Medication Regimen Complexity and Polypharmacy as Factors Associated With All-Cause Mortality in Older People: A Population-Based Cohort Study.
Medication Regimen Complexity and Polypharmacy as Factors Associated With All-Cause Mortality in Older People: A Population-Based Cohort Study.
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DOI：
10.1177/1060028015621071
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发表时间：
2016-02
期刊：
影响因子：
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通讯作者：
Johnell K
中科院分区：
文献类型：
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作者：
Wimmer BC;Bell JS;Fastbom J;Wiese MD;Johnell K
目的：调查药物治疗方案的复杂性和/或多种药物治疗是否与老年人的全因死亡率相关。方法：这是一项基于人群的队列研究，在社区居住和机构≥60岁的人（n = 3348）中进行。使用65项药物治疗方案复杂性指数（MRCI）以10个单位的步骤评估药物治疗方案的复杂性。多种药物治疗被评估为连续变量（药物数量）。死亡率数据来自瑞典国家死亡原因登记处。使用考克斯比例风险模型计算3年期间方案复杂性与多种药物治疗与全因死亡率之间关系的未校正和校正风险比（HR）和95% CI。亚组分析按年龄（≤80岁和>80岁）、性别和认知（简易精神状态检查[MMSE] <26和≥26）分层进行。结果：在随访期间，14%的参与者（n = 470）死亡。校正年龄、性别、合并症、教育水平、日常生活活动、MMSE和居住环境后，较高的MRCI与死亡率相关（校正HR = 1.12; 95%CI = 1.01-1.25）。多种药物治疗与死亡率无关（校正HR = 1.03; 95% CI = 0.99-1.06）。当按性别分层时，MRCI和多药治疗与男性死亡率相关，但与女性无关。MRCI与年龄≤80岁的受试者和MMSE ≥26的受试者的死亡率相关，但与年龄>80岁或MMSE <26的受试者无关。结论：方案复杂性是一个更好的整体预测死亡率比多种药物。然而，方案复杂性并不能预测女性、>80岁或MMSE<26的患者的死亡率。这些与死亡率的不同关联值得进一步研究。
Objectives: To investigate whether medication regimen complexity and/or polypharmacy are associated with all-cause mortality in older people. Methods: This was a population-based cohort study among community-dwelling and institutionalized people ≥60 years old (n = 3348). Medication regimen complexity was assessed using the 65-item Medication Regimen Complexity Index (MRCI) in 10-unit steps. Polypharmacy was assessed as a continuous variable (number of medications). Mortality data were obtained from the Swedish National Cause of Death Register. Cox proportional hazard models were used to compute unadjusted and adjusted hazard ratios (HRs) and 95% CIs for the association between regimen complexity and polypharmacy with all-cause mortality over a 3-year period. Subanalyses were performed stratifying by age (≤80 and>80 years), sex, and cognition (Mini-Mental State Examination [MMSE] <26 and ≥26). Results: During follow-up, 14% of the participants (n = 470) died. After adjusting for age, sex, comorbidity, educational level, activities of daily living, MMSE, and residential setting, a higher MRCI was associated with mortality (adjusted HR = 1.12; 95% CI = 1.01-1.25). Polypharmacy was not associated with mortality (adjusted HR = 1.03; 95% CI = 0.99-1.06). When stratifying by sex, both MRCI and polypharmacy were associated with mortality in men but not in women. MRCI was associated with mortality in participants ≤80 years old and in participants with MMSE ≥26 but not in participants >80 years old or with MMSE <26. Conclusion: Regimen complexity was a better overall predictor of mortality than polypharmacy. However, regimen complexity was not predictive of mortality in women, in participants >80 years old, or in those with MMSE<26. These different associations with mortality deserve further investigation.