Kim Hyungmin, Hong Song Hee
College of Pharmacy, Seoul National University, Seoul, Republic of Korea.
National Health Insurance Service, Wonju, Republic of Korea.
BMJ Open. 2024 Jul 17;14(7):e073367. doi: 10.1136/bmjopen-2023-073367.
To investigate the association between exposure to potentially inappropriate medication (PIM) and poor prognosis of COVID-19 in older adults, controlling for comorbidity and sociodemographic factors.
Nationwide retrospective cohort study based on the national registry of COVID-19 patients, established through the linkage of South Korea's national insurance claims database with the Korea Disease Control and Prevention Agency registry of patients with COVID-19, up to 31 July 2020.
A total of 2217 COVID-19 patients over 60 years of age who tested positive between 20 January 2022 and 4 June 2020. Exposure to PIM was defined based on any prescription record of PIM during the 30 days prior to the date of testing positive for COVID-19.
Mortality and utilisation of critical care from the date of testing positive until the end of isolation.
Among the 2217 COVID-19 patients over 60 years of age, 604 were exposed to PIM prior to infection. In the matched cohort of 583 pairs, PIM-exposed individuals exhibited higher rates of mortality (19.7% vs 9.8%, p<0.0001) and critical care utilisation (13.4% vs 8.9%, p=0.0156) compared with non-exposed individuals. The temporal association of PIM exposure with mortality was significant across all age groups (RR=1.68, 95% CI: 1.232.24), and a similar trend was observed for critical care utilisation (RR: 1.75, 95% CI: 1.262.39). The risk of mortality and critical care utilisation increased with exposure to a higher number of PIMs in terms of active pharmaceutical ingredients and drug categories.
Exposure to PIM exacerbates the poor outcomes of older patients with COVID-19 who are already at high risk. Effective interventions are urgently needed to address PIM exposure and improve health outcomes in this vulnerable population.
在控制合并症和社会人口学因素的情况下，调查老年人接触潜在不适当用药（PIM）与2019冠状病毒病（COVID-19）预后不良之间的关联。
基于韩国国家保险理赔数据库与韩国疾病控制和预防机构COVID-19患者登记系统的关联建立的全国COVID-19患者登记系统进行的全国性回顾性队列研究，截至2020年7月31日。
2022年1月20日至2020年6月4日期间检测呈阳性的2217名60岁以上的COVID-19患者。PIM暴露根据COVID-19检测呈阳性日期前30天内的任何PIM处方记录来定义。
从检测呈阳性之日起至隔离结束期间的死亡率和重症监护使用率。
在2217名60岁以上的COVID-19患者中，604人在感染前接触过PIM。在583对匹配队列中，与未接触PIM的个体相比，接触PIM的个体死亡率更高（19.7%对9.8%，p<0.0001），重症监护使用率更高（13.4%对8.9%，p=0.0156）。在所有年龄组中，PIM暴露与死亡率的时间关联均显著（风险比[RR]=1.68，95%置信区间[CI]：1.232.24），重症监护使用率也观察到类似趋势（RR：1.75，95%CI：1.262.39）。就活性药物成分和药物类别而言，如果接触的PIM数量越多，死亡率和重症监护使用率的风险就越高。
接触PIM会加剧已处于高风险的老年COVID-19患者的不良结局。迫切需要采取有效的干预措施来解决PIM暴露问题，并改善这一弱势群体的健康结局。
