Association between unemployment rates and prescription drug utilization in the United States, 2007–2010

Abstract

BackgroundWhile extensive evidence suggests that the economic recession has had far reaching effects on many economic sectors, little is known regarding its impact on prescription drug utilization. The purpose of this study is to describe the association between state-level unemployment rates and retail sales of seven therapeutic classes (statins, antidepressants, antipsychotics, angiotensin-converting enzyme [ACE] inhibitors, opiates, phosphodiesterase [PDE] inhibitors and oral contraceptives) in the United States.MethodsUsing a retrospective mixed ecological design, we examined retail prescription sales using IMS Health Xponent™ from September 2007 through July 2010, and we used the Bureau of Labor Statistics to derive population-based rates and mixed-effects modeling with state-level controls to examine the association between unemployment and utilization. Our main outcome measure was state-level utilization per 100,000 people for each class.ResultsMonthly unemployment levels and rates of use of each class varied substantially across the states. There were no statistically significant associations between use of ACE inhibitors or SSRIs/SNRIs and average unemployment in analyses across states, while for opioids and PDE inhibitors there were small statistically significant direct associations, and for the remaining classes inverse associations. Analyses using each state as its own control collectively exhibited statistically significant positive associations between increases in unemployment and prescription drug utilization for five of seven areas examined. This relationship was greatest for statins (on average, a 4% increase in utilization per 1% increased unemployment) and PDE inhibitors (3% increase in utilization per 1% increased unemployment), and lower for oral contraceptives and atypical antipsychotics.ConclusionWe found no evidence of an association between increasing unemployment and decreasing prescription utilization, suggesting that any effects of the recent economic recession have been mitigated by other market forces.

Assessment of the Adequacy of Russia’s Information Resources to the Health Criteria of the Organization for Economic Cooperation and Development

“…Prescriptions more generally rose across the United States during recessionary times (Bradford and Lastrapes, 2013). This finding was corroborated by Kozman et al (2012) who found that a 1% rise in unemployment is associated with a 4% increase in statins and 3% increase PDE inhibitors use. Leopold et al (2014) find that pharmaceutical sale volumes moderately increased in six European countries but declined in two of the countries where the global financial crisis hit hard.…”

A Review of Health Consequences of Recessions Internationally and a Synthesis of the US Response during the Great Recession

“…21,25,[42][43][44][45][46][47][48][49][50][51][52][53][54][55][56][57][58][59] While there is evidence of a decrease in overall alcohol consumption during recessions, 5,53 studies also consistently find an increase in alcohol related traffic accidents 55 (despite an overall decline in deaths from road traffic accidents), binge drinking, 5 and alcohol related hospitalization during economic contractions. 25 In other words, while on average some people reduce their drinking of alcohol, a subpopulation increases its use to potentially dangerous levels, reflecting that the hypotheses above may apply variously to different groups.…”

“…Similar patterns were found for tobacco use in a prospective study in Iceland, where the income effects dominated, but when income was not a constraint smoking increased during the recent downturn. 58 Even with prescription medications, a recent study found increases in opiate consumption in states with higher unemployment rates in the US, 47 though other categories of prescription drugs were largely unchanged. There is also a report of an increase in intravenous drug use-related HIV infections in Greece.…”

How did the use of psychotropic drugs change during the Great Recession in Portugal? A follow-up to the National Mental Health Survey

“…These measures tend to shift the cost-burden to those who needed medicines, in a country where out-of-pocket payments already represented an important part of total health care expenditure [8,9]. Concerns arose about the unintended risk of less equitable access to needed medicines and "cost-related non-adherence" [10,11].…”