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. 2023 Mar 1;80(3):211-219.
doi: 10.1001/jamapsychiatry.2022.4448.

Rates of Antipsychotic Drug Prescribing Among People Living With Dementia During the COVID-19 Pandemic

Hao Luo  1   2   3 , Wallis C Y Lau  4   5   6 , Yi Chai  5 , Carmen Olga Torre  7   8   9 , Robert Howard  10 , Kathy Y Liu  10 , Xiaoyu Lin  11 , Can Yin  11 , Stephen Fortin  12 , David M Kern  13 , Dong Yun Lee  14 , Rae Woong Park  14 , Jae-Won Jang  15 , Celine S L Chui  6   16   17 , Jing Li  11 , Christian Reich  11 , Kenneth K C Man  4   5   6 , Ian C K Wong  4   18
Affiliations

Rates of Antipsychotic Drug Prescribing Among People Living With Dementia During the COVID-19 Pandemic

Hao Luo et al. JAMA Psychiatry. .

Abstract

Importance: Concerns have been raised that the use of antipsychotic medication for people living with dementia might have increased during the COVID-19 pandemic.

Objective: To examine multinational trends in antipsychotic drug prescribing for people living with dementia before and during the COVID-19 pandemic.

Design, setting, and participants: This multinational network cohort study used electronic health records and claims data from 8 databases in 6 countries (France, Germany, Italy, South Korea, the UK, and the US) for individuals aged 65 years or older between January 1, 2016, and November 30, 2021. Two databases each were included for South Korea and the US.

Exposures: The introduction of population-wide COVID-19 restrictions from April 2020 to the latest available date of each database.

Main outcomes and measures: The main outcomes were yearly and monthly incidence of dementia diagnosis and prevalence of people living with dementia who were prescribed antipsychotic drugs in each database. Interrupted time series analyses were used to quantify changes in prescribing rates before and after the introduction of population-wide COVID-19 restrictions.

Results: A total of 857 238 people with dementia aged 65 years or older (58.0% female) were identified in 2016. Reductions in the incidence of dementia were observed in 7 databases in the early phase of the pandemic (April, May, and June 2020), with the most pronounced reduction observed in 1 of the 2 US databases (rate ratio [RR], 0.30; 95% CI, 0.27-0.32); reductions were also observed in the total number of people with dementia prescribed antipsychotic drugs in France, Italy, South Korea, the UK, and the US. Rates of antipsychotic drug prescribing for people with dementia increased in 6 databases representing all countries. Compared with the corresponding month in 2019, the most pronounced increase in 2020 was observed in May in South Korea (Kangwon National University database) (RR, 2.11; 95% CI, 1.47-3.02) and June in the UK (RR, 1.96; 95% CI, 1.24-3.09). The rates of antipsychotic drug prescribing in these 6 databases remained high in 2021. Interrupted time series analyses revealed immediate increases in the prescribing rate in Italy (RR, 1.31; 95% CI, 1.08-1.58) and in the US Medicare database (RR, 1.43; 95% CI, 1.20-1.71) after the introduction of COVID-19 restrictions.

Conclusions and relevance: This cohort study found converging evidence that the rate of antipsychotic drug prescribing to people with dementia increased in the initial months of the COVID-19 pandemic in the 6 countries studied and did not decrease to prepandemic levels after the acute phase of the pandemic had ended. These findings suggest that the pandemic disrupted the care of people living with dementia and that the development of intervention strategies is needed to ensure the quality of care.

