help button home button
AJRCCM
HOME HELP FEEDBACK SUBSCRIPTIONS ARCHIVE SEARCH
Published ahead of print on March 27, 2003, doi:10.1164/rccm.200210-1231OC

Am. J. Respir. Crit. Care Med., Volume 168, Number 1, July 2003, 49-53

A more recent version of this article appeared on July 1, 2003
This Article
Right arrow Full Text (PDF)
Right arrow All Versions of this Article:
200210-1231OCv1
168/1/49    most recent
Right arrow Alert me when this article is cited
Right arrow Alert me if a correction is posted
Services
Right arrow Similar articles in this journal
Right arrow Similar articles in PubMed
Right arrow Alert me to new issues of the journal
Right arrow Download to citation manager
Right arrow reprints & permissions
Citing Articles
Right arrow Citing Articles via HighWire
Right arrow Citing Articles via Google Scholar
Google Scholar
Right arrow Articles by Suissa, S.
Right arrow Search for Related Content
PubMed
Right arrow PubMed Citation
Right arrow Articles by Suissa, S.

Submitted on October 28, 2002
Accepted on March 24, 2003

Effectiveness of Inhaled Corticosteroids in COPD: Immortal Time Bias in Observational Studies

Samy Suissa1*

1 Division of Clinical Epidemiology, McGill University Health Centre, Royal Victoria Hospital, Montreal, Quebec, Canada; Epidemiology, Biostatistics and Medicine, McGill University, Montreal, Quebec, Canada

* To whom correspondence should be addressed. E-mail: samy.suissa{at}clinepi.mcgill.ca.

Recent large-scale cohort studies that reported an important reduction in mortality and COPD morbidity with inhaled corticosteroids may be biased. We used a population-based cohort of Saskatchewan residents 55 years of age or over, first hospitalised for COPD during 1990-97, to study this potential bias. These 979 subjects were followed for a year from discharge until their first readmission for COPD or death (389 subjects). Inhaled corticosteroid exposure was any dispensing within 90 days after discharge. Cox's proportional hazards model was used to compare the time-fixed analysis employed in the recent studies with an alternative time-dependent analysis. The time-fixed adjusted rate ratio was 0.69 (95% Cl: 0.55-0.86) for inhaled corticosteroid use within 90 days while the time-dependent rate ratio was 1.00 (95% Cl: 0.79-1.26). With the time-fixed analysis, the rate ratios were affected by the choice of the exposure period, decreasing from 0.98 for a 15-day exposure period to 0.51 for 365 days, but remained stable between 1.06 and 0.94 with the time-dependent analysis. Inhaled corticosteroid use after hospitalisation for COPD was not found to reduce mortality and morbidity. Recent observational reports of reductions in mortality and morbidity with inhaled corticosteroids are biased by their inappropriate allocation of exposure and immortal time.
Key words: COHORT STUDIES; DATABASE STUDIES; METHODS; CHRONIC OBSTRUCTIVE PULMONARY DISEASE; TREATMENT;




This article has been cited by other articles:


Home page
 Proc Am Thorac SocHome page
J. A. Falk, O. A. Minai, and Z. Mosenifar
Inhaled and Systemic Corticosteroids in Chronic Obstructive Pulmonary Disease
Proceedings of the ATS, May 1, 2008; 5(4): 506 - 512.
[Abstract] [Full Text] [PDF]

Home page
 J. Am. Soc. Nephrol.Home page
S. Z. Shariff, M. S. Cuerden, A. K. Jain, and A. X. Garg
The Secret of Immortal Time Bias in Epidemiologic Studies
J. Am. Soc. Nephrol., May 1, 2008; 19(5): 841 - 843.
[Full Text] [PDF]

Home page
 Am J EpidemiolHome page
S. Suissa
Immortal Time Bias in Pharmacoepidemiology
Am. J. Epidemiol., February 15, 2008; 167(4): 492 - 499.
[Abstract] [Full Text] [PDF]

