title: Inhaled anticholinergic use and all-cause mortality among elderly Medicare beneficiaries with chronic obstructive pulmonary disease.
abstract: BACKGROUND
  The purpose of this study was to examine the association between use of inhaled anticholinergics and all-cause mortality among elderly individuals with chronic obstructive pulmonary disease (COPD), after controlling for demographic, socioeconomic, health, functional status, smoking, and obesity.
  
  
  METHODS
  We used a retrospective longitudinal panel data design. Data were extracted for multiple years (2002-2009) of the Medicare Current Beneficiary Survey (MCBS) linked with fee-for-service Medicare claims. Generic and brand names of inhaled anticholinergics were used to identify inhaled anticholinergic utilization from the self-reported prescription medication files. All-cause mortality was assessed using the vital status variable. Unadjusted group differences in mortality rates were tested using the chi-square statistic. Multivariable logistic regressions with independent variables entered in separate blocks were used to analyze the association between inhaled anticholinergic use and all-cause mortality. All analyses accounted for the complex design of the MCBS.
  
  
  RESULTS
  Overall, 19.4% of the elderly Medicare beneficiaries used inhaled anticholinergics. Inhaled anticholinergic use was significantly higher (28.5%) among those who reported poor health compared with those reporting excellent or very good health (12.7%). Bivariate analyses indicated that inhaled anticholinergic use was associated with significantly higher rates of all-cause mortality (18.7%) compared with nonusers (13.6%). However, multivariate analyses controlling for risk factors did not suggest an increased likelihood of all-cause mortality (adjusted odds ratio 1.26, 95% confidence interval 0.95-1.67).
  
  
  CONCLUSIONS
  Use of inhaled anticholinergics among elderly individuals with COPD is potentially safe in terms of all-cause mortality when we adjust for baseline risk factors.
authors.affiliation: Department of Pharmaceutical Systems and Policy, School of Pharmacy, West Virginia University, Morgantown, WV, USA. mrajmera@hsc.wvu.edu
authors.forename: Mayank
authors.initials: M
authors.lastname: Ajmera
authors.forename: Chan
authors.initials: C
authors.lastname: Shen
authors.forename: Xiaoyun
authors.initials: X
authors.lastname: Pan
authors.forename: Patricia A
authors.initials: PA
authors.lastname: Findley
authors.forename: George
authors.initials: G
authors.lastname: Rust
authors.forename: Usha
authors.initials: U
authors.lastname: Sambamoorthi
mesh_terms: D000280:Administration, Inhalation; D000368:Aged; D018680:Cholinergic Antagonists / Q000008:administration & dosage / Q000009:adverse effects; D015897:Comorbidity; D003625:Data Collection; D003710:Demography; D005260:Female; D015577:Geriatric Assessment; D006801:Humans; D016015:Logistic Models; D008297:Male; D006278:Medicare / Q000706:statistics & numerical data*; D009026:Mortality; D009765:Obesity / Q000453:epidemiology; D029424:Pulmonary Disease, Chronic Obstructive / Q000175:diagnosis / Q000188:drug therapy / Q000401:mortality; D012129:Respiratory Function Tests; D012189:Retrospective Studies; D012307:Risk Factors; D012907:Smoking / Q000453:epidemiology; D012959:Socioeconomic Factors; D014481:United States / Q000453:epidemiology
chemical_list: D018680:Cholinergic Antagonists
keywords: chronic obstructive pulmonary disease; drug safety; geriatrics; inhaled anticholinergics; mortality