Therapeutic competition among diseases in elders: Frequency and outcomes

描述（由申请方提供）：在本项初步研究中，我们开始检查存在潜在治疗竞争（即，一种疾病的治疗与另一种疾病重叠或干扰治疗反应）的合并慢性疾病的患病率和健康影响。我们专注于治疗竞争，多发病率所产生的几个临床困境之一，因为固有的潜在造成伤害。 主要目的是确定：1）存在潜在治疗竞争的选定慢性疾病的合并发生率; 2）患有与不患有存在潜在治疗竞争的选定合并疾病的老年人接受和坚持的治疗是否存在差异。探索性的目的是确定健康和疾病特异性结果是否在患有选定疾病的老年人中存在差异，根据对具有潜在治疗竞争的共病所接受的治疗。 我们将评估具有潜在治疗竞争的共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。对于这项试点研究，我们专注于药物作为治疗竞争的来源。选择与选定疾病具有潜在治疗竞争的共病是基于：1）证据; 2）疾病和治疗的生物学;和3）疾病专科指南。 参与者是2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（MEPS）有超过11，000人，医疗保险当前受益人研究（MCBS）有超过18，000名65岁以上的参与者。MEPS和MCBS都包括大量关于慢性病、疾病治疗（包括药物治疗）、健康结果和选定疾病的疾病特异性结果的纵向数据。 这项试点研究的结果将提高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基础。越来越多的老年人患有多种疾病所带来的临床困境要求仔细审查，以确保我们的诊断，预防和治疗设备尽可能安全有效地部署。 公共卫生相关性：治疗竞争（即一种疾病的治疗与另一种疾病相冲突或干扰对治疗的反应）是两种或多种疾病同时发生所引起的几种临床困境之一。这项试点研究的结果将提高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基础。越来越多的老年人患有多种慢性疾病，这使得临床面临困境，需要仔细审查，以确保我们的诊断，预防和治疗设备尽可能安全有效地部署。

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.