不完整的死亡信息对美国索赔数据中的累积风险估计的影响
American journal of epidemiology
|April 7, 2024
概括
行政索赔数据可能会将死亡误解为审查,而不是竞争事件. 这项研究表明,随着随访时间和年龄的增加,心血管风险估计的差异增加,影响了药理流行病学研究.
科学领域:
- 药理流行病学 药理流行病学
- 生物统计学 生物统计学
- 医疗保健服务研究 医疗服务研究
背景情况:
- 行政索赔数据库经常缺乏完整的死亡数据,这可能导致死亡被误认为是审查事件.
- 这种错误分类可以在现实数据研究中对治疗效应和事件风险的估计产生偏差.
研究的目的:
- 评估将死亡视为审查事件而不是竞争事件对心血管结果累积风险估计的影响.
- 评估随访时间和患者年龄如何影响风险估计中的这些差异.
主要方法:
- 在一个大队列 (34,527名患者) 中使用逆治疗概率权重 (IPTW),开始使用telmisartan或ramipril.
- 使用Optum美国索赔数据 (2003-2020) 分析了复合心血管结果的1,3年和5年的累积风险.
- 使用等离子模拟来检查死亡率之间的关系和因果特异性和分发累积风险之间的差异.
主要成果:
- 心血管事件的因果特异性和分发累积风险之间的差异随着随访时间的延长和年龄的增加而增加.
- 对于75岁以上的拉米普利尔使用者,5年累积风险差异为3.6/100 (43.2比39.7),当将死亡视为审查与竞争事件时.
- 等离子模拟证实,较高的死亡率放大了风险估计的差异.
结论:
- 在行政索赔数据中将死亡视为审查事件,可能会导致严重低估累积心血管风险,特别是在老年人群或随访时间较长的人群中.
- 研究人员必须考虑基线死亡率,在评估声明数据与不完整的死亡信息适合药理学流行病学研究时.
- 准确处理死亡率作为一个竞争事件对于可靠的现实世界证据生成至关重要.
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