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Middleton S, Chalitsios CV, Mungale T, Hassanein ZM, Jenkins AR, Bolton CE, McKeever TM. Functional Recovery of Adults Following Acute COVID-19: A Systematic Review and Meta-Analysis. Phys Ther 2024:pzae023. [PMID: 38386981 DOI: 10.1093/ptj/pzae023] [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] [Received: 04/25/2023] [Revised: 09/29/2023] [Accepted: 02/19/2024] [Indexed: 02/24/2024]
Abstract
OBJECTIVE This systematic review and meta-analysis aimed to investigate the objective, functional recovery of patients more than 3 months after acute COVID-19 infection. METHODS Comprehensive database searches of EMBASE, PubMed/MEDLINE, Cochrane COVID-19 Study Register, CINAHL, and Google Scholar in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) statement were carried out until October 19, 2022. Data were extracted and agreed in duplicate. Data were narratively synthesized, and a series of meta-analyses were performed using the random-effects inverse variance method. RESULTS One-hundred six papers covering 20,063 patients who were either hospitalized or not hospitalized with acute COVID-19 who were followed-up between 3 to 24 months were included. Percentage predicted 6-minute walk distance at 3 months to <5 months was 84.3% (95% CI = 79.2-89.3; n = 21; I2 = 98.3%) and 92.5% (95% CI = 89.8-95.3; n = 9; I2 = 94.5%) at ≥11 months. Cardiopulmonary exercise testing revealed percentage predicted peak oxygen consumption rate ($peak\dot{\mathrm{V}}{\mathrm{o}}_2$) at 3 months to <5 months was 77.3% (95% CI = 71.0-83.7; n = 6; I2 = 92.3%) and 95.4% (95% CI = 87.1-103.6; n = 2; I2 = 77.3%) at ≥11 months. Mean handgrip strength was greatest at ≥11 months at 31.16 kg (95% CI = 19.89-42.43; n = 2; I2 = 98.3%) of all time points. All analyses showed marked heterogeneity. CONCLUSION Patients have reduced physical function more than 3 months after COVID-19 infection. Better physical function in multiple physical domains is found after a longer recovery time. IMPACT Physical function as measured by the 6-minute walk test, hand grip strength, and cardiopulmonary exercise testing is reduced at 3 months after COVID-19 infection and can remain over 11 months of follow-up. This protracted recovery following acute COVID-19 infection supports the need to assess physical function at any clinical follow-up, and further research into rehabilitation programs and intervention for patients who have not recovered.
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Affiliation(s)
- Sophie Middleton
- NIHR Nottingham Biomedical Research Centre, Nottingham, UK
- Centre for Respiratory Research, Translational Medical Sciences, School of Medicine, University of Nottingham, Nottingham, UK
- Dept. of Respiratory Medicine, City Hospital, Nottingham University Hospital NHS Trust, Nottingham, UK
| | - Christos V Chalitsios
- Nottingham Centre for Epidemiology and Public Health, Lifespan and population Health, School of Medicine, University of Nottingham, Nottingham, UK
| | - Tanvi Mungale
- NIHR Nottingham Biomedical Research Centre, Nottingham, UK
| | - Zeinab M Hassanein
- Nottingham Centre for Epidemiology and Public Health, Lifespan and population Health, School of Medicine, University of Nottingham, Nottingham, UK
| | - Alex R Jenkins
- NIHR Nottingham Biomedical Research Centre, Nottingham, UK
| | - Charlotte E Bolton
- NIHR Nottingham Biomedical Research Centre, Nottingham, UK
- Centre for Respiratory Research, Translational Medical Sciences, School of Medicine, University of Nottingham, Nottingham, UK
- Dept. of Respiratory Medicine, City Hospital, Nottingham University Hospital NHS Trust, Nottingham, UK
| | - Tricia M McKeever
- NIHR Nottingham Biomedical Research Centre, Nottingham, UK
- Nottingham Centre for Epidemiology and Public Health, Lifespan and population Health, School of Medicine, University of Nottingham, Nottingham, UK
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Chalitsios CV, Meena D, Manou M, Papagiannopoulos C, Markozannes G, Gill D, Su B, Tsilidis KK, Evangelou E, Tzoulaki I. Multiple long-term conditions in people with psoriasis: a latent class and bidirectional Mendelian randomization analysis. Br J Dermatol 2024; 190:364-373. [PMID: 37874776 DOI: 10.1093/bjd/ljad410] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2023] [Revised: 10/15/2023] [Accepted: 10/17/2023] [Indexed: 10/26/2023]
Abstract
BACKGROUND Coexisting long-term conditions (LTCs) in psoriasis and their potential causal associations with the disease are not well -established. OBJECTIVES To determine distinct clusters of LTCs in people with psoriasis and the potential bidirectional causal association between these LTCs and psoriasis. METHODS Using latent class analysis, cross-sectional data from people with psoriasis from the UK Biobank were analysed to identify distinct psoriasis-related comorbidity profiles. Linkage disequilibrium score regression (LDSR) was applied to compute the genetic correlation between psoriasis and LTCs. Two-sample bidirectional Mendelian randomization (MR) analysis assessed the potential causal direction using independent genetic variants that reached genome-wide significance (P < 5 × 10-8). RESULTS Five comorbidity clusters were identified in a population of 10 873 people with psoriasis. LDSR revealed that psoriasis was positively genetically correlated with heart failure [genetic correlation (rg) = 0.23, P = 8.8 × 10-8], depression (rg = 0.12, P = 2.7 × 10-5), coronary artery disease (CAD; rg = 0.15, P = 2 × 10-4) and type 2 diabetes (rg = 0.19, P = 3 × 10-3). Genetic liability to CAD was associated with an increased risk of psoriasis [inverse variance weighted (IVW) odds ratio (ORIVW) 1.159, 95% confidence interval (CI) 1.055-1.274; P = 2 × 10-3]. The MR pleiotropy residual sum and outlier (MR-PRESSO; ORMR-PRESSO 1.13, 95% CI 1.042-1.228; P = 6 × 10-3) and the MR-robust adjusted profile score (RAPS) (ORMR-RAPS 1.149, 95% CI 1.062-1.242; P = 5 × 10-4) approaches corroborate the IVW findings. The weighted median (WM) generated similar and consistent effect estimates but was not statistically significant (ORWM 1.076, 95% CI 0.949-1.221; P = 0.25). Evidence for a suggestive increased risk was detected for CAD (ORIVW 1.031, 95% CI 1.003-1.059; P = 0.03) and heart failure (ORIVW 1.019, 95% CI 1.005-1.033; P = 9 × 10-3) in those with a genetic liability to psoriasis; however, MR sensitivity analyses did not reach statistical significance. CONCLUSIONS Five distinct clusters of psoriasis comorbidities were observed with these findings to offer opportunities for an integrated approach to comorbidity prevention and treatment. Coexisting LTCs share with psoriasis common genetic and nongenetic risk factors, and aggressive lifestyle modification in these people is anticipated to have an impact beyond psoriasis risk. Genetically predicted CAD is possibly associated with an increased risk of psoriasis, altering our prior knowledge.
