1
|
Hecht CJ, Lavu MS, Kaelber DC, Homma Y, Kamath AF. Association between abductor tears and hip pathology: A nationwide large cohort study. J Orthop 2024; 53:140-146. [PMID: 38601894 PMCID: PMC11002529 DOI: 10.1016/j.jor.2024.03.036] [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: 03/13/2024] [Accepted: 03/30/2024] [Indexed: 04/12/2024] Open
Abstract
Introduction Although gluteal tears have been observed in a substantial percentage of total hip arthroplasty (THA) patients and hip osteoarthritis (OA) has been shown to alter the function of the gluteal muscles, the association between gluteal tears and hip OA has not been characterized. Therefore, we evaluated (1) the overlap between hip OA and gluteal tears, (2) the relative risks of gluteal tears in patients who have hip OA, and (3) gluteal tear-free survival after diagnosis or treatment for hip osteoarthritis. Methods This retrospective study sourced data from TriNetX, a research network that aggregates data from over 92 million patients. Relative risks for gluteal tears were calculated for known risk factors for gluteal tears, age ≥45 years, female sex, and obesity, as well as for hip OA, hip injections, and THA. A subgroup analysis was performed utilizing a Cox proportional hazard model for patients who were diagnosed with hip OA, received a hip injection, or underwent THA in 2015 to assess gluteal tear-free survival over a 9-year timeframe. Results There was a large degree of overlap between patients with hip OA and gluteal tears, as 17.9% of patients with hip OA and 27.5% of patients with a gluteal tear also had the other pathology. Hip OA was associated with a markedly increased risk of a gluteal tear compared to healthy controls (Relative risk: 26.75, 95% CI: 26.64-26.86). Upon controlling for the established risk factors of gluteal tears, patients with hip OA had a markedly more likely to subsequently be diagnosed with an abductor tear (Hazard ratio: 12.46, 95% CI: 11.75-13.22). Conclusion Overall, these findings suggest a strong association between hip OA and the development of gluteal tears, in which further investigation is merited to determine the biomechanical pathophysiology underlying this potential relationship to inform prevention and treatment strategies.
Collapse
Affiliation(s)
- Christian J. Hecht
- Department of Orthopaedics, Case Western Reserve University School of Medicine, Cleveland, OH, 44106, USA
- Department of Orthopaedic Surgery, Cleveland Clinic Foundation, Cleveland, OH, 44195, USA
| | - Monish S. Lavu
- Department of Orthopaedics, Case Western Reserve University School of Medicine, Cleveland, OH, 44106, USA
- Department of Orthopaedic Surgery, Cleveland Clinic Foundation, Cleveland, OH, 44195, USA
| | - David C. Kaelber
- Departments of Internal Medicine, Pediatrics, and Population and Quantitative Health Sciences, Case Western Reserve University, 44106, USA
- The Center for Clinical Informatics Research and Education, The MetroHealth System, Cleveland, OH, 44109, USA
| | - Yasuhiro Homma
- Department of Medicine for Orthopaedics and Motor Organ, Juntendo University Graduate School of Medicine, Tokyo, Japan
| | - Atul F. Kamath
- Department of Orthopaedic Surgery, Cleveland Clinic Foundation, Cleveland, OH, 44195, USA
| |
Collapse
|
2
|
Lavu MS, Porto JR, Hecht CJ, Acuña AJ, Kaelber DC, Parvizi J, Kamath AF. Low-Dose Aspirin Is the Safest Prophylaxis for Prevention of Venous Thromboembolism After Total Knee Arthroplasty Across All Patient Risk Profiles. J Bone Joint Surg Am 2024:00004623-990000000-01100. [PMID: 38753809 DOI: 10.2106/jbjs.23.01158] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 05/18/2024]
Abstract
BACKGROUND The International Consensus Meeting on Venous Thromboembolism (ICM-VTE) in 2022 proclaimed low-dose aspirin as the most effective agent in patients across all risk profiles undergoing joint arthroplasty. However, data on large patient populations assessing trends in chemoprophylactic choices and related outcomes following total knee arthroplasty (TKA) remain scant. The present study was designed to characterize the clinical use of various chemoprophylactic agents in patients undergoing TKA and to determine the efficacy of aspirin compared with other agents in patient groups stratified by VTE risk profiles. METHODS This study utilized a national database to determine the proportion of patients undergoing TKA who received low-dose aspirin versus other chemoprophylaxis between 2012 and 2022. VTE risk profiles were determined on the basis of comorbidities established in the ICM-VTE. The odds ratios (ORs) and 95% confidence intervals (CIs) between various classes of thromboprophylaxis in patients with high and low risk of VTE were calculated. The odds of deep-vein thrombosis (DVT), pulmonary embolus (PE), bleeding events, infections, mortality, and hospitalizations were also assessed in the 90-day postoperative period for propensity-matched cohorts receiving low-dose (81 mg) aspirin only versus other prophylaxis, segregating patients by VTE risk profile. RESULTS A total of 126,692 patients undergoing TKA across 60 health-care organizations were included. The proportion of patients receiving low-dose aspirin increased from 7.65% to 55.29% between 2012 and 2022, whereas the proportion of patients receiving other chemoprophylaxis decreased from 96.25% to 42.98%. Low-dose-aspirin-only use increased to approximately 50% in both high-risk and low-risk populations but was more likely in low-risk populations (OR, 1.17; 95% CI, 1.15 to 1.20) relative to high-risk populations. Both low-risk and high-risk patients in the low-dose-aspirin-only cohorts had decreased odds of DVT, PE, bleeding, infections, and hospitalizations compared with other prophylaxis regimens. CONCLUSIONS The findings of the present study on a very large population of patients undergoing TKA support the recent ICM-VTE statement by showing that low-dose aspirin is a safe and effective method of prophylaxis in patients across various risk profiles. LEVEL OF EVIDENCE Therapeutic Level III. See Instructions for Authors for a complete description of levels of evidence.
Collapse
Affiliation(s)
- Monish S Lavu
- Department of Orthopaedics, Case Western Reserve University School of Medicine, Cleveland, Ohio
- Department of Orthopaedic Surgery, Cleveland Clinic Foundation, Cleveland, Ohio
| | - Joshua R Porto
- Department of Orthopaedics, Case Western Reserve University School of Medicine, Cleveland, Ohio
- Department of Orthopaedic Surgery, Cleveland Clinic Foundation, Cleveland, Ohio
| | - Christian J Hecht
- Department of Orthopaedics, Case Western Reserve University School of Medicine, Cleveland, Ohio
- Department of Orthopaedic Surgery, Cleveland Clinic Foundation, Cleveland, Ohio
| | - Alexander J Acuña
- Department of Orthopaedics, Rush University Medical Center, Chicago, Illinois
| | - David C Kaelber
- Departments of Internal Medicine, Pediatrics, and Population and Quantitative Health Sciences, Case Western Reserve University, Cleveland, Ohio
- Center for Clinical Informatics Research and Education, The MetroHealth System, Cleveland, Ohio
| | - Javad Parvizi
- Rothman Orthopaedic Institute at Thomas Jefferson University, Philadelphia, Pennsylvania
| | - Atul F Kamath
- Department of Orthopaedic Surgery, Cleveland Clinic Foundation, Cleveland, Ohio
| |
Collapse
|
3
|
Gross RS, Thaweethai T, Rosenzweig EB, Chan J, Chibnik LB, Cicek MS, Elliott AJ, Flaherman VJ, Foulkes AS, Gage Witvliet M, Gallagher R, Gennaro ML, Jernigan TL, Karlson EW, Katz SD, Kinser PA, Kleinman LC, Lamendola-Essel MF, Milner JD, Mohandas S, Mudumbi PC, Newburger JW, Rhee KE, Salisbury AL, Snowden JN, Stein CR, Stockwell MS, Tantisira KG, Thomason ME, Truong DT, Warburton D, Wood JC, Ahmed S, Akerlundh A, Alshawabkeh AN, Anderson BR, Aschner JL, Atz AM, Aupperle RL, Baker FC, Balaraman V, Banerjee D, Barch DM, Baskin-Sommers A, Bhuiyan S, Bind MAC, Bogie AL, Bradford T, Buchbinder NC, Bueler E, Bükülmez H, Casey BJ, Chang L, Chrisant M, Clark DB, Clifton RG, Clouser KN, Cottrell L, Cowan K, D'Sa V, Dapretto M, Dasgupta S, Dehority W, Dionne A, Dummer KB, Elias MD, Esquenazi-Karonika S, Evans DN, Faustino EVS, Fiks AG, Forsha D, Foxe JJ, Friedman NP, Fry G, Gaur S, Gee DG, Gray KM, Handler S, Harahsheh AS, Hasbani K, Heath AC, Hebson C, Heitzeg MM, Hester CM, Hill S, Hobart-Porter L, Hong TKF, Horowitz CR, Hsia DS, Huentelman M, Hummel KD, Irby K, Jacobus J, Jacoby VL, Jone PN, Kaelber DC, Kasmarcak TJ, Kluko MJ, Kosut JS, Laird AR, Landeo-Gutierrez J, Lang SM, Larson CL, Lim PPC, Lisdahl KM, McCrindle BW, McCulloh RJ, McHugh K, Mendelsohn AL, Metz TD, Miller J, Mitchell EC, Morgan LM, Müller-Oehring EM, Nahin ER, Neale MC, Ness-Cochinwala M, Nolan SM, Oliveira CR, Osakwe O, Oster ME, Payne RM, Portman MA, Raissy H, Randall IG, Rao S, Reeder HT, Rosas JM, Russell MW, Sabati AA, Sanil Y, Sato AI, Schechter MS, Selvarangan R, Sexson Tejtel SK, Shakti D, Sharma K, Squeglia LM, Srivastava S, Stevenson MD, Szmuszkovicz J, Talavera-Barber MM, Teufel RJ, Thacker D, Trachtenberg F, Udosen MM, Warner MR, Watson SE, Werzberger A, Weyer JC, Wood MJ, Yin HS, Zempsky WT, Zimmerman E, Dreyer BP. Researching COVID to enhance recovery (RECOVER) pediatric study protocol: Rationale, objectives and design. PLoS One 2024; 19:e0285635. [PMID: 38713673 DOI: 10.1371/journal.pone.0285635] [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: 04/25/2023] [Accepted: 11/14/2023] [Indexed: 05/09/2024] Open
Abstract
IMPORTANCE The prevalence, pathophysiology, and long-term outcomes of COVID-19 (post-acute sequelae of SARS-CoV-2 [PASC] or "Long COVID") in children and young adults remain unknown. Studies must address the urgent need to define PASC, its mechanisms, and potential treatment targets in children and young adults. OBSERVATIONS We describe the protocol for the Pediatric Observational Cohort Study of the NIH's REsearching COVID to Enhance Recovery (RECOVER) Initiative. RECOVER-Pediatrics is an observational meta-cohort study of caregiver-child pairs (birth through 17 years) and young adults (18 through 25 years), recruited from more than 100 sites across the US. This report focuses on two of four cohorts that comprise RECOVER-Pediatrics: 1) a de novo RECOVER prospective cohort of children and young adults with and without previous or current infection; and 2) an extant cohort derived from the Adolescent Brain Cognitive Development (ABCD) study (n = 10,000). The de novo cohort incorporates three tiers of data collection: 1) remote baseline assessments (Tier 1, n = 6000); 2) longitudinal follow-up for up to 4 years (Tier 2, n = 6000); and 3) a subset of participants, primarily the most severely affected by PASC, who will undergo deep phenotyping to explore PASC pathophysiology (Tier 3, n = 600). Youth enrolled in the ABCD study participate in Tier 1. The pediatric protocol was developed as a collaborative partnership of investigators, patients, researchers, clinicians, community partners, and federal partners, intentionally promoting inclusivity and diversity. The protocol is adaptive to facilitate responses to emerging science. CONCLUSIONS AND RELEVANCE RECOVER-Pediatrics seeks to characterize the clinical course, underlying mechanisms, and long-term effects of PASC from birth through 25 years old. RECOVER-Pediatrics is designed to elucidate the epidemiology, four-year clinical course, and sociodemographic correlates of pediatric PASC. The data and biosamples will allow examination of mechanistic hypotheses and biomarkers, thus providing insights into potential therapeutic interventions. CLINICAL TRIALS.GOV IDENTIFIER Clinical Trial Registration: http://www.clinicaltrials.gov. Unique identifier: NCT05172011.
Collapse
Affiliation(s)
- Rachel S Gross
- Department of Pediatrics, New York University Grossman School of Medicine, New York, New York, United States of America
| | - Tanayott Thaweethai
- Department of Biostatistics, Massachusetts General Hospital, Boston, Massachusetts, United States of America
| | - Erika B Rosenzweig
- Division of Pediatric Cardiology, Department of Pediatrics, Columbia University Vagelos College of Physicians and Surgeons and NewYork-Presbyterian, New York, New York, United States of America
| | - James Chan
- Department of Biostatistics, Massachusetts General Hospital, Boston, Massachusetts, United States of America
| | - Lori B Chibnik
- Department of Biostatistics, Massachusetts General Hospital, Boston, Massachusetts, United States of America
| | - Mine S Cicek
- Department of Laboratory Medicine and Pathology, Mayo Clinic Hospital, Rochester, Minnesota, United States of America
| | - Amy J Elliott
- Avera Research Institute, Avera Health, Sioux Falls, South Dakota, United States of America
| | - Valerie J Flaherman
- Department of Pediatrics, University of California San Francisco, San Francisco, California, United States of America
| | - Andrea S Foulkes
- Department of Biostatistics, Massachusetts General Hospital, Boston, Massachusetts, United States of America
| | - Margot Gage Witvliet
- Department of Sociology, Lamar University, Beaumont, Texas, United States of America
| | - Richard Gallagher
- Department of Child and Adolescent Psychiatry, New York University Grossman School of Medicine, New York, New York, United States of America
| | - Maria Laura Gennaro
- Public Health Research Institute and Department of Medicine, Rutgers New Jersey Medical School, Newark, New Jersey, United States of America
| | - Terry L Jernigan
- Center for Human Development, Department of Cognitive Science, University of California San Diego, San Diego, California, United States of America
- Departments of Psychiatry and Radiology, University of California San Diego School of Medicine, San Diego, California, United States of America
| | - Elizabeth W Karlson
- Department of Medicine, Harvard Medical School, Boston, Massachusetts, United States of America
| | - Stuart D Katz
- Department of Medicine, New York University Grossman School of Medicine, New York, New York, United States of America
| | - Patricia A Kinser
- School of Nursing, Virginia Commonwealth University, Richmond, Virginia, United States of America
| | - Lawrence C Kleinman
- Department of Pediatrics, Rutgers Robert Wood Johnson Medical School, New Brunswick, New Jersey, United States of America
| | - Michelle F Lamendola-Essel
- Department of Medicine, New York University Grossman School of Medicine, New York, New York, United States of America
| | - Joshua D Milner
- Division of Pediatric Allergy, Department of Pediatrics, Immunology and Rheumatology, Columbia University Vagelos College of Physicians and Surgeons and NewYork-Presbyterian, New York, New York, United States of America
| | - Sindhu Mohandas
- Department of Infectious Diseases, Children's Hospital Los Angeles, Keck School of Medicine, University of Southern California, Los Angeles, California, United States of America
| | - Praveen C Mudumbi
- Department of Population Health, New York University Grossman School of Medicine, New York, New York, United States of America
| | - Jane W Newburger
- Department of Cardiology, Boston Children's Hospital, Boston, Massachusetts, United States of America
| | - Kyung E Rhee
- Division of Child and Community Health, Department of Pediatrics, University of California San Diego School of Medicine, San Diego, California, United States of America
| | - Amy L Salisbury
- School of Nursing, Virginia Commonwealth University, Richmond, Virginia, United States of America
| | - Jessica N Snowden
- Departments of Pediatrics and Biostatistics, University of Arkansas for Medical Sciences, Little Rock, Arkansas, United States of America
| | - Cheryl R Stein
- Department of Child and Adolescent Psychiatry, New York University Grossman School of Medicine, New York, New York, United States of America
| | - Melissa S Stockwell
- Division of Child and Adolescent Health, Department of Pediatrics, Columbia University Vagelos College of Physicians and Surgeons and NewYork-Presbyterian, New York, New York, United States of America
- Department of Population and Family Health, Columbia University Mailman School of Public Health, New York, New York, United States of America
| | - Kelan G Tantisira
- Division of Pediatric Respiratory Medicine, Department of Pediatrics, University of California San Diego School of Medicine, San Diego, California, United States of America
| | - Moriah E Thomason
- Department of Child and Adolescent Psychiatry, New York University Grossman School of Medicine, New York, New York, United States of America
| | - Dongngan T Truong
- Division of Pediatric Cardiology, University of Utah and Primary Children's Hospital, Salt Lake City, Utah, United States of America
| | - David Warburton
- Division of Neonatology, Department of Pediatrics, Children's Hospital Los Angeles, Keck School of Medicine, University of Southern California, Los Angeles, California, United States of America
| | - John C Wood
- Department of Pediatrics and Radiology, Children's Hospital Los Angeles, Los Angeles, California, United States of America
| | - Shifa Ahmed
- Department of Biostatistics, Massachusetts General Hospital, Boston, Massachusetts, United States of America
| | - Almary Akerlundh
- Department of Pulmonary Research, Rady Children's Hospital-San Diego, San Diego, California, United States of America
| | - Akram N Alshawabkeh
- College of Engineering, Northeastern University, Boston, Massachusetts, United States of America
| | - Brett R Anderson
- Division of Pediatric Cardiology, Department of Pediatrics, Columbia University Vagelos College of Physicians and Surgeons and NewYork-Presbyterian, New York, New York, United States of America
| | - Judy L Aschner
- Department of Pediatrics, Hackensack Meridian School of Medicine, Nutley, New Jersey, United States of America
| | - Andrew M Atz
- Department of Pediatrics, Medical University of South Carolina, Charleston, South Carolina, United States of America
| | - Robin L Aupperle
- Oxley College of Health Sciences, Laureate Institute for Brain Research, Tulsa, Oklahoma, United States of America
| | - Fiona C Baker
- Department of Biosciences, SRI International, Menlo Park, California, United States of America
| | - Venkataraman Balaraman
- Department of Pediatrics, Kapiolani Medical Center for Women and Children, Honolulu, Hawaii, United States of America
| | - Dithi Banerjee
- Department of Pathology and Laboratory Medicine, Children's Mercy Hospital, Kansas City, Missouri, United States of America
| | - Deanna M Barch
- Department of Psychiatry, Washington University in St. Louis, Saint Louis, Missouri, United States of America
| | - Arielle Baskin-Sommers
- Department of Psychology, Yale University School of Medicine, New Haven, Connecticut, United States of America
| | - Sultana Bhuiyan
- Department of Medicine, New York University Grossman School of Medicine, New York, New York, United States of America
| | - Marie-Abele C Bind
- Department of Biostatistics, Massachusetts General Hospital, Boston, Massachusetts, United States of America
| | - Amanda L Bogie
- Department of Pediatrics, University of Oklahoma Health Science Center, Oklahoma City, Oklahoma, United States of America
| | - Tamara Bradford
- Division of Pediatric Cardiology, Department of Pediatrics, Children's Hospital of New Orleans and LSU Health Sciences Center, New Orleans, United States of America
| | - Natalie C Buchbinder
- Center for Human Development, University of California San Diego, San Diego, California, United States of America
| | - Elliott Bueler
- Department of Medicine, New York University Grossman School of Medicine, New York, New York, United States of America
| | - Hülya Bükülmez
- Division of Rheumatology, Department of Pediatrics, The MetroHealth System, Case Western Reserve University, Cleveland, Ohio, United States of America
| | - B J Casey
- Department of Neuroscience and Behavior, Barnard College-Columbia University, New York, New York, United States of America
| | - Linda Chang
- Departments of Diagnostic Radiology & Nuclear Medicine and Neurology, University of Maryland Baltimore, Baltimore, Maryland, United States of America
| | - Maryanne Chrisant
- Department of Women's and Children's Health, Charles E. Schmidt College of Medicine at Florida Atlantic University, Hollywood, Florida, United States of America
| | - Duncan B Clark
- Department of Psychiatry, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, United States of America
| | - Rebecca G Clifton
- Biostatistics Center, George Washington University, Washington, DC, United States of America
| | - Katharine N Clouser
- Department of Pediatrics, Hackensack Meridian School of Medicine, Nutley, New Jersey, United States of America
| | - Lesley Cottrell
- Department of Pediatrics, West Virginia University, Morgantown, West Virginia, United States of America
| | - Kelly Cowan
- Department of Pediatrics, Robert Larner M.D. College of Medicine at the University of Vermont, Burlington, Vermont, United States of America
| | - Viren D'Sa
- Department of Pediatrics, Rhode Island Hospital, Providence, Rhode Island, United States of America
| | - Mirella Dapretto
- Department of Psychiatry and Biobehavioral Sciences, University of California Los Angeles, Los Angeles, California, United States of America
| | - Soham Dasgupta
- Department of Pediatrics, Norton Children's Hospital, University of Louisville, Louisville, Kentucky, United States of America
| | - Walter Dehority
- Division of Infectious Diseases, Department of Pediatrics, University of New Mexico, Albuquerque, New Mexico, United States of America
| | - Audrey Dionne
- Department of Cardiology, Boston Children's Hospital, Boston, Massachusetts, United States of America
| | - Kirsten B Dummer
- Department of Pediatrics, University of California San Diego, San Diego, California, United States of America
| | - Matthew D Elias
- Division of Cardiology, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, United States of America
| | - Shari Esquenazi-Karonika
- Department of Medicine, New York University Grossman School of Medicine, New York, New York, United States of America
| | - Danielle N Evans
- Arkansas Children's Research Institute, Arkansas Children's Hospital, Little Rock, Arkansas, United States of America
| | - E Vincent S Faustino
- Department of Pediatrics, Yale University School of Medicine, New Haven, Connecticut, United States of America
| | - Alexander G Fiks
- Department of Pediatrics, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, United States of America
| | - Daniel Forsha
- Department of Cardiology, Children's Mercy Kansas City, Ward Family Heart Center, Kansas City, Missouri, United States of America
| | - John J Foxe
- Department of Neuroscience, University of Rochester School of Medicine and Dentistry, Rochester, New York, United States of America
| | - Naomi P Friedman
- Institute for Behavioral Genetics and Department of Psychology and Neuroscience, University of Colorado Boulder, Bolder, Colorado, United States of America
| | - Greta Fry
- Pennington Biomedical Research Center Clinic, Pennington Biomedical Research Center, Baton Rouge, Louisiana, United States of America
| | - Sunanda Gaur
- Department of Pediatrics, Rutgers Robert Wood Johnson Medical School, New Brunswick, New Jersey, United States of America
| | - Dylan G Gee
- Department of Psychology, Yale University School of Medicine, New Haven, Connecticut, United States of America
| | - Kevin M Gray
- Department of Psychiatry and Behavioral Sciences, Medical University of South Carolina, Charleston, South Carolina, United States of America
| | - Stephanie Handler
- Division of Pediatric Cardiology, Department of Pediatrics, Medical College of Wisconsin, Milwaukee, Wisconsin, United States of America
| | - Ashraf S Harahsheh
- Division of Cardiology, Department of Pediatrics, George Washington University School of Medicine & Health Sciences, Washington, DC, United States of America
| | - Keren Hasbani
- Division of Pediatric Cardiology, Department of Pediatrics, Dell Children's Medical Center, Dell Medical School, Austin, Texas, United States of America
| | - Andrew C Heath
- Department of Psychiatry, Washington University School of Medicine, St Louis, Missouri, United States of America
| | - Camden Hebson
- Division of Pediatric Cardiology, Department of Pediatrics, University of Alabama at Birmingham, Birmingham, Alabama, United States of America
| | - Mary M Heitzeg
- Department of Psychiatry, University of Michigan, Ann Arbor, Michigan, United States of America
| | - Christina M Hester
- Division of Practice-Based Research, Innovation, & Evaluation, American Academy of Family Physicians, Leawood, Kansas, United States of America
| | - Sophia Hill
- Department of Medicine, New York University Grossman School of Medicine, New York, New York, United States of America
| | - Laura Hobart-Porter
- Departments of Pediatrics and Physical Medicine & Rehabilitation, Section of Pediatric Rehabilitation, University of Arkansas for Medical Sciences, Little Rock, Arkansas, United States of America
| | - Travis K F Hong
- Department of Pediatrics, Kapiolani Medical Center for Women and Children, Honolulu, Hawaii, United States of America
| | - Carol R Horowitz
- Center for Health Equity and Community Engaged Research and Department of Population Health Science and Policy, Icahn School of Medicine at Mount Sinai, New York, New York, United States of America
| | - Daniel S Hsia
- Clinical Trials Unit, Pennington Biomedical Research Center, Baton Rouge, Louisiana, United States of America
| | - Matthew Huentelman
- Division of Neurogenomics, Translational Genomics Research Institute, Phoenix, Arizona, United States of America
