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Potentially Inappropriate Medication Prescribing and Risk of Unplanned Hospitalization among the Elderly: A Self-Matched, Case-Crossover Study

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Abstract

Introduction/Objectives

An association between potentially inappropriate medication (PIM) use and adverse events has been established. However, PIM criteria for elderly patients and medical circumstance vary in different countries. We investigated the association between PIM use according to Japanese guidelines and unplanned hospitalization among elderly patients.

Design

A case-crossover study was conducted.

Setting/Participants

We used the Japanese Medical Data Vision database of 17.9 million people from 270 acute care hospitals across Japan. Records from 247,897 patients aged ≥ 65 years with unscheduled admissions between January 2009 and December 2015 were analyzed.

Measurements

We defined PIM use according to the Japanese Guidelines for Medical Treatment and Its Safety in the Elderly and used conditional logistic regression analysis to fit self-matched case-crossover models and compared each patient’s PIM use over five case periods (1, 2, 4, 8, and 12 weeks) prior to each unplanned hospitalization.

Results

We found the highest odds ratios (ORs) of unscheduled admission related to PIM use in the 1-week case period [OR 4.15; 95% confidence interval (CI) 4.05–4.25], followed by the 2-week (OR 3.01; 95% CI 2.95–3.07), 4-week (OR 3.91; 95% CI 3.83–4.00), 8-week (OR 2.00; 95% CI 1.96–2.05), and 12-week case periods (OR 1.48; 95% CI 1.44–1.51).

Conclusions

Elderly patients commonly used PIMs, especially antidiabetics and diuretics. PIM use was associated with a 1.5- to 4-fold increase in the ORs of unplanned hospitalization among them.

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Acknowledgements

This work was supported by both the Keihanshin Consortium for Fostering the Next Generation of Global Leaders in Research (K-CONNEX, Kyoto, Japan), established by the Human Resource Development Program for Science and Technology, and the Ministry of Education, Culture, Sports, Science and Technology (MEXT, Tokyo, Japan). We would like to thank Medical Data Vision (MDV) for generously providing the medical data and Editage (http://www.editage.jp) for English language editing. These contributors received no extra compensation.

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Authors and Affiliations

  1. Department of Pharmacoepidemiology, Graduate School of Medicine and Public Health, Kyoto University, Yoshida Konoe-cho, Sakyo-ku, Kyoto, 606-8501, Japan

    Izumi Sato & Koji Kawakami

  2. Keihanshin Consortium for Fostering the Next Generation of Global Leaders in Research (K-CONNEX), Kyoto, Japan

    Izumi Sato

  3. Department of Healthcare Epidemiology, Graduate School of Medicine and Public Health, Kyoto University, Kyoto, Japan

    Yosuke Yamamoto

  4. Solutions Center for Health Insurance Claims, Kyoto University Hospital, Kyoto, Japan

    Genta Kato

Authors
  1. Izumi Sato
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  2. Yosuke Yamamoto
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  4. Koji Kawakami
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Contributions

IS and KK had full access to all the data in the study and take responsibility for the integrity of the data and the accuracy of the data analysis. Study concept and design: IS and KK. Acquisition, analysis, or interpretation of data: IS, KK, GK, and YY. Drafting of the manuscript: IS Critical revision of the manuscript for important intellectual content: IS, KK, GK, and YY. Statistical analysis: IS. Obtained funding: IS. Administrative, technical, or material support: IS, KK, GK, and YY. Study supervision: KK.

Corresponding author

Correspondence to Koji Kawakami.

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Conflicts of Interest

Izumi Sato has received support from K-CONNEX and a grant from the Pfizer Health Research Foundation (Grant number 203150600035). Koji Kawakami received research funds from Dainippon Sumitomo Pharma, Olympus, Stella Pharma, Medical Platform Co., Novartis Pharmaceutical K.K., Bayer, and CMIC Inc. He has also received consultation fees from Olympus, Kyowa Hakko Kirin, Kaken Pharmaceutical, and Takeda Pharmaceutica, and lecture fees from Daiichi Sankyo, Eisai, Boehringer Ingelheim Japan Inc., Mitsubishi Tanabe Pharma, Abbie, Chugai, and Sanofi K.K. No other disclosures were reported. Yosuke Yamamoto and Genta Kato have no conflicts of interest that are directly relevant to the content of this study.

Funding

This work was supported by the Pfizer Health Research Foundation (Grant number 203150600035). This financial assistance was used to conduct the study described in the manuscript and to assist with the preparation of the manuscript.

Ethical Approval

The Institutional Review Board of Kyoto University approved the study protocol (approval R0541) on April 22, 2016. A collaborative research agreement was obtained from MDV.

Patient Consent

The requirement for written informed consent was waived because this was a retrospective study analyzing anonymized data.

Sponsor’s Role

The funding sources had no role in the design and conduct of the study; collection, management, analysis, and interpretation of the data; preparation, review, or approval of the manuscript; and decision to submit the manuscript for publication.

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Sato, I., Yamamoto, Y., Kato, G. et al. Potentially Inappropriate Medication Prescribing and Risk of Unplanned Hospitalization among the Elderly: A Self-Matched, Case-Crossover Study. Drug Saf 41, 959–968 (2018). https://doi.org/10.1007/s40264-018-0676-9

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