title: Geographical differences in the prevalence of chronic polypharmacy in older people: eleven years of the EPIFARM-Elderly Project.
abstract: OBJECTIVE
  To compare the geographical differences in the prevalence of chronic polypharmacy in community-dwelling older people over 11 years.
  
  
  METHODS
  This study analyzed nearly two million patients aged 65-94 years recorded in the Drug Administrative Database of the Lombardy Region (Northern Italy) from 2000 to 2010. Chronic polypharmacy was defined as taking five or more drugs in 1 month for at least 6 months (consecutive or not) in a year.
  
  
  RESULTS
  There was a significant spatial autocorrelation that increased at the municipality level from 2000 (Moran's I Index = 0.26, z score = 16.91, p < 0.0001) to 2010 (Moran's I Index = 0.36, z score = 23.78, p < 0.0001). Clusters of high (Z(G) > 1.96) and low (Z(G) < -1.96) prevalence rates of chronic polypharmacy were found and were not influenced by age. Chronic polypharmacy weakly correlated with hospital admission (2000: ρ = 0.08, p = 0.0032; 2005: ρ = 0.11, p < 0.0001; 2010: ρ = 0.18, p < 0.0001), but not with mortality.
  
  
  CONCLUSIONS
  There were geographical differences in the prevalence of older people with chronic polypharmacy that were only partly explained by health indicators. Targeted activities on prescription practice to ensure that the prescribing of chronic polypharmacy is appropriate are required.
authors.affiliation: Laboratory for Quality Assessment of Geriatric Therapies and Services, Istituto di Ricerche Farmacologiche Mario Negri-IRCCS, Via Giuseppe La Masa, 19, 20156, Milan, Italy. carlotta.franchi@marionegri.it
authors.forename: Carlotta
authors.initials: C
authors.lastname: Franchi
authors.forename: Massimo
authors.initials: M
authors.lastname: Cartabia
authors.forename: Paolo
authors.initials: P
authors.lastname: Risso
authors.forename: Daniela
authors.initials: D
authors.lastname: Mari
authors.forename: Mauro
authors.initials: M
authors.lastname: Tettamanti
authors.forename: Alberto
authors.initials: A
authors.lastname: Parabiaghi
authors.forename: Luca
authors.initials: L
authors.lastname: Pasina
authors.forename: Codjo
authors.initials: C
authors.lastname: Djignefa  Djade
authors.forename: Ida
authors.initials: I
authors.lastname: Fortino
authors.forename: Angela
authors.initials: A
authors.lastname: Bortolotti
authors.forename: Luca
authors.initials: L
authors.lastname: Merlino
authors.forename: Alessandro
authors.initials: A
authors.lastname: Nobili
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D000375:Aging; D016208:Databases, Factual; D011307:Drug Prescriptions; D005260:Female; D006304:Health Status; D006305:Health Status Indicators; D006760:Hospitalization; D006801:Humans; D007558:Italy / Q000453:epidemiology; D008297:Male; D009026:Mortality; D019338:Polypharmacy; D010818:Practice Patterns, Physicians'; D055553:Prescription Drugs / Q000627:therapeutic use*; D062211:Spatio-Temporal Analysis; D013222:State Medicine
chemical_list: D055553:Prescription Drugs
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