Socioeconomic factors and use of secondary preventive therapies for cardiovascular diseases in South Asia: The PURE study
Socioeconomic factors and use of secondary preventive therapies for cardiovascular diseases in South Asia: The PURE study
复制标题
DOI：
10.1177/2047487314540386
复制
发表时间：
2015-10-01
影响因子：
8.3
通讯作者：
Yusuf, Salim
中科院分区：
文献类型：
--
作者：
Gupta, Rajeev;Islam, Shofiqul;Yusuf, Salim
目标：本研究的目的是确定社会经济因素与南亚已知冠心病（CHD）或中风患者使用心脏保护药物的相关性。方法：我们招募了33，423名年龄在35-70岁之间的受试者2003-2009年期间，在印度、巴基斯坦和孟加拉国的150个社区中，妇女占56%，农村占53%，教育程度低的占51%，家庭财富低的占25%。记录了有关社会经济状况、疾病状况和治疗的信息。我们研究了农村地区、教育状况和家庭财富对药物治疗使用的影响。结果：冠心病683例（2.0%），脑卒中316例（0.9%），冠心病/脑卒中970例（2.9%）。自诊断以来的中位持续时间为4年。CHD/卒中患者年龄较大，吸烟、超重、高血压和糖尿病患病率较高（p < 0.01）。在CHD、卒中和CHD/卒中患者中，抗血小板药物的使用（%）分别为11.6、3.8和9.3，β受体阻滞剂11.9、7.0和10.4，血管紧张素转换酶抑制剂或血管紧张素受体阻滞剂6.4、1.9和5.3，他汀类药物4.8、0.6和3.5。在CHD/卒中患者中，18.1%的患者使用了这些药物中的任何一种，7.2%的患者使用了任何两种，2.8%的患者使用了任何三种，81.5%的患者没有使用这些药物。药物剂量详情不可用。在农村低教育和低财富指数的参与者中，药物使用率显着降低（所有p < 0.01）。低财富指数的参与者有最低的使用这些疗法没有衰减后，多次adjustment.Conclusion：使用二级预防药物治疗已知的冠心病或中风患者在南亚是低的，超过80%的接受没有有效的药物治疗。家庭财富低是最重要的决定因素。
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.Conclusion: 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.