 In 2014, NSAIDs were prescribed more than 100 million times per year in USA.  29 million adults (12.1%) were regular NSAIDs user in USA. 2

RenalGICVS 3

 Thailand has used painkillers more than 67 % of the population in the country.  More than 90% of GI bleeding cases were NSAIDs users. Information regarding NSAIDs used among Thai population is limited. 4

 This is a very first study that provided essential information for the current and reliable database of NSAIDs used in Thai population.  To improve the quality of patient health care services in the Thailand. 5

 To determine prevalence of regular NSAIDs used  To identify associated factors for regular NSAIDs used  To determine prevalence of adverse effects from NSAIDs used  To determine prevalence of alternative pain killer drugs 6

Inclusion criteriaExclusion criteria  Aged ≥18 years in Bann nayao Village No. 11, 15, 16, 18, 19, Sanam Chai Khet district, Chachoengsao Province, Thailand.  People who can not provide informed consent. Cross-sectional Study 7

 Face to face questionnaire  Questionnaire ◦ Approved by pharmacologists [IOC=1] ◦ Pilot was tested by 20 villagers ◦ Standardized test 8

Yes No NSAIDs user or Not ? Face to face questionnaire 9

Regular NSAIDs used NO YES Associated factors Age  Occupation Gender  Education Medical condition Provider Other factors Use NSAIDs at least 3 times per week more than 3 months Prevalence 10

n (%) Gender Male282 (36.6) Female489 (63.4) Age (yr) * 52.4±14.3 (18-99) < 60 yr521 (61.6) ≥ 60 yr247 (32.0) *Mean±SD(min-max) 12

Education Primary school581 (75.4) Higher than primary school134 (17.4) Uneducated56 (7.3) Income (Baht/month) <5, (51.1) ≥5, (48.9) n (%) *40 baht=1.00€ 13

Occupation Agriculture294 (38.1) Unemployed279 (36.2) Others198 (25.7) n(%) 14

Prevalence NSAIDs used 239(31.1%) Regular used 57(23.9%) Non – regular used 182(76.1%) 15

16 Alternative drugs n (%) Paracetamol490 (63.6) Multiple drugs92 (11.9) Muscle relaxants44 (5.7) Opioids23 (2.9)

Abdominal pain56 (23.4) Dyspepsia41 (17.2) Abdominal distention34 (14.2) Melena10 (4.2) Side effects n (%) 17

Non regular and non user Regular user Crude odds ratio p -value Adjusted odds ratio p-value n(%) 95%CI Income ≥5,000 Baht356(94.4)21(5.6)11 <5,000 Baht358(90.9)36(9.1) ( )( ) Pain at elbow No504(92.1)43(7.9)11 Yes24(80.0)6(20.2) ( )( ) *Final model of multivariate analysis adjusted for Sex, Age, Incomes, Chronic kidney diseases, Peptic ulcers, Gouts, Osteoarthritis, Antihypertensive drugs user, Herbal user, Both side shoulder joints pain, Right elbow joint pain, Right wrist joint pain, Neck pain, Midback pain, Abdominal pain, Upper thigh pain and Pain score 19

Non regular and non user Regular user Crude odds ratio p-value Adjusted odds ratio p-value n(%) 95%CI Pain at hip/thigh No399(93.2)29(6.8)11 Yes129(86.6)20(13.4) ( )( ) Increasing Pain score 5.81±(2.27)7.06±(2.11)1.28< ( )( ) *Final model of multivariate analysis adjusted for Sex, Age, Incomes, Chronic kidney diseases, Peptic ulcers, Gouts, Osteoarthritis, Antihypertensive drugs user, Herbal user, Both side shoulder joints pain, Right elbow joint pain, Right wrist joint pain, Neck pain, Midback pain, Abdominal pain, Upper thigh pain and Pain score 20

 The prevalence of regular NSAIDs used in rural community was 7.4%. ◦ Pain killers easily to assess ◦ Lack of awareness in adverse effects  In USA, prevalence of regular NSAIDs used in hospital-based setting was 12.1%. 21

In USA, the associated factors - Age - Occupation - Gender - Education - Medical conditions - Provider In USA, the associated factors - Age - Occupation - Gender - Education - Medical conditions - Provider In Thai rural community, the associated factors -Income (<5,000 baht, OR: 2.08, 95%CI: ) -Medical conditions -Pain at elbow (OR:3.19,95%CI: ) -Pain at hip and thigh (OR: 2.24, CI: ) -Pain score (OR:1.24, CI: ) In Thai rural community, the associated factors -Income (<5,000 baht, OR: 2.08, 95%CI: ) -Medical conditions -Pain at elbow (OR:3.19,95%CI: ) -Pain at hip and thigh (OR: 2.24, CI: ) -Pain score (OR:1.24, CI: ) 22

 The prevalence of NSAIDs used in our study was nearly 1/3.  The prevalence of regular NSAIDs used in a rural community was 7.4%  The associated factors of regular NSAIDs used were income, pain at elbow, pain at hip and thigh and increasing pain score. 23

 For the next study, this topic should be more widely covered in other communities.  Health care policy especially life-style modification should be a primary way before using drugs.  NSAIDs must be strictly prescribed according to the appropriateness.  Increase awareness of the situation and risk factors of the problem from NSAIDs used in rural society of Thailand 24

We gratefully acknowledge support for  Department of Military and Community Medicine  Department of Pharmacology  Department of Rheumatology, Medicine  Local village health volunteer Baan Na-Yao village and all participants for their help in this research 25

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