Inverse Probability Weighting Research Articles

Effect of immediate initiation of invasive ventilation on mortality in acute hypoxemic respiratory failure: a target trial emulation

PurposeInvasive ventilation is a fundamental treatment in intensive care but its precise timing is difficult to determine. This study aims at assessing the effect of initiating invasive ventilation versus waiting, in patients with hypoxemic respiratory failure without immediate reason for intubation on one-year mortality.MethodsEmulation of a target trial to estimate the benefit of immediately initiating invasive ventilation in hypoxemic respiratory failure, versus waiting, among patients within the first 48-h of hypoxemia. The eligible population included non-intubated patients with SpO2/FiO2 ≤ 200 and SpO2 ≤ 97%. The target trial was emulated using a single-center database (MIMIC-IV) which contains granular information about clinical status. The hourly probability to receive mechanical ventilation was continuously estimated. The hazard ratios for the primary outcome, one-year mortality, and the secondary outcome, 30-day mortality, were estimated using weighted Cox models with stabilized inverse probability weights used to adjust for measured confounding.Results2996 Patients fulfilled the inclusion criteria of whom 792 were intubated within 48 h. Among the non-invasive support devices, the use of oxygen through facemask was the most common (75%). Compared to patients with the same probability of intubation but who were not intubated, intubation decreased the hazard of dying for the first year after ICU admission HR 0.81 (95% CI 0.68–0.96, p = 0.018). Intubation was associated with a 30-day mortality HR of 0.80 (95% CI 0.64–0.99, p = 0.046).ConclusionThe initiation of mechanical ventilation in patients with acute hypoxemic respiratory failure reduced the hazard of dying in this emulation of a target trial.

Health-related quality of life and impact of socioeconomic status among primary and secondary school students after the third COVID-19 wave in Berlin, Germany.

In the earlier phases of the COVID-19 pandemic, studies in Germany and elsewhere found an overall reduction in health-related quality of life (HRQoL) among students. However, there is little evidence on later pandemic stages as well as socioeconomic influencing factors. We aimed to (1) describe HRQoL in a Berlin student cohort at two time points in mid-2021, and to (2) analyze the effects of household income and education. We assessed HRQoL of students from 24 randomly selected primary and secondary schools in Berlin, Germany, with the KIDSCREEN-10 index in June and September 2021. To adjust for non-response bias, inverse probability weighting was applied. The potential effects of both household income and education (lower vs. higher) were estimated in generalized linear mixed models, based on prior assumptions presented in directed acyclic graphs. Our cohort comprised 660 students aged 7-19 years. In June 2021, 11.3% [95% CI = 9.0% - 14.0%] reported low HRQoL, whereas in September 2021, this increased to 13.7% [95% CI = 11.1% - 16.5%], with adolescent girls more frequently reporting low HRQoL at both time points (20% [95% CI = 17.1% - 23.3%] and 29% [95% CI = 25.5% - 32.5%]) compared to boys and younger children. While there was no statistically significant total effect of lower household income on HRQoL, a negative effect of lower household education was statistically significant (β = -2.15, SE 0.95, 95% CI = -4.01 to -0.29, p = 0.024). In summary, students' HRQoL in mid-2021 was better than that documented in other studies conducted at pandemic onset using KIDSCREEN-10. Female adolescents reported low HRQoL more often, and lower household education significantly reduced children's HRQoL. Support strategies for psychosocial wellbeing should consider socioeconomically disadvantaged children as important target groups.

Effectiveness and safety of half-dose thrombolysis in intermediate-high risk pulmonary embolism: a single centre experience

