title: Influence of urban residence on use of psychotropic medications in Pennsylvania, USA: cross-sectional comparison of older adults attending senior centers.
abstract: BACKGROUND
  Differences in medication use by geographic region may indicate differences in access to specialist medical care, especially in the case of prescriptions for psychotropic medications. We assessed the effect of more or less urbanized residence on likelihood of psychotropic medication use in a large cohort of older adults in Pennsylvania, USA.
  
  
  METHODS
  Community-dwelling older adults were recruited from senior centers across Pennsylvania. Participant residences were geocoded and categorized according to US Department of Agriculture Rural-Urban Continuum Codes. We used the codes to identify respondents who live in relatively urban counties with 250,000 or more residents (n = 1,360) or less urban counties with fewer than 250,000 residents (n = 401). Participants reported prescription medications in a clinical interview. Psychotropic medications were categorized by class. Logistic regression models were estimated to assess the independent effect of residence on likelihood of psychotropic medication use.
  
  
  RESULTS
  Geographic region was significantly associated with use of psychotropic medications. Psychotropic medication use was higher in less urban areas (19.7%) relative to more urban areas (14.2%), p = 0.007. In adjusted models, degree of urban residence was a significant correlate in models that adjusted for sociodemographic features and medical status (odds ratio 1.62; 95% confidence interval 1.13-2.31, p < 0.01). Use of psychotropic medications on the Beers list also increased with less urban residence (13.0 vs. 8.3%, p = 0.005).
  
  
  CONCLUSIONS
  Older adults living in less urbanized areas are more likely to be prescribed psychotropic drugs. This difference may indicate a health disparity based on access to geriatric specialists or mental health care.
authors.affiliation: Department of Behavioral and Community Health Sciences, Pitt Public Health, 208 Parran Hall, 130 DeSoto St., Pittsburgh, PA, 15232, USA.
authors.forename: Offer
authors.initials: O
authors.lastname: Edelstein
authors.forename: Karen
authors.initials: K
authors.lastname: Pater
authors.forename: Ravi
authors.initials: R
authors.lastname: Sharma
authors.forename: Steven M
authors.initials: SM
authors.lastname: Albert
mesh_terms: D000058:Accidental Falls / Q000517:prevention & control; D000368:Aged; D000369:Aged, 80 and over; D003430:Cross-Sectional Studies; D004358:Drug Therapy / Q000706:statistics & numerical data*; D005260:Female; D005843:Geography; D006297:Health Services Accessibility; D054625:Healthcare Disparities; D006801:Humans; D057970:Inappropriate Prescribing / Q000517:prevention & control; D008297:Male; D010414:Pennsylvania; D011619:Psychotropic Drugs / Q000627:therapeutic use*; D012044:Regression Analysis; D012111:Residence Characteristics; D012307:Risk Factors; D064407:Senior Centers; D014505:Urban Population
chemical_list: D011619:Psychotropic Drugs