Background: Benzodiazepine (Bz) exposure has been identified as a risk factor of community-acquired pneumonia (CAP) in some observational studies, but this remains controversial. This study was designed to quantify the risk of CAP associated with treatment with Bz. Methods: All individuals ⩾14 years of age registered in any of 3 primary health care providers in our area between January 2011 and May 2013 were included in the study. This resulted in a population of 51 912 individuals who contributed to a total of 1 496 680 person-months of observation. Previously anonymized data for each participant were obtained from their personal health records and the official prescription database. The primary outcome measures were the incidence of CAP during the study period and the relative risk (RR) that could be attributed to Bz exposure. Results: A total of 696 CAP cases were diagnosed. Incidence density was 12.4 cases per 1000 person-years in individuals exposed to Bz and 4.51 cases per 1000 person-years in those who were not. Benzodiazepine exposure increased the risk of CAP in the whole population (RR: 2.76, 95% confidence interval: 2.35-3.25) and in all the evaluated subgroups. Stratified analysis showed an interaction only with age (RR: 2.99 in patients under 65 years and 1.78 in those aged 65 or older). Benzodiazepine exposure was associated with an excess 0.79 cases of CAP per 100 person-years. Conclusions: Benzodiazepine exposure increases the risk of CAP. Given the clinical relevance of CAP, prescribers should be aware of this potentially preventable risk and consider it while newly prescribing Bz.
Background Frailty is a geriatric syndrome with repercussions on health, disability, and dependency. Objectives To assess health resource use and costs attributable to frailty in the aged population. Methods A population-based observational longitudinal study was performed, with follow-up from January 2018 to December 2019. Data were obtained retrospectively from computerized primary care and hospital medical records. The study population included all inhabitants aged ≥ 65 years ascribed to 3 primary care centres in Barcelona (Spain). Frailty status was established according to the Electronic Screening Index of Frailty. Health costs considered were hospitalizations, emergency visits, outpatient visits, day hospital sessions, and primary care visits. Cost analysis was performed from a public health financing perspective. Results For 9315 included subjects (age 75.4 years, 56% women), frailty prevalence was 12.3%. Mean (SD) healthcare cost in the study period was €1420.19 for robust subjects, €2845.51 for pre-frail subjects, €4200.05 for frail subjects, and €5610.73 for very frail subjects. Independently of age and sex, frailty implies an additional healthcare cost of €1171 per person and year, i.e., 2.25-fold greater for frail compared to non-frail. Conclusions Our findings underline the economic relevance of frailty in the aged population, with healthcare spending increasing as frailty increases.
Background primary care screening for frailty status is recommended in clinical guidelines, but is impeded by doctor and nurse workloads and the lack of valid, easy-to-use and time-saving screening tools. Aim to develop and validate a new electronic tool (the electronic screening index of frailty, e-SIF) using routinely available electronic health data to automatically and massively identify frailty status in the population aged ≥65 years. Methods the e-SIF was developed in three steps: selection of clinical conditions; establishment of ICD-10 codes, criteria and algorithms for their definition; and electronic tool design and data extraction, transformation and load processes. The validation phase included an observational cohort study with retrospective data collection from computerised primary care medical records. The study population included inhabitants aged ≥65 years corresponding to three primary care centres (n = 9,315). Evaluated was the relationship between baseline e-SIF categories and mortality, institutionalisation, hospitalisation and health resource consumption after 2 years. Results according to the e-SIF, which includes 42 clinical conditions, frailty prevalence increases with age and is slightly greater in women. The 2-year adjusted hazard ratios for pre-frail, frail and very frail subjects, respectively, were as follows: 2.23 (95% CI: 1.74–2.85), 3.34 (2.44–4.56) and 6.49 (4.30–9.78) for mortality; 2.80 (2.39–3.27), 5.53 (4.59–6.65) and 9.14 (7.06–11.8) for hospitalisation; and 1.02 (0.70–1.49), 1.93 (1.21–3.08) and 2.69 (1.34–5.40) for institutionalisation. Conclusions the e-SIF shows good agreement with mortality, institutionalisation, hospitalisation and health resource consumption, indicating satisfactory validity. More studies in larger populations are needed to corroborate our findings.
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