Polypharmacy and Potentially Inappropriate Medication in Iranian People With Metabolic Syndrome: Epidemiological Aspects and Related Factors, a Multi-Level Cross-Sectional National Study

Background and Aims Polypharmacy, characterized by the concurrent use of five or more medications in a prescription, potentially resulting in adverse outcomes, is frequently observed among individuals with metabolic syndrome, which encompasses a collection of conditions that co-occur, heightening the likelihood of heart disease, stroke, and type 2 diabetes. This study seeks to ascertain the prevalence of polypharmacy and the use of potentially inappropriate medications (PIMs) among Iranian patients with metabolic syndrome, while also evaluating the contributing individual and sociodemographic factors. Methods This was a population-based, cross-sectional national study. Two databases were used: (a) Iranians Health Insurance Service database and (b) Iran's STEPS 2016 survey. Patients with metabolic syndrome conjoint in both databases were selected. Among these patients, polypharmacy and PIM were evaluated, and their association with individual and sociodemographic factors was assessed. Univariate and multivariate logistic regression were used to analyze the associations. All statistical analyses were done using SPSS 22 and Python 3. Results Out of 2075 metabolic syndrome patients, 10.3% had polypharmacy. Polypharmacy significantly increased by age (OR: 4.334, adjusted for > 80-year-olds vs. 25-39-year-olds [CI: 1.664-11.283], p < 0.001), and its prevalence was significantly higher in urban areas (OR: 2.326 [CI: 1.645-3.288], p < 0.001). Polypharmacy was 5.88% in West, 5.41% in Southeast, 5.04% in Central, and 4.83% in North-Northeast of Iran. PIM was 13.2% in >= 60 years and significantly higher in urban areas (OR: 2.014 [CI: 1.153-3.519], p < 0.001). Conclusions Since the area of residency affects polypharmacy and PIM more significantly than wealth status and education level, it is important to implement preventive measures in urban areas.