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

作者：Adrianna Murphy, Benjamin Palafox, Owen O’Donnell, David Stückler, Pablo Perel, Khalid F. AlHabib, Álvaro Avezum, Xiulin Bai, Jephat Chifamba, Clara K Chow, Daniel J. Corsi, Gilles R. Dagenais, Antonio L Dans, Rafael Díaz, Ayşe Naciye Erbakan, Noor Hassim Ismail, Romaina Iqbal, Roya Kelishadi, Rasha Khatib, Fernando Laņas, Scott A. Lear, Wei Li, Jia Liu, Patricio López‐Jaramillo, Viswanathan Mohan, Nahed Monsef, Prem Mony, Thandi Puoane, Sumathy Rangarajan, Annika Rosengren, Aletta E. Schutte, Mariz Sintaha, Koon Teo, Andreas Wielgosz, Karen Yeates, Lu Yin, Khalid Yusoff, Katarzyna Zatońska, Salim Yusuf, Martin McKee · 发表于：The Lancet Global Health · 年份：2018 · DOI：10.1016/s2214-109x(18)30031-7 · 被引用次数：110 · 研究领域：Healthcare Systems and Reforms、Global Public Health Policies and Epidemiology、Medication Adherence and Compliance

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 ...