Association of individual and community-level socioeconomic status and education with medication use: a multilevel analysis in the PERSIAN cohort
Abstract Background Socioeconomic status (SES) and education influence medication use, but their effects at both individual and community levels remain poorly understood. This study investigates the association between medication count and polypharmacy with SES and education at both levels. Methods...
Saved in:
| Main Authors: | , , , , , , , , , , , , , , , , , , , , , , , , , , , , , |
|---|---|
| Format: | Article |
| Language: | English |
| Published: |
BMC
2025-05-01
|
| Series: | BMC Public Health |
| Subjects: | |
| Online Access: | https://doi.org/10.1186/s12889-025-23062-y |
| Tags: |
Add Tag
No Tags, Be the first to tag this record!
|
| _version_ | 1850141373497344000 |
|---|---|
| author | Mohammadreza Akbari Hossein Poustchi Erfan Taherifard Seyed Reza Abdipour Mehrian Zahra Rahimian Bita Mesgarpour Farhad Pourfarzi Afshin Gharekhani Azim Nejatizadeh Farhad Moradpour Elahe Piraie Bahareh Fakhraei Farahnaz Joukar Nader Saki Ali Reza Safarpour Mehdi Moradinazar Abbas Rezaianzadeh Mohsen Tafaghodi Ali Esmaeili-Nadimi Alireza Moslem Moluk Hadi Alijanvand Mahmood Moosazadeh Amir Houshang Mehrparvar Alireza Ansari-Moghaddam Ehsan Taherifard SaharNaz Ghahramani Mahsa Pakroo Zahra Mohammadi Reza Malekzadeh Hossein Molavi Vardanjani |
| author_facet | Mohammadreza Akbari Hossein Poustchi Erfan Taherifard Seyed Reza Abdipour Mehrian Zahra Rahimian Bita Mesgarpour Farhad Pourfarzi Afshin Gharekhani Azim Nejatizadeh Farhad Moradpour Elahe Piraie Bahareh Fakhraei Farahnaz Joukar Nader Saki Ali Reza Safarpour Mehdi Moradinazar Abbas Rezaianzadeh Mohsen Tafaghodi Ali Esmaeili-Nadimi Alireza Moslem Moluk Hadi Alijanvand Mahmood Moosazadeh Amir Houshang Mehrparvar Alireza Ansari-Moghaddam Ehsan Taherifard SaharNaz Ghahramani Mahsa Pakroo Zahra Mohammadi Reza Malekzadeh Hossein Molavi Vardanjani |
| author_sort | Mohammadreza Akbari |
| collection | DOAJ |
| description | Abstract Background Socioeconomic status (SES) and education influence medication use, but their effects at both individual and community levels remain poorly understood. This study investigates the association between medication count and polypharmacy with SES and education at both levels. Methods We used data from the Prospective Epidemiological Research Studies in IrAN (PERSIAN), comprising 163,770 individuals aged 35–70 from 18 sites in Iran. Individual SES was evaluated using asset analysis, while community SES was determined based on the prevalence of low SES individuals in each site. Individual education level was dichotomized into having at least 5 years of schooling or not, while community education level was determined by the frequency of individuals with high education level in each site. Multi-level Poisson regressions, were conducted to explore the association between these variables and medication count in this cross-sectional study. Results Approximately 45% of participants used at least one medication, with an average of 1.32 medications per person. Polypharmacy was observed in 8.85% of the population. Higher individual SES was associated with a slightly increased medication count (PR 1.05; 95% CI: 1.02–1.08) and a modest increase in polypharmacy risk (PR 1.08; 95% CI: 1.03–1.14). Residing in middle-SES communities was linked to lower medication use (PR 0.88; 95% CI: 0.85–0.91) but was not significantly associated with polypharmacy. Higher individual education was associated with reduced medication count (PR 0.92; 95% CI: 0.88–0.96) and a lower likelihood of polypharmacy (PR 0.85; 95% CI: 0.79–0.91). However, living in highly educated communities was associated with increased medication count (PR 1.70; 95% CI: 1.62–1.78) and a higher risk of polypharmacy (PR 1.81; 95% CI: 1.16–2.81). The models were adjusted for age, gender, residence, ethnicity, marital status, body mass index, physical activity level, smoking status, opium use, hookah use, and alcohol consumption. Conclusion Higher education was associated with lower medication use, whereas living in more educated communities was linked to higher usage. Although the association between individual SES and medication use was relatively weak, residing in middle-SES communities was associated with lower medication usage. These findings show the importance of addressing community-level factors in health research and policymaking. |
