Morgan Steven, Hanley Gillian, Cunningham Colleen, Quan Hude
School of Population and Public Health, University of British Columbia, Vancouver, British Columbia, Canada.
Open Med. 2011;5(2):e87-93. Epub 2011 May 17.
Evidence from the United States and Europe suggests that the use of prescription drugs may vary by ethnicity. In Canada, ethnic disparities in prescription drug use have not been as well documented as disparities in the use of medical and hospital care. We conducted a cross-sectional analysis of survey and administrative data to examine needs-adjusted rates of prescription drug use by people of different ethnic groups.
For 19 370 non-Aboriginal people living in urban areas of British Columbia, we linked data on self-identified ethnicity from the Canadian Community Health Survey with administrative data describing all filled prescriptions and use of medical services in 2005. We used sex-stratified multivariable logistic regression analysis to measure differences in the likelihood of filling prescriptions by drug class (antihypertensives, oral antibiotics, antidepressants, statins, respiratory drugs and nonsteroidal anti-inflammatory drugs [NSAIDs]). Models were adjusted for age, general health status, treatment-specific health status, socio-economic factors and recent immigration (within 10 years).
We found evidence of significant needs-adjusted variation in prescription drug use by ethnicity. Compared with women and men who identified themselves as white, those who were South Asian or of mixed ethnicity were almost as likely to fill prescriptions for most types of medicines studied; moreover, South Asian men were more likely than white men to fill prescriptions for antibiotics and NSAIDs. The clearest pattern of use emerged among Chinese participants: Chinese women were significantly less likely to fill prescriptions for antihypertensives, antibiotics, antidepressants and respiratory drugs, and Chinese men for antidepressant drugs and statins.
We found some disparities in prescription drug use in the study population according to ethnic group. The nature of some of these variations suggest that ethnic differences in beliefs about pharmaceuticals may generate differences in prescription drug use; other variations suggest that there may be clinically important disparities in treatment use.
来自美国和欧洲的证据表明，处方药的使用可能因种族而异。在加拿大，与医疗和医院护理使用方面的差异相比，处方药使用方面的种族差异记录较少。我们对调查数据和行政数据进行了横断面分析，以研究不同种族人群经需求调整后的处方药使用率。
对于居住在不列颠哥伦比亚省城市地区的19370名非原住民，我们将来自加拿大社区健康调查的自我认定种族数据与描述2005年所有已配药处方和医疗服务使用情况的行政数据相链接。我们使用按性别分层的多变量逻辑回归分析来衡量按药物类别（抗高血压药、口服抗生素、抗抑郁药、他汀类药物、呼吸系统药物和非甾体抗炎药[NSAIDs]）配药可能性的差异。模型对年龄、总体健康状况、特定治疗的健康状况、社会经济因素和近期移民情况（10年内）进行了调整。
我们发现有证据表明，经需求调整后，不同种族的处方药使用存在显著差异。与自认为是白人的女性和男性相比，南亚裔或混血种族的人开具大多数所研究药物类型处方的可能性几乎相同；此外，南亚裔男性开具抗生素和非甾体抗炎药处方的可能性高于白人男性。最明显的使用模式出现在华裔参与者中：华裔女性开具抗高血压药、抗生素、抗抑郁药和呼吸系统药物处方的可能性显著较低，华裔男性开具抗抑郁药和他汀类药物处方的可能性较低。
我们在研究人群中发现了一些根据种族划分的处方药使用差异。其中一些差异的性质表明，关于药物的观念上的种族差异可能导致处方药使用的差异；其他差异表明，在治疗使用方面可能存在临床上重要的差异。
