Polypharmacy in African American Adults: A National Epidemiological Study

Abstract

Background: Despite the association between polypharmacy and undesired health outcomes being well established, very little is known about epidemiology of polypharmacy in the African American community. We are not aware of any nationally representative studies that have described the socioeconomic, behavioral, and health determinants of polypharmacy among African Americans. Aims: We aimed to investigate the socioeconomic and health correlates of polypharmacy in a national sample of African American adults in the US. Methods: The National Survey of American Life (NSAL, 2003–2004) included 3,570 African American adults. Gender, age, socioeconomic status (SES; education attainment, poverty index, and marital status), access to the healthcare system (health insurance and having a usual source of care), and health (self-rated health [SRH], chronic medical disease, and psychiatric disorders) in addition to polypharmacy (5 + medications) as well as hyper-polypharmacy (10 + medications) were measured. Logistic regressions were applied for statistical analysis. Results: that About 9% and 1% of all African American adults had polypharmacy and hyper-polypharmacy, respectively. Overall, higher age, higher SES (education and poverty index), and worse health (poor SRH, more chronic medical disease, and psychiatric disorders) were associated with polypharmacy and hyper-polypharmacy. Individuals with insurance and those with a routine place for healthcare also had higher odds of polypharmacy and hyper-polypharmacy. Conclusions: Given the health risks associated with polypharmacy, there is a need for systemic evaluation of medication use in older African Americans with multiple chronic conditions. Such policies may prevent medication errors and harmful drug interactions, however, they require effective strategies that are tailored to African Americans.

Polypharmacy and Depressive Symptoms in U.S.-Born Mexican American Older Adults

“…Individuals with low income and low educational attainment also experience more depressive symptoms [16,17]. Thus, any study on the potential link between polypharmacy and depressive symptoms should control for SES indicators such as education, income, and employment [3,6,7,18].…”

“…Physical health, particularly self-rated health (SRH), chronic medical conditions (CMC), and activities of daily living (ADL), are associated with polypharmacy and depression [19][20][21]. Polypharmacy is also a consequence of being diagnosed with multiple conditions [6,7,10,18]. This means that these health indicators are strong determinants and correlates of polypharmacy [6,7,10,18].…”

“…Polypharmacy is also a consequence of being diagnosed with multiple conditions [6,7,10,18]. This means that these health indicators are strong determinants and correlates of polypharmacy [6,7,10,18]. Poor physical health (CMC, SRH, and ADL) and depressive symptomatology also have bidirectional associations [19][20][21].…”

“…Poor physical health (CMC, SRH, and ADL) and depressive symptomatology also have bidirectional associations [19][20][21]. As a result, there is a need to control for physical health (e.g., CMC, SRH, and ADL) in the studies that wish to understand the association between polypharmacy and depressive symptoms [6,7,10,18].…”

“…What we know about the interplay between SES, physical health, mental health, and polypharmacy in ethnic minorities is very limited [3]. Across various ethnic minorities in the U.S., less is known about Latinos/Hispanics than African Americans [3,18]. Some studies have suggested different pattern of associations and sometimes inconsistencies in these associations in ethnic minorities [3,18].…”