Effect of treating one disease on other diseases and health outcomes in elders

描述(申请人提供)：在患有多种疾病的老年人中，针对一种疾病的治疗可能会加剧共生疾病或对整体健康产生不利影响。尽管越来越多的人患有多种共存的健康状况，但这一领域几乎没有受到研究的关注。我们探讨了使用基于国家人口的队列和新的分析技术来确定不同治疗策略对多种特定疾病和健康结果的危害和好处的能力，特别是在一种疾病的治疗可能恶化另一种情况的情况下。我们将使用这种创新的方法来研究患有高血压和高跌倒/骨折风险这两种常见并存疾病的老年人的抗高血压药物强度。温和但相互矛盾的证据表明，抗高血压药物可能会增加高危人群跌倒、受伤和其他健康后果的风险。一旦我们用这个重要的临床问题测试了这种方法，我们将扩展到其他条件和药物。该项目建立在我们正在进行的关于在相互竞争的健康状况之间进行权衡的工作，并将特定疾病的结果映射到总体的、普遍的健康结果上。具体目的是验证这样的假设：在患有共病高血压和高跌倒/骨折风险的可比人群中，较大的降压强度与较少的心血管事件和较低的死亡率相关，但与较低的降压强度相比，更频繁的严重跌伤、更严重的症状、较低的活动水平和更大的残疾。在二次分析中，我们将在由年龄、性别、种族和合并发病负担定义的相关亚组中探索这些目标。我们还将确定血压水平和变化是否混淆了抗高血压药物强度对结果的影响。将研究两个以人口为基础的国家队列，即医疗保险当前受益人调查和医疗支出小组调查(研究样本35,000-40,000)。这两家公司都拥有丰富的纵向参与者报告、药物和索赔/医疗保健利用数据。这些深度和广度的数据使我们能够使用创新的分析技术来评估治疗对特定疾病和普遍健康结果(例如残疾、症状负担、功能限制和死亡)的影响，考虑到接受治疗的倾向和其他混杂因素。我们提出了一种新的范式来量化治疗对患有多种疾病的复杂老年人的伤害和好处。如果抗高血压药物等治疗在一系列结果领域既有好处也有坏处，那么这些信息必须被发现，并且必须为临床决策提供信息。我们的最终目标是开发一种方法，用于确定具有多种疾病的老年人的最佳治疗方法，在每个患者最优先的结果域(S)内最大化收益并将危害降至最低。 公共卫生相关性：在患有多种慢性病的人中，对一种疾病的治疗可能会加剧共生疾病或对整体健康结果产生不利影响。我们正在探索，在高血压和跌倒/骨折风险并存的老年人中，更大的降压药物强度是否有利于心血管结局，但会恶化跌倒伤害结局、症状、残疾或活动水平。研究结果有助于确定在越来越多的患有多种健康状况的老年人中，普遍推荐的治疗的净益处或危害。

DESCRIPTION (provided by applicant): In older adults with multi-morbidity, treatments targeting one disease may exacerbate co-occurring diseases or adversely affect overall health. Despite the potential for harm for the increasing numbers of individuals with multiple co-existing health conditions, this area has received little research attention. We explore the capability of using national population-based cohorts and novel analytical techniques to determine the harms and benefits of different treatment strategies across multiple disease-specific and health outcomes, particularly in situations in which the treatment of one condition may worsen another. We will use this innovative approach to investigate anti-hypertensive medication intensity in older adults with two commonly co-occurring conditions, namely hypertension and high fall/fracture risk. Modest, but conflicting, evidence suggests that anti-hypertensive medications may increase risk of falls, injuries, and other health outcomes in those at risk. Once we have tested the method with this important clinical question, we will extend to other sets of conditions and medications. This project builds on our ongoing work on tradeoffs among competing health conditions and mapping disease-specific outcomes onto overall, universal health outcomes. Specific aims are to test the hypotheses that, among comparable persons older adults with co- occurring hypertension and high fall/fracture risk, greater anti-hypertensive intensity is associated with fewer CV events and lower mortality but more frequent serious fall injuries, worse symptoms, lower activity level, and greater disability than lower anti-hypertensive intensity. In secondary analyses, we will explore these aims in relevant subgroups defined by age, gender, race, and co-morbidity burden. We will also determine if blood pressure levels and changes confound the effects of anti-hypertensive medication intensity on the outcomes. Two national, population-based cohorts, the Medicare Current Beneficiary Survey and the Medical Expenditure Panel Survey will be studied (study sample 35,000-40,000). Both have a wealth of longitudinal participant-reported, medication, and claims/health care utilization data. This depth and breadth of data allows us to use innovative analytical techniques to assess the effect of treatments on disease-specific and universal health outcomes (e.g. disability, symptom burden, functional limitations, and death), accounting for propensity to receive the treatment and for other confounders. We propose a new paradigm for quantifying the harm and benefit of treatments in complex older persons with multiple conditions. If treatments such as anti-hypertensives cause benefit as well as harm across a range of outcome domains, then this information must be uncovered and must inform clinical decision-making. Our ultimate goal is to develop a method for determining the optimal treatments for older adults with multiple conditions that maximizes benefit and minimizes harm within the outcome domain(s) of highest priority for each patient. PUBLIC HEALTH RELEVANCE: Among persons with multiple chronic conditions, treatments for one condition may exacerbate co-occurring conditions or adversely affect overall health outcomes. We are exploring whether greater antihypertensive medication intensity in older adults with co-occurring hypertension and fall/fracture risk benefits cardiovascular outcomes but worsens fall injury outcomes, symptoms, disability, or activity levels. Study results can help determine the net benefit or harm of commonly recommended treatments among the growing number of older adults with multiple health conditions.