Abstract
BackgroundCoronary heart disease (CHD) mortality in England fell by 36% between 2000 and 2007 and it is estimated that approximately 50% of the fall was due to improved treatment uptake. Marked socio-economic inequalities in CHD mortality in the United Kingdom (UK) remain, with higher age-adjusted rates in more deprived groups. Inequalities in the persistence of medication for primary and secondary prevention of CHD may contribute to the observed social gradient and we investigated this possibility in the population of Wales (UK).Methods and findingsAn electronic cohort of individuals aged over 20 (n = 1,199,342) in Wales (UK) was formed using linked data from primary and secondary care and followed for six years (2004–2010). We identified indications for medication (statins, aspirin, ACE inhibitors, clopidogrel) recommended in UK National Institute for Clinical Excellence (NICE) guidance for CHD (high risk, stable angina, stable angina plus diabetes, unstable angina, and myocardial infarction) and measured the persistence of indicated medication (time from initiation to discontinuation) across quintiles of the Welsh Index of Multiple Deprivation, an area-based measure of socio-economic inequality, using Cox regression frailty models. In models adjusted for demographic factors, CHD risk and comorbidities across 15 comparisons for persistence of the medications, none favoured the least deprived quintile, two favoured the most deprived quintile and 13 showed no significant differences.ConclusionsDuring our study period (2004–2010) we found no significant evidence of socio-economic inequality in the persistence of recommended medication for primary and secondary prevention of CHD.
Highlights
Coronary heart disease (CHD) mortality has fallen in recent decades in the United Kingdom (UK) and other high-income countries a social gradient persists, with a higher age-adjusted mortality in more socioeconomically deprived groups [1]
Inequalities in the persistence of medication for primary and secondary prevention of coronary heart disease (CHD) may contribute to the observed social gradient and we investigated this possibility in the population of Wales (UK)
We identified indications for medication recommended in UK National Institute for Clinical Excellence (NICE) guidance for CHD and measured the persistence of indicated medication across quintiles of the Welsh Index of Multiple Deprivation, an area-based measure of socio-economic inequality, using Cox regression frailty models
Summary
Coronary heart disease (CHD) mortality has fallen in recent decades in the UK and other high-income countries a social gradient persists, with a higher age-adjusted mortality in more socioeconomically deprived groups [1]. An IMPACT study of the period 2000–2007 in England, during which CHD mortality fell by 36%, estimated that improved uptake of treatments accounted for approximately 50% of the fall [3], with lipid-lowering therapy accounting for 14%. A review of papers published between 1997 and 2005 that examined persistence of medication for hypertension and dyslipidaemia observed that few studies explicitly stated the definition of persistence used, and that different measures of persistence were employed [12]. Coronary heart disease (CHD) mortality in England fell by 36% between 2000 and 2007 and it is estimated that approximately 50% of the fall was due to improved treatment uptake. Inequalities in the persistence of medication for primary and secondary prevention of CHD may contribute to the observed social gradient and we investigated this possibility in the population of Wales (UK).
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