Journal of the American Pharmacists Association
Science and PracticeSystematic ReviewAssociation between polypharmacy and death: A systematic review and meta-analysis
Section snippets
Data source and search strategy
Search terms were defined, and a systematic literature search was performed by the first and fourth authors using MEDLINE/PubMed, EMBASE, Scopus, and International Pharmaceutical Abstract from inception to June 2016 using the terms “polypharmacy” (e.g., multiple drugs used) and “death” (e.g., mortality, survival) without applying language or study design restrictions. Synonyms of polypharmacy and death suggested by the search engines and 2 studies1, 27 were used. The MEDLINE database was
Study characteristics
The systematic literature search retrieved 3892 nonredundant manuscripts. Two studies were found by reviewing reference lists.32, 33 According to the inclusion and exclusion criteria, 47 studies were selected, including 26 prospective cohort studies, 11 retrospective cohort studies, 5 case control studies, 4 clinical trials, and 1 cross-sectional study (Figure 1). Using the World Health Organization criteria to define the older adult population,34 36 studies were performed in populations with
Discussion
Polypharmacy has been characterized discretely as number of drugs and categorically using a variety of threshold definitions. In this systematic review and meta-analysis of 47 studies using both discrete and categorical approaches, polypharmacy was associated with mortality risk. Among categorical definitions, mortality risk increased in a dose-dependent fashion as threshold values defining polypharmacy increased. Moreover, these risk estimates were highly consistent with extrapolation of the
Conclusion
Characterizing the potential harms of polypharmacy is clearly of scientific interest, given the nearly 50 studies that were identified in this systematic review and meta-analysis. Our goal was to summarize the existing knowledge regarding this topic, which revealed support for a statistical association between polypharmacy and mortality. However, the clinical interpretation and significance of this association must be considered with caution. Regardless of academic efforts to document the
Acknowledgment
We thank Cheuk-Chun Szeto, MD, for providing detailed information from his publication.
Nattawut Leelakanok, BSc (Pharm), PhD, Graduate Student, College of Pharmacy, The University of Iowa, Iowa City, IA; Instructor, Faculty of Pharmaceutical Sciences, Burapha University, Chonburi, Thailand
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Nattawut Leelakanok, BSc (Pharm), PhD, Graduate Student, College of Pharmacy, The University of Iowa, Iowa City, IA; Instructor, Faculty of Pharmaceutical Sciences, Burapha University, Chonburi, Thailand
Andrea L. Holcombe, MSc, Graduate Student, College of Public Health, The University of Iowa, Iowa City, IA
Brian C. Lund, PharmD, Core Investigator, Iowa City VA Health Care System, Iowa City, IA, and Clinical Assistant Professor, College of Public Health, University of Iowa, Iowa City, IA.
Xiaomei Gu, BDS, MSc, MSLS, Clinical Education Librarian, Hardin Library for the Health Sciences, The University of Iowa, Iowa City, IA
Marin L. Schweizer, PhD, Assistant Professor, Carver College of Medicine, University of Iowa, Iowa City, IA, and Core Investigator, Iowa City VA Health Care System, Iowa City, IA
Disclosure: The authors declare no conflicts of interest or financial interests in any product or service mentioned in this article.
Funding: Nattawut Leelakanok received support from The Royal Thai Government Scholarship. Additional support was contributed through Career Development Awards from the Health Services Research and Development Service, Department of Veterans Affairs (grant numbers CDA 10-017 [to Brian C. Lund] and CDA 11-215 [to Marin L. Schweizer]. This research did not receive any specific grant from funding agencies in the public, commercial, or nonprofit sectors.