Adherence to Prescribed Acamprosate in Alcohol Dependence and 1-Year Morbidities and Mortality: Utilizing a Data Linkage Methodology
Abstract
:1. Background and Significance
2. Objectives
3. Materials and Methods
3.1. Setting
3.2. Individuals on Acamprosate
3.3. Ethical, Information, and Research Governance
3.4. Calculation of Adherence
- We categorized individuals as having good adherence to acamprosate if the adherence index was ≥80%;
- We categorized individuals as having low adherence to acamprosate if the adherence index was <80%.
3.5. Datasets and Data Linkage
- Cardiovascular: e.g., chronic ischemic heart disease, cardiomyopathy, heart failure;
- Cerebrovascular: e.g., intracerebral hemorrhage, cerebral infarction, cerebral aneurysm;
- Neoplasm: e.g., neoplasm of the pancreas, neoplasm of the liver;
- Poisoning: e.g., poisoning by narcotics, poisoning by topical agents, poisoning by nonopioid analgesics;
- Respiratory: e.g., pulmonary disease, pneumonia, bronchitis, respiratory failure;
- Mental and behavioral disorder: e.g., anxiety, obsessive compulsive disorder, stress, mood disorder, schizophrenia, withdrawal state with delirium;
- Hepatic: e.g., cirrhosis, liver disease, chronic hepatitis;
- Gastrointestinal: e.g., gastro-esophageal reflux disease, gastrointestinal hemorrhage, gastroenteritis, and colitis.
- (1)
- Not direct: cardiovascular, cerebrovascular, neoplasm, poisoning and respiratory;
- (2)
- Direct: alcohol-related and unspecified alcohol issues, hepatic, gastrointestinal and alcohol-related causes on the certificate of death.
- (1)
- Not direct: acute stress, mood disorder, anxiety and panic attack;
- (2)
- Direct: mental and behavioral disorders due to use of alcohol and alcohol induced conditions (e.g., withdrawal, harmful use, dependence and hallucinations).
3.6. Statistical Methods
4. Results
4.1. Descriptive Statistics
4.2. Morbidities
4.2.1. Medical Admissions (SMR01)
4.2.2. Psychiatric Admissions (SMR04)
4.2.3. Accident and Emergency (A&E) Admissions
4.2.4. Other Medication as Proxy Measure of Morbidities
4.3. Cause of Death
4.4. Multivariable Associations between Covariates and Causes of Mortality
5. Discussion
6. Conclusions
Supplementary Materials
Author Contributions
Funding
Institutional Review Board Statement
Informed Consent Statement
Data Availability Statement
Acknowledgments
Conflicts of Interest
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Total | |
---|---|
Number | 3319 |
Ethnicity (white) | 3319 (100%) |
Mean age (SD) in years | 48.41 (11.88) |
Males | 2047 (61%) |
Females | 1272 (39%) |
SIMD | |
1 most deprived | 529 (16.0%) |
2 | 471 (14.0%) |
3 | 430 (12.6%) |
4 | 374 (10.6%) |
5 | 237 (8.0%) |
6+ least deprived | 1176 (35.5%) |
Total number of deaths within the 10-year study period | 617 |
Total number of Individuals who died within 1 year of starting acamprosate | 252 |
Predictor | HR | 95% CI | p-Value |
---|---|---|---|
Overall attendance at hospitals | 0.001 | ||
Low adherence | 1.001 | 1.0–1.002 | 0.01 |
Reasons | |||
Cardiovascular | 1.049 | 0.765–1.44 | 0.802 |
Cerebrovascular | 2.27 | 0.705–7.311 | 0.249 |
Neoplasm | 4.104 | 2.277–7.075 | <0.001 |
Poisoning | 1.406 | 1.175–1.684 | <0.01 |
Respiratory | 1.428 | 0.99–2.062 | 0.11 |
Mental and behavior disorder | 0.919 | 0.642–1.317 | 0.7 |
Hepatic | 1.053 | 0.802–1.384 | 0.754 |
Gastrointestinal | 1.375 | 1.0 | 1.892 |
Predictor | HR | 95% CI | p-Value |
---|---|---|---|
Overall attendance at psychiatric hospitals | <0.001 | ||
Low adherence | 3.00 | 3.0–3.002 | 0.02 |
Reasons | |||
Acute stress | 35.11 | 14.53–86.47 | <0.001 |
Mood disorder | 2.463 | 1.11–5.65 | 0.063 |
Alcohol induced conditions: withdrawal, harmful use, dependence, hallucinations | 3.734 | 1.79–7.8 | <0.01 |
Schizophrenia | 5.580 | 3.1–10.1 | <0.001 |
Mental and behavioral disorder due to use of alcohol | 7.412 | 2.43–22.67 | <0.01 |
Anxiety disorder, OCD, panic attack | 647.3 | 181.93–2303.19 | <0.001 |
Causes | ICD-10 Code | Examples | Number of Deaths within a 1-Year Period (%) |
---|---|---|---|
Alcohol liver disease | K70–K77 |
| 30 (33) |
Mental and behavioral disorder due to use of alcohol | F10 |
| 53 (57) |
Gastrointestinal | K40–K63 |
| 1 (2) |
Cardiovascular | I00–I69 |
| 12 (5) |
Neoplasm | C00–C72 |
| 7 (3) |
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Tolomeo, S.; Baldacchino, A. Adherence to Prescribed Acamprosate in Alcohol Dependence and 1-Year Morbidities and Mortality: Utilizing a Data Linkage Methodology. J. Clin. Med. 2021, 10, 2102. https://doi.org/10.3390/jcm10102102
Tolomeo S, Baldacchino A. Adherence to Prescribed Acamprosate in Alcohol Dependence and 1-Year Morbidities and Mortality: Utilizing a Data Linkage Methodology. Journal of Clinical Medicine. 2021; 10(10):2102. https://doi.org/10.3390/jcm10102102
Chicago/Turabian StyleTolomeo, Serenella, and Alex Baldacchino. 2021. "Adherence to Prescribed Acamprosate in Alcohol Dependence and 1-Year Morbidities and Mortality: Utilizing a Data Linkage Methodology" Journal of Clinical Medicine 10, no. 10: 2102. https://doi.org/10.3390/jcm10102102
APA StyleTolomeo, S., & Baldacchino, A. (2021). Adherence to Prescribed Acamprosate in Alcohol Dependence and 1-Year Morbidities and Mortality: Utilizing a Data Linkage Methodology. Journal of Clinical Medicine, 10(10), 2102. https://doi.org/10.3390/jcm10102102