RESEARCH REPORT

Neighbourhood social participation and women’s use of anxiolytic-hypnotic drugs: a multilevel analysis

K Johnell¹, J Merlo², J Lynch³ and G Blennow⁴

¹ Family Medicine Stockholm, Karolinska Institutet, Huddinge, Sweden
² Department of Community Medicine, Malmö University Hospital, Lund University, Malmö, Sweden
³ Department of Epidemiology, School of Public Health Center for Social Epidemiology and Population Health, and Institute for Social Research, University of Michigan, Ann Arbor, USA
⁴ The National Social Insurance Board, Stockholm, Sweden

Correspondence to:
Correspondence to:
Kristina Johnell
Family Medicine Stockholm, Karolinska Institutet, Alfred Nobels allé 12, S-141 83 Huddinge, Sweden; Kristina.Johnell{at}klinvet.ki.se

Study objectives: To identify and quantify a hypothesised collective effect of the neighbourhood on individual use of anxiolytic-hypnotic drugs (AHD). To analyse the general impact of neighbourhood social participation on use of AHD, adjusting for individual characteristics.

Design: Cross sectional analysis performed by multilevel logistic regression with women at the first level and neighbourhoods at the second level.

Setting: Malmö (250 000 inhabitants), Sweden.

Participants:15 456 women aged 45 to 73, residing in 95 neighbourhoods in Malmö, who took part in the Malmö diet and cancer study (1991–1996).

Main results: The prevalence of AHD use was 5.5% in the study sample. Overall, 1.7% of the total individual differences in the propensity for using AHD were explained by the neighbourhood level. This percentage, however, differed between different individuals. Low level of social participation in the neighbourhood was associated with higher probability of AHD use (OR = 3.10 (95% CI 1.51 to 6.41)), independently of individual age, low social participation, low educational level, and living alone. This association was reduced (OR = 2.01 (95% CI 0.97 to 4.14)) after the additional accounting for individual disability pension, low self rated health, stress, and medication for somatic disorders.

Conclusions: The neighbourhood level of social participation seems to affect individual use of AHD, possibly through individual characteristics. However, neighbourhood boundaries play a minor part in understanding individual AHD use in the city of Malmö.

Abbreviations: AHD, anxiolytic-hypnotic drugs; MDCS, Malmö diet and cancer study; ICC, intraclass correlation; VPC, variance partition coefficient; RIGLS, restricted iterative generalised least squares; PQL, penalised quasilikelihood

Keywords: anxiolytic-hypnotic drugs; social participation; multilevel analysis

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