Impact of high risk drug use on hospitalization and mortality in older people with and without Alzheimer's disease: a national population cohort study
Evidence is lacking about outcomes associated with the cumulative use of anticholinergic and sedative drugs in people with Alzheimer's disease (AD). This retrospective cohort study investigated the relationship between cumulative exposure to anticholinergic and sedative drugs and hospitalizatio...
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| creator | Gnjidic, Danijela Hilmer, Sarah N Hartikainen, Sirpa Tolppanen, Anna-Maija Taipale, Heidi Koponen, Marjaana Bell, J Simon |
| description | Evidence is lacking about outcomes associated with the cumulative use of anticholinergic and sedative drugs in people with Alzheimer's disease (AD). This retrospective cohort study investigated the relationship between cumulative exposure to anticholinergic and sedative drugs and hospitalization and mortality in people with and without AD in Finland.
Community-dwelling people aged 65 years and over, with AD on December 31(st) 2005 (n = 16,603) and individually matched (n = 16,603) comparison persons (age, sex, region of residence) were identified by the Social Insurance Institution of Finland. Drug utilization data were extracted from the Finnish National Prescription Register. Exposure to anticholinergic and sedative drugs was defined using the Drug Burden Index (DBI). Hospitalization and mortality data were extracted from national registers. Cox and zero-inflated negative binomial analyses were used to investigate the relationship between DBI and hospitalization and mortality over a one-year follow-up.
In total, 5.8% of people with AD and 3.7% without AD died during 2006. For every unit increase in DBI, the adjusted hazard ratio for mortality was 1.21 (95% confidence intervals [CI]: 1.09-1.33) among people with AD, and 1.37 (95%CI: 1.20-1.56) among people without AD. Overall, 44.3% of people with AD and 33.4% without AD were hospitalized. When using no DBI exposure as the reference group, the adjusted incidence rate ratio for length of hospital stay among high DBI group (≥1) in people with AD was 1.15 (95%CI: 1.05-1.26) and 1.63 (95%CI: 1.41-1.88) in people without AD.
There is a dose-response relationship between cumulative anticholinergic and sedative drug use and hospitalization and mortality in people with and without AD. |
| doi_str_mv | 10.1371/journal.pone.0083224 |
| format | Article |
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Community-dwelling people aged 65 years and over, with AD on December 31(st) 2005 (n = 16,603) and individually matched (n = 16,603) comparison persons (age, sex, region of residence) were identified by the Social Insurance Institution of Finland. Drug utilization data were extracted from the Finnish National Prescription Register. Exposure to anticholinergic and sedative drugs was defined using the Drug Burden Index (DBI). Hospitalization and mortality data were extracted from national registers. Cox and zero-inflated negative binomial analyses were used to investigate the relationship between DBI and hospitalization and mortality over a one-year follow-up.
In total, 5.8% of people with AD and 3.7% without AD died during 2006. For every unit increase in DBI, the adjusted hazard ratio for mortality was 1.21 (95% confidence intervals [CI]: 1.09-1.33) among people with AD, and 1.37 (95%CI: 1.20-1.56) among people without AD. Overall, 44.3% of people with AD and 33.4% without AD were hospitalized. When using no DBI exposure as the reference group, the adjusted incidence rate ratio for length of hospital stay among high DBI group (≥1) in people with AD was 1.15 (95%CI: 1.05-1.26) and 1.63 (95%CI: 1.41-1.88) in people without AD.
