Rahman Motiur, Howard George, Qian Jingjing, Garza Kimberly, Abebe Ash, Hansen Richard
Auburn University, Harrison School of Pharmacy, Department of Health Outcomes Research and Policy, Auburn, AL, USA.
University of Alabama at Birmingham, Ryals School of Public Health, Department of Biostatistics, Birmingham, AL, USA.
Res Social Adm Pharm. 2020 Dec;16(12):1702-1710. doi: 10.1016/j.sapharm.2020.02.008. Epub 2020 Feb 20.
Prior work has identified disparities in the quality and outcomes of healthcare across socioeconomic subgroups. Medication use may be subject to similar disparities.
To assess the association between demographic and socioeconomic factors (gender, age, race, income, education, and rural or urban residence) and appropriateness of medication use.
US adults aged ≥45 years (n = 26,798) from the REasons for Geographic And Racial Differences in Stroke (REGARDS) study were included in the analyses, of which 13,623 participants aged ≥65 years (recruited 2003-2007). Potentially inappropriate medication (PIM) use in older adults and drug-drug interactions (DDIs) were identified through 2015 Beers Criteria and clinically significant drug interactions list by Ament et al., respectively as measures of medication appropriateness. Multivariable logistic regression was used to assess the association of disparity parameters with PIM use and DDIs. Interactions between race and other disparity variables were investigated.
Approximately 87% of the participants aged ≥65 years used at least one drug listed in the Beers Criteria, and 3.8% of all participants used two or more drugs with DDIs. Significant gender-race interaction across prescription-only drug users revealed that white females compared with white males (OR = 1.33, 95% CI 1.20-1.48) and black males compared with white males (OR = 1.60, 95% CI 1.41-1.82) were more likely to receive PIM. Individuals with lower income and education also were more likely to use PIM in this sub-group. Females were less likely than males (female vs. male: OR = 0.55, 95% CI 0.48-0.63) and individuals resided in small rural areas as opposed to urban areas (small rural vs. urban: OR = 1.37, 95% CI 1.07-1.76) were more likely to have DDIs.
Demographic and socioeconomic disparities in PIM use and DDIs exist. Future studies should seek to better understand factors contributing to the disparities in order to guide development of interventions.
先前的研究已发现不同社会经济亚组在医疗保健质量和结果方面存在差异。药物使用情况可能也存在类似差异。
评估人口统计学和社会经济因素（性别、年龄、种族、收入、教育程度以及城乡居住情况）与药物使用合理性之间的关联。
来自“中风地理和种族差异原因”（REGARDS）研究的年龄≥45岁的美国成年人（n = 26,798）纳入分析，其中13,623名参与者年龄≥65岁（于2003 - 2007年招募）。分别通过2015年《Beers标准》和Ament等人列出的具有临床意义的药物相互作用清单来识别老年人潜在不适当用药（PIM）情况和药物 - 药物相互作用（DDIs），以此作为药物使用合理性的衡量指标。采用多变量逻辑回归来评估差异参数与PIM使用情况和DDIs之间的关联。研究了种族与其他差异变量之间的相互作用。
年龄≥65岁的参与者中约87%使用了《Beers标准》中列出的至少一种药物，所有参与者中有3.8%使用了两种或更多种存在药物相互作用的药物。仅使用处方药的人群中存在显著的性别 - 种族相互作用，结果显示白人女性与白人男性相比（比值比[OR] = 1.33，95%置信区间[CI] 1.20 - 1.48）以及黑人男性与白人男性相比（OR = 1.60，95% CI 1.41 - 1.82）更有可能接受潜在不适当用药。在这个亚组中，收入和教育程度较低的个体也更有可能使用潜在不适当用药。女性比男性更不可能出现药物相互作用（女性与男性相比：OR = 0.55，95% CI 0.48 - 0.63），居住在农村小地区的个体与城市地区个体相比（农村小地区与城市地区相比：OR = 1.37，95% CI 1.07 - 1.76）更有可能出现药物相互作用。
在潜在不适当用药和药物相互作用方面存在人口统计学和社会经济差异。未来的研究应致力于更好地理解导致这些差异的因素，以指导干预措施的制定。
