Table 1:
Baseline characteristics of patients with diabetic retinopathy prescribed ARBs and ACE inhibitors, before and after matching by propensity scores
| Characteristic | Before matching; no. (%) of patients* | After matching; no. (%) of patients* | ||||
|---|---|---|---|---|---|---|
|
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| ARB cohort n = 15 173 | ACE inhibitor cohort n = 11 246 | Standardized difference,† % | ARB cohort n = 9769 | ACE inhibitor cohort n = 9769 | Standardized difference,† % | |
| Age, yr, mean ± SD | 59.7 ± 11.1 | 58.6 ± 11.2 | 0.091 | 58.9 ± 11.1 | 59.0 ± 11.2 | −0.005 |
|
| ||||||
| Sex, male | 7 276 (48.0) | 6 044 (53.7) | −0.116 | 5 112 (52.3) | 5 075 (52.0) | 0.008 |
|
| ||||||
| Year of index date | ||||||
|
| ||||||
| 2000 | 117 (0.8) | 288 (2.6) | −0.140 | 117 (1.2) | 111 (1.1) | 0.006 |
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| 2001 | 210 (1.4) | 524 (4.7) | −0.192 | 210 (2.1) | 197 (2.0) | 0.009 |
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| 2002 | 500 (3.3) | 803 (7.1) | −0.174 | 488 (5.0) | 490 (5.0) | −0.001 |
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| 2003 | 779 (5.1) | 955 (8.5) | −0.134 | 731 (7.5) | 735 (7.5) | −0.002 |
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| 2004 | 1 160 (7.6) | 1 159 (10.3) | −0.093 | 996 (10.2) | 973 (10.0) | 0.008 |
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| 2005 | 1 365 (9.0) | 1 258 (11.2) | −0.073 | 1 122 (11.5) | 1 132 (11.6) | −0.003 |
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| 2006 | 1 478 (9.7) | 1 235 (11.0) | −0.041 | 1 158 (11.9) | 1 156 (11.8) | 0.001 |
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| 2007 | 1 704 (11.2) | 1 158 (10.3) | 0.030 | 1 131 (11.6) | 1 126 (11.5) | 0.002 |
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| 2008 | 2 074 (13.7) | 1 260 (11.2) | 0.075 | 1 272 (13.0) | 1 245 (12.7) | 0.008 |
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| 2009 | 2 474 (16.3) | 1 264 (11.2) | 0.147 | 1 238 (12.7) | 1 262 (12.9) | −0.007 |
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| 2010 | 3 312 (21.8) | 1 342 (11.9) | 0.266 | 1 306 (13.4) | 1 342 (13.7) | −0.011 |
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| Monthly income, NT$ | ||||||
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| Dependent | 4 785 (31.5) | 3 386 (30.1) | 0.031 | 2 965 (30.4) | 2 980 (30.5) | −0.003 |
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| < 19 100 | 2 897 (19.1) | 2 255 (20.1) | −0.024 | 1 946 (19.9) | 1 916 (19.6) | 0.008 |
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| 19 100–41 999 | 6 360 (41.9) | 4 855 (43.2) | −0.025 | 4 173 (42.7) | 4 201 (43.0) | −0.006 |
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| ≥ 42 000 | 1 131 (7.5) | 750 (6.7) | 0.031 | 685 (7.0) | 672 (6.9) | 0.005 |
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| Urbanization‡ | ||||||
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| Level 1 (most urban) | 5 833 (38.4) | 4 547 (40.4) | −0.041 | 3 909 (40.0) | 3 906 (40.0) | 0.001 |
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| Level 2 | 8 530 (56.2) | 6 156 (54.7) | 0.030 | 5 367 (54.9) | 5 379 (55.1) | −0.002 |
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| Level 3 | 699 (4.6) | 458 (4.1) | 0.026 | 419 (4.3) | 408 (4.2) | 0.006 |
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| Level 4 (least urban) | 111 (0.7) | 85 (0.8) | −0.003 | 74 (0.8) | 76 (0.8) | −0.002 |
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| Outpatient visits in the past year | ||||||
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| < 6 | 82 (0.5) | 63 (0.6) | −0.003 | 53 (0.5) | 52 (0.5) | 0.001 |
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| 6–10 | 819 (5.4) | 642 (5.7) | −0.014 | 544 (5.6) | 569 (5.8) | −0.011 |