Home page
 ChestHome page
R. McGhan, T. Radcliff, R. Fish, E. R. Sutherland, C. Welsh, and B. Make
Predictors of Rehospitalization and Death After a Severe Exacerbation of COPD
Chest, December 1, 2007; 132(6): 1748 - 1755.
[Abstract] [Full Text] [PDF]

Home page
 Proc Am Thorac SocHome page
S. Suissa, R. McGhan, D. Niewoehner, and B. Make
Inhaled Corticosteroids in Chronic Obstructive Pulmonary Disease
Proceedings of the ATS, October 1, 2007; 4(7): 535 - 542.
[Abstract] [Full Text] [PDF]

Home page
 ChestHome page
C. G. Grijalva, P. G. Arbogast, M. R. Griffin, and F. Frost
Statins and Influenza/COPD Mortality
Chest, October 1, 2007; 132(4): 1407 - 1408.
[Full Text] [PDF]

Home page
 Am. J. Respir. Crit. Care Med.Home page
P. Kardos, M. Wencker, T. Glaab, and C. Vogelmeier
Hospitalizations with Severe COPD
Am. J. Respir. Crit. Care Med., June 1, 2007; 175(11): 1207a - 1208.
[Full Text] [PDF]

Home page
 BrainHome page
Y. Mikaeloff, G. Caridade, S. Assi, M. Tardieu, S. Suissa, and on behalf of the KIDSEP study group of the French
Hepatitis B vaccine and risk of relapse after a first childhood episode of CNS inflammatory demyelination
Brain, April 1, 2007; 130(4): 1105 - 1110.
[Abstract] [Full Text] [PDF]

Home page
 JAMAHome page
S. Suissa
Statin Use and Risks for Death and Hospitalization in Chronic Heart Failure
JAMA, March 14, 2007; 297(10): 1057 - 1057.
[Full Text] [PDF]

Home page
 JAMAHome page
A. S. Go, J. Yang, and J. H. Gurwitz
Statin Use and Risks for Death and Hospitalization in Chronic Heart Failure--Reply
JAMA, March 14, 2007; 297(10): 1058 - 1058.
[Full Text] [PDF]

Home page
 ANN INTERN MEDHome page
M.-P. Sylvestre, E. Huszti, and J. A. Hanley
Do OSCAR winners live longer than less successful peers? A reanalysis of the evidence.
Ann Intern Med, September 5, 2006; 145(5): 361 - 363.
[Abstract] [Full Text] [PDF]

Home page
 ChestHome page
C. Macie, K. Wooldrage, J. Manfreda, and N. R. Anthonisen
Inhaled Corticosteroids and Mortality in COPD.
Chest, September 1, 2006; 130(3): 640 - 646.
[Abstract] [Full Text] [PDF]

Home page
 Proc Am Thorac SocHome page
D. D. Sin and S. F. P. Man
Pharmacotherapy for Mortality Reduction in Chronic Obstructive Pulmonary Disease
Proceedings of the ATS, September 1, 2006; 3(7): 624 - 629.
[Abstract] [Full Text] [PDF]

Home page
 Ann Fam MedHome page
G. Gartlehner, R. A. Hansen, S. S. Carson, and K. N. Lohr
Efficacy and Safety of Inhaled Corticosteroids in Patients With COPD: A Systematic Review and Meta-Analysis of Health Outcomes
Ann. Fam. Med, May 1, 2006; 4(3): 253 - 262.
[Abstract] [Full Text] [PDF]

Home page
 Am. J. Respir. Crit. Care Med.Home page
S. Suissa
Observational Studies of Inhaled Corticosteroids in Chronic Obstructive Pulmonary Disease: Misconstrued Immortal Time Bias
Am. J. Respir. Crit. Care Med., February 15, 2006; 173(4): 464 - 464.
[Full Text] [PDF]

Home page
 J Clin PharmacolHome page
M. Etminan, S. Gill, M. FitzGerald, and A. Samii
Challenges and Opportunities for Pharmacoepidemiology in Drug-Therapy Decision Making
J. Clin. Pharmacol., January 1, 2006; 46(1): 6 - 9.
[Abstract] [Full Text] [PDF]

