Daneshmand, Mojdeh e al.
A icle — Published Ve sion
Polypha macy and Po en ially Inapp op ia e Medica ion in I anian
People Wi h Me abolic Synd ome: Epidemiological Aspec s and Rela ed
Fac o s, a Mul i‐Le el C oss‐Sec ional Na ional S udy
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Sugges ed Ci a ion: Daneshmand, Mojdeh e al. (2025) : Polypha macy and Po en ially Inapp op ia e
Medica ion in I anian People Wi h Me abolic Synd ome: Epidemiological Aspec s and Rela ed
Fac o s, a Mul i‐Le el C oss‐Sec ional Na ional S udy, Heal h Science Repo s, ISSN 2398-8835,
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Heal h Science Repo s
ORIGINAL RESEARCH
Polypha macy and Po en ially Inapp op ia e Medica ion
in I anian People Wi h Me abolic Synd ome:
Epidemiological Aspec s and Rela ed Fac o s, a Mul i‐
Le el C oss‐Sec ional Na ional S udy
Mojdeh Daneshmand
1
| Hamid eza Jamshidi
1
| Mohammad‐Reza Malekpou
2
| E an Ghasemi
3
|
Saha Saeedi Moghaddam
3
| Seyede Salehe Mo aza i
4
| Mohsen Sha i
5
| Mohammad Hadi Fa joo
1
|
Fa shad Fa zad a
3
1
Depa men o Pha macology, School o Medicine, Shahid Behesh i Uni e si y o Medical Sciences, Teh an, I an |
2
Non‐Communicable Diseases Resea ch
Cen e , Endoc inology and Me abolism Popula ion Sciences Ins i u e, Teh an Uni e si y o Medical Sciences, Teh an, I an |
3
Non‐Communicable Diseases
Resea ch Cen e , Teh an Uni e si y o Medical Sciences, Teh an, I an |
4
Ge ia ic Men al Heal h Resea ch Can e , School o Beha iou al Sciences and Men al
Heal h, I an Uni e si y o Medical Sciences, Teh an, I an |
5
Depa men o Epidemiology, Psychosocial Heal h Resea ch Ins i u e, Men al Heal h Resea ch
Cen e, Teh an, I an
Co espondence: Mohammad Hadi Fa joo ([email p o ec ed])
Recei ed: 25 May 2024 | Re ised: 29 Janua y 2025 | Accep ed: 31 Janua y 2025
Funding: The au ho s ecei ed no speci ic unding o his wo k.
Keywo ds: me abolic synd ome | polypha macy | po en ially inapp op ia e medica ion | sociodemog aphic
ABSTRACT
Backg ound and Aims: Polypha macy, cha ac e ized by he concu en use o i e o mo e medica ions in a p esc ip ion,
po en ially esul ing in ad e se ou comes, is equen ly obse ed among indi iduals wi h me abolic synd ome, which en-
compasses a collec ion o condi ions ha co‐occu , heigh ening he likelihood o hea disease, s oke, and ype 2 diabe es. This
s udy seeks o asce ain he p e alence o polypha macy and he use o po en ially inapp op ia e medica ions (PIMs) among
I anian pa ien s wi h me abolic synd ome, while also e alua ing he con ibu ing indi idual and sociodemog aphic ac o s.
Me hods: This was a popula ion‐based, c oss‐sec ional na ional s udy. Two da abases we e used: (a) I anians Heal h Insu ance
Se ice da abase and (b) I an's STEPS 2016 su ey. Pa ien s wi h me abolic synd ome conjoin in bo h da abases we e selec ed.
Among hese pa ien s, polypha macy and PIM we e e alua ed, and hei associa ion wi h indi idual and sociodemog aphic
ac o s was assessed. Uni a ia e and mul i a ia e logis ic eg ession we e used o analyze he associa ions. All s a is ical
analyses we e done using SPSS 22 and Py hon 3.
