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40年里，非霍奇金淋巴瘤（NHL）的发病率在美国和大多数西方化国家几乎翻了一番，疾病报告和分类的变化以及已知危险因素的流行并不能解释这一增长的全部原因。先前的两项研究为三环抗抑郁药（TCAs）的使用与NHL的发生之间的关联提供了证据，但它们无法调查NHL亚型之间的关联，这些亚型在病因上是多样的。为了响应美国国立卫生研究院关于癌症流行病学小额资助的公告，我们建议在华盛顿州西部一个大型综合医疗服务系统——团体健康（GH）的成员中开展一项NHL病例对照研究。病例将包括1980-2009年间诊断为NHL的所有GH成员，年龄为25岁，诊断时已成为GH成员2年，符合排除标准。对照将从确定的GH成员人群中选择，因此他们应该代表产生病例的人群。他们将按年龄（5岁年龄组）、性别、病例诊断日期（参考日期）和会籍时间按8:1进行匹配。将使用一个30年的自动化药房数据库来确定TCA的使用情况，该数据库包含在GH分配的每个处方的详细数据，在整个研究期间（因此在参考日期之前）以及病例和对照的一致性和前瞻性记录。我们将测试：(1)以前的TCA使用者患NHL的风险是否增加，(2)这种关联是否因NHL类型而异。这些数据将允许有效评估NHL风险与TCA使用的持续时间、剂量、摄取量和类型的关系，包括总体和特定类型的NHL。拟议的研究具有病例对照设计的典型优势，因为它在成本和时间方面都是有效的，同时也避免了病例对照研究中经常发现的许多偏差。使用前瞻性收集的自动数据可以防止回忆偏差和信息偏差，并且使用定义的生长激素入组人群确保对照是NHL风险人群的代表。