1
|
Lehti V, Salama E, Niemelä S, Tanskanen A, Gissler M, Suvisaari J, Taipale H. Use of benzodiazepine and related drugs in migrants and Finnish-born persons: a nationwide register-based study. Scand J Public Health 2023; 51:1222-1230. [PMID: 35876428 PMCID: PMC10642218 DOI: 10.1177/14034948221112470] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2021] [Revised: 05/20/2022] [Accepted: 06/20/2022] [Indexed: 11/16/2022]
Abstract
AIMS Benzodiazepines and related drugs (BZDR) are often used longer than generally recommended. The aim is to study patterns of use among migrant and Finnish-born users of BZDR, and to identify factors that are associated with long-term use and BZDR polytherapy. METHODS This register-based study includes a nationwide sample of migrants (n=8729) and their Finnish-born controls (n=11 388) who had purchased BZDR in 2011-2014, but not in 2009-2010. Information on drug purchases was obtained from the National Prescription Register and the duration of drug use was estimated using PRE2DUP method. The main outcomes were long-term use of BZDR, polytherapy and time until discontinuation of BZDR use. Sociodemographic variables and information on preceding psychiatric diagnoses were included as covariates. Logistic and Cox regression analyses were the statistical methods used. RESULTS Only migrants from Sub-Saharan Africa were more likely to discontinue the medication once initiated than Finnish-born users. Migrants were significantly less likely to be long-term users (adjusted odds ratio 0.79, 95% CI 0.70-0.89) or polytherapy users (aOR 0.90, 95% CI 0.84-0.97) of BZDR compared with Finnish-born participants. CONCLUSIONS Migrants had less long-term and concomitant use of several BZDR than Finnish-born participants. The pattern of use is more optimal among migrants, but it may also reflect poorer access to mental health treatment.
Collapse
Affiliation(s)
- Venla Lehti
- Finnish Institute for Health and Welfare, Equality Unit, Finland
- University of Helsinki and Helsinki University Hospital; Department of Psychiatry, Finland
| | - Essi Salama
- Doctoral Programme for Clinical Investigation, Faculty of Medicine, University of Turku, Finland
- Department of Child Psychiatry, Turku University Hospital, Finland
| | - Solja Niemelä
- Department of Psychiatry, University of Turku, Finland
- Department of Psychiatry, Addiction Psychiatry Unit, Turku University Hospital, Finland
| | - Antti Tanskanen
- University of Eastern Finland, Department of Forensic Psychiatry, Niuvanniemi Hospital, Kuopio, Finland
- Karolinska Institutet, Department of Clinical Neuroscience, Stockholm, Sweden
- Finnish Institute for Health and Welfare, Impact Assessment Unit, Finland
| | - Mika Gissler
- Karolinska Institutet, Department of Molecular Medicine and Surgery and Region Stockholm, Academic Primary Health Care Centre, Sweden
- Finnish Institute for Health and Welfare, Department of Knowledge Brokers, Helsinki, Finland
- University of Turku, Research Centre for Child Psychiatry, Finland
| | - Jaana Suvisaari
- Finnish Institute for Health and Welfare, Equality Unit, Finland
| | - Heidi Taipale
- Finnish Institute for Health and Welfare, Equality Unit, Finland
- University of Eastern Finland, Department of Forensic Psychiatry, Niuvanniemi Hospital, Kuopio, Finland
- Karolinska Institutet, Department of Clinical Neuroscience, Stockholm, Sweden
- University of Eastern Finland, School of Pharmacy, Kuopio, Finland
| |
Collapse
|
2
|
Honkaniemi H, Juárez SP, Rostila M. Mental health by native–immigrant intermarriage in Sweden: a register-based retrospective cohort study. Eur J Public Health 2022; 32:877-883. [DOI: 10.1093/eurpub/ckac158] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Abstract
Background
Native–immigrant intermarriage is often regarded as a proxy for integration, given that intermarried immigrants are more socioeconomically and culturally similar to natives than intramarried immigrants. This study aimed to assess whether integration affects mental health and care-seeking behaviours, examining prescription hazards for psychotropic medications by native–immigrant marital composition in Sweden.