Resul s: Ou o 2075 me abolic synd ome pa ien s, 10.3% had polypha macy. Polypha macy signi ican ly inc eased by age (OR:
4.334, adjus ed o > 80‐yea ‐olds s. 25–39‐yea ‐olds [CI: 1.664–11.283], p< 0.001), and i s p e alence was signi ican ly highe
in u ban a eas (OR: 2.326 [CI: 1.645–3.288], p< 0.001). Polypha macy was 5.88% in Wes , 5.41% in Sou heas , 5.04% in Cen al,
and 4.83% in No h‐No heas o I an. PIM was 13.2% in ≥60 yea s and signi ican ly highe in u ban a eas (OR: 2.014 [CI:
1.153–3.519], p< 0.001).
Conclusions: Since he a ea o esidency a ec s polypha macy and PIM mo e signi ican ly han weal h s a us and educa ion
le el, i is impo an o implemen p e en i e measu es in u ban a eas.
This is an open access a icle unde he e ms o he C ea i e Commons A ibu ion License, which pe mi s use, dis ibu ion and ep oduc ion in any medium, p o ided he o iginal wo k is p ope ly
ci ed.
© 2025 The Au ho (s). Heal h Science Repo s published by Wiley Pe iodicals LLC.
1o 8Heal h Science Repo s, 2025; 8:e70600
h ps://doi.o g/10.1002/hs 2.70600
1 | In oduc ion
Polypha macy, a e m coined mo e han a cen u y ago,
desc ibes he u iliza ion o mul iple d ug egimens. Acco ding
o he e e ences, he e a e di e en de ini ions o poly-
pha macy, mos ly de ining i as he concu en use o ≥5 d ugs
ega dless o clinical indica ion [1–3]. Polypha macy can s em
om bo h physicians and pa ien s and is in luenced by ac o s
like communica ion gaps, misdiagnosis, imp ope p esc ip ions,
and inadequa e coo dina ion o physicians [4]. Pa ien s may
also con ibu e h ough sel ‐medica ion o ob aining mul iple
p esc ip ions om di e en heal hca e p o ide s [5, 6]. Mo e-
o e , acco ding o di e en s udies, sociodemog aphic ac o s
such as age, educa ion le el, and li es yle can also a ec poly-
pha macy [7]. Al hough polypha macy is no always ha m ul, i
can heigh en he likelihood o d ug in e ac ions, diminish he
quali y o li e, inc ease mo bidi y and mo ali y a es, and incu
expenses o bo h pa ien s and he heal hca e sys em [8].
In olde adul s, he likelihood o d ug in ole ance and medi-
ca ion e o s inc eases due o a highe suscep ibili y o poly-
pha macy s emming om mul iple como bidi ies and o en
poo adhe ence, which could lead o ad e se d ug eac ions
[9–13]. Po en ially inapp op ia e medica ion (PIM) is one o he
majo isk ac o s o ad e se d ug e en s [14, 15]. The e o e, i
is c ucial o assess he possibili y o PIM in he elde ly as a
consequence o polypha macy [15]. Acco ding o s udies,
unc ional s a us, dep ession, heal h quali y, economic si ua-
ion, a high como bidi y sco e, educed cogni ion, sel ‐
medica ion, and high isk o clinical‐ unc ional ulne abili y a e
some o he con ounding ac o s o PIM [16]. Since hese ac-
o s may be di e en in a ious socie ies, i is impo an o
assess hese co a ia es in I an as well.
Among a ious diseases, me abolic synd ome is a cons ella ion
o di e en isk ac o s associa ed wi h some ca dio ascula
diseases and diabe es melli us and is g owing wo ldwide. Due
o Me S's a ious como bidi ies, pa ien s o en ace poly-
pha macy o manage hei complica ions [17–19]. Also, ac-
co ding o di e en s udies, polypha macy is associa ed wi h
lowe he apeu ic bene i s and highe a es o mo bidi y and
mo ali y [20–22]. Some s udies ha e also ound ha wi h
mul iple he apies, he cos –bene i a io d ops in ch onic dis-
eases [23, 24]. The e o e, i is impo an o assess he p e alence
and con ounding ac o s o polypha macy among Me S pa ien s.
