Abstract
Empirical data of medication-related hospitalization are very limited. We aimed to investigate the associations between 12 high risk medication categories (diabetic agents, diuretics, nonsteroidal anti-inflammatory drugs (NSAIDs), anticoagulants, antiplatelets, antihypertensives, antiarrhythmics, anticonvulsants, antipsychotics, antidepressants, benzodiazepine (BZD)/Z-hypnotics, and narcotics) and unplanned hospitalizations. A population-based case–time–control study was performed using Taiwan’s National Health Insurance Research Database. Patients who experienced an unplanned hospitalization (index visit) were identified as index subjects and matched to a randomly selected reference visit within users of a specific category of high-risk medication. An unplanned hospitalization was defined as a hospital admission immediately after an emergency department visit. Discordant exposures to the high-risk medication during the case period (1–14 days before the visit) and the control period (366–379 days before the visit) were examined in both index and reference visits. Antipsychotics was associated with the highest risk of unplanned hospitalizations (adjusted OR: 1.54, 95% CI [1.37–1.73]), followed by NSAIDs (1.50, [1.44–1.56]), anticonvulsants (1.34, [1.10–1.64]), diuretics (1.24, [1.15–1.33]), BZD/Z-hypnotics (1.23, [1.16–1.31]), antidepressants (1.17, [1.05–1.31]) and antiplatelets (1.16, [1.07–1.26]). NSAIDs and narcotics were associated with the highest risks of unplanned hospitalizations with a length of stay ≥10 days. These medication categories should be targeted for clinical and policy interventions.
Highlights
Adverse drug events (ADEs) and their associated morbidity and mortality[1] represent a significant burden on the healthcare system[2]
The case–time–control odds ratios (ORs) revealed that exposure to antipsychotics was associated with the highest risk of unplanned hospitalizations, followed by exposure to nonsteroidal anti-inflammatory drugs (NSAIDs), anticonvulsants, diuretics, BZD/Z-hypnotics, antidepressants, and antiplatelets
Among the 12 high-risk medication categories studied, we found that antipsychotics, NSAIDs, anticonvulsants, diuretics, BZD/Z-hypnotics, antidepressants, and antiplatelets were significantly associated with increased risks
Summary
Adverse drug events (ADEs) and their associated morbidity and mortality[1] represent a significant burden on the healthcare system[2]. Previous studies have adopted different approaches to identify ADE-related hospitalizations, such as analysis of spontaneous reporting data[9], medical chart review[5,7,8,10,11,12,13,14], and screening diagnostic codes from electronic medical databases[15,16,17] These methods are plagued with under-reporting issues and reporting bias. Some suspected high-risk medications indicated in previous studies were not included in that study, such as central nervous system-acting drugs[4] To address these limitations, we evaluated the associations between 12 high-risk medication categories and unplanned hospitalizations. The other one is to test whether the association between high risk medication and unplanned hospitalization varied with age
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