Johnell Kristina, Lindström Martin, Sundquist Jan, Eriksson Charli, Merlo Juan
Centre for Family Medicine, Karolinska Institutet, Stockholm, Sweden.
BMC Public Health. 2006 Mar 2;6:52. doi: 10.1186/1471-2458-6-52.
Non-concordance with medication remains a major public health problem that imposes a considerable financial burden on the health care system, and there is still a need for studies on correlates of non-concordance. Our first aim is to analyse whether any of the individual characteristics age, educational level, financial strain, self-rated health, social participation, and trust in the health care system are associated with primary non-concordance with medication. Our second aim is to investigate whether people living in the same area have similar probability of primary non-concordance with medication, that relates to area social participation.
We analysed cross sectional data from 9,070 women and 6,795 men aged 18 to 79 years, living in 78 areas in central Sweden, who participated in the Life & Health year 2000 survey, with multilevel logistic regression (individuals at the first level and areas at the second level).
Younger age, financial strain, low self-rated health, and low trust in the health care system were associated with primary non-concordance with medication. However, area social participation was not related to primary non-concordance, and the variation in primary non-concordance between the areas was small.
Our results indicate that people in central Sweden with younger age, financial difficulties, low self-rated health, and low trust in the health care system may have a higher probability of primary non-concordance with medication. However, the area of residence--as defined by administrative boundaries--seems to play a minor role for primary non-concordance.
不遵医嘱服药仍然是一个重大的公共卫生问题，给医疗保健系统带来了相当大的经济负担，而且仍需要对不遵医嘱的相关因素进行研究。我们的首要目标是分析年龄、教育水平、经济压力、自评健康状况、社会参与度以及对医疗保健系统的信任度等个体特征是否与初次服药不依从有关。我们的第二个目标是调查居住在同一地区的人初次服药不依从的概率是否相似，这与地区社会参与度有关。
我们分析了来自瑞典中部78个地区的9070名年龄在18至79岁之间的女性和6795名男性的横断面数据，这些人参与了2000年生活与健康调查，并采用了多水平逻辑回归分析（个体为第一水平，地区为第二水平）。
年龄较小、经济压力、自评健康状况较差以及对医疗保健系统信任度较低与初次服药不依从有关。然而，地区社会参与度与初次服药不依从无关，且各地区之间初次服药不依从的差异较小。
我们的结果表明，瑞典中部年龄较小、经济困难、自评健康状况较差且对医疗保健系统信任度较低的人初次服药不依从的概率可能更高。然而，以行政边界定义的居住地区在初次服药不依从方面似乎作用较小。
