Bjerrum L, Søgaard J, Hallas J, Kragstrup J
Research Unit of General Practice, Odense University, Denmark.
Eur J Clin Pharmacol. 1998 May;54(3):197-202. doi: 10.1007/s002280050445.
To analyse the occurrence of multiple drug use (polypharmacy, PP) in the population and to identify individuals particularly prone to PP.
Data were derived from the Odense Pharmacoepidemiological Database (OPED) and covered all subsidised prescriptions during 1994 presented by inhabitants in the county of Funen (n = 466567). The number of individuals concurrently using two to four drugs (minor PP) and five or more drugs (major PP) was calculated on a random day in 1994. Drugs were classified according to the Anatomical Therapeutical Chemical (ATC) classification index. The main therapeutic class (second level of the ATC code) was used as an indicator for the type of health problem. A stepwise backwards logistic regression was used to identify predictors of major PP. Odds ratios were calculated for different drug classes, and the age and sex of all drug users.
On a random day, 8.3% of the population were exposed to minor PP and 1.2% to major PP. The prevalence of PP increased with age, and from the age of 70 years, two thirds of all drug users were PP users. Drug use was 50% more prevalent among women than men, but over the age of 70, the sexes did not differ in the prevalence of major PP. Many different drug combinations were found, and among major PP users (n = 5443), two thirds had their own unique drug regimen, different from all other drug users. Cardiovascular drugs and analgesics were often involved in PP among the elderly, while asthma drugs, psychotropic drugs and anti-ulcer drugs were predominant among young individuals exposed to PP. The odds ratio (OR) for major PP was substantially increased for individuals treated for cardiovascular diseases (OR, 4.5), anaemia (OR, 4.1) and respiratory diseases (OR, 3.6).
PP is widespread in the population. Clinicians and organisers who are responsible for quality assurance programmes should intensify their surveillance of the groups most prone to PP (the elderly and those using analgesics or drugs for cardiovascular disease, anaemia, asthma and diabetes).
分析人群中多重用药（多药合用，PP）的发生情况，并确定特别容易发生多药合用的个体。
数据来源于欧登塞药物流行病学数据库（OPED），涵盖1994年富恩岛居民开具的所有补贴处方（n = 466567）。计算1994年随机一天中同时使用两至四种药物（轻度多药合用）和五种及以上药物（重度多药合用）的个体数量。药物根据解剖治疗化学（ATC）分类索引进行分类。主要治疗类别（ATC代码的第二级）用作健康问题类型的指标。采用逐步向后逻辑回归来确定重度多药合用的预测因素。计算不同药物类别、所有用药者的年龄和性别的比值比。
在随机一天，8.3%的人群暴露于轻度多药合用，1.2%暴露于重度多药合用。多药合用的患病率随年龄增加而上升，70岁及以上人群中，三分之二的用药者为多药合用者。女性的用药率比男性高50%，但在70岁以上人群中，重度多药合用的患病率在性别上没有差异。发现了许多不同的药物组合，在重度多药合用者（n = 5443）中，三分之二有自己独特的用药方案，与所有其他用药者不同。老年人的多药合用中常涉及心血管药物和镇痛药，而在暴露于多药合用的年轻人中，哮喘药物、精神药物和抗溃疡药物占主导。患有心血管疾病（比值比，4.5）、贫血（比值比，4.1）和呼吸系统疾病（比值比，3.6）的个体发生重度多药合用的比值比大幅升高。
多药合用在人群中普遍存在。负责质量保证计划的临床医生和组织者应加强对最容易发生多药合用的群体（老年人以及使用镇痛药或治疗心血管疾病、贫血、哮喘和糖尿病药物的人群）的监测。
