Department of Clinical Sciences and Administration, College of Pharmacy, University of Houston, Texas Medical Center, 1441 Moursund Street, Houston, TX 77030-3407, USA.
Med Care. 2012 Nov;50(11):961-9. doi: 10.1097/MLR.0b013e31826ec185.
Antipsychotic use among dual-eligible nursing home residents is a concern for cost and safety considerations.
To examine the comparative risk of death in dual-eligible elderly nursing home residents using typical and atypical agents.
A retrospective cohort design matched on propensity score was used to examine the risk of death due to antipsychotic use among dual-eligible nursing home residents 65 years or older from four states. New typical and atypical users in nursing homes were followed for 6 months after the exposure without any censoring. The risk of death was modeled using the Cox proportional model and the extended Cox hazard model stratified on matched pairs based on propensity score.
The unadjusted mortality rate was 18.42% for atypical antipsychotic users and 24.06% for typical antipsychotic users. The Cox proportional-hazards regression model revealed significant increased risk of death [hazard ratio (HR), 1.41; 95% confidence interval (CI), 1.27-1.57] among typical users when compared with atypical users. The extended Cox model, used due to the violation of proportional hazards assumption, revealed that risk of death was nearly twice as great among typical antipsychotic users within 40 days of antipsychotic treatment (HR, 1.81; 95% CI, 1.49-2.18) when compared with atypical users. However, moderate increase in risk (HR, 1.24; 95% CI, 1.09-1.42] was observed for 40-180 days of typical antipsychotic exposure.
The use of typical antipsychotic agents was associated with highest risk of all-cause mortality within 40 days of typical antipsychotic use when compared with atypical use, and the risk decreased after 40 days among dual-eligible elderly nursing home residents.
双重资格的疗养院居民使用抗精神病药物引起了人们对成本和安全问题的关注。
研究使用典型和非典型药物的双重资格老年疗养院居民的死亡相对风险。
采用倾向评分匹配的回顾性队列设计，研究了来自四个州的 65 岁及以上双重资格疗养院居民使用抗精神病药物后死亡的风险。新的典型和非典型使用者在入住疗养院后 6 个月内没有任何截尾进行随访。使用 Cox 比例风险模型和基于倾向评分分层匹配对的扩展 Cox 危险模型来模拟死亡风险。
非典型抗精神病药物使用者的未调整死亡率为 18.42%，典型抗精神病药物使用者的死亡率为 24.06%。Cox 比例风险回归模型显示，与非典型使用者相比，典型使用者的死亡风险显著增加[风险比（HR），1.41；95%置信区间（CI），1.27-1.57]。由于违反比例风险假设，使用扩展 Cox 模型显示，与非典型使用者相比，在开始抗精神病药物治疗后 40 天内，典型抗精神病药物使用者的死亡风险几乎增加了一倍（HR，1.81；95%CI，1.49-2.18）。然而，在典型抗精神病药物暴露的 40-180 天内，风险适度增加（HR，1.24；95%CI，1.09-1.42）。
与使用非典型药物相比，双重资格的疗养院居民在开始使用典型抗精神病药物后 40 天内，所有原因死亡率的风险最高，而在 40 天后风险降低。
