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How Different Databases Shape Epidemiological Research Questions 2020

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How Different Databases Shape Epidemiological Research Questions 2020 The elderly, the young, and the ill: How different databases shape epidemiological research questions Inauguraldissertation zur Erlangung der Würde eines Doktors der Philosophie vorgelegt der Philosophisch-Naturwissenschaftlichen Fakultät der Universität Basel von Rahel Schneider 2020 Originaldokument gespeichert auf dem Dokumentenserver der Universität Basel edoc.unibas.ch Genehmigt von der Philosophisch-Naturwissenschaftlichen Fakultät Auf Antrag von Prof. Dr. Christoph R. Meier Prof. Dr. Kurt E. Hersberger Prof. Dr. David Schwappach Basel, den 26. Mai 2020 Prof. Dr. Martin Spiess Dekan Inference - Sämy Steiger, Swiss artist and architect « Words are, in my not-so-humble opinion, our most inexhaustible source of magic. Capable of both inflicting injury, and remedying it. » Dumbledore - Harry Potter and the Deathly Hallows Acknowledgements The work presented in this thesis was conducted between December 2016 and May 2020 at the Basel Pharmacoepidemiology Unit at the Institute for Clinical Pharmacy and Epidemiology of the University of Basel. ‘It takes a village to raise a child’ is an African proverb that says it needs an entire community of people to interact with children for them to experience and grow in a safe and healthy environment. In my case, it has indeed taken a village. Not to raise me as a child, but to raise me as an epidemiologist. The support, assistance, and trust of the people mentioned in this chapter was of immeasurable value for the successful outcome of this project, and fills my heart with gratitude. First and foremost, my special thank goes to Prof. Dr. Christoph Meier, without whom this thesis would not have been possible. Thank you, Christoph, for your unlimited trust and kindness, and for sharing your brilliant expertise of pharmacoepidemiology with me. You never said ‘no’ without listening, you were open to suggestions, and you gave me the opportunity to spend two months in Boston to start a project that brought me forward on both a personal and professional level. During the many Helsana meetings, you always had an open ear for our concerns and gave us diplomatic support. Working under your supervision was everything I could hope for. My heartfelt gratitude goes furthermore to my supervisor Dr. Daphne Reinau, who has been a wonderful mentor and a great source of support throughout the past three and a half years. You have guided me from point zero, and you opened up the world of pharmacoepidemiology to me. I want to thank you, Daphne, for everything you have taught me; be it to shorten texts to the essential (which still leaves me in awe sometimes), the concepts of basic and advanced epidemiology, the art of a thorough literature search, writing requests, or to stand up for one’s opinion. Your door has always been wide open for me and my concerns, and I cannot tell you how grateful I have been to know I can always count on you. It has been an incredible pleasure working with you and getting to know you. I would also like to express my special appreciation to Dr. Julia Spöndlin, who has, in a way I did not render possible, shaped the last project presented in this thesis with her tremendous knowledge of and her incredible passion for pharmacoepidemiology. Thanks to you, Julia, I have developed many new analytical skills in just a few months’ time that not only helped the project to become what it is now, but are also relevant for my personal future. Thank you for dealing with my (SAS) problems late at night, and for being such an inspiring person with your enthusiasm for this science. Many thanks to all the co-authors of the presented work, in particular for their critical reviews of the manuscripts and constructive contributions. A special thank goes to Prof. Dr. Matthias Schwenkglenks for his support regarding the Helsana drug report, and to Dr. Nadine Schur for the uncomplicated collaboration and teamwork. Working with the two of you has always been a pleasure. I also want to give many thanks to Prof. Dr. Susan Jick and her team from the Boston Collaborative Drug Surveillance Program for kindly hosting me for two months. I have greatly enjoyed the work and the warm atmosphere at the office in Lexington. Your expertise and your unique perspective on things have been very enriching for me. Furthermore, I would like to thank Julie Sigel (Novartis) und Nicole Waser (Boston Consulting Group), who have been two great mentors during my last year and helped me prepare for my future career. I want to express my deepest gratitude to all my dear colleagues from the Basel Pharmacoepidemiology Unit, namely Sarah Charlier (for being the best travel and sports buddy I could wish for, and for having become a great friend), Alexandra Müller (for being brilliant and inspiring in so many ways, for being my favourite desk neighbour, for giving your honest opinion on my texts and tables, and for many intriguing conversations), Dr. Theresa Burkard (for spending Thursday nights watching PPCR courses together, and your kindness and lively company), Dr. Noel Frey (for being my absolute role model in how you handled your PhD in such a relaxed, yet brilliant way), Dr. Fabienne Biétry (for laying the foundation of my PhD project), Pascal Egger (for your excellent IT-support and your ‘green thumb’ that enlivens the office), Nadja Stohler (for your upbeat and always helpful manner), Dr. Cornelia Schneider (for being such good company at lunch), Dr. Marlene Rauch (for your great laugh, your sense of humour, and your valuable comments), Dr. Claudia Becker (for your perspective on things, your pragmatism, and for your sincere interest in other people), Carole Marxer, Noah Aebi, Stephan Gut, Dr. Patrick Imfeld, Luis Velez, and Angela Filippi (for being such great colleagues and friends). Finally, I would like to thank my family and friends for all their support during the past three and a half years. Thank you Tanja, Gabi, Aline, Sändy, Sandra, Sarah, Fechu, Séverine, Jasmin, Philo, Nele, and Helene for your friendship and for all the beautiful moments I got to share with you over the past years. Helene, you made my time as a PhD student worthwhile all the way. Sharing every up and down with a friend like you (during lunch or during an episode of ‘Star Wars’) has given me the motivation to keep going. Thank you Pascal, Nicole, Ruedi, Helen, Ueli, Barbara, Rita, and Hans for your love and support. Mami and Dädi, you have always been there for me, raised me to be the person I am today, and made everything possible without ever thinking about what you have to give. I cannot find the words to tell you the love and appreciation I feel for having such a wonderful and supportive family. I am proud to be your daughter. To my grandmother Mutti, although you did not live to see this thesis finalised, your passionate interest in the progress of my work and your unreserved pride will always encourage me. Above all I would like to thank you Sämy for your unconditional love and for sharing your life with me. You have been an unbelievable pillar of strength and support over the past years. Your view of the world is unique and inspires me every day (and your cooking is, by the way, so phenomenal that it blows my mind each and every time). Thank you for everything, and for the painting for this thesis in particular. Table of contents Summary .................................................................................................................................................................. i Abbreviations ......................................................................................................................................................... iii 1 Introduction ................................................................................................................................................. 1 1.1 Pharmacoepidemiology ................................................................................................................................. 1 1.1.1 A young science growing up.......................................................................................................................... 1 1.1.2 Observational research and its role in medicine ............................................................................................ 2 1.1.3 The research question ................................................................................................................................... 7 1.1.4 Study designs ................................................................................................................................................ 9 1.1.5 Bias and confounding .................................................................................................................................. 13 1.1.6 Data sources ............................................................................................................................................... 17 1.1.7 When the database precedes the research question .................................................................................. 20 2 Aims of the thesis ..................................................................................................................................... 25 3 The elderly ................................................................................................................................................. 29 3.1 Drug prescription patterns, polypharmacy, and potentially inappropriate medication in Swiss nursing homes ........................................................................................................................................................
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