Department of Pharmaceutical Systems and Policy, West Virginia University, Morgantown, WV 26506, USA.
Rheumatology, West Virginia University Medicine, Morgantown, WV 26506, USA.
Int J Environ Res Public Health. 2020 Dec 28;18(1):155. doi: 10.3390/ijerph18010155.
Evidence from some studies suggest that osteoarthritis (OA) patients are often prescribed non-steroidal anti-inflammatory drugs (NSAIDs) that are not in accordance with their cardiovascular (CV) or gastrointestinal (GI) risk profiles. However, no such study has been carried out in the United States. Therefore, we sought to examine the prevalence and predictors of potentially inappropriate NSAIDs use in older adults (age > 65) with OA using machine learning with real-world data from Optum De-identified Clinformatics Data Mart. We identified a retrospective cohort of eligible individuals using data from 2015 (baseline) and 2016 (follow-up). Potentially inappropriate NSAIDs use was identified using the type (COX-2 selective vs. non-selective) and length of NSAIDs use and an individual's CV and GI risk. Predictors of potentially inappropriate NSAIDs use were identified using eXtreme Gradient Boosting. Our study cohort comprised of 44,990 individuals (mean age 75.9 years). We found that 12.8% individuals had potentially inappropriate NSAIDs use, but the rate was disproportionately higher (44.5%) in individuals at low CV/high GI risk. Longer duration of NSAIDs use during baseline (AOR 1.02; 95% CI:1.02-1.02 for both non-selective and selective NSAIDs) was associated with a higher risk of potentially inappropriate NSAIDs use. Additionally, individuals with low CV/high GI (AOR 1.34; 95% CI:1.20-1.50) and high CV/low GI risk (AOR 1.61; 95% CI:1.34-1.93) were also more likely to have potentially inappropriate NSAIDs use. Heightened surveillance of older adults with OA requiring NSAIDs is warranted.
一些研究表明，骨关节炎 (OA) 患者经常开处方的非甾体抗炎药 (NSAIDs) 与其心血管 (CV) 或胃肠道 (GI) 风险状况不符。然而，在美国还没有开展过此类研究。因此，我们利用来自 Optum 去识别 Clinformatics Data Mart 的真实世界数据，采用机器学习技术，检查美国年龄大于 65 岁的 OA 患者中潜在不适当 NSAIDs 使用的流行率和预测因素。我们使用 2015 年（基线）和 2016 年（随访）的数据，确定了合格个体的回顾性队列。通过 NSAIDs 的类型（COX-2 选择性与非选择性）和使用时长以及个体的 CV 和 GI 风险来确定潜在不适当 NSAIDs 使用。使用极端梯度提升来确定潜在不适当 NSAIDs 使用的预测因素。我们的研究队列包含 44990 名个体（平均年龄 75.9 岁）。我们发现，有 12.8%的个体存在潜在不适当 NSAIDs 使用，但在 CV 风险低/ GI 风险高的个体中，这一比例不成比例地更高（44.5%）。基线期间 NSAIDs 使用时间更长（非选择性和选择性 NSAIDs 的 AOR 均为 1.02；95%CI：1.02-1.02）与潜在不适当 NSAIDs 使用风险增加相关。此外，CV 风险低/ GI 风险高（AOR 1.34；95%CI：1.20-1.50）和 CV 风险高/ GI 风险低（AOR 1.61；95%CI：1.34-1.93）的个体也更有可能存在潜在不适当 NSAIDs 使用。需要加强对需要 NSAIDs 的 OA 老年患者的监测。
