Ascertainment of Aspirin Exposure Using Structured and Unstructured Large-scale Electronic Health Record Data

Bustamante, Ranier; Earles, Ashley; Murphy, James D.; Bryant, Alex K.; Patterson, Olga V.; Gawron, Andrew J.; Kaltenbach, Tonya; Whooley, Mary A.; Fisher, Deborah A.; Saini, Sameer D.; Gupta, Samir; Liu, Lin

doi:10.1097/mlr.0000000000001065

Cited by 18 publications

(10 citation statements)

References 21 publications

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“…Aspirin exposure was defined as at least two prescriptions or two mentions of aspirin in free-text notes up to 1 year prior to colonoscopy. We have shown this approach has a positive predictive value and a negative predictive value of 99.2% and 97.5%, respectively, for capturing EHR-documented aspirin use 16…”

Section: Methodsmentioning

confidence: 92%

Risk factors for colorectal cancer significantly vary by anatomic site

Demb

Earles

Martı́nez

et al. 2019

BMJ Open Gastroenterol

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ObjectiveTo conduct an anatomic site-specific case–control study of candidate colorectal cancer (CRC) risk factors.DesignCase–control study of US veterans with >1 colonoscopy during 1999–2011. Cases had cancer registry-identified CRC at colonoscopy, while controls were CRC free at colonoscopy and within 3 years of colonoscopy. Primary outcome was CRC, stratified by anatomic site: proximal, distal, or rectal. Candidate risk factors included age, sex, race/ethnicity, body mass index, height, diabetes, smoking status, and aspirin exposure summarised by adjusted ORs and 95% CIs.Results21 744 CRC cases (n=7017 rectal; n=7039 distal; n=7688 proximal) and 612 646 controls were included. Males had significantly higher odds relative to females for rectal cancer (OR=2.84, 95% CI 2.25 to 3.58) than distal cancer (OR=1.84, 95% CI 1.50 to 2.24). Relative to whites, blacks had significantly lower rectal cancer odds (OR=0.88, 95% CI 0.82 to 0.95), but increased distal (OR=1.27, 95% CI 1.19 to 1.37) and proximal odds (OR=1.62, 95% CI 1.52 to 1.72). Diabetes prevalence was more strongly associated with proximal (OR=1.29, 95% CI 1.22 to 1.36) than distal (OR=1.15, 95% CI 1.08 to 1.22) or rectal cancer (OR=1.12, 95% CI 1.06 to 1.19). Current smoking was more strongly associated with rectal cancer (OR=1.81, 95% CI 1.68 to 1.95) than proximal cancer (OR=1.53, 95% CI 1.43 to 1.65) or distal cancer (OR=1.46, 95% CI 1.35 to 1.57) compared with never smoking. Aspirin use was significantly more strongly associated with reduced rectal cancer odds (OR=0.71, 95% CI 0.67 to 0.76) than distal (OR=0.85, 95% CI 0.81 to 0.90) or proximal (OR=0.91, 95% CI 0.86 to 0.95).ConclusionCandidate CRC risk factor associations vary significantly by anatomic site. Accounting for site may enable better insights into CRC pathogenesis and cancer control strategies.

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Section: Methodsmentioning

confidence: 92%

Risk factors for colorectal cancer significantly vary by anatomic site

Demb

Earles

Martı́nez

et al. 2019

BMJ Open Gastroenterol

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“… 30 31 Aspirin exposure was defined as at least two prescriptions or mentions of aspirin in free-text notes up to 1 year prior to start of follow-up, an approach found to have a positive predictive value and negative predictive value of 99.2% and 97.5%, respectively. 32 Smoking status was determined from the VHA Health Factors structured data domain, classifying individuals based on terminology including ‘current smoker’, ‘former smoker’ or ‘never smoker’. 33 …”

Section: Methodsmentioning

confidence: 99%

Young-onset colorectal cancer risk among individuals with iron-deficiency anaemia and haematochezia