Methods
Total population register data were used to identify first-time married couples residing in Sweden between 31 December 2005 and 31 December 2016. Index persons were distinguished by gender and partners’ origin (native vs. immigrant), as well as by immigrants’ regions of origin, with intramarried natives as references. Using Cox regression, hazard ratios (HRs) with 95% confidence intervals (95% CIs) were calculated for antidepressant and anxiolytic prescriptions and adjusted for socioeconomic factors, presence of children and length and quality of marriage.
Results
Intramarried immigrant women had higher psychotropic prescription hazards than intramarried native references (HR 1.11, 95% CI 1.10–1.12), whereas intermarried immigrant women had equal hazards. Immigrant women’s hazards were lower than native references after adjustment. Intramarried immigrant men had the greatest prescription hazards (HR 1.33, 95% CI 1.32–1.34), and intermarried immigrant men slightly higher hazards (HR 1.11, 95% CI 1.10–1.13), than intramarried natives. All were partly attenuated after adjustment. Intermarriage hazards increased by similarities in regions of origin, especially among men.
Conclusions
Integration indicated by intermarriage appears to be protective for the mental health of immigrants, especially for immigrant men. Future research should empirically disentangle the social, cultural and socioeconomic mechanisms underlying these health differences.
Collapse
Affiliation(s)
- Helena Honkaniemi
- Department of Public Health Sciences, Stockholm University , Stockholm, Sweden
- Centre for Health Equity Studies (CHESS), Stockholm University/Karolinska Institutet , Stockholm, Sweden
| | - Sol Pía Juárez
- Department of Public Health Sciences, Stockholm University , Stockholm, Sweden
- Centre for Health Equity Studies (CHESS), Stockholm University/Karolinska Institutet , Stockholm, Sweden
| | - Mikael Rostila
- Department of Public Health Sciences, Stockholm University , Stockholm, Sweden
- Centre for Health Equity Studies (CHESS), Stockholm University/Karolinska Institutet , Stockholm, Sweden
| |
Collapse
|
3
|
Poppleton A, Howells K, Adeyemi I, Chew‐Graham C, Dikomitis L, Sanders C. The perceptions of general practice among Central and Eastern Europeans in the United Kingdom: A systematic scoping review. Health Expect 2022; 25:2107-2123. [DOI: 10.1111/hex.13433] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2021] [Revised: 12/17/2021] [Accepted: 12/29/2021] [Indexed: 11/28/2022] Open
Affiliation(s)
- Aaron Poppleton
- Centre for Primary Care and Health Services Research University of Manchester Manchester UK
- School of Medicine Keele University Keele UK
- NIHR Greater Manchester Patient Safety Translational Research Centre (GM‐PSTRC) Manchester UK
| | - Kelly Howells
- Centre for Primary Care and Health Services Research University of Manchester Manchester UK
| | - Isabel Adeyemi
- Centre for Primary Care and Health Services Research University of Manchester Manchester UK
| | | | - Lisa Dikomitis
- Kent and Medway Medical School University of Kent and Canterbury Christ Church University Canterbury UK
| | - Caroline Sanders
- Centre for Primary Care and Health Services Research University of Manchester Manchester UK
- NIHR Greater Manchester Patient Safety Translational Research Centre (GM‐PSTRC) Manchester UK
| |
Collapse
|
4
|
Rahman S, Filatova S, Chen L, Björkenstam E, Taipale H, Mittendorfer-Rutz E. Trajectories of antidepressant use and characteristics associated with trajectory groups among young refugees and their Swedish-born peers with diagnosed common mental disorders-findings from the REMAIN study. Soc Psychiatry Psychiatr Epidemiol 2022; 57:305-317. [PMID: 34297179 PMCID: PMC8784494 DOI: 10.1007/s00127-021-02139-0] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/21/2020] [Accepted: 07/09/2021] [Indexed: 11/28/2022]
Abstract
