ArticleJournal of the American Geriatrics Society2025
Polypharmacy's Association With Mortality: Confounding From Underlying Morbidity.
Article in Journal of the American Geriatrics Society, 2025. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 6 papers.
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Who cites it
6 citing papers in PubMed.
- Real-world evidence of the impact of polypharmacy on mortality and recovery after hip fracture in elderly patients.Scientific reports · 2026Observational
- Redeemed prescription medicines to measure quality of life of patients with long-term conditions: a national cross-sectional study.BMC medicine · 2026Article
- Evaluation of Beers Criteria Implementation in the Community Pharmacy Setting to Optimize Medication Management for Older Adults-A Pilot Study.Geriatrics (Basel, Switzerland) · 2026Article
- Impact of Traditional Korean Medicine on Reducing Polypharmacy and Potentially Inappropriate Medications in Elderly Stroke Patients: A Retrospective Cohort Study.Journal of multidisciplinary healthcare · 2026Article
- Use of Potentially Inappropriate Medications Identified by STOPPFrail Among Danish Care Home Residents: A Nationwide Drug Utilisation Study.Basic & clinical pharmacology & toxicology · 2025Article
- Polypharmacy's Association With Mortality: Confounding From Underlying Morbidity.Journal of the American Geriatrics Society · 2025Article
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Authors and funding
6 authors.
Funding
Abstract
backgroundStudies consistently associate use of multiple medications with increased mortality. However, such studies often lack adequate adjustment for confounding, particularly from underlying diseases.
objectiveTo illustrate challenges in studying the association between polypharmacy and mortality by examining this relationship in two separate populations.
methodsA register-based nationwide study utilizing a cohort of all Danish citizens admitted to nursing homes 2015-2021 (n = 95,057) and a community dwelling population cohort aged ≥ 65 years (n = 1,005,963). We examined the 1-year mortality using a Kaplan Meier plot from date of nursing home admission or index date and modeled the association between the number of medications used and death using restricted cubic splines with varying levels of adjustment. Further, we modeled the association between the 20 most used drugs and 1-year mortality.
resultsIn the nursing home cohort, we found an approximately linear increase in mortality with the number of medications used. Adjusting for sex, age, and comorbidities markedly attenuated the association from an odds ratio of 4.70 (95% CI: 4.24-5.21) to 2.23 (95% CI: 1.99-2.49). Paradoxical associations were observed for individual drug classes, such as antidementia drugs showing a strong inverse association with mortality. When examining the stability of the number of drugs used over time, we found considerable fluctuations for individual residents. In the community dwelling population cohort, adjustment for covariates showed an even stronger impact on the association, reducing the odds ratio from 10.39 (95% CI: 9.79-11.03) to 1.34 (95% CI: 1.25-1.43). Further, the individual-level use of medication was found to be stable over time in the general population.
conclusionThe association between levels of polypharmacy and mortality is strongly affected by confounding by indication. Basic adjustment for comorbidities attenuates but does not fully eliminate the association, with residual association possibly driven by residual confounding. This emphasizes the need for cautious interpretation of findings associating high use of medication with mortality.
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