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Institucional

Murphy, Adrianna

Palafox, Benjamin#O'Donnell, Owen#Stuckler, David#Perel, Pablo#AlHabib, Khalid F.#Avezum, Alvaro#Bai, Xiulin#Chifamba, Jephat#Chow, Clara K.#Corsi, Daniel J.#Dagenais, Gilles R.#Dans, Antonio L.#Diaz, Rafael#Erbakan, Ayse N.#Ismail, Noorhassim#Iqbal, Romaina#Kelishadi, Roya#Khatib, Rasha#Lanas, Fernando#Lear, Scott A.#Li, Wei#Liu, Jia#Lopez-Jaramillo, Patricio#Mohan, Viswanathan#Monsef, Nahed#Mony, Prem K.#Puoane, Thandi#Rangarajan, Sumathy#Rosengren, Annika#Schutte, Aletta E.#Sintaha, Mariz#Teo, Koon K.#Wielgosz, Andreas#Yeates, Karen#Yin, Lu#Yusoff, Khalid#Zatonska, Katarzyna#Yusuf, Salim#McKee, Martin

Inequalities in the use of secondary prevention of cardiovascular disease by socioeconomic status: evidence from the PURE observational study

ELSEVIER SCI LTD

LANCET GLOBAL HEALTH

en

Background There is little evidence on the use of secondary prevention medicines for cardiovascular disease by socioeconomic groups in countries at different levels of economic development. Methods We assessed use of antiplatelet, cholesterol, and blood-pressure-lowering drugs in 8492 individuals with self-reported cardiovascular disease from 21 countries enrolled in the Prospective Urban Rural Epidemiology (PURE) study. Defining one or more drugs as a minimal level of secondary prevention, wealth-related inequality was measured using the Wagstaff concentration index, scaled from -1 (pro-poor) to 1 (pro-rich), standardised by age and sex. Correlations between inequalities and national health-related indicators were estimated. Findings The proportion of patients with cardiovascular disease on three medications ranged from 0% in South Africa (95% CI 0-1.7), Tanzania (0-3.6), and Zimbabwe (0-5.1), to 49.3% in Canada (44.4-54.3). Proportions receiving at least one drug varied from 2.0% (95% CI 0.5-6.9) in Tanzania to 91.4% (86.6-94.6) in Sweden. There was significant (p<0.05) pro-rich inequality in Saudi Arabia, China, Colombia, India, Pakistan, and Zimbabwe. Pro-poor distributions were observed in Sweden, Brazil, Chile, Poland, and the occupied Palestinian territory. The strongest predictors of inequality were public expenditure on health and overall use of secondary prevention medicines. Interpretation Use of medication for secondary prevention of cardiovascular disease is alarmingly low. In many countries with the lowest use, pro-rich inequality is greatest. Policies associated with an equal or pro-poor distribution include free medications and community health programmes to support adherence to medications. Copyright (c) The Author(s). Published by Elsevier Ltd.

