中国社区老年人潜在不适当用药发生率及相关因素的Meta分析

Prevalence and Associated Factors of Potentially Inappropriate Medication in Community-dwelling Older Adults in China:a Meta-analysis

背景随着人口老龄化程度日益加深,老年人多病共存和多重用药现象明显增加,易发生潜在不适当用药。潜在不适当用药与不良健康结局相关。目的系统评价中国社区老年人潜在不适当用药发生率及相关因素,旨在为制定干预策略提供依据。方法于2022年6月,检索中国知网、维普中文科技期刊全文数据库、万方数据知识服务平台、中国生物医学文献数据库、PubMed、EmBase和Web of Science,获取有关中国社区老年人潜在不适当用药发生率及相关因素的文献,检索时限均为建库至2022年6月。由2名研究者独立筛选文献、提取数据后,采用美国卫生保健质量和研究机构推荐的横断面研究质量评价工具评价文献质量。采用Stata 12.0软件进行Meta分析。结果共纳入24篇文献,其中2篇文献质量为高,22篇文献质量中等。Meta分析结果显示,中国社区老年人潜在不适当用药发生率为34.8%[95%CI(31.3%,38.3%)],其发生潜在不适当用药的相关因素有年龄≥75岁[OR(95%CI)=1.261(1.074,1.481)]、合并多病(≥5种)[OR(95%CI)=3.287(1.405,7.691)]、用药数量≥5种[OR(95%CI)=1.800(1.305,2.481)]和用药数量≥10种[OR(95%CI)=4.380(2.612,7.347)]。结论中国社区老年人潜在不适当用药发生率较高,高龄、合并多病、用药数量多是社区老年人发生潜在不适当用药的危险因素,应重视对具有上述特征的社区老年人群潜在不适当用药的预防和干预管理。

Background As population aging progresses,the prevalence of multimorbidity and polypharmacy is increasing in older adults,which may increase the risk of potentially inappropriate medication,causing adverse health outcomes.Objective To systematically assess the prevalence and associated factors of potentially inappropriate medication in communitydwelling Chinese older adults,in order to provide a reference for developing relevant intervention strategies.Methods In June 2022,we searched databases of CNKI,CQVIP,Wanfang Data,SinoMed,PubMed,EmBase,and Web of Science from inception to June 2022 for studies on potentially inappropriate medication in community-dwelling older adults in China.Two reviewers independently selected studies,extracted data and assessed the quality of included studies according to the Agency for Healthcare Research and Quality methodology checklist.Meta-analysis was conducted using Stata 12.0.Results A total of 24 studies were included,including two with high quality and 22 with moderate quality.Meta-analysis showed that the pooled prevalence of potentially inappropriate medication was 34.8%[95%CI(31.3%,38.3%)]in community-dwelling older adults in China.Pooled estimates showed 75 years or above[OR(95%CI)=1.261(1.074,1.481)],five or more comorbidities [OR(95%CI)=3.287(1.405,7.691)],and taking five or more medications[OR(95%CI)=1.800(1.305,2.481)]or taking 10 or more medications[OR(95%CI)=4.380(2.612,7.347)]were associated factors of potentially inappropriate medication.Conclusion Potentially inappropriate medication is common in community-dwelling older adults in China,whose risk is associated with older age,multimorbidity and polypharmacy.Prevention and management of potentially inappropriate medication should be paid attention to individuals with the above characteristics.