title: [Socioeconomic position and appropriate antiplatelet therapy after percutaneous coronary intervention: a population-based cohort study in Rome (Lazio Region, Central Italy)].
abstract: OBJECTIVE
  to evaluate the association between socioeconomic position (SEP) and adherence to appropriate antiplatelet therapy (AAT) after percutaneous coronary intervention (PCI) in the year following the discharge.
  
  
  METHODS
  according to scientific guidelines, AAT for PCI patients consists of Clopidogrel for a minimum of 1 month and ideally up to 12 months after discharge, and with Acetylsalicylic Acid (ASA) indefinitely. For each patient, drug claims over a 1-year period after discharge were retrieved from Regional Drug Dispense Registry. Drug use was measured with Proportion of Days Covered (PDC). PDC was computed dividing the total number of dispensed Defined Daily Dose by each patient's follow-up time. Dual antiplatelet therapy with PDC ≥75% and single therapy based on Clopidogrel with PDC ≥75% were considered as AAT. We used a composite area-based index of socioeconomic position by census block of residence built using the 2001 census of Rome, assuming 5 levels (from 1 =High SEP to 5 =Low SEP).
  
  
  METHODS
  study population of 5,901 patients resident in Rome, who underwent their first PCI during 2006-2007 were selected from the Hospital Information System.
  
  
  METHODS
  proportions of patients treated with AAT by SEP was measured for the overall year and by semester. The association between SEP and adherence to AAT was estimated through logistic regression models adjusting for factors selected by a stepwise procedure (gender, age, comorbidities, discharged from cardiology or coronary care unit, new user of antiplatelet drugs).
  
  
  RESULTS
  76% of the study population were men, 96% were aged more than 44 years, and 63% belonged to medium-low SEP. In the 1-year follow-up, the proportion of patients adherent to appropriate antiplatelet therapy was 65%; SEP was associated with AAT (OR high vs. low SEP 1.26; 95%CI 1.05-1.51; p trend =0.002).
  
  
  CONCLUSIONS
  during the year after discharge, adherence to AAT of PCI patients was unsatisfactory and it decreased overtime more in medium-low SEP patients than in high SEP patients. Strategies to improve adherence to AAT among patients who underwent PCI need to be identified taking into account the multifactorial nature of poor medication adherence, and in particular patients' socioeconomic position.
authors.affiliation: Dipartimento di epidemiologia, Servizio sanitario regionale, Regione Lazio f.mayer@deplazio.it.
authors.forename: Flavia
authors.initials: F
authors.lastname: Mayer
authors.forename: Anna Maria
authors.initials: AM
authors.lastname: Bargagli
authors.forename: Valeria
authors.initials: V
authors.lastname: Belleudi
authors.forename: Nera
authors.initials: N
authors.lastname: Agabiti
authors.forename: Danilo
authors.initials: D
authors.lastname: Fusco
authors.forename: Luigi
authors.initials: L
authors.lastname: Pinnarelli
authors.forename: Ursula
authors.initials: U
authors.lastname: Kirchmayer
authors.forename: Giovanna
authors.initials: G
authors.lastname: Cappai
authors.forename: Mirko
authors.initials: M
authors.lastname: Di Martino
authors.forename: Silvia
authors.initials: S
authors.lastname: Cascini
authors.forename: Marina
authors.initials: M
authors.lastname: Davoli
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000077144:Clopidogrel; D015331:Cohort Studies; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D062645:Percutaneous Coronary Intervention; D010975:Platelet Aggregation Inhibitors / Q000627:therapeutic use*; D012189:Retrospective Studies; D012384:Rome; D012959:Socioeconomic Factors; D013988:Ticlopidine / Q000031:analogs & derivatives* / Q000627:therapeutic use; D055815:Young Adult; D016903:Drug Monitoring
chemical_list: D010975:Platelet Aggregation Inhibitors; D000077144:Clopidogrel; D013988:Ticlopidine