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Ohm M, Boef AGC, Stoof SP, van Ravenhorst MB, van der Klis FRM, Berbers GAM, Knol MJ. Sex-Related Differences in the Immune Response to Meningococcal Vaccinations During Adolescence. Front Public Health 2022; 10:871670. [PMID: 35602158 PMCID: PMC9120633 DOI: 10.3389/fpubh.2022.871670] [Citation(s) in RCA: 0] [Impact Index Per Article: 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] [Subscribe] [Scholar Register] [Received: 02/08/2022] [Accepted: 04/19/2022] [Indexed: 11/13/2022] Open
Abstract
Background Immune responses to pediatric vaccinations have been reported to differ according to sex. Such sex-differential responses may become more pronounced during adolescence due to hormonal differences. We investigated whether the vaccine response following primary vaccination against meningococcal serogroup A (MenA), MenW and MenY and booster vaccination against MenC differed between girls and boys using data from two clinical studies. Methods Children aged 10, 12, and 15 years, who had been primed with MenC vaccination between 14 months and 6 years of age, received a booster MenC vaccination or MenACWY vaccination. Polysaccharide-specific IgG concentrations and functional antibody titers [determined with the serum bactericidal antibody (SBA) assay] were measured at baseline, 1 month, 1 year, and 3 years (only MenC group) after vaccination. We calculated geometric mean concentrations and titers (GMC and GMT) ratios for girls vs. boys adjusted for age group. Additionally, we compared the proportion protected individuals between girls and boys at all timepoints. Results This study included 342 girls and 327 boys from two clinical trials. While MenAWY antibody levels did not differ consistently 1 month after vaccination, all GMC- and GMT-ratios were in favor of girls 1 year after vaccination [range: 1.31 (1.02–1.70) for MenA IgG to 1.54 (1.10–2.16) for MenW IgG]. Overall, MenC antibody levels were slightly higher in girls at all postvaccination timepoints (GMC- and GMT-ratios: 1.16/1.17 at 1 month, 1.16/1.22 at 1 year and 1.12/1.15 3 years postvaccination). Higher MenC antibody levels were observed in 12- and 15-year-old girls compared to boys of the same age, whereas 10-year-old boys and girls had similar antibody levels. The percentage of participants protected (SBA titer ≥ 8) was very high (95–100%) at all timepoints, and did not differ significantly between boys and girls. Conclusion Antibody responses were higher in girls than in boys for all serogroups at most timepoints after primary MenAWY vaccination and booster MenC vaccination. The differences in average titers were however small and the percentage participants with protective titers was very high for both sexes.
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Hoes J, Boef AGC, Knol MJ, de Melker HE, Mollema L, van der Klis FRM, Rots NY, van Baarle D. Socioeconomic Status Is Associated With Antibody Levels Against Vaccine Preventable Diseases in the Netherlands. Front Public Health 2018; 6:209. [PMID: 30140666 PMCID: PMC6094970 DOI: 10.3389/fpubh.2018.00209] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [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] [Received: 01/12/2018] [Accepted: 07/05/2018] [Indexed: 12/04/2022] Open
Abstract
Background: We investigated whether low socioeconomic status (SES), which is associated with reduced health and life expectancy, might play a role in increased risk for infectious diseases. Therefore, we explored the association between SES and immunoglobulin G (IgG) levels against various pathogens. Methods: We analyzed the association between SES [educational level and net household income (NHI)] and serum IgG concentration against measles, mumps, rubella, varicella, Haemophilus influenzae type B (HiB), pneumococcus, meningococcus serogroup C (MenC), and cytomegalovirus (CMV) collected within a national cross-sectional serosurvey (2006/2007) using linear regression analyses among non-vaccinated individuals. Results: Higher educational level was associated with higher IgG concentrations against measles (GMC ratio 1.34, 95% CI 1.18–1.53) and rubella (1.13, 1.02–1.25) compared to low education level. In contrast, higher education level was associated with lower IgG concentrations against pneumococcus (0.78, 0.70–0.88), MenC (0.54, 0.44–0.68), and CMV (0.23, 0.18–0.31) compared to low education level. This pattern was also evident when NHI was used as SES indicator. Conclusion: Our study suggests that socioeconomic status is associated with antibody levels in a pathogen-dependent manner. The results suggest that differences in serological response upon infection or differences in exposure might be involved in the variation in IgG levels between SES groups.
