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NCHS Data Brief  ■  No.

42  ■  September 2010

Prescription Drug Use Continues to Increase:


U.S. Prescription Drug Data for 2007–2008
Qiuping Gu, M.D., Ph.D.; Charles F. Dillon, M.D., Ph.D.; and Vicki L. Burt, Sc.M., R.N.

In the United States, spending for prescription drugs was $234.1 billion
Key findings in 2008, which was more than double what was spent in 1999 (1). As new
• Over the last 10 years, the drugs are introduced and new uses for old drugs are found, more patients
percentage of Americans who can have improved health and quality of life with the appropriate use of
took at least one prescription prescription drugs. Current prescription drug use patterns need to be better
drug in the past month understood. This report provides an overview of current prescription drug use
increased from 44% to 48%. in the United States, how many and what kinds of drugs are currently being
The use of two or more drugs prescribed, and who receives them.
increased from 25% to 31%. Keywords: National Health and Nutrition Examination Survey (NHANES) •
The use of five or more drugs medication • prevalence • trends
increased from 6% to 11%.
• In 2007–2008, 1 out of every What are the trends in prescription drug use in the United
5 children and 9 out of 10 older States over the past 10 years?
Americans reported using at
least one prescription drug in Prescription drug use in the United States increased from 1999–2000 through
the past month. 2007–2008 (Figure 1).
• Those who were without
a regular place for health Figure 1. Trends in the percentage of persons using prescription drugs: United States, 1999–2008

care, health insurance, or 50 Use of 1 or more drugs


prescription drug benefit had 1
48.3
47.6 46.8
less prescription drug use 40 43.5
46.2

compared with those who had


these benefits. Use of 2 or more drugs
30
Percent

31.1 30.9 1
31.2
• The most commonly used 28.6
25.4
types of drugs included: asthma 20
medicines for children, central
Use of 5 or more drugs
nervous system stimulants for 10 1
adolescents, antidepressants 8.3
10.2 10.1 10.7
6.3
for middle-aged adults, and 0
cholesterol lowering drugs for 1999–2000 2001–2002 2003–2004 2005–2006 2007–2008
older Americans. Year
1Significant linear trend from 1999–2000 through 2007–2008.

NOTE: Age adjusted by direct method to the year 2000 projected U.S. population.
SOURCE: CDC/NCHS, National Health and Nutrition Examination Survey.

u.s. department of health and human services


Centers for Disease Control and Prevention
National Center for Health Statistics
NCHS Data Brief  ■  No. 42  ■  September 2010

• The percentage of Americans who used at least one prescription drug in the past month
increased from 44% in 1999–2000 to 48% in 2007–2008.

• The percentage of persons who used two or more prescription drugs increased from 25% in
1999–2000 to 31% in 2007–2008.

• The percentage of persons who used five or more prescription drugs increased from 6% in
1999–2000 to 11% in 2007–2008.

What percentage of Americans used multiple prescription drugs in the past


month and how did this vary by age?
The use of multiple prescription drugs in the past month varied by age (Figure 2).
Figure 2. Percentage of prescription drugs used in the past month, by age: United States, 2007–2008

1 drug 2 drugs 3–4 drugs 5 or more drugs


40
36.7

30 27.3
Percent

19.6
20 17.3
14.1
11.4 12.0 12.4
9.4
10 6.9 7.9
4.6 4.8
2.7 1
0.9 0.9
0
0–11 12–19 20–59 60 and over
Age in years
1Estimate is unstable; the relative standard error is greater than 30%.

SOURCE: CDC/NCHS, National Health and Nutrition Examination Survey.

• Among children (under age 12), less than 10% used two or more prescription drugs in the
past month and only 1% used five or more.

• Among older Americans (aged 60 and over), more than 76% used two or more prescription
drugs and 37% used five or more.

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NCHS Data Brief  ■  No. 42  ■  September 2010

Did prescription drug use vary among demographic subgroups?


There were differences in prescription drug use by age, sex, and race and ethnicity (Figure 3).

Figure 3. Percentage of use of at least one prescription drug, by age, sex, and race and ethnicity: United States, 2007–2008

100
1
88.4

80

3
60 2
53.3 54.3
Percent

48.3
43.2 4
42.0
40 33.9
29.9
22.4
20

0
0–11 12–19 20–59 60 and Men Women White Black Mexican
over Non-Hispanic American
Age in years Sex5 Race and ethnicity5

1Significant linear trend over age.


2Significantly different from men.
3Significantly different from Non-Hispanic black and Mexican-American persons.
4Significantly different from Mexican-American persons.
5Age adjusted by direct method to the year 2000 projected U.S. population.

SOURCE: CDC/NCHS, National Health and Nutrition Examination Survey.

• Prescription drug use increased with age.

• Women were more likely to use prescription drugs than men.

