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Article: Short-term blood pressure variability – variation between arm side, body position and successive measurements: a population-based cohort study

Kuss, Oliver

BMC cardiovascular disorders, 17:31

2017

Abstract: BACKGROUND: Precise blood pressure (BP) measurements are central for the diagnosis of hypertension in clinical and epidemiological studies. The purpose of this study was to quantify the variability in BP associated with arm side, body position, and ... ...

Institution	Deutsches Diabetes-Zentrum
Abstract	BACKGROUND: Precise blood pressure (BP) measurements are central for the diagnosis of hypertension in clinical and epidemiological studies. The purpose of this study was to quantify the variability in BP associated with arm side, body position, and successive measurements in the setting of a population-based observational study. Additionally, we aimed to evaluate the influence of different measurement conditions on prevalence of hypertension. METHODS: The sample included 967 men and 812 women aged 45 to 83 years at baseline. BP was measured according to a standardized protocol with oscillometric devices including three sitting measurements at left arm, one simultaneous supine measurement at both arms, and four supine measurements at the arm with the higher BP. Hypertension was defined as systolic BP (SBP) ≥140 mmHg and/or diastolic BP (DBP) ≥90 mmHg. Variability in SBP and DBP were analysed with sex-stratified linear covariance pattern models. RESULTS: We found that overall, no mean BP differences were measured according to arm-side, but substantial higher DBP and for men also higher SBP was observed in sitting than in supine position and there was a clear BP decline by consecutive measurement. Accordingly, the prevalence of hypertension depends strongly on the number and scheme of BP measurements taken to calculate the index values. CONCLUSIONS: Thus, BP measurements should only be compared between studies applying equal measurement conditions and index calculation. Moreover, the first BP measurement should not be used to define hypertension since it overestimates BP. The mean of second and third measurement offers the advantage of better reproducibility over single measurements.
Keywords	(3–5) arm-side ; Body position ; Blood pressure variability ; Hypertension ; Successive measurements
Language	English
Document type	Article
Database	Repository for Life Sciences

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Article: Anthropometric markers and their association with incident type 2 diabetes mellitus: which marker is best for prediction? Pooled analysis of four German population-based cohort studies and comparison with a nationwide cohort study

Kuss, Oliver

BMJ open, 6(1):e009266

2016

Abstract: OBJECTIVE: To compare the association between different anthropometric measurements and incident type 2 diabetes mellitus (T2DM) and to assess their predictive ability in different regions of Germany. METHODS: Data of 10 258 participants from 4 ... ...

Institution	Deutsches Diabetes-Zentrum
Abstract	OBJECTIVE: To compare the association between different anthropometric measurements and incident type 2 diabetes mellitus (T2DM) and to assess their predictive ability in different regions of Germany. METHODS: Data of 10 258 participants from 4 prospective population-based cohorts were pooled to assess the association of body weight, body mass index (BMI), waist circumference (WC), waist-to-hip-ratio (WHR) and waist-to-height-ratio (WHtR) with incident T2DM by calculating HRs of the crude, adjusted and standardised markers, as well as providing receiver operator characteristic (ROC) curves. Differences between HRs and ROCs for the different anthropometric markers were calculated to compare their predictive ability. In addition, data of 3105 participants from the nationwide survey were analysed separately using the same methods to provide a nationally representative comparison. RESULTS: Strong associations were found for each anthropometric marker and incidence of T2DM. Among the standardised anthropometric measures, we found the strongest effect on incident T2DM for WC and WHtR in the pooled sample (HR for 1 SD difference in WC 1.97, 95% CI 1.75 to 2.22, HR for WHtR 1.93, 95% CI 1.71 to 2.17 in women) and in female DEGS participants (HR for WC 2.24, 95% CI 1.91 to 2.63, HR for WHtR 2.10, 95% CI 1.81 to 2.44), whereas the strongest association in men was found for WHR among DEGS participants (HR 2.29, 95% CI 1.89 to 2.78). ROC analysis showed WHtR to be the strongest predictor for incident T2DM. Differences in HR and ROCs between the different markers confirmed WC and WHtR to be the best predictors of incident T2DM. Findings were consistent across study regions and age groups (<65 vs ≥65 years). CONCLUSIONS: We found stronger associations between anthropometric markers that reflect abdominal obesity (ie, WC and WHtR) and incident T2DM than for BMI and weight. The use of these measurements in risk prediction should be encouraged.
Language	English
Document type	Article
Database	Repository for Life Sciences

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Article: Methods to estimate the between‐study variance and its uncertainty in meta‐analysis†

Kuss, Oliver

Research synthesis methods, 1(7):55–79

2015

Abstract: Meta‐analyses are typically used to estimate the overall/mean of an outcome of interest. However, inference about between‐study variability, which is typically modelled using a between‐study variance parameter, is usually an additional aim. The ... ...

