Undersøgelse af geografisk ulighed i forbruget af hjertemedicin i Nordjylland

Abstract

Baggrund Prævalænsen og mortaliteten af hjertekarsygdomme er geografisk varierende. Dette studie undersøgte om man kunne observerer en geografisk ulighed i behandlingen med hjertemedicin i de forskellige kom-muner i Nordjylland. Studiet undersøgte videre om en sociale konsekvens (i form af en svag tilknytning til arbejdsmarkedet) af at modtage hjertemedicin var tilstede og om den var forskellig, afhængigt af geogra-fi i Region Nordjylland. Metode Studiet var en tværsnitsundersøgelse fra juni 2009, med registerdata fra lægemiddeldatabasen (LMDB) og DREAM-databasen (N = 24.131). LMDB indeholdte oplysninger om udleveret medicin i form af ATC-koder. ATC-koder der begyndte med C, blev valgt som definitionen af at borgeren havde modtaget hjer-temedicin. DREAM-databasen indeholdte oplysninger om bopæl og arbejdsmarkedstilknytning. En svag tilknytning til arbejdsmarkedet blev defineret ud fra om borgeren havde modtaget en offentlig ydelse over 80% af året eller modtog en varig ydelse. Der blev fremstillet frekvenstabeller og foretaget logistisk regresionsanalyse. Analyser blev justeret for køn og alder. Nordjyllands kommuner blev inddelt i 3 kate-gorier: Aalborg, omkringliggende kommuner og yderkommuner. Resultater Andelen af borgere, som havde fået udleveret hjertemedicin var: Aalborg 18%, omkringliggende kom-muner 19% og yderkommuner 20%. Justerede odds ratio (J-OR) for udlevering af hjertemedicin i om-kringliggende kommuner var 1,03 (95% Konfidensinterval (95% KI): 0,94-1,13) og for yderkommunerne var den 1,06 (95% KI: 0,98-1,14), sammenlignet med Aalborg. Udlevering af hjertemedicin viste sig at være associeret med en svag tilknytning til arbejdsmarkedet i begge definitioner brugt i dette studie: J-OR 2,10 (95% KI: 1,93-2,27) for der modtog en offentlig ydelse over 80% af året, J-OR 2,31 (95% KI: 2,11-2,53) for de, som modtog en varig ydelse. Ingen geografisk variation blandt hjertepatienters tilknytning til ar-bejdsmarkedet blev fundet. Konklusion Studiet fandt ingen geografisk forskel i forbruget af hjertemedicin. Der blev fundet en association mellem at modtage hjertemedicin og at have en svag tilknytning til arbejdsmarkedet, som ikke var geografisk varierende.

Background A geographic variation of prevalence and mortality from heart disease exists. The aim of this study was to examine a potential unequal geographical variation in the treatment with heart medicine within the coun-ties of northern of Jutland. It has been proven that heart patients have a weaker connection to the labour market. This study further wanted to investigate if the social consequence of having a heart disease (in the form of a weak connection to the labour market) could be proven in the region of northern Jutland and whether this consequence was geographically unequal in within the region. Method This study was a cross sectional study by design. Data used were from June 2009 withdrawn from The Danish National Prescription Registry and the DREAM database. 24.131 residents took part in the study. The Danish National Prescription Registry provided information about prescribed medicines in the form of ATC-codes. This study used ATC-codes starting with “C” to define residents who had received medical treatment for a heart condition. The DREAM database provided information about the participants’ place of residency as well as their occupational status. A weak connection to the labour market was defined either by a participant receiving public services more than 80% of the time over the course of a year or by receiving a lasting public service. Frequency tables were constructed and logistics regression analyzes was performed to analyze the data. All analyzes were adjusted for age and sex. Counties of Region Nordjyl-land were divided into 3 categories: “Aalborg”, “surrounding counties” and “outlying counties”. Results The proportion of residents who had received a prescription for heart medicine was observed for the 3 categories of counties: Aalborg 18%, surrounding counties 19% and outlaying counties 20%. The Adjusted Odds ratio (A-OR) for prescribed heart medicine was 1,03 (95% confidence interval (95% CI): 0,94 - 1,13) for surrounding counties and 1,06 (95% CI: 0,98 - 1,14) for outlaying counties, both compared to Aalborg. The study found an association between a resident having received heart medicine and them having a weak connection to the labour market. For both definitions of “having a weak connection to the labour market” used in this paper this association was found. For the residents who had received public services over 80% over the course of an year an A-OR was found to be 2,10 (95% CI: 1,93 - 2,27) and for those re-ceiving a lasting public service the A-OR was found to be 2,31 (95% CI: 2,11 - 2,53). A geographical variation in the association between a resident having had prescribed heart medicine and having a weak connec-tion to the labour market could not be positively established though a tendency was found. Conclusion This study did not find a geographical variation the treatment with heart medicine across the counties in the region of northern Jutland. The study found an association between a resident having had prescribed heart medicine and having a week connection to the labour market. This association did not show to vary according to geography in the 3 chosen categories of residency used in this study.

A master thesis from Aalborg University

Undersøgelse af geografisk ulighed i forbruget af hjertemedicin i Nordjylland

[Exploration of Geographical Unequality in the use of Heart Medicine in the Nothern of Jutland in Denmark]