Propoxyphene Use in the Aged: Predictors and Outcomes

University Of Maryland Baltimore, Baltimore MD

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Abstract

DESCRIPTION (provided by the applicant): Over the past two decades, studies have documented a high prevalence of potentially inappropriate drug use among the elderly. Inappropriate drug use is defined in several ways; the most widely accepted explicit criteria are those developed by Beers (1997). Propoxyphene, an opiate analgesic, is one such inappropriate medication identified by the Beers' criteria. Its use is associated with such adverse effects as sedation and dependence, and it has no efficacy advantages over other analgesics. The CNS-related side effects with propoxyphene use may increase the likelihood of falls and, hence, of fall-related fractures in the elderly. Despite this, propoxyphene is the most prevalent among all inappropriate drugs used by the elderly according to a recent study by AHRQ. Prior research of propoxyphene use in the elderly is limited in several important respects. For example, no studies have examined the persistence or frequency of its use. None has systematically studied the factors associated with its use. Additionally, specific indications for which propoxyphene is still being prescribed have not been examined. Only two studies have assessed the risk of hip fractures with propoxyphene use; both used non-U.S. databases and have several limitations. This study aims to: (1) estimate the prevalence and persistence of propoxyphene use among community-dwelling aged; (2) determine the factors associated with propoxyphene use in the community-dwelling aged; and (3) establish whether propoxyphene use is associated with an increased risk of fractures in the aged. Data from the 1993-1999 Medicare Current Beneficiary Survey (MCBS) and the 1999 and 2000 MarketScan Datasets will be used. National-level annual prevalence estimates of propoxyphene use by community-dwelling aged Medicare beneficiaries will be made using 1993-1999 MCBS. A logistic regression will be estimated to identify specific patient, physician and drug plan characteristics associated with propoxyphene use. The MarketScan Dataset will be used to study proximate pain conditions for which propoxyphene is prescribed. A prospective cohort study design will be used with Cox regression analysis to estimate the increase in risk of fractures with propoxyphene use in the MarketScan Dataset. Determination of factors associated with propoxyphene use will help identify potential targets and design interventions to reduce its use. An establishment of an increased risk of fractures will strengthen the case for interventions to reduce propoxyphene use in the aged.