Contextual and individual aspects of use of medication : multilevel studies on anxiolytic-hypnotic drug use, social context, adherence to medication, and disability pension
Author: Johnell, Kristina
Date: 2005-11-25
Location: Hörsalen, entréplan, Alfred Nobels allé 12, Huddinge
Time: 13.00
Department: Institutionen för klinisk neurovetenskap, arbetsterapi och äldrevårdsforskning (NEUROTEC) / Department of Clinical Neuroscience, Occupational Therapy and Elderly Care Research (NEUROTEC)
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Thesis (1.556Mb)
Abstract
Aims: Study I. To estimate an influence of the neighbourhood on women's AHD
(anxiolytichypnotic drug) use, and to analyze whether neighborhood social
participation is associated with use of these medicines. Study II. To
investigate whether women living in the same neighborhood have similar
propensity for disability pension that relates to neighborhood social
participation, and whether there is an association between AHD use and
disability pension in women that is modified by the neighborhood context.
Study III. To investigate whether the contextual component of the
miniaturization of community concept is associated with AHD use, and
whether people living in the same area share a similar probability of AHD
use. Study IV. To investigate whether age, educational level, financial
strain, self-rated health, social participation, and trust in the health
care system are associated with primary nonconcordance with medication
(i.e., non-redemption of prescription), and whether people living in the
same area have similar probability of primary nonconcordance with
medication that relates to area social participation. Study V. To examine
whether individual low social participation is associated with low
adherence to antihypertensive medication, and whether this possible
association is modified by the municipality of residence.
Methods: We used multilevel logistic regression analysis with individuals at the first level and areas (neighborhoods) at the second level. Both fixed effects (measures of association) and random effects (measures of variation) were investigated. In Study I (n=1 5 456) and Study II (n=12 156), we used data from The Malmö Diet and Cancer Study, Sweden. The women, aged 45-73 years, who participated in the cohort lived in Malmö during the baseline period 1991-1996. In Study III (n=20 319 women and 17 850 men) and Study IV (n=9 070 women and 6 795 men), we used data from the Life & Health year 2000 survey, a postal questionnaire sent out to a random sample aged 1879 years in central Sweden. In Study V (n = 1288), we used data from The Health Survey in Scania 2000, a postal questionnaire sent out to a random sample of people aged 18-80 years in Scania, Sweden.
Results: Study I. A small proportion of the differences in AHD use were explained by the neighborhood level. A low level of social participation in the neighborhood was associated with higher probability of AHD use, after adjustment for socioeconomic status. Study II. Both AHD use and neighborhood social participation were associated with higher propensity for disability pension, after adjustment for individual factors. The association between AHD use and disability pension was not modified by the neighborhood context. There was variation in disability pension between the neighborhoods. Study III. The contextual component of the miniaturization of community concept was associated with AHD use, after adjustment for socioeconomic status. The variation in AHD use between the areas was fairly small. Study IV. Younger age, financial strain, low self-rated health, and low trust in the health care system were associated with primary non-concordance with medication. Area social participation was, however, not related, and the variation in primary nonconcordance between the areas was small. Study V. Individual low social participation was associated with low adherence to antihypertensives, independently of educational level. The association between low social participation and low adherence to antihypertensives varied among municipalities in Scania.
Conclusions: In the Swedish setting, the social context seems to influence use of AHD and disability pension. However, administrative area boundaries seem to play a minor role in understanding AHD use, but matters more for disability pension. People with younger age, financial difficulties, low self-rated health, and low trust in the health care system may have a higher probability of primary non-concordance with medication. However, the area of residence-as defined by administrative boundaries-seems to play a minor role for primary non-concordance. Also, individual low social participation seems to be associated with low adherence to antihypertensives, and this association may vary between different municipalities.
Methods: We used multilevel logistic regression analysis with individuals at the first level and areas (neighborhoods) at the second level. Both fixed effects (measures of association) and random effects (measures of variation) were investigated. In Study I (n=1 5 456) and Study II (n=12 156), we used data from The Malmö Diet and Cancer Study, Sweden. The women, aged 45-73 years, who participated in the cohort lived in Malmö during the baseline period 1991-1996. In Study III (n=20 319 women and 17 850 men) and Study IV (n=9 070 women and 6 795 men), we used data from the Life & Health year 2000 survey, a postal questionnaire sent out to a random sample aged 1879 years in central Sweden. In Study V (n = 1288), we used data from The Health Survey in Scania 2000, a postal questionnaire sent out to a random sample of people aged 18-80 years in Scania, Sweden.
