Abstract
Objectives
Natural health products (NHP) are increasingly being used to supplement prescription medications (PM) and over-the-counter (OTC) products. The objective of this study was to examine patterns of overall health product use and how these patterns are associated with social and health factors.
Methods
We used direct health measures data from the Canada Health Measures Survey (CHMS) Cycle 1.0 (2007/2009) to examine recent product use among adults aged 18–79 years (n=3,721). Latent class analyses were used to detect use (propensity) and intensity of use among users of all three product types. Associations between social and health covariates and product patterns were examined using linear and multinomial logit regression procedures.
Results
Three latent classes of health product use were identified. The largest (43%) was characterized by a high probability of PM and NHP but not OTC use. Class two (37%), in contrast, had a low probability of using any of the three health products. Class three (20%) had a high probability of PM and OTC but not NHP use. Age, gender, immigrant status, household size, co-morbidity, perceived health status, and having a regular doctor were associated with these patterns of use. Analyses of intensity of product use among users revealed seven distinct classes; these were differentiated by age, household size, co-morbidity and weight (BMI status).
Conclusion
If defining polypharmacy or polyherbacy is based simply on number of health products used, then for Canadians under age 80 neither practice appeared to be widespread. More work needs to be done to define the “poly” in polypharmacy and polyherbacy. This will inform the conversation on appropriate product use, particularly given that about one half of Canadians used medications and NHPs concurrently.
Key Words: Polypharmacy, over-the-counter drugs, dietary supplements, nonprescription drugs
Résumé
Objectifs
Les produits de santé naturels (PSN) sont de plus en plus utilisés comme suppléments aux médicaments d’ordonnance (MO) et aux produits en vente libre (VL). L’objectif de cette étude était d’examiner les patrons d’usage de l’ensemble des produits de santé et comment ces patrons sont associés à des facteurs sociaux et sanitaires.
Méthodes
Nous avons utilisé les données du cycle 1.0 (2007-2009) de l’Enquête canadienne sur les mesures de la santé (ECMS) afin d’examiner l’usage récent de produits chez les adultes âgés de 18 à 79 ans (n=3721). Des analyses de classes latentes ont été utilisées pour détecter l’usage (propension) et l’intensité de l’usage chez les utilisateurs des trois types de produits. Les associations entre les covariables sociales et sanitaires et les patrons d’usage des produits ont été examinées à l’aide d’analyses de régression logistique linéaire et multinomiale.
RéSULTATS
Trois classes latentes d’usage des produits de santé ont été identifiées. La plus grande classe (43 %) était caractérisée par une forte probabilité d’usage de MO et de PSN mais pas de VL. Par contre, la 2e classe (37 %) avait une faible probabilité d’utiliser l’un ou l’autre des trois produits de santé. La 3e classe (20 %) avait une forte probabilité d’utiliser les MO et les VL mais pas les PSN. L’âge, le genre, le statut d’immigrant, la taille du ménage, la comorbidité, l’état de santé perçue, et le fait d’avoir un médecin régulier étaient associés avec ces patrons d’usage. L’analyse de l’intensité d’usage des produits chez les utilisateurs a permis d’identifier sept classes distinctes; celles-ci variaient selon l’âge, la taille du ménage, la comorbidité et le poids (indice de masse corporelle).
Conclusion
Si la définition de la polypharmacie et de la polyherbacie est basée seulement sur le nombre de produits consommés, alors aucune des deux pratiques ne semble répandue chez les Canadiens de moins de 80 ans. Plus de travaux sont nécessaires pour définir la « poly » dans la polypharmacie et la polyherbacie. Ceci alimentera la discussion sur l’usage approprié des produits, surtout qu’environ la moitié des Canadiens consomment des médicaments et des PSN en même temps.
Mots Clés: polypharmacie, médicaments en vente libre, suppléments diététiques, médicaments sans ordonnance
Footnotes
Funding Acknowledgement: Canadian Institutes of Health Research (CIHR) Postdoctoral Fellowship for Kristine Votova.
Conflict of Interest: None to declare.
