Background
Methods
Study population
Definition
Statistical analysis
Results
Characteristic | Total mean: 3.5 | 0–4 medicines (N = 1769) mean: 1.7 | 5-8 medicines (N = 811) mean: 6.1 | |||||
---|---|---|---|---|---|---|---|---|
% | 95 % CI | % | 95 % CI | % | 95 % CI | % | 95 % CI | |
N = 2835 | 100.0 | 67.0 | 64.4–69.7 | 24.8 | 22.4–27.1 | 8.2 | 6.3–10.1 | |
Demographics (N = 2835) | ||||||||
Gender | ||||||||
Males | 41.2 | 39.1–43.3 | 43.5 | 40.7–46.3 | 37.6 | 32.9–42.3 | 33.4 | 19.3–47.5 |
Females | 58.8 | 56.7–60.9 | 56.5 | 53.7–59.3 | 62.4 | 57.7–67.0 | 66.6 | 52.5–80.7 |
Age | ||||||||
65–69 | 23.2 | 20.5–25.9 | 26.8 | 23.3–30.2 | 17.2 | 13.0–21.4 | 12.2 | 5.5–18.9 |
70–74 | 27.2 | 24.1–30.3 | 27.9 | 24.3–31.5 | 24.8 | 19.5–30.0 | 28.7 | 13.4–44.0 |
75–79 | 19.4 | 17.1–21.7 | 19.4 | 16.5–22.3 | 20.0 | 16.1–24.0 | 17.1 | 10.1–24.1 |
> = 80 | 30.2 | 27.7–32.8 | 25.9 | 23.0–28.9 | 38.0 | 33.1–42.8 | 42.0 | 31.1–52.9 |
Socioeconomic status | ||||||||
Education (N = 2689) | ||||||||
No degree/Primary | 30.4 | 27.3–33.4 | 27.6 | 24.1–31.1 | 35.0 | 29.9–40.0 | 38.9 | 27.4–50.4 |
Lower secondary | 24.4 | 21.0–27.7 | 22.4 | 18.8–26.0 | 26.3 | 21.1–31.4 | 34.9 | 20.1–49.8 |
Higher secondary | 27.0 | 23.8–30.2 | 29.2 | 25.3–33.1 | 23.9 | 19.1–28.8 | 18.4 | 10.3–26.5 |
Higher education | 18.2 | 15.6–20.9 | 20.8 | 17.5–24.0 | 14.8 | 10.6–19.0 | 7.8 | 3.2–12.3 |
Equivalent household income (N = 2271) | ||||||||
Quintile 1 | 20.5 | 17.2–23.8 | 19.6 | 16.2–23.0 | 17.6 | 13.6–21.6 | 37.1 | 20.7–53.6 |
Quintile 2 | 32.8 | 29.2–36.4 | 32.5 | 28.2–36.9 | 34.0 | 28.4–29.6 | 31.0 | 19.8–42.3 |
Quintile 3 | 25.4 | 21.9–28.8 | 24.2 | 20.1–28.3 | 30.2 | 24.5–35.8 | 20.3 | 11.1–29.5 |
Quintile 4 | 11.2 | 9.1–13.4 | 11.7 | 9.0–14.4 | 10.6 | 7.2–14.0 | 9.0 | 3.7–14.4 |
Quintile 5 | 10.1 | 7.9–12.2 | 11.9 | 9.2–14.7 | 7.6 | 4.2–11.0 | 2.5 | 0.2–4.8 |
Living situation (N = 2820) | ||||||||
Living alone or with other person(s) in home setting | 94.4 | 93.4–95.4 | 95.9 | 94.8–96.9 | 92.3 | 90.3–94.4 | 88.6 | 84.0–93.2 |
Living in a residential home for the elderly | 5.6 | 4.6–6.6 | 4.1 | 3.1–5.2 | 7.6 | 5.6–9.7 | 11.4 | 6.8–16.0 |
Region (N = 2835) | ||||||||
Flemish Region | 61.2 | 58.9–63.4 | 66.2 | 63.4–68.9 | 50.8 | 45.8–55.8 | 51.8 | 39.8–63.9 |
Brussels Region | 8.8 | 8.1–9.5 | 8.5 | 7.6–9.5 | 9.7 | 8.0–11.4 | 7.8 | 4.6–10.9 |
