1 Det Sundhedsvidenskabelige Fakultet, SDU2 Research Unit for General Practice in Odense, Department of Public Health, Det Sundhedsvidenskabelige Fakultet, SDU3 Register/Ulykker/Hjerter, National Institute of Public Health, Det Sundhedsvidenskabelige Fakultet, SDU4 Research Unit of General Practice, Department of Public Health, Det Sundhedsvidenskabelige Fakultet, SDU5 Register/Ulykker/Hjerter, National Institute of Public Health, Det Sundhedsvidenskabelige Fakultet, SDU6 Research Unit of General Practice, Department of Public Health, Det Sundhedsvidenskabelige Fakultet, SDU
Background: Supported by the growing evidence of the beneficial effects of statins in a range of conditions, statin utilization has increased considerably in most Western countries over the last decade. Objectives: To estimate to what extent a widening of indication scope for statins accounts for the increasing Danish statin utilization during 1996-2005, applying treatment incidence as a measure of changing prescribing behaviour Methods: Applying three nationwide registers, we followed Danish inhabitants with respect to demographics, dispensed prescriptions of cardiovascular drugs and antidiabetics along with discharge diagnoses and surgical procedures performed during 1977-2005. The disease status for all cohort members was assigned by means of disease markers for seven cardiovascular conditions, corresponding to a hierarchy of broad indications for statin therapy. Using the indication hierarchy, we computed treatment incidence of statins each year stratifying by indication, age and gender. We estimated the overall and age/indication specific increases in incidence as incidence Rate Ratios (IRR) with 95% confidence interval (CI), using Poisson regression analyses. Results: Treatment incidence increased from 4/1000 person years in 2000 to 17/1000 in 2005, the increase being slow until 2000. The relative increase 2000-2005 was largest among those with no disease markers, IRR 5.8 (95% CI, 5.7 to 6.0) and lowest among those with MI and IHD, IRR 2.1 (2.1 to 2.3). The largest growth was found among the elderly (75+), with an overall IRR of 6.8 (6.4 to 7.1) and among those with no disease markers IRR 10.4 (9.5 to 11.3). Conclusions: Growing statin utilization reflects a widening of statin indication and changing prescribing behaviors, including the abolition of ageism. Treatment incidence grew most among the elderly without disease markers, presumably related to increasing use of the risk score scheme.
statin prescribing elderly incidence
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International Conference on Pharmacoepidemiology & Therapeutic Risk Management, 2009