DataSheet1_Prevalence of Polypharmacy, Hyperpolypharmacy and Potentially Inappropriate Medication Use in Older Adults in India: A Systematic Review and Meta-Analysis.pdf

Background: Older people often receive multiple medications for chronic conditions, which often result in polypharmacy (concomitant use of 5‒9 medicines) and hyperpolypharmacy (concomitant use of ≥10 medicines). A limited number of studies have been performed to evaluate the prevalence of polypharmacy, hyperpolypharmacy, and potentially inappropriate medication (PIM) use in older people of developing countries. The present study aimed to investigate regional variations in the prevalence of polypharmacy, hyperpolypharmacy, and PIM use in older people (60 + years) in India.
Methods: Studies were identified using Medline/PubMed, Scopus, and Google Scholar databases published from inception (2002) to September 31, 2020. Out of the total 1890 articles, 27 were included in the study.
Results: Overall, the pooled prevalence of polypharmacy was 49% (95% confidence interval: 42–56; p < 0.01), hyperpolypharmacy was 31% (21–40; p < 0.01), and PIM use was 28% (24–32; p < 0.01) among older Indian adults. Polypharmacy was more prevalent in North-east India (65%, 50–79), whereas hyperpolypharmacy was prevalent in south India (33%, 17–48). Region-wize estimates for the pooled prevalence of PIM use in India were as follows: 23% (21–25) in East, 33% in West (24–42), 17.8% in North (11–23), and 32% (26–38) in South India. The prevalence of PIM use in adults aged ≥70°years was 35% (28–42), in those taking more medications (≥5.5/day) was 27% (22–31), and in adults using a high number of PIMs (≥3) was 29% (22–36). Subgroup analysis showed that cross-sectional studies had a higher pooled prevalence of polypharmacy 55% (44–65) than cohorts 45% (37–54). Hyperpolypharmacy in inpatient care settings was 37% (26–47), whereas PIM use was higher in private hospitals 31% (24–38) than government hospitals 25% (19–31).
Conclusion: Polypharmacy and hyperpolypharmacy are widely prevalent in India. About 28% of older Indian adults are affected by PIM use. Thus, appropriate steps are needed to promote rational geriatric prescribing in India.
Systematic Review Registration: https://clinicaltrials.gov, identifier [CRD42019141037].

背景：老年群体常因慢性疾病需服用多种药物，由此常引发多重用药（polypharmacy，即同时使用5~9种药物）及超多重用药（hyperpolypharmacy，即同时使用≥10种药物）。目前针对发展中国家老年群体的多重用药、超多重用药及潜在不适当用药（PIM）使用现状的研究较为有限。本研究旨在探究印度60岁及以上老年群体中多重用药、超多重用药及PIM使用情况的地域差异。
方法：本研究检索了2002年建库至2020年9月31日收录于Medline/PubMed、Scopus及Google Scholar数据库的相关文献。初检共获得1890篇文献，最终纳入27篇进行分析。
结果：整体而言，印度老年成人的多重用药合并患病率为49%（95%置信区间：42~56；p<0.01），超多重用药为31%（21~40；p<0.01），PIM使用率为28%（24~32；p<0.01）。多重用药在印度东北部地区更为普遍（65%，50~79），而超多重用药则在印度南部地区高发（33%，17~48）。印度各地区PIM使用的合并患病率估算结果如下：东部地区23%（21~25）、西部地区33%（24~42）、北部地区17.8%（11~23）、南部地区32%（26~38）。在70岁及以上老年成人中，PIM使用率为35%（28~42）；在每日服药量≥5.5种的群体中，PIM使用率为27%（22~31）；在同时使用≥3种PIM的群体中，PIM使用率为29%（22~36）。亚组分析显示，横断面研究的多重用药合并患病率为55%（44~65），高于队列研究的45%（37~54）。住院环境下的超多重用药率为37%（26~47），而私立医院的PIM使用率为31%（24~38），高于公立医院的25%（19~31）。
结论：多重用药与超多重用药在印度广泛流行。约28%的印度老年成人受PIM使用问题影响。因此，印度需采取合理措施推动老年合理处方实践。
系统评价注册：https://clinicaltrials.gov，标识符[CRD42019141037]。