Sex differences associated with adverse drug reactions resulting in hospital admissions

L C Hendriksen,J G Kuiper,P M L A Van Den Bemt,S J Siiskonen,B H Stricker,P D Van Der Linden,L E Visser,A L M Lagro-Janssen,R M C Herings,M Teichert

doi:10.1186/s13293-021-00377-0

L C Hendriksen, J G Kuiper + Show 8 more

Open Access

https://doi.org/10.1186/s13293-021-00377-0

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Abstract

BackgroundAdverse drug events, including adverse drug reactions (ADRs), are responsible for approximately 5% of unplanned hospital admissions: a major health concern. Women are 1.5–1.7 times more likely to develop ADRs. The main objective was to identify sex differences in the types and number of ADRs leading to hospital admission.MethodsADR-related hospital admissions between 2005 and 2017 were identified from the PHARMO Database Network using hospital discharge diagnoses. Patients aged ≥ 16 years with a drug possibly responsible for the ADR and dispensed within 3 months before admission were included. Age-adjusted odds ratios (OR) with 95% CIs for drug-ADR combinations for women versus men were calculated.ResultsA total of 18,469 ADR-related hospital admissions involving women (0.35% of all women admitted) and 14,678 admissions involving men (0.35% of all men admitted) were included. Most substantial differences were seen in ADRs due to anticoagulants and diuretics. Anticoagulants showed a lower risk of admission with persistent haematuria (ORadj 0.31; 95%CI 0.21, 0.45) haemoptysis (ORadj 0.47, 95%CI 0.30,0.74) and subdural haemorrhage (ORadj 0.61; 95%CI 0.42,0.88) in women than in men and a higher risk of rectal bleeding in women (ORadj 1.48; 95%CI 1.04,2.11). Also, there was a higher risk of admission in women using thiazide diuretics causing hypokalaemia (ORadj 3.03; 95%CI 1.58, 5.79) and hyponatraemia (ORadj 3.33, 95%CI 2.31, 4.81) than in men.ConclusionsThere are sex-related differences in the risk of hospital admission in specific drug-ADR combinations. The most substantial differences were due to anticoagulants and diuretics.

Highlights

Adverse drug events, including adverse drug reactions (ADRs), are responsible for approximately 5% of unplanned hospital admissions: a major health concern
The majority of the studies that showed that women are more at risk for ADRs than men are based on spontaneous reports of ADRs that can suffer from reporting bias between women and men [8,9,10,11]
In order to examine this, we investigated the number of ADR-associated hospital admissions over the years for both women and men, which drugs and ADRs caused most hospital admissions, and whether the associated risk for the most common drug-ADR combinations differed between women and men

Summary

Introduction

Adverse drug events, including adverse drug reactions (ADRs), are responsible for approximately 5% of unplanned hospital admissions: a major health concern. Women are 1.5–1.7 times more likely to develop ADRs. The main objective was to identify sex differences in the types and number of ADRs leading to hospital admission. Interest for sex differences in drug use and its effects is increasing. This is partly explained by a different incidence of several diseases in women compared with men. An earlier study related the risk difference between women and men to the total number of hospital admissions and the total number of prescriptions; it was not possible to adjust for age and drug use on patient level due to the ecological design [12]

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