Paradoxical relations of drug treatment with mortality in older persons
Paradoxical relations of drug treatment with mortality in older persons
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DOI：
10.1097/00001648-200111000-00017
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发表时间：
2001-11-01
期刊：
影响因子：
5.4
通讯作者：
Avorn, J
中科院分区：
文献类型：
--
作者：
Glynn, RJ;Knight, EL;Avorn, J
药物使用模式提供了流行的疾病替代指标，但老年患者可能无法测量的合并症的药物选择性使用不足，可能会导致使用特定药物和死亡率之间的人为“保护”关联。我们研究了新泽西65-99岁的129,111名居民中20种常见药物的使用与死亡率之间的关系，这些居民在1991-1994年期间至少有一次住院治疗，并通过医疗补助计划或该州的老年人和残疾人药房援助计划填写处方。在住院前120天内，超过5，000例受试者使用了每种研究药物类别; 41，930例受试者在住院期间或出院后一年内死亡。与非使用者相比，使用以下7种治疗药物的患者的年龄和性别校正死亡率均降低：降脂药、非甾体抗炎药、β受体阻滞剂、噻嗪类药物、青光眼药物、钙通道阻滞剂和抗焦虑药物。调整合并症和多药治疗对结果影响不大。我们在一个单独的132,071名老年人的非住院队列中发现了类似的结果。这种观察到的关联大多数似乎是非病因性的。这些发现引起了人们对在高风险人群中使用观察性研究来推断药物使用与结果之间关系的担忧。
Medication use patterns provide popular surrogate measures of disease, yet selective under-use of drugs by elderly patients with potentially unmeasured comorbidity may lead to artifactual "protective" associations between use of specific drugs and mortality. We examined the relation between use of 20 common classes of drugs and mortality among the 129,111 residents of New Jersey 65-99 years of age who had at least one hospitalization during the years 1991-1994 and filled prescriptions through either Medicaid or that state's Pharmacy Assistance for the Aged and Disabled program. Each study drug class was used by more than 5,000 subjects during the 120 days before hospitalization; 41,930 subjects died in the hospital or during the year after discharge. Users of drugs from each of seven therapeutic classes had reduced age- and sex-adjusted rates of death relative to non-users: lipid-lowering agents, nonsteroidal anti-inflammatory agents, beta blockers, thiazides, glaucoma drugs, calcium channel blockers, and antianxiety drugs. Adjustment for comorbidity and polypharmacy had tittle effect on these results. We found similar results in a separate nonhospitalized cohort of 132,071 elderly persons. Much of this observed association appears to be nonetiologic. These findings raise concerns about using observational studies in high-risk populations to infer associations between drug use and outcomes.