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Affiliation(s)
- Christos V Chalitsios
- Department of Hygiene and Epidemiology, School of Medicine, University of Ioannina, Ioannina, Greece
| | - Devendra Meena
- Department of Biostatistics and Epidemiology, School of Public Health, Imperial College London, London, UK
| | - Maria Manou
- Department of Hygiene and Epidemiology, School of Medicine, University of Ioannina, Ioannina, Greece
| | - Christos Papagiannopoulos
- Department of Hygiene and Epidemiology, School of Medicine, University of Ioannina, Ioannina, Greece
| | - Georgios Markozannes
- Department of Hygiene and Epidemiology, School of Medicine, University of Ioannina, Ioannina, Greece
- Department of Biostatistics and Epidemiology, School of Public Health, Imperial College London, London, UK
| | - Dipender Gill
- Department of Biostatistics and Epidemiology, School of Public Health, Imperial College London, London, UK
| | - Bowen Su
- Department of Biostatistics and Epidemiology, School of Public Health, Imperial College London, London, UK
| | - Konstantinos K Tsilidis
- Department of Hygiene and Epidemiology, School of Medicine, University of Ioannina, Ioannina, Greece
- Department of Biostatistics and Epidemiology, School of Public Health, Imperial College London, London, UK
| | - Evangelos Evangelou
- Department of Hygiene and Epidemiology, School of Medicine, University of Ioannina, Ioannina, Greece
- Department of Biostatistics and Epidemiology, School of Public Health, Imperial College London, London, UK
| | - Ioanna Tzoulaki
- Department of Biostatistics and Epidemiology, School of Public Health, Imperial College London, London, UK
- Centre for Systems Biology, Biomedical Research Foundation, Academy of Athens, Athens, Greece
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Chalitsios CV, Luney MS, Lindsay WA, Sanders RD, McKeever TM, Moppett I. Risk of Mortality Following Surgery in Patients With a Previous Cardiovascular Event. JAMA Surg 2024; 159:140-149. [PMID: 37991772 PMCID: PMC10867684 DOI: 10.1001/jamasurg.2023.5951] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2023] [Accepted: 08/26/2023] [Indexed: 11/23/2023]
Abstract
Importance There is a lack of consensus regarding the interval of time-dependent postoperative mortality risk following acute coronary syndrome or stroke. Objective To determine the magnitude and duration of risk associated with the time interval between a preoperative cardiovascular event and 30-day postoperative mortality. Design, Setting, and Participants This is a longitudinal retrospective population-based cohort study. This study linked data from the Hospital Episode Statistics for National Health Service England, Myocardial Ischaemia National Audit Project and the Office for National Statistics mortality registry. All adults undergoing a National Health Service-funded noncardiac, nonneurologic surgery in England between April 1, 2007, and March 31, 2018, registered in Hospital Episode Statistics Admitted Patient Care were included. Data were analyzed from July 2021 to July 2022. Exposure The time interval between a previous cardiovascular event (acute coronary syndrome or stroke) and surgery. Main Outcomes and Measures The primary outcome was 30-day all-cause mortality. Secondary outcomes were postoperative mortality at 60, 90, and 365 days. Multivariable logistic regression models with restricted cubic splines were used to estimate adjusted odds ratios. Results There were 877 430 patients with and 20 582 717 without a prior cardiovascular event (overall mean [SD] age, 53.4 [19.4] years; 11 577 157 [54%] female). Among patients with a previous cardiovascular event, the time interval associated with increased risk of postoperative mortality was surgery within 11.3 months (95% CI, 10.8-11.7), with subgroup risks of 14.2 months before elective surgery (95% CI, 13.3-15.3) and 7.3 months for emergency surgery (95% CI, 6.8-7.8). Heterogeneity in these timings was noted across many surgical specialties. The time-dependent risk intervals following stroke and myocardial infarction were similar, but the absolute risk was greater following a stroke. Regarding surgical urgency, the risk of 30-day mortality was higher in those with a prior cardiovascular event for emergency surgery (adjusted hazard ratio, 1.35; 95% CI, 1.34-1.37) and an elective procedure (adjusted hazard ratio, 1.83; 95% CI, 1.78-1.89) than those without a prior cardiovascular event. Conclusions and Relevance In this study, surgery within 1 year of an acute coronary syndrome or stroke was associated with increased postoperative mortality before reaching a new baseline, particularly for elective surgery. This information may help clinicians and patients balance deferring the potential benefits of the surgery against the desire to avoid increased mortality from overly expeditious surgery after a recent cardiovascular event.
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Affiliation(s)
- Christos V. Chalitsios
- Academic Unit of Lifespan and Population Health, University of Nottingham, Nottingham, United Kingdom
| | - Matthew S. Luney
- Anaesthesia and Critical Care Section, Academic Unit of Injury, Inflammation and Repair, Queen’s Medical Centre, University of Nottingham, Nottingham, United Kingdom
- Nuffield Division of Anaesthetics, Nuffield Department of Clinical Neurosciences, University of Oxford, Oxford, United Kingdom
| | - William A. Lindsay
- Anaesthesia and Critical Care Section, Academic Unit of Injury, Inflammation and Repair, Queen’s Medical Centre, University of Nottingham, Nottingham, United Kingdom
- Department of Anaesthesia, Nottingham University Hospitals National Health Service Trust, Nottingham, United Kingdom
| | - Robert D. Sanders
- Speciality of Anaesthetics, Central Clinical School, & National Health and Medical Research Council Clinical Trials Centre, University of Sydney
- Department of Anaesthesia & Institute of Academic Surgery, Royal Prince Alfred Hospital, Camperdown, New South Wales, Australia
| | - Tricia M. McKeever
- Academic Unit of Lifespan and Population Health, University of Nottingham, Nottingham, United Kingdom
| | - Iain Moppett
- Anaesthesia and Critical Care Section, Academic Unit of Injury, Inflammation and Repair, Queen’s Medical Centre, University of Nottingham, Nottingham, United Kingdom
- Department of Anaesthesia, Nottingham University Hospitals National Health Service Trust, Nottingham, United Kingdom
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O'Dowd E, Berovic M, Callister M, Chalitsios CV, Chopra D, Das I, Draper A, Garner JL, Gleeson F, Janes S, Kennedy M, Lee R, Mauri F, McKeever TM, McNulty W, Murray J, Nair A, Park J, Rawlinson J, Sagoo GS, Scarsbrook A, Shah P, Sudhir R, Talwar A, Thakrar R, Watkins J, Baldwin DR. Determining the impact of an artificial intelligence tool on the management of pulmonary nodules detected incidentally on CT (DOLCE) study protocol: a prospective, non-interventional multicentre UK study. BMJ Open 2024; 14:e077747. [PMID: 38176863 PMCID: PMC10773382 DOI: 10.1136/bmjopen-2023-077747] [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] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/14/2023] [Accepted: 11/28/2023] [Indexed: 01/06/2024] Open
Abstract
INTRODUCTION In a small percentage of patients, pulmonary nodules found on CT scans are early lung cancers. Lung cancer detected at an early stage has a much better prognosis. The British Thoracic Society guideline on managing pulmonary nodules recommends using multivariable malignancy risk prediction models to assist in management. While these guidelines seem to be effective in clinical practice, recent data suggest that artificial intelligence (AI)-based malignant-nodule prediction solutions might outperform existing models. METHODS AND ANALYSIS This study is a prospective, observational multicentre study to assess the clinical utility of an AI-assisted CT-based lung cancer prediction tool (LCP) for managing incidental solid and part solid pulmonary nodule patients vs standard care. Two thousand patients will be recruited from 12 different UK hospitals. The primary outcome is the difference between standard care and LCP-guided care in terms of the rate of benign nodules and patients with cancer discharged straight after the assessment of the baseline CT scan. Secondary outcomes investigate adherence to clinical guidelines, other measures of changes to clinical management, patient outcomes and cost-effectiveness. ETHICS AND DISSEMINATION This study has been reviewed and given a favourable opinion by the South Central-Oxford C Research Ethics Committee in UK (REC reference number: 22/SC/0142).Study results will be available publicly following peer-reviewed publication in open-access journals. A patient and public involvement group workshop is planned before the study results are available to discuss best methods to disseminate the results. Study results will also be fed back to participating organisations to inform training and procurement activities. TRIAL REGISTRATION NUMBER NCT05389774.
