Lewis James D, Schinnar Rita, Bilker Warren B, Wang Xingmei, Strom Brian L
Department of Medicine, University of Pennsylvania School of Medicine, Philadelphia, PA 19104-6021, USA.
Pharmacoepidemiol Drug Saf. 2007 Apr;16(4):393-401. doi: 10.1002/pds.1335.
The Health Improvement Network (THIN) is a new medical records database that contains records from general practices some of which have or continue to participate in the General Practice Research Database (GPRD) and others that never participated in GPRD. We sought to replicate in THIN well-established associations from the medical literature and to compare results from the GPRD practices to the non-GPRD practices within THIN.
Using THIN data from 1986-2003, we conducted case-control studies of associations between diseases (e.g., hypertension and stroke) and between diseases and drugs (e.g., aspirin and colon cancer). Conditional logistic regression was used to calculate odds ratios adjusted for potential confounders. Differences between GPRD and non-GPRD practices were assessed by testing for a statistical interaction by practice type in each outcome-exposure association.
We observed the expected positive associations (p < 0.05) of stroke with hypertension and diabetes mellitus; of myocardial infarction with hypertension, hypercholesterolemia, obesity, and smoking; and of peptic ulcer disease with aspirin, NSAIDs, and potassium. We observed the expected negative associations (p < 0.05) of colorectal cancer with aspirin, NSAIDs, and cox-2 inhibitors. The expected protective effect of aspirin use for myocardial infarction was not observed. In all cases, the results obtained from the GPRD practices were similar to the results obtained from the non-GPRD practices, only being statistically different for the associations of myocardial infarction with diabetes and aspirin use.
THIN data that are collected outside of the GPRD appear as valid as the data collected as part of the GPRD.
健康改善网络（THIN）是一个新的医疗记录数据库，包含来自全科医疗诊所的记录，其中一些诊所曾经或仍在参与全科医疗研究数据库（GPRD），而其他诊所从未参与过GPRD。我们试图在THIN中重现医学文献中已确立的关联，并比较THIN中GPRD诊所与非GPRD诊所的结果。
利用1986 - 2003年的THIN数据，我们对疾病之间（如高血压与中风）以及疾病与药物之间（如阿司匹林与结肠癌）的关联进行了病例对照研究。使用条件逻辑回归计算经潜在混杂因素调整后的比值比。通过在每个结局 - 暴露关联中按诊所类型检验统计交互作用来评估GPRD诊所与非GPRD诊所之间的差异。
我们观察到中风与高血压和糖尿病之间预期的正相关（p < 0.05）；心肌梗死与高血压、高胆固醇血症、肥胖和吸烟之间预期的正相关；消化性溃疡疾病与阿司匹林、非甾体抗炎药和钾之间预期的正相关。我们观察到结直肠癌与阿司匹林、非甾体抗炎药和cox - 2抑制剂之间预期的负相关（p < 0.05）。未观察到阿司匹林用于预防心肌梗死的预期保护作用。在所有情况下，从GPRD诊所获得的结果与从非GPRD诊所获得的结果相似，仅在心肌梗死与糖尿病及阿司匹林使用的关联上存在统计学差异。
在GPRD之外收集的THIN数据似乎与作为GPRD一部分收集的数据一样有效。
