Risk of death associated with the use of conventional versus atypical antipsychotic drugs among elderly patients
Public health advisories have warned that the use of atypical antipsychotic medications increases the risk of death among elderly patients. We assessed the short-term mortality in a population-based cohort of elderly people in British Columbia who were prescribed conventional and atypical antipsycho...
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Veröffentlicht in: | Canadian Medical Association journal 2007-02, Vol.176 (5), p.627-632 |
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description | Public health advisories have warned that the use of atypical antipsychotic medications increases the risk of death among elderly patients. We assessed the short-term mortality in a population-based cohort of elderly people in British Columbia who were prescribed conventional and atypical antipsychotic medications.
We used linked health care utilization data of all BC residents to identify a cohort of people aged 65 years and older who began taking antipsychotic medications between January 1996 and December 2004 and were free of cancer. We compared the 180-day all-cause mortality between residents taking conventional antipsychotic medications and those taking atypical antipsychotic medications.
Of 37 241 elderly people in the study cohort, 12 882 were prescribed a conventional antipsychotic medication and 24 359 an atypical formulation. Within the first 180 days of use, 1822 patients (14.1%) in the conventional drug group died, compared with 2337 (9.6%) in the atypical drug group (mortality ratio 1.47, 95% confidence interval [CI] 1.39-1.56). Multivariable adjustment resulted in a 180-day mortality ratio of 1.32 (1.23-1.42). In comparison with risperidone, haloperidol was associated with the greatest increase in mortality (mortality ratio 2.14, 95% CI 1.86-2.45) and loxapine the lowest (mortality ratio 1.29, 95% CI 1.19-1.40). The greatest increase in mortality occurred among people taking higher (above median) doses of conventional antipsychotic medications (mortality ratio 1.67, 95% CI 1.50-1.86) and during the first 40 days after the start of drug therapy (mortality ratio 1.60, 95% CI 1.42-1.80). Results were confirmed in propensity score analyses and instrumental variable estimation, minimizing residual confounding.
Among elderly patients, the risk of death associated with conventional antipsychotic medications is comparable to and possibly greater than the risk of death associated with atypical antipsychotic medications. Until further evidence is available, physicians should consider all antipsychotic medications to be equally risky in elderly patients. |
doi_str_mv | 10.1503/cmaj.061250 |
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We used linked health care utilization data of all BC residents to identify a cohort of people aged 65 years and older who began taking antipsychotic medications between January 1996 and December 2004 and were free of cancer. We compared the 180-day all-cause mortality between residents taking conventional antipsychotic medications and those taking atypical antipsychotic medications.
Of 37 241 elderly people in the study cohort, 12 882 were prescribed a conventional antipsychotic medication and 24 359 an atypical formulation. Within the first 180 days of use, 1822 patients (14.1%) in the conventional drug group died, compared with 2337 (9.6%) in the atypical drug group (mortality ratio 1.47, 95% confidence interval [CI] 1.39-1.56). Multivariable adjustment resulted in a 180-day mortality ratio of 1.32 (1.23-1.42). In comparison with risperidone, haloperidol was associated with the greatest increase in mortality (mortality ratio 2.14, 95% CI 1.86-2.45) and loxapine the lowest (mortality ratio 1.29, 95% CI 1.19-1.40). The greatest increase in mortality occurred among people taking higher (above median) doses of conventional antipsychotic medications (mortality ratio 1.67, 95% CI 1.50-1.86) and during the first 40 days after the start of drug therapy (mortality ratio 1.60, 95% CI 1.42-1.80). Results were confirmed in propensity score analyses and instrumental variable estimation, minimizing residual confounding.