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Affiliation(s)
- Joske Hoes
- Centre for Epidemiology and Surveillance of Infectious Diseases, Centre for Infectious Disease Control, National Institute for Public Health and the Environment, Bilthoven, Netherlands
| | - Anna G C Boef
- Centre for Epidemiology and Surveillance of Infectious Diseases, Centre for Infectious Disease Control, National Institute for Public Health and the Environment, Bilthoven, Netherlands
| | - Mirjam J Knol
- Centre for Epidemiology and Surveillance of Infectious Diseases, Centre for Infectious Disease Control, National Institute for Public Health and the Environment, Bilthoven, Netherlands
| | - Hester E de Melker
- Centre for Epidemiology and Surveillance of Infectious Diseases, Centre for Infectious Disease Control, National Institute for Public Health and the Environment, Bilthoven, Netherlands
| | - Liesbeth Mollema
- Centre for Epidemiology and Surveillance of Infectious Diseases, Centre for Infectious Disease Control, National Institute for Public Health and the Environment, Bilthoven, Netherlands
| | - Fiona R M van der Klis
- Centre for Immunology of Infectious Diseases and Vaccines, Centre for Infectious Disease Control, National Institute for Public Health and the Environment, Bilthoven, Netherlands
| | - Nynke Y Rots
- Centre for Immunology of Infectious Diseases and Vaccines, Centre for Infectious Disease Control, National Institute for Public Health and the Environment, Bilthoven, Netherlands
| | - Debbie van Baarle
- Centre for Immunology of Infectious Diseases and Vaccines, Centre for Infectious Disease Control, National Institute for Public Health and the Environment, Bilthoven, Netherlands.,Laboratory for Translational Immunology, Department Immunology, University Medical Centre Utrecht, Utrecht, Netherlands
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Boef AGC, van der Klis FRM, Berbers GAM, Buisman AM, Sanders EAM, Kemmeren JM, van der Ende A, de Melker HE, Rots NY, Knol MJ. Differences by sex in IgG levels following infant and childhood vaccinations: An individual participant data meta-analysis of vaccination studies. Vaccine 2017; 36:400-407. [PMID: 29223483 DOI: 10.1016/j.vaccine.2017.11.070] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2017] [Revised: 11/21/2017] [Accepted: 11/23/2017] [Indexed: 01/07/2023]
Abstract
BACKGROUND If immune responses to vaccination differ between males and females, sex-specific vaccination schedules may be indicated. We systematically reanalysed childhood vaccination studies conducted in The Netherlands for sex-differences in IgG-responses. To assess the impact of potential sex-differences in IgG-responses, we explored sex-differences in vaccine failure/effectiveness and reactogenicity. METHODS Six studies with IgG-measurements for 1577 children following infant pneumococcal (PCV7/PCV10/PCV13) and/or DTaP-IPV-Hib(-HepB) vaccinations, or the pre-school DTaP-IPV booster were included. We performed one-stage individual participant data meta-analyses per time-point of the effect of sex on IgG levels against pneumococcal serotypes, diphtheria toxoid, tetanus toxoid, pertussis Ptx/FHA/Prn and Hib-PRP using linear mixed models. Using existing study data, we compared reactogenicity after PCV7/PCV10 and DTaP-IPV-Hib(-HepB) vaccination in girls and boys. Vaccine failure/effectiveness was compared between girls and boys for invasive pneumococcal disease (IPD), invasive Hib disease and pertussis using notification data. RESULTS For pneumococcal vaccination, the geometric mean concentration ratio of IgG levels in girls versus boys pooled across serotypes was 1.15 (95%CI 0.91-1.45) 1 month following the primary series, 1.16 (1.02-1.32) at age 8 months, 1.12 (1.02-1.23) pre-booster (age 11 months) and 0.99 (0.89-1.10) post-booster (age 12 months). Diphtheria toxoid, tetanus toxoid, pertussis Ptx/FHA/Prn and Hib-PRP IgG levels did not differ between girls and boys, except for Hib post-booster (1.24; 95%CI 1.01-1.52) and tetanus before pre-school booster (0.71; 0.53-0.95). We found no difference between boys and girls in reactogenicity at age 4 or 11 months or in vaccine failure/effectiveness for IPD, invasive Hib disease or pertussis. CONCLUSION For most vaccine antigens investigated, there were no consistent differences in vaccine-induced IgG levels. Vaccine-induced pneumococcal IgG levels were slightly higher in girls, but only between the primary series and the 11-month booster. These results, along with similar reactogenicity and vaccine failure/effectiveness, support the uniform infant vaccination schedule in the Dutch national immunisation programme.
