老年人潜在不适当用药与死亡率和住院的关联:药物流行病学的方法学挑战。

IF 5.9 1区 医学 Q1 PUBLIC, ENVIRONMENTAL & OCCUPATIONAL HEALTH
Miriam Degen, Ben Schöttker
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引用次数: 0

摘要

先前关于潜在不适当药物(PIM)使用与老年人住院风险和全因死亡率之间关系的研究容易出现混淆和偏差。使用基于人群的英国生物银行的217,111名参与者的数据,年龄在60-69岁之间,其中包括95,187名具有初级保健数据联系的参与者,主要分析是一个前瞻性新用户设计,通过新的PIM用户和新的适当药物(AM)用户的适应症匹配(用EURO-FORTA列表进行评估),以1:1的倾向评分分层。结果比较了以前的方法与一个普遍的用户设计和一个新的用户设计没有倾向得分匹配。43,307名(19.9%)参与者在基线时至少使用了一种PIM。在11,812名倾向评分匹配的个体中,在基线后2年内使用新的PIM或新的AM处方,新的PIM使用与1个月住院率增加20%无显著性相关(风险比(HR)[95%置信区间(95% CI)]: 1.20[0.76-1.90])和1年死亡率增加23%(1.23[0.80-1.89])。流行用户设计(hr [95% ci]:住院1个月:1.04[0.83-1.31];1年死亡率:1.01[0.82-1.23])与新用户设计的相关性略强,未按适应症分层进行倾向评分匹配(住院1个月(1.24 [0.95-1.61]);1年死亡率(HR [95% CI] 1.57[1.24-2.00])。这第一项采用适当方法的研究表明,先前关于PIM对住院和死亡风险的药物流行病学研究要么低估了风险,要么高估了风险。大约20%的效应大小在生物学上似乎是合理的,需要更大规模的研究来检测这种具有统计显著性的弱关联。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
Associations of potentially inappropriate medications in older adults with mortality and hospitalizations: methodological challenges in pharmacoepidemiology.

Previous studies on the association of potentially inappropriate medication (PIM) use with hospitalization risk and all-cause mortality among older adults were prone to confounding and biases. Using data from 217,111 participants of the population-based United Kingdom Biobank, aged 60-69 years, including 95,187 participants with primary care data linkage, the main analysis was a prospective new user design with 1:1 propensity-score stratified by indication matching of new PIM users and new appropriate medication (AM) users (assessed with the EURO-FORTA list). Results were compared to previous approaches with a prevalent user design and a new user design without propensity score matching. 43,307 (19.9%) participants used at least one PIM at baseline. Among 11,812 propensity score matched individuals with new PIM or new AM prescription within 2 years after baseline, new PIM use was associated with non-significantly 20% increased 1-month hospitalization (hazard ratio (HR) [95% confidence interval (95% CI)]: 1.20 [0.76-1.90]) and 23% increased 1-year mortality (1.23 [0.80-1.89]). Null-results were obtained with the prevalent user design (HRs [95% CIs]: 1-month hospitalization: 1.04 [0.83-1.31]; 1-year mortality: 1.01 [0.82-1.23]) and slightly stronger associations in new user design without propensity score matching stratified by indication (1-month hospitalization (1.24 [0.95-1.61]); 1-year mortality (HR [95% CI] 1.57 [1.24-2.00]). This first study with an appropriate methodology showed that previous pharmacoepidemiologic studies on the risk of PIM for hospitalization and mortality have either under- or overestimated the risk. Effect sizes of about 20% appear biologically plausible and larger studies are needed to detect such weak associations with statistical significance.

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来源期刊
European Journal of Epidemiology
European Journal of Epidemiology 医学-公共卫生、环境卫生与职业卫生
CiteScore
21.40
自引率
1.50%
发文量
109
审稿时长
6-12 weeks
期刊介绍: The European Journal of Epidemiology, established in 1985, is a peer-reviewed publication that provides a platform for discussions on epidemiology in its broadest sense. It covers various aspects of epidemiologic research and statistical methods. The journal facilitates communication between researchers, educators, and practitioners in epidemiology, including those in clinical and community medicine. Contributions from diverse fields such as public health, preventive medicine, clinical medicine, health economics, and computational biology and data science, in relation to health and disease, are encouraged. While accepting submissions from all over the world, the journal particularly emphasizes European topics relevant to epidemiology. The published articles consist of empirical research findings, developments in methodology, and opinion pieces.
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