Home page
 JAMAHome page
S. Suissa
Risk-Treatment Mismatch for Heart Failure
JAMA, December 28, 2005; 294(24): 3087 - 3087.
[Full Text] [PDF]

Home page
 JAMAHome page
D. S. Lee, J. V. Tu, and A. Laupacis
Risk-Treatment Mismatch for Heart Failure--Reply
JAMA, December 28, 2005; 294(24): 3087 - 3088.
[Full Text] [PDF]

Home page
 NEJMHome page
W. A. Ray
Observational studies of drugs and mortality.
N. Engl. J. Med., December 1, 2005; 353(22): 2319 - 2321.
[Full Text] [PDF]

Home page
 Am J EpidemiolHome page
Z. Zhou, E. Rahme, M. Abrahamowicz, and L. Pilote
Survival Bias Associated with Time-to-Treatment Initiation in Drug Effectiveness Evaluation: A Comparison of Methods
Am. J. Epidemiol., November 15, 2005; 162(10): 1016 - 1023.
[Abstract] [Full Text] [PDF]

Home page
 Proc Am Thorac SocHome page
J. F. Donohue
Combination Therapy for Chronic Obstructive Pulmonary Disease: Clinical Aspects
Proceedings of the ATS, November 1, 2005; 2(4): 272 - 281.
[Abstract] [Full Text] [PDF]

Home page
 Am. J. Respir. Crit. Care Med.Home page
J. M. Samet
Inhaled Corticosteroids and Chronic Obstructive Pulmonary Disease: New and Improved Evidence?
Am. J. Respir. Crit. Care Med., August 15, 2005; 172(4): 407 - 408.
[Full Text] [PDF]

Home page
 Am. J. Respir. Crit. Care Med.Home page
V. A. Kiri, N. B. Pride, J. B. Soriano, and J. Vestbo
Inhaled Corticosteroids in Chronic Obstructive Pulmonary Disease: Results from Two Observational Designs Free of Immortal Time Bias
Am. J. Respir. Crit. Care Med., August 15, 2005; 172(4): 460 - 464.
[Abstract] [Full Text] [PDF]

Home page
 NeurologyHome page
M. Etminan, M. Fitzgerald, A. Samii, G. Li, R. Higdon, W.A. Kukull, E. Peskind, D. Tsuang, and E.B. Larson
Statin therapy and risk of dementia in the elderly
Neurology, April 12, 2005; 64(7): 1319 - 1319.
[Full Text] [PDF]

Home page
 Proc Am Thorac SocHome page
R. Buhl and S. G. Farmer
Future Directions in the Pharmacologic Therapy of Chronic Obstructive Pulmonary Disease
Proceedings of the ATS, April 1, 2005; 2(1): 83 - 93.
[Abstract] [Full Text] [PDF]

Home page
 Proc Am Thorac SocHome page
J. F. Donohue and J. A. Ohar
Effects of Corticosteroids on Lung Function in Asthma and Chronic Obstructive Pulmonary Disease
Proceedings of the ATS, November 1, 2004; 1(3): 152 - 160.
[Abstract] [Full Text] [PDF]

Home page
 Eur Respir JHome page
The TORCH Study Group
The TORCH (TOwards a Revolution in COPD Health) survival study protocol
Eur. Respir. J., August 1, 2004; 24(2): 206 - 210.
[Abstract] [Full Text] [PDF]

Home page
 ChestHome page
D. W. Mapel
Treatment Implications on Morbidity and Mortality in COPD
Chest, August 1, 2004; 126(2_suppl_1): 150S - 158S.
[Abstract] [Full Text] [PDF]

Home page
 Eur Respir JHome page
S. Suissa
From the Author
Eur. Respir. J., July 1, 2004; 24(1): 191 - 192.
[Full Text] [PDF]

Home page
 Eur Respir JHome page
V.A. Kiri, J. Vestbo, N.B. Pride, and J.B. Soriano
Inhaled steroids and mortality in COPD: bias from unaccounted immortal time.
Eur. Respir. J., July 1, 2004; 24(1): 190 - 191.
[Full Text] [PDF]

