVE The majority of cardiovascular diagnoses in the Danish National Patient Registry (DNPR) remain to be validated despite extensive use in epidemiological research. We therefore examined the positive predictive value (PPV) of cardiovascular diagnoses in the DNPR. DESIGN Population-based validation study. SETTING 1 university hospital and 2 regional hospitals in the Central Denmark Region, 2010-2012. PARTICIPANTS For each cardiovascular diagnosis, up to 100 patients from participating hospitals were randomly sampled during the study period using the DNPR. MAIN OUTCOME MEASURE Using medical record review as the reference standard, we examined the PPV for cardiovascular diagnoses in the DNPR, coded according to the International Classification of Diseases, 10th Revision. RESULTS A total of 2153 medical records (97% of the total sample) were available for review. The PPVs ranged from 64% to 100%, with a mean PPV of 88%. The PPVs were ≥90% for first-time myocardial infarction, stent thrombosis, stable angina pectoris, hypertrophic cardiomyopathy, arrhythmogenic right ventricular cardiomyopathy, takotsubo cardiomyopathy, arterial hypertension, atrial fibrillation or flutter, cardiac arrest, mitral valve regurgitation or stenosis, aortic valve regurgitation or stenosis, pericarditis, hypercholesterolaemia, aortic dissection, aortic aneurysm/dilation and arterial claudication. The PPVs were between 80% and 90% for recurrent myocardial infarction, first-time unstable angina pectoris, pulmonary hypertension, bradycardia, ventricular tachycardia/fibrillation, endocarditis, cardiac tumours, first-time venous thromboembolism and between 70% and 80% for first-time and recurrent admission due to heart failure, first-time dilated cardiomyopathy, restrictive cardiomyopathy and recurrent venous thromboembolism. The PPV for first-time myocarditis was 64%. The PPVs were consistent within age, sex, calendar year and hospital categories. CONCLUSIONS The validity of cardiovascular diagnoses in the DNPR is overall high and sufficient for use in research since 2010.
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Affiliation(s)
- Jens Sundbøll
- Department of Clinical Epidemiology, Aarhus University Hospital, Aarhus N, Denmark
- Department of Cardiology, Aarhus University Hospital, Skejby, Aarhus N, Denmark
| | - Kasper Adelborg
- Department of Clinical Epidemiology, Aarhus University Hospital, Aarhus N, Denmark
- Department of Cardiology, Aarhus University Hospital, Skejby, Aarhus N, Denmark
| | - Troels Munch
- Department of Clinical Epidemiology, Aarhus University Hospital, Aarhus N, Denmark
| | - Trine Frøslev
- Department of Clinical Epidemiology, Aarhus University Hospital, Aarhus N, Denmark
| | - Henrik Toft Sørensen
- Department of Clinical Epidemiology, Aarhus University Hospital, Aarhus N, Denmark
| | - Hans Erik Bøtker
- Department of Cardiology, Aarhus University Hospital, Skejby, Aarhus N, Denmark
| | - Morten Schmidt
- Department of Clinical Epidemiology, Aarhus University Hospital, Aarhus N, Denmark
- Department of Internal Medicine, Regional Hospital of Randers, Randers, Denmark
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Munch T, Harrison SL, Barrett-Connor E, Lane NE, Nevitt MC, Schousboe JT, Stefanick M, Cawthon PM. Pain and falls and fractures in community-dwelling older men. Age Ageing 2015; 44:973-9. [PMID: 26396181 DOI: 10.1093/ageing/afv125] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2015] [Accepted: 07/13/2015] [Indexed: 11/14/2022] Open
Abstract
BACKGROUND Pain may reduce stability and increase falls and subsequent fractures in older men. OBJECTIVES To examine the association between joint pain and any pain with falls, hip and non-spine fractures in older community-dwelling men. DESIGN A cohort study. SETTING AND PARTICIPANTS Analyses included 5,993 community-dwelling men aged ≥65 years from the MrOS cohort. MEASUREMENTS Pain at hip, knee and elsewhere (any) was assessed by self-report. Men reported falls via questionnaires mailed 3× per year during the year following the baseline visit. Fractures were verified centrally. Mean follow-up time for fractures was 9.7 (SD 3.1) years. Logistic regression models estimated likelihood of falls and proportional hazards models estimated risk of fractures. Models were adjusted for age, BMI, race, smoking, alcohol use, medications use, co-morbidities and arthritis; fracture models additionally adjusted for bone mineral density. RESULTS One quarter (25%, n = 1,519) reported ≥1 fall; 710 reported ≥2 falls in the year after baseline. In multivariate models, baseline pain at hip, knee or any pain increased likelihood of ≥1 fall and ≥2 falls over the following year. For example, knee pain increased likelihood of ≥1 fall (odds ratio, OR 1.44; 95% confidence interval, CI 1.25-1.65) and ≥2 falls (OR 1.75; 95% CI 1.46-2.10). During follow-up, 936 (15.6%) men suffered a non-spine fracture (n = 217, 3.6% hip). In multivariate models, baseline pain was not associated with incident hip or non-spine fractures. CONCLUSIONS Any pain, knee pain and hip pain were each strong independent risk factors for falls in older men. Increased risk of falls did not translate into an increased risk of fractures.
