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Precision public health: Mapping socioeconomic disparities in opioid dispensations at Swedish pharmacies by Multilevel Analysis of Individual Heterogeneity and Discriminatory Accuracy (MAIHDA)

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  • Anna Persmark
  • Maria Wemrell
  • Sofia Zettermark
  • George Leckie
  • S V Subramanian
  • Juan Merlo

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 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. 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.

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  • Anna Persmark & Maria Wemrell & Sofia Zettermark & George Leckie & S V Subramanian & Juan Merlo, 2019. "Precision public health: Mapping socioeconomic disparities in opioid dispensations at Swedish pharmacies by Multilevel Analysis of Individual Heterogeneity and Discriminatory Accuracy (MAIHDA)," PLOS ONE, Public Library of Science, vol. 14(8), pages 1-21, August.
  • Handle: RePEc:plo:pone00:0220322
    DOI: 10.1371/journal.pone.0220322
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    References listed on IDEAS

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    7. Aránzazu Hernández-Yumar & Maria Wemrell & Ignacio Abásolo Alessón & Beatriz González López-Valcárcel & George Leckie & Juan Merlo, 2018. "Socioeconomic differences in body mass index in Spain: An intersectional multilevel analysis of individual heterogeneity and discriminatory accuracy," PLOS ONE, Public Library of Science, vol. 13(12), pages 1-23, December.
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    11. Nermin Ghith & Philippe Wagner & Anne Frølich & Juan Merlo, 2016. "Short Term Survival after Admission for Heart Failure in Sweden: Applying Multilevel Analyses of Discriminatory Accuracy to Evaluate Institutional Performance," PLOS ONE, Public Library of Science, vol. 11(2), pages 1-20, February.
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    Cited by:

    1. Yang Li & Dario Spini & Dimitrios Lampropoulos, 2023. "Beyond Geography: Social Quality Environments and Health," Social Indicators Research: An International and Interdisciplinary Journal for Quality-of-Life Measurement, Springer, vol. 166(2), pages 365-379, April.
    2. Wilkes, Rima & Karimi, Aryan, 2024. "What does the MAIHDA method explain?," Social Science & Medicine, Elsevier, vol. 345(C).
    3. Gustafsson, Per E. & Fonseca-Rodríguez, Osvaldo & Castel Feced, Sara & San Sebastián, Miguel & Bastos, João Luiz & Mosquera, Paola A., 2024. "A novel application of interrupted time series analysis to identify the impact of a primary health care reform on intersectional inequities in avoidable hospitalizations in the adult Swedish populatio," Social Science & Medicine, Elsevier, vol. 343(C).
    4. Fagrell Trygg, Nadja & Månsdotter, Anna & Gustafsson, Per E., 2021. "Intersectional inequalities in mental health across multiple dimensions of inequality in the Swedish adult population," Social Science & Medicine, Elsevier, vol. 283(C).
    5. Philipp Jaehn & Emily Mena & Sibille Merz & Robert Hoffmann & Antje Gößwald & Alexander Rommel & Christine Holmberg & on behalf of the ADVANCE GENDER study group, 2020. "Non-response in a national health survey in Germany: An intersectionality-informed multilevel analysis of individual heterogeneity and discriminatory accuracy," PLOS ONE, Public Library of Science, vol. 15(8), pages 1-17, August.

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