Propensity Scores and Preventive Drug Use in the Elderly

老年人的倾向评分和预防性药物使用

• 批准号: 7074735
• 负责人: Til Sturmer
• 金额: $ 29.36万
• 依托单位: BRIGHAM AND WOMEN'S HOSPITAL
• 依托单位国家: 美国
• 财政年份: 2005
• 资助国家: 美国
• 起止时间: 2005-06-15 至 2007-11-30
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/7074735
• 关键词: cancer prevention; chemoprevention; clinical research; colorectal neoplasms; data collection methodology /evaluation; human data; human old age (65+); human subject; nonsteroidal antiinflammatory agent; statistics /biometry

DESCRIPTION (provided by applicant): The preventive use of prescription- and non-prescription drugs is a central feature of the care of the elderly. Randomized controlled trials assessing the efficacy of preventive medications in the elderly are costly and may be limited in their generalizability due to selection of participants, shorter duration of treatment, and competing outcomes. However, observational studies of these questions are frequently criticized for biased results. It is therefore vital to develop and apply adequate methods to reduce bias in observational studies that assess the preventive effects of medication use in older patients. Propensity scores and multivariate confounder scores have been proposed to improve control for confounding in such observational studies of medications. Despite increasing use, there is little evidence that better control of confounding is achieved. We propose to assess the validity, statistical efficiency, and applicability of propensity scores and related techniques compared to 'traditional' multivariate analysis in studying the effects of medications in the elderly. The relation between preventive NSAID use and colorectal cancer serves as our primary example to elucidate how propensity scores and multivariate confounder scores can reduce bias. We will use two large cohort studies the Physicians' Health Study and the Women's Health Study to evaluate this association. Because the study focuses on the analytic approach for evaluating such data, and not on the assessment of any single biological mechanism, we explore other possible associations between preventive drug use and health outcomes that were deliberately selected to reflect a wide range of typical analytic situations as the basis for our multivariate simulation studies. Based on the results of these large cohort studies we will conduct extensive statistical simulations to assess the determinants of improved validity and efficiency of propensity scores and multivariate confounder scores for a range of realistic scenarios. Results will be integrated into meaningful and easy-to-use decision rules and practical recommendations for the appropriate use of propensity scores and multivariable confounder scores in observational research in the elderly. These recommendations will be disseminated widely among researchers and practicing physicians.

描述（由申请人提供）：处方药和非处方药的预防性使用是老年人护理的一个中心特征。评估老年人预防性药物疗效的随机对照试验成本高昂，并且由于参与者的选择，治疗持续时间较短以及竞争性结局，其普遍性可能受到限制。然而，这些问题的观察性研究经常被批评为有偏见的结果。因此，至关重要的是开发和应用适当的方法，以减少偏倚的观察性研究，评估药物使用的预防效果在老年患者。倾向评分和多变量混杂因素评分已被提出来改善对药物观察性研究中混杂因素的控制。尽管使用越来越多，但几乎没有证据表明可以更好地控制混杂。 我们建议评估的有效性，统计效率和适用性的倾向分数和相关技术相比，“传统的”多变量分析研究药物在老年人的影响。 预防性使用NSAID与结直肠癌之间的关系是我们阐明倾向评分和多变量混杂因子评分如何减少偏倚的主要例子。我们将使用两项大型队列研究--医生健康研究和妇女健康研究来评估这种关联。因为这项研究的重点是评估这些数据的分析方法，而不是对任何单一的生物机制的评估，我们探索预防性药物使用和健康结果之间的其他可能的关联，这些结果是故意选择的，以反映广泛的典型分析情况，作为我们的多变量模拟研究的基础。 基于这些大型队列研究的结果，我们将进行广泛的统计模拟，以评估在一系列现实场景中改善倾向评分和多变量混杂因子评分的有效性和效率的决定因素。 结果将被整合到有意义的和易于使用的决策规则和实用的建议，在老年人的观察性研究中适当使用的倾向评分和多变量混杂因素评分。这些建议将在研究人员和执业医生中广泛传播。