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Affiliation(s)
- Troels Munch
- Department of Clinical Epidemiology, Aarhus University Hospital, Aarhus 8200, Denmark California Pacific Medical Center Research Institute, San Francisco, CA, USA
| | | | | | - Nancy E Lane
- Internal Medicine, University of California, Davis, Davis, CA, USA
| | | | - John T Schousboe
- Park Nicollet Institute for Research and Education, St Louis Park, MN, USA
| | - Marcia Stefanick
- Department of Medicine, Stanford University, Stanford Prevention Research Center, Palo Alto, CA, USA
| | - Peggy M Cawthon
- California Pacific Medical Center Research Institute, San Francisco, CA, USA
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Dufka FL, Munch T, Dworkin RH, Rowbotham MC. Results availability for analgesic device, complex regional pain syndrome, and post-stroke pain trials: comparing the RReADS, RReACT, and RReMiT databases. Pain 2015; 156:72-80. [PMID: 25599303 PMCID: PMC4280280 DOI: 10.1016/j.pain.0000000000000009] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2014] [Revised: 09/01/2014] [Accepted: 10/16/2014] [Indexed: 11/24/2022]
Abstract
Evidence-based medicine rests on the assumption that treatment recommendations are robust, free from bias, and include results of all randomized clinical trials. The Repository of Registered Analgesic Clinical Trials search and analysis methodology was applied to create databases of complex regional pain syndrome (CRPS) and central post-stroke pain (CPSP) trials and adapted to create the Repository of Registered Analgesic Device Studies databases for trials of spinal cord stimulation (SCS), repetitive transcranial magnetic stimulation (rTMS), and transcranial direct current stimulation (tDCS). We identified 34 CRPS trials, 18 CPSP trials, 72 trials of SCS, and 92 trials of rTMS/tDCS. Irrespective of time since study completion, 45% of eligible CRPS and CPSP trials and 46% of eligible SCS and rTMS/tDCS trials had available results (peer-reviewed literature, results entered on registry, or gray literature); peer-reviewed publications could be found for 38% and 39%, respectively. Examining almost 1000 trials across a spectrum of painful disorders (fibromyalgia, diabetic painful neuropathy, post-herpetic neuralgia, migraine, CRPS, CPSP) and types of treatment, no single study characteristic consistently predicts unavailability of results. Results availability is higher 12 months after study completion but remains below 60% for peer-reviewed publications. Recommendations to increase results availability include supporting organizations advocating for transparency, enforcing existing results reporting regulations, enabling all primary registries to post results, stating trial registration numbers in all publication abstracts, and reducing barriers to publishing "negative" trials. For all diseases and treatment modalities, evidence-based medicine must rigorously adjust for the sheer magnitude of missing results in formulating treatment recommendations.
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Affiliation(s)
- Faustine L. Dufka
- Research Institute, California Pacific Medical Center, San Francisco, CA, USA
| | - Troels Munch
- Research Institute, California Pacific Medical Center, San Francisco, CA, USA
- Department of Anaesthesia, Centre of Head and Orthopaedics, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark
| | - Robert H. Dworkin
- Department of Anesthesiology, University of Rochester School of Medicine and Dentistry, Rochester, NY, USA
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Munch T, Dufka FL, Greene K, Smith SM, Dworkin RH, Rowbotham MC. RReACT goes global: perils and pitfalls of constructing a global open-access database of registered analgesic clinical trials and trial results. Pain 2014; 155:1313-1317. [PMID: 24726925 DOI: 10.1016/j.pain.2014.04.007] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2014] [Revised: 03/29/2014] [Accepted: 04/04/2014] [Indexed: 11/19/2022]
Abstract
Eliminating publication bias requires ensuring public awareness of studies and access to results. Clinical trial registries provide basic trial information, but access to unbiased trial results is inadequate. Nearly all studies of trial registration and results reporting have been limited to the ClinicalTrials.gov registry. We analyzed trial registration, registry functionality, cross-registry harmonization, and results reporting on all 15 primary registries in the World Health Organization International Clinical Trials Registry Platform (ICTRP) for postherpetic neuralgia, painful diabetic neuropathy, and fibromyalgia. A total of 447 unique trials were identified, with 86 trials listed on more than one registry. A comprehensive search algorithm was used to find trial results in the peer-reviewed literature and the grey literature. Creating a global database of registered trials and trial results proved surprisingly difficult for several reasons: (1) ICTRP does not reliably identify trials listed on multiple registries, manual searches are necessary; (2) Searching ICTRP yields different results than searching individual registries; (3) Outcome measure descriptions for multiply registered trials vary between registries; (4) Registry-publication pairings are often inaccurate or incomplete; (5) Grey literature results are not permanent. Overall, only 46% of all trials had results available. Trials registered on ClinicalTrials.gov were significantly more likely to have results (52% vs. 18%, P<0.001), partly due to the ability to post results directly to the registry. In addition to the simple remedy of including trial registration numbers on all meeting abstracts and peer-reviewed papers, specific strategies are offered to facilitate identifying multiply registered studies and ensuring accurate pairing of results and publications.
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Affiliation(s)
- Troels Munch
- California Pacific Medical Center Research Institute, San Francisco, CA 94107, USA Department of Anaesthesia, Centre of Head and Orthopaedics, Copenhagen University Hospital, Rigshospitalet, Copenhagen 2100, Denmark University of Rochester School of Medicine and Dentistry, Rochester, NY 14642, USA
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Damsgaard R, Munch T, Mørkeberg J, Mortensen SP, González-Alonso J. Effects of blood withdrawal and reinfusion on biomarkers of erythropoiesis in humans: Implications for anti-doping strategies. Haematologica 2006; 91:1006-8. [PMID: 16584989] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2006] [Accepted: 03/08/2006] [Indexed: 05/08/2023] Open
Abstract
To discriminate autologous blood doping procedures from normal conditions, we examined the hematological response to blood withdrawal and reinfusion. We found that biomarkers of erythropoiesis are primarily affected in the anemic period. Therefore, individual variations in [Hb] exceeding 15% between samples obtained shortly before any major competition would be indicative of autologous blood manipulation.
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