Burden of Polypharmacy Among U.S. Medicare Beneficiaries with Incident Epilepsy
Abstract number :
1.152
Submission category :
16. Epidemiology
Year :
2024
Submission ID :
789
Source :
www.aesnet.org
Presentation date :
12/7/2024 12:00:00 AM
Published date :
Authors :
Presenting Author: Nicholas Schiltz, PhD – Case Western Reserve University
Long Vu, MS – Case Western Reserve University
Hannah Fein, MS, MPH – OCHIN
Wyatt Bensken, PhD – OCHIN
Martha Sajatovic, MD – Case Western Reserve University School of Medicine
Gena Ghearing, MD – University of Iowa
David Warner, PhD – University of Alabama - Birmingham
Siran Koroukian, PhD – Case Western Reserve University
Rationale: Polypharmacy, the concurrent use of multiple medications by a patient, is common in older adults with epilepsy and a significant concern due to the increased risk of drug-drug interactions, side effects, medication non-adherence, and other poor health outcomes. Although polypharmacy is known to be common in people with prevalent epilepsy due to a higher comorbidity burden and the use of multiple anticonvulsants in drug-resistant epilepsy, much less is known about the existing burden of polypharmacy among newly diagnosed cases. The aim of this study was to estimate the prevalence of polypharmacy among incident epilepsy cases and identify specific combinations of medications associated with higher rates of incident epilepsy in older adults.
Methods: This was a retrospective longitudinal cohort study using U.S. Medicare claims data from a sample of 2,768,656 Medicare beneficiaries without history of epilepsy in 2016 – 2018 and with Medicare Part D coverage for all 12 months in 2018. Of these, 13,819 (0.5%) beneficiaries were diagnosed with incident epilepsy in 2019, as defined by the Chronic Conditions Warehouse. Each prescribed medication in the 2018 Medicare Part D claims was assigned to a therapeutic drug class using the Veterans Affairs Drug Classification system. Frequent itemset mining, a machine learning technique, was performed to identify top combinations of drug class frequency among beneficiaries. Combinations most associated with incident epilepsy were found by comparing the frequency of combinations found between those diagnosed with incident epilepsy and those without. Logistic regression was used to calculate the odds ratio for these associations adjusted for age, race/ethnicity, and sex.
Results: Beneficiaries diagnosed with incident epilepsy in 2019 had filled a higher number of different therapeutic drug class prescriptions in the previous year compared to those without epilepsy (mean 10.5 vs 7.2 drug classes). Antidepressants, anticonvulsants, gastric medications, and loop diuretics were among the drug classes that ranked higher in the incident epilepsy group compared to the overall study population (Figure 1). Antipsychotics & antidepressants was the drug combination that had the highest adjusted odds of being prescribed to those with incident epilepsy (3.54 [95%CI: 3.33 – 3.76]) (Figure 2).
Conclusions: We found that existing polypharmacy is common in older adult Medicare beneficiaries with newly diagnosed epilepsy, and the burden is higher compared to those beneficiaries without epilepsy. Further, specific drug and drug combinations are more common among those with incident epilepsy. Future work will examine underlying comorbidities in relation to drug combinations, as well as expand to larger combinations.
Funding: Centers for Disease Control Special Improvement Project (#6 U48DP006404-03-01)
Epidemiology