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Affiliation(s)
- Anna G C Boef
- Centre for Infectious Disease Control, National Institute for Public Health and the Environment (RIVM), Bilthoven, The Netherlands
| | - Fiona R M van der Klis
- Centre for Infectious Disease Control, National Institute for Public Health and the Environment (RIVM), Bilthoven, The Netherlands
| | - Guy A M Berbers
- Centre for Infectious Disease Control, National Institute for Public Health and the Environment (RIVM), Bilthoven, The Netherlands
| | - Anne-Marie Buisman
- Centre for Infectious Disease Control, National Institute for Public Health and the Environment (RIVM), Bilthoven, The Netherlands
| | - Elisabeth A M Sanders
- Centre for Infectious Disease Control, National Institute for Public Health and the Environment (RIVM), Bilthoven, The Netherlands; Department of Pediatric Immunology and Infectious Diseases, Wilhelmina Children's Hospital, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Jeanet M Kemmeren
- Centre for Infectious Disease Control, National Institute for Public Health and the Environment (RIVM), Bilthoven, The Netherlands
| | - Arie van der Ende
- Netherlands Reference Laboratory of Bacterial Meningitis, Academic Medical Center, Amsterdam, The Netherlands
| | - Hester E de Melker
- Centre for Infectious Disease Control, National Institute for Public Health and the Environment (RIVM), Bilthoven, The Netherlands
| | - Nynke Y Rots
- Centre for Infectious Disease Control, National Institute for Public Health and the Environment (RIVM), Bilthoven, The Netherlands
| | - Mirjam J Knol
- Centre for Infectious Disease Control, National Institute for Public Health and the Environment (RIVM), Bilthoven, The Netherlands.
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Tielemans SMAJ, de Melker HE, Hahné SJM, Boef AGC, van der Klis FRM, Sanders EAM, van der Sande MAB, Knol MJ. Non-specific effects of measles, mumps, and rubella (MMR) vaccination in high income setting: population based cohort study in the Netherlands. BMJ 2017; 358:j3862. [PMID: 28855159 PMCID: PMC5576097 DOI: 10.1136/bmj.j3862] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Abstract
Objectives To investigate whether measles, mumps, and rubella (MMR) vaccine has positive non-specific effects in a high income setting and to compare rates of hospital admissions for infections between children aged ≤2 years who received live MMR vaccine and those who received an inactivated vaccine against diphtheria, tetanus, pertussis, polio, and Haemophilus influenzae type b (DTaP-IPV-Hib) as their most recent vaccination.Design Nationwide population based cohort study.Setting In the Netherlands, DTaP-IPV-Hib+pneumococcal vaccination (PCV) is recommended at ages 2, 3, 4, and 11 months and MMR + meningococcal C (MenC) vaccination at age 14 months. Data from the national vaccine register were linked to hospital admission data.Participants 1 096 594 children born in 2005-11 who received the first four DTaP-IPV-Hib+PCV vaccines.Main outcome measures Hazard ratio for admission to hospital for infection in children with MMR+MenC compared with the fourth DTaP-IPV-Hib+PCV as their most recent vaccination. Cox regression was performed with most recent vaccination as time dependent variable, adjusted for potential confounders. Analyses were repeated with admission for injuries or poisoning as a negative control outcome. In addition, rate of admission for infection was compared between the fourth and third DTaP-IPV-Hib+PCVas most recent vaccination.Results Having had MMR+MenC as the most recent vaccination was associated with a hazard ratio of 0.62 (95% confidence interval 0.57 to 0.67) for admission to hospital for infection and 0.84 (0.73 to 0.96) for injuries or poisoning, compared with the fourth DTaP-IPV-Hib+PCV as most recent vaccination. The fourth DTaP-IPV-Hib+PCV as most recent vaccination was associated with a hazard ratio of 0.69 (0.63 to 0.76) for admission to hospital for infection, compared with the third DTaP-IPV-Hib+PCV as most recent vaccination.Conclusions Healthy vaccinee bias could at least partly explain the observed lower rate of admission to hospital with infection after MMR vaccination. The lower rate is associated with receipt of any additional vaccine, not specifically MMR vaccine. This emphasises the caution required in the interpretation of findings from observational studies on non-specific effects of vaccination.
