Social Determinants of Polypharmacy in First Generation Mexican Immigrants in the United States

Document Type: Original Article

Authors

1 Department of Family Medicine, Charles R. Drew University of Medicine and Science, Los Angeles, USA

2 Health Behavior and Health Education (HBHE), University of Michigan, Ann Arbor, USA

3 Department of Pharmacy Practice, West Coast University School of Pharmacy, Los Angeles, CA, USA

4 Department of Family Medicine, UCLA, Los Angeles, USA

Abstract

Introduction: Socioeconomic status (SES) indicators are among the main social determinants of health and illness. Less, however, is known about the role of SES in the epidemiology of polypharmacy in immigrant Latino Americans living in the United States. This research studied the association between three SES indicators, education, income, and employment, and polypharmacy in older first generation Latino American immigrant adults.
Methods: Data was obtained from the Sacramento Area Latino Study on Aging (SALSA, 1996-2008). A total of 632 older first generation Mexican-American immigrants to the U.S. entered this analysis. The independent variables were education, income, and employment. Polypharmacy was the outcome. Age, gender, physical health, smoking, and drinking were the covariates. Binary logistic regression was used to analyze the data.
Results: Employment was associated with lower odds of polypharmacy. The association between education and polypharmacy was above and beyond demographic factors, physical health, health behaviors, and health insurance. Neither education nor income were associated with polypharmacy. Other determinants of polypharmacy were poor self-rated health (SRH) and a higher number of chronic medical conditions (CMCs).
Conclusion: Employment appears to be the major SES determinant of polypharmacy in older foreign-born Mexican Americans. Unemployed older Mexican American immigrants with multiple chronic diseases and those who have poor SRH have the highest need for an evaluation of polypharmacy. Given the age group of this population, most of them have health insurance, which provides an opportunity for reducing their polypharmacy.

