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The European Journal of Public Health Advance Access originally published online on October 17, 2005
The European Journal of Public Health 2006 16(4):361-367; doi:10.1093/eurpub/cki202
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© The Author 2005. Published by Oxford University Press on behalf of the European Public Health Association. All rights reserved.

Health Inequalities

Analysis of inequalities in secondary prevention of coronary heart disease in a universal coverage health care system

Miguel-Angel Munoz1,2, Izabella Rohlfs3, Sandra Masuet1, Carolina Rebato3, Marta Cabañero3, Jaume Marrugat2,3 for the ICAR Study Group*

1 Primary care unit, Montornés-Montmeló, and Family and Community Teaching Unit, Barcelona Centre, Institut Català de la Salut, Barcelona, Spain
2 School of Medicine, Universitat Autònoma de Barcelona, Spain
3 Lipids and Cardiovascular Epidemiology Research Unit, Institut Municipal d'Investigació Mèdica (IMIM), Barcelona, Spain

Correspondence: Jaume Marrugat, MD, PhD, Unitat de Lípids i Epidemiologia Cardiovascular, Institut Municipal d'Investigació Mèdica, IMIM, Carrer Dr. Aiguader 80, 08003 Barcelona, Spain, tel: +34 932257574; fax: +34 932257550; e-mail: jmarrugat{at}imim.es

Objective: The purpose of this study was to analyse whether differences exist in social class or education level in coronary heart disease (CHD) secondary prevention and in cardiovascular risk factor control in a universal coverage health care system. Design: Cross-sectional multi-centre study. Participants and setting: 1022 CHD patients recruited from residents in the catchment areas covered by 23 primary health care facilities in Catalonia, Spain. Main outcome measures: Demographic data, cardiovascular co-morbidity, smoking, blood pressure, fasting blood glucose, triglycerides, total cholesterol, HDL and LDL cholesterol, body mass index (BMI), drug therapy used for secondary prevention, educational level, and social class based on occupation. Results: Patients at the lowest educational level were more frequently women, older, and diabetic. Patients in the middle educational level were more frequently smokers than those in the highest or the lowest level (24.7, 8.7, and 12.0%, respectively; P = 0.008) and had better systolic blood pressure levels (125 mmHg (15), 135 mmHg (16), and 134 mmHg (17), respectively; P = 0.001). All educational levels and social classes had similar adjusted rates of risk factor control. Therapeutic management was also similar among all educational levels and social classes, after adjusting for confounders. Conclusions: CHD patients in the lower SES received similar treatment for secondary prevention and achieved similar control of risk factors. No social inequalities were found in secondary prevention in CHD patients using the National Health System in Spain.

Keywords: cardiovascular disease, health inequalities, secondary prevention, universal coverage health care system


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