Anticholinergic Burden in Patients With Overactive Bladder and Association With Health Outcomes: A Retrospective Database Claims Analysis.

OBJECTIVE: Increasing anticholinergic burden (ACB), especially in older adults, may be associated with increased risk of adverse outcomes. This analysis quantified the contribution of overactive bladder (OAB) anticholinergic medications (ACHs) to total ACB and the association of time-varying ACB with health outcomes in patients with OAB. METHODS: This retrospective study used medical and pharmacy claims from the Optum Research Database to identify adults with ≥ 1 pharmacy claim for ≥ 1 of 6 OAB ACHs from January 2010-November 2021. Patients had continuous enrollment in a commercial or Medicare Advantage plan with pharmacy and medical benefits for ≥6 months preindex (baseline) and postindex and were followed until disenrollment or 31 May 2022. Each ACH was assigned a burden score per established burden values and quantity received. Patient's daily ACB was categorized as 0 (< 0.5), 1 (≥ 0.5, < 1.5), 2 (≥ 1.5, < 2.5), 3 (≥ 2.5, < 3.5), or ≥ 4 (> 3.5) points/day. The mean ratio of OAB ACB to total ACB over follow-up was calculated. Adverse health outcomes assessed were: urinary tract infection (UTI), incontinence-associated dermatitis, urinary retention, delirium/drowsiness, cognitive impairment, falls/fractures, cardiovascular events, and mortality. The association between postindex event risk and ACB was analyzed with a time-varying Cox proportional hazard model to account for varying ACB and patient characteristics. RESULTS: In total, 428,142 patients were identified. Mean age was 65.2 years, 66.7% were female, mean (SD) baseline ACB was 0.53 (1.44), and mean (SD) follow-up was 1096 (862) days. Overall, 61% of ACB was attributable to OAB medications. Adjusted hazard ratios (HR) for UTI, urinary retention, delirium/drowsiness, cognitive impairment, fall/fractures, and cardiovascular events were >1 for all ACB categories (vs 0 points/day) and increased with ACB. Cognitive impairment had the highest association with ACB (HR range, 1.182-1.551). CONCLUSION: This analysis shows an association between increased ACB and greater risk of adverse health outcomes. OAB ACHs are a major contributor to total ACB in patients treated with OAB ACHs. [ABSTRACT FROM AUTHOR]