Evidence map›Paper›PMID 31900264›Full record

Observational studyBMJ open2020

All-cause mortality following low-dose aspirin treatment for patients with high cardiovascular risk in remote Australian Aboriginal communities: an observational study.

Yuejen Zhao, Kanakamani Jeyaraman, Paul Burgess, Christine Connors, Steven Guthridge, Louise Maple-Brown, Henrik Falhammar

Open access · goldAbstract readMulticenter StudyObservational Study
PubMed Full text at PMC Publisher
In one paragraph

Observational study in BMJ open, 2020. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 4 papers.

0numbers the graph read from it
0cells of the map it votes in
4citing papers in PubMed
1.0field-weighted citation impact, top 22% of its field
1 · What the graph read from it

What it found

Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.

The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.

2 · The registry

The trial behind it

Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.

Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.

3 · Its place in the literature

Who cites it

4 citing papers in PubMed, 9 citations in OpenAlex.

  1. Trial
  2. Article
  3. Article
  4. Effects of low-dose aspirin on the osseointegration process in rats.International journal of implant dentistry · 2021
    Article
4 · The record

Corrections and comments

PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.

5 · Who and what money

Authors and funding

7 authors at 6 institutions in 2 countries.

Yuejen ZhaoHealth Gains Planning, Department of Health, Darwin, Northern Territory, Australia.
Kanakamani JeyaramanDepartment of Endocrinology, Royal Darwin Hospital, Darwin, Northern Territory, Australia.
Paul BurgessNT Medical School, Flinders University, Darwin, Northern Territory, Australia.
Christine ConnorsTop End Health Services, NT Department of Health, Darwin, Northern Territory, Australia.
Steven GuthridgeMenzies School of Health Research, Darwin, Northern Territory, Australia.
Louise Maple-BrownDepartment of Endocrinology, Royal Darwin Hospital, Darwin, Northern Territory, Australia.
Henrik FalhammarDepartment of Endocrinology, Royal Darwin Hospital, Darwin, Northern Territory, Australia henrik.falhammar@ki.se.ORCID 0000-0002-5622-6987
Menzies School of Health Research · AUFlinders University · AUGovernment of Western Australia Department of Health · AUKarolinska Institutet · SENorthern Territory Health Services · AURoyal Darwin Hospital · AU

Funding

No grant is acknowledged in the PubMed record.

6 · The paper itself

Abstract

objectivesTo evaluate the benefit and risk of low-dose acetylsalicylic acid (aspirin) in patients from remote Aboriginal communities in the Northern Territory, Australia.

designRetrospective 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.

settingThe benefit and harm of aspirin were investigated in patients aged ≥18 years from 54 remote Aboriginal communities.

participantsNone had a previous cardiovascular event or major bleeds. Patients on anticoagulants or other antiplatelets were excluded.

interventionAspirin at a dose of 75-162 mg/day. OUTCOME MEASURES: Endpoints were all-cause, cardiovascular mortality and incidences of cardiovascular events and major bleeds.

results8167 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.

conclusionAspirin 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.

Indexed as

AspirinCardiovascular DiseasesDose-Response Relationship, DrugFemaleHumansIncidenceMaleNorthern TerritoryPlatelet Aggregation InhibitorsPrimary PreventionRetrospective StudiesRisk AssessmentRisk FactorsAspirinPlatelet Aggregation Inhibitorsacetylsalicylic acidcoarsened exact matchingmarginal structural modelspropensity score matchingrisk-benefit assessment

Identifiers

PMID31900264
PMCPMC6955566
OpenAlexW2997824821

What OpenQuestion holds

Textmetadata
LicenceCC BY-NC
Read underepoch 390

Registered trials

None linked

Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.