This s udy examined polypha macy and PIM in he p esc ip-
ions o indi iduals wi h Me S, alongside hei co ela ion wi h
bo h indi idual and sociodemog aphic ac o s, which, o ou
knowledge, has no been conduc ed a his scale in I an be o e.
2 | Me hods
2.1 | Da ase
This s udy was a c oss‐sec ional, mul i‐le el na ional in es i-
ga ion u ilizing da a om he I anian Heal h Insu ance and he
STEPS I an 2016 su ey. The STEPS su ey employed in his
s udy is an ongoing, sequen ial, la ge‐scale, c oss‐sec ional
popula ion‐based su eillance o ou noncommunicable dis-
eases (ca dio ascula , diabe es, espi a o y diseases, and cance )
ac oss all 31 p o inces o I an a he na ional le el. App oxi-
ma ely 31,050 indi iduals aged 25 yea s and abo e we e an-
domly en olled in he STEPS 2016 s udy and iden i ied by hei
Unique Na ional ID. Thei demog aphic and epidemiological
in o ma ion, as well as isky beha io s, we e documen ed
h ough labo a o y da a, medical examina ions, and ques ion-
nai es [25]. To iden i y pa ien s wi h a ailable p esc ip ion da a
as well as indi idual and sociodemog aphic in o ma ion, we
compa ed he na ional ID o pa ien s om he 102 million
p esc ip ions eco ded in he I anian Heal h Insu ance da ase
o 2015 and 2016 wi h he na ional ID o pa ien s included in
he STEPS 2016 su ey da ase in I an. App oxima ely 16,000
pa ien s we e chosen based on his o e lap. Subsequen ly, we
ca ego ized he p esc ip ions o hese pa ien s, along wi h hei
medica ions, using Ana omical The apeu ic Chemical (ATC)
codes [26]. Among hese 16,000 pa ien s, Me S pa ien s we e
sepa a ed based on he Ame ican Hea Associa ion c i e ia
[27, 28].
To iden i y p esc ip ions wi h polypha macy, we ollowed hese
s eps: (a) one p esc ip ion o each Me S pa ien was andomly
selec ed om he I anian Heal h Insu ance da ase o
each yea (2015 and 2016). (b) Gi en he ch onic na u e o
Me S, we assessed whe he medica ions ecu ed in pa ien s'
o he p esc ip ions wi hin he same yea , including only d ugs
epea ed a leas h ee imes annually [29]. (c) I he a o e-
men ioned c i e ion was me , we allied he numbe o medi-
ca ions in each speci ic p esc ip ion o e alua e polypha macy,
de ined as i e o mo e medica ions wi hin a single p esc ip ion.
2.2 | Da a Classi ica ion
The s udy examined ai s o Me S pa ien s, including gende ,
esiden ial a ea, age, ma i al s a us, and educa ion le el. Addi-
ionally, i u ilized a weal h index as ou lined in he STEPS
p o ocol o ca ego ize pa ien s in o i e economic g oups [30].
The popula ions o p o inces we e age‐s anda dized (excep
Qom, since i was no included in he STEPS s udy), and
polypha macy p e alence was assessed ac oss ou egions in
I an, based on a p e ious s udy, which di ided he coun y in o
ou egions o No h‐No heas , Wes , Cen al, and Sou heas
based on geog aphy and socioeconomic s a e (SES) o he pa-
ien s [31] (Figu e 1). To mi iga e PIM isks, he Ame ican
Ge ia ics Socie y (AGS) issues a lis o medica ions unsui able
o adul s aged 65 and abo e, based on he Bee s c i e ia [32].