| | - Kathy D Hummel
- Department of Pediatrics, Arkansas Children's Hospital, University of Arkansas Medical School, Little Rock, Arkansas, United States of America
| | - Katherine Irby
- Department of Pediatrics, Arkansas Children's Hospital, University of Arkansas Medical School, Little Rock, Arkansas, United States of America
| | - Joanna Jacobus
- Department of Psychiatry, University of California San Diego, San Diego, California, United States of America
| | - Vanessa L Jacoby
- Department of Obstetrics, Gynecology, and Reproductive Sciences, University of California San Francisco, San Francisco, California, United States of America
| | - Pei-Ni Jone
- Department of Pediatrics, Pediatric Cardiology, Lurie Children's Hospital, Northwestern University Feinberg School of Medicine, Chicago, Illinois, United States of America
| | - David C Kaelber
- The Center for Clinical Informatics Research and Education, The MetroHealth System and the Departments of Pediatrics, Internal Medicine, and Population and Quantitative Health Sciences, Case Western Reserve University, Cleveland, Ohio, United States of America
- Departments of Pediatrics, Internal Medicine, and Population & Quantitative Health Sciences, Case Western Reserve University, Cleveland, Ohio, United States of America
| | - Tyler J Kasmarcak
- Department of Pediatric Clinical Research, Medical University of South Carolina, Charleston, South Carolina, United States of America
| | - Matthew J Kluko
- Department of Pediatrics, Yale University School of Medicine, New Haven, Connecticut, United States of America
| | - Jessica S Kosut
- Department of Pediatrics, Kapiolani Medical Center for Women and Children, Honolulu, Hawaii, United States of America
| | - Angela R Laird
- Department of Physics, Florida International University, Miami, Florida, United States of America
| | - Jeremy Landeo-Gutierrez
- Respiratory Medicine Division, Department of Pediatrics, University of California San Diego, San Diego, California, United States of America
| | - Sean M Lang
- Heart Institute, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, United States of America
| | - Christine L Larson
- Department of Psychology, University of Wisconsin-Milwaukee, Milwaukee, Wisconsin, United States of America
| | - Peter Paul C Lim
- Department of Pediatric Infectious Disease, Avera McKennan University Health Center, University of South Dakota, Sioux Falls, South Dakota, United States of America
| | - Krista M Lisdahl
- Department of Psychology, University of Wisconsin-Milwaukee, Milwaukee, Wisconsin, United States of America
| | - Brian W McCrindle
- Department of Pediatrics, University of Toronto, Labatt Family Heart Center, The Hospital for Sick Children, Toronto, Ontario, Canada
| | - Russell J McCulloh
- Department of Pediatrics, University of Nebraska Medical Center, Omaha, Nebraska, United States of America
| | - Kimberly McHugh
- Department of Pediatric Clinical Research, Medical University of South Carolina, Charleston, South Carolina, United States of America
| | - Alan L Mendelsohn
- Division of Developmental-Behavioral Pediatrics, Department of Pediatrics, New York University Grossman School of Medicine, New York, New York, United States of America
| | - Torri D Metz
- Department of Obstetrics and Gynecology, University of Utah Health, Salt Lake City, Utah, United States of America
| | - Julie Miller
- Carelon Research, Newton, Massachusetts, United States of America
| | - Elizabeth C Mitchell
- Division of Pediatric Cardiology, Department of Pediatrics, Cohen Children's Medical Center (Northwell Health), New Hyde Park, New York, United States of America
| | - Lerraughn M Morgan
- Department of Pediatrics, Valley Children's Healthcare, Madera, California, United States of America
| | - Eva M Müller-Oehring
- Department of Biosciences, SRI International, Menlo Park, California, United States of America
| | - Erica R Nahin
- Department of Medicine, New York University Grossman School of Medicine, New York, New York, United States of America
| | - Michael C Neale
- Virginia Institute for Psychiatric and Behavioral Genetics, Virginia Commonwealth University, Richmond, Virginia, United States of America
| | - Manette Ness-Cochinwala
- Department of Pediatrics, Rutgers Robert Wood Johnson Medical School, New Brunswick, New Jersey, United States of America
| | - Sheila M Nolan
- Department of Pediatrics, New York Medical College, Valhalla, New York, United States of America
| | - Carlos R Oliveira
- Department of Pediatrics, Yale University School of Medicine, New Haven, Connecticut, United States of America
| | - Onyekachukwu Osakwe
- Division of Pediatric Cardiology, Department of Pediatrics, University of Mississippi Medical Center, Jackson, Mississippi, United States of America
| | - Matthew E Oster
- Department of Pediatric Cardiology, Children's Healthcare of Atlanta, Atlanta, Georgia, United States of America
| | - R Mark Payne
- Division of Pediatric Cardiology, Department of Pediatrics, Riley Hospital for Children, Indiana University School of Medicine, Indianapolis, Indiana, United States of America
| | - Michael A Portman
- Division of Cardiology, Department of Pediatrics, Seattle Children's and University of Washington, Seattle, Washington, United States of America
| | - Hengameh Raissy
- Department of Pediatrics, University of New Mexico, Health Sciences Center, Albuquerque, New Mexico, United States of America
| | - Isabelle G Randall
- Department of Medicine, New York University Grossman School of Medicine, New York, New York, United States of America
| | - Suchitra Rao
- Division of Infectious Diseases, Department of Pediatrics, Epidemiology and Hospital Medicine, University of Colorado Anschutz Medical Campus, Aurora, Colorado, United States of America
| | - Harrison T Reeder
- Department of Biostatistics, Massachusetts General Hospital, Boston, Massachusetts, United States of America
| | - Johana M Rosas
- Department of Medicine, New York University Grossman School of Medicine, New York, New York, United States of America
| | - Mark W Russell
- Department of Pediatrics, University of Michigan Health System, Ann Arbor, Michigan, United States of America
| | - Arash A Sabati
- Department of Pediatric Cardiology, Phoenix Children's Hospital, Phoenix, Arizona, United States of America
| | - Yamuna Sanil
- Division of Pediatric Cardiology, Department of Pediatrics, Children's Hospital of Michigan, Detroit, Michigan, United States of America
| | - Alice I Sato
- Department of Pediatric Infectious Disease, University of Nebraska Medical Center, Omaha, Nebraska, United States of America
| | - Michael S Schechter
- Department of Pediatrics, Children's Hospital of Richmond at Virginia Commonwealth University, Richmond, Virginia, United States of America
| | - Rangaraj Selvarangan
- Department of Pathology and Laboratory Medicine, Children's Mercy Hospital, Kansas City, Missouri, United States of America
| | - S Kristen Sexson Tejtel
- Division of Pediatric Cardiology, Department of Pediatrics, Texas Children's Hospital, Baylor College of Medicine, Houston, Texas, United States of America
| | - Divya Shakti
- Division of Pediatric Cardiology, Department of Pediatrics, University of Mississippi Medical Center, Jackson, Mississippi, United States of America
| | - Kavita Sharma
- Department of Pediatrics, University of Texas Southwestern Medical Center, Dallas, Texas, United States of America
| | - Lindsay M Squeglia
- Department of Psychiatry and Behavioral Sciences, Medical University of South Carolina, Charleston, South Carolina, United States of America
| | - Shubika Srivastava
- Division of Cardiovascular Medicine, Department of Pediatric Cardiology, Nemours Children's Health, Wilmington, Delaware, United States of America
| | - Michelle D Stevenson
- Department of Pediatrics, University of Louisville School of Medicine, Louisville, Kentucky, United States of America
| | - Jacqueline Szmuszkovicz
- Division of Cardiology, Children's Hospital Los Angeles, Los Angeles, California, United States of America
| | - Maria M Talavera-Barber
- Department of Pediatrics, Avera McKennan Hospital and University Health Center, Sioux Falls, South Dakota, United States of America
| | - Ronald J Teufel
- Department of Pediatrics, Medical University of South Carolina, Charleston, South Carolina, United States of America
| | - Deepika Thacker
- Division of Cardiovascular Medicine, Department of Pediatric Cardiology, Nemours Children's Health, Wilmington, Delaware, United States of America
| | | | - Mmekom M Udosen
- Department of Population Health, New York University Grossman School of Medicine, New York, New York, United States of America
| | - Megan R Warner
- Department of Pulmonary Research, Rady Children's Hospital-San Diego, San Diego, California, United States of America
| | - Sara E Watson
- Department of Pediatrics, University of Louisville School of Medicine, Louisville, Kentucky, United States of America
| | - Alan Werzberger
- Department of Pediatrics, Columbia University Vagelos College of Physicians and Surgeons, New York, New York, United States of America
| | - Jordan C Weyer
- Center for Individualized Medicine, Mayo Clinic Hospital, Rochester, Minnesota, United States of America
| | - Marion J Wood
- Department of Population Health, New York University Grossman School of Medicine, New York, New York, United States of America
| | - H Shonna Yin
- Departments of Pediatrics and Population Health, New York University Grossman School of Medicine, New York, New York, United States of America
| | - William T Zempsky
- Department of Pediatrics, Connecticut Children's Medical Center, University of Connecticut School of Medicine, Hartford, Connecticut, United States of America
| | - Emily Zimmerman
- Department of Communication Sciences & Disorders, Northeastern University, Boston, Massachusetts, United States of America
| | - Benard P Dreyer
- Department of Pediatrics, New York University Grossman School of Medicine, New York, New York, United States of America
| |
Collapse
|
4
|
Wang L, Berger NA, Kaelber DC, Xu R. Association of GLP-1 Receptor Agonists and Hepatocellular Carcinoma Incidence and Hepatic Decompensation in Patients With Type 2 Diabetes. Gastroenterology 2024:S0016-5085(24)00494-3. [PMID: 38692395 DOI: 10.1053/j.gastro.2024.04.029] [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: 11/22/2023] [Revised: 03/22/2024] [Accepted: 04/17/2024] [Indexed: 05/03/2024]
Abstract
BACKGROUND & AIMS Hepatocellular carcinoma (HCC) is a leading cause of cancer death. HCC is preventable with about 70% of HCC attributable to modifiable risk factors. Glucagon-like peptide-1 receptor agonists (GLP-1RAs), Food and Drug Administration-approved medications for treating type 2 diabetes mellitus (T2DM), have pleiotropic effects on counteracting risk factors for HCC. Here we evaluate the association of GLP-1RAs with incident HCC risk in a real-world population. METHODS This retrospective cohort included 1,890,020 patients with a diagnosis of T2DM who were prescribed GLP-1RAs or other non-GLP-1RA anti-diabetes medications and had no prior diagnosis of HCC. Incident (first-time) diagnosis of HCC and hepatic decompensating events during a 5-year follow-up was compared between cohorts of patients prescribed GLP-1 RAs vs other anti-diabetes medications. Time-to-first-event analysis was performed using Kaplan-Meier survival analysis with hazard ratio and 95% confidence interval calculated. RESULTS GLP-1RAs were associated with a lower risk of incident HCC with hazard ratio of 0.20 [0.14-0.31], 0.39 [0.21-0.69], 0.63 [0.26-1.50] compared with insulin, sulfonylureas, and metformin, respectively. GLP-1RAs were associated with a significantly lower risk of hepatic decompensation compared with 6 other anti-diabetes medications. Reduced risks were observed in patients without and with different stages of fatty liver diseases, with more profound effects in patients without liver diseases. Similar findings were observed in patients with and without obesity and alcohol or tobacco use disorders. GLP-1RA combination therapies were associated with decreased risk for HCC and hepatic decompensations compared with monotherapies. CONCLUSIONS GLP-1RAs were associated with a reduced risk of incident HCC and hepatic decompensation compared with other anti-diabetes medications in patients with T2DM. These findings provide supporting evidence for future studies to investigate the underlying mechanisms and their clinical use.
Collapse
Affiliation(s)
- Lindsey Wang
- Center for Science, Health, and Society, Case Western Reserve University School of Medicine, Cleveland, Ohio
| | - Nathan A Berger
- Center for Science, Health, and Society, Case Western Reserve University School of Medicine, Cleveland, Ohio; Case Comprehensive Cancer Center, Case Western Reserve University School of Medicine, Cleveland, Ohio.
| | - David C Kaelber
- Departments of Internal Medicine, Pediatrics, and Population and Quantitative Health Sciences and the Center for Clinical Informatics Research and Education, The MetroHealth System, Cleveland, Ohio
| | - Rong Xu
- Case Comprehensive Cancer Center, Case Western Reserve University School of Medicine, Cleveland, Ohio; Center for Artificial Intelligence in Drug Discovery, Case Western Reserve University School of Medicine, Cleveland, Ohio.
| |
Collapse
|
5
|
Bobak L, Dorney I, Kovacevich A, Barnett B, Kaelber DC. Preexisting Psychiatric Conditions as Risk Factors for Diagnosed Long COVID-19 Syndrome Within Aggregated Electronic Health Record Data. Psychosom Med 2024; 86:132-136. [PMID: 38193771 PMCID: PMC11001529 DOI: 10.1097/psy.0000000000001280] [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] [Indexed: 01/10/2024]
Abstract
OBJECTIVE This study aimed to investigate the frequency of long COVID diagnosis among patients infected with severe acute respiratory syndrome coronavirus 2 with preexisting psychiatric conditions versus those without preexisting psychiatric conditions. METHODS The TriNetX Analytics platform, an aggregated electronic health record research network containing the deidentified electronic health record data of more than 90 million patients, was queried for patients who were diagnosed with COVID-19 infection based on International Classifications of Disease, Tenth Revision codes. Patients were stratified based on their preexisting psychiatric conditions, and new diagnoses of long COVID were recorded and reported as the primary outcome. RESULTS Among 1,180,948 patients previously diagnosed with COVID-19, 17,990 patients (1.52%) were diagnosed with long COVID based on the newly implemented International Classifications of Disease, Tenth Revision code "U09: post-COVID-19 condition." After propensity score matching, patients with any preexisting psychiatric diagnosis had a 1.52 (95% confidence interval [CI] = 1.47-1.58) times greater prevalence of diagnosed long COVID within 180 days of infection than patients without preexisting psychiatric diagnoses. Patients with diagnosed anxiety disorders (relative risk [RR] = 1.64; 95% CI = 1.57-1.71), mood disorders (RR = 1.65; 95% CI = 1.57-1.72), bipolar disorder (RR = 1.37; 95% CI = 1.21-1.54), major depressive disorder (RR = 1.69; 95% CI = 1.56-1.83), psychotic disorders (RR = 1.23; 95% CI = 1.06-1.44), and substance use disorders (RR = 1.28; 95% CI = 1.22-1.36) had higher risks for long COVID diagnoses when compared with patients without preexisting psychiatric illness at the time of diagnosis. CONCLUSIONS Multiple preexisting psychiatric diagnoses are associated with an increased risk of being diagnosed with long COVID after COVID-19 infection.
Collapse
Affiliation(s)
- Lukas Bobak
- Case Western Reserve University School of Medicine, Cleveland, Ohio, USA
| | - Ian Dorney
- Case Western Reserve University School of Medicine, Cleveland, Ohio, USA
| | - Alexsandra Kovacevich
- Department of Psychiatry and Psychology, Center for Behavioral Health, Neurological Institute, Cleveland Clinic, 1730 W 25th Street, Cleveland, OH 44113, USA
| | - Brian Barnett
- Department of Psychiatry and Psychology, Center for Behavioral Health, Neurological Institute, Cleveland Clinic, 1730 W 25th Street, Cleveland, OH 44113, USA
- Cleveland Clinic Lerner College of Medicine at Case Western Reserve University, EC-10 Cleveland Clinic, 9501 Euclid Ave., Cleveland, OH, 44195, USA
| | - David C. Kaelber
- Case Western Reserve University School of Medicine, Cleveland, Ohio, USA
- Departments of Internal Medicine, Pediatrics, and Population and Quantitative Health Sciences, Case Western Reserve University
- The Center for Clinical Informatics Research and Education, The MetroHealth System, Cleveland, Ohio, USA
| |
Collapse
|
6
|
Lavu MS, Eghrari NB, Makineni PS, Kaelber DC, Savage JW, Pelle DW. Low-Density Lipoprotein Cholesterol and Statin Usage Are Associated With Rates of Pseudarthrosis Following Single-Level Posterior Lumbar Interbody Fusion. Spine (Phila Pa 1976) 2024; 49:369-377. [PMID: 38073195 DOI: 10.1097/brs.0000000000004895] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/26/2023] [Accepted: 11/29/2023] [Indexed: 02/29/2024]
Abstract
STUDY DESIGN Retrospective cohort study. OBJECTIVE To investigate the relationships of low-density lipoprotein cholesterol and statin usage with pseudarthrosis following single-level posterior or transforaminal lumbar interbody fusion (PLIF/TLIF). SUMMARY OF BACKGROUND DATA Hypercholesterolemia can lead to atherosclerosis of the segmental arteries, which branch into vertebral bone through intervertebral foramina. According to the vascular hypothesis of disc disease, this can lead to ischemia of the lumbar discs and contribute to lumbar degenerative disease. Yet, little has been reported regarding the effects of cholesterol and statins on the outcomes of lumbar fusion surgery. MATERIALS AND METHODS TriNetX, a global federated research network, was retrospectively queried to identify 52,140 PLIF/TLIF patients between 2002 and 2021. Of these patients, 2137 had high cholesterol (≥130 mg/dL) and 906 had low cholesterol (≤55 mg/dL). Perioperatively, 18,275 patients used statins, while 33,415 patients did not. One-to-one propensity score matching for age, sex, race, and comorbidities was conducted to balance the analyzed cohorts. The incidence of pseudarthrosis was then assessed in the matched cohorts within the six-month, one-year, and two-year postoperative periods. RESULTS After propensity score matching, high-cholesterol patients had greater odds of developing pseudarthrosis six months [odds ratio (OR): 1.73, 95% confidence interval (CI): 1.28-2.33], one year (OR: 1.59, 95% confidence interval (CI): 1.20-2.10), and two years (OR: 1.57, 95% CI: 1.20-2.05) following a PLIF/TLIF procedure. Patients with statin usage had significantly lower odds of developing pseudarthrosis six months (OR: 0.74, 95% CI: 0.69-0.79), one year (OR: 0.76, 95% CI: 0.71-0.81), and two years (OR: 0.77, 95% CI: 0.72-0.81) following single-level PLIF/TLIF. CONCLUSIONS The findings suggest that patients with hypercholesterolemia have an increased risk of developing pseudarthrosis following PLIF/TLIF while statin use is associated with a decreased risk. The data presented may underscore an overlooked opportunity for perioperative optimization in lumbar fusion patients, warranting further investigation in this area.
Collapse
Affiliation(s)
- Monish S Lavu
- Case Western Reserve University School of Medicine, Cleveland, OH
- Center for Spine Health, Neurological Institute, Cleveland Clinic Foundation, Cleveland, OH
| | - Nafis B Eghrari
- Case Western Reserve University School of Medicine, Cleveland, OH
- Center for Spine Health, Neurological Institute, Cleveland Clinic Foundation, Cleveland, OH
| | - Pratheek S Makineni
- Case Western Reserve University School of Medicine, Cleveland, OH
- Center for Spine Health, Neurological Institute, Cleveland Clinic Foundation, Cleveland, OH
| | - David C Kaelber
- Departments of Internal Medicine, Pediatrics, and Population and Quantitative Health Sciences, Case Western Reserve University, Cleveland, OH
- The Center for Clinical Informatics Research and Education, The MetroHealth System, Cleveland, OH
| | - Jason W Savage
- Center for Spine Health, Neurological Institute, Cleveland Clinic Foundation, Cleveland, OH
- Department of Orthopaedic Surgery, Cleveland Clinic Foundation, Cleveland, OH
| | - Dominic W Pelle
- Center for Spine Health, Neurological Institute, Cleveland Clinic Foundation, Cleveland, OH
- Department of Orthopaedic Surgery, Cleveland Clinic Foundation, Cleveland, OH
| |
Collapse
|
7
|
Makineni PS, Lavu MS, Eghrari NB, Kim CH, Kaelber DC, Kelly ML. Incidence of Sacroiliac Joint Pain Following Lumbar Fractures: A Retrospective-Cohort Study. World Neurosurg 2024; 183:e936-e943. [PMID: 38246533 DOI: 10.1016/j.wneu.2024.01.068] [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: 08/21/2023] [Revised: 01/11/2024] [Accepted: 01/12/2024] [Indexed: 01/23/2024]
Abstract
BACKGROUND Sacroiliac joint (SIJ) pain commonly affects patients with low back pain and can arise from traumatic and degenerative causes. However, the incidence of SIJ pain following lumbar fractures is not well understood. METHODS TriNetX, a national network of deidentified patient records, was retrospectively queried. The lumbar fracture cohort included 239,199 adults, while the no lumbar fracture group included 6,975,046 adults. Following a propensity-score match based on demographics and risk factors for SIJ, there were 239,197 patients in each cohort. The incidence of SIJ pain and clinical outcomes were analyzed from 1 day to 1 year following the index event. Moreover, the location and type of single-level lumbar fractures were reported. The incidence of SIJ pain for single-level fractures was compared using a χ2 goodness-of-fit. RESULTS The lumbar fracture cohort was more likely to develop SIJ pain at 3 months (odds ratio [OR]: 5.3, 95% confidence interval [CI]: 4.8-5.9), 6 months (OR: 4.4, 95% CI: 4.1-4.8), and 1 year (OR: 3.9, 95% CI: 3.6-4.2) postfracture. Among single-level lumbar fractures, the incidence of SIJ pain at 1 month (P = 0.005), 6 months (P = 0.010), and 1 year (P = 0.003) varied significantly, with the highest incidence in the L5 cohort. CONCLUSIONS Our findings suggest that lumbar fractures are a risk factor for developing SIJ pain. Moreover, the incidence of SIJ pain is greater following an L5 fracture than an L1 fracture. Further investigation is warranted to determine how the type and treatment of lumbar fractures affects the incidence of SIJ pain.
Collapse
Affiliation(s)
- Pratheek S Makineni
- Case Western Reserve University School of Medicine, Health Education Campus, Cleveland, Ohio, USA
| | - Monish S Lavu
- Case Western Reserve University School of Medicine, Health Education Campus, Cleveland, Ohio, USA
| | - Nafis B Eghrari
- Case Western Reserve University School of Medicine, Health Education Campus, Cleveland, Ohio, USA
| | - Chong H Kim
- Case Western Reserve University School of Medicine, Health Education Campus, Cleveland, Ohio, USA; Department of Neurological Surgery, The MetroHealth System, Cleveland, Ohio, USA
| | - David C Kaelber
- Case Western Reserve University School of Medicine, Health Education Campus, Cleveland, Ohio, USA; Department of Neurological Surgery, The MetroHealth System, Cleveland, Ohio, USA
| | - Michael L Kelly
- Case Western Reserve University School of Medicine, Health Education Campus, Cleveland, Ohio, USA; Department of Neurological Surgery, The MetroHealth System, Cleveland, Ohio, USA.
| |
Collapse
|
8
|
Igoe A, Merjanah S, Harley ITW, Clark DH, Sun C, Kaufman KM, Harley JB, Kaelber DC, Scofield RH. Association between systemic lupus erythematosus and myasthenia gravis: A population-based National Study. Clin Immunol 2024; 260:109810. [PMID: 37949200 DOI: 10.1016/j.clim.2023.109810] [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: 09/15/2023] [Accepted: 10/11/2023] [Indexed: 11/12/2023]
Abstract
BACKGROUND Systemic lupus erythematosus (SLE) and myasthenia gravis (MG) are autoimmune diseases. Previous case reports and case series suggest an association may exist between these diseases, as well as an increased risk of SLE after thymectomy for MG. We undertook this study to determine whether SLE and MG were associated in large cohorts. METHODS We searched the IBM Watson Health Explorys platform and the Department of Veterans Affairs Million Veteran Program (MVP) database for diagnoses of SLE and MG. In addition, we examined subjects enrolled in the Lupus Family Registry and Repository (LFRR) as well as controls for a diagnosis of MG. RESULTS Among 59,780,210 individuals captured in Explorys, there were 25,750 with MG and 65,370 with SLE. 370 subjects had both. Those with MG were >10 times more likely to have SLE than those without MG. Those with both diseases were more likely to be women, African American, and at a younger age than MG subjects without SLE. In addition, the MG patients who underwent thymectomy had an increased risk of SLE compared to MG patients who had not undergone thymectomy (OR 3.11, 95% CI: 2.12 to 4.55). Autoimmune diseases such as pernicious anemia and miscellaneous comorbidities such as chronic kidney disease were significantly more common in MG patients who developed SLE. In the MVP, SLE and MG were also significantly associated. Association of SLE and MG in a large SLE cohort with rigorous SLE classification confirmed the association of SLE with MG at a similar level. CONCLUSION While the number of patients with both MG and SLE is small, SLE and MG are strongly associated together in very large databases and a large SLE cohort.
