Prevalence of Non-Steroidal Anti-Inflammatory Drugs (NSAIDs) Use in Malaysian Adults and Associated Factors: A Population-Based Survey

Introduction

Non-steroidal anti-inflammatory drugs (NSAIDs) are among the most widely used medications globally, valued for their analgesic, anti-inflammatory, and antipyretic properties. Available both by prescription and over the counter, NSAIDs are commonly used for the management of pain conditions including arthritis, musculoskeletal disorders, headache, and dysmenorrhoea. However, chronic or inappropriate use of NSAIDs is associated with significant adverse effects including gastrointestinal bleeding, cardiovascular events, renal impairment, and drug interactions.

Understanding the patterns and determinants of NSAIDs use at the population level is essential for informing public health strategies aimed at promoting safe medication practices. This study, published in the Malaysian Journal of Public Health Medicine, analysed data from the National Health Morbidity Survey (NHMS) 2011 — a nationwide, population-based survey — to determine the prevalence of NSAIDs use among Malaysian adults and identify the socio-demographic and clinical factors associated with use.

Study Design and Data Source

The study utilised data from the NHMS 2011, a cross-sectional, nationwide survey conducted by the Institute for Public Health, Ministry of Health Malaysia. The NHMS employs a two-stage stratified random sampling design to produce nationally representative estimates. A total of 18,231 respondents aged 18 years and above provided data on NSAIDs use, defined as the reported use of non-steroidal anti-inflammatory medications (excluding paracetamol and aspirin) within the preceding six months. The survey collected information on frequency of use, socio-demographic characteristics, and self-reported chronic disease diagnoses. Multivariate logistic regression was used to identify factors independently associated with NSAIDs use.

Prevalence of NSAIDs Use

The overall prevalence of NSAIDs use among Malaysian adults was 14.2% (95% CI: 13.3–15.1). Among those who reported using NSAIDs, 4.2% (95% CI: 3.8–4.7) took them at least once daily, suggesting a substantial proportion engaged in regular or chronic use patterns that carry elevated risk of adverse effects.

These prevalence estimates fall within the range reported internationally but are lower than those observed in some Western countries; comparative data suggest prevalence rates of approximately 17% in the United States and up to 30% in the Netherlands, though methodological differences in measurement timeframes and definitions make direct comparisons challenging.

Associated Factors

Chronic Disease Comorbidities

The most striking associations were observed with chronic disease comorbidities. Individuals with self-reported kidney disease had significantly elevated NSAIDs use (adjusted odds ratio: 2.36; 95% CI: 1.74–3.20). This finding is particularly concerning given that NSAIDs are well-established nephrotoxins that can accelerate renal function decline in individuals with pre-existing kidney disease. The association may reflect inadequate awareness among patients — and potentially prescribers — of the contraindication for NSAIDs use in chronic kidney disease.

Other significant disease associations included asthma (aOR: 1.36; 95% CI: 1.17–1.58), heart disease (aOR: 1.34; 95% CI: 1.08–1.65), and known hypertension (aOR: 1.22; 95% CI: 1.08–1.37). Each of these comorbidities represents a clinical context where NSAIDs use requires careful risk-benefit assessment due to the potential for exacerbation of the underlying condition or adverse drug interactions.

Socio-Demographic Patterns

NSAIDs use was positively associated with markers of higher socio-economic status, including having government benefit schemes or private health insurance (aOR: 1.44), higher education (aOR: 1.35), higher household income, and current employment. Female sex was also associated with higher NSAIDs use (aOR: 1.17). These patterns may reflect greater healthcare access and medication availability among higher socio-economic groups, as well as higher rates of conditions prompting NSAIDs use.

Conversely, NSAIDs use was significantly lower among adults aged 60 years and above (aOR: 0.83), Chinese ethnicity (aOR: 0.41 compared to Malay ethnicity), and those of other ethnic backgrounds (aOR: 0.82). The notably lower prevalence among Chinese Malaysians warrants further investigation to understand whether this reflects differences in pain management preferences, traditional medicine use, or other cultural or health-system factors.

Public Health Implications

The study’s findings highlight several areas requiring public health attention. The high prevalence of NSAIDs use among individuals with kidney disease, heart disease, and hypertension is concerning and suggests a need for improved awareness among both healthcare providers and patients regarding the risks of NSAIDs in the context of these comorbidities. Over-the-counter availability of NSAIDs means that much of this use may occur without medical supervision or screening for contraindications.

Community-level educational campaigns about the appropriate use of NSAIDs, including the importance of reading product labels, adhering to recommended dosages, and consulting healthcare professionals when chronic use is contemplated, would help promote safer medication practices. For healthcare providers, the findings reinforce the importance of routinely enquiring about NSAIDs use when managing patients with chronic conditions and providing explicit guidance about safer analgesic alternatives when appropriate.

Limitations

The study relied on self-reported NSAIDs use, which may be subject to recall bias and may underestimate actual use, particularly casual or intermittent use. The cross-sectional design does not permit assessment of causal relationships. The 2011 data may not fully reflect current use patterns, as both NSAIDs availability and public awareness may have changed in the intervening years. Additionally, the study did not differentiate between prescribed and over-the-counter NSAIDs use, which have different risk profiles.

← Back to MJPHM Homepage