Artículo original

AM is funded by a Wellcome Trust Research Fellowship (number 104349/Z/14/Z). BP and MM are supported by a UK Economic and Social Research Council grant (number ES/L014696/1) under its Secondary Data Analysis Initiative scheme. DS is funded by a Wellcome Trust Investigator Award and ERC HRES 313590. K Yu is supported by a Ministry of Higher Education Malaysia Research Grant (number 600-RMI/LRGS 5/3 [2/2011]). SY is funded by the Marion Burke Chair of the Heart and Stroke Foundation of Canada. OO'D is supported by a Swiss Agency for Development and Cooperation/National Science Foundation grant (number 400640_160374) under their Programme for Research on Global Issues for Development. The main PURE study and its components are funded by the Population Health Research Institute, the Canadian Institutes of Health Research, Heart and Stroke Foundation of Ontario, and through unrestricted grants from several pharmaceutical companies (with major contributions from AstraZeneca [Canada], Sanofi-Aventis [France and Canada], Boehringer Ingelheim [Germany and Canada], Servier, and GlaxoSmithKline, and additional contributions from Novartis, King Pharma), and various national or local organisations in participating countries. These include: Argentina: Fundacion ECLA, Bangladesh: Independent University, Bangladesh and Mitra and Associates, Brazil: Unilever Health Institute, Brazil, Canada: Public Health Agency of Canada and Champlain Cardiovascular Disease Prevention Network, Chile: Universidad de la Frontera, China: National Center for Cardiovascular Diseases, Colombia: Colciencias, grant number 6566-04-18062 and Fundacion Oftalmologica de Santander, India: Indian Council of Medical Research, Malaysia: Ministry of Science, Technology and Innovation of Malaysia, grant number 100-IRDC/BIOTEK 16/6/21 (13/2007), grant number 07-05-IFN-BPH 010, Ministry of Higher Education of Malaysia grant number 600-RMI/LRGS/5/3 (2/2011), Universiti Teknologi MARA, Universiti Kebangsaan Malaysia (UKM-Hejim-Komuniti-15-2010), occupied Palestinian territory: the UN Relief and Works Agency for Palestine Refugees in the Near East (UNRWA), occupied Palestinian territory, International Development Research Centre (IDRC), Canada, Philippines: Philippine Council for Health Research & Development (PCHRD), Poland: Polish Ministry of Science and Higher Education grant number 290/W-PURE/2008/0, Wroclaw Medical University, Saudi Arabia: Saudi Heart Association, The Deanship of Scientific Research at King Saud University, Riyadh, Saudi Arabia (research group number RG-1436-013), South Africa: The North-West University, SANPAD (SA and Netherlands Programme for Alternative Development), National Research Foundation, Medical Research Council of South Africa, the South Africa Department of Science and Technology, The South African Sugar Association, Faculty of Community and Health Sciences (UWC), Sweden: AFA Insurance, Swedish Council for Working Life and Social Research, King Gustaf V's and Queen Victoria's Freemasons Foundation, Swedish Heart and Lung Foundation, Swedish Research Council, grant from the Swedish State under (LakarUtbildningsAvtalet), Agreement, grant from the Vastra Gotaland Region (FOUU), Turkey: Metabolic Syndrome Society, AstraZeneca (Turkey), Sanofi-Aventis (Turkey), United Arab Emirates: Sheikh Hamdan Bin Rashid Al Maktoum Award For Medical Sciences and Dubai Health Authority, Dubai, United Arab Emirates.

