Background
Methods
Setting
Participants
Exposures
Polypharmacy
Charlson comorbidity index
Outcomes
Statistical analysis
Results
PIP (n = 723,838) | No PIP (n = 295,653) | |
---|---|---|
Gender
| ||
-Male (%)
| 122,817 (28.7) | 304,622 (71.3) |
-Female (%)
| 172,834 (29.2) | 419,211 (70.8) |
-Missing (%)
| 2 | |
Age (years)
| ||
-70–74 (%)
| 82,177 (37.4) | 137,366 (62.6) |
-75–80 (%)
| 92,488 (37.6) | 153,778 (62.4) |
-81–85 (%)
| 62,407 (33.1) | 126,040 (66.9) |
- > 85 (%)
| 58,581 (18) | 306,654 (84) |
Morbidities (Charlson morbidity index score)
| ||
-1 (%)
| 189,864 (28.3) | 481,983 (71.7) |
-2 (%)
| 52,365 (46.8) | 59,519 (53.2) |
-3 (%)
| 53,424 (22.7) | 182,336 (77.3) |
Polypharmacy (≥4 medications)
| ||
-Never (%)
| 114,816 (14.6) | 669,572 (85.3) |
-Ever (%)
| 180,837 (76.9) | 54,266 (23.1) |
Chronic Obructive Pulmonary Disease
| ||
-No (%)
| 277,497 (28.2) | 707,447 (71.8) |
-Yes (%)
| 18,156 (52.6) | 16,391 (47.5) |
Peptic ulcer
| ||
-No (%)
| 274,487 (28.9) | 675,938 (71.1) |
-Yes (%)
| 21,166 (30.7) | 47,900 (69.4) |
Diabetes
| ||
-No (%)
| 225,280 (27.3) | 625,591 (72.7) |
-Yes (%)
| 70,373 (41.7) | 98,247 (58.3) |
Dementia
| ||
-No (%)
| 283,983 (28.5) | 710,985 (71.5) |
-Yes (%)
| 11,670 (47.6) | 12,853 (52.4) |
Hypertension
| ||
-No (%)
| 140,467 (21.1) | 525,316 (78.9) |
-Yes (%)
| 155,186 (43.9) | 198,522 (56.1) |
Osteoarthritis
| ||
-No (%)
| 216,981 (26.5) | 601,325 (73.5) |
-Yes (%)
| 78,672 (39.1) | 122,513 (60.9) |
Heart failure
| ||
-No (%)
| 292,294 (29.0) | 715,868 (71.0) |
-Yes (%)
| 3,359 (29.7) | 7,970 (70.4) |
Parkinsonism
| ||
-No (%)
| 290,071 (29.0) | 709,721 (71.0) |
-Yes (%)
| 5,582 (28.3) | 14,117 (71.7) |
Main outcomes
Overall prevalence of PIP in the UK in 2007 using 52 STOPP criteria
Prevalence of PIP according to individual STOPP criteria
Criteria description | Number of patients (N = 1,019,491) | % of patients (95% CIs) |
---|---|---|
Cardiovascular system
| ||
Digoxin > 125 mcg/day (increased risk of toxicity)
a
| 9327 | 0.9 (0.8-0.9) |
Thiazide diuretics with gout (exacerbates gout)
| 6094 | 0.6 (0.6-0.6) |
Beta-blocker + verapamil (risk of symptomatic heart block)
| 503 | 0.05 (0.05-0.05) |
Aspirin + Warfarin without a PPI/ H2RA (high risk of gastrointestinal bleeding)
| 3616 | 0.4 (0.3 -0.4) |
Dipyridamole as monotherapy for cardiovascular secondary prevention (no evidence of efficacy)
| 2137 | 0.2 (0.2-0.2) |
Aspirin > 150 mg/day ( increased bleeding risk)
| 5128 | 0.5 (0.5-0.5) |
Loop diuretic for dependent ankle oedema only i.e. no clinical signs of heart failure (no evidence of efficacy, compression hosiery usually more appropriate)
| 25843 | 2.54 (2.5-2.6) |
Loop diuretic as first-line monotherapy for hypertension (safer, more effective alternatives available)
| 7128 | 0.7 (0.7-0.7) |
Non-cardioselective beta-blocker with Chronic Obstructive Pulmonary Disease (COPD) (risk of bronchospasm)
