학술논문
Inequalities in the use of secondary prevention of cardiovascular disease by socioeconomic status: evidence from the PURE observational study
Document Type
article
Author
Adrianna Murphy, PhD; Benjamin Palafox, MSc; Owen O'Donnell, ProfPhD; David Stuckler, ProfPhD; Pablo Perel, PhD; Khalid F AlHabib, ProfMBBS; Alvaro Avezum, ProfPhD; Xiulin Bai, BSc; Jephat Chifamba, ProfDPhil; Clara K Chow, ProfPhD; Daniel J Corsi, PhD; Gilles R Dagenais, MD; Antonio L Dans, MD; Rafael Diaz, MD; Ayse N Erbakan, MD; Noorhassim Ismail, MD; Romaina Iqbal, PhD; Roya Kelishadi, MD; Rasha Khatib, PhD; Fernando Lanas, PhD; Scott A Lear, ProfPhD; Wei Li, ProfPhD; Jia Liu, MSc; Patricio Lopez-Jaramillo, ProfPhD; Viswanathan Mohan, ProfMD; Nahed Monsef, PhD; Prem K Mony, MD; Thandi Puoane, ProfDrPH; Sumathy Rangarajan, MSc; Annika Rosengren, ProfMD; Aletta E Schutte, ProfPhD; Mariz Sintaha, MSc; Koon K Teo, ProfPhD; Andreas Wielgosz, ProfMD; Karen Yeates, MD; Lu Yin, PhD; Khalid Yusoff, ProfMBBS; Katarzyna Zatońska, PhD; Salim Yusuf, ProfPhD; Martin McKee, ProfPhD
Source
The Lancet Global Health, Vol 6, Iss 3, Pp e292-e301 (2018)
Subject
Language
English
ISSN
2214-109X
Abstract
Summary: 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