Demb

Liu

Murphy

et al. 2020

Gut

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ObjectiveYoung-onset colorectal cancer (YCRC) incidence is rising. Scant data exist on YCRC risk after presentation with concerning symptoms such as iron-deficiency anaemia (IDA) or haematochezia. We examined the association between IDA and YCRC, and haematochezia and YCRC.DesignCohort study of US Veterans aged 18–49 years receiving Veterans Health Administration (VHA) care 1999–2016. IDA analytic cohort was created matching individuals without incident IDA to those with IDA 4:1 based on sex, birth year and first VHA visit date (n=239 000). We used this approach to also create a distinct haematochezia analytic cohort (n=653 740). Incident YCRC was ascertained via linkage to cancer registry and/or cause-specific mortality data. We computed cumulative incidence, risk difference (RD) and HRs using Cox models in each cohort.ResultsFive-year YCRC cumulative incidence was 0.45% among individuals with IDA versus 0.05% without IDA (RD: 0.39%, 95% CI: 0.33%–0.46%), corresponding to an HR of 10.81 (95% CI: 8.15–14.33). Comparing IDA versus no IDA, RD was 0.78% for men (95% CI: 0.64%–0.92%) and 0.08% for women (95% CI: 0.03%–0.13%), and RD increased by age from 0.14% for <30 years to 0.53% for 40–49 years. YCRC cumulative incidence was 0.33% among individuals with haematochezia versus 0.03% without haematochezia (RD: 0.30%, 95% CI: 0.26%–0.33%), corresponding to an HR of 10.66 (95% CI: 8.76–12.97). Comparing haematochezia versus no haematochezia, RD increased by age from 0.04% for <30 years to 0.43% for 40–49 years.ConclusionColonoscopy should be strongly considered in adults aged <50 years with IDA or haematochezia without a clinically confirmed alternate source.

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“…22 Second, there was an increase in the concurrent use of aspirin in the MHCs group, although this should be interpreted with caution as accurately assessing aspirin exposure has been shown to be problematic in other research because it is usually obtained over-the-counter. 23 This concern exists in this research. Regardless, the trend toward a higher risk of adverse events in patients with MHCs, frequent presence other comorbidities associated with stroke, and reluctance of health care providers to initiate warfarin therapy, makes this is an area that warrants additional attention and research.…”

Section: Discussionmentioning

confidence: 91%

Evaluation of Warfarin Use in Patients With Mental Health Conditions in a Rural Community Health Center System

Abell

Irwin

2020

Journal of Pharmacy Technology

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Background: Mental health conditions (MHCs) may affect a patient’s ability to comply with requirements necessary for safe warfarin use. Objective: To describe warfarin control, defined as time in therapeutic range (TTR), for patients with and without MHCs receiving care through a pharmacist-driven anticoagulation service within a rural community health center system. Methods: Retrospective cohort study of patients on warfarin between January 1, 2014, and December 31, 2017. The primary study endpoint was TTR. Secondary endpoints were the number of international normalized ratios (INRs) per 30 days, percentage of INRs within, above, and below target range, and warfarin-related adverse events. Results: A total of 79 patients were included—37 with and 42 without MHCs. Patients were mostly male (n = 47; 59.5%) and prescribed warfarin for atrial fibrillation (n = 45; 57.0%). There were no differences in overall TTR between those with (59.6%; interquartile range = 41.8-73.4) versus without (63.4%; interquartile range = 46.7-73.6) MHCs ( P = .542). Secondary outcomes showed no differences in the frequency or percentage of INRs in, above, or below target range (all P > .05). However, there were about twice as many hemorrhagic complications in the group with MHCs (27% vs 11.9%; P = .149). Conclusion: Patients with MHCs experienced no difference in overall TTR as compared to patients without MHCs. However, there was a non-statistically significant reduction in TTR, which would be consistent with limited existing data and demonstrates possible reproducibility to a rural, underserved patient population. Future research is needed to validate these outcomes.

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Ascertainment of Aspirin Exposure Using Structured and Unstructured Large-scale Electronic Health Record Data

Abstract: Supplemental Digital Content is available in the text.

Cited by 18 publications

References 21 publications

Risk factors for colorectal cancer significantly vary by anatomic site

Risk factors for colorectal cancer significantly vary by anatomic site

Young-onset colorectal cancer risk among individuals with iron-deficiency anaemia and haematochezia

Evaluation of Warfarin Use in Patients With Mental Health Conditions in a Rural Community Health Center System

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