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: 6918117
• 负责人: Til Sturmer
• 金额: $ 30.93万
• 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 2007-11-30
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/6918117
• 关键词: cancer prevention; chemoprevention; clinical research; colorectal neoplasms; data collection methodology /evaluation; human data; human old age (65+); human subject; nonsteroidal antiinflammatory agent; statistics /biometry

DESCRIPTION (provided by applicant): The preventive use of prescription- and non-prescription drugs is a central feature of the care of the elderly. Randomized controlled trials assessing the efficacy of preventive medications in the elderly are costly and may be limited in their generalizability due to selection of participants, shorter duration of treatment, and competing outcomes. However, observational studies of these questions are frequently criticized for biased results. It is therefore vital to develop and apply adequate methods to reduce bias in observational studies that assess the preventive effects of medication use in older patients. Propensity scores and multivariate confounder scores have been proposed to improve control for confounding in such observational studies of medications. Despite increasing use, there is little evidence that better control of confounding is achieved. We propose to assess the validity, statistical efficiency, and applicability of propensity scores and related techniques compared to 'traditional' multivariate analysis in studying the effects of medications in the elderly. The relation between preventive NSAID use and colorectal cancer serves as our primary example to elucidate how propensity scores and multivariate confounder scores can reduce bias. We will use two large cohort studies the Physicians' Health Study and the Women's Health Study to evaluate this association. Because the study focuses on the analytic approach for evaluating such data, and not on the assessment of any single biological mechanism, we explore other possible associations between preventive drug use and health outcomes that were deliberately selected to reflect a wide range of typical analytic situations as the basis for our multivariate simulation studies. Based on the results of these large cohort studies we will conduct extensive statistical simulations to assess the determinants of improved validity and efficiency of propensity scores and multivariate confounder scores for a range of realistic scenarios. Results will be integrated into meaningful and easy-to-use decision rules and practical recommendations for the appropriate use of propensity scores and multivariable confounder scores in observational research in the elderly. These recommendations will be disseminated widely among researchers and practicing physicians.

描述（由申请人提供）：处方药和非处方药的预防性使用是老年人护理的核心特征。评估老年人预防性药物疗效的随机对照试验成本高昂，而且由于参与者的选择、较短的治疗时间和相互竞争的结果，可能在推广方面受到限制。然而，这些问题的观察性研究经常被批评为有偏见的结果。因此，在评估老年患者用药的预防效果的观察性研究中，开发和应用适当的方法来减少偏倚是至关重要的。倾向评分和多变量混杂评分已被提出用于改善此类药物观察性研究中对混杂的控制。尽管越来越多地使用，但几乎没有证据表明更好地控制了混淆。