Antipsychotic Use and Risk of Nursing Home Admission Among Dual-Eligible Medicare Beneficiaries: A Propensity-Matched Study.
Antipsychotic Use and Risk of Nursing Home Admission Among Dual-Eligible Medicare Beneficiaries: A Propensity-Matched Study.
复制标题
双重资格医疗保险受益人中抗精神病药物的使用和入住疗养院的风险：一项倾向匹配研究。
DOI：
10.1007/s40801-015-0013-x
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发表时间：
2015
影响因子：
--
通讯作者：
Chen,Hua
中科院分区：
文献类型：
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作者：
Aparasu,RajenderR;Chatterjee,Satabdi;Chen,Hua
BackgroundAntipsychotic的使用与严重的不良事件，在老年人，因此可能会导致进一步的医疗保健利用，如nursing home admission.ObjectiveTo评估与典型与非典型抗精神病药物的使用在美国社区居住的老年人population.MethodsA回顾性队列设计的风险与美国四个州的医疗保险和医疗补助分析eXtract（MAX）数据进行。该队列包括2001年7月至2003年12月期间开始抗精神病药物治疗的所有双重合格受益人（年龄≥65岁）。采用考克斯比例风险回归模型和扩展的考克斯模型，以非典型药物作为参考类别，根据倾向评分对配对分层，评估6个月随访期间入住疗养院的风险。（风险比[HR] 0.91; 95%置信区间[CI] 0.81-1.01]）然而，扩展的考克斯回归结果显示，效果随时间而变化;典型的使用者在治疗的最初90天内入住疗养院的风险适度降低[HR 0.87; 95% CI 0.77-0.97]，但观察到90-180天的典型抗精神病药物暴露的实质性风险[HR 1.58; 95% CI 1.08-2.12].ConclusionThe研究发现，在老年受益人中，典型抗精神病药物的使用与疗养院入院风险的时间依赖性增加相关。鉴于非典型抗精神病药物的安全性问题及其在老年人中的广泛使用，在脆弱的老年人群中处方抗精神病药物时需要谨慎。
BackgroundAntipsychotic use is associated with serious adverse events in the elderly, and consequently can lead to further healthcare utilization such as nursing home admission.ObjectiveTo evaluate the risk of nursing home admission associated with typical versus atypical antipsychotic use among the US community-dwelling elderly population.MethodsA retrospective cohort design was conducted using Medicare and Medicaid Analytical eXtract (MAX) data from four US states. The cohort included all dual-eligible beneficiaries (aged ≥65 years) who initiated antipsychotic treatment during July 2001–December 2003. The risk of nursing home admission during the 6-month follow-up period was evaluated using Cox proportional hazards regression model and extended Cox model stratified on matched pairs based on propensity score, using atypical agents as the reference category.ResultsThe average risk of nursing home admission was similar among atypical antipsychotic users compared to typical users (hazard ratio [HR] 0.91; 95 % confidence interval [CI] 0.81–1.01]) However, the results of extended Cox regression revealed that the effect varied with time; typical users had a moderately lower risk of nursing home admission within the initial 90 days of therapy [HR 0.87; 95 % CI 0.77–0.97] but substantial risk was observed for 90–180 days of typical antipsychotic exposure [HR 1.58; 95 % CI 1.08–2.12].ConclusionThe study found that, among elderly beneficiaries, typical antipsychotic use was associated with a time-dependent increase in risk of nursing home admission. Given the safety concerns with atypical antipsychotics and their extensive use in the elderly, there is a need to be cautious while prescribing antipsychotics in the vulnerable elderly population.