Educational disparities in antipsychotic drug use among older people with and without dementia in Sweden.

OBJECTIVE: Antipsychotic drugs are commonly used to treat behavioural and psychological symptoms of dementia. The aim was to investigate if socioeconomic position was associated with antipsychotic drug treatment among older adults with and without dementia. METHOD: By record linkage of the Swedish Prescribed Drug Register, Patient Register, and Educational Register, we obtained information on antipsychotics, dementia status, and educational level for 641,566 persons aged 75-89 year old in Sweden 2005. RESULTS: Among persons diagnosed with dementia (n = 32 092), 21% used antipsychotics compared with 4% in the total sample (n = 641,566). Lower education was associated with a higher probability of antipsychotic use in the total sample (adjusted odds ratio [OR] low vs. high education: 1.56; 95% confidence interval [CI]: 1.48-1.64). In the dementia subpopulation, lower education was also associated with a higher likelihood of use of antipsychotics (adjusted OR(low vs. high) 1.43; 95% CI: 1.28-1.59). CONCLUSION: People with dementia were five times more likely to use antipsychotic drugs than the general population of older adults. Also, lower education was associated with a higher use of antipsychotics, both in the general population and in the subgroup of persons with dementia. This finding highlights the importance of investigating healthcare inequalities also among cognitively impaired older adults.

Educational level and use of osteoporosis drugs in elderly men and women: a Swedish nationwide register-based study.

SUMMARY: We examined educational disparities in use of osteoporosis drugs in a nationwide population of Swedes aged 75-89 years old. Individuals with high education were more likely to receive osteoporosis drug treatment than lower educated individuals, particularly among women. INTRODUCTION: This study aims to investigate whether educational level is associated with use of osteoporosis drugs in the general population of older men and women in Sweden, also after adjustment for fractures. METHODS: By record linkage of The Swedish Prescribed Drug Register, The Swedish Patient Register, and The Swedish Education Register, we obtained information on filling of prescriptions for osteoporosis drugs (bisphosphonates, calcium/vitamin D combinations, and selective estrogen receptor modulators) from July to October 2005, osteoporotic fractures from 1998 to 2004, and educational level for 645,429 people aged 75-89 years. Multivariate logistic regression analysis was used to investigate whether education was associated with use of osteoporosis drug therapy. RESULTS: Higher education was associated with use of osteoporosis drugs for both men [odds ratio (OR)(high education vs low), 1.27; 95% confidence interval (CI), 1.19-1.35] and women (OR(high education vs low), 1.57; 95% CI, 1.52-1.61), after adjustment for age, osteoporotic fractures, and comorbidity (i.e., number of other drugs). Among those who had sustained a fracture (n = 57,613), the educational differences in osteoporosis drug treatment were more pronounced in women than men. Further, women were more likely to receive osteoporosis drug treatment after osteoporotic fracture. CONCLUSION: Uptake of osteoporosis drug therapy seems to be unequally distributed in the elderly population, even in a country with presumably equal access to health care.

National surveillance of surgical-site infection through register-based analysis of antibiotic use after inguinal hernia repair.

BACKGROUND: Systematic surveillance of surgical-site infections is not standard. The aim of this retrospective cohort study was to evaluate the feasibility of using existing national health registers for surveillance of postoperative antibiotic treatment suggestive of surgical-site infection. METHODS: Data from national registers on hospital admissions and drug use were combined. Antibiotic purchases by 8856 patients subject to ambulatory care for inguinal hernia repair in Sweden during 2006 were ascertained during a 30-day interval immediately after surgery (postsurgical period) and in an 11-month control period (6 months before and 5 months after the postsurgical period). RESULTS: The incidence of first purchases of skin and soft tissue antibiotics was 245 per 8697 person-months in the first postoperative month and 180 per 52 612 person-months in the preoperative control period, representing a 1-month risk difference of 2.4 (95 per cent confidence interval (c.i.) 2.0 to 2.7) per cent. Hence, a 1-month risk of 2.4 per cent could be attributed tentatively to the surgery. The rate of episodes with antibiotics used mainly for skin and soft tissue infection was sevenfold higher in the first postoperative month than in the control period (rate ratio 7.01, 95 per cent c.i. 5.94 to 8.27). CONCLUSION: The risk of antibiotic treatment during the postsurgical period was of the same order of magnitude as infection rates reported in the Swedish Hernia Register and review studies. Surveillance of postoperative antibiotic use may be considered as a resource-saving surrogate marker for surgical-site infections or an indicator of inappropriate use.

Alcohol-related hospital utilization and mortality in different occupations in Sweden in 1991-1995.

