Elsevier

American Heart Journal

Volume 157, Issue 4, April 2009, Pages 709-715.e1
American Heart Journal

Clinical Investigation
Outcomes, Health Policy, and Managed Care
The association between socioeconomic status of high-risk patients with coronary heart disease and the treatment rates of evidence-based medicine for coronary heart disease secondary prevention in China: Results from the Bridging the Gap on CHD Secondary Prevention in China (BRIG) Project

https://doi.org/10.1016/j.ahj.2008.12.009Get rights and content

Background

In China, low socioeconomic status (SES) may be a barrier for patients with coronary heart disease (CHD) to receive adequate treatment because of their inadequate access to health resources. This study aims to evaluate whether and to what extent SES is associated with the treatment of CHD patients.

Methods

A cross-sectional survey was conducted among 2,803 CHD outpatients, a representative sample of China. An SES composite index was derived based on educational levels, monthly income, occupation, and access to medical insurance for each patient. The association between SES and treatment status of several key medications was analyzed.

Results

In total, 2,278 CHD outpatients with complete SES information were studied. The treatment rates of clopidogrel and statins were 6.7% and 34.2% in patients with the lowest SES and 41.7% and 75% in patients with the highest SES. In multiple logistic regression analyses, SES was independently associated with the use of aspirin, clopidogrel, statins and β-blockers. Compared with the patients with the highest SES, the patients with the lowest SES had a 43.4% lower treatment rate for aspirin, a 76% lower rate for clopidogrel, a 70.2% lower rate for statins, and a 70.2% lower rate for β-blockers after adjustment for various cofactors.

Conclusions

Socioeconomic status is closely associated with the treatment status of secondary prevention in CHD high-risk patients in China. Policy makers and medical professionals urgently need to develop policies and strategies to improve medical care for patients of low SES.

Section snippets

Study population

The study subjects of the BRIG project were selected from patients in both secondary and tertiary hospitals in all 31 provinces, autonomous regions, and municipalities of mainland China. Multistage nonrandomized sampling was used in this study. First, 57 cities or regions were selected based on their economic levels. Then, 32 secondary hospitals and 32 tertiary hospitals in the 57 cities or regions were recruited. Fifty consecutive outpatients with a history of acute coronary syndrome (ACS)

Characteristics of the study patients

A total of 2,278 CHD outpatients with complete SES information were analyzed. The characteristics of the study patients are presented in Table I. All of the patients had history of ACS, more than one third of the patients (34.3%) had history of recurrent ACS, and 10.4% had history of stroke. One third of male patients (33%) and 21% of female patients had history of PCI or CABG. Compared with male CHD patients, female CHD patients had significantly lower SES levels for all SES indicators.

The association between SES indicators and medication treatment rates

The

Discussion

This study aimed to identify the impact of SES on the treatment rates or treatment status of several key evidence-based medications for CHD secondary prevention based on a nationally representative sample of high-risk CHD outpatients in the World Heart Federation BRIG project in China.

The study provides evidence for a negative impact of low SES on medical care of high-risk CHD patients. The key findings include (1) a large disparity across SES gradients in the treatment rates of aspirin,

References (22)

  • LongdeW. et al.
  • Cited by (50)

    • Inequalities in the use of secondary prevention of cardiovascular disease by socioeconomic status: evidence from the PURE observational study

      2018, The Lancet Global Health
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      Only two studies looked beyond high-income countries, both set in China. One, which developed a composite measure of socioeconomic status based on education, income, occupation, and access to medical insurance, reported 43% lower use of aspirin and over 70% lower use of antiplatelet agents, statins, and β-blockers among patients with lower socioeconomic status.11 The other study examined inequalities by age, comparing patients older and younger than 65 years, finding lower use of secondary prevention in the former.12

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    For members of the BRIG Project see the Appendix, (available online).

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