Present: Amanda
Kennedy, Ben Littenberg, Connie van Eeghen
1.
Start Up: Integrated pharmacy project engaging
pharmacists in outpatient care is going well – good feedback from many
perspectives.
2.
Presentation: Connie
- using NHANES III to analyze mortality
outcomes based on reported use of prescribed medications took us on a long
discussion about the long term objective of the researcher (Connie, in this
case) and the tools that can move that objective forward. Retained learnings (not to be confused with
“retained earnings,” which is a different objective altogether):
a. Long
term objective: identify the determinants of successful change and adaptation
in health care systems in order to facilitate uptake of new practices of care
and management.
b. This
population-based data base does not support analysis of medical practice or
health system operations, but it can be used to link population behavior that
is influenced with both of these to mortality outcomes.
i.
Mortality outcomes include the date of death and, to
some degree, cause of death
c. The
study will give the researcher practice with these data and analysis for a
cross-sectional study that has mortality outcomes added, using a probabilistic
match between NHANES III and NDI death certificate records for subjects who
died up to 18 years after the survey.
Ben has linked NHANES data from the Household Adult, Examination, and
Leptin data sets to the mortality data.
This study will be limited to the use of these data sets.
d. Examples
of the survey data that reflect medical practice/health systems are:
i.
Access to health provider
ii.
Use of vitamins, minerals, and medicine: do they
matter?
iii.
Use of aspirin (which was asked in the context of pain
relief): what is their role in the prevention of heart attack (identified by
cause of death)?
iv.
Validation of the Framingham risk score (which included
cardiovascular mortality).
v.
Public health topics:
1. Oral
health (for which there is extensive data in the survey)
2. Obesity
3. Tobacco
use
4. Hypertension…
e. We
reconvened in Ben’s office to test the data base for an indication that there
is something of interest to study. We
wound up looking at aspirin use with the following results:
i.
33% of adult respondents (6,518) report having taken aspirin
in the past month (this includes Anacin, Bufferin, Ecotrin, Ascriptin, and
Midol) (starting pg. 27 in STAT log)
Note: the context of this question is under the heading of
“non-prescription pain relief medications”
ii.
The hazard ratio for ASA is 1.33 with a P value<0.001
and a CI of 1.26-1.41. This means that those
who took aspirin were 33% more likely to have died in the 18 years after participating
in the survey.
iii.
When adjusted for age, HR = 0.96, P=0.186, CI .911-1.02 We know that people are more likely to take
aspirin when they get older, and are also more likely to die when they get
older. Adjusting for age, taking aspirin
is associated with a 4% lower likelihood of dying.
iv.
When adjusted for age & sex, HR = .94, P=0.040, CI
.893-.997. In the 1980’s, men were more
likely to be advised to take aspirin than women were, as a preventive against
heart attack. Adjusting for age and sex,
taking aspirin is associated with a 6 % percent lower likelihood of dying.
v.
When adjusted for above plus heart disease, HR = .93,
P=0.006, CI .876-.979. Respondents who
have been told they have heart disease are more likely to be advised to take
aspirin. Adjusting for all three
characteristics, taking aspirin is associated with a 7% lower risk of
dying. Out of the 6,518 people who took
aspirin, one could hypothesize that 456 did not die that otherwise would have. And, the confidence interval range is below
1.0, indicating that if we collected data from many other, equivalent surveys,
95% of them would also indicate a relationship between aspirin and avoiding
death when adjusted for age, sex, and heart disease.
vi.
For respondents with no heart disease and adj for age
& sex, HR = .91, P=0.015, CI .837-.981.
Oddly, those patients who did not think they had heart disease (14,167
respondents) and took aspirin anyway, adjusting for age & sex, were even
less likely to die (by 9%). (Connie
hypothesized that a lot of them really did have heart disease, and just didn’t
know it, but the CDC currently reports the prevalence of heart disease (age
adjusted) is around 6% of adults, so this is unlikely. On the other hand, Hunink reported in a JAMA
1997 article that mortality from CHD from 1980 – 1990 dropped 34% - so maybe
the prevalence back then was more like 9%.)
vii.
For respondents with heart disease and adj for age
& sex, HR = .95, P=0.216, CI .881-1.020.
So if you did think you had heart disease (5,703) and took aspirin, you
were less likely to die by 5%. So
aspirin helped the apparently healthy more than the ill, with respect to heart
disease.
f. Next
steps:
i.
Connie will do a literature search (PubMed, OVID) on
NHANES III (and will first check to see if this is a MeSH term), aspirin, and
mortality. She will review the results
and summarize them for a future meeting.
ii.
Connie, Amanda, and Ben will develop a research
question to form the basis of a study design and bring to a future CROW
meeting.
3.
Workshop
Goals for 2012:
a. Journal
club: identify UVM guests and articles; invite to CROW ahead of time
b. Research
updates: share work-in-process
4.
Next Workshop Meeting(s): Thursday, 11:00 p.m.
– 12:00 p.m., at Given Courtyard Level 4.
a.
June 14: Abby - research update (no Connie)
b.
June 21: Kairn - research update (no Connie)
c.
June 28: Rodger
and Connie - R03 feedback from reviewers
d.
July 5: ???
e.
July 12: (no Connie, Abby)
f.
July 19: (no Abby)
g.
July 26:
h.
Aug 2:
i.
Aug 9: (no Abby)
j.
Aug 16: (no Abby)
k.
Aug 23:
l.
Aug 30: (new schedule?)
m. Future
agenda to consider:
i.
Ben: budgeting exercise for grant applications
ii.
Ben: Writer’s workshop on the effect of the built
environment on BMI (Littenberg & Austin Troy)
iii.
Journal Club: “Methods and metrics challenges of
delivery-system research,” Alexander and Hearld, March 2012 (for later in the
year?)
iv.
Rodger: Mixed methods article; article on Behavior’s
Influence on Medical Conditions (unpublished); drug company funding. Also: discuss design for PCBH clinical and
cost research.
v.
Amanda: presentation and interpretation of data in
articles
vi.
Sharon Henry: article by Cleland, Thoracic Spine
Manipulation, Physical Therapy 2007
Recorder: Connie van Eeghen
Posts
