title: Potentially high-risk medication categories and unplanned hospitalizations: a case-time-control study.
abstract: Empirical data of medication-related hospitalization are very limited. We aimed to investigate the associations between 12 high risk medication categories (diabetic agents, diuretics, nonsteroidal anti-inflammatory drugs (NSAIDs), anticoagulants, antiplatelets, antihypertensives, antiarrhythmics, anticonvulsants, antipsychotics, antidepressants, benzodiazepine (BZD)/Z-hypnotics, and narcotics) and unplanned hospitalizations. A population-based case-time-control study was performed using Taiwan's National Health Insurance Research Database. Patients who experienced an unplanned hospitalization (index visit) were identified as index subjects and matched to a randomly selected reference visit within users of a specific category of high-risk medication. An unplanned hospitalization was defined as a hospital admission immediately after an emergency department visit. Discordant exposures to the high-risk medication during the case period (1-14 days before the visit) and the control period (366-379 days before the visit) were examined in both index and reference visits. Antipsychotics was associated with the highest risk of unplanned hospitalizations (adjusted OR: 1.54, 95% CI [1.37-1.73]), followed by NSAIDs (1.50, [1.44-1.56]), anticonvulsants (1.34, [1.10-1.64]), diuretics (1.24, [1.15-1.33]), BZD/Z-hypnotics (1.23, [1.16-1.31]), antidepressants (1.17, [1.05-1.31]) and antiplatelets (1.16, [1.07-1.26]). NSAIDs and narcotics were associated with the highest risks of unplanned hospitalizations with a length of stay ≥10 days. These medication categories should be targeted for clinical and policy interventions.
authors.affiliation: Graduate Institute of Clinical Pharmacy, College of Medicine, National Taiwan University, Taipei, Taiwan.
authors.forename: Chih-Wan
authors.initials: CW
authors.lastname: Lin
authors.affiliation: Clinical Informatics and Medical Statistics Research Center, Chang Gung University, Taoyuan, Taiwan.
authors.forename: Yu-Wen
authors.initials: YW
authors.lastname: Wen
authors.affiliation: Aging and Health Research Center, National Yang Ming University, Taipei, Taiwan.|Center for Geriatrics and Gerontology, Taipei Veterans General Hospital, Taipei, Taiwan.
authors.forename: Liang-Kung
authors.initials: LK
authors.lastname: Chen
authors.affiliation: Graduate Institute of Clinical Pharmacy, College of Medicine, National Taiwan University, Taipei, Taiwan.|School of Pharmacy, College of Medicine, National Taiwan University, Taipei, Taiwan.|Department of Pharmacy, National Taiwan University Hospital, Taipei, Taiwan.
authors.forename: Fei-Yuan
authors.initials: FY
authors.lastname: Hsiao
mesh_terms: D000328:Adult; D000368:Aged; D000894:Anti-Inflammatory Agents, Non-Steroidal / Q000009:adverse effects; D000925:Anticoagulants / Q000009:adverse effects; D000928:Antidepressive Agents / Q000009:adverse effects; D001569:Benzodiazepines / Q000009:adverse effects; D016022:Case-Control Studies; D016208:Databases, Factual; D004232:Diuretics / Q000009:adverse effects; D064420:Drug-Related Side Effects and Adverse Reactions / Q000453:epidemiology / Q000503:physiopathology*; D004636:Emergency Service, Hospital; D005260:Female; D006760:Hospitalization; D006801:Humans; D008297:Male; D008875:Middle Aged; D012307:Risk Factors; D013624:Taiwan / Q000453:epidemiology
chemical_list: D000894:Anti-Inflammatory Agents, Non-Steroidal; D000925:Anticoagulants; D000928:Antidepressive Agents; D004232:Diuretics; D001569:Benzodiazepines