Evaluating different physician's prescribing preference based instrumental variables in two primary care databases: A study of inhaled long-acting beta2-agonist use and the risk of myocardial infarction

Md Jamal Uddin; Rolf H H Groenwold; Anthonius de Boer; Ana S M Afonso; Paola Primatesta; Claudia Becker; S. Belitser; Arno W. Hoes; Kit C B Roes; Olaf H. Klungel

doi:10.1002/pds.3860

Evaluating different physician's prescribing preference based instrumental variables in two primary care databases: A study of inhaled long-acting beta2-agonist use and the risk of myocardial infarction

Md Jamal Uddin, Rolf H H Groenwold, Anthonius de Boer, Ana S M Afonso, Paola Primatesta, Claudia Becker, S. Belitser, Arno W. Hoes, Kit C B Roes, Olaf H. Klungel^*

^*Corresponding author for this work

Pharmacoepidemiology and Clinical Pharmacology

Research output: Contribution to journal › Article › Academic › peer-review

Abstract

Purpose: Instrumental variable (IV) analysis with physician's prescribing preference (PPP) as IV is increasingly used in pharmacoepidemiology. However, it is unclear whether this IV performs consistently across databases. We aimed to evaluate the validity of different PPPs in a study of inhaled long-acting beta2-agonist (LABA) use and myocardial infarction (MI). Methods: Information on adults with asthma and/or COPD and at least one prescription of beta2-agonist, or muscarinic antagonist was extracted from the CPRD (UK) and the Mondriaan (Netherlands) databases. LABA exposure was considered time-fixed or time-varying. We measured PPPs using previous LABA prescriptions of physicians or proportion of LABA prescriptions per practice. Correlation (r) and standardized difference (SDif) were used to assess assumption of IV analysis. Results: For time-fixed LABA, the IV based on 10 previous prescriptions outperformed the other IVs regarding strength of the IV (r≥0.15) and balance of confounders between IV categories (SDif

Original language	English
Pages (from-to)	132-141
Number of pages	10
Journal	Pharmacoepidemiology and Drug Safety
Volume	25
Issue number	Supplement 1
DOIs	https://doi.org/10.1002/pds.3860
Publication status	Published - 1 Mar 2016

Keywords

Beta2-agonist
General practice databases
Instrumental variables
Myocardial infarction
Pharmacoepidemiology
Physician's prescribing preference
Unmeasured confounding

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Uddin_et_al-2016-Pharmacoepidemiology_and_Drug_Safety (2)Final published version, 455 KBLicence: Taverne

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Uddin, M. J., Groenwold, R. H. H., de Boer, A., Afonso, A. S. M., Primatesta, P., Becker, C., Belitser, S., Hoes, A. W., Roes, K. C. B., & Klungel, O. H. (2016). Evaluating different physician's prescribing preference based instrumental variables in two primary care databases: A study of inhaled long-acting beta2-agonist use and the risk of myocardial infarction. Pharmacoepidemiology and Drug Safety, 25(Supplement 1), 132-141. https://doi.org/10.1002/pds.3860

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abstract = "Purpose: Instrumental variable (IV) analysis with physician's prescribing preference (PPP) as IV is increasingly used in pharmacoepidemiology. However, it is unclear whether this IV performs consistently across databases. We aimed to evaluate the validity of different PPPs in a study of inhaled long-acting beta2-agonist (LABA) use and myocardial infarction (MI). Methods: Information on adults with asthma and/or COPD and at least one prescription of beta2-agonist, or muscarinic antagonist was extracted from the CPRD (UK) and the Mondriaan (Netherlands) databases. LABA exposure was considered time-fixed or time-varying. We measured PPPs using previous LABA prescriptions of physicians or proportion of LABA prescriptions per practice. Correlation (r) and standardized difference (SDif) were used to assess assumption of IV analysis. Results: For time-fixed LABA, the IV based on 10 previous prescriptions outperformed the other IVs regarding strength of the IV (r≥0.15) and balance of confounders between IV categories (SDif",

keywords = "Beta2-agonist, General practice databases, Instrumental variables, Myocardial infarction, Pharmacoepidemiology, Physician's prescribing preference, Unmeasured confounding",

author = "Uddin, {Md Jamal} and Groenwold, {Rolf H H} and {de Boer}, Anthonius and Afonso, {Ana S M} and Paola Primatesta and Claudia Becker and S. Belitser and Hoes, {Arno W.} and Roes, {Kit C B} and Klungel, {Olaf H.}",

