Is potentially inappropriate prescribing in UK middle-aged adults associated with healthcare utilisation and mortality? A prospective cohort study of a 1.2 million patient cohort conducted in the clinical practice research datalink.

Abstract

To estimate the prevalence of potentially inappropriate prescribing (PIP) in UK middle-aged adults, identify patient-level factors associated with PIP and its associations with subsequent primary care utilisation and mortality. A prospective observational cohort study. English routinely collected primary care electronic health record data from the Clinical Practice Research Datalink Aurum. The follow-up period was from 1 January 2018 to 7 February 2023. Randomly selected individuals (n=1 200 000) who were aged 45-64 years on 1 January 2018. Exposure was defined as at least one episode of PIP in the year 2018. The primary outcome was the rate of GP consultations in the year following exposure (2019). The secondary outcome was mortality between 2019 and 2023. 13.9% of participants experienced PIP in 2018. Factors significantly associated with PIP included polypharmacy (≥10 medications: OR 6.93, 95% CI 6.61 to 7.27), multimorbidity (OR 2.47, 95% CI 2.45 to 2.50), female sex (OR 1.14, 95% CI 1.13 to 1.16), older age (OR 1.01 95% CI 1.01 to 1.02) and higher primary care consultation frequency (OR 1.04 95% CI 1.04 to 1.04). PIP was associated with increased primary care consultations the following year (IRR 1.03, 95% CI 1.02 to 1.03) but not mortality (HR 0.99, 95% CI 0.93 to 1.04). One in seven middle-aged adults were exposed to PIP and PIP resulted in higher subsequent primary care consultations; medicine optimisation strategies for PIP warrant evaluation in middle aged adults.