External adjustment of unmeasured confounders in a case-control study of benzodiazepine use and cancer risk.
External adjustment of unmeasured confounders in a case-control study of benzodiazepine use and cancer risk.
复制标题
在苯二氮卓类药物使用和癌症风险的病例对照研究中对未测量的混杂因素进行外部调整。
DOI：
10.1111/bcp.13342
复制
发表时间：
2017
影响因子：
3.4
通讯作者：
Hallas,Jesper
中科院分区：
文献类型：
--
作者：
Thygesen,LauCaspar;Pottegård,Anton;Ersbøll,AnnetteKjaer;Friis,Søren;Stürmer,Til;Hallas,Jesper
目的以往的研究报告了苯二氮卓类药物使用与癌症风险之间关系的不同结果。方法：我们在一项匹配病例对照研究中调查了这种关联，该研究包括2002-2009年丹麦癌症登记处（n= 94 923）和年龄和性别匹配（1:8）的人群对照（n= 759 334）。长期使用苯二氮卓类药物定义为在索引日期前1-5年每日剂量≥500。我们使用从丹麦人口调查中获得的混杂因素的外部信息实施倾向评分（PS）校准。使用了两种PS：基于登记册的易出错PS和基于登记册和调查混杂的校准PS，均来自健康访谈调查。结果基于登记的数据显示，与人口对照组相比，癌症病例有更多的诊断、更高的合并症评分和更多的联合用药。基于调查的数据显示，在苯二氮卓类药物使用者中，自我评估的健康状况较低，自我报告的疾病更多，吸烟者和久坐生活方式的人更多。通过PS校准，与苯二氮卓类药物使用相关的癌症总体优势比从1.16降至1.09(95%可信区间1.00-1.19)，与吸烟相关的癌症总体优势比从1.20降至1.10（95%可信区间1.00-1.21）。结论：我们的结论是，在单基于登记的研究中观察到的风险增加可能部分归因于未测量的混杂因素。
AimsPrevious studies have reported diverging results on the association between benzodiazepine use and cancer risk.MethodsWe investigated this association in a matched case–control study including incident cancer cases during 2002–2009 in the Danish Cancer Registry (n= 94 923) and age‐ and sex‐matched (1:8) population controls (n= 759 334). Long‐term benzodiazepine use was defined as ≥500 defined daily doses 1–5 years prior to the index date. We implemented propensity score (PS) calibration using external information on confounders available from a survey of the Danish population. Two PSs were used: The error‐prone PS using register‐based confounders and the calibrated PS based on both register‐ and survey‐based confounders, retrieved from the Health Interview Survey.ResultsRegister‐based data showed that cancer cases had more diagnoses, higher comorbidity score and more co‐medication then population controls. Survey‐based data showed lower self‐rated health, more self‐reported diseases, and more smokers as well as subjects with sedentary lifestyle among benzodiazepine users. By PS calibration, the odds ratio for cancer overall associated with benzodiazepine use decreased from 1.16 to 1.09 (95% confidence interval 1.00–1.19) and for smoking‐related cancers from 1.20 to 1.10 (95% confidence interval 1.00–1.21).ConclusionWe conclude that the increased risk observed in the solely register‐based study could partly be attributed to unmeasured confounding.