Li Yuan, Zhang Xianzhuo, Yang Liu, Yang Yongjie, Qiao Gaoxing, Lu Chunyun, Liu Kefeng
Department of Nuclear Medicine, Henan medical key laboratory of molecular imaging, the First Affiliated Hospital of Zhengzhou University, Zhengzhou, China.
The First School of Clinical Medicine, Lanzhou University, Lanzhou, China.
Arch Gerontol Geriatr. 2022 May-Jun;100:104630. doi: 10.1016/j.archger.2022.104630. Epub 2022 Jan 28.
Polypharmacy and related adverse consequences are common in the older adults, especially mortality, but the causality of this relationship remains unclear. This meta-analysis aimed to explore the relationship between polypharmacy and mortality in older adults.
We systematically searched Pubmed, Embase, and the Cochrane Library from inception until August 2021 to identify observational studies providing quantitative estimates on the association between polypharmacy(≥5drugs) and mortality in the elderly (≥65 years). Results from individual studies were pooled using a random-effects or fixed-effects model.
A total of twenty-four cohort studies including 2,967,952 participants of 65 years or older in this meta-analysis. twenty-four studies found a significant increase in mortality associated with polypharmacy (≥5 drugs) [Relative Risk, RR=1.28, 95%CI (1.19,1.39), P<0.05] or excessive polypharmacy (≥10 drugs) [Relative Risk, RR=1.44, 95%CI (1.03,2.01), P<0.05] among older adults. Eight studies showed an 50% increased hospitalization rate for polypharmacy in the older adults [RR=1.50, 95%CI (1.18,1.89), P<0.05]. Subgroup analysis showed that the relationship between polypharmacy and mortality was different among older adults in community [RR=1.41, 95%CI (1.24,1.60), P<0.05], in hospital [RR=1.10, 95%CI (1.00,1.20), P<0.05], in institutions [RR=1.47, 95%CI (1.29,1.68), P<0.05]. The mortality rate of the elderly using 5 to 9 drugs was [RR=1.23, 95%CI (1.06,1.43), P<0.05] and using more than 10 drugs was [RR=1.44, 95%CI (1.03,2.01), P<0.05].
The results of this meta-analysis suggest that polypharmacy may be associated with increased mortality in older adults, but this association must be carefully considered and needed further validation.
CI=confidence interval; MOOSE=Meta-analysis of Observational Studies in Epidemiology; NOS = Newcastle-Ottawa Scale; PRISMA = Preferred Reporting Items for Systematic Reviews and Meta-Analyses; RR = relative risk; HR = hazard ratio; OR = odds ratio; GRADE = Grading of Recommendations Assessment Development and Evaluation.
多重用药及其相关不良后果在老年人中很常见，尤其是死亡率，但这种关系的因果性仍不明确。本荟萃分析旨在探讨老年人多重用药与死亡率之间的关系。
我们系统检索了从创刊至2021年8月的PubMed、Embase和Cochrane图书馆，以确定提供关于老年人（≥65岁）多重用药（≥5种药物）与死亡率关联定量估计的观察性研究。使用随机效应或固定效应模型汇总个体研究的结果。
本荟萃分析共纳入24项队列研究，包括2967952名65岁及以上的参与者。24项研究发现，老年人中多重用药（≥5种药物）[相对风险，RR = 1.28，95%置信区间（1.19，1.39），P < 0.05]或过度多重用药（≥10种药物）[相对风险，RR = 1.44，95%置信区间（1.03，2.01），P < 0.05]与死亡率显著增加相关。8项研究表明，老年人多重用药的住院率增加了50%[RR = 1.50，95%置信区间（1.18，1.89），P < 0.05]。亚组分析表明，社区老年人[RR = 1.41，95%置信区间（1.24，1.60），P < 0.05]、住院老年人[RR = 1.10，95%置信区间（1.00，1.20），P < 0.05]、机构老年人[RR = 1.47，95%置信区间（1.29，1.68），P < 0.05]中多重用药与死亡率的关系有所不同。使用5至9种药物的老年人死亡率为[RR = 1.23，95%置信区间（1.06，1.43），P < 0.05]，使用超过10种药物的老年人死亡率为[RR = 1.44，95%置信区间（1.03，2.01），P < 0.05]。
本荟萃分析结果表明，多重用药可能与老年人死亡率增加有关，但这种关联必须谨慎考虑且需要进一步验证。
CI = 置信区间；MOOSE = 流行病学观察性研究的荟萃分析；NOS = 纽卡斯尔 - 渥太华量表；PRISMA = 系统评价和荟萃分析的首选报告项目；RR = 相对风险；HR = 风险比；OR = 比值比；GRADE = 推荐分级评估、制定与评价
