Critical appraisal:Corley DA, Kubo A, Levin TR, Block G, Habel L, Rumore G, et al 2009 2

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Critical Appraisal

Article being appraised

Corley DA, Kubo A, Levin TR, Block G, Habel L, Rumore G, et al. Race, ethnicity, sex and temporal differences in Barrett's oesophagus diagnosis: a large community-based study, 1994-2006. Gut 2009 Feb;58(2):182-8 Abstract available at http://www.ncbi.nlm.nih.gov/pubmed/18978173.


Applicable clinical question

Key Facts

Study Design

cohort study, risk factors

Number of Patients:

4205


Includes an economic evaluation

no

Evidence ratings

Level of evidence

III-2

Risk of bias
High risk of bias Comments: Record linkage study (retrospective cohort design) identifying factors associated with Barrett's oesophagus in a US health maintenance organisation. While the overall methods and approach are high-quality, there remains an unquantified risk of bias from the underlying selection factors that promote the use of endoscopy.

Risk of bias assessment: cohort study (risk factors)

Bias in selection of participants into study
Selection of the exposed and non-exposed cohorts
Drawn from the same population (low risk)
Bias due to error in exposure measurement
Measurement of exposure
Objective measurements from pre-existing records or <img alt="File:Jutta's info icon.png" src="/australiawiki_test/images/d/d9/Jutta%27s_info_icon.png" width="16" height="16"> baseline (Existing at or before baseline, where baseline is the time at which a participant is recorded to have entered the cohort or, if obtained after baseline, before onset of symptoms of the outcome or any likely effect of the developing outcome on the exposure) physical or biological assessment blind to outcome status (low risk)
Bias due to error in outcome measurement
Measurement of outcome
Outcome measurement unlikely to be influenced by exposure (low risk)
Was outcome of interest absent at the time to which the exposure refers?
Yes (low risk)
Was follow-up long enough for outcome to occur as a consequence of measured exposure? (Requires prior specification of a sufficient follow-up period)
Yes (low risk)
Bias due to non-participation
Participation rate in cohort
Participation rate in exposed cohort ≤10 percentage points different from non-exposed cohort OR exposed and non-exposed are from the same cohort (low risk)
Bias due to missing data
Completeness of follow-up of cohort
Active or passive follow-up of participants with methods for ascertainment of outcome and death clearly described AND with methods for ascertainment of emigration from population-at-risk clearly described or censoring at date of last follow-up OR there is a plausible estimate of >90% follow-up (low risk)
Accuracy of dates of outcome or censoring
Dates of outcome or censoring ascertained to within one year (low risk)
Difference in follow-up between exposed and non-exposed members of cohort
Completeness of follow-up in exposed and non-exposed participants is very unlikely to be the same and difference between the two is, or is likely to be, large (≥10%) OR insufficient information to tell (high risk)
Difference in missing data for exposure between those with or without the outcome
Difference in missing data for exposure < 10 percentage points (low risk)
Bias due to confounding
Comparability of exposed and non-exposed cohorts with respect to potentially important confounding variables (Requires prior specification of potentially important confounders)
Age and other potentially important confounders measured and controlled by design or in analysis (low risk)
Analysis bias
Covariates are appropriately included in statistical analysis models
Variables measuring the same underlying concept or lying in the same causal pathway ARE NOT included together as covariates in statistical analysis models (low risk)
Size of effect
1 Reason for decision: AGE EFFECT (adjusted for endoscopy volume)

21-30 yrs: 7 / 100,000
61-70 yrs: 31 / 100,000

TEMPORAL TREND
Number of new Barrett’s oesophagus diagnoses: 298 in 1998 to 574 in 2006.
Crude incidence 14.5 to 23.8 diagnoses per 100 000 member years between 1998 to 2006 (p for trend,0.01).
Incidence adjusted for endoscopy volume: 14.5 to 22.9 per 100 000 member years (p for trend, 0.01)

Relevance of evidence
6 Additional comments: This study documented the incidence and prevalence of Barrett's oesophagus in a health maintenance organisation. It did not assess the effects of an intervention.
Result of appraisal

Jutta's tick icon.png Included




Completed by

David Whiteman


Jutta's tick icon.png This appraisal has been completed.


Article
Corley DA, Kubo A, Levin TR, Block G, Habel L, Rumore G, et al. Race, ethnicity, sex and temporal differences in Barrett's oesophagus diagnosis: a large community-based study, 1994-2006. Gut 2009 Feb;58(2):182-8 Abstract available at http://www.ncbi.nlm.nih.gov/pubmed/18978173.
Assigned to
User:David.whiteman
Topic area
Guidelines:Barrett's
Clinical question
Form
Form:Critical appraisal


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