Table 3.
Factors Associated with Potentially Inappropriate Prescribing among US Medicare Older Adults According to 2012 Beers Criteria.
| Characteristic | Level | N | % with PIP | ORc (95% IC) | ORa (95% IC) |
|---|---|---|---|---|---|
| Year | 2007 * | 210,878 | 37.6 | 1 | 1 |
| 2008 | 212,813 | 36.2 | 0.94 (0.93–0.96) | 0.94 (0.93–0.96) | |
| 2009 | 213,759 | 35.7 | 0.92 (0.90–0.95) | 0.92 (0.90–0.95) | |
| 2010 | 214,356 | 35.4 | 0.91 (0.89–0.93) | 0.91 (0.89–0.94) | |
| 2011 | 221,730 | 35.1 | 0.90 (0.88–0.93) | 0.92 (0.89–0.94) | |
| 2012 | 234,580 | 34.2 | 0.86 (0.84–0.89) | 0.90 (0.87–0.93) | |
| Patient Characteristics | |||||
| Age Group (year) | 66–69 * | 237,936 | 33.4 | 1 | 1 |
| 70–74 | 309,311 | 32.1 | 0.94 (0.90–0.98) | 0.90 (0.86–0.94) | |
| 75–79 | 261,074 | 34.4 | 1.04 (0.99–1.10) | 0.89 (0.84–0.94) | |
| 80–84 | 230,185 | 37.2 | 1.18 (1.12–1.25) | 0.92 (0.87–0.97) | |
| 85+ | 269,610 | 41.7 | 1.42 (1.35–1.50) | 0.94 (0.89–1.00) | |
| Sex | Male * | 446,165 | 32.9 | 1 | 1 |
| Female | 861,951 | 37.1 | 1.21 (1.16–1.26) | 1.12 (1.07–1.17) | |
| Race/Ethnicity | White * | 1,110,223 | 35.3 | 1 | 1 |
| African-American | 109,337 | 39.5 | 1.19 (1.12–1.27) | 0.93 (0.86–1.00) | |
| Hispanic | 33,035 | 38.1 | 1.13 (1.01–1.26) | 0.83 (0.74–0.93) | |
| Asian | 31,875 | 33.8 | 0.93 (0.83–1.04) | 0.83 (0.74–0.94) | |
| Non American Native | 4,713 | 38.1 | 1.13 (0.85–1.50) | 0.85 (0.64–1.13) | |
| Other | 17,160 | 32.6 | 0.88 (0.74–1.06) | 0.92 (0.76–1.11) | |
| Unknown | 1,773 | 33.6 | 0.93 (0.60–1.44) | 0.75 (0.45–1.23) | |
| Region | Northeast * | 244,361 | 34.1 | 1 | 1 |
| South | 514,112 | 37.2 | 1.14 (1.08–1.20) | 1.17 (1.10–1.24) | |
| West | 224,873 | 36.7 | 1.12 (1.05–1.19) | 1.28 (1.20–1.37) | |
| North-Central | 321,371 | 33.9 | 0.99 (0.93–1.05) | 1.03 (0.97–1.10) | |
| Charlson Comorbidities | |||||
| Myocardial Infarction | No | 1,228,373 | 35.1 | 1 | 1 |
| Yes | 79,743 | 44.9 | 1.51 (1.43–1.59) | 0.77 (0.72–0.81) | |
| CHF | No * | 1,063,952 | 30.7 | 1 | 1 |
| Yes | 244,164 | 57.5 | 3.07 (2.95–3.18) | 1.96 (1.88–2.04) | |
| Peripheral Vascular Disease | No * | 1,020,341 | 33.2 | 1 | 1 |
| Yes | 287,775 | 44.3 | 1.60 (1.54–1.65) | 0.98 (0.94–1.02) | |
| Cerebrovascular Disease | No * | 1,052,687 | 33.3 | 1 | 1 |
| Yes | 255,429 | 45.4 | 1.67 (1.61–1.72) | 1.05 (1.01–1.09) | |
| Dementia | No * | 1,196,587 | 33.5 | 1 | 1 |
| Yes | 111,529 | 58.8 | 2.83 (2.70–2.97) | 1.77 (1.68–1.87) | |
| Chronic Pulmonary Disease | No * | 843,744 | 31.9 | 1 | 1 |
| Yes | 464,372 | 42.5 | 1.58 (1.53–1.63) | 0.97 (0.94–1.01) | |
| Connective
Tissue/Rheumatic Disease |
No * | 1,235,615 | 35.3 | 1 | 1 |
| Yes | 72,501 | 42.5 | 1.36 (1.27–1.45) | 1.04 (0.97–1.11) | |
| Peptic Ulcer Disease | No * | 1,277,442 | 35.4 | 1 | 1 |
| Yes | 30,674 | 48.7 | 1.74 (1.62–1.86) | 1.23 (1.14–1.33) | |
| Mild Liver Disease | No * | 1,246,407 | 35.3 | 1 | 1 |
| Yes | 61,709 | 42.2 | 1.34 (1.26–1.42) | 1.05 (0.99–1.12) | |
| DM without complications | No * | 850,741 | 31.8 | 1 | 1 |
| Yes | 457,375 | 42.8 | 1.60 (1.55–1.66) | 1.12 (1.07–1.16) | |
| Paraplegia and Hemiplegia | No * | 1,298,889 | 35.5 | 1 | 1 |
| Yes | 9,227 | 54.4 | 2.16 (1.88–2.48) | 1.20 (1.03–1.40) | |
