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01.12.2012 | Research article | Ausgabe 1/2012 Open Access

BMC Health Services Research 1/2012

Association between unemployment rates and prescription drug utilization in the United States, 2007–2010

BMC Health Services Research > Ausgabe 1/2012
Daniel Kozman, Christopher Graziul, Robert Gibbons, G Caleb Alexander
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Electronic supplementary material

The online version of this article (doi:10.​1186/​1472-6963-12-435) contains supplementary material, which is available to authorized users.

Competing interests

GCA is a consultant for IMS Health.

Authors’ contributions

DK and GCA conceived of the study. All authors participated in the development of the analytic approach. RG supervised and CG performed the statistical analysis. DK drafted the manuscript. All authors provided substantive revisions to the manuscript and approved the final manuscript.



While extensive evidence suggests that the economic recession has had far reaching effects on many economic sectors, little is known regarding its impact on prescription drug utilization. The purpose of this study is to describe the association between state-level unemployment rates and retail sales of seven therapeutic classes (statins, antidepressants, antipsychotics, angiotensin-converting enzyme [ACE] inhibitors, opiates, phosphodiesterase [PDE] inhibitors and oral contraceptives) in the United States.


Using a retrospective mixed ecological design, we examined retail prescription sales using IMS Health Xponent™ from September 2007 through July 2010, and we used the Bureau of Labor Statistics to derive population-based rates and mixed-effects modeling with state-level controls to examine the association between unemployment and utilization. Our main outcome measure was state-level utilization per 100,000 people for each class.


Monthly unemployment levels and rates of use of each class varied substantially across the states. There were no statistically significant associations between use of ACE inhibitors or SSRIs/SNRIs and average unemployment in analyses across states, while for opioids and PDE inhibitors there were small statistically significant direct associations, and for the remaining classes inverse associations. Analyses using each state as its own control collectively exhibited statistically significant positive associations between increases in unemployment and prescription drug utilization for five of seven areas examined. This relationship was greatest for statins (on average, a 4% increase in utilization per 1% increased unemployment) and PDE inhibitors (3% increase in utilization per 1% increased unemployment), and lower for oral contraceptives and atypical antipsychotics.


We found no evidence of an association between increasing unemployment and decreasing prescription utilization, suggesting that any effects of the recent economic recession have been mitigated by other market forces.
Additional file 1: Appendix. Model specification. (DOC 98 KB)
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