Chae Jungmi, Cho Ho Jin, Yoon Sang-Heon, Kim Dong-Sook
Department of Research, Health Insurance Review and Assessment Service, Wonju, Republic of Korea.
Department of Health Administration, Kongju National University, Gongju, Republic of Korea.
Front Pharmacol. 2024 Jul 31;15:1382990. doi: 10.3389/fphar.2024.1382990. eCollection 2024.
This study aimed to investigate the association between continuous polypharmacy and hospitalization, emergency department (ED) visits, and death.
This retrospective study utilized 6,443,896 patients aged between 65 and 84 years of National Health Insurance claims data from 2016 to 2018. Polypharmacy and excessive polypharmacy were defined as the concurrent use of 5 or more and 10 or more medications, respectively, for durations of both 90 days or more and 180 days or more within a 1-year observation period. The primary outcome measures included all-cause hospitalization, ED visits, and mortality. Multiple logistic regression models were used adjusting for patients' general characteristics, comorbidities, and history of hospitalization or ED visits.
Among 2,693,897 patients aged 65-84 years who had used medicines for 180 days or more (2,955,755 patients taking medicines for 90 days or more), the adverse outcomes were as follows: 20.5% (20.3%) experienced hospitalization, 10.9% (10.8%) visited the ED, and 1% (1%) died, respectively. In patients who exhibited polypharmacy for more than 180 days, the adjusted odds ratio of adverse outcomes was 1.32 (95% confidence interval [CI], 1.31-1.33) for hospitalization, 1.32 (95% CI, 1.31-1.33) for ED visits, 1.63 (95% CI, 1.59-1.67) for death, and that in excessive polypharmacy patients for more than 180 days was 1.85 for hospitalization, 1.92 for ED visits, and 2.57 for death, compared to non-polypharmacy patients.
Our results suggest that polypharmacy in older adults might lead to negative health consequences. Thus, interventions to optimize polypharmacy may need to be implemented.
本研究旨在调查长期多重用药与住院、急诊就诊及死亡之间的关联。
这项回顾性研究利用了2016年至2018年期间6443896例年龄在65岁至84岁之间的国民健康保险理赔数据。多重用药和过度多重用药分别定义为在1年观察期内同时使用5种或更多种药物以及10种或更多种药物，且持续时间均达到90天或更长以及180天或更长。主要结局指标包括全因住院、急诊就诊和死亡率。使用多元逻辑回归模型对患者的一般特征、合并症以及住院或急诊就诊史进行了调整。
在2693897例年龄在65 - 84岁且用药180天或更长时间的患者中（2955755例用药90天或更长时间），不良结局如下：分别有20.5%（20.3%）经历过住院，10.9%（10.8%）去过急诊，1%（1%）死亡。在多重用药超过180天的患者中，与未多重用药的患者相比，住院的调整优势比为1.32（95%置信区间[CI]，1.31 - 1.33），急诊就诊的调整优势比为1.32（95%CI，1.31 - 1.33），死亡的调整优势比为1.63（95%CI，1.59 - 1.67）；在过度多重用药超过180天的患者中，住院的调整优势比为1.85，急诊就诊的调整优势比为1.92，死亡的调整优势比为2.57。
我们的结果表明，老年人多重用药可能会导致负面健康后果。因此，可能需要实施优化多重用药的干预措施。
