Epidemiology and Health

COVID-19: Original Article

The bounds of meta-analytics and an alternative method: Ramalingam Shanmugam, Mohammad Tabatabai, Derek Wilus, Karan P. Singh; Epidemiol Health. 2024;46:e2024016. Published online January 7, 2024; DOI: https://doi.org/10.4178/epih.e2024016

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Abstract Summary PDF Supplementary Material: Abstract
OBJECTIVES
Meta-analysis is a statistical appraisal of the data analytic implications of published articles (Y), estimating parameters including the odds ratio and relative risk. This information is helpful for evaluating the significance of the findings. The Higgins I2 index is often used to measure heterogeneity among studies. The objectives of this article are to amend the Higgins I2 index score in a novel and innovative way and to make it more useful in practice.
METHODS
Heterogeneity among study populations can be affected by many sources, including the sample size and study design. They influence the Cochran Q score and, thus, the Higgins I2 score. In this regard, the I2 score is not an absolute indicator of heterogeneity. Q changes by bound as Y increases unboundedly. An innovative methodology is devised to show the conditional and unconditional probability structures.
RESULTS
Various properties are derived, including showing that a zero correlation between Q and Y does not necessarily mean that they are independent. A new alternative statistic, S2, is derived and applied to mild cognitive impairment and coronavirus disease 2019 vaccination for meta-analysis.
CONCLUSIONS
A hidden shortcoming of the Higgins I2 index is overcome in this article by amending the Higgins I2 score. The usefulness of the proposed methodology is illustrated using 2 examples. The findings have potential health policy implications.; Summary

Key Message
An approach to overcome the hidden shortcomings of Higgens I2 in meta-analysis. The approach has potential health policy implications.

Original Articles

Effect of chemotherapy and radiotherapy on cognitive impairment in colorectal cancer: evidence from Korean National Health Insurance Database Cohort: Kwanghyun Kim, Chang Woo Kim, Aesun Shin, Hyunseok Kang, Sun Jae Jung; Epidemiol Health. 2021;43:e2021093. Published online November 2, 2021; DOI: https://doi.org/10.4178/epih.e2021093

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Abstract Summary PDF Supplementary Material

Abstract

OBJECTIVES
We investigated the risk of chemotherapy-related and radiotherapy-related cognitive impairment in colorectal cancer patients.

METHODS

Medical use data of colorectal cancer patients were obtained from the Korean National Health Insurance Database from 2004 to 2018. We randomly selected 40% of all colorectal cancer patients (n=148,848). Cognitive impairment was defined as having 1 or more International Classification of Diseases, 10th revision diagnostic codes for dementia or mild cognitive impairment. Patients aged 18 years or younger, patients diagnosed with cognitive impairment before colorectal cancer diagnosis (n=8,225), and patients who did not receive primary resection (n=45,320) were excluded. The effects of individual chemotherapy regimens on cognitive impairment were estimated. We additionally estimated the effect of radiotherapy in rectal cancer patients. Time-dependent competing risk Cox regression was conducted to estimate the overall and age-specific hazard ratios (HR) separately for colon and rectal cancer. Landmark analyses with different lag times were conducted as sensitivity analyses.

RESULTS

Chemotherapy did not increase the risk of cognitive impairment in colorectal cancer patients (colon cancer: HR, 0.92; 95% confidence interval [CI], 0.83 to 1.03; rectal cancer: HR, 0.88; 95% CI, 0.75 to 1.04), while radiotherapy was negatively associated with cognitive impairment in rectal cancer patients (HR, 0.01; 95% CI, 0.84 to 0.99). Varying directions of the associations between regimens and cognitive impairment were detected. The adverse effect of certain chemotherapy regimens on cognition was more prominent in older adults.

CONCLUSIONS

Chemotherapy and radiotherapy did not increase the risk of cognitive impairment. Older patients with low cognitive reserve could be affected by the adverse cognitive effects of chemotherapy.

Summary

Korean summary
- 대장암 환자를 대상으로 한 항암화학요법 및 방사선요법은 인지기능저하의 위험을 높이지 않았다 - 일부 항암화학요법의 경우 고령의 대장암 환자에서 인지기능저하의 위험을 증가시킬 수 있다

Key Message
Results from nationwide cohort of Korea showed that chemotherapy and radiotherapy did not increase the risk of cognitive impairment in colorectal cancer patients.

