Propensity Score Adjustment With Multilevel Data: Setting Your Sites on Decreasing Selection Bias

Editorials16 March 2010Propensity Score Adjustment With Multilevel Data: Setting Your Sites on Decreasing Selection BiasMichael E. Griswold, PhD, A. Russell Localio, PhD, and Cynthia Mulrow, MD, MSc, Senior Deputy EditorMichael E. Griswold, PhDFrom Center of Biostatistics, University of Mississippi Medical Center, Jackson, MS 39216; Center for Clinical Epidemiology and Biostatistics, University of Pennsylvania, Philadelphia, PA 19104; and American College of Physicians, Philadelphia, PA 19106., A. Russell Localio, PhDFrom Center of Biostatistics, University of Mississippi Medical Center, Jackson, MS 39216; Center for Clinical Epidemiology and Biostatistics, University of Pennsylvania, Philadelphia, PA 19104; and American College of Physicians, Philadelphia, PA 19106., and Cynthia Mulrow, MD, MSc, Senior Deputy EditorFrom Center of Biostatistics, University of Mississippi Medical Center, Jackson, MS 39216; Center for Clinical Epidemiology and Biostatistics, University of Pennsylvania, Philadelphia, PA 19104; and American College of Physicians, Philadelphia, PA 19106.Author, Article, and Disclosure Informationhttps://doi.org/10.7326/0003-4819-152-6-201003160-00010 SectionsSupplemental MaterialAboutFull TextPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissions ShareFacebookTwitterLinkedInRedditEmail Decision makers often rely on large, multisite observational studies to evaluate the benefits and harms of therapies. An important example is in this issue—a study from Ray and colleagues (1) adds to the debate about the potential harms of concurrent use of proton-pump inhibitors (PPIs) and clopidogrel. These drugs are frequently coprescribed, and the U.S. Food and Drug Administration, primarily on the basis of evidence from multisite observational studies, recently warned against concomitant use of one PPI, omeprazole, and clopidogrel (2). Ray and colleagues' analysis suggests that adverse consequences of concomitant PPI and clopidogrel use are not that clear. In ...References1. Ray WA, Murray KT, Griffin MR, Chung CP, Smalley WE, Hall K, et al. Outcomes with concurrent use of clopidogrel and proton-pump inhibitors. A cohort study. Ann Intern Med. 2010;152:337-45. LinkGoogle Scholar2. U.S. Food and Drug Administration. FDA announces new warning on Plavix: avoid use with Prilosec/Prilosec OTC [news release]. 18 November 2009. Silver Spring, MD: U.S. Food and Drug Administration; 2009. Accessed at www.fda.gov/NewsEvents/Newsroom/PressAnnouncements/ucm191169.htm 8 February 2010. Google Scholar3. Braitman LE, Rosenbaum PR. Rare outcomes, common treatments: analytic strategies using propensity scores [Editorial]. Ann Intern Med. 2002;137:693-5. [PMID: 12379071] LinkGoogle Scholar4. D'Agostino RB. Propensity score methods for bias reduction in the comparison of a treatment to a non-randomized control group. Stat Med. 1998;17:2265-81. [PMID: 9802183] CrossrefMedlineGoogle Scholar5. Austin PC, Mamdani MM. A comparison of propensity score methods: a case-study estimating the effectiveness of post-AMI statin use. Stat Med. 2006;25:2084-106. [PMID: 16220490] CrossrefMedlineGoogle Scholar6. Heagerty PJ, Zeger SL. Marginalized multilevel models and likelihood inference. Stat Sci. 2000;15:1-26. CrossrefGoogle Scholar7. Kang JDY, Schafer JL. Demystifying double robustness: a comparison of alternative strategies for estimating a population mean from incomplete data. Stat Sci. 2007;22:523-39. CrossrefGoogle Scholar8. Juurlink DN, Gomes T, Ko DT, Szmitko PE, Austin PC, Tu JV, et al. A population-based study of the drug interaction between proton pump inhibitors and clopidogrel. CMAJ. 2009;180:713-8. [PMID: 19176635] CrossrefMedlineGoogle Scholar9. Ho PM, Maddox TM, Wang L, Fihn SD, Jesse RL, Peterson ED, et al. Risk of adverse outcomes associated with concomitant use of clopidogrel and proton pump inhibitors following acute coronary syndrome. JAMA. 2009;301:937-44. [PMID: 19258584] CrossrefMedlineGoogle Scholar10. O'Donoghue ML, Braunwald E, Antman EM, Murphy SA, Bates ER, Rozenman Y, et al. Pharmacodynamic effect and clinical efficacy of clopidogrel and prasugrel with or without a proton-pump inhibitor: an analysis of two randomised trials. Lancet. 