41 research outputs found
Supplemental Material - Sex Differences in Healthcare Utilization in Persons Living with Dementia Between 2000 and 2017: A Population-Based Study in Quebec, Canada
No full textSupplemental Material for Sex Differences in Healthcare Utilization in Persons Living with Dementia Between 2000 and 2017: A Population-Based Study in Quebec, Canada by Genevieve Arsenault-Lapierre, Tammy Bui, Claire Godard-Sebillotte, Nia Kang, Nadia Sourial, Louis Rochette, Victoria Massamba, Amélie Quesnel-Vallée, and Isabelle Vedel in Journal of Aging and Health</p
Psychiatric and non-psychiatric polypharmacy among older adults with schizophrenia: Trends from a population-based study between 2000 and 2016
No full textBackground: Schizophrenia is a severe psychiatric disorder associated with multiple psychiatric and non-psychiatric comorbidities. As adults with schizophrenia age, they may use many medications, i.e., have polypharmacy. While psychiatric polypharmacy is well documented, little is known about trends and patterns of global polypharmacy. This study aimed to draw a portrait of polypharmacy among older adults with schizophrenia from 2000 to 2016.
Methods: This population-based cohort study was conducted using the data of the Quebec Integrated Chronic Disease Surveillance System of the National Institute of Public Health of Quebec to characterize recent trends and patterns of medication use according to age and sex. We identified all Quebec residents over 65 years with an ICD-9 or ICD-10 diagnosis of schizophrenia between 2000 and 2016. We calculated the total number of medications used by every individual each year and the age-standardized proportion of individuals with polypharmacy, as defined by the usage of 5+, 10+, 15+, and 20+ different medications yearly. We identified the clinical and socio-demographic factors associated with polypharmacy using robust Poisson regression models considering the correlation of the responses between subjects and analyzed trends in the prevalence of different degrees of polypharmacy.
Results: From 2000 to 2016, the median number of medications consumed yearly rose from 8 in 2000 to 11 in 2016. The age-standardized proportion of people exposed to different degrees of polypharmacy also increased from 2000 to 2016: 5+ drugs: 76.6%–89.3%; 10+ drugs: 36.9%–62.2%; 15+: 13.3%–34.4%; 20+: 3.9%–14.4%. Non-antipsychotic drugs essentially drove the rise in polypharmacy since the number of antipsychotics remained stable (mean number of antipsychotics consumed: 1.51 in 2000 vs. 1.67 in 2016). In the multivariate regression, one of the main clinically significant factor associated with polypharmacy was the number of comorbidities (e.g., Polypharmacy-10+: RR[2 VS. 0–1] = 1.4; 99% IC:1.3–1.4, RR[3–4] = 1.7 (1.7–1.8); RR[5+] = 2.1 (2.1–2.2); Polypharmacy-15+: RR[2 VS 0–1] = 1.6; 99% IC:1.5–1.7, RR[3–4] = 2.5 (2.3–2.7); RR[5+] = 4.1 (3.8–4.5).
Conclusion: There was a noticeable increase in polypharmacy exposure among older adults with schizophrenia in recent years, mainly driven by non-antipsychotic medications. This raises concerns about the growing risks for adverse effects and drug-drug interactions in this vulnerable population
Association between stimulant and non-stimulant ADHD medications and completed suicide in adolescents and adults: a population-based nested case-control study
No full textIntroduction: ADHD has been linked to an increased risk of completed suicide. The aim of this study was to assess the relationship between ADHD medication use and completed suicide.Methods: this nested case-control study included individuals aged 12–49 in Quebec, Canada, diagnosed with ADHD and/or dispensed ADHD medication. Suicide cases (n = 472) between 2000 and 2021 were matched with 5 controls each (n = 2360) on date of birth, sex, and continuous public drug insurance coverage for at least 365 days before suicide death (index date). Multivariable conditional logistic regression was used to estimate the association between ADHD medication use and completed suicide. The association between specific ADHD medication types and completed suicide was also assessed.Results: after controlling for potential confounders, no significant association was found between ADHD medication use and completed suicide in the overall sample, in individuals aged 12–24 and 25 to 49 years, and those with a prior ADHD physician diagnosis. No significant differences were found when comparing the use of non-stimulants only (aOR 1.27; 95 % CI: 0.62, 2.63), stimulants and non-stimulants (aOR 1.01; 95 % CI: 0.33, 3.08), and ADHD consultation without medication (aOR 0.94; 95 % CI: 0.69, 1.28) against stimulant-only use.Conclusion: both stimulants and non-stimulants were not associated with the risk of completed suicide. These findings can inform clinical decision-making
ADHD medications use and risk of mortality and unintentional injuries: a population-based cohort study
