Estimating Life Course Patterns and Years of Life Lived Taking Prescription Drugs

PROJECT SUMMARY Prescription drug use has reached historic highs in the United States, with nearly half of all Americans and over 80% of the population aged 60 and older reporting taking prescription drugs in the past 30 days in 2015-2016. Prescription drugs have become a mainstay of medical treatment for an ever expanding array of conditions. Not only are more Americans taking drugs, but they are taking more of them concurrently (polypharmacy) and for longer durations. While prescription drugs have contributed to improvements in health and mortality, these trends in prescription drug use have also prompted concerns related to overprescribing, rising health care costs, adverse drug events, and quality of life impacts. These issues are particularly salient for older adults, who are the largest per capita consumers of prescription drugs. Increasing attention is being paid to the consequences of prescription drug use, particularly in light of the contemporary American opioid epidemic, which was initially driven by the overuse of prescription opioid painkillers. However, there are no existing measures of life course patterns of prescription drug use, including how much of their lives Americans can now expect to spend taking prescription drugs or ages at initiation of sustained prescription drug use. This project will produce those measures leveraging data from the Medical Expenditure Panel Survey (MEPS), a long running, nationally representative survey that collects high quality data on prescription drug use, combined with life tables from the Human Mortality Database (HMD). We will estimate period life tables for prescription drug use using a novel application of Sullivan's method, which is used to estimate health expectancies. We will estimate the number of years Americans can expect to spend taking (and not taking): (1) any prescription drugs; (2) specific types of prescription drugs (i.e., therapeutic drug classes); and (3) numbers of prescription drugs (0, 1, 2, 3, 4, 5+) to capture polypharmacy by age and sex for each year between 1996 and 2017. We are also interested in changing patterns of prescription drug use across birth cohorts. The majority of drugs used to treat chronic disease were developed after 1950; thus, older adults today, unlike their predecessors, are the first birth cohorts of older adults to have experienced decades of sustained prescription drug use over the life course. We implement a methodological innovation that uses Sullivan's method to calculate temporary life expectancy (i.e., the years of life lived spent taking prescription drugs within a specific age range) for birth cohorts. This innovation, which can be extended to many other research questions using multistate methods for cohorts, will allow us to produce similar estimates to those described above of the number of years birth cohorts born between 1927 and 1996 have spent taking any prescription drugs, specific classes of drugs, and specific numbers of prescription drugs. These estimates have important implications for contemporary debates surrounding prescription drug use including overprescribing, spending, polypharmacy, and the risk of experiencing adverse drug events.