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Article ; Online: Managing NSTEMI in older patients - Authors' reply.

Kaura, Amit / Sterne, Jonathan A C / Trickey, Adam / Mayet, Jamil

2021 Volume 397, Issue 10272, Page(s) 371–372

MeSH term(s)	Aged ; Humans ; Non-ST Elevated Myocardial Infarction/therapy
Language	English
Publishing date	2021-02-10
Publishing country	England
Document type	Letter ; Comment
ZDB-ID	3306-6
ISSN	1474-547X ; 0023-7507 ; 0140-6736
ISSN (online)	1474-547X
ISSN	0023-7507 ; 0140-6736
DOI	10.1016/S0140-6736(20)32393-X
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Ua VI Zs.5: Show issues			Location: Je nach Verfügbarkeit (siehe Angabe bei Bestand) bis Jg. 2021: Bestellungen von Artikeln über das Online-Bestellformular ab Jg. 2022: Lesesaal (EG)
Zs.MG 94: Show issues

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Article ; Online: Comparative Effectiveness of Dynamic Treatment Strategies for Medication Use and Dosage: Emulating a Target Trial Using Observational Data.

Birnie, Kate / Tomson, Charles / Caskey, Fergus J / Ben-Shlomo, Yoav / Nitsch, Dorothea / Casula, Anna / Murray, Eleanor J / Sterne, Jonathan A C

Epidemiology (Cambridge, Mass.)

2023 Volume 34, Issue 6, Page(s) 879–887

Abstract: ... heteroscedastic linear regression for log dose; (C) logistic regression for zero dose, heteroscedastic ... and (D) ordinal logistic regression.: Results: For this dataset, method (C) was the only approach ...

Abstract	Background: Availability of detailed data from electronic health records (EHRs) has increased the potential to examine the comparative effectiveness of dynamic treatment strategies using observational data. Inverse probability (IP) weighting of dynamic marginal structural models can control for time-varying confounders. However, IP weights for continuous treatments may be sensitive to model choice. Methods: We describe a target trial comparing strategies for treating anemia with darbepoetin in hemodialysis patients using EHR data from the UK Renal Registry 2004 to 2016. Patients received a specified dose (microgram/week) or did not receive darbepoetin. We compared 4 methods for modeling time-varying treatment: (A) logistic regression for zero dose, standard linear regression for log dose; (B) logistic regression for zero dose, heteroscedastic linear regression for log dose; (C) logistic regression for zero dose, heteroscedastic linear regression for log dose, multinomial regression for patients who recently received very low or high doses; and (D) ordinal logistic regression. Results: For this dataset, method (C) was the only approach that provided a robust estimate of the mortality hazard ratio (HR), with less-extreme weights in a fully weighted analysis and no substantial change of the HR point estimate after weight truncation. After truncating IP weights at the 95th percentile, estimates were similar across the methods. Conclusions: EHR data can be used to emulate target trials estimating the comparative effectiveness of dynamic strategies adjusting treatment to evolving patient characteristics. However, model checking, monitoring of large weights, and adaptation of model strategies to account for these is essential if an aspect of treatment is continuous.
MeSH term(s)	Humans ; Anemia ; Proportional Hazards Models ; Logistic Models ; Linear Models ; Probability
Language	English
Publishing date	2023-09-26
Publishing country	United States
Document type	Journal Article ; Research Support, Non-U.S. Gov't
ZDB-ID	1053263-8
ISSN	1531-5487 ; 1044-3983
ISSN (online)	1531-5487
ISSN	1044-3983
DOI	10.1097/EDE.0000000000001649
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Zs.A 3121: Show issues

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Article ; Online: Inequality in uptake of bowel cancer screening by deprivation, ethnicity and smoking status: cross-sectional study in 86 850 citizens.

Creavin, Alexandra / Creavin, Sam / Kenward, Charlie / Sterne, Jonathan / Williams, Jo

Journal of public health (Oxford, England)

2023 Volume 45, Issue 4, Page(s) 904–911

Abstract: Background: Survival from colorectal cancer depends on stage at detection. In England, bowel cancer mortality has historically been highest in deprived areas. During the initial stages of the COVID-19 pandemic, it was necessary to temporarily halt many ... ...

