Merete Willemoes Nielsen

BACKGROUND: The use of natural medicines is widespread and increasing. In addition, natural medicine use is based primarily on individual's decisions without counseling from health professionals. Unlike with conventional medicines, it is not possible to evaluate sales statistics and prescription records to determine how much natural medicine is being used and by whom. Self-reporting is the only method available for investigating use of these products. OBJECTIVE: To investigate the use of natural medicines with respect to sociodemographic factors, health status, and conventional drug therapy in a general national population. METHODS: Data were derived from the Danish Health and Morbidity Survey 2000. A representative sample of the Danish population (N = 16 690%) was interviewed face-to-face. The association between use of natural medicines within the past 14 days and age, education, health status, and conventional medicine use was analyzed by logistic regression. All analyses were performed separately for each gender. RESULTS: Fourteen percent of the sample population had taken natural medicines within the past 14 days. Use was most prevalent among women and increased with age, but decreased again in the oldest age group (≥80 y). Respondents with poor health were the greatest consumers of natural medicines. Use was not associated with educational level and conventional drug therapy. Among conventional medicine users, 14% and 22% of men and women, respectively, used natural medicines. CONCLUSIONS: This study demonstrated that natural medicine use is common and widespread health behavior in all strata of the population and should not be regarded as an alternative to conventional medicine. Clinicians should ask patients about natural medicine use to avoid interactions with conventional drugs.

To assess whether the use of six main therapeutic groups was congruent with the occurrence of related diseases across educational groups. Two data sources were analysed: (i) Interview data from The Danish Health and Morbidity Survey 2000 on a representative sample of the Danish population ages 16 years and above (n = 16,690); (ii) Prescription records linked to a health survey on a representative sample of the population of Funen County 2000-2001 (n = 3,422). The use of six therapeutic main groups (ATC groups A, B, C, M, N and R) and related diseases in educational groups was analysed by indirect standardization. Age and gender standardized prevalence ratios (SPRs) and 95% confidence intervals were calculated on the basis of the total study population. In general, respondents in the two least educated groups used medicines more frequently and a higher proportion of them reported the related disease than could be expected from indirect standardization. The opposite picture appeared for respondents in the two highest educational groups (SPR < 100). The overall patterns were similar for the six medicine groups, although some of the SPRs were not significant. The results show the uneven distribution of disease in the general population. The distribution of medicine use generally followed this pattern, which means that those in the greatest medical need used the most medicine. Hence, individual co-payment for medicine did not seem to be a barrier to access to medicine in any of the educational groups.

To analyse whether the use of different groups of psychotropic medicines among educational groups in a general population was congruent with the occurrence of related diseases. Data from The Danish Health and Morbidity Survey 2000 were analysed. The survey was conducted by face-to-face interviews with a representative sample of the Danish population aged 16 years and above (n=16,690). The prevalence of four different types of psychotropic medicine use and related diseases in educational groups was analysed by indirect standardisation. Age and gender standardised prevalence ratios (SPRs) and 95% confidence intervals were calculated based on the total study population. In general, respondents in the two least-educated groups used psychotropic medicines more often and had a higher proportion reporting the related disease than could be expected according to indirect standardisation. The opposite picture appeared for respondents in the two highest educated groups (SPR<100). The overall patterns were similar for all four groups of psychotropic medicine users, although some of the SPRs were not significant. The results documented an uneven distribution of health problems in the general population. Psychotropic medicine use was congruent with the distribution of related health problems, which means that the least-educated groups in most need of treatment also had the most-frequent medicine use. Expenses incurred by the individual user did not seem to be a barrier to access to medicines, not even for specific groups of medicine ineligible for reimbursement in Denmark.