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Socioeconomic differences in self-medication among middle-aged and older people: data from the China health and retirement longitudinal study
  1. Jie Chang1,2,
  2. Qing Wang3,
  3. Yu Fang1,2
  1. 1 Department of Pharmacy Administration and Clinical Pharmacy, School of Pharmacy, Xi’an Jiaotong University, Xi’an, China
  2. 2 Center for Drug Safety and Policy Research, Xi’an Jiaotong University, Xi’an, China
  3. 3 School of Business, Dalian University of Technology, Panjin, China
  1. Correspondence to Dr Qing Wang; qingwang{at}


Objectives 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.

Methods 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.

Results 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.

Conclusion 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.

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

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  • Contributors JC and QW had the idea and designed the study. QW and JC did the statistical analyses. JC and QW did the analysis of the literature and wrote the article. YF contributed to study design and revision of the manuscript. All authors read and approved the final manuscript. The authors take responsibility for all aspects of the reliability and freedom from bias of the data presented and their discussed interpretation.

  • Funding This work was supported by the National Natural Science Foundation of China (71503196, 71503059, 71473192), the China Postdoctoral Science Foundation (2015M580862, 2016T90935), the Shaanxi Provincial Social Science Fund (2015R009) and the Fundamental Research Funds for the Central Universities (DUT17RC(4)24) .

  • Competing interests None declared.

  • Ethics approval Ethics committee of the Institutional Review Board of Peking University.

  • Provenance and peer review Not commissioned; externally peer reviewed.

  • Data sharing statement The data used for current analysis are available from the CHARLS at