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Conflict of interest statement

Conflict of Interest Disclosures: Dr Luo reported receiving grants from the Research Grants Council of Hong Kong outside the submitted work. Dr Lau reported receiving grants from AIR@InnoHK administered by the Innovation and Technology Commission of Hong Kong outside the submitted work. Dr Liu reported receiving grants from the UK Medical Research Council during the conduct of the study and outside the submitted work. Dr Fortin reported holding stock in Johnson & Johnson. Dr Kern reported holding stock in Johnson & Johnson. Dr Man reported receiving grants from the Hong Kong Research Grant Council during the conduct of the study and receiving grants from the CW Maplethorpe Fellowship, UK National Institute for Health and Care Research, European Commission Framework Horizon 2020, Innovation and Technology Commission of the Government of the Hong Kong Special Administrative Region, Amgen, and GSK and personal fees from IQVIA Ltd outside the submitted work. Dr Wong reported receiving grants from the Hong Kong Health and Medical Research Fund and research funding from Amgen, Bristol-Myers Squibb, Pfizer, Janssen, Bayer, GSK, Novartis, the Food and Health Bureau of the Government of the Hong Kong Special Administrative Region, the UK National Institute for Health and Care Research, the European Commission, and the National Health and Medical Research Council in Australia outside the submitted work; receiving consulting fees from IQVIA outside the submitted work; and serving as a nonexecutive director of Jacobson Medical in Hong Kong and a consultant to the World Health Organization. No other disclosures were reported.

Figures

Figure 1.
Figure 1.. Monthly Incidence of Dementia Diagnosis From 2017 to 2019 and in 2020 and 2021
The shaded area indicates the transitional period between March 1, 2020, and April 1, 2020. The 2017 to 2019 data represent the mean prepandemic level. The denominator for the incidence rate of dementia diagnosis was the number of people aged 65 years or older for whom the observation periods in the database fell within the same month. AUSOM indicates Ajou University School of Medicine; IMRD, IQVIA Medical Research Data; KUN, Kangwon National University; and MDCR, IBM MarketScan Medicare Supplemental and Coordination of Benefits Database.
Figure 2.
Figure 2.. Monthly Prevalence of People With Dementia Prescribed Antipsychotic Drugs From 2016 to 2019 and in 2020 and 2021
The shaded area indicates the transitional period between March 1, 2020, and April 1, 2020. AUSOM indicates Ajou University School of Medicine; IMRD, IQVIA Medical Research Data; KUN, Kangwon National University; and MDCR, IBM MarketScan Medicare Supplemental and Coordination of Benefits Database.
Figure 3.
Figure 3.. Interrupted Time Series Analysis of Changes in Rate of Antipsychotic Drug Prescribing Among People With Dementia
The shaded area indicates the period after the introduction of COVID-19–related containment and health policies. AUSOM indicates Ajou University School of Medicine; IMRD, IQVIA Medical Research Data; KUN, Kangwon National University; and MDCR, IBM MarketScan Medicare Supplemental and Coordination of Benefits Database.
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References

    1. Nørgaard A, Jensen-Dahm C, Gasse C, Hansen ES, Waldemar G. Psychotropic polypharmacy in patients with dementia: prevalence and predictors. J Alzheimers Dis. 2017;56(2):707-716. doi:10.3233/JAD-160828 - DOI - PubMed
    1. Kales HC, Kim HM, Zivin K, et al. . Risk of mortality among individual antipsychotics in patients with dementia. Am J Psychiatry. 2012;169(1):71-79. doi:10.1176/appi.ajp.2011.11030347 - DOI - PMC - PubMed
    1. Pink J, O’Brien J, Robinson L, Longson D; Guideline Committee . Dementia: assessment, management and support: summary of updated NICE guidance. BMJ. 2018;361:k2438. doi:10.1136/bmj.k2438 - DOI - PubMed
    1. Holmes EA, O’Connor RC, Perry VH, et al. . Multidisciplinary research priorities for the COVID-19 pandemic: a call for action for mental health science. Lancet Psychiatry. 2020;7(6):547-560. doi:10.1016/S2215-0366(20)30168-1 - DOI - PMC - PubMed
    1. Pfefferbaum B, North CS. Mental health and the COVID-19 pandemic. N Engl J Med. 2020;383(6):510-512. doi:10.1056/NEJMp2008017 - DOI - PubMed

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