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Controlling confounding of treatment effects in administrative data in the presence of time-varying baseline confounders.

Abstract：

PURPOSE:Confounding, a concern in nonexperimental research using administrative claims, is nearly ubiquitous in claims-based pharmacoepidemiology studies. A fixed-length look-back window for assessing comorbidity from claims is common, but it may be advantageous to use all historical claims. We assessed how the strength of association between a baseline-identified condition and subsequent mortality varied by when the condition was measured and investigated methods to control for confounding. METHODS:For Medicare beneficiaries undergoing maintenance hemodialysis on 1 January 2008 (n = 222 343), we searched all Medicare claims, 1 January 2001 to 31 December 2007, for four conditions representing chronic and acute diseases, and classified claims by number of months preceding the index date. We used proportional hazard models to estimate the association between time of condition and subsequent mortality. We simulated a confounded comorbidity-exposure relationship and investigated an alternative method of adjustment when the association between the condition and mortality varied by proximity to follow-up start. RESULTS:The magnitude of the mortality hazard ratio estimates for each condition investigated decreased toward unity as time increased between index date and most recent manifestation of the condition. Simulation showed more biased estimates of exposure-outcome associations if proximity to follow-up start was not considered. CONCLUSIONS:Using all-available claims information during a baseline period, we found that for all conditions investigated, the association between a comorbid condition and subsequent mortality varied considerably depending on when the condition was measured. Improved confounding control may be achieved by considering the timing of claims relative to follow-up start.

journal_name

Pharmacoepidemiol Drug Saf

journal_title

Pharmacoepidemiology and drug safety

authors

Gilbertson DT,Bradbury BD,Wetmore JB,Weinhandl ED,Monda KL,Liu J,Brookhart MA,Gustafson SK,Roberts T,Collins AJ,Rothman KJ

doi

10.1002/pds.3922

subject

Has Abstract

pub_date

2016-03-01 00:00:00

pages

269-77

issue

eissn

1053-8569

issn

1099-1557

journal_volume

pub_type

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Controlling confounding of treatment effects in administrative data in the presence of time-varying baseline confounders.