Okui Tasuku, Nakashima Naoki
Medical Information Center, Kyushu University Hospital, Maidashi3-1-1 Higashi-Ku, Fukuoka City Fukuoka Prefecture, 812-8582, Japan.
Res Health Serv Reg. 2023 Jan 5;2(1):1. doi: 10.1007/s43999-022-00018-y.
In Japan, regulations preventing the prescriptions of various types of psychotropic drugs have become stricter in recent years. However, the areas where multi-psychotropic drug prescriptions are common and the geographic factors that contribute to the regional difference, have not been studied. In this study, we used data from all claims in Japan to examine regional differences in the prescription for multi-psychotropic drugs using an ecological study.
The National Database of Health Insurance Claims and Specific Health Checkups of Japan Open data in 2019 were used. The outcome was the number of prescriptions for four or more different types of anxiolytics and hypnotics as well as for three or more of the same kind of psychotropic drugs (any one of anxiolytics, hypnotics, antipsychotics, antidepressants) for outpatients in each area. Among the 335 secondary medical areas in Japan, the data on 331 areas were used in the analysis. The standardized claim ratio (SCR), an indicator of the number of this multi-psychotropic drug prescription, correcting for regional differences in distribution of population by age and sex, was calculated for each of the secondary medical areas. The spatial cluster detection technique was used to locate a cluster of high-SCR areas. Furthermore, factors associated with regional differences in the SCRs were examined by a spatial statistics model.
North Japanese regions tend to have high SCRs, and 13 areas in Hokkaido were identified as the most likely cluster (cluster with the highest likelihood ratio) for multi-psychotropic drug prescription. Furthermore, a spatial regression analysis revealed that the proportion of people with lower educational levels, the total number of prescriptions per capita, and the number of physicians working in psychiatric departments per capita were statistically positively associated with the SCR for the prescription of multiple psychotropic drugs.
It was suggested that socioeconomic and medical characteristics of areas are related to the regional variation in the multi-psychotropic drug prescriptions, however, further research using individual-level data is required to confirm these results.
近年来，日本针对各类精神药物处方的监管愈发严格。然而，多精神药物处方常见的地区以及导致地区差异的地理因素尚未得到研究。在本研究中，我们利用日本所有理赔数据，通过生态研究来考察多精神药物处方的地区差异。
使用2019年日本医保理赔与特定健康检查国家数据库的开放数据。研究结果为各地区门诊患者开具四种或更多不同类型抗焦虑药和催眠药以及三种或更多同类型精神药物（抗焦虑药、催眠药、抗精神病药、抗抑郁药中的任何一种）的处方数量。在日本的335个二级医疗区域中，分析使用了331个区域的数据。计算每个二级医疗区域的标准化理赔比率（SCR），这是一种多精神药物处方数量指标，校正了按年龄和性别划分的人口分布的地区差异。采用空间聚类检测技术来定位高SCR区域的聚类。此外，通过空间统计模型研究与SCR地区差异相关的因素。
日本北部地区的SCR往往较高，北海道的13个地区被确定为多精神药物处方最可能的聚类（似然比最高的聚类）。此外，空间回归分析显示，教育水平较低的人群比例、人均处方总数以及人均精神科工作医生数量与多种精神药物处方的SCR在统计学上呈正相关。
研究表明，地区的社会经济和医疗特征与多精神药物处方的地区差异有关，然而，需要使用个体层面的数据进行进一步研究来证实这些结果。
