Propensity Score Approach Research Articles

Multiple Impacts of Ethiopia’s Health Extension Program on Adolescent Health and Well-Being: A Quasi-Experimental Study 2002–2013

PurposeEthiopia has registered remarkable achievements in reaching global development goals, including reducing child marriage. Policymakers are keen to understand which investments have contributed to this. We evaluated the association between Ethiopia’s Health Extension Program (HEP) and 12 adolescent health and wellbeing outcomes. MethodsWe used Young Lives Ethiopia cohort data between 2002 and 2013. We evaluated associations between household support from HEP at age 15 and 12 adolescent outcomes spread across health, gender-based violence, education, and employment at age 19 using the inverse probability of treatment weighting propensity score approach, stratifying by sex. Adjusted probability differences (APDs) and adjusted mean differences (AMDs) were used to contrast exposure to HEP versus no exposure. ResultsOf 775 adolescents with complete follow-up, 46% were female. Sixty-six percent of adolescents reported support from HEP, with higher rates of support in poorer, less educated, and rural households, particularly in Tigray Province. In boys, HEP was positively associated with education enrolment (APD: +20 percentage points [ppts], 95% confidence interval [CI]: +9 ppts, +31 ppts) and literacy (AMD: +6 ppts, 95% CI: +0.2, +11), and negatively associated with >4 hours in income-generating activities per day (APD: −19 ppts, 95% CI: −30 ppts, −9 ppts). In girls, HEP was positively associated with no child marriage (APD: +16 ppts, 95% CI: +4 ppts, +27 ppts), no adolescent pregnancy (APD: +17 ppts, 95% CI: +6 ppts, +28 ppts), education enrolment (APD: +27 ppts, 95% CI: +15 ppts, +39 ppts), literacy (AMD: +5 ppts, 95% CI: +0.2, +11), and numeracy (AMD: +8 ppts, 95% CI: +3; +13). DiscussionPolicies promoting HEP are likely to have supported improvements in multiple areas of adolescents’ lives in Ethiopia.

Influenza Vaccination and COVID-19 Outcomes in People Older than 50 Years: Data from the Observational Longitudinal SHARE Study.

Existing literature on the association between influenza vaccination and COVID-19 infection/outcomes is conflicting. Therefore, we aimed to investigate the association between influenza vaccination and COVID-19 outcomes in a large cohort of adults who participated in the SHARE (Survey of Health, Ageing, and Retirement in Europe). Information regarding influenza vaccination in the previous year, and medical and demographic characteristics, were self-reported. Positivity for COVID-19, symptomatology, and hospitalization were also ascertained using self-reported information. An adjusted logistic regression analysis (including 15 baseline factors or propensity score) was used to assess the association between influenza vaccination and COVID-19 outcomes. A total of 48,408 participants (mean age 67 years; 54.1% females) were included. The prevalence of influenza vaccination was 38.3%. After adjusting for 15 potential confounders, influenza vaccination was significantly associated with a lower risk of positivity for COVID-19 (OR = 0.95; p < 0.0001), symptomatic forms (OR = 0.87; p < 0.0001), and hospitalization for COVID-19 (OR = 0.95; p < 0.0001). The results were similar when using a propensity score approach. In conclusion, influenza vaccination may be beneficial for the prevention of COVID-19, as the present study found that influenza vaccination was associated with a small/moderate lower risk of COVID-19 infection and adverse outcomes.

Association between type of bystander cardiopulmonary resuscitation and survival in out-of-hospital cardiac arrest: A machine learning study

AimIn the event of an out of hospital cardiac arrest (OHCA) it is recommended for a sole untrained bystander to perform compression only CPR (CO-CPR). However, it remains unknown if CO-CPR is inferior to standard CPR (S-CPR), including both compressions and ventilation, in terms of survival. One could speculate that due to the current pandemic, bystanders may be more hesitant performing mouth-to-mouth ventilation. The aim of this study is to assess the association between type of bystander CPR and survival in OHCA. MethodsThis study included all patients with a bystander treated OHCA between year 2015–2019 in ages 18–100 using The Swedish Registry for Cardiopulmonary Resuscitation (SRCR). We compared CO-CPR to S-CPR in terms of 30-day survival using a propensity score approach based on machine learning adjusting for a large number of covariates. ResultsA total of 13,481 patients were included (5,293 with S-CPR and 8,188 with CO-CPR). The matched subgroup consisted of 2994 cases in each group.Gradient boosting were the best models with regards to predictive accuracy (for type of bystander CPR) and covariate balance. The difference between S-CPR and CO-CPR in all 30 models computed on covariate adjustment and 1-to-1 matching were non-significant. In the 30 weighted models, three comparisons (S-CPR vs. CO-CPR) were significant in terms of improved survival; odds ratio for men was 1.21 (99% confidence interval (CI) 1.02–1.43; Average treatment effect (ATE)); for patients ≥73 years 1.57 (99% CI 1.17–2.12) for Average treatment effect on treated (ATT) and 1.63 (99% CI 1.18–2.25) for ATE. Remaining 27 models showed no differences. No significances remain after adjustment for multiple testing. ConclusionWe found no significant differences between S-CPR and CO-CPR in terms of survival, supporting current recommendations for untrained bystanders regarding CO-CPR.

