TY - JOUR AB - Objectives: On the basis of current treatment guidelines, we developed and validated a medication-based chronic disease score (medCDS) and tested its association with all-cause mortality of older outpatients.Study Design and Setting: Considering the most prevalent chronic diseases in the elderly German population, we compiled a list of evidence-based medicines used to treat these disorders. Based on this list, a score (medCDS) was developed to predict mortality using data of a large longitudinal cohort of older outpatients (training sample; MultiCare Cohort Study). By assessing receiver-operating characteristics (ROC) curves, the performance of medCDS was then confirmed in independent cohorts (ESTHER, KORA-Age) of community-dwelling older patients and compared with already existing medication-based scores and a score using selected anatomical-therapeutic-chemical (ATC) codes.Results: The final medCDS score had an ROC area under the curve (AUC) of 0.73 (95% CI 0.70-0.76). In the validation cohorts, its ROC AUCs were 0.79 (0.76-0.82, KORA-Age) and 0.74 (0.71-0.78, ESTHER), which were superior to already existing medication-based scores (RxRisk, CDS) and scores based on pharmacological ATC code subgroups (ATC3) or age and sex alone (Age&Sex).Conclusions: A new medCDS, which is based on actual treatment standards, predicts mortality of older outpatients significantly better than already existing scores. (C) 2018 Elsevier Inc. All rights reserved. AU - Quinzler, R.* AU - Freitag, M.H.* AU - Wiese, B.* AU - Beyer, M.* AU - Brenner, H.* AU - Dahlhaus, A.* AU - Döring, A. AU - Freund, T.* AU - Heier, M. AU - Knopf, H.* AU - Luppa, M.* AU - Prokein, J.* AU - Riedel-Heller, S.* AU - Schäfer, I.* AU - Scheidt-Nave, C.* AU - Scherer, M.* AU - Schöttker, B.* AU - Szecsenyi, J.* AU - Thürmann, P.* AU - van den Bussche, H.* AU - Gensichen, J.* AU - Haefeli, W.E.* C1 - 54401 C2 - 45542 CY - 360 Park Ave South, New York, Ny 10010-1710 Usa SP - 112-124 TI - A novel superior medication-based chronic disease score predicted all-cause mortality in independent geriatric cohorts. JO - J. Clin. Epidemiol. VL - 105 PB - Elsevier Science Inc PY - 2019 SN - 0895-4356 ER - TY - JOUR AU - Johnson, S.B.* AU - Lynch, K.F.* AU - Lee, H.-S.* AU - Smith, L.* AU - Baxter, J.* AU - Lernmark, B.* AU - Roth, R. AU - Simell, T.* C1 - 31046 C2 - 34196 CY - New York SP - 609-611 TI - At high risk for early withdrawal: Using a cumulative risk model to increase retention in the first year of the TEDDY study. JO - J. Clin. Epidemiol. VL - 67 IS - 6 PB - Elsevier Science Inc PY - 2014 SN - 0895-4356 ER - TY - JOUR AB - OBJECTIVES: To examine the association between electrocardiographic (ECG) findings and disability status in older adults. STUDY DESIGN AND SETTING: KORA-Age, a population-based cross-sectional study of the MONICA/KORA project, a randomized sample from Southern Germany of people aged 65 years or older. RESULTS: A total of 534 (51.5%) of 1,037 participants were characterized as disabled. Disabled participants were on average 4.5 years older than those who were not disabled. Crude associations of left-axis deviation, ventricular conduction defects, atrial fibrillation, and QT prolongation with disability status were significant (P < 0.05). In models controlled for age and sex, these effects remained constant except for QT prolongation. In the models adjusted for the minimal sufficient adjustment set (consisting of the variables sex, physical activity, age, obesity, diabetes, education, heart diseases, income, lung diseases, and stroke) identified by a directed acyclic graph (DAG), no significant association could be shown. CONCLUSION: Associations between specific ECG findings and disability were found in unadjusted analysis and logistic models adjusted for age and sex. However, when adjusting for other possible confounders identified by the DAG, all these associations were no longer significant. It is important to adequately identify confounding in such settings. AU - Röhrig, N.