| format | Article |
| id | doaj-art-2707dafbde0743b79d9ca09887e21d48 |
| institution | OA Journals |
| issn | 1471-2458 |
| language | English |
| publishDate | 2025-05-01 |
| publisher | BMC |
| record_format | Article |
| series | BMC Public Health |
| spelling | doaj-art-2707dafbde0743b79d9ca09887e21d482025-08-20T02:29:27ZengBMCBMC Public Health1471-24582025-05-0125111310.1186/s12889-025-23062-yAssociation of individual and community-level socioeconomic status and education with medication use: a multilevel analysis in the PERSIAN cohortMohammadreza Akbari0Hossein Poustchi1Erfan Taherifard2Seyed Reza Abdipour Mehrian3Zahra Rahimian4Bita Mesgarpour5Farhad Pourfarzi6Afshin Gharekhani7Azim Nejatizadeh8Farhad Moradpour9Elahe Piraie10Bahareh Fakhraei11Farahnaz Joukar12Nader Saki13Ali Reza Safarpour14Mehdi Moradinazar15Abbas Rezaianzadeh16Mohsen Tafaghodi17Ali Esmaeili-Nadimi18Alireza Moslem19Moluk Hadi Alijanvand20Mahmood Moosazadeh21Amir Houshang Mehrparvar22Alireza Ansari-Moghaddam23Ehsan Taherifard24SaharNaz Ghahramani25Mahsa Pakroo26Zahra Mohammadi27Reza Malekzadeh28Hossein Molavi Vardanjani29Nephro-Urology Research Center, Shiraz University of Medical SciencesLiver and Pancreatobiliary Diseases Research Center, Digestive Diseases Research Institute, Tehran University of Medical SciencesMPH Department, School of Medicine, Shiraz University of Medical SciencesHealth Policy Research Center, Institute of Health, Shiraz University of Medical SciencesMPH Department, School of Medicine, Shiraz University of Medical SciencesNational Institute for Medical Research Development (NIMAD)Digestive Disease Research Center, Ardabil University of Medical SciencesLiver and Gastrointestinal Diseases Research Center, Tabriz University of Medical SciencesMolecular Medicine Research Center, Hormozgan University of Medical SciencesSocial Determinants of Health Research Center, Research Institute for Health Development, Kurdistan University of Medical SciencesSocial Determinants of Health Research Center, Yasuj University of Medical SciencesNon-Communicable Diseases Research Center, Fasa University of Medical SciencesGastrointestinal and Liver Diseases Research Center, Guilan University of Medical SciencesHearing Research Center, Clinical Sciences Research Institute, Department of Otolaryngology, Head and Neck Surgery, Ahvaz Jundishapur University of Medical SciencesGastroenterohepatology Research Center, Shiraz University of Medical SciencesSocial Development & Health Promotion Research Center, Health Institute, Kermanshah University of Medical SciencesColorectal Research Center, Shiraz University of Medical SciencesNanotechnology Research Center, Pharmaceutical Technology Institute, Mashhad University of Medical SciencesNon-Communicable Diseases Research Center, Rafsanjan University of Medical SciencesNon-Communicable Diseases Research Center, Sabzevar University of Medical SciencesModeling in Health Research Center, Shahrekord University of Medical SciencesGastrointestinal Cancer Research Center, Non-Communicable Diseases Institute, Mazandaran University of Medical SciencesIndustrial Diseases Research Center, Shahid Sadoughi University of Medical SciencesHealth Promotion Research Center, Zahedan University of Medical SciencesStudent Research Committee, Shiraz University of Medical SciencesMPH Department, School of Medicine, Shiraz University of Medical SciencesMPH Department, School of Medicine, Shiraz University of Medical SciencesLiver and Pancreatobiliary Diseases Research Center, Digestive Diseases Research Institute, Tehran University of Medical SciencesLiver and Pancreatobiliary Diseases Research Center, Digestive Diseases Research Institute, Tehran University of Medical SciencesMD-MPH Department, School of Medicine, Research Center for Traditional Medicine and History of Medicine, Shiraz University of Medical SciencesAbstract Background Socioeconomic status (SES) and education influence medication use, but their effects at both individual and community levels remain poorly understood. This study investigates the association between medication count and polypharmacy with SES and education at both levels. Methods