Prevalence, Determinants And Associated Risk Of Potentially Inappropriate Prescribing For Older Adults In Qatar: A National Retrospective Study

Figures & data

Table 1 Characteristics Of PIM And Polypharmacy Groups And Their Prevalence Within Different Determinants

Determinants	PIM					Polypharmacy							Total
	With		Without		p-value	0–5 Meds		6–10 Meds		> 10 Meds		p-value
	n	%	n	%		n	%	n	%	n	%	n (%)
Total	2215	62.6	1322	37.4		1144	32.3	1430	40.4	963	27.2		3537(100)
Age in years, µ and SD	72.9	6.7	72.5	7.3	0.082	72.3	7.3	72.9	6.9	73.1	6.7	0.024	72.8 (6.9)
Age group, years					0.003							0.001
65–69	871	59.5	593	40.5		527	36	571	39.0	366	25.0		1464 (41.4)
70–74	564	64.4	312	35.6		275	31.4	363	41.4	238	27.2		876 (24.8)
75-79	382	64.0	215	36		175	29.3	236	39.5	186	31.2		597 (16.9)
80–84	266	69.6	116	30.4		95	24.9	169	44.2	118	30.9		382 (10.8)
≥ 85	132	60.6	86	39.5	72	33	91	41.7	55	25.2	218 (6.2)
Gender					<0.001							<0.001
Female	1092	68.7	498	31.3		443	27.9	661	41.6	486	30.6		1590 (45.0)
Male	1123	57.7	824	42.3	701	36	769	39.5	477	24.5	1947 (55.0)
Weight in Kg, µ & SD	80.5	17.8	77.9	16.8	<0.001	76.2	16.7	78.9	16.4	83.6	19.1	<0.001	79.7(17.6)
Missing	342	45.8	405	54.2		410	54.9	225	30.1	112	15		747(21.1)
Height in cm, µ & SD	166	10	166	10.1	0.380	165	10.3	166	9.9	167	9.8	0.035	166(10.0)
Missing	91	42.9	121	57.1		126	59.4	66	31.1	20	9.43		212(6.0)
BMI (kg/m^2), µ & SD	29.4	6.6	28.3	6	<0.001	28	6	29	6	30	7.1	<0.001	29(6.4)
Missing	370	46.5	426	53.5		429	53.9	248	31.2	119	14.9		796 (22.5)
Classes, BMI range					<0.001							<0.001
Underweight, <19	40	60.6	26	39.4		29	43.9	23	34.9	14	21.2		66 (1.9)
Normal weight,19–24.9	431	64.0	242	36		197	29.3	296	44.0	180	26.8		673 (19.0)
Overweight, 25–29.9	597	64.7	326	35.3		249	27	409	44.3	265	28.7		923 (26.1)
Obese-Class I, 30–34.9	467	70.7	194	29.4		164	24.8	282	42.7	215	32.5		661 (18.7)
Obese-Class II, 35–39.9	190	72.2	73	27.8		52	19.8	117	44.5	94	35.7		263 (7.4)
Obese- Class III, ≥40	120	77.4	35	22.6		24	15.5	55	35.5	76	49.0		155 (4.4)
ethnicity					<0.001							<0.001
Asian	286	55.0	234	45		231	44.4	186	35.8	103	19.8		520 (14.7)
Black African	75	44.1	95	55.9		78	45.9	64	37.7	28	16.5		170 (4.8)
Gulf	1347	68.0	635	32		522	26.3	828	41.8	632	31.9		1982 (56.0)
North African	138	60.8	89	39.2		80	35.2	94	41.4	53	23.4		227 (6.4)
Others	2	25.0	6	75		7	87.5	0.0	0.0	1	12.5		8(0.2)
Eastern Mediterranean	335	61.9	206	38.1		172	31.8	227	42.0	142	26.3		541 (15.3)
White	32	36.0	57	64		54	60.7	31	34.8	4	4.5		89 (2.5)
S. Creatinine, umol/l, µ and SD	100.7	82.9	91.7	62.5	0.002	83.8	45.8	97.4	79.7	110.7	91.4	<0.001	97.6 (76.7)
eGFR, mL/min/1.73m^2	70.4	23.8	74.5	21.9	<0.001	77.9	20.1	72.2	22.9	65.6	24.8	<0.001	71.8 (23.2)
