Heavy users of non-steroidal anti-inflammatory drugs: a nationwide prescription database study in Finland

Objective. To describe characteristics of non-steroidal anti-inflammatory drugs (NSAIDs; Anatomical Therapeutic Chemical code M01A) users in Finland, with emphasis on intensity of use. Methods. Nationwide prescription database study over years 1997-2000 using a random sample of 500,000 persons. Low use was defined as 30 or fewer defined daily doses (DDDs) per year, moderate between 31 and 181 DDDs, and heavy 182 or more DDDs. Persons with rheumatoid arthritis (RA) were identified and analysed separately from non-RA patients. Results. The total NSAID consumption was 61.2 and reimbursed prescription NSAID use 31.2 DDD/1000 inhabitants per day in 2000. The annual prevalence of use varied between 17.1% and 18.8% throughout 1997-2000, and that of low, moderate and heavy use was 7.6%, 8.0% and 1.5%, respectively, in 2000. Females used more NSAIDs than men in all adult non-RA age groups, and of non-RA patients 58.4% were females. The share of females among the non-RA users increased with the intensity of use, as did the share of female patients 65 years or older. Among RA patients, the intensity of use was independent of age and gender, and 70% of RA patients were females. Of the heavy users in 2000, 27.7% (n=2117) had continuously used 182 or more DDDs per year throughout the years 1997-2000. Non-RA users accounted for 78.4% of the annual heavy and 64.2% of the continuous heavy users. Conclusions. Exposure of patients to long-term use of NSAIDs and upper gastrointestinal bleeding should be reduced by regular analysis of patient's pain and consideration of other treatment options.