Abstract
Background and Objective
The establishment of national guidelines is one approach to creating equity in terms of access to care, and both internationally and in Sweden, guidelines have been developed for coronary heart disease. We have analysed drug treatment in Sweden according to national guidelines after acute myocardial infarction (AMI). The aim was to investigate whether there are differences between population groups according to sex, education, country of birth and diabetes.
Methods
Information was obtained from the Swedish Prescribed Drug Register on drugs dispensed between July and October 2005 for incident cases of AMI during the period 2003–2004 (n = 28,168). Data on socio-economic and demographic conditions were included. Dispensed drugs after AMI were compared to the recommended drug treatment according to Swedish and European guidelines – acetylsalicylic acid (ASA), β-blockers, lipid-lowering drugs and angiotensin-converting enzyme inhibitors (ACE inhibitors).
Results
We found that, in general, there were only small differences between the sexes and between educational groups. The greatest differences were found in comparisons between regions of birth. In particular, foreign-born patients resident in Sweden but originally from outside the EU25 countries used fewer drugs than Swedish-born patients. The OR (odds ratio) for ASA was 0.73 [95% confidence interval (CI) 0.63–0.85], for β-blockers, 0.72 (0.63–0.83), for lipid-lowering drugs, 0.75 (0.65–0.86) and for ACE inhibitors, 0.76 (0.67–0.86).
Conclusions
In general, we found only slight differences – or none at all – between population groups in terms of drug treatment after AMI. Only among immigrants from outside the EU25 countries was there a tendency towards a lesser use of the recommended drugs according to the national guidelines.
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References
Rosén M (1988) Epidemiological measures in planning: observations from Sweden. Int J Health Plan Manage 3:261–270
Haglund B (1994) Vård på lika villkor (Equal access to care) (in Swedish). EpC-report 1994:3. The Swedish National Board of Health and Welfare, Stockholm
Hjern A, Haglund B, Persson G, Rosén M (2001) Is there equity in access to health services for ethnic minorities in Sweden? Eur J Public Health 11:147–152
Whitehead M, Evandrou M, Haglund B, Diderichsen F (1997) As the health divide widens in Sweden and Britain, what’s happening to access to care? Br Med J 315:1006–1009
Haglund B, Köster M, Nilsson T, Rosén M (2004) Inequality in access to coronary revascularization in Sweden. Scand Cardiovasc J 38:334–339
Hjern A, Haglund B, Rasmussen F, Rosén M (2000) Socio-economic differences in daycare arrangements and use of medical care and antibiotics in Swedish preschool children. Acta Paediatr 89:1250–1256
Gorecka K, Linhartova A, Vlcek J, Tilser I (2005) Cardiovascular drug utilisation and socio-economic inequalities in 20 districts of the Czech Republic. Eur J Clin Pharmacol 61:417–423
Stocks NP, Ryan P, McElroy H, Allan J (2004). Statin prescribing in Australia: socioeconomic and sex differences. A cross-sectional study. Med J Aust 180:229–231
Melander E, Nissen A, Henricson K et al (2003) Utilisation of antibiotics in young children: opposite relationships to adult educational level in Danish and Swedish counties. Eur J Clin Pharmacol 59:331–335
Tobi H, Meijer WM, Tuinstra J, de Jong-van den Berg LT (2003) Socio-economic differences in prescription and OTC drug use in Dutch adolescents. Pharm World Sci 25:203–206
Lundberg L, Johannesson M, Isacson DG, Borgquist L (1998) Effects of user charges on the use of prescription medicines in different socio-economic groups. Health Policy 44:123–134
De Backer G, Ambrosioni E, Borch-Johnsen K et al (2003) European guidelines on cardiovascular disease prevention in clinical practice. Eur J Cardiovasc Prev Rehab 10[Suppl 1]:S1–S78
Swedish National Board of Health and Welfare (2004) Socialstyrelsens riktlinjer för hjärtsjukvård (Guidelines on cardiovascular disease) (in Swedish). The Swedish National Board of Health and Welfare, Stockholm
Opolka JL, Rascati KL, Brown CM, Gibson PJ (2004) Ethnicity and prescription patterns for haloperidol, risperidone, and olazapine. Psychiatr Serv 55:151–156
Kuno E, Rothbard AB (2002) Racial disparities in antipsychotic prescription patterns for patients with schizophrenia. Am J Psychiatry 159:567–572
Vaccarino V, Rathore SS, Wenger NK et al (2005) Sex and racial differences in the management of acute myocardial infarction, 1994 through 2002. N Engl J Med 353:671–682
Canto JG, Allison JJ, Kiefe CI et al (2000) Relation of race and sex to the use of reperfusion therapy in Medicare beneficiaries with acute myocardial infarction. N Engl J Med 342:1094–1100
Rathore SS, Berger AK, Weinfurt KP et al (2000) Race, sex, poverty, and the medical treatment of acute myocardial infarction in the elderly. Circulation 102:642–648
EUROASPIRE II Study Group (2001) Lifestyle and risk factor management and use of drug therapies in coronary patients from 15 countries; principal results from EUROASPIRE II Euro Heart Survey Programme. Eur Heart J 22:554–572
Pyorala K, Lehto S, De Bacquer D et al (2004) Risk factor management in diabetic and non-diabetic patients with coronary heart disease. Findings from the EUROASPIRE I and II surveys. Diabetologica 47:1257–1265
Mayer O Jr, Simon J, Heidrich J, Cokkinos DV, De Baquer D, EUROASPIRE II Study Group (2004). Educational level and risk profile of cardiac patients in the EUROASPIRE II substudy. J Epidemiol Community Health 58:47–52
EUROASPIRE I and II Group (2001) Clinical reality of coronary prevention guidelines: a comparison of EUROASPIRE I and II in nine countries. EUROASPIRE I and II Group; European Action on Secondary Prevention by Intervention to Reduce Events. Lancet 357:995–1001
Eliasson M, Janlert U, Jansson JH, Stegmayr B (2006) Time trends in population cholesterol levels 1986–2004: influence of lipid-lowering drugs, obesity, smoking and educational level. The northern Sweden MONICA study. J Intern Med 260:551–559
Helman CG (Ed) (2000) Culture, health and illness, 4th edn. Butterworth Heineman, Oxford
Ringbäck Weitoft G, Gullberg A, Hjern A, Rosén M (1999) Mortality statistics in immigrant research: method for adjusting underestimation of mortality. Int J Epidemiol 28:756–763
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Ringbäck Weitoft, G., Ericsson, Ö., Löfroth, E. et al. Equal access to treatment? Population-based follow-up of drugs dispensed to patients after acute myocardial infarction in Sweden. Eur J Clin Pharmacol 64, 417–424 (2008). https://doi.org/10.1007/s00228-007-0425-y
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DOI: https://doi.org/10.1007/s00228-007-0425-y