| アブストラクト | Regression discontinuity design (RDD) is a quasi-experimental method intended for causal inference in observational settings. While RDD is gaining popularity in clinical studies, there are limited real-world studies examining the performance on estimating known trial casual effects. The goal of this paper is to estimate the effect of statins on myocardial infarction (MI) using RDD and compare with propensity score matching and Cox regression. For the RDD, we leveraged a 2008 UK guideline that recommends statins if a patient's 10-year cardiovascular disease (CVD) risk score > 20%. We used UK electronic health record data from the Health Improvement Network on 49,242 patients aged 65 + in 2008-2011 (baseline) without a history of CVD and no statin use in the two years prior to the CVD risk score assessment. Both the regression discontinuity (n = 19,432) and the propensity score matched populations (n = 24,814) demonstrated good balance of confounders. Using RDD, the adjusted point estimate for statins on MI was in the protective direction and similar to the statin effect observed in clinical trials, although the confidence interval included the null (HR = 0.8, 95% CI 0.4, 1.4). Conversely, the adjusted estimates using propensity score matching and Cox regression remained in the harmful direction: HR = 2.42 (95% CI 1.96, 2.99) and 2.51 (2.12, 2.97). RDD appeared superior to other methods in replicating the known protective effect of statins with MI, although precision was poor. Our findings suggest that, when used appropriately, RDD can expand the scope of clinical investigations aimed at causal inference by leveraging treatment rules from everyday clinical practice. |
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| ジャーナル名 | European journal of epidemiology |
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| Pubmed追加日 | 2023/3/21 |
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| 投稿者 | Odden, Michelle C; Zhang, Adina; Jawadekar, Neal; Tan, Annabel; Moran, Andrew E; Glymour, M Maria; Brayne, Carol; Zeki Al Hazzouri, Adina; Calonico, Sebastian |
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| 組織名 | Department of Epidemiology and Population Health, Stanford University, Stanford,;CA, USA. modden@stanford.edu.;Department of Epidemiology and Population Health, Stanford University School of;Medicine, 1701 Page Mill Rd., Palo Alto, CA, 94304, USA. modden@stanford.edu.;Department of Epidemiology, Mailman School of Public Health, Columbia University,;New York, NY, USA.;CA, USA.;Department of Medicine, Columbia University, New York, NY, USA.;Department of Epidemiology and Biostatistics, University of California, San;Francisco, CA, USA.;Department of Public Health and Primary Care, University of Cambridge, Cambridge,;UK.;Department of Health Policy and Management, Columbia University, New York, NY,;USA. |
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| Pubmed リンク | https://www.ncbi.nlm.nih.gov/pubmed/36935439/ |
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