Category: Statistics

JAMA Dermatol. 2023 Nov 29. doi: 10.1001/jamadermatol.2023.4579. Online ahead of print.

ABSTRACT

IMPORTANCE: Isotretinoin is hypothesized to contribute to the development of psychiatric disorders, but the epidemiological association and risk factors associated with psychiatric disorders among isotretinoin users remain unclear.

OBJECTIVE: To clarify the absolute and relative risk and risk factors associated with suicide and psychiatric disorders among isotretinoin users.

DATA SOURCES: PubMed, Embase, Web of Science, and Scopus were searched from inception until January 24, 2023.

STUDY SELECTION: Randomized trials and observational studies were selected if they reported the absolute risk, relative risk, and risk factors for suicide and psychiatric disorders among isotretinoin users.

DATA EXTRACTION AND SYNTHESIS: Relevant data were extracted and risk of bias was evaluated at the study level using the Newcastle-Ottawa Scale. Data were pooled using inverse variance-weighted meta-analyses. Heterogeneity was measured using the I2 statistic, and meta-regression analyses were performed.

MAIN OUTCOMES AND MEASURES: Absolute risk (percentage), relative risks (risk ratios [RR]), and risk factors (RR) of suicide and psychiatric disorders among isotretinoin users.

RESULTS: A total of 25 studies including 1 625 891 participants were included in the review and 24 in the meta-analysis. Among the included studies, participants’ average age ranged from 16 to 38 years, and distribution by sex ranged from 0% to 100% male. The 1-year pooled absolute risk from between 2 and 8 studies of completed suicide, suicide attempt, suicide ideation, and self-harm were each less than 0.5%, while that of depression was 3.83% (95% CI, 2.45-5.93; I2 = 77%) in 11 studies. Isotretinoin users were less likely than nonusers to attempt suicide at 2 years (RR, 0.92; 95% CI, 0.84-1.00; I2 = 0%), 3 years (RR, 0.86; 95% CI, 0.77-0.95; I2 = 0%), and 4 years (RR, 0.85; 95% CI, 0.72-1.00; I2 = 23%) following treatment. Isotretinoin was not associated with the risk of all psychiatric disorders (RR, 1.08; 95% CI, 0.99-1.19; I2 = 0%). Study-level meta-regression found that studies with participants of older age reported lower 1-year absolute risk of depression, while those with a higher percentage of male participants reported a higher 1-year absolute risk of completed suicide.

CONCLUSIONS AND RELEVANCE: The findings suggest that at a population level, isotretinoin users do not have increased risk of suicide or psychiatric conditions but may instead have a lower risk of suicide attempts at 2 to 4 years following treatment. While these findings are reassuring, clinicians should continue to practice holistic psychodermatologic care and monitor patients for signs of mental distress during isotretinoin treatment.

PMID:38019562 | DOI:10.1001/jamadermatol.2023.4579

Quintessence Int. 2023 Nov 29;0(0):0. doi: 10.3290/j.qi.b4706089. Online ahead of print.

ABSTRACT

OBJECTIVE: The aim of this study was to investigate whether psoriasis disease constitutes a comorbity of OLP and to elucidate the effect of depression and anxiety treatment.

METHODS AND MATERIAL: We analyzed a cohort of consecutive patients diagnosed clinical and histologically of OLP from years 2014-2022. The results were contrasted with those obtained in control series matched for age and sex. The correlation between OLP and gender, age, tobacco, alcohol, psoriasis, treatment of depression and anxiety was assessed using Chi-square of Pearson test. Multivariate regression analysis was performed to evaluate the association between psoriasis and OLP. For the assessment of the quality of the statistical models, the Akaike Information Criterion (AIC) was used.

RESULTS: The study involved 1016 patients, being 738 women (72.6%), and 278 men (27.4%). The average age was 59.38 (±12.55) years. From 508 patients with OLP 16 (3.15%) had comorbid psoriasis and in the control group 5 (0.98%). Age, gender, smoking and alcoholic habits are not predictive variables in the relationship between association of psoriasis and OLP patients. According to the multivariate analysis, the odd ratio (OR) of OLP were for psoriasis (OR 3.13, 1.20-9.68), and when compared to univariate analysis was higher for depression drugs (OR 1.88, 1.13-3.19] and for treatment of anxiety (OR 2.06, 1.18-2.70].

CONCLUSIONS: As far as we are aware, this is the first study showing the potential risk of psoriasis in OLP patients and our results should be taken into account to improve knowledge of comorbidity of OLP.

