Prevalence and factors associated with polypharmacy and potential drug interactions in adults in Manaus, Amazonas state, Brazil: a cross-sectional population-based study, 2019

Tiguman, Gustavo Magno Baldin; Biase, Tayanny Margarida Menezes Almeida; Silva, Marcus Tolentino; Galvão, Taís Freire

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Epidemiologia e Serviços de Saúde

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Original Article • Epidemiol. Serv. Saúde 31 (2) • 2022 • https://doi.org/10.1590/S2237-96222022000200003 copy

Prevalence and factors associated with polypharmacy and potential drug interactions in adults in Manaus, Amazonas state, Brazil: a cross-sectional population-based study, 2019

Authorship SCIMAGO INSTITUTIONS RANKINGS

Abstract

Objective:

To assess the prevalence and factors associated with polypharmacy and the presence of potential drug interactions in Manaus, Amazonas state, Brazil, in 2019.

Methods:

This was a population-based cross-sectional study conducted with adults aged ≥ 18 years. The presence of drug interactions among people on a polypharmacy regimen (≥ 5 drugs) was investigated on the Micromedex database. Prevalence ratios (PR) with 95% confidence intervals (95%CI) were calculated using Poisson regression model with robust variance, following hierarchical analysis and considering the complex sample design.

Results:

Of the 2,321 participants, 2.8% (95%CI 2.1;3.6) were on polypharmacy regimen, of whom, 74.0% presented drug interactions, usually with four or more drug interactions per person (40.4%) and high severity (59.5%). Polypharmacy was higher among older adults (PR = 3.24; 95%CI 1.25;8.42), people with poor health (PR = 2.54; 95%CI 1.14;5.67), previous hospitalization (PR = 1.90; 95%CI 1.09;3.32) and multimorbidity (PR = 3.20; 95%CI 1.53;6.67).

Conclusion:

Polypharmacy was more frequent among older adults and people with medical problems, who presented more drug interactions.

Keywords:
Polypharmacy; Drug Interactions; Pharmacoepidemiology; Drug Utilization; Health Surveys; Prevalence

Variables	Adults (n = 2,321)					Older adults (n = 251)
	Total		Polypharmacy		p-value^a	Total		Polypharmacy		p-value^a
	n	%	n	%	p-value^a	n	%	n	%	p-value^a
Sex					0.010					0.110
Male	1,088	51.0	25	2.1		111	49.0	4	9.1
Female	1,233	49.0	52	3.6		140	51.0	12	8.8
Age groups (years)					< 0.001					-
18-24	405	20.3	12	2.7		-	-	-	-
25-34	586	31.9	10	1.4		-	-	-	-
35-44	553	22.2	11	1.6		-	-	-	-
45-59	526	18.9	28	4.8		-	-	-	-
≥ 60	251	6.7	16	9.0		251	100.0	16	8.9
Economic classification					0.256					0.900
A/B	282	13.4	13	4.6		21	7.7	1	3.6
C	1,244	53.7	35	2.5		132	54.2	8	11.6
D/E	795	32.9	29	2.6		98	38.1	7	6.3
Schooling					0.003					0.425
Complete higher education or more	153	6.9	6	3.5		11	4.3	2	25.9
Complete high school	1,171	52.5	28	2.2		61	27.3	4	12.9
Complete elementary education	432	20.4	11	2.6		32	12.0	2	5.3
Below elementary education	565	20.2	32	4.6		147	56.4	8	6.3
Marital status					0.445					0.127
Without a partner	1,423	62.9	44	2.4		169	64.3	8	3.3
With a partner	898	37.1	33	3.6		82	35.7	8	19.1
Health insurance					0.597					0.899
No	1,978	85.5	64	2.6		217	85.7	14	6.9
Yes	343	14.5	13	4.1		34	14.3	2	21.2
Health status					< 0.001					0.012
Good	1,498	67.2	22	1.5		112	47.4	3	6.9
Regular	671	26,8	37	5,0		111	41.3	8	8.5
Poor	152	6.0	18	8.7		28	11.3	5	19.3
Medical consultation^b					< 0.001					0.148
No	587	26.1	3	0.6		51	18.7	1	1.4
Yes	1,734	73.9	74	3.6		200	81.3	15	10.7
Hospitalization^b					< 0.001					0.393
No	2,071	89.1	58	2.5		233	92.2	14	8.3
Yes	250	10.9	19	6.0		18	7.8	2	16.1
Number of chronic diseases					< 0.001					0.004
0	921	42.9	9	1.1		43	16.8	-	0.0
1	682	29.9	11	1.3		55	22.6	-	0.0
≥ 2	718	27.2	57	7.3		153	60.6	16	14.8
Tobacco dependence					0.828					0.842
No	2,219	95.5	74	2.9		238	92.8	15	9.4
Yes	102	4.5	3	2.6		13	7.2	1	3.8
Hazardous alcohol consumption					0.082					0.265
No	1,871	79.5	68	2.9		234	92.5	16	9.7
Yes	450	20.5	9	2.5		17	7.5	-	0.0
Total	2,321	100.0	77	2.8		251	100.0	16	8.9

