Influence of socioeconomic status on drug selection for the elderly in Canada

Ann Pharmacother. 2002 May;36(5):804-8. doi: 10.1345/aph.1A044.


Objective: To examine the association between socioeconomic status, as indicated by neighborhood median income levels, and physician drug selection between older, less expensive generic drugs and newer, more expensive brand-name drugs for elderly patients initiating drug therapy in a universal healthcare system.

Methods: We conducted a population-based, retrospective, cross-sectional study. Using healthcare administrative databases, we assessed the medication profiles of 128 314 patients from more than 1.4 million residents of Ontario > or =65 years old initiating antipsychotic, hydroxymethylglutaryl-coenzyme A reductase inhibitor (statin), or ocular beta-blocker drug therapy from January 1, 1998, through December 31, 1999. We examined the selection of older generic drugs relative to newer brand-name agents for patients in each of 5 income quintiles.

Results: Overall, brand-name drug prescribing modestly increased with increasing income quintile after adjusting for patient age and gender (61.2% in the lowest income quintile vs. 64.1% in the highest income quintile; p value for trend < 0.001). Significant risk ratios comparing the highest with the lowest income-quintile patients were observed for selection of newer, brand-name antipsychotics (RR 1.14; 95% CI 1.06 to 1.23), older generic statins (RR 0.86; 95% CI 0.77 to 0.95), and newer, brand-name ocular beta-blockers (RR 1.13; 95% CI 1.02 to 1.25).

Conclusions: This study suggests that income-related differences in treatment selection by physicians may exist. The reasons for these differences and subsequent impact on health outcomes warrant further investigation.

MeSH terms

  • Adrenergic beta-Antagonists / therapeutic use
  • Aged
  • Aged, 80 and over
  • Antipsychotic Agents / therapeutic use
  • Canada
  • Cross-Sectional Studies
  • Databases, Factual
  • Drug Prescriptions / economics
  • Drug Prescriptions / statistics & numerical data*
  • Drug Therapy / economics
  • Drug Therapy / statistics & numerical data*
  • Drugs, Generic / therapeutic use
  • Female
  • Humans
  • Hydroxymethylglutaryl-CoA Reductase Inhibitors / therapeutic use
  • Male
  • Retrospective Studies
  • Social Class*
  • Universal Health Insurance / economics
  • Universal Health Insurance / statistics & numerical data


  • Adrenergic beta-Antagonists
  • Antipsychotic Agents
  • Drugs, Generic
  • Hydroxymethylglutaryl-CoA Reductase Inhibitors