Treating children in underdeveloped countries

Abstract

<h3>Abstract</h3> <h3>Importance</h3> The most socioeconomically deprived individuals remain at the greatest risk of cardiovascular disease. Differences in risk adjusted use of statins between educational groups may contribute to these inequalities. <h3>Objective</h3> To identify whether people with lower levels of educational attainment are less likely to take statins for a given level of cardiovascular risk. <h3>Design</h3> Cross-sectional analysis of a population-based cohort study and linked longitudinal primary care records. <h3>Setting</h3> UK Biobank data from baseline assessment centres, linked primary care data and hospital episode statistics <h3>Participants</h3> UK Biobank participants (N = 489 679, mean age = 56, 54% female) with complete data on educational attainment and self-reported medication use. Secondary analyses were carried out on a subsample of participants with linked primary care data (N = 217 675). <h3>Main outcome measures</h3> Statin use self-reported to clinic nurses at baseline assessment centres, validated with linked prescription data in a subsample of participants in secondary analyses. <h3>Results</h3> Greater education was associated with lower statin use, whilst higher cardiovascular risk (assessed by QRISK3 score) was associated with higher statin use in both females and males. There was evidence of an interaction between QRISK3 and education, such that for the same QRISK3 score, people with more education were more likely to report taking statins. For example, in women with 7 years of schooling, equivalent to leaving school with no formal qualifications, a one unit increase in QRISK3 score was associated with a 6% higher odds of statin use (odds ratio (OR) 1.06, 95% CI 1.05, 1.06). In contrast, in women with 20 years of schooling, equivalent to obtaining a degree, a one unit increase in QRISK3 score was associated with an 11% higher odds of statin use (OR 1.11, 95% CI 1.10, 1.11). Comparable ORs in men were 1.04 (95% CI 1.04, 1.05) for men with 7 years of schooling and (95% CI 1.07, 1.07) for men with 20 years of schooling. <h3>Conclusions</h3> For the same level of cardiovascular risk, individuals with lower educational attainment are less likely to receive statins, likely contributing to health inequalities. <h3>Summary</h3> What is already known on this topic? Despite reductions in the rates of cardiovascular disease in high income countries, individuals who are the most socioeconomically deprived remain at the highest risk. Although intermediate lifestyle and behavioural risk factors explain some of this, much of the effect remains unexplained. <h3>What does this study add?</h3> For the same increase in QRISK3 score, the likelihood of statin use increased more in individuals with high educational attainment compared with individuals with lower educational attainment. These results were similar when using UK Biobank to derive QRISK3 scores and when using QRISK scores recorded in primary care records, and when using self-reported statin prescription data or prescription data from linked primary care records. The mechanisms leading to these differences are unknown, but both health seeking behaviours and clinical factors may contribute.