Medication utilization in traumatic brain injury patients—insights from a population-based matched cohort study
IntroductionTraumatic brain injury (TBI) is associated with health problems across multiple domains and TBI patients are reported to have high rates of medication use. However, prior evidence is thin due to methodological limitations. Our aim was thus to examine the use of a wide spectrum of medicat...
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Frontiers Media S.A.
2024-02-01
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| Series: | Frontiers in Neurology |
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| Online Access: | https://www.frontiersin.org/articles/10.3389/fneur.2024.1339290/full |
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| author | Yasmina Molero Yasmina Molero Yasmina Molero David J. Sharp Brian M. D’Onofrio Brian M. D’Onofrio Paul Lichtenstein Henrik Larsson Henrik Larsson Seena Fazel Elham Rostami Elham Rostami |
| author_facet | Yasmina Molero Yasmina Molero Yasmina Molero David J. Sharp Brian M. D’Onofrio Brian M. D’Onofrio Paul Lichtenstein Henrik Larsson Henrik Larsson Seena Fazel Elham Rostami Elham Rostami |
| author_sort | Yasmina Molero |
| collection | DOAJ |
| description | IntroductionTraumatic brain injury (TBI) is associated with health problems across multiple domains and TBI patients are reported to have high rates of medication use. However, prior evidence is thin due to methodological limitations. Our aim was thus to examine the use of a wide spectrum of medications prescribed to address pain and somatic conditions in a population-based cohort of TBI patients, and to compare this to a sex- and age-matched cohort. We also examined how patient factors such as sex, age, and TBI severity were associated with medication use.MethodsWe assessed Swedish nationwide registers to include all individuals treated for TBI in hospitals or specialist outpatient care between 2006 and 2012. We examined dispensed prescriptions for eight different non-psychotropic medication classes for the 12 months before, and 12 months after, the TBI. We applied a fixed-effects model to compare TBI patients with the matched population cohort. We also stratified TBI patients by sex, age, TBI severity and carried out comparisons using a generalized linear model.ResultsWe identified 239,425 individuals with an incident TBI and 239,425 matched individuals. TBI patients were more likely to use any medication [Odds ratio (OR) = 2.03, 95% Confidence Interval (CI) = 2.00–2.05], to present with polypharmacy (OR = 1.96, 95% CI = 1.90–2.02), and to use each of the eight medication classes before their TBI, as compared to the matched population cohort. Following the TBI, TBI patients were more likely to use any medication (OR = 1.83, 95% CI = 1.80–1.86), to present with polypharmacy (OR = 1.74, 95% CI = 1.67–1.80), and to use all medication classes, although differences were attenuated. However, differences increased for antibiotics/antivirals (OR = 2.02, 95% CI = 1.99–2.05) and NSAIDs/antirheumatics (OR = 1.62, 95% CI = 1.59–1.65) post-TBI. We also found that females and older patients were more likely to use medications after their TBI than males and younger patients, respectively. Patients with more severe TBIs demonstrated increased use of antibiotics/ antivirals and NSAIDs/antirheumatics than those with less severe TBIs.DiscussionTaken together, our results point to poor overall health in TBI patients, suggesting that medical follow-up should be routine, particularly in females with TBI, and include a review of medication use to address potential polypharmacy. |
| first_indexed | 2024-03-08T05:14:59Z |
| format | Article |
| id | doaj.art-4b341f08bdf44973ada2baa5bdb54e8d |
| institution | Directory Open Access Journal |
| issn | 1664-2295 |
| language | English |
| last_indexed | 2024-03-08T05:14:59Z |
| publishDate | 2024-02-01 |
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| series | Frontiers in Neurology |
| spelling | doaj.art-4b341f08bdf44973ada2baa5bdb54e8d2024-02-07T04:26:59ZengFrontiers Media S.A.Frontiers in Neurology1664-22952024-02-011510.3389/fneur.2024.13392901339290Medication utilization in traumatic brain injury patients—insights from a population-based matched cohort studyYasmina Molero0Yasmina Molero1Yasmina Molero2David J. Sharp3Brian M. D’Onofrio4Brian M. D’Onofrio5Paul Lichtenstein6Henrik Larsson7Henrik Larsson8Seena Fazel9Elham Rostami10Elham Rostami11Department of Clinical Neuroscience, Centre for Psychiatry Research, Karolinska Institutet, Stockholm, SwedenStockholm Health Care Services, Stockholm County Council, Stockholm, SwedenDepartment of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, SwedenDepartment