The European Journal of Public Health Advance Access originally published online on February 15, 2007
The European Journal of Public Health 2007 17(5):492-496; doi:10.1093/eurpub/ckm005
Health Inequalities |
Statins prescribing for the secondary prevention of ischaemic heart disease in Torino, Italy. A case of ageism and social inequalities
Roberto Gnavi1, Alessandro Migliardi1, Moreno Demaria2, Alessio Petrelli1, Adele Caprioglio1 and Giuseppe Costa1,3
1 Epidemiology Unit, ASL 5 – Regione Piemonte, Italy
2 Environmental Epidemiolgy Unit, Regional Enviromental Protection Agency of Piedmont, Italy
3 Department of Public Health, University of Turin, Italy
Correspondence: Dr Roberto Gnavi, Epidemiology Unit, ASL 5, Via Sabaudia 164, 10095 Grugliasco (TO), Italy, tel: +3901140188208, fax: +3901140188201, e-mail: roberto.gnavi{at}epi.piemonte.it
Received October 18, 2006 , accepted January 8, 2007
Background: Socio-demographic and clinical characteristics can influence statins prescribing for the secondary prevention of ischaemic heart disease (IHD). We studied the determinants of the prescription of statins in people with IHD in a population in Italy, the country with the lowest prescribing rate in Europe. Methods: All 2001/2002 residents in Torino, aged 30–85 years, with a hospital discharge diagnosis of IHD were linked to the regional Database of Drug Prescriptions to identify those persons who, within 3 months after discharge, had been prescribed statins. Log-binomial models were used to test statins prescription associations with clinical and socio-demographic characteristics. Results: Statins were prescribed to 31.0% of 7446 patients. Among persons >74 years of age, the prescription rate was 40% lower than that found for younger persons. A positive association was also found for: female gender, being married, a main discharge diagnosis of acute myocardial infarction, revascularization, diabetes and discharge from a cardiology ward. Age was an important effect modifier of the relationship between the prescribing rate and social, but not clinical, determinants. Conclusions: The prevention of IHD with statins is influenced by age, clinical and social factors. The prescribing rate is higher among population groups for whom statins are of proven efficacy. Among patients for whom the efficacy is uncertain, the decision to prescribe is influenced by non-clinical factors, suggesting that there exist both age-based and social-based mechanisims of rationing. Age and social determinants act in concert to further reduce the propensity of physicians to prescribe statins.
Keywords: coronary heart disease, drug, Italy, prescriptions, socioeconomic factors, statins