Walloon Region | 30.1 | 28.0–32.1 | 25.3 | 22.7–27.9 | 39.5 | 34.7–44.3 | 40.4 | 29.6–51.1 |
Health status | ||||||||
Longstanding illness, chronic conditions or handicaps (N = 2819) | ||||||||
Yes | 54.0 | 51.0–56.9 | 42.3 | 38.7–45.9 | 73.4 | 69.0–77.9 | 90.2 | 85.0–95.4 |
No | 46.0 | 43.1–49.0 | 57.7 | 54.1–61.3 | 26.6 | 22.1–31.0 | 9.8 | 4.6–15.0 |
Depression during the past 12 months (N = 2794) | ||||||||
Yes | 6.8 | 4.9–8.6 | 4.2 | 2.8–5.5 | 8.0 | 5.6–10.4 | 24.4 | 8.9–39.9 |
No | 93.2 | 91.4–95.1 | 95.8 | 94.4–97.2 | 92.0 | 89.6–94.4 | 75.6 | 60.1–91.1 |
Contact with health services | ||||||||
Contact with GP in past 2 months (N = 2811) | ||||||||
Yes | 73.8 | 71.1–76.4 | 65.4 | 61.8–69.0 | 89.4 | 86.4–92.5 | 94.1 | 89.9–98.3 |
No | 26.2 | 23.6–28.9 | 34.6 | 31.0–38.2 | 10.6 | 7.4–13.6 | 5.9 | 1.7–10.1 |
Contact with specialist in past 2 months (N = 2817) | ||||||||
Yes | 27.8 | 25.3–30.3 | 24.8 | 21.6–27.9 | 33.3 | 28.2–38.4 | 36.3 | 25.6–47.0 |
No | 72.2 | 69.7–74.7 | 75.2 | 72.1–78.3 | 66.7 | 61.6–71.8 | 63.7 | 53.0–74.4 |
Inpatient hospitalization in past 12 months (N = 2813) | ||||||||
Yes | 18.2 | 16.0–20.4 | 14.0 | 11.5–16.5 | 23.5 | 19.4–27.6 | 36.1 | 25.1–47.1 |
No | 81.8 | 79.6–84.0 | 86.0 | 83.5–88.5 | 76.5 | 72.4–90.6 | 63.9 | 52.9–74.9 |
1 day patient hospitalization in past 12 months (N = 2807) | ||||||||
Yes | 11.0 | 9.1–12.9 | 10.2 | 7.9–12.6 | 13.4 | 9.5–17.4 | 10.3 | 5.0–15.5 |
No | 89.0 | 87.1–90.9 | 89.8 | 87.4–92.1 | 86.6 | 82.6–90.5 | 89.7 | 84.5–95.0 |
Description of the study population by level of polypharmacy
Socio-demographic characteristics
Health status and use of health care characteristics
Use of specific groups of medicines by level of polypharmacy
ATC_1 | Total | 0–4 medicines (N = 1769) | 5–8 medicines (N = 811) | > = 9 medicines (N = 255) | |||||
---|---|---|---|---|---|---|---|---|---|
% | 95 % CI | % | 95 % CI | % | 95 % CI | % | 95 % CI | ||
C | Cardiovascular system | 61.9 | 59.1–64.7 | 46.6 | 43.1–50.2 | 92.2 | 89.5–94.9 | 95.3 | 91.7–98.8 |
N | Nervous system | 37.6 | 34.7–40.6 | 21.2 | 18.3–24.0 | 65.9 | 61.0–70.7 | 86.5 | 79.6–93.3 |
A | Alimentary tract and metabolism | 33.5 | 30.7–36.4 | 18.3 | 15.5–21.2 | 56.5 | 51.3–61.7 | 88.0 | 82.7–93.3 |
B | Blood and blood forming organs | 31.2 | 28.5–34.0 | 17.2 | 14.5–19.9 | 54.9 | 49.8–59.9 | 74.3 | 65.7–82.9 |
