Eshelman School of Pharmacy, University of North Carolina, Asheville, USA.
Ann Pharmacother. 2012 Feb;46(2):169-75. doi: 10.1345/aph.1P592. Epub 2012 Jan 17.
Adverse drug reactions (ADRs) are an important source of morbidity and mortality during medical care.
To examine the trends in mortality related to ADRs reported through the US vital statistics system since January 1999.
Demographic characteristics of people reported as dying as a result of ADRs from 1999 to 2006 were evaluated. The National Mortality Statistics database was queried for International Classification of Diseases, Tenth Revision, codes Y40-Y59, which are specific for deaths due to adverse effects of drugs in therapeutic use. The data were subgrouped based on demographic factors to identify important trends. Crude rates were calculated based on incidents per 100,000 population. Odds ratios and 95% confidence intervals for subgroups were calculated by logistical regression.
During the 8-year study period 2,313,902,748 person years were evaluated and 2341 ADR-related deaths were identified. Annual rates ranged from 0.08/100,000 to 0.12/100,000, and rates increased significantly over time at a rate of 0.0058 per year. ADR deaths were significantly more likely in persons older than 55 years. The risk was greatest in those aged 75 years or older (OR 6.96, 95% CI 6.30 to 7.69). ADR deaths were higher among men than women. Rates varied by race and ethnicity and were highest among blacks (OR 1.38, 95% CI 1.23 to 1.54). Geographically, rates varied widely between states. Based on urbanization, rates were highest in extremely rural (non-core) areas (OR 2.05, 95% CI 1.76 to 2.38). The most common drug classes associated with death were anticoagulants, opioids, and immunosuppressants.
ADR death rates have a clear association with age, race, and urbanization subgroups. Older individuals, males, blacks, and individuals residing in extremely rural areas experienced higher ADR death rates; these findings warrant further study to develop prevention strategies.
药物不良反应（ADR）是医疗过程中发病率和死亡率的重要来源。
自 1999 年 1 月以来，通过美国生命统计系统报告的与 ADR 相关的死亡率趋势。
评估了 1999 年至 2006 年因 ADR 而死亡的人的人口统计学特征。查询了国家死亡率统计数据库，使用国际疾病分类，第 10 次修订版，代码 Y40-Y59，这些代码是治疗用药中药物不良反应导致死亡的具体代码。根据人口统计学因素对数据进行了分组，以确定重要趋势。根据每 10 万人的发生率计算粗率。通过逻辑回归计算亚组的比值比和 95％置信区间。
在 8 年的研究期间，评估了 2313902748 人年，发现了 2341 例与 ADR 相关的死亡。年发生率范围为 0.08/100000 至 0.12/100000，且随着时间的推移呈明显上升趋势，每年增加 0.0058。ADR 死亡的风险在 55 岁以上的人群中明显更高。在 75 岁或以上的人群中，风险最大（OR 6.96，95％CI 6.30 至 7.69）。ADR 死亡的风险在男性中高于女性。种族和族裔之间的差异也很大，黑人的比率最高（OR 1.38，95％CI 1.23 至 1.54）。在地理上，各州之间的比率差异很大。根据城市化程度，在极为农村（非核心）地区的比率最高（OR 2.05，95％CI 1.76 至 2.38）。与死亡相关的最常见药物类别是抗凝剂，阿片类药物和免疫抑制剂。
ADR 死亡率与年龄，种族和城市化亚组有明显关联。年龄较大的个体，男性，黑人以及居住在极为农村地区的个体经历了更高的 ADR 死亡率；这些发现需要进一步研究，以制定预防策略。
