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- Bolin, Kristian, et al.
(författare)
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Characteristics of finasteride users in comparison with non-users: a Nordic nationwide study based on individual-level data from Denmark, Finland, and Sweden
- 2020
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Ingår i: Pharmacoepidemiology and Drug Safety. - : Wiley. - 1053-8569 .- 1099-1557. ; 29:4, s. 453-460
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Tidskriftsartikel (refereegranskat)abstract
- Purpose: Published epidemiological studies on the association between finasterideuse and the risk of male breast cancer have been inconclusive due to methodologicallimitations including a few male breast cancer cases included. Determinants of malebreast cancer have been studied, but it remains unexplored whether these are alsorelated to finasteride use and thereby constitute potential confounders. This studyaimed to assess whether there are differences between finasteride users andnonusers with regard to numerous potential confounders.Methods: In total, 246 508 finasteride users (≥35 years) were identified in the pre-scription registries of Denmark (1995-2014), Finland (1997-2013), and Sweden(2005-2014). An equal number of nonusers were sampled. The directed acyclic graph(DAG) methodology was used to identify potential confounders for the associationbetween finasteride and male breast cancer. A logistic regression model comparedfinasteride users and nonusers with regard to potential confounders that were mea-surable in registries and population surveys.Results: Finasteride users had higher odds of testicular abnormalities (odds ratio[OR] 1.40; 95% confidence interval [CI] 1.36-1.44), obesity (1.31; 1.23-1.39), exoge-nous testosterone (1.61; 1.48-1.74), radiation exposure (1.22; 1.18-1.27), and diabe-tes (1.07; 1.04-1.10) and lower odds of occupational exposure in perfume industry orin high temperature environments (0.93; 0.87-0.99), living alone (0.89; 0.88-0.91), liv-ing in urban/suburban areas (0.97; 0.95-0.99), and physical inactivity (0.70;0.50-0.99) compared to nonusers.Conclusions: Systematic differences between finasteride users and nonusers werefound emphasizing the importance of confounder adjustment of associationsbetween finasteride and male breast cancer.
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| 2. |
- Comendeiro-Maaløe, Micaela, et al.
(författare)
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Acknowledging the role of patient heterogeneity in hospital outcome reporting : Mortality after acute myocardial infarction in five European countries
- 2020
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Ingår i: PLoS ONE. - : Public Library of Science (PLoS). - 1932-6203. ; 15:2, s. 0228425-0228425
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Tidskriftsartikel (refereegranskat)abstract
- BACKGROUND: Hospital performance, presented as the comparison of average measurements, dismisses that hospital outcomes may vary across types of patients. We aim at drawing out the relevance of accounting for patient heterogeneity when reporting on hospital performance.METHODS: An observational study on administrative data from virtually all 2009 hospital admissions for Acute Myocardial Infarction (AMI) discharged in Denmark, Portugal, Slovenia, Spain, and Sweden. Hospital performance was proxied using in-hospital risk-adjusted mortality. Multilevel Regression Modelling (MLRM) was used to assess differences in hospital performance, comparing the estimates of random intercept modelling (capturing hospital general contextual effects (GCE)), and random slope modelling (capturing hospital contextual effects for patients with and without congestive heart failure -CHF). The weighted Kappa Index (KI) was used to assess the agreement between performance estimates.RESULTS: We analysed 46,875 admissions of AMI, 6,314 with coexistent CHF, discharged from 107 hospitals. The overall in-hospital mortality rate was 5.2%, ranging from 4% in Sweden to 6.9% in Portugal. The MLRM with random slope outperformed the model with only random intercept, highlighting a much higher GCE in CHF patients [VPC = 8.34 (CI95% 4.94 to 13.03) and MOR = 1.69 (CI95% 1.62 to 2.21) vs. VPC = 3.9 (CI95% 2.4 to 5.9), MOR of 1.42 (CI95% 1.31 to 1.54) without CHF]. No agreement was observed between estimates [KI = -0,02 (CI95% -0,08 to 0.04].CONCLUSIONS: The different GCE in AMI patients with and without CHF, along with the lack of agreement in estimates, suggests that accounting for patient heterogeneity is required to adequately characterize and report on hospital performance.
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