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Affiliation(s)
- Susanne M A J Tielemans
- Centre for Infectious Disease Control, National Institute for Public Health and the Environment, 3720 BA Bilthoven, Netherlands
| | - Hester E de Melker
- Centre for Infectious Disease Control, National Institute for Public Health and the Environment, 3720 BA Bilthoven, Netherlands
| | - Susan J M Hahné
- Centre for Infectious Disease Control, National Institute for Public Health and the Environment, 3720 BA Bilthoven, Netherlands
| | - Anna G C Boef
- Centre for Infectious Disease Control, National Institute for Public Health and the Environment, 3720 BA Bilthoven, Netherlands
| | - Fiona R M van der Klis
- Centre for Infectious Disease Control, National Institute for Public Health and the Environment, 3720 BA Bilthoven, Netherlands
| | - Elisabeth A M Sanders
- Centre for Infectious Disease Control, National Institute for Public Health and the Environment, 3720 BA Bilthoven, Netherlands
- Department of Paediatrics, University Medical Centre Utrecht, Utrecht, Netherlands
| | - Marianne A B van der Sande
- Centre for Infectious Disease Control, National Institute for Public Health and the Environment, 3720 BA Bilthoven, Netherlands
- Julius Centre for Health Sciences and Primary Care, University Medical Centre, Utrecht, Netherlands
| | - Mirjam J Knol
- Centre for Infectious Disease Control, National Institute for Public Health and the Environment, 3720 BA Bilthoven, Netherlands
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Boef AGC, Souverein PC, Vandenbroucke JP, van Hylckama Vlieg A, de Boer A, le Cessie S, Dekkers OM. Instrumental variable analysis as a complementary analysis in studies of adverse effects: venous thromboembolism and second-generation versus third-generation oral contraceptives. Pharmacoepidemiol Drug Saf 2016; 25:317-24. [PMID: 26749045 DOI: 10.1002/pds.3956] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2015] [Revised: 11/26/2015] [Accepted: 12/08/2015] [Indexed: 12/28/2022]
Abstract
PURPOSE A potentially useful role for instrumental variable (IV) analysis may be as a complementary analysis to assess the presence of confounding when studying adverse drug effects. There has been discussion on whether the observed increased risk of venous thromboembolism (VTE) for third-generation oral contraceptives versus second-generation oral contraceptives could be (partially) attributed to confounding. We investigated how prescribing preference IV estimates compare with conventional estimates. METHODS Women in the Clinical Practice Research Database who started a second-generation or third-generation oral contraceptive from 1989 to 2013 were included. Ordinary least squares and two-stage least squares regression were used to estimate risk differences in VTE. Cox regression and IV for Cox proportional hazards regression were used to calculate hazard ratios (HR). The instrument used was the proportion of prescriptions for third-generation oral contraceptives by the general practitioner in the year preceding the current prescription. RESULTS All analyses pointed in the direction of an increased VTE risk for third-generation oral contraceptives. The adjusted HR from the conventional Cox regression was 1.62 (95% confidence interval 1.16-2.27) and the fully adjusted HR from the IV Cox regression was 3.45 (95% confidence interval; 0.97-11.7), showing a larger risk and wider confidence intervals in the IV analysis. CONCLUSIONS The similarity in direction of results from the IV analyses and conventional analyses suggests that major confounding is unlikely. IV analysis can be a useful complementary analysis to assess the presence of confounding in studies of adverse drug effects in very large databases.
