Polypharmacy and Rising Medication Use in the United States: 25-Year National Trends
Poster #: 152
Session/Time: A
Author:
Juan Emilio Ferrando, MS
Mentor:
Rehan Qayyum, MD, MHS, SFHM, FAHA
Research Type: Public Health
Abstract
INTRODUCTION:
Prescription medication use has increased globally, driven by aging populations, rising prevalence of chronic diseases, and expanding therapeutic options. In the United States, monitoring trends in medication use is critical for understanding the implications for patient safety, health equity, and healthcare costs. While prior studies have described medication use at single time points, there is limited evidence on long-term population-level changes across demographic and socioeconomic subgroups. In particular, polypharmacy (the concurrent use of multiple medications) is increasingly recognized as a public health concern given its association with adverse drug events, hospitalizations, and diminished quality of life. Understanding temporal patterns in both overall medication use and polypharmacy is therefore essential to guide policy and practice. This study examined 25-year national trends in prescription medication use, with emphasis on differences by sex, race/ethnicity, and socioeconomic status.
METHODS:
We analyzed data from seven continuous cycles of a nationally representative health survey spanning 1999-2023. Prescription medication use was defined as current use of ≥1 prescription drug, and polypharmacy as use of ≥5 drugs. Demographic and socioeconomic information was obtained via structured interviews, including sex, age, race/ethnicity, and family income-to-poverty ratio (FIPR). Survey-weighted generalized linear models with log links and binomial distribution were used to estimate prevalence ratios (PRs) and assess temporal trends. Interaction terms were incorporated to evaluate differences in trends by subgroups
RESULTS:
A total of 119,389 participants were included (51% women, 23% Black, 29% Hispanic, 14% aged ≥65 years). The weighted prevalence of any prescription medication use was 48.7% (95%CI: 48.1-49.2), while polypharmacy prevalence was 11.1% (95%CI: 10.8-11.4). Both outcomes increased significantly over the 25-year study period (p<0.001 for trend). Women reported higher prevalence of any medication use compared with men (PR=1.12; 95%CI: 1.10-1.14; p<0.001) and higher prevalence of polypharmacy (PR=1.15; 95%CI: 1.10-1.20; p<0.001). However, temporal increases in both outcomes were steeper among men than women (interaction p<0.001). Racial differences were also observed: Black adults had lower prevalence of medication use (PR=0.90; 95%CI: 0.88-0.92; p<0.001) and polypharmacy (PR=0.92; 95%CI: 0.87-0.97; p=0.001) compared with White adults. Despite this, Black adults experienced a 1% per year greater increase in prevalence of any medication use (p<0.001), narrowing the racial gap over time; polypharmacy trends followed a similar trajectory. Across income levels, both medication use and polypharmacy were inversely associated with higher FIPR (p<0.001 for both), though temporal increases were consistent across strata.
CONCLUSION:
Over the past 25 years, prescription medication use and polypharmacy have increased substantially in the U.S. adult population, with notable differences by sex, race/ethnicity, and socioeconomic status. Women remain disproportionately exposed to polypharmacy, while Black adults, although historically less likely to use prescription medications, are experiencing faster increases in use. These findings underscore the growing scope of medication exposure and its potential impact on population health, health equity, and healthcare resource utilization. Future research should evaluate drivers of these trends, including clinical guidelines, prescribing practices, and access to care, and assess strategies to optimize medication use while minimizing risks associated with polypharmacy.
Prescription medication use has increased globally, driven by aging populations, rising prevalence of chronic diseases, and expanding therapeutic options. In the United States, monitoring trends in medication use is critical for understanding the implications for patient safety, health equity, and healthcare costs. While prior studies have described medication use at single time points, there is limited evidence on long-term population-level changes across demographic and socioeconomic subgroups. In particular, polypharmacy (the concurrent use of multiple medications) is increasingly recognized as a public health concern given its association with adverse drug events, hospitalizations, and diminished quality of life. Understanding temporal patterns in both overall medication use and polypharmacy is therefore essential to guide policy and practice. This study examined 25-year national trends in prescription medication use, with emphasis on differences by sex, race/ethnicity, and socioeconomic status.
METHODS:
We analyzed data from seven continuous cycles of a nationally representative health survey spanning 1999-2023. Prescription medication use was defined as current use of ≥1 prescription drug, and polypharmacy as use of ≥5 drugs. Demographic and socioeconomic information was obtained via structured interviews, including sex, age, race/ethnicity, and family income-to-poverty ratio (FIPR). Survey-weighted generalized linear models with log links and binomial distribution were used to estimate prevalence ratios (PRs) and assess temporal trends. Interaction terms were incorporated to evaluate differences in trends by subgroups
RESULTS:
A total of 119,389 participants were included (51% women, 23% Black, 29% Hispanic, 14% aged ≥65 years). The weighted prevalence of any prescription medication use was 48.7% (95%CI: 48.1-49.2), while polypharmacy prevalence was 11.1% (95%CI: 10.8-11.4). Both outcomes increased significantly over the 25-year study period (p<0.001 for trend). Women reported higher prevalence of any medication use compared with men (PR=1.12; 95%CI: 1.10-1.14; p<0.001) and higher prevalence of polypharmacy (PR=1.15; 95%CI: 1.10-1.20; p<0.001). However, temporal increases in both outcomes were steeper among men than women (interaction p<0.001). Racial differences were also observed: Black adults had lower prevalence of medication use (PR=0.90; 95%CI: 0.88-0.92; p<0.001) and polypharmacy (PR=0.92; 95%CI: 0.87-0.97; p=0.001) compared with White adults. Despite this, Black adults experienced a 1% per year greater increase in prevalence of any medication use (p<0.001), narrowing the racial gap over time; polypharmacy trends followed a similar trajectory. Across income levels, both medication use and polypharmacy were inversely associated with higher FIPR (p<0.001 for both), though temporal increases were consistent across strata.
CONCLUSION:
Over the past 25 years, prescription medication use and polypharmacy have increased substantially in the U.S. adult population, with notable differences by sex, race/ethnicity, and socioeconomic status. Women remain disproportionately exposed to polypharmacy, while Black adults, although historically less likely to use prescription medications, are experiencing faster increases in use. These findings underscore the growing scope of medication exposure and its potential impact on population health, health equity, and healthcare resource utilization. Future research should evaluate drivers of these trends, including clinical guidelines, prescribing practices, and access to care, and assess strategies to optimize medication use while minimizing risks associated with polypharmacy.