M | Musculo-skeletal system | 18.1 | 15.7–20.5 | 11.5 | 9.0–14.0 | 25.2 | 20.7–29.7 | 50.6 | 38.5–62.7 |
R | Respiratory system | 12.1 | 9.9–14.3 | 5.1 | 3.5–6.6 | 20.8 | 16.1–25.5 | 42.9 | 29.6–56.2 |
ATC_3 | Total | 0-4 medicines (N = 1769) | 5-8 medicines (N = 811) | > = 9 medicines (N = 255) | |||||
---|---|---|---|---|---|---|---|---|---|
% | 95 % CI | % | 95 % CI | % | 95 % CI | % | 95 % CI | ||
B01A | Antithrombotic agents | 30.5 | 27,8–33,3 | 17.0 | 14.2–19.7 | 53.3 | 48.2–58.4 | 72.5 | 63.6–81.4 |
C10A | Lipid modifying agents, plain | 27.9 | 25,0–30,7 | 18.7 | 15.8–21.7 | 44.8 | 39.7–50.0 | 51.3 | 39.3–63.3 |
C07A | Beta blocking agents | 24.2 | 21,4–26,9 | 13.7 | 11.3–16.1 | 42.2 | 37.2–47.2 | 55.2 | 43.6–66.7 |
A02B | Drugs for peptic ulcer and gastro–oesophageal reflux disease | 14.9 | 12,6–17,1 | 6.2 | 4.5–8.0 | 25.7 | 21.1–30.4 | 52.4 | 40.5–64.2 |
N05B | Anxiolytics | 13.4 | 11,3–15,6 | 6.1 | 4.5–7.6 | 22.0 | 17.7–26.4 | 47.4 | 34.9–59.9 |
C08C | Selective calcium channel blockers with mainly vascular effects | 12.7 | 10,4–15,0 | 6.8 | 4.8–8.8 | 21.5 | 16.9–26.1 | 34.0 | 19.7–48.4 |
C09A | Ace inhibitors, plain | 11.4 | 9,6–13,2 | 6.2 | 4.2–8.2 | 21.8 | 17.6–25.9 | 22.0 | 14.5–29.6 |
N06A | Antidepressants | 10.9 | 9,2–12,5 | 3.3 | 2.2–4.3 | 23.2 | 18.6–27.9 | 35.5 | 25.1–45.8 |
M01A | Antiinflammatory and antirheumatic products, non-steroids | 10.3 | 8,2–12,4 | 6.7 | 4.9–8.5 | 13.5 | 9.7–17.2 | 29.8 | 14.9–44.8 |
N05C | Hypnotics and sedatives | 10.2 | 8,4–12,0 | 5.4 | 3.6–7.3 | 18.1 | 14.0–22.1 | 24.8 | 16.1–33.5 |
Determinants for the use of specific groups of medicines
Characteristic (reference category) | ATC C (N = 1387) | ATC N (N = 886) | ATC A (N = 734) | ATC B (N = 752) | ATC R (N = 245) | ATC M (N = 379) | ||||||
---|---|---|---|---|---|---|---|---|---|---|---|---|
OR | 95 % CI | OR | 95 % CI | OR | 95 % CI | OR | 95 % CI | OR | 95 % CI | OR | 95 % CI | |
Gender (male) | ||||||||||||
Female | 1.12 | 0.92–1.37 | 1.92b
| 1.58–2.34 | 1.44 | 1.18–1.76 | 0.61b
| 0.51–0.75 | 0.67b
| 0.50–0.90 | 1.18 | 0.93–1.50 |
Age (65–69) | ||||||||||||
70–74 | 1.05 | 0.76–1.46 | 1.50b
| 1.06–2.11 | 1.15 | 0.82–1.61 | 1.50b
| 1.06–2.13 | 0.82 | 0.49–1.38 | 1.01 | 0.68–1.48 |
75–79 | 1.67b
| 1.20–2.34 | 1.32 | 0.93–1.88 | 0.96 | 0.67–1.35 | 1.80b