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Uddin, MJ, Groenwold, RHH, de Boer, A, Afonso, ASM, Primatesta, P, Becker, C, Belitser, S, Hoes, AW, Roes, KCB & Klungel, OH 2016, 'Evaluating different physician's prescribing preference based instrumental variables in two primary care databases: A study of inhaled long-acting beta2-agonist use and the risk of myocardial infarction', Pharmacoepidemiology and Drug Safety, vol. 25, no. Supplement 1, pp. 132-141. https://doi.org/10.1002/pds.3860

Evaluating different physician's prescribing preference based instrumental variables in two primary care databases: A study of inhaled long-acting beta2-agonist use and the risk of myocardial infarction. / Uddin, Md Jamal; Groenwold, Rolf H H; de Boer, Anthonius et al.
In: Pharmacoepidemiology and Drug Safety, Vol. 25, No. Supplement 1, 01.03.2016, p. 132-141.

Research output: Contribution to journal › Article › Academic › peer-review

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T2 - A study of inhaled long-acting beta2-agonist use and the risk of myocardial infarction

AU - Uddin, Md Jamal

AU - Groenwold, Rolf H H

AU - de Boer, Anthonius

AU - Afonso, Ana S M

AU - Primatesta, Paola

AU - Becker, Claudia

AU - Belitser, S.

AU - Hoes, Arno W.

AU - Roes, Kit C B

AU - Klungel, Olaf H.

PY - 2016/3/1

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N2 - Purpose: Instrumental variable (IV) analysis with physician's prescribing preference (PPP) as IV is increasingly used in pharmacoepidemiology. However, it is unclear whether this IV performs consistently across databases. We aimed to evaluate the validity of different PPPs in a study of inhaled long-acting beta2-agonist (LABA) use and myocardial infarction (MI). Methods: Information on adults with asthma and/or COPD and at least one prescription of beta2-agonist, or muscarinic antagonist was extracted from the CPRD (UK) and the Mondriaan (Netherlands) databases. LABA exposure was considered time-fixed or time-varying. We measured PPPs using previous LABA prescriptions of physicians or proportion of LABA prescriptions per practice. Correlation (r) and standardized difference (SDif) were used to assess assumption of IV analysis. Results: For time-fixed LABA, the IV based on 10 previous prescriptions outperformed the other IVs regarding strength of the IV (r≥0.15) and balance of confounders between IV categories (SDif

AB - Purpose: Instrumental variable (IV) analysis with physician's prescribing preference (PPP) as IV is increasingly used in pharmacoepidemiology. However, it is unclear whether this IV performs consistently across databases. We aimed to evaluate the validity of different PPPs in a study of inhaled long-acting beta2-agonist (LABA) use and myocardial infarction (MI). Methods: Information on adults with asthma and/or COPD and at least one prescription of beta2-agonist, or muscarinic antagonist was extracted from the CPRD (UK) and the Mondriaan (Netherlands) databases. LABA exposure was considered time-fixed or time-varying. We measured PPPs using previous LABA prescriptions of physicians or proportion of LABA prescriptions per practice. Correlation (r) and standardized difference (SDif) were used to assess assumption of IV analysis. Results: For time-fixed LABA, the IV based on 10 previous prescriptions outperformed the other IVs regarding strength of the IV (r≥0.15) and balance of confounders between IV categories (SDif

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KW - Unmeasured confounding

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Uddin MJ, Groenwold RHH, de Boer A, Afonso ASM, Primatesta P, Becker C et al. Evaluating different physician's prescribing preference based instrumental variables in two primary care databases: A study of inhaled long-acting beta2-agonist use and the risk of myocardial infarction. Pharmacoepidemiology and Drug Safety. 2016 Mar 1;25(Supplement 1):132-141. doi: 10.1002/pds.3860

Evaluating different physician's prescribing preference based instrumental variables in two primary care databases: A study of inhaled long-acting beta2-agonist use and the risk of myocardial infarction

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Keywords

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