Time Windows Used When Identifying Current Drug Use and Polypharmacy.

内容摘要

The length of the time window used to assess "current drug use" or "number of medications used" will influence the estimates hereof; however, no consensus exists on the optimal width of such time windows. We aimed to explore how the estimated prevalence of drug use in general, and of polypharmacy in particular, is affected by definitions used. We conducted a drug-utilization study divided into two parts. In the first part, we focused on current drug use. Using population-based registries from Denmark, we identified adults (i.e., individuals aged ≥ 18) during 2020-2022, and among them, current use of different drugs, including those with typically chronic or episodic patterns of use. The second part of the study focused on polypharmacy. We estimated its prevalence, based on different definitions, using population-based registries from Denmark in a cohort of older adults (i.e., individuals aged ≥ 65) in 2022. We also evaluated the accuracy of different criteria for predicting polypharmacy using simulations. Evaluating current drug use, the proportion of individuals classified as exposed increased with the length of the time window for all drugs, reaching a plateau considering a 120-150-day window for statins, glucose-lowering drugs, and selective serotonin reuptake inhibitors, and a 180-300-day window for opioids, whereas no plateau was reached for non-steroidal anti-inflammatory drugs within 360 days. The prevalence of polypharmacy ranged from 21% (10 different 4th level Anatomical Therapeutic Chemical (ATC) groups in 1 year) to 92% (two different 4th level ATC groups in 1 year) depending on the applied definition. In the simulation, the best criterion for identifying polypharmacy required at least two dispensations during the one-year study period for each of at least five drugs, with sensitivity ranging between 0.93 and 1.0, and specificity between 0.72 and 1.0. Time windows up to 120 days are too short to identify baseline drug use in the Danish setting. How polypharmacy is defined significantly influences its estimate, suggesting a need to use multiple definitions in each study. “Current drug use” is estimated in most pharmacoepidemiological studies. However, the impact of using different time window lengths is rarely investigated. The definition of such baseline drug use itself varies substantially—for example it may be based on prescriptions filled within the last 60, 90 or 120 days prior to, for example, cohort entry. In this study, we explored how the length of the time window considered influences the estimated prevalence of “current drug use” using Danish registry data. We observed that such prevalence was considerably underestimated when time windows shorter than 120 days were considered. We also investigated how both the number of different concomitant drugs and the time window considered affected the estimated prevalence of polypharmacy. Our findings show that these factors substantially influence the estimated prevalence, underscoring the need to include multiple definitions of polypharmacy within each study.