| Renal Disease | No * | 1,149,109 | 34.2 | 1 | 1 |
| Yes | 159,007 | 46.4 | 1.66 (1.59–1.74) | 0.90 (0.86–0.95) | |
| DM with chronic complications | No * | 1,159,769 | 34.1 | 1 | 1 |
| Yes | 148,347 | 48.1 | 1.79 (1.71–1.88) | 1.02 (0.96–1.08) | |
| Cancer | No * | 1,119,446 | 35.9 | 1 | 1 |
| Yes | 188,670 | 34.1 | 0.92 (0.88–0.97) | 0.89 (0.85–0.94) | |
| Moderate or
Severe Liver Disease |
No * | 1,303,360 | 35.6 | 1 | 1 |
| Yes | 4,756 | 55.7 | 2.27 (1.86–2.78) | 1.43 (1.16–1.78) | |
| Metastatic Carcinoma | No * | 1,285,287 | 35.6 | 1 | 1 |
| Yes | 22,829 | 37.6 | 1.09 (1.00–1.19) | 0.96 (0.87–1.05) | |
| AIDS/HIV | No * | 1,306,918 | 35.7 | 1 | 1 |
| Yes | 1,198 | 40.3 | 1.22 (0.80–1.85) | 0.90 (0.60–1.36) | |
| Healthcare utilization | |||||
| Prescription Drug Use | |||||
| # of Prescription Fills in Month | |||||
| 1–2* | 440,632 | 18.4 | 1 | 1 | |
| 3–4 | 348,296 | 30.2 | 1.92 (1.87–1.96) | 1.76 (1.71–1.81) | |
| 5–9 | 401,440 | 48.6 | 4.18 (4.05–4.32) | 3.38 (3.25–3.50) | |
| 10+ | 117,748 | 72.4 | 11.59 (11.01–12.21) | 7.51 (7.09–7.94) | |
| Polypharmacy (≥5 drugs) | No * | 788,928 | 23.6 | 1 | - |
| Yes | 519,188 | 54.0 | 3.79 (3.69–3.90) | - | |
| Any Outpatient Office Visits | None * | 87,134 | 42.4 | 1 | 1 |
| 1+ | 1,220,982 | 35.2 | 0.74 (0.70–0.78) | 1.01 (0.94–1.07) | |
| None * | 87,134 | 42.4 | 1 | 1 | |
| # of Outpatient Office Visits | 1–6 | 529,284 | 31.0 | 0.61 (0.58–0.65) | 0.98 (0.92–1.04) |
| 7–12 | 388,015 | 34.4 | 0.71 (0.67–0.76) | 1.00 (0.93–1.06) | |
| 13+ | 303,683 | 43.4 | 1.04 (0.98–1.11) | 1.13 (1.05–1.63) | |
| Any Emergency Visit | None * | 859,550 | 30.3 | 1 | 1 |
| 1+ | 448,566 | 45.9 | 1.95 (1.90–2.00) | 1.23 (1.19–1.26) | |
| # of Emergency Visits | None * | 859,550 | 30.3 | 1 | 1 |
| 1 | 240,605 | 40.3 | 1.55 (1.51–1.59) | 1.15 (1.12–1.19) | |
| 2–5 | 186,957 | 51.2 | 2.41 (2.33–2.49) | 1.33 (1.28–1.38) | |
| 6+ | 21,004 | 63.9 | 4.07 (3.76–4.41) | 1.48 (1.35–1.63) | |
| Any Hospital Admission | None * | 1,002,331 | 31.6 | 1 | 1 |
| 1+ | 305,785 | 49.1 | 2.09 (2.03–2.14) | 0.97 (0.87–1.09) | |
| # of Prescribers in Month | 1 * | 754,195 | 30.2 | 1 | 1 |
| 2 | 358,150 | 38.8 | 1.46 (1.43–1.50) | 1.07 (1.03–1.12) | |
| 3+ | 195,771 | 50.9 | 2.39 (2.31–2.47) | 1.06 (1.00–1.12) | |
| # of
Prescriber Specialties in Month |
1 * | 844,217 | 31.3 | 1 | 1 |
| 2 | 363,642 | 41.0 | 1.53 (1.49–1.56) | 0.96 (0.91–1.01) | |
| 3+ | 100,257 | 53.4 | 2.52 (2.42–2.63) | 1.00 (0.92–1.08) | |
| Prescriber Specialty | |||||
| Geriatrician Prescriber | No * | 1,276,492 | 35.5 | 1 | 1 |
| Yes | 31,624 | 43.5 | 1.40 (1.27–1.54) | 0.89 (0.79–0.99) | |
| GP/FP/Internist Prescriber | No * | 284,470 | 31.5 | 1 | 1 |
| Yes | 1,023,646 | 36.8 | 1.27 (1.22–1.31) | 0.99 (0.95–1.04) | |
| Other Specialty Prescriber | No * | 749,063 | 33.2 | 1 | 1 |
| Yes | 559,053 | 39.0 | 1.28 (1.25–1.32) | 1.08 (1.03–1.12) |
PIP: Potentially Inappropriate Prescribing; ORc: Odds Ratio Crude; ORa: Odds Ratio Adjusted; GP: General Practitioner; NAN: North American Native; DM: Diabetes Mellitus; CHF: Congestive Heart Failure, AIDS/HIV: Acquired immune deficiency syndrome/Human immunodeficiency virus; FP: Family Practitioner; 95% CI: 95% confidence intervals; *: reference group;