著者

Takumi Imai Takayuki Hosoi Hiroshi Hagino Takanori Yamamoto Tatsuhiko Kuroda Hiroshi Watanabe Shiro Tanaka

出版者

Japan Epidemiological Association

雑誌

Journal of Epidemiology (ISSN:09175040)

巻号頁・発行日

pp.JE20220099, (Released:2022-12-24)

参考文献数

22

被引用文献数

2

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ObjectiveThis study aimed to estimate incidence rates of femoral shaft fracture in patients who were treated with antiresorptive drugs.DesignCohort studyMethodsWe used data from the National Database of Health Insurance Claims of Japan from April 2009 and October 2016. All patients with new use of an antiresorptive drug, prescription-free period of ≥3 months, and no prior femoral fractures were included. Femoral shaft fractures were identified using a validated definition based on ICD-10 codes. Incidence rate ratios were estimated using Poisson regression with adjustment for sex, age, and the Charlson Comorbidity Index.ResultsWe identified 7,958,655 patients (women, 88.4%; age ≥75 years, 51.2%). Femoral shaft fractures were identified in 22,604 patients. Incidence rates per 100,000 person-years was 74.8 for women, 30.1 for men, 30.1 for patients aged ≤64 years, 47.7 for patients aged 65–74 years, and 99.0 for patients aged ≥75 years. Adjusted incidence rate ratios in patients taking versus not taking each type of antiresorptive drug were 1.00 (95% confidence interval (CI), 0.98–1.03) for bisphosphonates, 0.46 (95% CI, 0.44–0.48) for selective estrogen receptor modulators, 0.24 (95% CI, 0.18–0.32) for estrogens, 0.75 (95% CI, 0.71–0.79) for calcitonins, and 0.93 (95% CI, 0.84–1.03) for denosumab. The adjusted incidence rate ratio for alendronate was 1.18 (95% CI, 1.14–1.22).ConclusionsThe incidence rates of femoral shaft fracture varied across patients treated with different antiresorptive drugs. Further research on a specific antiresorptive drug can increase understanding of the risk of femoral shaft fracture

著者

Hisashi Noma Munechika Misumi Shiro Tanaka

出版者

Japan Epidemiological Association

雑誌

Journal of Epidemiology (ISSN:09175040)

巻号頁・発行日

pp.JE20210509, (Released:2022-06-25)

参考文献数

40

被引用文献数

1 3

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Background: In case-cohort studies with binary outcomes, ordinary logistic regression analyses have been widely used because of their computational simplicity. However, the resultant odds ratio estimates cannot be interpreted as relative risk measures unless the event rate is low. The risk ratio and risk difference are more favorable outcome measures that are directly interpreted as effect measures without the rare disease assumption.Methods: We provide pseudo-Poisson and pseudo-normal linear regression methods for estimating risk ratios and risk differences in analyses of case-cohort studies. These multivariate regression models are fitted by weighting the inverses of sampling probabilities. Also, the precisions of the risk ratio and risk difference estimators can be improved using auxiliary variable information, specifically by adapting the calibrated or estimated weights, which are readily measured on all samples from the whole cohort. Finally, we provide computational code in R (R Foundation for Statistical Computing, Vienna, Austria) that can easily perform these methods.Results: Through numerical analyses of artificially simulated data and the National Wilms Tumor Study data, accurate risk ratio and risk difference estimates were obtained using the pseudo-Poisson and pseudo-normal linear regression methods. Also, using the auxiliary variable information from the whole cohort, precisions of these estimators were markedly improved.Conclusion: The ordinary logistic regression analyses may provide uninterpretable effect measure estimates, and the risk ratio and risk difference estimation methods are effective alternative approaches for case-cohort studies. These methods are especially recommended under situations in which the event rate is not low.

著者

Jia GUAN Shiro TANAKA Shuhei YAMADA Izumi SATO Koji KAWAKAMI

出版者

Japanese Society for Pharmacoepidemiology

雑誌

薬剤疫学 (ISSN:13420445)

巻号頁・発行日

pp.25.e2, (Released:2020-07-15)

