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: 7753112
• 负责人: Til Sturmer
• 金额: $ 28.5万
• 依托单位: UNIV OF NORTH CAROLINA CHAPEL HILL
• 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 2011-03-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/7753112
• 关键词: Address; Anti-Inflammatory Agents; Anti-inflammatory; Aspirin; Attention; Biological; Cardiovascular Diseases; Caring; Chronic Disease; Clinical; Cohort Studies; Colorectal Cancer; Data; Data Set; Data Sources; Diagnostic; Drug usage; Effectiveness; Elderly; Epidemiologic Studies; Health; Health Professional; Height; Hip Fractures; Hormone replacement therapy; Hydroxymethylglutaryl-CoA Reductase Inhibitors; Knowledge; Medical; Medicare; Methods; Modeling; Multivariate Analysis; New Jersey; Non-Drug Prescriptions; Non-Prescription Drugs; Non-Steroidal Anti-Inflammatory Agents; Observational Study; Outcome; Participant; Patients; Pharmaceutical Preparations; Pharmacy facility; Physicians; Postmenopause; Prevention; Preventive; Principal Investigator; Probability; Procedures; Publications; Randomized Clinical Trials; Randomized Controlled Trials; Range; Recommendation; Research; Research Personnel; Role; Score; Scoring Method; Stratification; Techniques; Time; Woman; Women' s Health; base; colorectal cancer prevention; computerized; design; improved; mortality; older patient; prescription document; prescription procedure; simulation; theories; treatment duration

DESCRIPTION (provided by applicant): The use of prescription and non-prescription drugs for prevention of chronic diseases is a central feature of the care of the elderly. Growing attention has been paid recently to the evidence of efficacy of several drugs in this context, including non-steroidal anti-inflammatory drugs, statins, and hormone therapy in postmeno- pausal women. Randomized controlled trials assessing the effectiveness of pharmacoprevention of chronic diseases in the elderly are very costly, take a long time to design and implement, and may be of limited generalizability due to selection of participants, shorter duration of treatment, and competing outcomes. However, observational studies of these questions, including ones based on administrative data that often are the only ones available, have frequently been criticized as producing biased results. It is therefore vital to develop and apply innovative techniques to improve causal inference from non-experimental research assessing the preventive effects of medication use in older patients. Funded by RO1 AG023178, we previously assessed limitations and advantages of propensity scores (PSs) in real datasets and extensive simulations. We disseminated our results by means of oral presentations (12), posters (9), and symposia (2) at the highest ranked international epidemiologic and pharmacoepidemiologic meetings and in a series of 9 publications, including 4 in the highest ranked epidemiologic journal. The competing continuation will allow us to continue and expand our previous work on the limitations and value of propensity scores to assess the preventive effects of medication use in older patients. The team of researchers will continue to focus on several unresolved topics regarding the use of validation studies to adjust for confounding unmeasured in the main study and PSs. We propose to 1. compare methods for missing data and measurement error correction to adjust for confounding not measured in a main study using validation study data, 2. apply these methods to address unmeasured confounding in the prolongation of life with cholinesterase inhibitors, 3. assess the value of excluding patients with very low and very high PSs from the analysis, 4. assess the applicability and use of propensity scores in the setting of non-dichotomous exposures, and 5. assess the value empirical Bayes correction of the PS compared with variable selection. Dissemination of our results will increase correct application of PS methods including methods to adjust for unmeasured confounding.

描述(申请人提供)：使用处方药和非处方药预防慢性病是老年人护理的一个主要特点。最近，几种药物在这方面的有效性的证据越来越受到关注，包括非类固醇抗炎药、他汀类药物和绝经后妇女的激素治疗。评估老年人慢性病药物预防有效性的随机对照试验非常昂贵，需要很长时间来设计和实施，而且由于参与者的选择、治疗持续时间较短以及相互竞争的结果，推广可能有限。然而，对这些问题的观察性研究，包括基于行政数据的研究，往往是唯一可用的，经常被批评为产生有偏见的结果。因此，开发和应用创新技术以改进非实验研究对老年患者用药的预防效果的因果推断是至关重要的。在RO1AG023178的资助下，我们先前在真实数据集和广泛的模拟中评估了倾向性评分(PSS)的局限性和优势。我们通过口头陈述(12个)、海报(9个)和座谈会(2个)在排名最高的国际流行病学和药物流行病学会议上以及在9个系列出版物中传播我们的结果，其中4个发表在排名最高的流行病学杂志上。竞争的延续将使我们能够继续和扩大我们之前关于倾向评分的局限性和价值的工作，以评估老年患者使用药物的预防效果。研究团队将继续专注于几个未解决的主题，涉及使用验证性研究来调整主要研究和PSS中未测量的混杂情况。我们建议：1.比较缺失数据的方法和测量误差校正的方法，以调整未在主要研究中使用验证研究数据测量的混杂；2.应用这些方法来解决使用胆碱酯酶抑制剂延长生命中的未测量混杂；3.评估从分析中排除PSS非常低和非常高的患者的价值；4.评估倾向评分在设置非二分暴露中的适用性和使用；以及5.评估PS的经验贝叶斯校正的价值与变量选择的比较。我们结果的传播将增加PS方法的正确应用，包括对未测量的混杂进行调整的方法。