Sex, gender, and sociodemographic factors associated with repeated prescription refills in chronic pain: insights from a prescription claims cohort study

Purpose Chronic pain (CP) disproportionately affects women and gender-diverse individuals, raising questions about how sociodemographic factors influence medication use. Yet, the interplay between sex, gender, and prescribed medication use in CP remains poorly understood, limiting optimization, safety, and equity of care. We examined how sex and gender are associated with repeated prescription refills of pain medications among individuals with CP. Methods This study was conducted among individuals living with CP and links self-reported data to public and private prescription claims ( n = 561). Repeated prescription refills of medications prescribed for CP and related comorbidities in the year following questionnaire completion were analyzed (≥40% days covered; yes/no; sensitivity analyses were performed using alternative cut-offs). Main independent variables were sex, gender identity, and gender-stereotyped personality traits (Bem Sex-Role Inventory). Cluster analysis was used to create intersecting sociodemographic subgroups (incorporating sex, gender, and other sociodemographic factors). Multivariable logistic regression was achieved to examine associations between these subgroups and repeated prescription refills. Results Most commonly used medications prescribed for CP and related comorbidities were antidepressants (48%), anticonvulsants (35%), opioids (19%), and nonsteroidal anti-inflammatory drugs (18%) (repeated refills). Between clusters, statistically significant differences were found for the subgroups labelled: (1) ‘W omen with private drug insurance ’, who had lower odds of repeated opioid prescription refills ( a OR:0.38; 95%CI:0.15–0.95), and (2) ‘ Unemployed older men ’, who had lower odds of repeated antidepressant prescription refills ( a OR: 0.45; 95%CI:0.24–0.87) (vs. ‘ Unemployed women ’). Conclusion Our results highlight how sex, gender, and intersecting sociodemographic factors are associated with repeated prescription refills, particularly opioids and antidepressants, among individuals living with CP.