of Brain Sciences, Imperial College London, London, United KingdomDepartment of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, SwedenDepartment of Psychological and Brain Sciences, Indiana University, Bloomington, IN, United StatesDepartment of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, SwedenDepartment of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, SwedenSchool of Medical Sciences, Örebro University, Örebro, SwedenDepartment of Psychiatry, University of Oxford, Oxford, United KingdomDepartment of Neuroscience, Karolinska Institutet, Stockholm, SwedenDepartment of Medical Sciences, Uppsala University, Uppsala, SwedenIntroductionTraumatic brain injury (TBI) is associated with health problems across multiple domains and TBI patients are reported to have high rates of medication use. However, prior evidence is thin due to methodological limitations. Our aim was thus to examine the use of a wide spectrum of medications prescribed to address pain and somatic conditions in a population-based cohort of TBI patients, and to compare this to a sex- and age-matched cohort. We also examined how patient factors such as sex, age, and TBI severity were associated with medication use.MethodsWe assessed Swedish nationwide registers to include all individuals treated for TBI in hospitals or specialist outpatient care between 2006 and 2012. We examined dispensed prescriptions for eight different non-psychotropic medication classes for the 12 months before, and 12 months after, the TBI. We applied a fixed-effects model to compare TBI patients with the matched population cohort. We also stratified TBI patients by sex, age, TBI severity and carried out comparisons using a generalized linear model.ResultsWe identified 239,425 individuals with an incident TBI and 239,425 matched individuals. TBI patients were more likely to use any medication [Odds ratio (OR) = 2.03, 95% Confidence Interval (CI) = 2.00–2.05], to present with polypharmacy (OR = 1.96, 95% CI = 1.90–2.02), and to use each of the eight medication classes before their TBI, as compared to the matched population cohort. Following the TBI, TBI patients were more likely to use any medication (OR = 1.83, 95% CI = 1.80–1.86), to present with polypharmacy (OR = 1.74, 95% CI = 1.67–1.80), and to use all medication classes, although differences were attenuated. However, differences increased for antibiotics/antivirals (OR = 2.02, 95% CI = 1.99–2.05) and NSAIDs/antirheumatics (OR = 1.62, 95% CI = 1.59–1.65) post-TBI. We also found that females and older patients were more likely to use medications after their TBI than males and younger patients, respectively. Patients with more severe TBIs demonstrated increased use of antibiotics/ antivirals and NSAIDs/antirheumatics than those with less severe TBIs.DiscussionTaken together, our results point to poor overall health in TBI patients, suggesting that medical follow-up should be routine, particularly in females with TBI, and include a review of medication use to address potential polypharmacy.https://www.frontiersin.org/articles/10.3389/fneur.2024.1339290/fulltraumatic brain injurymedicationspharmacoepidemiologysex differencesmatched cohort studypopulation-based study |
| spellingShingle | Yasmina Molero Yasmina Molero Yasmina Molero David J. Sharp Brian M. D’Onofrio Brian M. D’Onofrio Paul Lichtenstein Henrik Larsson Henrik Larsson Seena Fazel Elham Rostami Elham Rostami Medication utilization in traumatic brain injury patients—insights from a population-based matched cohort study Frontiers in Neurology traumatic brain injury medications pharmacoepidemiology sex differences matched cohort study population-based study |
| title | Medication utilization in traumatic brain injury patients—insights from a population-based matched cohort study |
| title_full | Medication utilization in traumatic brain injury patients—insights from a population-based matched cohort study |
| title_fullStr | Medication utilization in traumatic brain injury patients—insights from a population-based matched cohort study |
| title_full_unstemmed | Medication utilization in traumatic brain injury patients—insights from a population-based matched cohort study |
| title_short | Medication utilization in traumatic brain injury patients—insights from a population-based matched cohort study |
| title_sort | medication utilization in traumatic brain injury patients insights from a population based matched cohort study |
| topic | traumatic brain injury medications pharmacoepidemiology sex differences matched cohort study population-based study |
| url | https://www.frontiersin.org/articles/10.3389/fneur.2024.1339290/full |
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