Ataei Seyed Mohammad-Navid, Golestani Ali, Khosravi Sepehr, Tabatabaei-Malazy Ozra, Malekpour Mohammad-Reza, Ebrahimpur Mahbube, Mirzadeh Fatemeh Sadat, Shahali Zahra, Amini Mohammad Reza, Effatpanah Mohammad
Non-Communicable Diseases Research Center, Endocrinology and Metabolism Population Sciences Institute, Tehran University of Medical Sciences, Tehran, Iran (the Islamic Republic of).
Endocrinology and Metabolism Research Center, Endocrinology and Metabolism Clinical Sciences Institute, Tehran University of Medical Sciences, Tehran, Iran (the Islamic Republic of).
BMJ Open. 2025 Aug 21;15(8):e097863. doi: 10.1136/bmjopen-2024-097863.
Polypharmacy, defined as the concurrent use of multiple medications, is a growing concern among the elderly, especially in low-income and middle-income countries such as Iran. This study aims to explore the prevalence and patterns of polypharmacy among the elderly in Iran, using health insurance claims data to identify common drug classes and coprescribed medications, with a focus on informing policy decisions and improving medication management.
Retrospective population-based observational study.
Nationwide data from the Iran Health Insurance Organization (IHIO) across 24 provinces.
1 876 527 individuals aged 65 years and older, insured by the IHIO from 2014 to 2017. Individuals with incomplete demographic information or lacking medication records in the database were excluded from the analysis.
Prevalence and patterns of polypharmacy, demographic factors associated with polypharmacy, and common drug classes used. Medications were classified using the Anatomical Therapeutic Chemical system. Polypharmacy was defined as the use of five or more medications, with cumulative polypharmacy considering total drug use over time, and consecutive polypharmacy focusing on the frequency of monthly drug use. Logistic regression and association rule mining were applied to explore demographic factors and medication patterns associated with polypharmacy.
Of the study population, 74.9% experienced cumulative polypharmacy over 6 months and 64.6% over 1 month, with 7.6% experiencing consecutive polypharmacy. Females and those aged 75-79 were more prone to polypharmacy. Systemic glucocorticoids were the most commonly used medications (50.02%), followed by HMG-CoA reductase inhibitors (42.73%) and platelet aggregation inhibitors (41.92%). Polypharmacy was most strongly associated with medications related to the alimentary tract and metabolism, cardiovascular system, nervous system and blood and blood-forming organs.
Polypharmacy is highly prevalent among the elderly in Iran, with significant variations by gender, age, insurance fund and region. The findings highlight the need for targeted interventions to manage polypharmacy and improve medication safety in this population.
多重用药定义为同时使用多种药物，这在老年人中日益引起关注，尤其是在伊朗等低收入和中等收入国家。本研究旨在利用健康保险理赔数据，探索伊朗老年人多重用药的患病率及模式，以确定常见药物类别和联合处方药物，重点是为政策决策提供信息并改善药物管理。
基于人群的回顾性观察研究。
来自伊朗健康保险组织（IHIO）在24个省份的全国性数据。
2014年至2017年期间由IHIO承保的1876527名65岁及以上的个体。数据库中人口统计学信息不完整或缺乏用药记录的个体被排除在分析之外。
多重用药的患病率及模式、与多重用药相关的人口统计学因素以及使用的常见药物类别。药物使用解剖治疗化学系统进行分类。多重用药定义为使用五种或更多药物，累积多重用药考虑随时间的总药物使用情况，连续多重用药关注每月药物使用频率。应用逻辑回归和关联规则挖掘来探索与多重用药相关的人口统计学因素和用药模式。
在研究人群中，74.9%的人在6个月内经历了累积多重用药，64.6%的人在1个月内经历了累积多重用药，7.6%的人经历了连续多重用药。女性和75 - 79岁的人更容易出现多重用药。全身用糖皮质激素是最常用的药物（50.02%），其次是HMG - CoA还原酶抑制剂（42.73%）和血小板聚集抑制剂（41.92%）。多重用药与与消化道和代谢、心血管系统、神经系统以及血液和造血器官相关的药物关联最为密切。
多重用药在伊朗老年人中非常普遍，在性别、年龄、保险基金和地区方面存在显著差异。研究结果凸显了针对该人群进行有针对性干预以管理多重用药并提高用药安全性的必要性。