Propensity score methods for observational studies with clustered data: A review.

Propensity score methods are a popular approach to mitigating confounding bias when estimating causal effects in observational studies. When study units are clustered (eg, patients nested within health systems), additional challenges arise such as accounting for unmeasured confounding at multiple levels and dependence between units within the same cluster. While clustered observational data are widely used to draw causal inferences in many fields, including medicine and healthcare, extensions of propensity score methods to clustered settings are still a relatively new area of research. This article presents a framework for estimating causal effects using propensity scores when study units are nested within clusters and are nonrandomly assigned to treatment conditions. We emphasize the need for investigators to examine the nature of the clustering, among other properties, of the observational data at hand in order to guide their choice of causal estimands and the corresponding propensity score approach.

Endovascular treatment for acute basilar artery occlusion due to different stroke etiologies of large artery atherosclerosis and cardioembolism.

Stroke etiology may affect the prognosis of acute basilar artery occlusion (BAO). This study aimed to estimate the efficacy and safety of endovascular treatment (EVT) in BAO strokes due to the underlying stroke etiologies of large artery atherosclerosis (LAA) and cardioembolism (CE). Patients with LAA and CE subtypes from the registry EVT for Acute Basilar Artery Occlusion Study (BASILAR) were selected for this analysis. We estimated the EVT treatment effect relative to standard medical treatment (SMT) in these patients by using a propensity score approach with inverse probability of treatment weighted estimation. Outcomes included 90-day favorable functional outcomes (modified Rankin scale (mRS) 0-3), functional independence (mRS 0-2), all-cause mortality, and symptomatic intracranial hemorrhage (sICH). A total of 744 patients were included in the final analysis. After weighting with inverse probability of treatment estimation, the patients who, based on their characteristics, were treated with EVT rather than SMT, demonstrated higher rates of favorable functional outcomes in both the LAA (29.2% vs 11.7%, adjusted OR with 95% CI: 4.34 [2.15-8.78], p < 0.001) and the CE subtype (36.0% vs 8.1%, adjusted OR with 95% CI: 9.14 [1.96-42.55], p = 0.005). A similar finding was also observed for functional independence. EVT patients also demonstrated lower rates of mortality than SMT. Among EVT patients, no significant difference was observed in mortality or sICH between LAA and CE groups, but LAA patients had lower rates of favorable functional outcome and functional independence (29.2% vs 37% and 24.2% vs 32.9%, respectively), where the latter remained significant after adjustment for imbalances in baseline data (p = 0.04). In acute BAO strokes, both LAA and CE patients who, based on their characteristics, were treated with EVT rather than SMT, demonstrated better outcomes. Among EVT patients, LAA and CE subtypes displayed important baseline and treatment differences, and LAA patients were less likely to achieve functional independence at 3 months, but mortality and sICH were similar between LAA or CE subtypes. These results need to be confirmed in future clinical trials.

Association Between Specific Type 2 Diabetes Therapies and Risk of Alzheimer's Disease and Related Dementias in Propensity-Score Matched Type 2 Diabetic Patients.

