The effect of socioeconomic disadvantage on prescription of guideline-recommended medications for patients with acute coronary syndrome: systematic review and meta-analysis

• Published in: International journal for equity in health 2017-08, Vol.16 (1), p.162-162, Article 162
• Main Authors: Hyun, Karice K, Brieger, David, Woodward, Mark, Richtering, Sarah, Redfern, Julie
• Format: Article
• Language: English
• Subjects: Acute coronary syndrome; Acute Coronary Syndrome - drug therapy; Aspirin; Care and treatment; Complications and side effects; Coronary heart disease; Dosage and administration; Drug Prescriptions - statistics & numerical data; Health inequity; Healthcare Disparities; Humans; In-hospital care; Medication prescription; Meta-analysis; Practice Guidelines as Topic; Risk factors; Social Class; Socioeconomic status; Systematic Review
• ISSN: 1475-9276; 1475-9276
• DOI: 10.1186/s12939-017-0658-z

There are varying data on whether socioeconomic status (SES) affects the treatment in patients with acute coronary syndrome (ACS). Our aim was to obtain a reliable estimate of the effect of SES on discharge prescription of medications following an ACS through systematic review and meta-analysis. Medline, EMBASE and Global Health were searched systematically on 6th April 2016. Studies were eligible if the participants had ACS and reported the rate/odds of guideline-recommended ACS medications prescription (aspirin, antiplatelet, beta blocker, angiotensin co-enzyme inhibitors (ACEi)/angiotensin receptor blockers (ARB) and statin) at discharge stratified by SES. A meta-analysis was performed to pool the estimates, comparing the prescription ratio (PR) between the lowest and the highest SES groups. Of 252 articles found from the search, seven met the eligibility criteria and it included 41,462 (20,986 from the lowest SES group) patients. We found that the individual/neighbourhood level SES did not affect the prescription of aspirin (PR (95% CI): 0.97 (0.91, 1.03)), but for beta blocker and statin, the lowest SES group were disadvantaged (0.84 (0.73, 0.94), 0.80 (0.62, 0.98), respectively). In contrast, ACEi were prescribed more often to the lowest individual/neighbourhood level SES group than the highest (1.13 (1.05, 1.22)). Although the risk of bias was low, there was considerable heterogeneity between the studies. Despite the recommendations to close the treatment gap, the rate of prescription of guideline-recommended medications in managing ACS is significantly different between patients with the lowest and the highest groups. A solution is needed to provide equitable care across the SES groups. Systematic review registration no.: CRD42016048503. Registered 28 September 2016.