1
|
Acton EK, Willis AW, Hennessy S. Core concepts in pharmacoepidemiology: Key biases arising in pharmacoepidemiologic studies. Pharmacoepidemiol Drug Saf 2023; 32:9-18. [PMID: 36216785 DOI: 10.1002/pds.5547] [Citation(s) in RCA: 9] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2021] [Revised: 09/13/2022] [Accepted: 09/22/2022] [Indexed: 02/06/2023]
Abstract
Pharmacoepidemiology has an increasingly important role in informing and improving clinical practice, drug regulation, and health policy. Therefore, unrecognized biases in pharmacoepidemiologic studies can have major implications when study findings are translated to the real world. We propose a simple taxonomy for researchers to use as a starting point when thinking through some of the most pervasive biases in pharmacoepidemiology. We organize this discussion according to biases best assessed with respect to the study population (including confounding by indication, channeling bias, healthy user bias, and protopathic bias), the study design (including prevalent user bias and immortal time bias), and the data source (including misclassification bias and missing data/loss to follow up). This tutorial defines, provides a curated list of recommended references, and illustrates through relevant case examples these key biases to consider when planning, conducting, or evaluating pharmacoepidemiologic studies.
Collapse
Affiliation(s)
- Emily K Acton
- Center for Real-world Effectiveness and Safety of Therapeutics, Department of Biostatistics, Epidemiology and Informatics, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, USA.,Center for Clinical Epidemiology and Biostatistics, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, USA.,Translational Center of Excellence for Neuroepidemiology and Neurology Outcomes Research, Department of Neurology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Allison W Willis
- Center for Real-world Effectiveness and Safety of Therapeutics, Department of Biostatistics, Epidemiology and Informatics, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, USA.,Center for Clinical Epidemiology and Biostatistics, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, USA.,Translational Center of Excellence for Neuroepidemiology and Neurology Outcomes Research, Department of Neurology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, USA.,Leonard Davis Institute of Health Economics, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Sean Hennessy
- Center for Real-world Effectiveness and Safety of Therapeutics, Department of Biostatistics, Epidemiology and Informatics, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, USA.,Center for Clinical Epidemiology and Biostatistics, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, USA.,Leonard Davis Institute of Health Economics, University of Pennsylvania, Philadelphia, Pennsylvania, USA.,Department of Systems Pharmacology and Translational Therapeutics, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| |
Collapse
|
2
|
Pottegård A, Morin L, Hallas J, Gerhard T, Winterstein AG, Perez-Gutthann S, Tadrous M. Where to begin? Thirty must-read papers for newcomers to pharmacoepidemiology. Pharmacoepidemiol Drug Saf 2021; 31:257-259. [PMID: 34738294 DOI: 10.1002/pds.5382] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2021] [Accepted: 10/29/2021] [Indexed: 10/19/2022]
Affiliation(s)
- Anton Pottegård
- Department of Public health, Clinical Pharmacology, Pharmacy, and Environmental Medicine, University of Southern Denmark, Odense, Denmark
| | - Lucas Morin
- Inserm U1018, High-Dimensional Biostatistics for Drug Safety and Genomics, CESP, Paris, France.,Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Solna, Sweden
| | - Jesper Hallas
- Department of Public health, Clinical Pharmacology, Pharmacy, and Environmental Medicine, University of Southern Denmark, Odense, Denmark
| | - Tobias Gerhard
- Department of Pharmacy Practice and Administration, Ernest Mario School of Pharmacy; Department of Biostatistics and Epidemiology, Rutgers School of Public Health, Center for Pharmacoepidemiology and Treatment Science, Rutgers University, New Brunswick, New Jersey, USA
| | - Almut G Winterstein
- Pharmaceutical Outcomes and Policy, College of Pharmacy, Department of Epidemiology, Colleges of Medicine and Public Health and Health Professions, Center for Drug Evaluation and Safety, University of Florida, Gainesville, Florida, USA
| | | | - Mina Tadrous
- Leslie Dan Faculty of Pharmacy, University of Toronto, Toronto, Ontario, Canada
| |
Collapse
|