Multimorbidity, polypharmacy and primary prevention in community-dwelling adults in Quebec: a cross-sectional study

Abstract

Background Polypharmacy carries the risk of adverse events, especially in people with multimorbidity. Objective To investigate the prevalence of polypharmacy in community-dwelling adults, the association of multimorbidity with polypharmacy and the use of medications for primary prevention. Methods Cross-sectional analysis of the follow-up data from the Program of Research on the Evolution of a Cohort Investigating Health System Effects (PRECISE) in Quebec, Canada. Multimorbidity was defined as the presence of three or more chronic diseases and polypharmacy as self-reported concurrent use of five or more medications. Primary prevention was conceptualized as the use of statin or low-dose antiplatelets without a reported diagnostic of cardiovascular disease. Results Mean age 56.7 ± 11.6, 62.5% female, 30.3% had multimorbidity, 31.9% had polypharmacy (n = 971). The most common drugs used were statins, renin–angiotensin system inhibitors and psychotropics. Compared to participants without any chronic disease, the adjusted odds ratios (ORs) for having polypharmacy were 2.78 [95% confidence interval (CI): 1.23–6.28] in those with one chronic disease, 8.88 (95% CI: 4.06–19.20) in those with two chronic diseases and 25.31 (95% CI: 11.77–54.41) in those with three or more chronic diseases, P < 0.001. In participants without history of cardiovascular diseases, 16.2% were using antiplatelets and 28.5% were using statins. Multimorbidity was associated with increased likelihood of using antiplatelets (adjusted OR: 2.98, 95% CI: 1.98–4.48, P < 0.001) and statins (adjusted OR: 3.76, 95% CI: 2.63–5.37, P < 0.001) for primary prevention. Conclusion There was a high prevalence of polypharmacy in community-dwelling adults in Quebec and a strong association with multimorbidity. The use of medications for primary prevention may contribute to polypharmacy and raise questions about safety.

Rising burden of multimorbidity and related socio-demographic factors: a repeated cross-sectional study of Ontarians

“…Persons with high multimorbidity often interact with multiple care providers and settings (Boyd and Fortin 2010 ; Wallace et al 2015 ), leading to a heightened risk for fragmented and poor quality of care, high (and potentially inappropriate) medication use, and adverse health outcomes (Gruneir et al 2016 ; Nguyen et al 2019 ; Petrosyan et al 2017 ; Ploeg et al 2017 ). It is essential to inform current and future health promotion and chronic disease management (Kernick et al 2017 ; Salisbury et al 2018 ); thus, providing timely population-level data regarding trends in multimorbidity across age, sex, and SES subgroups is key.…”

Sex differences in multimorbidity and polypharmacy trends: A repeated cross-sectional study of older adults in Ontario, Canada

“…Population-based investigations of sex- and age-specific trends in both multimorbidity and polypharmacy are scarce [ 20 ] especially among persons aged 65 and older. Additionally, among studies that have examined the independent association between multimorbidity and polypharmacy, most have focused on relatively younger populations [ 29 – 31 ] or were limited to older adults receiving home [ 21 ] or hospital [ 32 ] care or older data sources [ 19 ]. Consistent with previous observations of a strong positive association between number of chronic conditions and polypharmacy [ 19 – 22 , 31 ], our findings reveal that at any given age among men and women aged greater than 65 years, the prevalence of polypharmacy and hyper-polypharmacy is driven largely by the level of multimorbidity.…”

“…There are also notable sex differences in the prevalence of individual and co-occurring medication classes and chronic conditions [ 7 , 19 ] and potentially harmful drug-drug interactions [ 12 ]. Though recent studies have explored broad trends in multimorbidity [ 2 , 4 , 5 ] and/or polypharmacy [ 12 , 19 , 20 , 28 ], few have examined sex- and age-specific trends in both [ 20 ] among older adults or investigated variation over time in the impact of multimorbidity and age on medication use [ 29 – 32 ], particularly among older men and women.…”

Prevalência de competições terapêuticas na farmacoterapia de usuários das Unidades de Saúde da Família de Ribeirão Preto, São Paulo

“…Observou-se uma alta prevalência de multimorbidade, 98,7%, sendo este dado superior ao verificado em estudos anteriores (Salive, 2013;Melo & Lima, 2020;Nguyen, Ngangue, Haggerty, Bouhali & Fortin, 2019). Além disso, uma revisão sistemática da literatura mostrou que a prevalência de multimorbidade em pessoas idosas pode variar de 55 a 98% (Marengoni et al,2011).…”

“…Verificou-se também um aumento no número de CT em relação aos indivíduos idosos (idade maior ou igual a 60 anos) sobre os não idosos (idade menor do que 60 anos), tanto para o risco potencial de uma CT quanto para duas ou mais CTs. Com o envelhecimento, há um aumento da prevalência de multimorbidade, polifarmácia e consequentemente problemas na farmacoterapia (Salive, 2013;Lorgunpai et al, 2014;Nguyen et al, 2019).…”