PMID:38019555 | DOI:10.3290/j.qi.b4706089

Traffic Inj Prev. 2023 Nov 29:1-8. doi: 10.1080/15389588.2023.2286429. Online ahead of print.

ABSTRACT

OBJECTIVE: Driver characteristics have been linked to the frequency and severity of car crashes. Among these, age and gender have been shown to impact both the possibility and severity of a crash. Previous studies have used standard ordered probit (OP) models to analyze crash data, and some research has suggested heteroskedastic ordered probit (HETOP) could provide improved model fit. The objective of this paper is to evaluate potential improvements of the heteroskedastic ordered probit (HETOP) model compared to the standard ordered probit (OP) model in crash analysis, by examining the effect of gender across age on injury severity among drivers. This paper hypothesizes that the HETOP model can provide a better fit to crash data, by allowing heteroskedasticity in the distribution of injury severity across driver age and gender.

METHODS: Data for 20,222 crashes were analyzed for North Carolina from 2016 to 2018, which represents the state with the highest number of fatalities per 100 million vehicle miles traveled amongst available crash data from the Highway Safety Information System.

RESULTS: Darker lighting conditions, severe road surface conditions, and less severe weather were associated with increased injury severity. For driver demographics, the probability of severe injuries increased with age and for male drivers. Moreover, the variance of severity increased with age disproportionately within and across genders, and the HETOP was able to account for this.

CONCLUSIONS: The results of the two applied approaches revealed that HETOP model outperformed the standard OP model when measuring the effects of age and gender together in injury severity analysis, due to the heteroskedasticity in injury severity within gender and age. The HETOP statistical method presented in this paper can be more broadly applied across other contexts and combinations of independent variables for improved model prediction and accuracy of causal variables in traffic safety.

PMID:38019532 | DOI:10.1080/15389588.2023.2286429

Traffic Inj Prev. 2023 Nov 29:1-6. doi: 10.1080/15389588.2023.2282948. Online ahead of print.

ABSTRACT

OBJECTIVE: A driver’s active emergency response in dangerous traffic scenes consists of two parts, including reaction behavior and physiological state. In dangerous traffic scenes, the driver’s active emergency response has an important impact on human collision injury. Clarifying the driver’s active emergency response is an important prerequisite for the study of human collision injury under nonstandard posture. Therefore, this study investigates the driver’s active emergency response in different inevitable collision scenes using driving simulator.

METHODS: A driving simulator with a high-speed camera system and human physiological signal acquisition system was first built. Then, three typical vehicle dangerous collision scenes were developed, including frontal collision, side collision, and rear-end collision. Finally, twenty participants (15 males and 5 females) were recruited for a driving experiment, and their active emergency responses were recorded and analyzed.

RESULTS: All subjects would rotate the steering wheel to the left or right in the active emergency state, and the rotation of the hand would also cause the subject’s upper body to tilt in the same direction. The maximum angle for male subjects to rotate the steering wheel was 59.98°, while for the female subjects, it was 44.28°. In addition, the maximum grip force between the male subjects and the steering wheel was 280.5 N, compared to 192.5 N for female subjects. Compared to the female participants, the male participants not only have a greater rotation angle and a greater grip force on the steering wheel, but also have greater pressure on the brake pedal, and the foot moves quickly from the accelerator pedal to the brake pedal and presses the brake pedal.

CONCLUSIONS: Drivers have different active emergency responses to different vehicle collision scenes. Quantitative statistics of driver’s active emergency response will have important guiding significance for the analysis of the impact of human active emergency response on human injury characteristics in subsequent vehicle collision experiments.

PMID:38019530 | DOI:10.1080/15389588.2023.2282948

JAMA Netw Open. 2023 Nov 1;6(11):e2344722. doi: 10.1001/jamanetworkopen.2023.44722.

ABSTRACT

IMPORTANCE: Neighborhood segregation and poverty may be important drivers of health inequities. Epigenomic factors, including DNA methylation clocks that may mark underlying biological aging, have been implicated in the link between social factors and health.

OBJECTIVE: To examine the associations of neighborhood segregation and poverty with 4 DNA methylation clocks trained to capture either chronological age or physiological dysregulation.

