THE IMPACT OF RESEARCH QUALITY AND STUDY DESIGN ON EPIDEMIOLOGIC ESTIMATES OF THE EFFECT OF NONSTEROIDAL ANTIINFLAMMATORY DRUGS ON UPPER GASTROINTESTINAL-TRACT DISEASE
THE IMPACT OF RESEARCH QUALITY AND STUDY DESIGN ON EPIDEMIOLOGIC ESTIMATES OF THE EFFECT OF NONSTEROIDAL ANTIINFLAMMATORY DRUGS ON UPPER GASTROINTESTINAL-TRACT DISEASE
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DOI：
10.1001/archinte.152.6.1289
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发表时间：
1992-06-01
影响因子：
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通讯作者：
WALKER, AM
中科院分区：
文献类型：
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作者：
BOLLINI, P;RODRIGUEZ, LAG;WALKER, AM
背景。-已观察到与非甾体抗炎药（NSAID）治疗相关的上消化道疾病风险估计存在相当大的差异。我们对与NSAID相关的上消化道疾病的流行病学研究进行了荟萃分析，以回答以下研究问题：研究特征（研究设计和质量）是否与阿司匹林和非阿司匹林NSAID的不同风险估计相关？对于特殊人群，如女性和老年人，风险是否会增加？方法。我们对34项与NSAID（包括阿司匹林和非阿司匹林NSAID）相关的严重上消化道疾病的研究进行了检查，并根据我们为本次综述设计的质量检查表进行评分。只有44%的研究控制了主要的混杂变量（年龄和性别）。虽然分别在40%和78%的非阿司匹林NSAID和阿司匹林研究中将暴露定义为当前暴露，但很少有研究检查溃疡病史和并发疾病或其他已知为上消化道出血风险因素的合并用药。通过随机效应回归模型，总体风险比为3.0（95%置信区间，1.9至4.7）。阿司匹林和非阿司匹林NSAID的个体估计值相似。无论有无质量控制，队列研究提供的风险比估计值均低于病例对照研究。研究的设计和质量似乎是风险估计的强有力的独立预测因素;队列研究的风险估计低于病例对照研究，满意的研究的风险估计低于不满意的研究。
Background.-Considerable differences in the estimates of the risk of upper gastrointestinal tract disease associated with treatment with nonsteroidal anti-inflammatory drugs (NSAIDs) have been observed. We conducted a metaanalysis of epidemiologic studies of upper gastrointestinal tract disease related to NSAIDs to answer the following research questions: Are study characteristics (study design and quality) associated with different estimates of risk, for both aspirin and nonaspirin NSAIDs? Does the risk increase for particular groups of patients, such as women and the elderly?Methods.-Thirty-four studies addressing severe upper gastrointestinal tract disease associated with NSAIDs (including aspirin and nonaspirin NSAIDs) were examined and scored according to a quality checklist that we designed for this review.Results.-Only 44% of the studies controlled for major confounding variables (age and sex). While exposure was defined as current in 40% and 78% of the studies for nonaspirin NSAIDs and aspirin, respectively, few investigations checked for history of ulcer disease and concurrent diseases or other comedications known to be risk factors for upper gastrointestinal tract bleeding. The overall risk ratio, by means of a random-effects regression model, was 3.0 (95% confidence interval, 1.9 to 4.7). The individual estimates for aspirin and nonaspirin NSAIDs were similar. Both with and without control for quality, cohort studies provided a lower risk ratio estimate than did case-control studies.Conclusions.-The design and quality of the studies appear to be strong independent predictors of the risk estimate; cohort studies were associated with lower risk estimates than case-control studies, and satisfactory studies were associated with lower risk estimates than unsatisfactory studies.