Institution	Deutsches Diabetes-Zentrum
Abstract	Meta‐analyses are typically used to estimate the overall/mean of an outcome of interest. However, inference about between‐study variability, which is typically modelled using a between‐study variance parameter, is usually an additional aim. The DerSimonian and Laird method, currently widely used by default to estimate the between‐study variance, has been long challenged. Our aim is to identify known methods for estimation of the between‐study variance and its corresponding uncertainty, and to summarise the simulation and empirical evidence that compares them. We identified 16 estimators for the between‐study variance, seven methods to calculate confidence intervals, and several comparative studies. Simulation studies suggest that for both dichotomous and continuous data the estimator proposed by Paule and Mandel and for continuous data the restricted maximum likelihood estimator are better alternatives to estimate the between‐study variance. Based on the scenarios and results presented in the published studies, we recommend the Q‐profile method and the alternative approach based on a ‘generalised Cochran between‐study variance statistic’ to compute corresponding confidence intervals around the resulting estimates. Our recommendations are based on a qualitative evaluation of the existing literature and expert consensus. Evidence‐based recommendations require an extensive simulation study where all methods would be compared under the same scenarios.
Keywords	coverage probability ; conﬁdence interval ; bias ; heterogeneity ; mean squared error
Language	English
Document type	Article
Database	Repository for Life Sciences

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Article: A novel method for identifying settings for well‐motivated ecologic studies of cancer

Kuss, Oliver

International journal of cancer, 138(8): 1887-1893

2015

Abstract: A low within‐country variability and a large between‐country variability in cancer incidence may indicate that ecologic factors are involved in the etiology of the disease. The aim of this study is to explore the within‐ and between‐country variability ... ...

Institution	Deutsches Diabetes-Zentrum
Abstract	A low within‐country variability and a large between‐country variability in cancer incidence may indicate that ecologic factors are involved in the etiology of the disease. The aim of this study is to explore the within‐ and between‐country variability of cancer incidence to motivate high‐quality ecologic studies. We extracted age‐standardized incidence rate estimates (world standard population) from 135 regions for the ten most frequent invasive cancers in Europe for non‐Hispanic white populations from Cancer Incidence in Five Continents, Volume X. We fitted weighted multilevel Poisson regression models with random country effects for each cancer and sex. We estimated intraclass correlation coefficients (ICCs) and 95% confidence intervals (95% CIs). A high ICC indicates a low within‐ and a high between‐country variability of rates. The two cancer sites with the highest ICC among men were prostate cancer (0.96, 95% CI: 0.92–0.99) and skin melanoma (0.78, 0.64–0.93). Among women, high ICCs were observed for lung cancer (0.84, 0.73–0.95) and breast cancer (0.80, 0.69–0.91). The two most prominent sex differences for ICC occurred for cancers of the head and neck (men: 0.70, 0.55–0.85, women: 0.19, 0.08–0.30) and breast cancer (men: 0.04, 0.01–0.07, women: 0.80, 0.69–0.91). ICCs were relatively low for pancreatic cancer (men: 0.23, 0.10–0.35; women: 0.13, 0.04–0.21) and leukemia (men: 0.12, 0.04–0.21; women: 0.08, 0.02–0.14). For cancers with high ICC for which systematic factors of the health care system, screening and diagnostic activities are not plausible explanations for between‐country variations in incidence, cross‐country sex‐specific ecologic studies may be especially promising.
Keywords	cancer registries ; etiology ; incidence ; neoplasms
Language	English
Document type	Article
Database	Repository for Life Sciences

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Article: Changes of individual perception in psychosocial stressors related to German reunification in 1989/1990 and cardiovascular risk factors and cardiovascular diseases in a population-based study in East Germany

Bohley, Dr. Stefanie / Kuss, Oliver

BMJ open, 6(1):e008703

2016

Abstract: OBJECTIVES: Aim was to examine the relationship between individually perceived changes in psychosocial stressors associated with German reunification and cardiovascular effects. We hypothesised that higher levels of psychosocial stress related to German ... ...

