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Background Aspects of use of potentially addictive drugs among disability pensioners in Norwaydliktd-a record-linkage study

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Aspects of use of potentially addictive drugs among disability pensioners in Norway

d li k t d - a record-linkage study

Ingeborg Hartz

Dep. of Health and Sports, Hedmark University College Dep. of Pharmacoepidemiolgy, Norwegian Institute of Public Health

The ongoing project is part of a larger project

“The epidemiology of prescription drugs- a record-linkage study in Norway”.

This project is funded by the Norwegian Research Council, led by senior researcher Aage Tverdal at the Department of Pharmacoepidemiology, Norwegian Institute of Public Health.

Background

Proportions of Norwegians on a disability pension doubled since the 1980ies (now 11% of the adult population)

Huge political interest in Norway:

• The Norwegian Government wants action to stimulate the working capacity in those disability pensioners who have the potential to work.

• overall aim of a research programme by the Resarch Council of Norway :y

“To promote more cohesive knowledge about causes of sickness absence, disability and exclusion from working life”

Information on factors that may contribute to the deterioration of people’s daily functioning, including the unfavourable use of potentially addictive drugs, may be useful in this context.

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Data sources:

”The epidemology of prescription drugs – a record-linkage study in Noway”

1) Norwegian health surveys (1972 2004) 1) Norwegian health surveys (1972-2004)

2) Norwegian prescription database (NorPD) (2004- )

3) Population cencus and register data from Statistics Norway (1970-2002) 4) The national person registry ) p g y

- country of birth, date of death and emigration.

• Questionnaires

i t f i d hi h lth d

Norwegian health surveys 1974-2004

a variety of sociodemographic, health and lifestyle variables including drug use questions

• Blood samples

cholesterol, glukose, etc

M di l i ti

• Medical examination

weight, height, BP, others

Advantage: Information on potential confounders to the

association of disability pension status and drug use

(3)

Norwegian Prescription Database (NorPD)

-Prescription data from the total population (4 6 million) inPrescription data from the total population (4.6 million) in Norway since 2004

-Information from all prescription drugs, reimbursed or not,

dispensed at pharmacies to individual patients living outside institutions.

-The identity of patients has been encrypted, but each record contains a unique person identifier,

which makes it possible to identify all prescriptions for individuals and to link data.

Statistics Norway

• data on various aspects of an individual’s socio-economic p position from nationwide administrative registers (dynamic data) and population censuses (every tenth year):

marital status, income, education, occupation, disability pension (with belonging ICD-code), native country, place of residence, spouse’s education and occupational status, family type...

• most characteristics – dynamic data, or information at several points in time

• possible to link together members of a family

(4)

Research questions highlighted so far

• Evaluation of DP as a predictor of incident and long-

t b di i (BZD)

term benzodiazepine (BZD) use

• Description of aspects of problematic use of BZDs among DPs;

– long-term use pattern in terms of continuation rates and escalation of dose over time

rates and escalation of dose over time – use of other potentially addictive drugs

• Description of prevalences of BZD use among DPs in the entire Norwegian population

Health surveys in the counties Østfold og Aust Agder 1985 89:

Design: incident and long-term use of benzodiazepines among disability pensioners (20 year span)

Health surveys in the counties Østfold og Aust-Agder 1985-89:

- 40-42 year olds

- Use of benzodiazepines at baseline (yes/no) - Disability pension at baseline (yes/no) - Confounding factors

l k

NorPD 2004-2006

Prescriptions on benzodiazepins, opioids and carisoprodol

Register‐linkage

(5)

Incident use of BZDs 20 years after

30

29,4

) BZD

Women 0

5 10 15 20

25 20,5

9,2 16,4

ode prevalence(%) (2004-06)

0 Men

Yes

No

Peri

Disability pension 1985-89 Hartz I, Tverdal Aa, Skurtveit S. Scand J Public Health 2009

Long-term use of BZDs: 20 years after

80 65,3

f -06)

Women 0

20 40 60 80

56,9

40,1 52,4

Period-prevalence o zodiazepines (2004-

0 Men

Yes

No

P benz

Disability pension 1985-89

Hartz I, Tverdal AA, Skurtveit S. Social Science & Medicine, resubmitted

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Characteristics of long-term BZD users (disability pensioners)

Retrieval of opioids:

Women: 72 %

Men: 51 %

Retrieval of opioids and carisoprodol:

Women: 20 %

Men: 15 %

Hartz I, Tveedal Aa, Skurtveit S. Social Science & Medicine, resubmitted

2001: Health surveys in Oslo Hedmark Oppland:

