PMID- 25154551
OWN - NLM
STAT- MEDLINE
DCOM- 20150112
LR  - 20211021
IS  - 1573-7284 (Electronic)
IS  - 0393-2990 (Linking)
VI  - 29
IP  - 10
DP  - 2014 Oct
TI  - Sources of heterogeneity in case-control studies on associations between statins, 
      ACE-inhibitors, and proton pump inhibitors and risk of pneumonia.
PG  - 767-75
LID - 10.1007/s10654-014-9941-0 [doi]
AB  - The heterogeneity in case-control studies on the associations between 
      community-acquired pneumonia (CAP) and ACE-inhibitors (ACEi), statins, and proton 
      pump inhibitors (PPI) hampers translation to clinical practice. Our objective is 
      to explore sources of this heterogeneity by applying a common protocol in 
      different data settings. We conducted ten case-control studies using data from 
      five different health care databases. Databases varied on type of patients 
      (hospitalised vs. GP), level of case validity, and mode of exposure ascertainment 
      (prescription or dispensing based). Identified CAP patients and controls were 
      matched on age, gender, and calendar year. Conditional logistic regression was 
      used to calculate odds ratios (OR) for the associations between the drugs of 
      interest and CAP. Associations were adjusted by a common set of potential 
      confounders. Data of 38,742 cases and 118,019 controls were studied. Comparable 
      patterns of variation between case-control studies were observed for ACEi, 
      statins and PPI use and pneumonia risk with adjusted ORs varying from 1.04 to 
      1.49, 0.82 to 1.50 and 1.16 to 2.71, respectively. Overall, higher ORs were found 
      for hospitalised CAP patients matched to population controls versus GP CAP 
      patients matched to population controls. Prevalence of drug exposure was higher 
      in dispensing data versus prescription data. We show that case-control selection 
      and methods of exposure ascertainment induce bias that cannot be adjusted for and 
      to a considerable extent explain the heterogeneity in results obtained in 
      case-control studies on statins, ACEi and PPIs and CAP. The common protocol 
      approach helps to better understand sources of variation in observational 
      studies.
FAU - de Groot, Mark C H
AU  - de Groot MC
AD  - Division of Pharmacoepidemiology and Clinical Pharmacology, Utrecht Institute for 
      Pharmaceutical Sciences, Faculty of Science, Utrecht University, PO Box 80082, 
      3508 TB, Utrecht, The Netherlands, M.C.H.deGroot@uu.nl.
FAU - Klungel, Olaf H
AU  - Klungel OH
FAU - Leufkens, Hubert G M
AU  - Leufkens HG
FAU - van Dijk, Liset
AU  - van Dijk L
FAU - Grobbee, Diederick E
AU  - Grobbee DE
FAU - van de Garde, Ewoudt M W
AU  - van de Garde EM
LA  - eng
PT  - Journal Article
PT  - Research Support, Non-U.S. Gov't
DEP - 20140826
PL  - Netherlands
TA  - Eur J Epidemiol
JT  - European journal of epidemiology
JID - 8508062
RN  - 0 (Angiotensin-Converting Enzyme Inhibitors)
RN  - 0 (Hydroxymethylglutaryl-CoA Reductase Inhibitors)
RN  - 0 (Proton Pump Inhibitors)
SB  - IM
MH  - Adolescent
MH  - Adult
MH  - Aged
MH  - Aged, 80 and over
MH  - Angiotensin-Converting Enzyme Inhibitors/*therapeutic use
MH  - Case-Control Studies
MH  - Community-Acquired Infections/epidemiology/etiology/*prevention & control
MH  - Female
MH  - Humans
MH  - Hydroxymethylglutaryl-CoA Reductase Inhibitors/*therapeutic use
MH  - Logistic Models
MH  - Male
MH  - Middle Aged
MH  - Netherlands/epidemiology
MH  - Odds Ratio
MH  - Pneumonia/epidemiology/etiology/*prevention & control
MH  - Population Surveillance
MH  - Proton Pump Inhibitors/*adverse effects
MH  - Risk Assessment
MH  - Risk Factors
MH  - Treatment Outcome
EDAT- 2014/08/27 06:00
MHDA- 2015/01/13 06:00
CRDT- 2014/08/27 06:00
PHST- 2014/04/07 00:00 [received]
PHST- 2014/07/22 00:00 [accepted]
PHST- 2014/08/27 06:00 [entrez]
PHST- 2014/08/27 06:00 [pubmed]
PHST- 2015/01/13 06:00 [medline]
AID - 10.1007/s10654-014-9941-0 [doi]
PST - ppublish
SO  - Eur J Epidemiol. 2014 Oct;29(10):767-75. doi: 10.1007/s10654-014-9941-0. Epub 
      2014 Aug 26.