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Use of State Sequence Analysis in Pharmacoepidemiology: A Tutorial

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  • Jacopo Vanoli

    (London School of Hygiene and Tropical Medicine (LSHTM), London WC1E 7HT, UK
    School of Tropical Medicine and Global Health (TMGH), Nagasaki University, Nagasaki 852-8521, Japan)

  • Consuelo Rubina Nava

    (Department of Economics and Statistics “Cognetti de Martiis”, University of Turin, 10124 Turin, Italy)

  • Chiara Airoldi

    (Department of Translational Medicine, University of Eastern Piedmont, 28100 Novara, Italy)

  • Andrealuna Ucciero

    (Department of Translational Medicine, University of Eastern Piedmont, 28100 Novara, Italy)

  • Virginio Salvi

    (Department of Neuroscience, ASST Fatebenefratelli Sacco, 20157 Milan, Italy)

  • Francesco Barone-Adesi

    (Department of Neuroscience, ASST Fatebenefratelli Sacco, 20157 Milan, Italy)

Abstract

While state sequence analysis (SSA) has been long used in social sciences, its use in pharmacoepidemiology is still in its infancy. Indeed, this technique is relatively easy to use, and its intrinsic visual nature may help investigators to untangle the latent information within prescription data, facilitating the individuation of specific patterns and possible inappropriate use of medications. In this paper, we provide an educational primer of the most important learning concepts and methods of SSA, including measurement of dissimilarities between sequences, the application of clustering methods to identify sequence patterns, the use of complexity measures for sequence patterns, the graphical visualization of sequences, and the use of SSA in predictive models. As a worked example, we present an application of SSA to opioid prescription patterns in patients with non-cancer pain, using real-world data from Italy. We show how SSA allows the identification of patterns in prescriptions in these data that might not be evident using standard statistical approaches and how these patterns are associated with future discontinuation of opioid therapy.

Suggested Citation

  • Jacopo Vanoli & Consuelo Rubina Nava & Chiara Airoldi & Andrealuna Ucciero & Virginio Salvi & Francesco Barone-Adesi, 2021. "Use of State Sequence Analysis in Pharmacoepidemiology: A Tutorial," IJERPH, MDPI, vol. 18(24), pages 1-13, December.
  • Handle: RePEc:gam:jijerp:v:18:y:2021:i:24:p:13398-:d:706454
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    References listed on IDEAS

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