Among elderly patients, the risk of death associated with conventional antipsychotic medications is comparable to and possibly greater than the risk of death associated with atypical antipsychotic medications. Until further evidence is available, physicians should consider all antipsychotic medications to be equally risky in elderly patients.</description><identifier>ISSN: 0008-4409</identifier><identifier>ISSN: 0820-3946</identifier><identifier>EISSN: 1488-2329</identifier><identifier>DOI: 10.1503/cmaj.061250</identifier><identifier>PMID: 17325327</identifier><identifier>CODEN: CMAJAX</identifier><language>eng</language><publisher>Canada: Can Med Assoc</publisher><subject>Aged ; Aged patients ; Antipsychotic Agents - therapeutic use ; Antipsychotic drugs ; British Columbia - epidemiology ; Canada ; Causes of ; Complications and side effects ; Death & dying ; Female ; Health aspects ; Humans ; Male ; Mortality ; Multivariate Analysis ; Older people ; Patients ; Proportional Hazards Models ; Public health ; Risk Factors ; Tranquilizers</subject><ispartof>Canadian Medical Association journal, 2007-02, Vol.176 (5), p.627-632</ispartof><rights>COPYRIGHT 2007 CMA Impact Inc.</rights><rights>Copyright Canadian Medical Association Feb 27, 2007</rights><rights>2007 Canadian Medical Association or its licensors</rights><lds50>peer_reviewed</lds50><oa>free_for_read</oa><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c671t-299114386aa5329b654f6bea6ab7869c6daa51544643422a8e170f6cf01b939d3</citedby></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><linktopdf>$$Uhttps://www.ncbi.nlm.nih.gov/pmc/articles/PMC1800321/pdf/$$EPDF$$P50$$Gpubmedcentral$$H</linktopdf><linktohtml>$$Uhttps://www.ncbi.nlm.nih.gov/pmc/articles/PMC1800321/$$EHTML$$P50$$Gpubmedcentral$$H</linktohtml><link.rule.ids>230,314,727,780,784,864,885,27924,27925,53791,53793</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/17325327$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Schneeweiss, Sebastian</creatorcontrib><creatorcontrib>Setoguchi, Soko</creatorcontrib><creatorcontrib>Brookhart, Alan</creatorcontrib><creatorcontrib>Dormuth, Colin</creatorcontrib><creatorcontrib>Wang, Philip S</creatorcontrib><title>Risk of death associated with the use of conventional versus atypical antipsychotic drugs among elderly patients</title><title>Canadian Medical Association journal</title><addtitle>CMAJ</addtitle><description>Public health advisories have warned that the use of atypical antipsychotic medications increases the risk of death among elderly patients. We assessed the short-term mortality in a population-based cohort of elderly people in British Columbia who were prescribed conventional and atypical antipsychotic medications.
We used linked health care utilization data of all BC residents to identify a cohort of people aged 65 years and older who began taking antipsychotic medications between January 1996 and December 2004 and were free of cancer. We compared the 180-day all-cause mortality between residents taking conventional antipsychotic medications and those taking atypical antipsychotic medications.
Of 37 241 elderly people in the study cohort, 12 882 were prescribed a conventional antipsychotic medication and 24 359 an atypical formulation. Within the first 180 days of use, 1822 patients (14.1%) in the conventional drug group died, compared with 2337 (9.6%) in the atypical drug group (mortality ratio 1.47, 95% confidence interval [CI] 1.39-1.56). Multivariable adjustment resulted in a 180-day mortality ratio of 1.32 (1.23-1.42). In comparison with risperidone, haloperidol was associated with the greatest increase in mortality (mortality ratio 2.14, 95% CI 1.86-2.45) and loxapine the lowest (mortality ratio 1.29, 95% CI 1.19-1.40). The greatest increase in mortality occurred among people taking higher (above median) doses of conventional antipsychotic medications (mortality ratio 1.67, 95% CI 1.50-1.86) and during the first 40 days after the start of drug therapy (mortality ratio 1.60, 95% CI 1.42-1.80). Results were confirmed in propensity score analyses and instrumental variable estimation, minimizing residual confounding.