There is a dose-response relationship between cumulative anticholinergic and sedative drug use and hospitalization and mortality in people with and without AD.</description><identifier>ISSN: 1932-6203</identifier><identifier>EISSN: 1932-6203</identifier><identifier>DOI: 10.1371/journal.pone.0083224</identifier><identifier>PMID: 24454696</identifier><language>eng</language><publisher>United States: Public Library of Science</publisher><subject>Advertising executives ; Aged ; Aged, 80 and over ; Alzheimer Disease - mortality ; Alzheimer's disease ; Anticholinergics ; Biology ; Cholinergic Antagonists - adverse effects ; Cohort analysis ; Cohort Studies ; Confidence intervals ; Drugs ; Exposure ; Female ; Finland - epidemiology ; Health aspects ; Hospitalization - statistics & numerical data ; Humans ; Hypnotics and Sedatives - adverse effects ; Length of Stay - statistics & numerical data ; Male ; Medical research ; Medicine ; Mortality ; Neurodegenerative diseases ; Older people ; Population studies ; Population-based studies ; Prescription Drug Misuse - statistics & numerical data ; Psychotropic drugs ; Regression Analysis ; Risk Factors ; Studies</subject><ispartof>PloS one, 2014-01, Vol.9 (1), p.e83224</ispartof><rights>COPYRIGHT 2014 Public Library of Science</rights><rights>2014 Gnjidic et al. This is an open-access article distributed under the terms of the Creative Commons Attribution License: http://creativecommons.org/licenses/by/4.0/ (the “License”), which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited. Notwithstanding the ProQuest Terms and Conditions, you may use this content in accordance with the terms of the License.</rights><rights>2014 Gnjidic et al 2014 Gnjidic et al</rights><lds50>peer_reviewed</lds50><oa>free_for_read</oa><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c692t-83ff13996feebc96229a79254571b2af59557c8bfc7692ec04c2cf420042896b3</citedby><cites>FETCH-LOGICAL-c692t-83ff13996feebc96229a79254571b2af59557c8bfc7692ec04c2cf420042896b3</cites></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><linktopdf>$$Uhttps://www.ncbi.nlm.nih.gov/pmc/articles/PMC3890276/pdf/$$EPDF$$P50$$Gpubmedcentral$$Hfree_for_read</linktopdf><linktohtml>$$Uhttps://www.ncbi.nlm.nih.gov/pmc/articles/PMC3890276/$$EHTML$$P50$$Gpubmedcentral$$Hfree_for_read</linktohtml><link.rule.ids>230,314,723,776,780,860,881,2096,2915,23845,27901,27902,53766,53768,79569,79570</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/24454696$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Gnjidic, Danijela</creatorcontrib><creatorcontrib>Hilmer, Sarah N</creatorcontrib><creatorcontrib>Hartikainen, Sirpa</creatorcontrib><creatorcontrib>Tolppanen, Anna-Maija</creatorcontrib><creatorcontrib>Taipale, Heidi</creatorcontrib><creatorcontrib>Koponen, Marjaana</creatorcontrib><creatorcontrib>Bell, J Simon</creatorcontrib><title>Impact of high risk drug use on hospitalization and mortality in older people with and without Alzheimer's disease: a national population cohort study</title><title>PloS one</title><addtitle>PLoS One</addtitle><description>Evidence is lacking about outcomes associated with the cumulative use of anticholinergic and sedative drugs in people with Alzheimer's disease (AD). This retrospective cohort study investigated the relationship between cumulative exposure to anticholinergic and sedative drugs and hospitalization and mortality in people with and without AD in Finland.
Community-dwelling people aged 65 years and over, with AD on December 31(st) 2005 (n = 16,603) and individually matched (n = 16,603) comparison persons (age, sex, region of residence) were identified by the Social Insurance Institution of Finland. Drug utilization data were extracted from the Finnish National Prescription Register. Exposure to anticholinergic and sedative drugs was defined using the Drug Burden Index (DBI). Hospitalization and mortality data were extracted from national registers. Cox and zero-inflated negative binomial analyses were used to investigate the relationship between DBI and hospitalization and mortality over a one-year follow-up.
In total, 5.8% of people with AD and 3.7% without AD died during 2006. For every unit increase in DBI, the adjusted hazard ratio for mortality was 1.21 (95% confidence intervals [CI]: 1.09-1.33) among people with AD, and 1.37 (95%CI: 1.20-1.56) among people without AD. Overall, 44.3% of people with AD and 33.4% without AD were hospitalized. When using no DBI exposure as the reference group, the adjusted incidence rate ratio for length of hospital stay among high DBI group (≥1) in people with AD was 1.15 (95%CI: 1.05-1.26) and 1.63 (95%CI: 1.41-1.88) in people without AD.