Howe e , as many de eloping coun ies, including I an, de ine
elde ly age s a ing om 60, we adop ed his h eshold [32–34].
Bee s c i e ia p o ide a lis o d ugs o be a oided in he elde ly,
ca ego ized based on low, mode a e, and high quali y o e i-
dence. In his s udy, we only chose he d ugs in he mode a e
and high ca ego ies as PIM. Logis ic eg ession analyses we e
pe o med by me ging da a om 2015 o 2016, conside ing any
p esc ip ion wi h polypha macy o PIM in ei he yea .
2.3 | S a is ical Analysis
In his s udy, we aimed o e alua e he e ec o indi idual and
sociodemog aphic ac o s on polypha macy and PIM. To do so,
2o 8 Heal h Science Repo s, 2025
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desc ip i e s a is ical analysis was done based on bo h indi id-
ual ac o s (gende and age) and sociodemog aphic ac o s
(educa ion le el, a ea o li ing, ma i al s a us, and weal h index)
as independen a iables. Fi s , polypha macy was conside ed
as a dependen a iable, and indi idual and sociodemog aphic
ac o s we e all conside ed independen a iables. A e wa d,
d ugs conside ed PIMs we e de ined based on he Bee s c i e ia,
and hen using his da a and p esc ip ion da a among pa ien s
60 yea s and abo e, py hon p og amming was used o sepa a e
hese pa ien s in o wo g oups wi h and wi hou PIM. Subse-
quen ly, PIM was conside ed as he dependen a iable, and
polypha macy, indi idual, and sociodemog aphic ac o s we e
all conside ed as independen a iables. C ude (uni a ia e) and
adjus ed logis ic eg ession (mul i a ia e) models we e used o
assess he associa ions. SPSS e sion 22 and Py hon p og am-
ming sys em e sion 3 we e used o da a analyses wi h a
signi icance le el se a p≤0.05.
2.4 | E hics App o al
The E hical Commi ee o Shahid Behesh i Uni e si y o Med-
ical Sciences app o ed he s udy o he Medical School
Pha macology unde e e ence numbe IR.SBMU.MSP.REC.
1400.004.
3 | Resul s
3.1 | Gene al In o ma ion
Me S pa ien s o aled 2075 (12.9%), wi h 1391 (67.03%) emales,
ha ing a mean (SD) age o 54.75 (14). The p e alence o
polypha macy was 10.3%, escala ing om 2.8% in he 25–39 age
g oup o 17.2% in he 60–80 age b acke be o e declining o
12.9% in hose o e 80 yea s old (p< 0.001) (Table 1).
O he o al, 1314 (63.3%) pa ien s esided in u ban a eas.
Polypha macy was 6.3% in u al a eas and 12.6% in u ban se -
ings (OR: 2.33 [CI: 1.645–3.288], p< 0.001) (Table 1).
3.2 | Regional Dis ibu ion o Polypha macy
Polypha macy exhibi ed he highes p e alence in he Wes e n
egions o I an, while he lowes p e alence was obse ed in he
No h‐No heas e n a eas (Figu e 1).
3.3 | PIM
In 2015 and 2016, among 766 pa ien s aged 60 yea s and abo e,
13.2% we e iden i ied wi h PIM. The p e alence o PIM was
6.6% among pa ien s wi hou polypha macy, con as ing
wi h 46.1% among hose wi h polypha macy (OR: 11.6
[7.154–19.023], p< 0.001). PIM occu ence was no ably highe
in u ban se ings (16.8%) (OR: 2.01, [CI: 1.153–3.519], p= 0.01)
(Table 2).
4 | Discussion
In his s udy, polypha macy exhibi ed a signi ican co ela ion
wi h age and was no ably highe in u ban egions o I an,
a ec ing 10.3% o pa ien s in 2015 and 2016. This p e alence
was epo ed as 7%–45% based on an umb ella s udy, which
FIGURE 1 | Dis ibu ion o polypha macy as % in ou egions o I an. Cou esy o Fa zad a e al. [31].
