Inequalities in the use of secondary prevention of cardiovascular disease by socioeconomic status

evidence from the PURE observational study

Adrianna Murphy, Benjamin Palafox, Owen O'Donnell, David Stuckler, Pablo Perel, Khalid F. AlHabib, Alvaro Avezum, Xiulin Bai, Jephat Chifamba, Clara K. Chow, Daniel J. Corsi, Gilles R. Dagenais, Antonio L. Dans, Rafael Diaz, Ayse N. Erbakan, Noor Hassim Ismail, Romaina Iqbal, Roya Kelishadi, Rasha Khatib, Fernando Lanas & 20 others Scott A. Lear, Wei Li, Jia Liu, Patricio Lopez-Jaramillo, Viswanathan Mohan, Nahed Monsef, Prem K. Mony, Thandi Puoane, Sumathy Rangarajan, Annika Rosengren, Aletta E. Schutte, Mariz Sintaha, Koon K. Teo, Andreas Wielgosz, Karen Yeates, Lu Yin, Khalid Yusoff, Katarzyna Zatońska, Salim Yusuf, Martin McKee

Research output: Contribution to journalArticle

13 Citations (Scopus)

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).

Original languageEnglish
Pages (from-to)e292-e301
JournalThe Lancet Global Health
Volume6
Issue number3
DOIs
Publication statusPublished - 1 Mar 2018

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Secondary Prevention
Social Class
Observational Studies
Epidemiology
Cardiovascular Diseases
Zimbabwe
Tanzania
Sweden
Pharmaceutical Preparations
Colombia
Medication Adherence
Economic Development
Saudi Arabia
Chile
Pakistan
Health
Poland
Health Expenditures
South Africa
Canada

ASJC Scopus subject areas

  • Medicine(all)

Cite this

Inequalities in the use of secondary prevention of cardiovascular disease by socioeconomic status : evidence from the PURE observational study. / Murphy, Adrianna; Palafox, Benjamin; O'Donnell, Owen; Stuckler, David; Perel, Pablo; AlHabib, Khalid F.; Avezum, Alvaro; Bai, Xiulin; Chifamba, Jephat; Chow, Clara K.; Corsi, Daniel J.; Dagenais, Gilles R.; Dans, Antonio L.; Diaz, Rafael; Erbakan, Ayse N.; Ismail, Noor Hassim; Iqbal, Romaina; Kelishadi, Roya; Khatib, Rasha; Lanas, Fernando; Lear, Scott A.; Li, Wei; Liu, Jia; Lopez-Jaramillo, Patricio; Mohan, Viswanathan; Monsef, Nahed; Mony, Prem K.; Puoane, Thandi; Rangarajan, Sumathy; Rosengren, Annika; Schutte, Aletta E.; Sintaha, Mariz; Teo, Koon K.; Wielgosz, Andreas; Yeates, Karen; Yin, Lu; Yusoff, Khalid; Zatońska, Katarzyna; Yusuf, Salim; McKee, Martin.

In: The Lancet Global Health, Vol. 6, No. 3, 01.03.2018, p. e292-e301.