Abstract	Background: Survival from colorectal cancer depends on stage at detection. In England, bowel cancer mortality has historically been highest in deprived areas. During the initial stages of the COVID-19 pandemic, it was necessary to temporarily halt many screening programmes, which may have led to inequalities in uptake since screening restarted. Methods: Cross-sectional data from the Bristol, North Somerset and South Gloucestershire Systemwide Dataset were analyzed. Associations of baseline characteristics with uptake of bowel screening were examined using logistic regression. Results: Amongst 86 850 eligible adults aged 60-74 years, 5261 had no screening record. There was little evidence of association between no screening and sex (adjusted odds ratio 0.95 (95% confidence interval 0.90, 1.02)). Absence of screening record was associated with deprivation (1.26 (1.14, 1.40) for the most compared with the least deprived groups), smoking (1.11 (1.04, 1.18)) compared with no smoking record and black (1.36 (1.09, 1.70)) and mixed (1.08 (1.01, 1.15)) ethnicity compared with white ethnicity. Conclusions: In a data set covering a whole NHS Integrated Care Board, there was evidence of lower uptake of bowel cancer screening in adults living in more deprived areas, of minority ethnic groups and who smoked. These findings may help focus community engagement work and inform research aimed at reducing inequalities.
MeSH term(s)	Adult ; Humans ; Colorectal Neoplasms/diagnosis ; Colorectal Neoplasms/prevention & control ; Cross-Sectional Studies ; Early Detection of Cancer ; Ethnicity ; Pandemics ; Smoking/epidemiology ; COVID-19 ; Social Determinants of Health ; Healthcare Disparities ; Health Services Accessibility
Language	English
Publishing date	2023-09-22
Publishing country	England
Document type	Journal Article ; Research Support, Non-U.S. Gov't
ZDB-ID	2142082-8
ISSN	1741-3850 ; 1741-3842
ISSN (online)	1741-3850
ISSN	1741-3842
DOI	10.1093/pubmed/fdad179
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Zs.B 2186: Show issues

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Book: Essential medical statistics

Kirkwood, Betty R. / Sterne, Jonathan A. C.

2003

Author's details	Betty R. Kirkwood ; Jonathan A. C. Sterne
Keywords	Statistics ; Biometry
Language	English
Size	X, 501 S. : Ill., graph. Darst.
Edition	2. ed.
Publisher	Blackwell Science
Publishing place	Malden, Mass
Publishing country	United States
Document type	Book
HBZ-ID	HT013681460
ISBN	0-86542-871-9 ; 978-0-86542-871-3
Database	Catalogue ZB MED Medicine, Health

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Article ; Online: Albumin, white blood cell count, and body mass index improve discrimination of mortality in HIV-positive individuals.

Tate, Janet P / Sterne, Jonathan A C / Justice, Amy C

AIDS (London, England)

2019 Volume 33, Issue 5, Page(s) 903–912

Abstract: ... We fitted Cox models with established predictors and added new predictors based on model fit and Harrell's c ... 2.0) for validation in ART-CC patients. We compared discrimination using c-statistics and Kaplan ... blood count, and BMI, improved c-statistics in VACS from 0.776 to 0.805 and in ART-CC from 0.800 to 0 ...

Abstract	Objective: Despite viral suppression and immune response on antiretroviral therapy, people with HIV infection experience excess mortality compared with uninfected individuals. The Veterans Aging Cohort Study (VACS) Index incorporates clinical biomarkers of general health with age, CD4 cell count, and HIV-1 RNA to discriminate mortality risk in a variety of HIV-positive populations. We asked whether additional biomarkers further enhance discrimination. Design and methods: Using patients from VACS for development and from the Antiretroviral Therapy Cohort Collaboration (ART-CC) for validation, we obtained laboratory values from a randomly selected visit from 2000 to 2014, at least 1 year after antiretroviral therapy initiation. Patients were followed for 5-year, all-cause mortality through September 2016. We fitted Cox models with established predictors and added new predictors based on model fit and Harrell's c-statistic. We converted all variables to continuous functional forms and selected the best model (VACS Index 2.0) for validation in ART-CC patients. We compared discrimination using c-statistics and Kaplan-Meier plots. Results: Among 28 390 VACS patients and 12 109 ART-CC patients, 7293 and 722 died, respectively. Nadir CD4, CD8, and CD4 : CD8 ratio did not improve discrimination. Addition of albumin, white blood count, and BMI, improved c-statistics in VACS from 0.776 to 0.805 and in ART-CC from 0.800 to 0.831. Results were robust in all nine ART-CC cohorts, all lengths of follow-up and all subgroups. Conclusion: VACS Index 2.0, adding albumin, white blood count, and BMI to version 1.0 and using continuous variables, provides improved discrimination and is highly transportable to external settings.
MeSH term(s)	Adult ; Aging/metabolism ; Albumins/metabolism ; Anti-HIV Agents/therapeutic use ; Biomarkers/blood ; Body Mass Index ; CD4 Lymphocyte Count/statistics & numerical data ; Female ; HIV Infections/blood ; HIV Infections/drug therapy ; HIV Infections/mortality ; Humans ; Leukocyte Count/statistics & numerical data ; Longitudinal Studies ; Male ; Middle Aged ; Predictive Value of Tests ; RNA, Viral/blood ; Veterans
Chemical Substances	Albumins ; Anti-HIV Agents ; Biomarkers ; RNA, Viral
Language	English
Publishing date	2019-01-10
Publishing country	England
Document type	Journal Article ; Research Support, N.I.H., Extramural ; Research Support, Non-U.S. Gov't ; Research Support, U.S. Gov't, Non-P.H.S. ; Validation Study
ZDB-ID	639076-6
ISSN	1473-5571 ; 0269-9370 ; 1350-2840
ISSN (online)	1473-5571
ISSN	0269-9370 ; 1350-2840
DOI	10.1097/QAD.0000000000002140
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Zs.A 2228: Show issues

