title: Socioeconomic inequalities in access to specialized psychotropic prescribing among older Swedes: a register-based study.
abstract: BACKGROUND
  Mental disorders among older adults are mainly treated with psychotropic drugs. Few of these drugs are, however, prescribed by specialized geriatricians or psychiatrists, but rather from general practitioners (GPs). Socioeconomic inequalities in access to specialist prescribing have been found in younger age groups. Hence, we aimed to investigate whether there are socioeconomic differences in access to geriatrician and psychiatrist prescribing of psychotropic drugs among older adults.
  
  
  METHODS
  By record-linkage of The Swedish Prescribed Drug Register and The Swedish Education Register, we obtained information for persons aged 75-89 years who had filled a prescription for psychotropic drugs (antipsychotics, anxiolytics, hypnotic/sedatives or antidepressants) with information on prescriber specialty from July to October 2005 (n = 221 579). Multinomial regression analysis was used to investigate whether education was associated with geriatrician and psychiatrist prescribing of psychotropic drugs.
  
  
  RESULTS
  The vast majority of the psychotropic drugs were prescribed by 'GPs and other specialists' (∼95% GPs). Older adults with higher educational level were more likely to be prescribed psychotropic drugs from psychiatrists and geriatricians. However, after adjustment for place of residence, the association between patient's education and prescription by a geriatrician disappeared, whereas the association with seeing a psychiatrist was only attenuated.
  
  
  CONCLUSIONS
  Access to specialized prescribing of psychotropics is unequally distributed between socioeconomic groups of older adults in Sweden. This finding was partially confounded by place of residence for geriatrician but not for psychiatrist prescribing. Further research should examine if inequalities in specialized psychotropic prescribing translate into worse outcomes for socioeconomically deprived and non-metropolitan-living older individuals.
authors.affiliation: 1 Aging Research Center, Karolinska Institutet and Stockholm University, Stockholm, Sweden Jonas.Wastesson@ki.se.
authors.forename: Jonas W
authors.initials: JW
authors.lastname: Wastesson
authors.affiliation: 1 Aging Research Center, Karolinska Institutet and Stockholm University, Stockholm, Sweden.
authors.forename: Johan
authors.initials: J
authors.lastname: Fastbom
authors.affiliation: 2 National Board of Health and Welfare, Stockholm, Sweden.
authors.forename: Gunilla
authors.initials: G
authors.lastname: Ringbäck Weitoft
authors.affiliation: 1 Aging Research Center, Karolinska Institutet and Stockholm University, Stockholm, Sweden.
authors.forename: Stefan
authors.initials: S
authors.lastname: Fors
authors.affiliation: 1 Aging Research Center, Karolinska Institutet and Stockholm University, Stockholm, Sweden.
authors.forename: Kristina
authors.initials: K
authors.lastname: Johnell
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D005260:Female; D006297:Health Services Accessibility; D006801:Humans; D008297:Male; D001523:Mental Disorders / Q000188:drug therapy* / Q000453:epidemiology; D010818:Practice Patterns, Physicians' / Q000706:statistics & numerical data*; D011619:Psychotropic Drugs / Q000627:therapeutic use*; D012042:Registries; D012959:Socioeconomic Factors; D013548:Sweden / Q000453:epidemiology
chemical_list: D011619:Psychotropic Drugs