加权累积暴露模型评估生殖因素与女性未来心血管疾病之间的关系

IF 2.7 3区 医学 Q2 OBSTETRICS & GYNECOLOGY
Natalie Dayan, Marie-Eve Beauchamp, Melia Alcantara, Gabriel D Shapiro, Michal Abrahamowicz
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引用次数: 0

摘要

背景:生殖或妊娠事件的发生,如严重孕产妇发病率(SMM),可能揭示慢性疾病和过早死亡的易感性。然而,大多数研究都没有考虑到这些暴露的时间、严重程度或复发。目的:我们建议使用加权累积暴露(WCE)建模方法来灵活描述怀孕妇女纵向队列中生殖事件与长期健康结果之间的关系。方法:WCE建模方法的应用分三步完成。首先,根据每个生殖风险因素与给定健康结果的关联,从多变量Cox比例风险模型估计相对权重。然后,构建纵向数据集,定期(每3个月)记录所有生殖预测因素,从队列中每个妇女第一次分娩后42天开始,到结果或审查事件结束。研究人员将一个新的多变量Cox模型应用于该纵向数据集,该模型结合了时变wce衍生的生殖风险评分以及简单的时变生殖和非生殖预测因子。最后,计算了与不同生殖事件暴露史相关的调整后的基于wce的危险比(HR)。结果:在2008-2021年加拿大(不包括魁北克)1,992,972名新生儿的队列中,纵向数据集中的平均(SD)随访时间为7.3±3.8年,我们建议使用WCE方法预测诸如过早心血管疾病的结局(观察到16,846例心血管住院,或每1000人年1.19例)。结论:使用灵活的WCE模型来量化妊娠事件(如SMM)的风险,并根据生殖和非生殖性心血管疾病风险因素进行调整,将解释这些事件发生的时间和严重程度的变化,并将捕获其在女性生殖轨迹中的累积效应。这种方法可以完善病因关联的估计,并提供新的临床预测模型,有可能根据特定妇女独特的生殖史预测产后长期健康结果。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
Weighted Cumulative Exposure Modelling to Assess the Association Between Reproductive Factors and Future Cardiovascular Disease in Women.

Background: The occurrence of reproductive or pregnancy events, such as severe maternal morbidity (SMM), may reveal a predisposition to chronic disease and premature mortality. However, most studies have examined these exposures without considering their timing, severity, or recurrence.

Objectives: We propose using a weighted cumulative exposure (WCE) modelling approach to flexibly describe the relationship between reproductive events and longer-term health outcomes in a longitudinal cohort of pregnant women.

Methods: Application of the WCE modelling approach is accomplished in three steps. First, relative weights are estimated from a multivariable Cox proportional hazards model corresponding to the association of each reproductive risk factor with a given health outcome. Then, a longitudinal dataset is constructed in which all reproductive predictors are recorded at regular intervals (every 3 months), beginning 42 days after each woman's first birth in the cohort and ending at an outcome or censoring event. A new multivariable Cox model applied to this longitudinal dataset, incorporating time-varying WCE-derived reproductive risk scores along with simple time-varying reproductive and non-reproductive predictors, is estimated. Finally, adjusted WCE-based hazard ratios (HR) associated with different reproductive event exposure histories are calculated.

Results: In the cohort of 1,992,972 births in Canada (excluding Quebec), 2008-2021, with mean (SD) follow-up time in the longitudinal dataset of 7.3 ± 3.8 years, we propose to use the WCE approach to predict outcomes such as premature cardiovascular disease (16,846 cardiovascular hospitalisations observed, or 1.19 per 1000 person-years).

Conclusions: Use of flexible WCE modelling to quantify risks of pregnancy events such as SMM, adjusted for reproductive and non-reproductive CVD risk factors, will account for variation in timing and severity of these events and will capture their cumulative effects across a woman's reproductive trajectory. This approach can refine estimates of etiologic associations and inform novel clinical prediction models with the potential to predict postpartum long-term health outcomes for a given woman based on her unique reproductive history.

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来源期刊
CiteScore
5.40
自引率
7.10%
发文量
84
审稿时长
1 months
期刊介绍: Paediatric and Perinatal Epidemiology crosses the boundaries between the epidemiologist and the paediatrician, obstetrician or specialist in child health, ensuring that important paediatric and perinatal studies reach those clinicians for whom the results are especially relevant. In addition to original research articles, the Journal also includes commentaries, book reviews and annotations.
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