Home page
 ChestHome page
M. Cazzola and R. Dahl
Inhaled Combination Therapy With Long-Acting {beta}2-Agonists and Corticosteroids in Stable COPD
Chest, July 1, 2004; 126(1): 220 - 237.
[Abstract] [Full Text] [PDF]

Home page
 Am. J. Respir. Crit. Care Med.Home page
S. Suissa, V. S. Fan, J. R. Curtis, C. L. Bryson, S. D. Fihn, and D. H. Au
Inhaled Corticosteroids in COPD and Mortality: Inaccuracies?
Am. J. Respir. Crit. Care Med., May 15, 2004; 169(10): 1165 - 1166.
[Full Text]

Home page
 Eur Respir JHome page
S. Suissa
Inhaled steroids and mortality in COPD: bias from unaccounted immortal time
Eur. Respir. J., March 1, 2004; 23(3): 391 - 395.
[Abstract] [Full Text] [PDF]

Home page
 Am. J. Respir. Crit. Care Med.Home page
M. J. Tobin
Chronic Obstructive Pulmonary Disease, Pollution, Pulmonary Vascular Disease, Transplantation, Pleural Disease, and Lung Cancer in AJRCCM 2003
Am. J. Respir. Crit. Care Med., January 15, 2004; 169(2): 301 - 313.
[Full Text] [PDF]

Home page
 Am. J. Respir. Crit. Care Med.Home page
V. S. Fan, C. L. Bryson, J. R. Curtis, S. D. Fihn, P.-O. Bridevaux, M. B. McDonell, and D. H. Au
Inhaled Corticosteroids in Chronic Obstructive Pulmonary Disease and Risk of Death and Hospitalization: Time-dependent Analysis
Am. J. Respir. Crit. Care Med., December 15, 2003; 168(12): 1488 - 1494.
[Abstract] [Full Text] [PDF]

Home page
 Eur Respir JHome page
P. Ernst and S. Suissa
N-acetylcysteine is unlikely to reduce hospitalisation for chronic obstructive pulmonary disease
Eur. Respir. J., November 1, 2003; 22(5): 865 - 865.
[Full Text] [PDF]

Home page
 Eur Respir JHome page
C.M.J.M. Gerrits, R.M.C. Herings, H.G.M. Leufkens, and J.W.J. Lammers
From the Authors
Eur. Respir. J., November 1, 2003; 22(5): 865 - 865.
[Full Text] [PDF]

Home page
 Am. J. Respir. Crit. Care Med.Home page
M. J. Tobin
The Role of a Journal in a Scientific Controversy
Am. J. Respir. Crit. Care Med., September 1, 2003; 168(5): 511 - 511.
[Full Text] [PDF]

Home page
 Eur Respir JHome page
The pharmacoepidemiology of COPD: Recent advances and methodological discussion
Eur. Respir. J., September 1, 2003; 22(43_suppl): 1S - 44s.
[Full Text] [PDF]

Home page
 Am. J. Respir. Crit. Care Med.Home page
J. M. Samet
Measuring the Effectiveness of Inhaled Corticosteroids for COPD Is Not Easy!
Am. J. Respir. Crit. Care Med., July 1, 2003; 168(1): 1 - 2.
[Full Text] [PDF]

Home page
 Am. J. Respir. Crit. Care Med.Home page
D. D. Sin, S. F. P. Man, J. V. Tu, N. B. Pride, J. Vestbo, J. B. Soriano, and V. A. Kiri
Inhaled glucocorticoids in COPD: Immortal time bias
Am. J. Respir. Crit. Care Med., July 1, 2003; 168(1): 126 - 127.
[Full Text] [PDF]


HOME HELP FEEDBACK SUBSCRIPTIONS ARCHIVE SEARCH
Proc. Am. Thorac. Soc. Am. J. Respir. Cell Mol. Biol.
Copyright © 2003 American Thoracic Society