Hospital-Treated Pneumonia Associated with Opioid Use Among Community Dwellers with Alzheimer’s Disease

Article type: Research Article

Authors: Hamina, Aleksi^{a; b; *} | Taipale, Heidi^{a; b; c; d} | Karttunen, Niina^{a; b} | Tanskanen, Antti^{c; d; e} | Tiihonen, Jari^{c; d; f} | Tolppanen, Anna-Maija^{b; g} | Hartikainen, Sirpa^{a; b}

Affiliations: [a] Kuopio Research Centre of Geriatric Care, University of Eastern Finland, Kuopio, Finland | [b] School of Pharmacy, University of Eastern Finland, Kuopio, Finland | [c] Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden | [d] Department of Forensic Psychiatry, University of Eastern Finland, Niuvanniemi Hospital, Kuopio, Finland | [e] Public Health Solutions, National Institute for Health and Welfare, Helsinki, Finland | [f] Center for Psychiatric Research, Stockholm City Council, Stockholm, Sweden | [g] Research Centre for Comparative Effectiveness and Patient Safety (RECEPS), University of Eastern Finland, Kuopio, Finland

Correspondence: [*] Correspondence to: Aleksi Hamina, MSc (Pharm), Kuopio Research Centre of Geriatric Care, University of Eastern Finland, PO Box 1627, 70211 Kuopio, Finland. Tel.: +358503537868; Fax: +35817162424; E-mail: [email protected].

Abstract: Background:Pneumonia is a common cause for hospitalization and excess mortality among persons with Alzheimer’s disease (AD), but little research exists evaluating drug use as its risk factor. Objective:We investigated the association between opioid use and hospital-treated pneumonia among community dwellers with AD. Methods:This study was part of the Medication use and Alzheimer’s Disease (MEDALZ) cohort. We included all community dwellers newly diagnosed with AD during 2010–2011 in Finland with incident prescription opioid use (n = 5,623) and age-, sex-, and time since AD diagnosis-matched nonusers (n = 5,623). Opioid use data, modelled from pharmacy dispensing data, and hospital-treated pneumonia were retrieved from nationwide registers. Patients with active cancer treatment were excluded. Hazard models compared opioid users to nonusers, adjusting for comorbidities, socioeconomic position. and other drug use. Results:Incident opioid use was associated with an increased risk of hospital-treated pneumonia compared to nonuse (adjusted HR, aHR 1.34, 95% CI 1.14–1.57). Highest risk was observed during the first two months of use (aHR 2.58, 95% CI 1.87–3.55). Compared to weak opioids, buprenorphine was not associated with a higher risk of pneumonia (aHR 1.20, 95% CI 0.83–1.76), but strong opioids were (aHR 1.84, 95% CI 1.15–2.97). The risk was higher for those using ≥50 morphine milligram equivalents (MME)/day (aHR 2.03, 95% CI 1.24–3.31), compared to using <50 MME/day. Conclusions:Opioid use was associated with a risk of hospital-treated pneumonia in a dose-dependent manner among persons with AD. Risk-minimization strategies should be considered if opioid therapy is needed.

Keywords: Aged, Alzheimer’s disease, dementia, opioids, pharmacoepidemiology, pneumonia

DOI: 10.3233/JAD-181295

Journal: Journal of Alzheimer's Disease, vol. 69, no. 3, pp. 807-816, 2019