Are there socioeconomic inequalities in polypharmacy among older people? A systematic review and meta-analysis.
Ageing
Health Inequalities
Medication Usage
Meta-analysis
Polypharmacy
Socioeconomic Status
Journal
BMC geriatrics
ISSN: 1471-2318
Titre abrégé: BMC Geriatr
Pays: England
ID NLM: 100968548
Informations de publication
Date de publication:
18 03 2023
18 03 2023
Historique:
received:
10
09
2022
accepted:
20
02
2023
entrez:
19
3
2023
pubmed:
20
3
2023
medline:
22
3
2023
Statut:
epublish
Résumé
Socioeconomic status (SES) may influence prescribing, concordance and adherence to medication regimens. This review set out to investigate the association between polypharmacy and an individual's socioeconomic status. A systematic review and meta-analyses of observational studies was conducted across four databases. Older people (≥ 55 years) from any healthcare setting and residing location were included. The search was conducted across four databases: Medline (OVID), Web of Science, Embase (OVID) and CINAHL. Observational studies from 1990 that reported polypharmacy according to SES were included. A random-effects model was undertaken comparing those with polypharmacy (≥ 5 medication usage) with no polypharmacy. Unadjusted odds ratios (ORs), 95% confidence intervals (CIs) and standard errors (SE) were calculated for each study. Fifty-four articles from 13,412 hits screened met the inclusion criteria. The measure of SES used were education (50 studies), income (18 studies), wealth (6 studies), occupation (4 studies), employment (7 studies), social class (5 studies), SES categories (2 studies) and deprivation (1 study). Thirteen studies were excluded from the meta-analysis. Lower SES was associated with higher polypharmacy usage: individuals of lower educational backgrounds displayed 21% higher odds to be in receipt of polypharmacy when compared to those of higher education backgrounds. Similar findings were shown for occupation, income, social class, and socioeconomic categories. There are socioeconomic inequalities in polypharmacy among older people, with people of lower SES significantly having higher odds of polypharmacy. Future work could examine the reasons for these inequalities and explore the interplay between polypharmacy and multimorbidity.
Sections du résumé
BACKGROUND
Socioeconomic status (SES) may influence prescribing, concordance and adherence to medication regimens. This review set out to investigate the association between polypharmacy and an individual's socioeconomic status.
METHODS
A systematic review and meta-analyses of observational studies was conducted across four databases. Older people (≥ 55 years) from any healthcare setting and residing location were included. The search was conducted across four databases: Medline (OVID), Web of Science, Embase (OVID) and CINAHL. Observational studies from 1990 that reported polypharmacy according to SES were included. A random-effects model was undertaken comparing those with polypharmacy (≥ 5 medication usage) with no polypharmacy. Unadjusted odds ratios (ORs), 95% confidence intervals (CIs) and standard errors (SE) were calculated for each study.
RESULTS
Fifty-four articles from 13,412 hits screened met the inclusion criteria. The measure of SES used were education (50 studies), income (18 studies), wealth (6 studies), occupation (4 studies), employment (7 studies), social class (5 studies), SES categories (2 studies) and deprivation (1 study). Thirteen studies were excluded from the meta-analysis. Lower SES was associated with higher polypharmacy usage: individuals of lower educational backgrounds displayed 21% higher odds to be in receipt of polypharmacy when compared to those of higher education backgrounds. Similar findings were shown for occupation, income, social class, and socioeconomic categories.
CONCLUSIONS
There are socioeconomic inequalities in polypharmacy among older people, with people of lower SES significantly having higher odds of polypharmacy. Future work could examine the reasons for these inequalities and explore the interplay between polypharmacy and multimorbidity.
Identifiants
pubmed: 36934249
doi: 10.1186/s12877-023-03835-z
pii: 10.1186/s12877-023-03835-z
pmc: PMC10024437
doi:
Types de publication
Meta-Analysis
Systematic Review
Journal Article
Research Support, Non-U.S. Gov't
Langues
eng
Sous-ensembles de citation
IM
Pagination
149Subventions
Organisme : Department of Health
Pays : United Kingdom
Informations de copyright
© 2023. The Author(s).
