Analysis of the association between polypharmacy and socioeconomic position among elderly aged > or =77 years in Sweden

Syed Imran Haider, Kristina Johnell, Mats Thorslund, Johan Fastbom
Clinical Therapeutics 2008, 30 (2): 419-27

BACKGROUND: Polypharmacy is an important patient safety concern and has been associated with increased adverse drug reactions, hospitalization, and mortality in the elderly. However, few studies have analyzed the association between socioeconomic position (SEP) and the extent of drug use in older people.

OBJECTIVES: The aims of this study were to investigate the prevalence of polypharmacy and the association between polypharmacy and SEP, as measured by education, occupation, and income.

METHODS: For this cross-sectional study, data from a nationally representative sample (Swedish Panel Study of Living Conditions of the Oldest Old [SWEOLD] 2002) aged > or =77 years were analyzed (n = 621). Information on drug use was based on personal interviews, and polypharmacy was defined as concurrent use of > or =5 drugs. Other measurements included were age, sex, education, occupation, income, comorbidity, marital status, and living situation. The association between polypharmacy and SEP was assessed by logistic regression.

RESULTS: The mean number of drugs used in the sample was 4.4; in less educated patients, 4.6; more educated, 4.0. Polypharmacy was observed in 42.2% of the elderly. Overall, antithrombotic agents (42.5%), P-blocking agents (28.3%), and high-ceiling diuretics (28.0%) were the most prevalent drugs. Low education was associated with polypharmacy (odd ratio [OR], 1.46; 95% CI, 1.02-2.07), after controlling for age and sex. However, the association between low education level and polypharmacy was not significant after adjustment for age, sex, comorbidity, marital status, and living situation (OR, 1.39; 95% CI, 0.95-2.04). Moreover, we did not observe any association between occupation or income and polypharmacy.

CONCLUSIONS: The results from this study suggest that >40% of people aged > or =77 years in Sweden are exposed to polypharmacy, defined as the use of > or =5 drugs. There was a higher prevalence of polypharmacy among elderly with low education. However, after controlling for comorbidity, martial status, and living situation, polypharmacy was not related to low education. Further studies in larger populations are needed to elucidate the association between SEP and drug use.

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