Nordic Prescription Registers Iceland Helga Zoga Epidemiology Mount

Nordic Prescription Registers Iceland Helga Zoëga Epidemiology Mount Sinai School of Medicine (University of Iceland)

Essential Demographics • Size of population – 318, 452 as of January 1 st 2011 • Detailed public statistics available at – http: //www. statice. is/

Relevant Host Institution • The Icelandic Directorate of Health [Landlæknisembættið] www. landlaeknir. is – Department of Health Statistics

Prescription Variables - what is covered (I)? • Data on all reimbursed and non-reimbursed prescription drugs dispensed to the outpatient population from January 1 st 2003. • Similar variables included as in the other Nordic prescription registers.

Prescription Variables - what is covered (II)? Drug User Variables Dispensing Variables Prescriber Variables Pharmacy Variables Personal id no. (encrypted) Date of dispensing Specialty of prescriber Location and name of dispensing pharmacy Age at dispensing date (and at end of year) Date of prescribing Prescriber practice code (encrypted) Sex Product code (Nordic article number Region of residence Product name ATC-code Dose unit, DDDs Number of dose units in package No. of prescription fills Reimbursement type, and whether or not reimbursed Reference price

Prescription Variables - what is not included? • Prescribed drug indications. • Dosing instructions.

Coverage of Prescription Database What is covered? What is not covered? • Prescription drug dispensing to • Drugs dispensed over the counter (OTC, nontotal outpatient population. prescriptions). • Idependent of income. • Dispensings within hospitals • All dispensed prescription and nursing facilities. drugs. • Some mechanical dose • Reimbursed and nondispensings before January 1 st reimbursed drug prescriptions. 2006.

Available Data on Hospitalisation and Other Variables • In-Patient Registry – Data on hospitalizations available from 1999. • Other relevent registers? – National Population Registry (residency, migration, birthdate, marital satus, etc. ) – Medical Birth Register (1981) – Cancer Registry (1955) – Monica Heart Disease Register (1981, selected pop. ) – Cause of Death Registry (1911/1950) – Database on Standardized Scholastic Testing for Children (1990´s)

Procedures for Linkage • Ethical approvals needed from – – National Bioethics Committee Data Protection Authority Directorate of Health (pre-approval statement) Institution holding relevant linkage data (pre-approval statement) • In most cases linkage, decryption and re-encryption will take place at the Directorate of Health according to procedures specified by the Data Protection Authority.

Practicalitities Whom to approach – Directorate of Health www. landlaeknir. is – Regarding access to Icelandic Medicines Registry and most other health registers. Ethical Approvals: Yes, many! – National Bioethics Committee www. visindasidanefnd. is – Data Protection Authority www. personuvernd. is – Relevant data hosting institute (Directorate of Health, Cancer Institute, Statistics Iceland, etc. ) www. landlaeknir. is Can data be transferred? – Yes, with all required ethical approvals and according to procedures specified by the Data Protection Authority. Costs – Until now payment has not been required but may change. Time – A few months normally

Examples of Papers • Zoëga H, Rothman KJ, Huybrechts. KF, Ólafsson Ö, Baldursson G, Almarsdóttir AB, Jónsdóttir S, Halldórsson M, Hernández-Diaz S, Valdimarsdóttir UA. Stimulant Drug Treatment for ADHD and Academic Progress in Children. Submitted, Sep 2011. • Carlsen HK, Zoëga H, Valdimarsdóttir U, Gislason Th, Hrafnkelsson B. Hydrogen sulfide and particle matter levels associated with increased dispensing of anti-asthma drugs in Iceland's capital. Submitted, Sep 2011. • Zoëga H, Furu K, Halldórsson M, Thomsen PH, Sourander A, Martikainen JE. Use of ADHD drugs in the Nordic countries: a population-based comparison study. Acta Psychiatr Scand. 2011 May; 123(5): 360 -7. doi: 10. 1111/j. 1600 -0447. 2010. 01607. x. Epub 2010 Sep 23. • Gudbjornsson B, Thorsteinsson SB, Sigvaldason H, Einarsdottir R, Johannsson M, Zoega H, Halldorsson M, Thorgeirsson G. Rofecoxib, but not celecoxib, increases the risk of thromboembolic cardiovascular events in young adults-a nationwide registry-based study. Eur J Clin Pharmacol. 2010 Jun; 66(6): 619 -25. Epub 2010 Feb 16. • Zoëga H, Baldursson G, Hrafnkelsson B, Almarsdóttir AB, Valdimarsdóttir U, Halldórsson M. Psychotropic drug use among Icelandic children: a nationwide population-based study. J Child Adolesc Psychopharmacol. 2009 Dec; 19(6): 757 -64. • Samuelsson O, Zoega H, Gudmundsson A, Halldorsson M. [Prevalence of psychotropic drug use among elderly Icelanders living at home]. Laeknabladid. 2009 Jan; 95(1): 11 -7. Icelandic. • Zoëga H, Baldursson G, Halldórsson M. [Use of methylphenidate among children in Iceland 19892006]. Laeknabladid. 2007 Dec; 93(12): 825 -32. Icelandic.