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

治疗一种疾病对其他疾病和老年人健康结果的影响

• 批准号: 8322607
• 负责人: MARY E TINETTI
• 金额: $ 17.02万
• 依托单位: YALE UNIVERSITY
• 依托单位国家: 美国
• 财政年份: 2011
• 资助国家: 美国
• 起止时间: 2011-09-01 至 2013-02-28
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/8322607
• 关键词: Accounting; Address; Affect; Age; Antihypertensive Agents; Area; Attention; Benefits and Risks; Blood Pressure; Cardiovascular system; Cessation of life; Chronic; Clinic; Clinical; Comorbidity; Complement; Complex; Conflict (Psychology); Data; Disease; Elderly; Event; Expenditure; Fracture; Gender; Goals; Health; Hypertension; Individual; Injury; Intervention; Investigation; Maps; Medical; Medical Records; Medicare; Methods; Morbidity - disease rate; Motivation; Outcome; Outcome Study; Participant; Patients; Persons; Pharmaceutical Preparations; Prevalence; Race; Randomized Controlled Trials; Reporting; Research; Risk; Sampling Studies; Subgroup; Surveys; Symptoms; Techniques; Testing; Work; base; beneficiary; clinical decision-making; cohort; comparative effectiveness; design; disability; disorder risk; effectiveness research; fall risk; falls; health care service utilization; innovation; mortality; multiple chronic conditions; novel; novel strategies; population based; prevent; treatment effect; treatment strategy

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.

描述（由申请人提供）：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存疾病或对整体健康产生不利影响。尽管对越来越多同时存在多种健康状况的个体有潜在的危害，但这一领域的研究很少受到关注。我们探索使用基于国家人群的队列和新型分析技术的能力，以确定不同治疗策略在多种疾病特异性和健康结果中的危害和益处，特别是在一种疾病的治疗可能使另一种疾病恶化的情况下。我们将使用这种创新的方法来研究患有两种常见疾病的老年人的降压药物强度，即高血压和高跌倒/骨折风险。适度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。一旦我们在这个重要的临床问题上测试了这种方法，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相互竞争的健康状况之间的权衡和将特定疾病的结果映射到总体普遍健康结果的工作的基础上。具体目的是验证以下假设：在同时发生高血压和高跌倒/骨折风险的老年人中，与较低的抗高血压强度相比，较高的抗高血压强度与更少的心血管事件和更低的死亡率相关，但更频繁的严重跌倒损伤、更严重的症状、更低的活动水平和更大的残疾。在二次分析中，我们将根据年龄、性别、种族和合并症负担在相关亚组中探讨这些目标。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。将研究两个全国性的、以人口为基础的队列，即医疗保险当前受益人调查和医疗支出小组调查（研究样本为35,000-40,000）。两者都有大量的纵向参与者报告、药物和索赔/医疗保健利用数据。这种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的危害和利益在复杂的老年人有多种条件。如果抗高血压等治疗在一系列结果领域中既带来益处也带来危害，那么必须揭示这些信息，并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来确定具有多种疾病的老年人的最佳治疗方法，从而在每个患者最优先考虑的结果域内最大化收益并最小化危害。