National Centre for Epidemiology and Population Health, Australian National University, Canberra, ACT, Australia.
National Centre for Epidemiology and Population Health, Australian National University, Canberra, ACT, Australia; Sax Institute, Sydney, NSW, Australia.
Prev Med. 2022 Jan;154:106884. doi: 10.1016/j.ypmed.2021.106884. Epub 2021 Nov 13.
Cardiovascular disease (CVD) events are highly preventable through appropriate treatment and disproportionally affect socioeconomically disadvantaged individuals. This study quantified the relationship of socioeconomic factors to dispensing and persistent use of lipid- and blood pressure-lowering medication following hospital admission for a major CVD event (myocardial infarction, ischaemic stroke/transient ischaemic attack). Data from 8285 people with such events aged ≥45 years from the Australian 45 and Up Study with linked medication data were used to estimate relative risks (RRs) for combined lipid- and blood pressure-lowering dispensing at three-months following hospital discharge and for 12-month persistent use, in relation to education, income, and level of medication subsidisation. Overall, 56% were dispensed guideline-recommended medications at three months and 37% persistently used them across 12 months. After adjusting for demographic factors, type of CVD and history of CVD hospitalisation, RRs for lowest (no educational qualifications) compared to highest education level (university degree) were 1.14 (95% CI: 1.06, 1.22) for medication dispensing and 1.15 (1.02, 1.29) for persistent medication use; 1.14 (1.06, 1.22) and 1.17 (1.04, 1.32) respectively for lowest (<$20,000) versus highest (≥$70,000) household pre-tax income; and 1.25 (1.17, 1.33) and 1.28 (1.15, 1.43) respectively for those receiving highest versus lowest subsidisation. There was little to no evidence of a relationship of income and education to medication use after adjustment for medication subsidisation. While preventive medication use is sub-optimal, subsidisation is substantially associated with increased use and accounts for most of the relationship with socioeconomic position, suggesting subsidy schemes are working in the intended direction.
心血管疾病 (CVD) 事件通过适当的治疗是高度可预防的，但社会经济地位处于不利地位的个体受其影响的程度不成比例。本研究通过链接的药物数据，从澳大利亚 45 岁及以上研究中，对 8285 名年龄≥45 岁因主要 CVD 事件（心肌梗死、缺血性卒中和短暂性脑缺血发作）住院的患者，定量分析了社会经济因素与 CVD 事件后三个月内开列和持续使用降血脂和降压药物之间的关系。利用这些数据，评估了与教育、收入和药物补贴水平相关的，在出院后三个月内联合使用降血脂和降压药物的相对风险 (RR)，以及在 12 个月内持续使用的相对风险。总体而言，56%的患者在三个月时开列了指南推荐的药物，37%的患者在 12 个月时持续使用这些药物。在调整了人口统计学因素、CVD 类型和 CVD 住院史后，与最高教育水平（大学学位）相比，最低教育水平（无学历）的 RR 为药物开列的 1.14（95%CI：1.06，1.22），为持续药物使用的 1.15（1.02，1.29）；最低（<$20,000）和最高（≥$70,000）家庭税前收入的 RR 分别为 1.14（1.06，1.22）和 1.17（1.04，1.32）；最高和最低补贴的 RR 分别为 1.25（1.17，1.33）和 1.28（1.15，1.43）。在调整药物补贴后，收入和教育与药物使用之间的关系几乎没有证据表明存在关联。尽管预防性药物的使用并不理想，但补贴与使用的增加有很大关系，并且解释了与社会经济地位的大部分关系，这表明补贴计划正在朝着预期的方向发展。
