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To the Editor.—In their meta-analysis on adverse drug reactions (ADRs) in hospitalized patients, Dr Lazarou and colleagues1 state: "Fatal ADRs appear to be between the fourth and sixth leading cause of death. Their incidence has remained stable over the last 30 years." These 2 sequential sentences indicate the authors claim that their findings regarding fatal ADRs are applicable today. Although the figure in their article shows stability of the total ADR incidence over the years, it does not distinguish fatal ADRs from nonfatal. Plotting only fatal ADRs based on data contained in Tables 1 and 2 of their article shows that the incidence of fatal ADRs has decreased precipitously during the last 30 years (Figure 1).
—Adverse drug reaction (ADR) deaths reported in 1965 to 1995.
The authors' conclusion that fatal ADRs in the United States number approximately 106,000 annually is erroneous as applied to the present. This number of deaths was calculated by multiplying the total number of hospitalizations in 1994 by an incidence rate of fatal ADRs of 0.32%, based on data from all studies published since 1965. Thus, three quarters of these data are 20 to 30 years old. The studies published in the last 10 years report a total of only 5 ADR deaths among 11,376 hospitalized patients studied, ie, an overall incidence of 0.04%. Using the authors' estimation of the correct total number of hospitalizations, deaths in the United States attributable to ADRs is approximately 13,000. According to the data cited by Lazarou et al, ADRs are not a leading cause of death today.
Country-Specific Mortality and Growth Failure in Infancy and Yound Children and Association With Material Stature
Use interactive graphics and maps to view and sort country-specific infant and early dhildhood mortality and growth failure data and their association with maternal
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