Among elderly patients, the risk of death associated with conventional antipsychotic medications is comparable to and possibly greater than the risk of death associated with atypical antipsychotic medications. Until further evidence is available, physicians should consider all antipsychotic medications to be equally risky in elderly patients.</description><subject>Aged</subject><subject>Aged patients</subject><subject>Antipsychotic Agents - therapeutic use</subject><subject>Antipsychotic drugs</subject><subject>British Columbia - epidemiology</subject><subject>Canada</subject><subject>Causes of</subject><subject>Complications and side effects</subject><subject>Death & dying</subject><subject>Female</subject><subject>Health aspects</subject><subject>Humans</subject><subject>Male</subject><subject>Mortality</subject><subject>Multivariate Analysis</subject><subject>Older people</subject><subject>Patients</subject><subject>Proportional Hazards Models</subject><subject>Public health</subject><subject>Risk Factors</subject><subject>Tranquilizers</subject><issn>0008-4409</issn><issn>0820-3946</issn><issn>1488-2329</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2007</creationdate><recordtype>article</recordtype><sourceid>EIF</sourceid><sourceid>8G5</sourceid><sourceid>ABUWG</sourceid><sourceid>AFKRA</sourceid><sourceid>AZQEC</sourceid><sourceid>BENPR</sourceid><sourceid>CCPQU</sourceid><sourceid>DWQXO</sourceid><sourceid>GNUQQ</sourceid><sourceid>GUQSH</sourceid><sourceid>M2O</sourceid><recordid>eNqV0s1r2zAUAHAzNta022n3YXYojOFMX5bly6CUfRTKBt12For8bCuTLdeSk-W_r0LCkozCGDoI6f309JBekrzCaI5zRN_rTi3niGOSoyfJDDMhMkJJ-TSZIYRExhgqz5Jz75cIxX3EnidnuKAkp6SYJcOd8b9SV6cVqNCmynunjQpQpWsT16GFdPKwBdr1K-iDcb2y6QpGP_lUhc1gdFyrGBj8RrcuGJ1W49TEYOf6JgVbwWg36aCCicf9i-RZrayHl_v5Ivn56eOP6y_Z7bfPN9dXt5nmBQ4ZKUuMGRVcqVhoueA5q_kCFFeLQvBS8yoGcM4YZ5QRogTgAtVc1wgvSlpW9CL5sMs7TIsOKh3vHpWVw2g6NW6kU0aeRnrTysatJBYIUYJjgst9gtHdT-CD7IzXYK3qwU1eFohgjsvin5CgAouS5hG--Qsu3TTG59waJqgQmEaU7VCjLEjT1y5WpxvoIRbpeqhN3L7CHCFGcEEOSU-8Hsy9PEbzR1AcFXRGP5r17cmBaAL8Do2avJc33-_-w349tZdHtgVlQ-udnbZt5U_hux3Uo_N-hPrPz2Ekt20vt20vd20f9evjzz7YfZ8f7m1N067NCNJ3ytrIsVyv17jgMpc8wgc_OQfb</recordid><startdate>20070227</startdate><enddate>20070227</enddate><creator>Schneeweiss, Sebastian</creator><creator>Setoguchi, Soko</creator><creator>Brookhart, Alan</creator><creator>Dormuth, Colin</creator><creator>Wang, Philip S</creator><general>Can Med Assoc</general><general>CMA Impact Inc</general><general>CMA Impact, Inc</general><general>Canadian Medical Association</general><scope>CGR</scope><scope>CUY</scope><scope>CVF</scope><scope>ECM</scope><scope>EIF</scope><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>ISN</scope><scope>ISR</scope><scope>3V.</scope><scope>4T-</scope><scope>4U-</scope><scope>7RV</scope><scope>7X7</scope><scope>7XB</scope><scope>88E</scope><scope>88G</scope><scope>88I</scope><scope>8AF</scope><scope>8AO</scope><scope>8FI</scope><scope>8FJ</scope><scope>8FK</scope><scope>8FQ</scope><scope>8FV</scope><scope>8G5</scope><scope>ABUWG</scope><scope>AFKRA</scope><scope>AN0</scope><scope>ASE</scope><scope>AZQEC</scope><scope>BENPR</scope><scope>CCPQU</scope><scope>DWQXO</scope><scope>FPQ</scope><scope>FYUFA</scope><scope>GHDGH</scope><scope>GNUQQ</scope><scope>GUQSH</scope><scope>HCIFZ</scope><scope>K6X</scope><scope>K9.</scope><scope>KB0</scope><scope>M0S</scope><scope>M0T</scope><scope>M1P</scope><scope>M2M</scope><scope>M2O</scope><scope>M2P</scope><scope>M3G</scope><scope>MBDVC</scope><scope>NAPCQ</scope><scope>PQEST</scope><scope>PQQKQ</scope><scope>PQUKI</scope><scope>PRINS</scope><scope>PSYQQ</scope><scope>Q9U</scope><scope>7U1</scope><scope>7U2</scope><scope>C1K</scope><scope>7X8</scope><scope>5PM</scope></search><sort><creationdate>20070227</creationdate><title>Risk of death associated with the use of conventional versus atypical antipsychotic drugs among elderly patients</title><author>Schneeweiss, Sebastian ; Setoguchi, Soko ; Brookhart, Alan ; Dormuth, Colin ; Wang, Philip S</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c671t-299114386aa5329b654f6bea6ab7869c6daa51544643422a8e170f6cf01b939d3</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2007</creationdate><topic>Aged</topic><topic>Aged patients</topic><topic>Antipsychotic Agents - therapeutic use</topic><topic>Antipsychotic drugs</topic><topic>British Columbia - epidemiology</topic><topic>Canada</topic><topic>Causes of</topic><topic>Complications and side effects</topic><topic>Death & dying</topic><topic>Female</topic><topic>Health aspects</topic><topic>Humans</topic><topic>Male</topic><topic>Mortality</topic><topic>Multivariate Analysis</topic><topic>Older people</topic><topic>Patients</topic><topic>Proportional Hazards Models</topic><topic>Public health</topic><topic>Risk Factors</topic><topic>Tranquilizers</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Schneeweiss, Sebastian</creatorcontrib><creatorcontrib>Setoguchi, Soko</creatorcontrib><creatorcontrib>Brookhart, Alan</creatorcontrib><creatorcontrib>Dormuth, Colin</creatorcontrib><creatorcontrib>Wang, Philip S</creatorcontrib><collection>Medline</collection><collection>MEDLINE</collection><collection>MEDLINE (Ovid)</collection><collection>MEDLINE</collection><collection>MEDLINE</collection><collection>PubMed</collection><collection>CrossRef</collection><collection>Gale In Context: Canada</collection><collection>Gale In Context: Science</collection><collection>ProQuest Central (Corporate)</collection><collection>Docstoc</collection><collection>University Readers</collection><collection>Nursing & Allied Health Database</collection><collection>Health & Medical Collection</collection><collection>ProQuest Central (purchase pre-March 2016)</collection><collection>Medical Database (Alumni Edition)</collection><collection>Psychology Database (Alumni)</collection><collection>Science Database (Alumni Edition)</collection><collection>STEM Database</collection><collection>ProQuest Pharma Collection</collection><collection>Hospital Premium Collection</collection><collection>Hospital Premium Collection (Alumni Edition)</collection><collection>ProQuest Central (Alumni) (purchase pre-March 2016)</collection><collection>Canadian Business & Current Affairs Database</collection><collection>Canadian Business & Current Affairs Database (Alumni Edition)</collection><collection>Research Library (Alumni Edition)</collection><collection>ProQuest Central (Alumni Edition)</collection><collection>ProQuest Central UK/Ireland</collection><collection>British Nursing Database</collection><collection>British Nursing Index</collection><collection>ProQuest Central Essentials</collection><collection>ProQuest Central</collection><collection>ProQuest One Community College</collection><collection>ProQuest Central Korea</collection><collection>British Nursing Index (BNI) (1985 to Present)</collection><collection>Health Research Premium Collection</collection><collection>Health Research Premium Collection (Alumni)</collection><collection>ProQuest Central Student</collection><collection>Research Library Prep</collection><collection>SciTech Premium Collection</collection><collection>British Nursing Index</collection><collection>ProQuest Health & Medical Complete (Alumni)</collection><collection>Nursing & Allied Health Database (Alumni Edition)</collection><collection>Health & Medical Collection (Alumni Edition)</collection><collection>Healthcare Administration Database</collection><collection>Medical Database</collection><collection>Psychology Database</collection><collection>Research Library</collection><collection>Science Database</collection><collection>CBCA Reference & Current Events</collection><collection>Research Library (Corporate)</collection><collection>Nursing & Allied Health Premium</collection><collection>ProQuest One Academic Eastern Edition (DO NOT USE)</collection><collection>ProQuest One Academic</collection><collection>ProQuest One