Abstract
The wide life expectancy gap between the old and new member states of the European Union is most strongly related to the high rate of premature mortality caused by cardiovascular diseases (CVDs). To learn more about the background of this gap, the relationship of socioeconomic status (SES) with CVD mortality, morbidity and the utilization of antihypertensive drugs was studied in Hungary, a Central-Eastern European country with an extremely high relative risk of premature CVD mortality. Risk analysis capabilities were used to estimate the relationships between SES, which was characterized by tertiles of a multidimensional composite indicator (the deprivation index) and CVD burden (mortality and morbidity) as well as the antihypertensive medications at the district level in Hungary. The excess risks caused by premature mortality from CVDs showed a strong correlation with deprivation using the Rapid Inquiry Facility. The distribution of prevalence values related to these diseases was found to be similar, but in the areas of highest deprivation, where the prevalence of chronic ischaemic heart diseases and cerebrovascular diseases was found to be higher than the national average by 30 and 20%, the prevalence of hypertension exceeded the national average by only 4%. A linear association between the relative frequency of prescriptions/redemptions and deprivation for most antihypertensive drugs, except angiotensinogen receptor blockers, was shown. More intense screening for hypertension is proposed to improve the control of CVDs in countries affected by high disease burden.
Highlights
The Marmot’s report (European Commission, 2013) and the latest joint publication of the OECD and the European Commission (OECD and EU, 2016) on health and access to health services demonstrate that significant health inequalities exist between and within EU member states
This study focused on the comparative analysis of data regarding prescriptions by general practitioners and redeemed prescriptions for antihypertensive drugs in Hungary during 2012, the last year for which all data that are necessary for a district level analysis were available in the validated databases
Deprivation index values defined by districts varied widely from −3.76 to +5.83, which indicates a high level of socioeconomic inequalities in the country
Summary
The Marmot’s report (European Commission, 2013) and the latest joint publication of the OECD and the European Commission (OECD and EU, 2016) on health and access to health services demonstrate that significant health inequalities exist between and within EU member states. According to the latest available data, the average relative risk of premature death caused by CVDs is 2.86 in the EU13 countries, and it is high in Bulgaria (4.86), Latvia (4.69), Lithuania (4.29), Romania (3.53), and Hungary (3.35) [(World Health Organization (WHO) HFA, 2016)]. These figures clearly indicate that the effectiveness of preventive interventions against CVDs is not sufficient in these countries, studies to identify potential targets for prevention measures are missing
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