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Mixed Bag “Polypharmacy”: Methodological Pitfalls and Challenges of This Exposure Definition

  • Pharmacoepidemiology (U Haug, Section Editor)
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Abstract

Purpose of Review

The use of multiple medications is common in older adults but is associated with negative health outcomes. However, polypharmacy is not uniformly defined, and there is scant data on how the variety of definitions and their limitations hinder the development of sound scientific knowledge. The article intends to illustrate the challenges of this exposure definition.

Recent Findings

The array of thresholds for defining polypharmacy renders comparisons between results difficult. Few studies take into account the fact that polypharmacy is a changing exposure over time. In addition, although studies tend to recognize the confounding effect of multimorbidity, residual bias remains a concern.

Summary

Current studies in polypharmacy often ignore basic epidemiological principles for defining exposure. Future research should integrate time-varying exposure and methods to better control confounding bias. This will help determine the positive/negative impacts of polypharmacy and help establish if polypharmacy conveys information beyond being a marker of health status.

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References

Papers of particular interest, published recently, have been highlighted as: • Of importance •• Of major importance

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Authors and Affiliations

  1. Department of Social and Preventive Medicine, Laval University, Quebec, Canada

    Caroline Sirois, Emmanuelle Gosselin & Marie-Eve Gagnon

  2. Centre of Excellence on Aging of Quebec, CIUSSS-CN, Quebec, Canada

    Caroline Sirois, Emmanuelle Gosselin & Marie-Eve Gagnon

  3. Centre de recherche sur les soins et les services de première ligne de l’Université Laval, Quebec, Canada

    Caroline Sirois, Emmanuelle Gosselin & Marie-Eve Gagnon

  4. Institut national de santé publique du Québec, Quebec, Canada

    Caroline Sirois & Marc Simard

  5. Centre of Pharmacovigilance and Pharmacoepidemiology, University Hospital of Limoges, Limoges, France

    Barbara Roux & Marie-Laure Laroche

  6. INSERM UMR 1248, Faculty of Medicine, University of Limoges, Limoges, France

    Barbara Roux & Marie-Laure Laroche

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  1. Caroline Sirois
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Correspondence to Caroline Sirois.

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Caroline Sirois reports grants from the Fonds de recherche du Québec-Santé and from the Centre de recherche sur les soins et les services de première ligne de l’Université Laval. Marie-Eve Gagnon receives a scholarship from the Fonds de recherche du Québec-Santé. Marc Simard, Emmanuelle Gosselin, Barbara Roux, and Marie-Laure Laroche declare no conflict of interest.

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Sirois, C., Simard, M., Gosselin, E. et al. Mixed Bag “Polypharmacy”: Methodological Pitfalls and Challenges of This Exposure Definition. Curr Epidemiol Rep 6, 390–401 (2019). https://doi.org/10.1007/s40471-019-00214-4

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