参考文献数

32

被引用文献数

1 1

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Objective: To describe the treatment patterns and time to next treatment (TTNT) in newly diagnosed multiple myeloma patients (MM) using a large-scale claims database in Japan.Design: Cohort studyMethods: The patients with newly diagnosed MM from 2008 to 2015 were classified into two groups: age <65 years, and age ≥65 years. Specific regimens and general regimens were identified with a complex algorithm considering interval of no therapy, additional and discontinued agents. Correspondingly, TTNT between the first- and second-line were measured among non-transplant patients with Kaplan-Meier method.Results: A total of 425 patients were eligible to participate in the analysis. The most common regimen for the treatment of MM was bortezomib-based regimens (52.9% in the first-line, 28.2% in later lines), followed by melphalan-prednisolone (27.1% in the first-line, 12.9% in later lines) and lenalidomide-based regimens (4.7% in the first-line, 26.1% in later lines). TTNT between the first- and second-line was 11.4 months and was seen to vary greatly with each regimen. A statistically longer TTNT was observed in subgroups of patients aged 65 years or over compared with patients aged younger than 65 years, but no statistical difference was found between conventional therapy and novel therapy.Conclusion: Based on the data from the study, patients with MM were commonly treated with novel agent-based regimens, especially bortezomib-based regimens. Between the first- and second-line therapies a relatively short TTNT was observed, indicating that therapies in clinical practice poorly complied with treatment guidelines.

著者

Fumiko Ono Shiro Tanaka Yoko M. Nakao Koji Kawakami

出版者

日本循環器学会

雑誌

Circulation Journal (ISSN:13469843)

巻号頁・発行日

pp.CJ-17-0547, (Released:2017-09-07)

参考文献数

23

被引用文献数

8

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Background:The European Society of Cardiology recommends a risk-based antithrombotic strategy for patients with atrial fibrillation (AF) who undergo percutaneous coronary intervention (PCI) based on CHA2DS2-VASc and HAS-BLED scores. However, because it is unclear if that strategy can be generalized to Asians, we aimed to describe antithrombotic therapies among Japanese patients.Methods and Results:Using a nationwide claims database in Japan, this retrospective cohort study identified AF patients who underwent PCI from April 1, 2014 to March 31, 2015. The primary outcome was utilization of anticoagulant and antiplatelet agents before PCI, at discharge, and 6, 9, and 12 months after PCI. The secondary outcome was incidence of stroke after PCI. We identified 10,862 patients and 87.5% of them had high CHA2DS2-VASc and HAS-BLED scores. There were no significant differences in antithrombotic therapies across the risk strata. More than 30% of patients at high risk of thrombosis did not receive oral anticoagulant prescriptions at discharge. The hazard ratio of incidence of stroke in patients with prior stroke compared with patients without prior stroke was 9.09 (95% confidence interval 7.86–10.50, P<0.01).Conclusions:Among Japanese AF patients who underwent PCI, prescriptions for antiplatelet agents were more common than those for anticoagulant agents. The majority of study participants were classified as high risk, suggesting a need for a new risk classification that reflects the risk profiles of Japanese patients.

著者

Aki Kuwauchi Satomi Yoshida Shiro Tanaka Sachiko Tanaka Chikashi Takeda Hiroshi Yonekura Isao Nahara Koji Kawakami

出版者

Society for Clinical Epidemiology

雑誌

Annals of Clinical Epidemiology (ISSN:24344338)

巻号頁・発行日

pp.22011, (Released:2022-03-11)

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BackgroundThe controversy concerning the benefits of pulmonary artery catheter (PAC)-based hemodynamic monitoring in cardiac surgeries has not been adequately addressed. This study aims to compare the all-cause mortality between the PAC with venous oxygen saturation monitoring and the Vigileo/FloTrac (FloTrac) system with central venous oxygen saturation monitoring in cardiac surgeries.MethodsThis nationwide retrospective study includes adult patients who underwent elective cardiac surgeries between April 2010 and October 2014, based on the Japanese health insurance claims database. The main outcome was 30-day all-cause mortality. Propensity scores (PS) were used to adjust for the confounding factors. Treatment effects were estimated using multivariable logistic regression analysis, including PS.ResultsA total of 5,838 patients were included in this study. The crude 30-day mortality rates were 2.4% (8/334) and 1.7% (96/5,504) in the FloTrac and PAC groups, respectively. After PS matching, the ORs for 30-day all-cause mortality, in-hospital mortality after PAC placement (vs. FloTrac) were 0.36 (95% CI: 0.05 – 2.37; p= 0.28) and 0.59 (95% CI: 0.16 – 2.20; p= 0.43), respectively. The amount of dobutamine was larger in the PAC group (281±31 mg vs 155±19 mg; p <0.001). There were no significant differences in the amounts of other inotropes, the volume of fluids, or blood transfusions.ConclusionsThe association between PAC (with venous oxygen saturation monitoring) and mortality in patients who underwent elective cardiac surgeries was unclear compared to FloTrac (with central venous oxygen saturation monitoring). Additional investigation is needed to evaluate the benefits of PAC-specific hemodynamic parameters in this population.

