Anticholinergic burden among in-patients: a cross-sectional study on prevalence, determinants, and impact on mortality in Ethiopia

Eyob Alemayehu Gebreyohannes; Wagaye Atalay  Taye; Biniam Siyum  Shibe; Emneteab Mesfin Ayele; Kenneth Lee; Segenet Bizuneh  Mengistu; Roy Soiza; Phyo Kyaw Myint; Ousman Abubeker Abdela

doi:10.1177/20420986241259624

Anticholinergic burden among in-patients: a cross-sectional study on prevalence, determinants, and impact on mortality in Ethiopia

Eyob Alemayehu Gebreyohannes^* (Corresponding Author)
, Wagaye Atalay Taye
, Biniam Siyum Shibe
, Emneteab Mesfin Ayele
, Kenneth Lee
, Segenet Bizuneh Mengistu
, Roy Soiza
, Phyo Kyaw Myint
, Ousman Abubeker Abdela

^*Corresponding author for this work

Research output: Contribution to journal › Article › peer-review

1 Citation (Scopus)

7 Downloads (Pure)

Abstract

Background: Numerous studies report that anticholinergic burden (ACB) has been linked with several health consequences, including increased hospital admissions, prolonged hospitalization and physical and cognitive impairment. However, low- and middle-income settings, as well as younger individuals, are underrepresented.
Objectives: To assess the prevalence and determinants of ACB, and to assess the impact of ACB on in-hospital mortality among adult in-patients at University of Gondar comprehensive
Specialized Hospital (UOGCSH).
Design: A cross-sectional study was conducted from June to August 2022 at UOGCSH among
adult in-patients.
Methods: A pre-tested questionnaire was utilized to collect data from patients and their
corresponding medical charts. A consecutive sampling technique was used to select the
participants. Descriptive statistics were used to summarize socio-demographic and clinical
characteristics. Chi-squared, Fisher’s exact, and Wilcoxon rank sum tests, as appropriate, were used to determine associations between independent variables and ACB. Kaplan-Meier survival curve and cox proportional hazards regression test were used to assess the impact of ACB on inhospital mortality.
Results: A total of 420 adult in-patients, median (IQR) age of 38 (26, 55) years, participated in
this study. Over half (58.3%) were exposed to anticholinergic medicines, with a high ACB (≥3)
seen in 11.2% of participants. High ACB was associated with higher median number of medicines per patient (p=0.003) higher median hospital length of stay (p=0.033), and having mental and behavioral disorders (p<0.001). No significant association was found between ACB and inhospital mortality (log-rank test p=0.26, Cox regression adjusted HR: 1.47, 95% CI 0.335-6.453, p=0.61).
Conclusion: Among adult in-patients, a significant majority (58.3%) were subjected to
medications possessing anticholinergic properties, with a noteworthy 11.2% of the study subjects exhibiting a high ACB. Participants with higher median length of hospital stay were more likely to have high ACB even in this relatively younger adult patient population.

Original language	English
Pages (from-to)	1-12
Number of pages	12
Journal	Therapeutic Advances in Drug Safety
Volume	15
Early online date	14 Jun 2024
DOIs	https://doi.org/10.1177/20420986241259624
Publication status	Published - 2024

Bibliographical note

Acknowledgements
The authors express their sincere gratitude to the University of Gondar for their invaluable support throughout the research process. Special appreciation is extended to the study participants for their active involvement.

Data Availability Statement

The datasets used for the current study are available from the corresponding author on reasonable request.