3o 8
23988835, 2025, 4, Downloaded om h ps://onlinelib a y.wiley.com/doi/10.1002/hs 2.70600, Wiley Online Lib a y on [14/08/2025]. See he Te ms and Condi ions (h ps://onlinelib a y.wiley.com/ e ms-and-condi ions) on Wiley Online Lib a y o ules o use; OA a icles a e go e ned by he applicable C ea i e Commons License
TABLE 1 | Indi idual and sociodemog aphic cha ac e is ics o Me S pa ien s based on polypha macy (da a o pa ien s wi h no endency o answe a e no shown).
Fac o
To al
no. (%) Polypha macy (%)
C ude
OR
c
p alue
(c ude OR)
CI (95%)
(c ude OR) Adjus ed OR
p alue
(adjus ed OR)
CI
d
(95%)
(adjus ed OR)
Gende
Female 1391
(67.03)
139 (10)
Male 684 (32.96) 75 (11) 1.11 0.5 0.824–1.493 1.05 0.8 0.758–1.457
Age g oup < 0.001*< 0.001*
25–39 316 (15.2) 9 (2.8)
40–59 993 (47.9) 77 (7.8) 2.87 0.003*1.420–5.788 2.50 0.01*1.226–5.103
60–80 681 (32.8) 117 (17.2) 7.08 < 0.001*3.542–14.137 6.31 < 0.001*3.106–12.815
> 80 85 (4.1) 11 (12.9) 5.07 0.001* 2.027–12.683 4.33 0.003 *1.664–11.283
A ea o li ing
Ru al 761 (36.7) 48 (6.3)
U ban 1314 (63.3) 166 (12.6) 2.15 < 0.001*1.537–3.001 2.33 < 0.001*1.645–3.288
Yea s o schooling 0.7 0.7
0 597 (28.8) 57 (9.5)
1–6 650 (31.3) 68 (10.5) 1.11 0.6 0.764–1.604 1.15 0.5 0.783–1.678
7–12 527 (25.4) 60 (11.4) 1.22 0.3 0.830–1.785 1.21 0.3 0.815–1.799
> 12 301 (14.5) 29 (9.6) 1.01 0.9 0.631–1.616 0.94 0.8 0.580–1.539
Ma i al s a us
a
0.01*0.5
Ne e ma ied 55 (2.7) 1 (1.8)
Ma ied 1722 (83) 170 (9.9) 5.91 0.08 0.813–43.027 3.15 0.3 0.422–23.881
Di o ced/
sepa a ed
48 (2.3) 4 (8.3) 4.91 0.2 0.529–45.525 2.99 0.3 0.310–28.759
Widow 244 (11.8) 38 (15.6) 9.96 0.03*1.337–74.200 3.9 0.2 0.499–30.493
Weal h Index
b
0.2 0.3
Poo es 463 (22.3) 51 (11)
Poo 434 (20.9) 52 (12) 1.1 0.6 0.729–1.658 1.23 0.3 0.809–1.886
A e age 408 (19.7) 46 (11.3) 1.03 0.9 0.673–1.567 1.08 0.7 0.695–1.668
Rich 372 (17.9) 36 (9.7) 0.87 0.5 0.552–1.358 0.91 0.7 0.571–1.437
(Con inues)
4o 8 Heal h Science Repo s, 2025
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assessed 11 sys ema ic e iews o di e en coun ies [35]. A
sys ema ic e iew and me a‐analysis on polypha macy in Eu -
ope, Asia, No h Ame ica, Aus alia, Sou h Ame ica, and
A ica, among 54 s udies, epo ed 37% polypha macy, which
showed ha sex and geog aphical loca ion we e no associa ed
wi h di e ences in polypha macy p e alence [36]. In ano he
s udy in one o he p o inces o I an, he p e alence o poly-
pha macy was 9.51% among o e 14,000 indi iduals, which is
close o ou esul s [37]. Al hough all hese s udies conside ed
polypha macy as he concomi an use o 5 o mo e medica ions,
none o hem used ou c i e ion ha conside ed only he d ugs
epea ed 3 imes o mo e in he p esc ip ions o 1 yea . This
may be he eason o ou lowe p e alence, bu i gi es us
insigh in o he ch onic use o medica ions.