References
- 1.Hoffman F, van den Bussche H, Wiese B, Schön G, Koller D, Eisele M, et al. Impact of geriatric comorbidity and polypharmacy on cholinesterase inhibitors prescribing in dementia. BMC Psychiatry. 2011;11:190–96. doi: 10.1186/1471-244X-11-190. [DOI] [PMC free article] [PubMed] [Google Scholar]
- 2.Jyrkkä J, Mursu J, Enlund H, Lönnroos E. Polypharmacy and nutritional status in elderly people. Curr Opin Clin Nutr Metab Care. 2012;15(1):1–6. doi: 10.1097/MCO.0b013e32834d155a. [DOI] [PubMed] [Google Scholar]
- 3.Hayes BD, Klein-Schartz W, Barrueto F., Jr Polypharmacy and the geriatric patient. Clin Geriatr Med. 2007;23(2):371–90. doi: 10.1016/j.cger.2007.01.002. [DOI] [PubMed] [Google Scholar]
- 4.Hebert R, Raiche M, Dubois M, Gueye NR, Dobuc N, Tousignant M. PRISMA Group. Impact of PRISMA, a coordination-type integrated service delivery system for frail older people in Quebec (Canada): A quasi-experimental study. J Gerontol B Psychol Sci Soc Sci. 2010;65(1):107–18. doi: 10.1093/geronb/gbp027. [DOI] [PubMed] [Google Scholar]
- 5.Ness J, Johnson D, Nisly N. Polyherbacy: Herbal supplements as a form of polypharmacy in older adults. J Gerontol A Biol Sci Med Sci. 2003;58(5):M478. doi: 10.1093/gerona/58.5.M478. [DOI] [PubMed] [Google Scholar]
- 6.Nisly NL, Gryzlak BM, Zimmerman B, Wallace RB. Dietary supplement polypharmacy: An unrecognized public health problem? Evid Based Complement Alternat Med. 2012;7(1):107–13. doi: 10.1093/ecam/nem150. [DOI] [PMC free article] [PubMed] [Google Scholar]
- 7.Nitcher M, Thompson J. For my wellness, not just my illness: North American’s use of dietary supplements. Cult Med Psychiatry. 2006;30:175–222. doi: 10.1007/s11013-006-9016-0. [DOI] [PubMed] [Google Scholar]
- 8.Troppmann L, Johns T, Gray-Donald K. Natural health product use in Canada. Can J Public Health. 2002;93(6):426–30. doi: 10.1007/BF03405030. [DOI] [PMC free article] [PubMed] [Google Scholar]
- 9.Turunen JH, Mäntyselkä PT, Kumpusalo EA, Ahonen RS. Frequent analgesic use at population level: Prevalence and patterns of use. Pain. 2005;115(3):374–81. doi: 10.1016/j.pain.2005.03.013. [DOI] [PubMed] [Google Scholar]
- 10.Pokela N, Bell JS, Lihavainen K, Sulkava R, Hartikainen S. Analgesic use among community-dwelling people aged 75 years and older: A population-based interview study. Am J Geriatr Pharmacother. 2011;8(3):233–44. doi: 10.1016/j.amjopharm.2010.05.001. [DOI] [PubMed] [Google Scholar]
- 11.Mursu J, Robien K, Harnack LJ, Park K, Jacobs DR. Dietary supplements and mortality rate in older women: The Iowa Women’s Health Study. Arch Intern Med. 2011;171(18):1625–33. doi: 10.1001/archinternmed.2011.445. [DOI] [PMC free article] [PubMed] [Google Scholar]
- 12.Klein EA, Thompson IM, Jr, Tangen CM, Crowley JJ, Lucia MS, Goodman PJ, et al. Vitamin E and the risk of prostate cancer: The Selenium and Vitamin E Cancer Prevention Trial (SELECT) JAMA. 2011;306(14):1549–56. doi: 10.1001/jama.2011.1437. [DOI] [PMC free article] [PubMed] [Google Scholar]
- 13.Bjelakovic G, Gluud C. Vitamin and mineral supplement use in relation to allcause mortality in the Iowa Women’s Health Study. Arch Intern Med. 2011;171(18):1633–34. doi: 10.1001/archinternmed.2011.459. [DOI] [PubMed] [Google Scholar]
- 14.Cvijov K, Boon H, Jaeger W, Vohra S. Polypharmacy, multiple natural health products and hepatotoxicity. CMAJ. 2011;183(14):E1085–E1089. doi: 10.1503/cmaj.091948. [DOI] [PMC free article] [PubMed] [Google Scholar]
- 15.Singh SR, Levine MAH. Natural health product use in Canada: Analysis of the National Population Health Survey. Can J Clin Pharmacol. 2006;13(2):e240–e250. [PubMed] [Google Scholar]
- 16.Guo X, Willows N, Kuhle S, Jhangri G, Veugelers PJ. Use of vitamin and mineral supplements among Canadian adults. Can J Public Health. 2009;100(4):357–60. doi: 10.1007/BF03405270. [DOI] [PMC free article] [PubMed] [Google Scholar]
