Geographic variation and sociodemographic correlates of prescription psychotropic drug use among children and youth in Ontario, Canada: a population-based study

BMC Public Health

Research

Melanie Penner¹  Kathleen Pajer²  Daniel McCormack³  Sophie Kitchen³  Yona Lunsky⁴  David N. Juurlink⁵  Mina Tadrous⁶  William Gardner⁷  Tony Antoniou⁸  Tara Gomes⁹  Muhammad Mamdani^1,10 

[1] Autism Research Centre, Bloorview Research Institute, Holland Bloorview Kids Rehabilitation Hospital, Toronto, Canada;Department of Pediatrics, University of Toronto, Toronto, Ontario, Canada;Children’s Hospital of Eastern Ontario Research Institute, Ottawa, Ontario, Canada;Department of Psychiatry, University of Ottawa, Ottawa, Ontario, Canada;ICES, Toronto, Ontario, Canada;ICES, Toronto, Ontario, Canada;Azrieli Adult Neurodevelopmental Centre, Centre for Addiction and Mental Health, Toronto, Canada;Department of Psychiatry, University of Toronto, Toronto, Ontario, Canada;ICES, Toronto, Ontario, Canada;Department of Pediatrics, University of Toronto, Toronto, Ontario, Canada;Department of Medicine, University of Toronto, Toronto, Ontario, Canada;ICES, Toronto, Ontario, Canada;Leslie Dan Faculty of Pharmacy, University of Toronto, Toronto, Ontario, Canada;ICES, Toronto, Ontario, Canada;School of Epidemiology and Public Health, University of Ottawa, Ottawa, Ontario, Canada;Li Ka Shing Knowledge Institute, St. Michael’s Hospital, Toronto, Ontario, Canada;ICES, Toronto, Ontario, Canada;Department of Family and Community Medicine, University of Toronto, Toronto, Ontario, Canada;Department of Family and Community Medicine, St. Michael’s Hospital, Toronto, Ontario, Canada;Li Ka Shing Knowledge Institute, St. Michael’s Hospital, Toronto, Ontario, Canada;ICES, Toronto, Ontario, Canada;Leslie Dan Faculty of Pharmacy, University of Toronto, Toronto, Ontario, Canada;Institute of Health Policy, Management, and Evaluation, University of Toronto, Toronto, Ontario, Canada;Li Ka Shing Knowledge Institute, St. Michael’s Hospital, Toronto, Ontario, Canada;ICES, Toronto, Ontario, Canada;Leslie Dan Faculty of Pharmacy, University of Toronto, Toronto, Ontario, Canada;Li Ka Shing Centre for Healthcare Analytics Research & Training, Unity Health Toronto, Toronto, Ontario, Canada;Temerty Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada;Institute of Health Policy, Management, and Evaluation, University of Toronto, Toronto, Ontario, Canada;

关键词: Child;    Adolescent;    Psychotropic drugs;    Prescriptions / statistics & numerical data;    Geographic variation;    Small-area analysis;    Socioeconomic factors;   

DOI  :  10.1186/s12889-022-14677-6

 received in 2022-07-19, accepted in 2022-11-21,  发布年份 2022

来源: Springer

【 摘 要 】

BackgroundPopulation-based research examining geographic variability in psychotropic medication dispensing to children and youth and the sociodemographic correlates of such variation is lacking. Variation in psychotropic use could reflect disparities in access to non-pharmacologic interventions and identify potentially concerning use patterns.MethodsWe conducted a population-based study of all Ontario residents aged 0 to 24 years who were dispensed a benzodiazepine, stimulant, antipsychotic or antidepressant between January 1, 2018, and December 31, 2018. We conducted small-area variation analyses and identified determinants of dispensing using negative binomial generalized estimating equation models.ResultsThe age- and sex-standardized rate of psychotropic dispensing to children and youth was 76.8 (range 41.7 to 144.4) prescriptions per 1000 population, with large variation in psychotropic dispensing across Ontario’s census divisions. Males had higher antipsychotic [rate ratio (RR) 1.40; 95% confidence interval (CI) 1.36 to 1.44) and stimulant (RR 1.75; 95% CI 1.70 to 1.80) dispensing rates relative to females, with less use of benzodiazepines (RR 0.85; 95% CI 0.83 to 0.88) and antidepressants (RR 0.81; 95% CI 0.80 to 0.82). Lower antipsychotic dispensing was observed in the highest income neighbourhoods (RR 0.72; 95% CI 0.70 to 0.75) relative to the lowest. Benzodiazepine (RR 1.12; 95% CI 1.01 to 1.24) and stimulant (RR 1.11; 95% CI 1.01 to 1.23) dispensing increased with the density of mental health services in census divisions, whereas antipsychotic use decreased (RR 0.82; 95% CI 0.73 to 0.91). The regional density of child and adolescent psychiatrists and developmental pediatricians (RR 1.00; 95% CI 0.99 to 1.01) was not associated with psychotropic dispensing.ConclusionWe found significant variation in psychotropic dispensing among young Ontarians. Targeted investment in regions with long wait times for publicly-funded non-pharmacological interventions and novel collaborative service models may minimize variability and promote best practices in using psychotropics among children and youth.

【 授权许可】

CC BY   
© The Author(s) 2023

【 图 表 】

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Fig. 4