* AU - Strobl, R.* AU - Müller, M.* AU - Perz, S. AU - Kääb, S.* AU - Martens, E.* AU - Peters, A. AU - Linkohr, B. AU - Grill, E.* C1 - 28246 C2 - 33030 SP - 199-206 TI - Directed acyclic graphs helped to identify confounding in the association of disability and electrocardiographic findings: Results from the KORA-Age study. JO - J. Clin. Epidemiol. VL - 67 IS - 2 PB - Elsevier Science PY - 2014 SN - 0895-4356 ER - TY - JOUR AB - Objective: Crohn's disease is a highly distressful chronic disorder, characterized by frequent relapses. A symptom-based disease activity index was developed for use in epidemiological research. Study Design and Setting: One hundred and six consecutive patients presenting to a tertiary referral hospital in Southern Germany in 2004-2005 participated in a questionnaire-based survey. As a reference standard, disease activity was assessed using a clinical index (Crohn's Disease Activity Index [CDAI], based on symptoms reported to physician, laboratory markers, and physician assessed signs). A linear regression equation was calculated based on the survey data on severity of symptoms (dependent variable: CDAI). Survey index scores (S-CDAI) were then calculated using the estimated coefficients for pain, stools, and general well-being in an independent data set. Results: S-CDAI and CDAI showed moderate agreement (kappa = 0.57 for relapse vs. remission). High activity (high S-CDAI) correlated negatively with high quality of life (disease specific: Short Inflammatory Bowel Disease Quality-of-Life Questionnaire; r = -0.67; generic: Short Form 36 physical summary score, r = -0.47). Test-retest reliability and sensitivity for change were good (intraclass correlation coefficient 0.81). Conclusion: A useful, valid, and reliable disease activity score was developed, which will facilitate meaningful survey research in this chronic disorder. AU - Timmer, A. AU - Kemptner, D.* AU - Takses, A.* AU - Klebl, F.* AU - Jöckel, K.-H.* C1 - 1046 C2 - 26488 SP - 771-778 TI - A survey-based index was validated for measuring disease activity in inflammatory bowel disease: An evaluation study. JO - J. Clin. Epidemiol. VL - 62 IS - 7 PB - Pergamon-Elsevier Science Ltd PY - 2009 SN - 0895-4356 ER - TY - JOUR AU - Meisinger, C. AU - Schuler, A.* AU - Löwel, H. C1 - 1404 C2 - 22244 SP - 989-992 TI - Postal questionnaires identified hospitalizations for self-reported acute myocardial infarction. JO - J. Clin. Epidemiol. VL - 57 PY - 2004 SN - 0895-4356 ER - TY - JOUR AU - Uter, W.* AU - Ludwig, A.* AU - Balda, B.-R.* AU - Schnuch, A.* AU - Pfahlberg, A.* AU - Schäfer, T.* AU - Wichmann, H.-E. AU - Ring, J. C1 - 5160 C2 - 22361 SP - 627-632 TI - The prevalence of contact allergy differed between population-based and clinic-based data. JO - J. Clin. Epidemiol. VL - 57 PY - 2004 SN - 0895-4356 ER - TY - JOUR AU - Gasse, C.* AU - Stieber, J. AU - Döring, A. AU - Keil, U.* AU - Hense, H.-W.* C1 - 21109 C2 - 19142 SP - 695-703 TI - Population trends in antihypertensive drug use: Results from the MONICA Augsburg project 1984 to 1995. JO - J. Clin. Epidemiol. VL - 52 PY - 1999 SN - 0895-4356 ER - TY - JOUR AB - Several authors have proposed alternatives to sensitivity and specificity which they recommend as so-called "chance-corrected" versions of these parameters of diagnostic validity. We argue that these new measures have some undesirable properties in comparison with the established measures and no substantial advantages. In particular, the extension of this concept to chance-corrected ROC curves is shown to be less useful than classical ROC analysis. AU - Holle, R. AU - Windeler, J.