ObjectiveWe sought to determine the impact of Type 2 Diabetes Mellitus (T2D) anti-hyperglycemic medications (A-HgM) on risk of Alzheimer’s disease (AD) and related dementias (ADRD) outcomes including vascular dementia, and non-AD dementia such as frontotemporal, Lewy body, and mixed etiology dementias.Research Design and MethodsThis retrospective cohort study used the US-based Mariner claims dataset. 1,815,032 T2D participants 45 years and older with records 6 months prior and at least 3 years after the diagnosis of T2D were included. Claims were surveyed for a diagnosis of AD and ADRD 12 months post T2D diagnosis. A propensity score approach was used to minimize selection bias. Analyses were conducted between January 1st and February 28th, 2021.ResultsIn this cohort study A-HgM exposure was associated with decreased diagnosis of AD (RR, 0.61; 95% CI, 0.59–0.62; p < 0.001), vascular dementia (RR, 0.72; 95% CI, 0.69–0.74; p < 0.001) and non-AD dementia (RR, 0.67; 95% CI, 0.66–0.68; p < 0.001). Metformin was associated with the greatest risk reduction and insulin with the least reduction in risk compared to patients not receiving A-HgM for ADRD risk. Of interest, patients with a diagnosis of AD, while either on metformin or insulin, were older in age and predominately female, than individuals on these drugs that did not develop AD. Mean (SD) follow-up was 6.2 (1.8) years.ConclusionAfter controlling for age, sex, and comorbidities, A-HgM in patients with T2D was associated with a reduced risk of AD and ADRD. These findings provide evidence in support of T2D as a risk factor for AD and ADRD and the beneficial impact of early and effective control of hyperglycemia to mitigate risk.

Intracranial Pressure Monitoring in Patients With Spontaneous Intracerebral Hemorrhage: Insights From the SYNAPSE-ICU Study.

Uncertainties exist regarding the indications, management, and effect of intracranial pressure (ICP) monitoring and treatment on outcome in patients with spontaneous intracranial hemorrhage (ICH). We performed an analysis of patients with spontaneous ICH enrolled in the SYNAPSE-ICU study, an international prospective observational study on the use of ICP monitoring. This study aimed to describe, in a large cohort of patients with spontaneous ICH admitted to the intensive care unit (ICU), the clinical practice of ICP monitoring, the occurrence of intracranial hypertension, and its therapeutic management. We assessed in-hospital mortality and the association between ICP monitoring and 6-month mortality and outcome by a propensity score approach with inverse probability weighting. A total of 587 patients with ICH were included in this study; 281 (47.9%) received ICP monitoring. ICP-monitored patients, compared with nonmonitored patients, were younger (61 vs 67 years; p < 0.001), presented more frequently with both reactive pupils (67.2% vs 55.2%; p = 0.008), with better neurologic status at admission (Glasgow Coma Scale ≤8, 82.3% vs 88.8%; p = 0.038), and received higher therapy intensity level during the ICU stay. In 70.5% (170 out of 241) of ICP-monitored patients, the ICH score was equal to 3 or 4. Nearly half of monitored patients (46.6%) had at least one episode of ICP ≥20 mm Hg during the first week. An intraventricular catheter (53.6%) was the most frequently used device and was associated with fewer episodes of intracranial hypertension compared with the other monitoring devices (43.7% vs 64.9%, respectively). At weighted Cox regression model, ICP monitoring was associated with a significant reduction of 6-month mortality (hazard ratio 0.49 [95% CI 0.35-0.71; p = 0.001), but not with neurologic outcome (odds ratio 0.83 [95% CI 0.41-1.68]; p = 0.6077). ICP monitoring in ICH was utilized mainly in moderately severe cases. ICP monitoring was associated with a reduction of in-hospital and 6-month mortality but did not improve 6-month functional outcomes. Further research and randomized controlled trials to generate higher-level medical evidence to support guidelines regarding ICP use and treatment in patients with ICH are needed. SYNAPSE-ICU: ClinicalTrials.gov NCT03257904.

Androgen-targeting therapeutics mitigate the adverse effect of GnRH agonist on the risk of neurodegenerative disease in men treated for prostate cancer.

BackgroundProstate cancer and multiple neurodegenerative diseases (NDD) share an age‐associated pattern of onset. Therapy of prostate cancer is known to impact cognitive function. The objective of this study was to determine the impact of multiple classes of androgen‐targeting therapeutics (ATT) on the risk of NDD.MethodsA retrospective cohort study of men aged 45 and older with prostate within the US‐based Mariner claims data set between January 1 and 27, 2021. A propensity score approach was used to minimize measured and unmeasured selection bias. Disease risk was determined using Kaplan–Meier survival analyses.ResultsOf the 1,798,648 men with prostate cancer, 209,722 met inclusion criteria. Mean (SD) follow‐up was 6.4 (1.8) years. In the propensity score‐matched population, exposure to ATT was associated with a minimal increase in NDD incidence (relative risk [RR], 1.07; 95% CI, 1.05–1.10; p < 0.001). However, GnRH agonists alone were associated with significantly increased NDD risk (RR, 1.47; 95% CI, 1.30–1.66; p <0.001). Abiraterone, commonly administered with GnRH agonists and low‐dose prednisone, was associated with a significantly decreased risk (RR, 0.77; 95% CI, 0.68–0.87; p < 0.001) of any NDD.ConclusionsAmong patients with prostate cancer, GnRH agonist exposure was associated with an increased NDD risk. Abiraterone acetate reduced the risks of Alzheimer's disease and Parkinson's disease conferred by GnRH agonists, whereas the risk for ALS was reduced by androgen receptor inhibitors. Outcomes of these analyses contribute to addressing controversies in the field and indicate that GnRH agonism may be a predictable instigator of risk for NDD with opportunities for risk mitigation in combination with another ATT.

