Neighborhood socioeconomic characteristics and statin medication in patients with myocardial infarction: a Swedish nationwide follow-up study

Abstract

BackgroundCoronary heart disease (CHD) and myocardial infarction (MI) are associated with neighborhood-level socioeconomic status (SES). Statins are important drugs for secondary prevention of MI. However, no study has determined whether neighborhood-level SES is associated with statin medication in MI patients. We aimed to determine whether there is a difference in statin medication rate in MI patients across different levels of neighborhood SES.MethodsAll patients in Sweden, diagnosed with incident MI from January 1st, 2000 until December 31st 2010, were followed (n = 116,840). Of these, 89.7 % received statin medication. Data were analyzed by multilevel logistic regression, with individual-level characteristics (age, marital status, family income, educational attainment, country of origin, urban/rural status and comorbidities/chronic conditions related to MI) as covariates.ResultsLow neighborhood-level SES was significantly associated with low statin medication rate (Odds Ratio 0.80). In the full model, which took into account individual-level socioeconomic characteristics and MI comorbidities, the odds no longer remained significant.ConclusionsIndividual-level approaches may be most important in health care policies regarding statin medication in MI patients.Electronic supplementary materialThe online version of this article (doi:10.1186/s12872-016-0319-y) contains supplementary material, which is available to authorized users.

Neighborhood-level and individual-level socioeconomic status and self-reported management of ischaemic heart disease: cross-sectional results from the Korea Health Examinees Study

“…At the individual SES level, our study found that the education level was significantly associated with ongoing IHD management, whereas the income status was not. Similarly, previous studies also reported that IHD management may vary according to an individual’s SES, and suggested that the survivors with lower income and education levels might fail to manage themselves appropriately because of (a) a lack of knowledge related to prevention and healthy habits,28 (b) limited access to care or drugs due to economic constraints29 and (c) a lack of willingness or resources to change their lifestyles 73.…”

Educational inequalities in statin treatment for preventing cardiovascular disease: cross-sectional analysis of UK Biobank

“…The literature is mixed in the direction to which inequalities in access to statins exist, where some studies suggest that individuals with lower socioeconomic position are less likely to be prescribed statins (9, 10, 15, 16) and other studies finding the opposite or no differences (6, 8, 11, 13, 14). Of these previous studies, there was limited consideration for underlying cardiovascular risk in the analyses.…”

“…Of these previous studies, there was limited consideration for underlying cardiovascular risk in the analyses. Some studies adjusted for cardiovascular comorbidities (8, 13, 15, 16) such as cholesterol level, diabetes status or prevalent cardiovascular events. However, we only identified one other study that comprehensively adjusted for cardiovascular risk (11).…”

“…The UK Biobank study recruited 503 317 UK adults between 2006 and 2010. Participants attended baseline assessment centres involving questionnaires, interviews, anthropometric, physical and genetic measurements (15, 16). All UK Biobank participants are linked to hospital episode statistic (HES) data, with data available from 1997 in England, 1998 in Wales and 1981 in Scotland (28), with the most recent entry recorded in this analysis in May 2017.…”

“…In other studies it has been reported that those with lower socioeconomic position are more likely to be prescribed statins (6, 8, 13, 14). Conversely, some studies have found that individuals of lower socioeconomic position are less likely to be prescribed statins (9, 10, 15, 16).…”