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Income differences in the type of antihypertensive medicines used in ambulatory settings in Finland: a register-based study

  • Pharmacoepidemiology and Prescription
  • Published:
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Abstract

Purpose

The objective of this study was to explore income differences in the prevalence of moderate-to-severe hypertension, and among patients, in the use and costs of medicines.

Methods

Personal income was used to classify ≥25-year-old population in quintiles (QI–QV). Patients (N = 497,560) with moderate-to-severe hypertension were identified using special refund entitlements. Medicine use and costs derived from prescription register. Direct standardisation and multivariate regression were used to adjust for demographics and comorbidities.

Results

Low income was associated with higher prevalence of moderate-to-severe hypertension (overall 13 %). After adjusting for age, gender, residence, diabetes and coronary heart disease, nearly all patients purchased at least one antihypertensive medicine (93 vs. 96 % in QI and QV). Differences in the purchased quantities were small (mean estimates 1028 vs. 1054 defined daily doses (DDDs)/patient/year in QIV and QI). High-income patients were more likely to use angiotensin receptor blockers (37 vs. 54 % in QI and QV). Low-income patients were more likely to use beta-blockers (59 vs. 49 %, respectively) and ACE inhibitors (35 vs. 28 %, respectively). Higher income was associated with higher annual out-of-pocket costs (mean €66 vs. €71 in QI and QV) and reimbursements (€144 vs. €163, respectively).

Conclusions

Use of more expensive medicines contributed to higher costs among patients with higher incomes.

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References

  1. Lim SS, Vos T, Flaxman AD et al (2012) A comparative risk assessment of burden of disease and injury attributable to 67 risk factors and risk factor clusters in 21 regions, 1990-2010: a systematic analysis for the Global Burden of Disease Study 2010. Lancet 380(9859):2224–2260

    Article  PubMed Central  PubMed  Google Scholar 

  2. James PA, Oparil S, Carter BL et al (2014) 2014 evidence-based guideline for the management of high blood pressure in adults: report from the panel members appointed to the Eighth Joint National Committee (JNC 8). JAMA 311(5):507–520

    Article  CAS  PubMed  Google Scholar 

  3. Reunanen A, Kattainen A, Salomaa V (2009) Biological risk factors. In: Palosuo H et al (eds) Health inequalities in Finland. Trends in socioeconomic health differences 1980–2005. Publications of the Ministry of Social Affairs and Health 9, Helsinki, pp 169–177

    Google Scholar 

  4. Statistics Finland (2011) Causes of death http://tilastokeskus.fi/til/ksyyt/2011/ksyyt_2011_2012-12-21_tie_001_en.html. Accessed 11 March 2014

  5. Valkonen T, Ahonen H, Martikainen P et al (2009) Socio-economic differences in mortality. In: Palosuo H et al (eds) Health inequalities in Finland. Trends in socioeconomic health differences 1980–2005. Publications of the Ministry of Social Affairs and Health 9, Helsinki, pp 40–60

    Google Scholar 

  6. Manderbacka K, Keskimäki I, Reunanen A et al (2008) Equity in the use of antithrombotic drugs, beta-blockers and statins among Finnish coronary patients. Int J Equity Health. doi:10.1186/1475-9276-7-16

    PubMed Central  PubMed  Google Scholar 

  7. Vehko T, Sund R, Arffman M et al (2013) Monitoring the use of lipid-lowering medication among persons with newly diagnosed diabetes: a nationwide register-based study. BMJ Open. doi:10.1136/bmjopen-2013-003414

    PubMed Central  PubMed  Google Scholar 

  8. Brown AF, Gross AG, Gutierrez PR et al (2003) Income-related differences in the use of evidence-based therapies in older persons with diabetes mellitus in for-profit managed care. J Am Geriatr Soc 51:665–670

    Article  PubMed  Google Scholar 

  9. Thomsen RW, Johnsen SP, Olesen AV et al (2005) Socioeconomic gradient in use of statins among Danish patients: population-based cross-sectional study. Br J Clin Pharmacol 60(5):534–542

    Article  PubMed Central  PubMed  Google Scholar 

  10. Dominguez H, Schramm TK, Norgaard ML et al (2009) Initiation and persistence to statin treatment in patients with diabetes receiving glucose-lowering medications 1997–2006. Open Cardiovasc Med J 3:152–159

    Article  PubMed Central  CAS  PubMed  Google Scholar 

  11. Selmer R, Sakshaug S, Skurtveit S et al (2009) Statin treatment in a cohort of 20 212 men and women in Norway according to cardiovascular risk factors and level of education. Br J Clin Pharmacol 67(3):355–362

    Article  PubMed Central  PubMed  Google Scholar 

  12. Salomaa V, Miettinen H, Niemelä M et al (2001) Relation of socioeconomic position to the case fatality, prognosis and treatment of myocardial infarction events; the FINMONICA MI Register Study. J Epidemiol Community Health 55:475–482

