Comparison of health insurance claims and patient interviews in assessing drug use: data from the Three-City (3C) Study.

PURPOSE: Precise determination of drug exposure is fundamental in pharmacoepidemiology. Drug exposure is often presumed from health insurance claims but this may not correspond exactly to what subjects actually take. This study was designed to investigate French reimbursement databases in assessing drug use. METHODS: Between 1999 and 2001, 9294 subjects were included in the Three-City (3C) Study, a French cohort studying the relationship between vascular risk factors and dementia. Of these, 4112 subjects had data available from both clinical interviews and the reimbursement databases of the French national health insurance system. Agreement between drugs reported as used at interview and drugs reimbursed during the previous 30 or 60 days was measured with kappa coefficients. Using calculations of sensitivity (Se), specificity (Sp), positive predictive values (PPVs) and negative predictive values (NPVs), the validity of reimbursement data for the 30 or 60 days preceding the interview was investigated taking drugs reported at interview as the 'gold standard'. RESULTS: Declared drug use at interview was less well predicted by 30-day than by 60-day reimbursement data. Agreement between reimbursement data and interviews as well as validity of reimbursement data with reference to interviews were substantial for drugs used in cardiovascular diseases, diabetes, rheumatic disorders or neuropsychiatric conditions and were poor for laxatives, vitamins, vasculoprotectives, first and second line analgesics, anti-infective products or dermatologicals. CONCLUSIONS: Reimbursement data with an appropriate time frame and interviews estimate exposure to chronically used drugs similarly. Self-medication was better described with interviews whereas reimbursement data seem more useful for drugs used topically or intermittently.

Evolution of prevalence of depressive symptoms and antidepressant use between 1988 and 1999 in a large sample of older French people: Results from the personnes agées quid study.

OBJECTIVES: To describe the evolution of prevalence of depressive symptoms and antidepressant use between 1988 and 1999 in a large representative sample of older community-dwelling French people. DESIGN: Prospective cohort designed in 1988/89 to study cerebral and functional aging. SETTING: Urban and rural communities in southwestern France. PARTICIPANTS: Three thousand six hundred thirty-seven adults aged 65 and older living in noninstitutional settings at baseline. MEASUREMENTS: Participants were interviewed 3, 5, 8, and 10 years after the initial data collection. Depressive symptomatology was evaluated using a French version of the Center for Epidemiological Studies Depression Scale. Longitudinal analysis of the prevalence of depressive symptomatology was performed using a logistic mixed model adjusted for antidepressant use, sex, age, education level, living conditions, psychiatric antecedents, drug consumption, and diagnosis of dementia. RESULTS: Over the 10 years of follow-up, the prevalence of depressive symptomatology decreased from 13.8% to 8.3%. This decrease was statistically significant even after adjustment (odds ratio = 0.88 per increased year, 95% confidence interval = 0.85-0.90) and was more pronounced in subjects having reported previous depression at baseline. During the same period, antidepressant use rose from 5.2% to 11.9%, mainly due to increased use of selective serotonin reuptake inhibitors. Furthermore, the proportion of subjects who had depressive symptoms and did not use antidepressants decreased from 11.8% to 6.2%. CONCLUSION: This study suggests better management of late-life depression in the last decade and illustrates the heterogeneity of depression disorder in late life.

Incidence and characteristics of benzodiazepine use in an elderly cohort: the EVA study.

OBJECTIVE: The aim of this study was to estimate the incidence of benzodiazepine use in an elderly population and to identify associated factors. METHODS: Data were collected in four self-report questionnaires on the use of sedatives and sleeping drugs. These questionnaires were sent every 6 months, over a 2-year period, to the 1272 elderly subjects interviewed at the first follow-up examination of the EVA (Epidemiology of Vascular Aging) Study. RESULTS: The incidence rate of benzodiazepine use was 4.7 per 1000 person-months (95% confidence interval [CI] 3.6, 5.8). In multivariable analyses (logistic regression model), incident use of benzodiazepines was significantly associated with depressive or anxious symptoms (odds ratio [OR] = 3.3; 95% CI 1.7, 6.4), high use of non-psychotropic drugs (> or = 3; OR = 1.8; 95% CI 1.1, 3.1) and female gender (OR = 1.9; 95% CI 1.1, 3.3). CONCLUSION: Simultaneous use of benzodiazepines and other medications should be carefully assessed in elderly patients, considering the risk of adverse drug reactions and drug-drug interactions.