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Affiliation(s)
- Emma O'Dowd
- Nottingham University Hospitals NHS Trust, Nottingham, UK emma.o'
| | - Marko Berovic
- King's College Hospital NHS Foundation Trust, London, UK
| | | | | | | | - Indrajeet Das
- University Hospitals of Leicester NHS Trust, Leicester, UK
| | - Adrian Draper
- Respiratory Medicine, St George's Hospital, London, UK
| | | | - Fergus Gleeson
- Oxford University Hospitals NHS Foundation Trust, Oxford, UK
| | - Sam Janes
- University College London, London, UK
| | | | - Richard Lee
- Royal Marsden Hospital NHS Trust, London, UK
| | | | | | | | - James Murray
- Royal Free London NHS Foundation Trust, London, UK
| | | | - John Park
- Oxford University Hospitals NHS Foundation Trust, Oxford, UK
| | - Janette Rawlinson
- Consumer Forum, NCRI CSG (lung) Subgroup, BTOG Steering Committee, NHSE CEG, National Cancer Research Institute, London, UK
| | - Gurdeep Singh Sagoo
- Population Health Sciences Institute, University of Newcastle, Newcastle upon Tyne, UK
| | | | - Pallav Shah
- Royal Brompton and Harefield NHS Foundation Trust, London, UK
| | - Rajini Sudhir
- University Hospitals of Leicester NHS Trust, Leicester, UK
| | - Ambika Talwar
- Oxford University Hospitals NHS Foundation Trust, Oxford, UK
| | - Ricky Thakrar
- University College London Hospitals NHS Foundation Trust, London, UK
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Chalitsios CV, Akyea RK, Abdul-Hamid H, Leonardi-Bee J, Kanchau JD, Kamal A, Mohamed-Yassin MS, Baharudin N, Ramli AS, Qureshi N. Age and Sex Differences in LDL Cholesterol Distribution in Adults in Malaysia: A Cross-Sectional Study (2010-2021). Int J Gen Med 2023; 16:5885-5888. [PMID: 38111851 PMCID: PMC10725830 DOI: 10.2147/ijgm.s423091] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2023] [Accepted: 09/27/2023] [Indexed: 12/20/2023] Open
Affiliation(s)
- Christos V Chalitsios
- Nottingham Centre for Epidemiology and Public Health, Lifespan and Population Health Unit, School of Medicine, University of Nottingham, Nottingham, UK
| | - Ralph K Akyea
- PRISM Research Group, Centre for Academic Primary Care, Lifespan and Population Health Unit, School of Medicine, University of Nottingham, Nottingham, UK
| | - Hasidah Abdul-Hamid
- PRISM Research Group, Centre for Academic Primary Care, Lifespan and Population Health Unit, School of Medicine, University of Nottingham, Nottingham, UK
- Department of Primary Care Medicine, Faculty of Medicine, Universiti Teknologi MARA, Sungai Buloh, Selangor, Malaysia
| | - Jo Leonardi-Bee
- Nottingham Centre for Epidemiology and Public Health, Lifespan and Population Health Unit, School of Medicine, University of Nottingham, Nottingham, UK
- Centre for Evidence-Based Medicine, Faculty of Medicine and Health Sciences, University of Nottingham, Nottingham, UK
| | - Johanes D Kanchau
- Institute of Pathology, Laboratory and Forensic Medicine (I‑PPerForM), Universiti Teknologi MARA, Sungai Buloh, Selangor, Malaysia
| | - Aisyah Kamal
- Institute of Pathology, Laboratory and Forensic Medicine (I‑PPerForM), Universiti Teknologi MARA, Sungai Buloh, Selangor, Malaysia
| | - Mohamed-Syarif Mohamed-Yassin
- Department of Primary Care Medicine, Faculty of Medicine, Universiti Teknologi MARA, Sungai Buloh, Selangor, Malaysia
| | - Noorhida Baharudin
- Department of Primary Care Medicine, Faculty of Medicine, Universiti Teknologi MARA, Sungai Buloh, Selangor, Malaysia
- Institute of Pathology, Laboratory and Forensic Medicine (I‑PPerForM), Universiti Teknologi MARA, Sungai Buloh, Selangor, Malaysia
| | - Anis Safura Ramli
- Department of Primary Care Medicine, Faculty of Medicine, Universiti Teknologi MARA, Sungai Buloh, Selangor, Malaysia
- Institute of Pathology, Laboratory and Forensic Medicine (I‑PPerForM), Universiti Teknologi MARA, Sungai Buloh, Selangor, Malaysia
| | - Nadeem Qureshi
- PRISM Research Group, Centre for Academic Primary Care, Lifespan and Population Health Unit, School of Medicine, University of Nottingham, Nottingham, UK
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Khan N, Chalitsios CV, Nartey Y, Simpson G, Zaccardi F, Santer M, Roderick PJ, Stuart B, Farmer AJ, Dambha-Miller H. Clustering by multiple long-term conditions and social care needs: a cross-sectional study among 10 026 older adults in England. J Epidemiol Community Health 2023; 77:770-776. [PMID: 37620006 PMCID: PMC10646893 DOI: 10.1136/jech-2023-220696] [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] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2023] [Accepted: 08/07/2023] [Indexed: 08/26/2023]
Abstract
BACKGROUND : People with multiple long-term conditions (MLTC) face health and social care challenges. This study aimed to classify people by MLTC and social care needs (SCN) into distinct clusters and quantify the association between derived clusters and care outcomes. METHODS : A cross-sectional study was conducted using the English Longitudinal Study of Ageing, including people with up to 10 MLTC. Self-reported SCN was assessed through 13 measures of difficulty with activities of daily living, 10 measures of mobility difficulties and whether health status was limiting earning capability. Latent class analysis was performed to identify clusters. Multivariable logistic regression quantified associations between derived MLTC/SCN clusters, all-cause mortality and nursing home admission. RESULTS: Our study included 9171 people at baseline with a mean age of 66.3 years; 44.5% were men. Nearly 70.8% had two or more MLTC, the most frequent being hypertension, arthritis and cardiovascular disease. We identified five distinct clusters classified as high SCN/MLTC through to low SCN/MLTC clusters. The high SCN/MLTC included mainly women aged 70-79 years who were white and educated to the upper secondary level. This cluster was significantly associated with higher nursing home admission (OR=8.71; 95% CI: 4.22 to 18). We found no association between clusters and all-cause mortality. CONCLUSIONS: We have highlighted those at risk of worse care outcomes, including nursing home admission. Distinct clusters of individuals with shared sociodemographic characteristics can help identify at-risk individuals with MLTC and SCN at primary care level.
