Browsing by Subject "yksinasuminen"

Non-adherence to drug therapy is a serious public health problem that increases the risk of disease and mortality. Despite long-term adherence to statins is a key element in preventing cardiovascular disease (CVD) and myocardial infarction (MI), previous studies have shown that the level of adherence drops already within the first six months of treatment. Risk factors for non-adherence are older age, comorbidities, being nonmarried and a lower socioeconomic position. Less is known about the role of living arrangements in non-adherence. The aim of this study is to provide new information on the association between living alone and non-adherence to statin drug therapy after MI, and analyze whether household income mediates or moderates the association. The analysis utilizes a register-based dataset consisting of an 11 % sample of the Finnish population with an 80 % oversample of people who died between 1988 and 2007. The study population included patients with first hospitalization for MI and at least one purchase of statins. Individuals are followed for five years after MI and censored at the time of emigration, moving to institutional care, a recurring MI or death. General estimating equations (GEE) method, an application of logistic regression for correlated data, is used to analyze the associations. All analyses are conducted separately for men and women and are adjusted for age and year of medicine purchase. Non-adherence to statin drug therapy increased over the first four years after MI, and a sharp increase occurred after the first three months of follow-up. Among men, the risk of non-adherence was higher for those living alone (odds ratio [OR] =1.24, 95% confidence interval [CI] 1.14–1.36) and those with lower incomes (OR=1.28, 95% CI 1.14-1.42 for lowest quintile). Adjustment for income somewhat attenuated the risk associated with living alone, while adjusting for education and labor market status had a negligible effect. Living alone predicted non-adherence similarly across all income groups among men. No statistically significant associations emerged among women. In conclusion, men living alone have a higher risk of being non-adherent compared to men living with others. Lack of spousal support and generally poorer health behaviors can be mechanisms behind the observed association. Health care professionals should pay special attention to men living alone to identify patients in high risk of non-adherence. By improving medication adherence, lives and unnecessary healthcare costs can be saved.

Aims Hospitalisations due to ambulatory care sensitive conditions (ACSCs) are hospitalisations which could have been prevented by primary care interventions. Hospitalisations due to ACSCs have been used to indirectly evaluate effectiveness and quality of primary care. Previous studies have shown that the risk is higher among those who live in low-income neighborhoods, have low education, live alone, are elderly and male. Present study examined the association between living alone and socioeconomic position with the risk of being hospitalised due to ACSCs among the elderly. Methods Data for the current study was obtained from the Hospital Discharge Register (HDR), which contained information of all hospitalisations due to ACSCs of men and women over 65 years who lived in Finland during 2013. Hospitalisation risk was calculated by using age-standardised rates per 100 000 person years. Standardisation was made by using direct method, with the 2013 population as a standard. Risk ratios for ACSC hospitalisation were examined by living conditions, education, age and gender and compared to each other in four groups. Results and conclusions Living alone and low socioeconomic position increased the risk of hospitalisations due to ACSCs among the elderly. Men who lived alone had higher relative risk (RR) than women who lived alone, those with basic education had higher relative risk than those with upper secondary or tertiary education. To decrease the number of hospitalisations due to ACSCs it is necessary to pay more attention to the risk of social isolation of the particularly vulnerable elderly who live alone, already in primary care.