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Medication of Adults in Germany Results of the German Health Interview and Examination Survey for Adults (DEGS1)

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Medication of Adults in Germany Results of the German Health Interview and Examination Survey for Adults (DEGS1) Main topic English version of “Arzneimittelanwendung H. Knopf · D. Grams von Erwachsenen in Deutschland. Ergebnisse Department of Epidemiology and Health Monitoring, Robert Koch Institute, Berlin der Studie zur Gesundheit Erwachsener in Deutschland (DEGS1)” Bundesgesundheitsbl 2013 · 56:868–877 DOI 10.1007/s00103-013-1667-8 © Springer-Verlag Berlin Heidelberg 2013 Medication of adults in Germany Results of the German Health Interview and Examination Survey for Adults (DEGS1) Background and purpose users, they also result in unnecessary costs supplements in association with sociode- within the health system and for the in- mographic and socioeconomic parame- Medication is an essential pillar in the pre- dividuals. To estimate the use of medici- ters stratified by self-medication and pre- vention and therapy of illnesses. Detailed nal products, it is of decisive importance scribed medication. knowledge of medication at population to include the entire spectrum of drugs in level is indispensable for estimating mor- the observation. The data provided by the Materials and methods bidity and the related health care needs for health insurance funds can only reflect the population, and thus of great relevance the segment of medication prescribed by The German Health Interview and Exam- for public health [1]. Information on the a physician and reimbursed by the insur- ination Survey for Adults (“Studie zur Ge- use of medicine is also interesting in terms ance funds but information on prepara- sundheit Erwachsener in Deutschland”, of health economics. Roughly 17% of the tions used for self-medication cannot be DEGS) is part of the health monitoring expenditure of the statutory health insur- derived from this data. system at the Robert Koch Institute (RKI). ance funds went towards medication ther- A further restriction when assessing The concept and design of DEGS are de- apies in 2010 [2]. It should be noted that medication via prescription data is that scribed in detail elsewhere [14, 16, 17, 18]. in addition to the therapeutic effect, me- actual consumption cannot be derived The first wave (DEGS1) was conduct- dicinal products can also cause adverse ef- directly from the available data. Patient ed from 2008–2011 and comprised inter- fects which can impair or even endanger compliance with and adherence to the views, examinations and tests [19, 20]. The the health of users to a greater or lesser prescribed medication is decisive of what target population comprises the residents extent. In particular, the simultaneous use is actually consumed [11, 12, 13]. Against of Germany aged 18–79 years. DEGS1 has of several preparations can produce risks. this background, the medication data col- a mixed design which permits both cross- Studies have demonstrated the correlation lected in the first wave of the German sectional and longitudinal analyses. For between the number of preparations used Health Interview and Examination Sur- this purpose, a random sample from local and the risk of drug interactions as well as vey for Adults (DEGS1) proves to be suit- population registries was drawn to com- adverse drug reactions [3, 4, 5, 6]. In addi- able for filling information gaps on the use plete the participants of the German Na- tion to prescription drugs, over-the-coun- of drugs because it reflects all medicinal tional Health Interview and Examination ter (OTC) drugs acquired without a pre- products (prescribed and self-medicated) Survey 1998 (GNHIES98), who re-partic- scription are also used. According to in- as well as the extent and patterns of actu- ipated. There were 8,152 persons who par- formation provided by the pharmaceuti- al usage behaviour. Because of the linkage ticipated, including 4,193 first-time partic- cal manufacturers’ association “Bundes- of this data with health-relevant informa- ipants (response rate 42%) and 3,959 re- verband der Arzneimittelhersteller e. V.”, tion on living conditions and behaviour, visiting participants of GNHIES98 (re- people in Germany spent an average of it is also possible to provide a description sponse rate 62%). A total of 7,238 persons roughly 60 € per person on OTC prepa- of the determinants and profiles of med- attended one of the 180 examination