Abstract Funding Acknowledgements None. Introduction According to current guidelines, full-dose systemic thrombolysis for pulmonary embolism (PE) is limited to patients either classified as high risk or presenting intermediate risk with hemodynamically instability. As evidenced by recent clinical trials, "low" half-dose (50 mg) tissue plasminogen activator (HDrtPA) appears to offer a safe, effective alternative with a low bleeding risk, especially if catheter directed therapies are not available. Purpose we aimed to evaluate if HDrtPA in intermediate-high risk PE could improve right ventricular (RV)-arterial coupling by means of TAPSE/PAPs ratio, right ventricular basal dimensions in 4 chambers (RVD1), and tricuspid velocity (TV) between admission and discharge, exploring eventual associated bleeding risk. Methods we retrospectively analized 90 intermediate-high risk PE patients consecutively admitted to our intensive cardiac care unit between January 2016 and May 2023. Diagnosis was achieved by computed tomography in all cases. All patients underwent echocardiographic assessment upon admission and at discharge along with baseline lab values. HDrtPA patients (Group A, n=28) received low-dose thrombolytic therapy (0,6 mg/kg maximum 50 mg in 1 hour) combined with unfractionated heparin. Standard anticoagulation patients (Group B) included patients exclusively treated with parenteral anticoagulants. Primary endpoint was echocardiographic improvement of RV-arterial coupling (TAPSE/PAPS), and of pulmonary pressures (tricuspid velocity, TV) and right ventricular basal dimension (RVD1) between admission and dis-charge in the two treatment arms. To perform this analysis, linear regression models with Inverse Probability Weighting (IPW) propensity scores were used. Secondary endpoint was presence of mayor or minor bleeding between groups, and a descriptive analysis of mortality due to paucity of events. Results in the whole population mean age was 73.48 ± 12.49 (mean ± sd) and n=43 (47.8%) were males. Between admission and discharge, group A (HDrtPA) had an improvement of TAPSE/PAPs (+0.16, p=0.05, CI 95%: -0.002; 0.325), of RVD1 (-6.00 mm, p <0.01, CI 95%: -2.59; 9.41). Reduction of TV values (-0.45 m/s, p=0.108, CI 95%: -1.02; 0.10) was not statistically significant at IPW propensity score, but deserves further investigations. No significant increase of major bleedings were recorded between two groups (Group A: 1/28 3.5%, Group B: 0/52 0%) with an acceptable number of minor, non fatal bleedings (Group A: 7/28: 25%, Group B 1/62 1.6%). Death occurred in 3 patients in group A (10%) and 1 patient in group B (1.6%). Conclusion half dose of tissue plasminogen activator (HDrtPA) offer a promising alternative to anticoagulation alone therapy in selected patients with high-intermediate risk pulmonary embolism. In our experience, this approach seems to acutely improve RV-arterial coupling and right ventricular dimensions, without an increase of major bleeding risk.

Towards optimal model evaluation: enhancing active testing with actively improved estimators

With rapid advancements in machine learning and statistical models, ensuring the reliability of these models through accurate evaluation has become imperative. Traditional evaluation methods often rely on fully labeled test data, a requirement that is becoming increasingly impractical due to the growing size of datasets. In this work, we address this issue by extending existing work on active testing (AT) methods which are designed to sequentially sample and label data for evaluating pre-trained models. We propose two novel estimators: the Actively Improved Levelled Unbiased Risk (AILUR) and the Actively Improved Inverse Probability Weighting (AIIPW) estimators which are derived from nonparametric smoothing estimation. In addition, a model recalibration process is designed for the AIIPW estimator to optimize the sampling probability within the AT framework. We evaluate the proposed estimators on four real-world datasets and demonstrate that they consistently outperform existing AT methods. Our study also shows that the proposed methods are robust to changes in subsample sizes, and effective at reducing labeling costs.

Antidepressant exposure and long-term dementia risk in a nationwide retrospective study on US veterans with midlife major depressive disorder.

The use of antidepressants in major depressive disorder (MDD) has been reported to influence long-term risk of Alzheimer's disease (AD) and AD-related dementias (AD/ADRD), but studies are conflicting. We used inverse probability weighted (IPW) Cox models with time-varying covariates in a retrospective cohort study among midlife veterans with MDD within the US Veterans Affairs healthcare system from January 1, 2000 to June 1, 2022. A total of 35,200 patients with MDD were identified. No associations were seen regarding the effect of being exposed to any antidepressant versus no exposure on AD/ADRD risk (events=1,056, hazard ratio=0.94, 95% confidence interval: 0.81 to 1.09) or the exposure to specific antidepressant classes versus no exposure. A risk reduction was observed for female patients in a stratified analysis; however, the number of cases was small. Our study suggests that antidepressant exposure has no effect on AD/ADRD risk. The association in female patients should be interpreted with caution and requires further attention. We studied whether antidepressant use was associated with future dementia risk. We specifically focused on patients after their first-ever diagnosis of depression. We used IPW Cox models with time-varying covariates and a large observation window. Our study did not identify an effect of antidepressant use on dementia risk. A risk reduction was observed in female patients, but the number of cases was small.