AM cuenta con la financiación de una beca de investigación del Wellcome Trust (n.º 104349/Z/14/Z). BP y MM cuentan con el apoyo de una subvención del Consejo de Investigación Económica y Social del Reino Unido (n.º ES/L014696/1) en el marco de su programa de Iniciativa de Análisis de Datos Secundarios. DS cuenta con la financiación de una Beca de Investigador del Wellcome Trust y la ERC HRES 313590. K Yu cuenta con el apoyo de una Beca de Investigación del Ministerio de Educación Superior de Malasia (n.º 600-RMI/LRGS 5/3 [2/2011]). SY cuenta con la financiación de la Cátedra Marion Burke de la Fundación del Corazón y el Accidente Cerebrovascular de Canadá. OO'D cuenta con el apoyo de una subvención de la Agencia Suiza para el Desarrollo y la Cooperación/Fundación Nacional de Ciencias (n.º 400640_160374) en el marco de su Programa de Investigación sobre Asuntos Globales para el Desarrollo. El estudio principal PURE y sus componentes están financiados por el Population Health Research Institute, los Canadian Institutes of Health Research, la Heart and Stroke Foundation de Ontario y mediante subvenciones sin restricciones de varias compañías farmacéuticas (con importantes contribuciones de AstraZeneca [Canadá], Sanofi-Aventis [Francia y Canadá], Boehringer Ingelheim [Alemania y Canadá], Servier y GlaxoSmithKline, y contribuciones adicionales de Novartis y King Pharma) y varias organizaciones nacionales o locales en los países participantes. Estos incluyen: Argentina: Fundación ECLA, Bangladesh: Independent University, Bangladesh y Mitra and Associates, Brasil: Unilever Health Institute, Brasil, Canadá: Public Health Agency of Canada y Champlain Cardiovascular Disease Prevention Network, Chile: Universidad de la Frontera, China: National Center for Cardiovascular Diseases, Colombia: Colciencias, número de subvención 6566-04-18062 y Fundación Oftalmológica de Santander, India: Indian Council of Medical Research, Malasia: Ministry of Science, Technology and Innovation of Malaysia, número de subvención 100-IRDC/BIOTEK 16/6/21 (13/2007), número de subvención 07-05-IFN-BPH 010, Ministry of Higher Education of Malaysia, número de subvención 600-RMI/LRGS/5/3 (2/2011), Universiti Teknologi MARA, Universiti Kebangsaan Malaysia (UKM-Hejim-Komuniti-15-2010), territorio palestino ocupado: UN Relief y Obras Públicas para los Refugiados de Palestina en el Cercano Oriente (UNRWA), territorio palestino ocupado, Centro Internacional de Investigaciones para el Desarrollo (IDRC), Canadá, Filipinas: Consejo Filipino para la Investigación y el Desarrollo en Salud (PCHRD), Polonia: Ministerio de Ciencia y Educación Superior de Polonia, subvención número 290/W-PURE/2008/0, Universidad Médica de Wroclaw, Arabia Saudita: Asociación Saudita del Corazón, Decanato de Investigación Científica de la Universidad Rey Saud, Riad, Arabia Saudita (número de grupo de investigación RG-1436-013), Sudáfrica: Universidad del Noroeste, SANPAD (Programa de Sudáfrica y Países Bajos para el Desarrollo Alternativo), Fundación Nacional de Investigación, Consejo de Investigación Médica de Sudáfrica, Departamento de Ciencia y Tecnología de Sudáfrica, Asociación Sudafricana del Azúcar, Facultad de Ciencias de la Comunidad y la Salud (UWC), Suecia: AFA Insurance, Consejo Sueco para la Vida Laboral e Investigación Social, Fundación de los Francmasones del Rey Gustavo V y la Reina Victoria, Fundación Sueca del Corazón y los Pulmones, Consejo Sueco de Investigación, subvención del Estado sueco en virtud de (LakarUtbildningsAvtalet), Acuerdo, subvención de la Región Vastra Gotaland (FOUU), Turquía: Sociedad del Síndrome Metabólico, AstraZeneca (Turquía), Sanofi-Aventis (Turquía), Emiratos Árabes Unidos: Premio Sheikh Hamdan Bin Rashid Al Maktoum para Ciencias Médicas y Autoridad de Salud de Dubái, Dubái, Emiratos Árabes Unidos.

10.1016/S2214-109X(18)30031-7

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http://dx.doi.org/10.1016/S2214-109X(18)30031-7

Public, Environmental & Occupational Health

Sistema Cardiovascular y Cardiaco

Política de Salud y Servicios

Economía

WOS:000424738900020

Inequalities in the use of secondary prevention of cardiovascular disease by socioeconomic status: evidence from the PURE observational study

