Precision public health: mapping socioeconomic disparities in opioid dispensations at Swedish pharmacies by Multilevel Analysis of Individual Heterogeneity and Discriminatory Accuracy (MAIHDA)
Persmark, Anna LU
; Wemrell, Maria
LU
; Zettermark, Sofia
LU
; Leckie, George
LU
; Subramanian, S. V.
and Merlo, Juan
LU
(2019)
In PLoS ONE
p.1-21
- Abstract
- Background
In light of the opioid epidemic in the United States, there is growing concern about the use of opioids in Sweden as it may lead to misuse and overuse and, in turn, severe public health problems. However, little is known about the distribution of opioid use across different demographic and socioeconomic dimensions in the Swedish general population. Therefore, we applied an intersectional Multilevel Analysis of Individual Heterogeneity and Discriminatory Accuracy (MAIHDA), to obtain an improved mapping of the risk heterogeneity of and socioeconomic inequalities in opioid prescription receipt.
Methods and Findings
Using data from 6,846,106 residents in Sweden aged 18 and above, we constructed 72 intersectional... (More) - Background
In light of the opioid epidemic in the United States, there is growing concern about the use of opioids in Sweden as it may lead to misuse and overuse and, in turn, severe public health problems. However, little is known about the distribution of opioid use across different demographic and socioeconomic dimensions in the Swedish general population. Therefore, we applied an intersectional Multilevel Analysis of Individual Heterogeneity and Discriminatory Accuracy (MAIHDA), to obtain an improved mapping of the risk heterogeneity of and socioeconomic inequalities in opioid prescription receipt.
Methods and Findings
Using data from 6,846,106 residents in Sweden aged 18 and above, we constructed 72 intersectional strata from combinations of gender, age, income, cohabitation status, and presence or absence of psychological distress. We modelled the absolute risk (AR) of opioid prescription receipt in a series of multilevel logistic regression models distinguishing between additive and interaction effects. By means of the Variance Partitioning Coefficient (VPC) and the area under the receiver operating characteristic curve (AUC), we quantified the discriminatory accuracy (DA) of the intersectional strata for discerning those who received opioid prescriptions from those who did not.
The AR of opioid prescription receipt ranged from 2.77% (95% CI 2.69¬–2.86) among low-income men aged 18–34, living alone, without psychological distress, to 28.25% (95% CI 27.95–28.56) among medium-income women aged 65 and older, living alone, with psychological distress. In a model that conflated both additive and interaction effects, the intersectional strata had a fair DA for discerning opioid users from non-users (VPC=13.2%, AUC=0.68). However, in the model that decomposed total effects into additive and interaction effects, the VPC was very low (0.42%) indicating the existence of small interaction effects for a number of the intersectional strata.
Conclusions
The intersectional MAIHDA approach aligns with the aims of precision public health, through improving the evidence base for health policy by increasing understanding of both health inequalities and individual heterogeneity. This approach is particularly relevant for socioeconomically conditioned outcomes such as opioid prescription receipt. We have identified intersections of social position within the Swedish population at greater risk for opioid prescription receipt.
(Less)
Please use this url to cite or link to this publication:
https://lup.lub.lu.se/record/6b4ce6e4-80bb-4a42-ad5f-c9b1d51f2ae8
- author
- Persmark, Anna
LU
; Wemrell, Maria
LU
; Zettermark, Sofia
LU
; Leckie, George
LU
; Subramanian, S. V.
and Merlo, Juan
LU
- organization
- publishing date
- 2019-08-28
- type
- Contribution to journal
- publication status
- published
- subject
- in
- PLoS ONE
- pages
- 1 - 21
- publisher
- Public Library of Science (PLoS)
- external identifiers
-
- scopus:85071326617
- pmid:31454361
- ISSN
- 1932-6203
- DOI
- 10.1371/journal.pone.0220322
- language
- English
- LU publication?
- yes
- id
- 6b4ce6e4-80bb-4a42-ad5f-c9b1d51f2ae8
- date added to LUP
- 2019-08-15 15:46:03
- date last changed
- 2022-04-26 03:36:41
@article{6b4ce6e4-80bb-4a42-ad5f-c9b1d51f2ae8,
abstract = {{Background<br/>In light of the opioid epidemic in the United States, there is growing concern about the use of opioids in Sweden as it may lead to misuse and overuse and, in turn, severe public health problems. However, little is known about the distribution of opioid use across different demographic and socioeconomic dimensions in the Swedish general population. Therefore, we applied an intersectional Multilevel Analysis of Individual Heterogeneity and Discriminatory Accuracy (MAIHDA), to obtain an improved mapping of the risk heterogeneity of and socioeconomic inequalities in opioid prescription receipt. <br/><br/>Methods and Findings<br/>Using data from 6,846,106 residents in Sweden aged 18 and above, we constructed 72 intersectional strata from combinations of gender, age, income, cohabitation status, and presence or absence of psychological distress. We modelled the absolute risk (AR) of opioid prescription receipt in a series of multilevel logistic regression models distinguishing between additive and interaction effects. By means of the Variance Partitioning Coefficient (VPC) and the area under the receiver operating characteristic curve (AUC), we quantified the discriminatory accuracy (DA) of the intersectional strata for discerning those who received opioid prescriptions from those who did not. <br/>The AR of opioid prescription receipt ranged from 2.77% (95% CI 2.69¬–2.86) among low-income men aged 18–34, living alone, without psychological distress, to 28.25% (95% CI 27.95–28.56) among medium-income women aged 65 and older, living alone, with psychological distress. In a model that conflated both additive and interaction effects, the intersectional strata had a fair DA for discerning opioid users from non-users (VPC=13.2%, AUC=0.68). However, in the model that decomposed total effects into additive and interaction effects, the VPC was very low (0.42%) indicating the existence of small interaction effects for a number of the intersectional strata. <br/><br/>Conclusions<br/>The intersectional MAIHDA approach aligns with the aims of precision public health, through improving the evidence base for health policy by increasing understanding of both health inequalities and individual heterogeneity. This approach is particularly relevant for socioeconomically conditioned outcomes such as opioid prescription receipt. We have identified intersections of social position within the Swedish population at greater risk for opioid prescription receipt. <br/>}},
author = {{Persmark, Anna and Wemrell, Maria and Zettermark, Sofia and Leckie, George and Subramanian, S. V. and Merlo, Juan}},
issn = {{1932-6203}},
language = {{eng}},
month = {{08}},
pages = {{1--21}},
publisher = {{Public Library of Science (PLoS)}},
series = {{PLoS ONE}},
title = {{Precision public health: mapping socioeconomic disparities in opioid dispensations at Swedish pharmacies by Multilevel Analysis of Individual Heterogeneity and Discriminatory Accuracy (MAIHDA)}},
url = {{http://dx.doi.org/10.1371/journal.pone.0220322}},
doi = {{10.1371/journal.pone.0220322}},
year = {{2019}},
}