Funding

This study was part of a larger project and was undertaken as part of the requirements for the partial fulfillment of the Master’s Degree in Clinical Pharmacy. Full funding for the study was provided to the student (WAT) by the University of Gondar with the Ref No (PGC 393/9/2014)

Funders	Funder number
Gondar University	PGC 393/9/2014

Keywords

Anticholinergic burden
hospitalization
adult
anticholinergic cognitive burden score

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Alemayehu_etal_TADS_Anticholinergic_Burden_Among_VoR
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Cite this

@article{5a4e52c4ef1243fea1ee3fe3eac2cecc,

title = "Anticholinergic burden among in-patients: a cross-sectional study on prevalence, determinants, and impact on mortality in Ethiopia",

abstract = "Background: Numerous studies report that anticholinergic burden (ACB) has been linked with several health consequences, including increased hospital admissions, prolonged hospitalization and physical and cognitive impairment. However, low- and middle-income settings, as well as younger individuals, are underrepresented. Objectives: To assess the prevalence and determinants of ACB, and to assess the impact of ACB on in-hospital mortality among adult in-patients at University of Gondar comprehensive Specialized Hospital (UOGCSH). Design: A cross-sectional study was conducted from June to August 2022 at UOGCSH among adult in-patients. Methods: A pre-tested questionnaire was utilized to collect data from patients and their corresponding medical charts. A consecutive sampling technique was used to select the participants. Descriptive statistics were used to summarize socio-demographic and clinical characteristics. Chi-squared, Fisher{\textquoteright}s exact, and Wilcoxon rank sum tests, as appropriate, were used to determine associations between independent variables and ACB. Kaplan-Meier survival curve and cox proportional hazards regression test were used to assess the impact of ACB on inhospital mortality. Results: A total of 420 adult in-patients, median (IQR) age of 38 (26, 55) years, participated in this study. Over half (58.3\%) were exposed to anticholinergic medicines, with a high ACB (≥3) seen in 11.2\% of participants. High ACB was associated with higher median number of medicines per patient (p=0.003) higher median hospital length of stay (p=0.033), and having mental and behavioral disorders (p<0.001). No significant association was found between ACB and inhospital mortality (log-rank test p=0.26, Cox regression adjusted HR: 1.47, 95\% CI 0.335-6.453, p=0.61). Conclusion: Among adult in-patients, a significant majority (58.3\%) were subjected to medications possessing anticholinergic properties, with a noteworthy 11.2\% of the study subjects exhibiting a high ACB. Participants with higher median length of hospital stay were more likely to have high ACB even in this relatively younger adult patient population. ",

keywords = "Anticholinergic burden, hospitalization, adult, anticholinergic cognitive burden score",

author = "Gebreyohannes, \{Eyob Alemayehu\} and Taye, \{Wagaye Atalay\} and Shibe, \{Biniam Siyum\} and Ayele, \{Emneteab Mesfin\} and Kenneth Lee and Mengistu, \{Segenet Bizuneh\} and Roy Soiza and Myint, \{Phyo Kyaw\} and \{Abubeker Abdela\}, Ousman",

note = "Acknowledgements The authors express their sincere gratitude to the University of Gondar for their invaluable support throughout the research process. Special appreciation is extended to the study participants for their active involvement.",

year = "2024",

doi = "10.1177/20420986241259624",

language = "English",

volume = "15",

pages = "1--12",

journal = "Therapeutic Advances in Drug Safety",

issn = "2042-0986",

publisher = "SAGE Publications Ltd",

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TY - JOUR

T1 - Anticholinergic burden among in-patients

T2 - a cross-sectional study on prevalence, determinants, and impact on mortality in Ethiopia

AU - Gebreyohannes, Eyob Alemayehu

AU - Taye, Wagaye Atalay

AU - Shibe, Biniam Siyum

AU - Ayele, Emneteab Mesfin

AU - Lee, Kenneth

AU - Mengistu, Segenet Bizuneh

AU - Soiza, Roy

AU - Myint, Phyo Kyaw

AU - Abubeker Abdela, Ousman

N1 - Acknowledgements The authors express their sincere gratitude to the University of Gondar for their invaluable support throughout the research process. Special appreciation is extended to the study participants for their active involvement.

