Prevalence of Polypharmacy in Elderly Population Worldwide: A Systematic Review and Meta-Analysis.

IF 2.4 4区医学 Q3 PHARMACOLOGY & PHARMACY Pharmacoepidemiology and Drug Safety Pub Date : 2024-08-01 DOI:10.1002/pds.5880

Zeyu Wang, Tangyi Liu, Qiaoyu Su, Hui Luo, Lijun Lou, Lina Zhao, Xiaoyu Kang, Yanglin Pan, Yongzhan Nie

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Abstract

Background: Polypharmacy (PP) is common in elderly population and associated with some adverse clinical outcomes and increases healthcare burdens. We performed this systemic review and meta-analysis to estimate worldwide prevalence of PP and explore associated factors in the elderly.

Methods: The PubMed, Web of Science, Cochrane Library, and Ovid EMBASE databases were searched for studies published until May 30, 2022. We included observational studies representative of general patients aged ≥60 in which PP was defined as multiple drugs ≥5. Studies were excluded if only a particular group of the elderly population (e.g., with diabetes) were included. The primary outcome was the prevalence of PP. Random-effect models were employed to estimate the overall or variable-specific pooled estimates of PP. Secondary outcomes were hyperpolypharmacy (HPP, defined as multiple drugs ≥10) and PP prevalence based on different study years, genders, locations, populations, and so forth.

Results: We included 122 original observational studies with an overall population of 57 328 043 individuals in the meta-analysis. The overall prevalence of PP and HPP in the elderly population worldwide was 39.1% (95% confidence interval [CI], 35.5%-42.7%) and 13.3% (95% CI, 10.4%-16.5%), respectively. The prevalence of PP in Europe, Oceania, North America, Asia, and South America was 45.8% (95% CI, 41.5%-50.2%), 45.5% (95% CI, 26.7%-64.3%), 40.8% (95% CI, 29.8%-51.6%), 29.0% (95% CI, 20.0%-38.0%), and 28.4% (95% CI, 24.0%-32.8%), respectively (p < 0.01). Multivariate meta-regressions showed geographical regions of Europe or North America, age ≥70, and residence from nursing homes were independently associated with higher PP prevalence.

Conclusions: Nearly 40% of the elderly population is exposed to PP. The prevalence of PP is significantly higher in elderly individuals aged 70 or older, in developed regions and in nursing homes. It is important to focus on avoiding inappropriate PP in this population to address the growing burden of PP.

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全球老年人口中多药滥用的普遍性：系统回顾与元分析》。

背景：多药治疗（PP）在老年人群中很常见，与一些不良临床结果相关，并增加了医疗负担。我们进行了这一系统回顾和荟萃分析，以估算全球范围内老年人多药治疗的流行率并探讨相关因素：我们在 PubMed、Web of Science、Cochrane Library 和 Ovid EMBASE 数据库中检索了截至 2022 年 5 月 30 日发表的研究。我们纳入了代表年龄≥60岁的普通患者的观察性研究，其中PP被定义为多种药物≥5种。如果只纳入了老年人口中的某一特定群体（如糖尿病患者），则不纳入研究。主要结果是PP的患病率。采用随机效应模型估算PP的总体或变量特异性集合估计值。次要结果是超多药（HPP，定义为多种药物≥10种）和基于不同研究年份、性别、地点、人群等的PP患病率：我们在荟萃分析中纳入了 122 项原始观察性研究，研究总人数为 57328043 人。全球老年人口中 PP 和 HPP 的总患病率分别为 39.1%（95% 置信区间 [CI]，35.5%-42.7%）和 13.3%（95% 置信区间 [CI]，10.4%-16.5%）。欧洲、大洋洲、北美洲、亚洲和南美洲的 PP 患病率分别为 45.8%（95% CI，41.5%-50.2%）、45.5%（95% CI，26.7%-64.3%）、40.8%（95% CI，29.8%-51.6%）、29.0%（95% CI，20.0%-38.0%）和 28.4%（95% CI，24.0%-32.8%）（P 结论）：近 40% 的老年人口暴露于 PP。在发达地区和养老院中，70 岁及以上老年人的 PP 患病率明显更高。要解决 PP 带来的日益沉重的负担，就必须重视避免在这一人群中使用不适当的 PP。

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来源期刊

Pharmacoepidemiology and Drug Safety 医学-药学

CiteScore

4.80

自引率

7.70%

发文量

173

审稿时长

3 months

期刊介绍： The aim of Pharmacoepidemiology and Drug Safety is to provide an international forum for the communication and evaluation of data, methods and opinion in the discipline of pharmacoepidemiology. The Journal publishes peer-reviewed reports of original research, invited reviews and a variety of guest editorials and commentaries embracing scientific, medical, statistical, legal and economic aspects of pharmacoepidemiology and post-marketing surveillance of drug safety. Appropriate material in these categories may also be considered for publication as a Brief Report. Particular areas of interest include: design, analysis, results, and interpretation of studies looking at the benefit or safety of specific pharmaceuticals, biologics, or medical devices, including studies in pharmacovigilance, postmarketing surveillance, pharmacoeconomics, patient safety, molecular pharmacoepidemiology, or any other study within the broad field of pharmacoepidemiology; comparative effectiveness research relating to pharmaceuticals, biologics, and medical devices. Comparative effectiveness research is the generation and synthesis of evidence that compares the benefits and harms of alternative methods to prevent, diagnose, treat, and monitor a clinical condition, as these methods are truly used in the real world; methodologic contributions of relevance to pharmacoepidemiology, whether original contributions, reviews of existing methods, or tutorials for how to apply the methods of pharmacoepidemiology; assessments of harm versus benefit in drug therapy; patterns of drug utilization; relationships between pharmacoepidemiology and the formulation and interpretation of regulatory guidelines; evaluations of risk management plans and programmes relating to pharmaceuticals, biologics and medical devices.