Risk of Mortality Associated with Potentially Inappropriate Medication Use Including Opioids in Older Adults.

IF 4 2区 医学 Q1 PHARMACOLOGY & PHARMACY
Drug Safety Pub Date : 2024-08-01 Epub Date: 2024-05-09 DOI:10.1007/s40264-024-01429-1
Carina D'Aiuto, Carlotta Lunghi, Line Guénette, Djamal Berbiche, Karine Bertrand, Helen-Maria Vasiliadis
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引用次数: 0

Abstract

Introduction and objective: As the population ages, understanding the potential risks associated with inappropriate medication use becomes increasingly important. Given the lack of studies in this area, our objective was to study the risk of mortality associated with potentially inappropriate medication use involving opioids in community-dwelling older adults.

Methods: Data came from a longitudinal study on older adults aged ≥ 65 years recruited in primary care clinics between 2011 and 2013 with an average follow-up of 4.25 years. Older adults were excluded if they used an opioid or had a malignant tumor diagnosis in the year before the study survey. A nested case-control within a cohort of older adults with at least one opioid claim during follow-up was used to evaluate the risk of all-cause mortality. Four controls per case were matched on follow-up time using risk-set sampling, i.e., while still at risk of death when their matched case died. The risk of mortality was estimated using conditional logistic regression analyses. Exposure to potentially inappropriate medication use involving opioids, defined using the Beers 2019 criteria, was assessed from provincial drug claims data in the 0-90 days before death.

Results: In a cohort of 472 community-dwelling older adults with an incident episode of opioid use, there were 40 cases matched to 160 controls. Exposure to inappropriate medication use involving opioids in the 90 days before death was associated with an increased risk of mortality (odds ratio 6.81, 95% confidence interval 1.69-27.47), after adjusting for potential confounders.

Conclusions: Exposure to inappropriate medication use involving opioids in the 90 days before death is associated with an increased risk of mortality in older adults. These findings can be used to encourage safer pain management strategies in older adults.

Abstract Image

与包括阿片类药物在内的老年潜在不当用药相关的死亡风险。
引言和目的:随着人口老龄化的加剧,了解与用药不当相关的潜在风险变得越来越重要。鉴于缺乏这方面的研究,我们的目标是研究社区老年人阿片类药物潜在不当使用的相关死亡风险:数据来自一项纵向研究,研究对象是 2011 年至 2013 年期间在初级保健诊所招募的年龄≥ 65 岁的老年人,平均随访时间为 4.25 年。如果老年人在研究调查前一年使用过阿片类药物或被诊断患有恶性肿瘤,则排除在外。在随访期间至少有一次阿片类药物申领的老年人队列中进行嵌套病例对照,以评估全因死亡风险。每个病例有四个对照组,采用风险设置抽样法在随访时间上进行匹配,即当匹配病例死亡时,对照组仍有死亡风险。通过条件逻辑回归分析估算死亡风险。根据死亡前 0-90 天内的省级药物索赔数据,对涉及阿片类药物的潜在不当用药暴露进行了评估:在由 472 名社区老年人组成的队列中,有 40 名病例与 160 名对照组匹配,其中有 472 名老年人曾使用过阿片类药物。在对潜在的混杂因素进行调整后,死亡前 90 天内暴露于阿片类药物的不当用药与死亡风险的增加有关(几率比 6.81,95% 置信区间 1.69-27.47):结论:老年人在死前 90 天内接触过阿片类药物的不当用药与死亡风险增加有关。这些发现可用于鼓励对老年人采取更安全的疼痛管理策略。
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来源期刊
Drug Safety
Drug Safety 医学-毒理学
CiteScore
7.60
自引率
7.10%
发文量
112
审稿时长
6-12 weeks
期刊介绍: Drug Safety is the official journal of the International Society of Pharmacovigilance. The journal includes: Overviews of contentious or emerging issues. Comprehensive narrative reviews that provide an authoritative source of information on epidemiology, clinical features, prevention and management of adverse effects of individual drugs and drug classes. In-depth benefit-risk assessment of adverse effect and efficacy data for a drug in a defined therapeutic area. Systematic reviews (with or without meta-analyses) that collate empirical evidence to answer a specific research question, using explicit, systematic methods as outlined by the PRISMA statement. Original research articles reporting the results of well-designed studies in disciplines such as pharmacoepidemiology, pharmacovigilance, pharmacology and toxicology, and pharmacogenomics. Editorials and commentaries on topical issues. Additional digital features (including animated abstracts, video abstracts, slide decks, audio slides, instructional videos, infographics, podcasts and animations) can be published with articles; these are designed to increase the visibility, readership and educational value of the journal’s content. In addition, articles published in Drug Safety Drugs may be accompanied by plain language summaries to assist readers who have some knowledge of, but not in-depth expertise in, the area to understand important medical advances.
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