Use of psychotropic drugs in 0 to 5 years old children in Aquitaine (France): prevalence and associated factors.

PURPOSE: To describe the use of psychotropic drugs in children aged 0-5 years, in the Aquitaine region of South-west France and identify associated socio-demographic, familial and medical factors. METHODS: Data used in this study come from the regional drug claims database of the National Health Insurance System of Aquitaine and from postal self-questionnaires sent to parents and prescribing physicians. RESULTS: In Aquitaine, psychotropic drugs were redeemed at least once in 2002 for 3.2% of young children. Hydroxyzine, niaprazide or diazepam were claimed at least once by 2.7% of children registered in the database. Prescribers were mostly general practitioners (76.7%) and pediatricians (20.1%). Psychotropic claims were more frequent in children having the highest number of medical consultations in 2002 (more than 7: odds ratio (OR) = 1.5 [95% confidence interval (CI): 1.3-1.7]) or of drug deliveries (7-15 deliveries: OR = 1.8 [95%CI: 1.6-2.1]; more than 15 deliveries: OR = 3.2 [95%CI: 2.7-3.9]). Psychotropic claim frequency increased with age. No association of psychotropic use with parental psychotropic use, socio-professional category and familial situation was found. CONCLUSIONS: Psychotropic delivery prevalence in Aquitaine in young children was below 5% in 2002. It notably concerned drugs of which the use is not devoid of toxicity because of anticholinergic properties.

Drugs with anticholinergic properties and cognitive performance in the elderly: results from the PAQUID Study.

OBJECTIVES: To measure the association between the use of drugs with anticholinergic properties and cognitive performance in an elderly population, the PAQUID cohort. METHODS: The sample studied was composed of 1780 subjects aged 70 and older, living at home in South western France. Data on socio-demographic characteristics, medical history and drug use were collected using a standardized questionnaire. Cognitive performance was assessed using the following neuropsychological tests: the Mini-Mental State Examination (MMSE) which evaluates global cognitive functioning, the Benton Visual Retention Test (BVRT) which assesses immediate visual memory, and the Isaacs' Set Test (IST) which assesses verbal fluency. For each test, scores were dichotomized between low performance and normal to high performance using the score at the 10th percentile of the study sample as the cut-off point, according to age, gender and educational level. The association between the use of drugs with anticholinergic properties and cognitive performance was examined using logistic regression models, adjusting for several potential confounding factors. RESULTS: About 13.7% of the subjects used at least one drug with anticholinergic properties. In multivariate analyses, the use of these drugs was significantly associated with low performance in the BVRT [odds ratio (OR) = 1.6; 95% confidence interval (CI) 1.1, 2.3] and in the IST (OR = 1.9; 95% CI 1.3, 2.8). The association found with low performance in the MMSE (OR = 1.4; 95% CI 1.0, 2.1) was barely statistically significant. CONCLUSION: These findings suggest that the use of drugs with anticholinergic properties is associated with low cognitive performance among community-dwelling elderly people.

Frequency and risk factors of potentially inappropriate medication use in a community-dwelling elderly population: results from the 3C Study.

OBJECTIVE: To estimate the frequency of potentially inappropriate medication use among community-dwelling elderly subjects and to identify socio-demographic factors associated with this use. METHODS: Data were collected in the Three-City Study, a French longitudinal study on vascular factors and cognitive decline. The study population was composed of 9,294 subjects aged 65 years and older, living in the community. Inappropriate medication use was assessed using a list derived from the Beers criteria by a panel of French experts. RESULTS: Nearly 40% of the participants used at least one potentially inappropriate medication: 23.4% used cerebral vasodilators, 9.2% long-acting benzodiazepines and 6.4% drugs with anticholinergic properties. Excluding cerebral vasodilators from the list, the frequency of potentially inappropriate medication use was 21.7%. This use was significantly more frequent among women, older subjects and poorly educated subjects. Adjusted analyses showed that these associations could not be explained by a confounding effect of medical factors. Compared with 13.0% of men with a high educational level, 27.9% of women with a low educational level used at least one potentially inappropriate medication (odds ratio=2.0; 95% confidence interval: 1.7-2.3). CONCLUSION: This study is the first attempt to evaluate the frequency of potentially inappropriate medication use in the elderly French population. Female gender and low socio-economic characteristics reduced the chances of receiving optimal pharmacotherapy. The proportion of elderly subjects receiving potentially inappropriate medication was higher than shown in previous studies. This is mainly explained by differences in the use of cerebral vasodilators.