Marginal structural models for the estimation of the risk of Diabetes Mellitus in the presence of elevated depressive symptoms and antidepressant medication use in the Women’s Health Initiative observational and clinical trial cReportar como inadecuado




Marginal structural models for the estimation of the risk of Diabetes Mellitus in the presence of elevated depressive symptoms and antidepressant medication use in the Women’s Health Initiative observational and clinical trial c - Descarga este documento en PDF. Documentación en PDF para descargar gratis. Disponible también para leer online.

BMC Endocrine Disorders

, 15:56

First Online: 12 October 2015Received: 07 April 2015Accepted: 18 September 2015

Abstract

BackgroundWe evaluate the combined effect of the presence of elevated depressive symptoms and antidepressant medication use with respect to risk of type 2 diabetes among approximately 120,000 women enrolled in the Women’s Health Initiative WHI, and compare several different statistical models appropriate for causal inference in non-randomized settings.

MethodsData were analyzed for 52,326 women in the Women’s Health Initiative Clinical Trials CT Cohort and 68,169 women in the Observational Study OS Cohort after exclusions. We included follow-up to 2005, resulting in a median duration of 7.6 years of follow up after enrollment. Results from three multivariable Cox models were compared to those from marginal structural models that included time varying measures of antidepressant medication use, presence of elevated depressive symptoms and BMI, while adjusting for potential confounders including age, ethnicity, education, minutes of recreational physical activity per week, total energy intake, hormone therapy use, family history of diabetes and smoking status.

ResultsOur results are consistent with previous studies examining the relationship of antidepressant medication use and risk of type 2 diabetes. All models showed a significant increase in diabetes risk for those taking antidepressants. The Cox Proportional Hazards models using baseline covariates showed the lowest increase in risk , with hazard ratios of 1.19 95 % CI 1.06 – 1.35 and 1.14 95 % CI 1.01 – 1.30 in the OS and CT, respectively. Hazard ratios from marginal structural models comparing antidepressant users to non-users were 1.35 95 % CI 1.21 – 1.51 and 1.27 95 % CI 1.13 – 1.43 in the WHI OS and CT, respectively – however, differences among estimates from traditional Cox models and marginal structural models were not statistically significant in both cohorts. One explanation suggests that time-dependent confounding was not a substantial factor in these data, however other explanations exist. Unadjusted Cox Proportional Hazards models showed that women with elevated depressive symptoms had a significant increase in diabetes risk that remained after adjustment for confounders. However, this association missed the threshold for statistical significance in propensity score adjusted and marginal structural models.

ConclusionsResults from the multiple approaches provide further evidence of an increase in risk of type 2 diabetes for those on antidepressants.

KeywordsAntidepressant medication Depression Type 2 diabetes Marginal structural models Propensity score AbbreviationsWHI-CTWomen’s health initiative clinical trials cohort

WHI-OSWomen’s health initiative observational cohort

WHIWomen’s Health Initiative

BMIBody mass index

IPTWInverse probability of treatment weights

CES-DCenter for Epidemiological Studies Depression Scale

PHCox Proportional Hazards

CIConfidence interval

HRHazard ratio

MSMsMarginal structural models

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Autor: Christine Frisard - Xiangdong Gu - Brian Whitcomb - Yunsheng Ma - Penelope Pekow - Martha Zorn - Deidre Sepavich - Raji Ba

Fuente: https://link.springer.com/







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