Prevalence, trends, patterns and associations of analgesic use in Germany

BMC Clinical Pharmacology

Hildtraud Knopf¹  Christa Scheidt-Nave¹  Angelika Schaffrath Rosario¹  Daniel Grams¹  Ingrid-Katharina Wolf¹  Wanli Zhuang¹  Amanda K. Buttery¹  Giselle Sarganas¹ 

[1] Robert Koch Institute, Department of Epidemiology and Health Monitoring, General-Pape-Str. 64, Berlin, 12101, Germany

关键词: Population based;    Over-the-counter;    Trends;    Prevalence;    Analgesic use;   

Others  :  1228271
DOI  :  10.1186/s40360-015-0028-7

 received in 2015-04-10, accepted in 2015-09-22,  发布年份 2015

【 摘 要 】

Background

Despite the public health relevance of analgesic use, large-scale studies on this topic in Germany are lacking. This study describes the prevalence, trends, associations and patterns of use of prescription and over-the-counter (OTC) analgesics, focusing on five of the most common agents: aspirin, diclofenac, ibuprofen, naproxen and paracetamol.

Methods

Data from two representative population-based surveys: The German National Health Interview and Examination Survey 1998 (GNHIES98 n = 7099) and the German Health Interview and Examination Survey for Adults 2008–2011 (DEGS1 n = 7091) was investigated. Information on all medicines consumed in the previous 7 days was collected via computer-assisted personal interviews with adults aged 18–79 years. Associations between analgesic use and socio-demographic and health-behaviour factors were analysed using logistic regression models.

Results

Analgesic use has increased over the last decade from 19 to 21 %. This was exclusively due to the rise in OTC analgesic use from 10.0 to 12.2 %. Prescribed analgesic use remained constant (7.9 %). Findings from DEGS1 indicate that ibuprofen is the most commonly used analgesic followed by aspirin and paracetamol. OTC analgesic use is higher among women and smokers, but lower among older adults (65–79 years). Prescribed analgesics use is higher among women, older adults, smokers and obese adults with medium or high socio- economic status. Adults performing more than 2 h/week of physical exercise use fewer analgesics.

Discussion

Among the adult population of Germany, the prevalence of OTC analgesic use has significantly increased over the last decade. We found differences between adults consuming OTC and prescribed analgesics (or both) concerning their health behaviour and health conditions. International direct comparison between prevalence rates of analgesic use was limited due to varying availability of analgesics between countries and to methodological differences.

Conclusions

About one in five community dwelling adults aged 18–79 years in Germany use analgesics in a given week. Considering the potential harms of analgesic use, monitoring of prevalence, patterns and determinants of use at the population level are important steps to inform disease prevention and health promotion policies.

【 授权许可】

   
2015 Sarganas et al.

【 图 表 】

Fig. 1.

