Does the association between adherence to statin medications and mortality depend on measurement approach? A retrospective cohort study
Does the association between adherence to statin medications and mortality depend on measurement approach? A retrospective cohort study
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DOI：
10.1186/s12874-017-0339-z
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发表时间：
2017-04-20
影响因子：
4
通讯作者：
Blackburn, David F.
中科院分区：
文献类型：
--
作者：
Alsabbagh, Mhd. Wasem;Eurich, Dean;Blackburn, David F.
背景资料：本研究的目的是研究死亡率和他汀类药物坚持使用两种不同的方法来坚持测量（总结与重复措施）之间的关系：回顾性队列研究进行了使用行政数据从萨斯喀彻温省，加拿大1994年至2008年。符合条件的个体在急性冠状动脉综合征（ACS）住院后接受他汀类药物处方。使用覆盖天数比例（PDC）测量依从性，表示为：1）固定的汇总指标，或2）重复测量的协变量。多变量Cox比例风险模型用于估计依从性和mortality.Results之间的关联：在9，051例患者中，采用固定汇总测量建模的最佳依从性（>= 80%）与死亡率获益无关（调整后HR 0.97，95%CI 0.86至1.09，p = 0.60）。相反，重复测量方法导致死亡风险显著降低25%（校正HR 0.75，95%CI 0.67至0.85，p < 0.01）。结论：与汇总测量不同，重复测量方法在最佳依从性下显著降低全因死亡率。这种效应可能是重复测量方法更敏感或更容易产生生存偏倚的结果。我们的研究结果清楚地表明，在评估药物依从性的益处时，需要采取（和报告）多种方法。
Background: The aim of this study was to examine the relationship between mortality and statin adherence using two different approaches to adherence measurement (summary versus repeated-measures).Methods: A retrospective cohort study was conducted using administrative data from Saskatchewan, Canada between 1994 and 2008. Eligible individuals received a prescription for a statin following hospitalization for acute coronary syndrome (ACS). Adherence was measured using proportion of days covered (PDC) expressed either as: 1) a fixed summary measure, or 2) as a repeatedly measured covariate. Multivariable Cox-proportional hazards models were used to estimate the association between adherence and mortality.Results: Among 9,051 individuals, optimal adherence (>= 80%) modeled with a fixed summary measure was not associated with mortality benefits (adjusted HR 0.97, 95% CI 0.86 to 1.09, p = 0.60). In contrast, repeated-measures approach resulted in a significant 25% reduction in the risk of death (adjusted HR 0.75, 95% CI 0.67 to 0.85, p < 0.01).Conclusions: Unlike the summary measure, the repeated measures approach produces a significant reduction of allcause mortality with optimal adherence. This effect may be a result of the repeated measures approach being more sensitive, or more prone to survival bias. Our findings clearly demonstrate the need to undertake (and report) multiple approaches when assessing the benefits of medication adherence.