| Inhaled steroids and mortality in COPD: bias from unaccounted immortal time. | |
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MedLine Citation:
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PMID: 15065827 Owner: NLM Status: MEDLINE |
Abstract/OtherAbstract:
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A recent observational study, which suggested that inhaled corticosteroids (ICS) with or without long-acting bronchodilators are effective at reducing all-cause mortality in chronic obstructive pulmonary disease (COPD) patients, may be subject to immortal time bias. This bias was assessed using a population-based cohort of 3,524 newly treated COPD patients from Saskatchewan, Canada, observed from 1990-1999. Regular users of bronchodilators or ICS were followed for 3 yrs, during which time 860 deaths occurred. Cox's proportional hazards model was used to compare the hierarchical intention-to-treat approach employed in the recent study, a technique subject to bias from two sources of immortal time, with the conventional intention-to-treat approach and the according-to-treatment approach. The adjusted rate ratio of death using the hierarchical intention-to-treat approach was 0.66 (95%) confidence interval (CI) 0.57-0.76) for ICS use relative to bronchodilator use, compared with 0.75 (95% CI 0.62-0.90) with the conventional intention-to-treat approach. Conversely, the rate ratio was 0.94 (95% CI 0.81-1.09) with the according-to-treatment approach, which accounts for both sources of immortal time. In this study, regular inhaled corticosteroid use in chronic obstructive pulmonary disease was not found to reduce all-cause mortality. Suggestion of this benefit from a previous observational study is the result of bias from unaccounted immortal time in its cohort design and analysis. |
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Authors:
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S Suissa |
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Publication Detail:
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Type: Journal Article; Research Support, Non-U.S. Gov't |
Journal Detail:
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Title: The European respiratory journal Volume: 23 ISSN: 0903-1936 ISO Abbreviation: Eur. Respir. J. Publication Date: 2004 Mar |
Date Detail:
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Created Date: 2004-04-06 Completed Date: 2004-06-17 Revised Date: 2013-05-23 |
Medline Journal Info:
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Nlm Unique ID: 8803460 Medline TA: Eur Respir J Country: Denmark |
Other Details:
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Languages: eng Pagination: 391-5 Citation Subset: IM |
Affiliation:
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Division of Clinical Epidemiology, Royal Victoria Hospital, McGill University Health Centre, Montreal, Québec, Canada. samy.suissa@clinepi.mcgill.ca |
Export Citation:
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APA/MLA Format Download EndNote Download BibTex |
| MeSH Terms | |
Descriptor/Qualifier:
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Administration, Inhalation Aerosols Aged Bias (Epidemiology) Bronchodilator Agents / administration & dosage, therapeutic use Cohort Studies Databases, Factual Female Glucocorticoids / administration & dosage*, therapeutic use Humans Male Observation Proportional Hazards Models Pulmonary Disease, Chronic Obstructive / drug therapy*, mortality* Research Design Time Factors |
| Chemical | |
Reg. No./Substance:
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0/Aerosols; 0/Bronchodilator Agents; 0/Glucocorticoids |
| Comments/Corrections | |
Comment In:
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Eur Respir J. 2004 Jul;24(1):190-1; author reply 191-2
[PMID:
15293626
]
Eur Respir J. 2004 Oct;24(4):710-1; author reply 711 [PMID: 15459156 ] |
From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine
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