Prevalence of polypharmacy and associated factors in older adults living in Rio Branco, Acre, Brazil: a cross-sectional population-based study, 2014

Rezende, Gustavo Rodrigues de; Amaral, Thatiana Lameira Maciel; Amaral, Cledir de Araújo; Vasconcellos, Maurício Teixeira Leite de; Monteiro, Gina Torres Rego

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Brasil

Epidemiologia e Serviços de Saúde

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ORIGINAL ARTICLE • Epidemiol. Serv. Saúde 30 (2) • 2021 • https://doi.org/10.1590/S1679-49742021000200013 copy

Prevalence of polypharmacy and associated factors in older adults living in Rio Branco, Acre, Brazil: a cross-sectional population-based study, 2014^* * This research received financial support from the National Council for Scientific and Technological Development/Ministry of Science, Technology and Innovation - Grant No. 401081/2013-3 - and from the Acre State Research Support Foundation - Grant No. 6068-14-0000029.

Authorship SCIMAGO INSTITUTIONS RANKINGS

Abstract

Objective:

To analyze polypharmacy prevalence and associated factors in older adults living in Rio Branco, Acre, Brazil, in 2014.

Methods:

This was a cross-sectional population-based study using complex sampling with older adults. Polypharmacy was defined as concomitant use of five or more medications.

Results:

Polypharmacy prevalence was 14.9% (95%CI 11.8;18.6), positively associated with females (OR=2.29 - 95%CI 1.41;3.74), white race/skin color (OR=1.61 - 95%CI 1.10;2.38), dependence (OR=1.65 - 95%CI 1.05;2.60), change in eating habits/dieting (OR=1.66 - 95%CI 1.16;2.36), hospitalization in the last 12 months (OR=1.61 - 95%CI 1.02;2.53) and presence of the following self-reported morbidities: systemic arterial hypertension (OR=2.40 - 95%CI 1.33;4.34), diabetes mellitus (OR=2.17 - 95%CI 1.23;3.84), osteoporosis (OR=2.92 - 95%CI 1.84;4.64) and heart problems (OR=2.94 - 95%CI 1.90;4.56).

Conclusion:

This study found that polypharmacy in the older adults was associated with demographic and health conditions.

Keywords:
Polypharmacy; Aged; Prevalence; Drug Utilization; Cross-sectional Studies.

Variables	Total		Polypharmacy		p-value^b
Variables	Estimate (n)	% (95%CI^a)	Estimate (n)	% (95%CI^a)	p-value^b
Sex					0.001
Male	10,896	46.5 (43.4;49.7)	1,040	9.5 (6.2;14.5)
Female	12,520	53.5 (50.3;56.6)	2,452	19.6 (15.6;24.3)
Age (years)					0.303
60-69	13,394	57.2 (54.7;59.7)	1,810	13.5 (9.8;18.4)
70-79	6,687	28.6 (26.2;31.1)	1,054	15.8 (11.4;21.4)
≥80	3,335	14.2 (12.2;16.6)	628	18.8 (13.7;25.4)
Race/skin color					0.017
Non-white	5,614	76.0 (71.8;79.8)	1,127	13.3 (10.1;17.3)
White	17,802	24.0 (20.2;28.2)	2,365	20.1 (15.0;26.3)
Marital status^c					0.721
With partner	9,086	39.1 (35.7;42.6)	1,305	14.4 (9.8;20.6)
Without partner	14,172	60.9 (57.4;64.3)	2,187	15.4 (12.0;19.6)
Schooling^c					0.620
No schooling	17,471	75.2 (68.4;81.0)	2,612	15.0 (11.5;19.2)
Elementary education	1,963	8.5 (6.2;11.5)	301	15.3 (9.8;23.2)
High school education	2,802	12.1 (9.1;15.8)	380	13.5 (8.1;21.7)
Higher education	987	4.2 (2.7;6.7)	199	20.2 (11.2;33.6)
Practices physical activity^c					0.178
Yes	3,480	14.9 (11.9;18.4)	655	18.8 (12.0;28.3)
No	19,904	85.1 (81.6;88.1)	2,837	14.3 (11.4;17.7)
Change in eating habits/dieting					<0.001
Yes	7,372	35.6 (32.4;39.0)	1,611	21.9 (16.3;28.7)
No	13,327	64.4 (61.0;67.6)	1,395	10.5 (7.8;13.8)
Hospitalized in the last 12 months^c					0.001
Yes	3,746	16.6 (20.0;33.2)	890	23.7 (17.7;31.1)
No	18,868	83.4 (81.2;85.5)	2,526	13.4 (10.3;17.2)
Self-rated health					0.014
Very good/good	8,598	36.7 (33.4;40.1)	856	10.0 (6.7;14.6)
Regular	11,208	47.9 (44.7;51.0)	1,770	15.8 (11.3;21.6)
Poor/very poor	3,610	15.4 (12.9;18.3)	866	24.0 (15.4;35.3)
Signs and symptoms of depression^c					0.002
Yes	7,558	32.5 (28.9;36.4)	1,462	19.3 (15.0;24.5)
No	15,666	67.5 (63.6;71.1)	2,030	13.0 (9.9;16.9)
Degree of independence^c					0.003
Independent	11,907	51.1 (46.7;55.5)	1,350	11.3 (7.9;16.0)
Dependent	11,402	48.9 (44.5;53.3)	2,142	18.8 (14.9;23.4)
Body mass index (BMI: kg/m²)^c					0.027
≤27	11,321	51.4 (46.2;56.5)	1,388	12.3 (9.0;16.6)
>27	10,714	48.6 (43.5;53.8)	1,923	17.9 (13.5;23.4)
Morbidities
Arterial hypertension^c					<0.001
Yes	13,958	59.8 (56.3;63.2)	2,804	20.1 (16.3;24.6)
No	9,377	40.2 (36.8;43.7)	646	6.9 (4.3;10.9)
Diabetes mellitus ^c					<0.001
Yes	4,060	17.7 (15.3;20.2)	1,211	29.8 (23.1;37.6)
No	18,933	82.3 (79.8;84.7)	2,260	11.9 (9.1;15.6)
Insomnia^c					0.003
Yes	8,039	34.4 (31.6;37.3)	1,529	19.0 (14.7;24.3)
No	15,333	65.6 (62.7;68.4)	1,963	12.8 (9.8;16.6)
Arthritis/arthrosis^c					<0.001
Yes	3,679	16.0 (13.1;19.5)	1,034	28.1 (21.0;36.5)
No	19,251	84.0 (80.5;86.9)	2,399	12.5 (9.4;16.4)
Osteoporosis^c					<0.001
Yes	3,453	15.1 (12.7;17.8)	1,108	32.1 (24.5;40.8)
No	19,473	84.9 (82.2;87.3)	2,300	11.8 (9.0;15.3)
Heart problems^d					<0.001
Yes	2,432	10.4 (8.4;12.8)	814	33.5 (24.8;43.4)
No	20,984	89.6 (87.2;91.6)	2,678	12.8 (10.0;16.1)
Anemia^c					0.284
Yes	1,726	7.5 (5.9;9.7)	326	18.9 (11.3;29.8)
No	21,153	92.5 (90.3;94.1)	3,082	14.6 (11.5;18.3)
Dyslipidemia^c					<0.001
Yes	3,251	14.0 (11.9;16.5)	877	27.0 (19.3;36.4)
No	19,897	86.0 (83.5;88.1)	2,597	13.1 (10.3;16.4)
Depression^c					0.003
Yes	2,736	11.9 (9.6;14.5)	677	24.7 (17.2;34.3)
No	20,316	88.1 (85.5;90.4)	2,783	13.7 (10.7;17.4)
Total	23,416	100.0	3,492	14.9 (11.8;18.6)

