Americans will spend half their lives taking prescription drugs, study finds

Ho reported her findings this week (Oct. 1) in the journal Demography.

"As an American, I'd like to know what medications I'm putting in my body and how long I can expect to take them," said Ho, who is also an associate of Penn State's Social Science Research Institute. "The years that people can expect to spend taking prescription drugs are now higher than they might spend in their first marriage, getting an education or being in the labor force. It's important to recognize the central role that prescription drug use has taken on in our lives."

Ho used nationally representative surveys conducted by Agency for Healthcare Research and Quality (AHRQ) and the Centers for Disease Control and Prevention (CDC) from 1996 through 2019 to study prescription drug use across the United States. The surveys include information from approximately 15,000 households chosen annually and collect information every five months, offering better recall than surveys taken once a year. In addition, nearly 70% of survey respondents allow the AHRQ and CDC to verify their prescriptions with their pharmacies, affording the surveys higher levels of accuracy.

The researcher then used mortality data from the National Center for Health Statistics and the Human Mortality Database to estimate how long Americans born in 2019 could expect to live. She then combined this information with the survey data to estimate the percent of their lifetimes they could expect to spend taking prescription medications.

She found that the majority of American men are taking prescription drugs by age 40, while most American women are taking prescription drugs by age 15. On average, a newborn boy in 2019 could expect to take prescription drugs for approximately 37 years, or 48% of his life. A newborn girl in 2019 could expect to take them for approximately 47.5 years, or 60% of her life.

"We see that women start taking prescription drugs earlier than men do, and some of that is related to birth control and hormonal contraceptives," Ho said. "But it is also related to greater use of psychotherapeutic drugs and painkillers among women. If we consider the difference between men and women, excluding contraceptives would only account for about a third of the difference. The remaining two-thirds is primarily driven by the use of other hormone-related drugs, painkillers and psychotherapeutic drugs used to treat conditions such as depression, anxiety and ADHD."

Men, on the other hand, tend to take more statins and other medications to treat cardiovascular disease, explained Ho. But statin use varies across race and ethnicity, she said.

"Non-Hispanic Black men have lower rates of statin use than non-Hispanic whites or Hispanics," Ho said. "That's concerning because we know that cardiovascular disease, diabetes and other metabolic disorders are really high among Black men. There's no reason that they should be taking these drugs for fewer years of their lives than men in other racial and ethnic groups. Health care access, differential treatment by medical providers, and available socioeconomic resources vary across populations and may help to account for these differences."

She also found that rates of polypharmacy, or when an individual takes five or more drugs at the same time, have risen to alarming levels. In the mid-1990s, most people taking prescription medications were on one drug. Today, individuals taking prescription medications are equally likely to be taking five or more medications, according to Ho.

The findings have implications for Americans' health and health care expenditures. Many of the drugs that individuals are on for 40 or 50 years have only been on the market for the past five decades, so their long-term effects on the body are still unknown, Ho said. Further, polypharmacy puts the individual at greater risk for drug interactions and adverse health outcomes, she said.

As for health care costs, prescription drug expenditures hit $335 billion in 2018. Out-of-pocket expenditures on prescription medications account for 14% of drug spending, and prescription drug spending is projected to hit $875 billion, or 15.4% of national health expenditures, by 2026.

"This paper is not trying to say that use of prescription drugs is good or bad," Ho said. "Obviously, they have made a difference in treating many conditions, but there are growing concerns about how much is too much. There's a large body of research that shows Americans are less healthy and live shorter lives than our counterparts in other high-income countries. The prescription drug piece is part and parcel of that reality. What we find is, even above and beyond what we might expect to be seeing, the rates of prescription drug use in the United States are extraordinarily high."

The National Institutes of Health, through the National Institute on Aging, supported this work.