Association between Anti-Psychotic Drugs Use and Hip Fractures in Patients with Dementia: A Nationwide Population-Based Study
Abstract
:1. Introduction
1.1. Background/Rationale
1.2. Objectives
2. Materialss and Methods
2.1. Data Source
2.2. Study Cohort
2.3. Cases and Controls
2.4. Exposures
2.5. Covariates
2.6. Statistical Analysis
3. Results
4. Discussion
4.1. APD and Risk of Hip Fractures
4.2. The Impact of Different Classes of APD on the Risk of Hip Fractures
4.3. The Dose–Response Relationship
4.4. Strengths and Limitations
5. Conclusions
Supplementary Materials
Author Contributions
Funding
Institutional Review Board Statement
Informed Consent Statement
Data Availability Statement
Acknowledgments
Conflicts of Interest
References
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Characteristic | Hip Fracture N = 11,493 | No Hip Fracture N = 45,972 | p-Value |
---|---|---|---|
Age (Mean ± SD) | 77.72 ± 7.94 | 77.72 ± 7.94 | 1.0000 |
50–65 | 839 (7.30) | 3356 (7.30) | 1.0000 |
65–80 | 6252 (54.40) | 25,008 (54.40) | |
≥80 | 4402 (38.30) | 17,608 (38.30) | |
Gender | |||
Female | 6402 (55.70) | 25,608 (55.70) | 1.0000 |
Male | 5091 (44.30) | 20,364 (44.30) | |
Comorbidity | |||
Anemia | 581 (5.06) | 2261 (4.92) | 0.5445 |
Coronary heart disease | 1839 (16.00) | 7322 (15.93) | 0.8464 |
Hypertension | 5401 (46.99) | 22,321 (48.55) | 0.0028 |
Cerebrovascular disease | 2859 (24.88) | 13,545 (29.46) | <0.0001 |
COPD | 1167 (10.15) | 4918 (10.70) | 0.0901 |
Diabetes | 2535 (22.06) | 10,182 (22.15) | 0.8329 |
Malignant neoplasm | 537 (4.67) | 2231 (4.85) | 0.4188 |
Peripheral vascular disease | 52 (0.45) | 243 (0.53) | 0.3070 |
Parkinsonism | 747 (6.50) | 2773 (6.03) | 0.0615 |
Rheumatoid arthritis | 60 (0.52) | 209 (0.45) | 0.3435 |
Renal failure | 433 (3.77) | 1924 (4.19) | 0.0435 |
Hyperlipidemia | 1196 (10.41) | 5159 (11.22) | 0.0126 |
Menopause syndrome | 99 (0.86) | 480 (1.04) | 0.0794 |
Obesity | 5 (0.04) | 16 (0.03) | 0.6625 |
Arrhythmia | 993 (8.64) | 4336 (9.43) | 0.0089 |
Thyrotoxicosis | 46 (0.40) | 204 (0.44) | 0.5262 |
Psychiatry comorbidity | |||
Epilepsy | 150 (1.31) | 727 (1.58) | 0.0307 |
Psychosis-related disorder | 170 (1.48) | 515 (1.12) | 0.0015 |
Mood disorder | 566 (4.92) | 1961 (4.27) | 0.0021 |
Alcohol-related disorder | 61 (0.53) | 149 (0.32) | 0.0010 |
Substance use disorder | 22 (0.19) | 56 (0.12) | 0.0699 |
Sleep disorder | 1500 (13.05) | 5286 (11.50) | 0.0001 |
Concomitant drugs | |||
Anticholinergics | 1629 (14.17) | 4493 (9.77) | <0.0001 |
Antidepressants | 3997 (34.78) | 11,611 (25.26) | <0.0001 |
Anxiolytics | 7659 (66.64) | 24,066 (52.35) | <0.0001 |
Hypnotics and sedatives | 3541 (30.81) | 10,621 (23.10) | <0.0001 |
Z-drugs | 3995 (34.76) | 11,237 (24.44) | <0.0001 |
Mood stabilizers | 1468 (12.77) | 5146 (11.19) | <0.0001 |
Oral glucocorticoids | 3902 (33.95) | 13,415 (29.18) | <0.0001 |
HRT (HRT + SERM) | 270 (2.35) | 742 (1.61) | <0.0001 |
Other osteoporosis drugs | 688 (5.99) | 672 (1.46) | <0.0001 |
Variable | Hip Fracture | No Hip Fracture | Crude OR (95% CI) | Adjusted OR a (95% CI) | ||
---|---|---|---|---|---|---|
APD Non-Users | APD Users | APD Non-Users | APD Users | |||
Patients | 4417 (38.43) | 7076 (61.57) | 23,620 (51.38) | 22,352 (48.62) | 1.73 (1.66–1.81) | 1.38 (1.32–1.45) |
Age groups | ||||||
50–65 | 327 (7.40) | 512 (7.24) | 1785 (7.56) | 1571 (7.03) | 1.83 (1.56–2.15) | 1.40 (1.17–1.67) |
65–80 | 2349 (53.18) | 3903 (55.16) | 12,713 (53.82) | 12,295 (55.01) | 1.77 (1.67–1.88) | 1.41 (1.32–1.50) |
≥80 | 1741 (39.42) | 2661 (37.61) | 9122 (38.62) | 8486 (37.97) | 1.67 (1.56–1.79) | 1.33 (1.23–1.43) |
