Polypharmacy and Health-Related Quality of Life/Psychological Distress Among Patients With Chronic Disease

Abstract

Introduction: To date, no study has investigated the impact of polypharmacy (use of ≥5 medications concurrently) on health-related quality of life (HRQOL) and psychological distress in a combined sample of chronic disease patients and patients with multimorbidity, using diverse HRQOL measures. This study aimed to explore the association between polypharmacy and HRQOL/psychological distress by using data from a cross-sectional study in Flanders (Belgium).

Methods: We analyzed cross-sectional survey data on 544 chronically ill patients recruited from June 2019 through June 2021. HRQOL was measured with the EuroQol-5 Dimension-5 Level questionnaire (EQ-5D-5L) and the 12-Item Short Form Health Survey (SF-12); psychological distress was measured with the Hospital Anxiety and Depression Scale (HADS). Multiple linear regression models were built to assess the association between polypharmacy and HRQOL/psychological distress.

Results: Overall, compared with patients without polypharmacy, patients with polypharmacy reported worse EQ-5D-5L index values, EuroQol visual analogue scale (EQ-VAS) scores, SF-12 physical component scores (PCS), SF-12 mental component scores (MCS), and HADS anxiety and depression subscales. In the final regression model adjusting for age, sex, educational attainment, and multimorbidity, polypharmacy remained significantly associated with lower HRQOL in terms of the EQ-5D-5L index (β = -0.12; P = .008), EQ-VAS (β = -0.11; P = .01), and SF-12 PCS (β = -0.15; P = .002) but not with psychological distress (HADS) and SF-12 MCS.

Conclusion: This study found that polypharmacy was negatively associated with the physical domain of HRQOL, but not with the mental domain, among patients with chronic diseases. These results may be especially important for patients with multimorbidity, given their greater risk of polypharmacy.

Figure 1

Percentage of patients reporting problems on the 5 EQ-5D-5L dimensions, by whether patient reported polypharmacy, defined in study as use of ≥5 medications. P values were determined by logistic regression and were adjusted for age, sex, educational attainment, and multimorbidity; significance level set at <.05. Abbreviation: EQ-5D-5L, EuroQol-5 Dimension-5 Level questionnaire.

Figure 2

EQ-5D-5L index, EQ-VAS, SF-12 physical component score, SF-12 mental health component score, HADS anxiety subscale, and HADS depression subscale, by medication use. The horizontal bar inside the boxes indicates the median, the x indicates the mean, and the lower and upper ends of the boxes are the first and third quartiles. The whiskers indicate minimum and maximum values. P values were determined by F test (1-way analysis of variance) and adjusted for age, sex, educational attainment, and multimorbidity; significance level set at <.05. Abbreviations: EQ-5D-5L, EuroQol 5 Dimension-5 Level questionnaire; EQ-VAS, EuroQol visual analogue scale; HADS, Hospital Anxiety and Depression Scale; SF-12, 12-Item Short Form Health Survey.