• The non-Hispanic white population had the highest prescription drug use and the Mexican-
American population had the lowest.

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NCHS Data Brief  ■  No. 42  ■  September 2010

What is the relationship between access to health care services and


prescription drug use?
Having a regular source of health care, health insurance, and health insurance with prescription
drug benefits were all associated with increased use of prescribed medicines (Figure 4).

Figure 4. Relation of access to health care services to prescription drug use: United States, 2007–2008

Yes No
60
1
1
52.5 1
52.8 53.6

44.0

40
Percent

28.5

19.7
20

0
Have regular health care Have health insurance Have prescription drug benefit2

1Significantly
different from "no" category.
2Among persons with health insurance.

NOTE: Age adjusted by direct method to the year 2000 projected U.S. population.
SOURCE: CDC/NCHS, National Health and Nutrition Examination Survey.

• Persons with a regular place for health care were 2.7 times as likely to have used
prescription drugs in the past month as those without a regular place for health care.

• Those with health insurance were almost twice as likely to have used at least one
prescription drug in the past month as those without health insurance coverage.

• Among people with health insurance, those having a prescription drug benefit were 22%
more likely to use prescription drugs than those who did not have this benefit.

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NCHS Data Brief  ■  No. 42  ■  September 2010

What were the most frequently used types of prescription drugs?


The types of prescription drugs used by Americans varied by age (Figure 5).

Figure 5. Percentage of prescription drugs used most often, by drug type and age group: United States, 2007–2008

Children aged 0–11


Penicillins (treat infections) 3.7
Leukotriene modifiers (asthma, allergies) 3.9
Bronchodilators (asthma) 5.7
Adolescents aged 12–19
Age group and drug type

Antidepressants 4.8
Bronchodilators (asthma) 5.4
CNS stimulants (atttention deficit disorder) 6.1
Adults aged 20–59
Cholesterol lowering drugs 8.4
Analgesics (pain relief) 10.1
Antidepressants 10.8
Older adults aged 60 and over
Diuretics (high blood pressure, heart disease) 19.9
ß-blockers (high blood pressure, heart disease) 26.4
Cholesterol lowering drugs 44.9

0 10 20 30 40 50
Percent

NOTES: Primary indication for the use of the drug class is in parentheses. CNS is central nervous system.
SOURCE: CDC/NCHS, National Health and Nutrition Examination Survey.

The most commonly used types of prescription drugs in the United States by age were:

• Bronchodilators for children aged 0–11.

• Central nervous system stimulants for adolescents aged 12–19.

• Antidepressants for adults aged 20–59.

• Cholesterol lowering drugs for adults aged 60 and over.

Among children under age 6, penicillin antibiotics were the most frequently used prescription
drugs.

Diuretics and β-blockers were also very commonly used drugs in adults and older Americans.
These are usually used to treat high blood pressure and heart problems.

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NCHS Data Brief  ■  No. 42  ■  September 2010

Summary
Over the last decade the percentage of Americans who took at least one prescription drug in the
past month increased by 10%. The use of multiple prescription drugs increased by 20% and the
use of five or more drugs increased by 70%. By 2007–2008, one-half of Americans used at least
one or more prescription drugs; and 1 out of 10 used five or more. One out of every five children
used at least one or more prescription drugs compared with 9 of every 10 adults aged 60 and over.
Women were more likely to use prescription drugs than were men. Those who were without a
regular place for health care, health insurance, or prescription drug benefit were less likely to have
used prescription medication compared with their counterparts.

The types of prescription drugs that were most commonly used were asthma medicines for
children, central nervous system stimulants for adolescents, antidepressants for middle-aged
adults, and cholesterol lowering and high blood pressure drugs for older Americans. These
patterns reflect the main chronic diseases common at these ages, but may also likely reflect more
aggressive treatments for chronic medical conditions such as high cholesterol and high blood
pressure as recommended in the updated clinical guidelines (2,3).

Those without a regular place for health care, health insurance, or prescription drug benefits had
lower prescription drug use rates. Lack of access to medicines may impact health and quality of
life, as prescription drugs are essential to treat acute and chronic diseases.

Finally, almost 40% of older Americans used five or more prescription drugs in the past month.
This likely reflects the need to treat the many diseases that commonly occur in this age group;
however, excessive prescribing or polypharmacy is also an acknowledged safety risk for older
Americans, and a continuing challenge that may contribute to adverse drug events, medication
compliance issues, and increased health care costs (4–6).

Definitions
Prescription drug use: National Health and Nutrition Examination Survey (NHANES) participants
were asked if they had taken a prescription drug in the past month. Those who answered “yes”
were asked to show the interviewer the medication containers of all prescription drugs. For each
drug reported, the interviewer recorded the product’s complete name from the container (7).