Gender | ||||||
Female | 2418 (37.77) | 3984 (62.23) | 13,154 (51.37) | 12,454 (48.63) | 1.79 (1.69–1.89) | 1.42 (1.33–1.51) |
50–65 | 142 (5.87) | 222 (5.57) | 766 (5.82) | 690 (5.54) | 1.79 (1.41–2.27) | 1.35 (1.02–1.77) |
65–80 | 1279 (52.89) | 2208 (55.42) | 7074 (53.78) | 6874 (55.20) | 1.84 (1.70–1.99) | 1.45 (1.34–1.58) |
≥80 | 997 (41.23) | 1554 (39.01) | 5314 (40.40) | 4890 (39.26) | 1.72 (1.57–1.88) | 1.37 (1.24–1.51) |
Male | 1999 (39.27) | 3092 (60.73) | 10,466 (51.39) | 9898 (48.61) | 1.67 (1.57–1.78) | 1.33 (1.24–1.43) |
50–65 | 185 (9.25) | 290 (9.38) | 1019 (9.74) | 881 (8.90) | 1.87 (1.51–2.30) | 1.41 (1.11–1.78) |
65–80 | 1070 (53.53) | 1695 (54.82) | 5639 (53.88) | 5421 (54.77) | 1.70 (1.55–1.85) | 1.36 (1.23–1.49) |
≥80 | 744 (37.22) | 1107 (35.80) | 3808 (36.38) | 3596 (36.33) | 1.60 (1.44–1.77) | 1.26 (1.13–1.42) |
Characteristics of Antipsychotic Drug Exposure | Crude OR (95% CI) | Adjusted OR a (95% CI) | Adjusted OR b (95% CI) |
---|---|---|---|
Exposure status of APD | |||
Nonusers | Ref. | Ref. | - |
0–30 (current users) | 3.00 (2.85–3.16) | 2.36 (2.23–2.50) | 3.07 (2.84–3.32) |
31–180 (recent users) | 1.51 (1.40–1.63) | 1.23 (1.14–1.33) | 1.56 (1.41–1.73) |
>180 (past users) | 1.00 (0.95–1.06) | 0.85 (0.80–0.90) | Ref. |
Type of APD | |||
Nonusers | Ref. | Ref. | - |
FGA alone | 1.37 (1.28–1.46) | 1.18 (1.10–1.26) | Ref. |
SGA alone | 1.61 (1.52–1.69) | 1.36 (1.29–1.44) | 1.17 (1.08–1.27) |
Combination | 2.37 (2.23–2.51) | 1.70 (1.59–1.82) | 1.55 (1.42–1.69) |
Cumulative exposure dose (DDD) | |||
Nonusers | Ref. | Ref. | - |
0–25 | 1.53 (1.44–1.64) | 1.33 (1.24–1.42) | Ref. |
26–225 | 1.76 (1.65–1.88) | 1.44 (1.34–1.54) | 1.10 (1.01–1.21) |
226–1135 | 1.75 (1.64–1.86) | 1.37 (1.28–1.47) | 1.05 (0.96–1.15) |
>1135 | 1.91 (1.79–2.03) | 1.39 (1.30–1.49) | 1.12 (1.02–1.22) |
Cumulative exposure duration (day) | |||
Nonusers | Ref. | Ref. | - |
0–15 | 1.67 (1.57–1.79) | 1.46 (1.37–1.57) | Ref. |
16–65 | 1.61 (1.51–1.71) | 1.33 (1.24–1.42) | 0.94 (0.85–1.03) |
65–215 | 1.68 (1.57–1.79) | 1.29 (1.21–1.38) | 0.93 (0.85–1.02) |
>215 | 2.01 (1.89–2.14) | 1.47 (1.37–1.58) | 1.07 (0.97–1.17) |
Average daily dose (DDD/day) | |||
Nonusers | Ref. | Ref. | - |
≤0.5 | 1.40 (1.29–1.52) | 1.24 (1.14–1.35) | Ref. |
0.5–1 | 1.59 (1.45–1.75) | 1.34 (1.21–1.47) | 1.05 (0.92–1.20) |
1–2 | 1.64 (1.52–1.77) | 1.33 (1.23–1.44) | 1.10 (0.98–1.24) |
>2 | 1.86 (1.77–1.95) | 1.44 (1.37–1.52) | 1.19 (1.08–1.31) |
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Tang, C.-H.; Lai, Y.-C.; Chen, Y.-C.; Chang, S.-M.; Chen, Y.-H.; Liao, J.-Y.; Wang, Y.-C.; Ho, C.-H.; Chen, P.-J. Association between Anti-Psychotic Drugs Use and Hip Fractures in Patients with Dementia: A Nationwide Population-Based Study. Int. J. Environ. Res. Public Health 2021, 18, 8118. https://doi.org/10.3390/ijerph18158118
Tang C-H, Lai Y-C, Chen Y-C, Chang S-M, Chen Y-H, Liao J-Y, Wang Y-C, Ho C-H, Chen P-J. Association between Anti-Psychotic Drugs Use and Hip Fractures in Patients with Dementia: A Nationwide Population-Based Study. International Journal of Environmental Research and Public Health. 2021; 18(15):8118. https://doi.org/10.3390/ijerph18158118
Chicago/Turabian StyleTang, Chia-Hung, Yi-Chen Lai, Yi-Chen Chen, Shun-Min Chang, Yu-Han Chen, Jung-Yu Liao, Yi-Chi Wang, Chung-Han Ho, and Ping-Jen Chen. 2021. "Association between Anti-Psychotic Drugs Use and Hip Fractures in Patients with Dementia: A Nationwide Population-Based Study" International Journal of Environmental Research and Public Health 18, no. 15: 8118. https://doi.org/10.3390/ijerph18158118