【 参考文献 】

• [1]McGettigan P, Henry D. Use of Non-Steroidal Anti-Inflammatory Drugs That Elevate Cardiovascular Risk: An Examination of Sales and Essential Medicines Lists in Low-, Middle-, and High-Income Countries. PLoS Med. 2013; 10(2):e1001388.
• [2]Fosbøl EL, Gislason GH, Jacobsen S, Abildstrom SZ, Hansen ML, Schramm TK et al.. The pattern of use of non-steroidal anti-inflammatory drugs (NSAIDs) from 1997 to 2005: a nationwide study on 4.6 million people. Pharmacoepidemiol Drug Saf. 2008; 17(8):822-33.
• [3]Fendrick AM, Pan DE, Johnson GE. OTC analgesics and drug interactions: clinical implications. Osteopathic medicine and primary care. 2008; 2:2. BioMed Central Full Text
• [4]Roumie CL, Griffin MR. Over-the-counter analgesics in older adults: a call for improved labelling and consumer education. Drugs Aging. 2004; 21(8):485-98.
• [5]Freytag A, Quinzler R, Freitag M, Bickel H, Fuchs A, Hansen H et al.. Use and potential risks of over-the-counter analgesics. Schmerz. 2014; 28(2):175-82.
• [6]Lewinski D, Wind S, Belgardt C, Plate V, Behles C, Schweim HG. Prevalence and safety-relevance of drug-related problems in German community pharmacies. Pharmacoepidemiol Drug Saf. 2010; 19(2):141-9.
• [7]Vascular and upper gastrointestinal effects of non-steroidal anti-inflammatory drugs: meta-analyses of individual participant data from randomised trials. Lancet. 2013; 382(9894):769-79.
• [8]Petrolanu G, Mengel K. Intoxikationen und Drogenfälle (intoxication and drug cases). In: Ellinger, K., Genzwürker, H.: Kursbuch Notfallmedizin (text-book emergency medicine). 2. Auflage, 343–345. Deutscher Ärzte-Verlag; 2011. (ISBN 978-3-7691-0613-8):. http://www. lehmanns.de/shop/medizin-pharmazie/17225857-9783769106138-kursbuch-notfallmedizin webcite
• [9]Gunnel D, Hawton K, Murray V, Garnier R, Bismuth C, Fagg J et al.. Use of paracetamol for suicide and non-fatal poisoning in the UK and France: are restrictions on availability justified? J Epidemiol Community Health. 1997; 51:175-9.
• [10]Hawton K, Bergen H, Simkin S, Dodd S, Pocock P, Bernal W et al.. Long term effect of reduced pack sizes of paracetamol on poisoning deaths and liver transplant activity in England and Wales: interrupted time series analyses. BMJ. 2013; 346:f403.
• [11]Nourjah P, Ahmad SR, Karwoski C, Willy M. Estimates of acetaminophen (Paracetomal)-associated overdoses in the United States. Pharmacoepidemiol Drug Saf. 2006; 15(6):398-405.
• [12]aerzteblatt.de. Paracetamol: Ab zehn Gramm nur noch auf Rezept (paracetamol: from ten grams upwards only with prescription). http://www.aerzteblatt.de/nachrichten/35993/Paracetamol-Ab-zehn-Gramm-nur-noch-auf-Rezept. 27. March 2009.
• [13]der Arzneimittel-Hersteller B. Der Arzneimittelmarkt in Deutschland in Zahlen: Verordnungsmarkt und Selbstmedikation (The pharmaceutical market in Germany in figures: Prescription market and self-medication). BAH, Bonn; 2012.
• [14]Markets Ra. Analgesics Market in Germany to 2014 (OTC Healthcare) 2011. [30 Jan 2014]. Available from:. http://www. researchandmarkets.com/reports/1583700/analgesics_market_in_germany_to_2014_otc webcite
• [15]Scheidt-Nave C, Kamtsiuris P, Gosswald A, Holling H, Lange M, Busch MA et al.. German health interview and examination survey for adults (DEGS) - design, objectives and implementation of the first data collection wave. BMC Public Health. 2012; 12:730. BioMed Central Full Text
• [16]Gosswald A, Lange M, Kamtsiuris P, Kurth BM. DEGS: German Health Interview and Examination Survey for Adults. A nationwide cross-sectional and longitudinal study within the framework of health monitoring conducted by the Robert Koch Institute. Bundesgesundheitsbl. Gesundheitsforsch. Gesundheitsschutz. 2012; 55(6–7):775-80.
• [17]International Standard Classification of Education. UNESCO, Geneva, Switzerland; 1997.
• [18]Lampert T, Kroll LE, Von Der Lippe E, Müters S, Stolzenberg H. Socioeconomic status and health: Results of the German Health Interview and Examination Survey for Adults (DEGS1) [Sozioökonomischer Status und Gesundheit: Ergebnisse der Studie zur Gesundheit Erwachsener in Deutschland (DEGS1)]. Bundesgesundheitsbl Gesundheitsforsch Gesundheitsschutz. 2013; 56(5–6):814-21.