Therapeutic drug class (type of drugs): Prescription drugs were classified based on the three-level
nested therapeutic classification scheme of Cerner Multum’s Lexicon. Up to four classes were
assigned to each drug. The most commonly cited second level of drug categorical codes were
used in this analysis (7).

Health care access: Based on the question, “Is there a place you usually go when you are sick or
you need advice about your health?”

Health insurance coverage: Based on the question, “Are you covered by health insurance or some
other kind of health care plan?”

Prescription drug benefit: Based on the question, “Do any of these plans cover any part of cost of
prescriptions?”

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NCHS Data Brief  ■  No. 42  ■  September 2010

Data source and methods


NHANES data were used for these analyses (7). NHANES is designed to monitor the health and
nutritional status of the civilian noninstitutionalized U.S. population. NHANES is nationally
representative. Sample weights, accounting for the differential probabilities of selection,
nonresponse, and noncoverage were used for analyses. Variance estimates accounted for the
complex survey design using Taylor series linearization. Apart from age-specific estimates, all
estimates were age adjusted to the 2000 U.S. standard population using four age groups: under
age 12, 12–19, 20–59, and 60 and over (8). Trends were tested to evaluate changes in estimates
across survey periods and age groups. Differences among groups were evaluated using a
univariate t statistic. All significance tests were two-sided using p < 0.05 as the level of statistical
significance. For comparison of estimates by race and ethnic groups, adjustments for multiple
comparisons were made using the Bonferroni method (9). Reported differences are statistically
significant unless otherwise indicated. Statistical analyses were conducted using SAS version 9.2
(SAS Institute, Cary, N.C.) and SUDAAN version 10.0 (Research Triangle Institute, Research
Triangle Park, N.C.).

About the authors


Qiuping Gu, Charles F. Dillon, and Vicki L. Burt are with the Centers for Disease Control and
Prevention’s National Center for Health Statistics, Division of Health and Nutrition Examination
Surveys.

References
1. Centers for Medicare & Medicaid Services. National Health Expenditure Accounts,
Historical. Available from: http://www.cms.hhs.gov/NationalHealthExpendData/.

2. National Cholesterol Education Program expert panel on Detection, Evaluation, and


Treatment of High Blood Cholesterol in Adults (Adult Treatment Panel III). Third report of
the National Cholesterol Education Program (NCEP) expert panel on Detection, Evaluation,
and Treatment of High Blood Cholesterol in Adults (Adult Treatment Panel III) final report.
Circulation 106(25):3143–421. 2002.

3. Chobanian AV, Bakris GL, Black HR, Cushman WC, Green LA, Izzo JL Jr, et al. Seventh
report of the Joint National Committee on Prevention, Detection, Evaluation, and Treatment of
High Blood Pressure. Hypertension 42(6):1206–52. 2003.
4. Qato DM, Alexander GC, Conti RM, Johnson M, Schumm P, Lindau ST. Use of prescription
and over-the-counter medications and dietary supplements among older adults in the United
States. JAMA 300(24):2867–78. 2008.
5. O’Mahony D, Gallagher PF. Inappropriate prescribing in the older population: Need for new
criteria. Age Ageing 37(2):138–41. 2008.

6. Trygstad TK, Christensen DB, Wegner SE, Sullivan R, Garmise JM. Analysis of the North
Carolina long-term care polypharmacy initiative: A multiple-cohort approach using propensity-
score matching for both evaluation and targeting. Clin Ther 31(9):2018–37. 2009.

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NCHS Data Brief   ■  No. 42  ■  September 2010

7. CDC. National Center for Health Statistics. National Health and Suggested citation
Nutrition Examination Surveys, 1999–2008. Available from: http://www.cdc. Gu Q, Dillon CF, Burt VL. Prescription drug
gov/nchs/nhanes/nhanes_questionnaires.htm. use continues to increase: U.S. prescription
drug data for 2007–2008. NCHS data brief,
8. Klein RJ, Schoenborn CA. Age adjustment using the 2000 projected no 42. Hyattsville, MD: National Center for
U.S. population. Healthy People Statistical Notes, no 20. Hyattsville, MD: Health Statistics. 2010.
National Center for Health Statistics. 2001.
9. Miller RG Jr. Developments in multiple comparisons 1966–1976. J Am Copyright information
Stat Assoc 72(360):779–88. 1977.
All material appearing in this report is in
the public domain and may be reproduced
or copied without permission; citation as to
source, however, is appreciated.

National Center for Health


Statistics
Edward J. Sondik, Ph.D., Director
Jennifer H. Madans, Ph.D., Associate
Director for Science

Division of Health and Nutrition


Examination Surveys
Cliff L. Johnson, M.S.P.H., Director

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CS215116
T37112 (09/2010)
DHHS Publication No. (PHS) 2010–1209