* C1 - 24180 C2 - 31458 SP - 117-120 TI - Is there a gain from "chance-corrected" measures of diagnostic validity? JO - J. Clin. Epidemiol. VL - 50 IS - 1 PB - Pergamon-Elsevier Science PY - 1997 SN - 0895-4356 ER - TY - JOUR AB - The objective of this study was to compare psychosocial characteristics of children with asthma and children with bronchial hyperreactivity with those of normal children. A population-based study of 2634 children (mean age, 10 years) was carried out. Pulmonary function tests of children were performed in children before and after cold air hyperventilation challenge to determine bronchial hyperreactivity. Parental assessment of children's behavior was evaluated with 15 questions about school/learning habits, level of activity, communication/affection, and sleeping patterns. A factor analysis was performed and the factor loading adjusted for confounders compared in the different groups. Asthmatic children sleep less well than normal and hyperreactive children (p < 0.001). Unexpectedly, however, all other single items did not differ significantly. As a result of the factorial analysis we obtained two factors. On the first factor, measuring school behavior and learning, there was a small difference between asthmatic and normal children, which could not be found on the second factor indicating activity and communication. We conclude that psychosocial differences of asthmatic children are less remarkable than expected. As a result of the examination of the hyperreactive children it is likely that asthmatic children are influenced more by secondary psychosocial factors than by any primary effect of asthmatic disease. AU - Wjst, M. AU - Roell, G. AU - Dold, S.* AU - Wulff, A. AU - Reitmeir, P. AU - Fritzsch, C.* AU - Seth, V.* AU - Nicolai, T.* AU - von Mutius, E.* AU - Bach, H.* AU - Thiemann, H.H.* C1 - 24206 C2 - 31472 SP - 461-466 TI - Psychosocial characteristics of asthma. JO - J. Clin. Epidemiol. VL - 49 IS - 4 PB - Pergamon-Elsevier Science PY - 1996 SN - 0895-4356 ER - TY - JOUR AB - We investigated the relationship between antihypertensive drug treatment of hypertensives and their mean serum lipid concentrations in population based studies in Germany. Data from three surveys (Luebeck Blood Pressure Study (LBS) of 1984, MONICA Augsburg Survey I of 1984/85, MONICA Augsburg Survey II of 1989/90), obtained on random samples of the population aged 25-64 years, were used for cross-sectional analyses. Moreover, prospective analyses were carried out on participants of the MONICA Augsburg cohort study of 1987/88 (3-year-follow-up of the MONICA Survey I). Blood pressure, non-fasting serum total cholesterol and HDL-cholesterol, and body height and weight were measured under strictly standardized conditions. Interview data were available on medical history including medication use, and on smoking and alcohol consumption. In cross-sectional and prospective analyses treated male and female hypertensives in each population had significantly lower crude mean HDL-C concentrations than untreated hypertensives, borderliners, or normotensives. Differences in mean HDL-C between untreated and treated hypertensives were attenuated but still significant after control of confounders and ranged from 1.8 to 6.1 mg/dl (i.e. in relative terms, -3.4 to -12.9%) in men and from 3.6 to 9.4 mg/dl (-5.7 to -14.9%) in women. By contrast, crude and multivariate associations of antihypertensive treatment with non-HDL-C (total minus HDL-C) levels were inconsistent and not significant. The inverse association of drug therapy with HDL-C was confirmed by prospective analyses in the MONICA cohort study supporting a causal relationship. Treatment patterns in a community (prevalence of prescribed drug classes) correlated with the magnitude and significance of HDL-C effects. Despite the diversity of brands and substances used, treated hypertensives consistently had the lowest HDL-C levels of all blood pressure strata in a population. We assume this to indicate permanent, common and rather substantial HDL-C effects of present antihypertensive treatment patterns. Mass treatment of hypertension may suffer sizable reductions in the overall benefit as a consequence of the observed associations. We suggest that from a public health