    Article  PubMed Central  CAS  PubMed  Google Scholar 

  13. Vehko T, Manderbacka K, Arffman M et al (2010) Changing patterns of secondary preventive medication among newly diagnosed coronary heart disease patients with diabetes in Finland: a register-based study. Scand J Public Health 38:317–324

    Article  PubMed  Google Scholar 

  14. Working group appointed by the Finnish Medical Society Duodecim and the Finnish Hypertension Society (2009, updated version in 2014) Current Care Guideline: Hypertension. Duodecim, Helsinki

  15. National Clinical Guideline Centre commissioned by the National Institute for Health and Clinical Excellence (2011) Hypertension. The clinical management of primary hypertension in adults. Clinical Guideline 127. National Clinical Guideline Centre, London

  16. Mancia G, Fagard R, Narkiewicz K et al (2013) 2013 ESH/ESC Guidelines for the management of arterial hypertension: the task force for the management of arterial hypertension of the European Society of Hypertension (ESH) and of the European Society of Cardiology (ESC). J Hypertens 31(7):1281–1357

    Article  CAS  PubMed  Google Scholar 

  17. Ahola TL, Kantola IM, Mäki J et al (2012) Adding a low-dose antihypertensive regimen would substantially improve the control of hypertension and reduce cardiovascular morbidity among uncomplicated hypertensive patients. Eur J Prev Cardiol 19(4):712–722

    Article  PubMed  Google Scholar 

  18. Tamblyn R, McLeod P, Hanley JA et al (2003) Physician and practice characteristics associated with the early utilization of new prescription drugs. Med Care 41(8):895–908

    Article  PubMed  Google Scholar 

  19. Buusman A, Andersen M, Merrild C et al (2007) Factors influencing GPs’ choice between drugs in a therapeutic drug group. A qualitative study. Scand J Prim Health Care 25(4):208–213

    Article  PubMed Central  PubMed  Google Scholar 

  20. Haider SI, Johnell K, Ringbäck Weitoft G et al (2008) Patient educational level and use of newly marketed drugs: a register-based study of over 600,000 older people. Eur J Clin Pharmacol 64:1215–1222

    Article  PubMed  Google Scholar 

  21. Ohlsson H, Chaix B, Merlo J (2009) Therapeutic traditions, patient socioeconomic characteristics and physicians’ early new drug prescribing—a multilevel analysis of rosuvastatin prescription in south Sweden. Eur J Clin Pharmacol 65:141–150

    Article  PubMed  Google Scholar 

  22. Ohlsson H, Lynch K, Merlo J (2010) Is the physician’s adherence to prescription guidelines associated with the patient’s socio-economic position? An analysis of statin prescription in south Sweden. J Epidemiol Community Health 64(8):678–683

    Article  PubMed  Google Scholar 

  23. Semark B, Engström S, Brudin L et al (2013) Factors influencing the prescription of drugs of different price levels. Pharmacoepidemiol Drug Saf 22:286–293

    Article  PubMed  Google Scholar 

  24. OECD (2011) Health at a glance 2011: OECD Publishing. http://dx.doi.org/10.1787/health_glance-2011-63-en. Accessed 1 November 2013

  25. Mossialos E, Srivastava D. (2008) Pharmaceutical policies in Finland. Challenges and opportunities. Observatory studies series 10. European Observatory on Health Systems and Policies. http://www.euro.who.int/__data/assets/pdf_file/0020/80651/E91239.pdf

  26. Organisation for Economic Co-Operation and Development (2005) OECD reviews of health systems. OECD, Paris, Finland

    Google Scholar 

  27. Blomgren J, Aaltonen K, Tervola J et al. (2015) Kelan sairaanhoitokorvaukset tuloryhmittäin: kenelle korvauksia maksetaan ja kuinka paljon? (Finnish: National Health Insurance (NHI) reimbursements by income group) Sosiaali- ja terveysturvan selosteita 93. Kelan tutkimusosasto, Helsinki. http://hdl.handle.net/10138/154606

  28. Saastamoinen LK, Aaltonen K, Maljanen T et al (2012) Health registers as a source of data for research and policy making. Dosis 28(3):199–205

    Google Scholar 

  29. Furu K, Wettermark B, Andersen M et al (2010) The Nordic countries as a cohort for pharmacoepidemiological research. Basic Clin Pharmacol Toxicol 106:86–94

    Article  CAS  PubMed  Google Scholar 

  30. WHO Collaborating Centre for Drug Statistics Methodology (2013) ATC/DDD Index 2013 http://www.whocc.no/atcddd/. Accessed 11 September 2013

  31. WHO Collaborating Centre for Drug Statistics Methodology (2014) Guidelines for ATC classification and DDD assignment 2015 Oslo

  32. Searle SR, Speed FM, Milliken GA (1980) Population marginal means in the linear model: an alternative to least squares means. Am Stat 34(4):216–221