Association between divorce and access to healthcare services among married immigrants: propensity score approaches

BackgroundWhile divorce is a social determinant of health among married immigrants in Korea, its association with access to healthcare services is unclear. Given the rapid increase in the number of married immigrants in Korea, research is needed to improve minority groups’ access to healthcare services. Here, we examined healthcare service utilization among married immigrants.MethodsWe retrieved 11,778 adults from the 2018 Korea National Multicultural Family Survey. We analyzed whether the sex of divorced immigrants is associated with healthcare access using multivariable logistic regression analysis. Further, we analyzed the association between divorce and access to healthcare services among married immigrants using propensity score matching methods.ResultsThere were 691 (5.8%) divorced immigrants in the data set. The married male immigrants had no association between divorce status and healthcare access (adjusted odds ratio [OR] = 1.05, 95% confidence interval [CI] = 0.55–2.03, p = 0.8620). Divorced immigrants were less likely to receive healthcare services than married immigrants (adjusted OR = 1.42, 95% CI = 1.07–1.88).ConclusionOur findings revealed that divorce increases the risk of limited access to healthcare services among married immigrants. Policymakers and healthcare providers should be aware of these potential disparities in this vulnerable minority population.

Comparing SF-36 Scores Collected Through Web-Based Questionnaire Self-completions and Telephone Interviews: An Ancillary Study of the SENTIPAT Multicenter Randomized Controlled Trial.

BackgroundThe 36-Item Short Form Health Survey (SF-36) is a popular questionnaire for measuring the self-perception of quality of life in a given population of interest. Processing the answers of a participant comprises the calculation of 10 scores corresponding to 8 scales measuring several aspects of perceived health and 2 summary components (physical and mental). Surprisingly, no study has compared score values issued from a telephone interview versus those from an internet-based questionnaire self-completion.ObjectiveThis study aims to compare the SF-36 score values issued from a telephone interview versus those from an internet-based questionnaire self-completion.MethodsPatients with an internet connection and returning home after hospital discharge were enrolled in the SENTIPAT multicenter randomized trial on the day of discharge. They were randomized to either self-completing a set of questionnaires using a dedicated website (internet group) or providing answers to the same questionnaires administered during a telephone interview (telephone group). This ancillary study of the trial compared SF-36 data related to the posthospitalization period in these 2 groups. To anticipate the potential unbalanced characteristics of the responders in the 2 groups, the impact of the mode of administration of the questionnaire on score differences was investigated using a matched sample of individuals originating from the internet and telephone groups (1:1 ratio), in which the matching procedure was based on a propensity score approach. SF-36 scores observed in the internet and telephone groups were compared using the Wilcoxon-Mann-Whitney test, and the score differences between the 2 groups were also examined according to Cohen effect size.ResultsOverall, 29.2% (245/840) and 75% (630/840) of SF-36 questionnaires were completed in the internet and telephone groups, respectively (P<.001). Globally, the score differences between groups before matching were similar to those observed in the matched sample. Mean scores observed in the telephone group were all above the corresponding values observed in the internet group. After matching, score differences in 6 out of the 8 SF-36 scales were statistically significant, with a mean difference greater than 5 for 4 scales and an associated mild effect size ranging from 0.22 to 0.29, and with a mean difference near this threshold for 2 other scales (4.57 and 4.56) and a low corresponding effect size (0.18 and 0.16, respectively).ConclusionsThe telephone mode of administration of SF-36 involved an interviewer effect, increasing SF-36 scores. Questionnaire self-completion via the internet should be preferred, and surveys combining various administration methods should be avoided.Trial RegistrationClinicalTrials.gov NCT01769261; https://www.clinicaltrials.gov/ct2/show/record/NCT01769261

The effectiveness of post-professional physical therapist training in the treatment of chronic low back pain using a propensity score approach with machine learning.