Academic UKI Edition</collection><collection>ProQuest Central China</collection><collection>ProQuest One Psychology</collection><collection>ProQuest Central Basic</collection><collection>Risk Abstracts</collection><collection>Safety Science and Risk</collection><collection>Environmental Sciences and Pollution Management</collection><collection>MEDLINE - Academic</collection><collection>PubMed Central (Full Participant titles)</collection><jtitle>Canadian Medical Association journal</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Schneeweiss, Sebastian</au><au>Setoguchi, Soko</au><au>Brookhart, Alan</au><au>Dormuth, Colin</au><au>Wang, Philip S</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Risk of death associated with the use of conventional versus atypical antipsychotic drugs among elderly patients</atitle><jtitle>Canadian Medical Association journal</jtitle><addtitle>CMAJ</addtitle><date>2007-02-27</date><risdate>2007</risdate><volume>176</volume><issue>5</issue><spage>627</spage><epage>632</epage><pages>627-632</pages><issn>0008-4409</issn><issn>0820-3946</issn><eissn>1488-2329</eissn><coden>CMAJAX</coden><abstract>Public health advisories have warned that the use of atypical antipsychotic medications increases the risk of death among elderly patients. We assessed the short-term mortality in a population-based cohort of elderly people in British Columbia who were prescribed conventional and atypical antipsychotic medications.
We used linked health care utilization data of all BC residents to identify a cohort of people aged 65 years and older who began taking antipsychotic medications between January 1996 and December 2004 and were free of cancer. We compared the 180-day all-cause mortality between residents taking conventional antipsychotic medications and those taking atypical antipsychotic medications.
Of 37 241 elderly people in the study cohort, 12 882 were prescribed a conventional antipsychotic medication and 24 359 an atypical formulation. Within the first 180 days of use, 1822 patients (14.1%) in the conventional drug group died, compared with 2337 (9.6%) in the atypical drug group (mortality ratio 1.47, 95% confidence interval [CI] 1.39-1.56). Multivariable adjustment resulted in a 180-day mortality ratio of 1.32 (1.23-1.42). In comparison with risperidone, haloperidol was associated with the greatest increase in mortality (mortality ratio 2.14, 95% CI 1.86-2.45) and loxapine the lowest (mortality ratio 1.29, 95% CI 1.19-1.40). The greatest increase in mortality occurred among people taking higher (above median) doses of conventional antipsychotic medications (mortality ratio 1.67, 95% CI 1.50-1.86) and during the first 40 days after the start of drug therapy (mortality ratio 1.60, 95% CI 1.42-1.80). Results were confirmed in propensity score analyses and instrumental variable estimation, minimizing residual confounding.
Among elderly patients, the risk of death associated with conventional antipsychotic medications is comparable to and possibly greater than the risk of death associated with atypical antipsychotic medications. Until further evidence is available, physicians should consider all antipsychotic medications to be equally risky in elderly patients.</abstract><cop>Canada</cop><pub>Can Med Assoc</pub><pmid>17325327</pmid><doi>10.1503/cmaj.061250</doi><tpages>6</tpages><oa>free_for_read</oa></addata></record> |
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subjects | Aged Aged patients Antipsychotic Agents - therapeutic use Antipsychotic drugs British Columbia - epidemiology Canada Causes of Complications and side effects Death & dying Female Health aspects Humans Male Mortality Multivariate Analysis Older people Patients Proportional Hazards Models Public health Risk Factors Tranquilizers |
title | Risk of death associated with the use of conventional versus atypical antipsychotic drugs among elderly patients |
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