Contextual and individual aspects of use of medication : multilevel studies on anxiolytic-hypnotic drug use, social context, adherence to medication, and disability pension

Field: Social Sciences (Social Sciences)

Aims: Study I. To estimate an influence of the neighbourhood on women's AHD \n(anxiolytichypnotic drug) use, and to analyze whether neighborhood social \nparticipation is associated with use of these medicines. Study II. To \ninvestigate whether women living in the same neighborhood have similar \npropensity for disability pension that relates to neighborhood social \nparticipation, and whether there is an association between AHD use and \ndisability pension in women that is modified by the neighborhood context. \nStudy III. To investigate whether the contextual component of the \nminiaturization of community concept is associated with AHD use, and \nwhether people living in the same area share a similar probability of AHD \nuse. Study IV. To investigate whether age, educational level, financial \nstrain, self-rated health, social participation, and trust in the health \ncare system are associated with primary nonconcordance with medication \n(i.e., non-redemption of prescription), and whether people living in the \nsame area have similar probability of primary nonconcordance with \nmedication that relates to area social participation. Study V. To examine \nwhether individual low social participation is associated with low \nadherence to antihypertensive medication, and whether this possible \nassociation is modified by the municipality of residence. \n \n \n \nMethods: We used multilevel logistic regression analysis with individuals \nat the first level and areas (neighborhoods) at the second level. Both \nfixed effects (measures of association) and random effects (measures of \nvariation) were investigated. In Study I (n=1 5 456) and Study II (n=12 \n156), we used data from The Malmö Diet and Cancer Study, Sweden. The \nwomen, aged 45-73 years, who participated in the cohort lived in Malmö \nduring the baseline period 1991-1996. In Study III (n=20 319 women and 17 \n850 men) and Study IV (n=9 070 women and 6 795 men), we used data from \nthe Life & Health year 2000 survey, a postal questionnaire sent out to a \nrandom sample aged 1879 years in central Sweden. In Study V (n = 1288), \nwe used data from The Health Survey in Scania 2000, a postal \nquestionnaire sent out to a random sample of people aged 18-80 years in \nScania, Sweden. \n \n \n \nResults: Study I. A small proportion of the differences in AHD use were \nexplained by the neighborhood level. A low level of social participation \nin the neighborhood was associated with higher probability of AHD use, \nafter adjustment for socioeconomic status. Study II. Both AHD use and \nneighborhood social participation were associated with higher propensity \nfor disability pension, after adjustment for individual factors. The \nassociation between AHD use and disability pension was not modified by \nthe neighborhood context. There was variation in disability pension \nbetween the neighborhoods. Study III. The contextual component of the \nminiaturization of community concept was associated with AHD use, after \nadjustment for socioeconomic status. The variation in AHD use between the \nareas was fairly small. Study IV. Younger age, financial strain, low \nself-rated health, and low trust in the health care system were \nassociated with primary non-concordance with medication. Area social \nparticipation was, however, not related, and the variation in primary \nnonconcordance between the areas was small. Study V. Individual low \nsocial participation was associated with low adherence to \nantihypertensives, independently of educational level. The association \nbetween low social participation and low adherence to antihypertensives \nvaried among municipalities in Scania. \n \n \n \nConclusions: In the Swedish setting, the social context seems to influence \nuse of AHD and disability pension. However, administrative area \nboundaries seem to play a minor role in understanding AHD use, but \nmatters more for disability pension. People with younger age, financial \ndifficulties, low self-rated health, and low trust in the health care \nsystem may have a higher probability of primary non-concordance with \nmedication. However, the area of residence-as defined by administrative \nboundaries-seems to play a minor role for primary non-concordance. Also, \nindividual low social participation seems to be associated with low \nadherence to antihypertensives, and this association may vary between \ndifferent municipalities.