Low back pain (LBP) is a leading cause of disability in the United States creating substantial hardships through negative social, financial, and health effects. Chronic low back pain (CLBP) accounted for above half of patients treated in physical therapy (PT) clinics for LBP. However, research shows small benefit from PT in CLBP treatment. Preliminary evidence suggests clinician-level training variables may affect outcomes, but requires further investigation to determine whether patients with CLBP benefit from treatment by providers with post-professional training. This study examined the relationship between clinician training levels and patient-reported outcomes in CLBP treatment. Physical therapies were surveyed using a large patient outcome assessment system to determine and categorise them by level of post-professional education. To account for the possibility that clinicians with higher levels of training are referred more-complex patients, a machine learning approach was used to identify predictive variables for clinician group, then to construct propensity scores to account for differences between groups. Differences in functional status score change among pooled data were analysed using linear models adjusted for propensity scores. There were no clinically meaningful differences in patient outcomes when comparing clinician post-professional training level. The propensity score method proved to be a valuable way to account for differences at baseline between groups. Post-professional training does not appear to contribute to improved patient outcomes in the treatment of CLBP. This study demonstrates that propensity score analysis can be used to ensure that differences observed are true and not due to differences at baseline.

Survival Without Severe Neonatal Morbidity in Very Preterm Twins According to Planned Mode of Delivery.

To assess survival to discharge without severe neonatal morbidity by planned mode of delivery for twins born before 32 weeks of gestation. The JUMODA (JUmeaux MODe d'Accouchement) study was a French national prospective, population-based, cohort study of twin deliveries conducted from February 2014 to March 2015. This planned secondary analysis included diamniotic twin pregnancies from 26 0/7 through 31 6/7 weeks of gestation. Exclusion criteria included contraindications to vaginal delivery and situations for which planned cesarean delivery is favored, and neonatal prognosis depends largely on the underlying pathology rather than the planned mode of delivery. The primary outcome was survival to discharge without severe neonatal morbidity (bronchopulmonary dysplasia, grade 3 or grade 4 intraventricular hemorrhage, periventricular leukomalacia, stage 2 or stage 3 necrotizing enterocolitis). The association between planned mode of delivery and primary outcome was assessed by multivariate Poisson regression model. A propensity-score approach with inverse probability of treatment weighting also was performed to control for indication bias. Subgroup analyses according to birth order and sensitivity analyses limited to spontaneous preterm births only were performed. Among 424 very preterm twin pregnancies, 192 (45.3%) had a planned cesarean delivery and 232 (54.7%) had a planned vaginal delivery. Survival to discharge without severe morbidity did not differ in the two groups: 308 of 384 (80.2%) after planned cesarean and 375 of 464 (80.8%) after planned vaginal delivery (crude relative risk 0.99; 95% CI 0.91-1.15; adjusted relative risk 1.02; 95% CI 0.93-1.11). After applying inverse probability of treatment weighting, planned cesarean delivery still was not associated with higher survival to discharge without severe neonatal morbidity than planned vaginal birth (relative risk 1.11; 95% CI 0.84-1.46). Subgroup and sensitivity analyses showed similar results. Planned cesarean delivery for very preterm twins is not associated with higher survival to discharge without severe neonatal morbidity than planned vaginal delivery. These results suggest that very preterm delivery should not be considered a per se indication for planned cesarean in twin pregnancies.

Infant feeding practices and asthma in children aged 6 months to 5 years using a propensity score approach

We examined the association between exclusive breastfeeding, early introduction of feeding formula, early weaning, and asthma in children aged six months to five years in a sample of non-institutionalized US children using a propensity score approach. Our study used data from the National Survey of Children's Health (2012-2018) of 3,820 children with physician-diagnosed asthma aged 6 months to 5 years. Propensity score matching (PSM) was applied to control selection bias with age, sex, race, birth weight, Federal Poverty Level, parent's education, and parent smoking history used as covariates in PSM. The total number in the matched sample was 6,904 (3,452 non-asthmatics; 3,452 asthmatics). Matched and unmatched samples were analysed using the χ2 test and multiple logistic regression. Exclusive breastfeeding was protective against asthma in the pre-matching (AOR 0.72; 95% CI: 0.54-0.97; p = 0.03) and post-matching (AOR 0.66; 95% CI: 0.55-0.81; p < 0.001) samples. Formula feeding before 6 months was associated with asthma in unmatched (AOR 1.38; 95% CI: 1.15-1.66; p < 0.001) and matched (AOR 1.31; 95% CI: 1.16-1.47; p < 0.001) sample. Early weaning before 6 months was associated with asthma in unmatched (AOR 1.62; 95% CI: 1.35-1.54; p < 0.001) and matched sample (AOR 1.37; 95% CI: 1.23-1.54; p < 0.001). Public health systems should continue to recommend the implementation of the World Health Organization exclusive breastfeeding guideline in developed countries. Asthma interventions in children under two years should continue to emphasize exclusive breastfeeding to reduce the incidence of infant asthma.