DESIGN, SETTING, AND PARTICIPANTS: This cohort study uses data from the Multi-Ethnic Study of Atherosclerosis (MESA), a longitudinal study that started in 2000 to 2002, with follow-up in 2002 to 2004, 2004 to 2005, 2005 to 2007, and 2010 to 2012. In 2000 to 2002, adults who identified as White or Black race or Hispanic or Chinese ethnicity in 6 US sites (Baltimore, Maryland; Chicago, Illinois; Forsyth County, North Carolina; Los Angeles County, California; Northern Manhattan, New York; and St. Paul, Minnesota) were sampled for recruitment. A random subsample of 4 sites (Maryland, North Carolina, New York, and Minnesota) were selected for inclusion in the MESA epigenomics ancillary study at examination 5 (2010-2012). Participants who identified as White or Black race or Hispanic ethnicity, were aged 45 to 84 years, and did not have clinical cardiovascular disease were included in this analysis. Data were analyzed from May 2021 to October 2023.

EXPOSURE: Information on 2000 census tract poverty and Getis-Ord G statistic segregation of Hispanic residents, non-Hispanic Black residents, or non-Hispanic White residents were linked to participant addresses at examination 1 (2000-2002).

MAIN OUTCOMES AND MEASURES: At examination 5, DNA methylation was measured in purified monocytes. DNA methylation age acceleration was calculated using 4 clocks trained on either chronological age or physiological dysregulation. Linear regressions were used to test associations.

RESULTS: A total of 1102 participants (mean [SD] age, 69.7 [9.4] years; 562 [51%] women) were included, with 348 Hispanic participants, 222 non-Hispanic Black participants, and 533 non-Hispanic White participants. For non-Hispanic Black participants, living in tracts with greater segregation of Black residents was associated with GrimAge DNA methylation age acceleration, a clock designed to capture physiological dysregulation. A 1-SD increase in segregation was associated with 0.42 (95% CI, 0.20-0.64) years age acceleration (P < .001); this association was not observed with other clocks. This association was particularly pronounced for participants living in high poverty tracts (interaction term, 0.24; 95% CI, 0.07-0.42; P = .006). In the overall sample, census tract poverty level was associated with GrimAge DNA methylation age acceleration (β = 0.45; 95% CI, 0.20-0.71; adjusted P = .005).

CONCLUSIONS AND RELEVANCE: These findings suggest that epigenomic mechanisms may play a role in the associations of segregated and poor neighborhoods with chronic conditions.

PMID:38019517 | DOI:10.1001/jamanetworkopen.2023.44722

JAMA Netw Open. 2023 Nov 1;6(11):e2345540. doi: 10.1001/jamanetworkopen.2023.45540.

ABSTRACT

IMPORTANCE: Knowledge of medical care in US Immigration and Customs Enforcement (ICE) detention centers is limited. Reviews show high rates of preventable deaths while in detention due to substandard medical care within detention centers.

OBJECTIVE: To describe characteristics of medical emergencies at ICE detention centers in California.

DESIGN, SETTING, AND PARTICIPANTS: This cross-sectional study analyzed emergency medical services (EMS)-reported medical emergencies activated through 911 from January 1, 2018, to December 31, 2022, at 3 of the 5 ICE detention centers in California: Adelanto ICE Processing Center, Imperial Regional Detention Facility, and Otay Mesa Detention Center.

EXPOSURE: Medical services requiring 911 activation.

MAIN OUTCOMES AND MEASURES: Data included the number of EMS-reported medical emergencies; ICE-reported medical emergencies; patient age and sex; and medical data in the EMS report, including primary symptom, EMS provider (emergency medical technician or paramedic) impression, vital signs, and interventions performed, using descriptive statistics.

RESULTS: In this analysis of 3 detention centers with a mean daily census of 775 (range, 504-1001) individuals per center, there was a median of 68 (IQR, 10-88) EMS-reported emergencies per center per year for a total of 1224 emergencies. The EMS-reported emergencies involved 881 males (72%) and 338 females (28%) with a median age of 39.0 (IQR 30.0-49.0) years. The ratios of female-to-male EMS-reported emergencies were 0.51 (95% CI, 0.31-0.87) at Adelanto, 0.86 (95% CI, 0.31-2.43) at Imperial, and 1.60 (95% CI, 1.40-1.83) at Otay Mesa. Pregnancy-related emergencies accounted for 12.4% (42 of 338) of emergencies in females. A total of 357 individuals (29.2%) had at least 1 abnormal vital sign during their EMS encounter. Psychiatric emergencies comprised 48 EMS responses (3.9%), despite higher rates of ICE-reported psychiatric-related complaints. The median number of monthly EMS-reported emergencies across all 3 centers was 3 (IQR, 0-9) vs 4 ICE-reported emergencies (IQR, 1-15).

