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Association between cumulative anticholinergic burden and falls and fractures in patients with overactive bladder: US-based retrospective cohort study.
BMJ Open. 2019 05 05; 9(5):e026391.BO

Abstract

OBJECTIVE

To estimate the association between cumulative anticholinergic burden and falls and fractures in patients with overactive bladder (OAB).

DESIGN

A retrospective claims-based study (2007-2015) of patients with OAB; outcomes from a subset were contrasted to a non-OAB comparison.

SETTING

United States, commercially and Medicare-insured population.

PARTICIPANTS

154 432 adults with OAB and 86 966 adults without OAB, mean age of 56 years, and 67.9% women.

MAIN OUTCOME MEASURES

Cumulative anticholinergic burden, a unitless value representing exposure over time, was estimated over the 12 months pre-index ('at baseline') and every 6 months post index. Burden was categorised as no burden (0), low burden (1-89), medium burden (90-499) or high burden (500+). Unadjusted rates of falls or fractures were estimated, and the increased risk associated with anticholinergic burden (measured at the closest 6-month interval prior to a fall or fracture) was assessed using a Cox proportional hazards model and a marginal structural model.

RESULTS

Median (IQR) baseline anticholinergic burden was 30 (0.0-314.0) and higher among older (≥65 years, 183 [3.0-713.0]) versus younger (<65 years, 13 [0.0-200.0]) adults. The unadjusted rate of falls or fractures over the period was 5.0 per 100 patient-years, ranging from 3.1 (95% CI 3.0-3.2) for those with no burden, to 7.4 (95% CI 7.1-7.6) for those with high burden at baseline. The adjusted risk of falls and fractures was greater with higher anticholinergic burden in the previous 6 months, with an HR of 1.2 (95% CI 1.2 to 1.3) for low burden versus no burden, to 1.4 (95% CI 1.3 to 1.4) for high versus no burden. Estimates from marginal structural models adjusting for time-varying covariates were lower but remained significantly higher with a higher anticholinergic burden. Rates of falls and fractures were approximately 40% higher among those with OAB (vs those without).

CONCLUSION

Higher levels of anticholinergic burden are associated with higher rates of falls and fractures, highlighting the importance of considering anticholinergic burden when treating patients with OAB.

Authors+Show Affiliations

Broadstreet Health Economics & Outcomes Research, Vancouver, British Columbia, Canada.Medical Affairs, Astellas Pharma Global Development Inc, Northbrook, Illinois, USA.Medical Affairs, Astellas Pharma Global Development Inc, Northbrook, Illinois, USA.Medical Affairs, Astellas Pharma Global Development Inc, Northbrook, Illinois, USA.Broadstreet Health Economics & Outcomes Research, Vancouver, British Columbia, Canada.Broadstreet Health Economics & Outcomes Research, Vancouver, British Columbia, Canada.Broadstreet Health Economics & Outcomes Research, Vancouver, British Columbia, Canada.Feinberg School of Medicine, Northwestern University, Chicago, Illinois, USA.Department of Pharmacy Practice, Purdue University College of Pharmacy, West Lafayette, Indiana, USA.

Pub Type(s)

Journal Article
Research Support, Non-U.S. Gov't

Language

eng

PubMed ID

31061036

Citation

Szabo, Shelagh M., et al. "Association Between Cumulative Anticholinergic Burden and Falls and Fractures in Patients With Overactive Bladder: US-based Retrospective Cohort Study." BMJ Open, vol. 9, no. 5, 2019, pp. e026391.
Szabo SM, Gooch K, Schermer C, et al. Association between cumulative anticholinergic burden and falls and fractures in patients with overactive bladder: US-based retrospective cohort study. BMJ Open. 2019;9(5):e026391.
Szabo, S. M., Gooch, K., Schermer, C., Walker, D., Lozano-Ortega, G., Rogula, B., Deighton, A., Vonesh, E., & Campbell, N. (2019). Association between cumulative anticholinergic burden and falls and fractures in patients with overactive bladder: US-based retrospective cohort study. BMJ Open, 9(5), e026391. https://doi.org/10.1136/bmjopen-2018-026391
Szabo SM, et al. Association Between Cumulative Anticholinergic Burden and Falls and Fractures in Patients With Overactive Bladder: US-based Retrospective Cohort Study. BMJ Open. 2019 05 5;9(5):e026391. PubMed PMID: 31061036.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Association between cumulative anticholinergic burden and falls and fractures in patients with overactive bladder: US-based retrospective cohort study. AU - Szabo,Shelagh M, AU - Gooch,Katherine, AU - Schermer,Carol, AU - Walker,David, AU - Lozano-Ortega,G, AU - Rogula,Basia, AU - Deighton,Alison, AU - Vonesh,Edward, AU - Campbell,Noll, Y1 - 2019/05/05/ PY - 2019/5/8/entrez PY - 2019/5/8/pubmed PY - 2020/6/5/medline KW - anticholinergic burden KW - falls KW - fractures KW - marginal structural models KW - observational study KW - overactive bladder SP - e026391 EP - e026391 JF - BMJ open JO - BMJ Open VL - 9 IS - 5 N2 - OBJECTIVE: To estimate the association between cumulative anticholinergic burden and falls and fractures in patients with overactive bladder (OAB). DESIGN: A retrospective claims-based study (2007-2015) of patients with OAB; outcomes from a subset were contrasted to a non-OAB comparison. SETTING: United States, commercially and Medicare-insured population. PARTICIPANTS: 154 432 adults with OAB and 86 966 adults without OAB, mean age of 56 years, and 67.9% women. MAIN OUTCOME MEASURES: Cumulative anticholinergic burden, a unitless value representing exposure over time, was estimated over the 12 months pre-index ('at baseline') and every 6 months post index. Burden was categorised as no burden (0), low burden (1-89), medium burden (90-499) or high burden (500+). Unadjusted rates of falls or fractures were estimated, and the increased risk associated with anticholinergic burden (measured at the closest 6-month interval prior to a fall or fracture) was assessed using a Cox proportional hazards model and a marginal structural model. RESULTS: Median (IQR) baseline anticholinergic burden was 30 (0.0-314.0) and higher among older (≥65 years, 183 [3.0-713.0]) versus younger (<65 years, 13 [0.0-200.0]) adults. The unadjusted rate of falls or fractures over the period was 5.0 per 100 patient-years, ranging from 3.1 (95% CI 3.0-3.2) for those with no burden, to 7.4 (95% CI 7.1-7.6) for those with high burden at baseline. The adjusted risk of falls and fractures was greater with higher anticholinergic burden in the previous 6 months, with an HR of 1.2 (95% CI 1.2 to 1.3) for low burden versus no burden, to 1.4 (95% CI 1.3 to 1.4) for high versus no burden. Estimates from marginal structural models adjusting for time-varying covariates were lower but remained significantly higher with a higher anticholinergic burden. Rates of falls and fractures were approximately 40% higher among those with OAB (vs those without). CONCLUSION: Higher levels of anticholinergic burden are associated with higher rates of falls and fractures, highlighting the importance of considering anticholinergic burden when treating patients with OAB. SN - 2044-6055 UR - https://www.unboundmedicine.com/medline/citation/31061036/Association_between_cumulative_anticholinergic_burden_and_falls_and_fractures_in_patients_with_overactive_bladder:_US_based_retrospective_cohort_study_ L2 - https://bmjopen.bmj.com/lookup/pmidlookup?view=long&amp;pmid=31061036 DB - PRIME DP - Unbound Medicine ER -