Sex-Specific Associations Between Bipolar Disorder Pharmacological Maintenance Therapies and Inpatient Rehospitalizations: A 9-Year Swedish National Registry Study
Background: Long-term pharmacological maintenance therapy is often essential among people with bipolar disorder to reduce the need for inpatient care. Sex-specific responses to maintenance therapies are expected but remain largely unknown. Here, we examined for sex-specific associations between comm...
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| Format: | Article |
| Language: | English |
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Frontiers Media S.A.
2020-11-01
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| Series: | Frontiers in Psychiatry |
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| Online Access: | https://www.frontiersin.org/articles/10.3389/fpsyt.2020.598946/full |
| _version_ | 1818255932114599936 |
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| author | Dragos C. Ragazan Dragos C. Ragazan Jonas Eberhard Jonas Eberhard Jonas Berge Jonas Berge |
| author_facet | Dragos C. Ragazan Dragos C. Ragazan Jonas Eberhard Jonas Eberhard Jonas Berge Jonas Berge |
| author_sort | Dragos C. Ragazan |
| collection | DOAJ |
| description | Background: Long-term pharmacological maintenance therapy is often essential among people with bipolar disorder to reduce the need for inpatient care. Sex-specific responses to maintenance therapies are expected but remain largely unknown. Here, we examined for sex-specific associations between common maintenance therapies for bipolar disorder with inpatient rehospitalizations following patients' index discharges during 2006–2014.Methods: Population-based data on maintenance therapies and rehospitalizations were extracted from Swedish national registries. We adopted the within-individual design to compare the time on- vs. off- maintenance therapy for males and females, respectively. Extended stratified Cox proportional hazards regression models were employed to quantify the rate of rehospitalization as a function of common maintenance drugs and other important time-varying control variables.Results: Our primary analysis included 22,681 bipolar disorder rehospitalizations by 6,400 males and 9,588 (60.0%) females over an observation time of 62,813 person-years. The time spent on- vs. off- maintenance lithium, lamotrigine, quetiapine, or olanzapine was statistically significant upon adjustment among either sex for reducing the rate of bipolar rehospitalizations. Adjusted sex-specific statistically significant associations were also observed. Among females, the time on- (vs. off-) long-acting injectable risperidone reduced the rate of bipolar rehospitalizations by 73% (56–84%), carbamazepine by 44% (18–62%), aripiprazole by 29% (13–42%), and valproate by 23% (11–33%); whereas among males, ziprasidone by 65% (41–79%).Conclusion: The effectiveness of most maintenance therapies is generally comparable and uniform among both males and females. Despite some statistically significant sex-specific associations, estimates for each drug were fairly consistent between sexes. |
| first_indexed | 2024-12-12T17:19:43Z |
| format | Article |
| id | doaj.art-160d06ea6bff4c748749109fd8a48fe9 |
| institution | Directory Open Access Journal |
| issn | 1664-0640 |
| language | English |
| last_indexed | 2024-12-12T17:19:43Z |
| publishDate | 2020-11-01 |
| publisher | Frontiers Media S.A. |
| record_format | Article |
| series | Frontiers in Psychiatry |
| spelling | doaj.art-160d06ea6bff4c748749109fd8a48fe92022-12-22T00:17:41ZengFrontiers Media S.A.Frontiers in Psychiatry1664-06402020-11-011110.3389/fpsyt.2020.598946598946Sex-Specific Associations Between Bipolar Disorder Pharmacological Maintenance Therapies and Inpatient Rehospitalizations: A 9-Year Swedish National Registry StudyDragos C. Ragazan0Dragos C. Ragazan1Jonas Eberhard2Jonas Eberhard3Jonas Berge4Jonas Berge5Division of Psychiatry, Department of Clinical Sciences Lund, Faculty of Medicine, Lund University, Lund, SwedenVancouver Coastal Health Authority, University of British Columbia Hospital Detwiller Pavilion, Vancouver, BC, CanadaDivision