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Disparities in High-Risk Medication Use—Implications for Health Equity and Deprescribing Practices
Michelle S. Keller, Utibe R. Essien. JAMA Network Open, 2025-04-14
Topic: Risk, prevention and care in population studies
Potentially inappropriate medication (PIM) use-defined as the use of high-risk medications that can increase the risk of adverse events such as physical, cognitive, and functional decline; delirium; hospitalizations; and mortality-remains a significant concern in older adults in the US.Numerous guidelines, including the American Geriatrics Society Beers Criteria 1 and the STOPP criteria, 2 define PIMs as medications for which the risk of adverse effects outweighs potential benefits or are inappropriate for specific populations or disease states, such dementia or kidney disease.PIM use may be particularly harmful in populations experiencing other health care disparities, as communities experiencing other consequences of health care inequity, including limited access to physicians or pharmacies, greater financial stress, and a higher comorbidity burden, may experience disproportionate effects from the adverse consequences of PIM use.To examine potential racial and ethnic disparities in PIM use, Raver and colleagues 3 analyzed claims data from more than 21 million Medicare beneficiaries between 2016 and 2019, examining racial and ethnic differences in 3 medication use outcomes: (1) high-risk medication use among older adults, (2) potentially harmful drug-disease interactions in patients with dementia, and (3) potentially harmful drug-disease interactions in patients with a history of falls.The authors also stratified their analyses by Medicare plan type, including traditional Medicare (TM) and Medicare Advantage (MA).The authors found that individuals from racial and ethnic minoritized groups (ie, Asian or Pacific Islander, Black, and Hispanic) had lower rates of high-risk medication use in all 3 outcomes compared with White beneficiaries, with smaller disparities observed among MA compared with TM beneficiaries.A key strength of the analysis is its reliance on existing Healthcare Effectiveness Data and Information Set quality measures, which will enable others to perform comparisons across time and within and across health insurance plans and health systems.Additionally, the focus on 2 highly vulnerable populations-individuals with dementia and those with a history of falls-is particularly important, as polypharmacy and PIM use in these groups can disproportionately worsen cognitive, physical, and functional decline.To account for potentially important confounding factors, Raver et al 3 included measures to adjust for differences in socioeconomic status at t
Key findings
- Potentially inappropriate medication (PIM) use-defined as the use of high-risk medications that can increase the risk of adverse events such as physical, cognitive, and functional decline; delirium; hospitalizations; and mortality-remains a significant concern in older adults in the US.Numerous guid
Why it matters
This commentary discusses potentially inappropriate medication use in older adults, including harmful drug-disease interactions in patients with dementia, and racial and ethnic disparities in such use. It is about medication safety and deprescribing, not about treating, curing, or preventing Alzheimer's disease.
Study details
- Evidence strengthLow
How this study scored 36/100
Published in a leading specialty journal. Scored zero for study design, sample size, effect reported, studied in people and randomised / blinded because the record does not state it.
| Component | Points | Why |
|---|---|---|
| Journal tier | 9 / 10 | Tier 2 — leading specialty journal (JAMA Network Open) |
| Journal's citation record | 2 / 4 | JAMA Network Open: journal h-index 235 (OpenAlex, 2026-10-29) |
| Study design | 0 / 12 | No study design recorded — scores zero, not guessed (not stated in the record — scored 0) |
| Strength of evidence | 1 / 5 | Rated “low” in our summary |
| Peer-review validation | 10 / 10 | Peer-reviewed. Published as an article in a named peer-reviewed journal. |
| How recent | 4 / 5 | 2025 — within 3 year(s) of the newest study here |
| Sample size | 0 / 4 | Participant count not stated — scores zero (not stated in the record — scored 0) |
| Effect reported | 0 / 3 | No effect size reported — scores zero (not stated in the record — scored 0) |
| Studied in people | 0 / 3 | Not stated whether this was studied in people — scores zero (not stated in the record — scored 0) |
| Randomised / blinded | 0 / 2 | No randomisation or blinding stated — scores zero (not stated in the record — scored 0) |
| Times cited | 0 / 7 | Cited 0 times (OpenAlex, 2026-10-10) |
| Citations per year | 0 / 5 | 0.0 citations a year over 3 year(s) since 2025 |
| Impact for its field and year | 0 / 6 | Cited 0.0× the average for papers of its field and year (OpenAlex FWCI) |
| Cited by studies here | 0 / 6 | No other study in this library cites it |
| Still being cited | 0 / 4 | Cited 0 times in 2024–2026 (2026 still in progress; OpenAlex) |
| Senior author's track record | 2 / 4 | Last-listed author Utibe R. Essien: h-index 31 (OpenAlex, whole career) |
| Institution's track record | 2 / 3 | University of California, Los Angeles: institution h-index 1,923 (OpenAlex) |
| Multi-centre collaboration | 2 / 3 | OpenAlex lists 4 institution(s) in 1 country |
| Indexed in PubMed | 2 / 2 | Indexed in PubMed (PMID 40227691) |
| Free to read | 2 / 2 | Free to read |
| Total | 36 / 100 | — |
What each of these 20 components measures, and what this score is not →
Read the original
- DOI: 10.1001/jamanetworkopen.2025.4768
- PubMed: 40227691
- Original source →
- Free full text: JAMA Network Open →
Full text: free to read — OpenAlex lists this copy as free to read: the link above (checked 6 Feb 1020).
Cite this study APA, Vancouver, BibTeX · download .bib or .ris
Built from the record alzhub holds for this paper, not looked up. Volume, issue and page numbers are not held in the record. Check the citation against the original before you use it.
APA 7th
Keller, M. S., & Essien, U. R. (2025). Disparities in High-Risk Medication Use—Implications for Health Equity and Deprescribing Practices. JAMA Network Open. https://doi.org/10.1001/jamanetworkopen.2025.4768
Vancouver
Keller MS, Essien UR. Disparities in High-Risk Medication Use—Implications for Health Equity and Deprescribing Practices. JAMA Network Open. 2025. doi:10.1001/jamanetworkopen.2025.4768. PMID: 40227691.
BibTeX
@article{keller2025-40227691,
author = {Keller, Michelle S. and Essien, Utibe R.},
title = {{Disparities in High-Risk Medication Use—Implications for Health Equity and Deprescribing Practices}},
journal = {JAMA Network Open},
year = {2025},
doi = {10.1001/jamanetworkopen.2025.4768},
pmid = {40227691},
url = {https://doi.org/10.1001/jamanetworkopen.2025.4768}
}
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