PY - 2024

Y1 - 2024

N2 - Background: Numerous studies report that anticholinergic burden (ACB) has been linked with several health consequences, including increased hospital admissions, prolonged hospitalization and physical and cognitive impairment. However, low- and middle-income settings, as well as younger individuals, are underrepresented. Objectives: To assess the prevalence and determinants of ACB, and to assess the impact of ACB on in-hospital mortality among adult in-patients at University of Gondar comprehensive Specialized Hospital (UOGCSH). Design: A cross-sectional study was conducted from June to August 2022 at UOGCSH among adult in-patients. Methods: A pre-tested questionnaire was utilized to collect data from patients and their corresponding medical charts. A consecutive sampling technique was used to select the participants. Descriptive statistics were used to summarize socio-demographic and clinical characteristics. Chi-squared, Fisher’s exact, and Wilcoxon rank sum tests, as appropriate, were used to determine associations between independent variables and ACB. Kaplan-Meier survival curve and cox proportional hazards regression test were used to assess the impact of ACB on inhospital mortality. Results: A total of 420 adult in-patients, median (IQR) age of 38 (26, 55) years, participated in this study. Over half (58.3%) were exposed to anticholinergic medicines, with a high ACB (≥3) seen in 11.2% of participants. High ACB was associated with higher median number of medicines per patient (p=0.003) higher median hospital length of stay (p=0.033), and having mental and behavioral disorders (p<0.001). No significant association was found between ACB and inhospital mortality (log-rank test p=0.26, Cox regression adjusted HR: 1.47, 95% CI 0.335-6.453, p=0.61). Conclusion: Among adult in-patients, a significant majority (58.3%) were subjected to medications possessing anticholinergic properties, with a noteworthy 11.2% of the study subjects exhibiting a high ACB. Participants with higher median length of hospital stay were more likely to have high ACB even in this relatively younger adult patient population.

AB - Background: Numerous studies report that anticholinergic burden (ACB) has been linked with several health consequences, including increased hospital admissions, prolonged hospitalization and physical and cognitive impairment. However, low- and middle-income settings, as well as younger individuals, are underrepresented. Objectives: To assess the prevalence and determinants of ACB, and to assess the impact of ACB on in-hospital mortality among adult in-patients at University of Gondar comprehensive Specialized Hospital (UOGCSH). Design: A cross-sectional study was conducted from June to August 2022 at UOGCSH among adult in-patients. Methods: A pre-tested questionnaire was utilized to collect data from patients and their corresponding medical charts. A consecutive sampling technique was used to select the participants. Descriptive statistics were used to summarize socio-demographic and clinical characteristics. Chi-squared, Fisher’s exact, and Wilcoxon rank sum tests, as appropriate, were used to determine associations between independent variables and ACB. Kaplan-Meier survival curve and cox proportional hazards regression test were used to assess the impact of ACB on inhospital mortality. Results: A total of 420 adult in-patients, median (IQR) age of 38 (26, 55) years, participated in this study. Over half (58.3%) were exposed to anticholinergic medicines, with a high ACB (≥3) seen in 11.2% of participants. High ACB was associated with higher median number of medicines per patient (p=0.003) higher median hospital length of stay (p=0.033), and having mental and behavioral disorders (p<0.001). No significant association was found between ACB and inhospital mortality (log-rank test p=0.26, Cox regression adjusted HR: 1.47, 95% CI 0.335-6.453, p=0.61). Conclusion: Among adult in-patients, a significant majority (58.3%) were subjected to medications possessing anticholinergic properties, with a noteworthy 11.2% of the study subjects exhibiting a high ACB. Participants with higher median length of hospital stay were more likely to have high ACB even in this relatively younger adult patient population.

KW - Anticholinergic burden

KW - hospitalization

KW - adult

KW - anticholinergic cognitive burden score

U2 - 10.1177/20420986241259624

DO - 10.1177/20420986241259624

M3 - Article

SN - 2042-0986

VL - 15

SP - 1

EP - 12

JO - Therapeutic Advances in Drug Safety

JF - Therapeutic Advances in Drug Safety

ER -

Anticholinergic burden among in-patients: a cross-sectional study on prevalence, determinants, and impact on mortality in Ethiopia

Abstract

Bibliographical note

Data Availability Statement

Funding

Keywords

Access to Document

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