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- Gerdtham, Ulf, et al.
(författare)
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Värdet av nya läkemedel: en förstudie
- 2011
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Konferensbidrag (övrigt vetenskapligt/konstnärligt)abstract
- Denna rapport redovisar en förstudie till SNS fleråriga forskningsprojekt som undersöker hur värdet av nya läkemedel kan bedömas ur ett brett samhällsperspektiv. En slutsats av förstudien är att det finns goda möjligheter att få bättre svar på många av de policyfrågor som ställs i läkemedelspolitiken, t ex om förskrivning och offentlig subventionering av nya läkemedel. De omfattande svenska patientregistren erbjuder unika möjligheter att studera det faktiska, realiserade värdet av läkemedel.
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- Ljungvall, Åsa, et al.
(författare)
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Misreporting and misclassification: implications for socioeconomic disparities in body-mass index and obesity
- 2015
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Ingår i: European Journal of Health Economics. - : Springer Science and Business Media LLC. - 1618-7598 .- 1618-7601. ; 16:1, s. 5-20
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Tidskriftsartikel (refereegranskat)abstract
- Body-mass index (BMI) has become the standard proxy for obesity in social science research. This study deals with the potential problems related to, first, relying on self-reported weight and height to calculate BMI (misreporting), and, second, the concern that BMI is a deficient measure of body fat (misclassification). Using a regional Swedish sample, we analyze whether socioeconomic disparities in BMI are biased because of misreporting, and whether socioeconomic disparities in the risk of obesity are sensitive to whether BMI or waist circumference is used to define obesity. Education and income are used as socioeconomic indicators. The overall conclusion is that misreporting and misclassification may indeed matter for estimated educational and income disparities in BMI and obesity. In the misreporting part we find that women with higher education misreport less than those with lower education, leading to underestimation of the education disparity when using self-reported information. In the misclassification part we find that the probability of being misclassified decreases with income, for both men and women. Among women, the consequence is a steeper income gradient when obesity is defined using waist circumference instead of BMI. Among men the income gradient is statistically insignificant irrespective of how obesity is defined, but when estimating the probability of obesity defined by waist circumference, an educational gradient, which is not present when classifying men using BMI, arises.
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- Merlo, Juan, et al.
(författare)
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God vård på lika villkor vid hjärtinfarkt i dagens Sverige. Geografiska skillnader i dödlighet utan betyd
- 2005
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Ingår i: Läkartidningen. - 0023-7205. ; 102:1-2, s. 20-23
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Tidskriftsartikel (refereegranskat)abstract
- It is a known fact that the 1990s brought a decrease in mortality after myocardial infarction in Sweden but that differences in mortality rates following myocardial infarction still remain between the Swedish counties. Unresolved, however, are questions as to what these inter-county differences mean for the individual patient and what role hospital care plays in this context. We analysed all patients aged 64-85 years who were hospitalised following diagnosis of myocardial infarction in Sweden during the period 1993-1996. To gain an understanding of the relevance of geographical differences in mortality after myocardial infarction for the individual patient we applied multi-level regression analysis and calculated county and hospital median odds ratios (MORs) in relation to 28-day mortality. For hospitalised patients with myocardial infarction, being cared for in another hospital with higher mortality would increase the risk of dying by 9% (MOR=1.09) in men and 12% in women. If these patients moved to another county with higher mortality the risk would increase by 7% and 3%, respectively. The small geographical differences in 28-day mortality after myocardial infarction found in Sweden suggest a high degree of equality across the country; however, further improvement could be achieved in hospital care, especially for women - an issue that deserves further analysis.
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| 10. |
- Ohlsson, H, et al.
(författare)
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Understanding adherence to official guidelines on statin prescribing in primary health care-a multi-level methodological approach.
- 2005
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Ingår i: European Journal of Clinical Pharmacology. - : Springer Science and Business Media LLC. - 1432-1041 .- 0031-6970. ; 61:Aug 25, s. 657-665
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Tidskriftsartikel (refereegranskat)abstract
- Objective: The aim was to investigate the role that municipalities and out-patient health care centres (HCCs) have in understanding adherence to official guidelines on statin prescribing. Our hypothesis was that after guideline publication, adherence to recommended statin prescription would increase and variance among HCCs and municipalities would decrease. Since multi-level regression analysis (MLRA) is a relatively new methodology in pharmacoepidemiology, we also aimed to explore the application of MLRA in our investigation. Methods: We obtained data from the Swedish Corporation of Pharmacies record of sales regarding all initial prescriptions of statins issued between April and December 2003. We applied multi-level analysis on 34,514 individual prescriptions (level 1) nested within 226 HCCs (level 2), which in turn were nested within 33 municipalities (level 3). Temporal trends and gender differences were investigated by means of random slope analysis. Variance was expressed using median odds ratio (MOR) and interval odds ratio. Results: HCCs appeared to be more relevant than municipalities for understanding the physicians' propensity to prescribe a recommended statin (MORHCC=1.96 and MORMunicipality=1.41). Overall prevalence of adherence was very low (about 20%). After publication of the guidelines, prescription of recommended statins increased, and variance among HCCs decreased but only during the first 4 months of the observation period. Conclusion: The publication of official guidelines in the county of Scania exerted a positive influence on statin prescription but, at the end of the observation period, adherence was still low and practice variation high. These facts may reflect inefficient therapeutic traditions and suggest that more intensive interventions may be necessary to promote rational statin prescription.
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