Among he elde ly, he p e alence o PIM was 13.2%. Compa ed
wi h he Uni ed Kingdom and Canada, he p e alence was
no ably lowe in I an. The Uni ed Kingdom exhibi ed a highe
p e alence a 31% [38], while Canada epo ed an e en highe
a e o 56% among olde adul s wi h diabe es [39]. These di -
e ences in indings may s em om ou ocus solely on Me S
pa ien s as ou a ge popula ion, as well as ou s ingen
c i e ia o de ining polypha macy, which equi ed medica ions
o be epea ed h ee imes o mo e each yea .
Polypha macy escala es signi ican ly wi h age in I an, each-
ing i s peak in u ban locales. Howe e , he e is a dec ease in
pa ien s aged o e 80 compa ed o hose in he 60–80 age
b acke , po en ially a ibu ed o he la e g oup ha ing a
highe bu den o como bidi ies. This end mi o s indings
om a s udy conduc ed on elde ly I alians, whe e poly-
pha macy p e alence was highe among olde indi iduals and
u ban esiden s [40]. Enhanced access o medical acili ies
and heal hca e p o ide s in u ban a eas o I an likely con-
ibu es o he obse ed highe a es o polypha macy. Con-
e sely, he u al egions o I an ope a e unde a e e al
sys em whe ein pa ien s a e ini ially assessed by a amily
physician and hen, i necessa y, e e ed o a specialis . This
sys ema ic app oach may se e as a p e en i e measu e
agains pa ien s ecei ing mul iple p esc ip ions.
The iches pa ien g oup exhibi ed he lowes p e alence o
polypha macy. While his associa ion lacked signi icance, i
challenges he no ion, a leas wi hin I an, ha highe ‐income
indi iduals consume mo e medica ions. This inding may s em
om he inclina ion and capaci y o weal hie pa ien s o con-
sul specialis physicians, po en ially mi iga ing he isk o
unnecessa y polypha macy. Simila ly, a c oss‐sec ional s udy
in ol ing 730 pa ien s in England ound ha polypha macy was
no ably mo e p e alen in lowe ‐income g oups [41].
Regionally, he p e alence o polypha macy was highes in
he Wes , and lowes in he No h‐No heas o I an. Al hough
he Cen al egion o I an has he highes SES [31], poly-
pha macy was a he lowe in his egion. This inding again
con i ms he idea ha highe SES does no necessa ily
inc ease polypha macy.
A signi ican associa ion o PIM wi h polypha macy and u ban
esidence sugges s a po en ial need o close medica ion
managemen among he elde ly wi h mul iple p esc ip ions and
TABLE 1 | (Con inued)
Fac o
To al
no. (%) Polypha macy (%)
C ude
OR
c
p alue
(c ude OR)
CI (95%)
(c ude OR) Adjus ed OR
p alue
(adjus ed OR)
CI
d
(95%)
(adjus ed OR)
Riches 377 (18.2) 28 (7.4) 0.65 0.08 0.400–1.050 0.72 0.2 0.440–1.180
To al 2075
(12.9%)
214 (10.3)
*Indica es he signi icance o he associa ion.
a
0.3% o pa ien s did no gi e an answe based on hei ma i al s a us.
b
1% o pa ien s had no endency o answe o hei weal h index.
c
OR: odds a io.
d
CI: con idence in e al.
