Top

BMC Public Health

Published in:

Open Access 01-12-2010 | Research article

Socioeconomic determinants of psychotropic drug utilisation among elderly: a national population-based cross-sectional study

Authors: Eva Lesén, Karolina Andersson, Max Petzold, Anders Carlsten

Published in: BMC Public Health | Issue 1/2010

Abstract

Background

Psychotropic drugs are commonly utilised among the elderly. This study aimed to analyse whether two socioeconomic determinants - income and marital status - are associated with differences in utilisation of psychotropic drugs and potentially inappropriate psychotropic drugs among elderly in Sweden.

Methods

All individuals aged 75 years and older who had purchased a psychotropic drug in Sweden during 2006 were included (68.7% women, n = 384712). Data was collected from national individual-based registers. Outcome measures were utilisation of three or more psychotropic drugs and utilisation of potentially inappropriate psychotropic drugs, as classified by the Swedish National Board of Health and Welfare.

Results

Individuals with low income were more likely to utilise three or more psychotropic drugs compared to those with high income; adjusted odds ratio (aOR) 1.12 (95% confidence interval [CI] 1.10-1.14). The non-married had a higher probability for utilising three or more psychotropic drugs compared to the married (aOR 1.22; CI 1.20-1.25). The highest probability was observed among the divorced and the never married. Potentially inappropriate psychotropic drugs were more common among individuals with low compared to high income (aOR 1.14; CI 1.13-1.16). Compared to the married, potentially inappropriate psychotropic drug utilisation occurred more commonly among the non-married (aOR 1.08; CI 1.06-1.10). The never married and the divorced had the highest probability.

Conclusions

There was an association between socioeconomic determinants and psychotropic drug utilisation. The probability for utilising potentially inappropriate psychotropics was higher among individuals with low income and among the non-married.

Mort JR, Aparasu RR: Prescribing potentially inappropriate psychotropic medications to the ambulatory elderly. Arch Intern Med. 2000, 160 (18): 2825-2831. 10.1001/archinte.160.18.2825.CrossRefPubMed

Jano E, Aparasu RR: Healthcare outcomes associated with Beers' criteria: a systematic review. Ann Pharmacother. 2007, 41 (3): 438-447. 10.1345/aph.1H473.CrossRefPubMed

Banks J, Marmot M, Oldfield Z, Smith JP: Disease and disadvantage in the United States and in England. JAMA. 2006, 295 (17): 2037-2045. 10.1001/jama.295.17.2037.CrossRefPubMed

Mackenbach JP, Stirbu I, Roskam A-JR, Schaap MM, Menvielle G, Leinsalu M, Kunst AE, the European Union Working Group on Socioeconomic Inequalities in H: Socioeconomic inequalities in health in 22 European countries. N Engl J Med. 2008, 358 (23): 2468-2481. 10.1056/NEJMsa0707519.CrossRefPubMed

Lorant V, Deliege D, Eaton W, Robert A, Philippot P, Ansseau M: Socioeconomic inequalities in depression: a meta-analysis. Am J Epidemiol. 2003, 157 (2): 98-112. 10.1093/aje/kwf182.CrossRefPubMed

Fiscella K, Franks P, Gold MR, Clancy CM: Inequality in quality: addressing socioeconomic, racial, and ethnic disparities in health care. JAMA. 2000, 283 (19): 2579-2584. 10.1001/jama.283.19.2579.CrossRefPubMed

Kuno E, Rothbard AB: The effect of income and race on quality of psychiatric care in community mental health centers. Community Ment Health J. 2005, 41 (5): 613-622. 10.1007/s10597-005-6365-z.CrossRefPubMed

Williams K: The transition to widowhood and the social regulation of health: consequences for health and health risk behavior. J Gerontol B Psychol Sci Soc Sci. 2004, 59 (6): S343-349.CrossRefPubMed

Umberson D: Gender, marital status and the social control of health behavior. Soc Sci Med. 1992, 34 (8): 907-917. 10.1016/0277-9536(92)90259-S.CrossRefPubMed

10.

Iwashyna TJ, Christakis NA: Marriage, widowhood, and health-care use. Soc Sci Med. 2003, 57 (11): 2137-2147. 10.1016/S0277-9536(02)00546-4.CrossRefPubMed

11.

