Literature DB >> 26033374

Longitudinal average attributable fraction as a method for studying time-varying conditions and treatments on recurrent self-rated health: the case of medications in older adults with multiple chronic conditions.

Heather G Allore1, Yilei Zhan2, Mary Tinetti3, Mark Trentalange4, Gail McAvay4.   

Abstract

PURPOSE: The objective is to modify the longitudinal extension of the average attributable fraction (LE-AAF) for recurrent outcomes with time-varying exposures and control for covariates.
METHODS: We included Medicare Current Beneficiary Survey participants with two or more chronic conditions enrolled from 2005 to 2009 with follow-up through 2011. Nine time-varying medications indicated for nine time-varying common chronic conditions and 14 of 18 forward-selected participant characteristics were used as control variables in the generalized estimating equations step of the LE-AAF to estimate associations with the recurrent universal health outcome self-rated health (SRH). Modifications of the LE-AAF were made to accommodate these indicated medication-condition interactions and covariates. Variability was empirically estimated by bias-corrected and accelerated bootstrapping.
RESULTS: In the adjusted LE-AAF, thiazide, warfarin, and clopidogrel had significant contributions of 1.2%, 0.4%, 0.2%, respectively, to low (poor or fair) SRH; whereas there were no significant contributions of the other medications to SRH. Hyperlipidemia significantly contributed 4.6% to high SRH. All the other conditions except atrial fibrillation contributed significantly to low SRH.
CONCLUSIONS: Our modifications to the LE-AAF method apply to a recurrent binary outcome with time-varying factors accounting for covariates.
Copyright © 2015 Elsevier Inc. All rights reserved.

Entities:  

Keywords:  Aged; Chronic disease; Epidemiologic methods; Longitudinal study

Mesh:

Year:  2015        PMID: 26033374      PMCID: PMC4547873          DOI: 10.1016/j.annepidem.2015.03.022

Source DB:  PubMed          Journal:  Ann Epidemiol        ISSN: 1047-2797            Impact factor:   3.797


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