| 1.27–2.56 | 0.86 | 0.52–1.42 | 1.01 | 0.68–1.49 |
> = 80 | 1.45b
| 1.10–1.90 | 1.81b
| 1.35–2.42 | 1.05 | 0.79–1.40 | 2.36b
| 1.75–3.19 | 0.89 | 0.59–1.35 | 0.82 | 0.59–1.14 |
Education (Higher education) | ||||||||||||
No degree/Primary | 1.25 | 0.91–1.71 | 1.46b
| 1.07–1.98 | 1.17 | 0.86–1.58 | 1.33 | 0.98–1.81 | 1.23 | 0.78–1.93 | 1.25 | 0.87–1.79 |
Lower secondary | 0.87 | 0.63–1.19 | 1.52b
| 1.12–2.08 | 0.92 | 0.67–1.26 | 1.16 | 0.85–1.59 | 1.22 | 0.77–1.95 | 1.36 | 0.95–1.96 |
Higher secondary | 0.94 | 0.69–1.27 | 1.23 | 0.91–1.66 | 1.08 | 0.80–1.46 | 1.11 | 0.82–1.51 | 1.02 | 0.64–1.63 | 1.21 | 0.84–1.74 |
Equivalent household income (Quintile 5) | ||||||||||||
Quintile 1 | 0.95 | 0.65–1.38 | 1.12 | 0.77–1.63 | 1.20 | 0.82–1.75 | 0.91 | 0.63–1.32 | 1.00 | 0.56–1.77 | 0.93 | 0.59–1.44 |
Quintile 2 | 1.13 | 0.79–1.61 | 1.01 | 0.71–1.43 | 1.18 | 0.82–1.70 | 1.03 | 0.73–1.47 | 1.37 | 0.80–2.34 | 1.04 | 0.68–1.58 |
Quintile 3 | 1.37 | 0.95–1.96 | 1.18 | 0.83–1.70 | 1.12 | 0.77–1.62 | 1.07 | 0.75–1.54 | 1.24 | 0.71–2.16 | 1.08 | 0.70–1.67 |
Quintile 4 | 0.98 | 0.66–1.46 | 1.18 | 0.79–1.75 | 1.04 | 0.69–1.55 | 1.09 | 0.73–1.62 | 1.09 | 0.59–2.02 | 1.10 | 0.68–1.77 |
Living situation (Living at home) | ||||||||||||
Living in a residential home for the elderly | 0.48b
| 0.33–0.71 | 1.25 | 0.84–1.86 | 1.40 | 0.96–2.04 | 0.74 | 0.50–1.10 | 1.15 | 0.69–1.42 | 0.64 | 0.37–1.11 |
Region (Flemish Region) | ||||||||||||
Brussels Region | 0.85 | 0.67–1.08 | 1.26 | 0.98–1.62 | 1.07 | 0.84–1.38 | 1.03 | 0.80–1.32 | 0.98 | 0.68–1.42 | 1.29 | 0.96–1.73 |
Walloon Region | 1.76b
| 1.40–2.21 | 1.55b
| 1.25–1.93 | 1.51b
| 1.22–1.88 | 1.27b
| 1.02–1.57 | 0.99 | 0.72–1.37 | 1.23 | 0.95–1.61 |
Depression < 12 months (no) | ||||||||||||
Yes | 0.77 | 0.52–1.13 | 4.76b
| 2.97–7.64 | 1.51b
| 1.06–2.17 | 0.77 | 0.52–1.14 | 1.55 | 0.97–2.48 | 0.70 | 0.43–1.16 |
Longstanding disease, condition or handicap (no) | ||||||||||||
Yes | 1.42b
| 1.16–1.73 | 1.90b
| 1.56–2.39 | 2.18b
| 1.78–2.67 | 1.65b
| 1.35–2.02 | 2.74b
| 1.96–3.83 | 1.66b
| 1.30–2.14 |
Contact with GP in past 2 months (no) | ||||||||||||
Yes | 2.90b
| 2.31–3.66 | 1.86b
| 1.45–2.39 | 1.51b
| 1.17–1.96 | 1.86b
| 1.43–2.40 | 2.45b
| 1.54–3.90 | 1.18 | 0.87–1.60 |
Ambulatory contact with specialist in past 2 months (no) | ||||||||||||
Yes | 1.14 | 0.91–1.44 | 1.07 | 0.86–1.33 | 1.37b
