Statins are increasingly prescribed to prevent cardiovascular disease (CVD) in asymptomatic individuals. Yet, it is unknown whether those at higher CVD risk - i.e. individuals in lower socio-economic position (SEP) - are adequately reached by this high-risk strategy. We aimed to examine whether the Danish implementation of the strategy to prevent cardiovascular disease (CVD) by initiating statin (HMG-CoA reductase inhibitor) therapy in high-risk individuals is equitable across socioeconomic groups.
Cohort study.
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).
Stratified by gender, 5-year age-groups and socioeconomic position (SEP), incidence of MI was applied as a proxy for statin need. Need-standardized 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-standardized statin parameters and the lowest SEP-group as reference, a need-standardized 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-standardized 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.
The high-risk strategy to prevent CVD by initiating statin therapy seems to be inequitable, reaching primarily high-risk subjects in lower risk SEP-groups.
Notes
Cites: Eur Heart J. 2004 Mar;25(6):484-9115039128
Cites: Health Econ. 2004 Jul;13(7):629-4715259043
Cites: Int J Epidemiol. 1985 Mar;14(1):32-83872850
Cites: J Epidemiol Community Health. 1990 Dec;44(4):265-702277246
Cites: Lancet. 1991 Jun 8;337(8754):1387-931674771
Cites: Lancet. 1994 Nov 19;344(8934):1383-97968073
Cites: Am J Epidemiol. 1996 Nov 15;144(10):934-428916504
Cites: Soc Sci Med. 1997 Mar;44(6):757-719080560
Cites: J Epidemiol Community Health. 1998 Jun;52(6):399-4059764262
Cites: Pharmacoepidemiol Drug Saf. 2005 May;14(5):307-1715508133