{"doi":"10.1002/prp2.823","title":"Polypharmacy and mortality association by chronic kidney disease status: The <i>RE</i>asons for <i>G</i>eographic <i>A</i>nd <i>R</i>acial <i>D</i>ifferences in <i>S</i>troke Study","abstract":"Many Americans take multiple medications simultaneously (polypharmacy). Polypharmacy's effects on mortality are uncertain. We endeavored to assess the association between polypharmacy and mortality in a large U.S. cohort and examine potential effect modification by chronic kidney disease (CKD) status. The REasons for Geographic And Racial Differences in Stroke cohort data (n = 29 627, comprised of U.S. black and white adults) were used. During a baseline home visit, pill bottle inspections ascertained medications used in the previous 2 weeks. Polypharmacy status (major [≥8 ingredients], minor [6-7 ingredients], and none [0-5 ingredients]) was determined by counting the total number of generic ingredients. Cox models (time-on-study and age-time-scale methods) assessed the association between polypharmacy and mortality. Alternative models examined confounding by indication and possible effect modification by CKD. Over 4.9 years median follow-up, 2538 deaths were observed. Major polypharmacy was associated with increased mortality in all models, with hazard ratios and 95% confidence intervals ranging from 1.22 (1.07-1.40) to 2.35 (2.15-2.56), with weaker associations in more adjusted models. Minor polypharmacy was associated with mortality in some, but not all, models. The polypharmacy-mortality association did not differ by CKD status. While residual confounding by indication cannot be excluded, in this large American cohort, major polypharmacy was consistently associated with mortality.","journal":"Pharmacology Research & Perspectives","year":2021,"id":194949,"datarank":0.0,"base_score":0.0,"endowment":0.0,"self_citation_contribution":0.0,"citation_network_contribution":0.0,"self_endowment_contribution":0.0,"citer_contribution":0.0,"corpus_percentile":null,"corpus_rank":null,"citation_count":9,"citer_count":0,"citers_with_citation_signal":0,"citers_with_endowment":0,"datacite_reuse_total":0,"is_dataset":false,"is_dataset_confidence":0.9612,"is_data_producer":false,"deposit_databanks":null,"is_oa":true,"file_count":0,"downloads":0,"has_version_chain":false,"published_date":"2021-01-01","fair_score":null,"fair_percentile":null,"algorithm_id":"datarank_citation_only_1hop_v6","ranking_scope":"data_only","authors":[{"id":766206,"name":"William McClellan","orcid":null,"position":1,"is_corresponding":false},{"id":74972,"name":"Suzanne E. Judd","orcid":"0000-0001-7594-6587","position":2,"is_corresponding":false},{"id":765547,"name":"Abhinav Goyal","orcid":"0000-0003-2648-5627","position":3,"is_corresponding":false},{"id":765548,"name":"David G. Kleinbaum","orcid":"0000-0002-6544-2972","position":4,"is_corresponding":false},{"id":361427,"name":"Michael Goodman","orcid":"0000-0001-6956-6879","position":5,"is_corresponding":false},{"id":766207,"name":"Valerie Prince","orcid":null,"position":6,"is_corresponding":false},{"id":74980,"name":"Paul Muntner","orcid":"0000-0002-4711-5492","position":7,"is_corresponding":false},{"id":103407,"name":"George Howard","orcid":"0000-0002-3068-5720","position":8,"is_corresponding":false},{"id":750851,"name":"Winn Cashion","orcid":"0000-0003-2979-9103","position":0,"is_corresponding":true}],"reference_count":55,"raw_metadata":null,"created_at":"2026-07-18T23:50:03.719152Z","pmid":"34339112","pmcid":null,"fwci":null,"citation_percentile":null,"influential_citations":0,"oa_status":null,"license":null,"views":0,"total_file_size_bytes":0,"version_count":0,"fair_f":null,"fair_a":null,"fair_i":null,"fair_r":null,"fair_zscore":null,"fair_rationale":null,"fair_model":null,"fair_agent_version":null,"fair_fulltext_source":null,"fair_has_llm":null,"fair_computed_at":null,"clinical_trials":[],"software_tools":[],"db_accessions":[],"linked_datasets":[],"topics":[]}