The Association Between Sex and Potentially Inappropriate Medication Prescription Among Older Adults with Chronic Kidney Disease
Abstract
Introduction and Objective. The use of potentially inappropriate medications (PIMs) in older adults can result in adverse events, including increased risk of falls, cognitive impairment, and hospitalization. Studies have shown that both PIM prescription and chronic kidney disease (CKD) are more prevalent among females, compared to males, yet to our knowledge, there has not been research to assess the association between sex and PIM prescription in patients with CKD. The purpose of this study was to evaluate whether there is an association between sex and PIM prescription in patients ages 65 and older with CKD. Methods. We performed a secondary analysis of data from the 2015-2018 National Ambulatory Medical Care Survey (NAMCS). Participants of the NAMCS ages 65 and older with reported chronic kidney disease (CKD) or end-stage renal disease (ESRD) were included. The occurrence of the outcome was defined if patients were prescribed at least one medication for which there was a strong recommendation to avoid according to the 2015 American Geriatrics Society Beers Criteria for Potentially Inappropriate Medication use in Older Adults. To assess the association between sex and the outcome, uni- and multivariable binary logistic regression analyses were performed to calculate unadjusted and adjusted odds ratios (OR) with corresponding 95% confidence intervals (CI). Stata software, version 15, was used for all analyses. Results. A total of 912 participants with chronic kidney disease were assessed. 29.3% were prescribed PIMs. Prevalence of PIM use was greater among females (37.6% versus 21.0% in males, p-value = 0.007). The unadjusted odds ratio for being prescribed at least one PIM in females compared to males was 2.3 (95% confidence interval (CI) = 1.2-4.1). After adjusting for patient age, total number of chronic conditions, and primary care provider status, the odds ratio was 2.2 (95% CI = 1.2-4.0). Furthermore, for each additional chronic condition reported for a patient, the odds of being prescribed a PIM increased by 16% (OR 1.2; 95% CI = 1.0-1.3). Conclusions-Implications. This study shows that the odds of females ages 65 and older with chronic kidney disease receiving a PIM prescription was over double that of their male counterparts, independent of other risk factors. Such findings warrant concerns. Further longitudinal studies systematically assessing kidney function and medication prescription are needed. Additional research should be done to investigate reasons for this mismatch, evaluate its potential implications, and identify solutions to narrow this gap in healthcare.
Abstract Category
14. Internal Medicine
Secondary Abstract Category
11. Health Disparities
Keywords
geriatrics; potentially inappropriate medication; Beers Criteria; chronic kidney disease
Presentation Type
Poster Presentation
The Association Between Sex and Potentially Inappropriate Medication Prescription Among Older Adults with Chronic Kidney Disease
Introduction and Objective. The use of potentially inappropriate medications (PIMs) in older adults can result in adverse events, including increased risk of falls, cognitive impairment, and hospitalization. Studies have shown that both PIM prescription and chronic kidney disease (CKD) are more prevalent among females, compared to males, yet to our knowledge, there has not been research to assess the association between sex and PIM prescription in patients with CKD. The purpose of this study was to evaluate whether there is an association between sex and PIM prescription in patients ages 65 and older with CKD. Methods. We performed a secondary analysis of data from the 2015-2018 National Ambulatory Medical Care Survey (NAMCS). Participants of the NAMCS ages 65 and older with reported chronic kidney disease (CKD) or end-stage renal disease (ESRD) were included. The occurrence of the outcome was defined if patients were prescribed at least one medication for which there was a strong recommendation to avoid according to the 2015 American Geriatrics Society Beers Criteria for Potentially Inappropriate Medication use in Older Adults. To assess the association between sex and the outcome, uni- and multivariable binary logistic regression analyses were performed to calculate unadjusted and adjusted odds ratios (OR) with corresponding 95% confidence intervals (CI). Stata software, version 15, was used for all analyses. Results. A total of 912 participants with chronic kidney disease were assessed. 29.3% were prescribed PIMs. Prevalence of PIM use was greater among females (37.6% versus 21.0% in males, p-value = 0.007). The unadjusted odds ratio for being prescribed at least one PIM in females compared to males was 2.3 (95% confidence interval (CI) = 1.2-4.1). After adjusting for patient age, total number of chronic conditions, and primary care provider status, the odds ratio was 2.2 (95% CI = 1.2-4.0). Furthermore, for each additional chronic condition reported for a patient, the odds of being prescribed a PIM increased by 16% (OR 1.2; 95% CI = 1.0-1.3). Conclusions-Implications. This study shows that the odds of females ages 65 and older with chronic kidney disease receiving a PIM prescription was over double that of their male counterparts, independent of other risk factors. Such findings warrant concerns. Further longitudinal studies systematically assessing kidney function and medication prescription are needed. Additional research should be done to investigate reasons for this mismatch, evaluate its potential implications, and identify solutions to narrow this gap in healthcare.