Impact of high risk drug use on hospitalization and mortality in older people with and without Alzheimer's disease: A national population cohort study

Background: Evidence is lacking about outcomes associated with the cumulative use of anticholinergic and sedative drugs in people with Alzheimer s disease (AD). This retrospective cohort study investigated the relationship between cumulative exposure to anticholinergic and sedative drugs and hospitalization and mortality in people with and without AD in Finland. Methods: Community-dwelling people aged 65 years and over, with AD on December 31 st 2005 (n = 16,603) and individually matched (n = 16,603) comparison persons (age, sex, region of residence) were identified by the Social Insurance Institution of Finland. Drug utilization data were extracted from the Finnish National Prescription Register. Exposure to anticholinergic and sedative drugs was defined using the Drug Burden Index (DBI). Hospitalization and mortality data were extracted from national registers. Cox and zero-inflated negative binomial analyses were used to investigate the relationship between DBI and hospitalization and mortality over a one-year follow-up. Results: In total, 5.8 of people with AD and 3.7 without AD died during 2006. For every unit increase in DBI, the adjusted hazard ratio for mortality was 1.21 (95 confidence intervals [CI]: 1.09-1.33) among people with AD, and 1.37 (95 CI: 1.20-1.56) among people without AD. Overall, 44.3 of people with AD and 33.4 without AD were hospitalized. When using no DBI exposure as the reference group, the adjusted incidence rate ratio for length of hospital stay among high DBI group (=1) in people with AD was 1.15 (95 CI: 1.05-1.26) and 1.63 (95 CI: 1.41-1.88) in people without AD. Conclusion: There is a dose-response relationship between cumulative anticholinergic and sedative drug use and hospitalization and mortality in people with and without AD.