Deprivation-based risk scores: the re-emergence of postcode prescribing in the UK?
OBJECTIVE
Socioeconomic gradients exist in the prevalence of cardiovascular disease. This has prompted the development of risk scores such as ASSIGN and QRISK, which incorporate measures of deprivation, to address the issue of underprescribing of primary preventive medicines in the socially disadvantaged. The scores use area-based measures of deprivation rather than the socioeconomic status of the individual. We examined to what extent the decision to treat a patient might be influenced by where that individual lived.


METHODS
On the basis of individual patient risk factor data from the Scottish Health Survey, we compared the theoretical level of deprivation [Scottish Index of Multiple Deprivation (SIMD)] required to give a person an ASSIGN risk of 20% (the treatment cut-off), with the person's actual SIMD quintile. We assumed that patients are more likely to move between areas of similar deprivation (i.e. the same SIMD quintile). If the theoretical SIMD value for that individual fell within their actual SIMD quintile, we assumed that prescribing decisions could be influenced by the area of residence.


RESULTS
If the ASSIGN risk score was implemented, the area of residence would affect the decision to initiate statins in the case of 15.7% of the population (aged 30-74 years), and for borderline hypertension, in 3.0%. This corresponds to 407 000 and 15 000 people, respectively, in Scotland and 4.6 million and 169 000 in the entire UK.


CONCLUSIONS
These findings demonstrate that by using cardiovascular risk scores based on area deprivation, primary prevention treatment decisions will be affected by the area of residence in a large number of individuals.
Clinical Pharmacology Unit, Centre for Cardiovascular Science, The University of Edinburgh, Queen's Medical Research Institute, Edinburgh, UK. r.payne@ed.ac.uk
Rupert A
RA
Payne
Simon Rj
SR
Maxwell
D000328:Adult; D000368:Aged; D002317:Cardiovascular Agents / Q000627:therapeutic use*; D002318:Cardiovascular Diseases / Q000453:epidemiology / Q000517:prevention & control*; D005260:Female; D019983:Guideline Adherence; D006297:Health Services Accessibility / Q000706:statistics & numerical data*; D006306:Health Surveys; D054625:Healthcare Disparities / Q000706:statistics & numerical data*; D006801:Humans; D008297:Male; D008875:Middle Aged; D018579:Patient Selection; D011203:Poverty; D017410:Practice Guidelines as Topic; D010818:Practice Patterns, Physicians' / Q000706:statistics & numerical data*; D011322:Primary Prevention / Q000706:statistics & numerical data*; D011610:Psychosocial Deprivation; D012111:Residence Characteristics / Q000706:statistics & numerical data*; D018570:Risk Assessment; D012307:Risk Factors; D012606:Scotland / Q000453:epidemiology; D012923:Social Class
D002317:Cardiovascular Agents