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: 7317310
• 负责人: Til Sturmer
• 金额: $ 5.7万
• 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 2008-05-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/7317310
• 关键词: Address; Alzheimer' s Disease; American; Anti-Inflammatory Agents; Anti-inflammatory; Aspirin; Attention; Biological; Calibration; Caring; Cessation of life; Cholinesterase Inhibitors; Chronic Disease; Cohort Studies; Confounding Factors (Epidemiology); Data; Data Set; Disease; Drug usage; Educational workshop; Effectiveness; Elderly; Epidemiologist; Epidemiology; Funding; Guidelines; Influentials; International; Journals; Life Support Care; Measurement; Measures; Medical; Methods; Narcotics; Non-Drug Prescriptions; Non-Prescription Drugs; Non-Steroidal Anti-Inflammatory Agents; Observational Study; Oral; Outcome; Pain; Paper; Participant; Patients; Pharmaceutical Preparations; Physicians; Postmenopause; Prevention; Preventive; Probability; Procedures; Publications; Publishing; Randomized; Randomized Controlled Trials; Relative (related person); Reporting; Research Personnel; Residual state; Risk; Score; Scoring Method; Series; Techniques; Time; Woman; Work; base; concept; design; frailty; hormone therapy; improved; innovation; mortality; older patient; posters; prescription document; prescription procedure; programs; protective effect; research study; simulation; symposium; treatment duration; validation studies

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（由申请人提供）：使用处方药和非处方药预防慢性病是老年人护理的核心特征。最近，越来越多的注意力集中在几种药物在这种情况下的疗效证据上，包括非甾体抗炎药、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成本非常高，需要很长时间来设计和实施，并且由于参与者的选择，治疗持续时间较短以及竞争性结果，可能具有有限的普遍性。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，经常被批评为产生偏见的结果。因此，至关重要的是开发和应用创新技术，以改善因果推理的非实验性研究评估药物使用的预防效果在老年患者。在RO1 AG023178的资助下，我们之前评估了倾向评分（PS）在真实的数据集和广泛模拟中的局限性和优势。我们通过在最高级别的国际流行病学和药物流行病学会议上的口头报告（12）、海报（9）和研讨会（2）以及9篇系列出版物（包括4篇最高级别的流行病学杂志）传播我们的结果。竞争的延续将使我们能够继续和扩大我们以前的工作的局限性和价值的倾向评分，以评估预防作用的药物使用在老年患者。研究团队将继续关注几个尚未解决的主题，即使用验证研究来调整主要研究和PS中未测量的混杂因素。我们建议1。比较缺失数据和测量误差校正的方法，以使用验证研究数据调整主研究中未测量的混杂因素，2.应用这些方法来解决胆碱酯酶抑制剂延长生命方面的不可测量的混淆问题，3.评估从分析中排除极低和极高PS患者的价值，4.评估倾向评分在非二分暴露设置中的适用性和使用，以及5.评估PS与变量选择相比的经验贝叶斯校正值。我们的研究结果的传播将增加PS方法的正确应用，包括调整未测量混杂因素的方法。