著者

田中 史朗 Shiro TANAKA 鹿児島県立短期大学 KAGOSHIMA PREFECTURAL COLLEGE

巻号頁・発行日

vol.63, pp.71-87, 2012-12-26

著者

田中 史郎 Shiro Tanaka 宮城学院女子大学 Miyagi Gakuin Women's University

出版者

宮城学院女子大学附属人文社会科学研究所

雑誌

人文社会科学論叢 (ISSN:0916913X)

巻号頁・発行日

no.25, pp.47-61, 2016

著者

Shinako Inaida Kousuke Kanemoto Shiro Tanaka Yoko Gouji Tomohiro Oshima Riki Matsumoto Akio Ikeda Koji Kawakami

出版者

JAPAN EPILEPSY SOCIETY

雑誌

Epilepsy & Seizure (ISSN:18825567)

巻号頁・発行日

vol.10, no.1, pp.73-86, 2018 (Released:2018-09-08)

参考文献数

35

被引用文献数

3

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Purpose: Psychogenic non-epileptic seizures (PNES) are psychogenic disorders that often resemble epileptic seizures. Herein, we describe the recent clinical trends of PNES by using the data from a large, claims-based Japanese database obtained from the Japan Medical Data Center.Methods: A 10-year epidemiological study of patients of all ages with newly diagnosed PNES was conducted. Data were extracted using the International Classification of Diseases 10th Revision (ICD-10) diagnostic codes. Prevalence in new epilepsy patients and period of the diagnostic delay of PNES after epilepsy diagnosis were retrieved from the data. The study endpoint was change in frequency of hospital visits. Data of 413 patients with PNES were retrieved using the criterion of “PNES diagnosis after epilepsy diagnosis.”Results: The highest PNES prevalence in new epilepsy patients was observed in the 40-49 year age group (4.3%) for males, and in the 30-39 age group (4.9%) for females. The ratio of the prevalence in males to that in females was 1:2 for 0-9, 10-19, and >60 age groups, and 1:1 for the other age groups. A significant and positive correlation was found between the frequency of hospital visits and duration of the diagnostic delay of PNES. After PNES diagnosis, the average number of monthly hospital visits decreased over time.Discussion: The differences in the duration of diagnostic delay of PNES among cases and also a decrease in the frequency of hospital visits after PNES diagnosis highlight the importance of early differentiation between epilepsy and PNES.

著者

Satoru Kodama Kazumi Saito Shiro Tanaka Chika Horikawa Kazuya Fujiwara Reiko Hirasawa Yoko Yachi Yasuko Sone Kaoruko Tada Iida Hitoshi Shimano Yasuo Ohashi Nobuhiro Yamada Hirohito Sone

出版者

一般社団法人 日本動脈硬化学会

雑誌

Journal of Atherosclerosis and Thrombosis (ISSN:13403478)

巻号頁・発行日

vol.19, no.4, pp.385-396, 2012 (Released:2012-04-26)

参考文献数

50

被引用文献数

3 17 4

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Aim: The post-challenge glucose (PCG) level has been suggested to be superior to the fasting blood glucose (FG) level for predicting the risk of future cardiovascular disease (CVD); however, the extent of its superiority has not been consistently shown among previous cohort studies. Therefore, we conducted a meta-analysis to summarize the quantitative association of FG and PCG with CVD risk and compared the strengths of the two associations.Method: Electronic literature searches using MEDLINE and EMBASE with an additional manual search were conducted for prospective observational studies of the association of FG and PCG with CVD risk. Studies were included if they were prospective studies in which the relative risk (RR) of CVD per 1 standard deviation increase in both FG and PCG could be estimated. Pooled relative risks for the incremental increase were calculated as RRFG and RRPCG using a bivariate random-effects model.Result: Data were obtained from 14 eligible studies that included 70,889 participants and 2,927 cases. The pooled RRFG and RRPCG (95% confidence interval) were, respectively, 1.15 (1.06 to 1.26) and 1.24 (1.12 to 1.36); the difference was significant (P =0.001). The association of PCG with CVD risk was stronger in studies that targeted participants with a baseline mean FG < 100 mg/dl (P < 0.001) or mean age ≥ 55 years (P =0.004).Conclusions: Overall, the association of PCG with CVD risk was stronger than that of FG by approximately 50% on a log scale. Measuring PCG is especially important in populations with relatively low FG levels or in the elderly, although it is often burdensome in routine clinical practice.