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Article ; Online: Letter re: stratification of meta-analyses based on risk of bias is appropriate and does not induce selection bias.

Page, Matthew J / Hróbjartsson, Asbjørn / Hansen, Camilla / Sterne, Jonathan A C

Journal of clinical epidemiology

2019 Volume 115, Page(s) 175–176

MeSH term(s)	Data Interpretation, Statistical ; Selection Bias
Language	English
Publishing date	2019-06-06
Publishing country	United States
Document type	Letter ; Comment
ZDB-ID	639306-8
ISSN	1878-5921 ; 0895-4356
ISSN (online)	1878-5921
ISSN	0895-4356
DOI	10.1016/j.jclinepi.2019.06.003
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Article ; Online: Estimation of Improvements in Mortality in Spectrum Among Adults With HIV Receiving Antiretroviral Therapy in High-Income Countries.

Trickey, Adam / Glaubius, Robert / Pantazis, Nikos / Zangerle, Robert / Wittkop, Linda / Vehreschild, Janne / Grabar, Sophie / Cavassini, Matthias / Teira, Ramon / d'Arminio Monforte, Antonella / Casabona, Jordi / van Sighem, Ard / Jarrin, Inma / Ingle, Suzanne M / Sterne, Jonathan A C / Imai-Eaton, Jeffrey W / Johnson, Leigh F

Journal of acquired immune deficiency syndromes (1999)

2024 Volume 95, Issue 1S, Page(s) e89–e96

Abstract: Introduction: Mortality rates for people living with HIV (PLHIV) on antiretroviral therapy (ART) in high-income countries continue to decline. We compared mortality rates among PLHIV on ART in Europe for 2016-2020 with Spectrum's estimates.: Methods: ...

Abstract	Introduction: Mortality rates for people living with HIV (PLHIV) on antiretroviral therapy (ART) in high-income countries continue to decline. We compared mortality rates among PLHIV on ART in Europe for 2016-2020 with Spectrum's estimates. Methods: The AIDS Impact Module in Spectrum is a compartmental HIV epidemic model coupled with a demographic population projection model. We used national Spectrum projections developed for the 2022 HIV estimates round to calculate mortality rates among PLHIV on ART, adjusting to the age/country distribution of PLHIV starting ART from 1996 to 2020 in the Antiretroviral Therapy Cohort Collaboration (ART-CC)'s European cohorts. Results: In the ART-CC, 11,504 of 162,835 PLHIV died. Between 1996-1999 and 2016-2020, AIDS-related mortality in the ART-CC decreased from 8.8 (95% CI: 7.6 to 10.1) to 1.0 (0.9-1.2) and from 5.9 (4.4-8.1) to 1.1 (0.9-1.4) deaths per 1000 person-years among men and women, respectively. Non-AIDS-related mortality decreased from 9.1 (7.9-10.5) to 6.1 (5.8-6.5) and from 7.0 (5.2-9.3) to 4.8 (4.3-5.2) deaths per 1000 person-years among men and women, respectively. Adjusted all-cause mortality rates in Spectrum among men were near ART-CC estimates for 2016-2020 (Spectrum: 7.02-7.47 deaths per 1000 person-years) but approximately 20% lower in women (Spectrum: 4.66-4.70). Adjusted excess mortality rates in Spectrum were 2.5-fold higher in women and 3.1-3.4-fold higher in men in comparison to the ART-CC's AIDS-specific mortality rates. Discussion: Spectrum's all-cause mortality estimates among PLHIV are consistent with age/country-controlled mortality observed in ART-CC, with some underestimation of mortality among women. Comparing results suggest that 60%-70% of excess deaths among PLHIV on ART in Spectrum are from non-AIDS causes.
MeSH term(s)	Adult ; Male ; Humans ; Female ; Acquired Immunodeficiency Syndrome ; Developed Countries ; HIV Infections/drug therapy ; Age Distribution ; Epidemics
Language	English
Publishing date	2024-01-04
Publishing country	United States
Document type	Journal Article ; Research Support, N.I.H., Extramural ; Research Support, Non-U.S. Gov't
ZDB-ID	645053-2
ISSN	1944-7884 ; 1077-9450 ; 0897-5965 ; 0894-9255 ; 1525-4135
ISSN (online)	1944-7884 ; 1077-9450
ISSN	0897-5965 ; 0894-9255 ; 1525-4135
DOI	10.1097/QAI.0000000000003326
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Article ; Online: The effect of antithrombotic treatment on mortality in patients with acute infection: A meta-analysis of randomized clinical trials.