Institution	Deutsches Diabetes-Zentrum
Abstract	OBJECTIVES: Aim was to examine the relationship between individually perceived changes in psychosocial stressors associated with German reunification and cardiovascular effects. We hypothesised that higher levels of psychosocial stress related to German reunification were associated with an increase in cardiovascular risk factors and cardiovascular diseases (CVDs). DESIGN: Cross-sectional data from 2 cohort studies in East Germany were used: Cardiovascular Disease, Living and Ageing in Halle Study (CARLA), and Study of Health in Pomerania (SHIP). SETTING: 2 populations in East Germany. PARTICIPANTS: CARLA study: 1779 participants, aged 45–83 years at baseline (812 women), SHIP study: 4308 participants, aged 20–79 years at baseline (2193 women). PRIMARY AND SECONDARY OUTCOME MEASURES: Psychosocial stressors related to reunification were operationalised by the Reunification Stress Index (RSI; scale from 0 to 10). This index was composed of questions that were related to individually perceived changes in psychosocial stressors (occupational, financial and personal) after reunification. To examine the associations between the RSI and each stressor separately with cardiovascular risk factors and CVD, regression models were used. RESULTS: RSI was associated with CVD in women (RR=1.15, 95% CI 1.00 to 1.33). Cardiovascular risk factors were associated with RSI for both men and women, with strongest associations between RSI and diabetes in women (RR=1.10, 95% CI 1.01 to 1.20) and depressive disorders in men (RR=1.15, 95% CI 1.07 to 2.77). The change in occupational situation related to reunification was the major contributing psychosocial stressor. We observed a strong association with CVD in women who experienced occupational deterioration after reunification (RR=4.04, 95% CI 1.21 to 13.43). CONCLUSIONS: Individually perceived deterioration of psychosocial stressors (occupational, financial and personal) related to German reunification was associated with cardiovascular risk factors and CVD. The associations were stronger for women than for men. An explanation for these findings could be that women were more often affected by unemployment after reunification. Morbidity and mortality follow-up of both cohorts could enhance the results.
Language	English
Document type	Article
Database	Repository for Life Sciences

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Article: Incidence of lower extremity amputation in the diabetic compared to the non-diabetic population: a systematic review protocol

Kuss, Oliver / Icks, Andrea

Systematic Reviews, 4:74

2015

Abstract: BACKGROUND: Diabetic individuals have a largely increased risk of lower extremity amputation (LEA) compared with non-diabetic patients. Prior systematic reviews of incidence of LEA have some limitations with respect to lack of consensus in the definition ...

Institution	Deutsches Diabetes-Zentrum
Abstract	BACKGROUND: Diabetic individuals have a largely increased risk of lower extremity amputation (LEA) compared with non-diabetic patients. Prior systematic reviews of incidence of LEA have some limitations with respect to lack of consensus in the definition of LEA, level of LEA (all, major, minor), and definition of source population (general population or population with diabetes at risk). The purpose of our review is to evaluate the incidence of LEA in the diabetic population and its differences with regard to sex, ethnicity, age, and regions; to compare the incidence rate (IR) in the diabetic and non-diabetic population; and to investigate time trends. METHODS/ DESIGN: We will perform a systematic literature search in MEDLINE, Embase, Web of Knowledge, and publisher databases such as Journals@OVID and ScienceDirect. We will develop comprehensive systematic search strategies according to established guidelines for meta-analyses of observational studies in epidemiology (the MOOSE group). Two authors will independently screen abstracts and full text of all references on the basis of inclusion criteria with respect to types of study, types of population, and the main outcome. We will exclude studies if they report solely incidences of LEA among persons with diabetes mellitus when referring to the total population (diabetic and non-diabetic) and not exclusively to the diabetic population. Data extraction and assessment of risk of bias will be undertaken by two review authors working independently. We will assess incidence rate (IR) or cumulative incidence (CumI), relative risk of amputations comparing the diabetic to non-diabetic populations, cause of LEA, and type of diabetes. If we find subsets of studies to be homogeneous enough, we will perform meta-analyses for incidence rates by Poisson generalized linear mixed models (GLMM).SYSTEMATIC REVIEW REGISTRATION: PROSPERO CRD42015017809
Keywords	Diabetes ; Incidences ; Lower extremity amputations (LEA) ; Systematic review ; Population-based study ; Protocol
Language	English
Document type	Article
Database	Repository for Life Sciences

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Article ; Online: Comment on "Drug-Drug Interaction of the Sodium Glucose Co-Transporter 2 Inhibitors with Statins and Myopathy: A Disproportionality Analysis Using Adverse Events Reporting Data".

