4377.0 - National Health Survey: Use of Medications, Australia, 1995
ARCHIVED ISSUE Released at 11:30 AM (CANBERRA TIME) 29/01/1999
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MEDICATION USE
Types of medication The most commonly used medications were pain relievers (24% of the population), medications for heart problems or blood pressure (11%), skin ointments and creams (10%), and medicines for coughs and colds (7%) (table 1). Types of medications largely reflected the illness or injury for which they were used (table 5). Of people who used medications for heart problems or blood pressure 75% did so for hypertension, and pain relievers were most commonly used for headaches (54%). The most common reasons for using skin ointments or creams were eczema and/or dermatitis (22%) and injuries (15%). Age and sex A higher proportion of females than males had recently used a medication (64% compared to 54% respectively) (table 1). This was more apparent in adults. The main differences between women and men were in the use of pain relievers (27% compared to 20%), and in the use of 'other medications' (22% compared to 14%). 'Other medications' includes oral contraceptives and medications for hormone replacement (see Glossary). The proportion of people who used medications increased with age, from 42% of those aged less than 15 years, to 86% of those aged 65 years and over (table 1). Types of medications used by persons differed across age groups, in part reflecting the changing prevalence of illnesses with age. For example, asthma medications and cough/cold preparations were more commonly taken by persons in the younger age groups, whereas stomach medications, fluid/diuretic medications, and medications for heart problems and blood pressure were more commonly used by persons in older age groups (table 1). The use of pain relievers was lowest among children aged 5-9 years (9%), down from 16% of infants and children under 5 years of age. Use was highest in the 35-39 year age group (32%), declining across older age groups to 19% of those aged 65 years or more. For persons up to the age of 44 years, 57% of those who had recently used medications used only one medication. In the 45-64 year age group, 41% of persons who used medications used only one medication and 40% used two or three. Of those aged 85 years and over who used medications, 17% used only one, 45% used two or three, and 38% used four or more.
States and Territories After standardisation for age and sex, the Northern Territory and Victoria recorded the lowest proportions of people using medications (54% and 56% respectively) and the Australian Capital Territory and Western Australia the highest (63% and 64% respectively) (table 2). People in Queensland were more likely to use vitamins and minerals than elsewhere in Australia (29%), and those in Western Australia and the Australian Capital Territory were most likely to use herbal and natural preparations (11%). Levels of use of different types of medication in States and Territories usually reflected the prevalence rates of illness. For example, consistent with a higher prevalence rate of asthma in Queensland, the proportion of people in Queensland (8%) using asthma medications was higher than elsewhere in Australia. Similar associations were evident in other States; for example, diabetes in South Australia, and allergies in the Australian Capital Territory 1. 1. National Health Survey: Summary Results, Australian States and Territories, 1995 (ABS Cat. No. 4368.0). PAIN RELIEVERS Demographic characteristics Pain relievers were the most common type of medication, being used by 27% of females and 20% of males. The proportion of both males and females using pain relievers was highest in the 25-44 year age group (table 1). Differences between male and female usage varied considerably across age groups. For children under 10 years, the proportion of boys and girls using pain relievers was similar. The difference widened to 13 percentage points for those aged 20-24 years as a result of the rapid increase in the use of pain relievers by young females.
After standardising for age and sex, use of pain relievers was highest among those in de facto relationships and those who were separated (both 33%). The lowest proportion using pain relievers was recorded by those widowed or never married (both 24%) (table 3). A higher proportion of people born in New Zealand and Other Oceania, and United Kingdom and Ireland, used pain relievers (both 27%) than those born in Australia (24%) or other regions. Those born in Asia reported the lowest (16%) (table 3). Lifestyle behaviours People who reported what could be considered less healthy lifestyles were more likely to use pain relievers than those who lived healthier lifestyles (table 4). This pattern was evident for each lifestyle behaviour covered in the survey-smoking, being obese, doing little or no exercise, and drinking alcohol-but differences were most marked for smoking and alcohol consumption. Pain relievers were used by 29% of smokers compared with 25% of those who had never smoked, and 31% of people consuming alcohol at a high risk level compared with 25% who did not drink alcohol. ANALGESICS For over 90% of people using pain relievers, the medication was classified to the generic group of analgesics. Other types of medications were also classified as analgesics. Consequently, of the 4.7 million people who had recently used analgesics, 83% used the medication as a pain reliever, 8% as a medication for heart problems or blood pressure, and 5% for asthma, cough/cold or allergy (see Appendix). Two main types of analgesics were identified:
