Abstract

• DOI: 10.1002/pds.3512
• Publication Date: 2015-10-13T21:12:51Z
• Authors: Cornelia Schneider; Patrick C. Souverein; Ulrik Hesse; Frank de Vries; Miguel Gil; Sven Schmiedl; Victoria Abbing-K...; Montserrat Miret; Marietta Rottenko...; Consuelo Huerta; Ana Ruigómez; Saga Johanson; Yolanda Alvarez; Dolores Montero; Raymond G. Schlie...; Olaf H. Klungel; Helga Gardarsdottir; Robert Reynolds; Francisco J. de A...; Luis A. García; Jim Slattery; Marieke L. De Bruin; Mark C.H. De Groot; Andrew Bate; Gema Requena
• Keywords: custodial care; gastroesophageal reflux; anticoagulant agent; study design; multiple linear regression analysis; data base; Germany; attributable risk; life cycle; hospital; anticoagulation; benzodiazepine derivative; physician; beta 2 adrenergic receptor stimulating agent; adult; simulation; nausea; congestive heart failure; risk factor; hip fracture; statistics; monotherapy; diabetes mellitus; safety; heart; 03 medical and health sciences; acne; peptic ulcer; standardization; vein thrombosis; cardiovascular agent; linear regression analysis; incidence; observational study; meta analysis; validity; cancer incidence; Denmark; latent period; regression analysis; hydroxymethylglutaryl coenzyme A reductase inhibitor; gender; hirsutism; Netherlands; risk; general practice; prostate; non insulin dependent diabetes mellitus; 1. No poverty; health; prostate cancer; health care; sample size; drug therapy; Europe; comorbidity; colon cancer; brain hemorrhage; bootstrapping; community; blindness; pharmacy; health care personnel; drug surveillance program; mood; adverse drug reaction; abnormal dreaming; smoking; breast cancer; stratification; pneumonia; outcome assessment; breast; thrombosis; drug use; therapy; prescription; model; new drug; questionnaire; aging; community acquired pneumonia; antidiabetic agent; urine volume; logistic regression analysis; brain ischemia; kidney failure; penicillin derivative; acute heart infarction; monitoring; fracture; heart atrium fibrillation; pharmacoepidemiology; diagnosis; proportional hazards model; binocular convergence; population; sample (statistics); bevacizumab; pharmacovigilance database; drug safety; developed country; hazard ratio; 0302 clinical medicine; prevention; cardiovascular disease; dipeptidyl carboxypeptidase inhibitor; population dynamics; antibiotic agent; antidepressant agent; analytic method; drug effect; public health; risk assessment; cohort analysis; clinical practice; 3. Good health; patient; femur fracture; 0305 other medical science; liver injury; drug exposure; hypertension; proton pump inhibitor; heart infarction; sulfonylurea; SDG 3 - Good Health and Well-being; registration; health care utilization; oral contraceptive agent; human; binomial distribution; propensity score; aldosterone; abdominal pain; asthma; thromboembolism; mortality; predictor variable; blood clotting factor 5 Leiden; calcium channel blocking agent; exposure; metformin; urinary tract infection; caliper; anticonvulsive agent; nitrofurantoin; case study; diabetic patient; renin angiotensin aldosterone system; electronic medical record; agonist; hemoglobin A1c; off label drug use; density; register; child; accuracy; consumer; statin (protein); vascular disease; methodology; eye; Monte Carlo method; hospital patient; varenicline; female; paraesthesia; LOCAL ANAESTHESIA; DENTISTRY; DRUG SAFETY; epidemiology; lung embolism; sampling; respiratory tract infection; prevalence; oral antidiabetic agent; population distribution; risk management; bacterial clearance; fatality; male; statistical analysis; university; anaphylaxis; cancer registry; follow up; artery thrombosis; nitrogen 15; urinary tract; bleeding; United Kingdom; warfarin; Medical Dictionary for Regulatory Activities; general hospital; society; confidence interval; Spain; general practitioner; instrumental variable analysis; transient ischemic attack; glycemic control; serotonin uptake inhibitor; scientist; neoplasm; chronic obstructive lung disease

Background: Socio-economic profile, demographic composition and access to care are important predictors of local health and health care use. How such predictors are associated with medication use at local level is unknown, but knowledge is essential to improve efficiency of preventive programs in risk areas. Objectives: We explored spatial patterns of type 2 diabetes mellitus (T2DM) medication use at local level and determined its association with local demographic, socio-economic and access to care variables. Methods: Using the University of Groningen pharmacy database IADB.nl, we estimated the five-year prevalence of T2DM medication use (2005-2009) in persons aged 45+ at four-digit postal code level for two Dutch areas, totaling 141 postal code areas. Statistics Netherlands supplied data on potential predictor variables. We used empirical Bayes smoothing to deal with the small sample problem. We composed variables for socio-economic profile, ageing and access to care and estimated first an overall multiple linear regression model followed by two models for each separate geographical area. Results: Socioeconomic profile, ageing and access to care were all significant predictors for T2DM medication use in the model incorporating both areas. In our first area (Groningen-Veendam) the smoothed prevalence of T2DM medication use ranged from 5.0% to 24.3%. Access to care and socio-economic profile were statistically significant predictors in this area. In the second area (Zwolle-Kampen-Noordoostpolder) smoothed prevalence ranged from 6.2% to 20.2%. Here, socioeconomic profile and ageing were significant predictors. The discriminative value of the model was higher in our first area (adjusted R-squared 0.41 compared to 0.25 in the second area). The unstandardized coefficients pertaining to the three composite predictors were similar in all three models, indicating that the relations with T2DM are roughly stable across space. Conclusions: Our results demonstrate the importance of socio-economic profile, ageing and access to care variables for explaining and projecting local health care use for type 2 diabetes mellitus.