Dag Isacson

Epidemiology, co‐morbidity, and impact on health‐related quality of life of self‐reported headache and musculoskeletal pain—a gender perspective

Background. Headache and musculo‐skeletal pain are major public health problems. Substantial proportions of the general population report that they experience pain problems that affect their work, daily living and social life. Epidemiological studies have consistently shown that the prevalence of most pain conditions is higher in women than in men.

Hypertension and health-related quality of life: An epidemiological study in Sweden.

The aim of this study was to describe the relationship between hypertension and health-related quality of life (HRQL) in a Swedish general population using the 36-item short form questionnaire (SF-36). The study is based on a postal questionnaire that was sent to a random sample of 8000 inhabitants aged 20-84 years (response rate 68%) in Uppsala County, Sweden, in 1995. The results showed that those with hypertension scored lower in the linear regression analyses in most of the eight domains of the SF-36 than those without hypertension after controlling for age, sex, sociodemographic factors, and comorbidity. Diabetes and angina pectoris were related to lower scores in most of the domains of the SF-36. Previous myocardial infarction was associated with lower general health and vitality. Those with a previous stroke had lower scores in physical functioning, general health, vitality, and social functioning. The findings suggest that hypertensives represent a vulnerable population that merits special attention from health care providers and systems. This is especially important given that low HRQL can be a risk factor for subsequent cardiovascular events or complications.

The Relationship between Health-state Utilities and the SF-12 in a General Population:

It would be a major advance if quality-of-life instruments could be translated into health- state utilities. The aim with this study was to investigate the relationship between the SF-12 and health-state utilities, based on responses to a postal questionnaire sent to a random sample of 8,000 inhabitants, aged 20-84 years, in the general population. The questionnaire included the SF-12, a rating-scale (RS) question, and a time-tradeoff (TTO) question; the response rate was 68%. Age, gender, and the 12 items of the SF- 12 were used as explanatory variables in a linear regression analysis of the health- state utilities. The regression models explained about 50% of the variance in the RS answers and about 25% of the variance in the TTO answers. Most of the SF-12 items were related to the health-state utilities in the expected ways, with especially strong results for the RS method. The results suggest that the SF-12 can be converted to health-state utilities, but that further work is needed to reliably estimate the conversion function. Key words: health status; SF-12; rating scale; time-tradeoff; health-related quality of life; health-state utilities; population study. (Med Decis Making 1999;19:128- 140)

Long-term benzodiazepine use: Factors of importance and the development of individual use patterns over time—A 13-year follow-up in a Swedish community

Using data from a research registry of prescriptions, we studied benzodiazepine use in a Swedish community with a general population of 20,000. A sample of benzodiazepine users in 1976 (n = 561) aged 15 years and older was identified and followed for 13 years with respect to continued benzodiazepine use. A strong tendency towards continued use was observed. A majority of the cohort, 65%, continued benzodiazepine use during the first follow-up year, and 55% used benzodiazepines during the second. One-quarter of the sample continued using benzodiazepines during all years of the 13-year follow-up. One of the aims was to analyze factors predicting long-term benzodiazepine use. The multivariate analyses, using Cox regression analysis, showed that frequent/daily use and age were important factors. Gender and type of generic benzodiazepine were of little importance. Further, patients who were prescribed benzodiazepines by doctors working at hospitals and those who obtained prescriptions from both primary and hospital care physicians continued to use benzodiazepines to a greater extent than those patients who obtained prescriptions only from private practitioners or health center doctors. Another aim was to analyze to what extent long-term users were using these drugs on an infrequent, occasional, frequent, or daily basis and to what extent this use changed over time. Of those with benzodiazepine use persisting for eight or more years (n = 119), between one-half and two-thirds were frequent or daily users in each of those years. Because repeated measurements for the same individuals were analyzed, the generalized estimating equations (GEE) method was chosen for the multivariate analyses. Among long-term users, age, a combined use of tranquilizers and hypnotics, and prescriptions from more than one of the prescriber categories studied (i.e. doctors working at health centers, hospital doctors, and private doctors) were significant factors in frequent or daily use. The study also showed that frequent/daily use increased among the identified long-term users during the time period analyzed.

Doping among high school students in Uppsala, Sweden: A presentation of the attitudes, distribution, side effects, and extent of use

The aim of this study was to determine the extent of doping drug use among adolescents in Uppsala, Sweden, and to analyse the main reasons for the use. An anonymous multiple-choice questionnaire was distributed among pupils in the first and the third grades at high school; 2,742 pupils participated in the study. The results showed that 2.7% of the male and 0.4% of the female adolescents had used doping drugs at some time in their life. However, knowledge of how to get doping drugs far exceeded use. The main reasons for using doping drugs were to improve appearance and to enhance performance in sports. Some boys self-reported side effects of AAS. Despite the still predominantly negative attitude toward doping prevention programs have to be taken.

