The association between socioeconomic status and use of potentially inappropriate medications in older adults

Jimin Hwang, Beini Lyu, Shoshana Ballew, Josef Coresh, Morgan E. Grams, David Couper, Pamela Lutsey, Jung Im Shin

Research output: Contribution to journalArticlepeer-review

6 Scopus citations

Abstract

Background: Potentially inappropriate medication (PIM) use is an important public health problem, particularly among older adults who may need multiple pharmacologic therapies for various chronic conditions. As socioeconomic status (SES) affects the quality of healthcare that individuals receive, SES may be associated with the use of PIM in older adults. This study aimed to determine whether low SES is associated with increased use of PIM. Methods: We studied 4927 participants (aged 66–90 years) who were on at least one medication at visit five (2011–2013) of the Atherosclerosis Risk in Communities Study. We created a cumulative SES score categorized as high (7–9), middle (3–6), and low (0–2) based on education, income, and area deprivation index. We use multivariable logistic regression to examine the associations between SES and use of two or more PIM for older adults, defined by the 2019 Beers Criteria. Results: A total of 31.0% and 6.9% of the participants used one or more PIM and two or more PIM, respectively. After adjusting for demographic characteristics and insurance type, low cumulative SES score was associated with significantly greater use of two or more PIM (odds ratio [OR] = 1.83 [95% confidence interval (CI) 1.18–2.86]), as was middle cumulative SES score (OR = 1.40 [95% CI 1.06–1.83]), compared to high cumulative SES score. The results remained significant after further adjusting for comorbidities and medication burden for low cumulative SES score (OR = 1.66 [95%CI 1.02–2.71]). Conclusions: We found that lower SES was associated with greater use of PIM among older adults independent of their medication burden and comorbidities, suggesting socioeconomic disparities in quality of medication management. Focused efforts targeting older adults with low SES to reduce PIM use may be needed to prevent adverse drug events.

Original languageEnglish (US)
Pages (from-to)1156-1166
Number of pages11
JournalJournal of the American Geriatrics Society
Volume71
Issue number4
DOIs
StatePublished - Apr 2023

Bibliographical note

Funding Information:
The Atherosclerosis Risk in Communities study has been funded in whole or in part with Federal funds from the National Heart, Lung, and Blood Institute (NHLBI), National Institutes of Health, Department of Health and Human Services, under Contract nos. (HHSN268201700001I, HHSN268201700002I, HHSN268201700003I, HHSN268201700004I, HHSN268201700005I). The authors thank the staff and participants of the ARIC study for their important contributions. Dr. Shin was supported by grant K01 DK121825 from the National Institute of Diabetes and Digestive and Kidney Disease (NIDDK). Dr. Lutsey was supported by NHLBI K24 HL159246.

Publisher Copyright:
© 2022 The American Geriatrics Society.

Keywords

  • older adults
  • pharmacoequity
  • potentially inappropriate medications
  • socioeconomic status

PubMed: MeSH publication types

  • Journal Article
  • Research Support, N.I.H., Extramural

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