| 1. |
- Beckman, Anders, et al.
(författare)
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Country of birth, socioeconomic position, and health care expenditure― a multilevel analysis of the city of Malmö, Sweden
- 2004
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Ingår i: Journal of Epidemiology and Community Health. - : BMJ. - 1470-2738 .- 0143-005X. ; 58:2, s. 145-149
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Tidskriftsartikel (refereegranskat)abstract
- Study objective: The principle of equity aims to guarantee allocation of healthcare resources on the basis of need. Therefore, people with a low income and persons living alone are expected to have higher healthcare expenditures. Besides these individual characteristics healthcare expenditure may be influenced by country of birth. This study therefore aimed to investigate the role of country of birth in explaining individual healthcare expenditure.Design: Multilevel regression model based on individuals (first level) and their country of birth (second level).Setting: The city of Malmö, Sweden.Participants: All the 52 419 men aged 40–80 years from 130 different countries of birth, who were living in Malmö, Sweden, during 1999.Main results: At the individual level, persons with a low income and persons living alone showed a higher healthcare expenditure, with regression coefficients (and 95% confidence intervals) being 0.358 (0.325 to 0.392) and 0.197 (0.165 to 0.230), respectively. Country of birth explained a considerable part (18% and 13%) of the individual differences in the probability of having a low income and living alone, respectively. However, this figure was only 3% for having some health expenditure, and barely 0.7% with regard to costs in the 74% of the population with some health expenditure.Conclusions: Malmö is a socioeconomically segregated city, in which the country of birth seems to play only a minor part in explaining individual differences in total healthcare expenditure. These differences seem instead to be determined by individual low income and living alone.
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| 2. |
- Beckman, Anders, et al.
(författare)
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The role country of birth plays in receiving disability pensions in relation to patterns of health care utilisation and socioeconomic differences: a multilevel analysis of Malmo, Sweden
- 2006
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Ingår i: BMC Public Health. - : Springer Science and Business Media LLC. - 1471-2458. ; 6
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Tidskriftsartikel (refereegranskat)abstract
- Background: People of low socioeconomic status have worse health and a higher probability of being granted a disability pension than people of high socioeconomic status. It is also known that public and private general physicians and public and private specialists have varying practices for issuing sick leave certificates ( which, if longstanding, may become the basis of disability pensions). However, few studies have investigated the influence of a patient's country of birth in this context. Methods: We used multilevel logistic regression analysis with individuals ( first level) nested within countries of birth ( second level). We analysed the entire population between the ages of 40 and 64 years ( n = 80 212) in the city of Malmo, Sweden, in 2003, and identified 73% of that population who had visited a physician at least once during that year. We studied the associations between individuals and country of birth socioeconomic characteristics, as well as individual utilisation of different kinds of physicians in relation to having been granted a disability pension. Results: Living alone ( ORwomen = 1.72, 95% CI: 1.62 - 1.82; ORmen = 2.64, 95% CI: 2.46 - 2.83) and having limited educational achievement (ORwomen = 2.14, 95% CI: 2.00 - 2.29; ORmen = 2.12, 95% CI: 1.98 - 2.28) were positively associated with having a disability pension. Utilisation of public specialists was associated with a higher probability (ORwomen = 2.11, 95% CI: 1.98 - 2.25; ORmen = 2.16, 95% CI: 2.01 - 2.32) and utilisation of private GPs with a lower probability (ORmen = 0.76, 95% CI: 0.69 - 0.83) of having a disability pension. However, these associations differed by countries of birth. Over and above individual socioeconomic status, men from middle income countries had a higher probability of having a disability pension (ORmen = 1.61, 95% CI: 1.06 - 2.44). Conclusion: The country of one's birth appears to play a significant role in understanding how individual socioeconomic differences bear on the likelihood of receiving a disability pension and on associated patterns of health care utilisation.
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| 3. |
- Ekedahl, Anders, et al.
(författare)
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Benzodiazepine prescribing patterns in a high-prescribing Scandinavian community
- 1993
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Ingår i: European Journal of Clinical Pharmacology. - 1432-1041. ; 44:2, s. 141-146
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Tidskriftsartikel (refereegranskat)abstract
- Sales statistics indicate large variations in benzodiazepine consumption between the Scandinavian countries: the current difference between Denmark (highest) and Sweden (lowest) is almost two-fold. There are also large within-country variations: e.g. benzodiazepine sales in the Swedish city of Helsingborg, which is close to Denmark, were at the average Danish level and were the highest in Sweden. Repeated prescription analyses were carried out in Helsingborg, and register data were used to compare the extent of psychiatric morbidity and psychosocial problems in this city with those in neighbouring cities. Benzodiazepine consumption was higher than the national average in all age groups. However, neither the choice of the predominant benzodiazepine agents nor the dose size or number of doses per prescription showed any major deviation. Hence, Helsingborg may have a larger proportion of benzodiazepine users or longer exposure periods among users. The latter is supported by the fact that about 40% of all benzodiazepine prescriptions were repeated. Psychiatric morbidity, suicide rate, alcohol-related diseases, unemployment and the proportion of socially isolated subjects were higher than the county average. On the other hand, within the county, there were cities that despite lower benzodiazepine sales had an equal or higher rate of suicide, unemployment and alcohol-related diseases. Of all benzodiazepine prescriptions processed in Helsingborg, > 30% were issued by < 5% of the prescribers (> or = 15 prescriptions per prescriber and per week). Thus, the higher usage of benzodiazepines in Helsingborg may partly be related to higher psychiatric morbidity and more psychosocial problems, but deviant prescribing habits among a minority of physicians are also important.
