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- Khalaf, Kani, et al.
(författare)
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Geographical and sociodemographic differences in discontinuation of medication for chronic obstructive pulmonary disease – a cross-classified multilevel analysis of individual heterogeneity and discriminatory accuracy (MAIHDA)
- 2020
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Ingår i: Clinical Epidemiology. - 1179-1349. ; 12, s. 783-796
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Tidskriftsartikel (refereegranskat)abstract
- Background: While discontinuation of COPD maintenance medication is a known problem, the proportion of patients with discontinuation and its geographical and sociodemographic distribution are so far unknown in Sweden. Therefore, we analyse this question by applying an innovative approach called multilevel analysis of individual heterogeneity and discriminatory accuracy (MAIHDA). Patients and Methods: We analysed 49,019 patients categorized into 18 sociodemographic contexts and 21 counties of residence. All patients had a hospital COPD diagnosis and had been on inhaled maintenance medication during the 5 years before the study baseline in 2010. We defined “discontinuation” as the absolute lack of retrieval from a pharmacy of any inhaled maintenance medication during 2011. We performed a cross-classified MAIHDA and obtained the average proportion of discontinuation, as well as county and sociodemographic absolute risks, and compared them with a proposed benchmark value of 10%. We calculated the variance partition coefficient (VPC) and the area under the receiver operating characteristics curve (AUC) to quantify county and sociodemographic differences. To summarize the results, we used a framework with 15 scenarios defined by the size of the differences and the level of achievement in relation to the benchmark value. Results: Around 18% of COPD patients in Sweden discontinued maintenance medication, so the benchmark value was not achieved. There were very small county differences (VPC=0.35%, AUC=0.54). The sociodemographic differences were small (VPC=4.98%, AUC=0.57). Conclusion: Continuity of maintenance medication among COPD patients in Sweden could be improved by reducing the unjustifiably high prevalence of discontinuation. The very small county and small sociodemographic differences should motivate universal interventions across all counties and sociodemographic groups. Geographical analyses should be combined with sociodemographic analyses, and the cross-classified MAIHDA is an appropriate tool to assess health-care quality.
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| 2. |
- Khalaf, Kani, et al.
(författare)
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Low Adherence to Statin Treatment during the First Year after an Acute Myocardial Infarction is associated with Increased Second Year Mortality Risk- An Inverse Probability of Treatment Weighted Study on 54,872 Patients
- 2021
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Ingår i: European Heart Journal Cardiovascular Pharmacotherapy. - : Oxford University Press (OUP). - 2055-6837 .- 2055-6845. ; 7:2, s. 141-147
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Tidskriftsartikel (refereegranskat)abstract
- AIMS: Experiencing an acute myocardial infarction (AMI) is a life-threatening event and use of statins can reduce the probability of recurrence and improve long term survival. However, the effectiveness of statins in the real-world setting may be lower than the reported efficacy in randomized clinical trials. Therefore, we aimed to investigate whether low statin treatment adherence during the year following an AMI episode associated with increased second year mortality.METHODS AND RESULTS: We analysed all 54,872 AMI patients aged ≥45 years, admitted to Swedish hospitals between 2010-2012, and who survive at least one year after the AMI episode. We defined low adherence as a medication possession ratio <50% or non-use of statins. Applying inverse probability of treatment weighting (IPTW) we investigated the association between low adherence and all-cause, cardiovascular (CVD), and non-CVD mortality during the second year.Overall 20% of the patients had low adherence during the first year, and 8% died during the second. In the IPTW analysis, low adherence was associated with an increased risk of all-cause (Absolute risk difference (ARD) =0.048, Number Need to Harm (NNH) =21, Relative Risk (RR) =1.71), CVD (ARD=0.035, NNH=29, RR = 1.62) and non-CVD mortality (ARD=0.013, NNH=77, RR = 2.17).CONCLUSION: In the real-world setting, low statin adherence during the first year after an AMI episode is associated with increased mortality during the second year. Our results reaffirm the importance of achieving a high adherence to statin treatment after suffering from an AMI.
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| 3. |
- Ljungman, Hanna, et al.