Long-term oral administration of Huaier granules improves survival outcomes in hepatocellular carcinoma patients within Milan criteria following microwave ablation: a propensity score matching and stabilized inverse probability weighting analysis

ObjectiveThis study aimed to elucidate the therapeutic effects of Huaier granules on hepatocellular carcinoma (HCC) within the Milan criteria in patients who underwent microwave ablation (MWA).Materials and methodsA total of 228 patients were included, with 97 in the Huaier group and 131 in the control group. We evaluated progression-free survival (PFS), overall survival (OS), and extrahepatic metastasis survival (EMS) using Kaplan–Meier (KM) curves with a log-rank test. Propensity Score Matching (PSM) and Stabilized Inverse Probability of Treatment Weighting (IPTW) were performed to minimize selection and confounding biases.ResultsFollowing PSM, the 1-, 3-, and 5-year PFS rates in the Huaier and control groups were 83.5% vs 70.7%, 57.7% vs 42.6%, and 43.6% vs 31.9% (p = 0.030), respectively. The 1-, 3-, and 5-year OS rates were 98.9% vs 95.6%, 83.9% vs 72.3%, and 72.2% vs 53.7% (p = 0.023), respectively. The corresponding 1-, 3-, and 5-year EMS rates were 98.9% vs 93.4%, 91.7% vs 83.7%, and 91.7% vs 78.5% (p = 0.039), respectively. Stabilized IPTW analysis of KM curves yielded results similar to those of the PSM analysis. Additionally, administering Huaier granules for at least 6 months significantly improved PFS and OS.ConclusionHuaier granules can reduce the risk of recurrence and improve the OS of patients with HCC within the Milan criteria following MWA. Administering Huaier granules for over 6 months proved beneficial.

Estimation of the causal effect of sex on neonatal intensive care unit outcomes among very low birth weight infants.

Estimate the causal effect of sex on outcomes in the neonatal intensive care unit (NICU) among very low birth weight (VLBW) infants. Retrospective cohort study using Vermont Oxford Network data to compare NICU outcomes for VLBW males versus females. Odds ratios (OR) for outcomes that differed significantly by sex were computed using standard unweighted analysis and inverse probability weighted (IPW) analysis to correct for selection bias. Using standard analysis, males were significantly more likely to die before discharge and experience six other adverse outcomes. From IPW analysis, male sex caused a 56% increase in the odds of death before discharge (OR = 1.56, 95% confidence interval: 1.18-1.94). Standard unweighted results were significantly biased towards increased risk of adverse outcomes for males (p = 0.005) compared to IPW results for which three outcomes were no longer significantly associated with male sex. Standard statistical methods generally overestimate the casual effect of sex among VLBW infants.

Coronavirus Disease 2019 Pandemic and Reduced Surgical Site Infection After Cardiac Surgery: A Potential Blessing in Disguise.

Background: The coronavirus disease 2019 (COVID-19) pandemic has brought about drastic hygienic measures, one upside of which might be the mitigated occurrence of surgical site infection (SSI). This study investigated the association of the pandemic with SSI occurrence after cardiac surgeries. Patients and Methods: From 2014 to 2022, patients undergoing cardiac surgery were included and categorized into pre-pandemic and during-pandemic groups. Surgical site infections were classified into harvest-site, superficial sternal, and complex sternal infection. Multiple logistic regression and inverse probability weighting assessed the association of the pandemic with SSI. Results: Among a total of 26,143 patients, 793 SSIs occurred. The during-pandemic patients were younger (61.87 ± 10.58 vs. 65.64 ± 11.82) with a higher male proportion (70.1% vs. 67.4%) and a higher prevalence of all studied comorbidities/risk factors (expect cigarette smoking). Total SSI rate decreased substantially from 3.3% before COVID-19 to 1.8% afterward (p < 0.001). Inverse probability weights analyses evinced an independent association of the pandemic with a reduced risk of total (adjusted odds ratio [OR]; 0.59; 95% confidence interval [CI], 0.45-0.78), harvest-site (adjusted OR, 0.36; 95% CI, 0.19-0.70), and superficial sternal infection (adjusted OR, 0.60; 95% CI, 0.43-0.81). No significant association was observed with complex sternal site infection (adjusted OR, 1.05; 95% CI, 0.55-2.01). Multivariable regression recapitulated these findings. Conclusions: The COVID-19 pandemic independently pertained to more than a 40% reduction in SSI occurrence, particularly affecting harvest-site and superficial sternal infections. However, there remains the possibility of the implications of other known and unknown confounders on the observed association. To some extent, the decrease in SSIs after the pandemic can be justified by reinforced hygienic precautions, emphasizing the necessity of extending the adherence to these measurements into the post-COVID-19 era to maintain the status quo.

