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. 2021 Jun 30;16(6):e0253336.
doi: 10.1371/journal.pone.0253336. eCollection 2021.

Anticholinergic burden: First comprehensive analysis using claims data shows large variation by age and sex

Jonas Reinold  1 , Malte Braitmaier  2 , Oliver Riedel  1 , Ulrike Haug  1   3
Affiliations

Anticholinergic burden: First comprehensive analysis using claims data shows large variation by age and sex

Jonas Reinold et al. PLoS One. .

Abstract

Purpose: The cumulative effect of medication inhibiting acetylcholine activity-also known as anticholinergic burden (AB)-can lead to functional and cognitive decline, falls, and death. Given that studies on the population prevalence of AB are rare, we aimed to describe it in a large and unselected population sample.

Methods: Using the German Pharmacoepidemiological Research Database (GePaRD) with claims data from ~20% of the German population we analyzed outpatient drug dispensations in 2016. Based on the Anticholinergic Cognitive Burden (ACB) scale, we classified persons into four categories and determined the cumulative AB as continuous variable.

Results: Among 16,470,946 persons (54% female), the prevalence of clinically relevant AB (ACB≥3) was 10% (women) and 7% (men). Below age 40 it was highest in persons ≤18 years (6% both sexes). At older ages (50-59 vs. 90-99 years), prevalence of ACB≥3 increased from 7% to 26% (men) and from 10% to 32% (women). Medication classes contributing to the cumulative AB differed by age: antihistamines, antibiotics, glucocorticoids (≤19 years), antidepressants (20-49 years), antidepressants, cardiovascular medication, antidiabetics (50-64 years), and additionally medication for urinary incontinence/overactive bladder (≥65 years). Medication dispensed by general physicians contributed most to the cumulative AB.

Conclusion: Although a clinically relevant AB is particularly common in older persons, prevalence in younger age groups was up to 7%. Given the risks associated with AB in older persons, targeted interventions at the prescriber level are needed. Furthermore, risks associated with AB in younger persons should be explored.

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Conflict of interest statement

UH, OR, MB and JR are working at an independent, non-profit research institute, the Leibniz Institute for Prevention Research and Epidemiology – BIPS. Unrelated to this study, BIPS occasionally conducts studies financed by the pharmaceutical industry. Almost exclusively, these are post-authorization safety studies (PASS) requested by health authorities. The design and conduct of these studies as well as the interpretation and publication are not influenced by the pharmaceutical industry. The study presented was not funded by the pharmaceutical industry. The authors have no relevant financial or non-financial interests to disclose. Moreover, this does not alter our adherence to PLOS ONE policies on sharing data and materials.

Figures

Fig 1
Fig 1. Graphical depiction of study design.
Fig 2
Fig 2. Flow chart illustrating the inclusion and exclusion of persons into the study.
Fig 3
Fig 3. Proportion of anticholinergic burden measured through the Anticholinergic Cognitive Burden (ACB) scale (2016), by sex and age.
Fig 4
Fig 4. Median (Q1-Q3) cumulative anticholinergic burden, by sex and age.
See this image and copyright information in PMC

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