Drug trends among non-institutionalized Canadians and the impact of data collection changes in the Canadian Health Measures Survey 2007 to 2015

Abstract

Background There is a global trend of increasing use in prescription and over-the-counter (OTC) drugs. This hasn’t been verified in Canada. In addition, there are changes made to the collection method of medication information after the Canadian Health Measures Survey (CHMS) cycle 2. This study aims to review the potential impact of the changes in medication data collection and the trends in medication use if data quality remains similar throughout the CHMS cycles 1 to 4. This is fundamental for the analysis of this biomonitoring database. Methods The CHMS cycle 1 to 4 medication and household data were used to study the trends of medication use between 2007 and 2015. The use of prescription or OTC drugs was grouped based on the first levels of the Anatomical Therapeutic Chemical (ATC) Classification system. The total numbers of medications were asked in all cycles. However, only a maximum of 15 and 5 drugs could be respectively reported for existing and new prescription or OTC drugs in cycles 1 and 2. There were no restrictions on drug reporting after cycle 2. The trends of medication use were described as ratios, compared to cycle 1. Results The total numbers of the types of medication ever identified decreased from 739 to 603 between cycles 1 and 4. The proportions of using any drugs were from 0.90 to 0.88 between cycles 1 and 4 (ratio = 1.08 in cycle 4, 95% CI = 0.89 to 1.26). The numbers of drugs in use were from 3.9 to 3.8 (ratio = 1.05 in cycle 4, 95% CI = 0.86 to 1.24). The proportions of prescription drug use were from 0.53 to 0.55 (ratio = 1.13 in cycle 4, 95% CI = 0.89 to 1.37), while the numbers of prescription were from 1.51 to 1.68 (ratio = 1.20 in cycle 4, 95% CI = 0.92 to 1.48). The use of diabetes and thyroid medication had trends similar to the respective disease prevalence. The use and the numbers of drugs for blood and blood forming organs significantly increased between cycles 1 and 4 (ratio = 1.56 in cycle 4, 95% CI = 1.03 to 2.10). Conclusions There is an increasing trend in the use of blood and blood forming agents through cycles 2 to 4 and cardiovascular drugs in cycle 3. For diabetes and thyroid medication, the proportions of medication use increase proportionally with disease prevalence. The changes in the medication information collection method may not have important impact on the reporting of the use of prescription or OTC drugs.

Opportunities and Challenges From Leading Trends in a Biomonitoring Project: Canadian Health Measures Survey 2007–2017

“…The leading increasing or decreasing trends we identified have not been well-studied by researchers or CHMS administrators to our knowledge. Although there are a large number of variables collected in the CHMS, the number of variables in the CHMS remains manageable because efficient tools for trend analysis have been developed (8,25). We urge the CHMS administrators to introduce these tools and release the latest trends of all environmental chemicals and biomarkers.…”

“…Third, the immediate implementation of a trend analysis of the CHMS data has several benefits. Trend analysis is a tool that can be used to identify some of the data errors (8,25). Inconsistency in the measurement unit of fibrinogen, g/L and g/dL, is related to a 10-fold change that is much higher than the rate increases of any other variables and can be easily identified with trend analysis (personal communications with Statistics Canada).…”

“…Given the same amount of chemicals, larger distributional volumes can lead to lower concentrations in human bodies (24), and BMI is an important indicator of obesity. Obesity is becoming more prevalent and has emerged as one of the major issues in public health (8,25). It is not clear whether obesity and BMI increases may play a role in the increases or decreases of biomarker trends.…”

Trends in Diabetes Biomarkers and Treatment Statuses of Non-Institutionalized Canadians: Canadian Health Measures Survey 2007 to 2015

“…[13] Detailed inclusion and exclusion criteria and sampling frames were published elsewhere. [13][14][15][16] Participants in the CHMS were interviewed regarding their health conditions and individual characteristics. [13,17] Mobile units collected blood and urine samples to determine levels of disease biomarkers and environmental chemicals.…”

Medication Management Frameworks in the Context of Self-Management: A Scoping Review

“…The use of medication, prescribed and unprescribed, is common for the management of both acute and chronic health conditions, as well as for the maintenance of overall health. 1,2 There is a high prevalence of prescription medication use worldwide, with some countries reporting an increase in medication use over the last 20 years. [3][4][5] Among individuals taking medication, there is a large portion who are taking multiple medications (ie, polypharmacy).…”