Despite a 23% decline during the first 2 years of the COVID-19 pandemic, NSAID use remains prevalent among patients with CKD, HF, and/or HTN, especially in rural areas and among women, highlighting the need for tailored deprescribing efforts.
Key Findings
Results
Approximately 3.8 million NSAID prescriptions were dispensed to Virginians with CKD, HF, and/or HTN between 2019 and 2021.
Data were drawn from the Virginia All-Payer Claims Database covering the years 2019-2021.
The study population included patients with chronic kidney disease (CKD), heart failure (HF), and/or hypertension (HTN).
The 3.8 million figure represents an extrapolation to the statewide population.
All three conditions are identified as risk factors that make regular NSAID use potentially harmful.
Results
NSAID utilization rates declined by 23% during the first two years of the COVID-19 pandemic (March 1, 2020 – December 31, 2021).
A quasi-experimental difference-in-differences approach was used to assess the impact of the pandemic.
Poisson regression was applied to assess incidence rate ratios (IRRs).
The pandemic period was defined as March 1, 2020 through December 31, 2021.
Despite this decline, NSAID use was described as remaining prevalent in the high-risk population.
Results
NSAID utilization rates were significantly higher in rural areas compared to urban areas.
IRR for rural vs urban: 1.594 (95% CI, 1.408–1.803).
The pandemic impacted rural and urban areas similarly, meaning the rural-urban disparity persisted through the pandemic period.
Rural residence was identified as a key demographic characteristic associated with higher high-risk NSAID use.
Authors note that rural areas represent a priority target for deprescribing efforts.
Results
NSAID utilization rates were substantially higher among patients aged 40 and older compared to those aged 18 to 39 years.
IRR for ages 40–64 vs 18–39: 6.366 (95% CI, 5.979–6.778).
IRR for ages 65–79 vs 18–39: 6.980 (95% CI, 6.568–7.417).
IRR for ages ≥80 vs 18–39: 5.223 (95% CI, 4.772–5.715).
The 65–79 age group had the highest relative utilization rate compared to the youngest group.
Results
The COVID-19 pandemic was associated with greater reductions in NSAID utilization among older age groups compared to those aged 18 to 39 years.
Pandemic-associated IRR for ages 40–64 vs 18–39: 0.869 (95% CI, 0.812–0.931).
Pandemic-associated IRR for ages 65–79 vs 18–39: 0.788 (95% CI, 0.733–0.847).
Pandemic-associated IRR for ages ≥80 vs 18–39: 0.769 (95% CI, 0.709–0.833).
The pandemic did not differentially impact rural vs urban areas or men vs women.
Results
NSAID utilization rates were lower among men than women in this high-risk population.
IRR for men vs women: 0.779 (95% CI, 0.758–0.800).
The pandemic impacted women and men similarly, meaning the sex-based disparity persisted.
Women were identified as a priority group for targeted deprescribing efforts.
Sex was one of three demographic stratification variables alongside rurality and age.
What This Means
This research suggests that millions of prescriptions for nonsteroidal anti-inflammatory drugs (NSAIDs — such as ibuprofen and naproxen) are being dispensed to patients in Virginia who have conditions that make these medications potentially dangerous, including chronic kidney disease, heart failure, and high blood pressure. Using insurance claims data from 2019 to 2021, researchers found that roughly 3.8 million such prescriptions were filled over this three-year period. While NSAID use dropped by about 23% during the first two years of the COVID-19 pandemic — likely due to reduced healthcare visits — use remained widespread among these vulnerable patients.
The study also found important differences in who is receiving these high-risk prescriptions. Patients living in rural areas were about 60% more likely to receive NSAID prescriptions than those in urban areas, and this gap did not close during the pandemic. Women received NSAIDs at higher rates than men. Older patients (ages 40 and above) were far more likely to receive NSAIDs than younger adults, though the pandemic was associated with somewhat larger reductions in use among these older groups. The reasons behind these disparities — whether related to prescribing practices, patient preferences, access to alternatives, or other factors — were not examined in this study.
This research suggests that high-risk NSAID prescribing remains a significant concern, particularly for older adults, women, and people in rural communities. The authors emphasize the need for targeted 'deprescribing' efforts — structured approaches to safely reduce or discontinue medications that may be causing more harm than benefit — tailored to the groups most likely to be affected.
Rockwell M, Grubb C, Turner J, Vinson M, Yim I, Hanlon A, et al.. (2026). Trends and Disparities in High-Risk Nonsteroidal Anti-Inflammatory Drug Utilization.. The American journal of managed care. https://doi.org/10.37765/ajmc.2026.90002