2009;374:989-97. [PMID: 19726078] CrossrefMedlineGoogle Scholar Author, Article, and Disclosure InformationAffiliations: From Center of Biostatistics, University of Mississippi Medical Center, Jackson, MS 39216; Center for Clinical Epidemiology and Biostatistics, University of Pennsylvania, Philadelphia, PA 19104; and American College of Physicians, Philadelphia, PA 19106.Acknowledgment: The authors thank Ray and colleagues for providing their analytic data set and assistance in obtaining permission from the State of Tennessee Bureau of TennCare and Department of Health for its use.Disclosures: Disclosures can be viewed at www.acponline.org/authors/icmje/ConflictOfInterestForms.do?msNum=M10-0315.Corresponding Author: Michael E. Griswold, PhD, Center of Biostatistics, University of Mississippi Medical Center, 2500 North State Street, Jackson, MS 39216; e-mail, [email protected]umsmed.edu.Current Author Addresses: Dr. Griswold: Center of Biostatistics, University of Mississippi Medical Center, 2500 North State Street, Jackson, MS 39216.Dr. Localio: Center for Clinical Epidemiology and Biostatistics, University of Pennsylvania, 606 Blockley Hall, 423 Guardian Drive, Philadelphia, PA 19104.Dr. Mulrow: Annals of Internal Medicine, 190 N. Independence Mall West, Philadelphia, PA 19106. PreviousarticleNextarticle Advertisement FiguresReferencesRelatedDetailsSee AlsoOutcomes With Concurrent Use of Clopidogrel and Proton-Pump Inhibitors Wayne A. Ray , Katherine T. Murray , Marie R. Griffin , Cecilia P. Chung , Walter E. Smalley , Kathi Hall , James R. Daugherty , Lisa A. Kaltenbach , and C. Michael Stein Metrics Cited byEffectiveness of systemic thrombolysis on clinical outcomes in high-risk pulmonary embolism patients with venoarterial extracorporeal membrane oxygenation: a nationwide inpatient database studyImpact of COVID-19 on Outcomes of Patients Hospitalized With STEMI: A Nationwide Propensity-matched AnalysisAssociation between remimazolam and postoperative delirium in older adults undergoing elective cardiovascular surgery: a prospective cohort studyAdditive effectiveness of acrylonitrile‐co‐methallyl sulfonate surface‐treated membranes in the treatment of pneumonia: A propensity score‐matched retrospective cohort studyEffects of electroconvulsive therapy on the use of anxiolytics and sleep medications: a propensity score‐matched analysisPsychological factors underpinning vaccine willingness in Israel, Japan and HungaryAdditional effect of azithromycin over β-lactam alone for severe community-acquired pneumonia-associated acute respiratory distress syndrome: a retrospective cohort studyDelayed Tetracycline Initiation Increases Mortality Risk in Patients With Japanese Spotted Fever: Retrospective Analysis Using a National Inpatient DatabaseEffectiveness of fluoroquinolone antimicrobials in addition to tetracyclines for Japanese spotted fever: A retrospective analysis using a national inpatient databasePropensity score matching/reweighting analysis comparing autologous and allogeneic stem cell transplantation for B-lineage acute lymphoblastic leukemiaEarly electroconvulsive therapy in patients with bipolar depression: A propensity score-matched analysis using a nationwide inpatient databaseEffectiveness of early rehabilitation following aortic surgery: a nationwide inpatient database studyThe 30-Day Readmission Rate of Same-Day