北京社区老年人心血管相关潜在不适当用药情况的前瞻性队列研究

Potentially inappropriate medications with risk of cardiovascular events among community-dwelling old adults in Beijing:a prospective cohort study

【摘要】目的 分析社区老年人心血管相关潜在不适当用药(PIM)的风险因素及其对死亡的影响,为促进合理用药提供依据。方法 2009年9月至20110年6月,依据Beers标准(2019版)对北京市万寿路地区≥65岁老年人PIM的发生情况进行评价。数据经EpiData平行双录入。采用SPSS 25.0统计软件进行数据分析。根据数据类型分别采用t检验、Mann-Whitney U检验、χ²检验或Fisher精确检验进行组间比较。采用多因素logistic回归模型分析PIM的影响因素。采用Cox比例风险回归模型分析PIM对死亡的影响。结果 共纳入1730名社区老年人,罹患心血管疾病0~7种,常规用药0~11种。多种心血管病共存者占50.4%(872/1730),多重用药者占8.0%(139/1730),PIM的发生率为18.6%(321/1730)。多种心血管病共存(OR=2.610,95%CI 1.974~3.451)、心血管系统多重用药(OR=1.805,95%CI 1.215~2.681)及内生肌酐清除率(Ccr)＜30ml/min(OR=2.446,95%CI 0.991~6.035)是社区老年人群发生PIM的风险因素；大专及以上学历(OR=0.474,95%CI 0.351~0.640)和已婚(OR=0.681,95%CI 0.502~0.924)是PIM的保护因素。PIM的发生在总人群中增加了78.3%(HR=1.783,95%CI 1.155~2.752)的心血管死亡风险,在男性人群中增加了114.8%(HR=2.148,95%CI 1.154~3.996)的心血管死亡风险。结论 PIM在社区老人中普遍发生,可作为死亡风险预测的参考指标。

基金项目:国家自然科学基金(82173589,82173590)；国家重点研发计划(2022YFC2503605)；首都卫生发展科研专项(首发2022-2G-5031)

【Abstract】Objective To analyze the risk factors for cardiovascular events related to potentially inappropriate medication (PIM) among community-dwelling elderly people and investigate the impact of PIM on mortality in order to provide a reference for promoting rational use of medicine. Methods Between September 2009 and June 2010, a survey was conducted on the elderly people aged≥65 years living in the Wanshou Road area of Beijing based on the Beers standard (2019 version). Parallel double entry was employed to input the data through EpiData. SPSS statistics 25.0 was used for data analysis. Student′s t test, Mann-Whitney U test, Chi-square test, or Fisher exact test was applied for intergroup comparison depending on data type. Multivariate logistic regression model was conducted to analyze the influencing factors for PIM. Cox proportional hazards regression model was utilized to determine the effect of PIM on mortality. Results For the 1 730 included elderly people, they suffered from 0-7 types of cardiovascular diseases and had polypharmacy of 0-11 types of conventional medicines. The patients with comorbidity of multiple cardiovascular diseases accounted for 50.4% (872/1 730), the incidence of polypharmacy was 8.0% (139/1 730), and the incidence of PIM was 18.6% (321/1 730). Comorbidity of multiple cardiovascular diseases (OR=2.610,95%CI 1.974-3.451), multiple use of drugs in the cardiovascular system (OR=1.805,95%CI 1.215-2.681), and endogenous creatinine clearance rate (Ccr) <30 ml/min (OR=2.446,95%CI 0.991-6.035) were risk factors for PIM in the elderly population in the community. Education level of college degree or above (OR=0.474,95% CI 0.351-0.640) and married (OR=0.681,95%CI 0.502-0.924) were protective factors for PIM. The occurrence of PIM increased the risk of cardiovascular death by 78.3% (HR=1.783,95%CI 1.155-2.752) in the general population and 114.8% (HR=2.148,95%CI 1.154-3.996) in the male. Conclusion PIM is quite common among community-dwelling old adults and can be regarded as a reference indicator for predicting mortality risk.

This work was supported by the National Natural Science Foundation of China (82173589, 82173590), the National Key Research and Development Program of China (2022YFC2503605) and the Special Fund for Capital Health Improvement and Research (2022-2G-5031).