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）：在过去四十年中，美国和大多数西方化国家的非霍奇金淋巴瘤 (NHL) 发病率几乎翻了一番，并且疾病报告和分类以及已知危险因素的流行率并未发生变化。占这一增长的全部。先前的两项研究提供了三环类抗抑郁药 (TCA) 的使用与 NHL 发生之间关联的证据，但他们无法调查 NHL 亚型内的关联，而已知 NHL 亚型的病因多种多样。为了响应美国国立卫生研究院 (National Institutes of Health) 宣布为癌症流行病学提供小额资助，我们提议在 Group Health (GH)（华盛顿州西部大型综合医疗保健服务系统）的成员中开展 NHL 病例对照研究。病例将包括 1980 年至 2009 年间诊断为 NHL 的所有 GH 成员，年龄为 e25 岁，诊断时已成为 GH 成员 e2 年，并且符合排除标准。对照将从 GH 成员的定义人群中选择，因此他们应该代表引起病例的人群。他们将按照 8:1 的比例与病例进行年龄（5 岁年龄组）、性别、病例诊断日期（参考日期）和会员期限的匹配。 TCA 的使用将使用 30 年的自动化药房数据库来确定，该数据库包含 GH 开出的每张处方的详细数据，在整个研究期间一致且前瞻性地记录，因此在参考日期之前，病例和对照也类似。我们将测试：(1) 之前使用过 TCA 的人患 NHL 的风险是否增加，以及 (2) 这种关联是否因 NHL 类型而异。这些数据将允许对与 TCA 使用时间、剂量、摄食期和类型相关的 NHL 风险进行有效评估，包括总体风险和特定类型的 NHL 风险。拟议的研究具有病例对照设计的典型优点，因为它在成本和时间安排方面都很有效，同时还避免了病例对照研究中常见的许多偏差。使用前瞻性收集的自动化数据可以防止回忆偏差和信息偏差，并且使用确定的 GH 参与者群体可以确保对照能够代表 NHL 风险群体。 公共健康相关性：在过去四十年中，美国非霍奇金淋巴瘤 (NHL) 的发病率几乎翻了一番，使其成为男性和女性中第六大常见癌症，而且这种增长不能完全用已知因素来解释。先前的研究表明，三环类抗抑郁药 (TCA) 使用者患 NHL 的风险增加，但他们没有检查特定 NHL 亚型与 TCA 使用相关的风险。由于 TCA 继续被广泛使用，并且由于这类常见癌症中不同亚型的病因异质性，因此评估 TCA 用户中的 NHL 发病率是一项重要的任务。