在基于登记的肥胖研究中可能存在选择偏差
Lena Ms Carlsson1, Markku Peltonen2, Peter Jacobson1
1Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden.
European journal of epidemiology
|May 12, 2025
概括
肥胖研究中的对照组可能会扭曲结果. 那些在登记册中先前被诊断为肥胖的人的死亡率高于那些没有肥胖的人,影响了减肥手术生存益处估计.
科学领域:
- 腹腔外科手术的结果
- 肥胖研究方法研究方法.
- 流行病学 流行病学
背景情况:
- 关于肥胖治疗的研究通常使用来自现实世界注册的对照组.
- 这些对照组可能不能准确地代表肥胖的一般人口.
- 这可能会对治疗疗效的评估产生偏见.
研究的目的:
- 评估对照组选择对肥胖治疗结果研究的影响.
- 调查在国家患者登记册中先前诊断和未诊断的肥胖个体之间的死亡率差异.
- 评估在减肥手术研究中的潜在选择偏差.
主要方法:
- 对SOS研究队列的分析,比较减肥手术患者 (n=2,007) 与匹配的对照 (n=2,040).
- 对照组的细分基于瑞典国家患者登记处的肥胖诊断状态.
- 长期死亡率评估超过26年的中位随访时间,在单独的队列中得到证实 (n=2,759).
主要成果:
- 之前被诊断患有肥胖症的对照组与没有被诊断患有肥胖症的对照组相比,死亡率更高 (19.7例/1000人/年),死亡率更高 (14.4例/1000人/年).
- 这意味着风险比率为1.45 (p=0.005) 和预先诊断的对照人群的预期寿命缩短了3.4年.
- 在第二个队列中观察到类似的发现,表明危险比率为1.82 (p<0.001) 和预期寿命缩短了6.1年.
结论:
- 现实世界的对照组,特别是那些通过先前的肥胖诊断来确定的对照组,可能代表健康状况较差的个体.
- 在肥胖治疗研究中使用此类控制可以导致对治疗益处的高估,例如腹部外科手术后的生存优势.
- 仔细考虑对照组的选择和健康状况对于准确的研究结果在肥胖和减肥手术研究至关重要.
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