Polypharmacy occurrence and the related risk of premature death among older adults in Denmark: A nationwide register-based cohort study.
Journal
PloS one
ISSN: 1932-6203
Titre abrégé: PLoS One
Pays: United States
ID NLM: 101285081
Informations de publication
Date de publication:
2022
2022
Historique:
received:
01
06
2021
accepted:
08
02
2022
entrez:
23
2
2022
pubmed:
24
2
2022
medline:
9
3
2022
Statut:
epublish
Résumé
Polypharmacy, defined as the concurrent use of ≥5 medications, increases the risk of drug-drug and drug-disease interactions as well as non-adherence to drug therapy. This may have negative health consequences particularly among older adults due to age-related pharmacokinetic and pharmacodynamic changes. This study aims to uncover the occurrence of polypharmacy among older adults in Denmark and investigate how polypharmacy relates to mortality. This nationwide register-based study included 1,338,058 adults aged 65+ years between January 2013 and December 2017 in Denmark. Polypharmacy prevalence was measured at time of inclusion while incidence and the association between polypharmacy and mortality were measured over the five-year follow-up using Cox regression. In an attempt to adjust for confounding by indication, propensity scores with overlap weighting were introduced to the regression model. At time of inclusion, polypharmacy prevalence was 29% and over the five years follow-up, 47% of the remaining adults transitioned into polypharmacy. Identified risk factors included multimorbidity (2+ morbidities: HR = 3.51; 95% CI = 3.48-3.53), age (95+ years: HR = 2.85; 95% CI = 2.74-2.96), socioeconomic factors (Highest income quartile: HR = 0.81; 95% CI = 0.80-0.81), region of birth region (Non-western migrants: HR = 0.77; 95% CI = 0.75-0.79), marital status (Divorced: HR = 1.10; 95% CI = 1.10-1.12) and year of inclusion (2017: HR = 1.19; 95% CI = 1.19-1.22). Further analyses showed that polypharmacy involves many different drug cocktails with medication for the cardiovascular system (95%), blood and blood-forming organs (69%), alimentary tract and metabolism (61%) and nervous system (54%) contributing the most. After adjustment for propensity scores with OW, both polypharmacy (HR = 3.48, CI95% = 3.41-3.54) and excessive polypharmacy (HR = 3.48, CI95% = 3.43-3.53) increased the risk of death substantially. A considerable proportion of older adults in Denmark were exposed to polypharmacy dependent on health status, socio-economic status, and societal factors. The associated three- to four-fold mortality risk indicate a need for further exploration of the appropriateness of polypharmacy among older adults.
Sections du résumé
BACKGROUND
Polypharmacy, defined as the concurrent use of ≥5 medications, increases the risk of drug-drug and drug-disease interactions as well as non-adherence to drug therapy. This may have negative health consequences particularly among older adults due to age-related pharmacokinetic and pharmacodynamic changes. This study aims to uncover the occurrence of polypharmacy among older adults in Denmark and investigate how polypharmacy relates to mortality.
METHOD
This nationwide register-based study included 1,338,058 adults aged 65+ years between January 2013 and December 2017 in Denmark. Polypharmacy prevalence was measured at time of inclusion while incidence and the association between polypharmacy and mortality were measured over the five-year follow-up using Cox regression. In an attempt to adjust for confounding by indication, propensity scores with overlap weighting were introduced to the regression model.
RESULTS
At time of inclusion, polypharmacy prevalence was 29% and over the five years follow-up, 47% of the remaining adults transitioned into polypharmacy. Identified risk factors included multimorbidity (2+ morbidities: HR = 3.51; 95% CI = 3.48-3.53), age (95+ years: HR = 2.85; 95% CI = 2.74-2.96), socioeconomic factors (Highest income quartile: HR = 0.81; 95% CI = 0.80-0.81), region of birth region (Non-western migrants: HR = 0.77; 95% CI = 0.75-0.79), marital status (Divorced: HR = 1.10; 95% CI = 1.10-1.12) and year of inclusion (2017: HR = 1.19; 95% CI = 1.19-1.22). Further analyses showed that polypharmacy involves many different drug cocktails with medication for the cardiovascular system (95%), blood and blood-forming organs (69%), alimentary tract and metabolism (61%) and nervous system (54%) contributing the most. After adjustment for propensity scores with OW, both polypharmacy (HR = 3.48, CI95% = 3.41-3.54) and excessive polypharmacy (HR = 3.48, CI95% = 3.43-3.53) increased the risk of death substantially.
