Ajrouche Aya, De Rycke Yann, Dalichampt Marie, Messika Zeitoun David, Hulot Jean-Sebastien, Estellat Candice, Tubach Florence
Faculté de médecine Sorbonne Université, AP-HP, Hôpital Pitié-Salpêtrière, Département Biostatistique Santé Publique et Information Médicale, Centre de Pharmacoépidémiologie (Cephepi), Sorbonne Université INSERM, UMR 1123, ECEVE, CIC-P 1421, Paris, France.
Caisse nationale d'assurance maladie des travailleurs salariés cnamts, Paris, France.
Pharmacoepidemiol Drug Saf. 2019 Sep;28(9):1258-1266. doi: 10.1002/pds.4870. Epub 2019 Jul 23.
The effect of chronic use of low-dose aspirin (LDA) on overall cancer is still unclear owing to many controversial results and methodological limitations of studies. This study aimed to assess the effect of LDA use on overall cancer incidence among the French population.
We conducted a 10-year historical cohort study using the permanent sample of the French national health care databases: the Système National des Données de Santé (SNDS). We used data for 111 025 individuals aged 50 to 80 years at study entry (January 1, 2006) without prevalent cancer or LDA use. Individuals were followed until the earliest of cancer incidence, death from any cause, exit from the database, or end of the study on December 31, 2015. We estimated the effect of LDA on cancer incidence by using a dynamic model to account for the competing risk of death in the presence of time-dependent exposure and risk factors.
LDA use was associated with reduced 10-year risk of cancer (subdistribution hazard ratio [SHR] 0.81 [95% CI 0.77-0.86]). The SHRs were 0.88 [0.82-0.94] for men and 0.93 [0.85-1.02] for women. Moreover, each additional year of LDA use was associated with reduced 10-year risk of cancer (SHR 0.93 [0.92-0.95]). LDA use was also associated with reduced 10-year risk of death (SHR 0.86 [0.82-0.91]).
This is the first population-based study to demonstrate a protective effect of LDA on overall cancer incidence and to account for the main methodological issues of previous observational studies.
由于研究结果存在诸多争议以及方法学上的局限性，长期使用低剂量阿司匹林（LDA）对总体癌症的影响仍不明确。本研究旨在评估LDA使用对法国人群总体癌症发病率的影响。
我们利用法国国家医疗保健数据库的永久样本：全国卫生数据系统（SNDS），进行了一项为期10年的历史性队列研究。我们使用了研究开始时（2006年1月1日）年龄在50至80岁、无癌症病史或未使用LDA的111025名个体的数据。对个体进行随访，直至最早出现癌症发病、任何原因导致的死亡、退出数据库或2015年12月31日研究结束。我们使用动态模型估计LDA对癌症发病率的影响，以考虑在存在时间依赖性暴露和风险因素的情况下死亡的竞争风险。
使用LDA与降低10年癌症风险相关（亚分布风险比[SHR]为0.81[95%CI 0.77 - 0.86]）。男性的SHR为0.88[0.82 - 0.94]，女性为0.93[0.85 - 1.02]。此外，每多使用一年LDA与降低10年癌症风险相关（SHR为0.93[0.92 - 0.95]）。使用LDA还与降低10年死亡风险相关（SHR为0.86[0.82 - 0.91]）。
这是第一项基于人群的研究，证明了LDA对总体癌症发病率具有保护作用，并解决了以往观察性研究的主要方法学问题。
