Evidence mapPaperPMID 41287049Full record

ArticlePharmacoepidemiology and drug safety2025

Applying High-Dimensional Propensity Scores in a Study of Inhaled Corticosteroids and COVID-19 Outcomes.

Marleen Bokern, John Tazare, Christopher T Rentsch, Jennifer K Quint, Ian J Douglas, Anna Schultze

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Article in Pharmacoepidemiology and drug safety, 2025. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 1 paper.

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3 · Its place in the literature

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1 citing paper in PubMed.

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5 · Who and what money

Authors and funding

6 authors.

Marleen BokernLondon School of Hygiene and, Tropical Medicine, London, UK.ORCID 0000-0002-1481-3331
John TazareLondon School of Hygiene and, Tropical Medicine, London, UK.ORCID 0000-0002-7194-2615
Christopher T RentschLondon School of Hygiene and, Tropical Medicine, London, UK.ORCID 0000-0002-1408-7907
Jennifer K QuintFaculty of Medicine, National Heart & Lung Institute, Imperial College London, London, UK.
Ian J DouglasLondon School of Hygiene and, Tropical Medicine, London, UK.
Anna SchultzeLondon School of Hygiene and, Tropical Medicine, London, UK.

Funding

Wellcome Trust 224485/Z/21/Z
6 · The paper itself

Abstract

backgroundIn pharmacoepidemiologic studies of COVID-19, there were concerns about bias from residual confounding. We investigated the effects of inhaled corticosteroids (ICS) on COVID-19 outcomes, applying high-dimensional propensity scores (HDPS) to adjust for unmeasured confounding.

methodsWe selected patients with chronic obstructive pulmonary disease on 01 March 2020 from Clinical Practice Research Datalink (CPRD) Aurum, comparing ICS/LABA/(+/-LAMA) and LABA/LAMA users. ICS effects on the outcomes COVID-19 hospitalisation and death were assessed through IPT-weighted and unweighted Cox regression. HDPS were estimated from primary care observations, prescriptions and hospitalisations. SNOMED-CT codes and dictionary of medicines and devices codes from CPRD Aurum were mapped to International Classification of Disease 10th revision codes and British National Formulary paragraphs, respectively. We estimated propensity scores (PS) combining prespecified and HDPS covariates, selecting the top 100, 250, 500, 750 and 1000 covariates ranked by confounding potential.

resultsWhen excluding triple therapy users, conventional PS-weighted estimates showed weak evidence of increased COVID-19 hospitalisation risk among ICS users (HR 1.19 [95% CI: 0.92-1.54]). Results varied slightly based on the number of covariates included in HDPS (HR using 100 HDPS covariates excluding triple therapy 1.01 [95% CI: 0.76-1.33], HR using 250 HDPS covariates excluding triple therapy 1.24 [95% CI: 0.83-1.87]). Conventional PS-weighted models showed weak evidence of a harmful association of ICS with COVID-19 death when excluding triple therapy users (HR 1.24 [95% CI: 0.87-1.75]). HDPS-weighting moved estimates toward the null (HR using 250 HDPS covariates excluding triple therapy 1.08 [95% CI: 0.73-1.59]).

conclusionsHDPS may have better controlled confounding for COVID-19 deaths in this case. HDPS results can be sensitive to the number of covariates included, highlighting the importance of sensitivity analyses.

Indexed as

Adrenal Cortex HormonesCOVID-19COVID-19 Drug TreatmentPulmonary Disease, Chronic ObstructiveAdministration, InhalationAgedConfounding Factors, EpidemiologicFemaleHospitalizationHumansMaleMiddle AgedPharmacoepidemiologyPropensity ScoreAdrenal Cortex HormonesCOVID‐19high‐dimensional propensity scorespharmacoepidemiologyresidual confoundingrespiratory epidemiology

Identifiers

PMID41287049
PMCPMC12644305

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Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the Socratic graph.