Disparities in High-Risk Medication Use—Implications for Health Equity and Deprescribing Practices
Year: 2025
Type: article
Abstract: Potentially inappropriate medication (PIM) use-defined as the use of high-risk medications that can increase the risk of adverse events such as physical, cognitive, and functional decline; delirium; hospitalizations; and mortality-remains a significant concern in older adults in the US.Numerous guidelines, including the American Geriatrics Society Beers Criteria 1 and the STOPP criteria, 2 define PIMs as medications for which the risk of adverse effects outweighs potential benefits or are inappropriate for specific populations or disease states, such dementia or kidney disease.PIM use may be particularly harmful in populations experiencing other health care disparities, as communities experiencing other consequences of health care inequity, including limited access to physicians or pharmacies, greater financial stress, and a higher comorbidity burden, may experience disproportionate effects from the adverse consequences of PIM use.To examine potential racial and ethnic disparities in PIM use, Raver and colleagues 3 analyzed claims data from more than 21 million Medicare beneficiaries between 2016 and 2019, examining racial and ethnic differences in 3 medication use outcomes: (1) high-risk medication use among older adults, (2) potentially harmful drug-disease interactions in patients with dementia, and (3) potentially harmful drug-disease interactions in patients with a history of falls.The authors also stratified their analyses by Medicare plan type, including traditional Medicare (TM) and Medicare Advantage (MA).The authors found that individuals from racial and ethnic minoritized groups (ie, Asian or Pacific Islander, Black, and Hispanic) had lower rates of high-risk medication use in all 3 outcomes compared with White beneficiaries, with smaller disparities observed among MA compared with TM beneficiaries.A key strength of the analysis is its reliance on existing Healthcare Effectiveness Data and Information Set quality measures, which will enable others to perform comparisons across time and within and across health insurance plans and health systems.Additionally, the focus on 2 highly vulnerable populations-individuals with dementia and those with a history of falls-is particularly important, as polypharmacy and PIM use in these groups can disproportionately worsen cognitive, physical, and functional decline.To account for potentially important confounding factors, Raver et al 3 included measures to adjust for differences in socioeconomic status at the zip code level.This is an important consideration, as lower socioeconomic status can limit access to health care, including specialists, and contribute to the presence of pharmacy deserts, where access to prescription medications is constrained.At first glance, the lower use of PIMs among minoritized racial and ethnic groups appears to be a positive finding, especially considering the many health disparities these populations face in the US.However, these findings may mask important underlying factors that require further investigation.Residual confounding by individual-level socioeconomic status may persist despite the zip code-level adjustments performed in this analysis.As the authors note, lower PIM use among minoritized populations could reflect lower overall prescription drug use, which may be driven by limited access to physicians and pharmacies or the higher costs of health care.For instance, 36% of Black adults and 33% of Hispanic adults report difficulties affording prescription medications, compared with 24% of non-Hispanic White adults.4 Additionally, a greater proportion of Black adults (21%) and Hispanic adults (32%) substitute prescription medications with over-the-counter alternatives, compared with 17% of non-Hispanic White adults.4 This reliance on over-the-counter +
Source: JAMA Network Open
Authors: Michelle S. Keller, Utibe R. Essien
Language: English
Subfield: Geriatrics and Gerontology
Field: Medicine
Domain: Health Sciences
Open Access status: gold
Estimated APC paid: $3,000
Award: G6789731997
OpenAlex ID: W4409413687