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Are there socioeconomic inequalities in polypharmacy among older people? A systematic review and meta-analysis

Lookup NU author(s): Anum Iqbal, Dr Charlotte RichardsonORCiD, Hannah O'Keefe, Professor Barbara Hanratty, Professor Fiona MatthewsORCiD, Professor Adam ToddORCiD



This work is licensed under a Creative Commons Attribution 4.0 International License (CC BY 4.0).


© 2023, The Author(s).Background: Socioeconomic status (SES) may influence prescribing, concordance and adherence to medication regimens. This review set out to investigate the association between polypharmacy and an individual’s socioeconomic status. Methods: A systematic review and meta-analyses of observational studies was conducted across four databases. Older people (≥ 55 years) from any healthcare setting and residing location were included. The search was conducted across four databases: Medline (OVID), Web of Science, Embase (OVID) and CINAHL. Observational studies from 1990 that reported polypharmacy according to SES were included. A random-effects model was undertaken comparing those with polypharmacy (≥ 5 medication usage) with no polypharmacy. Unadjusted odds ratios (ORs), 95% confidence intervals (CIs) and standard errors (SE) were calculated for each study. Results: Fifty-four articles from 13,412 hits screened met the inclusion criteria. The measure of SES used were education (50 studies), income (18 studies), wealth (6 studies), occupation (4 studies), employment (7 studies), social class (5 studies), SES categories (2 studies) and deprivation (1 study). Thirteen studies were excluded from the meta-analysis. Lower SES was associated with higher polypharmacy usage: individuals of lower educational backgrounds displayed 21% higher odds to be in receipt of polypharmacy when compared to those of higher education backgrounds. Similar findings were shown for occupation, income, social class, and socioeconomic categories. Conclusions: There are socioeconomic inequalities in polypharmacy among older people, with people of lower SES significantly having higher odds of polypharmacy. Future work could examine the reasons for these inequalities and explore the interplay between polypharmacy and multimorbidity.

Publication metadata

Author(s): Iqbal A, Richardson C, Iqbal Z, O'Keefe H, Hanratty B, Matthews FE, Todd A

Publication type: Article

Publication status: Published

Journal: BMC Geriatrics

Year: 2023

Volume: 23

Issue: 1

Online publication date: 18/03/2023

Acceptance date: 20/02/2023

Date deposited: 04/04/2023

ISSN (electronic): 1471-2318

Publisher: BioMed Central Ltd


DOI: 10.1186/s12877-023-03835-z

PubMed id: 36934249


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