# Propensity scores and preventive drug use in the elderly

> **NIH NIH R01** · UNIV OF NORTH CAROLINA CHAPEL HILL · 2022 · $647,862

## Abstract

ABSTRACT
 Medical treatments, including drugs, surgical interventions, and vaccinations, play a crucial role in the
prevention and treatment of chronic and infectious disease in older adults. Studies providing the evidence base
for the benefits and harms of these treatments include both experimental studies (randomized controlled trials,
RCTs) and nonexperimental studies (observational, epidemiologic, or, more recently: real-world evidence).
Nonexperimental studies provide critically important evidence for older adults, especially those with multiple
chronic conditions with polypharmacy, as such adults are rarely included in RCTs; this is doubly important for
racially marginalized older adults that are historically underrepresented in trials. Such nonexperimental studies
often involve confounding, and many confounders in older adults-including frailty-can be difficult to capture in
real-world data. Failure to adjust for this confounding can distort findings and lead to suboptimal or even
harmful treatment decisions (if nonexperimental studies are the only evidence available) or the conduct of
costly RCTs of treatments without benefits. Timely assessment of treatment benefit and harm in older adults in
real-world (versus experimental) settings requires development, refinement, and application of methods to
reduce confounding bias in nonexperimental studies.
 We have addressed this topic since 2005 with funding from R01/R56 AG023178 and AG056479. This
effort has led to substantial advances in methods to improve the validity of nonexperimental research applying
propensity score methods. Using both empirical data and extensive simulations, we have developed novel
analytic techniques to reduce confounding, including propensity score calibration and the exclusion of patients
treated contrary to prediction. We have disseminated our results in the form of oral presentations, posters, and
workshops/symposia and 112 peer-reviewed publications, including 23 in top epidemiologic journals (AJE and
Epidemiology), 23 in the top pharmacoepidemiologic journal (PDS), 10 in Medical Care, and several in top
medical journals (JAMA, JNCI, Diabetes Care, and JAGS).
 Building on our work over the last 15 years to increase the validity of nonexperimental methods to assess
the preventive effects of treatments in older adults, we propose significant and innovative aims that improve
the rigor of nonexperimental research. We will address these aims using motivating examples from empirical
data and extensive simulations to improve the validity of real-world evidence. We will take advantage of our
interdisciplinary expertise and access to Medicare data linked with other data sources to improve real-world
studies using propensity scores. This proposal is timely: linked data are becoming more available and the role
of real-world evidence in regulatory decision making is a central discussion point. This work will directly inform
clinically relevant treatment decisions, provide re...

## Key facts

- **NIH application ID:** 10442004
- **Project number:** 2R01AG056479-05A1
- **Recipient organization:** UNIV OF NORTH CAROLINA CHAPEL HILL
- **Principal Investigator:** Til Sturmer
- **Activity code:** R01 (R01, R21, SBIR, etc.)
- **Funding institute:** NIH
- **Fiscal year:** 2022
- **Award amount:** $647,862
- **Award type:** 2
- **Project period:** 2017-09-15 → 2027-05-31

## Primary source

NIH RePORTER: https://reporter.nih.gov/project-details/10442004

## Citation

> US National Institutes of Health, RePORTER application 10442004, Propensity scores and preventive drug use in the elderly (2R01AG056479-05A1). Retrieved via AI Analytics 2026-05-22 from https://api.ai-analytics.org/grant/nih/10442004. Licensed CC0.

---

*[NIH grants dataset](/datasets/nih-grants) · CC0 1.0*