Multinational comparison of new antidepressant use in older adults: a cohort study

OBJECTIVES

We used an international pharmacosurveillance network to estimate the rate and characteristics of antidepressant use in older adults in countries with more conservative (UK) and liberal depression guidelines (Canada, USA).

SETTING

Electronic health records and population-based administrative data from six jurisdictions in four countries (UK, Taiwan, USA and Canada).

PARTICIPANTS

A historical cohort of older adults (≥65 years) who had a new episode of antidepressant use between 2009 and 2014.

OUTCOME MEASURES

The age and sex-standardised cumulative incidence of new episodes of antidepressant use in older adults was measured. Descriptive statistics were used to compare the proportion of new users by the antidepressant prescribed, therapeutic class, potential treatment indication and country, as well as the characteristics of the first treatment episode (standardised daily doses, duration and changes).

RESULTS

The incidence of antidepressant use between 2009 and 2014 varied from 4.7% (Montreal and Quebec City) to 18.6% (Taiwan). Tricyclic antidepressants (TCAs) were the most commonly used class in the UK (48.8%) and Taiwan (52.4%) compared with selective serotonin reuptake inhibitors (SSRIs) in North American jurisdictions (42.3%-53.3%). Chronic pain was the most common potential treatment indication (41.2%-68.2%). Among users with chronic pain, TCAs were used most frequently in the UK and Taiwan (55.2%-60.4%), whereas SSRIs were used most frequently in North America (33.5%-46.4%). Treatment was longer (252-525 vs 169-437 days), standardised doses were higher (0.7-1.3 vs 0.5-1.0) and treatment was more likely to be changed (31%-46% vs 21%-34%) among patients with depression (9.1%-43%) than those with chronic pain.

CONCLUSION

Antidepressant use in older adults varied 24-fold by country, with the UK, which has the most conservative treatment guidelines, being among the lowest. Chronic pain was the most common potential treatment indication. Evaluation of real-world risks of TCAs is a priority for future research, given high rates of use and the potential for increased toxicity in older adults because of potent anticholinergic effects.

South Korean anthropometric data and survey methodology: 'Size Korea' project

Considering the many emerging markets in East Asia, access to contemporary anthropometric data for this region is important for designers and manufacturers seeking to produce the best fitting products and living environments for consumers. The purpose of this paper is to describe Korean anthropometric data collection and survey techniques for those who are interested in ethnic characteristics, conducting surveys, and formulating ergonomic product designs for South Korean and, more broadly, East Asian populations. The Size Korea survey was conducted in 2003-2004 and 2010. A total of 14,200 civilians aged 0-90 years participated in the survey, with 119 body and weight dimensions measured in 2004. Twenty new dimensions from Inbody measurement were added in 2010 and the data were continuously updated. We referred to ISO 7250, 8559 and 15535 to ensure validity and reliability. Fifty major body dimensions, including weight, are summarised in this paper, and 34 of these dimensions can be compared with 11 multinational data already reported  in other publications. Practitioner Summary: This paper presents the up-to-date anthropometric database of East Asian physical characteristics and survey methodology. These data satisfy the ISO standards and comprise 50 physical dimensions including weight. Thirty-four dimensions of these can be directly compared with available multinational data.