The Royal (Dick) School of Veterinary Studies, University of Edinburgh, Edinburgh, UK.
Edinburgh Medical School, University of Edinburgh, Edinburgh, UK.
Lancet Healthy Longev. 2023 Aug;4(8):e421-e430. doi: 10.1016/S2666-7568(23)00105-8.
Concerns have been raised that antipsychotic drug prescribing, which has been associated with increased mortality in people with dementia, might have increased during the COVID-19 pandemic due to social restrictions imposed to limit the spread of SARS-CoV-2. We used multisource, routinely collected health-care data from Wales, UK to investigate prescribing and mortality variations in people with dementia before and during the COVID-19 pandemic.
In this retrospective cohort study, we used individual-level, anonymised, population-scale linked health data to identify adults aged 60 years and older with a diagnosis of dementia in Wales, UK. We used the CVD-COVID-UK initiative to access Welsh routinely collected electronic health record data from the Secure Anonymised Information Linkage (SAIL) Databank. Patients who were alive and registered with a SAIL general practice on Jan 1, 2016, and who received a dementia diagnosis before the age of 60 years and before or during the study period were included. We explored antipsychotic drug prescribing rate changes over 67 months, between Jan 1, 2016, and Aug 1, 2021, overall and stratified by age and dementia subtype. We used time-series analyses to examine all-cause and myocardial infarction and stroke mortality over the study period and identified the leading causes of death in people with dementia between Jan 1, 2020, and Aug 1, 2021.
Of 3 106 690 participants in SAIL between Jan 1, 2016 and Aug 1, 2021, 57 396 people (35 148 [61·2%] women and 22 248 [38·8%] men) met inclusion criteria for this study and contributed 101 428 person-years of follow-up. Of the 57 396 people with dementia, 11 929 (20·8%) were prescribed an antipsychotic drug at any point during follow-up. Accounting for seasonality, antipsychotic drug prescribing increased during the second half of 2019 and throughout 2020. However, the absolute difference in prescribing rates was small, ranging from 1253 prescriptions per 10 000 person-months in March, 2019, to 1305 per 10 000 person-months in September, 2020. All-cause mortality and stroke mortality increased throughout 2020, while myocardial infarction mortality declined. From Jan 1, 2020, to Aug 1, 2021, 1286 (17·1%) of 7508 participants who died had COVID-19 recorded as the underlying cause of death.
During the COVID-19 pandemic, antipsychotic drug prescribing in people with dementia in the UK increased slightly; however, it is unlikely that this was solely related to the pandemic and this increase was unlikely to be a major factor in the substantial increase in mortality during 2020. The long-term increase in antipsychotic drug prescribing in younger people and in those with Alzheimer's disease warrants further investigation using resources with access to more granular clinical data. Although deprescribing antipsychotic medications remains an essential aspect of dementia care, the results of this study suggest that changes in prescribing and deprescribing practices as a result of the COVID-19 pandemic are not required.
British Heart Foundation (via the British Heart Foundation Data Science Centre led by Health Data Research UK), and the Scottish Neurological Research Fund.
人们担心，由于为限制 SARS-CoV-2 传播而实施的社会限制，抗精神病药物的处方可能会增加，而这种药物的使用与痴呆患者的死亡率增加有关。我们使用来自英国威尔士的多源、常规收集的医疗保健数据，调查了痴呆患者在 COVID-19 大流行前后的处方和死亡率变化。
在这项回顾性队列研究中，我们使用个体水平、匿名、人群规模的链接健康数据，从英国威尔士确定患有痴呆症的 60 岁及以上成年人。我们使用 CVD-COVID-UK 计划从 SAIL 数据库中获取威尔士常规收集的电子健康记录数据。在 2016 年 1 月 1 日仍然存活并在 SAIL 普通科医生处登记、在 60 岁之前和研究期间被诊断患有痴呆症的患者被纳入研究。我们探讨了在 2016 年 1 月 1 日至 2021 年 8 月 1 日的 67 个月内，总体和按年龄和痴呆亚型分层的抗精神病药物处方率变化。我们使用时间序列分析研究了研究期间的全因和心肌梗死和中风死亡率，并确定了 2020 年 1 月 1 日至 2021 年 8 月 1 日期间痴呆患者的主要死亡原因。
在 2016 年 1 月 1 日至 2021 年 8 月 1 日期间 SAIL 中的 3106690 名参与者中，有 57396 人（35148 [61.2%] 名女性和 22248 [38.8%] 名男性）符合本研究的纳入标准，并提供了 101428 人年的随访。在 57396 名痴呆患者中，有 11929 人（20.8%）在随访期间的任何时候都开了抗精神病药物。考虑到季节性因素，抗精神病药物的处方在 2019 年下半年和 2020 年全年都有所增加。然而，处方率的绝对差异很小，从 2019 年 3 月的每 10000 人月 1253 张处方到 2020 年 9 月的每 10000 人月 1305 张处方不等。2020 年期间全因死亡率和中风死亡率增加，而心肌梗死死亡率下降。从 2020 年 1 月 1 日至 2021 年 8 月 1 日，在 1286 名死亡参与者中（17.1%），有 1250 名 COVID-19 被记录为根本死因。
在 COVID-19 大流行期间，英国痴呆患者的抗精神病药物处方略有增加；然而，这不太可能仅仅与大流行有关，这种增加不太可能是 2020 年死亡率大幅增加的主要因素。在年轻人和阿尔茨海默病患者中抗精神病药物处方的长期增加需要进一步研究，使用可以获得更精细的临床数据的资源。尽管减少抗精神病药物的使用仍然是痴呆症护理的一个重要方面，但这项研究的结果表明，由于 COVID-19 而改变处方和减少处方的做法并不是必需的。
英国心脏基金会（通过由健康数据研究英国领导的英国心脏基金会数据科学中心提供）和苏格兰神经学研究基金。