| 353 | 0.03 (0.03-0.03) |
Calcium channel blockers with chronic constipation (may exacerbate constipation)
| 16826 | 1.6 (1.6-1.7) |
Aspirin with a past history of peptic ulcer disease without histamine H2 receptor antagonist or Proton Pump Inhibitor (risk of bleeding)
| 3912 | 0.4 (0.4-0.4) |
Aspirin with no history of coronary, cerebral or peripheral vascular symptoms or occlusive arterial event (not indicated)
| 115576 | 11.3 (11.3-11.4) |
Central Nervous System
| ||
TCAs with dementia (worsening cognitive impairment)
| 354 | 0.03 (0.03-0.03) |
TCAs with glaucoma (exacerbate glaucoma)
| 354 | 0.03 (0.03-0.03) |
TCAs with opioid or calcium channel blocker (risk of severe constipation)
| 26649 | 2.6 (2.6-2.6) |
Long-term (>1 month) long-acting benzodiazepines (risk of prolonged sedation, confusion, impaired balance, falls)
| 15057 | 1.5 (1.5-1.5) |
Long-term (>1 month) neuroleptics (antipsychotics) ( risk of confusion, hypotension, extrapyramidal side-effects, falls)
| 21012 | 2.1 (2.1-2.1) |
Long- term (>1 month) neuroleptics with parkinsonism (worsen extrapyramidal symptoms)
| 852 | 0.1 (0.1-0.1) |
Anticholinergics to treat extrapyramidal symptoms of neuroleptic medications (risk of anticholinergic toxicity)
| 869 | 0.1 (0.1-1.0) |
Phenothiazines with epilepsy (may lower seizure threshold)
| 448 | 0.04 (0.04-0.04) |
Prolonged use (>1 week) of first-generation anti-histamines (risk of sedation and anti-cholinergic side-effects)
| 6020 | 0.6 (0.6-0.6) |
TCA’s with cardiac conductive abnormalities | 543 | 0.05 (0.05-0.05) |
TCA’s with prostatism or prior history of urinary retention (risk of urinary retention)
| 2623 | 0.3 (0.3-0.3) |
TCA’s with constipation (likely to worsen constipation)
| 7279 | 0.7 (0.7-0.7) |
Gastrointestinal System
| ||
Prochlorperazine or metoclopramide with parkinsonism (risk of exacerbating parkinsonism)
| 385 | 0.04 (0.04) |
PPI for peptic ulcer disease at maximum therapeutic dosage for > 8 weeks (dose reduction or earlier discontinuation indicated)
| 38153 | 3.7 (3.7-3.8) |
Anticholinergic antispasmodic drugs with chronic constipation (risk of exacerbation of constipation)
| 1208 | 0.1 (0.1-0.1) |
Respiratory system
| ||
Systemic corticosteroids instead of inhaled corticosteroids for maintenance therapy in moderate-severe COPD (unnecessary exposure to long-term side-effects of systemic steroids)
| 1339 | 0.1 (0.1-0.1) |
Nebulised ipatropium with glaucoma ( exacerbate glaucoma )
| 20 | 0 |
Musculoskeletal system
| ||
Long term NSAID use (>3 months) with osteoarthritis (simple analgesics preferable)
| 12167 | 1.2 (1.2-1.2) |
Warfarin and NSAID use (risk of gastrointestinal bleeding)
| 2495 | 0.2 (0.2-0.3) |
Non-steroidal anti-inflammatory drug (NSAID) with history of peptic ulcer disease or gastrointestinal bleeding, unless with concurrent histamine H2 receptor antagonist, PPI or misoprostol (risk of peptic ulcer relapse)
| 1040 | 0.1 (0.1-0.1) |