Gazzaniga, Gianluca / Tavecchia, Giovanni Amedeo / Bravi, Francesca / Scavelli, Francesca / Travi, Giovanna / Campo, Gianluca / Vandenbriele, Christophe / Tritschler, Tobias / Sterne, Jonathan A C / Murthy, Srinivas / Morici, Nuccia

International journal of cardiology

2023 Volume 383, Page(s) 75–81

Abstract: Background and aims: Acute infections cause relevant activation of innate immunity and inflammatory cascade. An excessive response against pathogens has been proved to trigger the pathophysiological process of thrombo-inflammation. Nevertheless, an ... ...

Abstract	Background and aims: Acute infections cause relevant activation of innate immunity and inflammatory cascade. An excessive response against pathogens has been proved to trigger the pathophysiological process of thrombo-inflammation. Nevertheless, an association between the use of antithrombotic agents and the outcome of critically ill patients with infectious diseases is lacking. The aim of this meta-analysis is to determine the impact of antithrombotic treatment on survival of patients with acute infective disease. Methods: MEDLINE, Embase, Cinahl, Web of Science and Cochrane Central Register of Controlled Trials (CENTRAL) databases were systematically searched from inception to March 2021. We included randomized controlled trials (RCTs) that evaluated any antithrombotic agent in patients with infectious diseases other than COVID-19. Two authors independently performed study selection, data extraction and risk of bias evaluation. The primary outcome was all-cause mortality. Summary estimates for mortality were calculated using the inverse-variance random-effects method. Results: A total of 16,588 patients participating in 18 RCTs were included, of whom 2141 died. Four trials evaluated therapeutic-dose anticoagulation, 1 trial prophylactic-dose anticoagulation, 4 trials aspirin, and 9 trials other antithrombotic agents. Overall, the use of antithrombotic agents was not associated with all-cause mortality (relative risk 0.96; 95% confidence interval, 0.90-1.03). Conclusions: The use of antithrombotics is not associated with all-cause mortality in patients with infectious disease other than COVID-19. Complex pathophysiological interplays between inflammatory and thrombotic pathways may explain these results and need further investigation. Registration: PROSPERO, CRD42021241182.
MeSH term(s)	Humans ; Anticoagulants/adverse effects ; Aspirin ; COVID-19 ; Fibrinolytic Agents/therapeutic use ; Randomized Controlled Trials as Topic
Chemical Substances	Anticoagulants ; Aspirin (R16CO5Y76E) ; Fibrinolytic Agents
Language	English
Publishing date	2023-05-04
Publishing country	Netherlands
Document type	Journal Article ; Meta-Analysis
ZDB-ID	779519-1
ISSN	1874-1754 ; 0167-5273
ISSN (online)	1874-1754
ISSN	0167-5273
DOI	10.1016/j.ijcard.2023.04.057
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Zs.A 1673: Show issues

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Article ; Online: Selection bias introduced by informative censoring in studies examining effects of vaccination in infancy.

López-López, José A / Sterne, Jonathan A C / Higgins, Julian P T

International journal of epidemiology

2019 Volume 48, Issue 6, Page(s) 2001–2009

Abstract: Background: Many studies have examined 'non-specific' vaccine effects on infant mortality: attention has been particularly drawn to diphtheria-tetanus-pertussis (DTP) vaccine, which has been proposed to be associated with an increased mortality risk. ... ...

