Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
. 2011 Nov;26(11):1329-35.
doi: 10.1007/s11606-011-1799-1. Epub 2011 Jul 13.

Income-related inequity in initiation of evidence-based therapies among patients with acute myocardial infarction

Gillian E Hanley  1 , Steve Morgan, Robert J Reid
Affiliations

Income-related inequity in initiation of evidence-based therapies among patients with acute myocardial infarction

Gillian E Hanley et al. J Gen Intern Med. 2011 Nov.

Abstract

Background: Previous research has shown a socioeconomic status (SES) gradient in the receipt of cardiac services following acute myocardial infarction (AMI), but much less is known about SES and the use of secondary preventive medicines following AMI.

Objectives: To examine the role of income in initiation of treatment with ACE-inhibitors, beta-blockers and statins in the 120 days following discharge from hospital for first AMI.

Design: A cross-sectional study with a population-based cohort.

Participants: First-time AMI patients between age 40 and 100 discharged alive from the hospital and surviving at least 120 days following discharge between January 1, 1999 and September 3, 2006.

Main measures: Binary variables indicating whether the patient had filled at least one prescription for each of the medicines of interest.

Key results: Our results reveal a significant and positive income gradient with initiation of the guideline-recommended medicines among male AMI patients. Men in the third income quintile and above were significantly more likely to initiate treatment with any of the medicines than those in the first quintile, with those in the fifth income quintile having 37%, 50% and 71% higher odds of initiating ACE-inhibitors, beta-blockers and statins, respectively, than men in the lowest income quintile [OR = 1.37 95% CI (1.24, 1.51); OR = 1.50 95% CI (1.35, 1.68); and OR = 1.71 95% CI (1.53, 190)]. The gradient was not present among women, although women in the fifth income quintile were more likely to initiate beta-blockers and statins than women in the lowest income quintile [OR = 1.25 95% CI (1.06, 1.47) and OR = 1.32 95% CI (1.12, 1.54)].

Conclusions: There were inequities in treatment following AMI in the form of a clear and often significant gradient between income and initiation of evidence-based pharmacologic therapies among male patients. This gradient persisted despite significant changes in coverage levels for the costs of these medicines.

PubMed Disclaimer

Conflict of interest statement

None disclosed

Figures

Figure 1
Figure 1
Sample description information.
See this image and copyright information in PMC

Similar articles

See all similar articles

Cited by

See all "Cited by" articles

References

    1. Alter DA, Naylor CD, Austin P, Tu JV. Effects of socioeconomic status on access to invasive cardiac procedures and on mortality after acute myocardial infarction. N Engl J Med. 1999;341(18):1359–1367. doi: 10.1056/NEJM199910283411806. - DOI - PubMed
    1. Pilote L, Joseph L, Bélisle P, Penrod J. Universal health insurance coverage does not eliminate inequities in access to cardiac procedures after acute myocardial infarction. Am Heart J. 2003;146(6):1030–1037. doi: 10.1016/S0002-8703(03)00448-4. - DOI - PubMed
    1. Alter DA, Naylor CD, Austin PC, Chan BT, Tu JV. Geography and service supply do not explain socioeconomic gradients in angiography use after acute myocardial infarction. CMAJ. 2003;168(3):261–264. - PMC - PubMed
    1. Gnavi R, Migliardi A, Demaria M, Petrelli A, Caprioglio A, Costa G. Statins prescribing for the secondary prevention of ischaemic heart disease in torino, italy. A case of ageism and social inequalities. Eur J Pub Health. 2007;17(5):492–496. doi: 10.1093/eurpub/ckm005. - DOI - PubMed
    1. Antman EM, Hand M, Armstrong PW, et al. 2007 focused update of the ACC/AHA 2004 guidelines for the management of patients with ST-elevation myocardial infarction: A report of the American College of Cardiology/American Heart Association task force on practice guidelines: Developed in collaboration with the Canadian Cardiovascular Society endorsed by the American Academy of Family Physicians: 2007 writing group to review new evidence and update the ACC/AHA 2004 guidelines for the management of patients with ST-elevation myocardial infarction, writing on behalf of the 2004 writing committee. Circulation. 2008;117(2):296–329. doi: 10.1161/CIRCULATIONAHA.107.188209. - DOI - PubMed

Publication types

MeSH terms

Substances