point of view this aspect should be given more attention. AU - Hense, H.W. AU - Döring, A. AU - Stieber, J. AU - Keil, U. C1 - 40638 C2 - 38741 SP - 1423-1430 TI - The association of antihypertensive treatment patterns and adverse lipid effects in population-based studies. JO - J. Clin. Epidemiol. VL - 45 IS - 12 PY - 1992 SN - 0895-4356 ER - TY - JOUR AB - The role of socioeconomic factors in the survival of patients with colorectal cancer was assessed using data from the cancer registry of Saarland/Germany, and census information. Among 2627 patients with colorectal cancer diagnosed from 1974 to 1983, patients from communities in the lowest of three categories defined by socioeconomic factors showed significantly lower survival rates than patients from other communities. After adjustment for potential biological and other sociogeographic risk factors in multivariate analyses, relative hazard of death associated with low socio-economic status (SES) compared with high SES was estimated to be 1.22 (95% CI: 1.01 - 1.47) for colon cancer and 1.32 (95% CI: 1.09 - 1.60) for rectum cancer. The results are in agreement with earlier studies from North America, Hawaii and Sweden and indicate that an attempt to improve health care services and acceptance and possibly other relevant general living conditions in socioeconomically less privileged communities may be a rewarding approach towards increasing survival of patients with colorectal cancer. AU - Brenner, H.H.* AU - Mielck, A. AU - Klein, R.F.* AU - Ziegler, H.D.* C1 - 40708 C2 - 40214 SP - 807-815 TI - The role of socioeconomic factors in the survival of patients with colorectal cancer in Saarland/Germany. JO - J. Clin. Epidemiol. VL - 44 IS - 8 PY - 1991 SN - 0895-4356 ER - TY - JOUR AU - Löwel, H. AU - Lewis, M. AU - Hörmann, A. AU - Keil, U. C1 - 18893 C2 - 11251 SP - 249-260 TI - Case Finding, Data Quality Aspects and Comparability of Myocardial Infarction Registers: Results of a South German Register Study. JO - J. Clin. Epidemiol. VL - 44 PY - 1991 SN - 0895-4356 ER - TY - JOUR AB - The population-based Augsburg Coronary Event Register (330,000 residents, age 25-74 years) has registered a total of 1012 cases of acute myocardial infarction (AMI) in 1985 and 1021 AMI in 1986 and categorized them on the basis of the current WHO diagnostic algorithm for AMI. The register is designed for longitudinal comparisons of annual AMI risk (incidence, attack rate, death rate), and the risk to the AMI patients themselves (28-day case fatality). The methodology and specific issues encountered during registration and data evaluation are described. With an estimated 95% completeness of case finding, the quality control data review which the register conducts annually shows a consistency of specific data structures which indicate stable case finding and validation procedures. However, local conditions which affect case finding and data completeness per case are responsible for the creation of subsets of AMI which are in turn distinguished by differences in diagnostic category structures. With regard to the study objectives, the differences among subsets appear to have the least effect on rate calculations if DEFINITE and POSSIBLE AMI are combined. The implications of methodological variations and subset differences within and across registers on annual rate calculations and result comparisons are discussed. AU - Löwel, H. AU - Lewis, M.A. AU - Hörmann, A. AU - Keil, U. C1 - 33625 C2 - 40246 SP - 249-260 TI - Case finding, data quality aspects and comparability of myocardial infarction registers: Results of a south German register study. JO - J. Clin. Epidemiol. VL - 44 IS - 3 PY - 1991 SN - 0895-4356 ER - TY - JOUR AU - Tunstall-Pedoe, H. C1 - 17629 C2 - 10534 SP - 105-114 TI - The World Health Organization MONICA Project (Monitoring Trends and Determinants in Cardiovascular Disease): a Major International Collaboration. JO - J. Clin. Epidemiol. VL - 41 PY - 1988 SN - 0895-4356 ER -