PURPOSE This study aimed to (1) identify the trajectories of prescribed antidepressants in refugee youth and matched Swedish-born peers diagnosed with common mental disorder (CMD) and (2) characterize the trajectories according to sociodemographic and medical factors. METHODS The study population comprised 2,198 refugees and 12,199 Swedish-born individuals with both Swedish-born parents, aged 16-25 years in 2011, residing in Sweden and treated in specialised healthcare for CMD 2009-11. Group-based trajectory modelling was used to identify different trajectory groups of antidepressant use-based on annual defined daily dosages (DDDs). Multinomial logistic regression was applied to investigate the association of sociodemographic and medical characteristics with the identified trajectories. Nagelkerke pseudo-R2 values were estimated to evaluate the strength of these associations. RESULTS Four trajectory groups of antidepressant use among young refugees were identified with following proportions and DDD levels in 2011: 'low constant' (88%, < 100), 'low increasing' (2%, ≈710), 'medium decreasing' (8%, ≈170) and 'high increasing' (2%, ≈860). Similar trajectories, however, with different proportions were identified in Swedish-born: 67%, 7%, 21% and 5%, respectively. The most influential factors discriminating the trajectory groups among refugees were 'duration of stay in Sweden' (R2 = 0.013), comorbid 'other mental disorders' (R2 = 0.009) and 'disability pension' (R2 = 0.007), while 'disability pension' (R2 = 0.017), comorbid 'other mental disorders' (R2 = 0.008) and 'educational level' (R2 = 0.008) were the most important determinants discriminating trajectory groups among Swedish-born youth. CONCLUSION The lower use of antidepressants in refugees with CMDs compared to their Swedish-born counterparts warrants health literacy programs for refugees and training in transcultural psychiatry for healthcare professionals.
Collapse
Affiliation(s)
- S. Rahman
- Epidemiology of Psychiatric Conditions, Substance Use and Social Environment (EPICSS), Department of Global Public Health, Karolinska Institutet, SE-113 65Solnavägen 1E, Stockholm, Sweden ,Division of Insurance Medicine, Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden
| | - S. Filatova
- Division of Insurance Medicine, Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden
| | - L. Chen
- Division of Insurance Medicine, Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden
| | - E. Björkenstam
- Division of Insurance Medicine, Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden
| | - H. Taipale
- Division of Insurance Medicine, Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden ,Niuvanniemi Hospital, Kuopio, Finland
| | - E. Mittendorfer-Rutz
- Division of Insurance Medicine, Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden
| |
Collapse
|
5
|
Pathak N, Zhang CX, Boukari Y, Burns R, Mathur R, Gonzalez-Izquierdo A, Denaxas S, Sonnenberg P, Hayward A, Aldridge RW. Development and Validation of a Primary Care Electronic Health Record Phenotype to Study Migration and Health in the UK. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:13304. [PMID: 34948912 PMCID: PMC8707886 DOI: 10.3390/ijerph182413304] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/04/2021] [Revised: 12/07/2021] [Accepted: 12/10/2021] [Indexed: 11/16/2022]
Abstract
International migrants comprised 14% of the UK's population in 2020; however, their health is rarely studied at a population level using primary care electronic health records due to difficulties in their identification. We developed a migration phenotype using country of birth, visa status, non-English main/first language and non-UK-origin codes and applied it to the Clinical Practice Research Datalink (CPRD) GOLD database of 16,071,111 primary care patients between 1997 and 2018. We compared the completeness and representativeness of the identified migrant population to Office for National Statistics (ONS) country-of-birth and 2011 census data by year, age, sex, geographic region of birth and ethnicity. Between 1997 to 2018, 403,768 migrants (2.51% of the CPRD GOLD population) were identified: 178,749 (1.11%) had foreign-country-of-birth or visa -status codes, 216,731 (1.35%) non-English-main/first-language codes, and 8288 (0.05%) non-UK-origin codes. The cohort was similarly distributed versus ONS data by sex and region of birth. Migration recording improved over time and younger migrants were better represented than those aged ≥50. The validated phenotype identified a large migrant cohort for use in migration health research in CPRD GOLD to inform healthcare policy and practice. The under-recording of migration status in earlier years and older ages necessitates cautious interpretation of future studies in these groups.