86 STEMI and multivessel disease: medical therapy amplifies the benefit of complete myocardial revascularization

Abstract Aims Patients with ST-elevation myocardial infarction (STEMI) with multivessel disease (MVD) may be treated with different revascularization strategies. However, the potential predictors of outcomes on top of different revascularization strategies are poorly studied. This study aimed to evaluate the prognostic impact of two different revascularization strategies and the potential impact of medical therapy. Methods and results Using a propensity score approach, the impact of two treatment strategies was analysed—staged non-culprit revascularization group vs. culprit-lesion-only percutaneous coronary intervention (PCI) group—on a composite outcome of cardiovascular death (CVD), myocardial infarction, and repeated revascularization. Moreover, models were further adjusted for medication at discharge. Among 1385 STEMI patients treated with primary PCI, a subgroup of 433 with MVD was analysed. At the median follow-up of 41 (IQR, 21–65) months, after propensity-score adjustment, the multivariable Cox proportional hazard analysis showed that the staged non-culprit revascularization group was associated with a lower composite endpoint (HR, 0.44; 95% CI, 0.24–0.82; P = 0.01), lower CVD (HR, 0.34; 95% CI, 0.14–0.82; P = 0.02), and lower all-cause death (HR, 0.46; 95% CI, 0.24–0.86; P = 0.02). Use of renin–angiotensin inhibitors was associated with lower CVD (HR, 0.51; 95% CI, 0.27–0.95; P = 0.03), and both renin–angiotensin inhibitors (HR, 0.52; 95% CI, 0.32–0.86; P = 0.01) and beta blockers (HR, 0.48; 95% CI, 0.29–0.79; P = 0.01) were associated with lower all-cause death. Conclusions In a real-word STEMI population with multivessel disease, staged non-culprit revascularization was associated with lower cardiovascular mortality compared with a culprit-only PCI strategy. However, both revascularization and medical therapy played a role in the improvement of mortality outcomes. Medical therapy amplified the benefit of myocardial revascularization.

The Effect of Community Socioeconomic Context on High School Attendance in China: A Generalized Propensity Score Approach

Many developing countries have experienced increasing spatial inequality, but little is known about the effect of community disadvantages on educational attainment in these societies. Using data from the China Family Panel Studies (2010–2016), I examine the effect of community socioeconomic status (SES) on the transition into high school in urban and rural China, and I explore several mechanisms explaining the community effects. I adopt the generalized propensity score method to estimate the potential probability of high school entrance at different levels of community SES. Results show that community SES is positively associated with high school attendance in both urban and rural China, and the relationship is stronger in more disadvantaged communities in both contexts. In urban areas, the effect of community SES is partly attributable to collective socialization and children’s academic performance. In rural areas, spatial accessibility to high schools and children’s academic performance are the salient mechanisms.

Breast cancer therapies reduce risk of Alzheimer’s disease and dementia: A claims‐based retrospective study with clinic to bench implications

