Urban–Rural Patterns of Increasing Antidepressant Use Among Nursing Facility Residents

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Objective To characterize changing patterns of antidepressant use in nursing facilities across the urban–rural continuum during the mid-1990s. Design Retrospective analysis of antidepressant drug codes and demographic/clinical data from the Minimum Data Set (MDS) 1994 to 1997. Setting Kansas nursing facilities. Participants Facility residents aged 65 and older. Measurements We examined (1) admission use and (2) after-admission use for newer and older antidepressants for each year separately, using a 4-stratum system to classify nursing facility location by county, from urban to most rural. Incidence rate ratios were determined for antidepressant use in each stratum using the urban strata as the reference. Results Remarkable increases in use of newer antidepressants were seen over time in all strata, but use was highest in the urban area. Modest urban–rural gradient effects attenuated over time and were not consistently seen across analyses and years. Tricyclic antidepressant (TCA) use remained largely unchanged over time and at much lower rates than newer agents. However, TCA use was also modestly higher in urban areas. Differences were clearer for use after admission, in contrast with admission use patterns. Conclusions Newer antidepressants were rapidly adopted across the urban–rural continuum from 1994 to 1997. Marked increases in both admission and after-admission use of newer antidepressants were seen. Both newer and older antidepressants were used at modestly higher rates in urban areas. Further work is needed to elucidate the patient, prescriber, and facility factors that explain these prescribing patterns.