Abstract PO4-23-04: Is breast-conserving surgery an optional local therapy for non-inflammatory skin involvement (T4b) breast cancer? A Propensity Score Matching and Inverse Probability Weighting Analysis of SEER Database Results

Abstract Introduction: Although breast-conserving surgery (BCS) usage has been widespread in breast cancer treatment, it is still controversial about its application in non-inflammatory skin involvement (T4b) breast cancer. We designed this study to compare the prognosis for BCS versus mastectomy in this population. Methods: This retrospective cohort study included patients from the SEER database diagnosed with tumor stage T4b breast cancer from 1998 to 2019. To create prognostic factors, balance between BCS+RT and Mastectomy+RT groups, we calculated propensity scores for each patient. The calculation was based on the advance assessment for factors affecting prognosis, with the use of univariable and multivariable Cox proportional hazards models. Based on it, two propensity score-based matchings were conducted, including propensity score matching (PSM) and inverse probability weighting (IPTW). After adjustment, we performed Kaplan-Meier curves and multivariable Cox proportional hazards models to estimate BCSS and OS. Results: Of 4,680 patients who met the criterion, 588 received BCS+RT, and 4092 received Mastectomy+RT. In the propensity score matching (PSM) cohort, BCS+RT was found to improve breast cancer cause-specific survival (HR, 0.67; 95% CI, 0.53 to 0.85; p=0.001) and overall survival (HR, 0.72; 95% CI, 0.59 to 0.88; p=0.001). Similar results in the analysis of the IPTW-matched cohort confirm this result (BCSS: HR, 0.672; OS: HR, 0.722). Subgroup analysis revealed that those less than 70 years old, grade I+II, 3cm or smaller tumor size, hormone receptor-positive, or received chemotherapy treatment were more likely to benefit from BCS+RT (all p&amp;lt; 0.05). Conclusions: Locally treatment with BCS usage presented a significantly better survival than with mastectomy for non-inflammatory skin involvement (T4b) breast cancer patients. This finding provided evidence of selection in the local treatment of these patients. Citation Format: Jingyi Lin, Shiping Luo, Jie Zhang, Chuangui Song. Is breast-conserving surgery an optional local therapy for non-inflammatory skin involvement (T4b) breast cancer? A Propensity Score Matching and Inverse Probability Weighting Analysis of SEER Database Results [abstract]. In: Proceedings of the 2023 San Antonio Breast Cancer Symposium; 2023 Dec 5-9; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2024;84(9 Suppl):Abstract nr PO4-23-04.

Investigating the causal association of generalized and abdominal obesity with microvascular complications in patients with type 2 diabetes: A community-based prospective study.

The paradoxical protective association between overweight/obesity and diabetic microvascular complications (DMC), a phenomenon well-known as the obesity paradox, has been considered a non-causal association based on methodological influences. We aimed to investigate the association of generalized and abdominal obesity, as measured by body mass index (BMI) and waist circumference (WC), respectively, with DMC in patients with type 2 diabetes (T2D), using a causal inference approach. We enrolled 1436 patients with clinically diagnosed T2D but not DMC at baseline in a community-based prospective cohort in China between 2017 and 2019 and followed them annually until 2022 with new-onset DMC recorded. Marginal structural Cox models with inverse probability weighting were constructed to determine the causal association. Subgroup analyses were performed to identify potential effect modifiers. We observed 360 incident DMC cases, including 109 cases of diabetic nephropathy (DN) and 277 cases of diabetic retinopathy (DR) during four follow-up visits. Multivariable-adjusted hazard ratios (95% confidence intervals) for overall DMC, DN and DR were 1.037 (1.005-1.071), 1.117 (1.062-1.175) and 1.018 (0.980-1.059) for 1 kg/m2 increase in BMI, and 1.005 (0.994-1.017), 1.034 (1.018-1.051) and 1.000 (0.987-1.014) for 1 cm increase in WC, respectively. Similar patterns were observed across the BMI and WC categories, while the positive association appeared to be more pronounced in women. Generalized but not abdominal obesity was associated with an increased risk for the overall DMC, whereas both obesities were causally related to DN, albeit not DR, in T2D. Routine weight management should not be neglected in diabetes care, particularly in women.