AbstractBackgroundWorldwide, breast cancer is the most common non‐skin cancer in women. Currently, Alzheimer’s disease affects 1 in 9 persons in the US over the age of 65, two thirds of whom are women. The high global prevalence and economic impact of Alzheimer’s disease presents a significant public health challenge while the identification of therapies to prevent Alzheimer’s disease (AD) remains a challenge. The object of this study was to determine whether estrogen modulating therapy (EMT) exposure is associated with risk of Alzheimer’s (AD) in women with breast cancer in the Symphony claims data set and identify potential mechanisms by which these drugs may impact risk.MethodsPatients receiving EMT for breast cancer treatment were identified and survival analysis, stratified by age and by individual therapeutics, was used to determine the association between EMT exposure and diagnosis of AD. A propensity score approach was used to minimize measured and unmeasured selection bias. The impact of the impact of EMT on mitochondrial bioenergetics and dynamics were determined using Metabolic flux analysis and live cell imaging using Rat E18 hippocampal neurons.ResultsIn this cohort study of propensity score matched perimenopausal to postmenopausal aged women with breast cancer, EMT exposure was associated with decrease in diagnosis of neurodegenerative disease, most specifically AD (RR, 0.85; 95% CI, 0.78‐0.92; P &lt; 0.001) and Dementia (RR, 0.88; 95% CI, 0.84‐0.93; P &lt; 0.001). The preventative effect of EMT was shown to increase with age and was associated with a 5‐year shift in disease conversion rate. Mitochondrial bioenergetic data suggest that tamoxifen and the aromatase inhibitors show estrogen‐like response.ConclusionAmong female patients with breast cancer, exposure to estrogen modulating therapies was associated with a decrease in diagnosis of AD and Dementia. If tamoxifen and aromatase inhibitors are acting to increase estrogen‐related actions in brain tissue, the argument for the protective association of estrogen with AD‐related outcomes is strengthened. Funding: This study was supported by grants from the Women’s Alzheimer’s Movement, National Institute on Aging grants P01AG026572 Perimenopause in Brain Aging and Alzheimer's Disease and T32AG061897 Translational Research in AD and related Dementias (TRADD) to RDB.

Individual classes of prostate cancer therapies impact risk of Alzheimer’s disease: A claims‐based retrospective study

AbstractBackgroundProstate cancer is the most prevalent non‐skin cancer in men and the second leading cause of cancer related deaths among men worldwide. There are growing concerns regarding a potential association between androgen targeting therapeutic exposure and Alzheimer’s disease (AD) where the existent literature is limited and highly controversial. The object of this study was to determine whether androgen targeting therapy (ATT) exposure is associated with risk of Alzheimer’s (AD) in men with prostate cancer in the Symphony claims data set.MethodsPatients receiving ATT for prostate cancer treatment were identified and survival analysis, stratified by age and by individual therapeutics, was used to determine the association between EMT exposure and diagnosis of AD. A propensity score approach was used to minimize measured and unmeasured selection bias. Individual classes of ATT were examined to determine risk impact profiles for each therapeutic target of hormone ablation in prostate cancer treatment.ResultsIn this cohort study of propensity score matched men, all ATT class exposure taken together was associated with no impact in diagnosis of neurodegenerative disease (RR, 1.01; 95% CI, 0.96‐1.07; P = 0.56). The class of androgen synthesis inhibitors were associated with a decreased risk of AD (RR, 0.61; 95% CI, 0.46‐0.80; P &lt; 0.001) whereas the class of androgen receptor blockers were associated with an increased risk of AD (RR, 1.29; 95% CI, 1.13‐1.34; P &lt; 0.001). All other classes of ATT were associated with increased AD risk.ConclusionAmong male patients with prostate cancer, exposure to the androgen synthesis inhibitor class of androgen targeting therapy was associated with a decrease in diagnosis of AD and Dementia. All other types of ATT were associated with an increased risk of AD diagnosis. These data help to explain the current controversies in the literature where groups reporting impact of ATT as a composite of each individual drug suggest contradicting results on AD risk. Funding: This study was supported by grants from the Women’s Alzheimer’s Movement, National Institute on Aging grants P01AG026572 Perimenopause in Brain Aging and Alzheimer's Disease and T32AG061897 Translational Research in AD and related Dementias (TRADD) to RDB.

Reduction of risk of development of Alzheimer’s disease and related dementias in patients with type 2 diabetes by drugs to treat hyperglycemia