Artículo original

version publicada

ELSEVIER SCI LTD

LANCET GLOBAL HEALTH

Salud pública, ambiental y ocupacional

2214-109X

en

Wellcome Trust104349/Z/14/Z#UK Economic and Social Research Council ES/L014696/1#Wellcome Trust ERC HRES 313590#Ministry of Higher Education Malaysia Research 600-RMI/LRGS 5/3 [2/2011]#Heart and Stroke Foundation#Swiss Agency for Development and Cooperation/National Science Foundation 400640_160374##Population Health Research Institute#Canadian Institutes of Health Research#Heart and Stroke#AstraZeneca [Canada]#Sanofi-Aventis [France and Canada]#Boehringer Ingelheim [Germany and Canada]#Servier and GlaxoSmithKline#Novartis, King Pharma#Fundacion ECLA#Independent University, Bangladesh and Mitra and Associates#Unilever Health Institute#Public Health Agency of Canada and Champlain Cardiovascular Disease Prevention Network#UFRO#National Center for Cardiovascular Diseases#COLCiencias6566-04-18062#Fundacion Oftalmologica de Santander#Indian Council of Medical Research#Ministry of Science, Technology and Innovation of Malaysia 100-IRDC/BIOTEK 16/6/21 (13/2007)#Ministry of Science, Technology and Innovation of Malaysia 07-05-IFN-BPH 010#Ministry of Higher Education of Malaysia 600-RMI/LRGS/5/3 (2/2011)#Universiti Teknologi MARA#Universiti Kebangsaan Malaysia UKM-Hejim-Komuniti-15-2010#UN Relief and Works Agency for Palestine Refugees in the Near East (UNRWA)#IDRC#Philippine Council for Health Research & Development (PCHRD)#Polish Ministry of Science and Higher Education 290/W-PURE/2008/0#Wroclaw Medical University#Saudi Heart Association#The Deanship of Scientific Research at King Saud University, Riyadh RG-1436-013#The North-West University#SANPAD#National Research Foundation#Medical Research Council of South Africa#the South Africa Department of Science and Technology#The South African Sugar Association#AFA Insurance#Swedish Council for Working Life and Social Research#King Gustaf V' and Queen Victoria's Freemasons Foundation#Swedish Heart and Lung Foundation#Swedish Research Council LakarUtbildningsAvtalet#Vastra Gotaland Region (FOUU)#Metabolic Syndrome Society#AstraZeneca (Turkey)#Sanofi-Aventis (Turkey)#Sheikh Hamdan Bin Rashid Al Maktoum Award For Medical Sciences and Dubai Health Authority

Wellcome Trust 104349/Z/14/Z

UK Economic and Social Research Council under Secondary Data Analysis Initiative scheme ES/L014696/1

Wellcome Trust

ERC HRES [313590]

Ministry of Higher Education Malaysia 600-RMI/LRGS 5/3

Heart and Stroke

Swiss Agency for Development and Cooperation/National Science Foundation under Programme for Research on Global Issues for Development 400640_160374

Population Health Research Institute

Canadian Institutes of Health Research

AstraZeneca (Canada)

Sanofi-Aventis (France)

Sanofi-Aventis (Canada)

Boehringer Ingelheim (Germany)

Boehringer Ingelheim (Canada)

Servier

GlaxoSmithKline

Novartis

King Pharma

Fundacion ECLA

Independent University, Bangladesh

Unilever Health Institute (Brazil)

Public Health Agency of Canada

Champlain Cardiovascular Disease Prevention Network

Universidad de la Frontera

National Center for Cardiovascular Diseases

Colciencias 6566-04-18062

Fundacion Oftalmologica de Santander

Indian Council of Medical Research

Ministry of Science, Technology and Innovation of Malaysia 100-IRDC/BIOTEK 16/6/21,

Ministry of Science, Technology and Innovation of Malaysia 07-05-IFN-BPH 010

Ministry of Higher Education of Malaysia 600-RMI/LRGS/5/3

Universiti Teknologi MARA

Universiti Kebangsaan Malaysia UKM-Hejim-Komuniti-15-2010

UN Relief and Works Agency for Palestine Refugees in the Near East (UNRWA)

IDRC, Canada

Philippine Council for Health Research AMP

PCHRD

Polish Ministry of Science and Higher Education 290/W-PURE/2008/0

Wroclaw Medical University

Saudi Heart Association

King Saud University RG-1436-013

The North-West University

SANPAD

Medical Research Council of South Africa

South Africa Department of Science and Technology

South African Sugar Association

Faculty of Community and Health Sciences (UWC)

AFA Insurance

Swedish Council for Working Life and Social Research

King Gustaf V's and Queen Victoria's Freemasons Foundation

Swedish Heart and Lung Foundation

Swedish Research Council

Swedish State

Vastra Gotaland Region (FOUU)