CONCLUSION
A considerable proportion of older adults in Denmark were exposed to polypharmacy dependent on health status, socio-economic status, and societal factors. The associated three- to four-fold mortality risk indicate a need for further exploration of the appropriateness of polypharmacy among older adults.
Identifiants
pubmed: 35196345
doi: 10.1371/journal.pone.0264332
pii: PONE-D-21-15519
pmc: PMC8865634
doi:
Types de publication
Journal Article
Research Support, Non-U.S. Gov't
Langues
eng
Sous-ensembles de citation
IM
Pagination
e0264332Déclaration de conflit d'intérêts
The authors have declared that no competing interests exist.
Références
Expert Opin Drug Saf. 2018 Dec;17(12):1185-1196
pubmed: 30540223
Eur J Clin Pharmacol. 2014 Apr;70(4):437-43
pubmed: 24398968
Clin Geriatr Med. 2012 May;28(2):173-86
pubmed: 22500537
Trop Med Int Health. 2014 Aug;19(8):958-67
pubmed: 24889930
BMJ. 2015 Mar 11;350:h949
pubmed: 25762567
BMJ. 2007 May 19;334(7602):1016-7
pubmed: 17510108
BMC Health Serv Res. 2017 Feb 27;17(1):167
pubmed: 28241764
J Am Geriatr Soc. 2017 Jan;65(1):160-164
pubmed: 27891576
Lancet Public Health. 2018 Sep;3(9):e438-e446
pubmed: 30143472
Pharmacoepidemiol Drug Saf. 2016 Feb;25(2):204-11
pubmed: 26687829
BMJ Open. 2015 Sep 18;5(9):e008656
pubmed: 26384726
Intern Emerg Med. 2016 Apr;11(3):319-26
pubmed: 26688327
Arch Womens Ment Health. 2014 Dec;17(6):485-92
pubmed: 25113318
Pharmacoepidemiol Drug Saf. 2009 Dec;18(12):1125-33
pubmed: 19795367
Scand J Public Health. 2016 Jul;44(5):462-79
pubmed: 27098981
PLoS One. 2018 Apr 23;13(4):e0196109
pubmed: 29684077
Fam Pract. 2000 Jun;17(3):261-7
pubmed: 10846147
Drug Saf. 2007;30(10):911-8
pubmed: 17867728
BMC Clin Pharmacol. 2010 Dec 02;10:16
pubmed: 21122160
Clin Geriatr Med. 2012 May;28(2):273-86
pubmed: 22500543
Eur J Clin Pharmacol. 2017 Aug;73(8):1041-1048
pubmed: 28540438
Cardiovasc Revasc Med. 2019 May;20(5):399-402
pubmed: 30115560
Pharmacoepidemiol Drug Saf. 2016 Jun;25(6):628-36
pubmed: 26710965
Br J Clin Pharmacol. 2014 Jun;77(6):1073-82
pubmed: 24428591
J Res Med Sci. 2013 Jul;18(7):601-10
pubmed: 24516494
J Gerontol A Biol Sci Med Sci. 2014 Apr;69(4):430-7
pubmed: 23913935
Eur J Clin Pharmacol. 2019 Aug;75(8):1125-1133
pubmed: 30949726
BMC Fam Pract. 2017 Jun 6;18(1):70
pubmed: 28587644
Clin Epidemiol. 2015 Nov 17;7:449-90
pubmed: 26604824
Am J Epidemiol. 2019 Jan 1;188(1):250-257
pubmed: 30189042
Clin Epidemiol. 2018 Mar 12;10:289-298
pubmed: 29559811
Eur J Clin Pharmacol. 1997;53(1):7-11
pubmed: 9349923
Scand J Public Health. 2011 Jul;39(7 Suppl):22-5
pubmed: 21775345
BMC Public Health. 2017 May 10;17(1):422
pubmed: 28486983
BMC Fam Pract. 2018 Jul 18;19(1):113
pubmed: 30021528
Int J Environ Res Public Health. 2018 Feb 10;15(2):
pubmed: 29439425
Scand J Public Health. 2011 Jul;39(7 Suppl):38-41
pubmed: 21775349