Abstract PO1-17-12: The impact of treatment sequence of CDK4/6 inhibitor therapy on Metastatic Breast Cancer treatment outcomes in Real-World practice in U.S

Abstract Background A retrospective study to describe the actual benefit of treatment sequence with Endocrine Therapy (ET) plus cyclin D/cyclin-dependent kinases 4 and 6 (CDK4/6) therapy including as 1st-line and 2nd -line treatment for Metastatic breast cancer (MBC) patients with hormone receptor positive (HR+) and HER2 negative. We examined the extent that treatment sequence of CDK4/6 inhibitor therapy is associated with progression-free survival, and overall survival under real-world conditions. Methods This study used the nationwide electronic health record-derived-Flatiron Health de-identified database to estimate the real-world progression-free survival (rwPFS) and overall survival (rwOS) of MBC patients under different treatment sequence of CDK4/6 inhibitors. A total of 2,771 patients with ≥ 3 months of follow-up received either CDK4/6 inhibitor plus ET in the first-line setting (n=2,170) or ET alone in the first-line and CDK4/6 inhibitor plus ET in the second-line setting (n=601) between February 3, 2015, and November 02, 2021. We performed inverse probability weighting (IPW) to balance the baseline demographic and clinical characteristics between patients in the two groups. Kaplan-Meier method and Cox proportional hazards were used to test for an association of CDK4/6 treatment line sequence on PFS as the primary outcome and OS as the secondary outcome, adjusting for patient characteristics (e.g., age, race, comorbidities, ECOG value, Tumor site, and health insurance). Results Median follow-up was 25.6 months (interquartile range [IQR], 12.7–41.3) for the group with CDK4/6 inhibitor plus ET in first-line treatment and 33.1 months (IQR, 18.1–50.4) in those taking ET alone in first-line and CDK4/6 inhibitor plus ET in the second-line treatment. CDK4/6 inhibitor combination with ET as the first-line treatment was associated with significantly longer median rwPFS compared to receiving ET alone on first line and CDK4/6 inhibitor plus ET in the second line (28.0 vs 13.1 months; hazard ratio [HR], 0.40; 95% CI, 0.35–0.44; P &amp;lt; 0.0001). Median rwOS was 52 months for the group with first line CDK4/6 inhibitor plus ET and 48 months for the other group who received CDK4/6 inhibitor in the second line of treatment. However, the difference was not statistically significant (HR=0.91, 95% CI, 0.78–1.09, P-value=0.33). A propensity scores matching analysis showed similar results. Conclusions In this “real-world” population of patients with HR+/HER2− MBC, receiving CDK4/6 inhibitor plus ET as first line of treatment was associated with improved progression free survival compared with patients treated with ET alone in the first-line and CDK4/6 inhibitor plus ET on the second line of treatment. Citation Format: Gretchen Kimmick, Asal PIlehvari, Wen You, Gloribel Bonilla, Roger Anderson. The impact of treatment sequence of CDK4/6 inhibitor therapy on Metastatic Breast Cancer treatment outcomes in Real-World practice in U.S [abstract]. In: Proceedings of the 2023 San Antonio Breast Cancer Symposium; 2023 Dec 5-9; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2024;84(9 Suppl):Abstract nr PO1-17-12.

Adherence and recommended optimal treatment to Azvudine application for the treatment of outpatient COVID-19 patients: A real-world retrospective study

BackgroundAzvudine was approved for the treatment of coronavirus disease 2019 (COVID-19) in China and has been widely used since the outbreak in December 2022. However, real-world research on the adherence of Azvudine is lacking. Additionally, limited research exists on determining the optimal duration for Azvudine treatment. MethodsWe studied adult patients with COVID-19 who got Azvudine or supportive treatment at an outpatient department between December 19, 2022 and January 5, 2023. The enrolled patients were divided into two groups: the Azvudine group, which received Azvudine, and the control group, which only received supportive care. We recorded their information and analyzed it using descriptive statistics. The primary outcome of this study was the compliance of outpatients with Azvudine, and the secondary outcome of this study was the optimal duration of Azvudine. Inverse probability weighting (IPW) was used to address the imbalance between groups when comparing the optimal duration of Azvudine, and Cox regression to evaluate the effect of Azvudine on the 28-day disease progression rate. ResultsWe enrolled a total of 882 patients, of which 382 received Azvudine. Among the patients, 94.0 % (359) had good compliance, and non-compliance was primarily attributed to dosage errors. Azvudine appeared to have a beneficial therapeutic effect when administered for at least 7 days. ConclusionsOutpatients have relatively good compliance with Azvudine, and optimal therapeutic effects were observed with the recommended duration of at least 7 days.

