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.

National Institute of Health (NIH)
National Institute on Aging (NIA)
Research Project (R01)
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Neurological, Aging and Musculoskeletal Epidemiology (NAME)
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Haaga, John G
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University of North Carolina Chapel Hill
Public Health & Prev Medicine
Schools of Public Health
Chapel Hill
United States
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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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