Polypharmacy characteristics of 2,819 Brazilians aged 55 years or more — the role of socioeconomic disadvantage and health indicators

Sgnaolin, Vanessa; Nogueira, Eduardo Lopes; Engroff, Paula; Gomes, Irenio; Cataldo Neto, Alfredo

doi:10.1590/1414-462X202432030253

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Original Article • Cad Saúde Colet. 32 (3) • 2024 • https://doi.org/10.1590/1414-462X202432030253 linkcopy

Polypharmacy characteristics of 2,819 Brazilians aged 55 years or more — the role of socioeconomic disadvantage and health indicators

Características da polifarmácia de 2.819 brasileiros com mais de 55 anos — o papel da desvantagem socioeconômica e dos indicadores de saúde

Authorship SCIMAGO INSTITUTIONS RANKINGS

Background: The aging process in low- and middle-income countries has accelerated. The increasing use of medicines is a global phenomenon, and middle-aged (45–64 yr) and older (65+ yr) individuals are the most extensive users of multiple medications.

Objective: To evaluate the prevalence of polypharmacy and verify its association with sociodemographic and lifestyle factors and clinical predictors in a sample of middle-aged and older Brazilians, in the context of a predominantly disadvantaged population.

Method: Cross-sectional population study with individuals aged 55 to 103 years. A total of 2,819 respondents registered in the Family Health Strategy of Porto Alegre, Brazil, were interviewed at home between 2013–2015.

Results: The prevalence of polypharmacy was 35.7%, including 28.1% in the middle-aged (55–59 yr) group. After adjustment for sociodemographic and health variables, a strong association with polypharmacy was found in the groups: women, individuals aged 75–79 years, 1–3 years of education, ex-smokers, poor or very poor self-perceived health, chronic conditions (cardiovascular) and depression symptoms.

Conclusion: The prevalence of polypharmacy is high and begins early. The studied population presented characteristics of low levels of income and education, making it extremely vulnerable to the effects of polypharmacy, and demonstrated a strong association with the presence of chronic diseases and depression.

Keywords:
elderly; middle-aged; pharmacoepidemiology; polypharmacy; public health

Variables		Population n (%)	Drug number (%)					Drugs
Variables		Population n (%)	0	1 to 2	3 to 4	≥5	p	M±SD	95%CI	p
Gender
	Male	897 (31.8)	22.7	23.1	24.0	30.2	<0.001*	3.3±2.8	(3.06–3.43)	<0.001†
	Female	1,922 (68.2)	13.8	21.6	26.3	38.2	<0.001*	3.9±2.8	(3.74–3.99)	<0.001†
Age (years)
	55–59	631 (22.7)	21.7	26.9	23.3	28.1	<0.001‡	3.2±2.8	(2.93–3.38)	<0.001§
	60–64	632 (22.8)	19.1	24.8	25.6	30.4		3.3±2.8	(3.11–3.55)
	65–69	552 (19.9)	13.9	22.3	25.9	37.9		3.8±2.8	(3.61–4.07)
	70–74	405 (14.6)	13.3	17.0	28.4	41.2		4.1±2.9	(3.83–4.39)
	75–79	286 (10.3)	12.9	16.8	27.3	43.0		4.2±2.8	(3.83–4.48)
	≥80	272 (9.8)	13.6	18.0	25.4	43.0		4.1±2.7	(3.72–4.37)
Education (years)
	0	314 (11.4)	18.2	18.2	25.2	38.5	<0.001‡	3.8±2.9	(3.48–4.13)	<0.001§
	1–3	721 (26.2)	13.6	18.0	27.2	41.2		4.1±2.8	(3.86–4.27)
	4–7	1,011 (36.8)	17.4	21.4	25.6	35.6		3.6±2.8	(3.47–3.82)
	≥8	704 (25.6)	17.5	28.8	24.7	29.0		3.3±2.7	(3.08–3.48)
Marital status
	Single	482 (17.6)	20.1	22.8	28.8	28.2	<0.001*	3.3±2.8	(3.07–3.57)	<0.001§
	Married/stable union	1,212 (44.2)	18.0	23.3	24.0	34.7		3.6±2.8	(3.42–3.74)
	Divorced	305 (11.1)	17.7	21.6	23.0	37.7		3.7±2.9	(3.38–4.04)
	Widowed	743 (27.1)	12.0	19.8	26.8	41.5		4.0±2.8	(3.84–4.24)
Living with partner
	Yes	1,320 (51.4)	19.2	22.3	24.6	33.9	0.003*	3.5±2.8	(3.36–3.67)	0.004†
	No	1,249 (48.6)	14.1	21.5	26.8	37.6	0.003*	3.8±2.8	(3.68–3.99)	0.004†
Individual income (minimum wage)
	No income	246 (10.1)	20.7	23.6	23.2	32.5	0.918‡	3.3±2.7	(2.97–3.66)	0.104§
	<1	1,179 (48.5)	15.0	21.2	27.1	36.7		3.8±2.8	(3.61–3.93)
	≥1–2	749 (30.8)	18.3	20.6	23.0	38.2		3.8±3.0	(3.56–3.99)
	≥2–4	223 (9.2)	16.1	23.8	23.8	36.3		3.7±2.8	(3.27–4.02)
	≥4	34 (1.4)	17.6	35.3	26.5	20.6		3.0±2.6	(2.13–3.93)
Family income (minimum wage)
	<1	666 (29.7)	16.8	22.7	27.5	33.0	0.115‡	3.5±2.7	(3.31–3.71)	0.028§
	≥1–3	1,275 (56.8)	15.5	21.8	24.6	38.1		3.8±2.9	(3.66–3.97)
	≥3	302 (13.5)	16.6	20.5	22.8	40.1		4.0±3.0	(3.62–4.30)
Total population		2819 (100)	16.6	22.1	25.6	35.7		3.7±2.8

