Department of Clinical Biochemistry, Copenhagen University Hospital Hvidovre, Hvidovre, Denmark.
Department of Public Health, University of Copenhagen, Research Unit for General Practice and Section of General Practice, Copenhagen, Denmark.
Scand J Prim Health Care. 2023 Jun;41(2):170-178. doi: 10.1080/02813432.2023.2198584. Epub 2023 Apr 10.
To examine whether education level influences screening, monitoring, and treatment of hypercholesterolemia.
Epidemiological cohort study.
Department of Clinical Biochemistry, Copenhagen University Hospital Hvidovre.
Cholesterol blood test results ordered by general practitioners in Greater Copenhagen were retrieved from 2000-2018. Using the International Standard Classification of Education classification, the population was categorized by length of education in three groups (basic education; up to 10 years, intermediate education; 11-12 years, advanced education; 13 years or more). The database comprised 13,019,486 blood sample results from 653,903 patients.
Frequency of lipid measurement, prevalence of statin treatment, age and comorbidity at treatment initiation, total cholesterol threshold for statin treatment initiation, and achievement of treatment goal.
The basic education group was measured more frequently (1.46% absolute percentage difference of total population measured [95% CI 0.86%-2.05%] in 2000 and 9.67% [95% CI 9.20%-10.15%] in 2018) over the period compared to the intermediate education group. The advanced education group was younger when receiving first statin prescription (1.87 years younger [95% CI 1.02-2.72] in 2000 and 1.06 years younger [95% CI 0.54-1.58 in 2018) compared to the intermediate education group. All education groups reached the treatment goals equally well when statin treatment was initiated.
Higher education was associated with earlier statin prescription, although the higher educated group was monitored less frequently. There was no difference in reaching treatment goal between the three education groups. These findings suggest patients with higher education level achieve an earlier dyslipidemia prevention intervention with an equally satisfying result compared to lower education patients.Key PointsLittle is known about the role of social inequality as a possible barrier for managing hypercholesterolemia in general practice.Increasing education level was associated to less frequent measurement and less frequent statin treatment.Patients with higher education level were younger, and less comorbidity at first statin prescription.Education level had no effect on frequency of statin treatment-initiated patients reaching the treatment goal was found.
探讨教育水平是否影响高胆固醇血症的筛查、监测和治疗。
流行病学队列研究。
哥本哈根大学医院 Hvidovre 临床生物化学系。
从 2000 年至 2018 年，检索哥本哈根大区全科医生开具的胆固醇血液检测结果。利用国际教育标准分类法，将人群按受教育年限分为三组（基础教育；10 年以下，中等教育；11-12 年，高等教育；13 年或以上）。该数据库包含了来自 653903 名患者的 13019486 份血样结果。
血脂检测频率、他汀类药物治疗的流行率、治疗起始时的年龄和合并症、他汀类药物治疗起始的总胆固醇阈值以及治疗目标的实现情况。
与中等教育组相比，在整个研究期间，基础教育组的检测频率更高（2000 年总人群检测的绝对百分比差异为[95%置信区间 0.86%-2.05%]，2018 年为[95%置信区间 9.20%-10.15%]）。与中等教育组相比，高等教育组在接受首次他汀类药物处方时年龄更小（2000 年年轻 1.87 岁[95%置信区间 1.02-2.72]，2018 年年轻 1.06 岁[95%置信区间 0.54-1.58]）。当开始他汀类药物治疗时，所有教育组都能很好地达到治疗目标。
较高的教育程度与更早的他汀类药物处方相关，尽管受教育程度较高的人群监测频率较低。三组受教育程度之间在达到治疗目标方面没有差异。这些发现表明，与受教育程度较低的患者相比，受教育程度较高的患者通过更早的血脂异常预防干预措施达到了同样令人满意的效果。
关于社会不平等是否是普通实践中管理高胆固醇血症的一个可能障碍，知之甚少。
随着教育水平的提高，测量的频率和他汀类药物治疗的频率都会降低。
在首次开具他汀类药物时，受教育程度较高的患者年龄更小，合并症更少。
发现教育程度对开始他汀类药物治疗的患者达到治疗目标的频率没有影响。