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| 11–15 | 1 944 (12.8) | 1 404 (12.5) | 0.010 | 1 262 (12.9) | 1 259 (12.9) | 0.001 |
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| > 15 | 12 328 (81.2) | 9 137 (81.2) | 0.000 | 7 910 (81.0) | 7 889 (80.8) | 0.005 |
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| Charlson Comorbidity Index score§ | ||||||
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| 2 | 4 105 (27.1) | 3 666 (32.6) | −0.121 | 2 999 (30.7) | 3 030 (31.0) | −0.007 |
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| 3 | 2 977 (19.6) | 2 445 (21.7) | −0.052 | 2 066 (21.1) | 2 049 (21.0) | 0.004 |
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| 4 | 2 663 (17.6) | 1 920 (17.1) | 0.013 | 1 711 (17.5) | 1 714 (17.5) | −0.001 |
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| ≥ 5 | 5 428 (35.8) | 3 215 (28.6) | 0.154 | 2 993 (30.6) | 2 976 (30.5) | 0.004 |
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| Adapted DCSI score,¶ mean ± SD | 3.0 ± 1.9 | 2.8 ± 1.8 | 0.135 | 2.8 ± 1.8 | 2.8 ± 1.8 | 0.001 |
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| Antidiabetic drug use | ||||||
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| Acarbose | 1 576 (10.4) | 855 (7.6) | 0.097 | 855 (8.8) | 821 (8.4) | 0.012 |
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| Sulfonylurea | 7 736 (51.0) | 5 819 (51.7) | −0.015 | 4 993 (51.1) | 5 058 (51.8) | −0.013 |
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| Insulin | 907 (6.0) | 595 (5.3) | 0.030 | 528 (5.4) | 527 (5.4) | 0.000 |
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| Metformin | 9 395 (61.9) | 6 958 (61.9) | 0.001 | 6 072 (62.2) | 6 071 (62.1) | 0.000 |
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| Thiazolidinedione | 2 304 (15.2) | 1 038 (9.2) | 0.183 | 999 (10.2) | 1 022 (10.5) | −0.008 |
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| Glinide | 1 092 (7.2) | 567 (5.0) | 0.090 | 575 (5.9) | 547 (5.6) | 0.012 |
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| DPP-4 inhibitor | 529 (3.5) | 103 (0.9) | 0.176 | 127 (1.3) | 103 (1.1) | 0.023 |
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| Antihypertensive drug use | ||||||
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| α-Blocker | 565 (3.7) | 372 (3.3) | 0.023 | 335 (3.4) | 326 (3.3) | 0.005 |
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| β-Blocker | 2 693 (17.7) | 1 874 (16.7) | 0.029 | 1 683 (17.2) | 1 625 (16.6) | 0.016 |
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| Calcium-channel blocker | 6 321 (41.7) | 3 833 (34.1) | 0.157 | 3 576 (36.6) | 3 488 (35.7) | 0.019 |
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| Diuretic | 2 715 (17.9) | 2 032 (18.1) | −0.005 | 1 762 (18.0) | 1 761 (18.0) | 0.000 |
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| Other | 178 (1.2) | 213 (1.9) | −0.059 | 140 (1.4) | 150 (1.5) | −0.008 |
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| Other medication use | ||||||
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| ASA | 3 101 (20.4) | 2 031 (18.1) | 0.060 | 1 850 (18.9) | 1 814 (18.6) | 0.009 |
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| Clopidogrel | 164 (1.1) | 52 (0.5) | 0.071 | 51 (0.5) | 52 (0.5) | −0.001 |
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| Ticlopidine | 71 (0.5) | 30 (0.3) | 0.033 | 30 (0.3) | 29 (0.3) | 0.002 |
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| Warfarin | 78 (0.5) | 40 (0.4) | 0.024 | 38 (0.4) | 37 (0.4) | 0.002 |
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| Dipyridamole | 760 (5.0) | 598 (5.3) | −0.014 | 477 (4.9) | 488 (5.0) | −0.005 |
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| Nitrate | 739 (4.9) | 479 (4.3) | 0.029 | 423 (4.3) | 408 (4.2) | 0.008 |
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| Statin | 4 161 (27.4) | 2 349 (20.9) | 0.153 | 2 226 (22.8) | 2 217 (22.7) | 0.002 |
