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Editor's Correspondence
September 28, 2009

The Healthy Adherer Effect—Reply

Arch Intern Med. 2009;169(17):1633-1638. doi:10.1001/archinternmed.2009.325

In reply

We thank the authors of the letter for their comments. Andersohn and Willich noted some methodological concerns with our analysis, particularly the potential “healthy adherer” bias. A recent study1 aimed to examine whether adherence with statin use is associated with a decreased risk of unintentional injuries that were sought to be unrelated to statins (eg, motor vehicle crashes and workplace injuries, burns, and falls). As expected, they found a modest (10%-15%) overall reduction in the rate of unintentional injuries among adherent patients compared with nonadherent ones. Thus, the “healthy adherer” bias could explain some of our results, but clearly not a 45% reduction in all-cause mortality.

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