高维与传统倾向评分在 Coxibs 与减少上消化道并发症的比较有效性研究中的应用。

High-dimensional versus conventional propensity scores in a comparative effectiveness study of coxibs and reduced upper gastrointestinal complications.

机构信息

Department of Clinical Epidemiology, BIPS-Institute for Epidemiology and Prevention Research, Achterstr. 30, 28359 Bremen, Germany.

出版信息

Eur J Clin Pharmacol. 2013 Mar;69(3):549-57. doi: 10.1007/s00228-012-1334-2. Epub 2012 Jul 5.

DOI:10.1007/s00228-012-1334-2

PMID:22763756

Abstract

PURPOSE

High-dimensional propensity score (hd-PS) adjustment has been proposed as a tool to improve control for confounding in pharmacoepidemiological studies using longitudinal claims databases. We investigated whether hd-PS matching improved confounding by indication in a study of Cox-2 inhibitors (coxibs) and traditional nonsteroidal anti-inflammatory drugs (tNSAIDs) and their association with the risk of upper gastrointestinal complications (UGIC).

METHODS

In a cohort study of new users of coxibs and tNSAIDs we compared the effectiveness of these drugs to reduce UGIC using hd-PS matching and conventional propensity score (PS) matching in the German Pharmacoepidemiological Research Database.

RESULTS

The unadjusted rate ratio (RR) of UGIC for coxib users versus tNSAID users was 1.21 [95 % confidence interval (CI) 0.91-1.61]. The conventional PS matched cohort based on 79 investigator-identified covariates resulted in a RR of 0.84 (0.56-1.26). The use of the hd-PS algorithm based on 900 empirical covariates further decreased the RR to 0.62 (0.43-0.91).

CONCLUSIONS

A comparison of hd-PS matching versus conventional PS matching resulted in improved point estimates for studying an intended treatment effect of coxibs versus tNSAIDs when benchmarked against results from randomized controlled trials.

摘要

目的

高维倾向评分（hd-PS）调整被提议作为一种工具，以改善使用纵向索赔数据库进行药物流行病学研究的混杂控制。我们研究了在 COX-2 抑制剂（coxibs）和传统非甾体抗炎药（tNSAIDs）及其与上胃肠道并发症（UGIC）风险相关性的研究中，hd-PS 匹配是否改善了指示性混杂。

方法

在一项新使用 coxibs 和 tNSAIDs 的患者队列研究中，我们在德国药物流行病学研究数据库中比较了使用 hd-PS 匹配和传统倾向评分（PS）匹配来评估这些药物对降低 UGIC 的有效性。

结果

coxib 使用者与 tNSAID 使用者发生 UGIC 的未调整率比（RR）为 1.21[95%置信区间（CI）0.91-1.61]。基于 79 个研究者确定的协变量的传统 PS 匹配队列得出的 RR 为 0.84（0.56-1.26）。基于 900 个经验协变量的 hd-PS 算法的使用进一步将 RR 降低至 0.62（0.43-0.91）。