Introduction
Methods
Descriptive Comparison of the Measures
Feature | Average daily score [6] | Cumulative dose [5] | Cumulative anticholinergic burden |
---|---|---|---|
Data requirements for implementation in administrative database studies | |||
Medication name | Yes | Yes | Yes |
Medication dose | No | Yes | Yes |
Days supplied | No | Yes | Yes |
Minimum-effective dose | No | Yes [29]a | No |
Daily dose of dispensed medications | No | No | Yesa |
Developed within the context of a specific disease/condition? | No | No | No |
Built from a specific anticholinergic burden scale? | Yes, ACB scale but can accommodate any scale | No | Yes, ACB scale but can accommodate any scale |
Can any scale be considered for this measure? | Yes | Yesb | Yes |
Does it consider duration of exposure? | Yes | Yesc | Yes |
Does it consider cumulative exposure? | Yes | Yes | Yes |
Does the calculation consider dose? | No | Yes | Yes |
Does it consider residual anticholinergic effect? | No | No | No |
What does the measure estimate | Average daily anticholinergic exposure | Cumulative total standardized daily dose | Cumulative anticholinergic exposure |
Score boundaries | Lower bound: 0, upper bound: depends on the scale considered (theoretical upper bound) | Lower bound: 0, upper bound: infinity (theoretical upper bound) | Lower bound: 0, upper bound: infinity (theoretical upper bound) |
Suggested score categories | 0: 0–0.49; 1: 0.50–1.49; 2: 1.50–2.49; etc | No use; 1–7; 7–17; 17–34; ≥ 34 | Study-specific |
Method for determining score categories | Arbitrary | Based on clinical interpretability and the observed exposure distribution within the study sample | May be informed by assessment of the distribution of the empirically observed outcomes |
Score depends on length of study period? | No | Yes | Yes |
Quantitative Evaluation of the Measures
Data Source
Cohort Identification
Scale Selection
Data Evaluation for Measure Implementation
Measurement of Cumulative Anticholinergic Exposure
Average Daily Dose Measure
Cumulative Dose Measure
Cumulative Anticholinergic Burden Measure
Statistical Analysis
Results
Descriptive Comparison of the Measures
Quantitative Evaluation of the Measures
General population n = 99,742 | By anticholinergic exposure | ||
---|---|---|---|
Treated with anticholinergics n = 55,969 | No anticholinergic exposure n = 43,773 | ||
Age (years) | |||
Mean (SD) | 73.1 (7.6) | 73.8 (7.8) | 72.2 (7.3) |
Median [IQR] | 71 [66, 78] | 72 [67, 79] | 70 [66, 77] |
n
| % |
n
| % |
n
| % | |
---|---|---|---|---|---|---|
Age categories (years) | ||||||
65 < 70 | 42,828 | 42.9 | 21,710 | 38.8 | 21,118 | 48.2 |
70 < 75 | 20,055 | 20.1 | 11,246 | 20.1 | 8809 | 20.1 |
75 < 80 | 15,308 | 15.3 | 9290 | 16.6 | 6018 | 13.7 |
80 < 85 | 11,543 | 11.6 | 7228 | 12.9 | 4315 | 9.9 |
≥ 85 | 10,008 | 10.0 | 6495 | 11.6 | 3513 | 8.0 |
Sex | ||||||
Female | 54,806 | 54.9 | 32,313 | 57.7 | 22,493 | 51.4 |
Male | 44,936 | 45.1 | 23,656 | 42.3 | 21,280 | 48.6 |
Region | ||||||
Northeast | 22,774 | 22.8 | 12,692 | 22.7 | 10,082 | 23.0 |
North central | 25,378 | 25.4 | 14,353 | 25.6 | 11,025 | 25.2 |
South | 31,478 | 31.6 | 18,622 | 33.3 | 12,856 | 29.4 |
West | 17,946 | 18.0 | 9101 | 16.3 | 8845 | 20.2 |
Unknown | 804 | 0.8 | 399 | 0.7 | 405 | 0.9 |
Multiple regions | 1362 | 1.4 | 802 | 1.4 | 560 | 1.3 |
Data Evaluation for Measure Implementation
Cumulative Anticholinergic Exposure Scores and Correlations
Measure | All cohort members (n= 99,742) | Cohort members with anticholinergic dispensations (n= 55,969) | ||
---|---|---|---|---|
Median (IQR) | Range | Median (IQR) | Range | |
Average daily dose (including days with no anticholinergics) | 0.1 (0.0, 0.9) | 0.0, 16.1 | 0.9 (0.3, 1.5) | 0.0, 16.1 |
Cumulative dose | 2.9 (0.0, 19.7) | 0.0, 390.3 | 16.9 (7.3, 33.9) | 0.1, 390.3 |
Cumulative Anticholinergic Burden | 24 (0, 240) | 0, 11,609 | 203 (68, 500) | 0, 11,609 |