Disparities in High-Risk Medication Use—Implications for Health Equity and Deprescribing Practices

Potentially inappropriate medication (PIM) use-defined as the use of high-risk medications that can increase the risk of adverse events such as physical, cognitive, and functional decline; delirium; hospitalizations; and mortality-remains a significant concern in older adults in the US.Numerous guidelines, including the American Geriatrics Society Beers Criteria 1 and the STOPP criteria, 2 define PIMs as medications for which the risk of adverse effects outweighs potential benefits or are inappropriate for specific populations or disease states, such dementia or kidney disease.PIM use may be particularly harmful in populations experiencing other health care disparities, as communities experiencing other consequences of health care inequity, including limited access to physicians or pharmacies, greater financial stress, and a higher comorbidity burden, may experience disproportionate effects from the adverse consequences of PIM use.To examine potential racial and ethnic disparities in PIM use, Raver and colleagues 3 analyzed claims data from more than 21 million Medicare beneficiaries between 2016 and 2019, examining racial and ethnic differences in 3 medication use outcomes: (1) high-risk medication use among older adults, (2) potentially harmful drug-disease interactions in patients with dementia, and (3) potentially harmful drug-disease interactions in patients with a history of falls.The authors also stratified their analyses by Medicare plan type, including traditional Medicare (TM) and Medicare Advantage (MA).The authors found that individuals from racial and ethnic minoritized groups (ie, Asian or Pacific Islander, Black, and Hispanic) had lower rates of high-risk medication use in all 3 outcomes compared with White beneficiaries, with smaller disparities observed among MA compared with TM beneficiaries.A key strength of the analysis is its reliance on existing Healthcare Effectiveness Data