Adverse drug reactions and hospital admissions: Large case‐control study of patients aged 65–100 years using linked English primary care and hospital data

Author:

van Staa Tjeerd Pieter1ORCID,Pirmohamed Munir2ORCID,Sharma Anita3,Ashcroft Darren M.4,Buchan Iain5

Affiliation:

1. Centre for Health Informatics & Health Data Research UK North, Division of Informatics, Imaging and Data Science, School of Health Sciences, Faculty of Biology, Medicine and Health The University of Manchester, Manchester Academic Health Science Centre Manchester UK

2. Centre for Drug Safety Science, Institute of Systems Molecular and Integrative Biology (ISMIB) University of Liverpool Block A: Waterhouse Building Liverpool UK

3. Chadderton South Health Centre Chadderton UK

4. Centre for Pharmacoepidemiology and Drug Safety, NIHR Greater Manchester Patient Safety Translational Research Centre, School of Health Sciences, Faculty of Biology, Medicine and Health The University of Manchester Manchester UK

5. Institute of Population Health, NIHR Applied Research Collaboration North West Coast University of Liverpool Liverpool UK

Abstract

AbstractBackgroundAdverse drug reactions (ADRs) are common and a leading cause of injury. However, information on ADR risks of individual medicines is often limited. The aim of this hypothesis‐generating study was to assess the relative importance of ADR‐related and emergency hospital admission for large group of medication classes.MethodsThis study was a propensity‐matched case‐control study in English primary care. Data sources were Clinical Practice Research Databank and Aurum with longitudinal, anonymized, patient level electronic health records (EHRs) from English general practices linked to hospital records. Cases aged 65–100 with ADR‐related or emergency hospital admission were matched to up to six controls by age, sex, morbidity and propensity scores for hospital admission risk. Medication groups with systemic administration as listed in the British National Formulary (used by prescribers for medication advice). Prescribing in the 84 days before the index date was assessed. Only medication groups with 50+ cases exposed were analysed. The outcomes of interest were ADR‐related and emergency hospital admissions. Conditional logistic regression estimated odds ratios (ORs) and 95% confidence intervals (CI).ResultsThe overall population included 121 546 cases with an ADR‐related and 849 769 cases with emergency hospital admission. The percentage of hospitalizations with an ADR‐related code for admission diagnosis was 1.83% and 6.58% with an ADR‐related code at any time during hospitalization. A total of 137 medication groups was included in the main ADR analyses. Of these, 13 (9.5%) had statistically non‐significant adjusted ORs, 58 (42.3%) statistically significant ORs between 1.0 and 1.5, 37 (27.0%) between 1.5–2.0, 18 (13.1%) between 2.0–3.0 and 11 (8.0%) 3.0 or higher. Several classes of antibiotics (including penicillins) were among medicines with largest ORs. Evaluating the 14 medications most often associated with ADRs, a strong association was found between the number of these medicines and the risk of ADR‐related hospital admission (adjusted OR of 7.53 (95% CI 7.15–7.93) for those exposed to 6+ of these medicines).Conclusions and RelevanceThere is a need for a regular systematic assessment of the harm‐benefit ratio of medicines, harvesting the information in large healthcare databases and combining it with causality assessment of individual case histories.

Funder

National Institute for Health and Care Research

Health Data Research UK

Publisher

Wiley

Subject

Pharmacology (medical),Epidemiology

Reference41 articles.

1. World Health Organization.Medication without harm. Accessed March 31 2022.https://www.who.int/initiatives/medication-without-harm.

2. Adverse drug reactions as cause of admission to hospital: prospective analysis of 18 820 patients

3. Emergency Hospitalizations for Adverse Drug Events in Older Americans

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