社区居住的老年人群抗精神病药物的比较死亡率风险。
Comparative mortality risks of antipsychotic medications in community-dwelling older adults.
机构信息
Tobias Gerhard, PhD, Institute for Health, Health Care Policy and Aging Research, Rutgers University, New Brunswick, New Jersey, and Department of Pharmacy Practice and Administration, Ernest Mario School of Pharmacy, Rutgers University, Piscataway, New Jersey; Krista Huybrechts, PhD, Division of Pharmacoepidemiology and Pharmacoeconomics, Department of Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, Massachusetts; Mark Olfson, MD MPH, Department of Psychiatry, College of Physicians and Surgeons, Columbia University, and the New York State Psychiatric Institute, New York, New York; Sebastian Schneeweiss, MD, ScD, Division of Pharmacoepidemiology and Pharmacoeconomics, Department of Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, Massachusetts; William V. Bobo, MD, Department of Psychiatry, Vanderbilt University School of Medicine, Nashville, Tennessee; P. Murali Doraiswamy, MD, Department of Psychiatry, Duke University Medical Center, Durham, North Carolina; D. P. Devanand, MD, Department of Psychiatry, College of Physicians and Surgeons, Columbia University, and the New York State Psychiatric Institute, New York, New York; Judith A. Lucas, EdD RN, Cecilia Huang, PhD, Edmond S. Malka, PhD, MPH, Institute for Health, Health Care Policy and Aging Research, Rutgers University, New Brunswick, New Jersey; Raisa Levin, MS, Division of Pharmacoepidemiology and Pharmacoeconomics, Department of Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, Massachusetts; Stephen Crystal, PhD, Institute for Health, Health Care Policy and Aging Research, Rutgers University, New Brunswick, New Jersey, USA.
出版信息
Br J Psychiatry. 2014 Jul;205(1):44-51. doi: 10.1192/bjp.bp.112.122499. Epub 2013 Aug 8.
BACKGROUND
All antipsychotic medications carry warnings of increased mortality for older adults, but little is known about comparative mortality risks between individual agents.
AIMS
To estimate the comparative mortality risks of commonly prescribed antipsychotic agents in older people living in the community.
METHOD
A retrospective, claims-based cohort study was conducted of people over 65 years old living in the community who had been newly prescribed risperidone, olanzapine, quetiapine, haloperidol, aripiprazole or ziprasidone (n = 136 393). Propensity score-adjusted Cox proportional hazards models assessed the 180-day mortality risk of each antipsychotic compared with risperidone.
RESULTS
Risperidone, olanzapine and haloperidol showed a dose-response relation in mortality risk. After controlling for propensity score and dose, mortality risk was found to be increased for haloperidol (hazard ratio (HR) = 1.18, 95% CI 1.06-1.33) and decreased for quetiapine (HR = 0.81, 95% CI 0.73-0.89) and olanzapine (HR = 0.82, 95% CI 0.74-0.90).
CONCLUSIONS
Significant variation in mortality risk across commonly prescribed antipsychotics suggests that antipsychotic selection and dosing may affect survival of older people living in the community.
背景
所有抗精神病药物都有增加老年人死亡率的警告，但对于个别药物之间的相对死亡率风险知之甚少。
目的
评估社区中老年人常用抗精神病药物的相对死亡率风险。
方法
对新处方利培酮、奥氮平、喹硫平、氟哌啶醇、阿立哌唑或齐拉西酮的 65 岁以上社区居住人群进行回顾性、基于索赔的队列研究（n=136393）。采用倾向评分调整的 Cox 比例风险模型评估每种抗精神病药物与利培酮相比的 180 天死亡率风险。
结果
利培酮、奥氮平和氟哌啶醇的死亡率风险与剂量呈正相关。在控制倾向评分和剂量后，发现氟哌啶醇的死亡率风险增加（风险比[HR] = 1.18，95%置信区间[CI] 1.06-1.33），而喹硫平和奥氮平的死亡率风险降低（HR = 0.81，95% CI 0.73-0.89）和奥氮平（HR=0.82，95%CI0.74-0.90）。
结论
常用抗精神病药物的死亡率风险存在显著差异，这表明抗精神病药物的选择和剂量可能会影响社区中老年人的生存。
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