Association Between Pneumonia Risk and Anticholinergic Burden Among Patients with Different Frailty Levels.

IF 3.2 2区医学 Q1 PUBLIC, ENVIRONMENTAL & OCCUPATIONAL HEALTH

Clinical Epidemiology Pub Date : 2025-09-30 eCollection Date: 2025-01-01 DOI:10.2147/CLEP.S524645

Avery Shuei-He Yang, Hsin-Yu Fan Chiang, Daniel Hsiang-Te Tsai, Albert Tzu-Ming Chuang, Edward Chia-Cheng Lai

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引用次数: 0

Abstract

Objective: We aimed to evaluate the association between recent increase in anticholinergic burden and risk of hospitalised pneumonia, taking frailty levels into consideration.

Setting: We conducted a case-crossover study using data drawn from Taiwan's National Health Insurance Research Database.

Participants: We enrolled patients aged over 65 years old who were hospitalised for pneumonia between 2011 and 2020. Exclusion criteria included prior diagnosis of ventilator dependency, pneumonia and immune dysfunction.

Measurements: The observational period was divided into a hazard period, a washout period and one of four reference periods, based on the 30-day interval before the admission. We calculated the anticholinergic cognitive burden (ACB) scale for the hazard period and one randomly selected reference period. Using a multimorbidity frailty index we classified patients into four groups (ie, fit, mildly frail, moderately frail and very frail).

Statistical analysis: We used conditional logistic regression to evaluate the risk of pneumonia by comparing the anticholinergic burden between the hazard window and the randomly selected reference window and conducted sensitivity analyses based on case-time control and case-case-time control analysis to examine the robustness of the findings.

Results: The fit group included 188,740 patients, followed by 133,038, 61,805 and 18,198 patients for the mildly, moderately and very frail groups, respectively. Each single point increase in ACB scale was associated with a pneumonia risk increase by 1.35 (95% CI: 1.34-1.35), 1.24 (95% CI: 1.24-1.24), 1.18 (95% CI: 1.17-1.18) and 1.12 (95% CI: 1.11-1.13) times in the fit and mildly, moderately and very frail groups, respectively. The results of the case-time control and case-case-time control analyses remained consistent with the main analysis.

Conclusion: Our study confirmed the association between recently elevated ACB and the risk of hospitalised pneumonia. Even in the less frail, exposure to anticholinergic drugs warrants close monitoring for pneumonia.

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不同虚弱程度患者肺炎风险与抗胆碱能负荷的关系

目的：我们旨在评估近期抗胆碱能负荷增加与住院肺炎风险之间的关系，并将虚弱程度考虑在内。背景：本研究采用台湾全民健保研究资料库之资料，进行个案交叉研究。参与者：我们招募了2011年至2020年期间因肺炎住院的65岁以上患者。排除标准包括先前诊断为呼吸机依赖、肺炎和免疫功能障碍。测量方法：根据入院前30天的间隔，观察期分为危险期、洗脱期和四个参考期之一。我们计算了危险期和随机选择一个参照期的抗胆碱能认知负荷（ACB）量表。使用多病虚弱指数，我们将患者分为四组（即，健康，轻度虚弱，中度虚弱和非常虚弱）。统计分析：通过比较危险窗和随机选择参考窗的抗胆碱能负担，采用条件logistic回归评价肺炎的风险，并基于病例-时间对照和病例-时间对照分析进行敏感性分析，检验结果的稳健性。结果：fit组共188,740例，轻度、中度、极弱组分别为133,038例、61,805例、18,198例。ACB量表每增加一个单点，在健康和轻度、中度和非常虚弱组中，肺炎风险分别增加1.35倍（95% CI: 1.34-1.35）、1.24倍（95% CI: 1.24-1.24）、1.18倍（95% CI: 1.17-1.18）和1.12倍（95% CI: 1.11-1.13）。病例-时间对照和病例-时间对照分析结果与主要分析结果一致。结论：我们的研究证实了近期ACB升高与住院肺炎风险之间的关联。即使身体不那么虚弱，暴露于抗胆碱能药物也需要密切监测肺炎。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

Clinical Epidemiology Medicine-Epidemiology

CiteScore

6.30

自引率

5.10%

发文量

169

审稿时长

16 weeks

期刊介绍： Clinical Epidemiology is an international, peer reviewed, open access journal. Clinical Epidemiology focuses on the application of epidemiological principles and questions relating to patients and clinical care in terms of prevention, diagnosis, prognosis, and treatment. Clinical Epidemiology welcomes papers covering these topics in form of original research and systematic reviews. Clinical Epidemiology has a special interest in international electronic medical patient records and other routine health care data, especially as applied to safety of medical interventions, clinical utility of diagnostic procedures, understanding short- and long-term clinical course of diseases, clinical epidemiological and biostatistical methods, and systematic reviews. When considering submission of a paper utilizing publicly-available data, authors should ensure that such studies add significantly to the body of knowledge and that they use appropriate validated methods for identifying health outcomes. The journal has launched special series describing existing data sources for clinical epidemiology, international health care systems and validation studies of algorithms based on databases and registries.