Comorbidity and repeat admission to hospital for adverse drug reactions in older adults: retrospective cohort study
Open Access
- 7 January 2009
- Vol. 338 (jan07 3), a2752
- https://doi.org/10.1136/bmj.a2752
Abstract
Objectives To identify factors that predict repeat admission to hospital for adverse drug reactions (ADRs) in older adults.Design Population based retrospective cohort study.Setting All public and private hospitals in Western Australia.Participants 28 548 patients aged ≥60 years with an admission for an ADR during 1980-2000 followed for three years using the Western Australian data linkage system.Results 5056 (17.7%) patients had a repeat admission for an ADR. Repeat ADRs were associated with sex (hazard ratio 1.08, 95% confidence interval 1.02 to 1.15, for men), first admission in 1995-9 (2.34, 2.00 to 2.73), length of hospital stay (1.11, 1.05 to 1.18, for stays ≥14 days), and Charlson comorbidity index (1.71, 1.46 to 1.99, for score ≥7); 60% of comorbidities were recorded and taken into account in analysis. In contrast, advancing age had no effect on repeat ADRs. Comorbid congestive cardiac failure (1.56, 1.43 to 1.71), peripheral vascular disease (1.27, 1.09 to 1.48), chronic pulmonary disease (1.61, 1.45 to 1.79), rheumatological disease (1.65, 1.41 to 1.92), mild liver disease (1.48, 1.05 to 2.07), moderate to severe liver disease (1.85, 1.18 to 2.92), moderate diabetes (1.18, 1.07 to 1.30), diabetes with chronic complications (1.91, 1.65 to 2.22), renal disease (1.93, 1.71 to 2.17), any malignancy including lymphoma and leukaemia (1.87, 1.68 to 2.09), and metastatic solid tumours (2.25, 1.92 to 2.64) were strong predictive factors. Comorbidities requiring continuing care predicted a reduced likelihood of repeat hospital admissions for ADRs (cerebrovascular disease 0.85, 0.73 to 0.98; dementia 0.62, 0.49 to 0.78; paraplegia 0.73, 0.59 to 0.89).Conclusions Comorbidity, but not advancing age, predicts repeat admission for ADRs in older adults, especially those with comorbidities often managed in the community. Awareness of these predictors can help clinicians to identify which older adults are at greater risk of admission for ADRs and, therefore, who might benefit from closer monitoring.This publication has 28 references indexed in Scilit:
- Repeat adverse drug reactions causing hospitalization in older Australians: a population‐based longitudinal study 1980–2003British Journal of Clinical Pharmacology, 2006
- Concealed Renal Failure and Adverse Drug Reactions in Older Patients With Type 2 Diabetes MellitusThe Journals of Gerontology: Series A, 2005
- Potentially Inappropriate Medication Use Among Elderly Home Care Patients in EuropeJama-Journal Of The American Medical Association, 2005
- The Association of Inappropriate Drug Use with Hospitalisation and MortalityDrugs & Aging, 2005
- New ICD-10 version of the Charlson comorbidity index predicted in-hospital mortalityJournal of Clinical Epidemiology, 2004
- Adverse drug reactions as cause of admission to hospital: prospective analysis of 18 820 patientsBMJ, 2004
- Moderate alcohol consumption and adverse drug reactions among older adultsPharmacoepidemiology and Drug Safety, 2002
- The nature and extent of drug‐related hospitalisations in AustraliaJournal of Quality In Clinical Practice, 1999
- Presentation adapting a clinical comorbidity index for use with ICD-9-CM administrative data: Differing perspectivesJournal of Clinical Epidemiology, 1993
- A new method of classifying prognostic comorbidity in longitudinal studies: Development and validationJournal of Chronic Diseases, 1987