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Association of Individual and Community-Level Socioeconomic Status and Education With Medication Use: A Multilevel Analysis in the Persian Cohort Publisher Pubmed



Akbari M1 ; Poustchi H2 ; Taherifard E3 ; Mehrian SRA4 ; Rahimian Z3 ; Mesgarpour B5 ; Pourfarzi F6 ; Gharekhani A7 ; Nejatizadeh A8 ; Moradpour F9 ; Piraie E10 ; Fakhraei B11 ; Joukar F12 ; Saki N13 Show All Authors
Authors
  1. Akbari M1
  2. Poustchi H2
  3. Taherifard E3
  4. Mehrian SRA4
  5. Rahimian Z3
  6. Mesgarpour B5
  7. Pourfarzi F6
  8. Gharekhani A7
  9. Nejatizadeh A8
  10. Moradpour F9
  11. Piraie E10
  12. Fakhraei B11
  13. Joukar F12
  14. Saki N13
  15. Safarpour AR14
  16. Moradinazar M15
  17. Rezaianzadeh A16
  18. Tafaghodi M17
  19. Esmaeilinadimi A18
  20. Moslem A19
  21. Alijanvand MH20, 21
  22. Moosazadeh M22
  23. Mehrparvar AH23
  24. Ansarimoghaddam A24
  25. Taherifard E3
  26. Ghahramani S3
  27. Pakroo M3
  28. Mohammadi Z2
  29. Malekzadeh R2
  30. Vardanjani HM26
Show Affiliations
Authors Affiliations
  1. 1. Nephro-Urology Research Center, Shiraz University of Medical Sciences, Shiraz, Iran
  2. 2. Liver and Pancreatobiliary Diseases Research Center, Digestive Diseases Research Institute, Tehran University of Medical Sciences, Tehran, Iran
  3. 3. MPH Department, School of Medicine, Shiraz University of Medical Sciences, Shiraz, Iran
  4. 4. Health Policy Research Center, Institute of Health, Shiraz University of Medical Sciences, Shiraz, Iran
  5. 5. National Institute for Medical Research Development (NIMAD), Tehran, Iran
  6. 6. Digestive Disease Research Center, Ardabil University of Medical Sciences, Ardabil, Iran
  7. 7. Liver and Gastrointestinal Diseases Research Center, Tabriz University of Medical Sciences, Tabriz, Iran
  8. 8. Molecular Medicine Research Center, Hormozgan University of Medical Sciences, Bandar Abbas, Iran
  9. 9. Social Determinants of Health Research Center, Research Institute for Health Development, Kurdistan University of Medical Sciences, Sanandaj, Iran
  10. 10. Social Determinants of Health Research Center, Yasuj University of Medical Sciences, Yasuj, Iran
  11. 11. Non-Communicable Diseases Research Center, Fasa University of Medical Sciences, Fasa, Iran
  12. 12. Gastrointestinal and Liver Diseases Research Center, Guilan University of Medical Sciences, Rasht, Iran
  13. 13. Hearing Research Center, Clinical Sciences Research Institute, Department of Otolaryngology, Head and Neck Surgery, Ahvaz Jundishapur University of Medical Sciences, Ahvaz, Iran
  14. 14. Gastroenterohepatology Research Center, Shiraz University of Medical Sciences, Shiraz, Iran
  15. 15. Social Development & Health Promotion Research Center, Health Institute, Kermanshah University of Medical Sciences, Kermanshah, Iran
  16. 16. Colorectal Research Center, Shiraz University of Medical Sciences, Shiraz, Iran
  17. 17. Nanotechnology Research Center, Pharmaceutical Technology Institute, Mashhad University of Medical Sciences, Mashhad, Iran
  18. 18. Non-Communicable Diseases Research Center, Rafsanjan University of Medical Sciences, Rafsanjan, Iran
  19. 19. Non-Communicable Diseases Research Center, Sabzevar University of Medical Sciences, Sabzevar, Iran
  20. 20. Modeling in Health Research Center, Shahrekord University of Medical Sciences, Shahrekord, Iran
  21. 21. Department of Epidemiology and Biostatistics, School of Health, Shahrekord University of Medical Sciences, Shahrekord, Iran
  22. 22. Gastrointestinal Cancer Research Center, Non-Communicable Diseases Institute, Mazandaran University of Medical Sciences, Sari, Iran
  23. 23. Industrial Diseases Research Center, Shahid Sadoughi University of Medical Sciences, Yazd, Iran
  24. 24. Health Promotion Research Center, Zahedan University of Medical Sciences, Zahedan, Iran
  25. 25. Student Research Committee, Shiraz University of Medical Sciences, Shiraz, Iran
  26. 26. MD-MPH Department, School of Medicine, Research Center for Traditional Medicine and History of Medicine, Shiraz University of Medical Sciences, Shiraz, Iran

Source: BMC Public Health Published:2025


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. © The Author(s) 2025.
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