SOCIOECONOMIC-FACTORS, MORBIDITY AND DRUG UTILIZATION - AN ECOLOGICALSTUDY

The aim of the present study was to elucidate the relations between de mographic and socioeconomic factors, morbidity and the utilization of major drug groups in an urban Swedish population. The study was perfor med as an ecological analysis during November 1991 in the 17 different districts of Malmo, the third largest Swedish city (235,000 inhabitan ts). The material comprised 86,228 ACT-coded drug items which correspo nded to 76% of all prescriptions dispensed during the study month. Of these, 43,032, dispensed to patients aged 15-64 years, were analysed i n the present work. Age standardized drug utilization was expressed as the number of dispensed Defined Daily Doses per 1000 inhabitants per day. Morbidity was measured in terms of reimbursed days on sick leave. The sociodemographic parameters used were socioeconomic status (SES), employment rate, median income per family, households on social allow ance, and ethnicity. For four of the five major pharmacological groups (ATC-groups A, C, J, N and R, i.e. alimentation, circulation, infecti ous diseases, nervous system and respiration), most pronouncedly group N and least so group R, utilization correlated positively with not on ly the extent of morbidity but also with an unfavourable socioeconomic situation, high proportion of immigrants, and households on social al lowance or with low income and/or with a low employment rate. The util ization of antibiotics (group J), however, instead correlated negative ly with these parameters. For all five drug groups, these trends were similar among men and women, albeit with varying strength. In conclusi on, socioeconomic factors may have a profound influence on the utiliza tion of several major drug groups. At least in the case of antibiotics , the consequence of this influence is irrational drug use. (C) 1998 J ohn Wiley & Sons, Ltd.