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The Relationship Between Anticholinergic Exposure and Falls, Fractures, and Mortality in Patients with Overactive Bladder

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Abstract

Background

Understanding risk factors associated with falls is important for optimizing care and quality of life for older patients.

Objective

Our objective was to determine the relationship between anticholinergic exposure and falls, fractures, and all-cause mortality.

Methods

An observational retrospective cohort study was conducted using administrative claims data from 1 January 2007 to 30 September 2015. Individuals aged 65–89 years newly diagnosed or treated for overactive bladder (OAB) were identified. Index date was the first OAB diagnosis or OAB medication prescription claim. Follow-up began on the index date and continued until death, disenrollment, or end of study period. The Anticholinergic Cognitive Burden (ACB) scale was used to define and quantify daily anticholinergic exposure and intensity. The primary study outcome was a combined endpoint of falls or fractures. All-cause mortality was a secondary endpoint.

Results

There were 113,311 patients with mean age of 74.8 ± standard deviation (SD) 6.2 years included. Current anticholinergic exposure was associated with a 1.28-fold increased hazard of a fall/fracture (95% confidence interval [CI] 1.23–1.32) compared with unexposed person-time, and past exposure was associated with a 1.14-fold increased hazard of a fall/fracture (95% CI 1.12–1.17). Compared with unexposed person-time, low-, moderate-, and high-intensity anticholinergic exposure was associated with a 1.04-fold (95% CI 1.00–1.07), 1.13-fold (95% CI 1.09–1.17), and 1.31-fold (95% CI 1.26–1.36) increased hazard of falls/fractures, respectively. A similar pattern was observed for all-cause mortality.

Conclusions

Anticholinergic exposure is associated with an increased risk of falls or fractures in older patients and is an important consideration when evaluating treatment options for such patients with OAB.

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Acknowledgements

The authors thank Dr. Mary Costantino, PhD, for drafting, reviewing and editing this manuscript. Dr. Costantino is an employee of Humana Inc., which received funding from Astellas Pharma Global Development, Inc.

Author information

Authors and Affiliations

  1. Humana Healthcare Research, Inc., Louisville, KY, USA

    Brandon T. Suehs, Eleanor O. Caplan & Jennifer Hayden

  2. Astellas Pharma Global Development, Inc., Northbrook, IL, USA

    Daniel B. Ng

  3. Humana Inc., Louisville, KY, USA

    Rainelle R. Gaddy

Authors
  1. Brandon T. Suehs
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Corresponding author

Correspondence to Brandon T. Suehs.

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Conflict of interest

Suehs, Caplan, and Hayden are employees of Humana Healthcare Research, Inc., which received funding from Astellas for this study. Ng is an employee of Astellas Pharma Global Development, Inc.. Suehs and Hayden own stock in Humana. Gaddy is an employee of Humana.

Funding

The present study was initiated and funded by Astellas Pharma Global Development, Inc.

Ethical Approval

The research protocol was reviewed and approved prior to study initiation by an independent institutional review board.

Informed Consent

A waiver of informed consent was obtained for this retrospective study as formal consent is not required.

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Suehs, B.T., Caplan, E.O., Hayden, J. et al. The Relationship Between Anticholinergic Exposure and Falls, Fractures, and Mortality in Patients with Overactive Bladder. Drugs Aging 36, 957–967 (2019). https://doi.org/10.1007/s40266-019-00694-5

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  • DOI: https://doi.org/10.1007/s40266-019-00694-5

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