Adverse Drug Reactions as Cause of Hospital Admissions: Results From the Italian Group of Pharmacoepidemiology in the Elderly (GIFA)

J Am Geriatr Soc. 2002 Dec;50(12):1962-8. doi: 10.1046/j.1532-5415.2002.50607.x.

Abstract

Objectives: To determine the prevalence of adverse drug reaction (ADR)-related hospital admissions in an older population, to describe the most common clinical manifestations and drugs most frequently responsible for ADR-related hospital admissions, and to identify independent factors predictive of these ADRs.

Design: Multicenter pharmacoepidemiology survey conducted between 1988 and 1997.

Setting: Eighty-one academic hospitals throughout Italy.

Participants: Twenty-eight thousand four hundred eleven patients consecutively admitted to participating centers during the survey periods.

Measurements: For each suspected ADR at admission, a physician, who coded description, severity, and potentially responsible drugs, completed a questionnaire.

Results: Mean age +/- standard deviation of the patients was 70 +/- 16. One thousand seven hundred four ADRs were identified upon hospital admission. In 964 cases (3.4% of all admissions), ADRs were considered to be the cause of these hospital admissions. Of these, 187 ADRs were coded as severe. Gastrointestinal complaints (19%) represented the most common events, followed by metabolic and hemorrhagic complications (9%). The drugs most frequently responsible for these ADRs were diuretics, calcium channel blockers, nonsteroidal antiinflammatory drugs, and digoxin. Female sex (odds ratio (OR) = 1.30, 95% confidence interval (CI) = 1.10-1.54), alcohol use (OR = 1.39, 95% CI = 1.20-1.60), and number of drugs (OR = 1.24, 95% CI = 1.20-1.27 for each drug increase) were independent predictors of ADR-related hospital admissions. For severe ADRs, age (OR = 1.50, 95% CI = 1.01-2.23 for age 65-79 and OR = 1.53, 95% CI = 1.00-2.33 for age > or =80, respectively), comorbidity (OR = 1.12, 95% CI = 1.05-1.20 for each point in the Charlson Comorbidity Index), and number of drugs (OR = 1.18, 95% CI = 1.11-1.25 for each drug increase) were the only predisposing factors.

Conclusions: The most important determinant of risk for ADR-related hospital admissions in older patients is number of drugs being taken. When considering only severe ADRs, risk is also related to age and frailty.

Publication types

  • Multicenter Study
  • Research Support, Non-U.S. Gov't

MeSH terms

  • Aged*
  • Alcohol Drinking / adverse effects
  • Anti-Inflammatory Agents, Non-Steroidal / adverse effects
  • Calcium Channel Blockers / adverse effects
  • Comorbidity
  • Digoxin / adverse effects
  • Diuretics / adverse effects
  • Drug-Related Side Effects and Adverse Reactions*
  • Female
  • Gastrointestinal Diseases / chemically induced
  • Hemorrhage / chemically induced
  • Humans
  • Male
  • Metabolic Diseases / chemically induced
  • Patient Admission / statistics & numerical data*
  • Risk Factors
  • Sex Factors
  • Surveys and Questionnaires

Substances

  • Anti-Inflammatory Agents, Non-Steroidal
  • Calcium Channel Blockers
  • Diuretics
  • Digoxin