Department of Epidemiology and Public Health, Sciensano, Brussels, Belgium.
Department of Public Health, Epidemiology and Health Economics, University of Liège, Liège, Belgium.
Pharmacoepidemiol Drug Saf. 2021 Dec;30(12):1716-1726. doi: 10.1002/pds.5321. Epub 2021 Jul 16.
To explore differences in the prevalence and determinants of polypharmacy in the older general population in Belgium between self-reported and prescription based estimates and assess the relative merits of each data source.
Data were used from participants aged ≥65 years of the Belgian national health survey 2013 (n = 1950). Detailed information was asked on the use of medicines in the past 24 h and linked with prescription data from the Belgian compulsory health insurance (BCHI). Agreement between polypharmacy (use or prescription ≥5 medicines) and excessive polypharmacy (≥10 medicines) between both sources was assessed with kappa statistics. Multinomial logistic regression was used to study determinants of moderate (5-9 medicines) and excessive polypharmacy (≥10 medicines) and over- and underestimation of prescription based compared to self-reported polypharmacy.
Self-reported and prescription based polypharmacy prevalence estimates were respectively 27% and 32%. Overall agreement was moderate, but better in men (kappa 0.60) than in women (0.45). Determinants of moderate polypharmacy did not vary substantially by source of outcome indicator, but restrictions in activities of daily living (ADL), living in an institution and a history of a hospital admission was associated with self-reported based excessive polypharmacy only.
Surveys and prescription data measure polypharmacy from a different perspective, but overall conclusions in terms of prevalence and determinants of polypharmacy do not differ substantially by data source. Linking survey data with prescription data can combine the strengths of both data sources resulting in a better tool to explore polypharmacy at population level.
探究在比利时，基于自我报告和处方的估计，老年人群中普遍存在的多药治疗的差异及其决定因素，并评估两种数据来源各自的优势。
本研究使用了 2013 年比利时全国健康调查中年龄≥65 岁的参与者的数据（n=1950）。详细询问了参与者在过去 24 小时内使用药物的情况，并与比利时强制性健康保险（BCHI）的处方数据进行了关联。使用 Kappa 统计评估两种来源的多药治疗（使用或处方≥5 种药物）和过度多药治疗（≥10 种药物）之间的一致性。使用多项逻辑回归研究了中剂量（5-9 种药物）和过度多药治疗（≥10 种药物）以及与自我报告的多药治疗相比，基于处方的多药治疗的高估和低估的决定因素。
自我报告和基于处方的多药治疗的流行率估计分别为 27%和 32%。总体一致性为中等水平，但在男性中更好（Kappa 值为 0.60），而在女性中较差（0.45）。决定中剂量多药治疗的因素在结果指标的来源之间没有实质性差异，但日常生活活动（ADL）受限、居住在机构中和有住院史与自我报告的过度多药治疗仅相关。
调查和处方数据从不同的角度测量多药治疗，但在多药治疗的流行率和决定因素方面，总体结论并没有因数据来源的不同而有很大差异。将调查数据与处方数据相联系，可以结合两种数据来源的优势，从而为探索人群水平的多药治疗提供更好的工具。