Discharge Following Transcatheter Aortic Valve Implantation (from National Readmission Database 2015 to 2019)Nasal pillow noninvasive ventilation versus high-flow nasal therapy after extubation in surgical intensive care patients: A propensity-matched cohort studyAntiplatelet pretreatment and mortality in patients with severe sepsis: A secondary analysis from a multicenter, prospective survey of severe sepsis in JapanThe 30-day readmission rate of same-day discharge protocol following catheter ablation for atrial fibrillation: a propensity score-matched analysis from National Readmission DatabaseEffect of antithrombin III among patients with disseminated intravascular coagulation in obstetrics: a nationwide observational study in JapanChoroidal microvasculature dropout is spatially associated with optic nerve head microvasculature loss in open-angle glaucomaTrends and safety of robot‐assisted partial nephrectomy during the initial 2‐year period after government approval in Japan: A nationwide database study from 2016 to 2018Preoperative beta-blocker in ventricular dysfunction patients: need a more granular quality metricEarly rehabilitation after acute myocardial infarction: A nationwide inpatient database studyEfficacy of Prophylactic Antibiotics during Extracorporeal Membrane Oxygenation: A Nationwide Cohort StudyEarly Electroconvulsive Therapy in Patients With Major Depressive DisorderLongitudinal Propensity Score Matching: A Demonstration of Counterfactual Conditions Adjusted for Longitudinal ClusteringEffect of Early Rehabilitation on Physical Function in Patients Undergoing Coronary Artery Bypass Grafting: A Nationwide Inpatient Database StudyRecombinant Thrombomodulin in Disseminated Intravascular Coagulation Associated with Stage IV Solid Tumors: A Nationwide Observational Study in JapanEffects of stellate ganglion block on postoperative trigeminal neuropathy after dental surgery: a propensity score matching analysisAntithrombin use and mortality in patients with stage IV solid tumor-associated disseminated intravascular coagulation: a nationwide observational study in JapanThe effect of antithrombin added to recombinant human-soluble thrombomodulin for severe community-acquired pneumonia-associated disseminated intravascular coagulation: a retrospective cohort study using a nationwide inpatient databaseHistamine-2 receptor antagonists versus proton pump inhibitors for septic shock after lower gastrointestinal tract perforation: a retrospective cohort study using a national inpatient databaseProton pump inhibitors versus histamine-2 receptor antagonists for stress ulcer prophylaxis during extracorporeal membrane oxygenation: a propensity score-matched analysisPhenytoin versus fosphenytoin for second-line treatment of status epilepticus: propensity score matching analysis using a nationwide inpatient databaseLevetiracetam vs. Fosphenytoin for Second-Line Treatment of Status Epilepticus: Propensity Score Matching Analysis Using a Nationwide Inpatient DatabaseDifferences in effect of early enteral nutrition on mortality among ventilated adults with shock requiring low-, medium-, and high-dose noradrenaline: A propensity-matched analysisEarly enteral nutrition in patients with severe traumatic brain injury: a propensity score–matched analysis using a nationwide inpatient database in JapanAzithromycin plus β-lactam versus levofloxacin plus β-lactam for severe community-acquired pneumonia: A retrospective nationwide database analysisEffect of tranexamic acid on mortality in patients with haemoptysis: a nationwide studyExtracorporeal membrane oxygenation improves outcomes of accidental hypothermia without vital signs: A nationwide observational studyEarly Enteral Nutrition in Patients Undergoing Sustained Neuromuscular BlockadeNationwide observational study of mortality from