Tennis P, Andrews E, Bombardier C, Wang Y, Strand L, West R, Tilson H, Doi P
ESP Division, Burroughs Wellcome Co., Research Triangle Park, NC 27709.
J Clin Epidemiol. 1993 Jul;46(7):685-95. doi: 10.1016/0895-4356(93)90049-7.
The objective of this effort was to assess the utility of the large automated database in Saskatchewan as a resource for pharmacoepidemiologic studies. To this end a study was undertaken to test the hypothesis that rheumatoid arthritis (RA) increases the risk of cancer, especially lymphoma. This was done by performing a retrospective cohort study based on record linkage data from Saskatchewan Health. From hospital discharge diagnoses in the hospital file an exposed group (RA) and two comparison groups matched to the RA group by age and sex were identified: (1) the RA group consisted of people with a discharge diagnosis of rheumatoid arthritis; (2) the osteoarthritis (OA) group consisted of people with OA discharge diagnoses; and (3) a comparison (CN) group consisted of hospitalized people with no discharge diagnoses of arthritis. Drug exposures were determined by linkage with the Prescription Drug File, cancer outcomes were determined by linkage with the Cancer Foundation file, and length of eligibility in the health plan and demographics information were determined by linkage with the registration file. The data were checked for quality of linkages across files and consistency with study definitions. Of 13,333 identified subjects, 2.8% were excluded because of apparent incorrect assignment to study group or age group or because of ineligibility in health plan during the study period. In order to decrease the possibility of misclassification of exposure (rheumatoid arthritis), hospital discharge diagnoses were used to exclude subjects with any inflammatory rheumatic diseases (IRD) from the CN (7.8%) and OA (8.3%) groups and subjects with IRD other than rheumatoid arthritis (4.6%) from the RA group. To decrease selection bias, those who had cancer within 1 year of enrollment (to exclude those in hospital because of symptoms of undiagnosed cancer) were excluded. Because RA subjects hospitalized by a rheumatologist were most likely to have valid rheumatoid arthritis diagnoses, each analysis was run twice: once with the entire RA group (N = 1210) and once with those in the RA group who were rheumatologist-hospitalized (N = 646). Logistic regression of incidence was used to control for age, sex, and use of individual disease-modifying anti-rheumatoid drugs (DMARDs). For the rheumatologist-hospitalized RA group compared to the CN group, a significant 4-fold greater risk for lymphoma/myeloma was detected when DMARD use was not controlled for, and a 3.4-fold increase in risk was detected even when use of individual DMARDs was controlled for.(ABSTRACT TRUNCATED AT 400 WORDS)
这项工作的目的是评估萨斯喀彻温省大型自动化数据库作为药物流行病学研究资源的效用。为此开展了一项研究，以检验类风湿性关节炎（RA）会增加患癌风险，尤其是淋巴瘤风险这一假设。这是通过基于萨斯喀彻温省医疗记录链接数据进行回顾性队列研究来完成的。从医院档案中的出院诊断信息里，确定了一个暴露组（RA）以及两个按年龄和性别与RA组匹配的对照组：（1）RA组由出院诊断为类风湿性关节炎的人组成；（2）骨关节炎（OA）组由出院诊断为OA的人组成；（3）一个对照组（CN）由没有关节炎出院诊断的住院患者组成。通过与处方药档案链接确定药物暴露情况，通过与癌症基金会档案链接确定癌症结局，通过与注册档案链接确定医保资格时长和人口统计学信息。对各档案间链接的质量以及与研究定义的一致性进行了数据检查。在13333名确定的受试者中，2.8%因明显被错误分配到研究组或年龄组，或因在研究期间不符合医保资格而被排除。为了降低暴露（类风湿性关节炎）误分类的可能性，利用医院出院诊断将患有任何炎性风湿性疾病（IRD）的受试者从CN组（7.8%）和OA组（8.3%）中排除，并将患有除类风湿性关节炎之外的IRD的受试者从RA组（4.6%）中排除。为了减少选择偏倚，排除了入组后1年内患癌的受试者（以排除因未确诊癌症症状而住院的患者）。由于由风湿病学家收治入院的RA受试者最有可能有有效的类风湿性关节炎诊断，每项分析都进行了两次：一次针对整个RA组（N = 1210），一次针对RA组中由风湿病学家收治入院的受试者（N = 646）。使用发病率的逻辑回归来控制年龄、性别以及使用的个别改善病情抗风湿药物（DMARDs）。对于由风湿病学家收治入院的RA组与CN组相比，在未控制DMARD使用时，检测到淋巴瘤/骨髓瘤风险显著高出4倍，即使在控制了个别DMARD使用的情况下，仍检测到风险增加3.4倍。（摘要截选至400字）