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Affiliation(s)
- Anna G C Boef
- Department of Clinical Epidemiology, Leiden University Medical Centre, Leiden, The Netherlands
| | - Patrick C Souverein
- Division of Pharmacoepidemiology and Clinical Pharmacology, Utrecht Institute for Pharmaceutical Sciences, Utrecht University, Utrecht, The Netherlands
| | - Jan P Vandenbroucke
- Department of Clinical Epidemiology, Leiden University Medical Centre, Leiden, The Netherlands
| | | | - Anthonius de Boer
- Division of Pharmacoepidemiology and Clinical Pharmacology, Utrecht Institute for Pharmaceutical Sciences, Utrecht University, Utrecht, The Netherlands
| | - Saskia le Cessie
- Department of Clinical Epidemiology, Leiden University Medical Centre, Leiden, The Netherlands.,Department of Medical Statistics and Bioinformatics, Leiden University Medical Centre, Leiden, The Netherlands
| | - Olaf M Dekkers
- Department of Clinical Epidemiology, Leiden University Medical Centre, Leiden, The Netherlands.,Department of Endocrinology and Metabolic Diseases, Leiden University Medical Centre, Leiden, The Netherlands
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Boef AGC, Dekkers OM, le Cessie S. Mendelian randomization studies: a review of the approaches used and the quality of reporting. Int J Epidemiol 2015; 44:496-511. [PMID: 25953784 DOI: 10.1093/ije/dyv071] [Citation(s) in RCA: 212] [Impact Index Per Article: 23.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/09/2015] [Indexed: 12/31/2022] Open
Abstract
BACKGROUND Mendelian randomization (MR) studies investigate the effect of genetic variation in levels of an exposure on an outcome, thereby using genetic variation as an instrumental variable (IV). We provide a meta-epidemiological overview of the methodological approaches used in MR studies, and evaluate the discussion of MR assumptions and reporting of statistical methods. METHODS We searched PubMed, Medline, Embase and Web of Science for MR studies up to December 2013. We assessed (i) the MR approach used; (ii) whether the plausibility of MR assumptions was discussed; and (iii) whether the statistical methods used were reported adequately. RESULTS Of 99 studies using data from one study population, 32 used genetic information as a proxy for the exposure without further estimation, 44 performed a formal IV analysis, 7 compared the observed with the expected genotype-outcome association, and 1 used both the latter two approaches. The 80 studies using data from multiple study populations used many different approaches to combine the data; 52 of these studies used some form of IV analysis; 44% of studies discussed the plausibility of all three MR assumptions in their study. Statistical methods used for IV analysis were insufficiently described in 14% of studies. CONCLUSIONS Most MR studies either use the genotype as a proxy for exposure without further estimation or perform an IV analysis. The discussion of underlying assumptions and reporting of statistical methods for IV analysis are frequently insufficient. Studies using data from multiple study populations are further complicated by the combination of data or estimates. We provide a checklist for the reporting of MR studies.