Variables		Populationn (%)	Drug number (%)					Drugs
Variables		Populationn (%)	0	1 to 2	3 to 4	≥5	p	M±SD	95%CI	p
Smoker
	No	1,167 (43.1)	16.4	21.9	24.6	37.2	<0.001*	3.7±2.9	(3.58–3.91)	<0.001†
	Ex-smoker	984 (36.4)	13.4	19.5	26.8	40.2		4.0±2.8	(3.82–4.18)
	Yes	556 (20.5)	22.7	26.8	24.8	25.7		3.0±2.7	(2.79–3.24)
Alcohol use
	No	2,009 (76.5)	14.6	21	26.3	38.1	<0.001*	3.9±2.8	(3.74–3.99)	<0.001‡
	Yes	616 (23.5)	21.8	24	25.6	28.6	<0.001*	3.1±2.7	(2.92–3.34)	<0.001‡
Self-perceived health
	Great/Good	1,214 (43.5)	24.8	27.8	24.5	22.8	<0.001§	2.7±2.5	(2.60–2.88)	<0.001†
	Regular	1,320 (47.3)	10.7	18.7	27.1	43.5		4.3±2.8	(4.10–4.41)
	Poor/Very poor	255 (9.1)	8.2	12.9	23.1	55.7		5.0±3.0	(4.65–5.39)
Hypertension
	No	848 (30.6)	42.6	31.1	16.5	9.8	<0.001*	1.7±2.1	(1.52–1.80)	<0.001‡
	Yes	1,920 (69.4)	4.9	17.8	29.7	47.6	<0.001*	4.6±2.6	(4.47–4.71)	<0.001‡
Diabetes mellitus
	No	1,898 (70.6)	22	26.3	26.6	25.1	<0.001*	3.0±2.6	(2.86–3.09)	<0.001‡
	Yes	792 (29.4)	3.3	11.1	22.7	62.9	<0.001*	5.4±2.7	(5.26–5.63)	<0.001‡
Congestive heart failure
	No	2,272 (87.0)	18.8	23.7	26	31.5	<0.001*	3.4±2.7	(3.27–3.50)	<0.001‡
	Yes	340 (13.0)	2.9	10.9	21.5	64.7	<0.001*	5.7±2.8	(5.37–5.97)	<0.001‡
Coronary disease
	No	2,128 (80.4)	19.5	24.8	26.2	29.5	<0.001*	3.3±2.7	(3.15–3.38)	<0.001‡
	Yes	519 (19.6)	5.4	10.4	21.4	62.8	<0.001*	5.4±2.9	(5.19–5.68)	<0.001‡
Cerebrovascular disease
	No	2,299 (88.3)	18.5	23.8	25.5	32.2	<0.001*	3.4±2.8	(3.33–3.56)	<0.001‡
	Yes	304 (11.7)	4.3	8.2	23.7	63.8	<0.001*	5.5±2.7	(5.21–5.82)	<0.001‡
Geriatric Depression Scale (GDS-15)
	0–5	1,855 (66.0)	19.4	24.5	25.1	31.0	<0.001*	3.3±2.7	(3.17–3.41)	<0.001‡
	≥6	957 (34.0)	10.8	16.8	27.0	45.5	<0.001*	4.4±2.9	(4.26–4.63)	<0.001‡
Vellore
	Normal	2,270 (80.2)	17.4	22.8	25.6	34.4	0.002*	3.6±2.8	(3.46–3.69)	<0.001‡
	Impaired	561 (19.8)	12.8	19.4	25.8	41.9	0.002*	4.1±2.8	(3.87–4.34)	<0.001‡
Total population		2,819 (100)	16.6	22.1	25.6	35.7		3.7±2.8

