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Author

Rachel Weinstein

Other affiliations: University of Pennsylvania
Bio: Rachel Weinstein is an academic researcher from Janssen Pharmaceutica. The author has contributed to research in topics: Epidemiology & Lean body mass. The author has an hindex of 12, co-authored 17 publications receiving 1383 citations. Previous affiliations of Rachel Weinstein include University of Pennsylvania.

Papers
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Journal ArticleDOI
TL;DR: The epidemiology of Psoriasis in the General Practice Research Database population is similar to that of other epidemiologic studies of psoriasis performed in the United Kingdom, the United States, and other Western countries.
Abstract: Objective To measure the prevalence and treatment of psoriasis in the United Kingdom. Design Cross-sectional study to determine prevalence and cohort study to determine treatment patterns. Setting Outpatient practices of general practitioners. Patients We included in the analysis all patients who were registered with a general practitioner in the General Practice Research Database from 1987 to 2002. Main Outcome Measures The prevalence and treatment of psoriasis. Results We identified 114 521 patients with psoriasis of a total population of 7 533 475 patients, yielding a prevalence of 1.5%. The prevalence of psoriasis increases more rapidly in young female patients compared with young male patients and declines significantly in patients 70 years and older, regardless of sex. Overall, 91.8% of patients with a diagnosis of psoriasis received a prescription for psoriasis treatment on or after the date of their first diagnostic code of psoriasis in the General Practice Research Database. Most of the patients (55.2%) received only 1 or 2 prescriptions for psoriasis in the first year after psoriasis was documented in the General Practice Research Database. Conclusions The epidemiology of psoriasis in the General Practice Research Database population is similar to that of other epidemiologic studies of psoriasis performed in the United Kingdom, the United States, and other Western countries. Psoriasis carries a substantial burden given its high prevalence and its associated need for prescription therapy. Additional studies are necessary to determine why the prevalence of psoriasis increases more rapidly in female patients and to determine why the prevalence decreases in patients 70 years and older.

584 citations

Journal ArticleDOI
TL;DR: Whether incidence rates are overestimated during the first year after registration, how long one needs to wait to obtain accurate incidence rates, and whether the time period of overestimation differs among disease types are examined.
Abstract: Background The General Practice Research Database (GPRD) is widely used to study incidence rates. This study examines whether incidence rates are overestimated during the first year after registration, how long one needs to wait to obtain accurate incidence rates, and whether the time period of overestimation differs among disease types. Methods We measured incidence rates of nine acute, eight chronic, and eight neoplastic outcomes in 3-month intervals through month 36 after enrollment in GPRD. The incidence rates in months 13–36 were used to estimate baseline incidence rates for each diagnosis. Results For patients registering with practices that were already UTS, incidence rates were highest in the first 3 months after registration. In eight of nine acute diagnoses, the incidence rate was within 20% of baseline by months 4–6; and in seven of eight cancers, the incidence rate was within 20% of baseline by months 7–9. For chronic conditions, the incidence rate in months 10–12 differed from baseline by more than 20% for five of the eight outcomes, respectively. For patients registering prior to UTS, incidence rates during the first quarter were within 20% of baseline for all acute and cancer diagnoses and six of eight chronic diagnoses. Conclusions Reported incidence rates are highest in the first 3 months after registration with an UTS practice and decline to baseline over the first year, more quickly for acute conditions than chronic conditions. For patients who registered prior to UTS, incidence rates are near the baseline level at the start of follow-up. Copyright © 2005 John Wiley & Sons, Ltd.

295 citations

Journal ArticleDOI
TL;DR: Higher levels of T are associated with IR, MetSyn, and CHD in elderly women, and whether T is a marker or mediator of cardiovascular disease in this population merits further investigation.
Abstract: Context: Early postmenopausal women with higher testosterone (T) levels have increased insulin resistance (IR) and cardiovascular risk factors, but whether this translates into increased cardiovascular disease later in life is unknown. Objective: The objective of the study was to determine whether higher T levels are associated with IR, the metabolic syndrome (MetSyn), and coronary heart disease (CHD) in elderly women. Design: Total T and free T by equilibrium dialysis were measured using ultrasensitive assays in 344 women aged 65–98 yr enrolled in the Cardiovascular Health Study. Cross-sectional analyses were performed to examine the associations between total and free T and IR, MetSyn, and CHD. Results: There was a stepwise increase in the homeostasis model assessment of insulin resistance with increasing total (P = 0.0.003) and free T (P = 0.02) level and a corresponding decrease in Quantitative Insulin Sensitivity Check Index (P < 0.001 and P = 0.002, respectively). In adjusted models, higher levels o...