CONCLUSIONS AND RELEVANCE: In this study of medical emergencies at 3 of 5 ICE detention facilities in California, there were discrepancies in EMS vs ICE reported emergencies. The data suggested that vulnerable populations, such as pregnant women, had an increased number of medical emergencies, while individuals with psychiatric emergencies accounted for fewer reported emergencies. Based on these findings, emergency medical care provision in ICE detention centers requires increased transparency to ensure appropriate delivery of care.

PMID:38019513 | DOI:10.1001/jamanetworkopen.2023.45540

JAMA Netw Open. 2023 Nov 1;6(11):e2345977. doi: 10.1001/jamanetworkopen.2023.45977.

ABSTRACT

IMPORTANCE: The association of tyrosine kinase inhibitors targeting vascular endothelial growth factor receptors (VEGFR-TKIs) with aneurysm and artery dissection (AAD) has been frequently reported in spontaneous reporting databases.

OBJECTIVE: To investigate the risk and incidence of AAD occurrence in patients with cancer treated with oral VEGFR-TKIs, with capecitabine as an active comparator.

DESIGN, SETTING, AND PARTICIPANTS: This national, historical cohort study was conducted using national claims data from the National Health Insurance Service in Korea from 2007 to 2020, with a 1-year follow-up. Patients with cancer aged 40 years or older prescribed oral VEGFR-TKIs or capecitabine were enrolled. Data were analyzed from September 2022 through April 2023.

EXPOSURE: Oral VEGFR-TKIs (sorafenib, regorafenib, vandetanib, sunitinib, lenvatinib, axitinib, and pazopanib) or capecitabine as a comparator.

MAIN OUTCOMES AND MEASURES: Hazard ratios (HRs) were used to investigate the association between VEGFR-TKI use and AAD after propensity score matching. The primary outcome was AAD, and secondary outcomes were aortic aneurysm and dissection and AAD with rupture. Outcomes were defined using International Statistical Classification of Diseases and Related Health Problems, Tenth Revision (ICD-10) diagnosis codes.

RESULTS: Among 127 710 patients with cancer eligible for the study (80 386 males [62.9%]; mean [SD] age, 62.6 [10.9] years), 37 308 patients received VEGFR-TKIs and 90 402 patients received capecitabine. Among 27 535 matched patients receiving VEGFR-TKIs, the incidence of AAD within 1 year of treatment initiation was 6.0 per 1000 person-years. The median (IQR) time to AAD onset in the matched AAD group was 114 (67-257) days after treatment initiation, with the highest incidence observed during the first 3 months (45 incidents vs 31, 17, and 16 incidents during 3- to 6-month, 6- to 9-month, and 9- to 12-month periods, respectively). Cox regression modeling showed that the risk of AAD occurrence was significantly higher among patients prescribed VEGFR-TKIs than those receiving capecitabine (HR, 1.48; 95% CI, 1.08-2.02); similar results were obtained among females (HR, 2.08; 95% CI, 1.26-3.42), older adults (aged ≥65 years; HR, 1.42; 95% CI, 1.01-1.99), and patients with dyslipidemia (HR, 1.58; 95% CI, 1.11-2.24).

CONCLUSIONS AND RELEVANCE: In this study, the use of oral VEGFR-TKIs was associated with an increased risk of AAD occurrence. These findings elucidate vascular toxic effects and may provide a substantial reference for reducing the socioeconomic burden of adverse events associated with VEGFR-TKI use.

PMID:38019511 | DOI:10.1001/jamanetworkopen.2023.45977

Transl Vis Sci Technol. 2023 Nov 1;12(11):35. doi: 10.1167/tvst.12.11.35.

ABSTRACT

PURPOSE: To evaluate the reliability and reproducibility of visual function assessments for patients with macula-off rhegmatogenous retinal detachment (RRD).

METHODS: This prospective study included patients with unilateral macula-off RRD of <10-day duration successfully treated with a single, uncomplicated surgery at least 1 year following repair. Visual function assessments were performed at time of enrollment and 1 month later. Testing included Early Treatment Diabetic Retinopathy Study (ETDRS) best-corrected visual acuity (BCVA), low-luminance visual acuity (LLVA), low-contrast visual acuity (VA) 2.5% and 5%, contrast sensitivity assessment with Mars and Gabor patches, reading speed (acuity, speed, and critical print size), color vision testing (protan, deutan, and tritan), and microperimetry. Spectral-domain ocular coherence tomography (SD-OCT) was performed. Paired t-statistics were used to compare values between visits and between the study and fellow eyes.