    Google Scholar 

  33. Sabaté E (2003) Adherence to long-term therapies: evidence for action. WHO/MNC/03.01, World Health Organization, Geneva

    Google Scholar 

  34. Lemstra M, Alsabbagh MW (2014) Proportion and risk indicators of nonadherence to antihypertensive therapy: a meta-analysis. Pat Pref Adhere 8:211–218

    Article  Google Scholar 

  35. Aaltonen K, Miettinen J, Airio I, Martikainen JE, Saastamoinen LK, Bell JS, Hartikainen S, Norris P (2015) Cost-related barriers to use of health services and prescription medicines in Finland: a cross-sectional survey. Eur J Public Health 25(3):368–372

    Article  PubMed  Google Scholar 

  36. Social Insurance Institution of Finland. Statistical database Kelasto. http://www.kela.fi/kelasto Accessed 17 September 2014

  37. Ringbäck Weitoft G, Rosén M, Ericsson Ö et al (2008) Education and drug use in Sweden—a nationwide register-based study. Pharmacoepidemiol Drug Saf 17:1020–1028

    Article  PubMed  Google Scholar 

  38. Merlo J, Ohlsson H, Carlsson M (2009) Tål inte rika skåningar ACE-hämmare? https://www.skane.se/upload/Webbplatser/UMAS/VERKSAMHETER%20UMAS/Socialmedicin/08-l%C3%A4kemedel/tal-inte-rika-skaningar-ace.pdf

  39. Greving JP, Denig P, van der Veen WJ et al (2006) Determinants for the adoption of angiotensin II receptor blockers by general practitioners. Soc Sci Med 63(11):2890–2898

    Article  PubMed  Google Scholar 

  40. Håkansson A, Andersson H, Cars H et al (2001) Prescribing, prescription costs and adherence to formulary committee recommendations: long-term differences between physicians in public and private care. Eur J Clin Pharmacol 57(1):65–70

    Article  PubMed  Google Scholar 

  41. Andersson K, Carlsten A, Hedenrud T (2009) Prescribing behaviour after the introduction of decentralized drug budgets: is there an association with employer and type of care facility? Scand J Prim Health Care 27:117–122

    Article  PubMed Central  PubMed  Google Scholar 

  42. van Doorslaer E, Masseria C, Koolman X, for the OECD Health Equity Research Group (2006) Inequalities in access to medical care by income in developed countries. CMAJ 174(2):177–183

    Article  PubMed Central  PubMed  Google Scholar 

  43. Entonen AH, Suominen SB, Korkeila K et al (2014) Migraine predicts hypertension—a cohort study of the Finnish working-age population. Eur J Public Health 24(2):244–248

    Article  PubMed  Google Scholar 

  44. Jula A, Salomaa V, Aromaa A et al (2012) Verenpaine (Finnish: hypertension). In: Koskinen S et al (eds) Health, functional capacity and welfare in Finland in 2011. National Institute for Health and Welfare (THL), Report 68, Helsinki, pp 66–69

    Google Scholar 

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Acknowledgments

The authors would like to thank research assistant Hilkka Ruuska for her help with data combining and management. Anonymous reviewers are thanked for their valuable comments and suggestions. Dr Jaana E. Martikainen (Kela), Dr. Kati Sepponen (University of Eastern Finland) and Prof. Mikko Niemelä (University of Turku) are also thanked for their valuable advice.

Conflict of interest

The authors declare that they have no competing interests.

Contributions of authors

Mirva Härkönen drafted the first version of the manuscript. Katri Aaltonen drafted the revised version of the manuscript. Katri Aaltonen, Mirva Härkönen and Johanna Timonen contributed to the acquisition, conception, design, and interpretation of data and drafting of the manuscript. Mirva Härkönen, Katri Aaltonen and Jussi Tervola contributed to the analysis of data. All authors contributed to the critical revision of the manuscript and approved the final manuscript.

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Authors and Affiliations

  1. School of Pharmacy, Faculty of Health Sciences, University of Eastern Finland, P.O. Box 1627, FIN-70211, Kuopio, Finland

    Härkönen Mirva & Timonen Johanna

  2. Research Department, The Social Insurance Institution of Finland, P.O. Box 450, FI-00101, Helsinki, Finland

    Tervola Jussi & Katri Aaltonen

Authors
  1. Härkönen Mirva
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  2. Timonen Johanna
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  4. Katri Aaltonen
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Correspondence to Katri Aaltonen.

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Mirva, H., Johanna, T., Jussi, T. et al. Income differences in the type of antihypertensive medicines used in ambulatory settings in Finland: a register-based study. Eur J Clin Pharmacol 71, 1263–1270 (2015). https://doi.org/10.1007/s00228-015-1911-2

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  • DOI: https://doi.org/10.1007/s00228-015-1911-2

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