120 citations

Journal ArticleDOI
01 Aug 2006-AIDS
TL;DR: CD4 cell count increase after initiating HAART has only moderate discriminative ability in identifying patients with an undetectable viral load, and the predictive ability is lower in patients with lower baseline CD4 cell counts.
Abstract: Objective: To derive and internally validate a clinical prediction rule for virologic response based on CD4 cell count increase after initiation of HAART in a resource-limited setting. Design and methods: A retrospective cohort study at two HIV care clinics in Gaborone, Botswana. The participants were previously treatment-naive HIV-1-infected individuals initiating HAART. The main outcome measure was a plasma HIV-1 RNA level (viral load) ≤ 400 copies/ml (i.e. undetectable) 6 months after initiating HAART. Results: The ability of CD4 cell count increase to predict an undetectable viral load was significantly better in those with baseline CD4 cell counts ≤ 100 cells/μl [area under the ROC curve (AUC), 0.78; 95% confidence interval (CI), 0.67–0.89; versus AUC, 0.60; 95% CI, 0.48–0.71; P = 0.018]. The sensitivity, specificity, and positive and negative predictive values of a CD4 cell count increase of ≥ 50 cells/μl for an undetectable viral load in those with baseline CD4 cell counts ≤ 100 cells/μl were 93.1, 61.3, 92.5 and 63.3%, respectively. Alternatively, these values were 47.8, 87.1, 95.0 and 24.5%, respectively, if a increase in CD4 cell count of ≥ 150 cells/μl was used. Conclusions: CD4 cell count increase after initiating HAART has only moderate discriminative ability in identifying patients with an undetectable viral load, and the predictive ability is lower in patients with lower baseline CD4 cell counts. Although HIV treatment programs in resource-constrained settings could consider the use of CD4 cell count increases to triage viral load testing, more accurate approaches to monitoring virologic failure are urgently needed.

78 citations

Journal ArticleDOI
TL;DR: Coronary artery calcification is prevalent in patients undergoing kidney transplant and may be a method to identify renal transplant recipients at increased risk for future cardiovascular events.

65 citations


Cited by
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Journal ArticleDOI
08 Jul 2020-Nature
TL;DR: A range of clinical factors associated with COVID-19-related death is quantified in one of the largest cohort studies on this topic so far and includes people of white ethnicity, Black and South Asian people were at higher risk, even after adjustment for other factors.
Abstract: Coronavirus disease 2019 (COVID-19) has rapidly affected mortality worldwide1. There is unprecedented urgency to understand who is most at risk of severe outcomes, and this requires new approaches for the timely analysis of large datasets. Working on behalf of NHS England, we created OpenSAFELY-a secure health analytics platform that covers 40% of all patients in England and holds patient data within the existing data centre of a major vendor of primary care electronic health records. Here we used OpenSAFELY to examine factors associated with COVID-19-related death. Primary care records of 17,278,392 adults were pseudonymously linked to 10,926 COVID-19-related deaths. COVID-19-related death was associated with: being male (hazard ratio (HR) 1.59 (95% confidence interval 1.53-1.65)); greater age and deprivation (both with a strong gradient); diabetes; severe asthma; and various other medical conditions. Compared with people of white ethnicity, Black and South Asian people were at higher risk, even after adjustment for other factors (HR 1.48 (1.29-1.69) and 1.45 (1.32-1.58), respectively). We have quantified a range of clinical factors associated with COVID-19-related death in one of the largest cohort studies on this topic so far. More patient records are rapidly being added to OpenSAFELY, we will update and extend our results regularly.

4,263 citations

Journal ArticleDOI
TL;DR: The data indicated that the occurrence of psoriasis varied according to age and geographic region, being more frequent in countries more distant from the equator and trends in incidence over time.

