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. 2021 Aug;9(4):e00823.
doi: 10.1002/prp2.823.

Polypharmacy and mortality association by chronic kidney disease status: The REasons for Geographic And Racial Differences in Stroke Study

Winn Cashion  1 , William McClellan  1 , Suzanne Judd  2 , Abhinav Goyal  1 , David Kleinbaum  1 , Michael Goodman  1 , Valerie Prince  3 , Paul Muntner  4 , George Howard  2
Affiliations

Polypharmacy and mortality association by chronic kidney disease status: The REasons for Geographic And Racial Differences in Stroke Study

Winn Cashion et al. Pharmacol Res Perspect. 2021 Aug.

Abstract

Many Americans take multiple medications simultaneously (polypharmacy). Polypharmacy's effects on mortality are uncertain. We endeavored to assess the association between polypharmacy and mortality in a large U.S. cohort and examine potential effect modification by chronic kidney disease (CKD) status. The REasons for Geographic And Racial Differences in Stroke cohort data (n = 29 627, comprised of U.S. black and white adults) were used. During a baseline home visit, pill bottle inspections ascertained medications used in the previous 2 weeks. Polypharmacy status (major [≥8 ingredients], minor [6-7 ingredients], and none [0-5 ingredients]) was determined by counting the total number of generic ingredients. Cox models (time-on-study and age-time-scale methods) assessed the association between polypharmacy and mortality. Alternative models examined confounding by indication and possible effect modification by CKD. Over 4.9 years median follow-up, 2538 deaths were observed. Major polypharmacy was associated with increased mortality in all models, with hazard ratios and 95% confidence intervals ranging from 1.22 (1.07-1.40) to 2.35 (2.15-2.56), with weaker associations in more adjusted models. Minor polypharmacy was associated with mortality in some, but not all, models. The polypharmacy-mortality association did not differ by CKD status. While residual confounding by indication cannot be excluded, in this large American cohort, major polypharmacy was consistently associated with mortality.

Keywords: REGARDS cohort study; chronic kidney disease; epidemiology; mortality; polypharmacy.

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Figures

FIGURE 1
FIGURE 1
Kaplan–Meier all‐cause‐mortality plot according to polypharmacy status (no polypharmacy [green], minor [red], and major [blue]). Log rank p < .0001. fu_years, follow‐up years
FIGURE 2
FIGURE 2
Kaplan–Meier all‐cause‐mortality plot for polypharmacy*CKD status (log rank p‐value < .0001). Green = CKD −, no polypharm; Red = CKD −, minor polypharm; Blue = CKD −, major polypharm; Yellow = CKD +, no polypharm; Pink = CKD +, minor polypharm; Brown = CKD +, major polypharm
See this image and copyright information in PMC

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