NSAID with heart failure (risk of exacerbation of heart failure)
| 409 | 0.04 (0.04-0.04) |
NSAID with chronic renal failure (risk of deterioration in renal function)
| 928 | 0.1 (0.1-0.1) |
Long-term corticosteroids (>3 months) as monotherapy for rheumatoid arthrtitis or osteoarthritis (risk of major systemic corticosteroid side-effects)
| 718 | 0.1 (0.1-0.1) |
Long-term NSAID or colchicine for chronic treatment of gout where there is no contraindication to allopurinol (allopurinol first choice prophylactic drug in gout)
| 2845 | 0.3 (0.3-0.3) |
Urinary System
| ||
Antimuscarinic drugs (urinary) with dementia (risk of increased confusion and agitation)
| 297 | 0.03 (0.03-0.03) |
Antimuscarinic drugs with chronic glaucoma (risk of acute exacerbation of glaucoma)
| 109 | 0.01 (0.01-0.01) |
Bladder antimuscarinic drugs with chronic constipation (risk of exacerbation of constipation)
| 3514 | 0.3 (0.3-0.4) |
Bladder antimuscarinic drugs with chronic prostatism (risk of urinary retention)
| 2791 | 0.3 (0.3-0.3) |
Alpha-blockers in males with frequent incontinence i.e. one or more episodes of incontinence daily (risk of urinary frequency and worsening of incontinence)
| 1426 | 0.1 (0.1-0.2) |
Alpha-blockers with long-term urinary catheter in situ i.e. more than 2 months (drug not indicated)
| 31226 | 3.1 (3.0-3.1) |
Endocrine system
| ||
Beta-blockers in those with diabetes mellitus and frequent hypoglycaemic episodes (risk of masking hypoglycaemic symptoms)
| 26563 | 2.6 (2.6-2.6) |
Glibenclamide with type 2 diabetes mellitus (risk of prolonged hypoglycaemia)
| 981 | 0.1 (0.1-0.1) |
H. Drugs that adversely affect those prone to falls (≥1 fall in past three months) | 0.3 (0.3-0.3) | |
1. Benzodiazepines (sedative, may cause reduced sensorium, impair balance)
| 3358 | 0.2 (0.2-0.3) |
2. Neuroleptic drugs (may cause gait dyspraxia, Parkinsonism)
| 2491 | |
3. Firstgeneration antihistamines (sedative, may impair sensorium)
| 250 | 0.02 (0.02-0.02) |
4. Vasodilator drugs (postural hypotension)
| 788 | 0.1 (0.1-0.1) |
5. Long-term opiates in those with recurrent falls | 10321 | 1.0 (0.1-1.0) |
Two concurrent drugs from the same group- therapeutic duplication (optimization of monotherapy within a single drug class)
| 121668 | 11.9 (11.9-12.0) |
PIP (ever/never) | Unadjusted odds ratios (95% CIs) | Adjusted odds ratios* and (95% CIs) |
---|---|---|
Polypharmacy | ||
-Never (ref) | 1.0 | 1.0 |
-Ever | 19.4 (19.2-19.7) | 18.2 (18.0-18.4) |
Age (years) | ||
-70–74 (ref) | 1.0 | 1.0 |
-75–80 | 1.0 (1.0- 1.0) | 0.9 (0.9-0.9) |
-81–85 | 0.8 (0.8-0 .8) | 0.8 (0.8-0.8) |
- > 85 | 0.3 (0.3-0.3) | 0.4 (0.4-0.4) |
Gender | ||
-Male (ref) | 1.0 | 1.0 |
-Female | 1.0 (1.0-1.0) | 0.9 (0.9- 0.9) |
-Missing | 1.5 (1.5-1.5) | |
Mobidities (Charlson morbidity index score) | ||
-1 (ref) | 1.0 | 1.0 |
-2 | 2.2 (2.2-2.3) | 1.51 (1.5-1.5) |
-3 | 0.4 (0.4-0.40) | 0.9 (0.9-0.9) |