Assessing the Most Vulnerable Subgroup to Type II Diabetes Associated with Statin Usage: Evidence from Electronic Health Record Data

TL;DR

This study develops a new analytical approach to identify which patient subgroups are most vulnerable to developing type II diabetes after statin use, revealing that females with high genetic risk are at greatest risk.

Contribution

The paper introduces a novel statistical methodology and causal framework to identify vulnerable subgroups for T2D post-statin use using electronic health record data.

Findings

Females with high T2D genetic risk are most vulnerable.

The approach provides sharp confidence intervals and debiased estimates.

The methodology improves causal inference in high-dimensional observational data.

Abstract

There have been increased concerns that the use of statins, one of the most commonly prescribed drugs for treating coronary artery disease, is potentially associated with the increased risk of new-onset type II diabetes (T2D). Nevertheless, to date, there is no robust evidence supporting as to whether and what kind of populations are indeed vulnerable for developing T2D after taking statins. In this case study, leveraging the biobank and electronic health record data in the Partner Health System, we introduce a new data analysis pipeline and a novel statistical methodology that address existing limitations by (i) designing a rigorous causal framework that systematically examines the causal effects of statin usage on T2D risk in observational data, (ii) uncovering which patient subgroup is most vulnerable for developing T2D after taking statins, and (iii) assessing the replicability and statistical significance of the most vulnerable subgroup via a bootstrap calibration procedure. Our proposed approach delivers asymptotically sharp confidence intervals and debiased estimate for the treatment effect of the most vulnerable subgroup in the presence of high-dimensional covariates. With our proposed approach, we find that females with high T2D genetic risk are at the highest risk of developing T2D due to statin usage.