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class: center, middle, inverse, title-slide .title[ # 공통데이터모델(CDM) 실습 ] .subtitle[ ## 고려의대 예방의학교실 ] .author[ ### 김진섭; <a href="https://github.com/jinseob2kim"><span><i class="fab fa-github faa-float animated "></i>jinseob2kim</span></a> ] .institute[ ### 차라투(주) ] .date[ ### 2022-06-02 ] --- layout: true <div class="my-footer"><span><a href="https://www.zarathu.com">Zarathu Co.,Ltd</a>                             <a href="https://github.com/jinseob2kim">김진섭</a></span></div> --- # Executive summary .large[ - Concept set: 약물, 시술, 질병 등 개념 정의 - Cohort definition: Concept set 이용 Target/Comparator/Outcome 코호트 설정 - Analysis: 관찰시간, PS매칭여부, 통계모델 설정 - Meta analysis: Feedernet 다기관분석 합침 ] --- class: center, middle # 코호트 디자인 --- # The new-user cohort design  --- # Main design choices | Choice | Description | |:----------------- |:-------------------------------------------------------- | | Target cohort | A cohort representing the target treatment | | Comparator cohort | A cohort representing the comparator treatment | | Outcome cohort | A cohort representing the outcome of interest | | Time-at-risk | At what time (often relative to the target and comparator cohort start and end dates) do we consider the risk of the outcome? | | Model | The model used to estimate the effect while adjusting for differences between the target and comparator | --- # 실습: 고혈압 약제 비교 Table: Main design choices for our comparative cohort study. | Choice | Value | |:----------------- |:-------------------------------------------------------- | | Target cohort | New users of ACE inhibitors as first-line monotherapy for hypertension. | | Comparator cohort | New users of thiazides or thiazide-like diuretics as first-line monotherapy for hypertension. | | Outcome cohort | Angioedema or acute myocardial infarction. | | Time-at-risk | Starting the day after treatment initiation, stopping when exposure stops. | | Model | Cox proportional hazards model using variable-ratio matching. | --- # Concept: ACEI | Concept Id | Concept Name | Excluded | Descendants | Mapped | | ---------- |:------------ | -------- | ----------- | ------ | | 1308216 | Lisinopril | NO | YES | NO | | 1310756 | moexipril | NO | YES | NO | | 1331235 | quinapril | NO | YES | NO | | 1334456 | Ramipril | NO | YES | NO | | 1335471 | benazepril | NO | YES | NO | | 1340128 | Captopril | NO | YES | NO | | 1341927 | Enalapril | NO | YES | NO | | 1342439 | trandolapril | NO | YES | NO | | 1363749 | Fosinopril | NO | YES | NO | | 1373225 | Perindopril | NO | YES | NO | --- # Concept: Thiazide or thiazide-like diuretic | Concept Id | Concept Name | Excluded | Descendants | Mapped | | ---------- |:------------ | -------- | ----------- | ------ | | 907013 | Metolazone | NO | YES | NO | | 974166 | Hydrochlorothiazide | NO | YES | NO | | 978555 | Indapamide | NO | YES | NO | | 1395058 | Chlorthalidone | NO | YES | NO | --- # Concept: outcome - Angioedema | Concept Id | Concept Name | Excluded | Descendants | Mapped | | ---------- |:------------ | -------- | ----------- | ------ | | 432791 | Angioedema | NO | YES | NO | - AMI with Inpatient or ER visit | Concept Id | Concept Name | Excluded | Descendants | Mapped | | ---------- |:------------ | -------- | ----------- | ------ | | 314666 | Old myocardial infarction | YES | YES | NO | | 4329847 | Myocardial infarction | NO | YES | NO | | Concept Id | Concept Name | Excluded | Descendants | Mapped | | ---------- |:------------ | -------- | ----------- | ------ | | 262 | Emergency Room and Inpatient Visit | NO | YES | NO | | 9201 | Inpatient Visit | NO | YES | NO | | 9203 | Emergency Room Visit | NO | YES | NO | --- # Cohort: New ACEI mono <center> <img src="https://ohdsi.github.io/TheBookOfOhdsi/images/Cohorts/CohortPractice.png" width=100%></a> </center> --- <center> <img src="acei.png" width=100%></a> </center> https://atlas-demo.ohdsi.org/#/cohortdefinition/1775515 --- # New, continuous 365 <center> <img src="https://ohdsi.github.io/TheBookOfOhdsi/images/Cohorts/EarliestEventExplained.png" width=70%></a> </center> --- # Concept for other criteria Table: Hypertensive disorder | Concept Id | Concept Name | Excluded | Descendants | Mapped | | ---------- |:------------ | -------- | ----------- | ------ | | 316866 | Hypertensive disorder | NO | YES | NO | Table: Hypertension drugs | Concept Id | Concept Name | Excluded | Descendants | Mapped | | ---------- |:------------ | -------- | ----------- | ------ | | 904542 | Triamterene | NO | YES | NO | | 907013 | Metolazone | NO | YES | NO | | 932745 | Bumetanide | NO | YES | NO | | 942350 | torsemide | NO | YES | NO | | 956874 | Furosemide | NO | YES | NO | | 970250 | Spironolactone | NO | YES | NO | | 974166 | Hydrochlorothiazide | NO | YES | NO | | 978555 | Indapamide | NO | YES | NO | | 991382 | Amiloride | NO | YES | NO | | 1305447 | Methyldopa | NO | YES | NO | | 1307046 | Metoprolol | NO | YES | NO | | 1307863 | Verapamil | NO | YES | NO | | 1308216 | Lisinopril | NO | YES | NO | | 1308842 | valsartan | NO | YES | NO | | 1309068 | Minoxidil | NO | YES | NO | | 1309799 | eplerenone | NO | YES | NO | | 1310756 | moexipril | NO | YES | NO | | 1313200 | Nadolol | NO | YES | NO | | 1314002 | Atenolol | NO | YES | NO | | 1314577 | nebivolol | NO | YES | NO | | 1317640 | telmisartan | NO | YES | NO | | 1317967 | aliskiren | NO | YES | NO | | 1318137 | Nicardipine | NO | YES | NO | | 1318853 | Nifedipine | NO | YES | NO | | 1319880 | Nisoldipine | NO | YES | NO | | 1319998 | Acebutolol | NO | YES | NO | | 1322081 | Betaxolol | NO | YES | NO | | 1326012 | Isradipine | NO | YES | NO | | 1327978 | Penbutolol | NO | YES | NO | | 1328165 | Diltiazem | NO | YES | NO | | 1331235 | quinapril | NO | YES | NO | | 1332418 | Amlodipine | NO | YES | NO | | 1334456 | Ramipril | NO | YES | NO | | 1335471 | benazepril | NO | YES | NO | | 1338005 | Bisoprolol | NO | YES | NO | | 1340128 | Captopril | NO | YES | NO | | 1341238 | Terazosin | NO | YES | NO | | 1341927 | Enalapril | NO | YES | NO | | 1342439 | trandolapril | NO | YES | NO | | 1344965 | Guanfacine | NO | YES | NO | | 1345858 | Pindolol | NO | YES | NO | | 1346686 | eprosartan | NO | YES | NO | | 1346823 | carvedilol | NO | YES | NO | | 1347384 | irbesartan | NO | YES | NO | | 1350489 | Prazosin | NO | YES | NO | | 1351557 | candesartan | NO | YES | NO | | 1353766 | Propranolol | NO | YES | NO | | 1353776 | Felodipine | NO | YES | NO | | 1363053 | Doxazosin | NO | YES | NO | | 1363749 | Fosinopril | NO | YES | NO | | 1367500 | Losartan | NO | YES | NO | | 1373225 | Perindopril | NO | YES | NO | | 1373928 | Hydralazine | NO | YES | NO | | 1386957 | Labetalol | NO | YES | NO | | 1395058 | Chlorthalidone | NO | YES | NO | | 1398937 | Clonidine | NO | YES | NO | | 40226742 | olmesartan | NO | YES | NO | | 40235485 | azilsartan | NO | YES | NO | --- # Cohort Exit Criteria <center> <img src="https://ohdsi.github.io/TheBookOfOhdsi/images/Cohorts/EarliestEventExplained.png" width=70%></a> </center> 복용기간 안중요하다면 크게 신경쓸 필요 없음. --- # Comparator: New Thiazide <center> <img src="aaa.png" width=100%></a> </center> https://atlas-demo.ohdsi.org/#/cohortdefinition/1770676 --- # Outcome: Angioedema <center> <img src="angioedema.png" width=100%></a> </center> https://atlas-demo.ohdsi.org/#/cohortdefinition/1770673 --- # Outcome: AMI <center> <img src="ami.png" width=100%></a> </center> https://atlas-demo.ohdsi.org/#/cohortdefinition/1770674 --- # Outcome: Negative control .large[ - 의미없으리라 예상되는 outcome - 관심없어도 최소 1개는 넣어야 실행됨 - Cohort 필요없고 Concept만 필요. https://atlas-demo.ohdsi.org/#/conceptset/1866136/expression ] --- class: center, middle # 분석 디자인 --- # Study population <center> <img src="https://ohdsi.github.io/TheBookOfOhdsi/images/PopulationLevelEstimation/studyPopulation.png" width=70%></a> </center> --- # Covariate .large[ Propensity score 계산때 광범위한 공변량 이용 - 따라서 제외할 공변량 반드시 정의해야함. 특히 Target/Comparator 코호트 내용은 반드시 제외. 광범위 공변량 싫다면 쓸 공변량만 넣을 수도 ] <center> <img src="https://ohdsi.github.io/TheBookOfOhdsi/images/PopulationLevelEstimation/covariateSettings.png" width=70%></a> </center> --- # Concept to exclude .large[ 코호트 디자인때 설정하면 모든 분석에 적용 ] <center> <img src="exclude.png" width=100%></a> </center> --- # Time at risk .large[ 보통 Cohort start 1일 후부터 살펴봄 ] <center> <img src="https://ohdsi.github.io/TheBookOfOhdsi/images/PopulationLevelEstimation/timeAtRisk.png" width=100%></a> </center> --- # PS adj .large[ No matching, matching, stratification(N 손실없음) 중 선택 ] <center> <img src="https://ohdsi.github.io/TheBookOfOhdsi/images/PopulationLevelEstimation/psSettings.png" width=70%></a> </center> --- # Outcome model .large[ Cox, logistic ] <center> <img src="https://ohdsi.github.io/TheBookOfOhdsi/images/PopulationLevelEstimation/outcomeModelSettings.png" width=70%></a> </center> --- class: center, middle # Evaluation Settings --- # Negative Control .large[ Negative control concept 를 어떻게 코호트로 만들것인가? ] <center> <img src="https://ohdsi.github.io/TheBookOfOhdsi/images/PopulationLevelEstimation/ncSettings.png" width=70%></a> </center> Postivie Control은 시뮬레이션용. 일단 무시. --- # Feedernet .large[ - My project -> 프로젝트 생성 -> Analysis탭 -> New analysis - Import from ATLAS 누르고 분석저장한 ATALS로 들어가기 - 저장한 분석 클릭 - Execute 누르고 분석할 병원 복수 선택 ] --- # Meta analysis .large[ - https://openstat.ai/ 의 meta-analysis 선택: HR, 95%CI 직접 입력 - 차라투 의뢰.. ] <center> <img src="meta.png" width=70%></a> </center> --- # Executive summary .large[ - Concept set: 약물, 시술, 질병 등 개념 정의 - Cohort definition: Concept set 이용 Target/Comparator/Outcome 코호트 설정 - Analysis: 관찰시간, PS매칭여부, 통계모델 설정 - Meta analysis: Feedernet 다기관분석 합침 ] --- class: center, middle # END