Dept. of Surgical Sciences, Anesthesiology and Intensive Care, Uppsala University, Uppsala, Sweden.
Dept. of Surgical Sciences, Urology, Uppsala University, Uppsala, Sweden.
PLoS One. 2020 Oct 29;15(10):e0241439. doi: 10.1371/journal.pone.0241439. eCollection 2020.
Understanding the association between patients' history of prescribed medications and mortality rate could optimize characterization of baseline risk when the Charlson Comorbidity Index is insufficient.
Using a Swedish cohort of men selected randomly as controls to men with prostate cancer diagnosed 2007-2013, we estimated the association between medications prescribed during the previous year and mortality rates, using Cox regression stratified for age.
Among the 326,450 older men with median age of 69 years included in this study, 73% were categorized as free of comorbidity according to the Charlson Comorbidity Index; however, 84% had received at least one prescription during the year preceding the follow-up. This was associated with a 60% overall increase in mortality rate (hazard ratio [HR] = 1.60, 95% confidence interval [CI] 1.56 to 1.64). Some drugs that were unexpectedly associated with mortality included locally acting antacids (HR = 4.7, 95% CI 4.4 to 5.1), propulsives (HR = 4.7, 95% CI 4.4 to 5.0), vitamin A and D (HR = 4.6, 95% CI 4.3 to 4.9), and loop diuretics, for example furosemide (HR = 3.7; 95% CI 3.6 to 3.8). Thiazide diuretics, however, were only weakly associated with a mortality risk (HR = 1.5; 95% CI 1.4 to 1.5). Surprisingly, only weak associations with mortality were seen for major cardiovascular drug classes.
A majority of older men had a history of prescribed medications and many drug classes were associated with mortality rate, including drug classes not directly indicated for a specific comorbidity represented in commonly used comorbidity measures. Prescription history can improve baseline risk assessment but some associations might be context-sensitive.
当 Charlson 共病指数不足时，了解患者既往用药史与死亡率之间的关系可以优化基线风险特征。
我们使用了瑞典一个在 2007-2013 年间随机选择的男性队列作为对照组，对诊断为前列腺癌的男性进行研究，通过 Cox 回归分层年龄估计了前一年开具的药物与死亡率之间的关系。
在这项研究中，纳入了 326450 名年龄中位数为 69 岁的老年男性，73%根据 Charlson 共病指数无共病；然而，84%的人在随访前一年至少接受过一次处方。这与总体死亡率增加 60%相关（风险比[HR] = 1.60，95%置信区间[CI] 1.56-1.64）。一些意想不到的与死亡率相关的药物包括局部作用的抗酸剂（HR = 4.7，95%CI 4.4-5.1）、推进剂（HR = 4.7，95%CI 4.4-5.0）、维生素 A 和 D（HR = 4.6，95%CI 4.3-4.9）和噻嗪类利尿剂，如呋塞米（HR = 3.7；95%CI 3.6-3.8）。然而，噻嗪类利尿剂与死亡率风险仅呈弱相关（HR = 1.5；95%CI 1.4-1.5）。令人惊讶的是，只有少数心血管药物类别与死亡率有弱相关。
大多数老年男性都有用药史，许多药物类别与死亡率相关，包括在常用共病指标中未直接针对特定共病的药物类别。处方史可以改善基线风险评估，但一些关联可能与背景有关。
