Therapeutic competition among diseases in elders: Frequency and outcomes

描述(申请人提供)：在这项初步研究中，我们开始研究存在潜在治疗竞争(即一种疾病的治疗加剧另一种疾病或干扰治疗反应)的共生慢性病的患病率和对健康的影响。我们将重点放在治疗竞争上，这是由多种疾病引起的几个临床困境之一，因为它固有的潜在危害。主要目的是确定：1)老年人中同时发生某些可能存在治疗竞争的慢性疾病的患病率；以及2)患有与不患有某些共同发生的疾病的老年人接受和坚持的治疗是否存在差异，是否存在潜在的治疗竞争。探索性的目的是根据对潜在治疗竞争的共生疾病所接受的治疗，确定在患有特定疾病的老年人中，健康和疾病特定结果是否有所不同。我们将评估与潜在治疗竞争的共生疾病的频率和后果的选定疾病包括糖尿病、心力衰竭、COPD和骨质疏松症。在这项初步研究中，我们将重点放在药物作为治疗竞争的来源上。与所选疾病具有潜在治疗竞争的共生疾病的选择基于：1)证据；2)疾病和治疗的生物学；以及3)疾病专业指南。参与者是两个具有全国代表性的老年人纵向队列的成员，这两个队列都是从美国各地抽样的。医疗支出小组研究(MEP)有超过11,000名参与者，联邦医疗保险当前受益人研究(MCBS)有超过18,000名年龄在65岁以上的参与者。MEP和MCBS都包括关于慢性病、疾病治疗(包括药物治疗)、健康结果以及所选疾病的特定疾病结果的大量纵向数据。这项初步研究的结果将提高人们对这一重要但研究不足的领域的认识和理解，并为今后的研究奠定方法论基础。越来越多患有多种疾病的老年人出现临床困境，需要仔细审查，以确保尽可能安全和有效地部署我们的诊断、预防和治疗军械。 公共卫生相关性：治疗竞争(即一种疾病的治疗使另一种疾病恶化或干扰对治疗的反应)是两种或两种以上疾病共同出现的几个临床难题之一。这项初步研究的结果将提高人们对这一重要但研究不足的领域的认识和理解，并为今后的研究奠定方法论基础。越来越多的患有多种慢性病的老年人面临临床困境，需要进行仔细的审查，以确保尽可能安全和有效地部署我们的诊断、预防和治疗军备。

DESCRIPTION (provided by applicant): In this pilot study, we begin to examine the prevalence and health effects of co-occurring chronic diseases for which there is potential therapeutic competition (i.e. the treatment of one disease worsens another disease or interferes with treatment response). We focus on therapeutic competition, one of several clinical dilemmas arising from multi-morbidity, because of the inherent potential to inflict harm. The Primary Aims are to determine: 1) the prevalence among older adults of the co- occurrence of selected chronic diseases for which there is potential therapeutic competition; and 2) whether there are differences in treatments received, and adhered to, by older adults with, vs. without, selected co-occurring conditions for which there is potential therapeutic competition. The exploratory aim is to determine whether health and disease-specific outcomes differ among older adults with a selected disease according to the treatment received for co-occurring diseases with potential therapeutic competition. The selected diseases for which we will evaluate the frequency and consequences of co-occurring diseases with potential therapeutic competition include diabetes, heart failure, COPD, and osteoporosis. For this pilot study, we focus on medications as the source of therapeutic competition. The co-occurring diseases with potential therapeutic competition with the selected diseases are chosen based on: 1) evidence; 2) biology of the diseases and treatments; and 3) disease specialty guidelines. Participants are members of 2 nationally representative longitudinal cohorts of older adults, both sampled from throughout the U.S. The Medical Expenditure Panel Study (MEPS) has over 11,000 and the Medicare Current Beneficiary Study (MCBS) over 18,000 participants age 65+ years. Both MEPS and MCBS include a wealth of longitudinal data on chronic diseases, disease treatments including medications, health outcomes, and disease-specific outcomes for the selected diseases. Results of this pilot study will heighten awareness and understanding of this important but understudied area and lay the methodological groundwork for future studies. The clinical dilemmas arising from the growing numbers of older adults with multi-morbidity mandate careful scrutiny to ensure that our diagnostic, preventive, and therapeutic armamentaria are deployed as safely and effectively as possible. PUBLIC HEALTH RELEVANCE: Therapeutic competition (i.e. the treatment of one disease worsens another disease or interferes with response to treatment) is one of several clinical dilemmas arising from the co-occurrence of two or more diseases. Results of this pilot study will heighten awareness and understanding of this important but understudied area and lay the methodological groundwork for future studies. The clinical dilemmas arising from growing numbers of older adults with multiple chronic diseases mandate careful scrutiny to ensure that our diagnostic, preventive, and therapeutic armamentaria are deployed as safely and effectively as possible.