PDF(Pubmed)
Abstract：
There is growing evidence supporting clinically important associations between age at neutering in bitches and subsequent urinary incontinence (UI), although much of this evidence to date is considered weak. Target trial emulation is an innovative approach in causal inference that has gained substantial attention in recent years, aiming to simulate a hypothetical randomised controlled trial by leveraging observational data. Using anonymised veterinary clinical data from the VetCompass Programme, this study applied the target trial emulation framework to determine whether later-age neutering (≥ 7 to ≤ 18 months) causes decreased odds of early-onset UI (diagnosed < 8.5 years) compared to early-age neutering (3 to < 7 months). The study included bitches in the VetCompass database born from January 1, 2010, to December 31, 2012, and neutered between 3 and 18 months old. Bitches were retrospectively confirmed from the electronic health records as neutered early or later. The primary outcome was a diagnosis of early-onset UI. Informed from a directed acyclic graph, data on the following covariates were extracted: breed, insurance status, co-morbidities and veterinary group. Inverse probability of treatment weighting was used to adjust for confounding, with inverse probability of censoring weighting accounting for censored bitches. The emulated trial included 612 early-age neutered bitches and 888 later-age neutered bitches. A pooled logistic regression outcome model identified bitches neutered later at 0.80 times the odds (95% CI 0.54 to 0.97) of early-onset UI compared with bitches neutered early. The findings show that later-age neutering causes reduced odds of early-onset UI diagnosis compared with early-age neutering. Decision-making on the age of neutering should be carefully considered, with preference given to delaying neutering until after 7 months of age unless other major reasons justify earlier surgery. The study is one of the first to demonstrate successful application of the target trial framework to veterinary observational data.
摘要：
越来越多的证据支持母犬绝育年龄与随后的尿失禁（UI）之间的临床重要关联，尽管迄今为止这些证据中的大部分被认为是薄弱的。目标试验仿真是因果推理中的一种创新方法，近年来获得了广泛的关注，旨在通过利用观察数据来模拟一项假设的随机对照试验。使用来自VetCompass计划的匿名兽医临床数据，本研究应用目标试验仿真框架,以确定与早期绝育(3~<7个月)相比,晚期绝育(≥7~≤18个月)是否导致早发性UI(诊断<8.5岁)的几率降低.该研究包括VetCompass数据库中的母狗，这些母狗出生在2010年1月1日至2012年12月31日，并且在3至18个月大之间进行了绝育。从电子健康记录中回顾性地确认母狗早或晚被绝育。主要结果是诊断为早发性UI。从有向无环图中得知，提取了以下协变量的数据：品种，保险状况,合并症和兽医组。使用治疗加权的逆概率来调整混杂因素，考虑到审查母狗的审查权重的逆概率。模拟试验包括612名早龄绝育母犬和888名晚龄绝育母犬。汇总逻辑回归结果模型确定，与早期绝育的母犬相比，早期发作UI的可能性为0.80倍（95％CI0.54至0.97）。研究结果表明，与早期绝育相比，年龄较晚的绝育原因降低了早发性UI诊断的几率。对绝育年龄的决策要慎重考虑,优先考虑将绝育推迟到7个月大以后，除非其他主要原因证明早期手术是合理的。该研究是第一个证明目标试验框架成功应用于兽医观察数据的研究之一。
