Antipsychotic drug use and mortality in older adults with dementia
Antipsychotic drug use and mortality in older adults with dementia
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DOI：
10.7326/0003-4819-146-11-200706050-00006
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发表时间：
2007-06-05
影响因子：
39.2
通讯作者：
Rochon, Paula A.
中科院分区：
文献类型：
--
作者：
Gill, Sudeep S.;Bronskill, Susan E.;Rochon, Paula A.
背景资料：抗精神病药物被广泛用于治疗痴呆患者的行为和心理症状，尽管其安全性受到关注。设计：基于人群的回顾性队列研究，地点：加拿大安大略，患者：在1997年4月1日至2003年3月31日期间随访的老年痴呆症患者。测量：在首次分发抗精神病药物后30、60、120和180天确定死亡风险。两个成对比较：非典型与无抗精神病药物的使用和传统与非典型抗精神病药物的使用。按居住地（社区或长期护理）对各组进行分层。倾向评分匹配用于调整基线健康状况的差异。结果：共确定了27259对匹配。在两个社区居住队列中，与未使用相比，新使用非典型抗精神病药物与30天死亡风险的统计学显著增加相关（校正的风险比，1.31 [95% CI，1.02至1.70];绝对风险差异，0.2个百分点）和长期护理队列（调整后的风险比，1.55 [CI，1.15至2.07];绝对风险差异，1.2个百分点）。过度风险似乎持续到180天，但随着时间的推移，不平等的审查率可能会影响这些结果。相对于非典型抗精神病药物的使用，常规抗精神病药物的使用在所有时间点均与较高的死亡风险相关。敏感性分析显示，增加死亡风险的未测量混杂因素可能会减少或消除观察到的相关性。许多患者在治疗1个月后没有继续他们的初始治疗。未测量的混杂因素可能会影响association.Conclusions：在老年痴呆患者中，与不使用抗精神病药物相比，非典型抗精神病药物的使用与死亡风险增加相关。使用常规抗精神病药物的死亡风险可能高于非典型抗精神病药物。
Background: Antipsychotic drugs are widely used to manage behavioral and psychological symptoms in dementia despite concerns about their safety.Objective: To examine the association between treatment with antipsychotics (both conventional and atypical) and all-cause mortality.Design: Population -based, retrospective cohort study.Setting: Ontario, Canada.Patients: Older adults with dementia who were followed between 1 April 1997 and 31 March 2003.Measurements: The risk for death was determined at 30, 60, 120, and 180 days after the initial dispensing of antipsychotic medication. Two pairwise comparisons were made: atypical versus no antipsychotic use and conventional versus atypical antipsychotic use. Groups were stratified by place of residence (community or long-term care). Propensity score matching was used to adjust for differences in baseline health status.Results: A total of 27 259 matched pairs were identified. New use of atypical antipsychotics was associated with a statistically significant increase in the risk for death at 30 days compared with nonuse in both the community-dwelling cohort (adjusted hazard ratio, 1.31 [95% CI, 1.02 to 1.70]; absolute risk difference, 0.2 percentage point) and the long-term care cohort (adjusted hazard ratio, 1.55 [CI, 1.15 to 2.07]; absolute risk difference, 1.2 percentage points). Excess risk seemed to persist to 180 days, but unequal rates of censoring over time may have affected these results. Relative to atypical antipsychotic use, conventional antipsychotic use was associated with a higher risk for death at all time points. Sensitivity analysis revealed that unmeasured confounders that in- crease the risk for death could diminish or eliminate the observed associations.Limitations: Information on causes of death was not available. Many patents did not continue their initial treatments after 1 month of therapy. Unmeasured confounders could affect associations.Conclusions: Atypical antipsychotic use is associated with an increased risk for death compared with nonuse among older adults with dementia. The risk for death may be greater with conventional antipsychotics than with atypical antipsychotics.