Références
Saudi Pharm J. 2022 Mar;30(3):230-236
pubmed: 35498218
Pharmacy (Basel). 2019 Apr 25;7(2):
pubmed: 31027176
J Am Geriatr Soc. 2009 Jan;57(1):62-9
pubmed: 19054196
Eur J Clin Pharmacol. 1999 Jul;55(5):411-5
pubmed: 10456493
Soc Sci Med. 2009 Dec;69(12):1805-12
pubmed: 19846245
BMC Health Serv Res. 2011 Oct 31;11:288
pubmed: 22040155
J Clin Pharm Ther. 2001 Apr;26(2):129-40
pubmed: 11350536
Arch Gerontol Geriatr. 2018 Sep - Oct;78:213-220
pubmed: 30015057
BMC Geriatr. 2020 Nov 25;20(1):501
pubmed: 33238894
BMJ Open. 2014 Sep 19;4(9):e005914
pubmed: 25239294
BMC Geriatr. 2018 May 16;18(1):118
pubmed: 29769020
J Geriatr Oncol. 2012 Jul 1;3(3):228-237
pubmed: 22712030
Osteoporos Int. 2018 Dec;29(12):2623-2637
pubmed: 30417253
Epidemiol Serv Saude. 2021 May 31;30(2):e2020386
pubmed: 34076227
PLoS One. 2019 Jul 17;14(7):e0220047
pubmed: 31314797
BMC Geriatr. 2018 Feb 23;18(1):59
pubmed: 29471806
Rev Saude Publica. 2016 Dec;50(suppl 2):9s
pubmed: 27982377
Rev Bras Epidemiol. 2012 Dec;15(4):817-27
pubmed: 23515777
BMJ Open. 2018 Sep 11;8(7):e023391
pubmed: 30206064
Curr Gerontol Geriatr Res. 2020 Jan 09;2020:4346035
pubmed: 32351556
Fam Pract. 2003 Feb;20(1):61-8
pubmed: 12509373
Rev Bras Epidemiol. 2020;23:e200077
pubmed: 32638852
Int J Clin Pract. 2021 Apr;75(4):e13742
pubmed: 32991028
Arch Gerontol Geriatr. 2015 Mar-Apr;60(2):328-33
pubmed: 25440757
J Family Community Med. 2003 Jan;10(1):39-45
pubmed: 23011979
Expert Opin Drug Saf. 2014 Jan;13(1):57-65
pubmed: 24073682
J Pharm Policy Pract. 2017 Aug 4;10:23
pubmed: 28785413
Int J Clin Pharm. 2019 Apr;41(2):516-524
pubmed: 30680513
Med J Aust. 2019 Jul;211(2):71-75
pubmed: 31219179
Rev Saude Publica. 2008 Feb;42(1):89-99
pubmed: 18200345
Rev Bras Epidemiol. 2017 Apr-Jun;20(2):335-344
pubmed: 28832855
Rev Saude Publica. 2013 Aug;47(4):759-67; discussion 768
pubmed: 24346667
Cien Saude Colet. 2018 Aug;23(8):2565-2574
pubmed: 30137126
Intern Med J. 2014 Dec;44(12a):1193-9
pubmed: 25039536
Ann Pharmacother. 2002 May;36(5):804-8
pubmed: 11978155
Cancer. 2018 Jul 1;124(13):2850-2857
pubmed: 29645083
PLoS One. 2017 Mar 8;12(3):e0173466
pubmed: 28273128
Rev Panam Salud Publica. 2008 Jan;23(1):34-43
pubmed: 18291071
Health Expect. 2022 Aug;25(4):1432-1443
pubmed: 35384182
Age Ageing. 2018 Mar 1;47(2):220-225
pubmed: 29036509
South Med J. 2017 Aug;110(8):540-545
pubmed: 28771653
PLoS One. 2021 Jan 19;16(1):e0245648
pubmed: 33465141
Medicina (Kaunas). 2018 Aug 24;54(4):
pubmed: 30344288
J Res Pharm Pract. 2015 Apr-Jun;4(2):85-8
pubmed: 25984546