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Affiliation(s)
- Nusrat Khan
- Primary Care Research Centre, University of Southampton, Southampton, UK
| | | | - Yvonne Nartey
- Primary Care Research Centre, University of Southampton, Southampton, UK
| | - Glenn Simpson
- Primary Care Research Centre, University of Southampton, Southampton, UK
| | - Francesco Zaccardi
- Leicester Real World Evidence Unit, Leicester Diabetes Centre, University of Leicester, Leicester, UK
| | - Miriam Santer
- Primary Care Research Centre, University of Southampton, Southampton, UK
| | - Paul J Roderick
- Primary Care Research Centre, University of Southampton, Southampton, UK
| | - Beth Stuart
- Centre for Evaluation and Methods, Wolfson Institute of Population Health, Queen Mary University of London, London, UK
| | - Andrew J Farmer
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, UK
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Nartey Y, Chalitsios CV, Khan N, Simpson G, Dambha-Miller H, Farmer A. Factors associated with multimorbidity in England: an analysis of the English Longitudinal Study of Ageing. Lancet 2023; 402 Suppl 1:S73. [PMID: 37997118 DOI: 10.1016/s0140-6736(23)02126-8] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/15/2023] [Revised: 08/24/2023] [Accepted: 09/22/2023] [Indexed: 11/25/2023]
Abstract
BACKGROUND Multimorbidity, defined as the presence of two or more long-term conditions, is a growing public health challenge, especially in terms of prevention and accumulation of long-term conditions among particular population cohorts. To date, efforts to understand multimorbidity has focused mainly on specific disease combinations, with little known about the sociodemographic factors associated with it. The study aimed to assess the factors associated with multimorbidity in England. METHODS A cross-sectional study was conducted using the English Longitudinal Study of Ageing (ELSA), a dataset of people aged 50 years and older. The study identified ten long-term conditions from waves 2 to 9. Wave 2 to 9 were conducted between June 2004 to July 2005, May 2006 to August 2007, May 2008 to July 2009, June 2010 to July 2011, May 2012 to June 2013, June 2014 to May 2015, May 2016 to June 2017 and June 2018 to July 2019, respectively. The study included people with two or more long-term conditions. We identified the number of long-term conditions and multimorbidity, and we examined their association with age, gender, ethnicity, marital status, employment status, education, weekly contact with relative, and feeling lonely, sad or depressed using multinomial logistic regression. FINDINGS Of 16 731 people recruited from wave 2 to wave 9, we identified 10 026 people with multimorbidity aged 50 years and older. The majority had two conditions (39%) and were female (55%), aged 50-69 years (32%), of white ethnicity (96%), married (69%) and unemployed (65·3%). The adjusted odds ratio (aOR) of having more than two long-term conditions increased with age, after adjusting for sex and ethnicity (≥5 conditions: aOR 12·89, 95% CI 2·23-3·76). Being female was associated with an increased risk of having more than two long-term conditions (≥5 conditions: aOR 1·21, 1·04-1·42). Similarly, being separated, divorced, or widowed were associated with having more than two long-term conditions (≥5 conditions: aOR 1·45, 1·21-1·74). Not owning a home was independently associated with more than two long-term conditions (≥5 conditions: aOR 1·59, 1·35-1·88). INTERPRETATION The current analysis used only ten long-term conditions that were available in the ELSA data, so a different association might have arisen if other conditions had been considered. Our findings provide insights into which particular groups of the multimorbid population could be the target of preventive public health strategies and wider clinical and social care interventions in England to reduce the burden of multimorbidity. FUNDING National Institute for Health and Care Research (NIHR).
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Affiliation(s)
- Yvonne Nartey
- Primary Care Research Centre, University of Southampton, Southampton, UK.
| | | | - Nusrat Khan
- Primary Care Research Centre, University of Southampton, Southampton, UK
| | - Glenn Simpson
- Primary Care Research Centre, University of Southampton, Southampton, UK
| | | | - Andrew Farmer
- Nuffield Department of Primary Care Health Sc, University of Oxford, Oxford, UK
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Georgiou AN, Zagkos L, Markozannes G, Chalitsios CV, Asimakopoulos AG, Xu W, Wang L, Mesa‐Eguiagaray I, Zhou X, Loizidou EM, Kretsavos N, Theodoratou E, Gill D, Burgess S, Evangelou E, Tsilidis KK, Tzoulaki I. Appraising the Causal Role of Risk Factors in Coronary Artery Disease and Stroke: A Systematic Review of Mendelian Randomization Studies. J Am Heart Assoc 2023; 12:e029040. [PMID: 37804188 PMCID: PMC7615320 DOI: 10.1161/jaha.122.029040] [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] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/02/2023] [Accepted: 06/27/2023] [Indexed: 10/09/2023]
Abstract
BACKGROUND Mendelian randomization (MR) offers a powerful approach to study potential causal associations between exposures and health outcomes by using genetic variants associated with an exposure as instrumental variables. In this systematic review, we aimed to summarize previous MR studies and to evaluate the evidence for causality for a broad range of exposures in relation to coronary artery disease and stroke. METHODS AND RESULTS MR studies investigating the association of any genetically predicted exposure with coronary artery disease or stroke were identified. Studies were classified into 4 categories built on the significance of the main MR analysis results and its concordance with sensitivity analyses, namely, robust, probable, suggestive, and insufficient. Studies reporting associations that did not perform any sensitivity analysis were classified as nonevaluable. We identified 2725 associations eligible for evaluation, examining 535 distinct exposures. Of them, 141 were classified as robust, 353 as probable, 110 as suggestive, and 926 had insufficient evidence. The most robust associations were observed for anthropometric traits, lipids, and lipoproteins and type 2 diabetes with coronary artery; disease and clinical measurements with coronary artery disease and stroke; and thrombotic factors with stroke. CONCLUSIONS Despite the large number of studies that have been conducted, only a limited number of associations were supported by robust evidence. Approximately half of the studies reporting associations presented an MR sensitivity analysis along with the main analysis that further supported the causality of associations. Future research should focus on more thorough assessments of sensitivity MR analyses and further assessments of mediation effects or nonlinearity of associations.
