Inequity of access to ACE inhibitors in Swedish heart failure patients: a register-based study
| Autor: | Bertil Lindahl, Ragnar Westerling, Anna Ohlsson, Marianne Hanning |
|---|---|
| Rok vydání: | 2015 |
| Předmět: |
Register based
Gerontology Adult Male Evidence-Based Public Health Policy and Practice Epidemiology International studies media_common.quotation_subject Angiotensin-Converting Enzyme Inhibitors 030204 cardiovascular system & hematology Health Services Accessibility 03 medical and health sciences Young Adult 0302 clinical medicine Sex Factors Sex factors Social medicine ACCESS TO HLTH CARE Medicine Humans cardiovascular diseases 030212 general & internal medicine Registries Young adult Healthcare Disparities Health inequalities media_common Aged Aged 80 and over Heart Failure Sweden business.industry Public Health Environmental and Occupational Health Age Factors Public Health Global Health Social Medicine and Epidemiology Middle Aged medicine.disease Cardiovascular disease Folkhälsovetenskap global hälsa socialmedicin och epidemiologi Unemployment Heart failure Female GENDER business SOCIO-ECONOMIC |
| Zdroj: | Journal of Epidemiology and Community Health |
| ISSN: | 1470-2738 |
| Popis: | BACKGROUND: Several international studies suggest inequity in access to evidence-based heart failure (HF) care. Specifically, studies of ACE inhibitors (ACEIs) point to reduced ACEI access related to female sex, old age and socioeconomic position. Thus far, most studies have either been rather small, lacking diagnostic data, or lacking the possibility to account for several individual-based sociodemographic factors. Our aim was to investigate differences, which could reflect inequity in access to ACEIs based on sex, age, socioeconomic status or immigration status in Swedish patients with HF. METHODS: Individually linked register data for all Swedish adults hospitalised for HF in 2005-2010 (n=93 258) were analysed by multivariate regression models to assess the independent risk of female sex, high age, low employment status, low income level, low educational level or foreign country of birth, associated with lack of an ACEI dispensation within 1 year of hospitalisation. Adjustment for possible confounding was made for age, comorbidity, Angiotensin receptor blocker therapy, period and follow-up time. RESULTS: Analysis revealed an adjusted OR for no ACEI dispensation for women of 1.31 (95% CI 1.27 to 1.35); for the oldest patients of 2.71 (95% CI 2.53 to 2.91); and for unemployed patients of 1.59 (95% CI 1.46 to 1.73). CONCLUSIONS: Access to ACEI treatment was reduced in women, older patients and unemployed patients. We conclude that access to ACEIs is inequitable among Swedish patients with HF. Future studies should include clinical data, as well as mortality outcomes in different groups. |
| Databáze: | OpenAIRE |
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