An improved score-type confidence interval for stratified risk differences involving rare events.

A stratified analysis of the differences in proportions has been widely employed in epidemiological research, social sciences, and drug development. It provides a useful framework for combining data across strata to produce a common effect. However, for rare events with incidence rates close to zero, popular confidence intervals for risk differences in a stratified analysis may not have appropriate coverage probabilities that approach the nominal confidence levels and the algorithms may fail to produce a valid confidence interval because of zero events in both the arms of a stratum. The main objective of this study is to evaluate the performance of certain methods commonly employed to construct confidence intervals for stratified risk differences when the response probabilities are close to a boundary value of zero or one. Additionally, we propose an improved stratified Miettinen-Nurminen confidence interval that exhibits a superior performance over standard methods while avoiding computational difficulties involving rare events. The proposed method can also be employed when the response probabilities are close to one.

Cytokine pathway variants modulate platelet production: IFNA16 is a thrombocytosis susceptibility locus in humans.

Inflammatory stimuli have divergent effects on peripheral platelet counts, although the mechanisms of thrombocytopenic and thrombocytotic responses remain poorly understood. A candidate gene approach targeting 326 polymorphic genes enriched in thrombopoietic and cytokine signaling pathways was applied to identify single nucleotide variants (SNVs) implicated in enhanced platelet responses in cohorts with reactive thrombocytosis (RT) or essential (myeloproliferative neoplasm [MPN]) thrombocytosis (ET). Cytokine profiles incorporating a 15-member subset, pathway topology, and functional interactive networks were distinct between ET and RT, consistent with distinct regulatory pathways of exaggerated thrombopoiesis. Genetic studies using aggregate (ET + RT) or ET-restricted cohorts identified associations with 2 IFNA16 (interferon-α16) SNVs, and the ET associations were validated in a second independent cohort (P = .0002). Odds ratio of the combined ET cohort (n = 105) was 4.92, restricted to the JAK2V617F-negative subset (odds ratio, 5.01). ET substratification analysis by variant IFNA16 exhibited a statistically significant increase in IFN-α16 levels (P = .002) among 16 quantifiable cytokines. Recombinantly expressed variant IFN-α16 encompassing 3 linked non-synonymous SNVs (E65H95P133) retained comparable antiviral and pSTAT signaling profiles as native IFN-α16 (V65D95A133) or IFN-α2, although both native and variant IFN-α16 showed stage-restricted differences (compared with IFN-α2) of IFN-regulated genes in CD34+-stimulated megakaryocytes. These data implicate IFNA16 (IFN-α16 gene product) as a putative susceptibility locus (driver) within the broader disrupted cytokine network evident in MPNs, and they provide a framework for dissecting functional interactive networks regulating stress or MPN thrombopoiesis.