Effect of treating one disease on other diseases and health outcomes in elders

治疗一种疾病对其他疾病和老年人健康结果的影响

• 批准号: 8021324
• 负责人: MARY E TINETTI
• 金额: $ 30.54万
• 依托单位: YALE UNIVERSITY
• 依托单位国家: 美国
• 财政年份: 2011
• 资助国家: 美国
• 起止时间: 2011-09-01 至 2013-02-28
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/8021324
• 关键词: Accounting; Address; Affect; Age; Antihypertensive Agents; Area; Attention; Benefits and Risks; Blood Pressure; Cardiovascular system; Cessation of life; Chronic; Clinic; Clinical; Comorbidity; Complement; Complex; Conflict (Psychology); Data; Disease; Elderly; Event; Expenditure; Fracture; Gender; Goals; Health; Hypertension; Individual; Injury; Intervention; Investigation; Maps; Medical; Medical Records; Medicare; Methods; Morbidity - disease rate; Motivation; Outcome; Outcome Study; Participant; Patients; Persons; Pharmaceutical Preparations; Prevalence; Race; Randomized Controlled Trials; Reporting; Research; Risk; Sampling Studies; Subgroup; Surveys; Symptoms; Techniques; Testing; Work; base; beneficiary; clinical decision-making; cohort; comparative effectiveness; design; disability; disorder risk; effectiveness research; fall risk; falls; health care service utilization; innovation; mortality; multiple chronic conditions; novel; novel strategies; population based; prevent; treatment effect; treatment strategy

DESCRIPTION (provided by applicant): In older adults with multi-morbidity, treatments targeting one disease may exacerbate co-occurring diseases or adversely affect overall health. Despite the potential for harm for the increasing numbers of individuals with multiple co-existing health conditions, this area has received little research attention. We explore the capability of using national population-based cohorts and novel analytical techniques to determine the harms and benefits of different treatment strategies across multiple disease-specific and health outcomes, particularly in situations in which the treatment of one condition may worsen another. We will use this innovative approach to investigate anti-hypertensive medication intensity in older adults with two commonly co-occurring conditions, namely hypertension and high fall/fracture risk. Modest, but conflicting, evidence suggests that anti-hypertensive medications may increase risk of falls, injuries, and other health outcomes in those at risk. Once we have tested the method with this important clinical question, we will extend to other sets of conditions and medications. This project builds on our ongoing work on tradeoffs among competing health conditions and mapping disease-specific outcomes onto overall, universal health outcomes. Specific aims are to test the hypotheses that, among comparable persons older adults with co- occurring hypertension and high fall/fracture risk, greater anti-hypertensive intensity is associated with fewer CV events and lower mortality but more frequent serious fall injuries, worse symptoms, lower activity level, and greater disability than lower anti-hypertensive intensity. In secondary analyses, we will explore these aims in relevant subgroups defined by age, gender, race, and co-morbidity burden. We will also determine if blood pressure levels and changes confound the effects of anti-hypertensive medication intensity on the outcomes. Two national, population-based cohorts, the Medicare Current Beneficiary Survey and the Medical Expenditure Panel Survey will be studied (study sample 35,000-40,000). Both have a wealth of longitudinal participant-reported, medication, and claims/health care utilization data. This depth and breadth of data allows us to use innovative analytical techniques to assess the effect of treatments on disease-specific and universal health outcomes (e.g. disability, symptom burden, functional limitations, and death), accounting for propensity to receive the treatment and for other confounders. We propose a new paradigm for quantifying the harm and benefit of treatments in complex older persons with multiple conditions. If treatments such as anti-hypertensives cause benefit as well as harm across a range of outcome domains, then this information must be uncovered and must inform clinical decision-making. Our ultimate goal is to develop a method for determining the optimal treatments for older adults with multiple conditions that maximizes benefit and minimizes harm within the outcome domain(s) of highest priority for each patient. PUBLIC HEALTH RELEVANCE: Among persons with multiple chronic conditions, treatments for one condition may exacerbate co-occurring conditions or adversely affect overall health outcomes. We are exploring whether greater antihypertensive medication intensity in older adults with co-occurring hypertension and fall/fracture risk benefits cardiovascular outcomes but worsens fall injury outcomes, symptoms, disability, or activity levels. Study results can help determine the net benefit or harm of commonly recommended treatments among the growing number of older adults with multiple health conditions.

描述（由申请人提供）：在具有多种多元车的老年人中，针对一种疾病的治疗可能会加剧同时发生的疾病或不利影响整体健康。尽管对拥有多个共存健康状况的个体数量越来越多，但该领域几乎没有受到研究的关注。我们探讨了使用基于国家人群的同伙和新颖的分析技术来确定多种疾病特异性和健康结果的不同治疗策略的危害和益处，尤其是在一种疾病治疗可能会使另一种疾病恶化的情况下。我们将使用这种创新方法来研究具有两个通常同时发生条件的老年人的抗高血压药物强度，即高血压和高跌落/断裂风险。谦虚但相互矛盾的证据表明，抗高血压药物可能会增加处于危险中的跌倒，伤害和其他健康状况的风险。一旦我们用这个重要的临床问题测试了该方法，我们将扩展到其他一组疾病和药物。该项目基于我们正在进行的关于竞争健康状况之间的权衡工作，并将特定疾病的结果映射到整体，普遍的健康状况。 具体目的是检验这些假设，在具有同类高血压和高跌落/断裂风险的可比较的老年人中，更大的抗高血压强度与更少的CV事件和较低的死亡率相关，但较低的严重跌倒损伤，较差的症状，较低的症状，较低的活动水平以及更大的残疾水平，比较低的抗高血压强度相关。在次要分析中，我们将在按年龄，性别，种族和同胞负担定义的相关亚组中探讨这些目标。我们还将确定血压水平和变化是否混淆了抗高血压药物强度对结果的影响。 将研究两个国家基于人口的同类同伙，Medicare当前的受益人调查和医疗支出小组调查将进行研究（研究样本35,000-40,000）。两者都有大量的纵向参与者报告，药物和索赔/医疗保健利用数据。数据的深度和广度使我们能够使用创新的分析技术来评估治疗对疾病特异性和普遍健康结果的影响（例如残疾，症状负担，功能局限性和死亡），考虑到接受治疗和其他混淆者的倾向。我们提出了一个新的范式，以量化具有多种疾病的复杂老年人的治疗危害和益处。如果诸如抗高血压等治疗范围内会在一系列结果领域造成益处和危害，则必须发现这些信息，并且必须为临床决策提供信息。我们的最终目标是开发一种确定多种疾病的老年人的最佳治疗方法，这些方法可最大程度地提高益处，并最大程度地减少每个患者最高优先级的危害。 公共卫生相关性：在具有多种慢性疾病的人中，一种疾病的治疗可能会加剧同时存在的状况或对整体健康状况产生不利影响。我们正在探索同时发生高血压和跌落/断裂风险的老年人中的降压药物强度是否有益于心血管结局，但会导致跌倒损伤结果，症状，残疾或活动水平恶化。研究结果可以帮助确定越来越多的健康状况的老年人中常见治疗的净益处或危害。