Changes in prevalence of and prescribing for ischaemic heart disease in Ireland 1990-2002.

BACKGROUND: Secondary prevention therapies, such as angiotension converting enzyme (ACE) inhibitors, beta-blockers and statins, are known to reduce cardiovascular morbidity and mortality. OBJECTIVE: The aim of the study was to examine the prevalence of coronary heart disease (CHD) and the prescribing of secondary preventive therapies in the period 1990-2002. METHODS: The General Medical Services prescription database was used to identify the study cohort, those with CHD, in each year 1990-2002. CHD was defined in two ways: prescription of any nitrate, and co-prescription of nitrate and aspirin. In addition, co-prescription of secondary preventive agents including statins, ACE inhibitors and beta blockers were examined. RESULTS: We found a significant increasing prevalence of CHD from 1990 to 2002 in both men and women. There was a significant increase (p < 0.0001) in the prescribing rate for beta blockers, ACE inhibitors, and for statins, buta significant decrease (p < 0.0001) for calcium channel blockers. CONCLUSION: These trends reflect the growing evidence base on the effectiveness of secondary preventive therapies, and the implementation of the National Cardiovascular Health Strategy.

Changing trend in congenital abdominal wall defects in eastern region of Ireland.

In the past six years, there have been reports from abroad of an unexplained rise in the birth prevalence rate of the congenital abdominal wall defect gastroschisis, while rates for the macroscopically similar anomaly omphalocoele have remained stable. The Dublin EUROCAT Registry of congenital anomalies monitors trends in the birth prevalence of birth defects in the eastern region of Ireland. We analysed births of children with omphalocoele and gastroschisis born in the period 1981-2000, with comparisons of a number of demographic and obstetric variables. During the 20 year period the birth prevalence rate for omphalocoele remained stable at 2.5/10,000 births, whereas the rate for gastroschisis increased significantly during the 1990s from 1.0/10,000 in 1991 to 4.9/10,000 in 2000. Most of the increase occurred among mothers under 25 years of age. Omphalocoele was associated with a relatively high proportion of other major congenital anomalies. This study showed that there has been an unexpected rise in the birth prevalence of gastroschisis in the region, similar to that experienced in other countries in the same time period and likely to have common aetiological features.

East Ireland 1980-1994: epidemiology of neural tube defects.

STUDY OBJECTIVE: The objective of the study was to describe the epidemiology of neural tube defects (NTD) in the eastern region of Ireland using the EUROCAT register of congenital malformations. DESIGN, SETTING AND PATIENTS: EUROCAT registries monitor the prevalence of congenital anomalies in defined populations using multiple sources for case ascertainment. All cases of NTD on the Dublin EUROCAT register born between 1980 and 1994 were extracted and analysed. The crude birth prevalence rate for all NTD, spina bifida, anencephaly and encephalocoele were calculated for each year. Parameters measured were: sex ratio, stillbirth rate, proportion of low birth-weight babies (< 2500 g) and the proportion who were premature (< 37 weeks gestation). MAIN RESULTS: Of 821 NTD cases, 419 (51.0%) had spina bifida, 322 (39.2%) had anencephaly, 69 (8.4%) had encephalocoele and 11 (1.3%) were iniencephalic. The crude birth prevalence of NTD decreased fourfold from 46.9/10,000 births in 1980 to 11.6/10,000 in 1994. The downward trend ceased during the early 1990's. Younger mothers had significantly higher rates of NTD affected births. Twenty two per cent of NTD cases had additional non-central nervous system anomalies. In 40 cases, there was a previous family history of NTD in siblings. Seasonal effects in birth prevalence were observed. Birth notification was the most frequent mechanism of ascertainment. CONCLUSION: There was a marked fall in the birth prevalence of NTD during the 15 year period. This change was real and not accounted for by pre-natal screening and diagnostic practises with termination of pregnancy, which is not legally permissible in Ireland. Dietary factors may have had an influence. Rates of NTD in this region are still higher than many other parts of Europe. Primary prevention strategies through increased folic acid intake are necessary to further reduce NTD affected births.

The standardized prescribing ratio--a new method for comparing prescribing between GPs, controlling for patient age and sex.

