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. 2014 Jan 13;9(1):e83224.
doi: 10.1371/journal.pone.0083224. eCollection 2014.

Impact of high risk drug use on hospitalization and mortality in older people with and without Alzheimer's disease: a national population cohort study

Danijela Gnjidic  1 , Sarah N Hilmer  2 , Sirpa Hartikainen  3 , Anna-Maija Tolppanen  4 , Heidi Taipale  3 , Marjaana Koponen  3 , J Simon Bell  5
Affiliations

Impact of high risk drug use on hospitalization and mortality in older people with and without Alzheimer's disease: a national population cohort study

Danijela Gnjidic et al. PLoS One. .

Abstract

Background: 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.

Methods: 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.

Results: 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.

Conclusion: There is a dose-response relationship between cumulative anticholinergic and sedative drug use and hospitalization and mortality in people with and without AD.

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Conflict of interest statement

Competing Interests: The authors have declared that no competing interests exist.

Figures

Figure 1
Figure 1. Flowchart of community-dwelling people with and without Alzheimer’s disease (AD) in Finland, and people included in the present analysis.
Figure 2
Figure 2. Percentage of people with and without Alzheimer’s disease hospitalized (2A) and died (2B) with increasing Drug Burden Index exposure.
*Chi-square tests for differences between the groups: p<0.0001 for hospitalization and death. #Trend test statistics between the groups: p<0.0001.
See this image and copyright information in PMC

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