Multimorbidity patterns, polypharmacy and their association with liver and kidney abnormalities in people over 65 years of age: a longitudinal study
Abstract Background: The implementation of individual clinical practice guidelines in patients with multimorbidity often results in polypharmacy. Our aim was to analyse medication use according to longitudinal multimorbidity patterns (MPs) and determine during a 5-year which MPs are associated with abnormal liver and kidney function in primary care patients over 65 years of age living in Catalonia. Methods: Design: Longitudinal study (years 2012 to 2016) based on the electronic health records (EHR) contained in the primary care information system database of the Catalan Institute of Health (SIDIAP). Variables : age, sex, MPs, medication and polypharmacy (drug exposure obtained from the Pharmacy Invoice Registry). Medicines were classified in accordance with the Anatomical Therapeutic Chemical Classification System. Glomerular filtration rate was used to determine abnormal kidney function, and serum levels of alkaline phosphatase, alanine transaminase and gamma-glutamyl transpeptidase were used to diagnose abnormal liver function. Statistics : For medication use in MPs, we calculated annual mean packages of each drug in each MP, and observed/expected ratios (O/E-ratios) were obtained by dividing mean packages in the cluster by mean packages of the same drug in the overall population. Logistic regression models were fitted to estimate the association between MPs at baseline and abnormal kidney and liver function tests during follow up. Results: 916,619 patients were included, and 743,827 completed the follow up. We identified one polypharmacy profile per MP, and concluded that the most prescribed drugs in each pattern corresponded to the diseases overrepresented in that specific MP. The median of drugs ranged from 3 (Cluster 1 - Non-Specific) to 8 (Cluster 10 - Multisystem Pattern). Abnormal kidney function was most commonly observed in the C4-Cardio-Circulatory and Renal (OR 2.19; CI 95% 2.15-2.23) and C3-Minority Metabolic Autoimmune-Inflammatory (OR 2.16; CI 95% 2.12-2.20) MPs. A higher risk of abnormal liver function was observed in the C8-Digestive (OR 3.39; CI 95% 3.30-3.49), and C4-Cardio-Circulatory and Renal (OR 1.96; CI 95% 1.91-2.02) MPs. Conclusions: A higher risk of abnormal kidney and liver function was observed in specific MPs. The long-term characterisation of MPs and polypharmacy illustrates the burden of chronic multimorbidity and polypharmacy in the elderly population..
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Preprint| Erscheinungsjahr: |
2022 |
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| Erschienen: |
2022 |
| Enthalten in: |
ResearchSquare.com - (2022) vom: 28. Juli Zur Gesamtaufnahme - year:2022 |
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| Sprache: |
Englisch |
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| Beteiligte Personen: |
Villen, Noemi [VerfasserIn] |
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| doi: |
10.21203/rs.3.rs-23421/v1 |
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| 520 | |a Abstract Background: The implementation of individual clinical practice guidelines in patients with multimorbidity often results in polypharmacy. Our aim was to analyse medication use according to longitudinal multimorbidity patterns (MPs) and determine during a 5-year which MPs are associated with abnormal liver and kidney function in primary care patients over 65 years of age living in Catalonia. Methods: Design: Longitudinal study (years 2012 to 2016) based on the electronic health records (EHR) contained in the primary care information system database of the Catalan Institute of Health (SIDIAP). Variables : age, sex, MPs, medication and polypharmacy (drug exposure obtained from the Pharmacy Invoice Registry). Medicines were classified in accordance with the Anatomical Therapeutic Chemical Classification System. Glomerular filtration rate was used to determine abnormal kidney function, and serum levels of alkaline phosphatase, alanine transaminase and gamma-glutamyl transpeptidase were used to diagnose abnormal liver function. Statistics : For medication use in MPs, we calculated annual mean packages of each drug in each MP, and observed/expected ratios (O/E-ratios) were obtained by dividing mean packages in the cluster by mean packages of the same drug in the overall population. Logistic regression models were fitted to estimate the association between MPs at baseline and abnormal kidney and liver function tests during follow up. Results: 916,619 patients were included, and 743,827 completed the follow up. We identified one polypharmacy profile per MP, and concluded that the most prescribed drugs in each pattern corresponded to the diseases overrepresented in that specific MP. The median of drugs ranged from 3 (Cluster 1 - Non-Specific) to 8 (Cluster 10 - Multisystem Pattern). Abnormal kidney function was most commonly observed in the C4-Cardio-Circulatory and Renal (OR 2.19; CI 95% 2.15-2.23) and C3-Minority Metabolic Autoimmune-Inflammatory (OR 2.16; CI 95% 2.12-2.20) MPs. A higher risk of abnormal liver function was observed in the C8-Digestive (OR 3.39; CI 95% 3.30-3.49), and C4-Cardio-Circulatory and Renal (OR 1.96; CI 95% 1.91-2.02) MPs. Conclusions: A higher risk of abnormal kidney and liver function was observed in specific MPs. The long-term characterisation of MPs and polypharmacy illustrates the burden of chronic multimorbidity and polypharmacy in the elderly population. | ||
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