Use of statins and beta-blockers after acute myocardial infarction according to income and education.
OBJECTIVE
To study the initiation of and long-term refill persistency with statins and beta-blockers after acute myocardial infarction (AMI) according to income and education.


METHODS
Linkage of individuals through national registers of hospitalisations, drug dispensation, income and education.


METHODS
30 078 patients aged 30-74 years surviving first hospitalisation for AMI in Denmark between 1995 and 2001.


METHODS
Initiation of statin or beta-blocker treatment (out-patient claim of prescriptions within 6 months of discharge) and refill persistency (first break in treatment lasting at least 90 days, and re-initiation of treatment after a break).


RESULTS
When simultaneously estimating the effect of income and education on initiation of treatment, the effect of education attenuated and a clear income gradient remained for both drugs. Among patients aged 30-64 years, high income (adjusted hazard ratio (HR) 1.27; 95% confidence interval (CI) 1.19-1.35) and medium income (HR 1.13; 95% CI 1.06-1.20) was associated with initiation of statin treatment compared with low income. The risk of break in statin treatment was lower for patients with high (HR 0.73; 95% CI 0.66-0.82) and medium (HR 0.82; 95% CI 0.74-0.92) income compared with low income, whereas there was a trend in the opposite direction concerning a break in beta-blocker treatment. There was no gradient in re-initiation of treatment.


CONCLUSIONS
Patients with low compared with high income less frequently initiated preventive treatment post-AMI, had worse long-term persistency with statins, but tended to have better persistency with beta-blockers. Low income by itself seems not to be associated with poor long-term refill persistency post-AMI.
Rasmussen
Jeppe N
JN
National Institute of Public Health, Øster Farimagsgade 5, DK-1399 Copenhagen K, Denmark. jnr@niph.dk
Gislason
Gunnar H
GH
Rasmussen
Søren
S
Abildstrom
Steen Z
SZ
Schramm
Tina K
TK
Køber
Lars
L
Diderichsen
Finn
F
Osler
Merete
M
Torp-Pedersen
Christian
C
Madsen
Mette
M
D000319:Adrenergic beta-Antagonists / Q000191:economics / Q000627:therapeutic use*; D000328:Adult; D000368:Aged; D016001:Confidence Intervals; D003718:Denmark; D016527:Drug Costs; D004522:Educational Status; D005260:Female; D006306:Health Surveys; D006760:Hospitalization; D006801:Humans; D019161:Hydroxymethylglutaryl-CoA Reductase Inhibitors / Q000191:economics / Q000627:therapeutic use*; D007182:Income; D008297:Male; D008875:Middle Aged; D009203:Myocardial Infarction / Q000188:drug therapy / Q000517:prevention & control*; D010349:Patient Compliance; D016016:Proportional Hazards Models; D013222:State Medicine / Q000458:organization & administration
D000319:Adrenergic beta-Antagonists; D019161:Hydroxymethylglutaryl-CoA Reductase Inhibitors