Study on the optimization of medical resources for the elderly using the National Database of Receipts (NDB)

2022 Fiscal Year Final Research Report

• Project/Area Number: 19K12870
• Research Category: Grant-in-Aid for Scientific Research (C)
• Allocation Type: Multi-year Fund
• Section: 一般
• Review Section: Basic Section 90140:Medical technology assessment-related
• Research Institution: Juntendo University
• Principal Investigator: Nojiri Shuko 順天堂大学, 革新的医療技術開発研究センター, 准教授 (80763466)
• Project Period (FY): 2019-04-01 – 2023-03-31
• Keywords: 高齢者 / 多剤併用 / 大腿骨骨折 / バイアス感度分析

Outline of Final Research Achievements

Research findings include the following four studies, two of which have been accepted for publication in international journals and the remainder are currently being submitted to international journals. A case-control study of SGLT2 inhibitors and femur fracture risk was conducted in elderly subjects using a large claim database. The odds ratio for drug was 0.83 (95% CI: 0.55-1.26). Second, the risk of femur fracture was assessed for Suvorexant, with an odds ratio of 0.86, 95% CI 0.61-1.20].Third, in the elderly with multiple medications, the risk of femur fracture with multiple medications was higher in the 60s, with increased risk in Parkinson's disease medications, ophthalmology, and musculoskeletal disease.Furthermore, in the study of bias assessment in epidemiological studies, with a particular focus on selection bias, he has developed a sensitivity analysis method based on causal inference, which has been submitted to J. Biometrics and is currently under peer review.

Free Research Field

Medica Informatics

Academic Significance and Societal Importance of the Research Achievements

本研究により、高齢者の健康上の特長としては合併症の増加，polypharmacyが生じやすいことを確認した。高齢者において、SGLT2阻害剤やSuvorexantの大腿骨骨折リスクは懸念するほどの大きいリスクではなかった。また、後期高齢者より60歳代でpolypharmacyのリスクが大きいことがわかった（投稿中）。レセプトデータベースは，傷病名の誤分類バイアス，未測定交絡因子が存在することにより薬剤の正しいリスク評価ができない可能性が高いため、申請者は選択バイアスに着目し，データベースによるリスク評価にバイアス感度分析を組み込んだ手法を提案した．