(författare)
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Antidepressant use in Sweden : an intersectional multilevel analysis of individual heterogeneity and discriminatory accuracy (MAIHDA)
- 2021
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Ingår i: Scandinavian Journal of Public Health. - : Sage Publications. - 1403-4948 .- 1651-1905. ; 50:3, s. 395-403
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Tidskriftsartikel (refereegranskat)abstract
- Introduction: Antidepressants are among the most commonly prescribed drugs in Sweden. However, we lack detailed knowledge on the socioeconomic and demographic distribution of antidepressant use in the population. To fill this gap, we performed an intersectional multilevel analysis of individual heterogeneity and discriminatory accuracy.Methods: Analysing all Swedish residents older than 10 years (n=8,190,990), we measured the absolute risk of antidepressant use across 144 intersectional strata defined by combinations of age, gender, income, country of birth and psychiatric diagnosis. We calculated the strata-specific absolute risk of antidepressant use in a series of multilevel logistic regression models. By means of the variance partitioning coefficient and the area under the receiver operating characteristic curve, we quantified the discriminatory accuracy of the intersectional contexts (i.e. strata) for discerning those who use antidepressants from those who do not.Results: The absolute risk of antidepressant use ranged between 0.93% and 24.78% among those without a psychiatric diagnosis, and between 21.41% and 77.56% among those with a psychiatric diagnosis. Both the variance partitioning coefficient of 41.88% and the area under the receiver operating characteristic curve of 0.81 were considerable.Conclusions: Besides overt psychiatric diagnoses, our study shows that antidepressant use is mainly conditioned by age, which might express the embodiment of socioeconomic conditions across the individual life course. Our analysis provides a detailed and highly discriminatory mapping of the heterogeneous distribution of antidepressant use in the Swedish population, which may be useful in public health management.
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| 4. |
- Merlo, Juan, et al.
(författare)
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Geographical and sociodemographic differences in statin dispensation after acute myocardial infarction in Sweden : a register-based prospective cohort study applying analysis of individual heterogeneity and discriminatory accuracy (AIHDA) for basic comparisons of healthcare quality
- 2023
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Ingår i: BMJ Open. - 2044-6055. ; 13:9, s. 1-12
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Tidskriftsartikel (refereegranskat)abstract
- BACKGROUND: In Sweden, as in many other countries, official monitoring of healthcare quality is mostly focused on geographical disparities in relation to a desirable benchmark. However, current evaluations could be improved by considering: (1) The intersection of other relevant axes of inequity like age, sex, income and migration status; and (2) The existence of individual heterogeneity around averages. Therefore, using an established quality indicator (ie, dispensation of statins after acute myocardial infarction, AMI), we valuate both geographical and sociodemographic inequalities and illustrate how the analysis of individual heterogeneity and discriminatory accuracy (AIHDA) enhances such evaluations.POPULATION AND METHODS: We applied AIHDA and calculated the area under the receiver operating characteristics curve (AUC) of regional and sociodemographic differences in the statin dispensations of 35 044 patients from 21 Swedish regions and 24 sociodemographic strata who were discharged from the hospital with an AMI diagnosis between January 2011 and December 2013. Following the Swedish National Board of Health and Welfare, we used a benchmark value of 90%.RESULTS: Dispensation of stains after AMI in Sweden did not reach the desired target of 90%. Regional differences were absent/very small (AUC=0.537) while sociodemographic differences were small (AUC=0.618). Women, especially those with immigrant background and older than 65 years, have the lowest proportions of statin dispensations after AMI.CONCLUSIONS: As the AUC statistics are small, interventions trying to achieve the benchmark value should be universal. However, special emphasis should nevertheless be directed towards women, especially older women with immigrant backgrounds.
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| 5. |
- Zettermark, Sofia, et al.
(författare)
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Population heterogeneity in associations between hormonal contraception and antidepressant use in Sweden : a prospective cohort study applying intersectional multilevel analysis of individual heterogeneity and discriminatory accuracy (MAIHDA)
- 2021
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Ingår i: BMJ Open. - : BMJ. - 2044-6055. ; 11, s. 1-11
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Tidskriftsartikel (refereegranskat)abstract
- OBJECTIVES: From a reproductive justice framework, we aimed to investigate how a possible association between hormonal contraceptive (HC) and antidepressants use (as a proxy for depression) is distributed across intersectional strata in the population. We aimed to visualise how intersecting power dynamics may operate in combination with HC use to increase or decrease subsequent use of antidepressants. Our main hypothesis was that the previously observed association between HC and antidepressants use would vary between strata, being more pronounced in more oppressed intersectional contexts. For this purpose, we applied an intersectional multilevel analysis of individual heterogeneity and discriminatory accuracy approach.DESIGN: Observational prospective cohort study using record linkage of national Swedish registers.SETTING: The population of Sweden.PARTICIPANTS: All 915 954 women aged 12-30 residing in Sweden 2010, without a recent pregnancy and alive during the individual 1-year follow-up.PRIMARY OUTCOME MEASURE: Use of any antidepressant, meaning being dispensed at least one antidepressant (ATC: N06A) during follow-up.RESULTS: Previously mentally healthy HC users had an OR of 1.79 for use of antidepressants compared with non-users, whereas this number was 1.28 for women with previous mental health issues. The highest antidepressant use were uniformly found in strata with previous mental health issues, with highest usage in women aged 24-30 with no immigrant background, low income and HC use (51.4%). The largest difference in antidepressant use between HC users and non-users was found in teenagers, and in adult women of immigrant background with low income. Of the total individual variance in the latent propensity of using antidepressant 9.01% (healthy) and 8.16% (with previous mental health issues) was found at the intersectional stratum level.CONCLUSIONS: Our study suggests teenagers and women with immigrant background and low income could be more sensitive to mood effects of HC, a heterogeneity important to consider moving forward.
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