PIMs can be identified through the formal STOPP criteria for potentially inappropriate drugs, drug–drug combinations and drug–disease combinations that are included in the second version of the validated STOPP/START list, which was developed by O’Mahony and colleagues.26 In this study, we identified PIMs using a coding algorithm27 based on these STOPP criteria,26 which we adapted for a Danish register-based context through iterative consensus group discussions (see details in Supplemental methods, online supplemental material 1). This process led to the selection of 29 STOPP criteria, which could be operationalised for application in the Danish registers. Thus, 47 of the 76 STOPP criteria were excluded due to unavailable data (ie, laboratory measurements, procedures or diagnoses made in primary care, severity of diseases, dosage of medications and some specific medications), due to lack of clinical relevance (generally or in Denmark specifically) or due to overlap between criteria (in some cases, two criteria were collapsed into one after relevant modifications) (see coding details for the STOPP criteria in online supplemental material 2 and details on consensus modifications in online supplemental material 3).



After redeeming a prescription of a drug in any of the PIM categories, individuals were considered continuous ‘users’ of that drug for a period of time corresponding to the number of redeemed defined daily doses (DDD), that is, the assumed average maintenance dose per day for a drug used for its main indication in adults, plus a grace period of 25% to allow for some leeway when redeeming prescriptions.28 This period of use was extended each time a user redeemed a new prescription. For the PIM criteria defined by two concurrent treatments, some individuals were excluded during quarantine periods in-between treatments, as we could not distinguish between overlapping treatments and treatment shifts before the first prescription expired (see details in Supplemental methods, online supplemental material 1).

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