Antipsychotics and the risk of death in the elderly: an instrumental variable analysis using two preference based instruments

2010 ◽  
Vol 19 (7) ◽  
pp. 699-707 ◽  
Author(s):  
Nicole Pratt ◽  
Elizabeth E. Roughead ◽  
Philip Ryan ◽  
Amy Salter
Keyword(s):  
Instrumental Variable ◽  
The Elderly ◽  
Instrumental Variable Analysis ◽  
Risk Of Death ◽  
Variable Analysis

scholarly journals Types of Erythropoietin-Stimulating Agents and Mortality among Patients Undergoing Hemodialysis

2019 ◽  
Vol 30 (6) ◽  
pp. 1037-1048 ◽  
Author(s):  
Yusuke Sakaguchi ◽  
Takayuki Hamano ◽  
Atsushi Wada ◽  
Ikuto Masakane
Keyword(s):  
Instrumental Variable ◽  
Cox Model ◽  
Cox Proportional Hazards ◽  
Instrumental Variable Analysis ◽  
Short Acting ◽  
Risk Of Death ◽  
Significant Difference ◽  
Long Acting ◽  
Erythropoietin Stimulating Agents ◽  
Variable Analysis

BackgroundDespite the widespread use of erythropoietin-stimulating agents (ESAs) to treat anemia in patients undergoing hemodialysis, the relative mortality risks associated with use of different types of ESAs are unknown.MethodsTo compare the mortality risk associated with use of short-acting ESAs versus long-acting ESAs, we conducted a nationwide cohort study of 194,698 hemodialysis patients in Japan who received either a short-acting (epoetin α/β or epoetin κ) or a long-acting (darbepoetin or epoetin β pegol) ESA. Study outcomes were 2-year all-cause and cause-specific mortality. In addition to Cox proportional hazards models, we performed an instrumental variable analysis in which facility-level long-acting ESA prescription rates were taken as the instrumental variable.ResultsDuring the 2-year follow-up period, 31,557 deaths occurred. In a multivariable Cox model, long-acting ESA users had a 13% higher rate of deaths compared with short-acting ESA users, a significant difference (P<0.001). Similar results were obtained in other analyses. This difference in risk was pronounced among patients receiving high doses of ESA (for whom the adjusted 2-year number needed to harm for death was 30.8). Long-acting ESA use was associated with an increased rate of death from cardiovascular diseases, infection, and malignancies. In the instrumental variable analysis, long-acting ESA users remained at a significantly higher risk of death. Compared with anemic (hemoglobin 9.0–9.9 g/dl) short-acting ESA users, long-acting ESA users who achieved more optimal hemoglobin levels (10.0–10.9 g/dl) showed a higher mortality rate.ConclusionsAmong patients undergoing hemodialysis, use of long-acting ESAs might be associated with a higher risk of death than use of short-acting ESAs.

Abstract 2323: Statin Use and Discharge Disposition After Ischemic Stroke Hospitalization

Stroke ◽  
2012 ◽  
Vol 43 (suppl_1) ◽  
Author(s):  
Alexander Flint ◽  
Hooman Kamel ◽  
Babak Navi ◽  
Vivek Rao ◽  
Bonnie Faigeles ◽  
...  
Keyword(s):  
Ischemic Stroke ◽  
Instrumental Variable ◽  
Multivariable Analysis ◽  
Treatment Patterns ◽  
High Dose ◽  
Instrumental Variable Analysis ◽  
Discharge Disposition ◽  
Usual Dose ◽  
Statin Use ◽  
Variable Analysis

Objective: To determine whether statin use is associated with improved discharge disposition after ischemic stroke. Methods: We analyzed 12,689 patients with ischemic stroke over a 7 year period at 17 hospitals in Kaiser Permanente Northern California. We used multivariable generalized ordinal logistic regression and instrumental variable analysis of treatment patterns by hospital to control for the possibility of confounding. Results: Statin users before and during stroke hospitalization were more likely to be discharged home (54.9% for statin users, 46.3% for statin non-users) and less likely to die in hospital (5.3% for statin users, 10.3% for statin non-users). Patients who underwent statin withdrawal in-hospital were less likely to be discharged home (39.1% for statin withdrawal, 54.9% for statin continuation) and more likely to die in hospital (22.3% for statin withdrawal, 5.3% for statin continuation). Users of higher statin doses (>60 mg / day) were even more likely to be discharged home (62.5% for high dose statin, 56.5% for usual dose statin, and 47.4% for no statin) and less likely to die in hospital in-hospital (3.5% for high dose statin, 5.6% for usual dose statin, and 10.6% for no statin). These results were confirmed by multivariable analysis. The association of statin use and improved outcomes was also confirmed by instrumental variable analysis of treatment patterns by hospital, and thus this association cannot be explained by confounding at the individual patient level. Conclusions: Statin use is associated with improved discharge disposition after ischemic stroke, particularly at higher doses.

Methods matter: dealing with low compliance in sports injury trials analyses using instrumental variable analysis

2020 ◽  
pp. bjsports-2020-102155
Author(s):  
Pascal Edouard ◽  
Kathrin Steffen ◽  
Laurent Navarro ◽  
Mohammad Ali Mansournia ◽  
Rasmus Oestergaard Nielsen
Keyword(s):  
Instrumental Variable ◽  
Sports Injury ◽  
Instrumental Variable Analysis ◽  
Variable Analysis
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