Variables		1 to 2			3 to 4			≥5
Variables		OR	95%CI	p	OR	95%CI	p	OR	95%CI	p
Gender
	Male	1			1			1
	Female	1.675	(1.220–2.299)	0.001	1.884	(1.344–2.642)	<0.001	2.458	(1.709–3.533)	<0.001
Age (years)
	55–59	1			1			1
	60–64	0.983	(0.665–1.453)	0.932	1.423	(0.927–2.184)	0.106	1.575	(0.988–2.511)	0.056
	65–69	1.102	(0.716–1.695)	0.659	1.457	(0.915–2.321)	0.113	1.952	(1.192–3.198)	0.008
	70–74	0.820	(0.497–1.355)	0.439	1.585	(0.947–2.652)	0.079	1.945	(1.126–3.358)	0.017
	75–79	1.068	(0.597–1.910)	0.825	2.166	(1.197–3.922)	0.011	3.126	(1.676–5.831)	<0.001
	≥80	0.808	(0.442–1.476)	0.487	1.242	(0.669–2.303)	0.492	1.766	(0.932–3.346)	0.081
Education (years)
	0	1			1			1
	1–3	1.812	(1.053–3.119)	0.032	2.668	(1.524–4.670)	0.001	2.566	(1.433–4.592)	0.002
	4–7	1.526	(0.917–2.539)	0.104	1.689	(0.993–2.874)	0.053	1.814	(1.046–3.145)	0.034
	≥8	2.328	(1.372–3.959)	0.002	2.333	(1.316–4.076)	0.003	2.225	(1.242–3.988)	0.007
Smoker
	No	1			1			1
	Ex-smoker	1.441	(1.011–2.055)	0.043	1.963	(1.357–2.840)	<0.001	1.892	(1.287–2.780)	0.001
	Yes	1.145	(0.796–1.647)	0.465	1.164	(0.786–1.724)	0.449	0.781	(0.508–1.199)	0.258
Alcohol use
	No	1			1			1
	Yes	0.826	(0.590–1.158)	0.268	0.78	(0.545–1.116)	0.173	0.674	(0.458–0.993)	0.046
Self-perceived health
	Great/Good	1			1			1
	Regular	1.513	(1.108–2.066)	0.009	2.065	(1.491–2.860)	<0.001	2.847	(2.014–4.024)	<0.001
	Poor/Very poor	1.700	(0.853–3.388)	0.131	3.361	(1.697–6.657)	0.001	6.426	(3.200–12.904)	<0.001
Hypertension
	No	1			1			1
	Yes	5.016	(3.605– 6.980)	<0.001	13.511	(9.555–19.103)	<0.001	25.456	(17.176–37.727)	<0.001
Diabetes mellitus
	No	1			1			1
	Yes	2.152	(1.246–3.718)	0.006	3.182	(1.854–5.462)	<0.001	10.439	(6.114–17.825)	<0.001
Congestive heart failure
	No	1			1			1
	Yes	3.038	(1.123–8.221)	0.029	3.114	(1.167–8.309)	0.023	4.844	(1.827–12.841)	0.002
Coronary disease
	No	1			1			1
	Yes	0.944	(0.521–1.712)	0.850	1.338	(0.753–2.376)	0.321	2.83	(1.601–5.000)	<0.001
Cerebrovascular disease
	No	1			1			1
	Yes	1.323	(0.578–3.029)	0.507	2.273	(1.024–5.046)	0.044	3.998	(1.804–8.863)	0.001
Geriatric Depression Scale (GDS-15)
	0-5	1			1			1
	≥6	1.156	(0.787–1.697)	0.460	1.504	(1.016–2.226)	0.041	1.603	(1.066–2.410)	0.023

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[TFN1] ^*
Pearson's chi-square test;

[TFN2] ^†
Student's t test;

[TFN3] ^‡
Chi-square test for linear tendency;

[TFN4] ^§
One way ANOVA. M: mean; SD: standard deviation; CI: confidence interval. Minimum wage USD 280.