Collapse
Affiliation(s)
- Ann Igoe
- OhioHealth Hospital, Rheumatology Department, Mansfield, OH 44903, USA
| | - Sali Merjanah
- Boston University Medical Center, Section of Rheumatology, Department of Medicine, Boston, MA 02118, USA
| | - Isaac T W Harley
- Division of Rheumatology, Departments of Medicine and Immunology/Microbiology, School of Medicine, University of Colorado Anschutz Medical Campus, Aurora, CO 80045, USA; Medicine Service, Rheumatology Section, Rocky Mountain Regional Veterans Affairs Medical Center, Aurora, CO 80045, USA
| | - Dennis H Clark
- Research Service, US Department of Veterans Affairs Medical Center, Cincinnati, OH, USA
| | - Celi Sun
- Research Service, US Department of Veterans Affairs Medical Center, Oklahoma City, OK 73104, USA
| | - Kenneth M Kaufman
- Research Service, US Department of Veterans Affairs Medical Center, Cincinnati, OH, USA; Department of Pediatrics, University of Cincinnati, Cincinnati, OH, USA
| | - John B Harley
- Research Service, US Department of Veterans Affairs Medical Center, Cincinnati, OH, USA; Cincinnati Education and Research for Veterans Foundation, Cincinnati, OH, USA
| | - David C Kaelber
- Departments of Internal Medicine, Pediatrics, and Population and Quantitative Health Sciences, Case Western Reserve University School of Medicine and The Center for Clinical Informatics Research and Education, The MetroHealth System, Cleveland, OH 44109, USA
| | - R Hal Scofield
- Research Service, US Department of Veterans Affairs Medical Center, Oklahoma City, OK 73104, USA; Department of Medicine, University of Oklahoma Health Sciences Center, Arthritis & Clinical Immunology Program, Oklahoma Medical Research Foundation, and Medical/Research Service, and Medicine Service, US Department of Veterans Affairs Medical Center, Oklahoma City, OK 73104, USA.
| |
Collapse
|
9
|
Lavu MS, Van Dorn C, Bobak L, Burkhart RJ, Kaelber DC, Mistovich RJ. Does rickets carry an increased risk of osteomyelitis and septic arthritis? An aggregated electronic health record data study. J Pediatr Orthop B 2024:01202412-990000000-00187. [PMID: 38375875 DOI: 10.1097/bpb.0000000000001168] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/21/2024]
Abstract
To investigate the prevalence of osteomyelitis and septic arthritis in pediatric patients with rickets, compared to the general population. A retrospective cohort study was conducted using the TriNetX analytics network, which aggregates deidentified electronic health record data from over 105 million US patients. We queried pediatric patients with rickets, based on ICD-10-CM (International Classification of Diseases, Tenth Revision, Clinical Modification) encounter diagnoses. Patients with any ICD-10-CM encounter diagnoses of osteomyelitis or septic arthritis were reported. We established a control cohort of pediatric patients without rickets. Of 7337 pediatric patients (≤18 years old) with a rickets diagnosis, 96 [1.31%, 95% confidence interval (CI): 1.05%-1.57%] had a diagnosis of osteomyelitis and 28 (0.38%, 95% CI: 0.24%-0.52%) had a diagnosis of septic arthritis. In comparison, of the 17 240 604 pediatric patients without a rickets diagnosis, 16 995 (0.10%, 95% CI: 0.10%-0.10%) had a diagnosis of osteomyelitis and 8521 (0.05%, 95% CI: 0.05%-0.05%) had a diagnosis of septic arthritis. The relative risk for an osteomyelitis diagnosis in pediatric patients with a rickets diagnosis was 13.27 (95% CI: 10.86-16.23), while the relative risk for a septic arthritis diagnosis was 7.72 (95% CI: 5.33-11.18). Pediatric patients with a diagnosis of rickets have over 10- and 5-times higher relative risks for having a diagnosis of osteomyelitis and septic arthritis, respectively, compared to those without a diagnosis of rickets. This is the first study to explore musculoskeletal infections in rickets patients, highlighting the importance of clinicians being vigilant about these conditions.
Collapse
Affiliation(s)
- Monish S Lavu
- Department of Orthopaedics, Case Western Reserve University School of Medicine
| | - Chloe Van Dorn
- Department of Orthopaedics, Case Western Reserve University School of Medicine
| | - Lukas Bobak
- Department of Orthopaedics, Case Western Reserve University School of Medicine
| | - Robert J Burkhart
- Division of Pediatric Orthopaedic Surgery, University Hospitals Rainbow Babies and Children's Hospital
| | - David C Kaelber
- Department of Orthopaedics, Case Western Reserve University School of Medicine
- Departments of Internal Medicine, Pediatrics, and Population and Quantitative Health Sciences, Case Western Reserve University
- The Center for Clinical Informatics Research and Education, The MetroHealth System
| | - R Justin Mistovich
- Department of Orthopaedics, Case Western Reserve University School of Medicine
- Division of Pediatric Orthopaedic Surgery, University Hospitals Rainbow Babies and Children's Hospital
- Department of Orthopaedic Surgery, The MetroHealth System, Cleveland, Ohio, USA
| |
Collapse
|
10
|
Upadhyaya DP, Tarabichi Y, Prantzalos K, Ayub S, Kaelber DC, Sahoo SS. Machine Learning Interpretability Methods to Characterize the Importance of Hematologic Biomarkers in Prognosticating Patients with Suspected Infection. medRxiv 2024:2023.05.30.23290757. [PMID: 37398448 PMCID: PMC10312863 DOI: 10.1101/2023.05.30.23290757] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 07/04/2023]
Abstract
Early detection of sepsis in patients admitted to the emergency department (ED) is an important clinical objective as early identification and treatment can help reduce morbidity and mortality rate of 20% or higher. Hematologic changes during sepsis-associated organ dysfunction are well established and a new biomarker called Monocyte Distribution Width (MDW) has been recently approved by the US Food and Drug Administration for sepsis. However, MDW, which quantifies monocyte activation in sepsis patients, is not a routinely reported parameter and it requires specialized proprietary laboratory equipment. Further, the relative importance of MDW as compared to other routinely available hematologic parameters and vital signs has not been studied, which makes it difficult for resource constrained hospital systems to make informed decisions in this regard. To address this issue, we analyzed data from a cohort of ED patients (n=10,229) admitted to a large regional safety-net hospital in Cleveland, Ohio with suspected infection who later developed poor outcomes associated with sepsis. We developed a new analytical framework consisting of seven data models and an ensemble of high accuracy machine learning (ML) algorithms (accuracy values ranging from 0.83 to 0.90) for the prediction of outcomes more common in sepsis than uncomplicated infection (3-day intensive care unit stay or death). To characterize the contributions of individual hematologic parameters, we applied the Local Interpretable Model-Agnostic Explanation (LIME) and Shapley Additive Value (SHAP) interpretability methods to the high accuracy ML algorithms. The ML interpretability results were consistent in their findings that the value of MDW is grossly attenuated in the presence of other routinely reported hematologic parameters and vital signs data. Further, this study for the first time shows that complete blood count with differential (CBC-DIFF) together with vital signs data can be used as a substitute for MDW in high accuracy ML algorithms to screen for poor outcomes associated with sepsis.
Collapse
|
11
|
Hoying D, Dorney I, Otteson T, Thuener J, Kaelber DC. Assessing the Association Between Head and Neck Cancer and Granulomatosis with Polyangiitis. Ear Nose Throat J 2024:1455613231223409. [PMID: 38321643 DOI: 10.1177/01455613231223409] [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] [Subscribe] [Scholar Register] [Indexed: 02/08/2024] Open
Abstract
Objective: To determine the odds of head and neck cancer (HNC) in patients with a concurrent or prior diagnosis of granulomatosis with polyangiitis (GPA). Methods and Materials: The TriNetX Analytics Network, a federated research platform that aggregates de-identified electronic health record data of over 130 million patients worldwide, was queried for patients with at least one ICD-10 encounter diagnosis of GPA. Patients within this group with an encounter diagnosis of cancer of the sinonasal, oral cavity, oropharynx, nasopharynx, and larynx concurrent or after the initial encounter diagnosis of GPA were recorded and compared to a standardized control population to determine odds ratios with a 95% confidence interval (CI). Relevant confounding variables, including human papillomavirus, Epstein Barr virus, tobacco, and alcohol exposure, were balanced between cohorts by 1:1 propensity matching. Results: Of the patients in the GPA cohort, 126 (0.48%) had an ICD-10 diagnosis of HNC. When stratifying by head and neck subsites, 20 (0.08%), 18 (0.07%), 23 (0.09%), 70 (0.27%), and 22 (0.084%) GPA patients had an ICD-10 encounter diagnosis of cancer involving the sinonasal, nasopharynx, larynx, oral cavity, and oropharynx. When comparing the experimental GPA group with the standardized control population after matching, patients in the GPA group had 1.3 times (95% CI: 1.03-1.175) greater odds of HNC when including cases diagnosed after or concurrently with the diagnosis of the vasculitis. There was no statistical difference in the odds of cancer at each anatomical subsite between the GPA and control cohort after matching. Conclusion: Our study identifies a statistically significant increase in the odds of HNC encounter diagnoses in patients with GPA.
Collapse
Affiliation(s)
- David Hoying
- Case Western Reserve University School of Medicine, Cleveland, OH, USA
| | - Ian Dorney
- Case Western Reserve University School of Medicine, Cleveland, OH, USA
| | - Todd Otteson
- Case Western Reserve University School of Medicine, Cleveland, OH, USA
- Department of Otolaryngology, University Hospitals Cleveland Medical Center, Cleveland, OH, USA
| | - Jason Thuener
- Case Western Reserve University School of Medicine, Cleveland, OH, USA
- Department of Otolaryngology, University Hospitals Cleveland Medical Center, Cleveland, OH, USA
| | - David C Kaelber
- Department of Internal Medicine, Pediatrics, and Population and Quantitative Health Sciences, Case Western Reserve University, Cleveland, OH, USA
- The Center for Clinical Informatics Research and Education, The MetroHealth System, Cleveland, OH, USA
| |
Collapse
|
12
|
Wang L, Wang W, Kaelber DC, Xu R, Berger NA. GLP-1 Receptor Agonists and Colorectal Cancer Risk in Drug-Naive Patients With Type 2 Diabetes, With and Without Overweight/Obesity. JAMA Oncol 2024; 10:256-258. [PMID: 38060218 PMCID: PMC10704339 DOI: 10.1001/jamaoncol.2023.5573] [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] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2023] [Accepted: 09/24/2023] [Indexed: 12/08/2023]
Abstract
This cohort study compares glucagon-like peptide 1 receptor agonists (GLP-1RAs) with 7 non–GLP-1RA antidiabetics among drug-naive patients with type 2 diabetes.
Collapse
Affiliation(s)
- Lindsey Wang
- Center for Science, Health, and Society, Case Western Reserve University School of Medicine, Cleveland, Ohio
| | - William Wang
- Center for Science, Health, and Society, Case Western Reserve University School of Medicine, Cleveland, Ohio
| | - David C. Kaelber
- Departments of Internal Medicine, Pediatrics, and Population and Quantitative Health Sciences and the Center for Clinical Informatics Research and Education, The MetroHealth System, Cleveland, Ohio
| | - Rong Xu
- Center for Artificial Intelligence in Drug Discovery, Case Western Reserve University School of Medicine, Cleveland, Ohio
- Case Comprehensive Cancer Center, Case Western Reserve University School of Medicine, Cleveland, Ohio
| | - Nathan A. Berger
- Center for Science, Health, and Society, Case Western Reserve University School of Medicine, Cleveland, Ohio
- Case Comprehensive Cancer Center, Case Western Reserve University School of Medicine, Cleveland, Ohio
| |
Collapse
|
13
|
Ishmael L, Apter A, Busse PJ, Calderon-Candelario R, Carroll JK, Casale T, Celedón JC, Cohen R, Coyne-Beasley T, Cui J, Ericson B, Hernandez P, Kaelber DC, Maher N, Merriman C, Mosnaim G, Nazario S, Phipatanakul W, Pinto-Plata V, Riley I, Shenoy K, Wisnivesky J, Yawn B, Israel E, Cardet JC. Asthma morbidity measures across Black ethnic subgroups. J Allergy Clin Immunol 2024; 153:408-417. [PMID: 38000696 PMCID: PMC10922293 DOI: 10.1016/j.jaci.2023.10.028] [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: 06/21/2023] [Revised: 10/04/2023] [Accepted: 10/31/2023] [Indexed: 11/26/2023]
Abstract
BACKGROUND Black adults are disproportionately affected by asthma and are often considered a homogeneous group in research studies despite cultural and ancestral differences. OBJECTIVE We sought to determine if asthma morbidity differs across adults in Black ethnic subgroups. METHODS Adults with moderate-severe asthma were recruited across the continental United States and Puerto Rico for the PREPARE (PeRson EmPowered Asthma RElief) trial. Using self-identifications, we categorized multiethnic Black (ME/B) participants (n = 226) as Black Latinx participants (n = 146) or Caribbean, continental African, or other Black participants (n = 80). African American (AA/B) participants (n = 518) were categorized as Black participants who identified their ethnicity as being American. Baseline characteristics and retrospective asthma morbidity measures (self-reported exacerbations requiring systemic corticosteroids [SCs], emergency department/urgent care [ED/UC] visits, hospitalizations) were compared across subgroups using multivariable regression. RESULTS Compared with AA/B participants, ME/B participants were more likely to be younger, residing in the US Northeast, and Spanish speaking and to have lower body mass index, health literacy, and <1 comorbidity, but higher blood eosinophil counts. In a multivariable analysis, ME/B participants were significantly more likely to have ED/UC visits (incidence rate ratio [IRR] = 1.34, 95% CI = 1.04-1.72) and SC use (IRR = 1.27, 95% CI = 1.00-1.62) for asthma than AA/B participants. Of the ME/B subgroups, Puerto Rican Black Latinx participants (n = 120) were significantly more likely to have ED/UC visits (IRR = 1.64, 95% CI = 1.22-2.21) and SC use for asthma (IRR = 1.43, 95% CI = 1.06-1.92) than AA/B participants. There were no significant differences in hospitalizations for asthma among subgroups. CONCLUSIONS ME/B adults, specifically Puerto Rican Black Latinx adults, have higher risk of ED/UC visits and SC use for asthma than other Black subgroups.
Collapse
Affiliation(s)
- Leah Ishmael
- Division of Allergy and Immunology, Department of Internal Medicine, University of South Florida Morsani College of Medicine, Tampa, Fla
| | - Andrea Apter
- Division of Pulmonary, Allergy and Critical Care, Department of Medicine, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pa
| | - Paula J Busse
- Division of Clinical Immunology, Icahn School of Medicine at Mount Sinai, New York, NY
| | | | - Jennifer K Carroll
- American Academy of Family Physicians National Research Network, Leawood, Kan; Department of Family Medicine, University of Colorado School of Medicine, Aurora, Colo
| | - Thomas Casale
- Division of Allergy and Immunology, Department of Internal Medicine, University of South Florida Morsani College of Medicine, Tampa, Fla
| | - Juan C Celedón
- Division of Pediatric Pulmonary Medicine, University of Pittsburgh, Pittsburgh, Pa
| | - Rubin Cohen
- Division of Pulmonary Critical Care and Sleep Medicine, Syracuse VA Medical Center, SUNY Upstate Medical University, Syracuse, NY
| | - Tamera Coyne-Beasley
- Department of Adolescent Medicine, University of North Carolina, Chapel Hill, NC
| | - Jing Cui
- Division of Rheumatology, Inflammation, and Immunity, Brigham and Women's Hospital, Boston, Mass
| | - Brianna Ericson
- Division of Pulmonary and Critical Care Medicine, Brigham and Women's Hospital, Boston, Mass
| | - Paulina Hernandez
- Division of Pulmonary and Critical Care Medicine, Brigham and Women's Hospital, Boston, Mass
| | - David C Kaelber
- Center for Clinical Informatics Research and Education, MetroHealth System, Cleveland, Ohio; Departments of Medicine, Pediatrics, and Population and Quantitative Health Sciences, Case Western Reserve University, Cleveland, Ohio
| | - Nancy Maher
- Division of Pulmonary and Critical Care Medicine, Brigham and Women's Hospital, Boston, Mass
| | - Conner Merriman
- Division of Allergy and Immunology, Department of Internal Medicine, University of South Florida Morsani College of Medicine, Tampa, Fla
| | - Giselle Mosnaim
- Division of Allergy, Asthma, and Immunology, Northshore University Health System, Evanston, Ill
| | - Sylvette Nazario
- Allergy and Immunology Section, University of Puerto Rico School of Medicine, San Juan, Puerto Rico
| | - Wanda Phipatanakul
- Departments of Allergy and Immunology and Pediatrics, Boston Children's Hospital, Harvard Medical School, Boston, Mass
| | - Victor Pinto-Plata
- Division of Pulmonary and Critical Care, Lahey Hospital and Medical Center, Burlington, Mass
| | - Isaretta Riley
- Division of Pulmonary and Critical Care Medicine, Duke University School of Medicine, Durham, NC
| | - Kartik Shenoy
- Temple Lung Center, Lewis Katz School of Medicine at Temple University, Philadelphia, Pa
| | - Juan Wisnivesky
- Division of General Internal Medicine, Icahn School of Medicine at Mount Sinai, New York, NY
| | - Barbara Yawn
- Department of Family and Community Health, University of Minnesota, Minneapolis, Minn
| | - Elliot Israel
- Divisions of Pulmonary and Critical Care Medicine and Allergy and Clinical Immunology, Brigham and Women's Hospital, Boston, Mass
| | - Juan Carlos Cardet
- Division of Allergy and Immunology, Department of Internal Medicine, University of South Florida Morsani College of Medicine, Tampa, Fla.
| |
Collapse
|
14
|
Terebuh P, Olaker VR, Kendall EK, Kaelber DC, Xu R, Davis PB. Liver abnormalities following SARS-CoV-2 infection in children 1 to 10 years of age. Fam Med Community Health 2024; 12:e002655. [PMID: 38272541 PMCID: PMC10824054 DOI: 10.1136/fmch-2023-002655] [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] [Indexed: 01/27/2024] Open
Abstract
OBJECTIVE Beginning in October 2021 in the USA and elsewhere, cases of severe paediatric hepatitis of unknown aetiology were identified in young children. While the adenovirus and adenovirus-associated virus have emerged as leading aetiological suspects, we attempted to investigate a potential role for SARS-CoV-2 in the development of subsequent liver abnormalities. DESIGN We conducted a study using retrospective cohorts of deidentified, aggregated data from the electronic health records of over 100 million patients contributed by US healthcare organisations. RESULTS Compared with propensity score matched children with other respiratory infections, children aged 1-10 years with COVID-19 had a higher risk of elevated transaminases (HR (95% CI) 2.16 (1.74 to 2.69)) or total bilirubin (HR (95% CI) 3.02 (1.91 to 4.78)), or new diagnoses of liver diseases (HR (95% CI) 1.67 (1.21 to 2.30)) from 1 to 6 months after infection. Patients with pre-existing liver abnormalities, liver abnormalities surrounding acute infection, younger age (1-4 years) or illness requiring hospitalisation all had similarly elevated risk. Children who developed liver abnormalities following COVID-19 had more pre-existing conditions than those who developed abnormalities following other infections. CONCLUSION These results indicate that SARS-CoV-2 may prime the patient for subsequent development of liver infections or non-infectious liver diseases. While rare (~1 in 1000), SARS-CoV-2 is a risk for subsequent abnormalities in liver function or the diagnosis of diseases of the liver.
Collapse
Affiliation(s)
- Pauline Terebuh
- Center for Artificial Intelligence in Drug Discovery, Case Western Reserve University, Cleveland, OH, USA
| | - Veronica R Olaker
- Center for Artificial Intelligence in Drug Discovery, Case Western Reserve University, Cleveland, OH, USA
| | - Ellen K Kendall
- Center for Artificial Intelligence in Drug Discovery, Case Western Reserve University, Cleveland, OH, USA
| | - David C Kaelber
- The Center for Clinical Informatics Research and Education, The MetroHealth System, Cleveland, OH, USA
- Department of Medicine, Pediatrics, Department of Population and Quantitative Health Sciences, Case Western Reserve University, Cleveland, OH, USA
| | - Rong Xu
- Center for Artificial Intelligence in Drug Discovery, Case Western Reserve University, Cleveland, OH, USA
| | - Pamela B Davis
- Center for Community Health Integration, Case Western Reserve University, Cleveland, OH, USA
| |
Collapse
|
15
|
Gulati R, Gulati K, Alkhouri N, Sahni H, Mhanna MJ, Kaelber DC, Durrani HM, Suri R. Missed Opportunities in Guideline-based Fatty Liver Screening among 3.5 million children. Acad Pediatr 2024:S1876-2859(24)00018-4. [PMID: 38278482 DOI: 10.1016/j.acap.2024.01.019] [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: 07/06/2023] [Revised: 01/16/2024] [Accepted: 01/20/2024] [Indexed: 01/28/2024]
Abstract
OBJECTIVE Determine screening rates and examine socio- demographic characteristics of MAFLD screening in a large population of obese children. METHODS We used Explorys (IBM) which contains aggregated population-level electronic health record data from approximately 360 hospitals and 317,000 providers across the United States to determine MAFLD screening rates. In children 10-14 years, obesity was determined based on BMI >=95%, or encounter with an ICD obesity code. We determined screening rates by calculating the percentage of children with obesity who had an alanine aminotransferase (ALT) tested, further analyzed by gender, race and insurance. RESULTS Of 3,558,420 children, 513,170 (14.4%) were obese. Of obese children, only 9.3% were screened for NAFLD. Females were more likely screened than males (odds ratio (OR) 1.09 (95% CI:1.07-1.12)); white children were more likely screened than non-white children (OR 1.21 (95% CI:1.18-1.23)), and children with Medicaid more likely screened than children with non-Medicaid insurance (OR 1.34 (95% CI:1.32- 1.37)). CONCLUSION(S) The percentage of obese children receiving screening for MAFLD was low. Female gender, white race, and Medicaid insurance were associated with increased screening rates. These findings highlight the need to increase adherence to MAFLD screening. Reporting screening as a health quality measure may reduce implementation gaps in MAFLD screening. WHAT'S NEW IN THIS STUDY?: Our study adds knowledge about screening rates and sociodemographic characteristics of MAFLD screening among children.
Collapse
Affiliation(s)
- Reema Gulati
- Department of Pediatrics, The MetroHealth System and Case Western Reserve University, Cleveland, Ohio
| | - Kabir Gulati
- Stephen M. Ross School of Business, University of Michigan, Ann Arbor, Michigan
| | | | | | - Maroun J Mhanna
- Department of Pediatrics, Louisiana State University Health Sciences Center, Shreveport, LA, United States
| | - David C Kaelber
- Department of Pediatrics, The MetroHealth System and Case Western Reserve University, Cleveland, Ohio
| | - Hafiza Mehreen Durrani
- Department of Pediatrics, The MetroHealth System and Case Western Reserve University, Cleveland, Ohio
| | | |
Collapse
|
16
|
Patel TN, Chaise AJ, Hanna JJ, Patel KP, Kochendorfer KM, Medford RJ, Mize DE, Melnick ER, Hron JD, Youens K, Pandita D, Leu MG, Ator GA, Yu F, Genes N, Baker CK, Bell DS, Pevnick JM, Conrad SA, Chandawarkar AR, Rogers KM, Kaelber DC, Singh IR, Levy BP, Finnell JT, Kannry J, Pageler NM, Mohan V, Lehmann CU. Structure and Funding of Clinical Informatics Fellowships: A National Survey of Program Directors. Appl Clin Inform 2024; 15:155-163. [PMID: 38171383 PMCID: PMC10881258 DOI: 10.1055/a-2237-8309] [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: 09/26/2023] [Accepted: 01/02/2024] [Indexed: 01/05/2024] Open
Abstract
BACKGROUND In 2011, the American Board of Medical Specialties established clinical informatics (CI) as a subspecialty in medicine, jointly administered by the American Board of Pathology and the American Board of Preventive Medicine. Subsequently, many institutions created CI fellowship training programs to meet the growing need for informaticists. Although many programs share similar features, there is considerable variation in program funding and administrative structures. OBJECTIVES The aim of our study was to characterize CI fellowship program features, including governance structures, funding sources, and expenses. METHODS We created a cross-sectional online REDCap survey with 44 items requesting information on program administration, fellows, administrative support, funding sources, and expenses. We surveyed program directors of programs accredited by the Accreditation Council for Graduate Medical Education between 2014 and 2021. RESULTS We invited 54 program directors, of which 41 (76%) completed the survey. The average administrative support received was $27,732/year. Most programs (85.4%) were accredited to have two or more fellows per year. Programs were administratively housed under six departments: Internal Medicine (17; 41.5%), Pediatrics (7; 17.1%), Pathology (6; 14.6%), Family Medicine (6; 14.6%), Emergency Medicine (4; 9.8%), and Anesthesiology (1; 2.4%). Funding sources for CI fellowship program directors included: hospital or health systems (28.3%), clinical departments (28.3%), graduate medical education office (13.2%), biomedical informatics department (9.4%), hospital information technology (9.4%), research and grants (7.5%), and other sources (3.8%) that included philanthropy and external entities. CONCLUSION CI fellowships have been established in leading academic and community health care systems across the country. Due to their unique training requirements, these programs require significant resources for education, administration, and recruitment. There continues to be considerable heterogeneity in funding models between programs. Our survey findings reinforce the need for reformed federal funding models for informatics practice and training.
