Use of statins and beta-blockers after acute myocardial infarction according to income and education

• Published in: Journal of epidemiology and community health (1979) 2007-12, Vol.61 (12), p.1091-1097
• Main Authors: Rasmussen, Jeppe N, Gislason, Gunnar H, Rasmussen, Søren, Abildstrom, Steen Z, Schramm, Tina K, Køber, Lars, Diderichsen, Finn, Osler, Merete, Torp-Pedersen, Christian, Madsen, Mette
• Format: Article
• Language: English
• Subjects: acute myocardial infarction; Adrenergic beta-Antagonists - economics; Adrenergic beta-Antagonists - therapeutic use; Adult; Aged; Beta blockers; Biological and medical sciences; Cardiology. Vascular system; Confidence Intervals; Contraindications; Coronary heart disease; Denmark; Disease; Drug Costs; Drug dosages; Drug prescriptions; Drug use; Education; Educational Status; Female; General aspects; Health Surveys; Heart; Heart attacks; High income; Hospital admissions; Hospitalization; Hospitals; Humans; Hydroxymethylglutaryl-CoA Reductase Inhibitors - economics; Hydroxymethylglutaryl-CoA Reductase Inhibitors - therapeutic use; Income; income and education; initiation and persistency; Low income; Low socioeconomic status; Male; Medical sciences; Middle Aged; Miscellaneous; Modeling; Mortality; Myocardial infarction; Myocardial Infarction - drug therapy; Myocardial Infarction - prevention & control; Patient Compliance; Patients; Pharmacy; Prescription drugs; Proportional Hazards Models; Public health. Hygiene; Public health. Hygiene-occupational medicine; Registration; Research Report; RESEARCH REPORTS; Socioeconomic factors; Socioeconomic status; State Medicine - organization & administration; Statins
• ISSN: 0143-005X; 1470-2738
• DOI: 10.1136/jech.2006.055525

Objective:To study the initiation of and long-term refill persistency with statins and beta-blockers after acute myocardial infarction (AMI) according to income and education.Design and setting:Linkage of individuals through national registers of hospitalisations, drug dispensation, income and education.Participants:30 078 patients aged 30–74 years surviving first hospitalisation for AMI in Denmark between 1995 and 2001.Main outcome measures:Initiation of statin or beta-blocker treatment (out-patient claim of prescriptions within 6 months of discharge) and refill persistency (first break in treatment lasting at least 90 days, and re-initiation of treatment after a break).Results:When simultaneously estimating the effect of income and education on initiation of treatment, the effect of education attenuated and a clear income gradient remained for both drugs. Among patients aged 30–64 years, high income (adjusted hazard ratio (HR) 1.27; 95% confidence interval (CI) 1.19–1.35) and medium income (HR 1.13; 95% CI 1.06–1.20) was associated with initiation of statin treatment compared with low income. The risk of break in statin treatment was lower for patients with high (HR 0.73; 95% CI 0.66–0.82) and medium (HR 0.82; 95% CI 0.74–0.92) income compared with low income, whereas there was a trend in the opposite direction concerning a break in beta-blocker treatment. There was no gradient in re-initiation of treatment.Conclusion:Patients with low compared with high income less frequently initiated preventive treatment post-AMI, had worse long-term persistency with statins, but tended to have better persistency with beta-blockers. Low income by itself seems not to be associated with poor long-term refill persistency post-AMI.