Open Access Research article

Association between unemployment rates and prescription drug utilization in the United States, 2007–2010

Daniel Kozman1, Christopher Graziul2, Robert Gibbons3456 and G Caleb Alexander678*

Author affiliations

1 Pritzker School of Medicine, University of Chicago, Chicago, IL, USA

2 Department of Sociology, University of Chicago, Chicago, IL, USA

3 Department of Hospital Medicine, University of Chicago, Chicago, IL, USA

4 Department of Health Studies, University of Chicago, Chicago, IL, USA

5 Center for Health Statistics, University of Chicago, Chicago, IL, USA

6 Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, 21205, USA

7 Department of Medicine, Johns Hopkins Medicine, Baltimore, MD, USA

8 Department of Pharmacy Practice, University of Illinois at Chicago School of Pharmacy, Chicago, IL, USA

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Citation and License

BMC Health Services Research 2012, 12:435  doi:10.1186/1472-6963-12-435

Published: 30 November 2012



While extensive evidence suggests that the economic recession has had far reaching effects on many economic sectors, little is known regarding its impact on prescription drug utilization. The purpose of this study is to describe the association between state-level unemployment rates and retail sales of seven therapeutic classes (statins, antidepressants, antipsychotics, angiotensin-converting enzyme [ACE] inhibitors, opiates, phosphodiesterase [PDE] inhibitors and oral contraceptives) in the United States.


Using a retrospective mixed ecological design, we examined retail prescription sales using IMS Health Xponent™ from September 2007 through July 2010, and we used the Bureau of Labor Statistics to derive population-based rates and mixed-effects modeling with state-level controls to examine the association between unemployment and utilization. Our main outcome measure was state-level utilization per 100,000 people for each class.


Monthly unemployment levels and rates of use of each class varied substantially across the states. There were no statistically significant associations between use of ACE inhibitors or SSRIs/SNRIs and average unemployment in analyses across states, while for opioids and PDE inhibitors there were small statistically significant direct associations, and for the remaining classes inverse associations. Analyses using each state as its own control collectively exhibited statistically significant positive associations between increases in unemployment and prescription drug utilization for five of seven areas examined. This relationship was greatest for statins (on average, a 4% increase in utilization per 1% increased unemployment) and PDE inhibitors (3% increase in utilization per 1% increased unemployment), and lower for oral contraceptives and atypical antipsychotics.


We found no evidence of an association between increasing unemployment and decreasing prescription utilization, suggesting that any effects of the recent economic recession have been mitigated by other market forces.

Economic recession; Pharmacoeconomics; Pharmacoepidemiology; Public health