Association between TB delay and TB treatment outcomes in HIV-TB co-infected patients: a study based on the multilevel propensity score method.

HIV-tuberculosis (HIV-TB) co-infection is a significant public health concern worldwide. TB delay, consisting of patient delay, diagnostic delay, treatment delay, increases the risk of adverse anti-TB treatment (ATT) outcomes. Except for individual level variables, differences in regional levels have been shown to impact the ATT outcomes. However, few studies appropriately considered possible individual and regional level confounding variables. In this study, we aimed to assess the association of TB delay on treatment outcomes in HIV-TB co-infected patients in Liangshan Yi Autonomous Prefecture (Liangshan Prefecture) of China, using a causal inference framework while taking into account individual and regional level factors. We conducted a study to analyze data from 2068 patients with HIV-TB co-infection in Liangshan Prefecture from 2019 to 2022. To address potential confounding bias, we used a causal directed acyclic graph (DAG) to select appropriate confounding variables. Further, we controlled for these confounders through multilevel propensity score and inverse probability weighting (IPW). The successful rate of ATT for patients with HIV-TB co-infection in Liangshan Prefecture was 91.2%. Total delay (OR = 1.411, 95% CI: 1.015, 1.962), diagnostic delay (OR = 1.778, 95% CI: 1.261, 2.508), treatment delay (OR = 1.749, 95% CI: 1.146, 2.668) and health system delay (OR = 1.480 95% CI: (1.035, 2.118) were identified as risk factors for successful ATT outcome. Sensitivity analysis demonstrated the robustness of these findings. HIV-TB co-infection prevention and control policy in Liangshan Prefecture should prioritize early treatment for diagnosed HIV-TB co-infected patients. It is urgent to improve the health system in Liangshan Prefecture to reduce delays in diagnosis and treatment.

Incidence of colon cancer among Medicaid beneficiaries with and without HIV under comparable colorectal cancer screening patterns

Abstract Background People with HIV (PWH) in the US have a lower incidence of colon cancer compared to the general population. The lower incidence may be explained by differences in receipt of screening. Thus, we sought to estimate colon cancer incidence under scenarios where Medicaid beneficiaries, with and without HIV, followed the same screening protocols. Methods We used data from 1.5 million Medicaid beneficiaries enrolled in 14 US states, 2001-2015, who were aged 50-64; 72,747 beneficiaries had HIV. We estimated risk of colon cancer and death by age, censoring beneficiaries when they deviated from 3 screening protocols, which were based on Medicaid’s coverage policy for endoscopies during the time period: receive one endoscopy every (1) two, (2) four, and (3) 10 years. We used inverse probability weights to control for baseline and time-varying confounding and informative loss to follow-up. Analyses were run overall, by sex, and by race/ethnicity. Results PWH had a lower incidence of colon cancer than beneficiaries without HIV. Compared to beneficiaries without HIV, the risk difference at age 65 was -1.6% (95% CI: -2.3, -0.7) lower among PWH under the two-year protocol and -0.8% (95% CI: -1.3, -0.3) lower under the ten-year protocol. Results were consistent across subgroup and sensitivity analyses. Conclusions Our findings suggest that the lower risk of colon cancer that has been observed among PWH aged 50-64 compared to those without HIV is not due to differences in receipt of lower endoscopy.

Coronavirus disease 2019 vaccination among young children: Associations with fathers’ and mothers’ influenza vaccination status

ObjectivesTo examine the association between parents’ influenza vaccination and their children’s coronavirus disease 2019 (COVID-19) vaccination status. MethodsParticipants included father-mother dyads from Fathers & Families, a cohort of fathers and their co-parents living in the United States. Parents’ influenza vaccination status and children’s COVID-19 vaccination status were reported from June 2022-July 2023. Logistic regression was used to examine the association between parental influenza vaccination (both parents vs. neither parent vs. mother only vs. father only vaccinated) and child COVID-19 vaccination (received at least 1 vs. 0 doses). Models were adjusted for recruitment site, income, parent education, child race/ethnicity, child age, and childcare enrollment. Inverse probability weighting was used to account for selection bias into the father-mother dyad sample. ResultsChildren were predominately non-Hispanic White (56 %) and aged 3–5 years (62 %). In most households, both parents (64 %) received the influenza vaccine and half (53 %) of children received the COVID-19 vaccine. One-in-four fathers (23 %) lacked knowledge about their child’s COVID-19 vaccination eligibility. Compared to children with two unvaccinated parents, having only their father (adjusted odds ratio [AOR] = 2.84, 95 % confidence interval [CI]: 1.52–5.36), only their mother (AOR = 4.04, 95 % CI: 2.16–7.68), and both parents (AOR = 10.33, 95 % CI: 6.29–17.53) vaccinated against influenza was associated with higher odds of children receiving the COVID-19 vaccine. ConclusionsFather and mother influenza vaccination is associated with child COVID-19 vaccination. Given many fathers were unaware their child was eligible for the COVID-19 vaccine, it is critical to tailor vaccine messaging for fathers.

