Yale School of Management, 135 Prospect Street, New Haven, CT 06511, USA.
Health Place. 2013 Mar;20:32-8. doi: 10.1016/j.healthplace.2012.11.007. Epub 2013 Jan 7.
This paper analyzes local and regional geographic variability in the use of antidepressant, antipsychotic and stimulant medications in the United States. Using a data set that covers 60% of prescriptions written in the United States, we find that use of antidepressants in three digit postal codes ranged from less than 1% of residents to more than 40% residents. Stimulant and antipsychotic use exhibited similar levels of local geographic variability. A Kulldorf Spatial Scan identified clusters of elevated use of antidepressants (RR 1.46; p<0.001), antipsychotics (RR 1.42; p<0.001), and stimulants (RR 1.77; p<0.001). Using a multilevel model, we find that access to health care, insurance coverage and pharmaceutical marketing efforts explain much of the geographic variation in use.
本文分析了美国在使用抗抑郁药、抗精神病药和兴奋剂方面的局部和区域地理差异。利用涵盖美国 60%处方的数据集，我们发现三个数字邮政编码地区的抗抑郁药使用率从不到 1%的居民到超过 40%的居民不等。兴奋剂和抗精神病药的使用也表现出类似的局部地理变异性。库尔多尔夫空间扫描发现了抗抑郁药（RR1.46；p<0.001）、抗精神病药（RR1.42；p<0.001）和兴奋剂（RR1.77；p<0.001）使用量升高的集群。使用多层次模型，我们发现获得医疗保健、保险覆盖范围和药物营销工作解释了使用方面的大部分地理差异。