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Affiliation(s)
- Andrea N. Georgiou
- Department of Hygiene and EpidemiologyUniversity of Ioannina School of MedicineIoanninaGreece
| | - Loukas Zagkos
- Department of Epidemiology and BiostatisticsSchool of Public Health, Imperial College LondonLondonUK
| | - Georgios Markozannes
- Department of Hygiene and EpidemiologyUniversity of Ioannina School of MedicineIoanninaGreece
- Department of Epidemiology and BiostatisticsSchool of Public Health, Imperial College LondonLondonUK
| | - Christos V. Chalitsios
- Department of Hygiene and EpidemiologyUniversity of Ioannina School of MedicineIoanninaGreece
| | | | - Wei Xu
- Centre for Global Health, Usher InstituteThe University of EdinburghEdinburghUK
| | - Lijuan Wang
- Centre for Global Health, Usher InstituteThe University of EdinburghEdinburghUK
| | | | - Xuan Zhou
- Centre for Global Health, Usher InstituteThe University of EdinburghEdinburghUK
| | - Eleni M. Loizidou
- Department of Hygiene and EpidemiologyUniversity of Ioannina School of MedicineIoanninaGreece
- Biobank Cyprus Center of Excellence in Biobanking and Biomedical ResearchUniversity of CyprusNicosiaCyprus
| | - Nikolaos Kretsavos
- Department of Hygiene and EpidemiologyUniversity of Ioannina School of MedicineIoanninaGreece
| | - Evropi Theodoratou
- Centre for Global Health, Usher InstituteThe University of EdinburghEdinburghUK
- Cancer Research UK Edinburgh Centre, Institute of Genetics and CancerThe University of EdinburghEdinburghUK
| | - Dipender Gill
- Department of Epidemiology and BiostatisticsSchool of Public Health, Imperial College LondonLondonUK
- Medical Research Council Biostatistics UnitUniversity of CambridgeCambridgeUK
| | - Stephen Burgess
- Medical Research Council Biostatistics UnitUniversity of CambridgeCambridgeUK
- Cardiovascular Epidemiology UnitUniversity of CambridgeCambridgeUK
| | - Evangelos Evangelou
- Department of Hygiene and EpidemiologyUniversity of Ioannina School of MedicineIoanninaGreece
- Department of Epidemiology and BiostatisticsSchool of Public Health, Imperial College LondonLondonUK
- Department of Biomedical Research, Institute of Molecular Biology and BiotechnologyFoundation for Research and Technology‐HellasIoanninaGreece
| | - Konstantinos K. Tsilidis
- Department of Hygiene and EpidemiologyUniversity of Ioannina School of MedicineIoanninaGreece
- Department of Epidemiology and BiostatisticsSchool of Public Health, Imperial College LondonLondonUK
| | - Ioanna Tzoulaki
- Department of Epidemiology and BiostatisticsSchool of Public Health, Imperial College LondonLondonUK
- Centre for Systems Biology, Biomedical Research FoundationAcademy of AthensAthensGreece
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9
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Chalitsios CV, Santoso C, Nartey Y, Khan N, Simpson G, Islam N, Stuart B, Farmer A, Dambha-Miller H. Trajectories of multiple long-term conditions and mortality in older adults: A retrospective cohort study using English Longitudinal Study of Ageing (ELSA). medRxiv 2023:2023.05.18.23290151. [PMID: 37292869 PMCID: PMC10246039 DOI: 10.1101/2023.05.18.23290151] [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] [Subscribe] [Scholar Register] [Indexed: 06/10/2023]
Abstract
Objectives To classify older adults with MLTC into clusters based on accumulating conditions as trajectories over time, characterise clusters and quantify associations between derived clusters and all-cause mortality. Design We conducted a retrospective cohort study using the English Longitudinal Study of Ageing (ELSA) over nine years (n=15,091 aged 50 years and older). Group-based trajectory modelling was used to classify people into MLTC clusters based on accumulating conditions over time. Derived clusters were used to quantify the associations between MLTC trajectory memberships, sociodemographic characteristics, and all-cause mortality. Results Five distinct clusters of MLTC trajectories were identified and characterised as: "no-LTC" (18.57%), "single-LTC" (31.21%), "evolving MLTC" (25.82%), "moderate MLTC" (17.12%), and "high MLTC" (7.27%). Increasing age was consistently associated with an increased number of MLTC. Female sex (aOR = 1.13; 95%CI 1.01 to 1.27) and ethnic minority (aOR = 2.04; 95%CI 1.40 to 3.00) were associated with the "moderate MLTC" and "high MLTC" clusters, respectively. Higher education and paid employment were associated with a lower likelihood of progression over time towards an increased number of MLTC. All the clusters had higher all-cause mortality than the "no-LTC" cluster. Conclusions The development of MLTC and the increase in the number of conditions over time follow distinct trajectories. These are determined by non-modifiable (age, sex, ethnicity) and modifiable factors (education and employment). Stratifying risk through clustering will enable practitioners to identify older adults with a higher likelihood of worsening MLTC over time to tailor effective interventions.
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Affiliation(s)
| | - Cornelia Santoso
- Primary Care Research Centre, University of Southampton, Southampton, UK
| | - Yvonne Nartey
- Primary Care Research Centre, University of Southampton, Southampton, UK
| | - Nusrat Khan
- Primary Care Research Centre, University of Southampton, Southampton, UK
| | - Glenn Simpson
- Primary Care Research Centre, University of Southampton, Southampton, UK
| | - Nazrul Islam
- Primary Care Research Centre, University of Southampton, Southampton, UK
| | - Beth Stuart
- Centre for Evaluation and Methods, Wolfson Institute of Population Health, Queen Mary University of London, London, UK
| | - Andrew Farmer
- Nuffield Department of Primary Care Health Sciences, University of Oxford, UK
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10
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Chalitsios CV, Tsilidis KK, Tzoulaki I. Psoriasis and COVID-19: A bidirectional Mendelian randomization study. J Am Acad Dermatol 2023; 88:893-895. [PMID: 36244549 PMCID: PMC9561435 DOI: 10.1016/j.jaad.2022.10.019] [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] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2022] [Revised: 10/04/2022] [Accepted: 10/11/2022] [Indexed: 11/15/2022]
Affiliation(s)
- Christos V Chalitsios
- Department of Hygiene and Epidemiology, School of Medicine, University of Ioannina, Ioannina, Greece.
| | - Kostas K Tsilidis
- Department of Hygiene and Epidemiology, School of Medicine, University of Ioannina, Ioannina, Greece; Department of Biostatistics and Epidemiology, School of Public Health, Imperial College London, London, UK
| | - Ioanna Tzoulaki
- Department of Hygiene and Epidemiology, School of Medicine, University of Ioannina, Ioannina, Greece; Department of Biostatistics and Epidemiology, School of Public Health, Imperial College London, London, UK; BHF Centre of Excellence, School of Public Health, Imperial College London, London, UK
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11
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Chalitsios CV, Georgiou A, Bouras E, Evangelou E, Gill D, Tsilidis KK, Tzoulaki I. Investigating modifiable pathways in psoriasis: A Mendelian randomization study. J Am Acad Dermatol 2023; 88:593-601. [PMID: 36370904 DOI: 10.1016/j.jaad.2022.11.010] [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] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2022] [Revised: 11/03/2022] [Accepted: 11/05/2022] [Indexed: 11/10/2022]
Abstract
BACKGROUND Potentially modifiable risk factors have previously been investigated only in conventional observational studies. OBJECTIVE To assess whether genetically predicted exposures to modifiable factors are associated with the risk of psoriasis. METHODS Two-sample Mendelian randomization (MR) analysis. RESULTS An increased risk of psoriasis was noted for genetically predicted lifetime smoking index (odds ratio [OR]MR-IVW = 2.11; 95% confidence interval [CI], 1.28-3.51), childhood (OR MR-IVW = 1.40; 95% CI, 1.14-1.71) and adult body mass index (OR MR-IVW = 1.63; 95% CI, 1.32-2), waist (OR IVW = 1.86; 95% CI, 1.31-2.64), and hip circumference (OR MR-IVW = 1.55; 95% CI, 1.15-2.07). Protective association was also reported between genetically predicted longer sleep duration (OR MR-IVW = 0.56; 95% CI 0.37-0.84) and increased years of education (OR MR-IVW = 0.78; 95% CI, 0.62-0.98). This effect of education persisted in multivariable MR after adjusting for genetic predictors of smoking and adult body mass index (ORMVMR-IVW = 0.72; 95% CI, 0.56-0.92). LIMITATIONS It was not possible to stratify for psoriasis severity. CONCLUSION Smoking cessation and prevention of obesity are important strategies for decreasing the incidence of psoriasis. Similarly, targeting education inequality is expected to lead further to reductions in cases of psoriasis.
