Epidemiology of asthma drug use in children, adolescents and young adults in Norway

Background Asthma is one of the most common chronic diseases among children, adolescents and young adults. The use of drugs to treat asthma has not been widely investigated in the Norwegian population and there has been a lack of longitudinal data. Most studies have been conducted in confined age groups and geographic regions. The occurrence of additional health problems in the young population with asthma has important implications for the management of asthma and needs investigation. Asthma is a clinical diagnosis that is not easily captured in population-based studies and there is no agreement on a gold standard for measuring asthma in epidemiology. Prescription data on asthma drug use may be a useful proxy measure for identifying individuals with current asthma in the population. Objectives The main objectives of this thesis were to study issues related to asthma in the Norwegian population of children, adolescents and young adults. Three areas have been studied: Asthma drug use, asthma drug use as a proxy measure of asthma, and selected additional diseases and drug treatments occurring in individuals with asthma. Materials and methods This thesis rests on data from population-based databases and questionnaires: 1) The Norwegian Prescription Database, 2) The Norwegian Mother and Child cohort study questionnaire for seven years old participants, 3) The Youth Health Surveys in five counties, 4) The Population and Housing Census from 2001, and 5) The Central Population Register. Data on filled prescriptions from the Norwegian Prescription Database is the central source for information and provided the outcome variables in all papers of this thesis. Main findings Mother-reported use of asthma drugs in children had high validity, compared to prescription data of asthma drug use. Furthermore, the prescription data on asthma drugs corresponded well with maternal reports of current physician-diagnosed asthma, and few individuals with no reported asthma had filled prescriptions. Filled prescriptions were used as a proxy measure in the other papers in this thesis to identify individuals with current asthma in the study populations. The prevalence and incidence of asthma drug use in the Norwegian population 2-29 years old was highest in preschool children and lowest in young adults. Males had higher levels than females at a young age, but this changed from about 15 years of age to higher levels in females. The persistence to asthma drugs over time was relatively low, with less than half of asthma drug users receiving drugs in three consecutive years. The type of asthma drugs used varied substantially by age but not by gender, and there were indications of suboptimal pharmacotherapy. The occurrence of chronic diseases in individuals with asthma was assessed by utilizing diagnostic codes provided by physician on reimbursed prescriptions. Several diseases occurred more frequently in children, adolescents and young adults with asthma than in the Norwegian general population. A majority of the asthma population had one of the nine comorbid diseases examined, while few had more than one of the comorbidities. In another study, young adults with asthma were at an increased risk for initiating use of hypnotic drugs. The risk was highest among individuals who recently had received asthma drugs, indicating that they had currently active asthma disease. Conclusions The findings in this thesis indicate that prescription data may serve as a proxy for current asthma in the population. It is important to carefully consider the length of the capture period for prescription data and possible overlapping conditions treated with the same drugs in different age groups. The relatively low persistence to asthma drug use may reflect the variability of asthma within and between patients, and illustrate the challenges encountered in defining asthma in epidemiologic studies. Several diseases and drug treatments occurred more frequently in the asthma population. The presence of comorbidities may influence and complicate several aspects of asthma and both the causes and consequences of comorbidities need further investigation

Reseptregisteret 2009-2013 / The Norwegian prescription database 2009-2013

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Drug Use and Cancer Risk: A Drug-Wide Association Study (DWAS) in Norway*

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Reseptregisteret 2008-2012. The Norwegian prescription database 2008-2012

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Prevalence trends and individual patterns of ADHD medication use in pregnancy in Norway and Sweden, 2010–2019

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Psychotropic drug use among 0-17 year olds during 2004-2014: a nationwide prescription database study

This is an Open Access article licensed under the Creative Commons Attribution License 3.0 (CC BY 3.0) and originally published in BMC Psychiatry. You can access the article by following this link: http://dx.doi.org/10.1186/s12876-016-0446-zDette er en vitenskapelig, fagfellevurdert artikkel som opprinnelig ble publisert i BMC Psychiatry. Artikkelen er publisert under lisensen Creative Commons Attribution License 3.0 (CC BY 3.0). Du kan også få tilgang til artikkelen ved å følge denne lenken: http://dx.doi.org/10.1186/s12876-016-0446-zBackground Time-trend studies on psychotropic drugs among children and adolescents are scarce, and most of them are outdated. The purpose of this study was to study prevalences of psychotropic drug use during 2004–2014 among Norwegians aged <18 years, overall and in psychotropic sub-groups. Methods Data were obtained from the Norwegian Prescription Database, which covers all dispensed prescription drugs in Norway from 2004 and onwards. Psychotropic drugs included: antipsychotics (ATC-group N05A), anxiolytics (N05B), hypnotic/sedatives (N05C), antidepressants (N06A), stimulants (N06BA), and alimemazine (R06AD01). Period (1-year) prevalence of use, overall and in subgroups of psychotropic drugs, was estimated by identifying individuals <18 years who had at least one psychotropic drug dispensed during each year. Results Psychotropic drug use increased in 0–17 year olds over an 11-year period, in which the main contributing drugs were stimulants (boys overall; 15.0 to 20.8/1000, girls overall; 3.8 to 8.5/1000), hypnotic/sedative drugs in adolescents (boys overall; 4.2 to 10.8/1000, girls overall; 2.6 to 8.8/1000) and to some extent antidepressants among adolescent girls (girls overall from 3.1 to 4.0/1000). Psychotropic drug use was, however, reduced by half in the youngest children, attributed to reduction of alimemazine only (1-year olds: boys; from 36.6 to 10.2/1000, girls; 26.9 to 7.2/1000). A higher level of psychotropic drug use was observed among younger boys, but there is a shift towards girls using more psychotropic drugs than boys during adolescence for all psychotropic drugs except for stimulants. Conclusion Different trends in psychotropic drug use exist in age and gender subgroups. Psychotropic drug use has decreased among the youngest children, attributed to alimemazine, and increased in older children and adolescents, attributed mainly to stimulants and hypnotics/sedatives

Prevalence and treatment of gestational diabetes in Norway 2010–2020

Abstract Aims Estimate prevalence of gestational diabetes mellitus (GDM) and its treatment in Norway 2010–2020 and explore impact of new national GDM guidelines in 2017. Methods We identified women giving birth in a nationwide cohort study using registers on births, prescriptions, education, primary and specialist care. For each year, we estimated prevalence of GDM overall, by BMI, age, education, and mother’s birthplace; proportions of GDM pregnancies receiving pharmacological treatment; and distribution of the gestational week when GDM was diagnosed. Results In 633,169 pregnancies, prevalence of GDM increased from 2.6 % in 2010 to 6.0 % in 2016, then stabilized. Similar patterns were seen across strata of BMI, age, education, and maternal birthplace, although prevalence was higher with higher BMI, higher age, lower education, and mothers born in Asia, Africa, or Middle East. The proportion of the GDM population pharmacologically treated increased from 11.6 % in 2010 to 13.6 % in 2016 and 31.6 % in 2020. GDM was diagnosed in recommended gestational week 24–28 in 19 % versus 45 % of GDM pregnancies in 2010 and 2020, respectively. Conclusions Both the proportion diagnosed with GDM within recommended time of screening, and who received pharmacological treatment, increased substantially following new guidelines in 2017. Prevalence of GDM increased from 2010 to 2016, then plateaued.Prevalence and treatment of gestational diabetes in Norway 2010–2020publishedVersio