Individual-level sociodemographic characteristics are presented by neighborhood deprivation quintile in (N=6,998,075). The proportion of women and men was similar across all neighborhood deprivation quintiles. Higher-deprivation neighborhoods had a slightly higher percentage of young adults (18–39 years), and a lower percentage of middle-aged adults (40–64 years), compared to lower-deprivation neighborhoods. Individuals in the highest-deprivation neighborhoods also tended to have lower educational attainment and family income; and were less likely to be married, employed, and/or to have lived at their current residence for five or more years.
Individual characteristics in 2005 by neighborhood deprivation quintile (N=6,998,075).
For each psychiatric medication class (antipsychotics, antidepressants, anxiolytics, and hypnotics/sedatives), a monotonic trend of increasing prescription rates was observed by increasing level of neighborhood deprivation (). A total of 376,722 (27.0%) individuals in the highest-deprivation neighborhood quintile were prescribed at least one of these medications, compared to 298,207 (21.3%) in the lowest-deprivation neighborhood quintile.
Number and percentage of individuals who were prescribed psychiatric medications in 2005–2007 by neighborhood deprivation quintile (N=6,998,075).
presents odds ratios and 95% confidence intervals from multilevel logistic regression, unadjusted and adjusted, for the association between neighborhood deprivation and psychiatric medication prescription. Higher neighborhood deprivation was associated with a monotonic increasing relative rate of antipsychotic, antidepressant, anxiolytic, and hypnotic/sedative prescription. A substantial part of these associations remained after adjusting for individual-level sociodemographic characteristics. After adjusting for these characteristics, individuals in the highest-deprivation neighborhood quintile were 1.15 times more likely to be prescribed at least one of the medications studied (95% CI 1.13–1.17), compared to individuals in the lowest-deprivation neighborhood quintile. The strongest associations were found for antipsychotics and anxiolytics (adjusted ORs 1.40 [95% CI, 1.36–1.44] and 1.24 [95% CI, 1.22–1.27], respectively, comparing the highest-deprivation quintile to the lowest). Weaker associations were found for antidepressants and hypnotics/sedatives, but a monotonic trend was still present across neighborhood deprivation quintile.
Odds ratios from multilevel logistic regression for association between neighborhood deprivation and psychiatric medication prescription in 2005–2007 (N=6,998,075).
provides further details for the relationship between neighborhood deprivation and antipsychotic prescription, for which the strongest association was found. Adjusted odds ratios and 95% confidence intervals are presented for all covariates included in the multilevel logistic regression model. Women were slightly more likely to be prescribed an antipsychotic medication than men after adjusting for the other covariates included in the model (adjusted OR 1.09; p<0.001). Individuals 40–64 years or ≥65 years old were more than twice as likely to be prescribed an antipsychotic than younger individuals. Other factors positively associated with antipsychotic medication prescription included never married marital status, unemployment (which had the largest adjusted OR, 3.85), lower educational attainment, lower family income, residence in a large city, and increased residential mobility (<5 years at current residence). Interestingly, individuals in the second-lowest income quartile were more likely to be prescribed antipsychotics than those in the other income quartiles, a relationship that was not well explained in these data. The second-lowest income quartile had the highest percentage of older adults (≥65 years) and divorced or widowed adults, but the increased risk of antipsychotic prescription in this quartile persisted after adjustment for these and all other individual-level characteristics included in .
Adjusted odds ratios from multilevel logistic regression for association between neighborhood deprivation and antipsychotic medication prescription in 2005–2007 (N=6,998,075).
Exploratory analyses were performed to evaluate for interactions between neighborhood deprivation and individual-level characteristics with respect to psychiatric medication prescription. Each of the individual-level characteristics included in had an interaction with neighborhood deprivation that was significant at the P=0.0001 level, after adjusting for all other individual-level characteristics in , but the effect sizes were generally small and did not appear clinically meaningful (data not shown). In particular, the association between neighborhood deprivation and psychiatric medication prescription tended to be stronger among younger adults (<40 years) than adults older than 65 years; and among adults who had never married than among those who had married, divorced, or widowed.