1,878 citations

Journal ArticleDOI
11 Oct 2006-JAMA
TL;DR: Psoriasis may confer an independent risk of MI when controlling for major cardiovascular risk factors, and was greatest in young patients with severe psoriasis, which had an increased adjusted relative risk (RR) for MI that varied by age.
Abstract: ContextPsoriasis is the most common T-helper cell type 1 (TH1) immunological disease. Evidence has linked TH1 diseases to myocardial infarction (MI). Psoriasis has been associated with cardiovascular diseases, but has only been investigated in hospital-based studies that did not control for major cardiovascular risk factors.ObjectiveTo determine if within a population-based cohort psoriasis is an independent risk factor for MI when controlling for major cardiovascular risk factors.Design, Setting, and PatientsA prospective, population-based cohort study in the United Kingdom of patients with psoriasis aged 20 to 90 years, comparing outcomes among patients with and without a diagnosis of psoriasis. Data were collected by general practitioners as part of the patient's medical record and stored in the General Practice Research Database between 1987 and 2002, with a mean follow-up of 5.4 years. Adjustments were made for hypertension, diabetes, history of myocardial infarction, hyperlipidemia, age, sex, smoking, and body mass index. Patients with psoriasis were classified as severe if they ever received a systemic therapy. Up to 5 controls without psoriasis were randomly selected from the same practices and start dates as the patients with psoriasis. A total of 556 995 control patients and patients with mild (n = 127 139) and severe psoriasis (n = 3837) were identified.Main Outcome MeasureIncident MI.ResultsThere were 11 194 MIs (2.0%) within the control population and 2319 (1.8%) and 112 (2.9%) MIs within the mild and severe psoriasis groups, respectively. The incidences per 1000 person-years for control patients and patients with mild and severe psoriasis were 3.58 (95% confidence interval [CI], 3.52-3.65), 4.04 (95% CI, 3.88-4.21), and 5.13 (95% CI, 4.22-6.17), respectively. Patients with psoriasis had an increased adjusted relative risk (RR) for MI that varied by age. For example, for a 30-year-old patient with mild or severe psoriasis, the adjusted RR of having an MI is 1.29 (95% CI, 1.14-1.46) and 3.10 (95% CI, 1.98-4.86), respectively. For a 60-year-old patient with mild or severe psoriasis, the adjusted RR of having an MI is 1.08 (95% CI, 1.03-1.13) and 1.36 (95% CI, 1.13-1.64), respectively.ConclusionsPsoriasis may confer an independent risk of MI. The RR was greatest in young patients with severe psoriasis.

1,649 citations

Journal ArticleDOI
27 Dec 2006-JAMA
TL;DR: Long-term PPI therapy, particularly at high doses, is associated with an increased risk of hip fracture.
Abstract: ContextProton pump inhibitors (PPIs) may interfere with calcium absorption through induction of hypochlorhydria but they also may reduce bone resorption through inhibition of osteoclastic vacuolar proton pumps.ObjectiveTo determine the association between PPI therapy and risk of hip fracture.Design, Setting, and PatientsA nested case-control study was conducted using the General Practice Research Database (1987-2003), which contains information on patients in the United Kingdom. The study cohort consisted of users of PPI therapy and nonusers of acid suppression drugs who were older than 50 years. Cases included all patients with an incident hip fracture. Controls were selected using incidence density sampling, matched for sex, index date, year of birth, and both calendar period and duration of up-to-standard follow-up before the index date. For comparison purposes, a similar nested case-control analysis for histamine 2 receptor antagonists was performed.Main Outcome MeasureThe risk of hip fractures associated with PPI use.ResultsThere were 13 556 hip fracture cases and 135 386 controls. The adjusted odds ratio (AOR) for hip fracture associated with more than 1 year of PPI therapy was 1.44 (95% confidence interval [CI], 1.30-1.59). The risk of hip fracture was significantly increased among patients prescribed long-term high-dose PPIs (AOR, 2.65; 95% CI, 1.80-3.90; P<.001). The strength of the association increased with increasing duration of PPI therapy (AOR for 1 year, 1.22 [95% CI, 1.15-1.30]; 2 years, 1.41 [95% CI, 1.28-1.56]; 3 years, 1.54 [95% CI, 1.37-1.73]; and 4 years, 1.59 [95% CI, 1.39-1.80]; P<.001 for all comparisons).ConclusionLong-term PPI therapy, particularly at high doses, is associated with an increased risk of hip fracture.

1,161 citations

Journal ArticleDOI
TL;DR: The classification of psoriasis; associated comorbidities including autoimmune diseases, cardiovascular risk, psychiatric/psychologic issues, and cancer risk; along with assessment tools for skin disease and quality-of-life issues; and the safety and efficacy of the biologic treatments used to treat patients with Psoriasis are discussed.
Abstract: Psoriasis is a common, chronic, inflammatory, multisystem disease with predominantly skin and joint manifestations affecting approximately 2% of the population. In this first of 5 sections of the guidelines of care for psoriasis, we discuss the classification of psoriasis; associated comorbidities including autoimmune diseases, cardiovascular risk, psychiatric/psychologic issues, and cancer risk; along with assessment tools for skin disease and quality-of-life issues. Finally, we will discuss the safety and efficacy of the biologic treatments used to treat patients with psoriasis.

1,103 citations