Citations

Citations to this article as recorded by

Research Progress: Exploring the Long-term Survival Status of Colorectal Cancer Survivors
Zhaobei Cai, Qianqian Chen, Enqiang Linghu
Clinical Cancer Investigation Journal.2024; 13(2): 34. CrossRef
Predictors of cognitive impairment in patients undergoing ileostomy for colorectal cancer: a retrospective analysis
Jing Xu, Yuelan Yang, Die Hu
PeerJ.2023; 11: e15405. CrossRef
Soluble HSPG and HS relaying neuroinflammation contribute to behavioral comorbidities associated with cancer located outside the central nervous system
Yue-peng Liu, Yan-jun Yang
Medical Hypotheses.2023; 177: 111113. CrossRef
Chemotherapy-induced functional brain abnormality in colorectal cancer patients: a resting‐state functional magnetic resonance imaging study
Siwen Liu, Yesong Guo, Jie Ni, Na Yin, Chenchen Li, Xuan Pan, Rong Ma, Jianzhong Wu, Shengwei Li, Xiaoyou Li
Frontiers in Oncology.2022;[Epub] CrossRef
Association between multimorbidity status and incident dementia: a prospective cohort study of 245,483 participants
He-Ying Hu, Ya-Ru Zhang, Qiaolifan Aerqin, Ya-Nan Ou, Zuo-Teng Wang, Wei Cheng, Jian-Feng Feng, Lan Tan, Jin-Tai Yu
Translational Psychiatry.2022;[Epub] CrossRef

Self-rated health as a predictor of mortality according to cognitive impairment: findings from the Korean Longitudinal Study of Aging (2006-2016): Goun Park, Wankyo Chung; Epidemiol Health. 2021;43:e2021021. Published online April 7, 2021; DOI: https://doi.org/10.4178/epih.e2021021

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3 Web of Science
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Abstract Summary PDF Supplementary Material

Abstract

OBJECTIVES
Self-rated health is an instrumental variable to assess the overall health status of a population. However, it remains questionable whether it is still useful for cognitively impaired individuals. Therefore, this study aims to analyze whether self-rated health by the cognitively impaired predicts mortality reliably.

METHODS

This study used 7,881 community-dwelling individuals, aged 45 and above, from the Korean Longitudinal Study of Aging (2006-2016). It used the Cox proportional hazard models for analysis. Cognitive status was classified based on the Korean Mini Mental State Examination score and a stratified analysis was used to determine whether the predictability of self-rated health varies according to cognitive status.

RESULTS

For cognitively intact individuals, the adjusted hazard ratios (aHR) of mortality were 2.00 (95% confidence interval [CI], 1.18 to 3.41, model 4) for those with ‘bad’ self-rated health and 2.40 (95% CI, 1.35 to 4.25, model 4) for those with ‘very bad’ self-rated heath, respectively, compared with those with ‘very good’ health. The results remain statistically significant even after adjusting for socio-demographic factors, health status, and health-related behaviors. For cognitively impaired individuals, the aHR of mortality was statistically significant for those with ‘very bad’ self-rated health, compared with those with ‘very good’ health, when socio-demographic factors were accounted for (aHR, 3.03; 95% CI, 1.11 to 8.28, model 2).

CONCLUSIONS

Self-rated health by cognitively impaired individuals remains useful in predicting mortality. It appears to be a valid and reliable health indicator for the rising population with cognitive impairment, especially caused by aging population.

Summary

Korean summary
본 연구는 인지 저하 여부에 따라 주관적 건강의 사망예측력이 달라지는지 확인하기 위해 K-MMSE 로 인지 저하 여부를 나누고 콕스 비례위험모델을 사용하여 분석을 시행하였다. 그 결과, 인지 저하군이 평가한 주관적 건강은 사망을 통계적으로 유의하게 예측하였다. 인구의 고령화로 지역 사회 내에서 인지 저하자가 지속적으로 증가하고 있는 상황에서 주관적 건강은 유효한 사망예측 인자이며 신뢰할 만한 건강지표이다.

Key Message
This study aims to analyze whether self-rated health by the cognitively impaired predicts mortality reliably. We used the Cox proportional hazard models for analysis. Cognitive status was classified based on the K-MMSE score. We found that self-rated health by cognitively impaired individuals remains useful in predicting mortality.

Citations

Citations to this article as recorded by

Factores sociodemográficos y de bienestar mediadores y moderadores de la relación entre la depresión y la demencia
Maria del Pilar Santacruz-Ortega, Bertha Lucia Avendaño, Maria Fernanda Cobo, Silvia Mejia-Arango
Neurología Argentina.2023; 15(3): 149. CrossRef
Impact of urban green space on self-rated health: Evidence from Beijing
Dongsheng Zhan, Qianyun Zhang, Mei-Po Kwan, Jian Liu, Bochuan Zhan, Wenzhong Zhang
Frontiers in Public Health.2022;[Epub] CrossRef
Association of the number of teeth and self-rated mastication with self-rated health in community-dwelling Japanese aged 40 years and older: the Yamagata cohort study
Shigeo Ishikawa, Tsuneo Konta, Shinji Susa, Kenichi Ishizawa, Naohiko Makino, Yoshiyuki Ueno, Naoki Okuyama, Mitsuyoshi Iino
Scientific Reports.2022;[Epub] CrossRef

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