No full textAbstract We assessed the association between the use of medications for attention-deficit/hyperactivity disorder (ADHD) and the risk of all-cause mortality and unintentional injuries leading to emergency department (ED) or hospital admission in individuals aged ≤24 years with ADHD. We conducted a population-based retrospective cohort study between 2000 and 2021 using Quebec health administrative data. Individuals were followed from the first ADHD diagnosis or ADHD medication claim until turning 25, death, or study end. Exposure was defined as mutually exclusive episodes of ADHD medication use and/or coverage under the public provincial drug plan (PDP): 1) covered and not treated with ADHD medication; 2) covered and treated with ADHD medication; and 3) not covered under the PDP. The risk of all-cause mortality and unintentional injuries associated with exposure episodes was estimated using multivariable survival analyses. The cohort included n = 217 192 individuals aged 1–24 years with a male to female ratio of close to 2:1. Compared to non-medication use, episodes of ADHD medication use, overall, were associated with reduced all-cause mortality (adjusted hazard ratio, aHR 0.61, 95% CI 0.48–0.76) and unintentional injury leading to ED (0.75, 0.74–0.77) or hospitalisation (0.71, 0.68–0.75). Episodes of stimulants were associated with a lower risk of all-cause mortality and reduced risk of unintentional injuries, while episodes with non-stimulants and with both stimulants and non-stimulants concomitantly were associated with reduced risk of unintentional injuries, but not of all-cause mortality. Although residual confounding cannot be excluded, stimulants may have a protective effect in terms of risk of all-cause mortality and both stimulants and non-stimulants for ADHD may reduce the risk of unintentional injuries. The findings of the current study should inform clinical decision making on the choice of starting a pharmacological treatment for ADHD, when a balance needs to be struck between expected benefits and possible risks
A descriptive review of variable selection methods in four epidemiologic journals : there is still room for improvement
No full textBackground : A review of epidemiological papers conducted in 2009 concluded that several studies employed variable selection methods susceptible to introduce bias and yield inadequate inferences. Many new confounder selection methods have been developed since then.
Methods: The goal of the study was to provide an updated descriptive portrait of which variable selection methods are used by epidemiologists for analyzing observational data. Studies published in four major epidemiological journals in 2015 were reviewed. Only articles concerned with a predictive or explicative objective and reporting on the analysis of individual data were included. Method(s) employed for selecting variables were extracted from retained articles.
Results : A total of 975 articles were retrieved and 299 met eligibility criteria, 292 of which pursued an explicative objective. Among those, 146 studies (50%) reported using prior knowledge or causal graphs for selecting variables, 34 (12%) used change in effect estimate methods, 26 (9%) used stepwise approaches, 16 (5%) employed univariate analyses, 5 (2%) used various other methods and 107 (37%) did not provide sufficient details to allow classification (more than one method could be employed in a single article).
Conclusions : Despite being less frequent than in the previous review, stepwise and univariable analyses, which are susceptible to introduce bias and produce inadequate inferences, were still prevalent. Moreover, 37% studies did not provide sufficient details to assess how variables were selected. We thus believe there is still room for improvement in variable selection methods used by epidemiologists and in their reporting
Etude sur l’impact de l’exposition aigüe de la pollution atmosphérique sur la morbi/mortalité cardiovasculaire et respiratoire à Charleroi: Méthodes utilisées dans les études traitant des associations entre la pollution atmosphérique et la santé
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Pollution atmosphérique et maladies cardiovasculaires à Charleroi: morbidité, mortalité, effets saisonniers, analyses par polluants et identification des principaux déterminants
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Impact de l’exposition aiguë de la pollution atmosphérique sur la morbi/mortalité cardiovasculaire et respiratoire à Charleroi: Projet Région Wallonne Environnement-Santé / Ecole de santé publique de l’ULB
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Effects of air pollution on the risk of acute myocardial infarction in Charleroi, Belgium
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Pollution atmosphérique et pathologies cardiovasculaires: revue de la littérature
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