title: Appropriate assessment of ethnic differences in adolescent use of psychotropic medication: multilevel analysis of discriminatory accuracy.
abstract: In the present study, we used a multilevel approach to investigate the role of maternal country of birth (MCOB) in predicting adolescent use of psychotropic medication in Sweden.
  
  
  
  Using the Swedish Medical Birth Register we identified all 428,314 adolescents born between 1987 and 1990 and who were residing in Sweden in the year they turned 18. We applied multilevel logistic regression analysis with adolescents (level 1) nested within MCOBs (level 2). Measures of association (odds ratio) and measures of variance (intra-class correlation (ICC)) were calculated, as well as the discriminatory accuracy by calculating the area under the Receiver Operator Characteristic (AU-ROC) curve.
  
  
  
  In comparison with adolescents with Swedish-born mothers, adolescents with mothers born in upper-middle, lower-middle and low-income countries were less likely to use psychotropic medication. However, the variance between MCOBs was small (ICC = 2.5 in the final model) relative to the variation within MCOBs. This was confirmed by an AU-ROC value of 0.598.
  
  
  
  Even though we found associations between MCOB and adolescent use of psychotropic medication, the small ICC and AU-ROC indicate that MCOB appears to be an inaccurate context for discriminating adolescent use of psychotropic medication in Sweden.
authors.affiliation: a Faculty of Medicine, Unit for Social Epidemiology , CRC, Skåne University Hospital, Lund University , Malmö , Sweden.|b Faculty of Health and Society , Malmö University , Malmö , Sweden.
authors.forename: Anna-Karin
authors.initials: AK
authors.lastname: Ivert
authors.affiliation: a Faculty of Medicine, Unit for Social Epidemiology , CRC, Skåne University Hospital, Lund University , Malmö , Sweden.|c Department of Sociology , Lund University , Lund , Sweden.
authors.forename: Shai
authors.initials: S
authors.lastname: Mulinari
authors.affiliation: a Faculty of Medicine, Unit for Social Epidemiology , CRC, Skåne University Hospital, Lund University , Malmö , Sweden.|d Medisch Centrum Leeuwarden , Leeuwarden , Netherlands.
authors.forename: Willemijn
authors.initials: W
authors.lastname: van Leeuwen
authors.affiliation: a Faculty of Medicine, Unit for Social Epidemiology , CRC, Skåne University Hospital, Lund University , Malmö , Sweden.|e Centre for Clinical Research Västmanland , Uppsala University , Sweden.
authors.forename: Philippe
authors.initials: P
authors.lastname: Wagner
authors.affiliation: a Faculty of Medicine, Unit for Social Epidemiology , CRC, Skåne University Hospital, Lund University , Malmö , Sweden.
authors.forename: Juan
authors.initials: J
authors.lastname: Merlo
mesh_terms: D000293:Adolescent; D000328:Adult; D003906:Developing Countries; D004363:Drug Utilization / Q000706:statistics & numerical data*; D005260:Female; D006801:Humans; D008297:Male; D009035:Mothers / Q000706:statistics & numerical data*; D055361:Multilevel Analysis; D011619:Psychotropic Drugs / Q000191:economics / Q000627:therapeutic use*; D012372:ROC Curve; D012042:Registries; D012307:Risk Factors; D012959:Socioeconomic Factors; D013548:Sweden / Q000453:epidemiology; D055815:Young Adult
chemical_list: D011619:Psychotropic Drugs
keywords: Adolescents; Sweden; discriminatory accuracy; ethnic differences; multilevel analysis; psychotropic medication