Race/Ethnicity, Socioeconomic Status, and Polypharmacy among Older Americans
Race/Ethnicity, Socioeconomic Status, and Polypharmacy among Older Americans
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DOI：
10.3390/pharmacy7020041
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发表时间：
2019-06-01
期刊：
影响因子：
2.2
通讯作者：
Bazargan, Mohsen
中科院分区：
文献类型：
--
作者：
Assari, Shervin;Bazargan, Mohsen
背景：很少有具有全国代表性样本的研究调查种族/民族和社会经济地位(SEP)对美国老年人多药(PP)的综合影响。例如，我们不知道非裔美国人(AA)和白人老年人的PP患病率是否存在差异，这种差异是否源于SEP中的种族差异，或者SEP指标对PP的影响是否存在种族和民族差异。目的：我们在一个美国老年人的全国家庭样本中调查了种族/民族和SEP对PP的联合影响。方法：密歇根大学关于健康老龄化的第一波全国民意调查共包括906名65岁或以上的老年人(80名AA和826名白人)。测量了种族/民族、SEP(收入、教育程度、婚姻状况和就业)、年龄、性别和PP(使用5种以上药物)。数据分析采用Logistic回归分析。结果：种族/民族、年龄、婚姻状况和就业与PP无关；然而，女性、低教育程度和低收入与参与者发生PP的几率较高相关。种族/民族与低收入在PP的发病几率上存在交互作用，这表明低收入与再障患者PP的相关性可能比白人老年人更强。结论：虽然体感诱发电位指标影响PP的风险，但这种影响在不同种族和民族之间可能并不相同。也就是说，种族/民族和SEP对PP具有联合/相互依赖的影响，而不是单独/独立的影响。低收入AA老年人尤其需要评估PP。鉴于种族和SEP对PP有相互交织的影响，针对低收入AA老年人PP的种族和人种定制干预措施可能优于忽略不同人群特定需求的普遍干预措施和计划。这些结果是初步的，需要在更大的样本量中重复，直接测量PP而不依赖于个人的自我报告，并使用收集的慢性病联合数据。
Background: Very few studies with nationally representative samples have investigated the combined effects of race/ethnicity and socioeconomic position (SEP) on polypharmacy (PP) among older Americans. For instance, we do not know if prevalence of PP differs between African Americans (AA) and white older adults, whether this difference is due to a racial gap in SEP, or whether racial and ethnic differences exist in the effects of SEP indicators on PP. Aims: We investigated joint effects of race/ethnicity and SEP on PP in a national household sample of American older adults. Methods: The first wave of the University of Michigan National Poll on Healthy Aging included a total of 906 older adults who were 65 years or older (80 AA and 826 white). Race/ethnicity, SEP (income, education attainment, marital status, and employment), age, gender, and PP (using 5+ medications) were measured. Logistic regression was applied for data analysis. Results: Race/ethnicity, age, marital status, and employment did not correlate with PP; however, female gender, low education attainment, and low income were associated with higher odds of PP among participants. Race/ethnicity interacted with low income on odds of PP, suggesting that low income might be more strongly associated with PP in AA than white older adults. Conclusions: While SEP indicators influence the risk of PP, such effects may not be identical across diverse racial and ethnic groups. That is, race/ethnicity and SEP have combined/interdependent rather than separate/independent effects on PP. Low-income AA older adults particularly need to be evaluated for PP. Given that race and SEP have intertwined effects on PP, racially and ethnically tailored interventions that address PP among low-income AA older adults may be superior to universal interventions and programs that ignore the specific needs of diverse populations. The results are preliminary and require replication in larger sample sizes, with PP measured directly without relying on individuals' self-reports, and with joint data collected on chronic disease.