Department of Gastroenterology, State Key Laboratory of Holistic Integrative Management of Gastrointestinal Cancers and National Clinical Research Center for Digestive Diseases, Xijing Hospital of Digestive Diseases, Fourth Military Medical University Xian, Xi'An, Shaanxi, China.
Department of Gastroenterology, Xi'an Medical University, Xi An, Shaanxi, China.
Pharmacoepidemiol Drug Saf. 2024 Aug;33(8):e5880. doi: 10.1002/pds.5880.
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.
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.
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.
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.
老年人普遍存在多重用药（PP）现象，与一些不良临床结局相关，并增加了医疗保健负担。我们进行了这项系统评价和荟萃分析，以估计全球老年人的 PP 患病率，并探讨相关因素。
检索了 PubMed、Web of Science、Cochrane Library 和 Ovid EMBASE 数据库，以获取截至 2022 年 5 月 30 日发表的研究。我们纳入了代表≥60 岁一般患者的观察性研究，其中 PP 定义为使用≥5 种药物。如果仅纳入老年人的特定群体（例如，糖尿病患者），则排除研究。主要结局是 PP 的患病率。采用随机效应模型估计 PP 的总体或变量特异性汇总估计值。次要结局是高多重用药（HPP，定义为使用≥10 种药物）和基于不同研究年份、性别、地点、人群等的 PP 患病率。
我们纳入了 122 项原始观察性研究，对其中 57328043 名个体进行了荟萃分析。全球老年人的 PP 和 HPP 总体患病率分别为 39.1%（95%置信区间[CI]，35.5%-42.7%）和 13.3%（95% CI，10.4%-16.5%）。欧洲、大洋洲、北美、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<0.01）。多变量荟萃回归显示，欧洲或北美地区、年龄≥70 岁和居住在养老院与更高的 PP 患病率独立相关。
近 40%的老年人存在 PP。70 岁或以上、发达地区和养老院的老年人中，PP 的患病率显著更高。关注避免这一人群中不适当的 PP，以应对日益增加的 PP 负担至关重要。