Age and sex Of children under 15 who used an analgesic, 90% used preparations containing only paracetamol, with the proportion decreasing steadily to 38% of people aged 65 years and over. Conversely, use of products containing only aspirin increased with age from 4% of those aged less than 15 years to 59% of those aged 65 years and over (table 6). This pattern may be explained in part by the high proportion of those using aspirin only medications who reported diseases of the circulatory system as the reason for use 43%) (table 9). Aspirin is often advised for people who either suffer from, or as a preventative measure against, coronary heart disease. Aspirin has also been shown to be of benefit to those who suffer from certain vascular conditions such as atherosclerosis and arterial embolism. Patterns of use Most people (65%) using analgesics did not do so on the advice of a doctor or other health professional (table 7). However, the pattern differed according to the type of analgesic. Of those persons who used paracetamol combinations, most (61%) reported that their use had been advised by a health professional. In contrast, most of those who used paracetamol only or aspirin combinations, reported that their use was without medical advice (78% and 63% respectively). Nearly all (96%) persons using opioids did so on medical advice. Around 20% of people using analgesics used the medication regularly (table 8). Of those, 83% used analgesics every day and/or night and 92% had regularly used the medication for six months or more. The most common reasons for using analgesics were headaches (49% of persons using analgesics), diseases of the musculoskeletal system, principally arthritis and back problems (14%), respiratory conditions, mainly for colds and flu (12%) and circulatory conditions (10%) (table 9). TRANQUILLISERS, SEDATIVES AND SLEEPING MEDICATIONS The medications covered in this category are those classified by respondents as:
Demographic characteristics Almost 4% of the population had recently used a tranquilliser, sedative and/or sleeping medication. The proportion of people using medications in this category increased with age (table 1), from less than 1% of those less than 25 years to 10% of those aged 65 years or more. Females were more likely to use these types of medications than males, particularly medications for anxiety, nervous tension and depression. Use of these medications by persons differed by marital status and employment status (table 3). Based on age standardised data, proportions using these medications were higher among people who were widowed, divorced or separated than other groups. Among those aged 15-64 years, a higher proportion of people not in the labour force used these medications than employed or unemployed people (table 3). Self-assessed health status Persons who used tranquillisers, sedatives and sleeping medications were more likely to report poorer health than the population overall. For example, 30% of those aged 15 years or more who recently used these medications rated their health as fair, and 18% rated their health as poor, compared with 13% and 4% respectively for all persons 15 years or more. The difference was slightly higher among males than females.
For the majority (87%) of people who used tranquillisers, sedatives and/or sleeping medications, the medication was classified to the generic categories of psycholeptic medications including anti-psychotics, anxiolytics, hypnotics and sedatives, and anti-depressants. Approximately 684,000 people had recently used psycholeptic medications and anti-depressants. Of the 411,400 people who had recently used a psycholeptic medication, 47% reported it as a sleeping medication. Of those who had used anti-depressants, 63% had reported the medication as a tranquilliser or sedative (see Appendix). Patterns of use Almost everyone who used psycholeptic medications and anti-depressants did so on the advice of a health professional, mostly a General Practitioner or medical specialist (table 11). Similarly, nearly all people who used medications in these groups obtained them either by a prescription or from a doctor or hospital. Patterns of use differed by the types of medication used (table 12). Of people who used anti-depressants, 94% used them regularly and 91% used them daily. Of people who used anti-psychotics, 90% used them regularly and 87% used them daily. People were less likely to regularly use anxiolytics or hypnotics and sedatives (72% and 65% respectively). Long-term use was common for people using these medications; 63% of those using psycholeptic medications and 71% of those using anti-depressants had used them regularly for six months or more. Of those who used medications in the anti-psychotic group, 80% used them for mental disorders, with depression the most commonly reported condition from that group (table 13). A similar pattern was reported for anti-depressants. The most common reasons for using anxiolytics were nerves, tension and nervousness (41%) and insomnia (24%). Insomnia was also the most common reason for using hypnotics and sedatives. VITAMINS, MINERALS, HERBAL AND NATURAL PREPARATIONS Use of vitamins and mineral supplements has been widespread for many years, not only in relation to specific illness conditions, but also for the prevention of illness and the maintenance of good health. Use of herbal and natural preparations is also gaining in popularity as the trend towards alternative forms of medicine and health-related treatment continues.1, 2 In 1995, 26% of Australians had recently used vitamins or minerals (table 1), an increase from 23% in 1989-90. Additional information was collected in the 1995 NHS, showing that just under 10% of people had recently used herbal or natural preparations. 1. G.M. Shenfield, P.A. Atkin & S.S. Kristofferesen, 'Alternative medicine: an expanding health industry', Medical Journal of Australia, vol. 166 pp. 516-517, 1997. 