OBJECTIVES: This study investigated alcohol-related hospital utilization and alcohol-related mortality according to occupation among men and women. Whether increased rates of alcoholism in some occupations result from circumstances within the occupation or from selective recruitment of persons prone to alcohol misuse was studied. METHODS: All Swedish residents were included who reported an occupation in the censuses of 1985 and 1990 and were born in 1926-1960. The relationships between occupation and hospitalization due to an alcoholism diagnosis in 1991-1994 and alcohol-related mortality in 1991-1995 were studied among stable workers (those who held the same occupation in both censuses) and newly recruited workers (those who held different occupations in the two censuses). Incidence and mortality rates were calculated for the different occupations using the person-year method, and standardized rate ratios were used as approximations of the relative risk of disease occurrence and mortality in different occupations as compared with the corresponding statistics of the entire study population. RESULTS: Several, mostly manual, occupations showed an increased relative risk of alcoholism diagnoses and alcohol-related mortality. Nonmanual occupations had low risks. Women in male-dominated high-risk occupations often showed increased relative risks. Stable and newly recruited employees in the same occupation showed very similar relative risks. CONCLUSIONS: New recruits into high-risk occupations often have increased relative risks of at least the same magnitude as persons employed long-term in the same occupations. This finding indicates that the increased relative risk of alcoholism found in some occupations can partly be explained by selective recruitment of heavy drinkers.

Maternal and paternal psychopathology increases risk of offspring ADHD equally.

BACKGROUND: Parental psychopathology may increase the risk of attention-deficit hyperactivity disorder (ADHD) in the offspring. The aim of this study was to analyze if/how gender influences the association between parental psychiatric/addictive disorders and ADHD medication in the offspring. METHODS: Register study in national birth cohorts of 1.1 million 6-19-year-olds. In this population, 7960 individuals with ADHD medication were identified in the Swedish Prescribed Drug Register during 2006. Data on parental psychiatric/addictive disorders and suicide death were obtained through linkages to national registers. Logistic regression was used for analyses with multiple adjustments for socio-economic, regional and demographic confounders. RESULTS: Parental diagnosis related to illicit drugs was associated with the highest odds ratios (ORs) of ADHD medication (OR: -3.5-4), followed by suicide attempt/death (OR: -3-3.5), alcohol (OR: -2.5-3), affective disorder (OR: -2.5) and psychosis (OR: -2-2.5). The ORs were of similar magnitudes for maternal and paternal psychopathology and did not vary by the gender of the offspring. Adjusting for social characteristics decreased the ORs substantially and in the same way regarding fathers' and mothers' possible influence on the risk of ADHD in children. CONCLUSIONS: Neither parental nor offspring gender seems to influence the link between parental addictive/psychiatric disorder and offspring ADHD.

Equal access to treatment? Population-based follow-up of drugs dispensed to patients after acute myocardial infarction in Sweden.

BACKGROUND AND OBJECTIVE: The establishment of national guidelines is one approach to creating equity in terms of access to care, and both internationally and in Sweden, guidelines have been developed for coronary heart disease. We have analysed drug treatment in Sweden according to national guidelines after acute myocardial infarction (AMI). The aim was to investigate whether there are differences between population groups according to sex, education, country of birth and diabetes. METHODS: Information was obtained from the Swedish Prescribed Drug Register on drugs dispensed between July and October 2005 for incident cases of AMI during the period 2003-2004 (n=28,168). Data on socio-economic and demographic conditions were included. Dispensed drugs after AMI were compared to the recommended drug treatment according to Swedish and European guidelines--acetylsalicylic acid (ASA), beta-blockers, lipid-lowering drugs and angiotensin-converting enzyme inhibitors (ACE inhibitors). RESULTS: We found that, in general, there were only small differences between the sexes and between educational groups. The greatest differences were found in comparisons between regions of birth. In particular, foreign-born patients resident in Sweden but originally from outside the EU25 countries used fewer drugs than Swedish-born patients. The OR (odds ratio) for ASA was 0.73 [95% confidence interval (CI) 0.63-0.85], for beta-blockers, 0.72 (0.63-0.83), for lipid-lowering drugs, 0.75 (0.65-0.86) and for ACE inhibitors, 0.76 (0.67-0.86). CONCLUSIONS: In general, we found only slight differences--or none at all--between population groups in terms of drug treatment after AMI. Only among immigrants from outside the EU25 countries was there a tendency towards a lesser use of the recommended drugs according to the national guidelines.

Socio-demographic risk factors for home-type injuries in Swedish infants and toddlers.

UNLABELLED: In this paper we use data from Swedish national registers to study socio-demographic patterns of hospital admissions as a result of injuries sustained at home (poisoning, falls, scalding and ingestion/intrusion of foreign objects) in children 0-3 y. The study population comprised 546 336 children born in Sweden during the period 1987-91. The different injury mechanisms peaked at different ages: ingestion of foreign objects at 10-12 mo, scald injuries at 13-15 mo, non-drug poisoning at 16-18 mo and drug poisoning at 24-30 mo. In a multivariate analysis it was demonstrated that children of young mothers (<24 y) were more likely to have been admitted to hospital because of fall injuries and poisonings, while children with more than two siblings had a slightly increased risk for all injuries. Children of mothers born in a non-western country were more likely to have been admitted to hospital because of scald injuries; odds ratio (OR) 1.7 (95% CI: 1.4-2.1), while they were less likely to have been admitted because of fall injuries; OR 0.8 (0.7-0.8) and non-drug poisoning; OR 0.5 (0.4-0.6). Children in families who received social welfare benefits were more likely to have been admitted to hospital because of fall injuries; OR 1.3 (1.2-1.4), drug poisoning; OR 1.8 (1.7-2.0), non-drug poisoning; OR 1.4 (1.3-15) and scald injuries; OR 1.1 (1.1-1.5), while injuries with ingestion/intrusion of foreign objects tended to vary little with socio-economic indicators. CONCLUSION: Infants and toddlers in families with young mothers and in families on social welfare are at particular risk for home injuries in Sweden. The knowledge that the risk of poisoning, scalding and ingestion of foreign objects is related to specific ages can be used in timing of parent counselling.

