Abstract
The risk of premature mortality caused by cardiovascular diseases (CVDs) is approximately three times higher in the Central Eastern European region than in high income European countries, which suggests a lack and/or ineffectiveness of preventive interventions against CVDs. The aim of the present study was to provide data on the relationship between premature CVD mortality, statin utilization as a preventive medication and socioeconomic deprivation at the district level in Hungary. As a conceptually new approach, the prescription of statins, the prescription redemption and the ratio between redemption and prescription rates were also investigated. The number of prescriptions for statins and the number of redeemed statin prescriptions were obtained from the National Health Insurance Fund Administration of Hungary for each primary healthcare practice for the entire year of 2012. The data were aggregated at the district level. To define the frequency of prescription and of redemption, the denominator was the number of the 40+-year-old population adjusted by the rates of 60+-year-old population of the district. The standardized mortality rates, frequency of statin prescriptions, redeemed statin prescriptions, and ratios for compliance in relation to the national average were mapped using the “disease mapping” option, and their association with deprivation (tertile of deprivation index as a district-based categorical covariate) was defined using the risk analysis capabilities within the Rapid Inquiry Facility. The risk analysis showed a significant positive association between deprivation and the relative risk of premature cardiovascular mortality, and a reverse J-shaped association between the relative frequency of statin prescriptions and deprivation. Districts with the highest deprivation showed a low relative frequency of statin prescriptions; however, significantly higher primary compliance (redemption) was observed in districts with the highest deprivation. Our data clearly indicate that insufficient statin utilization is strongly linked to the so-called physician-factor, i.e., a statin prescription. Consequently, statin treatment is poor and represents a significant barrier to reducing mortality, particularly among people living in highly deprived areas of the country.
Highlights
The health status of the population of Central Eastern European (CEE) member states of the European Union is less favorable than that of the countries that became members before May 2004 (EU15 countries)
This study focused on the comparative analysis of data for prescriptions by general practitioners (GPs) and redeemed prescriptions for statins in Hungary during 2012, the last year for which all data necessary for the analysis were available in validated databases in a district level study design
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 health status of the population of Central Eastern European (CEE) member states of the European Union is less favorable than that of the countries that became members before May 2004 (EU15 countries). In the Visegrad Group countries (Czech Republic, Hungary, Poland, and Slovakia), the relative risk of early death caused by CVDs varies between 1.96 and 3.18 (Czech Republic, 1.96; Poland, 2.57; Slovakia, 2.91, and Hungary, 3.18) according to the latest available data (WHO HFA, 2015). These figures clearly indicate that the effectiveness of preventive interventions against CVDs is not sufficient in these countries; identifying gaps and improving the scale and effectiveness of preventive interventions are necessary in the region. Despite the presently growing number of publications on certain adverse effects of statin medication, it is considered to be obvious that the benefits of statins far outweigh the risks for the vast majority of patients (Godlee, 2014)
Talk to us
Join us for a 30 min session where you can share your feedback and ask us any queries you have