Metabolic Syndrome Society, Turkey

AstraZeneca (Turkey)

Sanofi-Aventis (Turkey)

Sheikh Hamdan Bin Rashid Al Maktoum Award For Medical Sciences

Dubai Health Authority, Dubai, United Arab Emirates

Mitra and Associates

Economic and Social Research Council ES/L014696/1

Swiss National Science Foundation (SNF) 400640_160374

UKRI ESRC ES/L014696/1

AM is funded by a Wellcome Trust Research Fellowship (number 104349/Z/14/Z). BP and MM are supported by a UK Economic and Social Research Council grant (number ES/L014696/1) under its Secondary Data Analysis Initiative scheme. DS is funded by a Wellcome Trust Investigator Award and ERC HRES 313590. K Yu is supported by a Ministry of Higher Education Malaysia Research Grant (number 600-RMI/LRGS 5/3 [2/2011]). SY is funded by the Marion Burke Chair of the Heart and Stroke Foundation of Canada. OO'D is supported by a Swiss Agency for Development and Cooperation/National Science Foundation grant (number 400640_160374) under their Programme for Research on Global Issues for Development. The main PURE study and its components are funded by the Population Health Research Institute, the Canadian Institutes of Health Research, Heart and Stroke Foundation of Ontario, and through unrestricted grants from several pharmaceutical companies (with major contributions from AstraZeneca [Canada], Sanofi-Aventis [France and Canada], Boehringer Ingelheim [Germany and Canada], Servier, and GlaxoSmithKline, and additional contributions from Novartis, King Pharma), and various national or local organisations in participating countries. These include: Argentina: Fundacion ECLA, Bangladesh: Independent University, Bangladesh and Mitra and Associates, Brazil: Unilever Health Institute, Brazil, Canada: Public Health Agency of Canada and Champlain Cardiovascular Disease Prevention Network, Chile: Universidad de la Frontera, China: National Center for Cardiovascular Diseases, Colombia: Colciencias, grant number 6566-04-18062 and Fundacion Oftalmologica de Santander, India: Indian Council of Medical Research, Malaysia: Ministry of Science, Technology and Innovation of Malaysia, grant number 100-IRDC/BIOTEK 16/6/21 (13/2007), grant number 07-05-IFN-BPH 010, Ministry of Higher Education of Malaysia grant number 600-RMI/LRGS/5/3 (2/2011), Universiti Teknologi MARA, Universiti Kebangsaan Malaysia (UKM-Hejim-Komuniti-15-2010), occupied Palestinian territory: the UN Relief and Works Agency for Palestine Refugees in the Near East (UNRWA), occupied Palestinian territory, International Development Research Centre (IDRC), Canada, Philippines: Philippine Council for Health Research & Development (PCHRD), Poland: Polish Ministry of Science and Higher Education grant number 290/W-PURE/2008/0, Wroclaw Medical University, Saudi Arabia: Saudi Heart Association, The Deanship of Scientific Research at King Saud University, Riyadh, Saudi Arabia (research group number RG-1436-013), South Africa: The North-West University, SANPAD (SA and Netherlands Programme for Alternative Development), National Research Foundation, Medical Research Council of South Africa, the South Africa Department of Science and Technology, The South African Sugar Association, Faculty of Community and Health Sciences (UWC), Sweden: AFA Insurance, Swedish Council for Working Life and Social Research, King Gustaf V's and Queen Victoria's Freemasons Foundation, Swedish Heart and Lung Foundation, Swedish Research Council, grant from the Swedish State under (LakarUtbildningsAvtalet), Agreement, grant from the Vastra Gotaland Region (FOUU), Turkey: Metabolic Syndrome Society, AstraZeneca (Turkey), Sanofi-Aventis (Turkey), United Arab Emirates: Sheikh Hamdan Bin Rashid Al Maktoum Award For Medical Sciences and Dubai Health Authority, Dubai, United Arab Emirates.

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