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dc.contributor.authorZhao, Yuejen
dc.contributor.authorJeyaraman, Kanakamani
dc.contributor.authorBurgess, Paul
dc.contributor.authorConnors, Christine
dc.contributor.authorGuthridge, Steven
dc.contributor.authorMaple-Brown, Louise
dc.contributor.authorFalhammar, Henrik
dc.date2020
dc.date.accessioned2020-01-07T03:32:25Z-
dc.date.available2020-01-07T03:32:25Z-
dc.date.issued2020-01-02
dc.identifier.citationBMJ open 2020-01-02; 10(1): e030034
dc.identifier.urihttps://hdl.handle.net/10137/7987-
dc.description.abstractTo evaluate the benefit and risk of low-dose acetylsalicylic acid (aspirin) in patients from remote Aboriginal communities in the Northern Territory, Australia. Retrospective cohort study using primary care and hospital data routinely used for healthcare. Aspirin users and non-users were compared before and after controlling confounders by matching. Marginal structural models (MSM) were applied to ascertain the benefit and risk. The benefit and harm of aspirin were investigated in patients aged ≥18 years from 54 remote Aboriginal communities. None had a previous cardiovascular event or major bleeds. Patients on anticoagulants or other antiplatelets were excluded. Aspirin at a dose of 75-162 mg/day. Endpoints were all-cause, cardiovascular mortality and incidences of cardiovascular events and major bleeds. 8167 predominantly Aboriginal adults were included and followed between July 2009 and June 2017 (aspirin users n=1865, non-users n=6302, mean follow-up 4 years with hospitalisations 6.4 per person). Univariate analysis found material differences in demographics, prevalence of chronic diseases and outcome measures between aspirin users and non-users before matching. After matching, aspirin was significantly associated with reduced all-cause mortality (HR=0.45: 95% CI 0.34 to 0.60; p<0.001), but not bleeding (HR=1.13: 95% CI 0.39 to 3.26; p=0.820). After using MSMs to eliminate the effects of confounders, loss of follow-up and time dependency of treatment, aspirin was associated with reduced all-cause mortality (HR=0.60: 95% CI 0.47 to 0.76; p<0.001), independent of age (HR=1.06; p<0.001), presence of diabetes (HR=1.42; p<0.001), hypertension (HR=1.61; p<0.001) and alcohol abuse (HR=1.81; p<0.001). No association between aspirin and major bleeding was found (HR=1.14: 95% CI 0.48 to 2.73; p=0.765). Sensitivity analysis suggested these findings were unlikely to have been the result of unmeasured confounding. Aspirin was associated with reduced all-cause mortality. Bleeding risk was less compared with survival benefits. Aspirin should be considered for primary prevention in Aboriginal people with high cardiovascular risk.
dc.description.provenanceMade available in DSpace on 2020-01-07T03:32:25Z (GMT). No. of bitstreams: 0 Previous issue date: 2020-01-02en
dc.language.isoeng
dc.subjectacetylsalicylic acid
dc.subjectcoarsened exact matching
dc.subjectmarginal structural models
dc.subjectpropensity score matching
dc.subjectrisk-benefit assessment
dc.titleAll-cause mortality following low-dose aspirin treatment for patients with high cardiovascular risk in remote Australian Aboriginal communities: an observational study.
dc.typeJournal Article
dc.identifier.journaltitleBMJ open
dc.identifier.doi10.1136/bmjopen-2019-030034
dc.identifier.pubmedidhttps://www.ezpdhcs.nt.gov.au/login?url=https://www.ncbi.nlm.nih.gov/pubmed/31900264
dc.identifier.orcidhttp://orcid.org/0000-0002-5622-6987
dc.identifier.affiliationHealth Gains Planning, Department of Health, Darwin, Northern Territory, Australia..
dc.identifier.affiliationDepartment of Endocrinology, Royal Darwin Hospital, Darwin, Northern Territory, Australia..
dc.identifier.affiliationNT Medical School, Flinders University, Darwin, Northern Territory, Australia..
dc.identifier.affiliationTop End Health Services, NT Department of Health, Darwin, Northern Territory, Australia..
dc.identifier.affiliationMenzies School of Health Research, Darwin, Northern Territory, Australia..
dc.identifier.affiliationDepartment of Endocrinology, Royal Darwin Hospital, Darwin, Northern Territory, Australia.. Menzies School of Health Research, Darwin, Northern Territory, Australia..
dc.identifier.affiliationDepartment of Endocrinology, Royal Darwin Hospital, Darwin, Northern Territory, Australia henrik.falhammar@ki.se.. Department of Molecular Medicine and Surgery, Karolinska Institutet, Stockholm, Sweden..
dc.identifier.pubmedurihttps://www.ezpdhcs.nt.gov.au/login?url=https://www.ncbi.nlm.nih.gov/pubmed/31900264
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