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Pazzagli L, Linder M, Reutfors J, Brandt L. The use of uncertain exposure-A method to define switching and add-on in pharmacoepidemiology. Pharmacoepidemiol Drug Saf 2021; 31:28-36. [PMID: 34558772 DOI: 10.1002/pds.5363] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2021] [Revised: 05/16/2021] [Accepted: 09/16/2021] [Indexed: 11/06/2022]
Abstract
PURPOSE When defining exposure to pharmacological treatments in pharmacoepidemiology, register data often do not provide information regarding if a pharmacological treatment is a switch or an add-on. This study aims to compare two methods defining switching and add-on therapies and their impact on exposure-outcome associations. Additionally, to guide bias reduction, it aims to describe how the methods relate to immortal time bias and selection bias. METHODS Cohort study using Swedish population-based health registers to identify antidepressant (AD) prescriptions as exposures while hospitalizations for psychiatric reasons were used as an empirical outcome example. The first method for exposure definition used conditioning on future exposure (FE), the second used the concept of uncertain exposure (UE). To estimate associations between outcome and exposure categories "Use of one AD," "Use of two or more ADs", and "UE" compared to "Unexposed," hazard ratios (HRs) and 95% confidence intervals were estimated using Cox regression adjusted for age and sex. RESULTS Using the UE method, 7.2% of time periods were classified as "UE" with a notable proportion of psychiatric hospitalizations (7.7%) occurring during this time, while when using the FE method these hospitalizations were distributed over unexposed time and AD use time. The FE method resulted in slightly higher associations than the UE method. The highest HR was found during "UE": HR (95% CI) 5.54 (5.06-6.07). CONCLUSIONS This study suggests that to reduce the potential immortal time bias, selection bias, and exposure misclassification inherent to the FE method, the UE method could be used for identifying switching and add-on therapies. If not used as a main exposure definition, the UE method may be used to investigate the impact of UE time in a sensitivity analysis.
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Affiliation(s)
- Laura Pazzagli
- Department of Medicine Solna, Centre for Pharmacoepidemiology, Karolinska Institutet, Stockholm, Sweden
| | - Marie Linder
- Department of Medicine Solna, Centre for Pharmacoepidemiology, Karolinska Institutet, Stockholm, Sweden
| | - Johan Reutfors
- Department of Medicine Solna, Centre for Pharmacoepidemiology, Karolinska Institutet, Stockholm, Sweden
| | - Lena Brandt
- Department of Medicine Solna, Centre for Pharmacoepidemiology, Karolinska Institutet, Stockholm, Sweden
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Pinho MGM, Mackenbach JD, Charreire H, Oppert JM, Rutter H, Beulens JWJ, Brug J, Lakerveld J. Comparing Different Residential Neighborhood Definitions and the Association Between Density of Restaurants and Home Cooking Among Dutch Adults. Nutrients 2019; 11:E1796. [PMID: 31382624 PMCID: PMC6722945 DOI: 10.3390/nu11081796] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2019] [Revised: 07/31/2019] [Accepted: 08/01/2019] [Indexed: 11/16/2022] Open
Abstract
The definition of neighborhoods as areas of exposure to the food environment is a challenge in food environment research. We aimed to test the association of density of restaurants with home cooking using four different definitions of residential neighborhoods. We also tested effect modification by age, length of residency, education, and income. This innovative cross-sectional study was conducted in the Netherlands (N = 1245 adults). We calculated geographic information system-based measures of restaurant density using residential administrative neighborhood boundaries, 800 m and 1600 m buffers around the home and respondents' self-defined boundaries (drawn by the respondents on a map of their residential area). We used adjusted Poisson regression to test associations of restaurant density (tertiles) and the outcome "weekly consumption of home-cooked meals" (six to seven as compared to five days per week (day/week) or fewer). Most respondents reported eating home-cooked meals for at least 6 day/week (74.2%). Regardless of the neighborhood definition used, no association between food environment and home cooking was observed. No effect modification was found. Although exposure in terms of density of restaurants was different according to the four different neighborhood definitions, we found no evidence that the area under study influences the association between density of restaurants and home cooking among Dutch adults.
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Affiliation(s)
- Maria Gabriela M Pinho
- Department of Epidemiology and Biostatistics, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam Public Health, De Boelelaan 1089a, 1081 HV Amsterdam, The Netherlands.
| | - Joreintje D Mackenbach
- Department of Epidemiology and Biostatistics, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam Public Health, De Boelelaan 1089a, 1081 HV Amsterdam, The Netherlands
| | - Hélène Charreire
- Université Paris Est Créteil (UPEC), LabUrba, UPEC, 61 Avenue du Général de Gaulle, 94010 Créteil, France
- Equipe de Recherche en Epidémiologie Nutritionnelle (EREN), Centre de Recherche en Epidémiologie et Statistiques, Inserm (U1153), Inra (U1125), Cnam, COMUE Sorbonne Paris Cité, Université Paris 13, 74 Rue Marcel Cachin, 93017 Bobigny, France
| | - Jean-Michel Oppert
- Equipe de Recherche en Epidémiologie Nutritionnelle (EREN), Centre de Recherche en Epidémiologie et Statistiques, Inserm (U1153), Inra (U1125), Cnam, COMUE Sorbonne Paris Cité, Université Paris 13, 74 Rue Marcel Cachin, 93017 Bobigny, France
- Department of Nutrition, Institute of Cardiometabolism and Nutrition, Sorbonne Université, Pitié-Salpêtrière Hospital, 47-83 Boulevard de l'Hôpital, 75013 Paris, France
| | - Harry Rutter
- Department of Social and Policy Sciences, University of Bath, Bath BA2 7AY, UK
| | - Joline W J Beulens
- Department of Epidemiology and Biostatistics, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam Public Health, De Boelelaan 1089a, 1081 HV Amsterdam, The Netherlands
- Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Huispost Str. 6.131, PO Box 85500, 3508 GA Utrecht, The Netherlands
| | - Johannes Brug
- Amsterdam School of Communication Research (ASCoR), University of Amsterdam, Nieuwe Achtergracht 166, 1018 WV Amsterdam, The Netherlands
- National Institute for Public Health and the Environment, Antoni van Leeuwenhoeklaan 9, 3721 MA Bilthoven, The Netherlands
| | - Jeroen Lakerveld
- Department of Epidemiology and Biostatistics, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam Public Health, De Boelelaan 1089a, 1081 HV Amsterdam, The Netherlands
- Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Huispost Str. 6.131, PO Box 85500, 3508 GA Utrecht, The Netherlands
- Faculty of Geosciences, Utrecht University, Vening Meinesz building A, Princetonlaan 8a, 3584 CB Utrecht, The Netherlands
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