期刊
JOURNAL OF CLINICAL EPIDEMIOLOGY
卷 59, 期 8, 页码 819-828出版社
ELSEVIER SCIENCE INC
DOI: 10.1016/j.jclinepi.2005.12.012
关键词
aging; bias; confounding variables; hypercholesterolemia; prescriptions; drug; statins
资金
- NIA NIH HHS [AG18833] Funding Source: Medline
Objective: Observational studies have found beneficial effects of lipid-lowering drugs on diverse outcomes, including venous thromboembolism, hip fracture, dementia, and all-cause mortality. Selective use of these drugs in frail people may confound these relationships. Study Design and Setting: We measured 1-year mortality in two cohorts of New Jersey residents, aged 65-99 years, enrolled in state-sponsored drug benefits programs: 112,463 persons hospitalized during the years 1991-1994 and 106,838 nonhospitalized enrollees. Use of lipid-lowering drugs and other medications, as well as diagnoses, were evaluated before follow-up. Results: In age- and sex-adjusted analyses, users of lipid-lowering drugs had a 43% reduced death rate relative to nonusers among hospitalized enrollees and a 56% reduction in the nonhospitalized sample. Available markers of frailty and comorbidity predicted decreased use of these drugs. Control for the propensity to use lipid-lowering drugs attenuated but did not eliminate these effects. After such adjustment, users had a 30% reduction in death rate (95% confidence interval [Cl]: 25%-35%) among hospitalized enrollees and a 41% reduction (95% Cl: 35%-47%) in the nonhospitalized sample. Unmeasured frailty associated with a 26%-33% reduced odds of receiving lipid-lowering therapy could explain this effect. Conclusion: Frailty and comorbidity that influence use of preventive therapies can substantially confound apparent benefits of lipid-lowering drugs on outcomes. (C) 2006 Elsevier Inc. All fights reserved.
作者
我是这篇论文的作者
点击您的名字以认领此论文并将其添加到您的个人资料中。
推荐
暂无数据