5o 8
23988835, 2025, 4, Downloaded om h ps://onlinelib a y.wiley.com/doi/10.1002/hs 2.70600, Wiley Online Lib a y on [14/08/2025]. See he Te ms and Condi ions (h ps://onlinelib a y.wiley.com/ e ms-and-condi ions) on Wiley Online Lib a y o ules o use; OA a icles a e go e ned by he applicable C ea i e Commons License
hose esiding in u ban a eas. In he cu en s udy, no signi i-
can associa ion was obse ed be ween PIM, educa ion le el,
and weal h index; in con as , in Sweden, lowe educa ion le els
among women we e linked o highe a es o bo h poly-
pha macy and PIM, emphasizing he impo ance o educa ion
in medica ion managemen [1]. In F ance, sociodemog aphic
s a us played a signi ican ole, wi h unemploymen and lowe
household incomes co ela ing wi h inc eased PIM p e alence
[42]. Simila ly, in he Uni ed S a es, lowe educa ion and
income le els we e associa ed wi h highe PIM p e alence,
indica ing a need o a ge ed in e en ions o add ess heal h-
ca e dispa i ies among socioeconomically disad an aged popu-
la ions [43]. These di e ences highligh he impo ance o he
assessed popula ion, conside ing local con ex , cul u al ac o s,
u baniza ion, educa ion, socioeconomic s a us, geog aphical
di e ences, as well as heal hca e sys em cha ac e is ics, and
egula ions go e ning physician p esc ip ion s anda ds.
Add essing hese ac o s h ough comp ehensi e heal hca e
policies and in e en ions could help educe he bu den o
inapp op ia e medica ion use among pa ien s and, especially,
olde adul s.
4.1 | S eng hs
This s udy was pe o med on an indi idual le el based on an
o iginal da abase, on a na ional scale. The de ini ions we e
conside ed s ic ly, and he s udy was solely done on Me S pa-
ien s, as hey a e p one o polypha macy due o mul iple
complica ions. In polypha macy assessmen , we only coun ed
medica ions ha appea ed in p esc ip ions a leas h ee imes
o e he cou se o a yea . This app oach p o ides a mo e
accu a e unde s anding o polypha macy among Me S pa ien s.
4.2 | Limi a ions
This was a c oss‐sec ional s udy; he e o e, u he s udies a e
equi ed o assess he end o he issue o e pe iods o ime.
The da a used in his s udy was a subse o he STEPS su ey
da ase ; he e o e, he da a ela ed o he p o inces was age‐
s anda dized and combined in ou la ge egions o I an o gain
mo e eliable s a is ical esul s. Acco ding o he STEPS su ey,
Qom p o ince did no p o ide da a o analyses, which migh
TABLE 2 | Indi idual and sociodemog aphic cha ac e is ics o pa ien s abo e 60 yea s (da a o pa ien s wi h no endency o answe a e no
shown).
Fac o No. (%) PIM no.
b
(%) p alue Adjus ed OR
a
CI
c
(95%)
To al 766 (36.9) 101 (13.2)
Age g oup
60–80 699 (91.3) 92 (13.5)
> 80 67 (8.7) 9 (10.6) 0.7 0.83 0.365–1.896
Gende
Female 496 (64.8) 66 (13.3)
Male 270 (35.2) 35 (13.0) 0.4 0.8 0.483–1.337
A ea o li ing
Ru al 295 (38.5) 22 (7.5)
U ban 471 (61.5) 79 (16.8) 0.01*2.01 1.153–3.519
Yea s o schooling
0 389 (50.8) 31 (14.0)
1–6 189 (24.7) 31 (13.7) 0.9 0.95 0.519–1.764
7–12 105 (13.7) 31 (15.3) 0.7 1.11 0.601–2.067
> 12 83 (10.8) 8 (6.8) 0.03 0.36 0.140–0.912
Weal h Index
Poo es 196 (25.6) 28 (14.3)
Poo 149 (19.5) 21 (14.1) 0.9 0.98 0.488–1.980
A e age 153 (20.0) 16 (10.5) 0.1 0.58 0.276–1.215
Rich 138 (18.0) 20 (14.5) 0.6 1.23 0.604–2.518
Riches 121 (15.8) 15 (12.4) 0.9 0.97 0.450–2.095
Polypha macy
No 638 (83.3) 42 (6.6)
Yes 128 (16.7) 59 (46.1) < 0.001*11.6 7.154–19.023
*Indica es he signi icance o he associa ion.
a
OR: odds a io.
b
PIM: po en ially inapp op ia e medica ion.
c
CI: con idence in e al.