Collapse
Affiliation(s)
- Tushar N. Patel
- Department of Pathology, University of Illinois Chicago, Chicago, Illinois, United States
| | - Aaron J. Chaise
- Department of Pathology, University of Illinois Chicago, Chicago, Illinois, United States
| | - John J. Hanna
- Clinical Informatics Center, University of Texas Southwestern, Dallas, Texas, United States
| | - Kunal P. Patel
- Department of Pathology, University of Illinois Chicago, Chicago, Illinois, United States
| | - Karl M. Kochendorfer
- Department of Pathology, University of Illinois Chicago, Chicago, Illinois, United States
| | - Richard J. Medford
- Clinical Informatics Center, University of Texas Southwestern, Dallas, Texas, United States
| | - Dara E. Mize
- Departments of Biomedical Informatics and Medicine, Vanderbilt University Medical Center, Nashville, Tennessee, United States
| | - Edward R. Melnick
- Department of Emergency Medicine, Yale School of Medicine, New Haven, Connecticut, United States
- Department of Biostatistics (Health Informatics), Yale School of Public Health, New Haven, Connecticut, United States
| | - Jonathan D. Hron
- Division of General Pediatrics, Boston Children's Hospital, Boston, Massachusetts, United States
- Department of Pediatrics, Harvard Medical School, Boston, Massachusetts, United States
| | - Kenneth Youens
- Department of Pathology, Baylor Scott & White Health, Temple, Texas, United States
| | - Deepti Pandita
- Department of Internal Medicine, University of California, Irvine, California, United States
| | - Michael G. Leu
- Departments of Pediatrics and Biomedical Informatics and Medical Education, University of Washington, Seattle, Washington, United States
- Information Technology Services, UW Medicine, Seattle, WA, United States
- Information Technology Department, Seattle Children's Hospital, Seattle, WA, United States
| | - Gregory A. Ator
- Department of Otolaryngology-Head and Neck Surgery and Clinical Informatics, University of Kansas Medical Center, Kansas City, Kansas, United States
| | - Feliciano Yu
- Department of Pediatrics, University of Arkansas for Medical Sciences, Little Rock, Arkansas, United States
| | - Nicholas Genes
- Ronald O. Perelman Department of Emergency Medicine, NYU Grossman School of Medicine, New York, New York, United States
| | - Carrie K. Baker
- Department of Family Medicine, Kettering Health, Indu and Raj Soin Medical Center, Dayton, Ohio, United States
| | - Douglas S. Bell
- Department of Medicine, David Geffen School of Medicine at University of California, Los Angeles, Los Angeles, California, United States
| | - Joshua M. Pevnick
- Department of Medicine, Cedars-Sinai Health System, Los Angeles, California, United States
| | - Steven A. Conrad
- Division of Clinical Informatics, Department of Medicine, LSU Health Shreveport, Shreveport, Louisiana, United States
| | - Aarti R. Chandawarkar
- Division of Clinical Informatics, Nationwide Children's Hospital and The Ohio State, Columbus, Ohio, United States
- Department of Pediatrics, The Ohio State University College of Medicine, Columbus, Ohio, United States
| | - Kendall M. Rogers
- Division of Hospital Medicine, University of New Mexico Health Sciences Center, Albuquerque, New Mexico, United States
| | - David C. Kaelber
- Center for Clinical Informatics Research and Education, The MetroHealth System, and the Departments of Internal Medicine, Pediatrics, and Population and Quantitative Health Sciences, Case Western Reserve University, Cleveland, Ohio, United States
| | - Ila R. Singh
- Department of Pathology and Immunology, Baylor College of Medicine and Texas Children's Hospital, Houston, Texas, United States
| | - Bruce P. Levy
- Division of Informatics, Geisinger Health System, Danville, Pennsylvania, United States
| | - John T. Finnell
- Department of Emergency Medicine, Indiana University School of Medicine, Indianapolis, Indiana, United States
| | - Joseph Kannry
- Division of General Internal Medicine, Department of Medicine, Icahn School of Medicine at Mount Sinai, New York, New York, United States
| | - Natalie M. Pageler
- Division of Clinical Informatics, Department of Pediatrics, Stanford University School of Medicine, Palo Alto, California, United States
| | - Vishnu Mohan
- Department of Medical Informatics & Clinical Epidemiology, Oregon Health & Science University, Portland, Oregon, United States
| | - Christoph U. Lehmann
- Clinical Informatics Center, University of Texas Southwestern, Dallas, Texas, United States
| |
Collapse
|
17
|
Wang W, Volkow ND, Berger NA, Davis PB, Kaelber DC, Xu R. Association of semaglutide with risk of suicidal ideation in a real-world cohort. Nat Med 2024; 30:168-176. [PMID: 38182782 PMCID: PMC11034947 DOI: 10.1038/s41591-023-02672-2] [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] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2023] [Accepted: 10/30/2023] [Indexed: 01/07/2024]
Abstract
Concerns over reports of suicidal ideation associated with semaglutide treatment, a glucagon-like peptide 1 receptor (GLP1R) agonist medication for type 2 diabetes (T2DM) and obesity, has led to investigations by European regulatory agencies. In this retrospective cohort study of electronic health records from the TriNetX Analytics Network, we aimed to assess the associations of semaglutide with suicidal ideation compared to non-GLP1R agonist anti-obesity or anti-diabetes medications. The hazard ratios (HRs) and 95% confidence intervals (CIs) of incident and recurrent suicidal ideation were calculated for the 6-month follow-up by comparing propensity score-matched patient groups. The study population included 240,618 patients with overweight or obesity who were prescribed semaglutide or non-GLP1R agonist anti-obesity medications, with the findings replicated in 1,589,855 patients with T2DM. In patients with overweight or obesity (mean age 50.1 years, 72.6% female), semaglutide compared with non-GLP1R agonist anti-obesity medications was associated with lower risk for incident (HR = 0.27, 95% CI = 0.200.32-0.600.36) and recurrent (HR = 0.44, 95% CI = 0.32-0.60) suicidal ideation, consistent across sex, age and ethnicity stratification. Similar findings were replicated in patients with T2DM (mean age 57.5 years, 49.2% female). Our findings do not support higher risks of suicidal ideation with semaglutide compared with non-GLP1R agonist anti-obesity or anti-diabetes medications.
Collapse
Affiliation(s)
- William Wang
- Center for Science, Health, and Society, Case Western Reserve University School of Medicine, Cleveland, OH, USA
| | - Nora D Volkow
- National Institute on Drug Abuse, National Institutes of Health, Bethesda, MD, USA.
| | - Nathan A Berger
- Center for Science, Health, and Society, Case Western Reserve University School of Medicine, Cleveland, OH, USA
| | - Pamela B Davis
- Center for Community Health Integration, Case Western Reserve University School of Medicine, Cleveland, OH, USA
| | - David C Kaelber
- Center for Clinical Informatics Research and Education, The MetroHealth System, Cleveland, OH, USA
| | - Rong Xu
- Center for Artificial Intelligence in Drug Discovery, Case Western Reserve University School of Medicine, Cleveland, OH, USA.
| |
Collapse
|
18
|
Lavu MS, Hecht CJ, Rizk AA, Acuña AJ, Kaelber DC, Kamath AF. Total Hip Arthroplasty Outcomes in Patients Who Have a History of Prior Radiation. J Arthroplasty 2023; 38:2644-2649. [PMID: 37301238 DOI: 10.1016/j.arth.2023.05.066] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/11/2023] [Revised: 05/18/2023] [Accepted: 05/24/2023] [Indexed: 06/12/2023] Open
Abstract
BACKGROUND The purpose of this study was to assess the odds of developing medical and surgical adverse events following total hip arthroplasty (THA) in patients who have a history of radiation therapy (RT) for cancer. METHODS A retrospective cohort study was conducted using a national database to identify patients who underwent primary THA (Current Procedural Terminology code 27130) from 2002 to 2022. Patients who had a prior RT were identified by International Classification of Diseases, Tenth Revision, Clinical Modification codes Z51.0 (encounter for antineoplastic RT), Z92.3 (personal history of irradiation), or Current Procedural Terminology code 101843 (radiation oncology treatment). One-to-one propensity score matching was conducted to generate 3 pairs of cohorts: 1) THA with/without a history of RT; 2) THA with/without a history of cancer; and 3) THA patients who have a history of cancer treated with/without RT. Surgical and medical complications were assessed at the 30-day, 90-day, and 1-year postoperative periods. RESULTS Patients who have a history of RT had higher odds of developing anemia, deep vein thrombosis, pneumonia, pulmonary embolism, and prosthetic joint infection at all intervals. When controlling for a history of cancer, RT was associated with an increased risk of pulmonary embolism, heterotrophic ossification, prosthetic joint infection, and periprosthetic fracture at all postoperative time points. There was additionally an increased risk of aseptic loosening at 1 year (odds ratio: 2.0, 95% confidence interval: 1.2 to 3.1). CONCLUSION These findings suggest that patients who have a history of antineoplastic RT are at an increased risk of developing various surgical and medical complications following THA.
Collapse
Affiliation(s)
- Monish S Lavu
- Case Western Reserve University School of Medicine, Cleveland, Ohio; Department of Orthopaedic Surgery, Cleveland Clinic Foundation, Cleveland, Ohio
| | - Christian J Hecht
- Case Western Reserve University School of Medicine, Cleveland, Ohio; Department of Orthopaedic Surgery, Cleveland Clinic Foundation, Cleveland, Ohio
| | - Adam A Rizk
- Case Western Reserve University School of Medicine, Cleveland, Ohio; Department of Orthopaedic Surgery, Cleveland Clinic Foundation, Cleveland, Ohio
| | - Alexander J Acuña
- Department of Orthopaedics, Rush University Medical Center, Chicago, Illinois
| | - David C Kaelber
- Departments of Internal Medicine, Pediatrics, and Population and Quantitative Health Sciences, Case Western Reserve University, Cleveland, Ohio; The Center for Clinical Informatics Research and Education, The MetroHealth System, Cleveland, Ohio
| | - Atul F Kamath
- Department of Orthopaedic Surgery, Cleveland Clinic Foundation, Cleveland, Ohio
| |
Collapse
|
19
|
Wang L, Volkow ND, Berger NA, Davis PB, Kaelber DC, Xu R. Cardiac and mortality outcome differences between methadone, buprenorphine and naltrexone prescriptions in patients with an opioid use disorder. J Clin Psychol 2023; 79:2869-2883. [PMID: 37584532 DOI: 10.1002/jclp.23582] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [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: 02/04/2023] [Revised: 07/01/2023] [Accepted: 08/08/2023] [Indexed: 08/17/2023]
Abstract
IMPORTANCE More than 109,000 Americans died of drug overdose in 2022, with 81,231 overdose deaths involving opioids. Methadone, buprenorphine and naltrexone are the most widely used medications for opioid use disorders (MOUD) and the most effective intervention for preventing overdose deaths. However, there is a concern that methadone results in long QT syndrome, which increases the risk for fatal cardiac arrythmias. Currently few studies have systematically evaluated both the short-term and long-term differences in cardiac and mortality outcomes between MOUD. OBJECTIVES To compare the risks of cardiac arrythmias, long QT syndrome and overall mortality between patients with opioid use disorders (OUD) who were prescribed methadone, buprenorphine or naltrexone. DESIGN, SETTING, AND PARTICIPANTS Retrospective cohort study based on a multicenter and nationwide database of electronic health records (EHRs) in the United States. The study population was comprised of 144,141 patients who had medical encounters for OUD in 2016-2022, were prescribed MOUD within 1 month following a medical encounter for OUD diagnosis and had no diagnosis of cardiac arrythmias or long QT syndrome before any MOUD prescription. The study population was divided into three cohorts: (1) Methadone cohort (n = 40,938)-who were only prescribed methadone. (2) Buprenorphine cohort (n = 80,055)-who were only prescribed buprenorphine. (3) Naltrexone cohort (n = 5,738)-who were only prescribed naltrexone. EXPOSURES methadone, buprenorphine, or naltrexone. MAIN OUTCOMES AND MEASURES Cardiac arrythmias, long QT syndrome, and death. Hazard ratio (HR) and 95% confidence interval (CI) of outcomes at six different follow-up time frames (1-month, 3-month, 6-month, 1-year, 3-year, and 5-year) by comparing propensity-score matched cohorts using Kaplan-Meier survival analysis. RESULTS Patients with OUD who were prescribed methadone had significantly higher risks of cardiac arrhythmias, long QT syndrome and death compared with propensity-score matched patients with OUD who were prescribed buprenorphine or naltrexone. For the 1-month follow-up, the overall risk for cardiac arrythmias was 1.03% in the Methadone cohort, higher than the 0.87% in the matched Buprenorphine cohort (HR: 1.20, 95% CI: 1.04-1.39); The overall risk for long QT syndrome was 0.35% in the Methadone cohort, higher than the 0.15% in the matched Buprenorphine cohort (HR: 2.40, 95% CI: 1.75-3.28); The overall mortality was 0.59% in the Methadone cohort, higher than the 0.41% in the matched Buprenorphine cohort (HR: 1.48, 95% CI: 1.21-1.81). The increased risk persisted for 5 years: cardiac arrhythmias (HR: 1.31, 95% CI: 1.23-1.38), long QT syndrome (HR: 3.14, 95% CI: 2.76-3.58), death (HR: 1.50, 95% CI: 1.41-1.59). CONCLUSIONS AND RELEVANCE Methadone was associated with a significantly higher risk for cardiac and mortality outcomes than buprenorphine and naltrexone. These findings are relevant to the development of guidelines for medication selection when initiating MOUD treatment and inform future medication development for OUD that minimizes risks while maximizing benefits.
Collapse
Affiliation(s)
- Lindsey Wang
- Center for Science, Health, and Society, Case Western Reserve University School of Medicine, Cleveland, Ohio, USA
| | - Nora D Volkow
- National Institute on Drug Abuse, National Institutes of Health, Bethesda, Maryland, USA
| | - Nathan A Berger
- Center for Science, Health, and Society, Case Western Reserve University School of Medicine, Cleveland, Ohio, USA
| | - Pamela B Davis
- Center for Community Health Integration, Case Western Reserve University School of Medicine, Cleveland, Ohio, USA
| | - David C Kaelber
- The Center for Clinical Informatics Research and Education, The MetroHealth System, Cleveland, Ohio, USA
| | - Rong Xu
- Center for Artificial Intelligence in Drug Discovery, Case Western Reserve University School of Medicine, Cleveland, Ohio, USA
| |
Collapse
|
20
|
Gorenflo MP, Davis PB, Kaelber DC, Xu R. Ischemic stroke after COVID-19 bivalent vaccine administration in patients aged 65 years and older in the United States. NPJ Vaccines 2023; 8:180. [PMID: 37996515 PMCID: PMC10667491 DOI: 10.1038/s41541-023-00777-w] [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] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2023] [Accepted: 11/06/2023] [Indexed: 11/25/2023] Open
Abstract
The Centers for Disease Control and Prevention announced in January 2023 a potential connection between administration of the Pfizer novel coronavirus disease-2019 (COVID-19) bivalent vaccine booster and ischemic stroke (IS). A retrospective cohort study was conducted to compare the hazard of IS in patients aged 65 years and over administered the Pfizer bivalent booster versus those administered the Pfizer/Moderna monovalent or Moderna bivalent boosters. De-identified patient electronic health data were collected from TriNetX, a cloud-based analytics platform that includes data from over 90 million unique patients in the United States. Patients aged 65 years and over at the time of administration of a Pfizer bivalent, Moderna bivalent, or Pfizer/Moderna monovalent booster were included for analysis. Cohorts were propensity-score matched. The hazard ratios (HR) and 95% confidence intervals (CI) for IS between matched cohorts at 1-21 and 22-42 days after booster administration were calculated. There was reduced hazard of IS in the Pfizer bivalent cohort compared to the monovalent cohort at both timepoints: 1-21 days after vaccination (HR: 0.54, 95% CI: 0.47-0.62), and 22-42 days after vaccination (HR: 0.62, 95% CI: 0.54-0.72) (n = 79,036 patients per cohort). There was reduced hazard of IS in the Pfizer bivalent cohort compared to the Moderna bivalent cohort at 1-21 days after vaccination (HR: 0.75, 95% CI: 0.58-0.96) (n = 26,962 patients per cohort). This analysis provides no evidence that the Pfizer bivalent vaccine is associated with increased hazard of IS compared to the monovalent or Moderna bivalent vaccines.
Collapse
Affiliation(s)
- Maria P Gorenflo
- Center for Artificial Intelligence in Drug Discovery, Case Western Reserve University School of Medicine, Cleveland, OH, USA
| | - Pamela B Davis
- Center for Community Health Integration, Case Western Reserve University School of Medicine, Cleveland, OH, USA
| | - David C Kaelber
- Center for Clinical Informatics Research and Education, The MetroHealth System, and Department of Internal Medicine, Pediatrics, and Population and Quantitative Health Sciences, Case Western Reserve University, Cleveland, OH, USA
| | - Rong Xu
- Center for Artificial Intelligence in Drug Discovery, Case Western Reserve University School of Medicine, Cleveland, OH, USA.
| |
Collapse
|
21
|
Littenberg B, Clifton J, Crocker AM, Baldwin LM, Bonnell LN, Breshears RE, Callas P, Chakravarti P, Clark/Keefe K, Cohen DJ, deGruy FV, Eidt-Pearson L, Elder W, Fox C, Frisbie S, Hekman K, Hitt J, Jewiss J, Kaelber DC, Kelley KS, Kessler R, O'Rourke-Lavoie JB, Leibowitz GS, Macchi CR, Martin MP, McGovern M, Mollis B, Mullin D, Nagykaldi Z, Natkin LW, Pace W, Pinckney RG, Pomeroy D, Reynolds P, Rose GL, Scholle SH, Sieber WJ, Soucie J, Stancin T, Stange KC, Stephens KA, Teng K, Waddell EN, van Eeghen C. A Cluster Randomized Trial of Primary Care Practice Redesign to Integrate Behavioral Health for Those Who Need It Most: Patients With Multiple Chronic Conditions. Ann Fam Med 2023; 21:483-495. [PMID: 38012036 PMCID: PMC10681692 DOI: 10.1370/afm.3027] [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: 12/21/2022] [Revised: 05/05/2023] [Accepted: 05/31/2023] [Indexed: 11/29/2023] Open
Abstract
PURPOSE Patient outcomes can improve when primary care and behavioral health providers use a collaborative system of care, but integrating these services is difficult. We tested the effectiveness of a practice intervention for improving patient outcomes by enhancing integrated behavioral health (IBH) activities. METHODS We conducted a pragmatic, cluster randomized controlled trial. The intervention combined practice redesign, quality improvement coaching, provider and staff education, and collaborative learning. At baseline and 2 years, staff at 42 primary care practices completed the Practice Integration Profile (PIP) as a measure of IBH. Adult patients with multiple chronic medical and behavioral conditions completed the Patient-Reported Outcomes Measurement Information System (PROMIS-29) survey. Primary outcomes were the change in 8 PROMIS-29 domain scores. Secondary outcomes included change in level of integration. RESULTS Intervention assignment had no effect on change in outcomes reported by 2,426 patients who completed both baseline and 2-year surveys. Practices assigned to the intervention improved PIP workflow scores but not PIP total scores. Baseline PIP total score was significantly associated with patient-reported function, independent of intervention. Active practices that completed intervention workbooks (n = 13) improved patient-reported outcomes and practice integration (P ≤ .05) compared with other active practices (n = 7). CONCLUSION Intervention assignment had no effect on change in patient outcomes; however, we did observe improved patient outcomes among practices that entered the study with greater IBH. We also observed more improvement of integration and patient outcomes among active practices that completed the intervention compared to active practices that did not. Additional research is needed to understand how implementation efforts to enhance IBH can best reach patients.
Collapse
Affiliation(s)
- Benjamin Littenberg
- University of Vermont, Burlington, Vermont (B.L., J.C., A.M.C., L.N.B., P.C., K.C/K., S.F., J.H., J.J., K.S.K., J.B.O-L., L.W.N., R.G.P., D.P., P.R., G.L.R., C.vE.);
| | - Jessica Clifton
- University of Vermont, Burlington, Vermont (B.L., J.C., A.M.C., L.N.B., P.C., K.C/K., S.F., J.H., J.J., K.S.K., J.B.O-L., L.W.N., R.G.P., D.P., P.R., G.L.R., C.vE.)
- Parhelia Wellness, Santa Rosa, California (J.C.)
| | - Abigail M Crocker
- University of Vermont, Burlington, Vermont (B.L., J.C., A.M.C., L.N.B., P.C., K.C/K., S.F., J.H., J.J., K.S.K., J.B.O-L., L.W.N., R.G.P., D.P., P.R., G.L.R., C.vE.)
| | - Laura-Mae Baldwin
- University of Washington, Seattle, Washington (L-M.B., B.M., K.A.S.)
| | - Levi N Bonnell
- University of Vermont, Burlington, Vermont (B.L., J.C., A.M.C., L.N.B., P.C., K.C/K., S.F., J.H., J.J., K.S.K., J.B.O-L., L.W.N., R.G.P., D.P., P.R., G.L.R., C.vE.)
| | | | - Peter Callas
- University of Vermont, Burlington, Vermont (B.L., J.C., A.M.C., L.N.B., P.C., K.C/K., S.F., J.H., J.J., K.S.K., J.B.O-L., L.W.N., R.G.P., D.P., P.R., G.L.R., C.vE.)
| | | | - Kelly Clark/Keefe
- University of Vermont, Burlington, Vermont (B.L., J.C., A.M.C., L.N.B., P.C., K.C/K., S.F., J.H., J.J., K.S.K., J.B.O-L., L.W.N., R.G.P., D.P., P.R., G.L.R., C.vE.)
| | - Deborah J Cohen
- Oregon Health & Science University, Portland, Oregon (D.J.C., E.N.W.)
| | - Frank V deGruy
- University of Colorado School of Medicine, Aurora, Colorado (F.V.D., R.K.)
| | | | | | - Chester Fox
- University at Buffalo, Buffalo, New York (C.F.)
| | - Sylvie Frisbie
- University of Vermont, Burlington, Vermont (B.L., J.C., A.M.C., L.N.B., P.C., K.C/K., S.F., J.H., J.J., K.S.K., J.B.O-L., L.W.N., R.G.P., D.P., P.R., G.L.R., C.vE.)
| | - Katie Hekman
- University of California San Diego, San Diego, California (K.H., W.J.S.)
| | - Juvena Hitt
- University of Vermont, Burlington, Vermont (B.L., J.C., A.M.C., L.N.B., P.C., K.C/K., S.F., J.H., J.J., K.S.K., J.B.O-L., L.W.N., R.G.P., D.P., P.R., G.L.R., C.vE.)
| | - Jennifer Jewiss
- University of Vermont, Burlington, Vermont (B.L., J.C., A.M.C., L.N.B., P.C., K.C/K., S.F., J.H., J.J., K.S.K., J.B.O-L., L.W.N., R.G.P., D.P., P.R., G.L.R., C.vE.)
| | - David C Kaelber
- The MetroHealth System, Cleveland, Ohio (D.C.K., T.S., K.T.)
