George Mnatzaganian1, Crystal Man Ying Lee2,3, Suzanne Robinson4, Freddy Sitas5,6, Clara K Chow7,8,9, Mark Woodward9,10, Rachel R Huxley9,11. 1. La Trobe Rural Health School, La Trobe University, Australia. 2. School of Psychology and Public Health, La Trobe University, Australia. 3. Boden Collaboration for Obesity, Nutrition, Exercise and Eating Disorders, University of Sydney, Australia. 4. School of Public Health, Curtin University, Australia. 5. Centre for Primary Health Care and Equity, School of Public Health and Community Medicine, University of New South Wales, Australia. 6. Menzies Centre for Health Policy, School of Public Health, University of Sydney, Australia. 7. Westmead Applied Research Centre, University of Sydney, Australia. 8. Department of Cardiology, Westmead Hospital, Sydney, Australia. 9. The George Institute for Global Health, University of New South Wales, Australia. 10. The George Institute for Global Health, University of Oxford, UK. 11. Faculty of Health, Deakin University, Australia.
Abstract
BACKGROUND: This population-based cross-stional and panel study investigated disparities in the management of coronary heart disease (CHD) by level of socioeconomic status. METHODS: CHD patients (aged ≥18 years), treated in 438 general practices in Australia, with ≥3 recent encounters with their general practitioners, with last encounter being during 2016-2018, were included. Secondary prevention prescriptions and number of treatment targets achieved were each modelled using a Poisson regression adjusting for demographics, socioeconomic indicators, remoteness of patient's residence, comorbidities, lifetime follow-up, number of patient-general practitioner encounters and cluster effect within the general practices. The latter model was constructed using the Generalised Estimating Equations approach. Sensitivity analysis was run by comorbidity. RESULTS: Of 137,408 patients (47% women), approximately 48% were prescribed ≥3 secondary prevention medications. However, only 44% were screened for CHD-associated risk factors. Of the latter, 45% achieved ≥5 treatment targets. Compared with patients from the highest socioeconomic status fifth, those from the lowest socioeconomic status fifth were 8% more likely to be prescribed more medications for secondary prevention (incidence rate ratio (95% confidence interval): 1.08 (1.04-1.12)) but 4% less likely to achieve treatment targets (incidence rate ratio: 0.96 (0.95-0.98)). These disparities were also observed when stratified by comorbidities. CONCLUSION: Despite being more likely to be prescribed medications for secondary prevention, those who are most socioeconomically disadvantaged are less likely to achieve treatment targets. It remains to be determined whether barriers such as low adherence to treatment, failure to fill prescriptions, low income, low level of education or other barriers may explain these findings. Published on behalf of the European Society of Cardiology. All rights reserved.
BACKGROUND: This population-based cross-stional and panel study investigated disparities in the management of coronary heart disease (CHD) by level of socioeconomic status. METHODS: CHD patients (aged ≥18 years), treated in 438 general practices in Australia, with ≥3 recent encounters with their general practitioners, with last encounter being during 2016-2018, were included. Secondary prevention prescriptions and number of treatment targets achieved were each modelled using a Poisson regression adjusting for demographics, socioeconomic indicators, remoteness of patient's residence, comorbidities, lifetime follow-up, number of patient-general practitioner encounters and cluster effect within the general practices. The latter model was constructed using the Generalised Estimating Equations approach. Sensitivity analysis was run by comorbidity. RESULTS: Of 137,408 patients (47% women), approximately 48% were prescribed ≥3 secondary prevention medications. However, only 44% were screened for CHD-associated risk factors. Of the latter, 45% achieved ≥5 treatment targets. Compared with patients from the highest socioeconomic status fifth, those from the lowest socioeconomic status fifth were 8% more likely to be prescribed more medications for secondary prevention (incidence rate ratio (95% confidence interval): 1.08 (1.04-1.12)) but 4% less likely to achieve treatment targets (incidence rate ratio: 0.96 (0.95-0.98)). These disparities were also observed when stratified by comorbidities. CONCLUSION: Despite being more likely to be prescribed medications for secondary prevention, those who are most socioeconomically disadvantaged are less likely to achieve treatment targets. It remains to be determined whether barriers such as low adherence to treatment, failure to fill prescriptions, low income, low level of education or other barriers may explain these findings. Published on behalf of the European Society of Cardiology. All rights reserved.
Authors: Therese Kearns; Abbey Diaz; Lisa J Whop; Suzanne P Moore; John R Condon; Ross M Andrews; Judith M Katzenellenbogen; Veronica Matthews; William Wang; Trisha Johnston; Catherine Taylor; Boyd Potts; Alex Kathage; Abdulla Suleman; Lucy Stanley; Louise Mitchell; Gail Garvey; Daniel Williamson Journal: BMJ Open Date: 2021-03-19 Impact factor: 3.006
Authors: George Mnatzaganian; Mark Woodward; H David McIntyre; Liangkun Ma; Nicola Yuen; Fan He; Helen Nightingale; Tingting Xu; Rachel R Huxley Journal: BMC Pregnancy Childbirth Date: 2022-02-01 Impact factor: 3.007