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Gunnar Mouland1, Christian Lie Berg2, Mohammad Nouri Sharikabad2

  • 1Samhandlingsavdelingen, Sørlandet sykehus Arendal.

Tidsskrift for Den Norske Laegeforening : Tidsskrift for Praktisk Medicin, Ny Raekke
|September 6, 2022
PubMed
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Vitamin B12 (cobalamin) supplement use and testing varied significantly across Norwegian counties in 2020. These differences may stem from how doctors diagnose and assess vitamin B12 deficiency.

Area of Science:

  • Nutritional Science
  • Public Health
  • Pharmacoeconomics

Background:

  • Subclinical vitamin B12 deficiency affects a significant portion of the global population, yet its prevalence in Norway remains uninvestigated.
  • Norway introduced oral vitamin B12 (cobalamin) as an alternative to injections in 2017, prompting an examination of supplement usage patterns.
  • An unexpected variation in county-level vitamin B12 supplement use was observed, necessitating further investigation.

Purpose of the Study:

  • To investigate the geographical variations in vitamin B12 (cobalamin) supplement consumption and laboratory testing across Norwegian counties.
  • To explore potential factors contributing to observed differences in vitamin B12 management.

Main Methods:

  • Utilized data on dispensed vitamin B12 supplements from the Norwegian Prescription Database for 2020, categorized by county of residence.

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  • Obtained figures on reimbursed vitamin B12-related laboratory tests from the Norwegian Health Economics Administration (Helfo), classified by municipality.
  • Analyzed the consumption of vitamin B12 supplements (DDD per inhabitant) and the frequency of various laboratory analyses (total B12, folate, homocysteine, methylmalonic acid, active B12).

    • Main Results:

    • Vitamin B12 supplement sales averaged 12 defined daily doses (DDD) per inhabitant in Norway in 2020, with county variations ranging from 7 to 15 DDD.
    • The number of laboratory tests performed per 100 inhabitants varied considerably by county: 26-46 for total vitamin B12, 21-37 for folate, 1-12 for homocysteine, 1-13 for methylmalonic acid, and 0.01-8.13 for active vitamin B12.

    Conclusions:

    • Significant intercounty disparities in vitamin B12 (cobalamin) supplement consumption were identified in Norway.
    • Observed variations in laboratory testing rates suggest that differences in physician assessment and diagnostic practices may contribute to the uneven distribution of vitamin B12 management.