Systemic glucocorticoid use in Denmark: a population-based prevalence study

Abstract

Objectives: Glucocorticoid (GC) use is widespread and associated with many adverse effects. Thus, it is important to ascertain GC utilisation patterns. In this study, we examined the annual prevalence of prescription users and amount of use of systemic GCs.

Design: Population-wide prevalence study.

Setting: The primary healthcare and hospital sectors in Denmark from 1999 to 2015.

Results: Approximately 3% of the Danish population redeemed at least one prescription for a systemic GC annually between 1999 and 2015, with annual prevalence remaining constant over the period. However, after adjusting for age and sex, we observed a decrease in annual prevalence from 1999 to 2015, with a prevalence ratio of 0.92 (95% CI 0.91 to 0.92). Annual prevalence was highest among the elderly (7.0%-8.2% among persons 65-79 years of age and 8.4%-10% among persons 80+ years of age). Prednisolone was the most frequently redeemed systemic GC, with annual prevalence increasing from 1.4% to 2.1% during the 1999-2015 period. The amount of systemic GCs provided to the hospital sector increased from 2.3 defined daily doses (DDD)/1000 inhabitants/day in 1999 to 3.5 DDD/1000 inhabitants/day in 2015, while the amount provided to the primary healthcare sector remained constant in the range of 10-11 DDD/1000 inhabitants/day.

Conclusion: We found a high prevalence of systemic GC use of 3% with a remarkably high prevalence in elderly of up to 10%, wherefore continued awareness of its effects is mandated.

Keywords: Denmark; Drug utilisation; Glucocorticoids; Prevalence.

Figure 1

Annual prevalence of systemic glucocorticoid (GC) prescription users in Denmark, 1999–2015, overall and stratified by generic type. All systemic GCs (red line), prednisolone (dark blue line), betamethasone (green line), prednisone (orange line), methylprednisolone (blue line), triamcinolone (dark green line), hydrocortisone (purple line), dexamethasone (light blue line).