Collapse
Affiliation(s)
- Neha Pathak
- Institute of Health Informatics, University College London, 222 Euston Rd., London NW1 2DA, UK; (N.P.); (C.X.Z.); (Y.B.); (R.B.); (A.G.-I.); (S.D.)
- Guy’s & St. Thomas’ NHS Foundation Trust, London SE1 9RT, UK
| | - Claire X. Zhang
- Institute of Health Informatics, University College London, 222 Euston Rd., London NW1 2DA, UK; (N.P.); (C.X.Z.); (Y.B.); (R.B.); (A.G.-I.); (S.D.)
- Office for Health Improvement and Disparities, Department of Health and Social Care, 39 Victoria Street, London SW1H 0EU, UK
| | - Yamina Boukari
- Institute of Health Informatics, University College London, 222 Euston Rd., London NW1 2DA, UK; (N.P.); (C.X.Z.); (Y.B.); (R.B.); (A.G.-I.); (S.D.)
- Office for Health Improvement and Disparities, Department of Health and Social Care, 39 Victoria Street, London SW1H 0EU, UK
| | - Rachel Burns
- Institute of Health Informatics, University College London, 222 Euston Rd., London NW1 2DA, UK; (N.P.); (C.X.Z.); (Y.B.); (R.B.); (A.G.-I.); (S.D.)
| | - Rohini Mathur
- Department of Non-Communicable Disease Epidemiology, London School of Hygiene & Tropical Medicine, Keppel Street, London WC1E 7HT, UK;
| | - Arturo Gonzalez-Izquierdo
- Institute of Health Informatics, University College London, 222 Euston Rd., London NW1 2DA, UK; (N.P.); (C.X.Z.); (Y.B.); (R.B.); (A.G.-I.); (S.D.)
- Health Data Research UK, London NW1 2BF, UK
| | - Spiros Denaxas
- Institute of Health Informatics, University College London, 222 Euston Rd., London NW1 2DA, UK; (N.P.); (C.X.Z.); (Y.B.); (R.B.); (A.G.-I.); (S.D.)
- Health Data Research UK, London NW1 2BF, UK
| | - Pam Sonnenberg
- Institute for Global Health, University College London, 30 Guilford Street, London WC1N 1EH, UK;
| | - Andrew Hayward
- Institute of Epidemiology & Health Care, University College London, 1-19 Torrington Place, London WC1E 7HB, UK;
| | - Robert W. Aldridge
- Institute of Health Informatics, University College London, 222 Euston Rd., London NW1 2DA, UK; (N.P.); (C.X.Z.); (Y.B.); (R.B.); (A.G.-I.); (S.D.)