complicated intra-abdominal infections and the role of bacterial culturesIntravenous albumin for initial resuscitation and mortality in septic shock patients: propensity score analyses using a nationwide inpatient databaseSystemic Vascular Risk Factors for Multiple Retinal Nerve Fiber Layer DefectsImpact of renal replacement therapy on survival in patients with KDIGO stage 3 acute kidney injury: A propensity score matched analysisPropensity Score Weighting for Causal Inference with Clustered DataSuspected periprosthetic joint infection after total knee arthroplasty under propofol versus sevoflurane anesthesia: a retrospective cohort studyWhen Do Honors Programs Make the Grade? Conditional Effects on College Satisfaction, Achievement, Retention, and GraduationEffect of plasma exchange on in-hospital mortality in patients with pulmonary hemorrhage secondary to antineutrophil cytoplasmic antibody-associated vasculitis: A propensity-matched analysis using a nationwide administrative databaseMortality and Morbidity After Hartmann's Procedure Versus Primary Anastomosis Without a Diverting Stoma for Colorectal Perforation: A Nationwide Observational StudyProcesses and Outcomes of Congestive Heart Failure Care by Different Types of Primary Care ModelsSivelestat sodium and mortality in pneumonia patients requiring mechanical ventilation: propensity score analysis of a Japanese nationwide databaseThe Community College Penalty? Examining the Bachelor's Completion Rates of Community College Transfer Students as a Function of TimeOutcomes after helicopter versus ground emergency medical services for major trauma--propensity score and instrumental variable analyses: a retrospective nationwide cohort studyThe Effect of Intraaortic Balloon Pumping Under Venoarterial Extracorporeal Membrane Oxygenation on Mortality of Cardiogenic PatientsSafety of Seasonal Influenza Vaccination in Hospitalized Surgical Patients A Cohort StudySara Y. Tartof, PhD, Lei Qian, PhD, Gunter K. Rieg, MD, Kalvin C. Yu, MD, Lina S. Sy, MPH, Hung Fu Tseng, PhD, Rulin C. Hechter, MD, PhD, and Steven J. Jacobsen, MD, PhDDistinguishing Selection Bias and Confounding Bias in Comparative Effectiveness ResearchPancreatic Stent or Rectal Indomethacin—Which Better Prevents Post-ERCP Pancreatitis?Potential Survival Benefit of Polymyxin B Hemoperfusion in Septic Shock Patients on Continuous Renal Replacement Therapy: A Propensity-Matched AnalysisA comparison of alternative strategies for choosing control populations in observational studiesPalliative care consultation services in hospitals in the Netherlands: the design of the COMPASS studyEffectiveness of an Early Versus a Conservative Invasive Treatment Strategy in Acute Coronary Syndromes A Nationwide Cohort StudyKim Wadt Hansen, MD, Rikke Sorensen, MD, Mette Madsen, MSc, Jan Kyst Madsen, DMSc, Jan Skov Jensen, DMSc, Lene Mia von Kappelgaard, MScPH, Poul Erik Mortensen, MD, Theis Lange, MSc, and Soren Galatius, DMScComparison of short-term mortality and morbidity between parenteral and enteral nutrition for adults without cancer: a propensity-matched analysis using a national inpatient database ,Diabetes Mellitus Care Provided by Nurse Practitioners vs Primary Care PhysiciansPotentially Preventable Hospitalizations in Medicare Patients With DiabetesAnalysis of threats to research validity introduced by audio recording clinic visits: Selection bias, Hawthorne effect, both, or neither?Perioperative Outcome Comparisons Between Open and Laparoscopic Nephroureterectomy Among a Population-Based Cohort from 2010 to 2012An Evaluation of Weighting Methods Based on Propensity Scores to Reduce Selection Bias in Multilevel Observational StudiesPropensity Score Stratification Using Multilevel Models to Examine Charter School Achievement EffectsUse of Recombinant Human Soluble Thrombomodulin