Polypharmacy Among 200 000 Subjects of the Population-Based German National Cohort Study (NAKO), Aged 19-74: A...

Polypharmacy is associated with adverse events, reduced quality of life, and increased mortality, but populationbased studies including both prescribed and over-the-counter medications are scarce.

We analyzed baseline data from the German National Cohort (NAKO), Germany’s largest population-based cohort study (recruitment 2014–2019; participants aged 19–74 years at baseline). We estimated the proportion of participants with polypharmacy (defined as reporting regular use of ≥ 5 prescribed and over-the-counter medications) and hyperpolypharmacy (≥ 10 medications), stratified by sex and age. Determinants of polypharmacy were estimated using logistic regression.

Among 203 765 participants (mean age 49.8 years, 50.4% female), 6869 women (6.7%; 95% confidence interval [6.5; 6.8]) and 8126 men (8.0% [7.9; 8.2] reported regular use of ≥ 5 medications. Regular use of ≥ 10 medications was reported by 505 women (0.5% [0.45; 0.54]) and 722 men (0.7% [0.67;0.77]). Polypharmacy and hyperpolypharmacy increased with age. Diabetes and chronic cardiovascular conditions were strong determinants. Use of cardiovascular medications was most frequently reported.

Polypharmacy was common in NAKO, particularly among older participants, men, and persons with cardiovascular disease. Because medication appropriateness could not be assessed, future studies should examine inappropriate polypharmacy and evaluate risk factors and strategies for deprescribing.