of Psychiatry, Department of Clinical Sciences Lund, Faculty of Medicine, Lund University, Lund, SwedenRegion Skåne, Adult Psychiatry Clinic Helsingborg, Helsingborg, SwedenDivision of Psychiatry, Department of Clinical Sciences Lund, Faculty of Medicine, Lund University, Lund, SwedenRegion Skåne, Adult Psychiatry Clinic Malmö, Addiction Centre Malmö, Malmö, SwedenBackground: Long-term pharmacological maintenance therapy is often essential among people with bipolar disorder to reduce the need for inpatient care. Sex-specific responses to maintenance therapies are expected but remain largely unknown. Here, we examined for sex-specific associations between common maintenance therapies for bipolar disorder with inpatient rehospitalizations following patients' index discharges during 2006–2014.Methods: Population-based data on maintenance therapies and rehospitalizations were extracted from Swedish national registries. We adopted the within-individual design to compare the time on- vs. off- maintenance therapy for males and females, respectively. Extended stratified Cox proportional hazards regression models were employed to quantify the rate of rehospitalization as a function of common maintenance drugs and other important time-varying control variables.Results: Our primary analysis included 22,681 bipolar disorder rehospitalizations by 6,400 males and 9,588 (60.0%) females over an observation time of 62,813 person-years. The time spent on- vs. off- maintenance lithium, lamotrigine, quetiapine, or olanzapine was statistically significant upon adjustment among either sex for reducing the rate of bipolar rehospitalizations. Adjusted sex-specific statistically significant associations were also observed. Among females, the time on- (vs. off-) long-acting injectable risperidone reduced the rate of bipolar rehospitalizations by 73% (56–84%), carbamazepine by 44% (18–62%), aripiprazole by 29% (13–42%), and valproate by 23% (11–33%); whereas among males, ziprasidone by 65% (41–79%).Conclusion: The effectiveness of most maintenance therapies is generally comparable and uniform among both males and females. Despite some statistically significant sex-specific associations, estimates for each drug were fairly consistent between sexes.https://www.frontiersin.org/articles/10.3389/fpsyt.2020.598946/fullbipolar disorderpharmacoepidemiogyrehospitalizationsex-based analysissex-based differencesregister |
| spellingShingle | Dragos C. Ragazan Dragos C. Ragazan Jonas Eberhard Jonas Eberhard Jonas Berge Jonas Berge Sex-Specific Associations Between Bipolar Disorder Pharmacological Maintenance Therapies and Inpatient Rehospitalizations: A 9-Year Swedish National Registry Study Frontiers in Psychiatry bipolar disorder pharmacoepidemiogy rehospitalization sex-based analysis sex-based differences register |
| title | Sex-Specific Associations Between Bipolar Disorder Pharmacological Maintenance Therapies and Inpatient Rehospitalizations: A 9-Year Swedish National Registry Study |
| title_full | Sex-Specific Associations Between Bipolar Disorder Pharmacological Maintenance Therapies and Inpatient Rehospitalizations: A 9-Year Swedish National Registry Study |
| title_fullStr | Sex-Specific Associations Between Bipolar Disorder Pharmacological Maintenance Therapies and Inpatient Rehospitalizations: A 9-Year Swedish National Registry Study |
| title_full_unstemmed | Sex-Specific Associations Between Bipolar Disorder Pharmacological Maintenance Therapies and Inpatient Rehospitalizations: A 9-Year Swedish National Registry Study |
| title_short | Sex-Specific Associations Between Bipolar Disorder Pharmacological Maintenance Therapies and Inpatient Rehospitalizations: A 9-Year Swedish National Registry Study |
| title_sort | sex specific associations between bipolar disorder pharmacological maintenance therapies and inpatient rehospitalizations a 9 year swedish national registry study |
| topic | bipolar disorder pharmacoepidemiogy rehospitalization sex-based analysis sex-based differences register |
| url | https://www.frontiersin.org/articles/10.3389/fpsyt.2020.598946/full |
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