目的:病例交叉设计是一种自我对照研究设计,用于比较事件发生前的暴露与早期对照时期的暴露。该设计最适用于瞬态曝光,以避免在将情况交叉设计用于非瞬态时可能出现的偏差(即,慢性)暴露。我们的目标是对病例交叉研究及其变体(病例时间控制和病例时间控制)进行系统评价,以比较药物类型的设计和分析选择。
方法:我们进行了系统的搜索,以确定最近的病例交叉,case-time-control,病例-病例-时间对照研究侧重于药物暴露。确定了使用这些研究设计在2015年1月至2021年12月之间以英语发布的MEDLINE和EMBASE索引的文章。评论,方法学研究,评论,没有药物的物品作为感兴趣的暴露,没有可用全文的文章被排除在外。研究特点,包括研究设计,结果,风险窗口,控制窗口,报告不和谐的对,并对纳入的敏感性分析进行了总体总结和药物类型总结.我们进一步评估了推荐方法的实施情况,以解决在非瞬态暴露中使用案例交叉设计的文章中由非瞬态暴露引入的偏见。
结果:在最初确定的2,036篇文章中,共有114篇文章。病例交叉是最常见的研究设计(88%),其次是病例时间控制(17%),和病例-病例-时间控制(3%)。53%的文章只包括短暂的药物,35%仅包括非暂时性药物,12%包括两者。多年来,评估非暂时性药物治疗的病例交叉文章的比例从2018年的30%到2017年的69%不等.我们发现,41%的评价非暂时性药物的文章没有应用任何推荐的方法来解释偏见,其中一半以上是由没有病例交叉研究发表史的作者进行的。
结论:使用病例交叉设计来评估非暂时性药物在药物流行病学中仍然很常见。在选择使用非暂时性药物暴露的病例交叉设计时,研究人员应采用适当的设计和分析选择。本文受版权保护。保留所有权利。
The case-crossover design is a self-controlled study design used to compare exposure immediately preceding an event occurrence with exposure in earlier control periods. The design is most suitable for transient exposures in order to avoid
biases that can be problematic when using the case-crossover design for non-transient (i.e., chronic) exposures. Our goal was to conduct a systematic review of case-crossover studies and its variants (case-time-control and case-case-time-control) in order to compare design and analysis choices by medication type.
We conducted a systematic search to identify recent
case-crossover,
case-time-control, and
case-
case-time-control studies focused on medication exposures. Articles indexed in MEDLINE and EMBASE using these study designs that were published between January 2015 and December 2021 in the English language were identified. Reviews, methodological studies, commentaries, articles without medications as the exposure of interest, and articles with no available full text were excluded. Study characteristics including study design, outcome, risk window, control window, reporting of discordant pairs, and inclusion of sensitivity analyses were summarized overall and by medication type. We further evaluated the implementation of recommended methods to account for
biases introduced by non-transient exposures among articles that used the case-crossover design on a non-transient exposure.
Of the 2036 articles initially identified, 114 articles were included. The case-crossover was the most common study design (88%), followed by the case-time-control (17%), and
case-
case-time-control (3%). Fifty-three percent of the articles included only transient medications, 35% included only non-transient medications, and 12% included both. Across years, the proportion of case-crossover articles evaluating a non-transient medication ranged from 30% in 2018 to 69% in 2017. We found that 41% of the articles that evaluated a non-transient medication did not apply any of the recommended methods to account for
biases and more than half of which were conducted by authors with no previous publication history of case-crossover studies.
Using the case-crossover design to evaluate a non-transient medication remains common in pharmacoepidemiology. Researchers should apply appropriate design and analysis choices when opting to use a case-crossover design with non-transient medication exposures.