We used data from the Prospective Epidemiological Research Studies in IrAN (PERSIAN), comprising 163,770 individuals aged 35–70 from 18 sites in Iran. Individual SES was evaluated using asset analysis, while community SES was determined based on the prevalence of low SES individuals in each site. Individual education level was dichotomized into having at least 5 years of schooling or not, while community education level was determined by the frequency of individuals with high education level in each site. Multi-level Poisson regressions, were conducted to explore the association between these variables and medication count in this cross-sectional study. Results Approximately 45% of participants used at least one medication, with an average of 1.32 medications per person. Polypharmacy was observed in 8.85% of the population. Higher individual SES was associated with a slightly increased medication count (PR 1.05; 95% CI: 1.02–1.08) and a modest increase in polypharmacy risk (PR 1.08; 95% CI: 1.03–1.14). Residing in middle-SES communities was linked to lower medication use (PR 0.88; 95% CI: 0.85–0.91) but was not significantly associated with polypharmacy. Higher individual education was associated with reduced medication count (PR 0.92; 95% CI: 0.88–0.96) and a lower likelihood of polypharmacy (PR 0.85; 95% CI: 0.79–0.91). However, living in highly educated communities was associated with increased medication count (PR 1.70; 95% CI: 1.62–1.78) and a higher risk of polypharmacy (PR 1.81; 95% CI: 1.16–2.81). The models were adjusted for age, gender, residence, ethnicity, marital status, body mass index, physical activity level, smoking status, opium use, hookah use, and alcohol consumption. Conclusion Higher education was associated with lower medication use, whereas living in more educated communities was linked to higher usage. Although the association between individual SES and medication use was relatively weak, residing in middle-SES communities was associated with lower medication usage. These findings show the importance of addressing community-level factors in health research and policymaking.https://doi.org/10.1186/s12889-025-23062-yCommunity-level factorsHealth disparitiesMedication usePolypharmacyPERSIANMultilevel analysis |
| spellingShingle | Mohammadreza Akbari Hossein Poustchi Erfan Taherifard Seyed Reza Abdipour Mehrian Zahra Rahimian Bita Mesgarpour Farhad Pourfarzi Afshin Gharekhani Azim Nejatizadeh Farhad Moradpour Elahe Piraie Bahareh Fakhraei Farahnaz Joukar Nader Saki Ali Reza Safarpour Mehdi Moradinazar Abbas Rezaianzadeh Mohsen Tafaghodi Ali Esmaeili-Nadimi Alireza Moslem Moluk Hadi Alijanvand Mahmood Moosazadeh Amir Houshang Mehrparvar Alireza Ansari-Moghaddam Ehsan Taherifard SaharNaz Ghahramani Mahsa Pakroo Zahra Mohammadi Reza Malekzadeh Hossein Molavi Vardanjani Association of individual and community-level socioeconomic status and education with medication use: a multilevel analysis in the PERSIAN cohort BMC Public Health Community-level factors Health disparities Medication use Polypharmacy PERSIAN Multilevel analysis |
| title | Association of individual and community-level socioeconomic status and education with medication use: a multilevel analysis in the PERSIAN cohort |
| title_full | Association of individual and community-level socioeconomic status and education with medication use: a multilevel analysis in the PERSIAN cohort |
| title_fullStr | Association of individual and community-level socioeconomic status and education with medication use: a multilevel analysis in the PERSIAN cohort |
| title_full_unstemmed | Association of individual and community-level socioeconomic status and education with medication use: a multilevel analysis in the PERSIAN cohort |
| title_short | Association of individual and community-level socioeconomic status and education with medication use: a multilevel analysis in the PERSIAN cohort |
| title_sort | association of individual and community level socioeconomic status and education with medication use a multilevel analysis in the persian cohort |
| topic | Community-level factors Health disparities Medication use Polypharmacy PERSIAN Multilevel analysis |
| url | https://doi.org/10.1186/s12889-025-23062-y |
