European Journal of Clinical Pharmacology

, Volume 69, Issue 7, pp 1477–1483 | Cite as

Geographical differences in the prevalence of chronic polypharmacy in older people: eleven years of the EPIFARM-Elderly Project

  • Carlotta Franchi
  • Massimo Cartabia
  • Paolo Risso
  • Daniela Mari
  • Mauro Tettamanti
  • Alberto Parabiaghi
  • Luca Pasina
  • Codjo Djignefa Djade
  • Ida Fortino
  • Angela Bortolotti
  • Luca Merlino
  • Alessandro Nobili
Pharmacoepidemiology and Prescription



To compare the geographical differences in the prevalence of chronic polypharmacy in community-dwelling older people over 11 years.


This study analyzed nearly two million patients aged 65–94 years recorded in the Drug Administrative Database of the Lombardy Region (Northern Italy) from 2000 to 2010. Chronic polypharmacy was defined as taking five or more drugs in 1 month for at least 6 months (consecutive or not) in a year.


There was a significant spatial autocorrelation that increased at the municipality level from 2000 (Moran’s I Index = 0.26, z score = 16.91, p < 0.0001) to 2010 (Moran’s I Index = 0.36, z score = 23.78, p < 0.0001). Clusters of high (Z(G) > 1.96) and low (Z(G) < −1.96) prevalence rates of chronic polypharmacy were found and were not influenced by age. Chronic polypharmacy weakly correlated with hospital admission (2000: ρ = 0.08, p = 0.0032; 2005: ρ = 0.11, p < 0.0001; 2010: ρ = 0.18, p < 0.0001), but not with mortality.


There were geographical differences in the prevalence of older people with chronic polypharmacy that were only partly explained by health indicators. Targeted activities on prescription practice to ensure that the prescribing of chronic polypharmacy is appropriate are required.


Older people Chronic polypharmacy Geographical difference Clusters 


Conflict of interest



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Copyright information

© Springer-Verlag Berlin Heidelberg 2013

Authors and Affiliations

  • Carlotta Franchi
    • 1
  • Massimo Cartabia
    • 2
  • Paolo Risso
    • 3
  • Daniela Mari
    • 4
  • Mauro Tettamanti
    • 5
  • Alberto Parabiaghi
    • 3
  • Luca Pasina
    • 1
  • Codjo Djignefa Djade
    • 1
  • Ida Fortino
    • 6
  • Angela Bortolotti
    • 6
  • Luca Merlino
    • 6
  • Alessandro Nobili
    • 1
  1. 1.Laboratory for Quality Assessment of Geriatric Therapies and ServicesIstituto di Ricerche Farmacologiche Mario Negri-IRCCSMilanItaly
  2. 2.Laboratory of Mother and Child HealthIstituto di Ricerche Farmacologiche Mario Negri-IRCCSMilanItaly
  3. 3.Laboratory of Epidemiology and Social PsychiatryIstituto di Ricerche Farmacologiche Mario Negri-IRCCSMilanItaly
  4. 4.IRCCS Maggiore Hospital Foundation and University of Milan, Department of Clinical Sciences and Community Health, Geriatric UnitMilanItaly
  5. 5.Laboratory of Geriatric NeuropsychiatryIstituto di Ricerche Farmacologiche Mario Negri-IRCCSMilanItaly
  6. 6.Regional Health Ministry, Lombardy RegionMilanItaly

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