Environmental Health Sciences Laboratory, Graduate School of Advanced Science and Engineering, Hiroshima University, Hiroshima, Japan; Department of Community-Based Medical Systems, Graduate School of Biomedical and Health Sciences, Hiroshima University, Hiroshima, Japan.
Department of Community-Based Medical Systems, Graduate School of Biomedical and Health Sciences, Hiroshima University, Hiroshima, Japan.
J Am Med Dir Assoc. 2022 Jun;23(6):1045-1051. doi: 10.1016/j.jamda.2021.12.037. Epub 2022 Feb 2.
Natural disasters can impair the cognitive function of older victims. However, it is unknown whether such natural disasters affect drug treatment for dementia. The aim of this study was to evaluate the effect of the 2018 Japan Floods, the second largest water-related disaster in Japan, on the prescriptions of antidementia drugs (ADD) for older people (≥65 years of age).
Retrospective cohort study.
Prescription data in Hiroshima, Okayama, and Ehime prefectures for 1 year before and after the disaster were extracted from the National Database of Health Insurance Claims. From the database, we selected 1,710,119 people age 65 years or over as the study participants.
In logistic regression models, sex- and age-adjusted odds ratios (ORs) of victims for new ADD prescriptions were calculated. Trends for the ORs before and after the disaster were evaluated using difference-in-difference models. Whether or not there was an increase in the trend for ADD prescriptions (daily dose or number of drug types) was also evaluated among continuous ADD users.
Among 1,710,119 participants, 15,994 (0.9%) were recorded as a disaster-victims, and 112,289 (6.6%) were prescribed ADD. Among original nonusers, after the disaster, victims were more likely to start using ADD than nonvictims who had not been affected [adjusted OR = 1.33 (95% CI 1.16-1.52)]. Among continuous users, an increasing trend for ADD prescriptions was more often observed for victims than nonvictims [1.61 (1.13-2.31)]. This effect was robust even after the predisaster trend of ADD use was taken into consideration.
The disaster increased the number of users of antidementia medications. The findings suggest the need for evidence-based recommendations to address cognitive impairment among disaster victims, which is lacking in current clinical and disaster guidelines worldwide.
自然灾害可能损害老年受害者的认知功能。然而，目前尚不清楚自然灾害是否会影响痴呆症的药物治疗。本研究旨在评估 2018 年日本洪水（日本第二大与水有关的灾害）对老年人（≥65 岁）抗痴呆药物（ADD）处方的影响。
回顾性队列研究。
从国家健康保险索赔数据库中提取了灾害前和灾害后广岛、冈山和爱媛县的处方数据。从数据库中，我们选择了 1710119 名 65 岁或以上的人作为研究参与者。
在逻辑回归模型中，计算了新 ADD 处方受害者的性别和年龄调整比值比（OR）。使用差异模型评估了灾害前后 OR 的趋势。还评估了连续 ADD 用户中 ADD 处方（每日剂量或药物类型数量）趋势是否增加。
在 1710119 名参与者中，有 15994 人（0.9%）记录为受灾者，有 112289 人（6.6%）开具了 ADD 处方。在原始非使用者中，灾难后，与未受影响的非受害者相比，受害者更有可能开始使用 ADD[调整后的 OR=1.33（95%CI 1.16-1.52）]。在连续使用者中，与非受害者相比，ADD 处方的增加趋势在受害者中更为常见[1.61（1.13-2.31）]。即使考虑了 ADD 使用的灾前趋势，这种效果也是稳健的。
这场灾难增加了抗痴呆药物使用者的数量。研究结果表明，有必要根据循证建议来解决受灾者的认知障碍问题，而这在全球当前的临床和灾难指南中是缺乏的。
