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.

Agency
National Institute of Health (NIH)
Institute
National Institute on Aging (NIA)
Type
Research Project (R01)
Project #
5R01AG023178-03
Application #
7261209
Study Section
Epidemiology of Clinical Disorders and Aging Study Section (ECDA)
Program Officer
Stahl, Sidney M
Project Start
2005-06-15
Project End
2008-03-31
Budget Start
2007-06-01
Budget End
2008-03-31
Support Year
3
Fiscal Year
2007
Total Cost
$159,711
Indirect Cost
Name
Brigham and Women's Hospital
Department
Type
DUNS #
030811269
City
Boston
State
MA
Country
United States
Zip Code
02115
Hong, Jin-Liern; Jonsson Funk, Michele; Buse, John B et al. (2017) Comparative Effect of Initiating Metformin Versus Sulfonylureas on Breast Cancer Risk in Older Women. Epidemiology 28:446-454
Wyss, Richard; Hansen, Ben B; Ellis, Alan R et al. (2017) The ""Dry-Run"" Analysis: A Method for Evaluating Risk Scores for Confounding Control. Am J Epidemiol 185:842-852
Lund, Jennifer L; Horváth-Puhó, Erzsébet; Komjáthiné Szépligeti, Szimonetta et al. (2017) Conditioning on future exposure to define study cohorts can induce bias: the case of low-dose acetylsalicylic acid and risk of major bleeding. Clin Epidemiol 9:611-626
Gokhale, Mugdha; Buse, John B; Jonsson Funk, Michele et al. (2017) No increased risk of cardiovascular events in older adults initiating dipeptidyl peptidase-4 inhibitors vs therapeutic alternatives. Diabetes Obes Metab 19:970-978
Hong, Jin-Liern; Henderson, Louise M; Jonsson Funk, Michele et al. (2017) Differential Use of Screening Mammography in Older Women Initiating Metformin versus Sulfonylurea. Pharmacoepidemiol Drug Saf 26:666-675
Zhang, Henry T; McGrath, Leah J; Wyss, Richard et al. (2017) Controlling confounding by frailty when estimating influenza vaccine effectiveness using predictors of dependency in activities of daily living. Pharmacoepidemiol Drug Saf 26:1500-1506
Zimmerman, Kanecia O; Smith, P Brian; Benjamin, Daniel K et al. (2017) Sedation, Analgesia, and Paralysis during Mechanical Ventilation of Premature Infants. J Pediatr 180:99-104.e1
Bushnell, Greta A; Stürmer, Til; White, Alice et al. (2016) Predicting persistence to antidepressant treatment in administrative claims data: Considering the influence of refill delays and prior persistence on other medications. J Affect Disord 196:138-47
Brookhart, M Alan; Freburger, Janet K; Ellis, Alan R et al. (2016) Comparative Short-term Safety of Sodium Ferric Gluconate Versus Iron Sucrose in Hemodialysis Patients. Am J Kidney Dis 67:119-27
Kinlaw, Alan C; Jonsson Funk, Michele; Steiner, Michael J et al. (2016) Trends in Pharmacotherapy for Bladder Dysfunction Among Children in the United States, 2000 to 2013. Clin Pediatr (Phila) :

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