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Affiliation(s)
- Christos V Chalitsios
- Department of Hygiene and Epidemiology, School of Medicine, University of Ioannina, Ioannina, Greece.
| | - Andrea Georgiou
- Department of Hygiene and Epidemiology, School of Medicine, University of Ioannina, Ioannina, Greece
| | - Emmanouil Bouras
- Department of Hygiene and Epidemiology, School of Medicine, University of Ioannina, Ioannina, Greece
| | - Evangelos Evangelou
- Department of Hygiene and Epidemiology, School of Medicine, University of Ioannina, Ioannina, Greece; Department of Biostatistics and Epidemiology, School of Public Health, Imperial College London, London, UK; Institute of Biosciences, University Research Center of Ioannina, University of Ioannina, Ioannina, Greece
| | - Dipender Gill
- Department of Biostatistics and Epidemiology, School of Public Health, Imperial College London, London, UK
| | - Kostas K Tsilidis
- Department of Hygiene and Epidemiology, School of Medicine, University of Ioannina, Ioannina, Greece; Department of Biostatistics and Epidemiology, School of Public Health, Imperial College London, London, UK
| | - Ioanna Tzoulaki
- Department of Hygiene and Epidemiology, School of Medicine, University of Ioannina, Ioannina, Greece; Department of Biostatistics and Epidemiology, School of Public Health, Imperial College London, London, UK; Institute of Biosciences, University Research Center of Ioannina, University of Ioannina, Ioannina, Greece; BHF Centre of Excellence, School of Public Health, Imperial College London, London, UK
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12
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Chalitsios CV, Tsilidis KK, Tzoulaki I. Response to comment on "Psoriasis and COVID-19: A bidirectional Mendelian randomization study". J Am Acad Dermatol 2023; 88:e149. [PMID: 36442640 PMCID: PMC9729065 DOI: 10.1016/j.jaad.2022.11.037] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2022] [Accepted: 11/20/2022] [Indexed: 11/27/2022]
Affiliation(s)
- Christos V Chalitsios
- Department of Hygiene and Epidemiology, School of Medicine, University of Ioannina, Ioannina, Greece.
| | - Kostas K Tsilidis
- Department of Hygiene and Epidemiology, School of Medicine, University of Ioannina, Ioannina, Greece; Department of Biostatistics and Epidemiology, School of Public Health, Imperial College London, London, UK
| | - Ioanna Tzoulaki
- Department of Hygiene and Epidemiology, School of Medicine, University of Ioannina, Ioannina, Greece; Department of Biostatistics and Epidemiology, School of Public Health, Imperial College London, London, UK; BHF Centre of Excellence, School of Public Health, Imperial College London, London, UK
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13
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Chalitsios CV, Fogarty AW, McKeever TM, Shaw DE. Sedative medications: an avoidable cause of asthma and COPD exacerbations? Lancet Respir Med 2023; 11:e31-e32. [PMID: 36804029 DOI: 10.1016/s2213-2600(23)00042-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/26/2022] [Revised: 01/16/2023] [Accepted: 01/27/2023] [Indexed: 02/17/2023]
Affiliation(s)
- Christos V Chalitsios
- Lifespan and Population Health, Nottingham City Hospital, University of Nottingham, Nottingham NG5 1PB, UK; Nottingham NIHR Respiratory Biomedical Research Centre, Nottingham, UK.
| | - Andrew W Fogarty
- Lifespan and Population Health, Nottingham City Hospital, University of Nottingham, Nottingham NG5 1PB, UK; Nottingham NIHR Respiratory Biomedical Research Centre, Nottingham, UK
| | - Tricia M McKeever
- Lifespan and Population Health, Nottingham City Hospital, University of Nottingham, Nottingham NG5 1PB, UK; Nottingham NIHR Respiratory Biomedical Research Centre, Nottingham, UK
| | - Dominick E Shaw
- Nottingham NIHR Respiratory Biomedical Research Centre, Nottingham, UK
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14
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Chalitsios CV, Baskaran V, Harwood RH, Lim WS, McKeever TM. Incidence of cognitive impairment and dementia after hospitalisation for pneumonia: a UK population-based matched cohort study. ERJ Open Res 2022; 9:00328-2022. [DOI: 10.1183/23120541.00328-2022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2022] [Accepted: 10/18/2022] [Indexed: 11/05/2022] Open
Abstract
BackgroundSurvivors of common infections may develop cognitive impairment or dementia, however; the risk of these conditions in people hospitalised with pneumonia is not well-established.MethodsA matched cohort study was conducted using Hospital Episode Statistics (HES) data linked to Clinical Practice Research Database (CPRD). Adults with the first ICD-10 code for pneumonia recorded in HES between 1 July 2002 and 30 June 2017 were included and up to four controls without hospitalisation for pneumonia in CPRD were matched by gender, age, and practice. Cognitive impairment and dementia incidence rates were calculated, and survival analysis was performed comparing those hospitalised with pneumonia to the general population.ResultsThe incidence rates of cognitive impairment and dementia were 18 (95%CI 17.3 to 18.7) and 13.2 (95%CI 13 to 13.5) per 1000 person-years among persons previously hospitalised with pneumonia and the matched cohort respectively. People previously hospitalised with pneumonia had 53% higher incidence of cognitive impairment and dementia (aHR 1.53; 95% CI 1.46 to 1.61) than their matched cohort. The highest incidence was observed within 1-year of hospitalisation for pneumonia compared to the general population (aHR=1.89; 95%CI 1.75 to 2.05). Age modified the effect of hospitalisation for pneumonia on cognitive impairment and dementia such that the size of effect was stronger in people between 45 and 60 years old (pinteraction<0.0001).ConclusionCognitive impairment and dementia are more likely to be diagnosed in people who have been hospitalised for pneumonia, especially in the first year after discharge, than in the general population.
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Chalitsios CV, Shaw DE, McKeever TM. Risk of subtrochanteric and femoral shaft fractures due to bisphosphonate therapy in asthma: a population-based nested case-control study. Osteoporos Int 2022; 33:931-935. [PMID: 34635953 DOI: 10.1007/s00198-021-06197-7] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [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: 06/23/2021] [Accepted: 10/05/2021] [Indexed: 11/24/2022]
Abstract
UNLABELLED Concerns have been raised over the association between bisphosphonates and atypical fractures in subtrochanteric and femoral shaft regions, but the potential risk of these fractures due to bisphosphonate use in asthma has not been examined. INTRODUCTION Bisphosphonates are used as first-line treatment for osteoporosis; however, concerns have been raised over their association with atypical subtrochanteric (ST) and femoral shaft (FS) fractures. The potential risk of atypical ST/FS fractures from bisphosphonate use in asthma has not been examined. METHODS A nested case-control study was conducted using linked data from the Clinical Practice Research Datalink (CPRD) and Hospital Episode Statistics (HES) databases. Using an asthma cohort, we identified patients with atypical ST/FS fractures and sex, age, and practice-matched controls. Conditional logistic regression was used to determine the association between bisphosphonate exposure and atypical ST/FS fractures. RESULTS From a cohort of 69,074 people with asthma, 67 patients with atypical ST/FS fractures and 260 matched control subjects were identified. Of the case patients, 40.3% had received bisphosphonates as compared with 14.2% of the controls corresponding to an adjusted odds ratio (aOR) of 4.42 (95%CI, 2.98 to 8.53). The duration of use influenced the risk with long-term users to be at a greater risk (> 5 years vs no exposure; aOR = 7.67; 95%CI, 1.75 to 33.91). Drug withdrawal was associated with diminished odds of atypical ST/FS fractures. CONCLUSION Regular review of bisphosphonates should occur in patients with asthma. The risks and benefits of bisphosphonate therapy should be carefully considered in consultation with the patient. To improve AFF prevention, early signs which may warrant imaging, such as prodromal thigh pain, should be discussed.
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Affiliation(s)
- C V Chalitsios
- Division of Respiratory Medicine, Clinical Science Building, School of Medicine, University of Nottingham, Nottingham, UK.
