What is the clinical evidence from this study?

Study design: Meta-Analysis. Population: Polypharmacy and Potentially Inappropriate Medications (PIM) use (n=4558786). Intervention: Polypharmacy (≥5 drugs) vs. No polypharmacy. Primary outcome: Potentially inappropriate medication (PIM) use (RR 2.03, 95% CI 1.13, 3.64, p=0.018).

June 20, 2022Frontiers in Pharmacology52 citationsOpen Access

Prevalence of Polypharmacy and Potentially Inappropriate Medications Use in Elderly Chinese Patients: A Systematic Review and Meta-Analysis

FTFangyuan Tian ZCZhaoyan Chen JWJinhui Wu

Key Result

Polypharmacy significantly increased the risk of potentially inappropriate medication use (RR 2.03) in elderly Chinese patients, among whom the overall prevalence of polypharmacy was 48%.

Study Design

Type

Meta-Analysis (n=4,558,786)

Structured PICO

What is the prevalence of polypharmacy and potentially inappropriate medication use, and does polypharmacy increase the risk of PIM use in elderly Chinese patients?

Population

4,558,786 elderly Chinese patients from 8 observational studies (inpatients and outpatients)

Intervention

Polypharmacy (concomitant use of ≥5 medicines) and potentially inappropriate medication (PIM) use evaluated by Chinese criteria, Beers criteria, or STOPP criteria

Comparator

Patients without polypharmacy (for risk factor analysis)

Outcome

Prevalence of polypharmacy and potentially inappropriate medication (PIM) usesafety

There is a high prevalence of polypharmacy and potentially inappropriate medication use among elderly Chinese patients, and polypharmacy doubles the risk of receiving inappropriate medications.

Main Result

Effect estimate: RR 2.03 (95% CI 1.13, 3.64)

p-value: p=0.018

Limitations

Disease distribution, doctors' diagnostic level, and prescribing habits vary widely across hospitals in China, which may influence generalization of results
Majority of studies were conducted in Chinese provincial capital cities, so results for other urban and rural areas are unclear
Few studies were included and the overall quality was general
Most included studies were short-term

Abstract

Objectives: Polypharmacy and potentially inappropriate medication (PIM) use among elderly Chinese patients have not yet been investigated by systematic review and meta-analysis. The purposes of this study were to investigate the prevalence of polypharmacy and PIM use and the risk factors associated with PIM use in elderly Chinese patients. Methods: Databases including PubMed, EMBase, and Web of Science were searched to collect studies which used Chinese criteria, Beers criteria, or STOPP criteria to evaluate the PIM status of elderly Chinese patients from inception to August 2021 (PROSPERO Code No: CRD42021262821). Observational studies reporting the prevalence of polypharmacy and PIM use in elderly Chinese patients were meta-analyzed. The pooled prevalence and risk ratio (RR) were calculated with a 95% confidence interval (CI). Results: A total of 8 articles involving 4,558,786 patients were included. The overall prevalence of polypharmacy (concomitant use of more than 5 medicines) and PIM use pooled by meta-analysis in Chinese older patients was 48% (95% CI: 0.17, 0.79, p = 0.003) (inpatients 73%, outpatients 23%) and 39% (95% CI: 0.25, 0.54, p 0.001) (inpatients 50%, outpatients 29%), respectively. Polypharmacy (RR: 2.03, 95% CI: 1.13, 3.64) was significantly associated with PIM use. Conclusion: This meta-analysis demonstrated a high prevalence of polypharmacy and PIM use among elderly patients in China. Affected by the quantity and quality of the included studies, the aforementioned conclusions need to be confirmed by large samples and high-quality studies.

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