- Case Western Reserve University, Cleveland, Ohio (D.C.K., K.C.S.)
| | - Kairn Stetler Kelley
- University of Vermont, Burlington, Vermont (B.L., J.C., A.M.C., L.N.B., P.C., K.C/K., S.F., J.H., J.J., K.S.K., J.B.O-L., L.W.N., R.G.P., D.P., P.R., G.L.R., C.vE.)
| | - Rodger Kessler
- University of Colorado School of Medicine, Aurora, Colorado (F.V.D., R.K.)
| | - Jennifer B O'Rourke-Lavoie
- University of Vermont, Burlington, Vermont (B.L., J.C., A.M.C., L.N.B., P.C., K.C/K., S.F., J.H., J.J., K.S.K., J.B.O-L., L.W.N., R.G.P., D.P., P.R., G.L.R., C.vE.)
| | | | - C R Macchi
- Arizona State University, Tempe, Arizona (C.R.M., M.P.M.)
| | | | - Mark McGovern
- Stanford University School of Medicine, Stanford, California (M.M.)
| | - Brenda Mollis
- University of Washington, Seattle, Washington (L-M.B., B.M., K.A.S.)
| | - Daniel Mullin
- UMass Chan Medical School, Worcester, Massachusetts (L.E-P., D.M.)
| | - Zsolt Nagykaldi
- University of Oklahoma Health Sciences Center, Oklahoma City, Oklahoma (Z.N.)
| | - Lisa W Natkin
- University of Vermont, Burlington, Vermont (B.L., J.C., A.M.C., L.N.B., P.C., K.C/K., S.F., J.H., J.J., K.S.K., J.B.O-L., L.W.N., R.G.P., D.P., P.R., G.L.R., C.vE.)
| | | | - Richard G Pinckney
- University of Vermont, Burlington, Vermont (B.L., J.C., A.M.C., L.N.B., P.C., K.C/K., S.F., J.H., J.J., K.S.K., J.B.O-L., L.W.N., R.G.P., D.P., P.R., G.L.R., C.vE.)
| | - Douglas Pomeroy
- University of Vermont, Burlington, Vermont (B.L., J.C., A.M.C., L.N.B., P.C., K.C/K., S.F., J.H., J.J., K.S.K., J.B.O-L., L.W.N., R.G.P., D.P., P.R., G.L.R., C.vE.)
| | - Paula Reynolds
- University of Vermont, Burlington, Vermont (B.L., J.C., A.M.C., L.N.B., P.C., K.C/K., S.F., J.H., J.J., K.S.K., J.B.O-L., L.W.N., R.G.P., D.P., P.R., G.L.R., C.vE.)
| | - Gail L Rose
- University of Vermont, Burlington, Vermont (B.L., J.C., A.M.C., L.N.B., P.C., K.C/K., S.F., J.H., J.J., K.S.K., J.B.O-L., L.W.N., R.G.P., D.P., P.R., G.L.R., C.vE.)
| | | | - William J Sieber
- University of California San Diego, San Diego, California (K.H., W.J.S.)
| | - Jeni Soucie
- National Committee for Quality Assurance, Washington, DC (S.H.S., J.S.)
| | - Terry Stancin
- The MetroHealth System, Cleveland, Ohio (D.C.K., T.S., K.T.)
| | - Kurt C Stange
- Case Western Reserve University, Cleveland, Ohio (D.C.K., K.C.S.)
| | - Kari A Stephens
- University of Washington, Seattle, Washington (L-M.B., B.M., K.A.S.)
| | - Kathryn Teng
- The MetroHealth System, Cleveland, Ohio (D.C.K., T.S., K.T.)
| | | | - Constance van Eeghen
- University of Vermont, Burlington, Vermont (B.L., J.C., A.M.C., L.N.B., P.C., K.C/K., S.F., J.H., J.J., K.S.K., J.B.O-L., L.W.N., R.G.P., D.P., P.R., G.L.R., C.vE.)
| |
Collapse
|
22
|
Ali M, Phillips L, Kaelber DC, Bukulmez H. Characteristics of pediatric COVID-19 infections and the impact of influenza and COVID-19 vaccinations during the first two years of the pandemic. Front Pediatr 2023; 11:1046680. [PMID: 37900675 PMCID: PMC10600516 DOI: 10.3389/fped.2023.1046680] [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] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/16/2022] [Accepted: 09/25/2023] [Indexed: 10/31/2023] Open
Abstract
The data regarding the demographics of SARS-CoV-2 in the pediatric population has been published based on several single-center experiences or on metanalyses over short time frames. This article reports data on the demographics of pediatric patients with COVID-19 on a global scale using the TriNetX COVID-19 Research Network. In addition, we examined the risk of COVID-19 infection in relation to the body mass index (BMI) category and the protective value of influenza and COVID-19 immunization against COVID-19 infection. The incidence of COVID-19 infection was higher in the younger age group (≤6 years old), but no gender differences. The incidence of COVID-19 infection was higher among African Americans/Black race (28.57%) White race (27.10%), and obese patients; across all age groups, all genders, all races, and ethnicities (p < 0.0001). The incidence of MIS-C was also higher in patients with obesity (OR 1.71, CI 1.36-2.14). We found that the patients who were neither vaccinated for COVID-19 nor influenza within one year before their COVID-19 diagnoses compared to those who received influenza vaccine only, had significantly higher odds for hospitalization (OR 1.19, CI 1.18-1.21), development of MIS-C (OR 1.52, CI 1.32-1.74), and more importantly mortality (OR 1.47, CI 1.26-1.71). In addition, those patients who were neither vaccinated for COVID-19 nor influenza within one year before their COVID-19 diagnoses, compared to those who received at least one dose of COVID-19 vaccine, had significantly higher odds for hospitalization (OR 1.11, CI 1.04-1.19). However, those patients who did not receive the influenza vaccine within one year before their COVID-19 diagnoses nor received the COVID-19 vaccine had much higher odds for hospitalization (OR 1.46, CI 1.41-1.51), MIS-C (OR 3.72, CI 2.11-6.56), and mortality compared to those who received both vaccinations (OR 13.55, CI 1.91-9.62). Using the multiplicative interaction scale, we found a positive interaction between the COVID-19 vaccine and the influenza vaccine; they both combined have a larger effect than each separately. Our study is the largest of its kind (to date) examining the global demographic of the pandemic and the first of a kind to find a link between influenza vaccine and COVID-19-related hospitalization, MIS-C, and mortality in the pediatric population.
Collapse
Affiliation(s)
- Mahmoud Ali
- The Department of Pediatrics, The MetroHealth System, Case Western Reserve University, Cleveland, OH, United States
| | - Lynette Phillips
- College of Public Health, Kent State University, Kent, OH, United States
| | - David C. Kaelber
- The Department of Pediatrics, The MetroHealth System, Case Western Reserve University, Cleveland, OH, United States
- The Departments of Internal Medicine and Population and Quantitative Health Sciences and the Center for Clinical Informatics Research and Educations, The MetroHealth System, Case Western Reserve University, Cleveland, OH, United States
| | - Hulya Bukulmez
- The Department of Pediatrics, The MetroHealth System, Case Western Reserve University, Cleveland, OH, United States
| |
Collapse
|
23
|
Wang L, Davis PB, Berger N, Kaelber DC, Volkow N, Xu R. Association of COVID-19 with respiratory syncytial virus (RSV) infections in children aged 0-5 years in the USA in 2022: a multicentre retrospective cohort study. Fam Med Community Health 2023; 11:e002456. [PMID: 37832975 PMCID: PMC10582888 DOI: 10.1136/fmch-2023-002456] [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] [Indexed: 10/15/2023] Open
Abstract
OBJECTIVE To investigate whether COVID-19 infection was associated with increased risk for incident respiratory syncytial virus (RSV) infections and associated diseases among young children that might have contributed to the 2022 surge of severe paediatric RSV cases in the USA. DESIGN This is a retrospective population-based cohort study. Five outcomes were examined, including overall RSV infection, positive lab test-confirmed RSV infection, clinically diagnosed RSV diseases, RSV-associated bronchiolitis and unspecified bronchiolitis. Risk ratio (RR) and 95% CI of the outcomes that occurred during the 2022 and 2021 RSV seasons were calculated by comparing propensity-score matched cohorts. SETTING Nationwide multicentre database of electronic health records (EHRs) of 61.4 million patients in the USA including 1.7 million children 0-5 years of age, which was accessed through TriNetX Analytics that provides web-based and secure access to patient EHR data from hospitals, primary care and specialty treatment providers. PARTICIPANTS The study population consisted of 228 940 children of 0-5 years with no prior RSV infection who had medical encounters in October 2022. Findings were replicated in a separate study population of 370 919 children of 0-5 years with no prior RSV infection who had medical encounters in July 2021-August 2021 during a non-overlapping time period. RESULTS For the 2022 study population (average age 2.4 years, 46.8% girls, 61% white, 16% black), the risk for incident RSV infection during October 2022-December 2022 was 6.40% for children with prior COVID-19 infection, higher than 4.30% for the matched children without COVID-19 (RR 1.40, 95% CI 1.27 to 1.55); and among children aged 0-1 year, the overall risk was 7.90% for those with prior COVID-19 infection, higher than 5.64% for matched children without (RR 1.40, 95% CI 1.21 to 1.62). For the 2021 study population (average age 2.2 years, 46% girls, 57% white, 20% black), the risk for incident RSV infection during July 2021-December 2021 was 4.85% for children with prior COVID-19 infection, higher than 3.68% for the matched children without COVID-19 (RR 1.32, 95% CI 1.12 to 1.56); and 7.30% for children aged 0-1 year with prior COVID-19 infection, higher than 4.98% for matched children without (RR 1.47, 95% CI 1.18 to 1.82). CONCLUSION COVID-19 was associated with a significantly increased risk for RSV infections among children aged 0-5 years in 2022. Similar findings were replicated for a study population of children aged 0-5 years in 2021. Our findings suggest that COVID-19 contributed to the 2022 surge of RSV cases in young children through the large buildup of COVID-19-infected children and the potential long-term adverse effects of COVID-19 on the immune and respiratory system.
Collapse
Affiliation(s)
- Lindsey Wang
- Center for Science, Health, and Society, Case Western Reserve University, Cleveland, Ohio, USA
| | - Pamela B Davis
- Center for Community Health Integration, Case Western Reserve University School of Medicine, Cleveland, Ohio, USA
| | - Nathan Berger
- Center for Science, Health, and Society, Case Western Reserve University, Cleveland, Ohio, USA
| | - David C Kaelber
- The Center for Clinical Informatics Research and Education and the Departments ofInternal Medicine, Pediatrics, and Population and Quantitative Health Sciences, MetroHealth Medical Center, Cleveland, Ohio, USA
| | - Nora Volkow
- National Institute on Drug Abuse, National Institute of Health, Bethesda, Maryland, USA
| | - Rong Xu
- Center for AI in Drug Discovery, Case Western Reserve University School of Medicine, Cleveland, Ohio, USA
| |
Collapse
|
24
|
You JG, Samal L, Leung TI, Dharod A, Zhang HM, Kaelber DC, Mishuris RG. A Call to Support Informatics Curricula in U.S.-Based Residency Education. Appl Clin Inform 2023; 14:992-995. [PMID: 37879358 PMCID: PMC10733056 DOI: 10.1055/a-2198-7788] [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] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2023] [Accepted: 10/23/2023] [Indexed: 10/27/2023] Open
Affiliation(s)
- Jacqueline G. You
- Department of Pathology, Massachusetts General Hospital, Boston, Massachusetts, United States
- Department of Medicine, Brigham and Women's Hospital, Boston, Massachusetts, United States
| | - Lipika Samal
- Department of Medicine, Brigham and Women's Hospital, Boston, Massachusetts, United States
| | - Tiffany I. Leung
- Department of Internal Medicine (adjunct), Southern Illinois University School of Medicine, Springfield, Illinois, United States
- Care and Public Health Research Institute, Maastricht University, Maastricht, The Netherlands
| | - Ajay Dharod
- Department of Internal Medicine, Wake Forest School of Medicine, Informatics and Analytics, Winston Salem, North Carolina, United States
- Department of Internal Medicine, Wake Forest School of Medicine, Section on General Internal Medicine, Winston Salem, North Carolina, United States
| | - Haipeng M. Zhang
- Department of Psychosocial Oncology and Palliative Care, Division of Adult Palliative Care, Dana-Farber Cancer Institute, Boston, Massachusetts, United States
| | - David C. Kaelber
- Department of Internal Medicine, Pediatrics and Population, and Quantitative Health Sciences, The Center for Clinical Informatics Research and Education, MetroHealth System, Case Western Reserve University, Cleveland, Ohio, United States
| | - Rebecca G. Mishuris
- Department of Medicine, Brigham and Women's Hospital, Boston, Massachusetts, United States
- Digital, Mass General Brigham, Somerville, Massachusetts, United States
| |
Collapse
|
25
|
Wang L, Berger N, Davis PB, Kaelber DC, Volkow N, Xu R. Time trend and seasonality in medically attended respiratory syncytial virus (RSV) infections in US children aged 0-5 years, January 2010-January 2023. Fam Med Community Health 2023; 11:e002453. [PMID: 37844966 PMCID: PMC10582996 DOI: 10.1136/fmch-2023-002453] [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] [Indexed: 10/18/2023] Open
Abstract
OBJECTIVE The long-term time trend and seasonality variations of first-time medically attended respiratory syncytial virus (RSV) infections among young children are unknown. We aim to examine the time trend of medically attended first-time RSV infections among young children in the USA from January 2010 through January 2023. DESIGN This is a population-based cohort study using electronic health records (EHRs). Monthly incidence rate of medically attended first-time RSV infection (cases per 10 000 000 person-days). A time-series regression model was used to model and predict time trends and seasonality. SETTING Multicenter and nationwide TriNetX Network in the USA. PARTICIPANTS The study population comprised children aged 0-5 years who had medical visits during the period of January 2010 to January 2023. RESULTS The data included 29 013 937 medical visits for children aged 0-5 years (46.5% girls and 53.5% boys) from January 2010 through January 2023. From 2010 through 2019, the monthly incidence rate of first-time medically attended RSV infection in children aged 0-5 years followed a consistent seasonal pattern. Seasonal patterns of medically attended RSV infections were significantly disrupted during the COVID-19 pandemic. In 2020, the seasonal variation disappeared with a peak incidence rate of 20 cases per 1 000 000 person-days, a decrease of 97.4% from the expected peak rate (rate ratio or RR: 0.026, 95% CI 0.017 to 0.040). In 2021, the seasonality returned but started 4 months earlier, lasted for 9 months, and peaked in August at a rate of 753 cases per 1 000 000 person-days, a decrease of 9.6% from the expected peak rate (RR: 0.90, 95% CI 0.82 to 0.99). In 2022, the seasonal pattern is similar to prepandemic years but reached a historically high rate of 2182 cases per 10 000 000 person-days in November, an increase of 143% from the expected peak rate (RR: 2.43, 95% CI 2.25 to 2.63). The time trend and seasonality of the EHR-based medically attended RSV infections are consistent with those of RSV-associated hospitalisations from the Centers for Disease Control and Prevention (CDC) survey-based surveillance system. CONCLUSION The findings show the disrupted seasonality during the COVID-19 pandemic and a historically high surge of paediatric RSV cases that required medical attention in 2022. Our study demonstrates the potential of EHRs as a cost-effective alternative for real-time pathogen and syndromic surveillance of unexpected disease patterns including RSV infection.
Collapse
Affiliation(s)
- Lindsey Wang
- Center for Science, Health, and Society, Case Western Reserve University, Cleveland, Ohio, USA
| | - Nathan Berger
- Center for Science, Health, and Society, Case Western Reserve University, Cleveland, Ohio, USA
| | - Pamela B Davis
- Center for Community Health Integration, Case Western Reserve University School of Medicine, Cleveland, Ohio, USA
| | - David C Kaelber
- The Center for Clinical Informatics Research and Education and the Departments ofInternal Medicine, Pediatrics, and Population and Quantitative Health Sciences, MetroHealth Medical Center, Cleveland, Ohio, USA
| | - Nora Volkow
- National Institute on Drug Abuse, National Institute of Health, Bethesda, Maryland, USA
| | - Rong Xu
- Center for Artificial Intelligence in Drug Discovery, Case Western Reserve University School of Medicine, Cleveland, Ohio, USA
| |
Collapse
|
26
|
Gao Z, Winhusen TJ, Gorenflo M, Ghitza UE, Nunes E, Saxon AJ, Korthuis T, Brady K, Luo SX, Davis PB, Kaelber DC, Xu R. Potential effect of antidepressants on remission from cocaine use disorder - A nationwide matched retrospective cohort study. Drug Alcohol Depend 2023; 251:110958. [PMID: 37703770 PMCID: PMC10556849 DOI: 10.1016/j.drugalcdep.2023.110958] [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: 05/26/2023] [Revised: 08/30/2023] [Accepted: 09/02/2023] [Indexed: 09/15/2023]
Abstract
BACKGROUND Cocaine use disorder (CUD) is a significant public health issue for which there is no Food and Drug Administration-approved pharmacotherapy. Depressive disorders are common psychiatric comorbidity amongst individuals with CUD. METHODS A retrospective cohort study was conducted among 161,544 patients diagnosed with CUD and depression to evaluate the effectiveness of 13 antidepressants on CUD remission. For any antidepressant found to be associated with CUD remission that had an additional indication, we conducted an additional analysis to evaluate the effectiveness of the candidate drug in patients with CUD with that indication. We then analyzed publicly genomic and functional databases to identify potential explanatory mechanisms of action of the candidate drug in the treatment of CUD. RESULTS Among these antidepressants, bupropion was associated with higher rates of CUD remission compared to propensity-score matched patients prescribed other antidepressants: hazard ratio (HR) and 95% confidence interval (CI) 1.57 (95% CI: 1.27-1.94). Bupropion is also approved for smoking cessation. We identified CUD patients with co-occurring nicotine dependence and observed that patients prescribed bupropion displayed a higher rate of CUD remission compared to matched individuals prescribed other drugs for nicotine dependence: 1.38 (95% CI: 1.11-1.71). Genetic and functional analyses revealed that bupropion interacts with four protein-encoding genes (COMT, DRD2, SLC6A3, and SLC6A4) which are also associated with CUD and targets CUD-associated pathways including serotonergic synapses, cocaine addiction, and dopaminergic synapses. CONCLUSIONS Our findings suggest that bupropion might be considered a treatment for improving CUD remission in patients with CUD and co-occurring depression or nicotine dependence.
Collapse
Affiliation(s)
- Zhenxiang Gao
- Center for Artificial Intelligence in Drug Discovery, School of Medicine, Case Western Reserve University, Cleveland, OH, USA
| | - T John Winhusen
- Center for Addiction Research, University of Cincinnati College of Medicine, Cincinnati, OH, USA.
| | - Maria Gorenflo
- Center for Artificial Intelligence in Drug Discovery, School of Medicine, Case Western Reserve University, Cleveland, OH, USA; Cleveland Clinic Lerner College of Medicine, Case Western Reserve University, Cleveland, OH, USA
| | - Udi E Ghitza
- Center for the Clinical Trials Network (CCTN), National Institute on Drug Abuse (NIDA), National Institutes of Health (NIH), Bethesda, MD, USA
| | - Edward Nunes
- Department of Psychiatry, New York State Psychiatric Institute, Irving Medical Center, Columbia University, New York, NY, USA
| | - Andrew J Saxon
- Department of Psychiatry and Behavioral Science, School of Medicine, University of Washington, Seattle, WA, USA
| | - Todd Korthuis
- Addiction Medicine Section, Department of Medicine, Oregon Health & Science University, Portland, OR, USA
| | - Kathleen Brady
- Department of Psychiatry and Behavioral Sciences, College of Medicine, Medical University of South Carolina, Charleston, SC, USA
| | - Sean X Luo
- Columbia University Division on Substance Use Disorders, and Research Scientist, New York State Psychiatric Institute, New York, NY, USA
| | - Pamela B Davis
- Center for Community Health Integration, School of Medicine, Case Western Reserve University, Cleveland, OH, USA
| | - David C Kaelber
- Center for Clinical Informatics Research and Education, The Metro Health System, Cleveland, OH, USA
| | - Rong Xu
- Center for Artificial Intelligence in Drug Discovery, School of Medicine, Case Western Reserve University, Cleveland, OH, USA.
| |
Collapse
|
27
|
Tarabichi Y, Higginbotham J, Riley N, Kaelber DC, Watts B. Reducing Disparities in No Show Rates Using Predictive Model-Driven Live Appointment Reminders for At-Risk Patients: a Randomized Controlled Quality Improvement Initiative. J Gen Intern Med 2023; 38:2921-2927. [PMID: 37126125 PMCID: PMC10150669 DOI: 10.1007/s11606-023-08209-0] [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] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/23/2022] [Accepted: 04/11/2023] [Indexed: 05/02/2023]
Abstract
BACKGROUND Appointment no shows are prevalent in safety-net healthcare systems. The efficacy and equitability of using predictive algorithms to selectively add resource-intensive live telephone outreach to standard automated reminders in such a setting is not known. OBJECTIVE To determine if adding risk-driven telephone outreach to standard automated reminders can improve in-person primary care internal medicine clinic no show rates without worsening racial and ethnic show-rate disparities. DESIGN Randomized controlled quality improvement initiative. PARTICIPANTS Adult patients with an in-person appointment at a primary care internal medicine clinic in a safety-net healthcare system from 1/1/2022 to 8/24/2022. INTERVENTIONS A random forest model that leveraged electronic health record data to predict appointment no show risk was internally trained and validated to ensure fair performance. Schedulers leveraged the model to place reminder calls to patients in the augmented care arm who had a predicted no show rate of 15% or higher. MAINE MEASURES The primary outcome was no show rate stratified by race and ethnicity. KEY RESULTS There were 5840 appointments with a predicted no show rate of 15% or higher. A total of 2858 had been randomized to the augmented care group and 2982 randomized to standard care. The augmented care group had a significantly lower no show rate than the standard care group (33% vs 36%, p < 0.01). There was a significant reduction in no show rates for Black patients (36% vs 42% respectively, p < 0.001) not reflected in white, non-Hispanic patients. CONCLUSIONS In this randomized controlled quality improvement initiative, adding model-driven telephone outreach to standard automated reminders was associated with a significant reduction of in-person no show rates in a diverse primary care clinic. The initiative reduced no show disparities by predominantly improving access for Black patients.
Collapse
Affiliation(s)
- Yasir Tarabichi
- Center for Clinical Informatics Research and Education, MetroHealth, Cleveland, OH, USA.
- School of Medicine, Case Western Reserve University, Cleveland, OH, USA.
| | | | - Nicholas Riley
- Center for Clinical Informatics Research and Education, MetroHealth, Cleveland, OH, USA
- School of Medicine, Case Western Reserve University, Cleveland, OH, USA
| | - David C Kaelber
- Center for Clinical Informatics Research and Education, MetroHealth, Cleveland, OH, USA
- School of Medicine, Case Western Reserve University, Cleveland, OH, USA
| | - Brook Watts
- School of Medicine, University of Michigan, Ann Arbor, MI, USA
| |
Collapse
|
28
|
Terebuh P, Olaker VR, Kendall EK, Kaelber DC, Xu R, Davis PB. Liver abnormalities following SARS-CoV-2 infection in children under 10 years of age. medRxiv 2023:2023.09.21.23295905. [PMID: 37790424 PMCID: PMC10543044 DOI: 10.1101/2023.09.21.23295905] [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] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/05/2023]
Abstract
Objective Beginning in October 2021 in the US and elsewhere, cases of severe pediatric hepatitis of unknown etiology were identified in young children. While the adenovirus and adenovirus-associated virus have emerged as leading etiologic suspects, we attempted to investigate a potential role for SARS-CoV-2 in the development of subsequent liver abnormalities. Design We conducted a study utilizing retrospective cohorts of de-identified, aggregated data from the electronic health records of over 100 million patients contributed by US health care organizations. Results Compared to propensity-score-matched children with other respiratory infections, children aged 1-10 years with COVID-19 had a higher risk of elevated transaminases (Hazard ratio (HR) (95% Confidence interval (CI)) 2.16 (1.74-2.69)) or total bilirubin (HR (CI) 3.02 (1.91-4.78)), or new diagnoses of liver diseases (HR (CI) 1.67 (1.21-2.30)) from one to six months after infection. Patients with pre-existing liver abnormalities, liver abnormalities surrounding acute infection, younger age (1-4 years), or illness requiring hospitalization all had similarly elevated risk. Children who developed liver abnormalities following COVID-19 had more pre-existing conditions than those who developed abnormalities following other infections. Conclusion These results indicate that SARS-CoV-2 may prime the patient for subsequent development of liver infections or non-infectious liver diseases. While rare (~1 in 1,000), SARS-CoV-2 is a risk for subsequent abnormalities in liver function or the diagnosis of diseases of the liver. What is already known on this topic Clusters of severe hepatitis in children in 2022 coincident with the increase in COVID-19 infections in children raised the question of the contribution of SARS-CoV-2 to the hepatitis outbreak, though it was soon determined that SARS-CoV-2 was not the primary etiologic agent. What this study adds SARS-CoV-2 may prime the patient for subsequent development of liver infections or non-infectious liver diseases. How this study might affect research practice or policy Despite the mild initial disease in children, there may be longer term consequences of COVID-19, such as liver abnormalities, that warrants further investigation.
Collapse
Affiliation(s)
- Pauline Terebuh
- Center for Artificial Intelligence in Drug Discovery, Case Western Reserve University School of Medicine, Cleveland, Ohio
| | - Veronica R. Olaker
- Center for Artificial Intelligence in Drug Discovery, Case Western Reserve University School of Medicine, Cleveland, Ohio
| | - Ellen K. Kendall
- Center for Artificial Intelligence in Drug Discovery, Case Western Reserve University School of Medicine, Cleveland, Ohio
| | - David C. Kaelber
- The Center for Clinical Informatics Research and Education, Departments of Medicine and Pediatrics, The MetroHealth System, Cleveland, Ohio
| | - Rong Xu
- Center for Artificial Intelligence in Drug Discovery, Case Western Reserve University School of Medicine, Cleveland, Ohio
| | - Pamela B. Davis
- Center for Community Health Integration, Case Western Reserve University School of Medicine, Cleveland, Ohio
| |
Collapse
|
29
|
Bobak L, Dorney I, Lavu MS, Mistovich RJ, Kaelber DC. Increased risk of osteomyelitis and septic arthritis in osteogenesis imperfecta. J Pediatr Orthop B 2023; 33:01202412-990000000-00145. [PMID: 37669133 PMCID: PMC10894311 DOI: 10.1097/bpb.0000000000001121] [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] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 09/07/2023]
Abstract
We investigated the prevalence of osteomyelitis and septic arthritis in individuals with osteogenesis imperfecta (OI) as compared to the general population. We performed a retrospective cohort study utilizing the TriNetX Analytics platform, a federated, aggregated electronic health record (EHR) research network containing national, deidentified EHR data. We queried patients with OI, based on encounter diagnoses. Patients in this group with any occurrence of osteomyelitis or septic arthritis were recorded. A control cohort was established to compare the prevalence in patients without OI. Of 8444 individuals with OI, 433 (5.13%) had encounter diagnoses for osteomyelitis and 61 (0.72%) had encounter diagnoses for septic arthritis. In comparison, of 79 176 436 patients without OI, 352 009 (0.44%) had encounter diagnoses for osteomyelitis, while 106 647 (0.13%) had encounter diagnoses for septic arthritis. The relative risk for osteomyelitis in OI patients was 11.53 (95% CI: 10.52-12.64), while the relative risk for septic arthritis was 5.36 (95% CI: 4.18-6.89). The relative risk for osteomyelitis in pediatric OI patients was 30.55 (95% CI: 24.35-38.28). To our knowledge, this is the first study investigating musculoskeletal infections in patients with OI, as well as the first to report the overall prevalence in the general population. Clinicians may benefit from a high index of suspicion for musculoskeletal infections in OI patients with corresponding symptoms. Further study is warranted to investigate if modifications to conventional diagnostic pathways and criteria are valuable in this population. Level of evidence: Retrospective Cohort Study - Level II.