Reduction of the Risk of Hepatocellular Carcinoma over Time Using Direct-Acting Antivirals: A Propensity Score Analysis of a Real-Life Cohort (PITER HCV)

The treatment of hepatitis C virus (HCV) with direct-acting antivirals (DAA) leads to high sustained virological response (SVR) rates, but hepatocellular carcinoma (HCC) risk persists in people with advanced liver disease even after SVR. We weighted the HCC risk in people with cirrhosis achieving HCV eradication through DAA treatment and compared it with untreated participants in the multicenter prospective Italian Platform for the Study of Viral Hepatitis Therapies (PITER) cohort. Propensity matching with inverse probability weighting was used to compare DAA-treated and untreated HCV-infected participants with liver cirrhosis. Kaplan–Meier analysis and competing risk regression analysis were performed. Within the first 36 months, 30 de novo HCC cases occurred in the untreated group (n = 307), with a weighted incidence rate of 0.34% (95%CI: 0.23–0.52%), compared to 63 cases among SVR patients (n = 1111), with an incidence rate of 0.20% (95%CI: 0.16–0.26%). The 12-, 24-, and 36-month HCC weighted cumulative incidence rates were 6.7%, 8.4%, and 10.0% in untreated cases and 2.3%, 4.5%, and 7.0% in the SVR group. Considering death or liver transplantation as competing events, the untreated group showed a 64% higher risk of HCC incidence compared to SVR patients (SubHR 1.64, 95%CI: 1.02–2.62). Other variables independently associated with the HCC occurrence were male sex, increasing age, current alcohol use, HCV genotype 3, platelet count ≤ 120,000/µL, and albumin ≤ 3.5 g/dL. In real-life practice, the high efficacy of DAA in achieving SVR is translated into high effectiveness in reducing the HCC incidence risk.

Long-term outcomes following double kissing crush or mini-culotte stenting for complex coronary bifurcation lesions: the EVOLUTE-CRUSHIV study.

This study aimed to evaluate the long-term outcomes of double kissing crush stenting (DKC) and mini-culotte technique (MCT) in patients with complex bifurcation lesions. This retrospective study enrolled 236 patients who underwent percutaneous coronary intervention (PCI) for complex coronary bifurcation disease between January 2014 and November 2022. The primary endpoint was target lesion failure (TLF), defined as the combination of cardiac death, myocardial infarction (MI), or clinically driven target lesion revascularization (TLR). The secondary endpoint was major cardiovascular and cerebral events (MACCE) including all-cause death, MI, TLR, stroke, or stent thrombosis. The regression models were adjusted by applying the inverse probability weighted (IPW) approach to reduce treatment selection bias. The initial management strategy was DKC in 154 (65.3%) patients and MCT in 82(34.7%) patients (male: 194 [82.2%], mean age: 60.85 ± 10.86years). The SYNTAX scores were similar in both groups. The rates of long-term TLF and MACCE rates were 17.4% and 20%, respectively. The rate of TLF (26.8% vs. 12.3%, p = 0.005) was higher in patients treated with MCT than those treated with the DKC technique, mainly driven by more frequent TLR (15.9% vs. 7.1%, p = 0.035). The long-term TLF and MACCE rates were notably lower in the DKC group compared to the others: adjusted hazard ratio (HR; IPW): 0.407, p = 0.009 for TLF, and adjusted HR(IPW): 0.391 [95% CI: 0.209-0.730], p = 0.003 for MACCE. At long-term follow-up, the rates of TLF and MACCE were 17.4% and 20%, respectively. However, long-term TLF was significantly higher in patients treated with MCT than those treated with the DKC technique, primarily due to amore frequent occurrence of clinically driven TLR.

