基于保险和基于医院的数据库之间的结果事件覆盖的差异:日本糖尿病药物使用和心血管事件的方法研究
Takashi Ando1, Tomoaki Hasegawa1, Chieko Ishiguro2
1Department of Digital Health, Institute of Medicine, University of Tsukuba, Ibaraki, Japan.
Frontiers in pharmacology
|October 3, 2025
概括
在日本,近一半的心血管事件是在同一家医院捕获的,在那里SGLT2和DPP-4抑制剂等糖尿病药物被启动. 这一发现影响了使用医院数据库的药理流行病学研究.
科学领域:
- 药理流行病学 药理流行病学
- 心血管研究研究心血管研究
- 医疗信息学 医疗信息学
背景情况:
- 在日本,患者可能在一家医院接受初步糖尿病治疗,并在其他地方寻求随后的心血管事件的护理.
- 保险数据库理论上捕捉所有结果,而医院数据库仅限于在特定机构中发生的事件.
- 这项研究解决了日本保险和医院数据库之间的结果事件覆盖范围的差异.
研究的目的:
- 为了比较日本的保险和医院数据库之间的结果事件覆盖范围.
- 评估这种差异对药物流行病学研究的影响.
- 为了检查心血管事件捕获率,患者开始使用-葡萄糖共运输体-2 (SGLT2) 或二基化酶-4 (DPP-4) 抑制剂治疗2型糖尿病.
主要方法:
- 利用JMDC付款人数据库识别SGLT2或DPP-4抑制剂用于2型糖尿病的新用户.
- 定义综合结果为首次住院治疗心力衰竭,中风或心肌梗塞.
- 估计了在发起医院捕获的事件与保险数据中总事件的比例,并为假设的医院研究计算了调整后的危险比率 (aHR).
主要成果:
- 在在医院开始治疗的患者中,48%的DPP-4抑制剂使用者和45%的SGLT2抑制剂使用者在同一医院捕获了他们的心血管事件.
- 一项基于医院的假设研究给出了SGLT2与DPP-4抑制剂的aHR为0.74 (0.49-1.12) ,与基于保险的分析不同 (aHR为0.88 [0.64-1.21]).
- 在日本诊断程序组合 (DPC) 系统医院的灵敏度分析显示,复合和单个心血管事件的捕获率超过50%.
结论:
- 近一半的心血管事件是在发起医院捕获的,这突出了日本医院数据库的局限性.
- 超过一半的事件是在DPC医院捕获的,这表明这些系统中的数据完整性更好.
- 调查结果强调了考虑在日本制药流行病学研究中的数据库覆盖率差异的重要性.
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