Kuss, Oliver / Rathmann, Wolfgang

Drug safety

2023 Volume 46, Issue 5, Page(s) 509–512

MeSH term(s)	Humans ; Hydroxymethylglutaryl-CoA Reductase Inhibitors/adverse effects ; Sodium-Glucose Transporter 2 Inhibitors/adverse effects ; Drug Interactions ; Muscular Diseases/chemically induced ; Symporters ; Glucose ; Sodium
Chemical Substances	Hydroxymethylglutaryl-CoA Reductase Inhibitors ; Sodium-Glucose Transporter 2 Inhibitors ; Symporters ; Glucose (IY9XDZ35W2) ; Sodium (9NEZ333N27)
Language	English
Publishing date	2023-04-15
Publishing country	New Zealand
Document type	Letter ; Comment
ZDB-ID	1018059-x
ISSN	1179-1942 ; 0114-5916
ISSN (online)	1179-1942
ISSN	0114-5916
DOI	10.1007/s40264-023-01292-6
Database	MEDical Literature Analysis and Retrieval System OnLINE

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Article: Comparison of surveillance-based metrics for the assessment and monitoring of disease detection: simulation study about type 2 diabetes

Brinks, Ralph / Hoyer, Annika / Kuss, Oliver

BMC medical research methodology, 17:54

2017

Abstract: BACKGROUND: Screening and detection of cases are a common public health priority for treatable chronic conditions with long subclinical periods. However, the validity of commonly-used metrics from surveillance systems for rates of detection (or case- ... ...

Institution	Deutsches Diabetes-Zentrum
Abstract	BACKGROUND: Screening and detection of cases are a common public health priority for treatable chronic conditions with long subclinical periods. However, the validity of commonly-used metrics from surveillance systems for rates of detection (or case-finding) have not been evaluated. METHODS: Using data from a Danish diabetes register and a recently developed illness-death model of chronic diseases with subclinical conditions, we simulate two scenarios of different performance of case-finding. We report different epidemiological indices to assess case-finding in both scenarios and compare the validity of the results. RESULTS: The commonly used ratio of detected cases over total cases may lead to misleading conclusions. Instead, the ratio of undetected cases over persons without a diagnosis is a more valid index to distinguish the quality of case-finding. However, incidence-based measures are preferable to prevalence based indicators. CONCLUSION: Prevalence-based indices for assessing case-finding should be interpreted with caution. If possible, incidence-based indices should be preferred.
Keywords	Compartment model ; Case-finding ; Chronic disease ; Diabetes ; Incidence ; Screening ; Prevalence ; Undiagnosed disease
Language	English
Document type	Article
Database	Repository for Life Sciences

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Article ; Online: Mortality of type 2 diabetes in Germany: additional insights from Gompertz models.

Kuss, Oliver / Baumert, Jens / Schmidt, Christian / Tönnies, Thaddäus

Acta diabetologica

2024

Abstract: Aims: The Gompertz law of mortality proclaims that human mortality rates in middle to old ages grow log-linearly with age and this law has been confirmed at multiple instances. We investigated if diabetes mortality in Germany also obeys to the Gompertz ... ...

