Statins prescribing for the secondary prevention of ischaemic heart disease in Torino, Italy. A case of ageism and social inequalities.
BACKGROUND
Socio-demographic and clinical characteristics can influence statins prescribing for the secondary prevention of ischaemic heart disease (IHD). We studied the determinants of the prescription of statins in people with IHD in a population in Italy, the country with the lowest prescribing rate in Europe.


METHODS
All 2001/2002 residents in Torino, aged 30-85 years, with a hospital discharge diagnosis of IHD were linked to the regional Database of Drug Prescriptions to identify those persons who, within 3 months after discharge, had been prescribed statins. Log-binomial models were used to test statins prescription associations with clinical and socio-demographic characteristics.


RESULTS
Statins were prescribed to 31.0% of 7446 patients. Among persons >74 years of age, the prescription rate was 40% lower than that found for younger persons. A positive association was also found for: female gender, being married, a main discharge diagnosis of acute myocardial infarction, revascularization, diabetes and discharge from a cardiology ward. Age was an important effect modifier of the relationship between the prescribing rate and social, but not clinical, determinants.


CONCLUSIONS
The prevention of IHD with statins is influenced by age, clinical and social factors. The prescribing rate is higher among population groups for whom statins are of proven efficacy. Among patients for whom the efficacy is uncertain, the decision to prescribe is influenced by non-clinical factors, suggesting that there exist both age-based and social-based mechanisms of rationing. Age and social determinants act in concert to further reduce the propensity of physicians to prescribe statins.
Gnavi
Roberto
R
Epidemiology Unit, ASL 5 - Regione Piemonte, 10095 Grugliasco, Italy. roberto.gnavi@epi.piemonte.it
Migliardi
Alessandro
A
Demaria
Moreno
M
Petrelli
Alessio
A
Caprioglio
Adele
A
Costa
Giuseppe
G
D000328:Adult; D000367:Age Factors; D000368:Aged; D000369:Aged, 80 and over; D017723:Drug Utilization Review; D005260:Female; D015276:Health Care Rationing; D054625:Healthcare Disparities; D006801:Humans; D019161:Hydroxymethylglutaryl-CoA Reductase Inhibitors / Q000627:therapeutic use*; D007558:Italy / Q000453:epidemiology; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D017202:Myocardial Ischemia / Q000453:epidemiology / Q000517:prevention & control*; D010351:Patient Discharge / Q000706:statistics & numerical data; D010818:Practice Patterns, Physicians' / Q000706:statistics & numerical data*; D012737:Sex Factors; D012959:Socioeconomic Factors; D014504:Urban Health
D019161:Hydroxymethylglutaryl-CoA Reductase Inhibitors