title: Socioeconomic factors and use of secondary preventive therapies for cardiovascular diseases in South Asia: The PURE study.
abstract: OBJECTIVE
  The purpose of this study was to determine the association of socioeconomic factors on use of cardioprotective medicines in known coronary heart disease (CHD) or stroke in South Asia.
  
  
  METHODS
  We enrolled 33,423 subjects aged 35-70 years (women 56%, rural 53%, low education 51%, low household wealth 25%) in 150 communities in India, Pakistan and Bangladesh during 2003-2009. Information regarding socioeconomic status, disease conditions and treatments was recorded. We studied influence of rural location, educational status and household wealth on use of drug therapies. Odds ratios (ORs) and 95% confidence intervals were calculated.
  
  
  RESULTS
  CHD was reported in 683 (2.0%), stroke 316 (0.9%), and CHD/stroke in 970 (2.9%). Median duration since diagnosis was four years. Participants with CHD/stroke were older with greater prevalence of smoking, overweight, hypertension and diabetes (p < 0.01). In patients with CHD, stroke and CHD/stroke, respectively, use (%) of antiplatelets was 11.6, 3.8 and 9.3, beta-blockers 11.9, 7.0 and 10.4, angiotensin-converting enzyme inhibitors or angiotensin receptor blockers 6.4, 1.9 and 5.3 and statins 4.8, 0.6 and 3.5. In CHD/stroke patients any one of these drugs was used in 18.1%, any two in 7.2%, any three in 2.8% and none in 81.5%. Details of drug dose were not available. Use of drugs was significantly lower in rural low education and low wealth index participants (all p < 0.01). Low wealth index participants had the lowest use of these therapies with no attenuation after multiple adjustments.
  
  
  CONCLUSIONS
  The use of secondary preventive drug therapies in patients with known CHD or stroke in South Asia is low with over 80% receiving none of the effective drug treatments. Low household wealth is the most important determinant.
authors.affiliation: Department of Medicine, Fortis Escorts Hospital, India rajeevgg@gmail.com.
authors.forename: Rajeev
authors.initials: R
authors.lastname: Gupta
authors.affiliation: Population Health Research Institute and Hamilton Health Sciences, McMaster University, Canada.
authors.forename: Shofiqul
authors.initials: S
authors.lastname: Islam
authors.affiliation: St John's Research Institute, St John's Medical College, India.
authors.forename: Prem
authors.initials: P
authors.lastname: Mony
authors.affiliation: Health Action by People, India.
authors.forename: V Raman
authors.initials: VR
authors.lastname: Kutty
authors.affiliation: Madras Diabetes Research Foundation, India.
authors.forename: Viswanathan
authors.initials: V
authors.lastname: Mohan
authors.affiliation: School of Public Health, Postgraduate Institute of Medical Education and Research, India.
authors.forename: Rajesh
authors.initials: R
authors.lastname: Kumar
authors.affiliation: School of Public Health, Postgraduate Institute of Medical Education and Research, India.
authors.forename: J S
authors.initials: JS
authors.lastname: Thakur
authors.affiliation: St John's Research Institute, St John's Medical College, India.
authors.forename: V Kiruba
authors.initials: VK
authors.lastname: Shankar
authors.affiliation: Madras Diabetes Research Foundation, India.
authors.forename: Deepa
authors.initials: D
authors.lastname: Mohan
authors.affiliation: Health Action by People, India.
authors.forename: K
authors.initials: K
authors.lastname: Vijayakumar
authors.affiliation: Department of Public Health, Independent University, Bangladesh.
authors.forename: Omar
authors.initials: O
authors.lastname: Rahman
authors.affiliation: Department of Public Health, Independent University, Bangladesh.
authors.forename: Rita
authors.initials: R
authors.lastname: Yusuf
authors.affiliation: Department of Community Health Sciences, Aga Khan University, Pakistan.
authors.forename: Romaina
authors.initials: R
authors.lastname: Iqbal
authors.affiliation: Department of Emergency Medicine, Indus Hospital, Pakistan.
authors.forename: Mohammed
authors.initials: M
authors.lastname: Shahid
authors.affiliation: Department of Medicine, Fortis Escorts Hospital, India.
authors.forename: Indu
authors.initials: I
authors.lastname: Mohan
authors.affiliation: Population Health Research Institute and Hamilton Health Sciences, McMaster University, Canada.
authors.forename: Sumathy
authors.initials: S
authors.lastname: Rangarajan
authors.affiliation: Population Health Research Institute and Hamilton Health Sciences, McMaster University, Canada.
authors.forename: Koon K
authors.initials: KK
authors.lastname: Teo
authors.affiliation: Population Health Research Institute and Hamilton Health Sciences, McMaster University, Canada.
authors.forename: Salim
authors.initials: S
authors.lastname: Yusuf
mesh_terms: D000328:Adult; D000368:Aged; D001459:Bangladesh / Q000453:epidemiology; D002317:Cardiovascular Agents / Q000191:economics / Q000627:therapeutic use*; D015897:Comorbidity; D003327:Coronary Disease / Q000175:diagnosis / Q000191:economics / Q000453:epidemiology / Q000628:therapy*; D003906:Developing Countries / Q000191:economics; D016527:Drug Costs; D004522:Educational Status; D005260:Female; D006801:Humans; D007182:Income; D007194:India / Q000453:epidemiology; D016014:Linear Models; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D016017:Odds Ratio; D010154:Pakistan / Q000453:epidemiology; D011203:Poverty; D011446:Prospective Studies; D012111:Residence Characteristics; D012307:Risk Factors; D019035:Rural Health Services; D055502:Secondary Prevention / Q000191:economics / Q000379:methods*; D012959:Socioeconomic Factors; D020521:Stroke / Q000175:diagnosis / Q000191:economics / Q000453:epidemiology / Q000628:therapy*; D016896:Treatment Outcome; D019037:Urban Health Services
chemical_list: D002317:Cardiovascular Agents
keywords: Cardiovascular disease; coronary heart disease; epidemiology; low income countries; secondary prevention