title: Income differences in the type of antihypertensive medicines used in ambulatory settings in Finland: a register-based study.
abstract: OBJECTIVE
  The objective of this study was to explore income differences in the prevalence of moderate-to-severe hypertension, and among patients, in the use and costs of medicines.
  
  
  METHODS
  Personal income was used to classify ≥25-year-old population in quintiles (QI-QV). Patients (N = 497,560) with moderate-to-severe hypertension were identified using special refund entitlements. Medicine use and costs derived from prescription register. Direct standardisation and multivariate regression were used to adjust for demographics and comorbidities.
  
  
  RESULTS
  Low income was associated with higher prevalence of moderate-to-severe hypertension (overall 13%). After adjusting for age, gender, residence, diabetes and coronary heart disease, nearly all patients purchased at least one antihypertensive medicine (93 vs. 96% in QI and QV). Differences in the purchased quantities were small (mean estimates 1028 vs. 1054 defined daily doses (DDDs)/patient/year in QIV and QI). High-income patients were more likely to use angiotensin receptor blockers (37 vs. 54% in QI and QV). Low-income patients were more likely to use beta-blockers (59 vs. 49%, respectively) and ACE inhibitors (35 vs. 28%, respectively). Higher income was associated with higher annual out-of-pocket costs (mean €66 vs. €71 in QI and QV) and reimbursements (€144 vs. €163, respectively).
  
  
  CONCLUSIONS
  Use of more expensive medicines contributed to higher costs among patients with higher incomes.
authors.affiliation: School of Pharmacy, Faculty of Health Sciences, University of Eastern Finland, P.O. Box 1627, FIN-70211, Kuopio, Finland.
authors.forename: Härkönen
authors.initials: H
authors.lastname: Mirva
authors.affiliation: School of Pharmacy, Faculty of Health Sciences, University of Eastern Finland, P.O. Box 1627, FIN-70211, Kuopio, Finland.
authors.forename: Timonen
authors.initials: T
authors.lastname: Johanna
authors.affiliation: Research Department, The Social Insurance Institution of Finland, P.O. Box 450, FI-00101, Helsinki, Finland.
authors.forename: Tervola
authors.initials: T
authors.lastname: Jussi
authors.affiliation: Research Department, The Social Insurance Institution of Finland, P.O. Box 450, FI-00101, Helsinki, Finland. katri.aaltonen@kela.fi.
authors.forename: Katri
authors.initials: K
authors.lastname: Aaltonen
mesh_terms: D000319:Adrenergic beta-Antagonists / Q000008:administration & dosage / Q000191:economics; D000328:Adult; D000368:Aged; D000553:Ambulatory Care; D057911:Angiotensin Receptor Antagonists / Q000008:administration & dosage / Q000191:economics; D000806:Angiotensin-Converting Enzyme Inhibitors / Q000008:administration & dosage / Q000191:economics; D000959:Antihypertensive Agents / Q000008:administration & dosage* / Q000191:economics* / Q000627:therapeutic use; D002121:Calcium Channel Blockers / Q000008:administration & dosage / Q000191:economics; D015897:Comorbidity; D004363:Drug Utilization; D005260:Female; D005387:Finland / Q000453:epidemiology; D006801:Humans; D006973:Hypertension / Q000188:drug therapy* / Q000453:epidemiology*; D007182:Income / Q000706:statistics & numerical data*; D008297:Male; D008875:Middle Aged; D012111:Residence Characteristics
chemical_list: D000319:Adrenergic beta-Antagonists; D057911:Angiotensin Receptor Antagonists; D000806:Angiotensin-Converting Enzyme Inhibitors; D000959:Antihypertensive Agents; D002121:Calcium Channel Blockers
keywords: Antihypertensive agents; Drug utilisation; Finland; Hypertension; Income; Socioeconomic status