Is the high-risk strategy to prevent cardiovascular disease equitable? A pharmacoepidemiological cohort study Full Text
BMC Public Health, 08/20/2012
Wallach Kildemoes H et al. – The high–risk strategy to prevent cardiovascular disease (CVD) by initiating statin therapy seems to be inequitable, reaching primarily high–risk subjects in lower risk socio–economic position (SEP)–groups.Methods
- Applying individual–level nationwide register information on socio–demographics, dispensed prescription drugs and hospital discharges, all Danish citizens aged 20+ without previous register–markers of CVD, diabetes or statin therapy were followed during 2002–2006 for first occurrence of myocardial infarction (MI) and a dispensed statin prescription (N=3.3 mill).
- Main outcome measures: Stratified by gender, 5–year age–groups and socioeconomic position (SEP), incidence of MI was applied as a proxy for statin need.
- Need–standardised statin incidence rates were calculated, applying MI incidence rate ratios (IRR) as need–weights to adjust for unequal needs across SEP.
- Horizontal equity in initiating statin therapy was tested by means of Poisson regression analysis.
- Applying the need–standardised statin parameters and the lowest SEP–group as reference, a need–standardised statin IRR>1 translates into horizontal inequity favouring the higher SEP–groups.
- MI incidence decreased with increasing SEP without a parallel trend in incidence of statin therapy.
- According to the regression analyses, the need–standardised statin incidence increased in men aged 40–64 by 17%, IRR 1.17 (95% CI: 1.14–1.19) with each increase in income quintile.
- In women the proportion was 23%, IRR 1.23 (1.16–1.29).
- An analogous pattern was seen applying education as SEP indicator and among subjects aged 65–84.