Fialova D, Topinkova E, Gambassi G, Finne-Soveri H, Jonsson PV, Carpenter I, Schroll M, Onder G, Sorbye LW, Wagner C, et al: Potentially inappropriate medication use among elderly home care patients in Europe. JAMA. 2005, 293 (11): 1348-1358. 10.1001/jama.293.11.1348.CrossRefPubMed

12.

Laurier C, Moride Y, Kennedy WA: Health survey data on potentially inappropriate geriatric drug use. Ann Pharmacother. 2002, 36 (3): 404-409. 10.1345/aph.1Z445.CrossRefPubMed

13.

Haider SI, Johnell K, Weitoft GR, Thorslund M, Fastbom J: The influence of educational level on polypharmacy and inappropriate drug use: A register-based study of more than 600,000 older people. J Am Geriatr Soc. 2009, 57 (1): 62-69. 10.1111/j.1532-5415.2008.02040.x.CrossRefPubMed

14.

Empereur F, Baumann M, Alla F, Briancon S: Factors associated with the consumption of psychotropic drugs in a cohort of men and women aged 50 and over. J Clin Pharm Ther. 2003, 28 (1): 61-68. 10.1046/j.1365-2710.2003.00464.x.CrossRefPubMed

15.

Spinewine A, Schmader KE, Barber N, Hughes C, Lapane KL, Swine C, Hanlon JT: Appropriate prescribing in elderly people: how well can it be measured and optimised?. Lancet. 2007, 370 (9582): 173-184. 10.1016/S0140-6736(07)61091-5.CrossRefPubMed

16.

National Board of Health and Welfare: Indikatorer för utvärdering av kvaliteten i äldres läkemedelsanvändning: Socialstyrelsens förslag. [Indicators for evaluation of the quality in drug use among the elderly: Proposal from the National Board of Health and Welfare]. Report number 2003-110-20. Stockholm, Sweden. 2003

17.

Fick DM, Cooper JW, Wade WE, Waller JL, Maclean JR, Beers MH: Updating the Beers criteria for potentially inappropriate medication use in older adults: results of a US consensus panel of experts. Arch Intern Med. 2003, 163 (22): 2716-2724. 10.1001/archinte.163.22.2716.CrossRefPubMed

18.

Wettermark B, Hammar N, Fored CM, Leimanis A, Otterblad Olausson P, Bergman U, Persson I, Sundstrom A, Westerholm B, Rosen M: The new Swedish Prescribed Drug Register--opportunities for pharmacoepidemiological research and experience from the first six months. Pharmacoepidemiol Drug Saf. 2007, 16 (7): 726-735. 10.1002/pds.1294.CrossRefPubMed

19.

WHO Collaborating Centre for Drug Statistics Methodology: ATC index with DDDs. [http://www.whocc.no]

20.

Aaberge R, Björklund A, Jäntti M, Palme M, Pedersen PJ, Smith N, Wennemo T: Income inequality and income mobility in the Scandinavian countries compared to the United States. Rev Income Wealth. 2002, 48 (4): 443-469. 10.1111/1475-4991.00063.CrossRef

21.

Buhmann B, Rainwater L, Schmaus G, Smeeding TM: Equivalence scales, well-being, inequality, and poverty: Sensitivity estimates across ten countries using the Luxembourg Income Study (LIS) database. Rev Income Wealth. 1988, 34 (2): 115-142. 10.1111/j.1475-4991.1988.tb00564.x.CrossRef

22.

Schneeweiss S, Seeger JD, Maclure M, Wang PS, Avorn J, Glynn RJ: Performance of comorbidity scores to control for confounding in epidemiologic studies using claims data. Am J Epidemiol. 2001, 154 (9): 854-864. 10.1093/aje/154.9.854.CrossRefPubMed

23.

Lesén E, Petzold M, Andersson K, Carlsten A: To what extent does the indicator "concurrent use of three or more psychotropic drugs" capture use of potentially inappropriate psychotropics among the elderly?. Eur J Clin Pharmacol. 2009, 65 (6): 635-642. 10.1007/s00228-009-0623-x.CrossRefPubMed

24.

Mål för hälso-och sjukvården 2§ [Aims of the health care 2§]. Hälso-och sjukvårdslag (1982:763) [The Swedish health care law (1982:763)].

25.

Odubanjo E, Bennett K, Feely J: Influence of socioeconomic status on the quality of prescribing in the elderly -- a population based study. Br J Clin Pharmacol. 2004, 58 (5): 496-502. 10.1111/j.1365-2125.2004.02179.x.CrossRefPubMedPubMedCentral

26.

