Time Trends in Prevalence of Chronic Diseases and Multimorbidity Not Only due to Aging: Data from General Practices and Health Surveys.

Introduction: Chronic diseases and multimorbidity are common and expected to rise over the coming years. The objective of this study is to examine the time trend in the prevalence of chronic diseases and multimorbidity over the period 2001 till 2011 in the Netherlands, and the extent to which this can be ascribed to the aging of the population.

Methods: Monitoring study, using two data sources: 1) medical records of patients listed in a nationally representative network of general practices over the period 2002-2011, and 2) national health interview surveys over the period 2001-2011.

Inter-practice variation in polypharmacy prevalence amongst older patients in primary care.

Purpose: Complex medication management in older people with multiple chronic conditions can introduce practice variation in polypharmacy prevalence. This study aimed to determine the inter-practice variation in polypharmacy prevalence and examine how this variation was influenced by patient and practice characteristics.

Methods: This cohort study included 45,731 patients aged 55 years and older with at least one prescribed medication from 126 general practices that participated in NIVEL Primary Care Database in the Netherlands.

Effect of comprehensive oncogenetics training interventions for general practitioners, evaluated at multiple performance levels.

General practitioners (GPs) are increasingly called upon to identify patients at risk for hereditary cancers, and their genetic competencies need to be enhanced. This article gives an overview of a research project on how to build effective educational modules on genetics, assessed by randomized controlled trials (RCTs), reflecting the prioritized educational needs of primary care physicians. It also reports on an ongoing study to investigate long-term increase in genetic consultation skills (1-year follow-up) and interest in and satisfaction with a supportive website on genetics among GPs.

Mental health and health-care use of detainees in police custody.

Background: In many countries, forensic physicians function as primary care providers for detainees in police custody. Their task is comparable to the tasks of general practitioners. Nevertheless, problems presented by both patient populations may differ.

Multimorbidity of chronic diseases and health care utilization in general practice.

Background: Multimorbidity is common among ageing populations and it affects the demand for health services. The objective of this study was to examine the relationship between multimorbidity (i.e.

General practitioners' contribution to the management of community-acquired pneumonia in the Netherlands: a retrospective analysis of primary care, hospital, and national mortality databases with individual data linkage.

Background: Community-acquired pneumonia (CAP) is an important cause of hospital admission and death, but the extent of the problem of CAP at the primary healthcare level is largely unknown.

Aims: To investigate the contribution of general practitioners (GPs) to the management of patients with CAP in the Netherlands.

Methods: The study population consisted of all people enlisted in a GP network.

Health-care issues and health-care use among detainees in police custody.

Epidemiological research on the physical health status of police detainees is scarce. The present study fills this gap by first studying the somatic reasons for consultation (n = 4396) and related prescriptions (n = 4912) as assessed by the forensic medical service during police detainment. Secondly, a health interview survey was conducted among randomly selected police detainees (n = 264) to collect information regarding their recent disease history and use of health care.

Income inequalities in case death of ischaemic heart disease in the Netherlands: a national record-linked study.

Background: Socioeconomic inequalities in ischaemic heart disease (IHD) mortality have been found in most European countries, but it is unclear to what extent inequalities in survival, as opposed to incidence, contribute to these inequalities in mortality. The author studied income-related inequalities in short-term and long-term case death after first hospitalisation with acute myocardial infarction (AMI) and chronic ischaemic heart disease (CIHD), as well as inequalities in cardiovascular surgical procedures among patients admitted with IHD, in the Netherlands.

Design: A nationwide prospective cohort study of patients first admitted for IHD.

The contribution of educational inequalities to lifespan variation.

Background: Studies of socioeconomic inequalities in mortality consistently point to higher death rates in lower socioeconomic groups. Yet how these between-group differences relate to the total variation in mortality risk between individuals is unknown.

Methods: We used data assembled and harmonized as part of the Eurothine project, which includes census-based mortality data from 11 European countries.

Educational inequalities in blood pressure and cholesterol screening in nine European countries.

Background: To perform the first European overview of educational inequalities in the use of blood pressure and cholesterol screening.

Methods: Data were obtained on the use of screening services according to educational level from nationally representative cross-sectional surveys in Belgium, Czech Republic, Denmark, Estonia, Finland, Hungary, Italy, Latvia and Lithuania. Screening rates were examined in the preceding 12 months and 5 years, for respondents 35+ years (45+ for women).

Migrant mortality from diabetes mellitus across Europe: the importance of socio-economic change.

The first objective of this study was to determine and quantify variations in diabetes mortality by migrant status in different European countries. The second objective was to investigate the hypothesis that diabetes mortality is higher in migrant groups for whom the country of residence (COR) is more affluent than the country of birth (COB). We obtained mortality data from 7 European countries.