Long-term use of benzodiazepines in a Swedish community: An eight-year follow-up in a Swedish community: An eight-year follow-up

Abstract Use of benzodiazepines in a Swedish community with a general population of about 20,000 was studied using data from a research registry on prescriptions. A cohort of all benzodiazepine users in 1976, aged 15–84 years, was identified and followed for 8 years with respect to continued benzodiazepine use. A strong tendency towards continuous use was observed. Nearly 70% of the cohort continued use of benzodiazepines during the first follow-up year, 56% used benzodiazepines during the second year as well. One third continued using benzodiazepines during all 8 years of follow-up. Heavy use, previous use of benzodiazepines and age were of great importance for predicting long-term use while sex and type of benzodiazepine were of minor importance. However, after 3 or 4 years of use the pattern was very much the same in all subgroups, about 90% of users continued irrespective of user characteristics.

Epidemiology of analgesic use: a gender perspective.

Background and objective: Women consistently report significantly more frequent analgesic use in epidemiological studies. The aim of this study was to analyse the influence of medical and non-medical factors on the difference in use of analgesics between women and men from a population perspective. Methods: Cross-sectional survey. Postal questionnaires were sent to a random sample of the general population in the county of Uppland, Sweden (5404 answered the questionnaire, response rate: 68%). Results: 34.8% of the women and 21.4% of the men had used analgesics during the two week recall period (Odds Ratio = 1.96). Social structure, social status, marital status, educational level, economic situation, lifestyle, attitudes toward drugs, medication knowledge and self-care orientation were of minor importance for the difference in use between women and men. Difference in prevalence of various types of pain and ache and the degree of pain experienced were the most influential factors affecting the difference in use. However, when all factors were analysed there remained a substantial difference in use between women and men (OR = 1.39, CI (95%) 1.20 to 1.60). Conclusions: In the population, women use analgesics much more frequently than men. Consequently women may be at greater risk for adverse effects and dependency. Some of the gender difference is explained by the greater frequency of pain conditions among women, but a significant difference in use still remains to be explained.

The demand for health: results from new measures of health capital

Abstract This paper estimates a “Grossman” model of demand for health. We measure health status on a 0 (dead) to 1 (full health) cardinal scale by the rating scale method and the time trade-off method. We also use a categorical measure of overall health status commonly used in quality of life measurements. To estimate the demand for health equations, the Tobit technique is used for the rating scale and time trade-off health measure. The ordered probit model is used for the categorical health measure. The demand for health decreases with the price of medical care, age, overweight, smoking and living alone, and increases with income, education and the level of sporting activities.

Effects of user charges on the use of prescription medicines in different socio-economic groups

This study examined the sensitivity towards increases in user charges for different types of drugs and among different socio-economic groups. It was based on responses by 2008 consumers of prescription drugs to a self-administered postal questionnaire sent to a random sample of 8000 inhabitants in Uppsala County in Sweden. The questionnaire included a question about whether the respondents would use fewer prescription drugs if the user charges increased by a specific amount. The increase in user charges was varied between 9 and 150% in five different subsamples. Logistic regression analysis was used to estimate the probability that a respondent would reduce consumption of prescription drugs as a function of the size of the user charges increase, socio-economic characteristics and the type of drug used. Results showed that the price sensitivity decreased with increasing age, income, education and self-rated health status. Price sensitivity was highest for antitussives and lowest for climacteric drugs. If the user charges doubled, 40% of antitussives users would reduce their consumption whereas only 11% of climacteric drugs users would reduce their consumption. It is concluded that sensitivity to increases in user charges varied greatly between different types of drugs and between socio-economic groups. The young, those with poor health status, low education and low income are most likely to decrease consumption of prescription drugs when user charges increase.

Prescription Drug Use among Ambulatory Elderly in a Swedish Municipality

OBJECTIVE: To analyze prescription drug use among the elderly in a Swedish municipality. METHODS: The municipality of Tierp, located in mideastern Sweden, is a well-defined geographic area that includes both rural areas and a few small, industrial towns. All people aged 65 years and older (n=4769) as of 1986 in a total population of 21000 inhabitants were included in the study. Their drug use was studied by registering all prescriptions filled by the pharmacies in the area. RESULTS: Most of the elderly (>70 percent) obtained at least one prescription during the year studied. Drug use was more common among women than men. However, the difference between men and women was much smaller among those aged 85 years or more. The drugs most commonly prescribed were cardiovascular, psychotropic, and analgesic agents. Furthermore, the study showed that simultaneous use of several drugs was quite common. One-fourth of all people aged 65 years and older used drugs from at least four different pharmacologic groups. CONCLUSIONS: Our results revealed widespread use of prescription drugs among the elderly. An important finding was extensive drug use among men aged 85 years or more. This age group is increasing and there is need for further studies of its medication use.