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Restriction of Pharmacoepidemiologic Cohorts to Initiators of Unrelated Preventive Drug Classes to Reduce Confounding by Frailty in Older Adults.

08:00 EDT 30th March 2019 | BioPortfolio

Summary of "Restriction of Pharmacoepidemiologic Cohorts to Initiators of Unrelated Preventive Drug Classes to Reduce Confounding by Frailty in Older Adults."

Non-experimental studies of seasonal influenza vaccine effectiveness in older adults have reported 40-60% reductions in all-cause mortality associated with vaccination, potentially due to confounding by frailty. We restricted our cohort to initiators of preventive drug classes (statins, antiglaucoma drugs, and beta-blockers) as an approach to reduce confounding by frailty by excluding frail older adults who would not initiate these drugs. Using a random 20% sample of U.S. Medicare beneficiaries, we framed our study as a series of nonrandomized "trials" comparing vaccinated beneficiaries with unvaccinated beneficiaries who had an outpatient visit for the five influenza seasons from 2010-2015. We pooled data across seasons and used standardized-mortality-ratio-weighted Cox proportional hazards models to estimate the association between influenza vaccination and all-cause mortality before influenza season, expecting a null association. Weighted hazard ratios in the preventive drug initiators were generally closer to the null than those in the non-restricted cohort. Restriction to statin initiators with an uncensored approach resulted in a weighted hazard ratio of 1.00 (95%
CI:
0.84,1.19), and several others were above 0.95. Restricting analyses to initiators of preventive drug classes can reduce confounding by frailty in this setting, but further work is required to determine the most appropriate criteria to use.

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This article was published in the following journal.

Name: American journal of epidemiology
ISSN: 1476-6256
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