Samband aldurs og sýklalyfjanotkunar : sýklalyfjanotkun á Suðurnesjum og í Hafnarfirði 1986 borin saman við Svíþjóð

Jóhann Ág Sigurðsson, Ágúst Oddsson, Guðjón Magnússon, Halldór Jónsson, Þorsteinn Blöndal

Research output: Contribution to journalArticlepeer-review

Abstract

Effect of age distribution on the use of antimicrobials in Iceland. Earlier investigations by the Nordic Council on Medicines have demonstrated that the consumption of antimicrobial agents in Iceland is greater than in the other Nordic countries. One of many hypotheses put forward to explain this discrepancy is that this may reflect the difference in age distribution. The number of inhabitants in Iceland the year 1986 under age 15 was 28.6% compared to 18,2% in Sweden and since bacterial infections are more frequent in the younger age groups than in adults, it has been postulated that this may explain the difference in antimicrobial use. The aim of this study was to test this hypothesis. A prescription study was performed from April lst-15th, 1986 in Sudurnes and Hafnarfjördur districts. The age distribution of the total population of 27576 is representative of the Icelandic population as a whole. The frequency of antimicrobial prescriptions and amount measured in defined daily doses (DDD), was analysed and related to age groups and sex. In former comparisons between populations the unit DDD/1000 inhabitants/day has been used. As the denominator in this definition is the whole population, different age distributions introduce a confounding factor. In this study correction is made for possible age discrepancy by indirect standardization using similar statistical methods as have been described for »Standardized Mortality Ratio« (SMR). Prescribed amount of drugs to the study population was compared to that in Sweden and the following formula was designed for calculating the expected antimicrobial consumption in the study area, had the age distribution been the same as in Sweden: (consumption in group x percentage of §rouPs inhabitants in the group). The prescription rate was shown to be 85.5 prescriptions/1000 inhabitans/month. Antimicrobials were significantly more often prescribed to women compared to men (p<0.001). Both absolute and relative figures showed the highest prescription rate to the age group of 0-4 years. When examining the amount measured in DDD in relation to agegroups, it is evident that the the antimicrobial prescribing to children does not explain the observed difference in antimicrobial usage between the two countries. The total amount of antimicrobials prescribed was 23.5 DDD/1000 inhabitants/day. If age is corrected to the Swedish population the rate increases to 26.5 DDD/1000/inhabitants/day. These results do not support the study hypothesis. The antimicrobial consumption in Sweden 1986 was 15.1 DDD/1000 inhabitants/day. This figure can then be compared with the age correlated figure of our study (26,5 DDD/1000 inhabitants/day), demonstrating a »standardized DDD ratio« of 0.57 (p<0.05). These results emphasize the importance of using indirect standardization especially when comparing consumption of certain types of drugs between populations. It has been postulated that the age distribution of the Icelandicpopulation changes in the future and becomes similar to the distribution of the Swedish population today. Therefore indirectly standardized figure of 26.5 DDD/1000 inhabitants/day can be explained as expected antimicrobial consumption in Sudurnes and Hafnarfjordur districts. This means that if the doctors prescrip.tion habits will be unchanged, we can expect increased antimicrobial consumption in the future.
Eins og fram hefur komið hjá Norrænu lyfjanefndinni nota Íslendingar mun meira af sýklalyfjum en hinar Norðurlandaþjóðirnar (1). Skýringanna virðist hvorki að leita í mismun á algengi sýkinga né vinnuálagi lækna vegna smitsjúkdóma (2), sem þó getur verið nokkuð mismunandi milli landsvæða. Sýklalyfjum er oft beitt við vissar tegundir öndunarfærasýkinga, en samkvæmt erlendum rannsóknum eru þessir smitsjúkdómar algengastir á aldrinum 0-14 ára (3, 4). Ef athuguð er hlutfallsleg aldursdreifing íbúa á Norðurlöndum, kemur í ljós verulegur munur á milli þjóðanna (5, 6). Hlutfall barna og unglinga hér á landi af heildaríbúafjölda er mun hærra en á hinum Norðurlöndunum. Þessi munur er einkum áberandi á milli Íslands og Svíþjóðar þar sem 28,6% Íslendinga og 18,2% Svía eru yngri en 15 ára (mynd 1). Því hefur sú tilgáta verið nefnd (7), að mikil sýklalyfjaneysla Íslendinga skýrist að nokkru leyti af aldursdreifingu þjóðarinnar, þar eð sýkingar, svo sem eymabólga og öndunarfærasýkingar eru mjög algengar í yngri aldursfiokkunum, sem fyrr segir. Til þess að mismunur komi fram í magntölum þarf tíðni ávísana á sýklalyf til barna og unglinga að vera töluvert meiri en til fullorðinna, vegna þess að þau fá að jafnaði minni skammta. Tilgangur þessarar greinar var að athuga ofannefnda tilgátu með því að rannsaka: tíðni ávísana á sýklalyf eftir aldri og kyni sjúklinga, skiptingu skilgreindra dagsskammta (DDD) eftir aldri og kyni, hvernig notkun sýklalyfja hefði orðið ef aldursdreifing Suðurnesjabúa og Hafnfirðinga væri sú sama og í Svíþjóð.
Original languageIcelandic
JournalLæknablaðið
Publication statusPublished - 15 Dec 1989

Other keywords

  • Sýklalyf
  • Lyfjanotkun
  • Ísland
  • Svíþjóð
  • Anti-Bacterial Agents
  • Iceland
  • Sweden
  • Drug Utilization

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