Are there socioeconomic inequalities among older people prescribed potentially inappropriate medications? A systematic review and meta-analysis

Abstract Background and aims Socioeconomic status (SES) may influence prescribing quality and medication safety in older adults. This systematic review and meta-analysis aimed to investigate the association between SES and the prescribing of potentially inappropriate medicines (PIMs). Methods A systematic review and meta-analysis of observational studies was conducted across five databases: Medline (OVID), Web of Science, Embase (OVID), PsycINFO, and CINAHL. Older people (≥55 years) from any healthcare setting were included. Studies published from 1946 to July 2025 reporting PIM prevalence according to SES were eligible. A random-effects model was used to calculate unadjusted odds ratios (ORs) with 95% confidence intervals (CIs) comparing lower versus higher SES groups. Results Thirty-seven studies of 5905 met the inclusion criteria. Measures of SES included education (26 studies), income (15 studies), living environment (9 studies), occupation (1 study), deprivation indices (3 studies), and other measures that do not fit the previous domains (2 studies). Individuals with lower SES had significantly higher odds of receiving PIMs compared to those with higher SES (pooled OR = 1.29; 95% CI 1.13–1.47). Similar findings were observed across education (OR = 1.31; 95% CI 1.06–1.62) and income (OR = 1.28; 95% CI 1.05–1.55). Conclusions There are clear socioeconomic inequalities in potentially inappropriate prescribing among older adults, with those from lower SES backgrounds significantly more likely to receive PIMs. Further research should explore the causal mechanisms behind these disparities and develop interventions to reduce inequities in medication safety.