# Propensity scores and preventive drug use in the elderly

> **NIH NIH R01** · UNIV OF NORTH CAROLINA CHAPEL HILL · 2020 · $480,295

## Abstract

SUMMARY
 Prescription drugs play a crucial role in the prevention and treatment of chronic disease in older adults.
The evidence base for the benefit and harm of these treatments comes from experimental (randomized
controlled trials, RCTs) and nonexperimental (observational, epidemiologic) studies. For older adults, and
especially those with multiple comorbidities, critically important evidence comes from nonexperimental studies,
because these individuals – particularly those who use the most drugs – are often excluded from RCTs.
Unfortunately, nonexperimental studies often suffer from confounding by frailty, as recently evinced by two
RCTs on statins that failed to confirm nonexperimental findings of protective effects in sepsis-associated acute
respiratory distress syndrome and in chronic obstructive pulmonary disease. Confounding by frailty can lead to
suboptimal or even harmful treatment decisions (if nonexperimental studies are the only evidence available) or
the conduct of costly RCTs that fail to replicate the findings of nonexperimental research. For a timely
assessment of drug benefit and harm in older adults and real-world settings, it is therefore vital to develop and
apply improved methods to reduce confounding in nonexperimental studies.
 Funded by R01 (and now R56) AG023178 since 2005, we have achieved substantial advances in
knowledge about methods to improve the validity of nonexperimental research. Using both empirical data and
extensive simulations, we have developed several novel analytic techniques to reduce confounding, including
propensity score calibration and the exclusion of patients treated contrary to prediction. Over the last 11 years,
we have disseminated our results by means of oral presentations, posters, and workshops/symposia and in a
series of 67 publications (i.e., > 6 per year), including 15 in the top epidemiologic journals (AJE and
Epidemiology), 14 in the top pharmacoepidemiologic journal (PDS), 7 in Medical Care, and several in top
medical journals (JAMA, JNCI, Diabetes Care, and JAGS).
 We propose to continue building effective tools to address the most significant problem hindering
nonexperimental study designs from generating valid answers about beneficial and harmful effects of
treatments, i.e., the problem of unmeasured confounding. The proposed study will build on our work over the
last decade and extend it in the same domain – through increasing the validity of nonexperimental methods to
assess the preventive effects of treatments in older adults. We will focus on better defining study populations at
equipoise between treatments compared, as well as six additional aims, using empirical motivating examples
and a variety of simulations to improve the validity of nonexperimental Comparative Effectiveness Research
(CER). Improved validity of nonexperimental CER will result in more robust evidence about drug benefit and
harm in older adults. This work will directly inform clinically relevant treatment dec...

## Key facts

- **NIH application ID:** 9928870
- **Project number:** 5R01AG056479-04
- **Recipient organization:** UNIV OF NORTH CAROLINA CHAPEL HILL
- **Principal Investigator:** Til Sturmer
- **Activity code:** R01 (R01, R21, SBIR, etc.)
- **Funding institute:** NIH
- **Fiscal year:** 2020
- **Award amount:** $480,295
- **Award type:** 5
- **Project period:** 2017-09-15 → 2022-04-30

## Primary source

NIH RePORTER: https://reporter.nih.gov/project-details/9928870

## Citation

> US National Institutes of Health, RePORTER application 9928870, Propensity scores and preventive drug use in the elderly (5R01AG056479-04). Retrieved via AI Analytics 2026-05-23 from https://api.ai-analytics.org/grant/nih/9928870. Licensed CC0.

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