| work_keys_str_mv | AT mohammadrezaakbari associationofindividualandcommunitylevelsocioeconomicstatusandeducationwithmedicationuseamultilevelanalysisinthepersiancohort AT hosseinpoustchi associationofindividualandcommunitylevelsocioeconomicstatusandeducationwithmedicationuseamultilevelanalysisinthepersiancohort AT erfantaherifard associationofindividualandcommunitylevelsocioeconomicstatusandeducationwithmedicationuseamultilevelanalysisinthepersiancohort AT seyedrezaabdipourmehrian associationofindividualandcommunitylevelsocioeconomicstatusandeducationwithmedicationuseamultilevelanalysisinthepersiancohort AT zahrarahimian associationofindividualandcommunitylevelsocioeconomicstatusandeducationwithmedicationuseamultilevelanalysisinthepersiancohort AT bitamesgarpour associationofindividualandcommunitylevelsocioeconomicstatusandeducationwithmedicationuseamultilevelanalysisinthepersiancohort AT farhadpourfarzi associationofindividualandcommunitylevelsocioeconomicstatusandeducationwithmedicationuseamultilevelanalysisinthepersiancohort AT afshingharekhani associationofindividualandcommunitylevelsocioeconomicstatusandeducationwithmedicationuseamultilevelanalysisinthepersiancohort AT azimnejatizadeh associationofindividualandcommunitylevelsocioeconomicstatusandeducationwithmedicationuseamultilevelanalysisinthepersiancohort AT farhadmoradpour associationofindividualandcommunitylevelsocioeconomicstatusandeducationwithmedicationuseamultilevelanalysisinthepersiancohort AT elahepiraie associationofindividualandcommunitylevelsocioeconomicstatusandeducationwithmedicationuseamultilevelanalysisinthepersiancohort AT baharehfakhraei associationofindividualandcommunitylevelsocioeconomicstatusandeducationwithmedicationuseamultilevelanalysisinthepersiancohort AT farahnazjoukar associationofindividualandcommunitylevelsocioeconomicstatusandeducationwithmedicationuseamultilevelanalysisinthepersiancohort AT nadersaki associationofindividualandcommunitylevelsocioeconomicstatusandeducationwithmedicationuseamultilevelanalysisinthepersiancohort AT alirezasafarpour associationofindividualandcommunitylevelsocioeconomicstatusandeducationwithmedicationuseamultilevelanalysisinthepersiancohort AT mehdimoradinazar associationofindividualandcommunitylevelsocioeconomicstatusandeducationwithmedicationuseamultilevelanalysisinthepersiancohort AT abbasrezaianzadeh associationofindividualandcommunitylevelsocioeconomicstatusandeducationwithmedicationuseamultilevelanalysisinthepersiancohort AT mohsentafaghodi associationofindividualandcommunitylevelsocioeconomicstatusandeducationwithmedicationuseamultilevelanalysisinthepersiancohort AT aliesmaeilinadimi associationofindividualandcommunitylevelsocioeconomicstatusandeducationwithmedicationuseamultilevelanalysisinthepersiancohort AT alirezamoslem associationofindividualandcommunitylevelsocioeconomicstatusandeducationwithmedicationuseamultilevelanalysisinthepersiancohort AT molukhadialijanvand associationofindividualandcommunitylevelsocioeconomicstatusandeducationwithmedicationuseamultilevelanalysisinthepersiancohort AT mahmoodmoosazadeh associationofindividualandcommunitylevelsocioeconomicstatusandeducationwithmedicationuseamultilevelanalysisinthepersiancohort AT amirhoushangmehrparvar associationofindividualandcommunitylevelsocioeconomicstatusandeducationwithmedicationuseamultilevelanalysisinthepersiancohort AT alirezaansarimoghaddam associationofindividualandcommunitylevelsocioeconomicstatusandeducationwithmedicationuseamultilevelanalysisinthepersiancohort AT ehsantaherifard associationofindividualandcommunitylevelsocioeconomicstatusandeducationwithmedicationuseamultilevelanalysisinthepersiancohort AT saharnazghahramani associationofindividualandcommunitylevelsocioeconomicstatusandeducationwithmedicationuseamultilevelanalysisinthepersiancohort AT mahsapakroo associationofindividualandcommunitylevelsocioeconomicstatusandeducationwithmedicationuseamultilevelanalysisinthepersiancohort AT zahramohammadi associationofindividualandcommunitylevelsocioeconomicstatusandeducationwithmedicationuseamultilevelanalysisinthepersiancohort AT rezamalekzadeh associationofindividualandcommunitylevelsocioeconomicstatusandeducationwithmedicationuseamultilevelanalysisinthepersiancohort AT hosseinmolavivardanjani associationofindividualandcommunitylevelsocioeconomicstatusandeducationwithmedicationuseamultilevelanalysisinthepersiancohort |