title: Health inequalities associated with neighbourhood deprivation in the Quebec population with hypertension in primary prevention of cardiovascular disease.
abstract: BACKGROUND
  Although a number of studies look at prevalence, incidence, treatment, mortality and morbidity in relation to hypertension, few have taken into account the effect of residential neighbourhood on these health indicators in the population diagnosed with hypertension.
  
  
  OBJECTIVE
  The objective of this study was to measure and compare prevalence, mortality, morbidity, use of medical resources and treatments in relation to the level of material and social deprivation of the area of residence, in a population with a diagnosis of hypertension in primary prevention for cardiovascular disease (CVD) in Quebec in 2006-2007.
  
  
  METHODS
  This study is based on a secondary analysis of the medical administrative data of the Quebec health insurance board, the Régie de l'assurance maladie du Québec, for a cohort of 276 793 patients aged 30 years or older who had been diagnosed with hypertension in 2006 or 2007, but who did not have a known diagnosis of CVD. The health indicators adjusted for age and sex are prevalence, death, a cardiovascular event, physician visits, emergency department visits and use of antihypertensives. Twenty-five types of areas of residence were obtained by crossing the material and social deprivation quintiles.
  
  
  RESULTS
  Compared with patients living in materially and socially advantaged areas, those living in deprived areas were at 46% higher risk of a cardiovascular event, 47% higher risk of being frequent emergency department visitors and 31% higher risk of being frequent users of a general practitioner's services, but 25% lower risk of being frequent users of medical specialists' services. Little or no variation was observed in the use of antihypertensives.
  
  
  CONCLUSIONS
  This study reveals the existence, in a CVD primary prevention context, of large variations in a number of health indicators among hypertensive patients owing to the material and social deprivation of residential neighbourhood. It is therefore important to take the socioeconomic context into account when planning interventions to prevent CVDs and their consequences.
authors.affiliation: Department of Family and Emergency Medicine, Université de Sherbrooke, Sherbrooke, Quebec, Canada; Groupe de recherche PRIMUS, Centre de recherche CHUS, Sherbrooke, Quebec, Canada.
authors.forename: A
authors.initials: A
authors.lastname: Vanasse
authors.affiliation: Groupe de recherche PRIMUS, Centre de recherche CHUS, Sherbrooke, Quebec, Canada.
authors.forename: J
authors.initials: J
authors.lastname: Courteau
authors.affiliation: Primary Healthcare Research Unit, Faculty of Medicine, Health Sciences Centre, St. John's, Newfoundland and Labrador, Canada.
authors.forename: S
authors.initials: S
authors.lastname: Asghari
authors.affiliation: Department of Geography, Université du Québec à Trois-Rivières (UQTR), Trois-Rivières, Quebec, Canada.
authors.forename: D
authors.initials: D
authors.lastname: Leroux
authors.affiliation: Department of Nursing, Université du Québec à Trois-Rivières (UQTR), Trois-Rivières, Quebec, Canada.
authors.forename: L
authors.initials: L
authors.lastname: Cloutier
mesh_terms: D000328:Adult; D000368:Aged; D000959:Antihypertensive Agents / Q000627:therapeutic use; D002561:Cerebrovascular Disorders / Q000453:epidemiology / Q000517:prevention & control; D004636:Emergency Service, Hospital / Q000706:statistics & numerical data*; D005260:Female; D058006:General Practice / Q000706:statistics & numerical data*; D006295:Health Resources / Q000706:statistics & numerical data*; D054624:Health Status Disparities; D006305:Health Status Indicators; D006333:Heart Failure / Q000453:epidemiology / Q000517:prevention & control; D006760:Hospitalization / Q000706:statistics & numerical data; D006801:Humans; D006973:Hypertension / Q000188:drug therapy / Q000453:epidemiology* / Q000401:mortality; D015994:Incidence; D008297:Male; D008875:Middle Aged; D017202:Myocardial Ischemia / Q000453:epidemiology / Q000517:prevention & control; D011204:Poverty Areas; D015995:Prevalence; D011322:Primary Prevention / Q000706:statistics & numerical data; D011792:Quebec / Q000453:epidemiology; D012111:Residence Characteristics / Q000706:statistics & numerical data; D012424:Rural Population / Q000706:statistics & numerical data; D013038:Specialization / Q000706:statistics & numerical data; D014505:Urban Population / Q000706:statistics & numerical data
chemical_list: D000959:Antihypertensive Agents
keywords: cardiovascular disease; frequent users of services; health indicator; hypertension; material deprivation; rural areas; social deprivation; urban areas