title: Social deprivation and statin prescribing: a cross-sectional analysis using data from the new UK general practitioner 'Quality and Outcomes Framework'.
abstract: We aimed to study the relationship between the prescribing of lipid-lowering medication, social deprivation and other general practice characteristics. We conducted a cross-sectional survey of all general practices in England, 2004-05. For each practice, the following variables were obtained: standardized cost and volume data for lipid-lowering medication, descriptors of general practices, Index of Multiple Deprivation, 2004, ethnicity data from the 2001 Census and Quality and Outcomes Framework data. A regression model was constructed which explained 34.5% of the variation in statin prescribing by general practitioners. The most powerful predictors were higher social deprivation, higher prevalence of coronary heart disease and achievement of cholesterol targets for diabetics. Negative regression coefficients were demonstrated for the proportion of elderly patients in the practice and, to a lesser extent, for the proportion of south Asian and Afro-Caribbean patients. In conclusion, contrary to previous local studies, we found that statin prescribing was higher in more deprived communities, even after adjustment for increased disease prevalence and practice variables associated with deprivation. Statin prescribing was also independently associated with success at achieving cholesterol targets in established disease (secondary prevention). However, our findings suggest under-prescribing of statins to the elderly and possibly also to ethnic minorities.
authors.affiliation: Department of General Practice and Primary Care, King's College London School of Medicine at Guy's, King's College and St Thomas' Hospitals, 5 Lambeth Walk, London SE11 6SP, UK. mark.ashworth@kcl.ac.uk
authors.forename: M
authors.initials: M
authors.lastname: Ashworth
authors.forename: D
authors.initials: D
authors.lastname: Lloyd
authors.forename: R S
authors.initials: RS
authors.lastname: Smith
authors.forename: A
authors.initials: A
authors.lastname: Wagner
authors.forename: G
authors.initials: G
authors.lastname: Rowlands
mesh_terms: D000293:Adolescent; D000328:Adult; D000367:Age Factors; D000368:Aged; D002318:Cardiovascular Diseases / Q000208:ethnology / Q000517:prevention & control; D003430:Cross-Sectional Studies; D003920:Diabetes Mellitus / Q000208:ethnology / Q000517:prevention & control; D004363:Drug Utilization / Q000706:statistics & numerical data*; D004739:England / Q000453:epidemiology; D005194:Family Practice / Q000592:standards*; D019538:Health Care Surveys; D006801:Humans; D019161:Hydroxymethylglutaryl-CoA Reductase Inhibitors / Q000191:economics / Q000627:therapeutic use*; D006937:Hypercholesterolemia / Q000188:drug therapy / Q000208:ethnology; D016014:Linear Models; D008875:Middle Aged; D011204:Poverty Areas; D010818:Practice Patterns, Physicians' / Q000706:statistics & numerical data*; D011320:Primary Health Care / Q000592:standards*; D019984:Quality Indicators, Health Care; D017062:Small-Area Analysis; D012959:Socioeconomic Factors; D035862:Vulnerable Populations / Q000145:classification* / Q000208:ethnology
chemical_list: D019161:Hydroxymethylglutaryl-CoA Reductase Inhibitors