Abstract	Background: Many studies have examined 'non-specific' vaccine effects on infant mortality: attention has been particularly drawn to diphtheria-tetanus-pertussis (DTP) vaccine, which has been proposed to be associated with an increased mortality risk. Both right and left censoring are common in such studies. Methods: We conducted simulation studies examining right censoring (at measles vaccination) and left censoring (by excluding early follow-up) in a variety of scenarios in which confounding was and was not present. We estimated both unadjusted and adjusted hazard ratios (HRs), averaged across simulations. Results: We identified scenarios in which right-censoring at measles vaccination was informative and so introduced bias in the direction of a detrimental effect of DTP vaccine. In some, but not all, situations, adjusting for confounding by health status removed the bias caused by censoring. However, such adjustment will not always remove bias due to informative censoring: inverse probability weighting was required in one scenario. Bias due to left censoring arose when both health status and DTP vaccination were associated with mortality during the censored early follow-up and was in the direction of attenuating a beneficial effect of DTP on mortality. Such bias was more severe when the effect of DTP changed over time. Conclusions: Estimates of non-specific effects of vaccines may be biased by informative right or left censoring. Authors of studies estimating such effects should consider the potential for such bias and use appropriate statistical approaches to control for it. Such approaches require measurement of prognostic factors that predict censoring.
MeSH term(s)	Diphtheria-Tetanus-Pertussis Vaccine/administration & dosage ; Diphtheria-Tetanus-Pertussis Vaccine/adverse effects ; Female ; Humans ; Immunization Schedule ; Infant ; Male ; Measles Vaccine/administration & dosage ; Measles Vaccine/adverse effects ; Mortality ; Proportional Hazards Models ; Selection Bias ; United Kingdom ; Vaccination
Chemical Substances	Diphtheria-Tetanus-Pertussis Vaccine ; Measles Vaccine
Language	English
Publishing date	2019-05-07
Publishing country	England
Document type	Journal Article ; Observational Study ; Research Support, Non-U.S. Gov't
ZDB-ID	187909-1
ISSN	1464-3685 ; 0300-5771
ISSN (online)	1464-3685
ISSN	0300-5771
DOI	10.1093/ije/dyz092
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Article ; Online: Accounting for missing data in statistical analyses: multiple imputation is not always the answer.

Hughes, Rachael A / Heron, Jon / Sterne, Jonathan A C / Tilling, Kate

International journal of epidemiology

2019 Volume 48, Issue 4, Page(s) 1294–1304

Abstract: Background: Missing data are unavoidable in epidemiological research, potentially leading to bias and loss of precision. Multiple imputation (MI) is widely advocated as an improvement over complete case analysis (CCA). However, contrary to widespread ... ...

Abstract	Background: Missing data are unavoidable in epidemiological research, potentially leading to bias and loss of precision. Multiple imputation (MI) is widely advocated as an improvement over complete case analysis (CCA). However, contrary to widespread belief, CCA is preferable to MI in some situations. Methods: We provide guidance on choice of analysis when data are incomplete. Using causal diagrams to depict missingness mechanisms, we describe when CCA will not be biased by missing data and compare MI and CCA, with respect to bias and efficiency, in a range of missing data situations. We illustrate selection of an appropriate method in practice. Results: For most regression models, CCA gives unbiased results when the chance of being a complete case does not depend on the outcome after taking the covariates into consideration, which includes situations where data are missing not at random. Consequently, there are situations in which CCA analyses are unbiased while MI analyses, assuming missing at random (MAR), are biased. By contrast MI, unlike CCA, is valid for all MAR situations and has the potential to use information contained in the incomplete cases and auxiliary variables to reduce bias and/or improve precision. For this reason, MI was preferred over CCA in our real data example. Conclusions: Choice of method for dealing with missing data is crucial for validity of conclusions, and should be based on careful consideration of the reasons for the missing data, missing data patterns and the availability of auxiliary information.
MeSH term(s)	Bias ; Biomedical Research/methods ; Biomedical Research/standards ; Biomedical Research/statistics & numerical data ; Data Accuracy ; Data Interpretation, Statistical ; Humans ; Probability ; Research Design/standards ; Research Design/statistics & numerical data
Language	English
Publishing date	2019-03-16
Publishing country	England
Document type	Journal Article ; Research Support, Non-U.S. Gov't
ZDB-ID	187909-1
ISSN	1464-3685 ; 0300-5771
ISSN (online)	1464-3685
ISSN	0300-5771
DOI	10.1093/ije/dyz032
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