Sessio 7

Sessio 7: Rekisteriaineistot vaikuttavuustutkimuksessa

Puheenjohtaja: professori Reijo Sund, Itä-Suomen yliopisto

7.1 Prevalence of oral anticoagulants use in people with and without Alzheimer’s disease

Barkat Babar, Mai Vu, Marjaana Koponen, Heidi Taipale, Antti Tanskanen, Jari Tiihonen, Raimo Kettunen, Miia Tiihonen, Sirpa Hartikainen, Anna-Maija Tolppanen

Background
Cardio- and cerebrovascular diseases are more common in people with Alzheimer’s disease (AD) than general population. However, it is unknown whether the use of oral anticoagulants (OAC) is affected by AD diagnosis. We investigated the prevalence of OAC use in relation to AD diagnosis, and compared to a matched cohort without AD.

Methods
Medication Use and Alzheimer’s disease (MEDALZ) cohort includes 70718 Finnish people who received a clinically verified AD diagnosis between 2005-2011. Point prevalence of OAC during a two-week time period was calculated every six months from five years before to five years after AD diagnosis, and compared to matched cohort without AD. OAC use was obtained from the prescription register by Anatomical Therapeutic Chemical (ATC) Classification system (B01A) with Prescription to drug use periods (PRE2DUP) method. The difference regarding OAC prevalence among person with and without AD was calculated by using GEE (generalized estimating equations) model.

Results
OACs were more commonly used by people with AD before the AD diagnosis (OR = 1.17; 95% CI = 1.14-1.21). At the time of AD diagnosis, prevalence of OAC use was a bit higher in persons with AD than without AD (22% and 19%, respectively), but the use in people with AD began to decline gradually after AD diagnosis (OR = 0.94; 95% CI = 0.92-0.96) whereas usage increased continuously in persons without AD. Warfarin was the most common OAC in both AD (15% of users) and non-AD groups (13% of users).

7.2 Pään vammojen ja aivovammojen ilmaantuvuus Parkinsonin tautia sairastavilla ja heidän verrokeillaan

Sarianna Ilmaniemi

Tausta
Väestön ikääntyessä Parkinsonin taudin esiintyvyys on kasvanut. Parkinsonin tautia sairastavilla on huomattavasti korkeampi kaatumisriski sekä riski kaatumisiin liittyviin vammoihin. Erityisesti pään vammat ja aivovammat voivat merkittävästi vaikuttaa henkilön toimintakykyyn ja elinajan ennusteeseen.

Tavoitteet
Tutkimuksessa selvitettiin pään vammojen ja aivovammojen ilmaantuvuutta Parkinsonin tautia sairastavilla verrattuna henkilöihin, joilla ei ole diagnosoitu Parkinsonin tautia.

Aineisto ja menetelmät
Tässä rekisteripohjaisessa kohorttitutkimuksessa käytettiin FINPARK-aineistoa, joka koostuu henkilöistä, joille on Parkinsonin taudin perusteella myönnetty erityiskorvausoikeus Parkinsonin taudin lääkkeisiin vuosina 1996-2015 (N=21,683). Lisäksi jokaista Parkinsonin tautia sairastavalle on poimittu seitsemän iän, sukupuolen ja asuinpaikan perusteella kaltaistettua verrokkia. Jos seitsemää verrokkia ei ollut tunnistettavissa, poimittiin niin monta verrokkia kuin mahdollista. Seuranta-aika alkoi indeksitapauksen Parkinsonin taudin diagnoosipäivästä ja loppui pään vammaan, kuolemaan tai aineiston seuranta-ajan loppuun 31.12.2016. Tämä tutkimus rajattiin niihin Parkinsonin tautia sairastaviin (n=20 059) ja heidän verrokkeihinsa (n=130 186), joilla ei ollut ennen seurannan alkua aiempaa pään vammaa. Pään vammat (ICD-10 koodit S00.0-S09.9 ) ja aivovammat (S06.0-S06.9) tunnistettiin THL:n ylläpitämästä terveydenhuollon hoitoilmoitusrekisteristä. Vammojen riskiä Parkinsonin tautia sairastavilla arviontiin joustavalla parametrisella mallilla.

Tulokset
Pään vammojen ilmaantuvuus Parkinsonin tautia sairastavilla oli 17,3 (n=2301, 11,5%) ja verrokeilla 9,1 (n=9087, 7,2%) tuhatta henkilövuotta kohden. Aivovammojen ilmaantuvuudet olivat vastaavasti 8,6 (n=1138, 5,7%) ja 4,9 (n=4878, 3,9%).