Design: incident and long-term use of benzodiazepines among disability pensioners (3-4 year span)

2001: Health surveys in Oslo, Hedmark, Oppland:

- 40+45, 60 year olds - non-users of BZDs

- Confounding factors (including mental health problems) - Disability pension at baseline (Statistic Norway)

l k

NorPD 2004-2007

Prescriptions on benzodiazepins (and opioids/carisoprodol)

Register‐linkage

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Drug use 3-4 years later among non-users of BZDs at baseline

40-45 years 60 years

Men Women Men Women

Disabilty pension (2001)

Disability pension (2001)

Disabilty pension (2001)

Disability pension (2001) Yes

(N=167) No (N=5735) p

Yes (N=268)

No (N=7059) p

Yes (N=483)

No (N=2557) p

Yes (N=674)

No (N=2577) p NorPD 2004

benzodiazepines 22 (13.2) 173 (3.0) * 53 (19.8) 384 (5.4) * 53 (11.0) 109 (4.3) * 121 (18.0) 214 (8.3) * z-hypnoticsyp 18 (10.8)( ) 243 (4.2) *( ) 55 (20.5)( ) 508 (7.2) *( ) 49 (10.1)( ) 184 (7.2) *( ) 138 (20.5) 346 (13.4) *( ) ( ) opioids 35 (21.0) 537 (9.4) * 71 (26.5) 712 (10.1) * 89 (18.4) 286 (11.2) * 164 (24.3) 320 (12.4) * carisoprodol 10 (6.0) 135 (2.4) * 30 (11.2) 276 (3.9) * 15 (3.1) 34 (1.3) * 41 (6.1) 63 (2.4) * NorPD 2004-07

benzodiazepines 9 (5.4) 59 (1.0) * 29 (10.8) 117 (1.7) * 29 (6.0) 32 (1.3) * 76 (11.3) 74 (2.9) * Norw Epidemiol, in press

Predictors of long-term BZD use

Variables (self-report) Adjusted OR (95% CI)

Socioeconomy

Older age 1.72 (1.37-2.15)

Female gender 1.81 (1.58-2.10) Disability pension 2.47 (1.90-3.20)

Unmarried 1.39 (1.13-1.72)

Lifestyle Smoking habits

ex-smoker 2.16 (1.68-2.78) daily smoker 1.33 (1.00-1.76) Physically inactive 1 41 (1 13 1 76)

Norw Epidemiol, in press Physically inactive 1.41 (1.13-1.76)

Alcohol consumption n.s.

Health

Poor perceived health 1.78 (1.41-2.43) Mental health problems 3.21 (2.58-4.98) Fibromyalgia/pain synd. n.s.

CVD history 1.54 (1.05-2.25)

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Long-term use (2004-07) among BZD users in 2004

100

30 40 50 60 70 80 90

ued retrieval of BZDs g users in 2004 (%)

+DP (40+45) - DP (40+45) +DP (60) - DP (60)

0 10 20 30

2004 2005 2006 2007

Continu amon DP (60)

Norw Epidemiol, in press

Median amount (DDDs ) of BZDs retrieved among long-term users (2004-2007)

250

100 150 200

ian DDD BZD among continuedusers

+DP (40+45)

‐DP (40+45) +DP (60)

DP (60) 0

50

2004 2005 2006 2007

Medi c ‐DP (60)

Norw Epidemiol, accepted

(9)

Benzodiazepine use in 18-61 year old Norwegians according to diability pension (DP) status (N =2,667,703)

) 40

10 15 20 25 30 35

prevalence of BZD (%

DP women DP men non-DP women

DP

0 5 10

1-year p non-DP men

Age (years) ICPE 2009 

Conclusion so far

• DP (situation) may have an independent effect on DP (situation) may have an independent effect on being prescribed benzodiazepines as well as becoming a long-term user

• High continuation rates, with a steadily increasing

annual amount of use among the long-term users

may reflect an unfavourable use pattern of potentially

may reflect an unfavourable use pattern of potentially

addictive drugs among disability pensioners, most

worrisome among the youngest.

(10)

Questions (feedback)

Register-based (NorPD) measure of problematic drug use pattern at a level considered to be incompatible with an adequate job performance (daily functioning)?

S i t l (R i t li k St ti ti N N PD)

Screening-tool (Register linkage Statistics Norway- NorPD):

-people at risk of falling out of the job-market and

-people on sickleave/DP with impaired rehabilitation potential

Attending

work force Sick leave Disability pension Statistics

Norway :

Drug use pattern

NorPD:

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