Results: Study I. A small proportion of the differences in AHD use were explained by the neighborhood level. A low level of social participation in the neighborhood was associated with higher probability of AHD use, after adjustment for socioeconomic status. Study II. Both AHD use and neighborhood social participation were associated with higher propensity for disability pension, after adjustment for individual factors. The association between AHD use and disability pension was not modified by the neighborhood context. There was variation in disability pension between the neighborhoods. Study III. The contextual component of the miniaturization of community concept was associated with AHD use, after adjustment for socioeconomic status. The variation in AHD use between the areas was fairly small. Study IV. Younger age, financial strain, low self-rated health, and low trust in the health care system were associated with primary non-concordance with medication. Area social participation was, however, not related, and the variation in primary nonconcordance between the areas was small. Study V. Individual low social participation was associated with low adherence to antihypertensives, independently of educational level. The association between low social participation and low adherence to antihypertensives varied among municipalities in Scania.
Conclusions: In the Swedish setting, the social context seems to influence use of AHD and disability pension. However, administrative area boundaries seem to play a minor role in understanding AHD use, but matters more for disability pension. People with younger age, financial difficulties, low self-rated health, and low trust in the health care system may have a higher probability of primary non-concordance with medication. However, the area of residence-as defined by administrative boundaries-seems to play a minor role for primary non-concordance. Also, individual low social participation seems to be associated with low adherence to antihypertensives, and this association may vary between different municipalities.
List of papers:
I. Johnell K, Merlo J, Lynch J, Blennow G (2004). "Neighbourhood social participation and womens use of anxiolytic-hypnotic drugs: a multilevel analysis." J Epidemiol Community Health 58(1): 59-64.
Fulltext (DOI)
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II. Johnell K, Mansson NO, Sundquist J, Melander A, Blennow G, Merlo J (2005). "Neighborhood social participation use of anxiolytic-hypnotic drugs and womens propensity for disability pension: a multilevel analysis." Scand J Public Health. [Accepted]
Fulltext (DOI)
Pubmed
View record in Web of Science®
III. Johnell K, Lindstrom M, Melander A, Sundquist J, Eriksson C, Merlo J (2005). "Anxiolytic-hypnotic drug use associated with trust, social participation, and the miniaturization of community: A multilevel analysis." [Accepted]
Fulltext (DOI)
Pubmed
View record in Web of Science®
IV. Johnell K, Lindstrom M, Sundquist J, Eriksson C, Merlo J (2005). "Individual characteristics, area social participation, and primary non-concordance with medication: a multilevel analysis." [Submitted]
Fulltext (DOI)
Pubmed
View record in Web of Science®
V. Johnell K, Rastam L, Lithman T, Sundquist J, Merlo J (2005). "Low adherence with antihypertensives in actual practice: the association with social participation--a multilevel analysis. " BMC Public Health 5(1): 17.
Fulltext (DOI)
Pubmed
View record in Web of Science®
I. Johnell K, Merlo J, Lynch J, Blennow G (2004). "Neighbourhood social participation and womens use of anxiolytic-hypnotic drugs: a multilevel analysis." J Epidemiol Community Health 58(1): 59-64.
Fulltext (DOI)
Pubmed
View record in Web of Science®
II. Johnell K, Mansson NO, Sundquist J, Melander A, Blennow G, Merlo J (2005). "Neighborhood social participation use of anxiolytic-hypnotic drugs and womens propensity for disability pension: a multilevel analysis." Scand J Public Health. [Accepted]
Fulltext (DOI)
Pubmed
View record in Web of Science®
III. Johnell K, Lindstrom M, Melander A, Sundquist J, Eriksson C, Merlo J (2005). "Anxiolytic-hypnotic drug use associated with trust, social participation, and the miniaturization of community: A multilevel analysis." [Accepted]
Fulltext (DOI)
Pubmed
View record in Web of Science®
IV. Johnell K, Lindstrom M, Sundquist J, Eriksson C, Merlo J (2005). "Individual characteristics, area social participation, and primary non-concordance with medication: a multilevel analysis." [Submitted]
Fulltext (DOI)
Pubmed
View record in Web of Science®
V. Johnell K, Rastam L, Lithman T, Sundquist J, Merlo J (2005). "Low adherence with antihypertensives in actual practice: the association with social participation--a multilevel analysis. " BMC Public Health 5(1): 17.
Fulltext (DOI)
Pubmed
View record in Web of Science®
Issue date: 2005-11-04
Rights:
Publication year: 2005
ISBN: 91-7140-444-9
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