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| Proton pump inhibitor | 315 (2.1) | 173 (1.5) | 0.040 | 158 (1.6) | 159 (1.6) | −0.001 |
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| NSAID | 2 251 (14.8) | 1 928 (17.1) | −0.063 | 1 580 (16.2) | 1 581 (16.2) | −0.000 |
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| Comorbidities | ||||||
|
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| Hypertension | 14 299 (94.2) | 10 271 (91.3) | 0.113 | 9 037 (92.5) | 9 030 (92.4) | 0.003 |
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| Coronary artery disease | 5 559 (36.6) | 3 532 (31.4) | 0.111 | 3 223 (33.0) | 3 204 (32.8) | 0.004 |
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| Heart failure | 1 726 (11.4) | 991 (8.8) | 0.085 | 904 (9.3) | 903 (9.2) | 0.000 |
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| Peripheral vascular disease | 809 (5.3) | 587 (5.2) | 0.005 | 520 (5.3) | 512 (5.2) | 0.004 |
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| Peptic ulcer disease | 6 211 (40.9) | 4 071 (36.2) | 0.097 | 3 709 (38.0) | 3 717 (38.0) | −0.002 |
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| Liver disease | 5 266 (34.7) | 3 625 (32.2) | 0.052 | 3 275 (33.5) | 3 262 (33.4) | 0.003 |
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| Chronic kidney disease | 2 957 (19.5) | 1 756 (15.6) | 0.102 | 1 589 (16.3) | 1 600 (16.4) | −0.003 |
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| Atrial fibrillation | 354 (2.3) | 176 (1.6) | 0.056 | 176 (1.8) | 170 (1.7) | 0.005 |
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| Dyslipidemia | 10 432 (68.8) | 7 073 (62.9) | 0.124 | 6 343 (64.9) | 6 388 (65.4) | −0.010 |
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| Valvular heart disease | 1 155 (7.6) | 635 (5.6) | 0.079 | 601 (6.2) | 598 (6.1) | 0.001 |
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| Cancer | 1 400 (9.2) | 832 (7.4) | 0.066 | 788 (8.1) | 773 (7.9) | 0.006 |
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| Autoimmune disease | 593 (3.9) | 346 (3.1) | 0.045 | 306 (3.1) | 328 (3.4) | −0.013 |
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| Physical limitation | 727 (4.8) | 496 (4.4) | 0.018 | 443 (4.5) | 451 (4.6) | −0.004 |
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| Propensity score, mean ± SD | 0.61 ± 0.13 | 0.53 ± 0.14 | 0.590 | 0.56 ± 0.12 | 0.56 ± 0.12 | 0.002 |
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| ACE inhibitor or ARB use before diabetic retinopathy diagnosis | ||||||
|
| ||||||
| ACE inhibitor use | 549 (3.6) | 6 168 (54.8) | 319 (3.3) | 4 781 (48.9) | ||
|
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| ARB use | 9 927 (65.4) | 200 (1.8) | 5 023 (51.4) | 163 (1.7) | ||
Note: ACE = angiotensin-converting enzyme, ARB = angiotensin II receptor blocker, ASA = acetylsalicylic acid, DCSI = Diabetes Complications Severity Index, DPP = dipeptidyl peptidase, NSAID = nonsteroidal anti-inflammatory drug, NT$ = new Taiwan dollars.
*
Unless stated otherwise.
†
Imbalance defined as absolute value greater than 0.024 for unmatched cohorts and greater than 0.028 for matched cohorts.
‡
Urbanization levels in Taiwan are divided into 4 strata according to Taiwan National Health Research Institute publications. Level 1 designates the most urbanized areas, and level 4 designates the least urbanized areas.
§
Charlson Comorbidity Index score is used to determine overall systemic health. With each increased level of the score, there are stepwise increases in the cumulative mortality.
¶
Adapted Diabetes Complications Severity Index is a 13-point scale derived from 7 complication categories (retinopathy, nephropathy, neuropathy, cerebrovascular, cardiovascular, peripheral vascular disease and metabolic). Each complication produces a numeric score ranging from 0 to 2 (0 = no abnormality, 1 = some abnormality, 2 = severe abnormality).