- 17.Green TJ, Barr SI, Chapman GE. The majority of older British Columbians take Vitamin D-containing supplements. Can J Public Health. 2010;101(3):246–50. doi: 10.1007/BF03404383. [DOI] [PMC free article] [PubMed] [Google Scholar]
- 18.McKenzie J, Keller HH. Vitamin-mineral supplementation and use of herbal preparations among community-living older adults. Can J Public Health. 2001;92(4):296–301. doi: 10.1007/BF03404962. [DOI] [PMC free article] [PubMed] [Google Scholar]
- 19.Robson PJ, Siou GL, Ullman R, Bryant HE. Sociodemographic, health and lifestyle characteristics reported by discrete groups of adult dietary supplement users in Alberta, Canada: Findings from the Tomorrow Project. Public Health Nutr. 2008;11(12):1238–47. doi: 10.1017/S136898000800219X. [DOI] [PubMed] [Google Scholar]
- 20.Vermunt JK, Magidson J. Latent class analysis. In: Lewis-Beck MS, Bryman A, Futing Liao T, editors. Encyclopedia of Social Science Research Methods. Thousand Oaks, CA: Sage Publications Ltd.; 2003. pp. 1–21. [Google Scholar]
- 21.Magnusson D, Cairns RB. Developmental science: Towards a unified framework. In: Cairns RB, Elder GH, editors. Developmental Science. Cambridge Studies in Social and Emotional Development. New York, NY: Cambridge Press; 1996. pp. 7–30. [Google Scholar]
- 22.Esmail N. Complementary and alternative medicine in Canada: Trends in use and public attitudes, 1997–2006. The Fraser Institute: Public Policy Sources, 2007;87.
- 23.Grzywacz JG, Suerken CK, Neiberg RH. Age, ethnicity, and use of complementary and alternative medicine in health self-management. J Health Soc Behav. 2007;48:84–98. doi: 10.1177/002214650704800106. [DOI] [PubMed] [Google Scholar]
- 24.Gardiner P, Graham R, Legedza ATR, Ahn AC, Eisenberg DM, Phillips RS. Factors associated with herbal therapy use by adults in the United States. Altern Ther Health Med. 2007;13(2):22–29. [PubMed] [Google Scholar]
- 25.Arcury TA, Grzywacz JG, Bell RA, Neiberg RH, Lang W, Quandt SA. Herbal remedy use as health self-management among older adults. J Gerontol. 2007;62B(2):S142–S149. doi: 10.1093/geronb/62.2.S142. [DOI] [PubMed] [Google Scholar]
- 26.Eisenberg DM, Davis RB, Ettner SL, Appel S, Wilkey S, Van Rompay M, Kessler RC. Trends in alternative medicine use in the United States, 1990–1997: Results of a follow-up national survey. JAMA. 1998;280(18):1569–75. doi: 10.1001/jama.280.18.1569. [DOI] [PubMed] [Google Scholar]
- 27.Boon HS, Verhoef MJ, Vanderheyden LC, Westlake KP. Complementary and alternative medicine: A rising healthcare issue. Healthcare Policy. 2006;1(3):19–30. [PMC free article] [PubMed] [Google Scholar]
- 28.Dawe JR, Morgan SG. Stitching the gaps in the Canadian public drug coverage patchwork? A review of provincial pharmacare policy changes from 2000 to 2012. Health Policy. 2012;104:19–26. doi: 10.1016/j.healthpol.2011.08.015. [DOI] [PMC free article] [PubMed] [Google Scholar]
- 29.Lupton D. Consumerism, reflexivity, and the medical encounter. Soc Sci Med. 1997;45(3):373–81. doi: 10.1016/S0277-9536(96)00353-X. [DOI] [PubMed] [Google Scholar]
- 30.Ramage-Morin PL. Medication use among senior Canadians. Health Matters. 2009;20(1):37–44. [PubMed] [Google Scholar]
- 31.Morin P, De Wals P, St-Cyr-Tribble D, Niyonsenga T, Payette H. Pregnancy planning: A determinant of folic acid supplements use for the primary prevention of neural tube defects. Can J Public Health. 2002;93(4):259–63. doi: 10.1007/BF03405012. [DOI] [PMC free article] [PubMed] [Google Scholar]
- 32.McLeod PJ, Huang AR, Tamblyn RM, Gayton DC. Defining inappropriate practices in prescribing for elderly people: A national consensus panel. CMAJ. 1997;156(3):385–91. [PMC free article] [PubMed] [Google Scholar]