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@ARTICLE{Degen:304096,
      author       = {M. Degen$^*$ and B. Schöttker$^*$},
      title        = {{A}ssociations of potentially inappropriate medications in
                      older adults with mortality and hospitalizations:
                      methodological challenges in pharmacoepidemiology.},
      journal      = {European journal of epidemiology},
      volume       = {nn},
      issn         = {0393-2990},
      address      = {[Cham]},
      publisher    = {Springer Nature Switzerland AG},
      reportid     = {DKFZ-2025-01764},
      pages        = {nn},
      year         = {2025},
      note         = {#EA:C070#LA:C070# / epub},
      abstract     = {Previous studies on the association of potentially
                      inappropriate medication (PIM) use with hospitalization risk
                      and all-cause mortality among older adults were prone to
                      confounding and biases. Using data from 217,111 participants
                      of the population-based United Kingdom Biobank, aged 60-69
                      years, including 95,187 participants with primary care data
                      linkage, the main analysis was a prospective new user design
                      with 1:1 propensity-score stratified by indication matching
                      of new PIM users and new appropriate medication (AM) users
                      (assessed with the EURO-FORTA list). Results were compared
                      to previous approaches with a prevalent user design and a
                      new user design without propensity score matching. 43,307
                      $(19.9\%)$ participants used at least one PIM at baseline.
                      Among 11,812 propensity score matched individuals with new
                      PIM or new AM prescription within 2 years after baseline,
                      new PIM use was associated with non-significantly $20\%$
                      increased 1-month hospitalization (hazard ratio (HR) $[95\%$
                      confidence interval $(95\%$ CI)]: 1.20 [0.76-1.90]) and
                      $23\%$ increased 1-year mortality (1.23 [0.80-1.89]).
                      Null-results were obtained with the prevalent user design
                      (HRs $[95\%$ CIs]: 1-month hospitalization: 1.04
                      [0.83-1.31]; 1-year mortality: 1.01 [0.82-1.23]) and
                      slightly stronger associations in new user design without
                      propensity score matching stratified by indication (1-month
                      hospitalization (1.24 [0.95-1.61]); 1-year mortality (HR
                      $[95\%$ CI] 1.57 [1.24-2.00]). This first study with an
                      appropriate methodology showed that previous
                      pharmacoepidemiologic studies on the risk of PIM for
                      hospitalization and mortality have either under- or
                      overestimated the risk. Effect sizes of about $20\%$ appear
                      biologically plausible and larger studies are needed to
                      detect such weak associations with statistical
                      significance.},
      keywords     = {Clinicalpharmacology (Other) / Drug safety (Other) /
                      Pharmacoepidemiology (Other) / Potentially inappropriate
                      medication (Other)},
      cin          = {C070},
      ddc          = {610},
      cid          = {I:(DE-He78)C070-20160331},
      pnm          = {313 - Krebsrisikofaktoren und Prävention (POF4-313)},
      pid          = {G:(DE-HGF)POF4-313},
      typ          = {PUB:(DE-HGF)16},
      pubmed       = {pmid:40847213},
      doi          = {10.1007/s10654-025-01294-x},
      url          = {https://inrepo02.dkfz.de/record/304096},
}