Sex differences in patterns of potentially inappropriate prescribing and adverse drug reactions in hospitalized older people: Findings from the SENATOR trial

Author:

O'Mahony Denis1,Cruz‐Jentoft Alfonso J.2,Gudmundsson Adalsteinn3,Soiza Roy L.4,Petrovic Mirko5,Cherubini Antonio6,Byrne Stephen7,Rochon Paula8ORCID

Affiliation:

1. Department of Medicine (Geriatrics) University College Cork Cork Ireland

2. Hospital Universario Ramón y Cajal—Geriatrics Madrid Spain

3. Landspitali University Hospital Reykjavik, Landspitali Reykjavik Iceland

4. NHS Grampian University of Aberdeen Institute of Applied Health Sciences—Ageing Clinical and Experimental Research Aberdeen UK

5. Section of Geriatrics, Department of Internal Medicine and Paediatrics Ghent University Ghent Belgium

6. Department of Clinical and Molecular Sciences Università politecnica delle Marche Ancona Italy

7. School of Pharmacy University College Cork Cork Ireland

8. Women's Age Lab, Women's College Hospital & Department of Medicine & Dalla Lana School of Public Health University of Toronto Toronto Ontario Canada

Abstract

AbstractBackgroundOlder women experience more adverse drug reactions (ADRs) than older men. However, the underlying basis for this sex difference is unclear. Sex (biological status) and/or gender (sociocultural constructs) influences on patterns of inappropriate prescribing in multimorbid older adults may be one reason for this ADR sex difference. In this secondary analysis, we examined whether incident ADR sex differences could be related to concurrent sex differences in potentially inappropriate prescribing.Design and SettingA retrospective secondary analysis of sex differences in the prevalence of potentially inappropriate medications (PIMs), potential prescribing omissions (PPOs), and ADRs among the 1537 participants (47.2% female, median [IQR] age 78 [72–84] years) was undertaken in the SENATOR clinical trial database, conducted in six large European medical centers.Participants and MethodsWe looked specifically for male/female differences relating to PIMs and PPOs (defined by STOPP/START version 2 criteria) identified within 48 h of acute hospitalization. We also assessed sex differences for ADRs identified at 14 days from admission or discharge, whichever came first. ADRs were assessed by blinded endpoint adjudication panel consensus.ResultsDuring hospitalization, significantly more females experienced ≥1 ADR compared to males (28% and 21%, respectively; odds ratio 1.40, 95% CI 1.10–1.78, p < 0.005). Nine of the 11 STOPP‐criteria PIMs showing a significant sex difference occurred more often in females. Of the four START‐criteria PPOs showing a significant sex difference, all occurred more often in females. Some sex‐associated PIMs reflect higher prevalence of related conditions in older women.ConclusionWe conclude that specific STOPP‐criteria PIMs and START‐criteria PPOs were identified more frequently in older women than older men during acute hospitalization, possibly contributing to higher ADR incidence in older women. Prescribers should appreciate sex differences in exposure to potentially inappropriate prescribing and ADR risk, given the preponderance of older women over older men in most clinical settings.

Funder

European Commission

Publisher

Wiley

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