Examining patterns of multimorbidity, polypharmacy and risk of adverse drug reactions in chronic obstructive pulmonary disease: a cross-sectional UK Biobank study

Hanlon, P. , Nicholl, B. I. , Jani, B. D. , McQueenie, R., Lee, D. , Gallacher, K. I. and Mair, F. S. (2018) Examining patterns of multimorbidity, polypharmacy and risk of adverse drug reactions in chronic obstructive pulmonary disease: a cross-sectional UK Biobank study. BMJ Open, 8(1), e018404. (doi: 10.1136/bmjopen-2017-018404) (PMID:29332840) (PMCID:PMC5781016)

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Objective: This study aims: (1) to describe the pattern and extent of multimorbidity and polypharmacy in UK Biobank participants with chronic obstructive pulmonary disease (COPD) and (2) to identify which comorbidities are associated with increased risk of adverse drug reactions (ADRs) resulting from polypharmacy. Design: Cross-sectional. Setting: Community cohort. Participants: UK Biobank participants comparing self-reported COPD (n=8317) with no COPD (n=494 323). Outcomes: Multimorbidity (≥4 conditions) and polypharmacy (≥5 medications) in participants with COPD versus those without. Risk of ADRs (taking ≥3 medications associated with falls, constipation, urinary retention, central nervous system (CNS) depression, bleeding or renal injury) in relation to the presence of COPD and individual comorbidities. Results: Multimorbidity was more common in participants with COPD than those without (17% vs 4%). Polypharmacy was highly prevalent (52% with COPD taking ≥5 medications vs 18% in those without COPD). Adjusting for age, sex and socioeconomic status, those with COPD were significantly more likely than those without to be prescribed ≥3 medications contributing to falls (OR 2.27, 95% CI 2.13 to 2.42), constipation (OR 3.42, 95% CI 3.10 to 3.77), urinary retention (OR 3.38, 95% CI 2.94 to 3.87), CNS depression (OR 3.75, 95% CI 3.31 to 4.25), bleeding (OR 4.61, 95% CI 3.35 to 6.19) and renal injury (OR 2.22, 95% CI 1.86 to 2.62). Concomitant cardiovascular disease was associated with the greatest risk of taking ≥3 medications associated with falls/renal injury. Concomitant mental health conditions were most strongly associated with medications linked with CNS depression/urinary retention/bleeding. Conclusions: Multimorbidity is common in COPD and associated with high levels of polypharmacy. Co-prescription of drugs with various ADRs is common. Future research should examine the effects on healthcare outcomes of co-prescribing multiple drugs with similar potential ADRs. Clinical guidelines should emphasise assessment of multimorbidity and ADR risk.

Item Type:Articles
Glasgow Author(s) Enlighten ID:Jani, Dr Bhautesh and Gallacher, Dr Katie and Lee, Professor Duncan and Mair, Professor Frances and Nicholl, Dr Barbara and McQueenie, Dr Ross and Hanlon, Dr Peter
Authors: Hanlon, P., Nicholl, B. I., Jani, B. D., McQueenie, R., Lee, D., Gallacher, K. I., and Mair, F. S.
College/School:College of Medical Veterinary and Life Sciences > School of Health & Wellbeing > General Practice and Primary Care
College of Science and Engineering > School of Mathematics and Statistics > Statistics
Journal Name:BMJ Open
Publisher:BMJ Publishing Group
ISSN (Online):2044-6055
Published Online:14 January 2018
Copyright Holders:Copyright © 2018 The Authors
First Published:First published in BMJ Open 8(1):e018404
Publisher Policy:Reproduced under a Creative Commons License

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Project CodeAward NoProject NamePrincipal InvestigatorFunder's NameFunder RefLead Dept
756021Multimorbidity in UK BiobankBarbara NichollOffice of the Chief Scientist (CSO)CGA/16/39IHW - GENERAL PRACTICE & PRIMARY CARE