| Application: | 14151, Exploring multimorbidity in UK Biobank ? patterns of illness reporting and effects of comorbidity and multimorbidity on health outcomes |
| Title: | Assessing Risks of Polypharmacy Involving Medications With Anticholinergic Properties |
| Size: | 579157 B |
| Archived: | 29 Jul 2021 |
| Stability: | Complete |
| Personal: | No individual-level data |
Return 3688
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Notes
Purpose:Anticholinergic burden (ACB), the cumulative effect of anticholinergic medications, is associated with adverse outcomes in older people but is less studied in middle-aged populations. Numerous scales exist to quantify ACB. The aims of this study were to quantify ACB in a large cohort using the 10 most common anticholinergic scales, to assess the association of each scale with adverse outcomes, and to assess overlap in populations identified by each scale.
Methods:
We performed a longitudinal analysis of the UK Biobank community cohort (502,538 participants, baseline age: 37-73 years, median years of follow-up: 6.2). The ACB was calculated at baseline using 10 scales. Baseline data were linked to national mortality register records and hospital episode statistics. The primary outcome was a composite of all-cause mortality and major adverse cardiovascular event (MACE). Secondary outcomes were all-cause mortality, MACE, hospital admission for fall/fracture, and hospital admission with dementia/delirium. Cox proportional hazards models (hazard ratio [HR], 95% CI) quantified associations between ACB scales and outcomes adjusted for age, sex, socioeconomic status, body mass index, smoking status, alcohol use, physical activity, and morbidity count.
Results:
Anticholinergic medication use varied from 8% to 17.6% depending on the scale used. For the primary outcome, ACB was significantly associated with all-cause mortality/MACE for each scale. The Anticholinergic Drug Scale was most strongly associated with mortality/MACE (HR = 1.12; 95% CI, 1.11-1.14 per 1-point increase in score). The ACB was significantly associated with all secondary outcomes. The Anticholinergic Effect on Cognition scale was most strongly associated with dementia/delirium (HR = 1.45; 95% CI, 1.3-1.61 per 1-point increase).
Conclusions:
The ACB was associated with adverse outcomes in a middle- to older-aged population. Populations identified and effect size differed between scales. Scale choice influenced the population identified as potentially requiring reduction in ACB in clinical practice or intervention trials.
Application 14151
Exploring multimorbidity in UK Biobank ? patterns of illness reporting and effects of comorbidity and multimorbidity on health outcomes
Our aim is to determine the extent and patterns of morbidity reporting and treatment use, and to investigate the impact of comorbidity, multimorbidity and polypharmacy on healthcare outcomes. We will also investigate prognostic factors and the specific impact of having chronic pain and/or depression on individuals with chronic illness. Research questions include but are not limited to: - What are the patterns of morbidity reporting? - What are the patterns of polypharmacy reporting among people with co/multimorbidity? - What are health related outcomes of people with co/multimorbidity and do these vary by combination of conditions, e.g. pain and depression? This research will investigate reporting of chronic illness, including heart disease, stroke, arthritis, osteoporosis, and depression, all of which are priorities for UK Biobank; and examine treatment, including polypharmacy, and outcomes for people with multiple conditions, taking into account sociodemographic and other factors. We will examine casual pathways and prognostic factors and this will allow us to gain a better understanding of multimorbidity and to consider potential management and treatment approaches for individuals with multimorbidity. The proposed research therefore aims to promote improved understanding and treatment of a wide range of illnesses. Initial statistical models will utilise assessment centre data to determine patterns of morbidity reporting and relationships with sociodemographic, lifestyle and other factors. We intend to use assay data to determine relationships between chronic illness reporting and biomarkers. Medications will be examined to determine the treatment burden that individuals with multiple conditions experience. Subsequent analysis will build on this initial work and allow investigation of the relationship over time between chronic illness and health-related outcomes using hospitalisation, primary care, and mortality data, taking into account other factors measured at the assessment centre, which may also affect these relationships. We require the full cohort for this research as information on medical conditions was gathered from all participants. This will allow the identification of morbidity groups, including a comparison group (1 or no long-term conditions).
| Lead investigator: | Dr Barbara Nicholl |
| Lead institution: | University of Glasgow |
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1 Publication
| Pub ID | Title | Author(s) | Year | Journal |
|---|---|---|---|---|
| 3689 | Assessing Risks of Polypharmacy Involving Medications With Anticholinergic Properties | Peter Hanlon (+10) | 2020 | The Annals of Family Medicine |
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