| |
Collapse
|
6
|
Hollander AC, Mackay E, Sjöqvist H, Kirkbride JB, Bäärnhielm S, Dalman C. Psychiatric care use among migrants to Sweden compared with Swedish-born residents: a longitudinal cohort study of 5 150 753 people. BMJ Glob Health 2021; 5:bmjgh-2020-002471. [PMID: 32972966 PMCID: PMC7517566 DOI: 10.1136/bmjgh-2020-002471] [Citation(s) in RCA: 21] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2020] [Revised: 07/16/2020] [Accepted: 07/17/2020] [Indexed: 11/24/2022] Open
Abstract
Background To investigate differences in psychiatric care use over time between Swedish born and those born abroad who migrate to Sweden. Methods Population-based cohort study analysing linked population and health registers, following individuals born 1944–1990 from 1 January 2005 to 31 December 2016. Time-stratified survival analysis using Cox regression estimated time to psychiatric care use. Population included 5 150 753 individuals with 78.1% Swedish born. Migrant status was coded as Swedish born or migrant. Migrants were grouped by year of immigration and region of origin. The main outcome: psychiatric care use, defined as any psychiatric care; psychiatric inpatient or outpatient care; or use of psychotropics. Results Migrants arriving before 2005 had a higher use of any psychiatric care relative to Swedish born but migrants arriving 2005 onwards had lower use. Migrants from sub-Saharan Africa and Asia had a lower use of any psychiatric care during the first decade in Sweden whereas migrants from Middle East and North Africa had a higher use, driven by use of psychotropics. Conclusions The lower use of psychiatric care during the first decade contrasts with higher use among migrants with a longer duration of stay. Psychiatric care use among migrants should be analysed multi-dimensionally, taking duration of stay, region of origin and type of care into account.
Collapse
Affiliation(s)
| | - Euan Mackay
- Global Public Health Sciences, Karolinska Institutet, Stockholm, Sweden
| | - Hugo Sjöqvist
- Global Public Health Sciences, Karolinska Institutet, Stockholm, Sweden
| | | | - Sofie Bäärnhielm
- Clinical Neuroscience, Karolinska Institute, Stockholm, Sweden.,Transkulturellt Centrum, Stockholm Region, Stockholm, Sweden
| | - Christina Dalman
- Global Public Health Sciences, Karolinska Institutet, Stockholm, Sweden.,Centrum för epidemiologi och samhällsmedicin, Stockholm Region, Stockholm, Sweden
| |
Collapse
|
7
|
O’Reilly D, Bateson O, McGreevy G, Snoddy C, Power T. Administrative Data Research Northern Ireland (ADR NI). Int J Popul Data Sci 2020; 4:1148. [PMID: 32935044 PMCID: PMC7477783 DOI: 10.23889/ijpds.v4i2.1148] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND The Administrative Data Research Northern Ireland (ADR NI), is a partnership between academia and the local statistics agency to advance the access to and use of administrative data in Northern Ireland. These goals are currently being advanced by undertaking a series of demonstrator Strategic Impact Projects developed to provide input to departmental areas of research interest and the current draft Programme for Government. APPROACH ADR NI does not currently operate as a data repository but will negotiate access to and link subsets of administrative data from other departments and agencies as required for specific and approved projects. It is, however, anticipated that this model will broaden with the creation and retention of large linked datasets that could be used to address questions across a range of policy areas. At present accredited researchers can access the anonymised data only from within the safe setting situated in Belfast, although consideration is being given to using the Office for National Statistics Secure Researcher Service to access data more widely within the UK. ADR NI is currently being used to inform policy in a wide array of areas including health, education, environmental and urban planning. DISCUSSION ADR NI continues to develop and change. The growing confidence amongst data owners which has been supported by new and facilitating UK legislation has increased the willingness and ability to share and link administrative data. However, the associated logistical and administrative processes for accessing data will need further streamlining so that the timelines become more efficient and predictable. The evidence for the potential utility of research based on administrative data to influence policy continues to grow. CONCLUSION Over the last decade we have demonstrated to data owners and the different publics that it is safe and acceptable to link administrative data for public benefit. The evolution and maturation of the ADR NI progresses apace and we continue to learn from developments in our sister organisations throughout the UK and throughout the world. We look forward to greater access to and use of administrative data both within Northern Ireland and across the UK.
Collapse
Affiliation(s)
| | - O Bateson
- Northern Ireland Statistics and Research Agency
| | - G McGreevy
- Northern Ireland Statistics and Research Agency
| | - C Snoddy
- Northern Ireland Statistics and Research Agency
| | - T Power
- Northern Ireland Statistics and Research Agency
| |
Collapse
|