{'fraction_non_alphanumeric': 0.03730569948186528, 'fraction_numerical': 0.022797927461139896, 'mean_word_length': 5.149681528662421, 'pattern_counts': {'":': 0, '<': 2, '<?xml version=': 0, '>': 0, 'https://': 0, 'lorem ipsum': 0, 'www.': 0, 'xml': 0}, 'pii_count': 0, 'substrings_counts': 0, 'word_list_counts': {'cursed_substrings.json': 0, 'profanity_word_list.json': 0, 'sexual_word_list.json': 0, 'zh_pornsignals.json': 0}}
Risk of hospitalization and use of first- versus second-generation antipsychotics among nursing home residents.

OBJECTIVE
The study compared the risk of all-cause hospitalization associated with use of first- versus second-generation antipsychotics among elderly nursing home residents who were eligible for both Medicare and Medicaid.


METHODS
A retrospective cohort study design was used to compare the risk of all-cause hospitalization among dual-eligible nursing home residents (≥65 years) during the 180 days after a new prescription for a first-generation (N=3,611) or a second-generation (N=46,293) antipsychotic. Propensity scores created from Medicare and Medicaid Analytic eXtract data were used to identify a matched cohort of equal numbers of users of each antipsychotic class (N=3,609). The Cox proportional model and the extended Cox hazard model were used to evaluate the risk of all-cause hospitalization in the matched cohort.


RESULTS
The unadjusted rates of all-cause hospitalization were 21.3% and 30.5% among users of first- and second-generation antipsychotics, respectively. The Cox proportional model revealed a significant difference between the two classes in risk of all-cause hospitalization (hazard ratio [HR]=1.33, p<.001). There was no difference in hospitalization risk among users of first- versus second-generation antipsychotics within the first 20 days of use; however, the odds of hospitalization among users of first-generation antipsychotics increased by 58% after 20 days of use (HR=1.58, p<.001).


CONCLUSIONS
The study findings suggest that use of first- versus second-generation antipsychotics lasting more than 20 days is associated with a differential risk of all-cause hospitalization, possibly due to differential safety profiles of the two classes. Consequently, there is a need to monitor the use of antipsychotics by elderly patients, especially after a period of initial use.