Rochon Paula A, Li Joyce, O'Mahony Denis, Onder Graziano, Petrovic Mirko, Sternberg Shelley A, Gurwitz Jerry H, Savage Rachel D, Wu Wei, Giannakeas Vasily, Kthupi Altea, Dalton Kieran, McCarthy Lisa M, Mason Robin, Giancola Amanda, Borhani Parya, Cherubini Antonio
Women's Age Lab and Women's College Research Institute, Women's College Hospital, Toronto, Ontario, Canada.
ICES, Toronto, Ontario, Canada.
J Am Geriatr Soc. 2025 Feb;73(2):520-532. doi: 10.1111/jgs.19282. Epub 2024 Dec 19.
Few studies describe how gender-related factors may contribute to polypharmacy and prescribing cascades. Describing these patterns using cross-national comparisons can improve the robustness of findings and provide lessons on the importance of considering age, sex, and gender in pharmacological research. The aim of the study was to explore the intersection of age, sex, and gender with polypharmacy and co-prescribing suggesting a potential prescribing cascade.
In this cross-sectional descriptive study, we assessed polypharmacy and calcium channel blocker and diuretic co-prescribing suggesting a prescribing cascade in patients aged ≥65 years from five international secondary databases: population-level community and nursing home (ICES, Maccabi Healthcare Services), clinical trial (SENATOR), and patient registry (Report-AGE, SHELTER). The intersection of age, sex, and gender was explored.
All databases provided age and sex; none included gender-identity data. Gender-related sociocultural factors, socioeconomic status (SES) measured as income and educational attainment, and marital status were not uniformly collected. Compared with males, females had lower income, has less educational attainment, and were more frequently widowed. Polypharmacy was more common in men. Co-prescribing suggesting a prescribing cascade was more frequent in females in four databases and was also more frequent in lower SES and unmarried groups (significant in ICES (community and nursing home) and Maccabi (community), with a nonsignificant trend in Maccabi (nursing home) and three remaining databases). Using two population-level databases, the prevalence of co-prescribing suggesting a prescribing cascade was highest among females 85 years and older who were also in the lower SES group (11.0% ICES and 14.6% Maccabi). Gender disparity was highest in this group (ICES Differential Prevalence = 3.0%, Maccabi Differential Prevalence = 3.8%).
Older adults with lower SES experienced polypharmacy or co-prescribing suggesting a prescribing cascade more frequently than those with higher SES. Within the lower SES groups, females more frequently than males had evidence of co-prescribing suggesting a prescribing cascade. Considering the role of sex and gender-related sociocultural factors may help to better understand some contributors to polypharmacy and prescribing cascades. The research applications are highlighted in our five lessons learned.
很少有研究描述与性别相关的因素如何导致多重用药和处方级联反应。通过跨国比较来描述这些模式可以提高研究结果的稳健性，并为在药理学研究中考虑年龄、性别和社会性别因素的重要性提供经验教训。本研究的目的是探讨年龄、性别和社会性别与多重用药以及提示潜在处方级联反应的联合用药之间的关联。
在这项横断面描述性研究中，我们从五个国际二级数据库评估了年龄≥65岁患者的多重用药情况以及提示处方级联反应的钙通道阻滞剂和利尿剂联合用药情况：人群水平的社区和养老院数据库（ICES、Maccabi医疗保健服务公司）、临床试验数据库（SENATOR）以及患者登记数据库（Report-AGE、SHELTER）。我们探讨了年龄、性别和社会性别之间的关联。
所有数据库都提供了年龄和性别信息；没有一个包含社会性别认同数据。与性别相关的社会文化因素、以收入和教育程度衡量的社会经济地位（SES）以及婚姻状况并未统一收集。与男性相比，女性收入较低、受教育程度较低且丧偶的频率更高。多重用药在男性中更为常见。在四个数据库中，提示处方级联反应的联合用药在女性中更为频繁，在社会经济地位较低和未婚群体中也更为频繁（在ICES（社区和养老院）和Maccabi（社区）中显著，在Maccabi（养老院）和其余三个数据库中有不显著的趋势）。使用两个人群水平数据库，提示处方级联反应的联合用药患病率在85岁及以上且社会经济地位较低的女性中最高（ICES为11.0%，Maccabi为14.6%）。该组中的性别差异最大（ICES差异患病率 = 3.0%，Maccabi差异患病率 = 3.8%）。
社会经济地位较低的老年人比社会经济地位较高的老年人更频繁地经历多重用药或提示处方级联反应的联合用药。在社会经济地位较低的群体中，女性比男性更频繁地有提示处方级联反应的联合用药证据。考虑性别和与社会性别相关的社会文化因素的作用可能有助于更好地理解多重用药和处方级联反应的一些促成因素。我们从五个经验教训中突出了研究应用。
