ArticleEpidemiology (Cambridge, Mass.)2015
Mediators of First- Versus Second-generation Antipsychotic-related Mortality in Older Adults.
Article in Epidemiology (Cambridge, Mass.), 2015. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 11 papers, 2 of them syntheses that pooled it.
What it found
Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.
The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.
The trial behind it
Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.
Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.
Who cites it
11 citing papers in PubMed, 2 syntheses or guidelines pooled it.
- Biological substantiation of antipsychotic-associated pneumonia: Systematic literature review and computational analyses.PloS one · 2017Pooled it
- Implementation and reporting of causal mediation analysis in 2015: a systematic review in epidemiological studies.BMC research notes · 2016Pooled it
- Inpatient antipsychotic medication switching and rehospitalization risk among patients with schizophrenia-spectrum disorders.Schizophrenia research · 2024Article
- The direct and mediating effects of cognitive impairment on the occurrence of falls: a cohort study based on community-dwelling old adults.Frontiers in medicine · 2023Article
- Cardiovascular Events Associated with Antipsychotics in Newly Diagnosed Parkinson's Disease Patients: A Propensity Score Matched Cohort Study.International journal of general medicine · 2021Article
- Psychotropic Drug-Associated Pneumonia in Older Adults.Drugs & aging · 2020Review
- Antipsychotics and the Risk of Mortality or Cardiopulmonary Arrest in Hospitalized Adults.Journal of the American Geriatrics Society · 2020Article
- Article
- Safety, tolerability, and risks associated with first- and second-generation antipsychotics: a state-of-the-art clinical review.Therapeutics and clinical risk management · 2017Review
- Diagnostics for Confounding of Time-varying and Other Joint Exposures.Epidemiology (Cambridge, Mass.) · 2016Article
- Toward a clearer portrayal of confounding bias in instrumental variable applications.Epidemiology (Cambridge, Mass.) · 2015Article
Corrections and comments
PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.
Authors and funding
4 authors.
Funding
Abstract
backgroundObservational studies of older adults showed higher mortality for first-generation antipsychotics than their second- generation counterparts, which led to US Food and Drug Administration warnings, but the actual mechanisms involved remain unclear.
methodsA cohort of 9,060 initiators of first-generation antipsychotics and 17,137 of second-generation antipsychotics enrolled in New Jersey and Pennsylvania Medicare were followed for 180 days. Medical events were assessed using diagnostic and procedure codes on inpatient billing claims. For the individual and joint set of medical events (mediators), we estimated the total, direct, and indirect effects of antipsychotic type (first versus second generation) on mortality on the risk ratio scale and the proportion mediated on the risk difference scale, obtaining 95% confidence intervals through bootstrapping. We performed bias analyses for false-negative mediator misclassification in claims data, with sensitivity ranging from 0.25 to 0.75.
resultsThere were 3,199 deaths (outcomes), 862 cardiovascular events, 675 infectious events, and 491 hip fractures (potential mediators). Mortality was higher for first- than second-generation antipsychotic initiators (adjusted risk ratio: 1.14; 95% confidence interval: 1.06, 1.22). In naïve analyses, that ignored potential misclassification, less than 4% of this difference was explained by any particular medical event. In bias analyses, the proportion mediated ranged from 6% to 16% for stroke, 3% to 9% for ventricular arrhythmia, 3% to 11% for myocardial infarction, 0% venous thromboembolism, 3% to 9% for pneumonia, 0% to 1% for other bacterial infection, and 1% to 3% for hip fracture.
conclusionsAcute cardiovascular events and pneumonia may explain part of the mortality difference between first- and second-generation antipsychotic initiators in this analysis.
Indexed as
Identifiers
What OpenQuestion holds
Registered trials
Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.