Research output: Contribution to journalArticle

Murphy, A, Palafox, B, O'Donnell, O, Stuckler, D, Perel, P, AlHabib, KF, Avezum, A, Bai, X, Chifamba, J, Chow, CK, Corsi, DJ, Dagenais, GR, Dans, AL, Diaz, R, Erbakan, AN, Ismail, NH, Iqbal, R, Kelishadi, R, Khatib, R, Lanas, F, Lear, SA, Li, W, Liu, J, Lopez-Jaramillo, P, Mohan, V, Monsef, N, Mony, PK, Puoane, T, Rangarajan, S, Rosengren, A, Schutte, AE, Sintaha, M, Teo, KK, Wielgosz, A, Yeates, K, Yin, L, Yusoff, K, Zatońska, K, Yusuf, S & McKee, M 2018, 'Inequalities in the use of secondary prevention of cardiovascular disease by socioeconomic status: evidence from the PURE observational study', The Lancet Global Health, vol. 6, no. 3, pp. e292-e301. https://doi.org/10.1016/S2214-109X(18)30031-7
Murphy, Adrianna ; Palafox, Benjamin ; O'Donnell, Owen ; Stuckler, David ; Perel, Pablo ; AlHabib, Khalid F. ; Avezum, Alvaro ; Bai, Xiulin ; Chifamba, Jephat ; Chow, Clara K. ; Corsi, Daniel J. ; Dagenais, Gilles R. ; Dans, Antonio L. ; Diaz, Rafael ; Erbakan, Ayse N. ; Ismail, Noor Hassim ; Iqbal, Romaina ; Kelishadi, Roya ; Khatib, Rasha ; Lanas, Fernando ; Lear, Scott A. ; Li, Wei ; Liu, Jia ; Lopez-Jaramillo, Patricio ; Mohan, Viswanathan ; Monsef, Nahed ; Mony, Prem K. ; Puoane, Thandi ; Rangarajan, Sumathy ; Rosengren, Annika ; Schutte, Aletta E. ; Sintaha, Mariz ; Teo, Koon K. ; Wielgosz, Andreas ; Yeates, Karen ; Yin, Lu ; Yusoff, Khalid ; Zatońska, Katarzyna ; Yusuf, Salim ; McKee, Martin. / Inequalities in the use of secondary prevention of cardiovascular disease by socioeconomic status : evidence from the PURE observational study. In: The Lancet Global Health. 2018 ; Vol. 6, No. 3. pp. e292-e301.
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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).",
author = "Adrianna Murphy and Benjamin Palafox and Owen O'Donnell and David Stuckler and Pablo Perel and AlHabib, {Khalid F.} and Alvaro Avezum and Xiulin Bai and Jephat Chifamba and Chow, {Clara K.} and Corsi, {Daniel J.} and Dagenais, {Gilles R.} and Dans, {Antonio L.} and Rafael Diaz and Erbakan, {Ayse N.} and Ismail, {Noor Hassim} and Romaina Iqbal and Roya Kelishadi and Rasha Khatib and Fernando Lanas and Lear, {Scott A.} and Wei Li and Jia Liu and Patricio Lopez-Jaramillo and Viswanathan Mohan and Nahed Monsef and Mony, {Prem K.} and Thandi Puoane and Sumathy Rangarajan and Annika Rosengren and Schutte, {Aletta E.} and Mariz Sintaha and Teo, {Koon K.} and Andreas Wielgosz and Karen Yeates and Lu Yin and Khalid Yusoff and Katarzyna Zatońska and Salim Yusuf and Martin McKee",
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T1 - Inequalities in the use of secondary prevention of cardiovascular disease by socioeconomic status

T2 - evidence from the PURE observational study

AU - Murphy, Adrianna

AU - Palafox, Benjamin

AU - O'Donnell, Owen

AU - Stuckler, David

AU - Perel, Pablo

AU - AlHabib, Khalid F.

AU - Avezum, Alvaro

AU - Bai, Xiulin

AU - Chifamba, Jephat

AU - Chow, Clara K.

AU - Corsi, Daniel J.

AU - Dagenais, Gilles R.

AU - Dans, Antonio L.

AU - Diaz, Rafael

AU - Erbakan, Ayse N.

AU - Ismail, Noor Hassim

AU - Iqbal, Romaina

AU - Kelishadi, Roya

AU - Khatib, Rasha

AU - Lanas, Fernando

AU - Lear, Scott A.

AU - Li, Wei

AU - Liu, Jia

AU - Lopez-Jaramillo, Patricio

AU - Mohan, Viswanathan

AU - Monsef, Nahed

AU - Mony, Prem K.

AU - Puoane, Thandi

AU - Rangarajan, Sumathy

AU - Rosengren, Annika

AU - Schutte, Aletta E.

AU - Sintaha, Mariz

AU - Teo, Koon K.

AU - Wielgosz, Andreas

AU - Yeates, Karen

AU - Yin, Lu

AU - Yusoff, Khalid

AU - Zatońska, Katarzyna

AU - Yusuf, Salim

AU - McKee, Martin

PY - 2018/3/1

Y1 - 2018/3/1

N2 - 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).

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