Alsabbagh Mhd Wasem, Alsefaou Moad, Elliott Susan J, Cooke Martin, Chang Feng
School of Pharmacy, Faculty of Science, University of Waterloo, 10 Victoria St S, Kitchener, ON, N2G 1C5, Canada.
Department of Geography and Environmental Studies, Faculty of Environment, University of Waterloo, 200 University Avenue West Waterloo, Kitchener, ON, N2L 3G1, Canada.
Drugs Real World Outcomes. 2025 May 30. doi: 10.1007/s40801-025-00498-7.
Previous research in Canada has examined opioids prescription dispensing at the population level but did not examine the potential relationship with area-level income and rates of opioid dispensing.
The aim was to estimate average and annual opioid dispensing rate ratios (RRs) between lowest and highest income quintile geographic areas in Canada.
We performed a population-based retrospective study using the National Prescription Drug Utilization Information System (NPDUIS) between 2010 and 2018 that contains prescription records for all public drug plan beneficiaries (65+) in all Canadian provinces, excluding Quebec, Nova Scotia, and New Brunswick. We used census median household income, calculated at the Forward Sortation Area (FSA-the first three letters of the postal code) to assign income quintiles. Morphine milligram equivalent (MME) was calculated for all opioid dispensing and was divided by population of the FSA quintile. Population census year 2016 was used for population and income estimations. We calculated the average and annual RR between lowest and highest quintiles and stratified them by patients' sex. The significance of the trend of annual RR was tested by linear regression.
The average MME per capita for the 65+ population ranged from 2321.8 in quintile 1 to 5831.9 in quintile 5. The RR between highest and lowest quintile was 2.5 (95% confidence interval [CI] 1.3-3.7), and was more profound for males (3.2, 95% CI 1.4-4.9) than females (2.2, 95% CI 1.2-3.3). Over the study period, the RR reduced slightly from 2.7 to 2.3 (p < 0.01). However, this trend was only significant for females.
Inequity in opioid prescriptions dispensing was persistent over time. Patients in the lowest income quintiles received higher amounts of opioids per capita, with some sex variation. Dispensing policies must take these equity issues into account.
加拿大此前的研究在总体层面上考察了阿片类药物的处方配药情况，但未研究其与地区层面收入及阿片类药物配药率之间的潜在关系。
旨在估算加拿大收入最低和最高的五分之一地理区域之间阿片类药物的平均及年度配药率比（RRs）。
我们利用2010年至2018年期间的国家处方药利用信息系统（NPDUIS）开展了一项基于人群的回顾性研究，该系统包含加拿大除魁北克、新斯科舍和新不伦瑞克之外所有省份所有公共药品计划受益人群（65岁及以上）的处方记录。我们使用在邮政编码前三位（即前向分拣区，FSA）计算得出的人口普查家庭收入中位数来划分收入五等份。计算所有阿片类药物配药的吗啡毫克当量（MME），并除以FSA五等份的人口数。2016年人口普查数据用于人口和收入估算。我们计算了最低和最高五等份之间的平均及年度RRs，并按患者性别进行分层。年度RRs趋势的显著性通过线性回归进行检验。
65岁及以上人群的人均平均MME从第一五等份的2321.8到第五五等份的5831.9不等。最高和最低五等份之间的RR为2.5（95%置信区间[CI] 1.3 - 3.7），男性（3.2，95% CI 1.4 - 4.9）比女性（2.2，95% CI 1.2 - 3.3）更为显著。在研究期间，RR从2.7略有降至2.3（p < 0.01）。然而，这一趋势仅在女性中具有显著性。
阿片类药物处方配药方面的不平等现象长期存在。收入最低的五等份人群人均获得的阿片类药物更多，且存在一定的性别差异。配药政策必须考虑到这些公平性问题。
