Inequity of access to ACE inhibitors in Swedish heart failure patients: a register-based study.
BACKGROUND
Several international studies suggest inequity in access to evidence-based heart failure (HF) care. Specifically, studies of ACE inhibitors (ACEIs) point to reduced ACEI access related to female sex, old age and socioeconomic position. Thus far, most studies have either been rather small, lacking diagnostic data, or lacking the possibility to account for several individual-based sociodemographic factors. Our aim was to investigate differences, which could reflect inequity in access to ACEIs based on sex, age, socioeconomic status or immigration status in Swedish patients with HF.


METHODS
Individually linked register data for all Swedish adults hospitalised for HF in 2005-2010 (n=93,258) were analysed by multivariate regression models to assess the independent risk of female sex, high age, low employment status, low income level, low educational level or foreign country of birth, associated with lack of an ACEI dispensation within 1 year of hospitalisation. Adjustment for possible confounding was made for age, comorbidity, Angiotensin receptor blocker therapy, period and follow-up time.


RESULTS
Analysis revealed an adjusted OR for no ACEI dispensation for women of 1.31 (95% CI 1.27 to 1.35); for the oldest patients of 2.71 (95% CI 2.53 to 2.91); and for unemployed patients of 1.59 (95% CI 1.46 to 1.73).


CONCLUSIONS
Access to ACEI treatment was reduced in women, older patients and unemployed patients. We conclude that access to ACEIs is inequitable among Swedish patients with HF. Future studies should include clinical data, as well as mortality outcomes in different groups.
Department of Public Health and Caring Sciences, Uppsala University, Uppsala, Sweden.
Anna
http://orcid.org/0000-0001-6897-6390
A
Ohlsson
Department of Medical Sciences, Uppsala Clinical Research Center, Uppsala University, Uppsala, Sweden.
Bertil
B
Lindahl
Department of Public Health and Caring Sciences, Uppsala University, Uppsala, Sweden National Board of Health and Welfare, Stockholm, Sweden.
Marianne
M
Hanning
Department of Public Health and Caring Sciences, Uppsala University, Uppsala, Sweden.
Ragnar
R
Westerling
D000328:Adult; D000367:Age Factors; D000368:Aged; D000369:Aged, 80 and over; D000806:Angiotensin-Converting Enzyme Inhibitors / Q000600:supply & distribution* / Q000627:therapeutic use; D005260:Female; D006297:Health Services Accessibility; D054625:Healthcare Disparities; D006333:Heart Failure / Q000188:drug therapy*; D006801:Humans; D008297:Male; D008875:Middle Aged; D012042:Registries; D012737:Sex Factors; D013548:Sweden; D014478:Unemployment; D055815:Young Adult
D000806:Angiotensin-Converting Enzyme Inhibitors
ACCESS TO HLTH CARE; Cardiovascular disease; GENDER; Health inequalities; SOCIO-ECONOMIC