Association between cancer and dementia risk in the UK Biobank: evidence of diagnostic bias.
Association between cancer and dementia risk in the UK Biobank: evidence of diagnostic bias.
复制标题
英国生物银行癌症与痴呆风险之间的关联：诊断偏倚的证据。
DOI：
10.1007/s10654-023-01036-x
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发表时间：
2023
影响因子：
13.6
通讯作者：
Glymour,MMaria
中科院分区：
文献类型：
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作者：
Wang,Jingxuan;Buto,Peter;Ackley,SarahF;Kobayashi,LindsayC;Graff,RebeccaE;Zimmerman,ScottC;Hayes-Larson,Eleanor;Mayeda,ElizabethRose;Asiimwe,StephenB;Calmasini,Camilla;Glymour,MMaria
流行病学研究发现癌症和痴呆症之间存在负相关。潜在的方法学偏差已经被假定，但还没有研究系统地调查单个数据集中每个偏差来源的可能性。我们使用英国生物库，使用不同的分析规范来比较癌症和痴呆症相关性的估计，这些分析规范旨在按顺序处理多个偏差来源，包括竞争死亡风险、选择性生存、混淆偏差和诊断偏差。我们包括140,959名英国生物库参与者，年龄为 ≥ 55岁，注册前没有痴呆症，并有相关的初级保健数据。我们使用癌症登记数据来识别在英国生物库注册之前流行的癌症病例和注册后被诊断为癌症的事件。我们使用COX模型来评估癌症流行和发病与全因痴呆症、阿尔茨海默病(AD)和血管性痴呆的关系。我们使用时变模型来评估诊断偏差。在12.3年的中位数随访中，3310例痴呆症患者被诊断出来。全部位癌症与全因痴呆发病率呈正相关(危险比[HR] = 1.14，95%CI：1.0 2~1.2 9)，而患癌与全因痴呆发病率无关(HR = 1.0 4，95%CI：0.92~1.17)。血管性痴呆症的结果与此类似。AD与癌症的流行或偶发无关。在癌症诊断后的第一年，痴呆症的诊断率大幅上升(HR = 1.83，95%CI：1.42-2.36)，此后这种联系减弱到零，表明诊断存在偏差。在癌症诊断后，医疗保健利用或诊断或治疗的认知后果可能会增加接受痴呆症诊断的机会，从而在基于电子健康记录的研究中造成潜在的诊断偏差。
Epidemiological studies have identified an inverse association between cancer and dementia. Underlying methodological biases have been postulated, yet no studies have systematically investigated the potential for each source of bias within a single dataset. We used the UK Biobank to compare estimates for the cancer-dementia association using different analytical specifications designed to sequentially address multiple sources of bias, including competing risk of death, selective survival, confounding bias, and diagnostic bias. We included 140,959 UK Biobank participants aged ≥ 55 without dementia before enrollment and with linked primary care data. We used cancer registry data to identify cancer cases prevalent before UK Biobank enrollment and incident cancer diagnosed after enrollment. We used Cox models to evaluate associations of prevalent and incident cancer with all-cause dementia, Alzheimer’s disease (AD), and vascular dementia. We used time-varying models to evaluate diagnostic bias. Over a median follow-up of 12.3 years, 3,310 dementia cases were diagnosed. All-site incident cancer was positively associated with all-cause dementia incidence (hazard ratio [HR] = 1.14, 95% CI: 1.02–1.29), but prevalent cancer was not (HR = 1.04, 95% CI: 0.92–1.17). Results were similar for vascular dementia. AD was not associated with prevalent or incident cancer. Dementia diagnosis was substantially elevated in the first year after cancer diagnosis (HR = 1.83, 95% CI: 1.42–2.36), after which the association attenuated to null, suggesting diagnostic bias. Following a cancer diagnosis, health care utilization or cognitive consequences of diagnosis or treatment may increase chance of receiving a dementia diagnosis, creating potential diagnostic bias in electronic health records-based studies.