多药与死亡率的关联:从潜在的发病率混
Emma Bjørk1,2,3, Christopher T Rentsch4,5, Rishi J Desai6
1Hospital Pharmacy Funen, Odense University Hospital, Odense, Denmark.
Journal of the American Geriatrics Society
|July 4, 2025
概括
多药与较高的死亡率有关,但通过调整潜在的健康状况,这种关联显著减弱. 由于药物研究中的混因素,需要谨慎解释.
科学领域:
- 老年学是一门学科.
- 药理学 药理学是指药理学的学科.
- 流行病学 流行病学
背景情况:
- 研究将多药性 (使用多种药物) 与死亡率的增加联系起来.
- 以前的研究往往无法充分调整混因素,特别是潜在疾病.
研究的目的:
- 突出多药性死亡率研究中的挑战.
- 检查多药与两种不同人群的死亡率之间的关联:养老院居民和社区居住的老年人.
主要方法:
- 利用全国性的丹麦登记册,对两个群体进行调查:养老院入院者 (2015-2021,n=95,057) 和65岁以上 (n=1,005,963) 的社区居民.
- 使用卡普兰-梅尔图表评估1年死亡率,并模拟了多药房死亡率与受限立方线的关联,并应用了不同级别的调整.
- 研究了20种最常用的药物与1年死亡率之间的关联.
主要成果:
- 在养老院居民中,随着药物数量的增加,死亡率增加,但对伴随疾病的调整使得赔率比率从4.70降至2.23.
- 在社区生活的老年人中,调整的影响更大,使得赔率比率从10.39降至1.34.
- 观察到某些药物类别 (例如,抗痴呆药物) 的矛盾反向关联,并注意到养老院居民的药物使用波动,但在一般人群中稳定.
结论:
- 多药与死亡率之间的关联在很大程度上受到根据指示的混的影响.
- 虽然并发症调整减轻了这种关联,但残留混可能会持续存在.
- 强调需要仔细解释那些将高药用量与死亡率联系起来的研究.
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