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Adherence to preventive statin therapy according to socioeconomic position

  • Pharmacoepidemiology and Prescription
  • Published:
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Abstract

Aim

To explore whether long-term adherence to preventive statin therapy depends on socioeconomic position (SEP).

Methods

A cohort of individuals without established cardiovascular disease (CVD) or diabetes initiating preventive statin therapy during 2002–2005 was followed in the individual-level Danish registries for 4 years or until censoring events (death, emigration, CVD or diabetes). Only individuals aged 40–84 years for whom information was available on the SEP indicators, education and income were included (N = 76,038). Two different aspects of poor adherence were applied as outcome measures: (1) Proportion of days covered (PDC) with medication below 80 %, assuming a daily dose of one tablet (continuity); (2) Discontinuation defined as a gap between two consecutive prescriptions exceeding 365 days (persistence). Stratum-specific logistic regression analyses were applied to estimate the odds ratio (OR) for PDC <80 % across SEP, adjusting for age and hypertension. Hazard ratio (HR) for discontinuation was estimated by Cox regression analyses.

Results

Adjusting mutually for income and education, the OR for PDC <80 % decreased with increasing income. Comparing the highest income quintile with the lowest, the OR were 0.64 (95 % Confidence Interval 0.64–0.65) and 0.73 (0.73–0.74) in men aged 40–64 and 65–84 years, respectively; in women, the figures were 0.79 (0.79–0.79) and 0.95 (0.94–0.95), respectively. While observed increases in adherence with longer education in unadjusted analyses were attenuated after adjustment for income among men, the potential inverse relationship between length of education and adherence was enhanced among women. Applying discontinuation as outcome, analogous differences were demonstrated.

Conclusion

Adherence to preventive statin therapy in Denmark decreases with decreasing income—especially in men aged 40–64 years.

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Acknowledgement

This study was financed partly by a grant from the Danish Health Foundation and partly by the Nordea Foundation, the latter financing the Centre for Healthy Aging. The study was defined and performed by the researchers, only.

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Authors and Affiliations

  1. Section for Health Service Research, Centre for Healthy Ageing, Faculty of Health and Medical Science, University of Copenhagen, CSS, Øster Farimagsgade 5, 1014, Copenhagen, Denmark

    Helle Wallach-Kildemoes

  2. Centre for Pharmacoepidemiology, Karolinska Institutet, Stockholm, Sweden

    Morten Andersen

  3. Research Unit for General Practice, University of Southern Denmark, Odense, Denmark

    Morten Andersen

  4. Section for Social Medicine, Department of Public Health, University of Copenhagen, Copenhagen, Denmark

    Finn Diderichsen

  5. Biostatistic, Department of Public Health, University of Copenhagen, Copenhagen, Denmark

    Theis Lange

  6. Section of Social and Clinical Pharmacy, Department of Pharmacy, Faculty of Health and Medical Science, University of Copenhagen, Universitetsparken 2, 2100, Copenhagen, Denmark

    Helle Wallach-Kildemoes

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  1. Helle Wallach-Kildemoes
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  3. Finn Diderichsen
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Correspondence to Helle Wallach-Kildemoes.

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Wallach-Kildemoes, H., Andersen, M., Diderichsen, F. et al. Adherence to preventive statin therapy according to socioeconomic position. Eur J Clin Pharmacol 69, 1553–1563 (2013). https://doi.org/10.1007/s00228-013-1488-6

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  • DOI: https://doi.org/10.1007/s00228-013-1488-6

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