Abstract	Aims: The Gompertz law of mortality proclaims that human mortality rates in middle to old ages grow log-linearly with age and this law has been confirmed at multiple instances. We investigated if diabetes mortality in Germany also obeys to the Gompertz law and how this information helps to communicate diabetes mortality more intuitively. Methods: We analyzed all statutory health-insured persons in Germany in 2013 that were aged 30 years or older. Deaths in 2014 were recorded and given in 5-year age groups. We fitted weighted linear regression models (separately for females and males and for people with and without diabetes) and additionally computed the probability that a person with diabetes dies before a person of the same age and sex without diabetes, and the "diabetes age", that is, the additional years of mortality risk added to an individual's chronological age due to diabetes-related excess mortality. Results: We included N = 47,365,120 individuals, 6,541,181 of them with diabetes. In 2014, 763,228 deaths were recorded, among them 288,515 with diabetes. Diabetes mortality followed nearly perfectly Gompertz distributions. The probability that a person with diabetes dies before a person without diabetes was 61.9% for females and 63.3% for males. Conclusions: Diabetes mortality for females and males aged 30 years or older in Germany in 2014 followed the Gompertz law of mortality. The survival information of the population with diabetes during a large part of the lifespan can thus be reduced to the two parameters of the Gompertz distribution.
Language	English
Publishing date	2024-03-11
Publishing country	Germany
Document type	Journal Article
ZDB-ID	1097676-0
ISSN	1432-5233 ; 0940-5429
ISSN (online)	1432-5233
ISSN	0940-5429
DOI	10.1007/s00592-024-02237-w
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Article ; Online: Gütemaße und Kriterien bei der Anwendung von Propensity Scores

Kuß, Oliver / Strobel, Alexandra

GMS Medizinische Informatik, Biometrie und Epidemiologie

2024 Volume 20, Page(s) 1

Abstract: Propensity Scores (PS) haben sich in den letzten Jahren als eine valide Alternative zu herkömmlichen Regressionsmodellen bei der Auswertung von nichtrandomisierten Behandlungsstudien etabliert. PS-Analysen werden in zwei Schritten durchgeführt. Im ersten ...

Title translation	Quality measures and criteria for the application of propensity scores
Abstract	Propensity Scores (PS) haben sich in den letzten Jahren als eine valide Alternative zu herkömmlichen Regressionsmodellen bei der Auswertung von nichtrandomisierten Behandlungsstudien etabliert. PS-Analysen werden in zwei Schritten durchgeführt. Im ersten Schritt wird der PS, also die Wahrscheinlichkeit, mit der ein Individuum die zu prüfende Behandlung erhält, geschätzt. Im zweiten Schritt erfolgt die Schätzung des eigentlich interessierenden Behandlungseffekts unter Zuhilfenahme des PS. Die Güte einer PS-Analyse ist im Wesentlichen davon abhängig, ob es im ersten Schritt gelingt, eine hinreichende Balanciertheit der PatientInnenmerkmale in den Behandlungsgruppen zu erreichen. Nur dann ist gewährleistet, dass diese PatientInnenmerkmale nicht die Schätzung des Behandlungseffekts verzerren. Zur Messung dieser Balanciertheit wurden verschiedene Maße vorgeschlagen, z.B. die standardisierte Differenz oder die z-Differenz. Eng verwandt mit der Balanciertheit der PatientInnenmerkmale und damit auch ein Maß für die Güte eines PS-Modells ist die Überlappung („overlap“), also die Ähnlichkeit der Verteilung der geschätzten PS in den beiden Behandlungsgruppen. In Wertebereichen des PS ohne Overlap, in denen sich unter Umständen also nur Beobachtungen aus einer der beiden Behandlungsgruppen finden, ist streng genommen ein Vergleich der Behandlungen gar nicht möglich. In diesem Beitrag werden die beiden Konzepte anhand eines Beispiels aus der Herzchirurgie vorgestellt und diskutiert. Propensity scores (PS) have been established as a valid alternative to conventional regression models when evaluating non-randomized treatment studies. The PS describes the probability for an individual to receive a treatment, conditional on a set of observed covariates. PS analyses are performed in two steps. In the first step, the PS is generally estimated via logistic regression. In the second step, the actual treatment effect is estimated. The quality of a PS analysis depends on whether it is possible to achieve a sufficient balance of the patient characteristics in the treatment groups in the first step. This is the only way to ensure that these patient characteristics do not bias the estimate of the treatment effect. Various measures have been proposed to measure this balance, e.g. the standardized difference or the z-difference. Closely related to the balance of patient characteristics (and thus also a measure of the quality for a PS model) is the overlap, i.e. the similarity in the distribution of the estimated propensity scores in the two treatment groups. A valid comparison of the treatments is only possible in regions of sufficient overlap. In this article, the two concepts of balance and overlap are presented and discussed using an example from cardiac surgery.
Keywords	Medizin, Gesundheit ; Propensity Scores
Publishing date	2024-01-05
Publisher	German Medical Science GMS Publishing House; Düsseldorf
Document type	Article ; Online
ISSN	1860-9171
ISSN (online)	1860-9171
DOI	10.3205/mibe000257
Database	German Medical Science

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