Background Polypharmacy, a growing phenomenon within the British population, has been linked with increased falls, reduced functional status and higher all-cause mortality in later life. However the risk profile for individual medications is not universal, with cardiovascular medications in particular posing a high risk. Prior research has found that greater socioeconomic disadvantage is associated with higher levels of polypharmacy but studies rarely control for disease burden or distinguish between cardiological and non-cardiological polypharmacy. The aim of this study was to describe the development of polypharmacy and its composition in a British birth cohort in its seventh decade and to investigate socioeconomic and gender differences independent of disease burden.

Methods Medication data from the Medical Research Council National Survey for Health and Development (NSHD), the oldest British birth cohort, were analysed to determine the prevalence and composition of polypharmacy at age 69 and its change from ages 60–64. Multinomial regression was used to test associations between gender, education and occupational social class and total, cardiological and non-cardiological polypharmacy controlling for the number of diagnosed diseases.

Results At age 69, 22.8% of individuals were taking more than 5 medications. There was an increase in the use of 5 to 8 medications (+2.3%) and over 9 medications (+0.8%) between ages 60 to 64 and 69. The greatest increases were found for cardiovascular (+13.4%) and gastrointestinal medications (+7.3%). Men experienced greater cardiological polypharmacy, women greater non-cardiological polypharmacy. Higher levels of education were associated with lower levels of both types of polypharmacy independent of disease burden, with strongest effects seen for over five cardiological medications (RRR 0.3, 95% CI 0.2,0.5 p<0.001 for advanced secondary qualifications compared with no qualifications); there was no additional effect of occupational class.

Conclusion Polypharmacy, particularly cardiological polypharmacy, increased over the seventh decade and was associated with lower educational attainment. While this study could not assess the appropriateness of the polypharmacy observed, it provided understanding of its genesis and the possible benefits of targeted interventions to reduce potential harm caused by adverse drug events. Further study of the consequences of different types of polypharmacy should take into account these educational differences.