抗精神病药物种类与住院率之间的关联：来自 2005 年医疗保险当前受益人调查数据的回顾性分析结果。

The association between class of antipsychotic and rates of hospitalization: results of a retrospective analysis of data from the 2005 Medicare current beneficiary survey.

机构信息

Department of Health Policy and Administration, Washington State University, Pullman, Washington 99210-1495, USA.

出版信息

Clin Ther. 2009 Dec;31(12):2931-9. doi: 10.1016/j.clinthera.2009.12.017.

DOI:10.1016/j.clinthera.2009.12.017

PMID:20110033

Abstract

BACKGROUND

When second-generation antipsychotics (SGAs), also called atypical antipsychotics, were introduced in the 1990s, early research suggested that these drugs offered better tolerability and adherence than first-generation antipsychotics (FGAs), or typical antipsychotics. This presumably would reduce the need for hospital services. However, health research to test this hypothesis has focused mostly on psychiatric readmissions.

OBJECTIVE

The objective of this study was to compare rates of all-cause hospitalization among patients receiving different classes of antipsychotics (SGAs, FGAs, both, or neither) in a large, all-ages sample of both institutionalized and noninstitutionalized Medicare beneficiaries.

METHODS

We examined the 2005 Medicare Current Beneficiary Survey Cost and Use file for 11,236 survey participants. Antipsychotic utilization was characterized in terms of class: FGA (ie, chlorpromazine, fluphenazine, haloperidol, loxapine, perphenazine, thiothixene, thioridazine, or trifluoperazine) or SGA (ie, aripiprazole, clozapine, olanzapine, quetiapine, risperidone, or ziprasidone). Hospitalization was defined in terms of whether a Medicare beneficiary was admitted to the hospital for any reason in 2005, and was measured in terms of the number of hospital visits. In our final model, we included the following confounding variables: disability status (> or =1 limitation in activities of daily living), Rosow-Breslau impairment score (difficulty with walking, stooping, crouching, kneeling, or doing heavy housework), cognitive impairment (diagnosis of Alzheimer's disease or memory loss that interfered with daily activity), and health behavior variables (body mass index and smoking status).

RESULTS

A total of 3.5% of Medicare beneficiaries (1.3 million) filled > or =1 prescription for an antipsychotic medication in 2005. Controlling for demographic, socioeconomic, health, and disability variables, SGA-only users were more than twice as likely (odds ratio [OR] = 2.2 [95% CI, 1.7-2.9]) and combination users were more than 6 times as likely (OR = 6.3 [95% CI, 2.4-16.2]) as nonusers to be hospitalized. The odds of FGA users being hospitalized were not significantly different from nonusers (OR = 1.4 [95% CI, 0.7-2.8]).

CONCLUSIONS

This analysis yielded provocative, but by no means conclusive, evidence that SGAs as a class are not necessarily superior to FGAs in mitigating patient's use of hospital services under real-world conditions. Systematic analysis of this relationship with a large, multiple-year sample of Medicare beneficiaries is warranted.

摘要

背景

20 世纪 90 年代第二代抗精神病药物（也称为非典型抗精神病药物）问世后，早期研究表明，与第一代抗精神病药物（FGA，或典型抗精神病药物）相比，这些药物具有更好的耐受性和依从性。这可能会减少对医院服务的需求。然而，测试这一假设的健康研究主要集中在精神科再入院上。

目的

本研究的目的是在一个大型的、所有年龄段的机构化和非机构化医疗保险受益人群中，比较接受不同类别的抗精神病药物（SGA、FGA、两者或两者都没有）的患者的全因住院率。

方法

我们对 11236 名调查参与者的 2005 年医疗保险当前受益人大调查费用和使用文件进行了检查。抗精神病药物的使用情况是根据类别来描述的：FGA（即氯丙嗪、氟奋乃静、氟哌啶醇、洛沙平、奋乃静、硫利达嗪或三氟拉嗪）或 SGA（即阿立哌唑、氯氮平、奥氮平、喹硫平、利培酮或齐拉西酮）。住院治疗是指 2005 年是否因任何原因住院治疗，用住院次数来衡量。在我们的最终模型中，我们纳入了以下混杂变量：残疾状况（> =1 项日常生活活动受限）、Rosow-Breslau 损伤评分（行走、弯腰、下蹲、跪地或做重家务困难）、认知障碍（阿尔茨海默病或记忆障碍诊断，干扰日常活动）和健康行为变量（体重指数和吸烟状况）。

结果

2005 年，共有 3.5%的医疗保险受益人（130 万人）开了> =1 种抗精神病药物处方。在控制人口统计学、社会经济、健康和残疾变量后，仅使用 SGA 的患者住院的可能性是未使用者的两倍多（比值比[OR] = 2.2 [95%CI，1.7-2.9]），联合使用者的可能性是未使用者的 6 倍多（OR = 6.3 [95%CI，2.4-16.2]）。FGA 使用者住院的可能性与未使用者无显著差异（OR = 1.4 [95%CI，0.7-2.8]）。