6o 8 Heal h Science Repo s, 2025
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al e he esul s. Mo eo e , in addi ion o p esc ip ion d ugs,
o e ‐ he‐coun e d ugs a e also ob ained by me abolic syn-
d ome pa ien s; he e o e, his comp omises he ac ual numbe
o polypha macy and PIM.
5 | Conclusion
These esul s highligh he impo ance o implemen ing mea-
su es o con ol unnecessa y polypha macy, hus mi iga ing he
isk o PIM and medica ion e o s. Fo example, le e aging he
e e al sys em in u al a eas o I an could se e as a bene icial
s a egy o educe polypha macy in u ban se ings; u he mo e,
enhancing elec onic p esc ibing sys ems in I an could aid in
de ec ing p esc ip ion e o s and unnecessa y polypha macy by
bo h p esc ibe s and pha macis s. Fu u e esea ch endea o s
could ocus on analyzing mo e ecen da ase s o disce n ends
in polypha macy o e ime. Addi ionally, explo ing di e se
insu ance da abases and examining p esc ip ions wi hou
insu ance co e age could p o ide aluable insigh s in o a ia-
ions in polypha macy pa e ns.
Au ho Con ibu ions
Mojdeh Daneshmand: in es iga ion, w i ing –o iginal d a , isual-
iza ion, w i ing – e iew and edi ing, o mal analysis, da a cu a ion.
Hamid eza Jamshidi: concep ualiza ion, alida ion, p ojec adminis-
a ion, supe ision. Mohammad‐Reza Malekpou : in es iga ion,
o mal analysis, so wa e. E an Ghasemi: so wa e, o mal analysis.
Saha Saeedi Moghaddam: o mal analysis. Seyede Salehe
Mo aza i: supe ision, alida ion. Mohsen Sha i: alida ion, supe -
ision. Mohammad Hadi Fa joo: in es iga ion, w i ing – e iew and
edi ing, supe ision. Fa shad Fa zad a : concep ualiza ion, me hod-
ology, alida ion, p ojec adminis a ion, da a cu a ion, supe ision,
esou ces.
Acknowledgmen s
The au ho s ha e no hing o epo .
E hics S a emen
The E hical Commi ee o Shahid Behesh i Uni e si y o Medical Sci-
ences app o ed he s udy o he Medical School Pha macologyunde
e e ence numbe IR.SBMU.MSP.REC.1400.004.
Consen
The da a used o his s udy is de i ed om he STEPS I an 2016 su ey,
and he a o emen ioned consen has al eady been ob ained by he
su ey au ho i ies.
Con lic s o In e es
The au ho s decla e no con lic s o in e es .
Da a A ailabili y S a emen
The da a ha suppo he indings o his s udy a e a ailable on eques
om he co esponding au ho . The da a a e no publicly a ailable due
o p i acy o e hical es ic ions.
The da ase s gene a ed du ing and/o analyzed du ing he cu en s udy
a e no publicly a ailable due o con iden iali y bu a e a ailable om
he co esponding au ho s upon easonable eques .
T anspa ency S a emen
D . Mojdeh Daneshmand; he lead au ho , a i ms ha his manusc ip
is an hones , accu a e, and anspa en accoun o he s udy being e-
po ed; ha no impo an aspec s o he s udy ha e been omi ed; and
ha any disc epancies om he s udy as planned (and, i ele an , e-
gis e ed) ha e been explained.
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