Polypharmacy, socioeconomic indicators and number of diseases: results from ELSA-Brasil

Abstract

Objective: To estimate the prevalence of polypharmacy, describe the pharmacotherapeutic classes used, and investigate whether polypharmacy is associated with demographic and socioeconomic indicators, regardless of the number of diseases, among participants in the Brazilian Longitudinal Study of Adult Health (ELSA-Brasil) baseline (2008-2010). Method: In this analysis, 14,523 adults and elderly (35-74 years) participated. Polypharmacy was characterized as regular use of five or more medicines. The demographic and socioeconomic indicators analyzed were: gender, age, education level, per capita family income, and access to private health insurance. The independent association between demographic and economic indicators and polypharmacy was estimated by binary logistic regression. Results: The prevalence of polypharmacy was 11.7%. The most used drugs were those with action on the cardiovascular system. After adjustments, including by number of diseases, the chances of being on polypharmacy treatment were significantly higher among women, older participants and those with greatest number of diseases. Individuals without health insurance had lower chance to be under polypharmacy, as well as those with lower income. Conclusion: The occurrence of polypharmacy among ELSA-Brasil baseline participants was mainly due to drugs for the treatment of chronic diseases. The relation between polypharmacy and the female gender, as well as its association with old age, are in consonance with the results obtained in other studies. Despite the absence of an association between polypharmacy and education level, the income and health insurance results reinforce the existence of social inequalities regarding drug use.

Prevalência e fatores associados à polifarmácia e potenciais interações medicamentosas em adultos na cidade de Manaus: estudo transversal de base populacional, 2019

“…26 O elevado número de interações medicamentosas de alta gravidade entre indivíduos em polifarmácia em Manaus indica a potencial necessidade de fortalecimento A prevalência de polifarmácia em adultos relatada neste estudo foi inferior à encontrada no Estudo Longitudinal de Saúde do Adulto (12%), que incluiu 14.523 servidores públicos de instituições de ensino superior e/ou pesquisa localizadas nas regiões Nordeste, Sul e Sudeste do Brasil. 19 A polifarmácia foi identificada em 9% dos usuários de medicamentos brasileiros, sendo que a menor prevalência correspondeu à região Norte, de acordo com a Pesquisa Nacional de Acesso, Uso e Promoção do Uso Racional de Medicamentos 2014-2015 (PNAUM), conduzida com uma subamostra de 8.803 adultos cadastrados na APS. 20 Além das discrepâncias nas representatividades e entre os contextos dos estudos, dificuldades no uso e acesso a serviços de saúde e medicamentos na região Norte podem explicar essas diferenças, especialmente entre indivíduos socialmente desfavorecidos e vulneráveis.…”

The patterns and implications of potentially suboptimal medicine regimens among older adults: a narrative review

“… 32 , 70 The relationship between sex and polypharmacy was mixed; however, being female was a commonly identified risk factor ( Table 3 ). Indicators of poorer health were variably defined across the literature and may include the Charlson comorbidity index, 71 crude number of chronic diseases, 32 , 41 , 43 , 60 , 62 , 70 binary indicators of specific chronic conditions 28 , 30 , 33 , 50 , 67 , 68 or comorbidity (present/absent), 51 , 55 frailty 28 or poor self-perceived health. 30 , 33 , 67 Poorer health appears to be a strong predictor of polypharmacy and hyperpolypharmacy across a range of age categories and study populations ( Table 3 ), though it remains unclear whether polypharmacy is causing poorer health or polypharmacy is required due to poor health.…”

“…The relationship between polypharmacy and indicators of social disadvantage seems to be less frequently investigated ( Table 3 ). As with measures of poor health, social disadvantage was also defined according to a range of measures, including area-level indicators of relative social advantage and disadvantage, 32 , 72 household income 43 , 55 , 62 and employment status. 55 , 73 The emerging evidence appears to have been observed among relatively younger cohorts, compared with other risk factors, with inconclusive results ( Table 3 ).…”

“…Two studies reported models that did not adjust for indicators of poorer health, 72 , 73 as a likely confounder in the social disadvantage–polypharmacy relationship. 74 , 75 A single study found greater social disadvantage was protective against polypharmacy in Brazil, 43 though it remains unclear whether the decreased risk may be driven by barriers to accessing health care and subsequent potential underprescribing.…”

“…From a broader perspective, the direction of the relationships predicting polypharmacy appears relatively stable among studies investigating associations among older cohorts ( Table 3 ). However, the conflicting results observed for sex, 41 , 60 education 73 and social disadvantage 43 seem to be occurring in samples that include younger and middle-aged adults, which may suggest the predictors of polypharmacy differ across age groups ( Table 3 ). Two studies conducted age sub-analyses in Australian and South Korean populations.…”