(Z) Polypharmacy Trends Among US Middle-Aged Adults from 2007 to 2020

Publication Number: 649

Background: Polypharmacy, or multi-medication use, is well-studied among older adults and is linked to multi-morbidity and adverse clinical outcomes. However, studies on younger community-dwelling populations are limited.

Objectives: To characterize changes in polypharmacy among middle-aged adults in the US.

Methods: Using a 10% sample from Optum’s de-identified Clinformatics® Data Mart Database between 2007-01-01 to 2020-12-31, we examined trends of polypharmacy among commercially insured middle-aged adults using quarterly cross-sectional panels. Patients were required to be continuously enrolled and between 50 and 64 years of age at the start of each panel period. Polypharmacy in each quarterly panel was defined as having 5+ unique medications dispensed during each period. For sensitivity, we assessed excessive polypharmacy defined as 10+ unique medications in the quarter. Patient characteristics were assessed in the 6-months prior to and 3-months following the start of each period, including comorbidities and healthcare utilization.

Results: The number of qualifying patients in each quarter ranged from 222,826 to 293,606 (mean =261,539). Multi-medication use stayed relatively constant from 2007 to 2020. Prevalence of polypharmacy dropped slightly across quarters, with an average decrease of 0.05% (95% CI: 0.04-0.07%) per quarter, and the average number of unique medications in each quarter increasingly slightly from 4.79 in 2007-Q1 to 5.37 in 2020-Q4, with average change of 0.001 (95% CI: -0.002 to 0.004) per quarter. There was no change (0.00%) in prevalence of excessive polypharmacy per quarter. Polypharmacy was more common among those aged 60-64 than those aged 50-54, on average 12.0% (95% CI: 11.8% to 12.3%) higher across all quarters. Polypharmacy stayed relatively consistent within age group. Polypharmacy was consistently more common among women by 4.9% (95% CI: 4.7% to 5.1%) on average. Polypharmacy among healthiest patients (Charlson score=0) slightly decreased by 4.1% from 28.5% of patients in 2007-Q1 to 24.4% of patients 2020-Q4, with an average drop of 0.09% (95% CI: 0.08% to 0.10%) per quarter. Polypharmacy increased slightly among the sickest patients (Charlson score 5+) by 1.7% from 81.6% in 2007-Q1 to 83.3% in 2020-Q4. Polypharmacy remained consistently the lowest among Asians (mean=20.8%, SD=0.8%) and consistently the highest among whites (mean=33.2%, SD=1.2%) and blacks (mean=34.3%, SD=1.8%).

Conclusions: Contrary to aging populations, polypharmacy among commercially insured US middle aged adults appears to stay constant with time, with consistent differences by sex, age, multi-morbidity, and race.