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Affiliation(s)
- Anna G C Boef
- Department of Clinical Epidemiology, Department of Endocrinology and Metabolic Diseases, and Department of Medical Statistics and Bioinformatics, Leiden University Medical Centre, Leiden, The Netherlands.
| | - Olaf M Dekkers
- Department of Clinical Epidemiology, Department of Endocrinology and Metabolic Diseases, and Department of Medical Statistics and Bioinformatics, Leiden University Medical Centre, Leiden, The Netherlands. Department of Clinical Epidemiology, Department of Endocrinology and Metabolic Diseases, and Department of Medical Statistics and Bioinformatics, Leiden University Medical Centre, Leiden, The Netherlands
| | - Saskia le Cessie
- Department of Clinical Epidemiology, Department of Endocrinology and Metabolic Diseases, and Department of Medical Statistics and Bioinformatics, Leiden University Medical Centre, Leiden, The Netherlands. Department of Clinical Epidemiology, Department of Endocrinology and Metabolic Diseases, and Department of Medical Statistics and Bioinformatics, Leiden University Medical Centre, Leiden, The Netherlands
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Boef AGC, Postmus I, Siegerink B. Re: "Mendelian randomization and estimation of treatment efficacy for chronic diseases". Am J Epidemiol 2014; 179:264. [PMID: 24335383 DOI: 10.1093/aje/kwt306] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Affiliation(s)
- Anna G C Boef
- Department of Clinical Epidemiology, Leiden University Medical Centre, 2300 RC Leiden, The Netherlands
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Eriksson UK, van Bodegom D, May L, Boef AGC, Westendorp RGJ. Low C-reactive protein levels in a traditional West-African population living in a malaria endemic area. PLoS One 2013; 8:e70076. [PMID: 23922912 PMCID: PMC3724900 DOI: 10.1371/journal.pone.0070076] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2013] [Accepted: 06/14/2013] [Indexed: 12/21/2022] Open
Abstract
Background C-reactive protein (CRP) levels are reported to be elevated in populations of African descent living in affluent environments compared to populations of European ancestry. However, the natural history of CRP levels in populations of African descent living under adverse environments remains largely unknown. Methods CRP levels were measured with a high sensitivity assay in 624 apparently healthy individuals who contributed blood as part of a study on innate immune responsiveness in a traditional Ghanaian population living under adverse environmental conditions in a malaria endemic area. As a comparison, we included CRP measurements from 2931 apparently healthy individuals from the Dutch population that were included in the same batch of CRP analyses. Associations between CRP and body mass index (BMI), immune responsiveness, and P. falciparum parasitaemia were investigated. Results In an age- and sex-adjusted model, CRP levels were 0.54 mg/L lower in the Ghanaian compared to the Dutch cohort (1.52 vs. 0.98 mg/L, p<0.001). When accounting for the substantially higher average BMI in the Dutch compared to the Ghanaians (25.6 vs. 18.4 kg/m2) the difference in CRP levels disappeared. BMI associated positively with CRP in the Dutch but not in the Ghanaians. In individuals with an acute phase response, CRP levels were higher in the Ghanaian compared to the Dutch cohort (24.6 vs. 17.3 mg/L, p = 0.04). Levels of CRP were positively related to immune responsiveness and P. falciparum parasitaemia (all p<0.001) among Ghanaians. Conclusions Our study demonstrates that West-Africans do not exhibit an inherently high inflammatory state. The role of genes, environment and gene-environment interaction in explaining reports of elevated CRP levels in populations of African ancestry when compared to other ethnicities living in affluent environments thus merits further investigation.
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Affiliation(s)
- Ulrika K Eriksson
- Department of Gerontology & Geriatrics, Leiden University Medical Center, Leiden, the Netherlands.
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Boef AGC, le Cessie S, Dekkers OM. [Instrumental variable analysis]. Ned Tijdschr Geneeskd 2013; 157:A5481. [PMID: 23343737] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/01/2023]
Abstract
Instrumental variable analysis is a recently propagated method to deal with confounding and to estimate therapeutic effects in observational studies. An instrumental variable is a factor which affects treatment but is not related to patient prognosis. A theoretical advantage of a well-chosen instrumental variable is that both measured and unmeasured confounders do not influence the effect estimator. Examples of instrumental variables previously used are regional differences in treatment and physician prescribing preference. Application of instrumental variable analysis seems most suited to large patient registries with considerable expected residual confounding in case standard analytical methods are applied.
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Affiliation(s)
- Anna G C Boef
- Leids Universitair Medisch Centum, afd. Klinische Epidemiologie, Leiden, the Netherlands.
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