Br J Gen Pract. 2009 Oct;59(567):721-3
pubmed: 19843420
BMJ Open. 2020 Oct 1;10(10):e036591
pubmed: 33004388
Lancet. 2017 Mar 25;389(10075):1229-1237
pubmed: 28159391
Arch Public Health. 2015 Nov 09;73:50
pubmed: 26557365
Int J Environ Res Public Health. 2022 Jan 18;19(3):
pubmed: 35162054
J Family Med Prim Care. 2020 Mar 26;9(3):1647-1655
pubmed: 32509666
Basic Clin Pharmacol Toxicol. 2019 Jan;124(1):74-83
pubmed: 30003664
Med Princ Pract. 2020;29(2):166-173
pubmed: 31509828
J Clin Nurs. 2018 Aug;27(15-16):2942-2952
pubmed: 29603814
J Family Med Prim Care. 2021 Jul;10(7):2636-2641
pubmed: 34568148
J Clin Epidemiol. 2012 Sep;65(9):989-95
pubmed: 22742913
J Family Community Med. 2013 Sep;20(3):162-7
pubmed: 24672273
BMC Geriatr. 2017 Oct 10;17(1):230
pubmed: 29017448
Eur J Public Health. 2015 Aug;25(4):597-603
pubmed: 25395395
PLoS One. 2021 Apr 8;16(4):e0249849
pubmed: 33831073
Drugs Aging. 2009;26(4):345-54
pubmed: 19476401
J R Soc Med. 2013 Apr;106(4):120-3
pubmed: 23564895
Front Public Health. 2020 Jun 18;8:231
pubmed: 32626678
Acta Clin Belg. 2016 Jun;71(3):158-66
pubmed: 27105401
Pharmaceutics. 2021 Jul 20;13(7):
pubmed: 34371791
Br J Clin Pharmacol. 2004 Nov;58(5):496-502
pubmed: 15521897
Clin Ther. 2008 Feb;30(2):419-27
pubmed: 18343279
Int J Qual Health Care. 2017 Jun 01;29(3):378-383
pubmed: 28371903
Qual Saf Health Care. 2008 Dec;17(6):442-6
pubmed: 19064660
Health Expect. 2022 Apr;25(2):628-638
pubmed: 34951087
BMC Med. 2015 Apr 07;13:74
pubmed: 25889849
Ther Adv Drug Saf. 2020 Jun 12;11:2042098620933741
pubmed: 32587680
J Gerontol A Biol Sci Med Sci. 2015 Aug;70(8):989-95
pubmed: 25733718
Res Gerontol Nurs. 2015 Nov-Dec;8(6):273-85
pubmed: 25975347
Geriatr Gerontol Int. 2018 Jul;18(7):1064-1070
pubmed: 29582533
Geriatr Gerontol Int. 2021 Sep;21(9):810-817
pubmed: 34318576
BMC Geriatr. 2018 Nov 29;18(1):295
pubmed: 30497404
Clin Epidemiol. 2018 Mar 12;10:289-298
pubmed: 29559811
Scand J Public Health. 2023 Feb;51(1):11-20
pubmed: 34190622
J Women Aging. 2001;13(4):39-51
pubmed: 11876433
Ann Pharmacother. 2010 Sep;44(9):1410-21
pubmed: 20702755
J Gen Intern Med. 2007 Jun;22(6):782-6
pubmed: 17431697
Pharmacoepidemiol Drug Saf. 2016 Sep;25(9):1033-41
pubmed: 27133740
Can J Cardiol. 2012 Sep-Oct;28(5):574-80
pubmed: 22884278
Aust N Z J Public Health. 2018 Apr;42(2):186-194
pubmed: 29442409
Int J Travel Med Glob Health. 2019 Summer;7(3):86-90
pubmed: 31840027
BMJ. 2020 Jan 6;368:l6964
pubmed: 31907164
BMJ Open. 2020 Sep 14;10(9):e034346
pubmed: 32928845
J Aging Res. 2017;2017:6026358
pubmed: 28630771