Inequalities in utilisation of general practitioner and specialist services in 9 European countries.

Background: The aim of this study is to describe the magnitude of educational inequalities in utilisation of general practitioner (GP) and specialist services in 9 European countries. In addition to West European countries, we have included 3 Eastern European countries: Hungary, Estonia and Latvia. To cover the gap in knowledge we pay a special attention to the magnitude of inequalities among patients with chronic conditions.

The impact of interventions to improve attendance in female cancer screening among lower socioeconomic groups: a review.

Objective: To review the scientific evidence on the effectiveness of interventions to promote attendance to breast and cervical cancer screening among lower socioeconomic groups.

Methods: We performed a computerized literature search looking for relevant papers published between 1997 and 2006. Papers were classified into three groups based on the type of intervention evaluated: (1) implementation of organized population screening programs; (2) different strategies of enhancing attendance within an organized program; (3) local interventions in disadvantaged populations.

Educational inequalities in avoidable mortality in Europe.

Background: The magnitude of educational inequalities in mortality avoidable by medical care in 16 European populations was compared, and the contribution of inequalities in avoidable mortality to educational inequalities in life expectancy in Europe was determined.

Methods: Mortality data were obtained for people aged 30-64 years. For each country, the association between level of education and avoidable mortality was measured with the use of regression-based inequality indexes.

Association between forgone care and household income among the elderly in five Western European countries - analyses based on survey data from the SHARE-study.

Background: Studies on the association between access to health care and household income have rarely included an assessment of 'forgone care', but this indicator could add to our understanding of the inverse care law. We hypothesize that reporting forgone care is more prevalent in low income groups.

Methods: The study is based on the 'Survey of Health, Ageing and Retirement in Europe (SHARE)', focusing on the non-institutionalized population aged 50 years or older.

[Socioeconomic inequalities in mortality in Europe].

In all European countries, the rates of death were higher in groups of lower socioeconomic status, but the magnitude of the inequalities between groups of higher and lower socioeconomic status was much larger in some countries than in others. Inequalities in mortality were small in some Southern European countries and very large in most countries in the eastern and Baltic regions. These variations among countries appeared to be attributable in part to causes of death related to smoking or alcohol use or amenable to medical intervention.

Educational inequalities in mortality in four Eastern European countries: divergence in trends during the post-communist transition from 1990 to 2000.

Background: Post-communist transition has had a huge impact on mortality in Eastern Europe. We examined how educational inequalities in mortality changed between 1990 and 2000 in Estonia, Lithuania, Poland and Hungary.

Methods: Cross-sectional data for the years around 1990 and 2000 were used.

Socioeconomic inequalities in health in 22 European countries.

Background: Comparisons among countries can help to identify opportunities for the reduction of inequalities in health. We compared the magnitude of inequalities in mortality and self-assessed health among 22 countries in all parts of Europe.

Methods: We obtained data on mortality according to education level and occupational class from census-based mortality studies.

Educational inequalities in cancer mortality differ greatly between countries around the Baltic Sea.

Objective: To compare educational inequalities in cancer mortality between Poland, Lithuania, Estonia, Finland and Sweden.

Methods: Data are either follow-up or unlinked cross-sectional studies. The relative index of inequality (RII) and the slope index of inequality (SII) are calculated to express the magnitude of mortality differences according to educational level for all cancers and for specific cancers.

Socioeconomic inequalities in alcohol related cancer mortality among men: to what extent do they differ between Western European populations?

We aim to study socioeconomic inequalities in alcohol related cancers mortality [upper aerodigestive tract (UADT) (oral cavity, pharynx, larynx, oesophagus and liver)] in men and to investigate whether the contribution of these cancers to socioeconomic inequalities in cancer mortality differs within Western Europe. We used longitudinal mortality datasets, including causes of death. Data were collected during the 1990s among men aged 30-74 years in 13 European populations [Madrid, the Basque region, Barcelona, Turin, Switzerland (German and Latin part), France, Belgium (Walloon and Flemish part, Brussels), Norway, Sweden, Finland].

Cancer mortality rates among first and second generation migrants in the Netherlands: Convergence toward the rates of the native Dutch population.

This study investigates the difference in cancer mortality rates between migrant groups and the native Dutch population, and determines the extent of convergence of cancer mortality rates according to migrants' generation, age at migration and duration of residence. Data were obtained from the national cause of death and population registries in the period 1995-2000. We used Poisson regression to compare the cancer mortality rates of migrants originating from Turkey, Morocco, Surinam, Netherlands Antilles and Aruba to the rates for the native Dutch.