Trends of potentially inappropriate prescribing among older outpatients in China between 2015-21

Potentially inappropriate medication (PIM) remains a significant global concern due to its association with adverse drug events in older adults. The prevalence of potentially inappropriate prescriptions (PIPs) varies considerably across different countries. However, there is a lack of evidence using standardised Chinese national criteria to explore variations in prescribing trends. We aimed to evaluate the trends in the prevalence of PIP based on these criteria.

In this descriptive epidemiological study, we utilised prescription data from older outpatients across 59 hospitals in six major geographic regions of China. We analysed the prevalence of PIP overall, as well as the prevalence of PIP caused by varying numbers of PIMs and high-risk PIMs (clopidogrel, estazolam, zolpidem, sliding-scale insulin, alprazolam) for the period between 2015-21. We calculated the average annual percent change (AAPC) using joinpoint regression to examine temporal trends.

A total of 982 605 prescriptions for older outpatients between 2015-21 were included in the analysis. The prevalence of PIP related to multiple PIMs increased from 4.70% to 6.09% (AAPC = 4.45). Notably, the prevalence of PIP associated with estazolam (AAPC = 3.71), zolpidem (AAPC = 13.51), and alprazolam (AAPC = 8.86) demonstrated a steady upward trend, while the prevalence of PIP linked to clopidogrel (AAPC = -4.70) consistently declined.

We observed an increasing trend in PIP associated with sedative-hypnotic medications. It demands heightened attention in subsequent use to ensure drug safety.