Several international studies of Angiotensin-converting Enzyme 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 socio-demographic 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 heart failure (HF) patients.
Method and results
Individually-linked register data for all Swedish adults hospitalized for HF in 2005-2010 (n=93, 258) was analysed by multivariate regression models to assess the independent risk of female sex, age, low employment status, low income level, low educational level and foreign country of birth, for not being dispensed an ACEI within 1 year of hospitalization. Analysis revealed an adjusted OR for no ACEI dispensation for women of 1.31 [95% Confidence interval (CI): 1.27, 1.35]; for the oldest patients of 2.71 (95% CI: 2.53, 2.91); and for unemployed patients of 1.59 (95% CI: 1.46, 1.73). Adjustment for possible confounding was made for age, comorbidity, Angiotensin receptor blocker-therapy, period and follow-up time.
Access to ACEI treatment was reduced in women, older patients, and unemployed patients. We conclude that access to ACEIs is inequitable among Swedish HF patients. Future studies should include clinical data, as well as mortality outcomes in different groups.
Keywords: Access to Angiotensin-converting Enzyme Inhibitor (ACEI). Heart failure (HF). Inequity. Guideline-recommended therapy. Socioeconomic position. Sex/gender.
Access to Angiotensin-converting Enzyme Inhibitor (ACEI). Heart failure (HF). Inequity. Guideline-recommended therapy. Socioeconomic position. Sex/gender
Social Stratification and Health March 3, 2015. Arranged by GOCARTs at the University of Gothenburg/Sahlgrenska Academy