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Requena G, Logie J, Martin E, Boudiaf N, González González R, Huerta C, Alvarez A, Webb D, Bate A, García Rodríguez LA, Reynolds R, Schlienger R, Gardarsdottir H, de Groot M, Klungel OH, de Abajo F, Douglas IJ. Do case-only designs yield consistent results across design and different databases? A case study of hip fractures and benzodiazepines. Pharmacoepidemiol Drug Saf 2015; 25 Suppl 1:79-87. [PMID: 26112821 PMCID: PMC4949640 DOI: 10.1002/pds.3822] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2014] [Revised: 05/27/2015] [Accepted: 05/29/2015] [Indexed: 01/04/2023]
Abstract
Background The case‐crossover (CXO) and self‐controlled case series (SCCS) designs are increasingly used in pharmacoepidemiology. In both, relative risk estimates are obtained within persons, implicitly controlling for time‐fixed confounding variables. Objectives To examine the consistency of relative risk estimates of hip/femur fractures (HFF) associated with the use of benzodiazepines (BZD) across case‐only designs in two databases (DBs), when a common protocol was applied. Methods CXO and SCCS studies were conducted in BIFAP (Spain) and CPRD (UK). Exposure to BZD was divided into non‐use, current, recent and past use. For CXO, odds ratios (OR; 95%CI) of current use versus non‐use/past were estimated using conditional logistic regression adjusted for co‐medications (AOR). For the SCCS, conditional Poisson regression was used to estimate incidence rate ratios (IRR; 95%CI) of current use versus non/past‐use, adjusted for age. To investigate possible event‐exposure dependence the relative risk in the 30 days prior to first BZD exposure was also evaluated. Results In the CXO current use of BZD was associated with an increased risk of HFF in both DBs, AORBIFAP = 1.47 (1.29–1.67) and AORCPRD = 1.55 (1.41–1.70). In the SCCS, IRRs for current exposure was 0.79 (0.72–0.86) in BIFAP and 1.21 (1.13–1.30) in CPRD. However, when we considered separately the 30‐day pre‐exposure period, the IRR for current period was 1.43 (1.31–1.57) in BIFAP and 1.37 (1.27–1.47) in CPRD. Conclusions CXO designs yielded consistent results across DBs, while initial SCCS analyses did not. Accounting for event‐exposure dependence, estimates derived from SCCS were more consistent across DBs and designs. © 2015 The Authors. Pharmacoepidemiology and Drug Safety published by John Wiley & Sons Ltd.
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Affiliation(s)
- Gema Requena
- Pharmacology Unit, Department of Biomedical Sciences, School of Medicine, University of Alcalá, Madrid, Spain
| | - John Logie
- Worldwide Epidemiology, GlaxoSmithKline, Research and Development, Uxbridge, Middlesex, UK
| | - Elisa Martin
- BIFAP Research Unit, Spanish Agency of Medicines and Medical Devices, Madrid, Spain
| | - Nada Boudiaf
- Worldwide Epidemiology, GlaxoSmithKline, Research and Development, Uxbridge, Middlesex, UK
| | | | - Consuelo Huerta
- BIFAP Research Unit, Spanish Agency of Medicines and Medical Devices, Madrid, Spain
| | - Arturo Alvarez
- BIFAP Research Unit, Spanish Agency of Medicines and Medical Devices, Madrid, Spain
| | - David Webb
- Worldwide Epidemiology, GlaxoSmithKline, Research and Development, Uxbridge, Middlesex, UK
| | | | | | - Robert Reynolds
- Epidemiology, Pfizer Research and Development, New York, USA
| | | | - Helga Gardarsdottir
- Division of Pharmacoepidemiology and Clinical Pharmacology, Utrecht University, Utrecht, the Netherlands
| | - Mark de Groot
- Division of Pharmacoepidemiology and Clinical Pharmacology, Utrecht University, Utrecht, the Netherlands
| | - Olaf H Klungel
- Division of Pharmacoepidemiology and Clinical Pharmacology, Utrecht University, Utrecht, the Netherlands
| | - Fancisco de Abajo
- Pharmacology Unit, Department of Biomedical Sciences, School of Medicine, University of Alcalá, Madrid, Spain.,Clinical Pharmacology Unit, University Hospital Príncipe de Asturias, Madrid, Spain
| | - Ian J Douglas
- London School of Hygiene and Tropical Medicine (LSHTM), London, UK
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