Abstract
Background: Older women experience more adverse drug reactions (ADRs) than older men. However, the underlying basis for this sex difference is unclear. Sex (biological status) and/or gender (sociocultural constructs) influences on patterns of inappropriate prescribing in multimorbid older adults may be one reason for this ADR sex difference. In this secondary analysis, we assessed whether potentially inappropriate prescribing sex differences exist that could possibly explain concurrent ADR sex differences.
Design & setting: A retrospective secondary analysis of sex differences in the prevalence of potentially inappropriate medications (PIMs), potential prescribing omissions (PPOs) and ADRs among the 1537 participants (47.2% female, median [IQR] age 78 [72-84] years) in the SENATOR clinical trial, conducted in six large European medical centers.
Participants & methods: We looked specifically for male/female differences relating to PIMs and PPOs (defined by STOPP/START version 2 criteria) identified within 48 hours of acute hospitalization. We also assessed sex differences for ADRs identified at 14 days from admission or discharge, whichever came first. ADRs were assessed by blinded endpoint adjudication panel consensus.
Results: During hospitalization, significantly more females experienced ≥ 1 ADR compared to males (28% and 21%, respectively; odds ratio 1.40, 95% CI 1.10 – 1.78, p<0.005). Nine of the eleven STOPP criteria PIMs showing a significant sex difference occurred more often in females. Of the four START criteria PPOs showing a significant sex difference, all occurred more often in females. Some sex associated PIMs reflect higher prevalence of related conditions in older women.
Conclusion: We conclude that specific STOPP-criteria PIMs and START-criteria PPOs were identified more frequently in older women than older men during acute hospitalization, possibly contributing to higher ADR incidence in older women. Prescribers should appreciate sex differences in exposure to potentially inappropriate prescribing and ADR risk, given the preponderance of older women over older men in most clinical settings.
Design & setting: A retrospective secondary analysis of sex differences in the prevalence of potentially inappropriate medications (PIMs), potential prescribing omissions (PPOs) and ADRs among the 1537 participants (47.2% female, median [IQR] age 78 [72-84] years) in the SENATOR clinical trial, conducted in six large European medical centers.
Participants & methods: We looked specifically for male/female differences relating to PIMs and PPOs (defined by STOPP/START version 2 criteria) identified within 48 hours of acute hospitalization. We also assessed sex differences for ADRs identified at 14 days from admission or discharge, whichever came first. ADRs were assessed by blinded endpoint adjudication panel consensus.
Results: During hospitalization, significantly more females experienced ≥ 1 ADR compared to males (28% and 21%, respectively; odds ratio 1.40, 95% CI 1.10 – 1.78, p<0.005). Nine of the eleven STOPP criteria PIMs showing a significant sex difference occurred more often in females. Of the four START criteria PPOs showing a significant sex difference, all occurred more often in females. Some sex associated PIMs reflect higher prevalence of related conditions in older women.
Conclusion: We conclude that specific STOPP-criteria PIMs and START-criteria PPOs were identified more frequently in older women than older men during acute hospitalization, possibly contributing to higher ADR incidence in older women. Prescribers should appreciate sex differences in exposure to potentially inappropriate prescribing and ADR risk, given the preponderance of older women over older men in most clinical settings.
| Original language | English |
|---|---|
| Pages (from-to) | 3476-3483 |
| Number of pages | 7 |
| Journal | Journal of the American Geriatrics Society |
| Volume | 72 |
| Issue number | 11 |
| Early online date | 9 Jul 2024 |
| DOIs | |
| Publication status | Published - 1 Nov 2024 |
Bibliographical note
AcknowledgementsThis secondary analysis study was supported by a grant provided by the Irish Research Council (grant number GNP-172) as part of the iKASCADE project funded through the European Commission’s GENDERNet research grant scheme.
The SENATOR project was funded by the European Commission’s FP7 Programme (Project No.
305930). The authors wish to express thanks to Dr Darren Dahly, Principal Statistician of the HRB Clinical Research Facility University College Cork (UCC), Ireland and Senior Lecturer in Research Methods in the UCC School of Public Health for his assistance with data extraction and analysis for this brief report.
Keywords
- Sex and gender
- Adverse drug reactions
- Older people
- Polypharmacy
- Potentially inappropriate medication