• [19]Krug S, Jordan S, Mensink GB, Muters S, Finger J, Lampert T. Physical activity: results of the German Health Interview and Examination Survey for Adults (DEGS1). Bundesgesundheitsbl. Gesundheitsforsch. Gesundheitsschutz. 2013; 56(5–6):765-71.
• [20]Bush K, Kivlahan DR, McDonell MB, Fihn SD, Bradley KA. for the Ambulatory Care Quality Improvement Project. The AUDIT Alcohol Consumption Questions (AUDIT-C): An Effective Brief Screening Test for Problem Drinking. Arch Intern Med. 1998; 158(16):1789-95.
• [21]Reinert DF, Allen JP. The Alcohol Use Disorders Identification Test: An Update of Research Findings. Alcohol Clin Exp Res. 2007; 31(2):185-99.
• [22]Kamtsiuris P, Lange M, Hoffmann R, Schaffrath Rosario A, Dahm S, Kuhnert R et al.. The first wave of the German Health Interview and Examination Survey for Adults (DEGS1): sample design, response, weighting and representativeness. Bundesgesundheitsbl. Gesundheitsforsch. Gesundheitsschutz. 2013; 56(5–6):620-30.
• [23]Kaufman DW, Kelly JP, Rosenberg L, Anderson TE, Mitchell AA. Recent patterns of medication use in the ambulatory adult population of the united states: The slone survey. JAMA. 2002; 287(3):337-44.
• [24]Duong M, Salvo F, Pariente A, Abouelfath A, Lassalle R, Droz C et al.. Usage patterns of ‘over-the-counter’ vs. prescription-strength nonsteroidal anti-inflammatory drugs in France. Br J Clin Pharmacol. 2014; 77(5):887-95.
• [25]Fosbol EL, Gislason GH, Jacobsen S, Folke F, Hansen ML, Schramm TK et al.. Risk of Myocardial Infarction and Death Associated With the Use of Nonsteroidal Anti-Inflammatory Drugs (NSAIDs) Among Healthy Individuals: A Nationwide Cohort Study. Clin Pharmacol Ther. 2009; 85(2):190-7.
• [26]American College of Preventive Medicine. Over-The-Counter Medications: Use In General And Special Populations, Therapeutic Errors, Misuse, Storage and Disposal 2011. [27th Jan 2014]. Available from:. www. acpm.org/resource/resmgr/timetools-files/otcmedsclinicalreference.pdf webcite
• [27]Fuchs J, Rabenberg M, Scheidt-Nave C. Prevalence of selected musculoskeletal conditions in Germany: results of the German Health Interview and Examination Survey for Adults (DEGS1). Bundesgesundheitsbl. Gesundheitsforsch. Gesundheitsschutz. 2013; 56(5–6):678-86.
• [28]Schjerning Olsen A-M, Fosbøl EL, Lindhardsen J, Folke F, Charlot M, Selmer C et al.. Duration of Treatment With Nonsteroidal Anti-Inflammatory Drugs and Impact on Risk of Death and Recurrent Myocardial Infarction in Patients With Prior Myocardial Infarction: A Nationwide Cohort Study. Circulation. 2011; 123(20):2226-35.
• [29]Wilcox CM, Cryer B, Triadafilopoulos G. Patterns of use and public perception of over-the-counter pain relievers: focus on nonsteroidal antiinflammatory drugs. J. Rheumatol. 2005; 32(11):2218-24.
• [30]Hudec R, Kriska M, Bozekova L, Foltan V. Comparison of NSAID consumption in Slovakia, Finland and Norway. Bratisl Lek Listy. 2008; 109(8):370-3.
• [31]Stosic R, Dunagan F, Palmer H, Fowler T, Adams I. Responsible self-medication: Perceived risks and benefits of over-the-counter analgesic use. Int J Pharm Pract. 2011; 19(4):236-45.
• [32]Petric M, Tasic L, Sukljevic S. Nonsteroidal anti-inflammatory drug usage and gastrointestinal outcomes in the Republic of Serbia. J. Pain Palliat. Care Pharmacother. 2009; 23(1):40-7.
• [33]Conaghan P. A turbulent decade for NSAIDs: update on current concepts of classification, epidemiology, comparative efficacy, and toxicity. Rheumatol Int. 2012; 32(6):1491-502.
• [34]Chan FK, Abraham NS, Scheiman JM, Laine L. Management of patients on nonsteroidal anti-inflammatory drugs: a clinical practice recommendation from the First International Working Party on Gastrointestinal and Cardiovascular Effects of Nonsteroidal Anti-inflammatory Drugs and Anti-platelet Agents. Am J Gastroenterol. 2008; 103(11):2908-18.
• [35]Gabriel SE, Jaakkimainen L, Bombardier C. Risk for serious gastrointestinal complications related to use of nonsteroidal anti-inflammatory drugs. A meta-analysis. Ann Intern Med. 1991; 115(10):787-96.
