Risk of Non-Hodgkin's Lymphoma in Relation to Tricyclic Antidepressant Use

与三环类抗抑郁药使用相关的非霍奇金淋巴瘤风险

• 批准号: 8192623
• 负责人: Jessica Chubak
• 金额: $ 8万
• 依托单位: KAISER FOUNDATION HEALTH PLAN OF WASHINGTON
• 依托单位国家: 美国
• 财政年份: 2011
• 资助国家: 美国
• 起止时间: 2011-09-01 至 2012-08-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/8192623
• 关键词: 5 year old; AIDS/HIV problem; Accounting; Address; Age; Age-Years; Case-Control Studies; Chronic Lymphocytic Leukemia; Classification; Cohort Studies; Country; Data; Databases; Diagnosis; Disease; Dose; Electronics; Enrollment; Ensure; Exclusion Criteria; Follicular Lymphoma; Genetic; Grant; Health; Healthcare Systems; Heterogeneity; Immune; Incidence; Individual; Length; Lymphoid; Malignant Neoplasms; Matched Case-Control Study; Mature B-Lymphocyte; Morbidity - disease rate; Multiple Myeloma; Non-Hodgkin' s Lymphoma; Pattern; Pharmaceutical Preparations; Pharmacy facility; Plasma Cell Neoplasm; Plasmacytic Leukemia; Population; Population Group; Population-Based Registry; Populations at Risk; Prevalence; Public Health; Race; Recording of previous events; Records; Relative (related person); Relative Risks; Reporting; Research; Risk; Risk Assessment; Risk Factors; Risk-Benefit Assessment; Sample Size; Sampling; Skin Carcinoma; Small-Cell Lymphoma; System; Testing; TimeLine; Tricyclic Antidepressive Agents; United States National Institutes of Health; Washington; Woman; age group; cancer diagnosis; cancer epidemiology; case control; computerized; cost; design; disease classification; follow-up; health care delivery; health record; large cell Diffuse non-Hodgkin' s lymphoma; meetings; member; men; mortality; population based; prevent; response; sex; sound

DESCRIPTION (provided by applicant): The incidence of non-Hodgkin's lymphoma (NHL) has nearly doubled over the past four decades in the US and most westernized countries, and changes in disease reporting and classification and in the prevalence of known risk factors do not account for the entirety of this increase. Two prior studies provided evidence for an association between use of tricyclic antidepressants (TCAs) and the occurrence of NHLs, but they were unable to investigate associations within NHL subtypes, which are known to be etiologically diverse. In response to the National Institutes of Health announcement for small grants in cancer epidemiology, we propose to conduct a case-control study of NHL among members of Group Health (GH), a large integrated healthcare delivery system in western Washington State. Cases will include all GH members with a diagnosis of NHL between 1980-2009, who were e25 years old and had been GH members for e2 years at diagnosis, and who meet the exclusion criteria. Controls will be selected from the defined population of GH members, thus they should be representative of the population that gave rise to cases. They will be matched 8:1 with cases on age (5-year age groups), sex, date of case's diagnosis (the reference date), and length of membership. TCA use will be ascertained using a 30-year automated pharmacy database which contains detailed data on every prescription dispensed at GH, recorded consistently and prospectively throughout the study period and thus prior to reference date and similarly for cases and controls. We will test whether: (1) prior TCA users are at an increased risk of NHL, and (2) whether the association varies by type of NHL. These data will permit a valid assessment of the risk of NHL in relation to the duration, dose, regency, and type of TCA use, both overall and for specific types of NHL. The proposed study has the advantages typical of the case-control design, as it is efficient in terms of both costs and timeline, while also avoiding many of the biases often found in case-control studies. The use of prospectively collected automated data prevents recall bias and information bias, and use of the defined population of GH enrollees ensures that controls are representative of the population at risk of NHL. PUBLIC HEALTH RELEVANCE: Rates of non-Hodgkin's lymphoma (NHL) have nearly doubled over the past four decades in the US, making it the sixth most common cancer in both men and women, and this increase is not entirely explained by known factors. Previous studies suggest that tricyclic antidepressant (TCA) users are at an increased risk of NHL, but they did not examine the risk of specific NHL subtypes in association with TCA use. Because TCAs continue to be widely used, and because of the etiologic heterogeneity across subtypes in this common class of cancers, an assessment of NHL incidence in TCA users represents an important undertaking.

描述（由申请人提供）：在过去的四十年中，非霍奇金淋巴瘤（NHL）的发病率几乎翻了一番，在美国和最西方国家，疾病报告和分类的变化以及已知危险因素的普遍性的变化并未解释这一增加的全部增加。两项先前的研究提供了证据证明使用三环类抗抑郁药（TCA）与NHL的发生之间存在关联，但它们无法研究NHL亚型内的关联，这是病理学上多样的。为了回应美国国家卫生研究院对癌症流行病学中的小额赠款的公告，我们建议在华盛顿州西部的大型综合医疗保健系统中对NHL进行病例对照研究。病例将包括所有具有NHL诊断为1980 - 2009年的GH成员，他们已有E25岁，并且在诊断中曾是GH成员已有E2年的成员，并且符合排除标准。控制措施将从定义的GH成员人口中选择，因此它们应代表引起案件的人口。它们将与年龄（5岁年龄段），性别，病例诊断日期（参考日期）和会员期限的年龄（5岁年龄段）的病例进行匹配。将使用30年自动化药房数据库确定TCA使用情况，该数据库包含有关分配在GH处的每个处方的详细数据，在整个研究期间，在参考日期之前以及相似的病例和对照组都始终如一地记录。我们将测试：（1）先前的TCA用户的NHL风险增加，以及（2）该关联是否随NHL类型而变化。这些数据将允许对NHL的持续时间，剂量，摄政和类型的TCA使用，包括整体和特定类型的NHL的持续时间，剂量，摄政和类型。拟议的研究具有典型的病例对照设计的优势，因为它在成本和时间表方面都是有效的，同时还避免了在病例对照研究中经常发现的许多偏见。前瞻性收集的自动数据的使用阻止了回忆偏见和信息偏见，并且使用定义的GH参与者人群确保控制措施代表了有NHL风险的人群。 公共卫生相关性：在过去的四十年中，非霍奇金淋巴瘤（NHL）的比率几乎翻了一番，这使其成为男性和女性中第六个最常见的癌症，并且这一增加并不能完全通过已知因素来解释。先前的研究表明，三环抗抑郁药（TCA）使用者的NHL风险增加，但他们没有检查与TCA使用有关的特定NHL亚型的风险。由于TCA继续被广泛使用，并且由于这种常见类型的癌症中亚型的病因异质性，因此对TCA用户中NHL发病率的评估是一项重要的事业。