title: Geographic region and racial variations in polypharmacy in the United States.
abstract: OBJECTIVE
  Medications can have unintended effects. High medication use populations may benefit from increased regimen oversight. Limited knowledge exists concerning racial and regional polypharmacy variation. We estimated total medication distributions (excluding supplements) of American black and white adults and assessed racial and regional polypharmacy variation.
  
  
  METHODS
  REasons for Geographic And Racial Differences in Stroke (REGARDS) cohort data (n = 30,239 U.S. blacks and whites aged ≥45 years) were analyzed. Home pill bottle inspections assessed the last two weeks' medications. Polypharmacy (≥8 medications) was determined by summing prescription and/or over-the-counter ingredients. Population-weighted logistic regression assessed polypharmacy's association with census region, race, and sex.
  
  
  RESULTS
  The mean ingredient number was 4.12 (standard error = 0.039), with 15.7% of REGARDS using 8 ingredients or more. In crude comparisons, women used more medications than men, and blacks and whites reported similar mean ingredients. A cross-sectional, logistic model adjusting for demographics, socioeconomics, and comorbidities showed increased polypharmacy prevalence in whites versus blacks (OR [95% CI]: 0.63, [0.55-0.72]), women (1.94 [1.68-2.23]), and Southerners (broadly Southeasterners and Texans; 1.48 [1.17-1.87]) versus Northeasterners (broadly New England and upper Mid-Atlantic). Possible limitations include polypharmacy misclassification and model misspecification.
  
  
  CONCLUSIONS
  Polypharmacy is common. Race and geography are associated with polypharmacy variation. Further study of underlying factors explaining these differences is warranted.
authors.affiliation: Department of Epidemiology, Emory University Rollins School of Public Health, Atlanta, GA. Electronic address: cashionw@upmc.edu.
authors.forename: Winn
authors.initials: W
authors.lastname: Cashion
authors.affiliation: Department of Epidemiology, Emory University Rollins School of Public Health, Atlanta, GA.
authors.forename: William
authors.initials: W
authors.lastname: McClellan
authors.affiliation: Department of Biostatistics, University of Alabama at Birmingham.
authors.forename: George
authors.initials: G
authors.lastname: Howard
authors.affiliation: Department of Epidemiology, Emory University Rollins School of Public Health, Atlanta, GA.
authors.forename: Abhinav
authors.initials: A
authors.lastname: Goyal
authors.affiliation: Department of Epidemiology, Emory University Rollins School of Public Health, Atlanta, GA.
authors.forename: David
authors.initials: D
authors.lastname: Kleinbaum
authors.affiliation: Department of Epidemiology, Emory University Rollins School of Public Health, Atlanta, GA.
authors.forename: Michael
authors.initials: M
authors.lastname: Goodman
authors.affiliation: Department of Pharmacy Practice, Samford University McWhorter School of Pharmacy, Birmingham, AL.
authors.forename: Valerie
authors.initials: V
authors.lastname: Prince
authors.affiliation: Department of Epidemiology, University of Alabama at Birmingham.
authors.forename: Paul
authors.initials: P
authors.lastname: Muntner
authors.affiliation: Department of Biostatistics, University of Alabama at Birmingham.
authors.forename: Leslie A
authors.initials: LA
authors.lastname: McClure
authors.affiliation: Department of Epidemiology, Emory University Rollins School of Public Health, Atlanta, GA.
authors.forename: Ann
authors.initials: A
authors.lastname: McClellan
authors.affiliation: Department of Biostatistics, University of Alabama at Birmingham.
authors.forename: Suzanne
authors.initials: S
authors.lastname: Judd
mesh_terms: D001741:Black or African American / Q000706:statistics & numerical data*; D000368:Aged; D000369:Aged, 80 and over; D015331:Cohort Studies; D015897:Comorbidity; D003430:Cross-Sectional Studies; D005260:Female; D005843:Geography; D006801:Humans; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D019338:Polypharmacy; D014481:United States; D044465:White People / Q000706:statistics & numerical data*
keywords: Geographic variations; Medications; Pharmacoepidemiology; Polypharmacy; REGARDS; Race