Potentially high-risk medication categories and unplanned hospitalizations: a case-time-control study
Potentially high-risk medication categories and unplanned hospitalizations: a case-time-control study
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DOI：
10.1038/srep41035
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发表时间：
2017-01-23
影响因子：
4.6
通讯作者：
Hsiao, Fei-Yuan
中科院分区：
文献类型：
--
作者：
Lin, Chih-Wan;Wen, Yu-Wen;Hsiao, Fei-Yuan
药物相关住院的经验数据非常有限。我们旨在研究12种高风险药物类别（糖尿病药物、利尿剂、非甾体抗炎药（NSAID）、抗凝剂、抗血小板药、抗高血压药、抗抑郁药、抗惊厥药、抗精神病药、抗抑郁药、苯二氮卓类（BZD）/Z-催眠药和麻醉剂）与计划外住院之间的相关性。一项基于人群的病例-时间-对照研究使用台湾全民健康保险研究数据库。发生计划外住院（索引访视）的患者被确定为索引受试者，并与特定类别高风险药物使用者中随机选择的参考访视匹配。计划外住院定义为急诊科就诊后立即入院。在索引访视和参考访视中，检查了病例期（访视前1-14天）和对照期（访视前366-379天）内高风险药物的不一致暴露。抗精神病药物与计划外住院的最高风险相关（调整后的OR：1.54，95% CI [1.37-1.73]），其次为NSAID（1.50，[1.44-1.56]），抗惊厥药（1.34，[1.10-1.64]）、利尿剂（1.24，[1.15-1.33]）、BZD/Z-催眠药（1.23，[1.16-1.31]）、抗抑郁药（1.17，[1.05-1.31]）和抗血小板药（1.16，[1.07-1.26]）。非甾体类抗炎药和麻醉剂与住院时间>= 10天的计划外住院风险最高相关。这些药物类别应作为临床和政策干预的目标。
Empirical data of medication-related hospitalization are very limited. We aimed to investigate the associations between 12 high risk medication categories (diabetic agents, diuretics, nonsteroidal anti-inflammatory drugs (NSAIDs), anticoagulants, antiplatelets, antihypertensives, antiarrhythmics, anticonvulsants, antipsychotics, antidepressants, benzodiazepine (BZD)/Z-hypnotics, and narcotics) and unplanned hospitalizations. A population-based case-time-control study was performed using Taiwan's National Health Insurance Research Database. Patients who experienced an unplanned hospitalization (index visit) were identified as index subjects and matched to a randomly selected reference visit within users of a specific category of high-risk medication. An unplanned hospitalization was defined as a hospital admission immediately after an emergency department visit. Discordant exposures to the high-risk medication during the case period (1-14 days before the visit) and the control period (366-379 days before the visit) were examined in both index and reference visits. Antipsychotics was associated with the highest risk of unplanned hospitalizations (adjusted OR: 1.54, 95% CI [1.37-1.73]), followed by NSAIDs (1.50, [1.44-1.56]), anticonvulsants (1.34, [1.10-1.64]), diuretics (1.24, [1.15-1.33]), BZD/Z-hypnotics (1.23, [1.16-1.31]), antidepressants (1.17, [1.05-1.31]) and antiplatelets (1.16, [1.07-1.26]). NSAIDs and narcotics were associated with the highest risks of unplanned hospitalizations with a length of stay >= 10 days. These medication categories should be targeted for clinical and policy interventions.