Hayes Kaleen N, Niznik Joshua David, Gnjidic Danijela, Moriarty Frank, Tran Nha, Coe Antoinette B, Zullo Andrew R, Zhang Sirui, Alcusky Matthew, Bennett Dimitri, Hartikainen Sirpa, Laroche Marie-Laure, Li Xiaojuan, Lin Joshua K, Lund Jennifer L, Sessa Maurizio, Shmuel Shahar, Sirois Caroline, Talbot Denis, Tiihonen Miia, Wen Xuerong, Sawan Mouna J, Moga Daniela C
Department of Health Services, Policy & Practice, Brown University School of Public Health, Providence, RI 02903, United States.
Division of Geriatric Medicine and Center for Aging and Health, University of North Carolina at Chapel Hill, School of Medicine, Chapel Hill, NC 27599, United States.
Am J Epidemiol. 2025 Aug 5;194(8):2431-2439. doi: 10.1093/aje/kwae425.
Observational studies using real-world data (RWD) can address gaps in knowledge on deprescribing medications but are subject to methodological issues. Limited data exist on the methods employed to use RWD to measure the effects of deprescribing. To describe methodological approaches used in observational studies of deprescribing medications in older adults, we conducted a systematic review in Medline for observational studies published in English (January 1, 2000, to September 14, 2023) that examined the health effects of medication deprescribing in older adults. We described study characteristics and methods, focusing on the operationalization of deprescribing as an exposure and potential time-related biases. Forty-five studies were included, representing a variety of drug classes (eg, statins, aspirin, bisphosphonates) and diseases. Most studies adequately addressed potential time-related biases. The definition of deprescribing was not clearly defined in 12 studies. There was heterogeneity regarding the minimum duration of time that qualified as deprescribing, even within a drug class; fewer than one-third of studies provided a justification for these definitions. Observational studies are common to examine the effects of deprescribing; however, there were inconsistencies in measuring deprescribing and a lack of transparency in reporting. There is a need for minimum sufficient reporting criteria for observational studies on deprescribing.
使用真实世界数据（RWD）的观察性研究可以填补减药知识方面的空白，但存在方法学问题。关于使用RWD来衡量减药效果所采用的方法，现有数据有限。为了描述老年人减药观察性研究中使用的方法学方法，我们在Medline中对2000年1月1日至2023年9月14日以英文发表的观察性研究进行了系统综述，这些研究探讨了老年人药物减停的健康影响。我们描述了研究特征和方法，重点关注减药作为一种暴露因素的操作化以及潜在的时间相关偏倚。纳入了45项研究，涉及多种药物类别（如他汀类药物、阿司匹林、双膦酸盐）和疾病。大多数研究充分解决了潜在的时间相关偏倚。12项研究中未明确界定减药的定义。即使在同一药物类别中，符合减药标准的最短时间也存在异质性；不到三分之一的研究为这些定义提供了理由。观察性研究常用于检验减药的效果；然而，在衡量减药方面存在不一致性，报告缺乏透明度。需要为减药观察性研究制定最低充分报告标准。
