Statin prescribing in Nottingham general practices: a cross-sectional study

Abstract

The aim of the study was to determine the effect of deprivation on variations in statin prescribing in Nottingham general practices. Deprivation is used as a measure of population cardiovascular morbidity and need for statin treatment. The setting was all 118 general practices in contract with Nottingham Health Authority. A cross-sectional study was undertaken. Statin prescribing in general practice during 1996 was related to indices of practice deprivation based on enumeration district (ED) level data from the 1991 Census. The relationship between statin prescribing per 1000 patients aged 35-69 and practice deprivation (measured both as Townsend score and as Jarman UPA(8) score) with additional adjustment for practice characteristics (number of partners, training status, total list size, fundholding status) cardiovascular prescribing costs net of lipid prescribing and hospital activity (total and medical admissions and new general practitioner total and medical out-patient referrals) for each practice. The prescription of statins during 1996 varied between nil and 14.1 'statin-years' of prescribing per 1000 patients aged 35-69. There was a significant inverse relationship between the rate of statin prescribing and the level of deprivation of that practice (p < 0.0001). Deprivation, as measured by Townsend index, accounted for 13 per cent of the total variability in statin prescribing, which rose to 19 per cent after adjustment. The prescribing of other lipid lowering agents of the fibrate class was positively associated with statin prescribing (p=0.001) and this association persisted after adjusting for deprivation. None of the other practice characteristics were found to be significantly associated with rates of statin prescribing. General practices with high deprivation indices serve more deprived populations with a higher prevalence of cardiovascular disease, and may be assumed to have a greater need for statins. Despite this, practices with higher deprivation indices prescribed fewer statins to their patients than less deprived practices. It was not possible to identify whether the more deprived general practices had successfully identified at risk individuals but it is likely that special efforts are needed to increase the uptake of effective health care in their patients.