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BMJ Open. 2017 Dec 19;7(12):e017306. doi: 10.1136/bmjopen-2017-017306.

Socioeconomic differences in self-medication among middle-aged and older people: data from the China health and retirement longitudinal study.

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Department of Pharmacy Administration and Clinical Pharmacy, School of Pharmacy, Xi'an Jiaotong University, Xi'an, China.
Center for Drug Safety and Policy Research, Xi'an Jiaotong University, Xi'an, China.
School of Business, Dalian University of Technology, Panjin, China.



Self-medication with over-the-counter medicines (OTCs) and prescription-only medicines (POMs) are both pervasive in China, although the latter is an inappropriate practice. We examined the relationship between socioeconomic status (SES) and self-medication with OTCs versus POMs.


Multivariate logistic regressions based on the Andersen framework were estimated using a subsample of respondents aged 45 years and over from the China Health and Retirement Longitudinal Study collected between 2011 and 2013 (n=23 699). As dependent variables, we used OTC and POM consumption without a medical prescription. SES was operationalised by household income per capita and education. Control variables included health indicators, demographic characteristics, and health behaviours.


In our study sample, 32.69% and 15.02% of people aged 45 years and over had self-medicated with OTCs and POMs in the 4 weeks before the survey, respectively. OTC use by income exhibited an inverse U shape. Respondents from middle income groups were more likely to self-medicate with OTCs compared with those from the lowest and highest income groups. In contrast, respondents from the lowest income group were more inclined to self-medicate with POMs. There was a clear trend towards more self-medication with OTCs, but not POMs, among those with higher educational attainment.


People with low income tended to rely on self-medication with POMs for treatment, which is risky and of low quality. A health education programme for older people, particularly those living in low-income households, aimed at improving the quality of self-medication behaviour is warranted. Urgent measures are needed to address the issue of easy access to POMs at community pharmacies, and to improve access to formal medical care among the low-income population.


drug safety; over-the-counter medicines; prescription-only medicines; self-medication; socioeconomic status

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