The Burden of Potentially Inappropriate Medications in Chronic Polypharmacy
Abstract
:1. Introduction
2. Methods
2.1. Study Design
2.2. Data Source
2.3. Study Population
2.4. Drugs of Interest
2.5. Exposure
2.6. Potentially Inappropriate Medications
2.7. Descriptive Analyses
3. Results
3.1. Description of the Study Population
3.2. Potentially Inappropriate Medications in Chronic Polypharmacy
4. Discussion
5. Conclusions
Supplementary Materials
Author Contributions
Funding
Conflicts of Interest
References
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Cohort n = 276,788 | Middle-Aged 1 n = 159,243 | Older Adults 2 n = 117,545 | |
---|---|---|---|
Age, mean (sd) | 63.5 (10.2) | 54.1 (5.7) | 76.2 (14.2) |
Sex, n (%) | |||
Men | 131,275 (47.4) | 79,920 (50.2) | 51,355 (43.7) |
Women | 145,513 (52.6) | 79,323 (49.8) | 66,190 (56.3) |
Dead in 2016, n (%) | 4239 (1.5) | 663 (0.4) | 3576 (3.0) |
Chronic polypharmacy n (% ± 95CI) | 36,500 (13.2 ± 0.2) | 8666 (5.4 ± 0.1) | 27,834 (23.7 ± 0.2) |
Chronic hyperpolypharmacy n (% ± 95CI) | 3628 (1.3 ± 0.0) | 760 (0.5 ± 0.0) | 2868 (2.4 ± 0.0) |
Most frequent chronic diseases 3 | |||
Diabetes (type 1 or type 2) | 26,622 (9.6) | 9602 (6.0) | 17,020 (14.5) |
Cancer or leukemia | 21,991 (8.0) | 6914 (4.3) | 15,077 (12.8) |
Coronary artery disease | 13,248 (4.8) | 3566 (2.2) | 9682 (8.2) |
Heart failure, arrhythmia or valvular heart disease | 12,437 (4.5) | 1908 (1.2) | 10,529 (9.0) |
Psychiatric diseases | 10,108 (3.7) | 6301 (4.0) | 3807 (3.2) |
Older Adults with Chronic Polypharmacy | Older Adults with Chronic Hyperpolypharmacy | Cumulated Exposure to PIMs in Older Adults with Chronic Polypharmacy (%) | |
---|---|---|---|
n = 27,834 | n = 2868 | ||
Potentially inappropriate medications-broad 1 | 18,036 (64.8) | 2544 (88.7) | 13.5 |
Potentially inappropriate medications-narrow 2 | 10,220 (36.7) | 1730 (60.3) | 6.7 |
Proton pump inhibitors (PPIs) without chronic use of nonsteroidal anti-inflammatory drugs (NSAIDs) or corticosteroids 1 | 12,073 (43.4) | 1924 (67.1) | 6.3 |
Benzodiazepines—short- and intermediate-acting | 3807 (13.7) | 660 (23.0) | 2.0 |
Hypnotics (z-drugs) | 1688 (6.1) | 382 (13.3) | 0.8 |
Central alpha-agonists | 1404 (5.0) | 308 (10.7) | 0.8 |
Antidepressants (Tricyclic antidepressants (TCAs)/Paroxetine) | 1324 (4.8) | 228 (8.0) | 0.7 |
Benzodiazepines—long-acting | 1271 (4.6) | 286 (10.0) | 0.6 |
Sulfonylureas—long-acting | 1071 (3.9) | 201 (7.0) | 0.6 |
First-generation antihistamines | 659 (2.4) | 159 (5.5) | 0.5 |
Anticholinergic antispasmodics | 626 (2.3) | 119 (4.2) | 0.3 |
Antidepressants (TCA, Selective serotonin reuptake inhibitors (SSRIs), or Serotonin–norepinephrine reuptake inhibitors (SNRIs)) with history of falls or fractures 1 | 420 (1.5) | 73 (2.6) | 0.2 |
Non-cyclooxygenase-selective NSAIDs, oral without PPI 1 | 418 (1.5) | 65 (2.3) | 0.2 |
Ergoloid mesylates | 380 (1.4) | 71 (2.5) | 0.2 |
Middle-Aged Adults with Chronic Polypharmacy | Middle-Aged Adults with Chronic Hyperpolypharmacy | Cumulated Exposure to PIM in Middle-Aged Adults with Chronic Polypharmacy (%) | |
---|---|---|---|
n = 8666 | n = 760 | ||
Potentially inappropriate medications | 4009 (46.2) | 570 (75.0) | 10.4 |
Benzodiazepines—short- and intermediate-acting | 1395 (16.1) | 232 (30.5) | 2.7 |
Sulfonylureas—long- acting | 1069 (12.3) | 178 (23.4) | 1.9 |
Benzodiazepines—long- acting | 879 (10.1) | 138 (18.2) | 1.5 |
Opioid (use without laxative) | 639 (7.4) | 143 (18.8) | 1.1 |
Hypnotics (z-drugs) | 637 (7.4) | 115 (15.1) | 1.0 |
First generation antihistamines | 450 (5.2) | 90 (11.8) | 0.7 |
Association of esomeprazole/omeprazole and clopidogrel 1 | 251 (2.9) | 59 (7.8) | 0.8 |
Oral corticoid (without use of bisphosphonate) | 176 (2.0) | 38 (5.0) | 0.3 |
Tricyclic antidepressants in first-line treatment | 107 (1.2) | 16 (2.1) | 0.2 |
Chronic NSAIDs | 80 (0.9) | 14 (1.8) | 0.1 |
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Guillot, J.; Maumus-Robert, S.; Marceron, A.; Noize, P.; Pariente, A.; Bezin, J. The Burden of Potentially Inappropriate Medications in Chronic Polypharmacy. J. Clin. Med. 2020, 9, 3728. https://doi.org/10.3390/jcm9113728
Guillot J, Maumus-Robert S, Marceron A, Noize P, Pariente A, Bezin J. The Burden of Potentially Inappropriate Medications in Chronic Polypharmacy. Journal of Clinical Medicine. 2020; 9(11):3728. https://doi.org/10.3390/jcm9113728
Chicago/Turabian StyleGuillot, Jordan, Sandy Maumus-Robert, Alexandre Marceron, Pernelle Noize, Antoine Pariente, and Julien Bezin. 2020. "The Burden of Potentially Inappropriate Medications in Chronic Polypharmacy" Journal of Clinical Medicine 9, no. 11: 3728. https://doi.org/10.3390/jcm9113728