cen- rations in 2010 [7]. The use of self-medi- icine use. tres, and 914 were interviewed only. The cation and dietary supplements on top of The objective of this study is to de- net sample (n=7,988) permits representa- prescribed medicinal products is proven scribe the prevalence and spectrum of tive cross-sectional and time trend analy- to increase the risk of drug interactions [8, medication among the adult population ses for the age range of 18–79 years in com- 9, 10]. Drug interactions may not only im- in Germany. The focus of this study is the parison with GNHIES98 (n=7,124). The pair the health and quality of life of drug evaluation of the use of drugs and dietary data of the revisiting participants can be Bundesgesundheitsblatt - Gesundheitsforschung - Gesundheitsschutz 5/6 · 2013 | 1 Main topic Tab. 1 Prevalence of medication use by sex, age and social status, DEGS1 2008–2011 Age Group n 18–29 years 30–39 years 40–49 years 50–59 years 60–69 years 70–79 years Total Sex Women 3,692 81.9% 78.1% 83.0% 83.9% 92.3% 96.3% 85.4% (95% CI) (77.6–85.6%) (72.8–82.5%) (79.4–86.0%) (80.9–86.6%) (88.5–94.9%) (93.8–97.8%) (83.9–86.9%) Men 3,400 41.2% 52.7% 58.8% 67.0% 85.4% 94.9% 63.8% (95% CI) (36.2–46.4%) (46.4–58.9%) (53.7–63.7%) (62.3–71.4%) (82.0–88.2%) (92.0–96.8%) (61.6–66.1%) Total 7,092 61.2% 65.2% 70.6% 75.5% 88.9% 95.7% 74.7% (95% CI) (57.4–64.9%) (60.9–69.2%) (67.3–73.7%) (72.6–78.1%) (86.4–91.0%) (94.0–96.9%) (73.3–76.0%) Social status Women Low 611 79.4% 65.7% 75.7% 85.8% 89.1% 93.2% 83.0% (95% CI) (70.3–86.3%) (45.4–81.6%) (63.8–84.5%) (76.1–91.9%) (76.9–95.2%) (85.7–96.9%) (78.8–86.4%) Medium 2283 84.1% 82.2% 85.1% 81.7% 93.3% 98.3% 86.9% (95% CI) (78.9–88.2%) (75.8–87.2%) (80.9–88.6%) (77.2–85.5%) (89.2–95.9%) (96.4–99.2%) (85.0–88.7%) High 774 80.0% 73.5% 81.1% 88.8% 94.0% 93.1% 83.5% (95% CI) (68.1–88.3%) (62.6–82.1%) (73.0–87.2%) (81.2–93.6%) (87.2–97.3%) (83.2–97.4%) (79.4–86.9%) Men Low 545 41.5% 60.3% 60.9% 65.1% 85.5% 95.8% 65.4% (95% CI) (32.0–51.7%) (44.9–73.9%) (47.8–72.6%) (54.7–74.3%) (76.0–91.7%) (87.9–98.6%) (60.8–69.8%) Medium 1919 40.9% 49.4% 57.2% 69.0% 84.9% 94.0% 62.7% (95% CI) (34.8–47.2%) (41.2–57.5%) (51.0–63.3%) (63.2–74.3%) (79.6–89.1%) (89.4–96.7%) (59.8–65.5%) High 896 41.6% 56.1% 63.0% 62.2% 86.4% 98.4% 66.1% (95% CI) (29.7–54.6%) (44.5–66.9%) (54.5–70.7%) (51.7–71.7%) (80.1–91.0%) (95.7–99.4%) (61.6–70.4%) used for longitudinal analyses. The cross- professional status and net household in- (NVS) are integrated into the data record- sectional and trend analyses are conduct- come (weighted by household needs), al- ing program (“Arzneimittel Erfassungs- ed with a weighting factor which corrects lowing for a classification into low, middle Datenbank”, AmEDa, Medication Record- deviations in the sample from the popu- and high status groups [21]. ing Database) [19]. The supplements da- lation structure (as of 31 Dec 2010) with Current medication intake is record- tabase enables the collection of informa- regard to age, sex, region and nationali- ed via a computer-assisted personal inter- tion on vitamin and mineral preparations ty, as well as community type and educa- view (CAPI) by an appropriately trained which are not authorised medicinal prod- tion [18]. A separate weighting factor was interviewer. In the letter of invitation, the ucts. The “Central Pharmaceutical Num- prepared for the examination part. Calcu- survey participants are asked to bring ber” (PZN) is scanned at the study centre, lation of the weighting factor also consid- with them all of the original packages of thereby automatically recording the name ered re-participation probability of GN- the medicines they have used in the last of the preparation, the “Anatomical Ther- HIES98 participants, based on a logistic 7 days prior to the examination date. With apeutic Chemical” (ATC) code, the in- regression model. A non-response analy- the question: “Have you taken any me- dication group, the dosage form and the sis and a comparison of selected indicators dicinal products or dietary supplements standard package size. If there is no PZN with data from census statistics indicate a within the last 7 days, such as vitamins or available, the brand name is documented. high level of representativity of the net minerals? Please don’t forget any painkill- In addition to this, the indication and ori- sample for the residential population aged ers, insulin preparations, medications is- gin (prescribed vs. self-medicated) are re- 18–79 years of Germany [18].
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