title: Individual characteristics, area social participation, and primary non-concordance with medication: a multilevel analysis.
abstract: BACKGROUND
  Non-concordance with medication remains a major public health problem that imposes a considerable financial burden on the health care system, and there is still a need for studies on correlates of non-concordance. Our first aim is to analyse whether any of the individual characteristics age, educational level, financial strain, self-rated health, social participation, and trust in the health care system are associated with primary non-concordance with medication. Our second aim is to investigate whether people living in the same area have similar probability of primary non-concordance with medication, that relates to area social participation.
  
  
  METHODS
  We analysed cross sectional data from 9,070 women and 6,795 men aged 18 to 79 years, living in 78 areas in central Sweden, who participated in the Life & Health year 2000 survey, with multilevel logistic regression (individuals at the first level and areas at the second level).
  
  
  RESULTS
  Younger age, financial strain, low self-rated health, and low trust in the health care system were associated with primary non-concordance with medication. However, area social participation was not related to primary non-concordance, and the variation in primary non-concordance between the areas was small.
  
  
  CONCLUSIONS
  Our results indicate that people in central Sweden with younger age, financial difficulties, low self-rated health, and low trust in the health care system may have a higher probability of primary non-concordance with medication. However, the area of residence--as defined by administrative boundaries--seems to play a minor role for primary non-concordance.
authors.affiliation: Centre for Family Medicine, Karolinska Institutet, Stockholm, Sweden. Kristina.Johnell@ki.se
authors.forename: Kristina
authors.initials: K
authors.lastname: Johnell
authors.forename: Martin
authors.initials: M
authors.lastname: Lindström
authors.forename: Jan
authors.initials: J
authors.lastname: Sundquist
authors.forename: Charli
authors.initials: C
authors.lastname: Eriksson
authors.forename: Juan
authors.initials: J
authors.lastname: Merlo
mesh_terms: D000293:Adolescent; D000328:Adult; D000367:Age Factors; D000368:Aged; D003430:Cross-Sectional Studies; D003695:Delivery of Health Care; D005260:Female; D006801:Humans; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D010349:Patient Compliance / Q000523:psychology* / Q000706:statistics & numerical data; D012646:Self Administration / Q000523:psychology* / Q000706:statistics & numerical data; D012944:Social Support; D012959:Socioeconomic Factors; D013548:Sweden; D035502:Trust