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Inequity of access to ACE inhibitors in Swedish heart failure patients: a register-based study
Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för folkhälso- och vårdvetenskap, Socialmedicin. (Socialmedicinsk epidemiologi)ORCID-id: anna.ohlsson@pubcare.uu.se
Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för medicinska vetenskaper, Kardiologi. Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska och farmaceutiska vetenskapsområdet, centrumbildningar mm, Uppsala kliniska forskningscentrum (UCR).ORCID-id: 0000-0002-5795-0061
Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för folkhälso- och vårdvetenskap, Socialmedicin.
Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för folkhälso- och vårdvetenskap, Socialmedicin. (Socialmedicinsk epidemiologi)
2016 (engelsk)Inngår i: Journal of Epidemiology and Community Health, ISSN 0143-005X, E-ISSN 1470-2738, Vol. 70, nr 1, s. 97-103Artikkel i tidsskrift (Fagfellevurdert) Published
Abstract [en]

BACKGROUND:

Several international studies suggest inequity in access to evidence-based heart failure (HF) care. Specifically, studies of ACE inhibitors (ACEIs) point to reduced ACEI access related to female sex, old age and socioeconomic position. Thus far, most studies have either been rather small, lacking diagnostic data, or lacking the possibility to account for several individual-based sociodemographic factors. Our aim was to investigate differences, which could reflect inequity in access to ACEIs based on sex, age, socioeconomic status or immigration status in Swedish patients with HF.

METHODS:

Individually linked register data for all Swedish adults hospitalised for HF in 2005-2010 (n=93,258) were analysed by multivariate regression models to assess the independent risk of female sex, high age, low employment status, low income level, low educational level or foreign country of birth, associated with lack of an ACEI dispensation within 1 year of hospitalisation. Adjustment for possible confounding was made for age, comorbidity, Angiotensin receptor blocker therapy, period and follow-up time.

RESULTS:

Analysis revealed an adjusted OR for no ACEI dispensation for women of 1.31 (95% CI 1.27 to 1.35); for the oldest patients of 2.71 (95% CI 2.53 to 2.91); and for unemployed patients of 1.59 (95% CI 1.46 to 1.73).

CONCLUSIONS:

Access to ACEI treatment was reduced in women, older patients and unemployed patients. We conclude that access to ACEIs is inequitable among Swedish patients with HF. Future studies should include clinical data, as well as mortality outcomes in different groups.

sted, utgiver, år, opplag, sider
2016. Vol. 70, nr 1, s. 97-103
HSV kategori
Identifikatorer
URN: urn:nbn:se:uu:diva-287902DOI: 10.1136/jech-2015-205738PubMedID: 26261264OAI: oai:DiVA.org:uu-287902DiVA, id: diva2:923572
Tilgjengelig fra: 2016-04-26 Laget: 2016-04-26 Sist oppdatert: 2017-08-29bibliografisk kontrollert

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Ohlsson, AnnaLindahl, BertilHanning, MarianneWesterling, Ragnar

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