- Division of Epidemiology and Public Health, Clinical Science Building, School of Medicine, University of Nottingham, Nottingham, UK.
| | - D E Shaw
- Division of Respiratory Medicine, Clinical Science Building, School of Medicine, University of Nottingham, Nottingham, UK
| | - T M McKeever
- Division of Epidemiology and Public Health, Clinical Science Building, School of Medicine, University of Nottingham, Nottingham, UK
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16
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Heydarian M, Behzadifar M, Chalitsios CV, Keshvari M, Omidifar R, Ghanbari MK, Gorji HA, Kong JD, Wu J, Bragazzi NL. Effect of COVID-19 on the Number of CT-scans and MRI Services of Public Hospitals in Iran: An Interrupted Time Series Analysis. Ethiop J Health Sci 2021; 31:1109-1114. [PMID: 35392347 PMCID: PMC8968382 DOI: 10.4314/ejhs.v31i6.5] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2021] [Accepted: 08/26/2021] [Indexed: 11/18/2022] Open
Abstract
Background In February 2020, the Ministry of Health and Medical Education in Iran announced the first case of COVID-19. The aim of this study was to investigate the impact of COVID-19 on the number of CT-Scans and MRI services in public hospitals in western Iran. Methods We collected CT-scans and MRI services data from 18 public hospitals via Vice-Chancellor Office, Lorestan University of Medical Sciences from January 2017 to February 2021. Interrupted time series analysis (ITSA) was conducted to assess the impact of COVID-19 on CT-Scans and MRI services. More specifically, ITSA was conducted using ordinary least squares regression with the number of CT-Scans and MRI services per 1,000 registered persons per month as dependent variable. Results At the beginning of the observation period, the monthly rate of CT-Scans was constant (p for trend = 0.267) at 291.9 (from 95%CI 240.5 to 343.4) per 1,000 registered patients. The first case of COVID-19 coincided with an abrupt increase by 211.8 (from 95%CI 102.9 to 320.7) per 1,000 patients. Thereafter, the trend of CT-Scans did not change (p=0.576) compared to the pre-pandemic period. The rate of MRI services was 363.5 per 1,000 per registered patients per month (P = <0.0001) with a slightly decreasing trend (coefficient=-5; 95%CI, -6.9 to -3.1). Conclusion The findings of this study showed that crises such as COVID-19 can affect the service delivery process. Health policymakers and decision makers should work to prevent potential reductions in health care during events such as COVID-19.
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Affiliation(s)
- Mohammad Heydarian
- Department of Radiology, Faculty of Medicine, Lorestan University of Medical Sciences, Khorramabad, Iran
| | - Masoud Behzadifar
- Social Determinants of Health Research Center, Lorestan University of Medical Sciences, Khorramabad, Iran
| | - Christos V Chalitsios
- Division of Respiratory Medicine, Clinical Science Building, School of Medicine, University of Nottingham, Nottingham NG5 1PB, UK, Division of Epidemiology and Public Health, Clinical Science Building, School of Medicine, University of Nottingham, Nottingham NG5 1PB, UK
| | - Mohammad Keshvari
- Vice Chancellor Office, Lorestan University of Medical Sciences, Khorramabad, Iran
| | - Roodabeh Omidifar
- Vice Chancellor Office, Lorestan University of Medical Sciences, Khorramabad, Iran
| | | | | | - Jude Dzevela Kong
- Laboratory for Industrial and Applied Mathematics (LIAM), Department of Mathematics and Statistics, York University, Toronto, Canada
| | - Jianhong Wu
- Laboratory for Industrial and Applied Mathematics (LIAM), Department of Mathematics and Statistics, York University, Toronto, Canada
| | - Nicola Luigi Bragazzi
- Laboratory for Industrial and Applied Mathematics (LIAM), Department of Mathematics and Statistics, York University, Toronto, Canada, School of Public Health, Department of Health Sciences (DISSAL), University of Genoa, Genoa, Italy
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Chalitsios CV, McKeever TM, Langley TE, Shaw DE. Impact of COVID-19 on corticosteroids and antibiotics prescribing in England: an interrupted time series analysis. J Public Health (Oxf) 2021; 43:517-520. [PMID: 33539527 PMCID: PMC7928821 DOI: 10.1093/pubmed/fdab017] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [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] [Received: 01/18/2021] [Revised: 01/18/2021] [Accepted: 01/19/2021] [Indexed: 11/30/2022] Open
Abstract
Inhaled corticosteroids (ICS), prednisolone and antibiotics all play a crucial role in the management of respiratory diseases. The aim of this study was to analyse whether the declaration of the COVID-19 pandemic affected prescribing rates, as public health measures were implemented to reduce transmission of SARS-CoV-2. Monthly practise-level prescribing data published by NHS Digital were analysed. At the point, the COVID-19 outbreak was declared a pandemic, ICS prescriptions rose significantly. This was followed by a decrease in ICS and prednisolone prescribing in the following months. There was no difference in the antibiotic prescribing trend.
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Affiliation(s)
- Christos V Chalitsios
- Division of Respiratory Medicine, Clinical Science Building, School of Medicine, University of Nottingham, Nottingham NG5 1PB, UK.,Division of Epidemiology and Public Health, Clinical Science Building, School of Medicine, University of Nottingham, Nottingham NG5 1PB, UK
| | - Tricia M McKeever
- Division of Epidemiology and Public Health, Clinical Science Building, School of Medicine, University of Nottingham, Nottingham NG5 1PB, UK
| | - Tessa E Langley
- Division of Epidemiology and Public Health, Clinical Science Building, School of Medicine, University of Nottingham, Nottingham NG5 1PB, UK
| | - Dominick E Shaw
- Division of Respiratory Medicine, Clinical Science Building, School of Medicine, University of Nottingham, Nottingham NG5 1PB, UK
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18
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Chalitsios CV, Shaw DE, McKeever TM. Corticosteroids and bone health in people with asthma: A systematic review and meta-analysis. Respir Med 2021; 181:106374. [PMID: 33799052 DOI: 10.1016/j.rmed.2021.106374] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/16/2021] [Revised: 03/17/2021] [Accepted: 03/18/2021] [Indexed: 12/31/2022]
Abstract
BACKGROUND Understanding the potential deleterious effects of corticosteroids on bone health in people with asthma is important when making treatment decisions. There is a need for clearer evidence to better quantify the risk and effect size. METHODS Databases were systematically searched to identify studies reporting on bone mineral density (BMD) measurement and risk of osteoporosis or fracture, comparing people with asthma exposed to inhaled (ICS) or oral (OCS) corticosteroids, with nonexposed people with asthma and healthy controls. Data were narratively synthesized, and a series of meta-analyses were performed using the random-effects inverse variance method. RESULTS This review consists of 28 studies (six randomized control trials and 22 observational). There was no effect of ICS on bone loss both at spine and femoral neck in asthma. People with asthma receiving OCS were at greater risk of osteoporosis than nonexposed people with asthma (pooled HR = 1.76; 95%CI: 1.48 to 2.09; I2=68%). Similarly, higher ICS exposure was associated with higher risk of osteoporosis (OR = 1.63; 95%CI: 1.33 to 1.99) and fracture (pooled OR = 1.19; 95%CI: 1.05 to 1.35; I2=0%) when comparing people with asthma receiving ICS and not. CONCLUSION Patients with asthma exposed to OCS or high ICS doses become more susceptible to bone comorbidities. Striking the right balance between efficacy and safety of steroids in asthma is important to improve patients' quality of life.
