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  • 1.
    Ohlsson, Anna
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Public Health and Caring Sciences, Social Medicine.
    Inequity of access to Angiotensin-converting Enzyme inhibitors in SwedishHeart failure patients2015In: http://simsam.nu/wp-content/uploads/2015/03/Recap-GOCARTs-150303.pdf, 2015Conference paper (Other academic)
    Abstract [en]

    Background

    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.

     

    Conclusion

    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.  

  • 2.
    Ohlsson, Anna
    et al.
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Public Health and Caring Sciences, Social Medicine.
    Lindahl, Bertil
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Medical Sciences, Cardiology. Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Medicinska och farmaceutiska vetenskapsområdet, centrumbildningar mm, UCR-Uppsala Clinical Research Center.
    Hanning, Marianne
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Public Health and Caring Sciences, Health Services Research. Natl Board Hlth & Welf, Stockholm, Sweden..
    Westerling, Ragnar
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Public Health and Caring Sciences, Social Medicine.
    Gender inequity in heart failure treatment affects mortality in a Swedish total population cohort2016In: European Journal of Public Health, ISSN 1101-1262, E-ISSN 1464-360X, Vol. 26Article in journal (Refereed)
  • 3.
    Ohlsson, Anna
    et al.
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Public Health and Caring Sciences, Social Medicine.
    Lindahl, Bertil
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Medical Sciences, Cardiology. Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Medicinska och farmaceutiska vetenskapsområdet, centrumbildningar mm, UCR-Uppsala Clinical Research Center.
    Hanning, Marianne
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Public Health and Caring Sciences, Social Medicine.
    Westerling, Ragnar
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Public Health and Caring Sciences, Social Medicine.
    Inequity of access to ACE inhibitors in Swedish heart failure patients: a register-based study2016In: Journal of Epidemiology and Community Health, ISSN 0143-005X, E-ISSN 1470-2738, Vol. 70, no 1, p. 97-103Article in journal (Refereed)
    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.

  • 4.
    Ohlsson, Anna
    et al.
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Public Health and Caring Sciences, Social Medicine.
    Lindahl, Bertil
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Medical Sciences, Cardiology.
    Hanning, Marianne
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Public Health and Caring Sciences, Health Services Research.
    Westerling, Ragnar
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Public Health and Caring Sciences, Social Medicine.
    Inequity of access to ACE inhibitors in Swedish heart failure patients: a register-based study2016In: Journal of Epidemiology and Community Health, ISSN 0143-005X, E-ISSN 1470-2738, Vol. 70, no 1, p. 97-103Article in journal (Refereed)
    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.

  • 5.
    Ohlsson, Anna
    et al.
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Public Health and Caring Sciences, Social Medicine.
    Westerling, Ragnar
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Public Health and Caring Sciences, Social Medicine.
    Lindahl, Bertil
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Medical Sciences, Cardiology.
    Hanning, Marianne
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Public Health and Caring Sciences, Social Medicine.
    Heart failure mortality in relation to unequal access to Renin-Angiotensin system blocking therapy.: A register based study.2016Conference paper (Other academic)
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