{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,26]],"date-time":"2026-08-26T20:34:26Z","timestamp":1787776466029,"version":"build-2784847793"},"reference-count":27,"publisher":"Public Library of Science (PLoS)","issue":"8","license":[{"start":{"date-parts":[[2022,8,15]],"date-time":"2022-08-15T00:00:00Z","timestamp":1660521600000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"DOI":"10.13039\/100000133","name":"agency for healthcare research and quality","doi-asserted-by":"publisher","award":["HHSA290-2005-0016-I TO3"],"award-info":[{"award-number":["HHSA290-2005-0016-I TO3"]}],"id":[{"id":"10.13039\/100000133","id-type":"DOI","asserted-by":"publisher"}]},{"name":"centers for medicare and medicaid services and u.s. dhhs","award":["500-2010-00001I TO6, 500-2010-00001I TO2"],"award-info":[{"award-number":["500-2010-00001I TO6, 500-2010-00001I TO2"]}]}],"content-domain":{"domain":["www.plosone.org"],"crossmark-restriction":false},"short-container-title":["PLoS ONE"],"abstract":"<jats:sec id=\"sec001\">\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>Confounding by indication is a serious threat to comparative studies using real world data. We assessed the utility of automated data-adaptive analytic approach for confounding adjustment when both claims and clinical registry data are available.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec id=\"sec002\">\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>We used a comparative study example of carotid artery stenting (CAS) vs. carotid endarterectomy (CEA) in 2005\u20132008 when CAS was only indicated for patients with high surgical risk. We included Medicare beneficiaries linked to the Society for Vascular Surgery\u2019s Vascular Registry &gt;65 years old undergoing CAS\/CEA. We compared hazard ratios (HRs) for death while adjusting for confounding by combining various 1) Propensity score (PS) modeling strategies (investigator-specified [IS-PS] vs. automated data-adaptive [ada-PS]); 2) data sources (claims-only, registry-only and claims-plus-registry); and 3) PS adjustment approaches (matching vs. quintiles-adjustment with\/without trimming). An HR of 1.0 was used as a benchmark effect estimate based on CREST trial.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec id=\"sec003\">\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>The cohort included 1,999 CAS and 3,255 CEA patients (mean age 76). CAS patients were more likely symptomatic and at high surgical risk, and experienced higher mortality (crude HR = 1.82 for CAS vs. CEA). HRs from PS-quintile adjustment without trimming were 1.48 and 1.52 for claims-only IS-PS and ada-PS, 1.51 and 1.42 for registry-only IS-PS and ada-PS, and 1.34 and 1.23 for claims-plus-registry IS-PS and ada-PS, respectively. Estimates from other PS adjustment approaches showed similar patterns.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec id=\"sec004\">\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>In a comparative effectiveness study of CAS vs. CEA with strong confounding by indication, ada-PS performed better than IS-PS in general, but both claims and registry data were needed to adequately control for bias.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1371\/journal.pone.0272975","type":"journal-article","created":{"date-parts":[[2022,8,15]],"date-time":"2022-08-15T13:29:21Z","timestamp":1660570161000},"page":"e0272975","update-policy":"https:\/\/doi.org\/10.1371\/journal.pone.corrections_policy","source":"Crossref","is-referenced-by-count":2,"title":["Utility of automated data-adaptive propensity score method for confounding by indication in comparative effectiveness study in real world Medicare and registry data"],"prefix":"10.1371","volume":"17","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-9759-6191","authenticated-orcid":true,"given":"Hiraku","family":"Kumamaru","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jessica J.","family":"Jalbert","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Louis L.","family":"Nguyen","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-3443-3552","authenticated-orcid":true,"given":"Lauren A.","family":"Williams","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Hiroaki","family":"Miyata","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-1583-752X","authenticated-orcid":true,"given":"Soko","family":"Setoguchi","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"340","published-online":{"date-parts":[[2022,8,15]]},"reference":[{"key":"pone.0272975.ref001","doi-asserted-by":"crossref","first-page":"2628","DOI":"10.1016\/j.jacc.2018.03.009","article-title":"Cardiovascular Events Associated With SGLT-2 Inhibitors Versus Other Glucose-Lowering Drugs: The CVD-REAL 2 Study","volume":"71","author":"M Kosiborod","year":"2018","journal-title":"J Am Coll Cardiol"},{"key":"pone.0272975.ref002","doi-asserted-by":"crossref","first-page":"2142","DOI":"10.1016\/j.jacc.2013.02.043","article-title":"Impact of baseline heart failure burden on post-implantable cardioverter-defibrillator mortality among medicare beneficiaries","volume":"61","author":"CY Chen","year":"2013","journal-title":"J Am Coll Cardiol"},{"key":"pone.0272975.ref003","doi-asserted-by":"crossref","first-page":"1","DOI":"10.1161\/CIRCOUTCOMES.115.002336","article-title":"Comparative effectiveness of carotid artery stenting versus carotid endarterectomy among medicare beneficiaries","volume":"9","author":"JJ Jalbert","year":"2016","journal-title":"Circ Cardiovasc Qual Outcomes"},{"key":"pone.0272975.ref004","article-title":"Cardiovascular outcomes associated with canagliflozin versus other non-gliflozin antidiabetic drugs: Population based cohort study","volume":"360","author":"E Patorno","year":"2018","journal-title":"BMJ"},{"key":"pone.0272975.ref005","doi-asserted-by":"crossref","first-page":"2469","DOI":"10.1161\/STROKEAHA.119.025824","article-title":"Effectiveness and Safety of Rivaroxaban 15 or 20 mg Versus Vitamin K Antagonists in Nonvalvular Atrial Fibrillation: A Population-Based New Users High-Dimensional Propensity Score Matched Cohorts Study","volume":"50","author":"P Blin","year":"2019","journal-title":"Stroke"},{"key":"pone.0272975.ref006","doi-asserted-by":"crossref","first-page":"157","DOI":"10.1161\/CIRCULATIONAHA.114.012061","article-title":"Cardiovascular, Bleeding, and Mortality Risks in Elderly Medicare Patients Treated With Dabigatran or Warfarin for Nonvalvular Atrial Fibrillation","volume":"131","author":"DJ Graham","year":"2014","journal-title":"Circulation"},{"key":"pone.0272975.ref007","unstructured":"Centers for Medicare & Medicaid Services Dicision Memo for Carotid Artery Stenting (CAG-00085R). 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