Inequalities in the use of secondary prevention of cardiovascular disease by socioeconomic status: evidence from the PURE observational study

Murphy, Adrianna and Palafox, Benjamin and O'Donnell, Owen and Stuckler, David and Perel, Pablo and AlHabib, Khalid F and Avezum, Alvaro and Bai, Xiulin and Chifamba, Jephat and Chow, Clara K and Corsi, Daniel J and Dagenais, Gilles R and Dans, Antonio L and Diaz, Rafael and Erbakan, Ayse N and Ismail, Noorhassim and Iqbal, Romaina and Kelishadi, Roya and Khatib, Rasha and Lanas, Fernando and Lear, Scott A and Li, Wei and Liu, Jia and Lopez-Jaramillo, Patricio and Mohan, V and Monsef, N and Mony, P K and Puoane, T and Rangarajan, Sumathy and Rosengren, Annika and Schutte, Aletta E and Sintaha, Mariz and Teo, Koon K and Wielgosz, Andreas and Yeates, Karen and Yin, Lu and Yusoff, Khalid and Zatońska, Katarzyna and Yusuf, Salim and McKee, Martin (2018) Inequalities in the use of secondary prevention of cardiovascular disease by socioeconomic status: evidence from the PURE observational study. The Lancet Global Health, 6 (3). e292. ISSN 2214109X



Background There is little evidence on the use of secondary prevention medicines for cardiovascular disease by socioeconomic groups in countries at different levels of economic development. Methods We assessed use of antiplatelet, cholesterol, and blood-pressure-lowering drugs in 8492 individuals with self-reported cardiovascular disease from 21 countries enrolled in the Prospective Urban Rural Epidemiology (PURE) study. Defining one or more drugs as a minimal level of secondary prevention, wealth-related inequality was measured using the Wagstaff concentration index, scaled from –1 (pro-poor) to 1 (pro-rich), standardised by age and sex. Correlations between inequalities and national health-related indicators were estimated. Findings The proportion of patients with cardiovascular disease on three medications ranged from 0% in South Africa (95% CI 0–1·7), Tanzania (0–3·6), and Zimbabwe (0–5·1), to 49·3% in Canada (44·4–54·3). Proportions receiving at least one drug varied from 2·0% (95% CI 0·5–6·9) in Tanzania to 91·4% (86·6–94·6) in Sweden. There was significant p<0·05) pro-rich inequality in Saudi Arabia, China, Colombia, India, Pakistan, and Zimbabwe. Pro-poor distributions were observed in Sweden, Brazil, Chile, Poland, and the occupied Palestinian territory. The strongest predictors of inequality were public expenditure on health and overall use of secondary prevention medicines. Interpretation Use of medication for secondary prevention of cardiovascular disease is alarmingly low. In many countries with the lowest use, pro-rich inequality is greatest. Policies associated with an equal or pro-poor distribution include free medications and community health programmes to support adherence to medications.

Item Type:Article
Official URL/DOI:
Uncontrolled Keywords:PURE; Socioeconomic
Subjects:Diabetes Epidemiology
Divisions:Department of Epidemiology
ID Code:1076
Deposited By:surendar radha
Deposited On:09 Mar 2018 12:47
Last Modified:09 Mar 2018 12:47

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