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: 7851375
• 负责人: Til Sturmer
• 金额: $ 29.94万
• 依托单位: UNIV OF NORTH CAROLINA CHAPEL HILL
• 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 2011-09-30
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/7851375
• 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-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; Scoring Method; Series; Techniques; Time; Woman; Work; base; design; frailty; hormone therapy; improved; innovation; meetings; mortality; older patient; posters; 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疾病是老年人护理的一个核心特征。近年来，人们越来越关注几种药物在这方面的疗效，包括非甾体抗炎药、他汀类药物和绝经后妇女的激素治疗。评估老年人慢性疾病药物预防有效性的随机对照试验非常昂贵，需要很长时间来设计和实施，并且由于参与者的选择，较短的治疗时间和相互竞争的结果，可能具有有限的推广能力。然而，对这些问题的观察性研究，包括基于通常是唯一可用的行政数据的研究，经常被批评为产生有偏见的结果。因此，至关重要的是开发和应用创新技术，以改进评估老年患者用药预防效果的非实验研究的因果推断。在RO1 AG023178的资助下，我们之前评估了倾向得分（ps）在真实数据集和广泛模拟中的局限性和优势。我们在最高级别的国际流行病学和药物流行病学会议上通过口头报告（12）、海报(9)和专题讨论会(2)以及一系列9份出版物（包括最高级别的流行病学期刊中的4份）传播了我们的结果。竞争的延续将使我们能够继续和扩展我们之前的工作，即倾向分数的局限性和价值，以评估老年患者使用药物的预防效果。研究小组将继续关注几个未解决的主题，这些主题涉及使用验证研究来调整主要研究和ps中未测量的混淆。我们提议……比较缺失数据和测量误差校正的方法，以调整使用验证研究数据的主要研究中未测量的混淆，2。应用这些方法来解决胆碱酯酶抑制剂延长寿命中未测量的混杂因素，3。评估从分析中排除极低和极高PSs患者的价值；4 .评估倾向评分在非二分类暴露情况下的适用性和使用；与变量选择相比，评估PS的经验贝叶斯修正值。传播我们的结果将增加PS方法的正确应用，包括调整未测量混淆的方法。