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A data visualisation method for assessing exposure misclassification in case-crossover studies: the example of tricyclic antidepressants and the risk of hip fracture in older people.
Leach, Michael J; Roughead, Elizabeth E; Pratt, Nicole L.
Afiliación
  • Leach MJ; Quality Use of Medicines and Pharmacy Research Centre (QUMPRC), UniSA Clinical and Health Sciences, CEA-19, University of South Australia, Adelaide, SA, 5001, Australia. michael.leach@monash.edu.
  • Roughead EE; School of Rural Health, Monash University, 26 Mercy Street, Bendigo, VIC, 3550, Australia. michael.leach@monash.edu.
  • Pratt NL; Quality Use of Medicines and Pharmacy Research Centre (QUMPRC), UniSA Clinical and Health Sciences, CEA-19, University of South Australia, Adelaide, SA, 5001, Australia.
BMC Med Res Methodol ; 21(1): 43, 2021 02 27.
Article en En | MEDLINE | ID: mdl-33639849
ABSTRACT

BACKGROUND:

The case-crossover design is suited to medication safety studies but is vulnerable to exposure misclassification. Using the example of tricyclic antidepressants and the risk of hip fracture, we present a data visualisation tool for observing exposure misclassification in case-crossover studies.

METHODS:

A case-crossover study was conducted using Australian Government Department of Veterans' Affairs claims data. Beneficiaries aged over 65 years who were hospitalised for hip fracture between 2009 and 2012 were included. The case window was defined as 1-50 days pre fracture. Control window one and control window two were defined as 101-150 and 151-200 days pre fracture, respectively. Patients were stratified by whether exposure status changed when control window two was specified instead of control window one. To visualise potential misclassification, each subject's tricyclic antidepressant dispensings were plotted over the 200 days pre fracture.

RESULTS:

The study population comprised 8828 patients with a median age of 88 years. Of these subjects, 348 contributed data to the analyses with either control window. The data visualisation suggested that 14% of subjects were potentially misclassified with control window one while 45% were misclassified with control window two. The odds ratio for the association between tricyclic antidepressants and hip fracture was 1.18 (95% confidence interval = 0.91-1.52) using control window one, whereas risk was significantly increased (odds ratio = 1.43, 95% confidence interval = 1.11-1.83) using control window two.

CONCLUSIONS:

Exposure misclassification was less likely to be present with control window one than with an earlier control window, control window two. When specifying different control windows in a case-crossover study, data visualisation can help to assess the extent to which exposure misclassification may contribute to variable results.
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Texto completo: 1 Colección: 01-internacional Banco de datos: MEDLINE Asunto principal: Fracturas de Cadera / Antidepresivos Tricíclicos Tipo de estudio: Clinical_trials / Diagnostic_studies / Etiology_studies / Risk_factors_studies Límite: Aged / Aged80 / Humans País/Región como asunto: Oceania Idioma: En Revista: BMC Med Res Methodol Asunto de la revista: MEDICINA Año: 2021 Tipo del documento: Article País de afiliación: Australia

Texto completo: 1 Colección: 01-internacional Banco de datos: MEDLINE Asunto principal: Fracturas de Cadera / Antidepresivos Tricíclicos Tipo de estudio: Clinical_trials / Diagnostic_studies / Etiology_studies / Risk_factors_studies Límite: Aged / Aged80 / Humans País/Región como asunto: Oceania Idioma: En Revista: BMC Med Res Methodol Asunto de la revista: MEDICINA Año: 2021 Tipo del documento: Article País de afiliación: Australia