Mortality among lone mothers in Sweden: a population study.

BACKGROUND: An increasing number of lone mothers are experiencing financial and health disadvantages. Our aim was to assess mortality among lone mothers compared with mothers with partners. METHODS: In this population-based study, overall and cause-specific mortality, between 1991 and 1995, was estimated for 90,111 lone mothers and 622,368 mothers with partners from data collected in the Swedish Population and Housing Census 1990. We estimated relative risks by Poisson regression, adjusted for socioeconomic status, and, to handle health-selection effects, we adjusted for previous inpatient history from 1987 to 1990. FINDINGS: Lone mothers showed an almost 70% higher premature risk of death than mothers with partners. The excess risk remained significantly increased (relative risk 1.2 [95% CI 1.1-1.4]) after adjustments for socioeconomic status and previous severe somatic and psychiatric inpatient history. Increased mortality was especially pronounced for suicides (2.2 [1.5-3.1]), violence (3.0 [0.9-10.6]), and alcohol-related mortality (2.4 [1.4-4.1]) among mothers who were without a partner in 1985 and in 1990. INTERPRETATION: The increase of lone mothers in society shows financial, social, and health disadvantages. Nevertheless, the increased mortality risk of lone mothers seems to be partly independent of socioeconomic status and health selection into lone motherhood. For long-term lone mothers the risks may be underestimated when adjusting for selection bias by taking hospital discharge history into account, since these events may be part of the consequences of the stress of lone motherhood.

Avoidable mortality among psychiatric patients.

Avoidable mortality is a selection of causes of death considered to be amenable to health care and thereby used as an indicator of the quality of health care. In this study avoidable mortality for more than 30,000 psychiatric patients discharged from any hospital of Stockholm County between 1981 and 1985 has been followed up in the Cause of Death Register for the period 1986-1990. Standardised rate ratios were calculated for different groups of psychiatric disorders compared to the general population of Stockholm County for indicators of avoidable mortality, suicide, other mortality ("unavoidable") and causes possibly related to treatment with psychotrophic drugs. As expected, the psychiatric patients had the most pronounced elevated risk for suicide. i.e. 6- to 24-fold compared to the general population, and noticeably more elevated for women. It is also noteworthy that the relative mortality risks for diagnoses amenable to medical interventions and potential side-effects of psychotrophic drugs are higher than for other causes of death ("unavoidable"). The relative risks for avoidable mortality were 4.7 for men and 3.8 for women and for diagnoses possibly related to side-effects of psychotrophic drugs, 7.2. The relative risks for "unavoidable" mortality were 3.4 for men and 3.2 for women. The excess avoidable mortality rates for psychiatric patients and the elevated suicide risk, especially for female patients, are warning signals of shortcomings in psychiatric care that warrants further investigation.

Social adversity, migration and hospital admissions for childhood asthma in Sweden.

The number of children admitted to hospitals because of asthma has been reported to decrease in Sweden in recent decades despite an increasing prevalence of childhood asthma. This decrease has been explained by improved maintenance therapy of children with severe asthma. In this study we used data on hospital admissions for asthma from the Swedish National Patient Discharge Registers in Stockholm, Malmö and Gothenburg 1990-1994 to identify social and ethnic characteristics of children 2-18-y-old in need of improvement in disease management. Children in families on social welfare (adjusted odds ratios (OR): 1.3 and 1.5) and children in single-parent households (adjusted OR: 1.3 and 1.4) were more often admitted to hospital because of asthma at least once during a calendar year in the 2-6- and 7-18-y-old groups. Children in families on social welfare had a particularly high risk of being admitted more than once during a calendar year (adjusted OR: 1.6 in the younger age group and 2.9 in the older group). Exposure to smoking during pregnancy was more common in socially disadvantaged families and increased the risk of hospital admission in children below 3 y of age. Children born outside Western Europe, the USA and Australia were less commonly admitted to hospital because of asthma than other children in the population (adjusted OR: 0.1-0.5). Swedish-born children with mothers who were born in Eastern and Southern Europe were also at lower risk for admission to hospital with a diagnosis of asthma (adjusted OR: 0.2-0.6). This probably indicates a lower prevalence of asthma in these ethnic groups. Further studies are needed to identify factors that can explain these ethnic differences in childhood asthma.