RESULTS: Fourteen patients (9 male, 5 female) with a mean age of 69 years at time of surgery were evaluated. Correlation coefficients across the two visits were highest for ETDRS BCVA (0.97), tritan color vision testing (0.96), and low-contrast VA 5% (0.96), while the average t-statistic was largest for low-luminance deficit (4.2), ETDRS BCVA (4.1), and reading speed critical print size (3.7). ETDRS BCVA did not correlate with SD-OCT findings.

CONCLUSIONS: ETDRS BCVA can be considered a highly reliable and reproducible outcome measure. LLVA, protan color discrimination, contrast sensitivity, and reading speed may be useful secondary outcome measures.

TRANSLATIONAL RELEVANCE: This study provides guidance on the selection of visual function outcome measures for clinical trials of patients with macula-off RRD.

PMID:38019499 | DOI:10.1167/tvst.12.11.35

Traffic Inj Prev. 2023 Nov 29:1-9. doi: 10.1080/15389588.2023.2278419. Online ahead of print.

ABSTRACT

OBJECTIVE: The engagement of the lap belt with the pelvis is critical for occupant safety during vehicle frontal crashes to prevent occupant submarining. This study aims to develop a predictive model for submarining risk based on anthropometric parameters and lap belt positioning using finite element (FE) analyses.

METHODS: FE analyses were conducted using human body models representing various body shapes (a 50th percentile male, low and high BMI males, and a 5th percentile female) in three seated postures (standard, reclined, and slouched). The lap belt-ASIS overlap and the belt-pelvis angle were used as key parameters for predicting submarining risk. A logistic regression analysis was utilized to correlate submarining occurrence with the initial values of these two parameters at the beginning of impact. Subsequently, this submarining prediction model was applied to computer tomography (CT) measurements of human subjects in different seated postures (upright, reclined, and slouched), and submarining risks were calculated based on the developed model.

RESULTS: FE simulations indicated that submarining was more likely to occur as the initial belt-pelvis angle approached zero and there was a smaller initial belt-ASIS overlap. The logistic regression analysis demonstrated that the initial belt-pelvis angle and belt-ASIS overlap were statistically significant for predicting submarining risk. The derived model effectively distinguished submarining occurrence based on the initial values of these two parameters. The application of the submarining model to CT measurements of human subjects showed that submarining risk was lower in the order of upright, slouched, and reclined postures. In the reclined posture, the high submarining risk was attributed to a small belt-ASIS overlap and a rearward-tilted pelvis angle; whereas in the slouched posture, the risk was mostly associated with a rearward-tilted pelvis angle.

CONCLUSIONS: The submarining prediction model was developed based on the belt-pelvis angle and the belt-ASIS overlap. This predictive model may help to design restraint systems for various body types and seated postures of occupants.

PMID:38019483 | DOI:10.1080/15389588.2023.2278419

J Pain Palliat Care Pharmacother. 2023 Nov 29:1-10. doi: 10.1080/15360288.2023.2288109. Online ahead of print.

ABSTRACT

A retrospective, cohort, single center, chart review was conducted to compare rates of opioid-associated serious adverse events (SAEs) in a patient cohort 6 months before and 6 months after data-based opioid risk review. The primary objective was the composite reduction in opioid-related SAEs including suicide-related events and opioid overdoses. The impact of the reviews was assessed via multivariate logistic regression and a McNemar’s test to analyze difference in rates of opioid-associated SAEs. This study demonstrates that data-based opioid risk review can reduce opioid-related SAEs, opioid overdoses, and suicide-related events in the 6 months post-review. The primary outcome was not statistically significant with a p-value of 0.080. In the population that underwent opioid tapers, the hazard ratios (HR) for suicide-related events and opioid-related SAEs were 6.64 (1.09-40.53, p = 0.05) and 10.43 (0.48-226.80, p = 0.02) respectively when compared to non-tapered patients. The HR for suicide-related events and opioid-related SAEs when opioid therapy was discontinued were 9.95 (2.16-45.94, p = 0.009) and 15.64 (1.09-225.19, p = 0.001) respectively when compared to continuation of opioids. This study showed that data-based opioid risk review may reduce incidence of opioid-related SAEs in patients with chronic pain. Additionally, opioid tapers and discontinuations are significant risk factors for suicide-related events and opioid-related SAEs.

PMID:38019479 | DOI:10.1080/15360288.2023.2288109