Front Public Health. 2026 Jul 16;14:1879178. doi: 10.3389/fpubh.2026.1879178. eCollection 2026.
ABSTRACT
BACKGROUND: Polypharmacy is closely linked to multimorbidity in older adults, but its distribution may also reflect social inequalities in health. We aimed to describe pharmacological burden and multimorbidity among individuals with polypharmacy in La Rioja, Spain, and to examine their relationship with age, sex, and socioeconomic conditions.
METHODS: This retrospective cross-sectional study included all individuals in La Rioja, Spain, who met the operational definition of polypharmacy between January 1 and December 31, 2024. Polypharmacy was defined as the dispensing of five or more distinct ATC4 medication groups, each dispensed at least six times during the study period. Only publicly funded prescriptions dispensed in community pharmacies were considered. Sociodemographic and clinical data were obtained from electronic health records. Pharmacological burden was quantified as the number of distinct ATC4 groups dispensed per individual and categorized as 5, 6-9, and ≥10 groups.
RESULTS: Among 33,534 individuals with polypharmacy, 54.7% were women and the mean age was 73.9 years. The mean pharmacological burden was 7.07 ATC4 groups (SD 2.17), with 58.4% of participants receiving 6-9 groups. Burden increased with age and was higher among individuals with chronic conditions, particularly congestive heart failure, renal disease, peripheral vascular disease, myocardial infarction, and chronic pulmonary disease. Sex differences were modest. In contrast, socioeconomic differences were marked: 71.8% of participants belonged to the low socioeconomic group, which also showed the highest proportion of individuals receiving ≥10 ATC4 groups (14.9%), compared with the middle (9.2%) and high (8.0%) socioeconomic groups. The highest burdens were observed in very low-income individuals and lower-income pensioners.
CONCLUSIONS: In this population-based study, pharmacological burden among individuals with polypharmacy was concentrated on older adults, those with multimorbidity, and socioeconomically disadvantaged groups. These findings support interpreting polypharmacy not only as an indicator of clinical complexity, but also as a socially patterned health phenomenon. Efforts to optimize medication use should therefore integrate both clinical and socioeconomic vulnerability.
PMID:42535037 | PMC:PMC13422552 | DOI:10.3389/fpubh.2026.1879178