Socioeconomic inequality in medication persistence in primary and secondary prevention of coronary heart disease - A population-wide electronic cohort study.

King, William Lacey, Arron White, James Farewell, Daniel Dunstan, Frank Fone, David

REVIEW


01 July 2018

On the surface, this paper does not appear to offer anything attractive because of the negative findings. However, the findings challenge our own clinical perceptions that low socioeconomic status causes adverse outcomes due to poor adherence. If resources are to be allocated to improving outcomes in people with low socioeconomic status, this paper suggests that medication adherence should not be one of those considerations.


RELEVANCE 4
INNOVATIVENESS 4
APPLICABILITY 2
OVERALL 3

PAPER DETAILS


TITLE

Socioeconomic inequality in medication persistence in primary and secondary prevention of coronary heart disease - A population-wide electronic cohort study.

ABSTRACT

BACKGROUND
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. 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 FINDINGS
An 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.

CONCLUSIONS
During 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.



AUTHOR(S)

King, William Lacey, Arron White, James Farewell, Daniel Dunstan, Frank Fone, David

JOURNAL

PloS one

PLACE

United States