法国在新冠疫情期间全国范围内启动心血管疾病风险治疗：女性是否处于不利境地？

Nationwide Initiation of Cardiovascular Risk Treatments During the COVID-19 Pandemic in France: Women on a Slippery Slope?

作者信息

Gabet Amélie, Grave Clémence, Tuppin Philippe, Lesuffleur Thomas, Guenancia Charles, Nguyen-Thanh Viêt, Guignard Romain, Blacher Jacques, Olié Valérie

机构信息

Santé Publique France, Paris, France.

Caisse Nationale de l'Assurance Maladie, Paris, France.

出版信息

Front Cardiovasc Med. 2022 Apr 25;9:856689. doi: 10.3389/fcvm.2022.856689. eCollection 2022.

DOI:10.3389/fcvm.2022.856689

PMID:35548431

原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC9081923/

Abstract

OBJECTIVES

This study examines the initiation of prescribed medication treatments for cardiovascular risk (antihypertensives, lipid-lowering drugs, oral anticoagulants in atrial fibrillation, and smoking cessation medications) during the COVID-19 pandemic in the French population.

METHODS

For each year between 2017 and 2021, we used the French National Insurance Database to identify the number of people with at least one reimbursement for these medications but no reimbursement in the previous 12 months. We computed incidence rate ratios (IRRs) between 2017-2019 and, respectively 2020 and 2021 using Poisson regression adjusted for age and 2017-2019 time trends. We recorded the number of lipid profile blood tests, Holter electrocardiograms, and consultations with family physicians or cardiologists.

RESULTS

In 2020, IRR significantly decreased for initiations of antihypertensives (-11.1%[CI95%, -11.4%;-10.8%]), lipid-lowering drugs (-5.2%[CI95%, -5.5%;-4.8%]), oral anticoagulants in atrial fibrillation (-8.6%[CI95%, -9.1%;-8.0%]), and smoking cessation medications (-50.9%[CI95%, -51.1%;-50.7%]) compared to 2017-2019. Larger decreases were found in women compared to men except for smoking cessation medications, with the sex difference increasing with age. Similar analyses comparing 2021 to 2017-2019 showed an increase in the initiation of lipid-lowering drugs (+ 11.6%[CI95%, 10.7%;12.5%]) but even lower rates for the other medications, particularly in women. In addition, the 2020 number of people visiting a family physician or cardiologist decreased by 8.4 and 7.4%. A higher decrease in these visits was observed in those over 65 years of age compared to those under 65 years of age. A greater use of teleconsultation was found in women.

CONCLUSION

The COVID-19 pandemic heavily impacted the initiation of medication treatments for cardiovascular risk in France, particularly in women and people over 65 years.

摘要

目的

本研究调查了法国人群在新冠疫情期间开始使用规定药物治疗心血管疾病风险（抗高血压药、降脂药、房颤口服抗凝药和戒烟药物）的情况。

方法

在2017年至2021年期间，我们利用法国国家保险数据库确定了至少报销过一次这些药物但在过去12个月内未报销过的人数。我们使用经年龄和2017 - 2019年时间趋势调整的泊松回归计算了2017 - 2019年与2020年及2021年之间的发病率比（IRR）。我们记录了血脂检查、动态心电图检查以及与家庭医生或心脏病专家会诊的次数。

结果

与2017 - 2019年相比，2020年抗高血压药起始治疗的IRR显著下降（-11.1%[95%CI，-11.4%；-10.8%]），降脂药（-5.2%[95%CI，-5.5%；-4.8%]），房颤口服抗凝药（-8.6%[95%CI，-9.1%；-8.0%]）和戒烟药物（-50.9%[95%CI，-51.1%；-50.7%]）。除戒烟药物外，女性的下降幅度大于男性，且性别差异随年龄增加而增大。将2021年与2017 - 2019年进行类似分析发现，降脂药起始治疗有所增加（+11.6%[95%CI，10.7%；12.5%]），但其他药物的起始率更低，尤其是女性。此外，2020年拜访家庭医生或心脏病专家的人数减少了8.4%和7.4%。与65岁以下人群相比，65岁以上人群的这些就诊次数下降幅度更大。女性使用远程会诊的频率更高。