Heat Waves, Medication Use, and Adverse Health Outcomes Among Older Adults

热浪、药物使用和老年人的不良健康后果

基本信息

批准号：
8636377
负责人：
Soko Setoguchi Iwata
金额：
$ 23.55万
依托单位：
DUKE UNIVERSITY
依托单位国家：
美国
项目类别：
财政年份：
2013
资助国家：
美国
起止时间：
2013-09-30 至 2015-06-30
项目状态：
已结题

来源：
https://reporter.nih.gov/project-details/8636377
关键词：
Accounting Adverse effects Adverse event Age Aging Air Pollution Anti-Cholinergics Antidepressive Agents Antiepileptic Agents Antihypertensive Agents Antipsychotic Agents Categories Chronic Chronic Care Climate Data Data Sources Development Diuretics Drug Prescriptions Earthquakes Elderly Electrolytes Electronic Health Record Event Floods Frequencies Health Healthcare Heat Stroke Heat Waves Heating High Prevalence Hospitalization Humidity Intensive Care Units Interruption Link Lipids Liquid substance Medical Medicare Methodology Methods Morbidity - disease rate Older Population Outcome Outcomes and Health Services Research Parkinson Disease Patients Pharmaceutical Preparations Pharmacoepidemiology Pharmacy facility Physiologic Thermoregulation Planets Policy Maker Polypharmacy Population Process Property Prospective Studies Research Personnel Resources Risk Solid Surveys Temperature Testing Thirst Tornadoes United States Urbanization Vulnerable Populations Work clinical risk cost design extreme temperature health care service utilization indexing interest killings mortality multidisciplinary older patient programs public health relevance

项目摘要

DESCRIPTION (provided by applicant): The frequency and duration of heat waves have increased significantly over the last 50 years in the United States. Heat waves killed more people during a typical year than floods, tornadoes, and earthquakes combined. The health impacts of extreme heat events are likely to increase as a result of the synergistic effects of a warming climate, urbanization, and the aging of the population. Older people are especially vulnerable to heat waves, not only because of age and preexisting medical conditions, but also because of the multiple medications they take for comorbid conditions. Several researchers have proposed hypotheses about interactions between heat waves and medication use. Given the high prevalence of medication use and polypharmacy among older persons, it is important to understand the combined impact of medication use and heat waves. A multidisciplinary team of experts in climatology, pharmacoepidemiology, and health services and outcomes research will work collaboratively to design and conduct analyses to (1) identify and quantify the potential magnifying effects of commonly used prescription medications on the short- and long-term health consequences of heat waves and the heat-related side effects of these medications, and (2) quantify health care resource use (hospitalizations, intensive care unit stays, and costs) during heat waves, considering both the direct effects of heat waves and the effects of drug-heat wave interactions. To conduct the proposed analyses, we will link several existing data sources, including temperature, humidity, heat index, and air pollution data, data on health care resource use in the Medicare program, and longitudinal data on pharmacy dispensing. The drug categories of interest include antipsychotics, antidepressants, stimulants, diuretics, antihypertensive drugs, antiepileptic drugs, anti-Parkinson drugs, lipid-lowering agents, and other medications with significant anticholinergic properties that may increase the risk of heat stroke by disturbing thermoregulation, inducing fluid and electrolyte imbalance, or decreasing thirst or that have known adverse effects that may be magnified by extreme heat conditions. The conceptual framework and methods being developed in the proposal can be adapted to other populations and data sources, including other climate data and electronic health records. At the completion of this preliminary study, we will have provided the first clear analyses on interactions between heat waves and commonly used prescription drugs among older patients. These data may inform clinicians, policy makers, patients, and other key stakeholders by characterizing the scope of the problem and can be further expanded to assist in the development of tailored guides and adaptive strategies for vulnerable populations.

描述（由申请人提供）：过去 50 年来，美国热浪的频率和持续时间显着增加。通常一年中，热浪造成的死亡人数比洪水、龙卷风和地震造成的死亡人数总和还要多。由于气候变暖、城市化和人口老龄化的协同效应，极端高温事件对健康的影响可能会增加。老年人特别容易受到热浪的影响，这不仅是因为年龄和既往健康状况，还因为他们为治疗合并症而服用多种药物。一些研究人员提出了关于热浪和药物使用之间相互作用的假设。鉴于老年人中药物使用和多种药物的普遍存在，了解药物使用和热浪的综合影响非常重要。由气候学、药物流行病学以及卫生服务和结果研究领域的多学科专家团队将共同设计和进行分析，以 (1) 识别和量化潜力放大常用处方药对热浪的短期和长期健康后果以及这些药物与热相关的副作用的影响，以及 (2) 量化医疗保健资源的使用（住院、重症监护病房住院和费用））在热浪期间，同时考虑热浪的直接影响和药物与热波相互作用的影响。为了进行拟议的分析，我们将链接几个现有的数据源，包括温度、湿度、炎热指数和空气污染数据、医疗保险计划中医疗保健资源使用的数据以及药房配药的纵向数据。感兴趣的药物类别包括抗精神病药、抗抑郁药、兴奋剂、利尿剂、抗高血压药、抗癫痫药、抗帕金森药、降脂药以及其他具有显着抗胆碱能特性的药物，这些药物可能通过扰乱体温调节、诱发中暑而增加中暑的风险。液体和电解质不平衡，或口渴减少，或已知的不利影响可能会因极端炎热条件而放大。该提案中正在制定的概念框架和方法可以适应其他人群和数据源，包括其他气候数据和电子健康记录。在完成这项初步研究后，我们将首次对热浪与老年患者常用处方药之间的相互作用进行清晰的分析。这些数据可以通过描述问题的范围来为临床医生、政策制定者、患者和其他主要利益相关者提供信息，并且可以进一步扩展以协助为弱势群体制定量身定制的指南和适应性策略。