Background In light of the opioid epidemic in the United States, there is growing concern about the use of opioids in Sweden as it may lead to misuse and overuse and, in turn, severe public health problems. However, little is known about the distribution of opioid use across different demographic and socioeconomic dimensions in the Swedish general population. Therefore, we applied an intersectional Multilevel Analysis of Individual Heterogeneity and Discriminatory Accuracy (MAIHDA), to obtain an improved mapping of the risk heterogeneity of and socioeconomic inequalities in opioid prescription receipt. Methods and findings Using data from 6,846,106 residents in Sweden aged 18 and above, we constructed 72 intersectional strata from combinations of gender, age, income, cohabitation status, and presence or absence of psychological distress. We modelled the absolute risk (AR) of opioid prescription receipt in a series of multilevel logistic regression models distinguishing between additive and interaction effects. By means of the Variance Partitioning Coefficient (VPC) and the area under the receiver operating characteristic curve (AUC), we quantified the discriminatory accuracy (DA) of the intersectional strata for discerning those who received opioid prescriptions from those who did not. The AR of opioid prescription receipt ranged from 2.77% (95% CI 2.69–2.86) among low-income men aged 18–34, living alone, without psychological distress, to 28.25% (95% CI 27.95–28.56) among medium-income women aged 65 and older, living alone, with psychological distress. In a model that conflated both additive and interaction effects, the intersectional strata had a fair DA for discerning opioid users from non-users (VPC = 13.2%, AUC = 0.68). However, in the model that decomposed total effects into additive and interaction effects, the VPC was very low (0.42%) indicating the existence of small interaction effects for a number of the intersectional strata. Conclusions The intersectional MAIHDA approach aligns with the aims of precision public health, through improving the evidence base for health policy by increasing understanding of both health inequalities and individual heterogeneity. This approach is particularly relevant for socioeconomically conditioned outcomes such as opioid prescription receipt. We have identified intersections of social position within the Swedish population at greater risk for opioid prescription receipt.

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To report trends and characteristics of post-prostate biopsy (PBx) infections, with regard to aetiology and resistance patterns, in a large unique cohort from a single-centre using the same antibiotic prophylactic regimens during a 15-year period. Patients and MethodsAn observational cross-sectional cohort study, including all patients who underwent transrectal ultrasonography-guided PBx (TRUS PBx) for the suspicion of prostate cancer at the Department of Urology, Sk ane University Hospital between 1 May 2003 and 31 December 2017. Positive blood and urinary cultures were considered markers of bloodstream infection (BSI) and urinary tract infection (UTI), respectively. For all patients, details regarding blood or urine cultures from the date of the TRUS PBx and 14 days onwards were retrieved. ResultsIn total, 8973 TRUS PBx procedures were performed in 6597 men during the study period. Over time, there was a trend towards a changing case-mix, with PBx procedures increasingly being performed in older patients, patients with lower prostate-specific antigen values, and higher prostate volumes. During the study period, the number of PBx procedures performed increased for each time period and we found an increasing rate of infectious complications in the last period. Overall, the rates of BSI and UTI with at least one relevant pathogen were 1% (88/8973) and 1.8% (159/8973), respectively. In total, 16 of 90 strains (18%) were extended spectrum beta-lactamases producing, with an increasing proportion over time. The proportion of ciprofloxacin-resistant pathogens did not increase over time. ConclusionDuring the 15 years of this study, BSI and UTI after TRUS PBx increased. The rise of infectious complications after TRUS PBx in this population is unlikely to be explained by quinolone-resistance, as ciprofloxacin-resistance did not increase in the blood and urinary samples obtained during the study period. Future longitudinal studies are warranted to investigate why infectious complications after TRUS PBx are increasing.