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Affiliation(s)
- Christos V Chalitsios
- Division of Respiratory Medicine, Clinical Science Building, School of Medicine, University of Nottingham, Nottingham, NG5 1PB, UK; Division of Epidemiology and Public Health, Clinical Science Building, School of Medicine, University of Nottingham, Nottingham, NG5 1PB, UK.
| | - Dominick E Shaw
- Division of Respiratory Medicine, Clinical Science Building, School of Medicine, University of Nottingham, Nottingham, NG5 1PB, UK
| | - Tricia M McKeever
- Division of Epidemiology and Public Health, Clinical Science Building, School of Medicine, University of Nottingham, Nottingham, NG5 1PB, UK
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Chalitsios CV, McKeever TM, Shaw DE. Incidence of osteoporosis and fragility fractures in asthma: a UK population-based matched cohort study. Eur Respir J 2021; 57:13993003.01251-2020. [PMID: 32764111 DOI: 10.1183/13993003.01251-2020] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2020] [Accepted: 07/29/2020] [Indexed: 11/05/2022]
Abstract
INTRODUCTION Osteoporosis and fragility fractures are associated with corticosteroids which are the mainstay treatment for asthma; however, these bone comorbidities within asthma need to be better described. METHODS A matched cohort study was conducted using the UK Clinical Practice Research Database (CPRD). Adults with an incident asthma code were identified and matched, with up to four randomly selected people without asthma, by age, sex and practice. Osteoporosis and fragility fracture incidence rates were calculated, and Cox regression was performed comparing hazard rates to the general population. We report the impact of age, sex, glucocorticoids and the risk of specific fractures. RESULTS Patients with asthma had a higher risk of osteoporosis (adjusted hazard ratio (aHR) 1.18, 95% CI 1.13-1.23) and were 12% (aHR 1.12, 95% CI 1.07-1.16) more likely to sustain fragility fractures than the general population. Age modified the effect of asthma on osteoporosis and fragility fractures, such that the effect was stronger in younger people (pinteraction<0.0001). The vertebra (aHR 1.40, 95% CI 1.33-1.48) and forearm/wrist (aHR 1.27, 95% CI 1.22-1.32) were the sites linked with a larger incidence. A dose-response relationship between oral corticosteroids (OCS) and osteoporosis was observed, whereas the risk of fragility fractures increased in those with six or more OCS courses per year. Regular use of inhaled corticosteroids (ICS) increased the risk of both bone conditions. CONCLUSIONS Patients with asthma are more likely to develop osteoporosis or sustain fragility fractures than the general population, with a particular concern in younger people and those more frequently using OCS and ICS.
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Affiliation(s)
- Christos V Chalitsios
- Division of Respiratory Medicine, School of Medicine, University of Nottingham, Nottingham, UK
| | - Tricia M McKeever
- Division of Epidemiology and Public Health, School of Medicine, University of Nottingham, Nottingham, UK
| | - Dominick E Shaw
- Division of Respiratory Medicine, School of Medicine, University of Nottingham, Nottingham, UK
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Chalitsios CV, Shaw DE, McKeever TM. Risk of osteoporosis and fragility fractures in asthma due to oral and inhaled corticosteroids: two population-based nested case-control studies. Thorax 2020; 76:21-28. [PMID: 33087546 DOI: 10.1136/thoraxjnl-2020-215664] [Citation(s) in RCA: 21] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2020] [Revised: 09/04/2020] [Accepted: 09/10/2020] [Indexed: 11/04/2022]
Abstract
BACKGROUND Inhaled (ICS) and oral (OCS) corticosteroids are used widely in asthma; however, the risk of osteoporosis and fragility fracture (FF) due to corticosteroids in asthma is not well-established. METHODS We conducted two nested case-control studies using linked data from the Clinical Practice Research Datalink (CPRD) and Hospital Episode Statistics (HES) databases. Using an asthma cohort, we separately identified patients with osteoporosis or FF and gender-, age- and practice-matched controls. Conditional logistic regression was used to determine the association between ICS and OCS exposure, and the risk of osteoporosis or FF. The prevalence of patients receiving at least one bisphosphonate was also calculated. RESULTS There was a dose-response relationship between both cumulative dose and number of OCS/ICS prescriptions within the previous year, and risk of osteoporosis or FF. After adjusting for confounders, people receiving more OCS prescriptions (≥9 vs 0) had a 4.50 (95% CI 3.21 to 6.11) and 2.16 (95% CI 1.56 to 3.32) increased risk of osteoporosis and FF, respectively. For ICS (≥11 vs 0) the ORs were 1.60 (95% CI 1.22 to 2.10) and 1.31 (95% CI 1.02 to 1.68). The cumulative dose had a similar impact, with those receiving more OCS or ICS being at greater risk. The prevalence of patients taking ≥9 OCS and at least one bisphosphonate prescription was just 50.6% and 48.4% for osteoporosis and FF, respectively. CONCLUSIONS The findings suggest that exposure to OCS or ICS is an independent risk factors for bone health in patients with asthma. Steroid administration at the lowest possible level to maintain asthma control is recommended.
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Affiliation(s)
- Christos V Chalitsios
- School of Medicine, Division of Respiratory Medicine, University of Nottingham, Nottingham, UK
| | - Dominick E Shaw
- School of Medicine, Division of Respiratory Medicine, University of Nottingham, Nottingham, UK
| | - Tricia M McKeever
- School of Medicine, Division of Epidemiology and Public Health, University of Nottingham, Nottingham, UK
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Chalitsios CV, Shaw DE, McKeever TM. A retrospective database study of oral corticosteroid and bisphosphonate prescribing patterns in England. NPJ Prim Care Respir Med 2020; 30:5. [PMID: 32054843 PMCID: PMC7018734 DOI: 10.1038/s41533-020-0162-6] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2019] [Accepted: 01/16/2020] [Indexed: 11/28/2022] Open
Abstract
Exposure to oral corticosteroids (OCS) is associated with an increased risk of osteoporosis and fragility fractures. Guidelines suggest bisphosphonate (BP) therapy as the first-line treatment of glucocorticoid-induced osteoporosis (GIOP). This population study used publicly available data, including prescription annual cost analysis and monthly practice-level data. Our aim was to examine the prescribing of OCS and BP at practice level and investigate reasons for variation using a mixed-effect negative binomial regression analysis. There was a rise in OCS and BP prescriptions of 55% and 1200% from 1998 to 2018, respectively. Of the 6586 included practices, the median (IQR) of OCS and BP prescriptions were 120.8 (84.8-160.4) and 107.7 (73.8-147.4) per 1000 patients, respectively. Asthma and chronic obstructive pulmonary disease (COPD) were significantly associated with OCS use (p < 0.0001), but only COPD was associated with BP use (p < 0.0001). Higher OCS prescribing rates were associated with higher BP prescribing rates (5th to 1st quintile-IRR = 1.99; 95% CI: 1.88-2.10). Practice list size, deprivation and advanced age were all associated with both drugs (p < 0.0001). In conclusion, although OCS use is positively associated with BP prescription, variation among practices and CCGs exists. The variation in prescribing suggests there is still a need to improve GIOP prevention.
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Affiliation(s)
| | - Dominick E Shaw
- NIHR Division of Respiratory Medicine, University of Nottingham, Nottingham, UK
| | - Tricia M McKeever
- Division of Epidemiology and Public Health, University of Nottingham, Nottingham, UK
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