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Dose-response relationships between polypharmacy and all-cause and cause-specific mortality among older people

Huang, Y-T; Steptoe, A; Wei, L; Zaninotto, P; (2022) Dose-response relationships between polypharmacy and all-cause and cause-specific mortality among older people. The Journals of Gerontology: Series A , 77 (5) pp. 1002-1008. 10.1093/gerona/glab155. Green open access

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Abstract

BACKGROUND: Although medicines are prescribed based on clinical guidelines and expected to benefit patients, both positive and negative health outcomes have been reported associated with polypharmacy. Mortality is the main outcome, and information on cause-specific mortality is scarce. Hence, we investigated the association between different levels of polypharmacy and all-cause and cause-specific mortality among older adults. METHODS: The English Longitudinal Study of Ageing is a nationally representative study of people aged 50+. From 2012/2013, 6295 individuals were followed up to April 2018 for all-cause and cause-specific mortality. Polypharmacy was defined as taking 5-9 long-term medications daily and heightened polypharmacy as 10+ medications. Cox proportional hazards regression and competing-risks regression were used to examine associations between polypharmacy and all-cause and cause-specific mortality, respectively. RESULTS: Over a 6-year follow-up period, both polypharmacy (19.3%) and heightened polypharmacy (2.4%) were related to all-cause mortality, with hazard ratios of 1.51 (95% CI 1.05-2.16) and 2.29 (95% CI 1.40-3.75) respectively, compared with no medications, independently of demographic factors, serious illnesses and long-term conditions, cognitive function and depression. Polypharmacy and heightened polypharmacy also showed 2.45 (95% CI 1.13-5.29) and 3.67 (95% CI 1.43-9.46) times higher risk of cardiovascular disease (CVD) deaths, respectively. Cancer mortality was only related to heightened polypharmacy. CONCLUSION: Structured medication reviews are currently advised for heightened polypharmacy, but our results suggest that greater attention to polypharmacy in general for older people may reduce adverse effects and improve older adults' health.

Type: Article
Title: Dose-response relationships between polypharmacy and all-cause and cause-specific mortality among older people
Location: United States
Open access status: An open access version is available from UCL Discovery
DOI: 10.1093/gerona/glab155
Publisher version: https://doi.org/10.1093/gerona/glab155
Language: English
Additional information: Copyright © The Author(s) 2021. Published by Oxford University Press on behalf of The Gerontological Society of America. This is an Open Access article distributed under the terms of the Creative Commons Attribution License (https://creativecommons.org/licenses/by/4.0/), which permits unrestricted reuse, distribution, and reproduction in any medium, provided the original work is properly cited.
Keywords: Polypharmacy, all-cause mortality, cardiovascular disease mortality, epidemiology, heightened polypharmacy
UCL classification: UCL
UCL > Provost and Vice Provost Offices > School of Life and Medical Sciences
UCL > Provost and Vice Provost Offices > School of Life and Medical Sciences > Faculty of Life Sciences
UCL > Provost and Vice Provost Offices > School of Life and Medical Sciences > Faculty of Life Sciences > UCL School of Pharmacy
UCL > Provost and Vice Provost Offices > School of Life and Medical Sciences > Faculty of Life Sciences > UCL School of Pharmacy > Practice and Policy
UCL > Provost and Vice Provost Offices > School of Life and Medical Sciences > Faculty of Population Health Sciences
UCL > Provost and Vice Provost Offices > School of Life and Medical Sciences > Faculty of Population Health Sciences > Institute of Epidemiology and Health
UCL > Provost and Vice Provost Offices > School of Life and Medical Sciences > Faculty of Population Health Sciences > Institute of Epidemiology and Health > Behavioural Science and Health
UCL > Provost and Vice Provost Offices > School of Life and Medical Sciences > Faculty of Population Health Sciences > Institute of Epidemiology and Health > Epidemiology and Public Health
URI: https://discovery.ucl.ac.uk/id/eprint/10129340
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