Department of Pharmaceutical Systems and Policy, School of Pharmacy, West Virginia University, Morgantown, WV, USA.
Int J Chron Obstruct Pulmon Dis. 2013;8:287-94. doi: 10.2147/COPD.S45166. Epub 2013 Jun 10.
The purpose of this study was to examine the association between use of inhaled anticholinergics and all-cause mortality among elderly individuals with chronic obstructive pulmonary disease (COPD), after controlling for demographic, socioeconomic, health, functional status, smoking, and obesity.
We used a retrospective longitudinal panel data design. Data were extracted for multiple years (2002-2009) of the Medicare Current Beneficiary Survey (MCBS) linked with fee-for-service Medicare claims. Generic and brand names of inhaled anticholinergics were used to identify inhaled anticholinergic utilization from the self-reported prescription medication files. All-cause mortality was assessed using the vital status variable. Unadjusted group differences in mortality rates were tested using the chi-square statistic. Multivariable logistic regressions with independent variables entered in separate blocks were used to analyze the association between inhaled anticholinergic use and all-cause mortality. All analyses accounted for the complex design of the MCBS.
Overall, 19.4% of the elderly Medicare beneficiaries used inhaled anticholinergics. Inhaled anticholinergic use was significantly higher (28.5%) among those who reported poor health compared with those reporting excellent or very good health (12.7%). Bivariate analyses indicated that inhaled anticholinergic use was associated with significantly higher rates of all-cause mortality (18.7%) compared with nonusers (13.6%). However, multivariate analyses controlling for risk factors did not suggest an increased likelihood of all-cause mortality (adjusted odds ratio 1.26, 95% confidence interval 0.95-1.67).
Use of inhaled anticholinergics among elderly individuals with COPD is potentially safe in terms of all-cause mortality when we adjust for baseline risk factors.
本研究旨在探讨在控制人口统计学、社会经济、健康、功能状态、吸烟和肥胖等因素后，吸入性抗胆碱能药物在老年慢性阻塞性肺疾病（COPD）患者中的使用与全因死亡率之间的关系。
我们使用回顾性纵向面板数据设计。从 Medicare 现收现付受益人调查（MCBS）中提取了多年的数据（2002-2009 年），并与按服务收费的 Medicare 索赔数据相链接。通过自我报告的处方药物档案，使用吸入性抗胆碱能药物的通用名和商品名来识别吸入性抗胆碱能药物的使用情况。使用生命状态变量评估全因死亡率。使用卡方检验测试未调整组间死亡率的差异。使用多变量逻辑回归，将独立变量分别输入到不同的块中，分析吸入性抗胆碱能药物的使用与全因死亡率之间的关系。所有分析都考虑了 MCBS 的复杂设计。
总体而言，19.4%的老年医疗保险受益人使用了吸入性抗胆碱能药物。与报告健康状况极好或非常好的患者（12.7%）相比，报告健康状况较差的患者使用吸入性抗胆碱能药物的比例显著更高（28.5%）。双变量分析表明，与非使用者相比，吸入性抗胆碱能药物使用者的全因死亡率明显更高（18.7%）。然而，在控制风险因素的多变量分析中，并没有表明全因死亡率的增加（调整后的优势比 1.26，95%置信区间 0.95-1.67）。
在调整基线风险因素后，老年 COPD 患者使用吸入性抗胆碱能药物在全因死亡率方面可能是安全的。