Johtopäätökset
Parkinsonin tautia sairastavilla on korkeampi pään vammojen ja aivovammojen ilmaantuvuus verrattuna henkilöihin, joilla ei ole Parkinsonin taudin diagnoosia. Päähän kohdistuvat vammat voivat heikentää Parkinsonin tautia sairastavien ennustetta sekä toimintakykyä ja johtaa omatoimisuuden heikkenemiseen jo taudin varhaisessa vaiheessa. Parkinsonin tautia sairastavilla on keskeistä kiinnittää huomiota kaatumisten ja niihin liittyvien vammojen ennaltaehkäisyyn.

7.3 Incidence of muscle relaxant use in relation to diagnosis of Parkinson’s disease

Anne Paakinaho, N. Karttunen, M. Taipale, A. M. Tolppanen, S. Hartikainen, M. Tiihonen

Background
Parkinson’s disease is the second most common neurodegenerative disorder. Parkinson’s disease may have long prodromal period when symptoms are present, but do not fulfil the diagnostic criteria. Motor and non-motor symptoms seem to precede the diagnosis and muscle relaxants could be used as symptomatic drugs.

Objective
To evaluate the incidence of muscle relaxant use in community-dwelling persons with and without Parkinson’s disease from 4 years before to 4 years after the diagnosis of Parkinson’s disease.

Method
Nationwide register-based cohort included all community-dwelling Finnish persons who received reimbursement of Parkinson’s disease drugs between 2000 and 2015 (N = 17,450) and comparison persons without Parkinson’s disease who were matched for age, gender and region of residence (N = 122,694). Data on muscle relaxant use during 1995–2016 were collected from the Prescription Register.

Results
The incidence of muscle relaxant use was higher among persons with Parkinson’s disease in comparison to persons without Parkinson’s disease from 3 years before the diagnosis until 6 months after the diagnosis. The largest difference in incidence rates was observed at the time of the diagnosis (incidence rate ratio = 2.04, 95% confidence interval = 1.81–2.30). Tizanidine was the most frequently initiated muscle relaxant.

Conclusions
The incidence of muscle relaxant use starts increasing years before the diagnosis of Parkinson’s disease but declines after that. It is important to identify the causes of muscle symptoms to avoid unnecessary muscle relaxant use and consequent adverse effects and events. Non-specific muscle symptoms and consequent muscle relaxant use might be preceding Parkinson’s disease diagnosis.

7.4 Length of hospital stay after hip fracture and readmission rates of persons with and without Alzheimer’s disease

Blair Rajamäki, Marjaana Koponen, Sirpa Hartikainen, Anna-Maija Tolppanen

Introduction
Hospital length of stay (LOS) for incident of hip fracture are decreasing, but it is unknown if these changes have negative impacts on vulnerable older patient populations, like those with Alzheimer’s disease (AD). We aimed to assess if persons with and without AD have different LOS for hip fracture, and is the LOS associated with hospital readmissions.

Methods
Utilizing register-based data for a matched cohort study nested in the Medication use and Alzheimer’s disease study (MEDALZ), we collected all community-dwelling persons in Finland diagnosed with AD during 2005-2012, had incident of first hip fracture between 2005 and 2015 after AD diagnosis, and were discharged alive from an acute care hospital. Hospital LOS and hospital readmissions within 30-days and 90-days were compared between those with and without AD and risk of readmission was assessed using binary logistic regression analysis.

Results
In this matched cohort study of 12,532 persons (mean age 84.6 years (95% CI: 84.5-84.7), 76.8% women), the median LOS in an acute care hospital was one day shorter for those with AD (median 4 days, IQR 3-7) than those without AD (median 5 days, IQR 3-7). However, the AD cohort had respectively 6 days and 5 days longer median LOS in a community hospital, and total hospital stay compared to the non-AD cohort. Those with AD had fewer readmissions within 30-days (10.7%) and 90-days (16.9%) compared to those without AD (13.3% 30-days and 20.7% 90-days). Both cohorts had a reduced readmission risk within 30-days when the LOS in an acute care hospital was 4-14 days, compared to a LOS <4 days.

Key conclusions
Short LOS in acute care hospitals may be associated with poor health outcomes for vulnerable older populations after hip fracture.