Keywords


  1. Leelakanok N, Holcombe AL, Lund BC, Gu X, Schweizer ML. Association between polypharmacy and death: A systematic review and meta-analysis. J Am Pharm Assoc (2003). 2017;57(6):729- 738.e710. doi:10.1016/j.japh.2017.06.002.
  2. Armstrong KS, Temmingh H. Prevalence of and factors associated with antipsychotic polypharmacy in patients with serious mental illness: Findings from a cross-sectional study in an upper-middle-income country. Braz J Psychiatry. 2017;39(4):293-301. doi:10.1590/1516-4446-2016-2015.
  3. Baek YH, Shin JY. Trends in polypharmacy over 12 years and changes in its social gradients in South Korea. PLoS One. 2018;13(9):e0204018. doi:10.1371/journal.pone.0204018.
  4. Haider SI, Johnell K, Thorslund M, Fastbom J. Analysis of the association between polypharmacy and socioeconomic position among elderly aged > or =77 years in Sweden. Clin Ther. 2008;30(2):419-427. doi:10.1016/j.clinthera.2008.02.010.
  5. Assari S, Bazargan M. Race/Ethnicity, Socioeconomic Status, and Polypharmacy among Older Americans. Pharmacy (Basel). 2019;7(2). doi:10.3390/pharmacy7020041.
  6. Assari S, Helmi H, Bazargan M. Polypharmacy in African American Adults: A National Epidemiological Study. Pharmacy (Basel). 2019;7(2). doi:10.3390/pharmacy7020033.
  7. Assari S, Moghani Lankarani M. Does multi-morbidity mediate the effect of socioeconomics on self-rated health? Cross-country differences. Int J Prev Med. 2015;6:85. doi:10.4103/2008-7802.164413.
  8. Assari S. Cross-country variation in additive effects of socio-economics, health behaviors, and comorbidities on subjective health of patients with diabetes. J Diabetes Metab Disord. 2014;13(1):36. doi:10.1186/2251-6581-13-36.
  9. Assari S, Moghani Lankarani R, Moghani Lankarani M. Cross-country differences in the association between diabetes and disability. J Diabetes Metab Disord. 2014;13(1):3. doi:10.1186/2251-6581-13-3.
  10. Assari S. Cross-country differences in the additive effects of socioeconomics, health behaviors and medical comorbidities on disability among older adults with heart disease. J Tehran Heart Cent. 2015;10(1):24-33.
  11. Assari S. Combined racial and gender differences in the long-term predictive role of education on depressive symptoms and chronic medical conditions. J Racial Ethn Health Disparities. 2017;4(3):385-396. doi:10.1007/s40615-016-0239-7.
  12. Zeki Al Hazzouri A, Haan MN, Osypuk T, Abdou C, Hinton L, Aiello AE. Neighborhood socioeconomic context and cognitive decline among older Mexican Americans: results from the Sacramento Area Latino Study on Aging. Am J Epidemiol. 2011;174(4):423- 431. doi:10.1093/aje/kwr095.
  13. Haan MN, Zeki Al-Hazzouri A, Aiello AE. Life-span socioeconomic trajectory, nativity, and cognitive aging in Mexican Americans: the Sacramento Area Latino Study on Aging. J Gerontol B Psychol Sci Soc Sci. 2011;66 Suppl 1:i102-110. doi:10.1093/geronb/gbq071.
  14. Zeki Al Hazzouri A, Haan MN, Kalbfleisch JD, Galea S, Lisabeth LD, Aiello AE. Life-course socioeconomic position and incidence of dementia and cognitive impairment without dementia in older Mexican Americans: results from the Sacramento area Latino study on aging. Am J Epidemiol. 2011;173(10):1148-1158. doi:10.1093/aje/kwq483.
  15. Garcia L, Lee A, Zeki Al Hazzouri A, Neuhaus J, Epstein M, Haan M. The impact of neighborhood socioeconomic position on prevalence of diabetes and pre-diabetes in older Latinos: the Sacramento area Latino study on aging. Hisp Health Care Int. 2015;13(2):77-85. doi:10.1891/1540-4153.13.2.77.
  16. Afable-Munsuz A, Mayeda ER, Pérez-Stable EJ, Haan MN. Immigrant generation and diabetes risk among Mexican Americans: the Sacramento Area Latino Study on Aging. Am J Public Health. 2013;103(5):e45-52. doi:10.2105/AJPH.2012.300969.
  17. Rodriquez EJ, Sabado-Liwag M, Pérez-Stable EJ, et al. Allostatic Load, Unhealthy Behaviors, and Depressive Symptoms by Birthplace Among Older Adults in the Sacramento Area Latino Study on Aging (SALSA). J Aging Health. 2019:898264319857995. doi:10.1177/0898264319857995.
  18. González HM, Haan MN, Hinton L. Acculturation and the prevalence of depression in older Mexican Americans: baseline results of the Sacramento Area Latino Study on Aging. J Am Geriatr Soc. 2001;49(7):948-953. doi:10.1046/j.1532-5415.2001.49186.x.
  19. Xiang YT, Weng YZ, Leung CM, Tang WK, Ungvari GS. Clinical and social determinants of antipsychotic polypharmacy for Chinese patients with schizophrenia. Pharmacopsychiatry. 2007;40(2):47- 52. doi:10.1055/s-2007-970062.
  20. Ulley J, Harrop D, Ali A, Alton S, Fowler Davis S. Deprescribing interventions and their impact on medication adherence in community-dwelling older adults with polypharmacy: a systematic review. BMC Geriatr. 2019;19(1):15. doi:10.1186/s12877-019-1031-4.
  21. Walsh EK, Cussen K. “Take ten minutes”: a dedicated ten minute medication review reduces polypharmacy in the elderly. Ir Med J. 2010;103(8):236-238.
  22. van der Meer HG, Wouters H, Pont LG, Taxis K. Reducing the anticholinergic and sedative load in older patients on polypharmacy by pharmacist-led medication review: a randomised controlled trial. BMJ Open. 2018;8(7):e019042. doi:10.1136/bmjopen-2017-019042.
  23. Skinner M. A literature review: polypharmacy protocol for primary care. Geriatr Nurs. 2015;36(5):367-371.e364. doi:10.1016/j.gerinurse.2015.05.003.
  24. Tani H, Uchida H, Suzuki T, Fujii Y, Mimura M. Interventions to reduce antipsychotic polypharmacy: a systematic review. Schizophr Res. 2013;143(1):215-220. doi:10.1016/j.schres.2012.10.015.
  25. Tranulis C, Skalli L, Lalonde P, Nicole L, Stip E. Benefits and risks of antipsychotic polypharmacy: an evidence-based review of the literature. Drug Saf. 2008;31(1):7-20. doi:10.2165/00002018-200831010-00002.