年龄、性别和性别对多重用药和潜在处方级联的影响:来自五个数据库的经验教训。

IF 4.3 2区 医学 Q1 GERIATRICS & GERONTOLOGY
Paula A. Rochon MD, MPH, Joyce Li MSc, Denis O'Mahony MD, DSc, Graziano Onder MD, Mirko Petrovic MD, PhD, Shelley A. Sternberg MD, Jerry H. Gurwitz MD, Rachel D. Savage PhD, Wei Wu MSc, Vasily Giannakeas PhD, Altea Kthupi MPH, Kieran Dalton PhD, Lisa M. McCarthy PharmD, MSc, Robin Mason PhD, Amanda Giancola MSc, Parya Borhani MPH, Antonio Cherubini MD, PhD
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引用次数: 0

摘要

背景:很少有研究描述与性别相关的因素是如何促成多重用药和处方级联的。使用跨国比较来描述这些模式可以提高研究结果的稳健性,并提供在药理学研究中考虑年龄、性别和性别的重要性的经验教训。该研究的目的是探讨年龄、性别和性别与多重用药和联合处方之间的交叉关系,这表明了潜在的处方级联。方法:在这项横断面描述性研究中,我们从5个国际二级数据库(人口水平社区和养老院(ICES, Maccabi Healthcare Services)、临床试验(SENATOR)和患者登记(Report-AGE, SHELTER))评估了多药联用、钙通道阻滞剂和利尿剂联合处方,表明65岁以上患者的处方级联。探讨了年龄、性别和社会性别的交集。结果:所有数据库均提供了年龄和性别;没有包括性别认同数据。与性别相关的社会文化因素、以收入和受教育程度衡量的社会经济地位(SES)和婚姻状况并未统一收集。与男性相比,女性的收入较低,受教育程度较低,而且更容易丧偶。多种用药在男性中更为常见。在四个数据库中,共同处方提示处方级联在女性中更频繁,在低社会经济地位和未婚群体中也更频繁(在ICES(社区和养老院)和马卡比(社区)中显著,在马卡比(养老院)和其他三个数据库中无显著趋势)。使用两个人口水平的数据库,共同处方的患病率表明处方级联在85岁及以上的女性中最高,这些女性也属于较低的社会经济地位组(11.0% ICES和14.6%马卡比)。该组性别差异最大(ICES差异患病率= 3.0%,马卡比差异患病率= 3.8%)。结论:社会经济地位较低的老年人比社会经济地位较高的老年人更容易出现多重用药或联合用药的连锁反应。在社会经济地位较低的群体中,女性比男性更频繁地有共同处方的证据,这表明处方级联。考虑性别和与性别相关的社会文化因素的作用可能有助于更好地理解多种用药和处方级联的一些因素。研究应用重点是我们的五个经验教训。
本文章由计算机程序翻译,如有差异,请以英文原文为准。

The impact of age, sex, and gender on polypharmacy and potential prescribing cascades: Lessons from five databases

The impact of age, sex, and gender on polypharmacy and potential prescribing cascades: Lessons from five databases

Background

Few studies describe how gender-related factors may contribute to polypharmacy and prescribing cascades. Describing these patterns using cross-national comparisons can improve the robustness of findings and provide lessons on the importance of considering age, sex, and gender in pharmacological research. The aim of the study was to explore the intersection of age, sex, and gender with polypharmacy and co-prescribing suggesting a potential prescribing cascade.

Methods

In this cross-sectional descriptive study, we assessed polypharmacy and calcium channel blocker and diuretic co-prescribing suggesting a prescribing cascade in patients aged ≥65 years from five international secondary databases: population-level community and nursing home (ICES, Maccabi Healthcare Services), clinical trial (SENATOR), and patient registry (Report-AGE, SHELTER). The intersection of age, sex, and gender was explored.

Results

All databases provided age and sex; none included gender-identity data. Gender-related sociocultural factors, socioeconomic status (SES) measured as income and educational attainment, and marital status were not uniformly collected. Compared with males, females had lower income, has less educational attainment, and were more frequently widowed. Polypharmacy was more common in men. Co-prescribing suggesting a prescribing cascade was more frequent in females in four databases and was also more frequent in lower SES and unmarried groups (significant in ICES (community and nursing home) and Maccabi (community), with a nonsignificant trend in Maccabi (nursing home) and three remaining databases). Using two population-level databases, the prevalence of co-prescribing suggesting a prescribing cascade was highest among females 85 years and older who were also in the lower SES group (11.0% ICES and 14.6% Maccabi). Gender disparity was highest in this group (ICES Differential Prevalence = 3.0%, Maccabi Differential Prevalence = 3.8%).

Conclusion

Older adults with lower SES experienced polypharmacy or co-prescribing suggesting a prescribing cascade more frequently than those with higher SES. Within the lower SES groups, females more frequently than males had evidence of co-prescribing suggesting a prescribing cascade. Considering the role of sex and gender-related sociocultural factors may help to better understand some contributors to polypharmacy and prescribing cascades. The research applications are highlighted in our five lessons learned.

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来源期刊
CiteScore
10.00
自引率
6.30%
发文量
504
审稿时长
3-6 weeks
期刊介绍: Journal of the American Geriatrics Society (JAGS) is the go-to journal for clinical aging research. We provide a diverse, interprofessional community of healthcare professionals with the latest insights on geriatrics education, clinical practice, and public policy—all supporting the high-quality, person-centered care essential to our well-being as we age. Since the publication of our first edition in 1953, JAGS has remained one of the oldest and most impactful journals dedicated exclusively to gerontology and geriatrics.
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