Polypharmacy prescribing amongst ethnic groups: A scoping review

Problem

Polypharmacy is considered the use of 5 or more medication by an individual. Although not all polypharmacy is inappropriate, the use of multiple medications is associated with adverse consequences.Approximately 15% of England’s population take 5 or more medication daily. The key contributory factors include age and multimorbidity. Furthermore, the National Overprescribing Review highlighted that ethnic minority groups are more likely to take 8 or more medication. Therefore, indicating a possible link between ethnicity and polypharmacy. There is limited in research investigating the relationship between ethnicity and polypharmacy. This is despite evidence suggesting individuals from ethnic minority groups report poorer health and more long-term conditions and are less likely to take medication as prescribed or engage in regular medication reviews. This scoping review aims to summarise the current literature on polypharmacy amongst ethnic groups.

Approach

A scoping review was carried out using the Joanna Briggs Institute guidelines and Arksey and O’Malley’s scoping review framework. MEDLINE, Embase, Scopus, Wed of Science, CINAHL, PsycINFO and Cochrane library searches were conducted to identify all English language studies published before March 2022 that reported ethnicity of participants in the context of polypharmacy. A full review was independently completed by two investigators using the pre-determined criteria. A thematic analysis identified key themes.

Findings

Thirty-two of 2658 studies were selected for full review. These included 28 quantitative, 2 qualitative and 2 mixed-method studies spanning 26 countries and 31 different ethnic groups. The four main themes relating to polypharmacy prescribing amongst ethnic groups identified were, sociodemographic factors, clinical factors, patient factors and health system factors. Sociodemographic and clinical factors were the largest theme identified. The key findings were that increasing age, low household income and multiple health conditions were associated with higher levels of polypharmacy amongst all ethnic groups. There were inconsistent findings relating to the prevalence of polypharmacy amongst different ethnic groups. Six studies reported no significant difference in polypharmacy prevalence, 7 studies reported higher prevalence of polypharmacy amongst White ethnic groups and 5 studies reported that higher prevalence of polypharmacy amongst ethnic minority groups.

Consequences

Our findings suggest that there is a lack of consensus into the factors influencing polypharmacy amongst different ethnic groups. Furthermore, the included studies were predominantly quantitative and explored polypharmacy prevalence. Consequently, wider factors, including, cultural beliefs, that may influence polypharmacy amongst ethnic groups have not been explored.This scoping review also highlighted that having multiple health conditions increases the risk of polypharmacy amongst all ethnic groups. Within the UK, Asian and Black ethnic groups, have the highest average number of co-morbidities and the highest prevalence of polypharmacy. Therefore, suggesting complex unexplored factors may influence polypharmacy within these groups. Further studies are required to explore the clinical, behavioural, socioeconomic and cultural differences.