in Patients with Sepsis-Induced Disseminated Intravascular Coagulation after Intestinal PerforationThe off-pump technique in redo coronary artery bypass grafting reduces mortality and major morbidities: propensity score analysis of data from the Japan Cardiovascular Surgery DatabaseRecombinant human soluble thrombomodulin and mortality in severe pneumonia patients with sepsis‐associated disseminated intravascular coagulation: an observational nationwide studyHUMeral Shaft Fractures: MEasuring Recovery after Operative versus Non-operative Treatment (HUMMER): a multicenter comparative observational studyComparison of Perioperative Outcomes including Severe Bladder Injury between Monopolar and Bipolar Transurethral Resection of Bladder Tumors: A Population Based ComparisonRobot‐assisted versus other types of radical prostatectomy: Population‐based safety and cost comparison in Japan, 2012–2013Acute Kidney Injury After CABG Versus PCIAntithrombin and mortality in severe pneumonia patients with sepsis‐associated disseminated intravascular coagulation: an observational nationwide studyComparative Effectiveness of Senna to Prevent Problematic Constipation in Pediatric Oncology Patients Receiving Opioids: A Multicenter Study of Clinically Detailed Administrative DataPostoperative Polymyxin B Hemoperfusion and Mortality in Patients With Abdominal Septic ShockComparative Safety of Vascular Closure Devices and Manual Closure Among Patients Having Percutaneous Coronary InterventionHitinder S. Gurm, MD, Carrie Hosman, PhD, David Share, MD, Mauro Moscucci, MD, and Ben B. Hansen, PhD, for the Blue Cross Blue Shield of Michigan Cardiovascular ConsortiumComparisons of perioperative outcomes and costs between open and laparoscopic radical prostatectomy: A propensity-score matching analysis based on the Japanese Diagnosis Procedure Combination databaseDoes Mechanical Bowel Preparation Improve Quality of Laparoscopic Nephrectomy? Propensity Score-matched Analysis in Japanese SeriesImpact of remifentanil use on early postoperative outcomes following brain tumor resection or rectal cancer surgeryConcomitant use of clopidogrel and proton pump inhibitors may attenuate the prognosis of coronary heart disease in hemodialysis patientsConcurrent and Predictive Relationships Between Compulsive Internet Use and Substance Use: Findings from Vocational High School Students in China and the USAAcupuncture and chiropractic care for chronic pain in an integrated health plan: a mixed methods studyOseltamivir Shortens Hospital Stays of Critically Ill Children Hospitalized With Seasonal InfluenzaAssociation of Hospitalist Care With Medical Utilization After Discharge: Evidence of Cost Shift From a Cohort StudyYong-Fang Kuo, PhD and James S. Goodwin, MDBeyond efficacy: pharmacokinetic differences between clopidogrel, prasugrel and ticagrelorThe Use of Propensity Scores for Nonrandomized Designs With Clustered DataRacial Differences in Mortality Among Patients With Acute Ischemic Stroke An Observational StudyYing Xian, MD, PhD, Robert G. Holloway, MD, MPH, Katia Noyes, PhD, MPH, Manish N. Shah, MD, MPH, and Bruce Friedman, PhD, MPHEffect of the Japanese Herbal Kampo Medicine Dai-Kenchu-To on Postoperative Adhesive Small Bowel Obstruction Requiring Long-Tube Decompression: A Propensity Score AnalysisCompliance and persistence with osteoporosis medications: A critical review of the literatureNonresponders to clopidogrel: pharmacokinetics and interactions involved 16 March 2010Volume 152, Issue 6Page: 393-395KeywordsBiostatisticsHemorrhageObservational studiesPatientsProton pump inhibitorsRunningSafetySafety studiesStatistical dataTest statistics ePublished: 16 March 2010 Issue Published: 16 March 2010 Copyright & PermissionsCopyright © 2010 by American College of Physicians. All Rights Reserved.PDF downloadLoading ...