用于原发性心血管疾病预防的他汀类药物处方差异：横断面分析
Variations in statin prescribing for primary cardiovascular disease prevention: cross-sectional analysis.
作者信息
Fleetcroft Robert, Schofield Peter, Ashworth Mark
机构信息
Department of Population Health and Primary Care, Norwich Medical School, University of East Anglia, Norwich NR4 7TJ, UK.
出版信息
BMC Health Serv Res. 2014 Sep 20;14:414. doi: 10.1186/1472-6963-14-414.
BACKGROUND
Statins are an important intervention for primary and secondary cardiovascular disease (CVD) prevention. We aimed to establish the variation in primary preventive treatment for CVD with statins in the English population.
METHODS
Cross sectional analyses of 6155 English primary care practices with 40,017,963 patients in 2006/7. Linear regression was used to model prescribing rates of statins for primary CVD prevention as a function of IMD (index of multiple deprivation) quintile, proportion of population from an ethnic minority, and age over 65 years. Defined Daily Doses (DDD) were used to calculate the numbers of patients receiving a statin. Statin prescriptions were allocated to primary and secondary prevention based on the prevalence of CVD and stroke.
RESULTS
We estimated that 10.5% (s.d.3.7%) of the registered population were dispensed a statin for any indication and that 6.3% (s.d. 3.0%) received a statin for primary CVD prevention. The regression model explained 21.2% of the variation in estimates of prescribing for primary prevention. Practices with higher prevalence of hypertension (β co-efficient 0.299 p <0.001) and diabetes (β co-efficient 0.566 p < 0.001) prescribed more statins for primary prevention. Practices with higher levels of ethnicity (β co-efficient-0.026 p <0.001), greater deprivation (β co-efficient -0.152 p < 0.001) older patients (β co-efficient -0.032 p 0.002), larger lists (β co-efficient -0.085, p < 0.001) and were more rural (β co-efficient -0.121, p0.026) prescribed fewer statins. In a small proportion of practices (0.5%) estimated prescribing rates for statins were so low that insufficient prescriptions were issued to meet the predicted secondary prevention requirements of their registered population.
CONCLUSIONS
Absolute estimated prescribing rates for primary prevention of CVD were 6.3% of the population. There was evidence of social inequalities in statin prescribing for primary prevention. These findings support the recent introduction of a financial incentive for primary prevention of CVD in England.
背景
他汀类药物是一级和二级心血管疾病（CVD）预防的重要干预措施。我们旨在确定英国人群中使用他汀类药物进行CVD一级预防治疗的差异。
方法
对2006/7年度6155家英国基层医疗诊所的40,017,963名患者进行横断面分析。采用线性回归模型，将用于CVD一级预防的他汀类药物处方率作为多重剥夺指数（IMD）五分位数、少数民族人口比例以及65岁以上人口比例的函数。使用限定日剂量（DDD）来计算接受他汀类药物治疗的患者人数。根据CVD和中风的患病率，将他汀类药物处方分配到一级和二级预防中。
结果
我们估计，10.5%（标准差3.7%）的注册人口因任何适应症而被配给他汀类药物，6.3%（标准差3.0%）的人口接受他汀类药物用于CVD一级预防。回归模型解释了一级预防处方估计差异的21.2%。高血压患病率较高（β系数0.299，p<0.001）和糖尿病患病率较高（β系数0.566，p<0.001）的诊所，用于一级预防的他汀类药物处方更多。种族水平较高（β系数 -0.026，p<0.001）、贫困程度较高（β系数 -0.152，p<0.001）、老年患者（β系数 -0.032，p0.002）、名单较大（β系数 -0.085，p<0.001）以及更偏远地区（β系数 -0.121，p0.026）的诊所，他汀类药物处方较少。在一小部分诊所（0.5%）中，他汀类药物的估计处方率非常低，以至于开出的处方不足以满足其注册人口预测的二级预防需求。
结论
CVD一级预防的绝对估计处方率为人口的6.3%。有证据表明在他汀类药物一级预防处方方面存在社会不平等。这些发现支持了英国最近引入的针对CVD一级预防的经济激励措施。
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