• [36]Biskupiak JE, Brixner DI, Howard K, Oderda GM. Gastrointestinal complications of over-the-counter nonsteroidal antiinflammatory drugs. J. Pain Palliat. Care Pharmacother. 2006; 20(3):7-14.
• [37]Helin-Salmivaara A, Virtanen A, Vesalainen R, Gronroos JM, Klaukka T, Idanpaan-Heikkila JE et al.. NSAID use and the risk of hospitalization for first myocardial infarction in the general population: a nationwide case–control study from Finland. Eur Heart J. 2006; 27(14):1657-63.
• [38]Schmiedl S, Rottenkolber M, Hasford J, Rottenkolber D, Farker K, Drewelow B et al.. Self-medication with over-the-counter and prescribed drugs causing adverse-drug-reaction-related hospital admissions: results of a prospective, long-term multi-centre study. Drug Saf. 2014; 37(4):225-35.
• [39]European Medicines Agency. Assessment report for diclofenac containing medicinal products (systemic formulations). 2013.
• [40]Gosswald A, Schienkiewitz A, Nowossadeck E, Busch MA. Prevalence of myocardial infarction and coronary heart disease in adults aged 40–79 years in Germany: results of the German Health Interview and Examination Survey for Adults (DEGS1). Bundesgesundheitsbl. Gesundheitsforsch. Gesundheitsschutz. 2013; 56(5–6):650-5.
• [41]Antonov KI, Isacson DG. Prescription and nonprescription analgesic use in Sweden. Ann Pharmacother. 1998; 32(4):485-94.
• [42]Cham E, Hall L, Ernst AA, Weiss SJ. Awareness and use of over-the-counter pain medications: a survey of emergency department patients. South Med J. 2002; 95(5):529-35.
• [43]Ozkan O, Hamzaoglu O, Erdine S, Balta E, Domac M. Use of analgesics in adults with pain complaints: prevalence and associated factors, Turkey. Rev Saude Publica. 2009; 43(1):140-6.
• [44]Paulose-Ram R, Hirsch R, Dillon C, Losonczy K, Cooper M, Ostchega Y. Prescription and non-prescription analgesic use among the US adult population: results from the third National Health and Nutrition Examination Survey (NHANES III). Pharmacoepidemiol Drug Saf. 2003; 12(4):315-26.
• [45]Turunen JH, Mantyselka PT, Kumpusalo EA, Ahonen RS. Frequent analgesic use at population level: prevalence and patterns of use. Pain. 2005; 115(3):374-81.
• [46]Hargreave M, Andersen TV, Nielsen A, Munk C, Liaw KL, Kjaer SK. Factors associated with a continuous regular analgesic use - a population-based study of more than 45,000 Danish women and men 18–45 years of age. Pharmacoepidemiol Drug Saf. 2010; 19(1):65-74.
• [47]Carrasco-Garrido P, de Andres AL, Barrera VH, Jimenez-Trujillo I, Fernandez-de-Las-Penas C, Palacios-Cena D et al.. Predictive factors of self-medicated analgesic use in Spanish adults: a cross-sectional national study. BMC Pharmacol Toxicol. 2014; 15:36. BioMed Central Full Text
• [48]Florou AN, Gkiozos IC, Tsagouli SK, Souliotis KN, Syrigos KN. Clinical significance of smoking cessation in subjects with cancer: a 30-year review. Respir Care. 2014; 59(12):1924-36.
• [49]Weingarten TN, Podduturu VR, Hooten WM, Thompson JM, Luedtke CA, Oh TH. Impact of tobacco use in patients presenting to a multidisciplinary outpatient treatment program for fibromyalgia. Clin J Pain. 2009; 25(1):39-43.
• [50]Toblin RL, Mack KA, Perveen G, Paulozzi LJ. A population-based survey of chronic pain and its treatment with prescription drugs. Pain. 2011; 152(6):1249-55.
• [51]Strine TW, Hootman JM, Chapman DP, Okoro CA, Balluz L. Health-related quality of life, health risk behaviors, and disability among adults with pain-related activity difficulty. Am J Public Health. 2005; 95(11):2042-8.
• [52]Delaney JA, Biggs ML, Kronmal RA, Psaty BM. Demographic, medical, and behavioral characteristics associated with over the counter non- steroidal anti- inflammatory drug use in a population- based cohort: Results from the Multi- Ethnic Study of Atherosclerosis. Pharmacoepidemiol Drug Saf. 2011; 20(1):83-9.
• [53]Knopf H, Grams D. Medication of adults in Germany: Results of the German Health Interview and Examination Survey for Adults (DEGS1). Bundesgesundheitsbl. Gesundheitsforsch. Gesundheitsschutz. 2013; 56:868-77.