Potential Cuases of Higher Mortality Among Elderly User of Conventional Vs. Atypical Antipsychotics. Effective Health Care Research Report No. 11

摘要

Objectives. Evidence is growing that conventional antipsychotic medication (APM) use may be associated with greater risks of death than aytpicals. To investigate the potential mechanisms through the conventionals might act, we sought to compare the specific causes of death in elderly patients newly started on conventional vs. atypical APMs. Design. Cohort study Setting. Community setting Participants. All British Columbia residents 65 who initiated a conventional or atypical APM (1996 2004). Measurements. Cox proportional hazards models were used to compare risks of developing the specific cause of death within 180 days since APM initiation. We adjusted for potential confounders using traditional multivariable, propensity score, and instrumental variable adjustments. Results. The study cohort included 12,882 initiators of conventional APMs and 24,359 atypical APMs. Of 3,821 total deaths within the first 180 day of use, cardiovascular (CV) deaths accounted for 49% of deaths. Conventional vs. atypical APM initiators had a significantly higher adjusted hazard of all CV (hazard ratio (HR) 1.23; 95% CI 1.10-1.36), and out-of-hospital CV death (HR 1.36; 95% CI 1.19-1.56). Initiators of conventional APMs also had a higher risk for death due to respiratory diseases, nervous system diseases and other causes. Conclusions. These data suggest that increased risk of CV deaths might explain about half of the excess mortality in conventional APM initiators. The risk of death due to respiratory causes was also significantly higher in conventional APM use.