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Inequalities in the Use of Secondary Prevention of Cardiovascular Disease by Socioeconomic Status: Evidence From the Pure Observational Study Publisher Pubmed



Murphy A1 ; Palafox B1 ; Odonnell O2, 3 ; Stuckler D4 ; Perel P1 ; Alhabib KF5 ; Avezum A6 ; Bai X7 ; Chifamba J8 ; Chow CK9 ; Corsi DJ10 ; Dagenais GR11 ; Dans AL12 ; Diaz R13 Show All Authors
Authors
  1. Murphy A1
  2. Palafox B1
  3. Odonnell O2, 3
  4. Stuckler D4
  5. Perel P1
  6. Alhabib KF5
  7. Avezum A6
  8. Bai X7
  9. Chifamba J8
  10. Chow CK9
  11. Corsi DJ10
  12. Dagenais GR11
  13. Dans AL12
  14. Diaz R13
  15. Erbakan AN14
  16. Ismail N15
  17. Iqbal R16
  18. Kelishadi R17
  19. Khatib R18
  20. Lanas F19
  21. Lear SA20
  22. Li W7
  23. Liu J7
  24. Lopezjaramillo P21
  25. Mohan V22
  26. Monsef N23
  27. Mony PK24
  28. Puoane T25
  29. Rangarajan S26
  30. Rosengren A27
  31. Schutte AE28
  32. Sintaha M29
  33. Teo KK26
  34. Wielgosz A30
  35. Yeates K31
  36. Yin L7
  37. Yusoff K32
  38. Zatonska K33
  39. Yusuf S26
  40. Mckee M1
Show Affiliations
Authors Affiliations
  1. 1. Centre for Global Chronic Conditions, London School of Tropical Medicine, London, United Kingdom
  2. 2. Erasmus School of Economics, Erasmus University Rotterdam, Rotterdam, Netherlands
  3. 3. Faculty of Economics and Business, University of Lausanne, Lausanne, Switzerland
  4. 4. Department of Policy Analysis and Public Management, Bocconi University, Milan, Italy
  5. 5. Department of Cardiac Sciences, King Fahad Cardiac Center, College of Medicine, King Saud University, Riyadh, Saudi Arabia
  6. 6. Institute of Cardiology, University of Santo Amaro, Sao Paulo, Brazil
  7. 7. State Key Laboratory of Cardiovascular Disease, Fuwai Hospital, National Center for Cardiovascular Disease, Peking Union Medical College and Chinese Academy of Medical Sciences, Beijing, China
  8. 8. Department of Physiology, College of Health Sciences, University of Zimbabwe, Harare, Zimbabwe
  9. 9. The University of Sydney and The George Institute for Global Health, Camperdown, NSW, Australia
  10. 10. Ottawa Hospital Research Institute, OMNI Research Group, Clinical Epidemiology Program, Ottawa, ON, Canada
  11. 11. Institut Universitaire de Cardiologie et Pneumologie de Quebec, Quebec City, QC, Canada
  12. 12. University of the Philippines—Manila, Manila, Philippines
  13. 13. Estudios Clinicos Latinoamerica (ECLA) International, Rosario, Santa Fe, Argentina
  14. 14. Nisa Hastanesi, Fatih, Istanbul, Turkey
  15. 15. Department of Community Health, UKM Medical Centre, University Kebangsaan Malaysia, Kuala Lumpur, Malaysia
  16. 16. Departments of Community Health Sciences and Medicine, Aga Khan University, Karachi, Pakistan
  17. 17. Isfahan Cardiovascular Research Center, Cardiovascular Research Institute, Isfahan University of Medical Sciences, Chamran Hospital, Isfahan, Iran
  18. 18. Department of Public Health Sciences, Loyola Medical Center, Maywood, IL, United States
  19. 19. Universidad de La Frontera, Temuco, Chile
  20. 20. Simon Fraser University, Burnaby, BC, Canada
  21. 21. Fundacion Oftalmologica de Santander-FOSCAL—FOSCAL Internacional, Floridablanca, Santander, Colombia
  22. 22. Madras Diabetes Research Foundation and DrMohan's Diabetes Specialities Centre, Gopalapuram, Chennai, India
  23. 23. Dubai Health Authority, Dubai, United Arab Emirates
  24. 24. St John's Medical College and Research Insitute, Bangalore, India
  25. 25. School of Public Health, University of the Western Cape, Cape Town, Western Cape Province, South Africa
  26. 26. Population Health Research Institute, McMaster University, C2-106 DBCVSRI Hamilton General Hospital, Hamilton, ON, Canada
  27. 27. Department of Molecular and Clinical Medicine, Sahlgrenska Academy, University of Gothenburg, Sahlgrenska University Hospital/Ostra, Goteborg, Sweden
  28. 28. South African Medical Research Council Unit for Hypertension and Cardiovascular Disease, Hypertension in Africa Research Team (HART), North-West University, Potchefstroom, South Africa
  29. 29. Independent University, Bangladesh, Dhaka, Bangladesh
  30. 30. University of Ottawa Department of Medicine, Ottawa, ON, Canada
  31. 31. Department of Medicine, Queen's University, Kingston, ON, Canada
  32. 32. Universiti Teknologi MARA, Selyang Campus, Selangor and UCSI University, Selayang, Cheras, Malaysia
  33. 33. Department of Social Medicine, Medical University, Wroclaw, Poland

Source: The Lancet Global Health Published:2018


Abstract

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. Funding: Full funding sources listed at the end of the paper (see Acknowledgments). © 2018 The Author(s). Published by Elsevier Ltd. This is an Open Access article under the CC BY 4.0. license
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