Influence of socioeconomic deprivation on the primary care burden and treatment of patients with a diagnosis of heart failure in general practice in Scotland: population based study.
OBJECTIVE
To examine whether there are socioeconomic gradients in the incidence, prevalence, treatment, and follow up of patients with heart failure in primary care.


METHODS
Population based study.


METHODS
53 general practices (307,741 patients) participating in the Scottish continuous morbidity recording project between 1 April 1999 and 31 March 2000.


METHODS
2186 adults with heart failure.


METHODS
Comorbid diagnoses, frequency of visits to general practitioner, and prescribed drugs.


RESULTS
2186 patients with heart failure were seen (prevalence 7.1 per 1000 population, incidence 2.0 per 1000 population). The age and sex standardised incidence of heart failure increased with greater socioeconomic deprivation, from 1.8 per 1000 population in the most affluent stratum to 2.6 per 1000 population in the most deprived stratum (odds ratio 1.44, P = 0.0003). On average, patients were seen 2.4 times yearly, but follow up rates were less frequent with increasing socioeconomic deprivation (from 2.6 yearly in the most affluent subgroup to 2.0 yearly in the most deprived subgroup, P = 0.00009). Overall, 812 (80.6%) patients were prescribed diuretics, 396 (39.3%) angiotensin converting enzyme inhibitors, 216 (21.4%) beta blockers, 208 (20.7%) digoxin, and 86 (8.5%) spironolactone. The wide discrepancies in prescribing between different general practices disappeared after adjustment for patient age and sex. Prescribing patterns did not vary by deprivation categories on univariate or multivariate analyses.


CONCLUSIONS
Compared with affluent patients, socioeconomically deprived patients were 44% more likely to develop heart failure but 23% less likely to see their general practitioner on an ongoing basis. Prescribed treatment did not differ across socioeconomic gradients.
McAlister
F A
FA
Department of Medicine, University of Alberta, Edmonton, AB, Canada T6G 2R7.
Murphy
N F
NF
Simpson
C R
CR
Stewart
S
S
MacIntyre
K
K
Kirkpatrick
M
M
Chalmers
J
J
Redpath
A
A
Capewell
S
S
McMurray
J J V
JJ
D002303:Cardiac Output, Low / Q000191:economics / Q000453:epidemiology / Q000628:therapy*; D017281:Cost of Illness; D005194:Family Practice / Q000706:statistics & numerical data; D006801:Humans; D015994:Incidence; D010342:Patient Acceptance of Health Care / Q000706:statistics & numerical data; D011203:Poverty; D015995:Prevalence; D012606:Scotland / Q000453:epidemiology; D012959:Socioeconomic Factors