OBJECTIVES: To develop a method for comparing the proportion of patients on any drug or group of drugs for individual GP patient panels in Ireland, taking account of the age and sex structure of the panel. DESIGN: Calculations based on prescribing data for the fourth-quarter of 1995 supplied by the Irish General Medical Services Payments Board for the Eastern Health Board area.Setting-Five hundred and fifty Irish general practices serving 355,000 persons entitled to free medical care under the General Medical Services Scheme in the Eastern Health Board area (28% of the population). MAIN OUTCOME MEASURES: Weightings for number of persons prescribed each of four drug groups, and all drugs combined, for 22 age/sex groupings, leading to a single age/sex adjusted prescribing index-the standardized prescribing ratio (SPR) for each GPs practice population. RESULTS: The SPRs showed a large amount of variation from the average figure of 100 for practices of 1000 or more patients for all drugs and for each of the four drug groups studied: all drugs 54-125, antibiotics 52-165, H(2) antagonists/proton pump inhibitors 38-197, antidepressants 13-213 and thyroxine 33-175. Practices with above average SPRs for all drugs, antibiotics and H(2) antagonists/proton pump inhibitors were significantly larger than those with below-average SPRs. Practices with below average SPRs for thyroxine were significantly larger than those with above-average SPRs. CONCLUSIONS: The SPR provides a useful age/sex adjusted method of comparing prescribing between GPs and it can be applied to any drug or group of drugs.

The epidemiology of Down syndrome in four counties in Ireland 1981-1990.

BACKGROUND: We conducted a descriptive epidemiological study of Down syndrome (DS) in the four Irish counties (Dublin, Kildare, Wicklow and Galway) covered by EUROCAT registries of congenital malformations for the years 1981-1990. METHODS: EUROCAT registries, which cover defined populations, use multiple sources for case ascertainment. All DS cases born between 1 January 1981 and 31 December 1990 to mothers resident in the four counties were identified. Crude birth prevalence rates and maternal age-standardized rates (SPRs) were calculated for each county and for each year in the study period. The prevalence of DS by maternal age grouped in five-year periods and the risk for each five-year group were also estimated. RESULTS: The crude birth prevalence for the four counties was 18.5/10 000 for all births and 18.3 for live births. There was a fall in the total number of DS births over the decade, but less change in the crude birth prevalence owing to an increase in the proportion of mothers aged 35+. Galway had the highest crude birth prevalence of DS (23.5/10 000) but the SPR was within average for the four counties as a whole - 110.3, 95 per cent confidence interval (CI) 86.7-139. The risk of having a DS child increased 70-fold from 1:1841 at age 15-19 to 1:26 at 45 years or older. Nearly half of all DS cases (47.4 per cent) had at least one additional anomaly. CONCLUSIONS: The parts of Ireland covered by EUROCAT have a high birth prevalence of DS births as compared with some other countries, but the maternal age-specific rates are not substantially different from those in large international studies.

Small area analysis of low birth weight.

Birthweight is a broad indicator of health and socio-economic development in a population. This study was designed to examine small area patterns in the incidence of low birthweight in Dublin for the years 1986-89 and to explore the relationship between low birthweight and socio-economic factors. A number of district electoral divisions with a significantly raised incidence of low birthweight were identified. These were mainly in areas with a high proportion of local authority housing. There was significant positive correlation between the incidence of low birthweight and male unemployment, percentage of population in social classes 5 & 6 and proportion of population covered by medical cards, and a significant negative correlation with percentage of population in social classes 1 & 2 and number of cars per house. Forward stepwise multiple regression showed that the proportion of population covered by medical cards was the best predictor of low birthweight, but it only explained 22% of the total variance. These findings are consistent with previous work published in the international literature and provide evidence of an association between socioeconomic disadvantage and poor health in Dublin.

Small area mortality patterns.

Little information on the health of populations living in small geographic areas of Ireland is available and it is therefore difficult to clearly identify small communities whose health is significantly below average. The aim of this study was to identify areas within Dublin having above average death rates by application of the technique of small area analysis. By using mortality and census data and by calculating standardised mortality ratios, a number of electoral wards/district electoral divisions in Dublin with significantly elevated mortality rates from all causes and from specific disease groups were identified. In general these were in inner city areas and new suburbs to the north and west of the city. A considerable proportion of the excess mortality can be attributed to conditions amenable to preventive measures. Before specific intervention is attempted, local investigation by Directors of Community Care/Medical Officers of Health will be necessary in order to confirm the findings and to identify factors which may be amenable to prevention. If intervention is attempted it should be carefully planned and should be implemented on a pilot basis initially.

The epidemiological information system.

Increasing demand for health care services coupled with limited resources require that services should be planned and delivered on the basis of a priority of needs. The Eastern Health Board is developing an Epidemiological Information System in order to measure such needs. The system will bring together computerized health data from diverse sources into an integrated information system and powerful software will be used to analyse and map the data on a small area basis. Pilot work suggests that this approach can be useful in identifying areas of greater need.