There is a dose-response relationship between cumulative anticholinergic and sedative drug use and hospitalization and mortality in people with and without AD.</description><subject>Advertising executives</subject><subject>Aged</subject><subject>Aged, 80 and over</subject><subject>Alzheimer Disease - mortality</subject><subject>Alzheimer's disease</subject><subject>Anticholinergics</subject><subject>Biology</subject><subject>Cholinergic Antagonists - adverse effects</subject><subject>Cohort analysis</subject><subject>Cohort Studies</subject><subject>Confidence intervals</subject><subject>Drugs</subject><subject>Exposure</subject><subject>Female</subject><subject>Finland - epidemiology</subject><subject>Health aspects</subject><subject>Hospitalization - statistics & numerical data</subject><subject>Humans</subject><subject>Hypnotics and Sedatives - adverse effects</subject><subject>Length of Stay - statistics & numerical data</subject><subject>Male</subject><subject>Medical research</subject><subject>Medicine</subject><subject>Mortality</subject><subject>Neurodegenerative diseases</subject><subject>Older people</subject><subject>Population studies</subject><subject>Population-based studies</subject><subject>Prescription Drug Misuse - 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Academic</collection><collection>PubMed Central (Full Participant titles)</collection><collection>DOAJ Directory of Open Access Journals</collection><jtitle>PloS one</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Gnjidic, Danijela</au><au>Hilmer, Sarah N</au><au>Hartikainen, Sirpa</au><au>Tolppanen, Anna-Maija</au><au>Taipale, Heidi</au><au>Koponen, Marjaana</au><au>Bell, J Simon</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Impact of high risk drug use on hospitalization and mortality in older people with and without Alzheimer's disease: a national population cohort study</atitle><jtitle>PloS one</jtitle><addtitle>PLoS One</addtitle><date>2014-01-13</date><risdate>2014</risdate><volume>9</volume><issue>1</issue><spage>e83224</spage><pages>e83224-</pages><issn>1932-6203</issn><eissn>1932-6203</eissn><abstract>Evidence is lacking about outcomes associated with the cumulative use of anticholinergic and sedative drugs in people with Alzheimer's disease (AD). This retrospective cohort study investigated the relationship between cumulative exposure to anticholinergic and sedative drugs and hospitalization and mortality in people with and without AD in Finland.
Community-dwelling people aged 65 years and over, with AD on December 31(st) 2005 (n = 16,603) and individually matched (n = 16,603) comparison persons (age, sex, region of residence) were identified by the Social Insurance Institution of Finland. Drug utilization data were extracted from the Finnish National Prescription Register. Exposure to anticholinergic and sedative drugs was defined using the Drug Burden Index (DBI). Hospitalization and mortality data were extracted from national registers. Cox and zero-inflated negative binomial analyses were used to investigate the relationship between DBI and hospitalization and mortality over a one-year follow-up.
In total, 5.8% of people with AD and 3.7% without AD died during 2006. For every unit increase in DBI, the adjusted hazard ratio for mortality was 1.21 (95% confidence intervals [CI]: 1.09-1.33) among people with AD, and 1.37 (95%CI: 1.20-1.56) among people without AD. Overall, 44.3% of people with AD and 33.4% without AD were hospitalized. When using no DBI exposure as the reference group, the adjusted incidence rate ratio for length of hospital stay among high DBI group (≥1) in people with AD was 1.15 (95%CI: 1.05-1.26) and 1.63 (95%CI: 1.41-1.88) in people without AD.
There is a dose-response relationship between cumulative anticholinergic and sedative drug use and hospitalization and mortality in people with and without AD.</abstract><cop>United States</cop><pub>Public Library of Science</pub><pmid>24454696</pmid><doi>10.1371/journal.pone.0083224</doi><tpages>e83224</tpages><oa>free_for_read</oa></addata></record> |
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| source | Public Library of Science (PLoS) Journals Open Access; MEDLINE; DOAJ Directory of Open Access Journals; Elektronische Zeitschriftenbibliothek - Frei zugängliche E-Journals; PubMed Central; Free Full-Text Journals in Chemistry |
| subjects | Advertising executives Aged Aged, 80 and over Alzheimer Disease - mortality Alzheimer's disease Anticholinergics Biology Cholinergic Antagonists - adverse effects Cohort analysis Cohort Studies Confidence intervals Drugs Exposure Female Finland - epidemiology Health aspects Hospitalization - statistics & numerical data Humans Hypnotics and Sedatives - adverse effects Length of Stay - statistics & numerical data Male Medical research Medicine Mortality Neurodegenerative diseases Older people Population studies Population-based studies Prescription Drug Misuse - statistics & numerical data Psychotropic drugs Regression Analysis Risk Factors Studies |
| title | Impact of high risk drug use on hospitalization and mortality in older people with and without Alzheimer's disease: a national population cohort study |
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