Collapse
Affiliation(s)
- Lukas Bobak
- Case Western Reserve University School of Medicine
| | - Ian Dorney
- Case Western Reserve University School of Medicine
| | | | - R Justin Mistovich
- Case Western Reserve University School of Medicine
- Department of Orthopaedic Surgery, The MetroHealth System
- Division of Pediatric Orthopaedic Surgery, University Hospitals Rainbow Babies and Children's Hospital
| | - David C Kaelber
- Case Western Reserve University School of Medicine
- Departments of Internal Medicine
- Pediatrics
- Population and Quantitative Health Sciences, Case Western Reserve University
- The Center for Clinical Informatics Research and Education, The MetroHealth System, Cleveland, Ohio, USA
| |
Collapse
|
30
|
Pan Y, Gorenflo MP, Davis PB, Kaelber DC, De Luca S, Xu R. Suicidal ideation and suicide attempt following ketamine prescription in patients with treatment-resistant depression: a nation-wide cohort study. Res Sq 2023:rs.3.rs-3207199. [PMID: 37609161 PMCID: PMC10441476 DOI: 10.21203/rs.3.rs-3207199/v1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 08/24/2023]
Abstract
Ketamine, including esketamine, is an effective treatment for patients with treatment-resistant depression (TRD); however, its long-term efficacy in real-world populations remains poorly characterized. This is a retrospective cohort study using TriNetX US Collaborative Network, a platform aggregating electronic health records (EHRs) data from 93 million patients from 56 health care organizations in the US, and the study population includes 321,367 patients with a diagnosis of TRD who were prescribed relevant treatment in their EHRs. The prescription of ketamine (including esketamine) was associated with significant decreased risk of suicidal ideation compared to prescription of other common antidepressants: HR = 0.65 (95% CI: 0.53 - 0.81) at 1 day - 7 days, 0.78 (95% CI: 0.66 - 0.92) at 1 day - 30 days, 0.81 (95% CI: 0.70 - 0.92) at 1 day - 90 days, 0.82 (95% CI: 0.72 - 0.92) at 1 day - 180 days, and 0.83 (95% CI: 0.74 - 0.93) at 1 day - 270 days. This trend was especially robust among adults over 24 years of age, males, and White patients with TRD. No significant difference was observed for suicide attempts, except significantly increased risk for adolescents (aged 10-24) at 1 day - 30 days with HR = 2.22 (95% CI: 1.01-4.87). This study provides real-world evidence that ketamine has long-term benefits in mitigating suicidal ideation in patients with treatment-resistant depression. Future work should focus on optimizing dosage regimens for ketamine, understanding the mechanism, and the difference in various demographic subpopulations.
Collapse
Affiliation(s)
- Yiheng Pan
- Center for Artificial Intelligence in Drug Discovery, Case Western Reserve University School of Medicine, Cleveland, OH, USA
- Department of Computer and Data Science, Case Western Reserve University, Cleveland, OH, USA
| | - Maria P. Gorenflo
- Center for Artificial Intelligence in Drug Discovery, Case Western Reserve University School of Medicine, Cleveland, OH, USA
| | - Pamela B. Davis
- Center for Community Health Integration, Case Western Reserve University School of Medicine, Cleveland, OH, USA
| | - David C. Kaelber
- The Center for Clinical Informatics Research and Education, The MetroHealth System, Cleveland, OH, USA
| | - Susan De Luca
- Population Health Research Institute, The MetroHealth System, Cleveland, OH, USA
| | - Rong Xu
- Center for Artificial Intelligence in Drug Discovery, Case Western Reserve University School of Medicine, Cleveland, OH, USA
| |
Collapse
|
31
|
Ashruf OS, Orozco Z, Kaelber DC. Risk and Severity of COVID-19 Infection in Monoclonal Gammopathy of Undetermined Significance: A 3-Year Propensity Matched Cohort Study. Clin Lymphoma Myeloma Leuk 2023; 23:626-632. [PMID: 37208255 PMCID: PMC10140469 DOI: 10.1016/j.clml.2023.04.010] [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] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/23/2023] [Revised: 04/21/2023] [Accepted: 04/24/2023] [Indexed: 05/21/2023]
Abstract
INTRODUCTION Monoclonal gammopathy of undetermined significance (MGUS) is a premalignant disorder causing monoclonal plasma cell proliferation in bone marrow. This population is at risk of developing multiple myeloma (MM) and severe viral infections; risk factors of severe COVID-19 infection. Using TriNetX, a global platform providing data of 120 million patients, we aimed to quantify the risk and severity of COVID-19 in MGUS patients. PATIENTS AND METHODS A retrospective cohort analysis was performed using the TriNetX Global Collaborative Network. From January 20, 2020, to January 20, 2023, we identified a cohort of 58,859 MGUS patients and compared to non-MGUS patients, determined by relevant diagnosis/LOINC test codes. After 1:1 propensity score-matching, we identified COVID-19 cases to quantify risk and identify patients who had been hospitalized, ventilated/intubated, and deceased to quantify severity. Measures of association and Kaplan-Meier analysis were conducted. RESULTS After propensity-score matching, there were 58,668 patients in both cohorts. MGUS patients were found to be at a reduced risk of contracting COVID-19 (RR 0.88, 95% CI 0.85-0.91). MGUS patients with COVID-19 showed higher mortality risk and decreased survival time compared to the general population (HR 1.14, 95% CI 1.01-1.27). MGUS patients with COVID-19 who were hospitalized exhibited significantly decreased survival time (log-rank test, P = 0.04). CONCLUSION As COVID-19 remains a looming health concern, especially amongst vulnerable populations, our analysis emphasizes the need for adequate vaccination and treatment regimens as well as an understanding of the severity of infection in MGUS patients and justification for precautionary measures.
Collapse
Affiliation(s)
- Omer S Ashruf
- Northeast Ohio Medical University, College of Medicine, Rootstown, OH, United States.
| | - Zara Orozco
- Northeast Ohio Medical University, College of Medicine, Rootstown, OH, United States
| | - David C Kaelber
- Center for Education and Training in Health Informatics, The Metro Health System and the Departments of Internal Medicine, Pediatrics, and Population and Quantitative Health Sciences, Case Western Reserve University, Cleveland, OH, United States
| |
Collapse
|
32
|
Kloos J, Kaelber DC. Treacher Collins Syndrome Associated with Disproportionate Nervous System, Cardiovascular, Otologic Complications Among 1,114 Patients. Cleft Palate Craniofac J 2023:10556656231187302. [PMID: 37415506 DOI: 10.1177/10556656231187302] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/08/2023] Open
Abstract
OBJECTIVE To compare the rates of selected nervous system, cardiovascular, and otologic abnormalities in patients with and without Treacher Collins Syndrome (TCS). DESIGN Retrospective TriNetX platform cohort study. SETTING Aggregated and deidentified electronic health record (EHR) data from across the United States. PATIENTS, PARTICIPANTS Patients with TCS (n = 1,114) and a propensity matched control cohort without TCS (n = 1,114 matched from n = 110,368,585). MAIN OUTCOME MEASURED Prevalence and relative risk (RR) of selected diagnoses in a propensity-matched cohort. RESULTS The RR of congenital malformations of the circulatory system in patients with TCS was 8.5 (95% CI 4.44-16.28). Patients with TCS also had higher rates of otologic abnormalities including conductive hearing loss (RR 44, 95% CI 24-83) and nervous system disorders including movement disorders (RR 2.60, 95% CI 1.27-5.50) and recurrent seizures (RR 4.2, 95% CI 2.12-8.33). CONCLUSIONS We found a significantly elevated risk in TCS patients within all three systems. We postulate that the nervous system effects may be the result of one of the TCS-linked genes, for which a mutation has also been associated with progressive ataxia, cerebellar atrophy, hypomyelination, and seizures. As the previously-identified causal genes influence neural crest cells that form the head and face, these cells may also populate cardiac structures, resulting in cardiovascular abnormalities. Finally, the characteristic craniofacial abnormalities identified in TCS impair hearing and are associated with increased risk of otitis media. Our findings may help researchers to hypothesize the function of the genes underlying TCS, as well as to inform the care of affected individuals.
Collapse
Affiliation(s)
- Jacqueline Kloos
- Case Western Reserve University School of Medicine, Cleveland, Ohio
| | - David C Kaelber
- Departments of Internal Medicine, Pediatrics, and Population and Quantitative Health Sciences, Center for Clinical Informatics Research and Education, The MetroHealth System, Cleveland, Ohio
| |
Collapse
|
33
|
Gao Z, Winhusen TJ, Gorenflo M, Ghitza UE, Davis PB, Kaelber DC, Xu R. Repurposing ketamine to treat cocaine use disorder: integration of artificial intelligence-based prediction, expert evaluation, clinical corroboration and mechanism of action analyses. Addiction 2023; 118:1307-1319. [PMID: 36792381 PMCID: PMC10631254 DOI: 10.1111/add.16168] [Citation(s) in RCA: 11] [Impact Index Per Article: 11.0] [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: 08/26/2022] [Accepted: 01/25/2023] [Indexed: 02/17/2023]
Abstract
BACKGROUND AND AIMS Cocaine use disorder (CUD) is a significant public health issue for which there is no Food and Drug Administration (FDA) approved medication. Drug repurposing looks for new cost-effective uses of approved drugs. This study presents an integrated strategy to identify repurposed FDA-approved drugs for CUD treatment. DESIGN Our drug repurposing strategy combines artificial intelligence (AI)-based drug prediction, expert panel review, clinical corroboration and mechanisms of action analysis being implemented in the National Drug Abuse Treatment Clinical Trials Network (CTN). Based on AI-based prediction and expert knowledge, ketamine was ranked as the top candidate for clinical corroboration via electronic health record (EHR) evaluation of CUD patient cohorts prescribed ketamine for anesthesia or depression compared with matched controls who received non-ketamine anesthesia or antidepressants/midazolam. Genetic and pathway enrichment analyses were performed to understand ketamine's potential mechanisms of action in the context of CUD. SETTING The study utilized TriNetX to access EHRs from more than 90 million patients world-wide. Genetic- and functional-level analyses used DisGeNet, Search Tool for Interactions of Chemicals and Kyoto Encyclopedia of Genes and Genomes databases. PARTICIPANTS A total of 7742 CUD patients who received anesthesia (3871 ketamine-exposed and 3871 anesthetic-controlled) and 7910 CUD patients with depression (3955 ketamine-exposed and 3955 antidepressant-controlled) were identified after propensity score-matching. MEASUREMENTS EHR analysis outcome was a CUD remission diagnosis within 1 year of drug prescription. FINDINGS Patients with CUD prescribed ketamine for anesthesia displayed a significantly higher rate of CUD remission compared with matched individuals prescribed other anesthetics [hazard ratio (HR) = 1.98, 95% confidence interval (CI) = 1.42-2.78]. Similarly, CUD patients prescribed ketamine for depression evidenced a significantly higher CUD remission ratio compared with matched patients prescribed antidepressants or midazolam (HR = 4.39, 95% CI = 2.89-6.68). The mechanism of action analysis revealed that ketamine directly targets multiple CUD-associated genes (BDNF, CNR1, DRD2, GABRA2, GABRB3, GAD1, OPRK1, OPRM1, SLC6A3, SLC6A4) and pathways implicated in neuroactive ligand-receptor interaction, cAMP signaling and cocaine abuse/dependence. CONCLUSIONS Ketamine appears to be a potential repurposed drug for treatment of cocaine use disorder.
Collapse
Affiliation(s)
- Zhenxiang Gao
- Center for Artificial Intelligence in Drug Discovery, School of Medicine, Case Western Reserve University, Cleveland, OH, USA
| | - T. John Winhusen
- Center for Addiction Research, University of Cincinnati College of Medicine, Cincinnati, OH, USA
| | - Maria Gorenflo
- Center for Artificial Intelligence in Drug Discovery, School of Medicine, Case Western Reserve University, Cleveland, OH, USA
- Cleveland Clinic Lerner College of Medicine, Case Western Reserve University, Cleveland, OH, USA
| | - Udi E. Ghitza
- Center for the Clinical Trials Network (CCTN), National Institute on Drug Abuse (NIDA), National Institutes of Health (NIH), Bethesda, MD, USA
| | - Pamela B. Davis
- Center for Community Health Integration, School of Medicine, Case Western Reserve University, Cleveland, OH, USA
| | - David C. Kaelber
- Center for Clinical Informatics Research and Education, The Metro Health System, Cleveland, OH, USA
| | - Rong Xu
- Center for Artificial Intelligence in Drug Discovery, School of Medicine, Case Western Reserve University, Cleveland, OH, USA
| |
Collapse
|
34
|
Dorney I, Bobak L, Otteson T, Kaelber DC. Prevalence of New-Onset Tinnitus after COVID-19 Vaccination with Comparison to Other Vaccinations. Laryngoscope 2023; 133:1722-1725. [PMID: 36098476 PMCID: PMC9539087 DOI: 10.1002/lary.30395] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2022] [Revised: 07/21/2022] [Accepted: 08/16/2022] [Indexed: 11/16/2022]
Abstract
OBJECTIVE To investigate how often patients are diagnosed with new-onset tinnitus within 21 days after COVID-19 vaccination in comparison to after three other common vaccinations: influenza, Tdap (tetanus, diphtheria, and acellular pertussis), and polysaccharide pneumococcus. METHODS The TriNetX Analytics Network, a federated health research network that aggregates the de-identified electronic health record (EHR) data of over 78 million patients, was queried for patients receiving each vaccination. Instances of new-onset tinnitus within 21 days of vaccination were recorded and reported. RESULTS Out of 2,575,235 patients receiving a first dose of the mRNA COVID-19 vaccine without any prior tinnitus diagnosis, 0.038% (95% CI: 0.036%-0.041%) of patients had a new diagnosis of tinnitus within 21 days. There was a higher risk of a new tinnitus diagnosis after the influenza vaccine (RR: 1.95, 95% CI: 1.72-2.21), Tdap vaccine (RR: 2.36, 95% CI: 1.93-2.89), and pneumococcal vaccine (RR: 1.97, 95% CI: 1.48-2.64) than after the first dose of the COVID-19 vaccine. There was a lower risk of a new tinnitus diagnosis after the second dose of COVID-19 than after the first dose (RR: 0.80, 95% CI: 0.71-0.91). CONCLUSION The rate of newly diagnosed tinnitus acutely after the first dose of the COVID-19 vaccine is very low. There was a higher risk of newly diagnosed tinnitus after influenza, Tdap, and pneumococcal vaccinations than after the COVID-19 vaccine. The present findings can help to address COVID-19 vaccine hesitancy during the ongoing pandemic. LEVEL OF EVIDENCE Level 3 Laryngoscope, 133:1722-1725, 2023.
Collapse
Affiliation(s)
- Ian Dorney
- School of Medicine, Case Western Reserve University, Cleveland, Ohio, USA
| | - Lukas Bobak
- School of Medicine, Case Western Reserve University, Cleveland, Ohio, USA
| | - Todd Otteson
- School of Medicine, Case Western Reserve University, Cleveland, Ohio, USA
- Department of Otolaryngology-Head and Neck Surgery, University Hospitals Cleveland Medical Center, Cleveland, Ohio, USA
| | - David C Kaelber
- Departments of Internal Medicine, Pediatrics, and Population and Quantitative Health Sciences, Case Western Reserve University, Cleveland, Ohio, USA
- The Center for Clinical Informatics Research and Education, The MetroHealth System, Cleveland, Ohio, USA
| |
Collapse
|
35
|
Tarabichi Y, Kaelber DC, Watts B. Care Coordinator Insights Offer Significant Additive Value to Electronic Health Record Data-Based 30-Day Readmission Risk Predictions. J Gen Intern Med 2023; 38:2220-2222. [PMID: 36749435 PMCID: PMC10361928 DOI: 10.1007/s11606-023-08052-3] [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] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/12/2022] [Accepted: 01/20/2023] [Indexed: 02/08/2023]
Affiliation(s)
- Yasir Tarabichi
- Center for Clinical Informatics Research and Education, MetroHealth, Cleveland, OH, USA.
- School of Medicine, Case Western Reserve University, Cleveland, OH, USA.
| | - David C Kaelber
- Center for Clinical Informatics Research and Education, MetroHealth, Cleveland, OH, USA
- School of Medicine, Case Western Reserve University, Cleveland, OH, USA
| | - Brook Watts
- Department of Quality, Michigan Medicine, Ann Arbor, MI, USA
- School of Medicine, University of Michigan, Ann Arbor, MI, USA
| |
Collapse
|
36
|
Poston LM, Leavitt T, Pope S, Hill H, Tollinche LE, Kaelber DC, Alter JA. Pre-appendectomy hyponatremia is associated with increased rates of complicated appendicitis. Surg Open Sci 2023; 13:88-93. [PMID: 37274135 PMCID: PMC10238878 DOI: 10.1016/j.sopen.2023.05.001] [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] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2023] [Accepted: 05/10/2023] [Indexed: 06/06/2023] Open
Abstract
Background Acute appendicitis is one of the most common surgical emergencies worldwide. Preoperative assessment of the risk of complicated appendicitis may aid in treatment planning. We sought to investigate the association between pre-appendectomy hyponatremia and diagnosis of complicated appendicitis. Methods The TriNetX platform, a federated health research network that aggregates de-identified electronic health record data of over 90 million patients across the United States, was queried for patients who underwent appendectomy starting January 2019 and who had at least one sodium value from the preoperative period. The study population was stratified into three age groups: pediatric (age < 18), adult (age 18-64), and older adult (age ≥ 65). These groups were subdivided into patients with preoperative hyponatremia (<135 mmol/L) and normonatremia (135-145 mmol/L). Results Among the 61,245 patients who met inclusion criteria, 17,546 were included for analysis following propensity score matching. The odds of complicated appendicitis were highest in pediatric patients (age < 18) with pre-appendectomy hyponatremia (odds ratio [OR] = 2.91, 95 % CI [2.53, 3.35]). Patients age 18-64 and aged ≥ 65 with preoperative hyponatremia also demonstrated increased odds of a complicated appendicitis diagnosis, but to a lesser extent (OR = 2.11, 95 % CI [1.92, 2.32] (OR = 1.49, 95 % CI [1.25, 1.77], respectively). Conclusions In a large analysis of matched patients with acute appendicitis, we found an association between immediate preoperative hyponatremia and complicated appendicitis. Future studies are indicated to further evaluate the role of hyponatremia as a potential diagnostic marker for complicated appendicitis in all age groups. Key message This study suggests a role of hyponatremia as one of multiple variables to incorporate into future clinical decision tools for complicated acute appendicitis.
Collapse
Affiliation(s)
- Lauren M. Poston
- Case Western Reserve University School of Medicine, Cleveland, OH 44106, USA
| | - Tripp Leavitt
- Department of Plastic Surgery, Cleveland Clinic, Cleveland, OH 44195, USA
| | - Samantha Pope
- Department of Anesthesiology, The MetroHealth System, Cleveland, OH 44109, USA
| | - Hannah Hill
- Population Health Research Institute, The MetroHealth System, Cleveland, OH 44109, USA
| | - Luis E. Tollinche
- Case Western Reserve University School of Medicine, Cleveland, OH 44106, USA
- Department of Anesthesiology, The MetroHealth System, Cleveland, OH 44109, USA
| | - David C. Kaelber
- Departments of Internal Medicine, Pediatrics, and Population and Quantitative Health Sciences, Case Western Reserve University, Cleveland, OH 44109, USA
- The Center for Clinical Informatics Research and Education, The MetroHealth System, Cleveland, OH 44109, USA
| | - Jonathan A. Alter
- Case Western Reserve University School of Medicine, Cleveland, OH 44106, USA
- Department of Anesthesiology, The MetroHealth System, Cleveland, OH 44109, USA
| |
Collapse
|
37
|
Gao Z, Gorenflo M, Kaelber DC, Monnier VM, Xu R. Drug repurposing for reducing the risk of cataract extraction in patients with diabetes mellitus: integration of artificial intelligence-based drug prediction and clinical corroboration. Front Pharmacol 2023; 14:1181711. [PMID: 37274099 PMCID: PMC10232753 DOI: 10.3389/fphar.2023.1181711] [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] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2023] [Accepted: 05/05/2023] [Indexed: 06/06/2023] Open
Abstract
Diabetes mellitus (DM) increases the incidence of age-related cataracts. Currently, no medication is approved or known to delay clinical cataract progression. Using a novel approach based on AI, we searched for drugs with potential cataract surgery-suppressing effects. We developed a drug discovery strategy that combines AI-based potential candidate prediction among 2650 Food and Drug Administration (FDA)-approved drugs with clinical corroboration leveraging multicenter electronic health records (EHRs) of approximately 800,000 cataract patients from the TriNetX platform. Among the top-10 AI-predicted repurposed candidate drugs, we identified three DM diagnostic ICD code groups, such as cataract patients with type 1 diabetes mellitus (T1DM), type 2 diabetes mellitus (T2DM), or hyperglycemia, and conducted retrospective cohort analyses to evaluate the efficacy of these candidate drugs in reducing the risk of cataract extraction. Aspirin, melatonin, and ibuprofen were associated with a reduced 5-, 10-, and 20-year cataract extraction risk in all types of diabetes. Acetylcysteine was associated with a reduced 5-, 10-, and 20-year cataract extraction risk in T2DM and hyperglycemia but not in T1DM patient groups. The suppressive effects of aspirin, acetylcysteine, and ibuprofen waned over time, while those of melatonin became stronger in both genders. Thus, the four repositioned drugs have the potential to delay cataract progression in both genders. All four drugs share the ability to directly or indirectly inhibit cyclooxygenase-2 (COX-2), an enzyme that is increased by multiple cataractogenic stimuli.
Collapse
Affiliation(s)
- Zhenxiang Gao
- Center for Artificial Intelligence in Drug Discovery, School of Medicine, Case Western Reserve University, Cleveland, OH, United States
| | - Maria Gorenflo
- Center for Artificial Intelligence in Drug Discovery, School of Medicine, Case Western Reserve University, Cleveland, OH, United States
- Cleveland Clinic Lerner College of Medicine, Case Western Reserve University, Cleveland, OH, United States
| | - David C. Kaelber
- The Center for Clinical Informatics Research and Education, The Metro Health System, Cleveland, OH, United States
| | - Vincent M. Monnier
- Department of Pathology and Biochemistry, School of Medicine, Case Western Reserve University, Cleveland, OH, United States
| | - Rong Xu
- Center for Artificial Intelligence in Drug Discovery, School of Medicine, Case Western Reserve University, Cleveland, OH, United States
| |
Collapse
|
38
|
Wang L, Davis PB, Berger NA, Kaelber DC, Volkow ND, Xu R. Disrupted seasonality and association of COVID-19 with medically attended respiratory syncytial virus infections among young children in the US: January 2010-January 2023. medRxiv 2023:2023.05.12.23289898. [PMID: 37292931 PMCID: PMC10246033 DOI: 10.1101/2023.05.12.23289898] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/10/2023]
Abstract
Respiratory syncytial virus (RSV) infections and hospitalizations surged sharply in 2022 among young children. To assess whether COVID-19 contributed to this surge, we leveraged a real-time nation-wide US database of electronic health records (EHRs) using time series analysis from January 1, 2010 through January 31, 2023, and propensity-score matched cohort comparisons for children aged 0-5 years with or without prior COVID-19 infection. Seasonal patterns of medically attended RSV infections were significantly disrupted during the COVID-19 pandemic. The monthly incidence rate for first-time medically attended cases, most of which were severe RSV-associated diseases, reached a historical high rate of 2,182 cases per 1,0000,000 person-days in November 2022, corresponding to a related increase of 143% compared to expected peak rate (rate ratio: 2.43, 95% CI: 2.25-2.63). Among 228,940 children aged 0-5 years, the risk for first-time medically attended RSV during 10/2022-12/2022 was 6.40% for children with prior COVID-19 infection, higher than 4.30% for the matched children without COVID-19 (risk ratio or RR: 1.40, 95% CI: 1.27-1.55); and among 99,105 children aged 0-1 year, the overall risk was 7.90% for those with prior COVID-19 infection, higher than 5.64% for matched children without (RR: 1.40, 95% CI: 1.21-1.62). These data provide evidence that COVID-19 contributed to the 2022 surge of severe pediatric RSV cases.