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| 4. |
- Johnell, K, et al.
(författare)
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Low adherence with antihypertensives in actual practice: the association with social participation - a multilevel analysis
- 2005
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Ingår i: BMC Public Health. - : Springer Science and Business Media LLC. - 1471-2458. ; 5:17
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Tidskriftsartikel (refereegranskat)abstract
- Background: Low adherence is a key factor in explaining impaired effectiveness and efficiency in the pharmacological treatment of hypertension. However, little is known about which factors determine low adherence in actual practice. The purpose of this study is to examine whether low social participation is associated with low adherence with antihypertensive medication, and if this association is modified by the municipality of residence. Methods: 1288 users of antihypertensive medication were identified from The Health Survey in Scania 2000, Sweden. The outcome was low adherence with antihypertensives during the last two weeks. Multilevel logistic regression with participants at the first level and municipalities at the second level was used for analyses of the data. Results: Low social participation was associated with low adherence with antihypertensives during the last two weeks (OR = 2.05, 95% CI: 1.05-3.99), independently of low educational level. However, after additional adjustment for poor self-rated health and poor psychological health, the association between low social participation and low adherence with antihypertensives during the last two weeks remained but was not conclusive (OR = 1.80, 95% CI: 0.90-3.61). Furthermore, the association between low social participation and low adherence with antihypertensives during the last two weeks varied among municipalities in Scania (i.e., cross-level interaction). Conclusion: Low social participation seems to be associated with low adherence with antihypertensives during the last two weeks, and this association may be modified by the municipality of residence. Future studies aimed at investigating health-related behaviours in general and low adherence with medication in particular might benefit if they consider area of residence.
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| 5. |
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| 6. |
- Möllerberg, Marie-Louise, et al.
(författare)
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The effects of a cancer diagnosis on the health of a patient's partner : a population-based registry study of cancer in Sweden
- 2016
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Ingår i: European Journal of Cancer Care. - : Hindawi Limited. - 0961-5423 .- 1365-2354. ; 25:5, s. 744-752
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Tidskriftsartikel (refereegranskat)abstract
- The aim of this population-based registry study was to explore how cancer influences the health of partners, by examining the onset of new diagnoses for partners, health care use and health care costs among partners living with patients with cancer. The sample consisted of partners of patients with cancer (N = 10 353) and partners of age- and sex-matched controls who did not have cancer (N = 74 592). Diagnoses, health care use and health care costs were studied for a continuous period starting 1 year before the date of cancer diagnosis and continued for 3 years. One year after cancer diagnosis, partners of patients with cancer had significantly more mood disorders, reactions to severe stress and ischaemic heart disease than they exhibited in the year before the diagnosis. Among partners of patients with cancer, the type of cancer was associated with the extent and form of increased health care use and costs; both health care use and costs increased among partners of patients with liver cancer, lung cancer, colon cancer and miscellaneous other cancers. The risk of poorer health varied according to the type of cancer diagnosed, and appeared related to the severity and prognosis of that diagnosis.
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| 7. |
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| 8. |
- Norlund, A, et al.
(författare)
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Prostate cancer - Prevalence-based healthcare costs
- 2003
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Ingår i: Scandinavian Journal of Urology and Nephrology. - : Informa UK Limited. - 0036-5599 .- 1651-2065. ; 37:5, s. 371-375
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Tidskriftsartikel (refereegranskat)abstract
- Objective: To calculate the total costs of in- and outpatient healthcare for patients with prostate cancer based on an episode-of-care approach. The cost analysis includes costs incurred during the first year of diagnosis, a longitudinal 3-year analysis and the incremental cost of prostate cancer during the first year of diagnosis. Material and Methods: Patients registered with prostate cancer between 1998 and 2000, according to the data files of the Southern Swedish Regional Tumour Registry, were given encrypted identifiers that could also be used in the Patient Administrative System of the Region Skane County Council, making it possible to identify consumption of healthcare on an episode-of-care basis. Itemized costs for resources used by each individual patient were calculated from the complete accounting system of the County Council. Results: Healthcare costs for prostate cancer during the first year varied between 45 000 and 51 000 SEK per patient. The second- and third-year costs were progressively lower, with an estimated total cost of 114 000 SEK over a period of 3 years. The age-standardized incremental cost of prostate cancer corresponded to 33 000 SEK during the first year, compared to the average cost per inhabitant. Conclusions: The episode-of-care approach, based on encrypted identifiers for the identification of the diagnoses of individual patients and their utilization of healthcare, gives a unique opportunity to estimate the healthcare costs of specific diseases. The incremental healthcare cost per patient with prostate cancer corresponded to 33 000 SEK during the first year.
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| 9. |
- 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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| 10. |
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