The association between socioeconomic status of high-risk patients with coronary heart disease and the treatment rates of evidence-based medicine for coronary heart disease secondary prevention in China: Results from the Bridging the Gap on CHD Secondary Prevention in China (BRIG) Project

Am Heart J. 2009 Apr;157(4):709-15.e1. doi: 10.1016/j.ahj.2008.12.009. Epub 2009 Jan 31.


Background: In China, low socioeconomic status (SES) may be a barrier for patients with coronary heart disease (CHD) to receive adequate treatment because of their inadequate access to health resources. This study aims to evaluate whether and to what extent SES is associated with the treatment of CHD patients.

Methods: A cross-sectional survey was conducted among 2,803 CHD outpatients, a representative sample of China. An SES composite index was derived based on educational levels, monthly income, occupation, and access to medical insurance for each patient. The association between SES and treatment status of several key medications was analyzed.

Results: In total, 2,278 CHD outpatients with complete SES information were studied. The treatment rates of clopidogrel and statins were 6.7% and 34.2% in patients with the lowest SES and 41.7% and 75% in patients with the highest SES. In multiple logistic regression analyses, SES was independently associated with the use of aspirin, clopidogrel, statins and beta-blockers. Compared with the patients with the highest SES, the patients with the lowest SES had a 43.4% lower treatment rate for aspirin, a 76% lower rate for clopidogrel, a 70.2% lower rate for statins, and a 70.2% lower rate for beta-blockers after adjustment for various cofactors.

Conclusions: Socioeconomic status is closely associated with the treatment status of secondary prevention in CHD high-risk patients in China. Policy makers and medical professionals urgently need to develop policies and strategies to improve medical care for patients of low SES.

Publication types

  • Comparative Study

MeSH terms

  • Aged
  • China / epidemiology
  • Clopidogrel
  • Coronary Disease / economics
  • Coronary Disease / epidemiology*
  • Coronary Disease / prevention & control
  • Cross-Sectional Studies
  • Evidence-Based Medicine / methods*
  • Female
  • Humans
  • Hydroxymethylglutaryl-CoA Reductase Inhibitors / therapeutic use*
  • Male
  • Middle Aged
  • Morbidity
  • Platelet Aggregation Inhibitors / therapeutic use
  • Prognosis
  • Risk Assessment / methods*
  • Secondary Prevention / methods*
  • Socioeconomic Factors
  • Survival Rate
  • Ticlopidine / analogs & derivatives*
  • Ticlopidine / therapeutic use


  • Hydroxymethylglutaryl-CoA Reductase Inhibitors
  • Platelet Aggregation Inhibitors
  • Clopidogrel
  • Ticlopidine