英格兰药品不良反应住院情况趋势：1998 - 2005年国家医院住院病例统计分析
Trends in hospital admissions for adverse drug reactions in England: analysis of national hospital episode statistics 1998-2005.
作者信息
Patel Hitesh, Bell Derek, Molokhia Mariam, Srishanmuganathan Janakan, Patel Mitesh, Car Josip, Majeed Azeem
机构信息
Charing Cross Hospital, London W6 8RF, UK.
出版信息
BMC Clin Pharmacol. 2007 Sep 25;7:9. doi: 10.1186/1472-6904-7-9.
BACKGROUND
Adverse drug reactions (ADRs) are a frequent cause of mortality and morbidity to patients worldwide, with great associated costs to the healthcare providers including the NHS in England. We examined trends in hospital admissions associated with adverse drug reaction in English hospitals and the accuracy of national reporting.
METHODS
Data from the Hospital Episode Statistics database (collected by the Department of Health) was obtained and analysed for all English hospital episodes (1998-2005) using ICD-10 codes with a primary (codes including the words ('drug-induced' or 'due to') or secondary diagnosis of ADR (Y40-59). More detailed analysis was performed for the year 2004-2005
RESULTS
Between 1998 and 2005 there were 447 071 ADRs representing 0.50% of total hospital episodes and over this period the number of ADRs increased by 45%. All ADRs with an external code increased over this period. In 2005 the total number of episodes (all age groups) was 13,706,765 of which 76,692 (0.56%) were drug related. Systemic agents, which include anti-neoplastic drugs, were the most implicated class (15.7%), followed by analgesics (11.7%) and cardiovascular drugs (10.1%). There has been a 6 fold increase in nephropathy secondary to drugs and a 65% decline in drug induced extra-pyramidal side effects. 59% of cases involving adverse drug reactions involved patients above 60 years of age.
CONCLUSION
ADRs have major public health and economic implications. Our data suggest that national Hospital Episode Statistics in England have recognised limitations and that consequently, admissions associated with adverse drug reactions continue to be under-recorded. External causes of ADR have increased at a greater rate than the increase in total hospital admissions. Improved and more detailed reporting combined with educational interventions to improve the recording of ADRs are needed to accurately monitor the morbidity caused by ADRs and to meaningfully evaluate national initiatives to reduce adverse drug reactions.
背景
药物不良反应（ADR）是全球患者发病和死亡的常见原因，给包括英国国民医疗服务体系（NHS）在内的医疗服务提供者带来了巨大的相关成本。我们研究了英国医院中与药物不良反应相关的住院趋势以及国家报告的准确性。
方法
获取并分析了来自医院事件统计数据库（由卫生部收集）的数据，该数据涵盖了1998 - 2005年所有英国医院事件，使用国际疾病分类第十版（ICD - 10）编码，主要诊断（编码包含“药物引起的”或“由于”字样）或药物不良反应的次要诊断（Y40 - 59）。对2004 - 2005年进行了更详细的分析。
结果
1998年至2005年间，共有447071例药物不良反应，占医院事件总数的0.50%，在此期间，药物不良反应的数量增加了45%。所有带有外部编码的药物不良反应在此期间均有所增加。2005年，事件总数（所有年龄组）为13706765例，其中76692例（0.56%）与药物相关。全身性药物，包括抗肿瘤药物，是最常涉及的类别（15.7%），其次是镇痛药（11.7%）和心血管药物（10.1%）。药物继发的肾病增加了6倍，药物引起的锥体外系副作用下降了65%。59%的药物不良反应病例涉及60岁以上的患者。
结论
药物不良反应具有重大的公共卫生和经济影响。我们的数据表明，英国国家医院事件统计存在明显局限性，因此，与药物不良反应相关的住院病例仍记录不足。药物不良反应的外部原因增加速度高于医院总住院人数的增加速度。需要改进并提供更详细的报告，同时结合教育干预措施以改善药物不良反应的记录，以便准确监测药物不良反应导致的发病率，并切实评估国家减少药物不良反应的举措。
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