A Machine Learning Approach to Identify Predictors of Potentially Inappropriate Non-Steroidal Anti-Inflammatory Drugs (NSAIDs) Use in Older Adults with Osteoarthritis.

Jayeshkumar Patel,Amit Ladani,Nethra Sambamoorthi,Traci Lemasters,Usha Sambamoorthi,Nilanjana Dwibedi

doi:10.3390/ijerph18010155

Abstract

Evidence from some studies suggest that osteoarthritis (OA) patients are often prescribed non-steroidal anti-inflammatory drugs (NSAIDs) that are not in accordance with their cardiovascular (CV) or gastrointestinal (GI) risk profiles. However, no such study has been carried out in the United States. Therefore, we sought to examine the prevalence and predictors of potentially inappropriate NSAIDs use in older adults (age > 65) with OA using machine learning with real-world data from Optum De-identified Clinformatics® Data Mart. We identified a retrospective cohort of eligible individuals using data from 2015 (baseline) and 2016 (follow-up). Potentially inappropriate NSAIDs use was identified using the type (COX-2 selective vs. non-selective) and length of NSAIDs use and an individual’s CV and GI risk. Predictors of potentially inappropriate NSAIDs use were identified using eXtreme Gradient Boosting. Our study cohort comprised of 44,990 individuals (mean age 75.9 years). We found that 12.8% individuals had potentially inappropriate NSAIDs use, but the rate was disproportionately higher (44.5%) in individuals at low CV/high GI risk. Longer duration of NSAIDs use during baseline (AOR 1.02; 95% CI:1.02–1.02 for both non-selective and selective NSAIDs) was associated with a higher risk of potentially inappropriate NSAIDs use. Additionally, individuals with low CV/high GI (AOR 1.34; 95% CI:1.20–1.50) and high CV/low GI risk (AOR 1.61; 95% CI:1.34–1.93) were also more likely to have potentially inappropriate NSAIDs use. Heightened surveillance of older adults with OA requiring NSAIDs is warranted.

Highlights

Introduction in published maps and institutionalEach year, nearly 29 million people in the United States use non-steroidal antiinflammatory drugs (NSAIDs) for the relief of various types of pain [1]
We examine the association of CV and GI risk profiles at baseline to potentially inappropriate NSAIDs use during the follow-up period
Compared to the older adults with low CV/low GI risk, those with low CV/high GI (UOR: 2.61; 95% confidence intervals (CI):2.45–2.77) and high CV/high GI (UOR: 1.72; 95% CI:1.55–1.91) were more likely to have potentially inappropriate NSAIDs use and those with high CV/low GI (UOR: 0.80; 95% CI:0.71–0.90) were less likely to have potentially inappropriate NSAIDs use

Summary

Introduction

Nearly 29 million people in the United States use non-steroidal antiinflammatory drugs (NSAIDs) for the relief of various types of pain [1]. These drugs are moderately effective in treating pain and are recommended by numerous clinical guidelines for its treatment [2,3]. Their use is associated with several cardiovascular (CV) and gastrointestinal (GI) adverse events (AE), some of which can be life-threatening [4].

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