Department of Medicine (Neurology) University of Toronto, Sunnybrook Health Sciences Centre Toronto ON Canada.
ICES Toronto ON Canada.
J Am Heart Assoc. 2024 Apr 16;13(8):e034118. doi: 10.1161/JAHA.123.034118. Epub 2024 Apr 2.
In the wake of pandemic-related health decline and health care disruptions, there are concerns that previous gains for cardiovascular risk factors may have stalled or reversed. Population-level excess burden of drug-treated diabetes and hypertension during the pandemic compared with baseline is not well characterized. We evaluated the change in incident prescription claims for antihyperglycemics and antihypertensives before versus during the pandemic.
In this retrospective, serial, cross-sectional, population-based study, we used interrupted time series analyses to examine changes in the age- and sex-standardized monthly rate of incident prescriptions for antihyperglycemics and antihypertensives in patients aged ≥66 years in Ontario, Canada, before the pandemic (April 2014 to March 2020) compared with during the pandemic (July 2020 to November 2022). Incident claim was defined as the first prescription filled for any medication in these classes. The characteristics of patients with incident prescriptions of antihyperglycemics (n=151 888) or antihypertensives (n=368 123) before the pandemic were comparable with their pandemic counterparts (antihyperglycemics, n=97 015; antihypertensives, n=146 524). Before the pandemic, monthly rates of incident prescriptions were decreasing (-0.03 per 10 000 individuals [95% CI, -0.04 to -0.01] for antihyperglycemics; -0.14 [95% CI, -0.18 to -0.10] for antihypertensives). After July 2020, monthly rates increased (postinterruption trend 0.31 per 10 000 individuals [95% CI, 0.28-0.34] for antihyperglycemics; 0.19 [95% CI, 0.14-0.23] for antihypertensives).
Population-level increases in new antihyperglycemic and antihypertensive prescriptions during the pandemic reversed prepandemic declines and were sustained for >2 years. Our findings are concerning for current and future cardiovascular health.
在与大流行相关的健康下降和医疗服务中断之后,人们担心心血管风险因素的先前获益可能已经停滞或逆转。大流行期间与基线相比,人群中药物治疗的糖尿病和高血压的负担过高,尚未得到充分描述。我们评估了大流行前后新的抗高血糖药和抗高血压药处方的发生率。
在这项回顾性、连续、横断面、基于人群的研究中,我们使用中断时间序列分析来检查加拿大安大略省≥66 岁患者在大流行前(2014 年 4 月至 2020 年 3 月)与大流行期间(2020 年 7 月至 2022 年 11 月)每月新的抗高血糖药和抗高血压药处方的年龄和性别标准化发生率的变化。新处方定义为这些类别中任何药物的首次处方。大流行前和大流行期间新的抗高血糖药(n=151888)或抗高血压药(n=368123)处方患者的特征与大流行期间的患者相似(抗高血糖药,n=97015;抗高血压药,n=146524)。在大流行之前,新处方的每月发生率呈下降趋势(抗高血糖药为-0.03/10000 人[95%CI,-0.04 至-0.01];抗高血压药为-0.14[95%CI,-0.18 至-0.10])。2020 年 7 月之后,每月的发生率增加(中断后趋势为抗高血糖药为 0.31/10000 人[95%CI,0.28-0.34];抗高血压药为 0.19[95%CI,0.14-0.23])。
大流行期间人群中新型抗高血糖药和抗高血压药处方的增加逆转了大流行前的下降趋势,并持续了>2 年。我们的发现令人担忧,因为这对当前和未来的心血管健康产生影响。