Mamdani MM, Tu K, Austin PC, Alter DA: Influence of socioeconomic status on drug selection for the elderly in Canada. Ann Pharmacother. 2002, 36 (5): 804-808. 10.1345/aph.1A044.CrossRefPubMed

27.

Carey IM, De Wilde S, Harris T, Victor C, Richards N, Hilton SR, Cook DG: What factors predict potentially inappropriate primary care prescribing in older people? Analysis of UK primary care patient record database. Drugs Aging. 2008, 25 (8): 693-706. 10.2165/00002512-200825080-00006.CrossRefPubMed

28.

Prosser H, Almond S, Walley T: Influences on GPs' decision to prescribe new drugs-the importance of who says what. Fam Pract. 2003, 20 (1): 61-68. 10.1093/fampra/20.1.61.CrossRefPubMed

29.

Haider SI, Johnell K, Ringback Weitoft G, Thorslund M, Fastbom J: Patient educational level and use of newly marketed drugs: a register-based study of over 600,000 older people. Eur J Clin Pharmacol. 2008, 64 (12): 1215-1222. 10.1007/s00228-008-0549-8.CrossRefPubMed

30.

Blalock SJ, Byrd JE, Hansen RA, Yamanis TJ, McMullin K, DeVellis BM, DeVellis RF, Panter AT, Kawata AK, Watson LC, et al: Factors associated with potentially inappropriate drug utilization in a sample of rural community-dwelling older adults. Am J Geriatr Pharmacother. 2005, 3 (3): 168-10.1016/S1543-5946(05)80023-6.CrossRefPubMed

31.

Pizzetti P, Manfredini M, Lucchetti E: Variations in late-age mortality by household structure and marital status in Parma, Italy. Ageing Soc. 2005, 25 (6): 305-318. 10.1017/S0144686X04003290.CrossRef

32.

Foss C, Sundby J: The construction of the gendered patient: hospital staff's attitudes to female and male patients. Patient Educ Couns. 2003, 49 (1): 45-52. 10.1016/S0738-3991(02)00039-3.CrossRefPubMed

33.

Manzoli L, Villari P, M Pirone G, Boccia A: Marital status and mortality in the elderly: A systematic review and meta-analysis. Soc Sci Med. 2007, 64 (1): 77-10.1016/j.socscimed.2006.08.031.CrossRefPubMed

34.

Piette JD, Heisler M, Wagner TH: Cost-related medication underuse among chronically ill adults: the treatments people forgo, how often, and who is at risk. Am J Public Health. 2004, 94 (10): 1782-1787. 10.2105/AJPH.94.10.1782.CrossRefPubMedPubMedCentral

35.

Spinewine A, Swine C, Dhillon S, Franklin BD, Tulkens PM, Wilmotte L, Lorant V: Appropriateness of use of medicines in elderly inpatients: qualitative study. BMJ. 2005, 331 (7522): 935-10.1136/bmj.38551.410012.06.CrossRefPubMedPubMedCentral

The pre-publication history for this paper can be accessed here:http://www.biomedcentral.com/1471-2458/10/118/prepub

Title: Socioeconomic determinants of psychotropic drug utilisation among elderly: a national population-based cross-sectional study
Authors: Eva Lesén
Karolina Andersson
Max Petzold
Anders Carlsten
Publication date: 01-12-2010
Publisher: BioMed Central
Published in: BMC Public Health / Issue 1/2010
Electronic ISSN: 1471-2458
DOI: https://doi.org/10.1186/1471-2458-10-118

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Socioeconomic determinants of psychotropic drug utilisation among elderly: a national population-based cross-sectional study

Abstract

Background

Methods

Results

Conclusions

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Abstract

Background

Methods

Results

Conclusions

Please log in to get access to this content

Other articles of this Issue 1/2010

The Primary Care Practitioner and the diagnosis of occupational diseases

Modeling the cost of influenza: the impact of missing costs of unreported complications and sick leave

Rationale and methods of the cardiometabolic valencian study (escarval-risk) for validation of risk scales in mediterranean patients with hypertension, diabetes or dyslipidemia

Maternal age, education level and migration: Socioeconomic determinants for smoking during pregnancy in a field study from Turkey

Understanding young adult physical activity, alcohol and tobacco use in community colleges and 4-year post-secondary institutions: A cross-sectional analysis of epidemiological surveillance data

Are self-report of disability pension and long-term sickness absence accurate? Comparisons of self-reported interview data with national register data in a Swedish twin cohort