Neurodevelopmental Outcomes After Late Preterm Antenatal Corticosteroids

The Antenatal Late Preterm Steroids (ALPS) trial changed clinical practice in the United States by finding that antenatal betamethasone at 34 to 36 weeks decreased short-term neonatal respiratory morbidity. However, the trial also found increased risk of neonatal hypoglycemia after betamethasone. This follow-up study focused on long-term neurodevelopmental outcomes after late preterm steroids. To evaluate whether administration of late preterm (34-36 completed weeks) corticosteroids affected childhood neurodevelopmental outcomes. Prospective follow-up study of children aged 6 years or older whose birthing parent had enrolled in the multicenter randomized clinical trial, conducted at 13 centers that participated in the Maternal-Fetal Medicine Units (MFMU) Network cycle from 2011-2016. Follow-up was from 2017-2022. Twelve milligrams of intramuscular betamethasone administered twice 24 hours apart. The primary outcome of this follow-up study was a General Conceptual Ability score less than 85 (-1 SD) on the Differential Ability Scales, 2nd Edition (DAS-II). Secondary outcomes included the Gross Motor Function Classification System level and Social Responsiveness Scale and Child Behavior Checklist scores. Multivariable analyses adjusted for prespecified variables known to be associated with the primary outcome. Sensitivity analyses used inverse probability weighting and also modeled the outcome for those lost to follow-up. Of 2831 children, 1026 enrolled and 949 (479 betamethasone, 470 placebo) completed the DAS-II at a median age of 7 years (IQR, 6.6-7.6 years). Maternal, neonatal, and childhood characteristics were similar between groups except that neonatal hypoglycemia was more common in the betamethasone group. There were no differences in the primary outcome, a general conceptual ability score less than 85, which occurred in 82 (17.1%) of the betamethasone vs 87 (18.5%) of the placebo group (adjusted relative risk, 0.94; 95% CI, 0.73-1.22). No differences in secondary outcomes were observed. Sensitivity analyses using inverse probability weighting or assigning outcomes to children lost to follow-up also found no differences between groups. In this follow-up study of a randomized clinical trial, administration of antenatal corticosteroids to persons at risk of late preterm delivery, originally shown to improve short-term neonatal respiratory outcomes but with an increased rate of hypoglycemia, was not associated with adverse childhood neurodevelopmental outcomes at age 6 years or older.

A practical guide to estimating treatment effects in patients with rheumatic diseases using real-world data.

Randomized controlled trials are considered the gold standard in study methodology. However, due to their study design and inclusion criteria, these studies may not capture the heterogeneity of real-world patient populations. In contrast, the lack of randomization and the presence of both measured and unmeasured confounding factors could bias the estimated treatment effect when using observational data. While causal inference methods allow for the estimation of treatment effects, their mathematical complexity may hinder their application in clinical research. We present a practical, nontechnical guide using a common statistical package (Stata) and a motivational simulated dataset that mirrors real-world observational data from patients with rheumatic diseases. We demonstrate regression analysis, regression adjustment, inverse-probability weighting, propensity score (PS) matching and two robust estimation methods. Although the methods applied to control for confounding factors produced similar results, the commonly used one-to-one PS matching method could yield biased results if not thoroughly assessed. The guide we propose aims to facilitate the use of readily available methods in a common statistical package. It may contribute to robust and transparent epidemiological and statistical methods, thereby enhancing effectiveness research using observational data in rheumatology.

The impact of family residence structure on adolescents' non-cognitive abilities: evidence from China.

The family residence structure serves as a crucial pathway through which the family environment influences adolescents' development. Drawing on nationally representative data, this study employs multiple linear regression models and propensity score matching to examine the impact of various family residence structures on adolescents' non-cognitive abilities. Causal identification is achieved through propensity score matching, while robustness is assessed using methods such as augmented inverse probability weighting and placebo tests. Heterogeneity analysis is conducted based on gender and household registration, aiming to explore the mechanisms by which family residence structure affects adolescents' non-cognitive abilities. The findings indicate that compared to two-parent co-residence households, three-generation co-residence families have significantly positive effects on emotional stability, conscientiousness, and agreeableness among adolescents. In contrast, skip-generation coresidence families exhibit significant negative effects on emotional stability and agreeableness in adolescents. Further investigation into the underlying mechanisms reveals that parental involvement and family socioeconomic status within three-generation co-residence families positively influence adolescents' non-cognitive abilities. This study highlights the importance of considering grandparents' role in adolescent growth and advocates for policy recommendations focusing on enhancing non-cognitive abilities in adolescents from skip-generation co-residence families.