Sex Differences in Multimorbidity, Inappropriate Medication and Adverse Outcomes of Inpatient Care: MoPIM Cohort Study

Abstract

There is no published evidence on the possible differences in multimorbidity, inappropriate prescribing, and adverse outcomes of care, simultaneously, from a sex perspective in older patients. We aimed to identify those possible differences in patients hospitalized because of a chronic disease exacerbation. A multicenter, prospective cohort study of 740 older hospitalized patients (≥65 years) was designed, registering sociodemographic variables, frailty, Barthel index, chronic conditions (CCs), geriatric syndromes (GSs), polypharmacy, potentially inappropriate prescribing (PIP) according to STOPP/START criteria, and adverse drug reactions (ADRs). Outcomes were length of stay (LOS), discharge to nursing home, in-hospital mortality, cause of mortality, and existence of any ADR and its worst consequence. Bivariate analyses between sex and all variables were performed, and a network graph was created for each sex using CC and GS. A total of 740 patients were included (53.2% females, 53.5% ≥85 years old). Women presented higher prevalence of frailty, and more were living in a nursing home or alone, and had a higher percentage of PIP related to anxiolytics or pain management drugs. Moreover, they presented significant pairwise associations between CC, such as asthma, vertigo, thyroid diseases, osteoarticular diseases, and sleep disorders, and with GS, such as chronic pain, constipation, and anxiety/depression. No significant differences in immediate adverse outcomes of care were observed between men and women in the exacerbation episode.

Gender Differences in Potentially Inappropriate Medication Use among Older Adults

“…In terms of the most common types of PIM category used, our findings are consistent with those of other studies in that the majority of the elderly patients in this study used potentially inappropriate cardiovascular medications, which were substantially more frequently taken by women than by men. Furthermore, the results of our analysis that women have higher use of a potentially inappropriate prescription is in line with some earlier research that reported a higher prevalence in women compared to men [ 6 , 9 , 10 , 11 , 12 , 13 , 14 ].…”

“…Recently, growing attention and consideration has been given to individual characteristics, including gender differences, in the context of medication use. Gender is a pivotal element in various aspects of healthcare, including the prevalence of chronic illness, healthcare utilization, medication utilization, adherence to medications, use of self-medication, and health outcomes [ 3 , 4 , 5 , 6 ]. In addition, gender differences are known to be driven by biological factors such as metabolism and hormones, which may impact the pharmacokinetics and pharmacodynamics of medications and health-related behavioral risk factors such as lifestyle and healthcare provider communication [ 7 , 8 ].…”

“…Gender disparities have been reported in medication-related utilization and appropriate use of medications, with women at higher risk of potentially inappropriate medications (PIMs) and polypharmacy [ 6 , 9 , 10 , 11 , 12 , 13 , 14 ]. PIMs are defined as “medications that should be avoided due to their risk which outweighs their benefit and when there are equally or more effective but lower risk alternatives are available” [ 15 ].…”

“…Few studies have examined sex differences in PIM use among older adults [ 6 , 9 , 10 , 11 , 12 , 13 , 14 ]. For example, using a retrospective cohort study design, Morgan et al evaluated PIM use in 660,679 older adults aged 65 and older.…”