CKD stage					0.002							<0.001
G1, >90	472	61.8	292	38.2		265	34.7	332	43.5	167	21.9		764 (21.6)
G2, 60–90	979	65.1	524	34.9		453	30.1	645	42.9	405	27.0		1503 (42.5)
G3a,45–59	278	69.2	124	30.9		76	18.9	175	43.5	151	37.6		402 (11.4)
G3b, 30–44	163	71.8	64	28.2		29	12.8	98	43.2	100	44.1		227 (6.4)
G4, 15–29	60	71.4	24	28.6		16	19.1	21	25.0	47	56.0		84 (2.4)
G5, <15	111	76.0	35	24		23	15.8	60	41.1	63	43.2		146 (4.1)
Missing renal parameters	152	37	259	63		282	68.6	99	24.1	30	7.3		411 (11.6)
Sodium mEq/L, µ and SD	138.3	3.4	138.8	3.5	<0.001	139.1	3.3	138.6	3.3	137.7	3.6	<0.001	138.5 (3.4)
Sodium levels					0.013							<0.001
Hyponatremia < 135	267	72.2	103	27.8		68	18.4	142	38.4	160	43.2		370 (10.5)
Normonatremia 135–145	1770	65.3	941	34.7		767	28.3	1176	43.4	768	28.3		2711(76.6)
Hypernatremia >145	8	50	8	50		8	50	5	31.3	3	18.8		16 (0.5)
Missing sodium	170	38.6	270	61.4		301	68.4	107	24.3	32	7.27		440 (12.4)
Medications, µ and SD	9.7	4.2	4.7	3.7	<0.001	2.6	1.9	7.9	1.4	13.7	2.8	-	8 (4.7)
PIMs, µ and SD	1.5	0.8	0	0	-	0.4	0.6	1	0.9	1.5	1	<0.001	0.9 (1)
CNS active meds, µ and SD	1.67	2.6	0.7	1.8	<0.001	0.7	1.7	1.2	2	2.3	3.2	<0.001	1.3 (2.4)
Anticholinergics, µ and SD	1.8	1.8	0.9	1.2	<0.001	0.9	1.2	1.4	1.5	2.1	2	<0.001	1.4 (1.7)
Comorbidities, µ and SD	2.4	1.2	1.7	1.3	<0.001	1.3	1.2	2.3	1	2.9	1.1	<0.001	2 (1.3)
Diabetes mellitus					<0.001							<0.001
No	707	50.2	701	49.8		817	58	465	33.0	126	9.0		1408 (39.8)
Yes	1508	70.8	621	29.2	327	15.4	965	45.3	837	39.3	2129 (60.2)
Hypertension					<0.001							<0.001
No	289	41.9	401	58.1		504	73	152	22.0	34	4.9		690 (19.5)
Yes	1926	67.7	921	32.4	640	22.5	1278	44.9	929	32.6	2847 (80.5)
Heart failure					<0.001							<0.001
No	1876	60.6	1221	39.4		1093	35.3	1291	41.7	713	23.0		3097 (87.6)
Yes	339	77.1	101	23	51	11.6	139	31.6	250	56.8	440 (12.4)
CAD					<0.001							<0.001
No	1466	58	1063	42		1019	40.3	1014	40.1	496	19.6		2529 (71.5)
Yes	749	74.3	259	25.7	125	12.4	416	41.3	467	46.3	1008 (28.5)
Infection					<0.001							<0.001
No	592	51	579	49.4		549	47	423	36.1	199	17		1171 (33.1)
Yes	1623	68.6	743	31.4	595	25.2	1007	42.6	764	32.3	2366 (66.9)
Dementia					0.106							0.611
No	1962	62.2	1194	37.8		1029	32.6	1269	40.2	858	27.2		3156 (89.2)
Yes	253	66.4	128	33.6	115	30.2	161	42.3	105	27.6	381 (10.8)
Schizophrenia/bipolar					0.217							0.942
No	2195	62.5	1315	37.5		1136	32.4	1419	40.4	955	27.2		3510 (99.2)
Yes	20	74.1	7	25.9	8	29.6	11	40.7	8	29.6	27 (0.8)
Homecare services					<0.001							<0.001
No	1812	61.1	1154	38.9		1021	34.4	1174	39.6	771	26.0		2966 (83.9)
Yes	403	70.6	168	29.4	123	21.5	256	44.8	192	33.6	571 (16.1)
ED visits, µ and SD	1.4	4	0.9	1.9	<0.001	0.7	1.6	1.2	2.8	1.8	5.3	<0.001	1.2 (3.4)

