Sociodemographic differences in discontinuation of high-risk medications: a retrospective cohort study

Older adults frequently use medications deemed high-risk, despite clinical recommendations supporting their discontinuation. We conducted a retrospective cohort study using administrative claims data from a large national U.S. health insurer (2017-2023) to assess high-risk medication discontinuation among adults aged ≥65 years and their association with sociodemographic factors. Among 729,705 long-term users of high-risk medications (mean age 74 [SD: 7], 59% female), only 22.8% discontinued for ≥90 consecutive days without subsequent refills (mean follow-up: 626 days). Discontinuation was more likely among Black adults (HR = 1.07, 95% CI: 1.03-1.11), particularly between 2020-2021, while men (HR = 0.89, 95% CI: 0.87-0.91) and those aged ≥75 years (HR = 0.86, 95% CI: 0.84-0.91) were less likely to discontinue compared to women and younger older adults, respectively. Notably, the combined effect of male gender and older age was associated with increased discontinuation (HR = 1.04, 95% CI: 1.02-1.06), whereas other sociodemographic combinations showed no meaningful interaction. When stratified by medication class, significant variation persisted for central nervous system, gastrointestinal, and pain medications but not for endocrine or cardiovascular medications. These findings highlight persistently low discontinuation rates and suggest the need for targeted interventions to reduce inappropriate medication use in older adults.