Evaluating confounding control in estimations of influenza antiviral effectiveness in electronic health plan data.

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Observational studies of oseltamivir and influenza complications could suffer from residual confounding. Using negative control risk periods and a negative control outcome, we examined confounding control in a claims-based study of oseltamivir and influenza complications (pneumonia, all-cause hospitalization, antibiotic dispensing). Within the FDA's Sentinel System we identified individuals ≥18 years initiating oseltamivir on the influenza diagnosis date versus those who did not, during three influenza seasons (2014-2017). We evaluated primary outcomes in the following 1-30 days (primary risk period) and 61-90 days (negative control period), and non-vertebral fractures (negative control outcome) in days 1-30. We estimated propensity score-matched risk ratios (RR) per season. During 2014-15, oseltamivir was associated with a reduction in the risk of pneumonia (0.72, 95% CI 0.70, 0.75) and all-cause hospitalization (0.54, 95% CI 0.53, 0.55) in days 1-30. During days 61-90, estimates were near-null for pneumonia (1.04, 95% CI 0.95, 1.15) and hospitalization: (0.94, 95% CI 0.91, 0.98), but slightly increased for antibiotic dispensing (1.14, 95% CI 1.08, 1.21). The RR for fractures was near-null (1.09, 95% CI 0.99, 1.20). The 2016-17 estimates were comparable, while the 2015-16 season had conflicting results. Our study suggests minimal residual confounding for specific outcomes, but results differed by season.

Abbreviation
Am J Epidemiol
Publication Date
2022-02-02
Pubmed ID
35106530
Medium
Print-Electronic
Full Title
Evaluating confounding control in estimations of influenza antiviral effectiveness in electronic health plan data.
Authors
Htoo PT, Measer G, Orr R, Bohn J, Sorbello A, Francis H, Dutcher SK, Cosgrove A, Carruth A, Toh S, Cocoros NM