O'Connor Lauren F, Resnik Jenna B, Simmens Sam, Bhandaru Vinay, Benator Debra, Wingate La'Marcus, Castel Amanda D, Monroe Anne K
Department of Epidemiology, Milken Institute School of Public Health, George Washington University, Washington, District of Columbia, USA.
Department of Biostatistics, Milken Institute School of Public Health, George Washington University, Washington, District of Columbia, USA.
Pharmacoepidemiology. 2025 Jun;4(2). doi: 10.3390/pharma4020010. Epub 2025 May 12.
The validated Screening Tool of Older People's Prescriptions (STOPP) identifies potentially inappropriate prescribing (PIP) - treatments where potential risk outweighs potential benefit. STOPP is particularly important for people aging with HIV and comorbidities, since PIP may exacerbate symptoms and decrease adherence.
We analyzed data from the DC Cohort, a longitudinal cohort of people with HIV (PWH). We applied STOPP criteria to identify PIP among DC Cohort participants aged ≥50 years who completed a Patient Reported Outcomes (PROs) survey. All medications prescribed in the 2 years prior to PROs survey completion were considered. Negative binomial models were used to evaluate factors associated with PIP and structural equation modeling was used to evaluate whether symptom burden mediates the relationship between PIP and quality of life.
Of 1048 eligible DC Cohort participants, 486 (46%) had at least one PIP. The most common systems implicated were musculoskeletal (23%), analgesic drugs (N=172, 16%), and central nervous system (13%). All baseline characteristics (age, race/ethnicity, gender, HIV transmission risk, SDOH, comorbidities, viral suppression, and type of HIV care site) were significantly associated with PIP in the crude models. In the multivariable model with just demographic variables, the association between age (aIRR: 1.03 (95% CI: 1.02, 1.04)), intravenous drug use (aIRR: 1.68 (95% CI: 1.20, 2.35)), site type (aIRR: 0.75 (95% CI: 0.62, 0.92)) and PIP remained significant (Table 3, Model I). In the fully adjusted multivariable model with demographics and SDOH, the association between between age, intravenous drug use, and PIP remained significant. Statistical evidence that symptom burden mediates the relationship between PIP and each of the QOL dimensions was present.
Future interventions should work to decrease PIP among these high-risk groups, especially for PIPs associated with increased symptom burden.
经过验证的老年人处方筛查工具（STOPP）可识别潜在不适当处方（PIP）——即潜在风险超过潜在益处的治疗方法。STOPP对于感染HIV且患有合并症的老年人尤为重要，因为PIP可能会加重症状并降低依从性。
我们分析了来自DC队列的数据，这是一个HIV感染者（PWH）的纵向队列。我们应用STOPP标准来识别年龄≥50岁且完成了患者报告结局（PROs）调查的DC队列参与者中的PIP。考虑了PROs调查完成前2年内开具的所有药物。使用负二项式模型评估与PIP相关的因素，并使用结构方程模型评估症状负担是否介导了PIP与生活质量之间的关系。
在1048名符合条件的DC队列参与者中，486人（46%）至少有一项PIP。涉及的最常见系统是肌肉骨骼系统（23%）、镇痛药（N = 172，16%）和中枢神经系统（13%）。在粗略模型中，所有基线特征（年龄、种族/族裔、性别、HIV传播风险、社会人口学因素、合并症、病毒抑制和HIV护理场所类型）均与PIP显著相关。在仅包含人口统计学变量的多变量模型中，年龄（调整后发病率比：1.03（95%置信区间：1.02，1.04））、静脉吸毒（调整后发病率比：1.68（95%置信区间：1.20，2.35））、场所类型（调整后发病率比：0.75（95%置信区间：0.62，0.92））与PIP之间的关联仍然显著（表3，模型I）。在包含人口统计学和社会人口学因素的完全调整多变量模型中，年龄、静脉吸毒与PIP之间的关联仍然显著。有统计证据表明症状负担介导了PIP与每个生活质量维度之间的关系。
未来的干预措施应致力于降低这些高危人群中的PIP，特别是与症状负担增加相关的PIP。
