Multimorbidity, polypharmacy and primary prevention in community-dwelling adults in Quebec: a cross-sectional study
Multimorbidity, polypharmacy and primary prevention in community-dwelling adults in Quebec: a cross-sectional study
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DOI：
10.1093/fampra/cmz023
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发表时间：
2019-12-01
期刊：
影响因子：
2.2
通讯作者：
Fortin, Martin
中科院分区：
文献类型：
--
作者：
Nguyen, Tu N.;Ngangue, Patrice;Fortin, Martin
背景多种药物治疗会带来不良事件的风险，特别是在患有多种疾病的人群中。调查社区成年人多种用药的患病率、多种药物与多种用药的关系以及一级预防药物的使用。来自加拿大魁北克队列研究影响演变研究计划（PRECISE）的随访数据的横断面分析。多药治疗定义为存在三种或三种以上慢性疾病，多药治疗定义为自我报告同时使用五种或五种以上药物。一级预防的概念是在没有心血管疾病诊断报告的情况下使用他汀类药物或低剂量抗血小板药物。结果。平均年龄56.7 ± 11.6岁，62.5%为女性，30.3%患有多药症，31.9%患有多种药物（n = 971）。最常用的药物是他汀类药物、肾素-血管紧张素系统抑制剂和精神药物。与没有任何慢性疾病的参与者相比，患有一种慢性疾病的参与者中，患有多种药物的校正比值比（OR）为2.78 [95%置信区间（CI）：1.23-6.28]，有2种慢性疾病者的平均患病率为4.06-19.20，有3种以上慢性疾病者为25.31（95%CI：11.77-54.41），P < 0.001。在没有心血管疾病史的参与者中，16.2%使用抗血小板药物，28.5%使用他汀类药物。多药耐药与使用抗血小板药物（校正OR：2.98，95%CI：1.98-4.48，P < 0.001）和他汀类药物（校正OR：3.76，95%CI：2.63-5.37，P < 0.001）作为一级预防的可能性增加相关。在魁北克社区居住的成年人中，多种药物的患病率很高，并且与多发性硬化症有很强的关联。使用药物进行一级预防可能会导致多种药物，并提出有关安全性的问题。
Background. Polypharmacy carries the risk of adverse events, especially in people with multimorbidity.Objective. To investigate the prevalence of polypharmacy in community-dwelling adults, the association of multimorbidity with polypharmacy and the use of medications for primary prevention.Methods. Cross-sectional analysis of the follow-up data from the Program of Research on the Evolution of a Cohort Investigating Health System Effects (PRECISE) in Quebec, Canada. Multimorbidity was defined as the presence of three or more chronic diseases and polypharmacy as self-reported concurrent use of five or more medications. Primary prevention was conceptualized as the use of statin or low-dose antiplatelets without a reported diagnostic of cardiovascular disease.Results. Mean age 56.7 +/- 11.6, 62.5% female, 30.3% had multimorbidity, 31.9% had polypharmacy (n = 971). The most common drugs used were statins, renin-angiotensin system inhibitors and psychotropics. Compared to participants without any chronic disease, the adjusted odds ratios (ORs) for having polypharmacy were 2.78 [95% confidence interval (CI): 1.23-6.28] in those with one chronic disease, 8.88 (95% CI: 4.06-19.20) in those with two chronic diseases and 25.31 (95% CI: 11.77-54.41) in those with three or more chronic diseases, P < 0.001. In participants without history of cardiovascular diseases, 16.2% were using antiplatelets and 28.5% were using statins. Multimorbidity was associated with increased likelihood of using antiplatelets (adjusted OR: 2.98, 95% CI: 1.98-4.48, P < 0.001) and statins (adjusted OR: 3.76, 95% CI: 2.63-5.37, P < 0.001) for primary prevention.Conclusion. There was a high prevalence of polypharmacy in community-dwelling adults in Quebec and a strong association with multimorbidity. The use of medications for primary prevention may contribute to polypharmacy and raise questions about safety.