AbstractBackgroundAlzheimer’s Disease and Related Dementias (ADRD) are progressive neurodegenerative disorders that manifest in reduced cognition, executive function and memory impairments. Type 2 Diabetes (T2D) is suggested to be a risk factor for the development of ADRD. In this study, we evaluated the effects of anti‐hyperglycemic medications (HM) to treat hyperglycemia in T2D patients on the incidence of newly diagnosed ADRD.MethodUsing a retrospective analysis of healthcare claims dataset (Mariner 30), patients receiving HM for T2D treatment were identified and survival analysis, stratified by individual therapeutics, was used to determine the association between HM exposure and diagnosis of ADRD. A propensity score approach was used to minimize measured and unmeasured selection bias.ResultIn this cohort study of propensity score matched T2D patients over the age of 45, HM exposure was associated with decrease in diagnosis of ADRD, most specifically AD (RR, 0.61; 95% CI, 0.59‐0.62; P &lt;0.001), Vascular Dementia (RR, 0.72; 95% CI, 0.69‐0.74; P &lt; 0.001) and Dementia (RR, 0.65; 95% CI, 0.64‐0.66; P &lt; 0.001). Patients that did not use HM were more likely to develop an ADRD. The protection by the use of HM was more pronounced after propensity score matching comorbidities significantly correlated with the assignment to HM treatment. Metformin was the most protective and insulin was the least protective compared to patients not taking any HM. The differences between these therapies was not due to age, gender or Charleston Comorbidity Index.ConclusionAfter controlling for age, gender and comorbidities, the use of HM in patients with T2D protected against the development of ADRD.

P.136: Impact of Insulin Therapy in Pancreas Transplantation Donors on Graft Outcomes: An Analysis of the OPTN/UNOS Database

Introduction: Hyperglycemia requiring insulin treatment is frequent in critically ill patients and potential pancreas donors. Information on the impact of donor insulin use on pancreas outcomes is scarce. Thus, we explored the influence of donor insulin use on recipient and pancreas graft survival. Methods: Retrospective study with 12841 pancreas recipients (either simultaneous pancreas-kidney, pancreas after kidney or pancreas alone) from the OPTN/UNOS registry performed between 2000 and 2017. Multivisceral recipients other than simultaneous pancreas-kidney, those transplants from a donor < 30 kg and recipients with diabetes other than type 1 or 2 were excluded. Insulin donor requirements were defined as the need for any dose of insulin within 24 hours prior to donation. A Propensity Score (Inverse Probability of Treatment Weighting) approach was performed. Results: A total of 7765 (60%) patients received a pancreas from a donor with insulin requirements. After inverse probability of treatment weighting on donor and recipient covariates, pancreas graft survival (death-censored) at 1 year was similar between those who received an insulin-requiring donor and the remaining (89% vs 89%, P > 0.05), as well as at 5 and 10 years (78% and 69% vs 79% and 70%, respectively, P = 0.35)(Figure). Donor insulin therapy was not associated neither with an increased risk of recipient death (HR 0.94 [95% CI 0.85–1.04], P = 0.26), pancreas graft failure (HR 1.06 [95% CI 0.98–1.16], P = 0.15) nor any post-transplant complication (HR 1.11 [95% CI 0.98–1.24], P = 0.06). Discussion/Conclusions: Insulin requirements in a potential pancreas donor is not associated, per se, with an impaired pancreas graft and patient survival. Thus, donors who require insulin therapy may be suitable for pancreas transplantation.The data reported here have been supplied by the United Network for Organ Sharing as the contractor for the Organ Procurement and Transplantation Network. The interpretation and reporting of these data are the responsibility of the author(s) and in no way should be seen as an official policy of or interpretation by the OPTN or the U.S. Government.

Did School Meal Programs and SNAP Participation Improve Diet Quality of US Children from Low-Income Households: Evidence from NHANES 2013-2014?

Nutrition assistance programs such as school meals and the Supplemental Nutrition Assistance Program (SNAP) are designed to provide a safety net for the dietary intake of children from low-income families. However, compared with eligible non-participants, the relationship of diet quality with school meals only and school meals + SNAP is not well understood. The objectives of the study include: (1) To explore whether and to what extent nutrition assistance program participation (school meals only and school meals + SNAP) is related to diet quality; and (2) to examine the differences of diet quality between participating in school meals only, school meals + SNAP, or non-participation among American children. Children aged 5 to 18 years old from income eligible households who participated in the 2013–2014 National Health and Nutrition Examination Survey (NHANES) were included in this cross-sectional study (n = 1425). Diet quality was measured using the Healthy Eating Index (HEI)–2015 and its 13 subcomponents. A Rao-Scott Chi-square test, propensity scores approach, and Analysis of Covariance were performed. Covariates included age, sex, race/ethnicity, weight status, and family monthly poverty index. SAS survey procedures were used to incorporate the appropriate sample design weights. Participation in school meals + SNAP was not associated with higher diet quality compared to eligible non-participants or school meals-only participants. Participation in school meals + SNAP improved the intake of total dairy, but not added sugars or total vegetables compared to school meals only. Overall, school meal + SNAP participation did not significantly improve the overall diet quality of children in low-income households relative to comparable non-participants.