Inequalities in the Use of Secondary Prevention of Cardiovascular Disease by Socioeconomic Status: Evidence From the Pure Observational Study

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Inequalities in the Use of Secondary Prevention of Cardiovascular Disease by Socioeconomic Status: Evidence From the Pure Observational Study Publisher Pubmed

Murphy A¹ ; Palafox B¹ ; Odonnell O^{2, 3} ; Stuckler D⁴ ; Perel P¹ ; Alhabib KF⁵ ; Avezum A⁶ ; Bai X⁷ ; Chifamba J⁸ ; Chow CK⁹ ; Corsi DJ¹⁰ ; Dagenais GR¹¹ ; Dans AL¹² ; Diaz R¹³ Show All Authors

Murphy A¹
Palafox B¹
Odonnell O^{2, 3}
Stuckler D⁴
Perel P¹
Alhabib KF⁵
Avezum A⁶
Bai X⁷
Chifamba J⁸
Chow CK⁹
Corsi DJ¹⁰
Dagenais GR¹¹
Dans AL¹²
Diaz R¹³
Erbakan AN¹⁴
Ismail N¹⁵
Iqbal R¹⁶
Kelishadi R¹⁷
Khatib R¹⁸
Lanas F¹⁹
Lear SA²⁰
Li W⁷
Liu J⁷
Lopezjaramillo P²¹
Mohan V²²
Monsef N²³
Mony PK²⁴
Puoane T²⁵
Rangarajan S²⁶
Rosengren A²⁷
Schutte AE²⁸
Sintaha M²⁹
Teo KK²⁶
Wielgosz A³⁰
Yeates K³¹
Yin L⁷
Yusoff K³²
Zatonska K³³
Yusuf S²⁶
Mckee M¹

Source: The Lancet Global Health Published:2018

Abstract

Background: There is little evidence on the use of secondary prevention medicines for cardiovascular disease by socioeconomic groups in countries at different levels of economic development. Methods: We assessed use of antiplatelet, cholesterol, and blood-pressure-lowering drugs in 8492 individuals with self-reported cardiovascular disease from 21 countries enrolled in the Prospective Urban Rural Epidemiology (PURE) study. Defining one or more drugs as a minimal level of secondary prevention, wealth-related inequality was measured using the Wagstaff concentration index, scaled from −1 (pro-poor) to 1 (pro-rich), standardised by age and sex. Correlations between inequalities and national health-related indicators were estimated. Findings: The proportion of patients with cardiovascular disease on three medications ranged from 0% in South Africa (95% CI 0–1·7), Tanzania (0–3·6), and Zimbabwe (0–5·1), to 49·3% in Canada (44·4–54·3). Proportions receiving at least one drug varied from 2·0% (95% CI 0·5–6·9) in Tanzania to 91·4% (86·6–94·6) in Sweden. There was significant (p<0·05) pro-rich inequality in Saudi Arabia, China, Colombia, India, Pakistan, and Zimbabwe. Pro-poor distributions were observed in Sweden, Brazil, Chile, Poland, and the occupied Palestinian territory. The strongest predictors of inequality were public expenditure on health and overall use of secondary prevention medicines. Interpretation: Use of medication for secondary prevention of cardiovascular disease is alarmingly low. In many countries with the lowest use, pro-rich inequality is greatest. Policies associated with an equal or pro-poor distribution include free medications and community health programmes to support adherence to medications. Funding: Full funding sources listed at the end of the paper (see Acknowledgments). © 2018 The Author(s). Published by Elsevier Ltd. This is an Open Access article under the CC BY 4.0. license

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Style	Citing Format
MLA	Murphy A, et al.. "Inequalities in the Use of Secondary Prevention of Cardiovascular Disease by Socioeconomic Status: Evidence From the Pure Observational Study." The Lancet Global Health, vol. 6, no. 3, 2018, pp. e292-e301.
APA	Murphy A, Palafox B, Odonnell O, Stuckler D, Perel P, Alhabib KF, Avezum A, Bai X, Chifamba J, Chow CK, Corsi DJ, Dagenais GR, Dans AL, Diaz R, Erbakan AN, Ismail N, Iqbal R, Kelishadi R, Khatib R, ... Mckee M (2018). Inequalities in the Use of Secondary Prevention of Cardiovascular Disease by Socioeconomic Status: Evidence From the Pure Observational Study. The Lancet Global Health, 6(3), e292-e301.
Chicago	Murphy A, Palafox B, Odonnell O, Stuckler D, Perel P, Alhabib KF, Avezum A, et al.. "Inequalities in the Use of Secondary Prevention of Cardiovascular Disease by Socioeconomic Status: Evidence From the Pure Observational Study." The Lancet Global Health 6, no. 3 (2018): e292-e301.
Harvard	Murphy A et al. (2018) 'Inequalities in the Use of Secondary Prevention of Cardiovascular Disease by Socioeconomic Status: Evidence From the Pure Observational Study', The Lancet Global Health, 6(3), pp. e292-e301.
Vancouver	Murphy A, Palafox B, Odonnell O, Stuckler D, Perel P, Alhabib KF, et al.. Inequalities in the Use of Secondary Prevention of Cardiovascular Disease by Socioeconomic Status: Evidence From the Pure Observational Study. The Lancet Global Health. 2018;6(3):e292-e301.
BibTex	@article{ author = {Murphy A and Palafox B and Odonnell O and Stuckler D and Perel P and Alhabib KF and Avezum A and Bai X and Chifamba J and Chow CK and Corsi DJ and Dagenais GR and Dans AL and Diaz R and Erbakan AN and Ismail N and Iqbal R and Kelishadi R and Khatib R and Lanas F and Lear SA and Li W and Liu J and Lopezjaramillo P and Mohan V and Monsef N and Mony PK and Puoane T and Rangarajan S and Rosengren A and Schutte AE and Sintaha M and Teo KK and Wielgosz A and Yeates K and Yin L and Yusoff K and Zatonska K and Yusuf S and Mckee M}, title = {Inequalities in the Use of Secondary Prevention of Cardiovascular Disease by Socioeconomic Status: Evidence From the Pure Observational Study}, journal = {The Lancet Global Health}, volume = {6}, number = {3}, pages = {e292-e301}, year = {2018} }
RIS	TY - JOUR AU - Murphy A AU - Palafox B AU - Odonnell O AU - Stuckler D AU - Perel P AU - Alhabib KF AU - Avezum A AU - Bai X AU - Chifamba J AU - Chow CK AU - Corsi DJ AU - Dagenais GR AU - Dans AL AU - Diaz R AU - Erbakan AN AU - Ismail N AU - Iqbal R AU - Kelishadi R AU - Khatib R AU - Lanas F AU - Lear SA AU - Li W AU - Liu J AU - Lopezjaramillo P AU - Mohan V AU - Monsef N AU - Mony PK AU - Puoane T AU - Rangarajan S AU - Rosengren A AU - Schutte AE AU - Sintaha M AU - Teo KK AU - Wielgosz A AU - Yeates K AU - Yin L AU - Yusoff K AU - Zatonska K AU - Yusuf S AU - Mckee M TI - Inequalities in the Use of Secondary Prevention of Cardiovascular Disease by Socioeconomic Status: Evidence From the Pure Observational Study JO - The Lancet Global Health VL - 6 IS - 3 SP - e292 EP - e301 PY - 2018 ER -