| 1.11–1.71 | 1.35b
| 1.09–1.69 | 1.21 | 0.89–1.63 | 1.25 | 0.96–1.62 |
Inpatient hospitalization in past 12 months (no) | ||||||||||||
Yes | 1.46b
| 1.13–1.91 | 1.52b
| 1.20–1.94 | 1.32b
| 1.04–1.68 | 1.43b
| 1.13–1.81 | 1.38b
| 1.01–1.88 | 0.85 | 0.63–1.14 |
Day patient hospitalization in past 12 months (no) | ||||||||||||
Yes | 0.86 | 0.62–1.19 | 1.13 | 0.82–1.56 | 0.97 | 0.71–1.34 | 1.20 | 0.87–1.65 | 0.80 | 0.49–1.30 | 0.80 | 0.54–1.20 |
Determinants of polypharmacy
Characteristic | 5–8 medicines (N = 617) | > = 9 medicines (N = 181) | ||
---|---|---|---|---|
OR | 95 % CI | OR | 95 % CI | |
Gender | ||||
Males | 1 | 1 | ||
Females | 1.13 | (0.91–1.40) | 1.19 | (0.83–1.71) |
Age | ||||
65–69 | 1 | 1 | ||
70–74 | 1.30 | (0.89–1.92) | 1.51 | (0.74–3.06) |
75–79 | 1.38 | (0.94–2.02) | 1.69 | (0.86–3.34) |
> = 80 | 1.78a
| (1.29–2.45) | 2.08a
| (1.15–3.77) |
Education | ||||
No degree/Primary | 1.52a
| (1.07–2.15) | 1.32 | (0.75–2.31) |
Lower secondary | 1.19 | (0.83–1.71) | 1.17 | (0.64–2.13) |
Higher secondary | 1.18 | (0.84–1.67) | 1.19 | (0.66–2.13) |
Higher education | 1 | 1 | ||
Equivalent household income in quintiles | ||||
1 | 0.95 | (0.63–1.45) | 1.62 | (0.79–3.31) |
2 | 1.05 | (0.70–1.55) | 1.31 | (0.66–2.60) |
3 | 1.22 | (0.82–1.83) | 1.41 | (0.68–2.90) |
4 | 0.88 | (0.56–1.39) | 1.20 | (0.55–2.62) |
5 | 1 | 1 | ||
Living situation | ||||
Living at home | 1 | 1 | ||
Living in a residential home for the elderly | 1.09 | (0.71–1.65) | 1.68 | (0.92–3.05) |
Region | ||||
Flemish Region | 1 | 1 | ||
Brussels Region | 1.06 | (0.81–1.39) | 1.08 | (0.66–1.77) |
Walloon Region | 1.48a
| (1.17–1.88) | 2.57a
| (1.71–3.85) |
Depression < 12 months | ||||
Yes | 1.54a
| (1.02–2.33) | 3.48a
| (2.03–5.97) |
No | 1 | 1 | ||
Longstanding disease, condition or handicap | ||||
Yes | 2.45a
| (1.97–3.05) | 5.67a
| (3.58–8.98) |
No | 1 | 1 | ||
Contact with GP in past 2 months | ||||
Yes | 2.92a
| (2.14–3.98) | 4.72a
| (2.32–9.61) |
No | 1 | 1 | ||
Ambulatory contact with specialist in past 2 months | ||||
Yes | 1.19 | (0.93–1.51) | 1.58a
| (1.09–2.28) |
No | 1 | 1 | ||
Inpatient hospitalization in past 12 months | ||||
Yes | 1.36a
| (1.05–1.77) | 2.20a
| (1.51–3.20) |
No | 1 | 1 | ||
Day patient hospitalization in past 12 months | ||||
Yes | 1.04 | (0.74–1.47) | 1.07 | (0.62–1.86) |
No | 1 | 1 |