Current Epidemiology Reports

, Volume 6, Issue 3, pp 390–401 | Cite as

Mixed Bag “Polypharmacy”: Methodological Pitfalls and Challenges of This Exposure Definition

  • Caroline SiroisEmail author
  • Marc Simard
  • Emmanuelle Gosselin
  • Marie-Eve Gagnon
  • Barbara Roux
  • Marie-Laure Laroche
Pharmacoepidemiology (U Haug, Section Editor)
Part of the following topical collections:
  1. Topical Collection on Pharmacoepidemiology


Purpose of Review

The use of multiple medications is common in older adults but is associated with negative health outcomes. However, polypharmacy is not uniformly defined, and there is scant data on how the variety of definitions and their limitations hinder the development of sound scientific knowledge. The article intends to illustrate the challenges of this exposure definition.

Recent Findings

The array of thresholds for defining polypharmacy renders comparisons between results difficult. Few studies take into account the fact that polypharmacy is a changing exposure over time. In addition, although studies tend to recognize the confounding effect of multimorbidity, residual bias remains a concern.


Current studies in polypharmacy often ignore basic epidemiological principles for defining exposure. Future research should integrate time-varying exposure and methods to better control confounding bias. This will help determine the positive/negative impacts of polypharmacy and help establish if polypharmacy conveys information beyond being a marker of health status.


Pharmacoepidemiology Polypharmacy Definition Exposure Methodology 


Compliance with Ethical Standards

Conflict of Interest

Caroline Sirois reports grants from the Fonds de recherche du Québec-Santé and from the Centre de recherche sur les soins et les services de première ligne de l’Université Laval. Marie-Eve Gagnon receives a scholarship from the Fonds de recherche du Québec-Santé. Marc Simard, Emmanuelle Gosselin, Barbara Roux, and Marie-Laure Laroche declare no conflict of interest.

Human and Animal Rights and Informed Consent

This article does not contain any studies with human or animal subjects performed by any of the authors.


Papers of particular interest, published recently, have been highlighted as: • Of importance •• Of major importance

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Copyright information

© Springer Nature Switzerland AG 2019

Authors and Affiliations

  • Caroline Sirois
    • 1
    • 2
    • 3
    • 4
    Email author
  • Marc Simard
    • 4
  • Emmanuelle Gosselin
    • 1
    • 2
    • 3
  • Marie-Eve Gagnon
    • 1
    • 2
    • 3
  • Barbara Roux
    • 5
    • 6
  • Marie-Laure Laroche
    • 5
    • 6
  1. 1.Department of Social and Preventive MedicineLaval UniversityQuebecCanada
  2. 2.Centre of Excellence on Aging of QuebecCIUSSS-CNQuebecCanada
  3. 3.Centre de recherche sur les soins et les services de première ligne de l’Université LavalQuebecCanada
  4. 4.Institut national de santé publique du QuébecQuebecCanada
  5. 5.Centre of Pharmacovigilance and PharmacoepidemiologyUniversity Hospital of LimogesLimogesFrance
  6. 6.INSERM UMR 1248, Faculty of MedicineUniversity of LimogesLimogesFrance

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