Unit for Cardiovascular Epidemiology, Gertner Institute for Epidemiology and Health Policy Research, Sheba Medical Center, Ramat-Gan 52621, Israel; Department of Epidemiology and Preventive Medicine, School of Public Health, Sackler Faculty of Medicine, Tel-Aviv University, Tel-Aviv 6997801, Israel.
Unit for Cardiovascular Epidemiology, Gertner Institute for Epidemiology and Health Policy Research, Sheba Medical Center, Ramat-Gan 52621, Israel.
Mech Ageing Dev. 2023 Apr;211:111788. doi: 10.1016/j.mad.2023.111788. Epub 2023 Feb 8.
Elderly individuals are characterized by multimorbidity and high medication intake, entailing risks for adverse events. We examined the overall and sex-specific association of polypharmacy (≥5 drugs concurrently) with 20-year mortality among community-dwelling older adults.
Survivors of the longitudinal Israel Study of Glucose Intolerance, Obesity, and Hypertension underwent extensive evaluation during 1999-2004, and were followed-up for all-cause mortality until 2019. Cox regression examined association of polypharmacy with all-cause mortality.
Data included 1210 participants (mean baseline age 72.9 ± 7.4 years, 53% females), 50.7% of them died over a median follow-up of 12.8 years. Women received a higher mean number of drugs (4.3 vs 3.5; p < 0.0001), were twice more likely to take vitamins, and had higher comorbidity. Polypharmacy prevalence was 38.3%, and more frequent with age, female sex, European-American origin, sedentary lifestyle and poor self-rated health. Polypharmacy was independently associated with mortality in women only (HR=1.41, 95%CI:1.05-1.89). An interaction was found with sex (p = 0.045).
Polypharmacy was more prevalent in older women than men and associated with increased 20-year mortality in women only. Sex-specific adaptation of guidelines for appropriate drug use among community-dwelling older adults is warranted.
老年人的特点是多病共存和高药物摄入，这带来了不良事件的风险。我们研究了同时使用≥5 种药物的多种药物疗法（polypharmacy）与社区居住的老年成年人 20 年死亡率之间的总体和性别特异性关联。
纵向以色列葡萄糖耐量、肥胖和高血压研究的幸存者在 1999-2004 年期间接受了广泛的评估，并在 2019 年之前进行了全因死亡率的随访。Cox 回归分析了多种药物疗法与全因死亡率的关系。
数据包括 1210 名参与者（平均基线年龄 72.9±7.4 岁，53%为女性），中位随访 12.8 年后，有 50.7%的人死亡。女性服用的平均药物数量更多（4.3 比 3.5；p<0.0001），服用维生素的可能性是男性的两倍，且合并症更多。多种药物疗法的患病率为 38.3%，且随年龄、女性性别、欧洲裔美国人血统、久坐的生活方式和较差的自我健康评估而增加。多种药物疗法与女性的死亡率独立相关（HR=1.41，95%CI：1.05-1.89）。性别之间存在交互作用（p=0.045）。
与男性相比，女性中多种药物疗法更为普遍，与女性 20 年死亡率增加有关。需要根据性别特异性调整社区居住的老年成年人适当用药的指南。