Notes: We used frequencies and percentages for categorical variables, otherwise the mean (µ) and the Standard Deviation (SD) were specified in the most left column for continuous and count variables. A dash was used if the test is not applicable.

Abbreviations: BMI, Body mass index; ED, Emergency Department; CAD, Coronary Artery Disease; CKD, Chronic Kidney Disease; CNS, Central Nervous System; eGFR, estimated Glomerular filtration rate; meds, medications; PIM, Potentially Inappropriate Medications; S, serum.

Table 2 Crude And Adjusted Odds Ratios Of PIM And Polypharmacy Against Clinical Outcomes Before And After MI

Exposure	Cases	Univariate Analysis N=(3537)				Multivariate Logistic Regression
		Complete Case Analysis (N=2759)				After MI (N=3537)
		OR	95% CI		P-value	aOR	95% CI		P-value	aOR	95% CI		P-value
		ED Admissions (N=1456)
PIM	n (%)
No	448 (30.8)	1				1				1
Yes	1008 (69.2)	1.63	1.41	1.88	<0.001	1.2	1.01	1.43	0.04	1.27	1.09	1.48	0.002
Polypharmacy	n (%)
0–5	360 (24.7)	1				1				1
6–10	606 (41.6)	1.6	1.36	1.89	<0.001	1.2	0.97	1.49	0.095	1.27	1.05	1.54	0.012
>10	490 (33.7)	2.26	1.89	2.69	<0.001	1.34	1.04	1.72	0.026	1.46	1.17	1.83	0.001
		Bone fractures (N=629)
PIM	n (%)
No	188 (29.9)	1				1				1
Yes	441 (70.1)	1.5	1.24	1.8	<0.001	1.34	1.07	1.68	0.011	1.33	1.09	1.63	0.005
Polypharmacy	n (%)
0–5	163 (25.9)	1				1				1
6–10	265 (42.1)	1.37	1.11	1.69	0.004	1.29	0.98	1.71	0.067	1.34	1.05	1.71	0.019
>10	201 (32)	1.59	1.26	1.99	<0.001	1.45	1.05	2	0.023	1.59	1.19	2.12	0.002
		Falls (N=615)
PIM	n (%)
No	195 (31.7)	1				1				1
Yes	420 (68.3)	1.35	1.12	1.63	0.001	1.02	0.82	1.26	0.89	1.13	0.93	1.38	0.212
Polypharmacy	n (%)
0–5	156 (25.4)	1				1				1
6–10	254 (41.3)	1.37	1.1	1.7	0.005	1.07	0.81	1.4	0.651	1.19	0.93	1.52	0.174
>10	205 (33.3)	1.71	1.36	2.15	<0.001	1.16	0.85	1.6	0.352	1.39	1.05	1.85	0.023
		Constipation (N=1176)
PIM	n (%)
No	329 (28)	1				1				1
Yes	847 (72)	1.87	1.61	2.17	<0.001	1.31	1.08	1.58	0.005	1.4	1.18	1.66	<0.001
Polypharmacy	n (%)
0–5	237 (20.2)	1				1				1
6–10	492 (41.8)	2	1.68	2.4	<0.001	1.47	1.15	1.87	0.002	1.47	1.19	1.81	<0.001
>10	447 (38)	3.32	2.74	4.01	<0.001	2.03	1.54	2.67	<0.001	2.07	1.62	2.64	<0.001

Abbreviations: CI, Confidence interval; MI, Multiple Imputations; OR, Crude Odds Ratio; aOR, Odds Ratio adjusted for age, gender, ethnicity, weight, serum creatinine, sodium, infection, hypertension, diabetes, heart failure, coronary artery disease, Schizophrenia/bipolar disorder, cognitive impairment, and being under a home healthcare service.