Applicability of STOPP/START prescribing criteria in integrated Swedish administrative health registries and a Swedish population-based cohort

Cheima Amrouch; Souad Amrouch; Lu Dai; Amaia Calderón-Larrañaga; Jonas W Wastesson; Kristina Johnell; Davide Liborio Vetrano; Delphine De Smedt; Mirko Petrovic

doi:10.1007/s41999-024-00990-3

Applicability of STOPP/START prescribing criteria in integrated Swedish administrative health registries and a Swedish population-based cohort

Eur Geriatr Med. 2024 May 16. doi: 10.1007/s41999-024-00990-3. Online ahead of print.

Authors

Cheima Amrouch^{1

2}, Souad Amrouch³, Lu Dai⁴, Amaia Calderón-Larrañaga^{4

5}, Jonas W Wastesson^{4

6}, Kristina Johnell⁶, Davide Liborio Vetrano^{4

5}, Delphine De Smedt^#⁷, Mirko Petrovic^#⁸

Affiliations

¹ Department of Public Health and Primary Care, Ghent University, Ghent, Belgium. cheima.amrouch@ugent.be.
² Department of Internal Medicine and Paediatrics, Ghent University, Ghent, Belgium. cheima.amrouch@ugent.be.
³ Department of Medicine, Antwerp University, Antwerp, Belgium.
⁴ Aging Research Center, Department of Neurobiology, Care Sciences and Society, Karolinska Institutet and Stockholm University, Stockholm, Sweden.
⁵ Stockholm Gerontology Research Center, Stockholm, Sweden.
⁶ Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden.
⁷ Department of Public Health and Primary Care, Ghent University, Ghent, Belgium.
⁸ Department of Internal Medicine and Paediatrics, Ghent University, Ghent, Belgium.

^# Contributed equally.

PMID: 38753270
DOI: 10.1007/s41999-024-00990-3

Abstract

Purpose: The STOPP/START criteria are frequently applied in observational studies to assess potentially inappropriate prescribing in older adults. This study aimed to assess the applicability of the three available STOPP/START versions in two distinct data sources.

Methods: To evaluate the applicability of the three versions of STOPP/START criteria, we used two observational data sources: (i) Integrated Swedish administrative health registries (ISHR) encompassing routinely collected health data and (ii) the population-based Swedish National study on Aging and Care in Kungsholmen (SNAC-K), based on health professional-led clinical assessments. The Anatomical Therapeutic Classification code (ATC) was used to categorise medications. Diseases were categorised using the international classification of diseases version 10 (ICD10).

Results: The first STOPP/START version demonstrated an applicability rate of 80% in ISHR and 84% in SNAC-K. The second version demonstrated an applicability of 64% in ISHR and 74% in SNAC-K. The third version showed an applicability of 66% in ISHR and 77% in SNAC-K. Challenges in applicability included broad definitions, vague terminology, and the lack of information on disease severity, symptomatic traits, and stability of certain conditions.

Conclusion: The applicability of the STOPP/START criteria in observational studies seems to have decreased in more recent versions of the tool. Population-based studies with comprehensive clinical assessments may offer higher applicability compared to studies based on administrative data. Future versions of the STOPP/START criteria should prioritise clear and unambiguous definitions to improve their applicability in research and promote result generalisability and comparability.

Keywords: Applicability of STOPP/START; Automation of STOPP/START; Medication review; STOPP/START; Screening tool.