Association between polypharmacy and death: A systematic review and meta-analysis

Area of Science:

• Gerontology
• Clinical Pharmacy
• Epidemiology

Background:

• Polypharmacy is a growing concern, especially in older adults, and is associated with numerous adverse health outcomes.
• Understanding the link between polypharmacy and mortality is crucial for improving patient care and public health strategies.

Purpose of the Study:

• To systematically review and meta-analyze existing literature on the association between polypharmacy and mortality.
• To quantify the risk of death associated with different definitions and thresholds of polypharmacy.

Main Methods:

• A comprehensive literature search was conducted across major databases (EMBASE, PubMed, Scopus, International Pharmaceutical Abstracts) up to June 2016.
• Eligible studies investigating the polypharmacy-mortality link were included. Data extraction and meta-analysis using random effect models were performed.
• Heterogeneity was assessed using the I-squared statistic to evaluate the variability across studies.

Main Results:

• Forty-seven studies were included, revealing significant heterogeneity (I²=91.5%).
• Polypharmacy, defined discretely, showed a significant association with death (aOR 1.08; 95% CI 1.04-1.12).
• A dose-response relationship was observed categorically, with increasing medication numbers (5, 6-9, and ≥10) significantly associated with higher mortality risk (aORs ranging from 1.24 to 1.96).

Conclusions:

• Polypharmacy is robustly associated with an increased risk of mortality, regardless of its definition.
• While causality is not definitively established, the findings emphasize the critical need for judicious medication prescribing to balance risks and benefits.
• Healthcare delivery models should prioritize optimizing medication regimens to mitigate polypharmacy-related harms.