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

King, William, Lacey, Aaron, White, Jamie ORCID: https://orcid.org/0000-0001-8371-8453, Farewell, Daniel ORCID: https://orcid.org/0000-0002-8871-1653, Dunstan, Frank ORCID: https://orcid.org/0000-0002-1043-5281 and Fone, David ORCID: https://orcid.org/0000-0002-6476-4881 2018. Socioeconomic inequality in medication persistence in primary and secondary prevention of coronary heart disease - a population-wide electronic cohort study. PLoS ONE 13 (3) , e0194081. 10.1371/journal.pone.0194081

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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.

Item Type:	Article
Date Type:	Publication
Status:	Published
Schools:	Medicine
Additional Information:	This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.
Publisher:	Public Library of Science
ISSN:	1932-6203
Funders:	Medical Research Council
Date of First Compliant Deposit:	5 March 2018
Date of Acceptance:	25 February 2018
Last Modified:	26 Aug 2023 00:27
URI:	https://orca.cardiff.ac.uk/id/eprint/109677

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