Pharmacoepidemiology of Antibiotics, Weak Opioids and Statins with Special Reference to Socioeconomic Aspects - an Ecological Approach

Abstract: The influence of socioeconomic factors on drug utilisation has been studied by pharmacoepidemiological analyses involving 1) drugs that are used to cure disease, such as antibiotics, 2) drugs that are used to alleviate symptoms, such as weak opioids, and 3) drugs that are used to prevent disease, such as statins. In a large Swedish city (Malmö), the utilisation of four major drug groups (ATC-groups A = alimentation, C = circulation, N = nervous system, and R = respiration) correlated positively with an unfavourable socioeconomic situation, most pronouncedly with group N and least so with group R. In contrast, affluence seemed to promote utilisation of antibiotics (ATC-group J), both overall and in pre-school and school children, not only in Malmö but also in the municipalities of a large Swedish county (Skåne). Parental affluence seemed to favour children’s utilisation of antibiotics in general, and particularly other antibiotics than penicillin V. However, the opposite relation was seen in the municipalities of a Danish county, suggesting that conclusions concerning the influence of socio-economic factors on drug utilisation should not be generalised. The utilisation of codeine in two major Swedish cities differed pronouncedly from that of another weak opioid, d-propoxyphene. It correlated positively with unfavourable socioeconomic factors and predominated among middle-aged women. Presumably, the utilisation of codeine seemed to be inappropriate in these cities. The ecological correlation of statin utilisation and mortality from acute myocardial infarction in Sweden’s municipalities was evaluated. Although statins reduce cardiovascular mortality in randomised clinical trials, no effect on acute myocardial infarction could be observed at the population level.