2. P.A. Komesaroff, 'Use of complementary medicines: scientific and ethical issues', Medical Journal of Australia, vol. 169, pp. 180-181, 1998. Demographic characteristics Females were more likely than males to have used vitamins or mineral supplements, or herbal or natural preparations (table 1). Use was highest for both males and females aged 45-64 years (29% and 44% respectively). After standardising for age and sex, people who were separated or divorced were more likely to use vitamins and minerals than those who were married, widowed or never married. Differences by marital status were smaller for herbal or natural preparations (table 3). Unemployed persons were less likely to have used these types of medication (26%) than employed persons (34%) or those not in the labour force (32%). Use was highest among those born in United Kingdom and Ireland (36%), and lowest among those born in the Middle East (15%). Lifestyle behaviours People who led healthier lifestyles were generally more likely to have used vitamins and minerals than those who did not (table 4). This is consistent with the high use of these medications for preventive health purposes. The pattern of higher usage was evident for non-smokers, people who did some form of exercise and those who were not overweight. People who consumed alcohol at low or medium risk levels were more likely to use vitamins and minerals than those who did not consume, or consumed at high risk levels (table 3). The patterns of use of herbal and natural preparations were similar, but differences tended to be smaller. Reasons for use The most common reason for using vitamins and minerals was as a preventive measure. This reason was reported by 86% of males and 77% of females who used them (table 14). The most common illness for which vitamins and minerals were used was respiratory conditions (4%); common cold accounted for just over half (51%) of these. Fewer people used herbal and natural preparations for preventive reasons (63% of men and 55% of women) than vitamins and minerals. Herbal and natural preparations were more likely to be taken for specific conditions than were vitamins and minerals (41% compared with 18%, respectively). The main conditions for which herbal and natural preparations were used were respiratory conditions (10%), musculoskeletal disorders (7%) and digestive conditions (6%) (table 15). Self-assessed health status Of those aged 15 years or more using vitamins, minerals, herbal and natural preparations, the majority rated their health as very good or good, and only around 5% rated their health as poor (table 16). This was consistent with the finding that most people using these medications did so for preventive health purposes rather than specific conditions.
ANTIBIOTICS Antibiotics are the wide group of medications used in the treatment of infections caused by bacteria. Recently, concern has developed about the number of antibiotics that are prescribed for and used by the population, particularly in regard to use for conditions not caused by bacteria. Inappropriate use of antibiotics is considered the major contributing factor in the development of new bacteria which have become resistant to many current antibiotics.1 These new strains increase the risk to communities from conditions which may now be more difficult to cure or, in some cases, no longer treatable. The declining effectiveness of antibiotics has also been linked with their use in production of some foods.2 In the 1995 NHS, antibiotics were classified to the 'other medications' group which also included contraceptives, hormone therapies, vaccines and other medications not classified separately. This 'other medications' group was the second most commonly used type of medication. To enable analysis of antibiotics and other medications in this group, a sub-sample of one-quarter of the NHS records was recoded to a more detailed classification for analysis and presentation in this publication. The following discussion on use of antibiotics is based on analysis of 515 records of persons who had recently used antibiotics (see paragraphs 17 and 18 of Explanatory Notes). 1. John Turnidge, 'Antibiotic use or misuse?', Medical Journal of Australia, vol. 167, pp. 116-117, 1997. 2. NHMRC Working Party on Antibiotics, Emergence of Vancomycin Resistant Enterococci in Australia, Canberra, 1996. Age and sex Some 22% of people who used a medication originally coded to the 'other medications' category used an antibiotic, representing around 4% of the sub-sampled records. For both males and females, usage was lowest in the 45-64 year age group (under 3%) and highest for males aged less than 15 years and females aged 15-24 years (both 6%) (table 18). Health status The majority of people aged 15 years or more who used antibiotics assessed their health as very good or good (35% and 26% respectively) (table 19). Overall, the pattern of self-assessed health among persons who used antibiotics was similar to that of all those using medications. Types of antibiotic Most people (93%) who had recently used an antibiotic had used only one type (table 19). The most commonly used were penicillins (47%).
The most common reasons for using antibiotics across all age groups were respiratory conditions (43% of those using antibiotics) (table 19). Other common reasons varied by age. For those aged under 15 years, 27% used antibiotics for ear problems, in particular otitis media. Those aged 15-44 years reported problems of the skin and subcutaneous tissue as the second most common reason for using antibiotics (27% for those aged 15-24 years, 11% for those aged 25-44 years). Disorders of the digestive system (16%) and problems of the genitourinary system (11%) were common reasons for using antibiotics among those aged 45-64 years.
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