External adjustment for unmeasured confounders improved drug-outcome association estimates based on health care utilization data.
External adjustment for unmeasured confounders improved drug-outcome association estimates based on health care utilization data.
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对未测量的混杂因素的外部调整改善了基于医疗保健利用数据的药物结果关联估计。
DOI：
10.1016/j.jclinepi.2012.03.014
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发表时间：
2012
影响因子：
7.2
通讯作者：
G. Mancia
中科院分区：
文献类型：
--
作者：
G. Corrao;F. Nicotra;Andrea Parodi;A. Zambon;D. Soranna;F. Heiman;L. Merlino;G. Mancia
目的卫生保健利用(HCU)数据库是药物流行病学调查的广泛数据来源。可能的混杂因素通常不会在这样的数据库中进行测量。在一项旨在比较心血管(CV)风险的研究中，我们展示了如何评估混杂因素的影响，该研究旨在根据开始抗高血压治疗时开出的药物方案，名义上是一种药物(单一疗法)或单一药片(固定剂量组合)或至少两种不同药片(即兴联合)中的药物组合。STUDY设计和SETTINGSA嵌套病例对照研究包括2000至2001年间新治疗的209,650名来自意大利伦巴第市的患者。这些病例是截至2007年因心血管疾病住院的10,688名患者。每个病例选择三个对照。使用Logistic回归对与初始治疗方案相关的心血管风险进行建模。结果与固定剂量联合用药组和单用药组比较，临时联合用药组和单纯用药组的心血管风险分别增加到15%(95%可信区间：3%，29%)和17%(95%可信区间：8%，26%)。外部调节并没有改变单一疗法的风险。相反，当应用外部调节时，与即兴结合相关的额外风险被取消。结论核磁共振数据可以用于评估从HCU数据库中未测量的混杂偏倚。与单一治疗相比，开始联合用药进行降压治疗可能会降低心血管风险，即使在一级预防的情况下也是如此。
OBJECTIVESHealth care utilization (HCU) databases are widespread sources of data for pharmacoepidemiologic investigations. Possible confounders are typically not measured in such databases. We show how to assess the impact of confounders in a study aimed at comparing cardiovascular (CV) risk according to drug regimen prescribed at starting antihypertensive therapy, nominally one agent (monotherapy) or a combination of agents in a unique tablet (fixed-dose combination) or in at least two distinct tablets (extemporaneous combination).STUDY DESIGN AND SETTINGSA nested case–control study was carried out by including the 209,650 patients from Lombardy (Italy) newly treated between 2000 and 2001. Cases were the 10,688 patients who were hospitalized for CV disease until 2007. Three controls were selected for each case. Logistic regression was used to model the CV risk associated with initial therapeutic regimen. A Monte Carlo sensitivity analysis was performed for accounting unmeasured confounders (hypertension severity and chronic disease score) by means of external adjustment with medical record (MR) data.RESULTSCompared with patients on fixed-dose combination, those on extemporaneous combination or monotherapy, respectively, had CV risk increased to 15% (95% confidence interval [CI]: 3%, 29%) or 17% (95% CI: 8%, 26%). External adjustment did not modify the risk associated with monotherapy. In contrast, the excess of risk associated with extemporaneous combination was annulled when external adjustment was applied.CONCLUSIONMR data can be used to assess confounding bias unmeasured from HCU database. Starting antihypertensive therapy with a combination of agents probably reduces the CV risk with respect to monotherapy, even in the setting of primary prevention.
影响因子：
--
作者：
Psaty, BM;Furberg, CD;Lumley, T
通讯作者：
Lumley, T
影响因子：
--
作者：
Miura, K;Daviglus, ML;Greenland, P
通讯作者：
Greenland, P
影响因子：
1.9
作者：
Lin, DY;Psaty, BM;Kronmal, RA
通讯作者：
Kronmal, RA