Variables	_crude OR ^a (95%CI ^b )	p-value	_adjusted OR ^a (95%CI ^b )	p-value
Distal level
Sex		0.001		0.00^d
Male	1.00		1.00
Female	2.31 (1.42;3.76)		2.29 (1.41;3.74)
Race/skin color		0.017		0.016^d
Non-white	1.00		1.00
White	1.64 (1.09;2.45)		1.61 (1.10;2.38)
Intermediate level
Degree of independence		0.003		0.029^e
Independent	1.00		1.00
Dependent	1.81 (1.24;2.64)		1.65 (1.05;2.60)
Body mass index (BMI: kg/m²)		0.027		0.164^e
≤27	1.00		1.00
>27	1.57 (1.06;2.32)		1.37 (0.87;2.16)
Change in eating habits/dieting		<0.001		0.003^e
No	1.00		1.00
Yes	2.39 (1.66;3.45)		1.66 (1.16;2.36)
Signs and symptoms of depression		0.002		0.144^e
No	1.00		1.00
Yes			1.31 (0.91;1.90)
Self-rated health		0.014		0.240^e
Very good/good	1.00		1.00
Regular	1.70 (1.03;2.79)		1.46 (0.82;2.60)
Poor and very poor	2.85 (1.38;5.89)		2.06 (0.85;4.99)
Proximal level
Hospitalized in the last 12 months		0.001		0.041^f
No	1.00		1.00
Yes	2.01 (1.38;2.94)		1.61 (1.02;2.53)
Self-reported morbidities
Arterial hypertension		<0.001		0.005^f
No	1.00		1.00
Yes	3.39 (2.16;5.35)		2.40 (1.33;4.34)
Diabetes mellitus		<0.001		0.009^f
No	1.00		1.00
Yes	3.14 (2.13;4.62)		2.17 (1.23;3.84)
Insomnia		0.003		0.671^f
No	1.00		1.00
Yes	1.60 (1.19;2.15)		1.09 (0.73;1.64)
Arthritis/arthrosis		<0.001		0.320^f
No	1.00		1.00
Yes	2.74 (1.74;4.32)		1.39 (0.72;2.69)
Osteoporosis		<0.001		<0.001^f
No	1.00		1.00
Yes	3.53 (2.44;5.10)		2.92 (1.84;4.64)
Heart problems^c		<0.001		<0.001^f
No	1.00		1.00
Yes	3.44 (2.30;5.14)		2.94 (1.90;4.56)
Dyslipidemia		<0.001		0.451^f
No	1.00		1.00
Yes	2.46 (1.71;3.53)		1.24 (0.70;2.19)
Depression		0.003		0.679^f
No	1.00		1.00
Yes	2.07 (1.30;3.30)		1.11 (0.66;1.88)

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[1] Correspondence: Thatiana Lameira Maciel Amaral - Universidade Federal do Acre, Centro de Ciências da Saúde e do Desporto, Campus Universitário, BR 364, km 4, Distrito Industrial, Rio Branco, AC, Brazil, Postcode: 69920-900, Caixa postal: 500 E-mail: thatianalameira27@gmail.com