Collapse
Affiliation(s)
- Lindsey Wang
- Center for Science, Health, and Society, Case Western Reserve University School of Medicine, Cleveland, OH, USA
| | - Pamela B. Davis
- The Center for Community Health Integration, Case Western Reserve University School of Medicine, Cleveland, OH, USA
| | - Nathan A. Berger
- Center for Science, Health, and Society, Case Western Reserve University School of Medicine, Cleveland, OH, USA
| | - David C. Kaelber
- Departments of Internal Medicine, Pediatrics, and Population and Quantitative Health Sciences and the Center for Clinical Informatics Research and Education, The MetroHealth System, Cleveland, OH, USA
| | - Nora D. Volkow
- National Institute on Drug Abuse, National Institutes of Health, Bethesda, MD, USA
| | - Rong Xu
- Center for Artificial Intelligence in Drug Discovery, Case Western Reserve University School of Medicine, Cleveland, OH, USA
| |
Collapse
|
39
|
Gross R, Thaweethai T, Rosenzweig EB, Chan J, Chibnik LB, Cicek MS, Elliott AJ, Flaherman VJ, Foulkes AS, Witvliet MG, Gallagher R, Gennaro ML, Jernigan TL, Karlson EW, Katz SD, Kinser PA, Kleinman LC, Lamendola-Essel MF, Milner JD, Mohandas S, Mudumbi PC, Newburger JW, Rhee KE, Salisbury AL, Snowden JN, Stein CR, Stockwell MS, Tantisira KG, Thomason ME, Truong DT, Warburton D, Wood JC, Ahmed S, Akerlundh A, Alshawabkeh AN, Anderson BR, Aschner JL, Atz AM, Aupperle RL, Baker FC, Balaraman V, Banerjee D, Barch DM, Baskin-Sommers A, Bhuiyan S, Bind MAC, Bogie AL, Buchbinder NC, Bueler E, Bükülmez H, Casey B, Chang L, Clark DB, Clifton RG, Clouser KN, Cottrell L, Cowan K, D’Sa V, Dapretto M, Dasgupta S, Dehority W, Dummer KB, Elias MD, Esquenazi-Karonika S, Evans DN, Faustino EVS, Fiks AG, Forsha D, Foxe JJ, Friedman NP, Fry G, Gaur S, Gee DG, Gray KM, Harahsheh AS, Heath AC, Heitzeg MM, Hester CM, Hill S, Hobart-Porter L, Hong TK, Horowitz CR, Hsia DS, Huentelman M, Hummel KD, Iacono WG, Irby K, Jacobus J, Jacoby VL, Jone PN, Kaelber DC, Kasmarcak TJ, Kluko MJ, Kosut JS, Laird AR, Landeo-Gutierrez J, Lang SM, Larson CL, Lim PPC, Lisdahl KM, McCrindle BW, McCulloh RJ, Mendelsohn AL, Metz TD, Morgan LM, Müller-Oehring EM, Nahin ER, Neale MC, Ness-Cochinwala M, Nolan SM, Oliveira CR, Oster ME, Payne RM, Raissy H, Randall IG, Rao S, Reeder HT, Rosas JM, Russell MW, Sabati AA, Sanil Y, Sato AI, Schechter MS, Selvarangan R, Shakti D, Sharma K, Squeglia LM, Stevenson MD, Szmuszkovicz J, Talavera-Barber MM, Teufel RJ, Thacker D, Udosen MM, Warner MR, Watson SE, Werzberger A, Weyer JC, Wood MJ, Yin HS, Zempsky WT, Zimmerman E, Dreyer BP. Researching COVID to enhance recovery (RECOVER) pediatric study protocol: Rationale, objectives and design. medRxiv 2023:2023.04.27.23289228. [PMID: 37214806 PMCID: PMC10197716 DOI: 10.1101/2023.04.27.23289228] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/24/2023]
Abstract
Importance The prevalence, pathophysiology, and long-term outcomes of COVID-19 (post-acute sequelae of SARS-CoV-2 [PASC] or "Long COVID") in children and young adults remain unknown. Studies must address the urgent need to define PASC, its mechanisms, and potential treatment targets in children and young adults. Observations We describe the protocol for the Pediatric Observational Cohort Study of the NIH's RE searching COV ID to E nhance R ecovery (RECOVER) Initiative. RECOVER-Pediatrics is an observational meta-cohort study of caregiver-child pairs (birth through 17 years) and young adults (18 through 25 years), recruited from more than 100 sites across the US. This report focuses on two of five cohorts that comprise RECOVER-Pediatrics: 1) a de novo RECOVER prospective cohort of children and young adults with and without previous or current infection; and 2) an extant cohort derived from the Adolescent Brain Cognitive Development (ABCD) study ( n =10,000). The de novo cohort incorporates three tiers of data collection: 1) remote baseline assessments (Tier 1, n=6000); 2) longitudinal follow-up for up to 4 years (Tier 2, n=6000); and 3) a subset of participants, primarily the most severely affected by PASC, who will undergo deep phenotyping to explore PASC pathophysiology (Tier 3, n=600). Youth enrolled in the ABCD study participate in Tier 1. The pediatric protocol was developed as a collaborative partnership of investigators, patients, researchers, clinicians, community partners, and federal partners, intentionally promoting inclusivity and diversity. The protocol is adaptive to facilitate responses to emerging science. Conclusions and Relevance RECOVER-Pediatrics seeks to characterize the clinical course, underlying mechanisms, and long-term effects of PASC from birth through 25 years old. RECOVER-Pediatrics is designed to elucidate the epidemiology, four-year clinical course, and sociodemographic correlates of pediatric PASC. The data and biosamples will allow examination of mechanistic hypotheses and biomarkers, thus providing insights into potential therapeutic interventions. Clinical Trialsgov Identifier Clinical Trial Registration: http://www.clinicaltrials.gov . Unique identifier: NCT05172011.
Collapse
Affiliation(s)
- Rachel Gross
- Department of Pediatrics, New York University Grossman School of Medicine, New York, NY, USA
| | - Tanayott Thaweethai
- Department of Biostatistics, Massachusetts General Hospital, Boston, MA, USA
| | - Erika B. Rosenzweig
- Department of Pediatrics, Columbia University Vagelos College of Physicians and Surgeons, New York, NY, USA
| | - James Chan
- Department of Biostatistics, Massachusetts General Hospital, Boston, MA, USA
| | - Lori B. Chibnik
- Department of Biostatistics, Massachusetts General Hospital, Boston, MA, USA
| | - Mine S. Cicek
- Department of Laboratory Medicine and Pathology, Mayo Clinic Hospital, Rochester, MN, USA
| | - Amy J. Elliott
- Avera Research Institute, Avera Health, Sioux Falls, SD, USA
| | - Valerie J. Flaherman
- Department of Pediatrics, University of California San Francisco, San Francisco, CA, USA
| | - Andrea S. Foulkes
- Department of Biostatistics, Massachusetts General Hospital, Boston, MA, USA
| | | | - Richard Gallagher
- Department of Child and Adolescent Psychiatry, New York University Grossman School of Medicine, New York, NY, USA
| | - Maria Laura Gennaro
- Public Health Research Institute and Department of Medicine, Rutgers New Jersey Medical School, Newark, NJ, USA
| | - Terry L. Jernigan
- Center for Human Development, Cognitive Science, Psychiatry, Radiology, University of California San Diego, La Jolla, CA, USA
| | | | - Stuart D. Katz
- Department of Medicine, New York University Grossman School of Medicine, New York, NY, USA
| | - Patricia A. Kinser
- Department of Physical Medicine and Rehabilitation, Virginia Commonwealth University School of Nursing, Richmond, VA, USA
| | - Lawrence C. Kleinman
- Department of Pediatrics, Division of Population Health, Quality, and Implementation Sciences (POPQuIS), Rutgers Robert Wood Johnson Medical School, New Brunswick, NJ, USA
| | | | - Joshua D. Milner
- Department of Pediatrics, Columbia University Medical Center: Columbia University Irving Medical Center, New York, NY, USA
| | - Sindhu Mohandas
- Department of Infectious Diseases, Children’s Hospital Los Angeles and the Keck School of Medicine, University of Southern California, Los Angeles, CA, USA
| | - Praveen C. Mudumbi
- Department of Population Health, New York University Grossman School of Medicine, New York, NY, USA
| | - Jane W. Newburger
- Department of Cardiology, Boston Children’s Hospital, Boston, MA, USA
| | - Kyung E. Rhee
- Department of Pediatrics, University of California San Diego School of Medicine, San Diego, CA, USA
| | - Amy L. Salisbury
- School of Nursing, Virginia Commonwealth University, Richmond, VA, USA
| | - Jessica N. Snowden
- Departments of Pediatrics and Biostatistics, University of Arkansas for Medical Sciences, Little Rock, AR, USA
| | - Cheryl R. Stein
- Department of Child and Adolescent Psychiatry, Hassenfeld Children’s Hospital at NYU Langone, New York, NY, USA
| | - Melissa S. Stockwell
- Department of Pediatrics, Division of Child and Adolescent Health, Columbia University Vagelos College of Physicians and Surgeons and NewYork-Presbyterian, New York, NY, USA
| | - Kelan G. Tantisira
- Division of Pediatric Respiratory Medicine, University of California San Diego, San Diego, CA, USA
| | - Moriah E. Thomason
- Department of Child and Adolescent Psychiatry, New York University Grossman School of Medicine, New York, NY, USA
| | - Dongngan T. Truong
- Division of Pediatric Cardiology, University of Utah and Primary Children’s Hospital, Salt Lake City, UT, USA
| | - David Warburton
- Department of Pediatrics, Children’s Hospital Los Angeles, Los Angeles, CA, USA
| | - John C. Wood
- Department of Pediatrics and Radiology, Children’s Hospital Los Angeles, Los Angeles, CA, USA
| | - Shifa Ahmed
- Department of Biostatistics, Massachusetts General Hospital, Boston, MA, USA
| | - Almary Akerlundh
- Department of Pulmonary Research, Rady Children’s Hospital-San Diego, San Diego, CA, USA
| | | | - Brett R. Anderson
- Division of Pediatric Cardiology, NewYork-Presbyterian/Columbia University Irving Medical Center, New York, NY, USA
| | - Judy L. Aschner
- Department of Pediatrics, Hackensack University Medical Center, Hackensack, NJ, USA
| | - Andrew M. Atz
- Department of Pediatrics, Medical University of South Carolina, Charleston, SC, USA
| | - Robin L. Aupperle
- Oxley College of Health Sciences, Laureate Institute for Brain Research, Tulsa, OK, USA
| | - Fiona C. Baker
- Center for Health Sciences, SRI International, Menlo Park, CA, USA
| | - Venkataraman Balaraman
- Department of Pediatrics, Kapiolani Medical Center for Women and Children, Honolulu, HI, USA
| | - Dithi Banerjee
- Department of Pathology and Laboratory Medicine, Children’s Mercy Hospital, Kansas City, MO, USA
| | - Deanna M. Barch
- Department of Psychological & Brain Sciences, Psychiatry, and Radiology, Washington University in St. Louis, Saint Louis, MO, USA
| | | | - Sultana Bhuiyan
- Department of Medicine, New York University Grossman School of Medicine, New York, NY, USA
| | - Marie-Abele C. Bind
- Department of Biostatistics, Massachusetts General Hospital, Boston, MA, USA
| | - Amanda L. Bogie
- Department of Pediatrics, University of Oklahoma Health Science Center, Oklahoma City, OK, USA
| | - Natalie C. Buchbinder
- Center for Human Development, University of California San Diego, San Diego, CA, USA
| | - Elliott Bueler
- Department of Medicine, New York University Grossman School of Medicine, New York, NY, USA
| | - Hülya Bükülmez
- Department of Pediatrics, Division of Rheumatology, The MetroHealth System, Case Western Reserve University, Cleveland, OH, USA
| | - B.J. Casey
- Department of Neuroscience and Behavior, Barnard College - Columbia University, New York, NY, USA
| | - Linda Chang
- Department of Diagnostic Radiology and Nuclear Medicine, University of Maryland School of Medicine, Baltimore, MD, USA
| | - Duncan B. Clark
- Departments of Psychiatry and Pharmaceutical Sciences, University of Pittsburgh, Pittsburgh, PA, USA
| | | | - Katharine N. Clouser
- Department of Pediatrics, Hackensack Meridian School of Medicine, Nutley, NJ, USA
| | - Lesley Cottrell
- Department of Pediatrics, West Virginia University, Morgantown, WV, USA
| | - Kelly Cowan
- Department of Pediatrics, Robert Larner M.D. College of Medicine at the University of Vermont, Burlington, VT, USA
| | - Viren D’Sa
- Department of Pediatrics, Rhode Island Hospital, Providence, RI, USA
| | - Mirella Dapretto
- Department of Psychiatry and Biobehavioral Sciences, University of California Los Angeles, Los Angeles, CA, USA
| | - Soham Dasgupta
- Department of Pediatrics, Norton Children’s Hospital, University of Louisville, Louisville, KY, USA
| | - Walter Dehority
- Department of Pediatrics, Division of Infectious Diseases, University of New Mexico, Albuquerque, NM, USA
| | - Kirsten B. Dummer
- Department of Pediatrics, University of California San Diego, San Diego, CA, USA
| | - Matthew D. Elias
- Division of Cardiology, Children’s Hospital of Philadelphia, Philadelphia, PA, USA
| | - Shari Esquenazi-Karonika
- Department of Population Health, New York University Grossman School of Medicine, New York, NY, USA
| | - Danielle N. Evans
- Arkansas Children’s Research Institute, Arkansas Children’s Hospital, Little Rock, AR, USA
| | | | - Alexander G. Fiks
- Department of Pediatrics, Children’s Hospital of Philadelphia, Philadelphia, PA, USA
| | - Daniel Forsha
- Department of Cardiology, Children’s Mercy Kansas City, Ward Family Heart Center, Kansas City, MO, USA, Kansas City, MO, USA
| | - John J. Foxe
- Department of Neuroscience, University of Rochester School of Medicine and Dentistry, Rochester, NY, USA
| | - Naomi P. Friedman
- Institute for Behavioral Genetics and Department of Psychology and Neuroscience, University of Colorado Boulder, Bolder, CO, USA
| | - Greta Fry
- Pennington Biomedical Research Center Clinic, Pennington Biomedical Research Center, Baton Rouge, LA, USA
| | - Sunanda Gaur
- Department of Pediatrics, Rutgers Robert Wood Johnson Medical School, New Brunswick, NJ, USA
| | - Dylan G. Gee
- Department of Psychology, Yale University, New Haven, CT, USA
| | - Kevin M. Gray
- Department of Psychiatry and Behavioral Sciences, Medical University of South Carolina, Charleston, SC, USA
| | - Ashraf S. Harahsheh
- Department of Pediatrics, Division of Cardiology, George Washington University School of Medicine & Health Sciences, Washington, DC, USA
| | - Andrew C. Heath
- Department of Psychiatry, Washington University School of Medicine, St Louis, MO, USA
| | - Mary M. Heitzeg
- Department of Psychiatry, University of Michigan, Ann Arbor, MI, USA
| | - Christina M. Hester
- Division of Practice-Based Research, Innovation, & Evaluation, American Academy of Family Physicians, Leawood, KS, USA
| | - Sophia Hill
- Department of Medicine, New York University Grossman School of Medicine, New York, NY, USA
| | - Laura Hobart-Porter
- Departments of Pediatrics and Physical Medicine & Rehabilitation, Section of Pediatric Rehabilitation, University of Arkansas for Medical Sciences, Little Rock, AR, USA
| | - Travis K.F. Hong
- Department of Pediatrics, Kapiolani Medical Center for Women and Children, Honolulu, HI, USA
| | - Carol R. Horowitz
- Center for Health Equity and Community Engaged Research and Department of Population Health Science and Policy, New York, NY, USA
| | - Daniel S. Hsia
- Clinical Trials Unit, Pennington Biomedical Research Center, Baton Rouge, LA, USA
| | - Matthew Huentelman
- Division of Neurogenomics, Translational Genomics Research Institute, Phoenix, AZ, USA
| | - Kathy D. Hummel
- Department of Pediatrics, University of Arkansas for Medical Sciences, Little Rock, AR, USA
| | - William G. Iacono
- Department of Psychology, University of Minnesota, Minneapolis, MN, USA
| | - Katherine Irby
- Department of Pediatrics, Arkansas Children’s Hospital, University of Arkansas Medical School, Little Rock, AR, USA
| | - Joanna Jacobus
- Department of Psychiatry, University of California San Diego, La Jolla, CA, USA
| | - Vanessa L. Jacoby
- Department of Obstetrics, Gynecology, and Reproductive Sciences, University of California San Francisco, San Francisco, CA, USA
| | - Pei-Ni Jone
- Department of Pediatrics, Pediatric Cardiology, Lurie Children’s Hospital, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| | - David C. Kaelber
- Departments of Pediatrics, Internal Medicine, and Population and Quantitative Health Sciences, Case Western Reserve University, Cleveland, OH, USA
| | - Tyler J. Kasmarcak
- Department of Pediatric Clinical Research, Medical University of South Carolina, Charleston, SC, USA
| | - Matthew J. Kluko
- Department of Pediatrics, Yale School of Medicine, New Haven, CT, USA
| | - Jessica S. Kosut
- Department of Pediatrics, Kapiolani Medical Center for Women and Children, Honolulu, HI, USA
| | - Angela R. Laird
- Department of Physics, Florida International University, Miami, FL, USA
| | - Jeremy Landeo-Gutierrez
- Department of Pediatrics, Respiratory Medicine Division, University of California San Diego, San Diego, CA, USA
| | - Sean M. Lang
- Heart Institute, Cincinnati Children’s Hospital Medical Center, Cincinnati, OH, USA
| | - Christine L. Larson
- Department of Psychology, University of Wisconsin-Milwaukee, Milwaukee, WI, USA
| | - Peter Paul C. Lim
- Department of Pediatric Infectious Disease, Avera McKennan University Health Center, University of South Dakota, Sioux Falls, SD, USA
| | - Krista M. Lisdahl
- Department of Psychology, University of Wisconsin-Milwaukee, Milwaukee, WI, USA
| | - Brian W. McCrindle
- Department of Pediatrics, University of Toronto, Labatt Family Heart Center, The Hospital for Sick Children, Toronto, ON, Canada
| | - Russell J. McCulloh
- Department of Pediatrics, University of Nebraska Medical Center, Omaha, NE, USA
| | - Alan L. Mendelsohn
- Department of Pediatrics, Division of Developmental-Behavioral Pediatrics, New York University Grossman School of Medicine, New York, NY, USA
| | - Torri D. Metz
- Department of Obstetrics and Gynecology, University of Utah Health, Salt Lake City, UT, USA
| | - Lerraughn M. Morgan
- Department of Pediatrics, Valley Children’s Healthcare, Department of Pediatrics, Madera, CA, Madera, CA, USA
| | | | - Erica R. Nahin
- Department of Medicine, New York University Grossman School of Medicine, New York, NY, USA
| | - Michael C. Neale
- Department of Psychiatry, Virginia Commonwealth University, Richmond, VA, USA
| | - Manette Ness-Cochinwala
- Department of Pediatrics, Rutgers Robert Wood Johnson Medical School, New Brunswick, NJ, USA
| | - Sheila M. Nolan
- Department of Pediatrics, New York Medical College, Valhalla, NY, USA
| | - Carlos R. Oliveira
- Department of Pediatrics, Section of Infectious Diseases and Global Health, Yale University School of Medicine, New Haven, CT, USA
| | - Matthew E. Oster
- Department of Pediatric Cardiology, Children’s Healthcare of Atlanta, Atlanta, GA, USA
| | - R. Mark Payne
- Department of Pediatrics, Division of Pediatric Cardiology, Riley Hospital for Children, Indiana University School of Medicine, Indianapolis, IN, USA
| | - Hengameh Raissy
- Department of Pediatrics, University of New Mexico, Health Sciences Center, Albuquerque, NM, USA
| | - Isabelle G. Randall
- Department of Medicine, New York University Grossman School of Medicine, New York, NY, USA
| | - Suchitra Rao
- Department of Pediatrics, Division of Infectious Diseases, Epidemiology and Hospital Medicine, University of Colorado Anschutz Medical Campus, Aurora, CO, USA
| | - Harrison T. Reeder
- Department of Biostatistics, Massachusetts General Hospital, Boston, MA, USA
| | - Johana M. Rosas
- Department of Medicine, New York University Grossman School of Medicine, New York, NY, USA
| | - Mark W. Russell
- Department of Pediatrics, University of Michigan Health System, Ann Arbor, MI, USA
| | - Arash A. Sabati
- Department of Pediatric Cardiology, Phoenix Children’s Hospital, Phoenix, AZ, USA
| | - Yamuna Sanil
- Division of Pediatric Cardiology, Children’s Hospital of Michigan, Detroit, MI, USA
| | - Alice I. Sato
- Department of Pediatric Infectious Disease, University of Nebraska Medical Center, Omaha, NE, USA
| | - Michael S. Schechter
- Department of Pediatrics, Children’s Hospital of Richmond at Virginia Commonwealth University, Richmond, VA, USA
| | - Rangaraj Selvarangan
- Department of Pathology and Laboratory Medicine, Children’s Mercy Hospital, Kansas City, MO, USA
| | - Divya Shakti
- Department of Pediatrics, Pediatric Cardiology, University of Mississippi Medical Center, Jackson, MS, USA
| | - Kavita Sharma
- Department of Pediatrics, University of Texas Southwestern Medical Center, Dallas, TX, USA
| | - Lindsay M. Squeglia
- Department of Psychiatry and Behavioral Sciences, Medical University of South Carolina, Charleston, SC, USA
| | - Michelle D. Stevenson
- Department of Pediatrics, University of Louisville School of Medicine, Louisville, KY, USA
| | | | - Maria M. Talavera-Barber
- Department of Pediatrics, Avera McKennan Hospital and University Health Center, Sioux Falls, SD, USA
| | - Ronald J. Teufel
- Department of Pediatrics, Medical University of South Carolina, Charleston, SC, USA
| | - Deepika Thacker
- Nemours Cardiac Center, Nemours Childrens Health, Delaware, Wilmington, DE, USA
| | - Mmekom M. Udosen
- RECOVER Neurocognitive and Wellbeing/Mental Health Team, NYU Grossman School of Medicine, New York, NY, USA
| | - Megan R. Warner
- Department of Pulmonary Research, Rady Children’s Hospital-San Diego, San Diego, CA, USA
| | - Sara E. Watson
- Department of Pediatrics, University of Louisville School of Medicine, Louisville, KY, USA
| | - Alan Werzberger
- Department of Pediatrics, Columbia University Medical Center: Columbia University Irving Medical Center, New York, NY, USA
| | - Jordan C. Weyer
- Center for Individualized Medicine, Mayo Clinic Hospital, Rochester, MN, USA
| | - Marion J. Wood
- Department of Population Health, New York University Grossman School of Medicine, New York, NY, USA
| | - H. Shonna Yin
- Departments of Pediatrics and Population Health, New York University Grossman School of Medicine, New York, NY, USA
| | - William T. Zempsky
- Department of Pediatrics, Connecticut Children’s Medical Center, Hartford, CT, USA
| | - Emily Zimmerman
- Department of Communication Sciences & Disorders, Northeastern University, Boston, MA, USA
| | - Benard P. Dreyer
- Department of Pediatrics, New York University Grossman School of Medicine, New York, NY, USA
| |
Collapse
|
40
|
Dorney I, Shaia J, Kaelber DC, Talcott KE, Singh RP. Risk of New Retinal Vascular Occlusion After mRNA COVID-19 Vaccination Within Aggregated Electronic Health Record Data. JAMA Ophthalmol 2023; 141:441-447. [PMID: 37052897 PMCID: PMC10102921 DOI: 10.1001/jamaophthalmol.2023.0610] [Citation(s) in RCA: 11] [Impact Index Per Article: 11.0] [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: 11/01/2022] [Accepted: 01/31/2023] [Indexed: 04/14/2023]
Abstract
Importance New-onset retinal vascular occlusion (RVO) occurring acutely after messenger RNA (mRNA) COVID-19 vaccination has been described in recent literature. Because RVO can cause vision loss or blindness, an epidemiologic investigation evaluating this potential association is of great importance to public health. Objective To investigate how often patients are diagnosed with new RVO acutely after the mRNA COVID-19 vaccine compared with influenza and tetanus, diphtheria, pertussis (Tdap) vaccines. Design, Setting, and Participants A retrospective population-based cohort design using the TriNetX Analytics platform, a federated, aggregated electronic health record (EHR) research network containing the deidentified EHR data of more than 103 million patients, was used to examine aggregate EHR data. Data were collected and analyzed on October 20, 2022. Data on patients within the TriNetX Analytics platform were searched for the presence of vaccination Common Procedural Technology codes, and instances of newly diagnosed RVO within 21 days of vaccination were recorded and reported. Propensity score matching based on demographic characteristics (age, sex, race and ethnicity) and comorbidities (diabetes, hypertension, and hyperlipidemia) was performed between vaccination groups for evaluation of relative risks (RRs). Main Outcomes and Measures The appearance of a new-encounter diagnosis of RVO within 21 days of the mRNA COVID-19 vaccination was the primary outcome. Historical comparison cohorts of patients receiving influenza and Tdap vaccinations allowed for evaluation of the RRs for RVO. Results Of 3 108 829 patients (mean [SD] age at vaccination, 50.7 [20.4] years; 56.4% women) who received the mRNA COVID-19 vaccine, 104 (0.003%; 95% CI, 0.003%-0.004%) patients had a new diagnosis of RVO within 21 days of vaccination. After propensity score matching, the RR for new RVO diagnosis after the first dose of COVID-19 vaccination was not significantly different from that after influenza (RR, 0.74; 95% CI, 0.54-1.01) or Tdap (RR, 0.78; 95% CI, 0.44-1.38) vaccinations, but was greater when compared with the second dose of the COVID-19 vaccination (RR, 2.25; 95% CI, 1.33-3.81). Conclusions and Relevance The findings of this study suggest that RVO diagnosed acutely after mRNA COVID-19 vaccination occurs extremely rarely at rates similar to those of 2 different historically used vaccinations, the influenza and Tdap vaccines. No evidence suggesting an association between the mRNA COVID-19 vaccination and newly diagnosed RVO was found.
