To investigate the prevalence of potentially inappropriate medication (PIM) prescribing and its number-dependent association (PIM=1, 2, ≥3) with all-cause hospitalizations, emergency department (ED) visits, and medication expenditures in Beijing, China.A retrospective cohort analysis was conducted to analyze PIM prescribing in community-dwelling older adults aged ≥ 65 years within the Beijing Municipal Medical Insurance Database (data from July to September 2016). The prevalence of PIMs was estimated based on the 2015 Beers Criteria. Logistic models were utilized to investigate the associations between PIM use and all-cause hospitalizations and ED visits. Generalized linear models with the logic link and gamma distribution were used to analyze associations between PIM use and medication expenditures.Among the 506,214 older adults, the prevalence of PIM was 38.07%. After adjusting for covariables, prescribing 2 and ≥3 PIMs was associated with increased risks of hospitalizations (PIM=2: OR 1.34, 95%CI: 1.22-1.47; PIM≥3: OR=1.47, 95%CI: 1.32-1.63) and ED visits (PIM=2: OR = 1.29, 95%CI 1.12-1.48; PIM≥3: OR=1.23, 95%CI: 1.04-1.44). Exposures of 2 and ≥3 PIMs were associated with higher medication expenditures for inpatient visits (PIM=2: incidence rate ratio IRR = 1.08, 95%CI 1.01-1.16; PIM≥3: IRR=1.18, 95%CI: 1.08-1.28). Vasodilators were the most frequent PIM prescribing group among patients who ended with hospitalizations or ED visits.PIMs were prescribed at a high rate among community-dwelling older adults in Beijing. PIMs ≥2 were associated with increased risks of hospitalizations, ED visits, and increased inpatient medication expenditures. Effective interventions are needed to target unnecessary and inappropriate medications in older adults.This article is protected by copyright. All rights reserved.