Medications	ATC^a code	n	%
Losartan	C09CA01	27	6.1
Dipyrone	N02BB02	24	5.4
Acetylsalicylic acid	N02BA51	20	4.5
Simvastatin	C10AA01	18	4.1
Ibuprofen	M01AE01	15	3.4
Metformin	A10BA02	15	3.4
Hydrochlorothiazide	C03AA03	11	2.5
Omeprazole	A02BC01	11	2.5
Enalapril	C09AA02	10	2.3
Atenolol	C07AB03	9	2.0
Pharmacological group
Alimentary tract and metabolism	A	89	20.1
Blood and blood-forming organs	B	27	6.1
Cardiovascular system	C	118	26.7
Genito-urinary system and sex hormones	G	5	1.1
Systemic hormonal preparations	H	7	1.6
Anti-infectives for systemic use	J	17	3.8
Antineoplastic and immunomodulating	L	2	0.5
Musculoskeletal system	M	44	10.0
Nervous system	N	67	15.2
Antiparasitic products, insecticides e repellents	P	4	0.9
Respiratory system	R	15	3.4
Sensory organs	S	5	1.1
Herbal medicines	-	3	0.7
Uncoded	-	39	8.8

Variables	n	%
Drug-drug interactions
Number of interactions per person
1	25	19.1
2	20	15.3
3	33	25.2
≥ 4	53	40.4
Severity
High	78	59.5
Moderate	50	38.2
Low	1	0.8
Contraindicated	2	1.5
Information quality
Regular	68	51.9
Good	38	29.0
Excellent	25	19.1
Total	131	100.0
Drug-alcohol interaction
Number of interactions per person
1	3	-
2	4	-
Severity
High	5	-
Moderate	2	-
Information quality
Regular	2	-
Good	5	-
Total	7	-
Drug interactions with tobacco smoking
Number of interactions per person
2	2	-
Severity
High	2	-
nformation quality
Regular	2	-
Total	2	-

Variables	Unadjusted analysis		Adjusted analysis
Variables	PR (95%CI)	p-value^a	PR (95%CI)	p-value^a
Level 1 - Demographic
Sex		0.070		0.066
Male	1.00		1.00
Female	1.74 (0.96;3.15)		1.73 (0.96;3.10)
Age group (in years)		< 0.001		< 0.001
18-24	1.00		1.00
25-34	0.52 (0.21;1.32)		0.51 (0.20;1.27)
35-44	0.59 (0.24;1.46)		0.58 (0.23;1.41)
45-59	1.80 (0.84;3.86)		1.75 (0.83;3.71)
≥ 60	3.35 (1.31;8.59)		3.24 (1.25;8.42)
Level 2 - Socioeconomic
Economic classification		0.256		0.150
A/B	1.00		1.00
C	0.55 (0.26;1.16)		0.49 (0.23;1.05)
D/E	0.57 (0.27;1.20)		0.44 (0.18;1.07)
Schooling		0.091		0.546^b
Complete higher education or more	1.00		1.00
Complete high school	0.62 (0.23;1.67)		0.80 (0.30;2.13)
Complete elementary education	0.72 (0.24;2.20)		1.06 (0.33;3.40)
Below elementary education	1.31 (0.51;3.38)		1.40 (0.49;3.96)
Marital status		0.134		0.148
Without a partner	1.00		1.00
With a partner	1.51 (0.88;2.60)		1.48 (0.87;2.51)
Health insurance		0.265		0.323^b
No	1.00		1.00
Yes	1.56 (0.72;3.38)		1.47 (0.68;3.19)
Level 3 - Health
Health status		< 0.001		0.076
Good	1.00		1.00
Regular	3.47 (1.79;6.69)		1.89 (0.91;3.91)
Poor	6.02 (2.88;12.57)		2.54 (1.14;5.67)
Medical consultation^c		0.002		0.024
No	1.00		1.00
Yes	2.45 (1.39;4.33)		1.90 (1.09;3.32)
Hospitalization^c		0.030		0.113
No	1.00		1.00
Yes	5.86 (1.19;28.86)		3.28 (0.76;14.20)
Number of chronic diseases		0.002		0.024
0	1.00		1.00
1	2.45 (1.39;4.33)		1.90 (1.09;3.32)
≥ 2		< 0.001		< 0.001
Tobacco dependence	1.00		1.00
No	1.14 (0.43;3.04)		0.91 (0.33;2.47)
Yes	6.50 (2.90;14.58)		3.20 (1.53;6.67)
Hazardous alcohol consumption		0.881		0.574
No	1.00		1.00
Yes	0.91 (0.25;3.34)		0.66 (0.16;2.79)

Secretaria de Vigilância em Saúde e Ambiente - Ministério da Saúde do Brasil SRTVN Quadra 701, Via W5 Norte, Lote D, Edifício P0700, CEP: 70719-040, +55 61 3315-3464, Fax: +55 61 3315-3464 - Brasília - DF - Brazil
E-mail: ress.svs@gmail.com

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[1] Correspondence
Gustavo Magno Baldin Tiguman gustavo.tiguman@gmail.com