Economic, cultural and social inequalities in potentially inappropriate medication-An Austrian perspective

Inappropriate prescribing remains a global challenge with implications for patient outcomes and healthcare costs. A recent Danish nationwide study investigated potentially inappropriate medications (PIMs), defined using a modified screening tool of older persons' prescriptions (STOPP)/screening tool to alert to right treatment (START) framework and their associations with socioeconomic and sociocultural factors. The STOPP-defined PIMs, indicating potential overtreatment, were present in 3.1% and strongly associated with lower income, education, limited social support and living alone, while START-defined PIMs (12.5%), reflecting potential undertreatment, showed no such associations. These findings highlight the role of socioeconomic and cultural determinants for obtaining optimal care, even within a universal healthcare system, which minimizes cost-related barriers.This article provides an Austrian perspective on this important topic. Available Austrian (and international) data confirm socioeconomic status as a key driver of polypharmacy and PIM exposure, although patterns vary across regions and populations. Broader evidence links PIMs to higher costs, reduced quality of life and increased hospitalizations. Addressing this complex issue requires multifaceted strategies: strengthening health literacy, educating healthcare professionals and fostering multidisciplinary collaboration, integrating deprescribing into clinical care and targeting vulnerable groups such as those with low socioeconomic status or migration backgrounds. Effective implementation of these measures may improve equity, safety and sustainability in pharmacotherapy.