King's College London

Context: Polypharmacy is often appropriate for children with life-limiting conditions but is associated with an increase in hospitalizations and inappropriate prescribing, and can affect the quality of life of children and their families as they manage complex medication schedules. Despite this, little is known about polypharmacy in this population. Objective: To describe the prevalence and patterns of polypharmacy in children with a life-limiting condition in a nationally representative cohort in England. Methods: Observational study of children (age 0–19 years) with a life-limiting condition in a national database from 2000 to 2015. Common definitions of polypharmacy were used to determine polypharmacy prevalence in each year based on unique medications and regular medications. Hierarchical regression analyses were used to explore factors associated with polypharmacy. Results: Data on 15,829 individuals were included. Each year 27%–39% of children were prescribed ≥5 unique medications and 8%–12% were prescribed ≥10. Children with a respiratory (OR 7.6, 95%CI 6.4–9.0), neurological (OR 2.8, 95%CI 2.4–3.2), or metabolic (OR 2.2, 95%CI 1.7–2.8) condition were more likely than those with a congenital condition to experience polypharmacy. Increasing age, being diagnosed with a LLC under one year of age, having >1 life-limiting or chronic condition or living in areas of higher deprivation were also associated with higher prevalence of polypharmacy. Conclusion: Children with life-limiting conditions have a high prevalence of polypharmacy and some children are at greater risk than others. More research is needed to understand and address the factors that lead to problematic polypharmacy in this population.