How Much Did Biases in the Study of Chronic Obstructive Pulmonary Disease Medications and Mortality Affect the Outcome?
Authors: Todd A. Lee
Journal: Annals of Internal Medicine (2009)

Letters17 March 2009How Much Did Biases in the Study of Chronic Obstructive Pulmonary Disease Medications and Mortality Affect the Outcome?Todd A. Lee, PharmD, PhD, A. Simon Pickard, PhD, and David H. Au, MD, MSTodd A. Lee, PharmD, PhDFrom Hines Veterans Affairs Hospital, Hines, IL 60141; University of Illinois at Chicago, Chicago, IL 60637; and Veterans Affairs Puget Sound Health Care System, Seattle, WA 98174.Search for more papers by this author, A. Simon Pickard, PhDFrom Hines Veterans Affairs Hospital, Hines, IL 60141; University of Illinois at Chicago, Chicago, IL 60637; and Veterans Affairs Puget Sound Health Care System, Seattle, WA 98174.Search for more papers by this author, and David H. Au, MD, MSFrom Hines Veterans Affairs Hospital, Hines, IL 60141; University of Illinois at Chicago, Chicago, IL 60637; and Veterans Affairs Puget Sound Health Care System, Seattle, WA 98174.Search for more papers by this authorAuthor, Article, and Disclosure Informationhttps://doi.org/10.7326/0003-4819-150-6-200903170-00020 SectionsAboutFull TextPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissions ShareFacebookTwitterLinkedInRedditEmail IN RESPONSE:We thank the correspondents for their thoughtful comments. Drs. Suissa and Ernst raise 3 concerns about our article. First, to alleviate concerns that the observed risk for ipratropium and cardiovascular mortality was a result of an increased risk for exacerbations in the case patients, we conducted an analysis restricted to those without an exacerbation in the 180 days before their event date and found a level of risk (odds ratio, 1.45 [CI, 1.14 to 1.85]) similar to the results reported in the article. Second, unmeasured confounding and bias is a possible explanation for the discordant results between the ...References1. Anthonisen NR, Connett JE, Enright PL, Manfreda J; Lung Health Study Research Group. Hospitalizations and mortality in the Lung Health Study. Am J Respir Crit Care Med. 2002;166:333-9. [PMID: 12153966] CrossrefMedlineGoogle Scholar2. Singh S, Loke YK, Furberg CD. Inhaled anticholinergics and risk of major adverse cardiovascular events in patients with chronic obstructive pulmonary disease: a systematic review and meta-analysis. JAMA. 2008;300:1439-50. [PMID: 18812535] CrossrefMedlineGoogle Scholar3. Jha AK, Shlipak MG, Hosmer W, Frances CD, Browner WS. Racial differences in mortality among men hospitalized in the Veterans Affairs health care system. JAMA. 2001;285:297-303. [PMID: 11176839] CrossrefMedlineGoogle Scholar4. Selim AJ, Fincke G, Berlowitz DR, Cong Z, Miller DR, Ren XS, et al. No racial differences in mortality found among Veterans Health Administration out-patients. J Clin Epidemiol. 2004;57:539-42. [PMID: 15196625] CrossrefMedlineGoogle Scholar Author, Article, and Disclosure InformationAffiliations: From Hines Veterans Affairs Hospital, Hines, IL 60141; University of Illinois at Chicago, Chicago, IL 60637; and Veterans Affairs Puget Sound Health Care System, Seattle, WA 98174.Disclosures:Honoraria: T.A. Lee (AstraZeneca, Novartis), D.H. Au (GlaxoSmithKline). Stock ownership or options (other than mutual funds): D.H. Au (Pfizer). Grants received: T.A. Lee (Altana, Aventis, AstraZeneca, Boehringer Ingelheim, Chiesi, GlaxoSmithKline, Merck & Co., Novartis, Pfizer, Schering-Plough, Sepracor, University of Kentucky). Other: D.H. Au (Assessing the Impact of Recent Updates for Advair and Serevent Special Issues Board). PreviousarticleNextarticle Advertisement FiguresReferencesRelatedDetailsSee AlsoRisk for Death Associated with Medications for Recently Diagnosed Chronic Obstructive Pulmonary Disease Todd A. Lee , A. Simon Pickard , David H. Au , Brian Bartle , and Kevin B. Weiss How Much Did Biases in the Study of Chronic Obstructive Pulmonary Disease Medications and Mortality Affect the Outcome? Samy Suissa and Pierre Ernst How Much Did Biases in the Study of Chronic Obstructive Pulmonary Disease Medications and Mortality Affect the Outcome? Nicholas J. Gross How Much Did Biases in the Study of Chronic Obstructive Pulmonary Disease Medications and Mortality Affect the Outcome? Takeharu Koga , Tomoko Kamimura , and Munetsugu Nishimura Metrics 17 March 2009Volume 150, Issue 6Page: 426-427KeywordsHealth careHospitalizationsPopulation statisticsProspective studiesRisk managementTreatment guidelinesVeteran care ePublished: 17 March 2009 Issue Published: 17 March 2009 Copyright & PermissionsCopyright © 2009 by American College of Physicians. All Rights Reserved.PDF downloadLoading ...