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Abstract
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This dissertation can separate two steps in integrant framework. The first step evidences the methodology of sequential method of age-period-cohort (APC) model. The aims try to establish an appropriate methodological procedure to support the application of sequential method. In consequence, this dissertation suggests using mean absolute of percentage error (MAPE) to choice the more accurate one of the two sub models (AP-C and AC-P) and using Akaike information criterion (AIC) to find the parameters in splines function of the best model-fitting.
Second, in order to test the practicability of first step, I apply this methodological procedure in two epidemiological topics, colorectal cancer and cervical cancer. However, the two epidemiological topics have submitted to international journal. Up to now, the manuscript of colorectal cancer has published in international journal of colorectal disease, and another manuscript has under review in BMC public health.
The sequential method is just one of the many methods of APC analysis. Furthermore, the new methods still continuously develop. It means that the technology of APC model still cannot practice in mostly epidemiological topics in existence. Therefore, that will be necessary to reorganize and integrate the presently methods of APC model in subsequent development, or address another new method in the future.
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Abstract
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Purpose：The purpose of this study was to explore the association between utilization of Anti-hypertensive drugs or Anti-hyperlipidemic drugs and chronic kidney disease (CKD) in elderly.
Method：A retrospective cohort study method was used in this study,the database is composed of 320,000 subjects whom were randomly selected from National Health Insurance (NHI) Research Database,the study participations were 60 years old and more in Taiwan from 2000 to 2009.To compare the comorbidity and drug use between CKD and non-CKD,we conducted the logistic models to predict the odds ratio of Anti-hypertensive drugs or Anti-hyperlipidemic drugs cause CKD.
Results：After adjusted for the other comorbidity covariables,multivariate logistic model showed the odds ratio for hypertension 【OR=2.11 for male and OR=2.36 for female】and diabetes mellitus【OR=1.22 for male and OR=1.41 for female】and gout【OR=1.41 for male and OR=1.28 for female】and Gastric ulcer【OR=1.24 for male and OR=1.32 for female】and abnormal acid-base balance【OR=1.32 for male and OR=2.29 for female,but there was only significant for male Atrial fibrillation 【OR=1.47】not female. After adjusted other drugs covariables,multivariate logistic model showed CKD was associated with hypotensive drugs utilization of Valsartan【OR=0.44 for male and OR=0.29 for female】,Losartan potassium【OR=1.40 for male and OR=0.55 for female】,Irbesartan【OR=1.29 for male and OR=1.26 for female】,Terazosin【OR=0.63 for male and OR=3.81 for female】,Doxazosin (METHANESULFONATE) 【OR=0.75 for male and OR=2.35 for female】, Doxazosin (MESYLATE)【OR=0.86 for male and OR=6.79 for female】,and Enalapril【OR=3.54 for male and OR=2.49 for female】;and Anti- hyperlipidemic drugs utilization of Atorvastatin【OR=0.40 for male and OR=0.36 for female】,Simvastatin【OR=0.79 for male and OR=0.84 for female】,Lovastatin【OR=1.53 for male and OR=0.75 for female】,Fluvastatin sodium【OR=4.19 for male and OR=2.29 for female】,Pravastatin sodium 【OR=2.59 for male and OR=2.42 for female】,Gemfibrozil【OR=2.59 for male and OR=2.42 for female】,and Fenofibrate【OR=2.20 for male and OR=2.07 for female】.
Conclusion：Our findings suggested that Valsartan and Atorvastatin could be a better choice of the medical treatment for the elderly and to protection efficiency of kidney function.
The results of this study also found that Enalapril and Hyderalazine hcl are higher risk for their kidney function in the Anti-hypertensive drugs. Additionally，Fluvastatin、Pravastatin、Fenofibrate are higher risk for their kidney function in the Anti-hyperlipidemic drugs.
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