Collapse
Affiliation(s)
- Ian Dorney
- Case Western Reserve University School of Medicine, Cleveland, Ohio
| | - Jacqueline Shaia
- Center for Ophthalmic Bioinformatics, Cole Eye Institute, Cleveland Clinic, Cleveland, Ohio
| | - David C. Kaelber
- Departments of Internal Medicine, Pediatrics, and Population and Quantitative Health Sciences, Case Western Reserve University, Cleveland, Ohio
- The Center for Clinical Informatics Research and Education, The MetroHealth System, Cleveland, Ohio
| | - Katherine E. Talcott
- Center for Ophthalmic Bioinformatics, Cole Eye Institute, Cleveland Clinic, Cleveland, Ohio
| | - Rishi P. Singh
- Center for Ophthalmic Bioinformatics, Cole Eye Institute, Cleveland Clinic, Cleveland, Ohio
| |
Collapse
|
41
|
Birabaharan M, Hill E, Begur M, Kaelber DC, Martin TCS, Mehta SR. Cardiovascular Outcomes After Tixagevimab and Cilgavimab use for Pre-Exposure Prophylaxis Against Coronavirus Disease 2019: A Population-Based Propensity-matched Cohort Study. Clin Infect Dis 2023; 76:1500-1503. [PMID: 36380460 DOI: 10.1093/cid/ciac894] [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: 10/03/2022] [Revised: 11/02/2022] [Accepted: 11/10/2022] [Indexed: 11/17/2022] Open
Abstract
Tixagevimab and cilgavimab treatment was associated with higher rates of cardiovascular events in a post hoc analysis of a phase 3 trial. In this large population-based propensity-matched study, we found no increased risk of cardiovascular events up to 90 days after tixagevimab and cilgavimab administration, including in patients with pre-existing cardiovascular disease.
Collapse
Affiliation(s)
- Morgan Birabaharan
- Division of Infectious Diseases and Global Public Health, Department of Medicine, University of California, San Diego, La Jolla, California, USA
| | - Eddie Hill
- Division of Infectious Diseases and Global Public Health, Department of Medicine, University of California, San Diego, La Jolla, California, USA
| | - Maedha Begur
- Division of Infectious Diseases and Global Public Health, Department of Medicine, University of California, San Diego, La Jolla, California, USA
| | - David C Kaelber
- The Center for Clinical Informatics Research and Education, The MetroHealth System, Cleveland, OH, USA
- Departments of Internal Medicine, Pediatrics, and Population and Quantitative Health Sciences, School of Medicine, Case Western Reserve University, Cleveland, OH, USA
| | - Thomas C S Martin
- Division of Infectious Diseases and Global Public Health, Department of Medicine, University of California, San Diego, La Jolla, California, USA
- San Diego Veterans Affairs Healthcare System, San Diego, California, USA
| | - Sanjay R Mehta
- Division of Infectious Diseases and Global Public Health, Department of Medicine, University of California, San Diego, La Jolla, California, USA
- San Diego Veterans Affairs Healthcare System, San Diego, California, USA
| |
Collapse
|
42
|
Tarabichi Y, Kaelber DC, Thornton JD. Early Racial and Ethnic Disparities in the Prescription of Nirmatrelvir for COVID-19. J Gen Intern Med 2023; 38:1329-1330. [PMID: 36717431 PMCID: PMC9886417 DOI: 10.1007/s11606-022-07844-3] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/10/2022] [Accepted: 10/06/2022] [Indexed: 02/01/2023]
|
43
|
McCauley KL, Kaelber DC, Mistovich RJ. Did the COVID-19 pandemic lead to increased pediatric musculoskeletal nonaccidental trauma? A cross-sectional study. J Pediatr Orthop B 2023; 32:192-196. [PMID: 35357345 PMCID: PMC9522884 DOI: 10.1097/bpb.0000000000000971] [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] [Indexed: 02/04/2023]
Abstract
Lockdowns due to COVID-19 increased known risk factors for nonaccidental trauma (NAT), including economic instability and parental stress. We sought to evaluate potential changes in the frequency and types of fractures associated with NAT during the COVID-19 pandemic. A retrospective cross-sectional study was conducted using de-identified data obtained from the IBM Watson Health Explorys Cohort Discovery database. Systematized Nomenclature of Medicine-Clinical Terms were used to query the database for victims of NAT in 2019 and 2020. Within this cohort of patients, we then identified those who were also diagnosed with a fracture within 21 days of the NAT event. Demographic data were compared between 2019 and 2020 where possible using chi-squared testing, and relative risks for various fracture diagnoses were calculated with 95% confidence intervals. There were 9500 records overall of pediatric NAT in 2019 compared to 9350 in 2020. Of those, in 2019 550 were associated with a diagnosis of fracture versus 570 in 2020. The relative risk of fracture due to NAT in 2020 when compared to 2019 was not significantly higher [relative risk, 1.05 (95% confidence interval, 0.94-1.17)]. The relative risk for each category of fracture diagnosis in 2020 was slightly higher, but not to a statistically significant degree. Despite increasing known risk factors, the frequency of NAT remained unchanged as the result of the COVID-19 pandemic. We also did not identify significant changes in the risk of fracture due to NAT, nor any changes in the associated types of fractures.
Collapse
Affiliation(s)
| | - David C Kaelber
- Case Western Reserve University School of Medicine
- Department of Internal Medicine and Pediatrics, Chief Medical Informatics Office
| | - R Justin Mistovich
- Case Western Reserve University School of Medicine
- Department of Internal Medicine and Pediatrics, Chief Medical Informatics Office
- Department of Orthopaedic Surgery, Metrohealth Medical Center
- Division of Pediatric Orthopaedic Surgery, Rainbow Babies and Children's Hospital, Cleveland, Ohio, USA
| |
Collapse
|
44
|
Gorenflo MP, Davis PB, Kaelber DC, Xu R. Ischemic stroke after COVID-19 bivalent vaccine administration in patients aged 65 years and older: analysis of nation-wide patient electronic health records in the United States. medRxiv 2023:2023.02.11.23285801. [PMID: 36824915 PMCID: PMC9949210 DOI: 10.1101/2023.02.11.23285801] [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] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/16/2023]
Abstract
Importance The Centers for Disease Control and Prevention (CDC) announced in January 2023 that they were investigating a potential connection between administration of the Pfizer novel coronavirus disease-2019 (COVID-19) bivalent vaccine booster and ischemic stroke (IS). Objective To explore the relationship between Pfizer bivalent booster administration and IS in older patients in the United States and compare it to other COVID-19 vaccines. Design A retrospective cohort study was conducted to compare hazard of IS among patients aged 65 years or over who received the Pfizer bivalent, Moderna bivalent, or Pfizer/Moderna monovalent COVID-19 booster vaccine 1-21 and 22-42 days after vaccination. Setting Patient data were collected from TriNetX, a cloud-based analytics platform that includes electronic health record data from over 90 million unique patients in the United States. Participants Patients in the United States aged 65 years or over at the time of administration of a Pfizer bivalent (n = 43,216), Moderna bivalent (n = 4,267), or Pfizer/Moderna monovalent (n = 100,583) booster were included for analysis. Cohorts were propensity-score matched by demographic factors and risk factors for IS and severe COVID-19. Exposures Pfizer bivalent, Moderna bivalent, or Pfizer/Moderna monovalent COVID-19 booster administration. Main outcomes The hazard ratio (HR) and 95% confidence interval (CI) for IS in the cohorts at 1-21 and 22-42 days after administration. Results After matching, the Pfizer bivalent cohort included 4,267 patients, with an average age of 73.7 years (44.43% male, 76.59% white). The Moderna bivalent cohort included 4,267 patients, with an average age of 74.0 years (44.08% male, 77.39% white). There was no significant difference in the hazard of IS encounters between the Pfizer bivalent versus Moderna bivalent cohorts at 1-21- or 22-42-days post-administration: HR = 0.59 (0.31, 1.11), 0.73 (0.33, 1.60). The hazard for IS was lower in the Pfizer bivalent cohort than in the Pfizer/Moderna monovalent cohort at both timepoints: HR = 0.24 (0.19, 0.29), 0.25 (0.20, 0.31). Conclusions and relevance Older adults administered the Pfizer bivalent booster had similar hazard for IS encounters compared to those administered the Moderna bivalent booster vaccine, but lower hazard than those administered the Pfizer/Moderna monovalent boosters.
Collapse
Affiliation(s)
- Maria P. Gorenflo
- Center for Artificial Intelligence in Drug Discovery, Case Western Reserve University School of Medicine, Cleveland, OH, USA
| | - Pamela B. Davis
- Center for Community Health Integration, Case Western Reserve University School of Medicine, Cleveland, OH, USA
| | - David C. Kaelber
- The Center for Clinical Informatics Research and Education, The MetroHealth System, Cleveland, OH, USA
| | - Rong Xu
- Center for Artificial Intelligence in Drug Discovery, Case Western Reserve University School of Medicine, Cleveland, OH, USA
| |
Collapse
|
45
|
Khan MTF, Lewis D, Kaelber DC, Winhusen TJ. Health outcomes associated with patterns of substance use disorders among patients with type 2 diabetes and hypertension: Electronic health record findings. Prim Care Diabetes 2023; 17:43-47. [PMID: 36437216 PMCID: PMC10855015 DOI: 10.1016/j.pcd.2022.11.006] [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: 08/04/2022] [Revised: 11/17/2022] [Accepted: 11/21/2022] [Indexed: 11/26/2022]
Abstract
AIMS To identify substance use disorder (SUD) patterns and their association with T2DM health outcomes among patients with type 2 diabetes and hypertension. METHODS We used latent class analysis on electronic health records from the MetroHealth System (Cleveland, Ohio) to obtain the target SUD groups: i) only tobacco (TUD), ii) tobacco and alcohol (TAUD), and iii) tobacco, alcohol, and at least one more substance (PSUD). A matching program with Mahalanobis distance within propensity score calipers created the matched control groups: no SUD (NSUD) for TUD and TUD for the other two SUD groups. The numbers of participants for the target-control groups were 8009 (TUD), 1672 (TAUD), and 642 (PSUD). RESULTS TUD was significantly associated with T2DM complications. Compared to TUD, the TAUD group showed a significantly higher likelihood for all-cause mortality (adjusted odds ratio (aOR) = 1.46) but not for any of the T2DM complications. Compared to TUD, the PSUD group experienced a significantly higher risk for cerebrovascular accident (CVA) (aOR = 2.19), diabetic neuropathy (aOR = 1.76), myocardial infarction (MI) (aOR = 1.76), and all-cause mortality (aOR = 1.66). CONCLUSIONS The findings of increased risk associated with PSUDs may provide insights for better management of patients with T2DM and hypertension co-occurrence.
Collapse
Affiliation(s)
- Md Tareq Ferdous Khan
- Division of Biostatistics and Bioinformatics, Department of Environmental and Public Health Sciences, College of Medicine, University of Cincinnati, Cincinnati, OH, USA; Department of Statistics, Jahangirnagar University, Dhaka, Bangladesh.
| | - Daniel Lewis
- Center for Addiction Research, College of Medicine, University of Cincinnati, Cincinnati, OH, USA; Department of Psychiatry and Behavioral Neuroscience, College of Medicine, University of Cincinnati, Cincinnati, OH, USA
| | - David C Kaelber
- Department of Information Services, The MetroHealth System, Cleveland, OH, USA; Departments of Internal Medicine, Pediatrics, and Population and Quantitative Health Sciences, Case Western Reserve University, Cleveland, OH, USA; The Center for Clinical Informatics Research and Education, The MetroHealth System, Cleveland, OH, USA
| | - T John Winhusen
- Center for Addiction Research, College of Medicine, University of Cincinnati, Cincinnati, OH, USA; Department of Psychiatry and Behavioral Neuroscience, College of Medicine, University of Cincinnati, Cincinnati, OH, USA
| |
Collapse
|
46
|
Wang L, Davis PB, Kaelber DC, Xu R. COVID-19 breakthrough infections and hospitalizations among vaccinated patients with dementia in the United States between December 2020 and August 2021. Alzheimers Dement 2023; 19:421-432. [PMID: 35417628 PMCID: PMC9073984 DOI: 10.1002/alz.12669] [Citation(s) in RCA: 25] [Impact Index Per Article: 25.0] [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: 01/10/2022] [Revised: 01/31/2022] [Accepted: 03/02/2022] [Indexed: 01/05/2023]
Abstract
INTRODUCTION There is lack of data on COVID-19 breakthrough infections in vaccinated patients with dementia in the United States. METHODS This is a retrospective cohort study of 262,847 vaccinated older adults (age 73.8 ± 6.81 years old) between December 2020 and August 2021. RESULTS Among the fully vaccinated patients with dementia, the overall risk of COVID-19 breakthrough infections ranged from 8.6% to 12.4%. Patients with dementia were at increased risk for breakthrough infections compared with patients without dementia, with the highest odds for patients with Lewy body dementia (LBD) (adjusted odds ratio or AOR: 3.06, 95% confidence interval or CI [1.45 to 6.66]), followed by vascular dementia (VD) (AOR: 1.99, 95% CI [1.42 to 2.80]), Alzheimer's disease (AD) (1.53, 95% CI [1.22 to 1.92]), and mild cognitive impairment (MCI) (AOR: 1.78, 95% CI [1.51 to 2.11]). The incidence rate of breakthrough infections among fully vaccinated patients with dementia increased since December 2020 and accelerated after May 2021. The overall risk for hospitalization after breakthrough infections in patients with dementia was 39.5% for AD, 46.2% for VD, and 30.4% for MCI. DISCUSSION These results highlight the need to continuously monitor breakthrough severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infections and outcomes in vaccinated patients with dementia.
Collapse
Affiliation(s)
- Lindsey Wang
- Center for Artificial Intelligence in Drug Discovery, Case Western Reserve University School of Medicine, Cleveland, OH, USA
| | - Pamela B Davis
- Center for Community Health Integration, Case Western Reserve University School of Medicine, Cleveland, OH, USA
| | - David C. Kaelber
- The Center for Clinical Informatics Research and Education, The MetroHealth System, Cleveland, OH, USA
| | - Rong Xu
- Center for Artificial Intelligence in Drug Discovery, Case Western Reserve University School of Medicine, Cleveland, OH, USA
| |
Collapse
|
47
|
Olaker VR, Kendall EK, Wang CX, Parran TV, Terebuh P, Kaelber DC, Xu R, Davis PB. Association of Recent SARS-CoV-2 Infection With New-Onset Alcohol Use Disorder, January 2020 Through January 2022. JAMA Netw Open 2023; 6:e2255496. [PMID: 36757694 PMCID: PMC9912133 DOI: 10.1001/jamanetworkopen.2022.55496] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/10/2023] Open
Abstract
IMPORTANCE The COVID-19 pandemic affects many diseases, including alcohol use disorders (AUDs). As the pandemic evolves, understanding the association of a new diagnosis of AUD with COVID-19 over time is required to mitigate negative consequences. OBJECTIVE To examine the association of COVID-19 infection with new diagnosis of AUD over time from January 2020 through January 2022. DESIGN, SETTING, AND PARTICIPANTS In this retrospective cohort study of electronic health records of US patients 12 years of age or older, new diagnoses of AUD were compared between patients with COVID-19 and patients with other respiratory infections who had never had COVID-19 by 3-month intervals from January 20, 2020, through January 27, 2022. EXPOSURES SARS-CoV-2 infection or non-SARS-CoV-2 respiratory infection. MAIN OUTCOMES AND MEASURES New diagnoses of AUD were compared in COVID-19 and propensity score-matched control cohorts by hazard ratios (HRs) and 95% CIs from either 14 days to 3 months or 3 to 6 months after the index event. RESULTS This study comprised 1 201 082 patients with COVID-19 (56.9% female patients; 65.7% White; mean [SD] age at index, 46.2 [18.9] years) and 1 620 100 patients with other respiratory infections who had never had COVID-19 (60.4% female patients; 71.1% White; mean [SD] age at index, 44.5 [20.6] years). There was a significantly increased risk of a new diagnosis of AUD in the 3 months after COVID-19 was contracted during the first 3 months of the pandemic (block 1) compared with control cohorts (HR, 2.53 [95% CI, 1.82-3.51]), but the risk decreased to nonsignificance in the next 3 time blocks (April 2020 to January 2021). The risk for AUD diagnosis increased after infection in January to April 2021 (HR, 1.30 [95% CI, 1.08-1.56]) and April to July 2021 (HR, 1.80 [95% CI, 1.47-2.21]). The result became nonsignificant again in blocks 7 and 8 (COVID-19 diagnosis between July 2021 and January 2022). A similar temporal pattern was seen for new diagnosis of AUD 3 to 6 months after infection with COVID-19 vs control index events. CONCLUSIONS AND RELEVANCE Elevated risk for AUD after COVID-19 infection compared with non-COVID-19 respiratory infections during some time frames may suggest an association of SARS-CoV-2 infection with the pandemic-associated increase in AUD. However, the lack of excess hazard in most time blocks makes it likely that the circumstances surrounding the pandemic and the fear and anxiety they created also were important factors associated with new diagnoses of AUD.
Collapse
Affiliation(s)
- Veronica R. Olaker
- Center for Artificial Intelligence in Drug Discovery, Case Western Reserve University School of Medicine, Cleveland, Ohio
| | - Ellen K. Kendall
- Center for Artificial Intelligence in Drug Discovery, Case Western Reserve University School of Medicine, Cleveland, Ohio
| | - Christina X. Wang
- Center for Artificial Intelligence in Drug Discovery, Case Western Reserve University School of Medicine, Cleveland, Ohio
| | - Theodore V. Parran
- Center for Medical Education, Case Western Reserve University School of Medicine, Cleveland, Ohio
| | - Pauline Terebuh
- Center for Community Health Integration, Case Western Reserve University School of Medicine, Cleveland, Ohio
| | - David C. Kaelber
- The Center for Clinical Informatics Research and Education, The MetroHealth System, Cleveland, Ohio
| | - Rong Xu
- Center for Artificial Intelligence in Drug Discovery, Case Western Reserve University School of Medicine, Cleveland, Ohio
| | - Pamela B. Davis
- Center for Community Health Integration, Case Western Reserve University School of Medicine, Cleveland, Ohio
| |
Collapse
|
48
|
Gorenflo MP, Davis PB, Kendall EK, Olaker VR, Kaelber DC, Xu R. Association of Aspirin Use with Reduced Risk of Developing Alzheimer's Disease in Elderly Ischemic Stroke Patients: A Retrospective Cohort Study. J Alzheimers Dis 2023; 91:697-704. [PMID: 36502331 DOI: 10.3233/jad-220901] [Citation(s) in RCA: 7] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
BACKGROUND Currently there are no effective therapies to prevent or halt the development of Alzheimer's disease (AD). Multiple risk factors are involved in AD, including ischemic stroke (IS). Aspirin is often prescribed following IS to prevent blood clot formation. Observational studies have shown inconsistent findings with respect to the relationship between aspirin use and the risk of AD. OBJECTIVE To investigate the relationship between aspirin therapy after IS and the new diagnosis of AD in elderly patients. METHODS This retrospective cohort study leveraged a large database that contains over 90 million electronic health records to compare the hazard rates of AD after IS in elderly patients prescribed aspirin versus those not prescribed aspirin after propensity-score matching for relevant confounders. RESULTS At 1, 3, and 5 years after first IS, elderly patients prescribed aspirin were less likely to develop AD than those not prescribed aspirin: Hazard Ratio = 0.78 [0.65,0.94], 0.81 [0.70,0.94], and 0.76 [0.70,0.92]. CONCLUSION Our findings suggest that aspirin use may prevent AD in patients with IS, a subpopulation at high risk of developing the disease.
Collapse
Affiliation(s)
- Maria P Gorenflo
- Center for Artificial Intelligence in Drug Discovery, Case Western Reserve University School of Medicine, Cleveland, OH, USA
| | - Pamela B Davis
- Center for Community Health Integration, Case Western Reserve University School of Medicine, Cleveland, OH, USA
| | - Ellen K Kendall
- Center for Artificial Intelligence in Drug Discovery, Case Western Reserve University School of Medicine, Cleveland, OH, USA
| | - Veronica R Olaker
- Center for Artificial Intelligence in Drug Discovery, Case Western Reserve University School of Medicine, Cleveland, OH, USA
| | - David C Kaelber
- The Center for Clinical Informatics Research and Education, The MetroHealth System, Cleveland, OH, USA
| | - Rong Xu
- Center for Artificial Intelligence in Drug Discovery, Case Western Reserve University School of Medicine, Cleveland, OH, USA
| |
Collapse
|
49
|
Dorney I, Otteson T, Kaelber DC. Epidemiology of Eustachian tube dysfunction and related otologic diagnoses among children with achondroplasia. Int J Pediatr Otorhinolaryngol 2022; 163:111339. [PMID: 36257169 DOI: 10.1016/j.ijporl.2022.111339] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/20/2022] [Revised: 09/18/2022] [Accepted: 10/07/2022] [Indexed: 11/06/2022]
Abstract
OBJECTIVE To investigate the prevalence of diagnosed Eustachian tube dysfunction and related otologic diagnoses among children with achondroplasia as compared to a control population. METHODS The TriNetX Analytics Network, a federated health research network that aggregates the de-identified electronic health record data of over 78 million patients across the United States, was queried for patients 18 years old or younger with achondroplasia. Patients in this group with any occurrence of diagnosed Eustachian tube dysfunction or specified otologic diagnoses were recorded and reported. RESULTS Out of 2,195 patients 18 years old or younger with diagnosed achondroplasia, 379 (17.27%, 95% CI: 15.71-18.91) had a diagnosis of Eustachian tube dysfunction with an 8.65 (95% CI: 7.89-9.48) times higher risk than children without achondroplasia (n = 12,818,655). Children with achondroplasia also had higher risks for diagnosed otitis media (RR: 2.21), tympanic membrane retraction (RR: 7.29), middle ear cholesteatoma (RR: 6.35), cleft palate (RR: 12.24), conductive hearing loss (RR: 12.15), and tympanostomy tube placement (RR: 9.71). Each increased risk was maintained when cleft palate patients were removed from the achondroplasia group. CONCLUSION Children with achondroplasia are at a significantly higher risk for diagnosed Eustachian tube dysfunction and related middle ear diagnoses. Atypical craniofacial anatomy among children with achondroplasia may play a role in the dysfunction of the Eustachian tube and thus the observed epidemiology of otologic conditions. Children with achondroplasia should be monitored closely for middle ear conditions and the constellation of symptoms related to a dysfunctional Eustachian tube.
Collapse
Affiliation(s)
- Ian Dorney
- Case Western Reserve University School of Medicine, Cleveland, OH, USA.
| | - Todd Otteson
- Case Western Reserve University School of Medicine, Cleveland, OH, USA; Department of Otolaryngology-Head and Neck Surgery, University Hospitals Cleveland Medical Center, USA
| | - David C Kaelber
- Departments of Internal Medicine, Pediatrics, and Population and Quantitative Health Sciences, Case Western Reserve University, USA; The Center for Clinical Informatics Research and Education, The MetroHealth System, Cleveland, OH, USA
| |
Collapse
|
50
|
Wang L, Davis PB, Berger NA, Kaelber DC, Volkow ND, Xu R. Disruption in seasonality, patient characteristics and disparities of respiratory syncytial virus infection among young children in the US during and before the COVID-19 pandemic: 2010-2022. medRxiv 2022:2022.11.29.22282887. [PMID: 36482981 PMCID: PMC9727767 DOI: 10.1101/2022.11.29.22282887] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 06/17/2023]
Abstract
Respiratory syncytial virus (RSV) infections and hospitalization have surged sharply among young children. Here we test how the seasonal patterns of RSV infections in 2022 compared with those from other COVID-19 pandemic and pre-pandemic years. For this purpose, we analyzed a nation-wide and real-time database of electronic health records of 56 million patients across 50 states in the US. The monthly incidence rate of first-time RSV infection in young children (<5 years of age) and very young children (<1 year of age) followed a seasonal pattern from 2010 to 2019 with increases during the autumn, peaking in winter, subsiding in spring and summer. This seasonal pattern was significantly disrupted during the COVID-19 pandemic. In 2020, the incidence rate of RSV infections was remarkably low throughout the year. In 2021, the RSV season expanded to 9 months starting in the early summer and peaking in October. In 2022, RSV infections started to rise in May and were significantly higher than in previous years reaching a historically highest incidence rate in November 2022. There were significant racial and ethnic disparities in the peak RSV infection rate during 2010-2021 and the disparities further exacerbated in 2022 with peak incidence rate in black and Hispanic children 2-3 times that in white children. Among RSV-infected children in 2022, 19.2% had prior documented COVID-19 infection, significantly higher than the 9.7% among uninfected children, suggesting that prior COVID-19 could be a risk factor for RSV infection or that there are common risk factors for both viral infections. Our study calls for continuous monitoring of RSV infection in young children alongside its clinical outcomes and for future work to assess potential COVID-19 related risk factors.
Collapse
Affiliation(s)
- Lindsey Wang
- Center for Science, Health, and Society, Case Western Reserve University School of Medicine, Cleveland, OH, USA
| | - Pamela B. Davis
- Center for Community Health Integration, Case Western Reserve University School of Medicine, Cleveland, OH, USA
| | - Nathan A. Berger
- Center for Science, Health, and Society, Case Western Reserve University School of Medicine, Cleveland, OH, USA
| | - David C. Kaelber
- The Center for Clinical Informatics Research and Education, The MetroHealth System, Cleveland, OH, USA
| | - Nora D. Volkow
- National Institute on Drug Abuse, National Institutes of Health, Bethesda, MD, USA
| | - Rong Xu
- Center for Artificial Intelligence in Drug Discovery, Case Western Reserve University School of Medicine, Cleveland, OH, USA
| |
Collapse
|